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HDL subfraction changes with a low-fat, plant-based Complete Health Improvement Program (CHIP)
Abstract
Background and objectives:
Low HDL concentrations are considered an important risk factor for cardiovascular disease. Interventions promoting a low-fat, plant-based eating pattern appear to reduce CVD risk while paradoxically also reducing HDL concentrations. Recent studies show HDL to comprise a range of subfractions, but the role these play in ameliorating the risk of CVD is unclear. The purpose of this study was to characterise changes in HDL subfractions in participants where HDL decreased following the CHIP intervention which promotes a low-fat, plant-based diet, with physical activity.
Methods and study design:
Individuals (n=22; mean age=55.4±16.3 years; 45.5% men, 54.5% women) participating in a CHIP intervention were assessed at baseline and 30 days for changes in BMI, blood pressure, lipid profile, (including large-, intermediate- and small-HDL subfractions) and fasting glucose.
Results:
HDL significantly decreased (10.6%, p<0.001) together with BMI (2.5%, p=0.028), systolic blood pressure (7.1%, p=-0.005), total cholesterol (9.5%, p=0.002), LDL (11.2%, p=0.007) and fasting glucose (8.2%, p=0.028). Triglycerides (TG) did not significantly change. Physical activity (22.7%, p=0.016) and consumption of whole plant-foods (13.9%, p=0.003) significantly increased, while nonplant (energy and animal) foods decreased (43.1%, p=0.009). Large-, intermediate- and small-HDL decreased (-10.0%, p=0.003; -8.3%, p=0.013 and 22%, p=0.005, respectively).
Conclusions:
This paper discusses specific changes in HDL subfractions when overall-HDL decreases as a response to low fat, whole-food, plant-based eating and exercise. Additional research is required to elucidate the reasons through which behavioural therapies remodel the HDL particle and how this impacts the functional properties of HDL and CVD risk.
... 41 However, a low-fat, plant-based eating pattern was linked to a decrease in HDL levels. 42 Although there was a lack of individual information on physical activities and dietary habits in the current study, the association of HDL levels with lifestyle may partly explain our results. The principle of the Markov model in our study indicates that the transitions between weight states were influenced by HDL levels, which is changeable with lifestyle. ...
... The right food choices can lower HDL level. 36,41,42 This study has some limitations. First, behavioural factors, such as dietary habits, physical activity and sleep time, were not included in the analysis. ...
Background:
Obesity is well recognized as a risk factor for cardiometabolic diseases. The development of obesity is a dynamic process that can be described as a multistate process with an emphasis on transitions between weight states. However, it is still unclear what convenient biomarkers predict transitions between weight states. The aim of this study was to show the dynamic nature of weight status in adults stratified by age and sex and to explore blood markers of metabolic syndrome (MetS) that predict transitions between weight states.
Methods:
This study involved 9795 individuals aged 18 to 56 at study entry who underwent at least two health check-ups in the eight-year period of study in the health check-up centre of our institution. Weight, height and biochemical indices were measured at each check-up. The participants were divided into four groups based on age and sex (young male, middle-aged male, young female and middle-aged female groups). A multistate Markov model containing 3 states (healthy weight, overweight and obesity) was adopted to study the longitudinal weight data.
Results:
Young people were more likely to transit between weight states than middle-aged people, and middle-aged people were more resistant to recover from worse states. The mean sojourn time in obesity was greatest in the middle-aged male group (6.23 years), and the predicted rate of obesity beginning with healthy weight was greatest in the young male group (13.7%). In multivariate models, age group and triglyceride (TG) and high-density lipoprotein cholesterol (HDL) levels were significant for specific transitions in females, whereas age group and HDL levels were significant in males. In females, if HDL levels increased 1 mmol/L, the probability of progression from healthy weight to overweight decreased by 37.0% (HR= 0.63), and the probabilities of recovery (overweight to healthy weight and obesity to overweight) increased by 62.0% (HR= 1.62) and 1.23-fold (HR= 2.23), respectively. In males, if TG levels increased 1 mmol/L, the risk of progression from healthy weight to overweight increased by 24.0% (HR= 1.24). Each unit increase in HDL levels was associated with a 0.99-fold (HR= 1.99) increase in the chance of recovery from overweight to healthy weight and with a 0.37-fold (HR= 0.63) decrease in the risk of progression from healthy weight to overweight.
Conclusion:
The weight status of young people was less stable than that of middle-aged people. Males were more likely to become overweight and more resistant to recover from worse states than females. Young males with healthy weight were more likely to develop obesity than other healthy weight groups. Blood lipid levels, especially HDL, were predictors of weight transitions in adults. Prevention and intervention measures should be applied early.
... Seven studies [26,34,[40][41][42][43][44] reported FPG data for 5862 subjects, and five studies [30,38,39,45,46] Page 8 of 17 ...
Background
Vegetarian diets and aerobic exercise are increasingly accepted as a common way to improve lifestyle. Several studies have shown that vegetarian diets combined with aerobic exercise interventions have a significant effect on preventing and reducing the risk of metabolic diseases.
Methods
A search of the PubMed, EBSCO, Embase, CENTRAL, and Web of Science databases was conducted for comparative studies of pre- and post-vegetarian diet adoption combined with aerobic exercise interventions on glycemic control and body composition. Qualitative reviews and meta-analyses of fixed and random effects were conducted to pool available data. The results were validated by sensitivity analysis.
Results
A total of 27 studies were selected for meta-analysis. Combining the studies included in the meta-analysis showed a mean difference for homeostasis model assessment of insulin resistance of − 0.75 (− 1.08 to − 0.42), fasting plasma glucose of − 0.27(− 0.30 to − 0.23), waist circumference of − 1.10 (− 5.06 to 2.86) and body mass index of − 0.70 (− 1.38 to − 0.01).
Conclusion
In summary, our findings suggest that participants who adopted a vegetarian diet combined with aerobic exercise intervention had significantly lower fasting plasma glucose and insulin levels and improved body composition compared to preintervention participants.
Level of evidence
Level I, systematic review and meta-analysis.
... As is typical of CHIP, all biomarkers, other than HDL, had positive short-term changes [8,9]. The decrease in HDL in CHIP has been described and discussed before, and is not considered detrimental, but a compensatory response to lower LDL levels [12,18] (Table 2). ...
The initial benefits of lifestyle modification programs such as reduction in chronic and cardiovascular diseases (CVD) risk factors have been well documented. However, such positive effects may deteriorate over time following relapse into inactivity. Timely detection of weight regain leading to the deterioration of the accrued benefits could trigger early resumption of intensive lifestyle intervention. To date, no known cost-effective, noninvasive approach for monitoring long-term outcomes has yet been established. The purpose of this study was to determine if body mass index (BMI) change predicted changes in other CVD biometric markers during an intensive lifestyle modification program. This study was an observational, retrospective review of records of participants from the Complete Health Improvement Program (CHIP). Biomarker changes of participants in this community-based Intensive Therapeutic Lifestyle Modification Program (ITLMP) offered in Athens, Ohio, a rural Appalachian college town, between April 2011 and June 2017 were reviewed retrospectively. BMI, heart rate (Pulse), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and glucose (FBS) were monitored before and after program completion. Data were analyzed using a multivariate general linear model. The sample analyzed consisted of 620 participants (mean age of 52.3±13.0 years, 74.5% female). Controlling for age and gender, BMI change significantly predicted 5 out of the 8 biomarker changes measured [Wilk's λ = 0.939, F(8,526) = 4.29, p <.0001]. Specifically, a 1-point BMI decrease was associated with 4.4 units decrease in TC, 3.2 units in LDL, 5.3 units in TG, 2 units in SBP, and 1 unit in DBP (all p values < .05). These results suggest that change in BMI may be a useful predictor of change in other CVD biomarkers' outcomes during and after an ITLMP participation. Tracking BMI, therefore, could serve as a proxy measure for identifying regressing biomarker changes following participation in an ITLMP leading to a timelier reassessment and intervention. Future studies evaluating the value of BMI as a surrogate for highlighting overall cardiovascular health are warranted.
