Most studies support that saturated fatty acid replacement with polyunsaturated fatty acids (PUFA... more Most studies support that saturated fatty acid replacement with polyunsaturated fatty acids (PUFAs) may reduce the risk of cardiovascular diseases (CVDs) and put emphasis on the effects of N-3 PUFAs. The reported relationships between N-6 PUFAs and CVD risks vary. We aimed to examine the associations between N-6 PUFA concentrations and CVD risks. In this community-based prospective cohort study on CVD-free patients at baseline (N = 1835, age: 60.6 ± 10.5 years, women: 44.5%), we measured the fatty acid concentrations in the blood using gas chromatography. Four hundred twentyfour participants developed CVDs during follow up. The total N-6 PUFA concentration was inversely associated with the CVD risk, with a 48% lower risk in the highest N-6 PUFA concentration quartile (hazard ratio = 0.52; P for trend <0.001). The estimated population attributable risk of N-6 PUFAs indicated that approximately 20.7% of CVD events would have been prevented if the plasma N-6 PUFA concentration had been higher than the median value. The total N-6 PUFA concentration presented the highest net reclassification improvement (NRI = 7.2%, P = 0.03) for predicting incident CVD. Further studies on N-6 PUFAs, diet habits, and their relationships with healthcare are warranted.
We studied myocardial injury during acute coronary occlusion-reperfusion and atherosclerosis in r... more We studied myocardial injury during acute coronary occlusion-reperfusion and atherosclerosis in rabbits fed a high cholesterol diet with or without fish oil supplementation. New Zealand white male rabbits were divided into 3 groups. Eight control rabbits fed with laboratory standard rabbit chow were group I. In addition to the standard chow, 15 rabbits fed with a 1% cholesterol-enriched diet for 6 weeks were group II, and 10 rabbits fed with a 1% cholesterol-enriched and 10% fish oil supplemented diet for 6 weeks were group III. Acute coronary occlusion was induced by ligating the marginal branch of the left circumflex coronary artery for 1 h, followed by reperfusion for 4 h. Myocardial injury was assessed by tissue creatine kinase activities and amino-nitrogen concentrations from the ischemic (infarct) and nonischemic (normal) myocardium, and the infarct area/risk area ratios of the left ventricle. The surface area of the atherosclerotic lesions of the aorta and pulmonary artery was measured by planimeter. There was significantly more myocardial loss of creatine kinase and amino-nitrogen in the cholesterol-fed rabbits than the controls (p less than 0.01 and 0.02, respectively). The cholesterol and fish oil-treated rabbits had a nonsignificant reduction in myocardial loss of both agents as compared to their corresponding cholesterol-fed ones. The same trend was also found in the infarct area/risk area ratio. Fish oil treated rabbits had a good effect on the reduction of atherosclerotic lesions and tissue cholesterol levels in the aorta and pulmonary artery, but not in the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)
Statins inhibit cholesterol biogenesis and modulate atheroma inflammation to reduce cardiovascula... more Statins inhibit cholesterol biogenesis and modulate atheroma inflammation to reduce cardiovascular risks. Promoted by immune and non-immune cells, serum C-reactive protein (CRP) might be a biomarker suboptimal to assess inflammation status. Although it has been reported that statins modulated inflammation via microRNAs (miRNAs), evidence remains lacking on comprehensive profiling of statin-induced miRNAome alterations in immune cells. We recruited 19 hypercholesterolemic patients receiving 2 mg/day pitavastatin and 15 ones receiving 10 mg/day atorvastatin treatment for 12 weeks, and performed microarray-based profiling of 1733 human mature miRNAs in peripheral blood mononuclear cells (PBMCs) before and after statin treatment. Differentially expressed miRNAs were determined if their fold changes were >1.50 or <0.67, after validated using quantitative polymerase chain reaction (qPCR). The miRSystem and miTALOS platforms were utilized for pathway analysis. Of the 34 patients aged 63.7 + − 6.2 years, 27 were male and 19 were with coronary artery disease. We discovered that statins induced differential expressions of miR-483-5p, miR-4667-5p, miR-1244, and miR-3609, with qPCR-validated fold changes of 1.74 (95% confidence interval, 1.33-2.15), 1.61 (1.25-1.98), 1.61 (1.01-2.21), and 1.68 (1.19-2.17), respectively. The fold changes of the four miRNAs were not correlated with changes of low-density-lipoprotein cholesterol or CRP, after sex, age, and statin type were adjusted. We also revealed that RhoA and transforming growth factor-β signaling pathways might be regulated by the four miR-NAs. Given our findings, miRNAs might be involved in statin-induced inflammation modulation in PBMCs, providing likelihood to assess and reduce inflammation in patients with atherosclerotic cardiovascular diseases.