... As is typical of CHIP, all biomarkers, other than HDL, had positive short-term changes [8,9]. The decrease in HDL in CHIP has been described and discussed before, and is not considered detrimental, but a compensatory response to lower LDL levels [12,18] (Table 2). ...
We aimed to evaluate the combined effects of a vegetarian diet (VD) and exercise on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) parameters. A literature search was conducted in electronic databases from build to February 27, 2022. Data were synthesized using random effects model and were expressed as standardized mean difference (SMD)/weighted mean difference (WMD) and 95% confidence interval (CI). Overall, 27 trials with 9,251 participants were included. Pooled results indicated that the combination of a VD and exercise significantly reduced TC (SMD: −0.524; 95% CI: −0.602, −0.446; p < 0.001), LDL-C (SMD: −0.379; 95% CI: −0.471, −0.287; p < 0.001), HDL-C (SMD: −0.213; 95% CI: −0.299, −0.126; p < 0.001), TG (SMD: −0.090; 95% CI: −0.160, −0.020; p = 0.012), SBP (WMD: −7.664 mm Hg; 95% CI: −9.219, −6.109 mm Hg; p < 0.001), and DBP (WMD: −4.347 mm Hg; 95% CI: −5.099, −3.596 mm Hg; p < 0.001). These parameters were reduced more following a low-fat VD, or a mixed high-frequency exercise, especially under strict supervision. Surprisingly, the decreased HDL-C due to VD was observed to recover with the prolongation of exercise.
AimTo study how a plant-based diet and dietary acid load (DAL) are related to cardiovascular disease (CVD) risk factors among type 2 diabetic women.Methods
In this cross-sectional study, a validated food frequency questionnaire was used to assess the dietary intake of 230 diabetic women. We created a plant-based dietary index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI). DAL was calculated based on potential renal acid load (PRAL) and net endogenous acid production (NEAP).ResultsPatients in the highest tertile of PDI had lower fasting blood sugar (146.74 ± 6.16 vs. 152.87 ± 6.09, p = 0.009) and lower 2-h postprandial glucose (181.76 ± 7.03 vs. 203.01 ± 6.94, p = 0.002). Patients in the highest tertile of PDI were at lower risk of high waist circumference in a crude model (odd ratios: 0.43; 95% CI: 0.19; 0.96, p = 0.039); however, this association did not reach statistical significant after adjustment for confounders.Conclusion
Our study suggests that plant-based dietary indices and DAL are not associated with CVD risk factors among diabetic patients.
Obesity is a costly and pervasive risk factor that requires attention to reduce chronic disease rates. This study evaluated the effect of a lifestyle medicine intervention, Complete Health Improvement Program (CHIP), on reducing weight, blood pressure, lipid levels, and hemoglobin A1c. A secondary aim was to build a preliminary predictive model for computing new participants’ potential weight change from CHIP. We evaluated pre- and post-intervention biometric data of 68 individuals who completed a 10-week CHIP intervention at a Midwestern university clinic. Significant reductions ( p < 0.05) were observed in weight, diastolic blood pressure, total cholesterol, low-density lipoprotein, and A1c. Regression analyses indicated that the best linear model for predicting change in weight was a one-predictor model with systolic blood pressure. The CHIP intervention effectively promoted weight loss and meaningful reductions in chronic disease risk factors. Larger samples are needed for future regression analyses to create a more robust linear model.
Background and Objectives: The Mediterranean diet has been demonstrated to provide a range of health benefits in observational and clinical trials and adopted by various dietary guidelines. However, a broad range of definitions exist impeding synthesis across trials. This review aims to provide a historical description of Mediterranean diets, from the ancient to the modern, to inform future educational and diet index tool development representing the 'traditional' Mediterranean diet. Methods and Study Design: Nine databases were searched from inception to July 2015 to identify papers defining the Mediterranean diet. The definition accepted by the United Nations Educational, Scientific and Cultural Organization (UNESCO) was also reviewed. Results: The 'traditional' Mediterranean diet is described as high in unprocessed plant foods (grains, vegetables, fruits, legumes, nuts/seeds and extra virgin olive oil), moderate in fish/shellfish and wine and low in meat, dairy, eggs, animal fats and discretionary foods. Additional elements relating to cuisine and eating habits identified in this review include frequent intake of home cooked meals; use of moist, lower temperature, cooking methods; eating main meals in company; reduced snacking occasions; fasting practice; ownership of a vegetable garden; use of traditional foods and combinations; and napping after the midday meal. Conclusions: Scope exists for future tools to incorporate additional elements of the 'traditional' Mediterranean diet to improve the quality, consistency, and synthesis of ongoing research on the Mediterranean diet.
Objective
. To investigate the relationship between inflammatory markers and atherogenic lipoprotein subfractions.
Methods
. We studied 520 eligible subjects who were not receiving any lipid-lowering therapy. The inflammatory markers including white blood cell (WBC) count, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, erythrocyte sedimentation rate (ESR), and D-dimer were measured. A multimarker inflammatory index was developed. Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) separation processes were performed using Lipoprint System.
Results
. In age- and sex-adjusted analysis, several inflammatory markers (WBC count, hs-CRP, fibrinogen, and ESR) were positively related to circulating non-HDL cholesterol and remnant cholesterol (
p
<
0.05
, all). Among lipoprotein subfractions, we observed a positive association of inflammatory markers with very low-density lipoprotein cholesterol, small LDL cholesterol, and LDL score (
p
<
0.05
, all). Meanwhile, a negative association was detected between inflammatory markers and mean LDL particle size (
p
<
0.05
) or large HDL cholesterol (
p
<
0.05
). Moreover, we found that the relationships between multimarker index quartiles and small LDL cholesterol, LDL score, and mean LDL particle size were slightly stronger in patients with CAD.
Conclusions
. Systemic inflammatory markers are positively correlated with small LDL cholesterol and LDL score while being negatively linked with mean LDL particle size and large HDL cholesterol, highlighting the potential contribution to increased cardiovascular risk.
Background:
Our goal was to investigate the effect of short term exercise on fasting and postprandial lipoprotein profile.
Methods:
Healthy sedentary men exercised 20 min for four days. The intensity of exercise was modulated to maintain 75-80 % of a calculated HRmax. Before and after the exercise program, fasting and postprandial (4 h after standard meal) concentrations of lipoprotein subfractions were measured by an electrophoresis in polyacrylamide gel and total concentrations of TAG, LDL and HDL by enzymatic colorimetric method. After 2 days of rest, fasting and postprandial concentrations of lipoprotein fractions and subfractions were measured to determine a persistency of a changes in the lipoprotein profile.
Results:
4 days of physical exercise led to statistically significant decrease of concentration of triacylglycerol in fasting (76.29 ± 20.07, 53.92 ± 10.90, p < 0.05) and postprandial state (139.06 ± 23.72, 96.55 ± 25.21, p < 0.05) VLDL in fasting (21.88 ± 3.87, 18.00 ± 3.93, p < 0.05) and postprandial state (23.88 ± 3.52, 19.25 ± 3.62, p < 0.05), total cholesterol in fasting (162.26 ± 23.38, 148.91 ± 17.72, p < 0.05) and postprandial state (163.73 ± 23.02, 150.08 ± 18.11, p < 0.05). Atherogenic medium LDL decreased also in fasting (9.89 ± 3.27, 6.22 ± 2.55, p < 0.001) and postprandial state (8.88 ± 6.51, 6.88 ± 5.57, p < 0.001). However decrease of large IDL (25.38 ± 3.54, 23.88 ± 3.91, p < 0.05) and large LDL particles (42.89 ± 11.40, 38.67 ± 9.30) was observed only in postprandial state. Total HDL concentration remained unchanged but we observed statistically significant decrease of small HDL particles in fasting (6.11 ± 2.89, 4.22, p < 0.05) and postprandial state (6.44 ± 3.21, 4.56 ± 1.33, p < 0.05). Concentration of these particles are associated with progression of atherosclerosis. All changes of fasting and postprandial lipoprotein profile disappeared after 2 days of rest.
Conclusion:
Just 4 daily settings of 20 min of physical exercise can lead to significant positive changes of fasting and postprandial lipoprotein profile.
The exact mechanisms of hypertension contributing to atherosclerosis have not been fully elucidated. Although multiple studies have clarified the association with low-density lipoprotein (LDL) subfractions, uncertainty remains about its relationship with high-density lipoprotein (HDL) subfractions. Therefore, we aimed to comprehensively determine the relationship between distribution of HDL subfractions and hypertensive status.
A total of 953 consecutive subjects without previous lipid-lowering drug treatment were enrolled and were categorized based on hypertension history (with hypertension [n = 550] or without hypertension [n = 403]). Baseline clinical and laboratory data were collected. HDL separation was performed using the Lipoprint System.
Plasma large HDL-cholesterol (HDL-C) and large HDL percentage were dramatically lower whereas the small HDL-C and small HDL percentage were higher in patients with hypertension (all P < 0.05). The antihypertensive drug therapy was not associated with large or small HDL subfractions (on treatment vs not on treatment, P > 0.05; combination vs single drug therapy, P > 0.05). However, the blood pressure well-controlled patients have significantly lower small HDL subfraction (P < 0.05). Moreover, large HDL-C and percentage were inversely whereas small HDL percentage was positively associated with incident hypertension after adjusting potential confounders (all P < 0.05). In the multivariate model conducted in patients with and without hypertension separately, the cardio-protective value of large HDL-C was disappeared in patients with hypertension (OR 95%CI: 1.011 [0.974–1.049]).
The distribution of HDL subfractions is closely associated with hypertensive status and hypertension may potentially impact the cardio-protective value of large HDL subfraction.
Issue addressed:
Complete Health Improvement Program (CHIP) is a lifestyle modification program that promotes healthy diet, physical activity and stress management techniques. Among US CHIP participants, differences in gender responsiveness to improvements in chronic disease risk factors were demonstrated. This study examined gender differences in outcomes to the CHIP intervention in Australasia.
Methods:
Changes in body weight, blood pressure (BP), blood lipid profile and fasting plasma glucose (FPG) were assessed in 925 participants (34.3% men, mean age=56.0±12.5 years; 65.7% women, mean age=54.4±13.5 years) 30 days after program commencement.
Results:
Significant reductions (P<0.001) in all biometrics measured were found for men and women but were greater among men for total (TC) and low-density lipoprotein cholesterol (LDL), triglycerides (TG), FPG, body mass index (BMI) and TC/high-density lipoprotein cholesterol (HDL) ratio. Participants with highest baseline classifications of BMI, systolic BP, blood lipids and FPG showed greatest reductions in 30 days.
Conclusions:
CHIP more effectively reduced chronic disease risk factors among men than women. All participants, but particularly men, entering the program with the greatest risk achieved the largest reductions. Possible physiological or behavioural factors include food preferences, making commitments and differential support modes. SO WHAT?: Developers of lifestyle intervention programs should consider gender differences in physiological and behavioural factors when planning interventions. In particular, developers should manage expectations of people entering lifestyle interventions to increase awareness that men tend to respond better than women. In addition, this is a call for further research to identify the underlying mechanisms responsible for the disproportionate responsiveness of males.
Background
Recent data suggest that high‐density lipoprotein cholesterol (HDL‐C) levels are likely not in the causative pathway of atheroprotection, shifting focus from HDL‐C to its subfractions and associated proteins. This study's goal was to determine which HDL phenotype was the better predictor of carotid artery disease (CAAD).
Methods and Results
HDL‐2 and HDL‐3 were measured in 1725 participants of European ancestry in a prevalent case‐control cohort study of CAAD. Stratified analyses were conducted for men (n=1201) and women (n=524). Stepwise linear regression was used to determine whether HDL‐C, HDL‐2, HDL‐3, or apolipoprotein A1 was the best predictor of CAAD, while adjusting for the confounders of censored age, diabetes, and current smoking status. In both men and women, HDL‐3 was negatively associated with CAAD (P=0.0011 and 0.033 for men and women, respectively); once HDL‐3 was included in the model, no other HDL phenotype was significantly associated with CAAD. Addition of paraoxonase 1 activity to the aforementioned regression model showed a significant and independent (of HDL‐3) association with CAAD in men (P=0.001) but not in the smaller female subgroup.
Conclusions
This study is the first to contrast the associations of HDL‐2 and HDL‐3 with CAAD. We found that HDL‐3 levels were more predictive of CAAD status than HDL‐2, HDL‐C, or apolipoprotein A1. In addition, for men, paraoxonase 1 activity improved the overall model prediction for CAAD independently and additively with HDL‐3 levels. Further investigation into the molecular mechanisms through which HDL‐3 is associated with protection from CAAD is warranted.
To examine the long-term (three or more years) effectiveness of the volunteer-delivered Complete Health Improvement Program (CHIP) intervention.
Cohort study.
Hawera, New Zealand.
Of the total cohort of 284 individuals who self-selected to complete the CHIP lifestyle intervention between 2007 and 2009, 106 (37% of the original cohort, mean age=64.9±7.4 years, range 42-87 years; 35% males, 65% female) returned in 2012 for a complimentary follow-up health assessment (mean follow-up duration=49.2+10.4 months).
30-day lifestyle modification programme (diet, physical activity, substance use and stress management) delivered by volunteers in a community setting.
Changes in body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG).
After approximately 4 years, participants with elevated biometrics at programme entry maintained significantly lowered BMI (-3.2%; 34.8±5.4 vs 33.7±5.3 kg/m(2), p=0.02), DBP (-9.4%; 89.1±4.1 vs 80.8±12.6 mm Hg, p=0.005), TC (-5.5%; 6.1±0.7 vs 5.8±1.0 mmol/L, p=0.04) and TG (-27.5%; 2.4±0.8 vs 1.7±0.7 mmol/L, p=0.002). SBP, HDL, LDL and FPG were not significantly different from baseline. Participants with elevated baseline biometrics who reported being compliant to the lifestyle principles promoted in the intervention (N=71, 67% of follow-up participants) recorded further reductions in BMI (-4.2%; 34.8±4.5 vs 33.4±4.8 kg/m(2), p=0.02), DBP (-13.3%; 88.3±3.2 vs 77.1±12.1 mm Hg, p=0.005) and FPG (-10.4%; 7.0±1.5 vs 6.3±1.3 mmol/L, p=0.02).
Individuals who returned for follow-up assessment and entered the CHIP lifestyle intervention with elevated risk factors were able to maintain improvements in most biometrics for more than 3 years. The results suggest that the community-based CHIP lifestyle intervention can be effective in the longer term, even when delivered by volunteers.
Low levels of high-density lipoproteins (HDL) are considered an important risk factor for cardiovascular disease and constitute one of the criteria for the Metabolic Syndrome (MetS). Lifestyle interventions promoting a low-fat, plant-based eating pattern appear to paradoxically reduce cardiovascular risk but also HDL levels. This study examined the changes in MetS risk factors, in particular HDL, in a large cohort participating in a 30-day lifestyle intervention that promoted a low-fat, plant-based eating pattern.