Hyperhomocysteinemia (HHCYS) has been associated with systolic heart failure. However, it is stil... more Hyperhomocysteinemia (HHCYS) has been associated with systolic heart failure. However, it is still unknown that serum homocycsteine level was useful in predicting the outcome in patients with diastolic dysfunction. We conducted a cohort study to determine if HHCYS was associated with poor prognosis in diastolic dysfunction patients. The Chin-Shan Community Cardiovascular Cohort (CCCC) study was designated to investigate the trends of cardiovascular morbidity and mortality in a community. Individuals who were 35 years and above were enrolled. Participants were categorized by homocysteine concentration quartiles. We used multivariate Cox proportional hazards models to calculate the hazard ratio (HR) of the 4th quartiles versus the 1st quartile. Area under the receiver-operating characteristic (ROC) curve was to compare prediction measures. A total of 2020 participants had completed the echocardiography examination, and 231 individuals were diagnosed as diastolic dysfunction. A total 75 participants had died during follow-up period. HHCYS was found to be significantly associated with poor prognosis. The adjusted HR for homocysteine level was 1.07 (95% confidence interval [CI], 1.01-1.14). Participants in the highest quartile had a 1.90 (95% CI, 0.88-4.12, P for trend, .026) fold risk for all cause death, compared with those in the lowest quartiles. The HR was 1.88 (95% CI, 1.07-3.29) using 11.11 mmol/L as cut point for hyperhomocysteine. HHCYS was significantly associated with poor prognosis in diastolic dysfunction participants in the community. Abbreviations: CAD = coronary artery disease, CCCC = Chin-Shan Community Cardiovascular Cohort, CI = confidence interval, HCY = homocysteine, HHCYS = hyperhomocysteinemia, HR = hazard ratio, LVH = left ventricular hypertrophy, ROC = receiveroperating character.
We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occ... more We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occlusion-reperfusion in controls and those rabbits (11 in each group) fed a 1% high cholesterol diet with or without 10% fish oil supplementation for one week. Acute coronary occlusion for 10 minutes was induced by ligating the marginal branch of the left circumflex coronary artery. The vessels were then reperfused for 1 hour. The cholesterol and fish oil treated rabbits had the lowest malondialdehyde levels both in the ischemic and non-ischemic (normal) areas, the least increase of malondialdehyde level in the ischemic area, and the highest 6-keto-PGF1 alpha/thromboxane B2 ratio in the non-ischemic area after reperfusion among the 3 groups. These rabbits had the highest myocardial superoxide dismutase levels both in the ischemic and normal areas, and the least decrease of superoxide dismutase level in the ischemic area. These data suggest that rabbits fed a high cholesterol diet with fish oil supplementation had an attenuated lipid peroxidation, which reflected a reduced free radical generation during a short-term coronary occlusion followed by reperfusion.