Individuals (n = 5,046; mean age = 57.3 ± 12.9 years; 33.5% men, 66.5% women) participating in a in a Complete Health Improvement Program (CHIP) lifestyle intervention within the United States were assessed at baseline and 30 days for changes in body mass index (BMI), blood pressure (BP), lipid profile and fasting plasma glucose (FPG).
HDL levels decreased by 8.7% (p<0.001) despite significant reductions (p<0.001) in BMI (-3.2%), systolic BP (-5.2%), diastolic BP (-5.2%), triglycerides (TG; -7.7%), FPG (-6.3%), LDL (-13.0%), total cholesterol (TC, -11.1%), TC: HDL ratio (-3.2%), and LDL: HDL ratio (-5.3%). While 323 participants classified as having MetS at program entry no longer had this status after the 30 days, 112 participants acquired the MetS classification as a result of reduction in their HDL levels.
When people move towards a low-fat, plant-based diet, HDL levels decrease while other indicators of cardiovascular risk improve. This observation raises questions regarding the value of using HDL levels as a predictor of cardiovascular risk in populations who do not consume a typical western diet. As HDL is part of the assemblage of risk factors that constitute MetS, classifying individuals with MetS may not be appropriate in clinical practice or research when applying lifestyle interventions that promote a plant-based eating pattern.
To examine the effectiveness within the Australasian context of the Complete Health Improvement Program (CHIP) lifestyle intervention, which has been shown to produce meaningful reductions in selected chronic disease risk factors in the United States.
Changes in body weight, blood pressure, blood lipid profile and fasting plasma glucose were assessed in 836 self-selected participants (age=55.9 plus or minus 12.7 yrs, 35% male/65% female) from 18 sites throughout New Zealand (N=731) and Australia (N=105).
In the 30 days of the program, significant overall reductions (p<0.001) were recorded in the participants' body mass (-3.8%; 87.1 plus or minus 22.4 versus 83.9 plus or minus 21.5 kg), systolic blood pressure (-5.6%; 135 plus or minus 19 versus 127 plus or minus 17 mmHg), diastolic blood pressure (-4.6%; 80 plus or minus 12 versus 76 plus or minus 12 mmHg), total cholesterol (-14.7%; 5.17 plus or minus 1.08 versus 4.41 plus or minus 0.96 mmol/L), low-density lipoprotein cholesterol (-17.9%; 3.17 plus or minus 0.95 versus 2.60 plus or minus 0.83 mmol/L), triglycerides (-12.5%; 1.51 plus or minus 0.98 versus 1.32 plus or minus 0.71 mmol/L) and fasting plasma glucose (-5.6%; 5.55 plus or minus 1.49 versus 5.24 plus or minus 1.11 mmol/L). Participants at program entry with the highest classifications of total cholesterol, low-density lipoprotein, triglycerides and fasting plasma glucose experienced over 20% reductions in these measures in 30 days.
Significant reductions in selected chronic disease risk factors were observed in 30 days using the CHIP intervention and the improvements were comparable to that observed in cohorts from the United States. The results of this feasibility study indicate that lifestyle interventions like CHIP may be useful for combating the burgeoning epidemic of chronic disease and further research is warranted.
High-density lipoproteins (HDL) are structurally and metabolically heterogeneous and subclasses with differential effects on coronary heart disease (CHD) might exist. Apolipoprotein (apo) C-III, a small proinflammatory protein that resides on the surface of lipoproteins, enhances the atherogenicity of VLDL and LDL particles, but little is known about the role apoC-III on HDL. We investigated whether the presence or absence of apoC-III differentiates HDL into subtypes with nonprotective or protective associations with risk of future CHD.
High-density lipoprotein cholesterol (HDL-C) levels were measured in plasma separated according to apoC-III (by immunoaffinity chromatography) in two prospective case-control studies nested within the Nurses' Health and the Health Professionals Follow-Up Studies. Baseline was in 1990 and 1994, and 634 incident CHD cases were documented through 10 to 14 years of follow-up. The relative risk of CHD per each standard deviation of total HDL-C was 0.78 (95% confidence intervals, 0.63-0.96). The HDL-C subtypes were differentially associated with risk of CHD, HDL-C without apoC-III inversely and HDL-C with apoC-III directly (P=0.02 for a difference between the HDL types). The relative risk per standard deviation of HDL-C without apoC-III was 0.66 (0.53 to 0.93) and 1.18 (1.03 to 1.34) for HDL-C with apoC-III. HDL-C with apoC-III comprised ∼13% of the total HDL-C. Adjustment for triglycerides and apoB attenuated the risks; however, the two HDL-C subgroups remained differentially associated with risk of CHD (P=0.05).
Separating HDL-C according to apoC-III identified two types of HDL with opposing associations with risk of CHD. The proatherogenic effects of apoC-III, as a component of VLDL and LDL, may extend to HDL. (J Am Heart Assoc. 2012;1:jah3-e000232 doi: 10.1161/JAHA.111.000232.).
Small dense low-density lipoprotein (sdLDL) has been suggested to be more atherogenic than large buoyant LDL. High-density lipoprotein (HDL) consists of two major subfractions (HDL2, HDL3), and just as controversy remains regarding which of the two is the more powerful negative risk factor for atherosclerosis, associations between sdLDL and these HDL subfractions are unclear.
We measured sdLDL cholesterol (sdLDL-C), HDL2 cholesterol (HDL2-C) and HDL3 cholesterol (HDL3-C) by a newly developed method in 481 Japanese-Americans who were not using lipid-lowering medication, and examined the associations of these cholesterol concentrations with variables related to atherosclerosis.
In multivariate analysis, sdLDL-C was positively correlated with the body mass index (BMI), fasting glucose and insulin, 2-h glucose, HOMA-IR, high sensitivity C-reactive protein (hsCRP), and carotid artery intima-media thickness (IMT) after adjustment for age and sex. In particular, sdLDL-C was positively correlated with IMT, even after adjustment for sex, age, smoking status, hypertension, diabetes mellitus and hsCRP. HDL2-C was more closely inversely correlated than total HDL-C with BMI, fasting glucose and insulin, 2-h glucose, HOMA-IR, and hsCRP, whereas HDL3-C was not correlated with these factors. Additionally, HDL2-C was more closely correlated than total HDL-C or HDL3-C with sdLDL-C, LDL-C, triglycerides (TG), and apolipoprotein B (apoB).
SdLDL-C was closely associated with insulin resistance and glucose tolerance, lending credence to its potential as a useful risk marker in assessing carotid artery IMT and the present degree of atherosclerosis in Japanese-Americans. The findings also suggest that subjects with higher HDL2-C levels were better protected from atherosclerosis.
Few studies have compared lipoprotein composition with dietary intake.
The lipoprotein subfraction profile was evaluated in relation to diet in Alaska Eskimos at high cardiovascular risk but with a low frequency of hyperlipidemia and high intake of n-3 (omega-3) fatty acids.
A population-based sample (n = 1214) from the Norton Sound Region of Alaska underwent a physical examination and blood sampling. Analyses were from 977 individuals who did not have diabetes or use lipid-lowering medications and had complete dietary information (food-frequency questionnaire) and a lipoprotein subfraction profile (nuclear magnetic resonance spectroscopy).