Background: Treatment of hyperlipidemic patients with fish oil results in an increase in plasma L... more Background: Treatment of hyperlipidemic patients with fish oil results in an increase in plasma LDL cholesterol despite a marked decrease in the LDL precursor, VLDL. Objective: We studied the relation between VLDL composition and LDL concentrations. Design: Fourteen hypertriglyceridemic patients were treated with encapsulated fish oil (containing 1.45 g eicosapentaenoic acid and 1.55 g docosahexaenoic acid/d) for 4 wk. Venous blood samples were collected before and after treatment. Eleven normolipidemic subjects served as a control group. Results: Fish oil effectively lowered plasma lipid and apolipoprotein (apo) E concentrations in the hypertriglyceridemic patients, whereas apo B concentrations increased. The lipid and apolipoprotein content of VLDL decreased, whereas LDL cholesterol and LDL apo B increased. Fractionation of VLDL by heparinaffinity chromatography showed that before treatment hypertriglyceridemic patients had more VLDL in the 0.05-mol NaCl/L subfraction and less in the 0.20-mol/L subfraction than did control subjects (P < 0.05), whereas the subfraction distribution pattern was normalized after fish-oil treatment. Nevertheless, plasma concentrations of the 0.05-mol NaCl/L subfraction were decreased and those of the 0.20-mol/L subfraction were increased in hypertriglyceridemic patients after fish-oil treatment (P < 0.05). Fish-oil treatment both enhanced VLDL binding and lowered LDL binding to fibroblasts. Conclusion: Treatment of hypertriglyceridemic patients with fish oil caused differential effects on VLDL subfractions and decreased LDL binding to fibroblast receptors, which may have contributed to the paradoxical increase in LDL-cholesterol concentrations.
1. Myocardial thromboxane Az production increases in patients with pacing-induced ischaemia and c... more 1. Myocardial thromboxane Az production increases in patients with pacing-induced ischaemia and correlates with a decrease in myocardial lactate extraction. The release of myocardial thromboxane AZ before any lactate production was observed in patients with unstable angina. This study was proposed to clarify whether the early thromboxane AZ release contributed to the ongoing myocardial ischaemia and to determine which metabolites can be attributed to the thromboxane Az release. Thirtyfive patients with chest pain and positive treadmill exercise test underwent atrial pacing to the predicted maximal heart rate. The pacing was maintained at this peak rate for lOmin, then ceased. Blood samples of the ascending aorta and coronary sinus were drawn simultaneously at rest, at 2 and 10 rnin of peak-pacing, and 5 and 10 rnin after termination of the pacing; samples were used for analyses of lipid profiles, prostacyclin, thromboxane Az, lactate and lipid peroxides on plasma and lowdensity lipoprotein particles. 2. Wenty out of 35 patients who displayed pacinginduced ischaemia were documented by electrocardiographic evidence of ST depression >2 mm developing after 2 min of peak-pacing [ischaemic group, STA(+)]. They had (i) negative fractional lactate extraction; (ii) pacing-induced decreases of plasma thromboxane A2 levels in the coronary sinus blood (564+57 versus 479 +47 ng/l, Px0.05) at 2 rnin of peak-pacing; the data increased at 10 rnin of peak-pacing (564 & 57 versus 620 f 60 ng/l, P<O.O5), then returned to baseline levels at 5 and 10 min post-pacing; (iii) significantly increased lipid peroxides on low-density lipoprotein of the coronary sinus blood at 2 and 10min of peakpacing (each P<O.OOl), as well as at 5 rnin post-pacing (P < 0.05); (iv) significant correlation between thromboxane A2 levels and lipid peroxides on low-density lipoprotein of the coronary sinus blood samples. 3. In STA(+) patients, myocardial thromboxane synthesis changed before lactate production and correlated with the increase of lipid peroxides on low-density lipoprotein of the coronary venous blood. This implies that lipid peroxides on lowdensity lipoprotein participate in thromboxane production and play a determinative role in pacing-induced ischaemia.