After adjustment for age, BMI, total energy intake, and percentage of energy from fat, the intake of n-3 fatty acids was significantly associated with fewer large VLDLs (P = 0.022 in women, P = 0.064 in men), a smaller VLDL size (P = 0.018 and P = 0.036), more large HDLs (P = 0.179 and P = 0.021), and a larger HDL size (P = 0.004 and P = 0.001). After adjustment for carbohydrate and sugar intakes, large VLDLs (P = 0.042 and 0.018) and VLDL size (P = 0.011 and 0.025) remained negatively associated with n-3 fatty acid intake in women and men, and large HDLs (P = 0.067 and 0.005) and HDL size (P = 0.001 in both) remained positively associated with n-3 fatty acid intake in women and men. In addition, large LDLs (P = 0.040 and P = 0.025) were positively associated in both sexes, and LDL size (P = 0.006) showed a positive association in women. There were no significant relations with total LDL particles in either model.
Dietary n-3 fatty acids, independent of the reciprocal changes in carbohydrate and sugar intakes, are associated with an overall favorable lipoprotein profile in terms of cardiovascular risk. Because there are no relations with total LDL particles, the benefit may be related to cardiovascular processes other than atherosclerosis.
Plasma levels of high density lipoprotein (HDL) cholesterol are strongly inversely correlated to the risk of atherosclerotic cardiovascular disease. A major recognized functional property of HDL particles is to elicit cholesterol efflux and consequently mediate reverse cholesterol transport (RCT). The recent introduction of a surrogate method aiming at determining specifically RCT from the macrophage compartment has facilitated research on the different components and pathways relevant for RCT. The current review provides a comprehensive overview of studies carried out on macrophage-specific RCT including a quick reference guide of available data. Knowledge and insights gained on the regulation of the RCT pathway are summarized. A discussion of methodological issues as well as of the respective relevance of specific pathways for RCT is also included.
Combining foods with recognized cholesterol-lowering properties (dietary portfolio) has proven highly effective in lowering serum cholesterol under metabolically controlled conditions.
To assess the effect of a dietary portfolio administered at 2 levels of intensity on percentage change in low-density lipoprotein cholesterol (LDL-C) among participants following self-selected diets.
A parallel-design study of 351 participants with hyperlipidemia from 4 participating academic centers across Canada (Quebec City, Toronto, Winnipeg, and Vancouver) randomized between June 25, 2007, and February 19, 2009, to 1 of 3 treatments lasting 6 months.
Participants received dietary advice for 6 months on either a low-saturated fat therapeutic diet (control) or a dietary portfolio, for which counseling was delivered at different frequencies, that emphasized dietary incorporation of plant sterols, soy protein, viscous fibers, and nuts. Routine dietary portfolio involved 2 clinic visits over 6 months and intensive dietary portfolio involved 7 clinic visits over 6 months.
Percentage change in serum LDL-C.
In the modified intention-to-treat analysis of 345 participants, the overall attrition rate was not significantly different between treatments (18% for intensive dietary portfolio, 23% for routine dietary portfolio, and 26% for control; Fisher exact test, P = .33). The LDL-C reductions from an overall mean of 171 mg/dL (95% confidence interval [CI], 168-174 mg/dL) were -13.8% (95% CI, -17.2% to -10.3%; P < .001) or -26 mg/dL (95% CI, -31 to -21 mg/dL; P < .001) for the intensive dietary portfolio; -13.1% (95% CI, -16.7% to -9.5%; P < .001) or -24 mg/dL (95% CI, -30 to -19 mg/dL; P < .001) for the routine dietary portfolio; and -3.0% (95% CI, -6.1% to 0.1%; P = .06) or -8 mg/dL (95% CI, -13 to -3 mg/dL; P = .002) for the control diet. Percentage LDL-C reductions for each dietary portfolio were significantly more than the control diet (P < .001, respectively). The 2 dietary portfolio interventions did not differ significantly (P = .66). Among participants randomized to one of the dietary portfolio interventions, percentage reduction in LDL-C on the dietary portfolio was associated with dietary adherence (r = -0.34, n = 157, P < .001).
Use of a dietary portfolio compared with the low-saturated fat dietary advice resulted in greater LDL-C lowering during 6 months of follow-up.
clinicaltrials.gov Identifier: NCT00438425.
The effects of dietary macronutrient composition on metabolic profiles in patients with type 2 diabetes have been inconsistent. This meta-analysis aimed to elucidate the effect of replacing dietary fat with carbohydrate on glucose and lipid parameters in patients with type 2 diabetes.
We searched for randomized trials that investigated the effects of two kinds of prescribed diets (a low-fat, high-carbohydrate [LFHC] diet and a high-fat, low-carbohydrate [HFLC] diet); in these studies, energy and protein intake did not differ significantly between the two dietary groups. Nineteen studies that included 306 patients met our inclusion criteria. Median diet composition of carbohydrate/fat in the LFHC and HFLC diets was 58%/24% and 40%/40%, respectively.
Changes in values for A1C, fasting plasma glucose (FPG), and total and LDL cholesterol did not differ significantly between the LFHC and HFLC groups. However, the LFHC diet significantly increased fasting insulin and triglycerides by 8% (P = 0.02) and 13% (P < 0.001), respectively, and lowered HDL cholesterol by 6% (P < 0.001) compared with the HFLC diet. There were positive associations among the magnitude of changes in FPG, fasting insulin, and triglycerides for the diets analyzed. However, stratified analysis indicated that the increase in triglycerides was insignificant when accompanied by energy intake restriction.
Our findings suggested that replacing fat with carbohydrate could deteriorate insulin resistance while the adverse effect on triglycerides from the LFHC diet could be avoided by restricting energy intake to a degree sufficient for the attainment of weight reduction.
To investigate the association between treatment induced change in high density lipoprotein cholesterol and total death, coronary heart disease death, and coronary heart disease events (coronary heart disease death and non-fatal myocardial infarction) adjusted for changes in low density lipoprotein cholesterol and drug class in randomised trials of lipid modifying interventions.
Systematic review and meta-regression analysis of randomised controlled trials.
Medline, Embase, Central, CINAHL, and AMED to October 2006 supplemented by contact with experts in the field.
In teams of two, reviewers independently determined eligibility of randomised trials that tested lipid modifying interventions to reduce cardiovascular risk, reported high density lipoprotein cholesterol and mortality or myocardial infarctions separately for treatment groups, and treated and followed participants for at least six months.
Using standardised, pre-piloted forms, reviewers independently extracted relevant information from each article. The change in lipid concentrations for each trial and the weighted risk ratios for clinical outcomes were calculated.
The meta-regression analysis included 108 randomised trials involving 299 310 participants at risk of cardiovascular events. All analyses that adjusted for changes in low density lipoprotein cholesterol showed no association between treatment induced change in high density lipoprotein cholesterol and risk ratios for coronary heart disease deaths, coronary heart disease events, or total deaths. With all trials included, change in high density lipoprotein cholesterol explained almost no variability (<1%) in any of the outcomes. The change in the quotient of low density lipoprotein cholesterol and high density lipoprotein cholesterol did not explain more of the variability in any of the outcomes than did the change in low density lipoprotein cholesterol alone. For a 10 mg/dl (0.26 mmol/l) reduction in low density lipoprotein cholesterol, the relative risk reduction was 7.2% (95% confidence interval 3.1% to 11%; P=0.001) for coronary heart disease deaths, 7.1% (4.5% to 9.8%; P<0.001) for coronary heart disease events, and 4.4% (1.6% to 7.2%; P=0.002) for total deaths, when adjusted for change in high density lipoprotein cholesterol and drug class.
Available data suggest that simply increasing the amount of circulating high density lipoprotein cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in low density lipoprotein cholesterol as the primary goal for lipid modifying interventions.
High-density lipoproteins (HDL) possess key atheroprotective biological properties, including cellular cholesterol efflux capacity, and anti-oxidative and anti-inflammatory activities. Plasma HDL particles are highly heterogeneous in physicochemical properties, metabolism, and biological activity. Within the circulating HDL particle population, small, dense HDL particles display elevated cellular cholesterol efflux capacity, afford potent protection of atherogenic low-density lipoprotein against oxidative stress and attenuate inflammation. The antiatherogenic properties of HDL can, however be compromised in metabolic diseases associated with accelerated atherosclerosis. Indeed, metabolic syndrome and type 2 diabetes are characterized not only by elevated cardiovascular risk and by low HDL-cholesterol (HDL-C) levels but also by defective HDL function. Functional HDL deficiency is intimately associated with alterations in intravascular HDL metabolism and structure. Indeed, formation of HDL particles with attenuated antiatherogenic activity is mechanistically related to core lipid enrichment in triglycerides and cholesteryl ester depletion, altered apolipoprotein A-I (apoA-I) conformation, replacement of apoA-I by serum amyloid A, and covalent modification of HDL protein components by oxidation and glycation. Deficient HDL function and subnormal HDL-C levels may act synergistically to accelerate atherosclerosis in metabolic disease. Therapeutic normalization of attenuated antiatherogenic HDL function in terms of both particle number and quality of HDL particles is the target of innovative pharmacological approaches to HDL raising, including inhibition of cholesteryl ester transfer protein, enhanced lipidation of apoA-I with nicotinic acid and infusion of reconstituted HDL or apoA-I mimetics. A preferential increase in circulating concentrations of HDL particles possessing normalized antiatherogenic activity is therefore a promising therapeutic strategy for the treatment of common metabolic diseases featuring dyslipidemia, inflammation, and premature atherosclerosis.
Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.
The exact role of different high-density lipoprotein (HDL) subfractions in the pathogenesis of coronary artery disease (CAD) has not yet been fully explored. The aim of the present study was to examine the relationship between HDL subfractions and the severity of CAD in patients without statin therapy.
A total of 382 consecutive patients (mean: 55.36 ± 11.30 years of age) who underwent coronary angiography from angina-like chest pain were investigated. Patients were classified into 2 groups according to the angiographic results: a CAD group (n = 283) and a control group (n = 99). The distribution of HDL subfractions was analyzed using a Quantimetrix Lipoprint HDL system. CAD severity was measured by Gensini score (GS).
Compared with the control group, HDL-cholesterol (HDL-C), large HDL-C level, and the large HDL subfraction percentages in the CAD group were significantly lower (P = .002, P < .001, P < .001, respectively). Meanwhile, a small HDL-C level and the percentage of small HDL subfraction were significantly higher (P = .003, P < .001, respectively). Correlation analysis showed that the percentage of a large HDL subfraction was negatively correlated with GS (β = -0.191, P = .005), whereas the percentage of a small HDL subfraction positively correlated with GS (β = 0.145, P = .023) in patients with CAD.
Small HDL subfraction was associated with the presence of CAD, whereas the percentage of large HDL and small HDL subfraction was negatively and positively associated with the severity of CAD, respectively.
Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.
The Complete Health Improvement Program (CHIP) is a premier lifestyle intervention targeting chronic disease that has been offered for more than 25 years. The intervention has been used in clinical, corporate, and community settings, and the short-term and long-term clinical benefits of the intervention, as well as its cost-effectiveness, have been documented in more than 25 peer-reviewed publications. Being an easily administered intervention, CHIP has been presented not only by health professionals but also by non-health-trained volunteers. The benefits of the program have been extensively studied under these 2 delivery channels, consistently demonstrating positive outcomes. This article provides a brief history of CHIP and describes the content and structure of the intervention. The published evaluations and outcomes of the intervention are presented and discussed and future directions are highlighted.
High-density lipoprotein (HDL) is astonishingly complex, but the de facto standard for its measurement has been remarkably simple: total cholesterol content. It is time to prioritize higher-resolution HDL measurement techniques that capture better the biologically and clinically important characteristics of HDL. Scientific advances have ushered in a new era in which we view HDL in terms of its subfractions, particle structure, metabolism, and functional integration of its proteome and lipidome. HDL subfractions appear to be associated with function. In general, smaller, denser HDL3 is more tightly linked to favorable atheroprotective functions and clinical outcomes. Techniques to measure the cholesterol content or particle concentrations of HDL subfractions are available clinically. In the future, we anticipate subfractionating HDL based on its functional properties.
The PREDIMED trial showed that Mediterranean diets supplemented with either extra-virgin olive oil or nuts reduced incident cardiovascular events compared to a control diet. Consumption of both supplemental foods has been associated with reduced LDL-cholesterol, but it is unknown whether they can shift lipoprotein subfractions to a less atherogenic pattern. We investigated changes in adiposity and lipoprotein subfractions after consumption of the PREDIMED diets.
In a PREDIMED sub-cohort (n = 169), lipoprotein subclasses (particle concentrations and size) were determined by nuclear magnetic resonance spectroscopy at baseline and after intervention for 1 year.
Participants allocated to the Mediterranean diet supplemented with nuts showed significant reductions from baseline of waist circumference (mean [95% CI]; -5 cm [-7; -3]) and concentrations of medium-small (-27 nmol/l [-46; -8]) and very small LDL (-111 nmol/l [-180; -42]); decreased LDL particle number (a nuclear magnetic resonance-specific measurement) (-98 nmol/l [-184; -11]); and an increase of large LDL concentrations (54 nmol/l [18; 90]), with a net increase (0.2 nmol/l [0.1; 0.4]) of LDL size. The Mediterranean diets with olive oil and nuts increased large HDL concentrations (0.6 μM [0.0; 1.1] and 1.0 μM [0.4; 1.5], respectively). Compared to the other two intervention groups, participants in the nut-enriched diet showed significantly reduced waist circumference (p ≤ 0.006, both) and increased LDL size (p < 0.05, both).
Lipoprotein subfractions are shifted to a less atherogenic pattern by consumption of Mediterranean diets enriched with nuts. The results contribute mechanistic evidence for the reduction of cardiovascular events observed in the PREDIMED trial.
Context:
Although intensive lifestyle change (ILS) and metformin reduce diabetes incidence in subjects with impaired glucose tolerance (IGT), their effects on lipoprotein subfractions have not been studied.
Objective:
The objective of the study was to characterize the effects of ILS and metformin vs placebo interventions on lipoprotein subfractions in the Diabetes Prevention Program.
Design:
This was a randomized clinical trial, testing the effects of ILS, metformin, and placebo on diabetes development in subjects with IGT.
Participants:
Selected individuals with IGT randomized in the Diabetes Prevention Program participated in the study.
Interventions:
Interventions included randomization to metformin 850 mg or placebo twice daily or ILS aimed at a 7% weight loss using a low-fat diet with increased physical activity.
Main outcome measures:
Lipoprotein subfraction size, density, and concentration measured by magnetic resonance and density gradient ultracentrifugation at baseline and 1 year were measured.
Results:
ILS decreased large and buoyant very low-density lipoprotein, small and dense low-density lipoprotein (LDL), and small high-density lipoprotein (HDL) and raised large HDL. Metformin modestly reduced small and dense LDL and raised small and large HDL. Change in insulin resistance largely accounted for the intervention-associated decreases in large very low-density lipoprotein, whereas changes in body mass index (BMI) and adiponectin were strongly associated with changes in LDL. Baseline and a change in adiponectin were related to change in large HDL, and BMI change associated with small HDL change. The effect of metformin to increase small HDL was independent of adiponectin, BMI, and insulin resistance.
Conclusion:
ILS and metformin treatment have favorable effects on lipoprotein subfractions that are primarily mediated by intervention-related changes in insulin resistance, BMI, and adiponectin. Interventions that slow the development of diabetes may also retard the progression of atherosclerosis.
Lifestyle modification has been demonstrated to effectively reduce the risk factors associated with cardiovascular disease, but there is a perception that it is costly to administer and resource. The present study examined the results achieved by a 30-day lifestyle modification program (Coronary Health Improvement Project) delivered by volunteers in a community setting. Changes in selected biometric measures of 5,070 participants in the Coronary Health Improvement Project programs delivered throughout North America (January 2006 to October 2009), were assessed. Overall, significant reductions (p < 0.001) were recorded in body mass (-3.2%), systolic and diastolic blood pressure (-4.9% and -5.3%, respectively), total cholesterol (-11.0%), low-density lipoprotein cholesterol (-13.0%), triglycerides (-7.7%), and fasting plasma glucose (-6.1%). Stratification of the data revealed more dramatic responses in those presenting with the greatest risk factor levels. Those presenting with cholesterol levels >280 mg/dl recorded an average reduction of 19.8%. A mean decrease of 16.1% in low-density lipoprotein levels was observed among those who entered the program with a low-density lipoprotein level >190 mg/dl. Individuals who presented with triglycerides >500 mg/dl recorded a mean reduction of 44.1%. The Framingham assessment forecast that approximately 70 cardiac events would be averted during the subsequent decade in the cohort because of the program. In conclusion, significant reductions in cardiovascular disease risk factors can be achieved in a 30-day lifestyle intervention delivered by volunteers, providing a cost-effective mode of administering lifestyle medicine.
The concept of raising high-density lipoprotein (HDL) has been the focus of increasing attention as a strategy to reduce cardiovascular disease. HDL particles are, however, highly heterogeneous in structure, intravascular metabolism and biological activity. In this review, we describe major HDL subpopulations and discuss new findings on the antiatherogenic properties of HDL particles. Across the HDL subpopulation spectrum, small, dense, protein-rich HDLs display potent atheroprotective properties, which can be attributed to specific clusters of proteins and lipids; such activities can be compromised under conditions of atherogenic dyslipidemia. Comprehensive structural and compositional analyses of HDL may provide key information to identify subpopulations displaying specific biological functions and acquiring deficient functionality, with the potential to reveal novel biomarkers of cardiovascular risk and new pharmacological targets.
The purpose of this study was to determine if exercise, whether continuous (CE: completed all in one session) or intermittent (completed in either two (IE 2) or three (IE 3) exercise sessions) expending the same number of calories alters reverse cholesterol transport or low density lipoprotein (LDL) particle size.
Sixteen healthy (22±2.1 year old) men (VO(2) max=37.0±3.3mL/kg/min) randomly completed three exercise trials, CE, IE 2 and IE 3, expending 450 calories. Blood samples were drawn immediately post-exercise (IPE) and 24 and 48h following exercise and analyzed for total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C) and subfractions (HDL(2)-C, HDL(3)-C). Samples were also analyzed to determine LDL-C particle size, lecithin cholesterol acyl transferase activity (LCATa) and cholesterol ester transfer protein activity (CETPa).
HDL(2)-C increased significantly 48h post-exercise in the CE and IE 2 groups. Additionally, the IE 3 group had significant increases in HDL(2)-C at 24 (39%) and 48h post-exercise by 66%. This change in HDL(2)-C was significantly and positively correlated (r=0.62; p<0.05) to the changes in LCATa which increased compared to baseline at 48h post-exercise in the CE and IE 3 groups. No significant changes in LDL particle size or alterations in CETPa were seen.
The results of this study indicate that whether the exercise is continuous or intermittent, keeping calorie expenditure the same, causes significant changes in the HDL(2)-C subfraction, which was augmented by an increase in LCATa.
Our purpose is to review recent findings highlighting the metabolic and functional diversity of HDL subspecies.
HDL heterogeneity - both structural and functional - is the main focus of this review. Recent work indicates that the metabolism and functionality of HDL particles differ greatly among HDL subspecies. With the introduction of new and improved methodology (e.g., proteomics), new aspects of the structural complexity and functionality of HDL have been revealed. It has been confirmed that HDL functions - including, but not limited to decreasing inflammation, apoptosis, macrophage adhesion to the endothelium and insulin resistance - are due to HDL's ability to remove cholesterol from cells (reverse cholesterol transport). A new level of HDL complexity has recently been revealed by investigating the lipid composition of HDL with gas chromatography, gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry. There are about 100 different HDL-associated proteins; however, there are many more lipid species potentially associated with HDL particles.
The most important recent findings disclose that HDL is more complex than previously thought. HDL subclasses differ in physical-chemical properties, protein and lipid composition, metabolism, physiological functions and pathophysiological significance. The staggering complexity of HDL demands significantly more investigation before we can truly begin to understand HDL metabolism and function in humans.
Clinical and epidemiologic studies have consistently shown that low levels of high-density lipoprotein (HDL) cholesterol are strongly associated with an increase in the risk of coronary artery disease.1 Moreover, hypercholesterolemic mice with genetic defects in HDL metabolism are markedly atherosclerotic,2,3 providing compelling evidence that HDL is a key modulator of the disease in animal models. These observations, together with the large residual disease risk among patients with coronary disease who are treated with statins, have triggered intense interest in therapies that raise levels of HDL cholesterol. Despite the abundant evidence for the inverse association between HDL cholesterol and the . . .
Dyslipidemia is a primary risk factor for cardiovascular disease, peripheral vascular disease, and stroke. Current guidelines recommend diet as first-line therapy for patients with elevated plasma cholesterol concentrations. However, what constitutes an optimal dietary regimen remains a matter of controversy. Large prospective trials have demonstrated that populations following plant-based diets, particularly vegetarian and vegan diets, are at lower risk for ischemic heart disease mortality. The investigators therefore reviewed the published scientific research to determine the effectiveness of plant-based diets in modifying plasma lipid concentrations. Twenty-seven randomized controlled and observational trials were included. Of the 4 types of plant-based diets considered, interventions testing a combination diet (a vegetarian or vegan diet combined with nuts, soy, and/or fiber) demonstrated the greatest effects (up to 35% plasma low-density lipoprotein cholesterol reduction), followed by vegan and ovolactovegetarian diets. Interventions allowing small amounts of lean meat demonstrated less dramatic reductions in total cholesterol and low-density lipoprotein levels. In conclusion, plant-based dietary interventions are effective in lowering plasma cholesterol concentrations.
Serum lipoproteins, body composition, and adipose cholesterol contents of six obese women were studied during and after major weight loss by very-low-calorie diets (VLCDs). Subjects started at 168 +/- 11% of ideal body weight, lost 30.3 +/- 3.7 kg in 5-7 mo, followed by 2+ mo in weight maintenance. Serum cholesterol fell from a prediet (baseline) value of 5.49 +/- 0.32 to 3.62 +/- 0.31 mmol/L (P less than 0.01) after 1-2 mo of VLCDs (nadir), after which it rose to 5.95 +/- 0.36 mmol/L (peak, P less than 0.01 compared with nadir and baseline) as weight loss continued. With weight maintenance, serum cholesterol fell to 4.92 +/- 0.34 mmol/L (P less than 0.05 compared with peak). Adipose cholesterol content did not change in peripheral (arm and leg) biopsy sites but rose significantly in abdominal adipose tissue with weight loss. We conclude that major weight loss was associated with a late rise in serum cholesterol, possibly from mobilization of adipose cholesterol stores, which resolved when weight loss ceased.
Life-style modification has been recommended by the National Cholesterol Education Program as the first approach to reduce serum lipid values and the risk for coronary heart disease. Presented are data from 4587 adults who attended a 3-week residential, life-style modification program consisting of a high-complex-carbohydrate, high-fiber, low-fat, and low-cholesterol diet combined with daily aerobic exercise, primarily walking. Total cholesterol values were reduced by 23%, from 6.06 to 4.66 mmol/L (234 to 180 mg/dL). Low-density cholesterol (LDL-C) values were also reduced by 23%, from 3.9 to 3.0 mmol/L (151 to 116 mg/dL), with most of the change occurring during the first 2 weeks. Male subjects showed a greater reduction in total cholesterol (24.4% vs 20.8%) and LDL-C (25% vs 19.4%) values compared with female subjects. Follow-up studies for 18 months on a small group showed that, in most cases, continued compliance with the program maintained total cholesterol values well below 5.18 mmol/L (200 mg/dL), the level recommended by the National Cholesterol Education Program. High-density cholesterol (HDL-C) was reduced by 16%, but the ratio of total cholesterol to HDL-C was reduced by 11%. Female subjects showed a greater drop in HDL-C values than did male subjects (19.4% vs 11.6%). Serum triglyceride values were reduced by 33%, from 2.29 to 1.54 mmol/L (200 to 135 mg/dL); again, male subjects showed a greater reduction than the did female subjects (37.9% vs 22.5%). Body weight was also significantly reduced, 5.5% for male subjects and 4.4% for female subjects. These results show that most adults can significantly reduce serum lipid values and the risk for atherosclerosis and its clinical sequelae through life-style modification consisting of diet and exercise.
DESPITE early observations suggesting an inverse relation between serum levels of high-density lipoprotein (HDL) cholesterol and coronary disease,1 2 3 the possible protective role of HDL in atherogenesis received little attention until its "rediscovery" by Miller and Miller4 in 1975 and the publication of confirmatory results from the Honolulu,5 Framingham,6 and Tromso7 heart studies in 1976 and 1977. In the ensuing decade, research into the biochemistry, metabolism, epidemiology, and genetics of HDL has expanded rapidly, but many questions remain unanswered. The recent publication of the results of the Helsinki Heart Study8 , 9 — in which simultaneous 11 percent increases in HDL and reductions . . .
The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year.
To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease.
Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design.
Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography.
Two tertiary care university medical centers.
Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years.
Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events.
Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]).
More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.
Measures of the two major high-density lipoprotein (HDL) subfractions, HDL(2) and HDL(3), and the major apolipoproteins of HDL and low-density lipoprotein (LDL), Apo A-I and Apo B, may be etiologically important factors in the development of coronary artery disease. The association of lifestyle factors with these lipoprotein-related variables remains unclear.
HDL-C, HDL(2)-C, HDL(3)-C, Apo A-I, and Apo B levels were determined in a population-based sample of 1,027 healthy women and men aged 25-64 years, from four California cities who participated in the 1989/1990 survey of the Stanford Five City Project. In this cross-sectional study we examined the independent associations of these lipoprotein-related variables with body mass index (BMI), cigarette smoking, daily energy expenditure, alcohol intake, dietary intake, and hormone use (oral contraceptives and estrogen replacement therapy).
In general, BMI and alcohol intake were the strongest independent predictors of the lipoprotein-related variables. The negative association of BMI with HDL-C was attributable primarily to the association with the HDL(2)-C subfraction, while for alcohol intake the positive association with HDL-C was attributable primarily to the association with HDL(3)-C, particularly in men. Among men, but not women, energy expenditure was a significant independent predictor of each of the lipoprotein-related variables, with positive associations observed for HDL-C, HDL(2)-C, HDL(2)-C, and Apo A-I and a negative association observed for Apo B (P < 0.005).
Data from this population-based sample suggest that specific lifestyle factors are more strongly associated with some lipoprotein-related variables than with others, with notable gender differences.
Currently, modern chronic diseases, including cardiovascular diseases, Type 2 diabetes, metabolic syndrome, and cancer, are the leading killers in Westernized society and are increasing rampantly in developing nations. In fact, obesity, diabetes, and hypertension are now even commonplace in children. Clearly, however, there is a solution to this epidemic of metabolic disease that is inundating today's societies worldwide: exercise and diet. Overwhelming evidence from a variety of sources, including epidemiological, prospective cohort, and intervention studies, links most chronic diseases seen in the world today to physical inactivity and inappropriate diet consumption. The purpose of this review is to 1) discuss the effects of exercise and diet in the prevention of chronic disease, 2) highlight the effects of lifestyle modification for both mitigating disease progression and reversing existing disease, and 3) suggest potential mechanisms for beneficial effects.
HDL metabolism represents a major target for the development of therapies intended to reduce the risk of atherosclerotic cardiovascular disease. HDL metabolism is complex and involves dissociation of HDL apolipoprotein and HDL cholesterol metabolism. Advances in our understanding of the molecular regulation of HDL metabolism, macrophage cholesterol efflux, and HDL function will lead to a variety of novel therapeutics.
This study determined whether the Coronary Health Improvement Project (CHIP) can improve cardiovascular disease risk factors through one year of follow-up and identified factors influencing loss to follow-up.
The CHIP program, an intensive four week community-based health education intervention designed to improve coronary risk factors, was evaluated using a quasi-experimental design. Analyses were based on 1,712 community volunteers, ages 30 to 87 from the Rockford, Illinois Metropolitan area. Of the participants, 97.7% completed the lifestyle evaluation at both baseline and after four weeks, and 51% provided data through one year.
Participants showed significant improvements in all cardiovascular risk factors considered (body mass index, resting heart rate, systolic blood pressure, diastolic blood pressure, cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, and glucose) after both four weeks and one year. Loss to follow-up was highest among those who were ages 30-39, had a history of diabetes, had a history of being overweight, smoked, lived with a heavy smoker, were physically less active, or were experiencing stress. Those with higher BMI, SBP, DBP, or glucose at baseline were also more likely to be lost to follow-up through one year. Those who failed to improve their BMI, resting heart rate, serum cholesterol, HDL, LDL, triglycerides, or glucose after four weeks were 16%, 9%, 22%, 21%, 16%, 22%, and 15% more likely to be lost to follow-up, respectively.
The CHIP program improves cardiovascular disease risk factors through one year of follow-up. Poorer health status at baseline is associated with increased loss to follow-up. Failure to improve one or more cardiovascular risk factors after four weeks of intervention is predictive of loss to follow-up through one year.
Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III)
Expert Panel on Detection Evaluation and Treatment of
High Blood Cholesterol in Adults: Executive summary of
the third report of the national cholesterol education
program (NCEP) expert panel on detection, evaluation, and
treatment of high blood cholesterol in adults (adult
treatment panel III). JAMA. 2001;285:2486-97. doi: 10.
1001/jama.285.19.2486.
Effect of a short-term diet and exercise intervention on inflammatory/anti-inflammatory properties of HDL in overweight/obese men with cardiovascular risk factors
- C K Roberts
- C Ng
- S Hama
- A J Eliseo
- R J Barnard
Roberts CK, Ng C, Hama S, Eliseo AJ, Barnard RJ. Effect
of a short-term diet and exercise intervention on
inflammatory/anti-inflammatory properties of HDL in
overweight/obese men with cardiovascular risk factors. J
Appl Physiol. 2006;101:1727-32. doi: 10.1152/japplphysiol.
00345.2006.
HDL cholesterol studies-more of the same?
- J P Despres
Despres JP. HDL cholesterol studies-more of the same? Nat
Rev Cardiol. 2013;10:70-2. doi:10.1038/nrcardio.2013.16.
The Diabetes Prevention Program (DPP) -Description of lifestyle intervention
Diabetes Prevention Program Research Group (DPP). The
Diabetes Prevention Program (DPP) -Description of
lifestyle intervention. Diabetes Care. 2002;25:2165-71. doi:
10.2337/diacare.25.12.2165.