1. Myocardial thromboxane Az production increases in patients with pacing-induced ischaemia and c... more 1. Myocardial thromboxane Az production increases in patients with pacing-induced ischaemia and correlates with a decrease in myocardial lactate extraction. The release of myocardial thromboxane AZ before any lactate production was observed in patients with unstable angina. This study was proposed to clarify whether the early thromboxane AZ release contributed to the ongoing myocardial ischaemia and to determine which metabolites can be attributed to the thromboxane Az release. Thirtyfive patients with chest pain and positive treadmill exercise test underwent atrial pacing to the predicted maximal heart rate. The pacing was maintained at this peak rate for lOmin, then ceased. Blood samples of the ascending aorta and coronary sinus were drawn simultaneously at rest, at 2 and 10 rnin of peak-pacing, and 5 and 10 rnin after termination of the pacing; samples were used for analyses of lipid profiles, prostacyclin, thromboxane Az, lactate and lipid peroxides on plasma and lowdensity lipoprotein particles. 2. Wenty out of 35 patients who displayed pacinginduced ischaemia were documented by electrocardiographic evidence of ST depression >2 mm developing after 2 min of peak-pacing [ischaemic group, STA(+)]. They had (i) negative fractional lactate extraction; (ii) pacing-induced decreases of plasma thromboxane A2 levels in the coronary sinus blood (564+57 versus 479 +47 ng/l, Px0.05) at 2 rnin of peak-pacing; the data increased at 10 rnin of peak-pacing (564 & 57 versus 620 f 60 ng/l, P<O.O5), then returned to baseline levels at 5 and 10 min post-pacing; (iii) significantly increased lipid peroxides on low-density lipoprotein of the coronary sinus blood at 2 and 10min of peakpacing (each P<O.OOl), as well as at 5 rnin post-pacing (P < 0.05); (iv) significant correlation between thromboxane A2 levels and lipid peroxides on low-density lipoprotein of the coronary sinus blood samples. 3. In STA(+) patients, myocardial thromboxane synthesis changed before lactate production and correlated with the increase of lipid peroxides on low-density lipoprotein of the coronary venous blood. This implies that lipid peroxides on lowdensity lipoprotein participate in thromboxane production and play a determinative role in pacing-induced ischaemia.
Heart rate trajectory patterns integrate information regarding multiple heart rate measurements a... more Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were enrolled in a prospective investigation of cardiovascular risk factors and outcomes from 1990 to 2013. The primary outcome was all-cause mortality, and the secondary outcome was a composite of coronary artery disease and cerebrovascular accidents. The following trajectory patterns were identified: stable, 61%; decreased, 5%; mildly increased, 32%; and markedly increased, 2%. During follow-up (median, 13.9 years), 557 participants died and 217 experienced secondary outcomes. The adjusted hazard ratios of primary and secondary outcomes for participants with a markedly increased trajectory pattern were 1.80 (95% CI [1.18-2.76]) and 1.45 (95% CI [0.67-3.12]), respectively, compared to those for participants with a stable trajectory pattern. A markedly increased heart rate trajectory pattern may be associated with all-cause mortality risks. Heart rate trajectory patterns demonstrated the utility of repeated heart rate measurements for risk assessment.
Background: Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c) level... more Background: Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c) levels, although the cardiovascular disease (CVD) risk could be better reflected by other lipid parameters. This study aimed at comparing a comprehensive lipid profile between patients with type 2 diabetes mellitus (T2DM) with LDL-c concentration within and above target. Methods: A comprehensive lipid profile was characterized in 96 T2DM patients. The European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2016 and 2019 Guidelines for the Management of Dyslipidemias were used to define LDL-c targets. Results: In this population, only 28.1 and 16.7% of patients had mean LDL-c levels within target, as defined by the 2016 and 2019 guidelines, respectively. Applying the 2016 guidelines criteria, in patients with LDL-c within target, 22, 25 and 44% presented non-high-density lipoprotein cholesterol (non-HDL-c), Apolipoprotein B (ApoB) and oxidized LDL-c levels above the recommended range, respectively, whereas according to the 2019 guidelines criteria, 50, 39 and 44% of the patients with LDL-c within target had elevated high-density lipoprotein cholesterol (HDL-c), ApoB and oxidized LDL-c levels, respectively. LDL-c was strongly correlated with non-HDL-c (r = 0.850), ApoB (r = 0.656) and oxidized LDL-c (r = 0.508). Similarly, there was a strong correlation between non-HDL-c with both ApoB (r = 0.808) and oxidized LDL-c (r = 0.588). Conclusions: These findings emphasize the limitations of only considering LDL-c concentration for cardiovascular (CV) risk assessment. Targeting only LDL-c could result in missed opportunities for CV risk reduction in T2DM patients. These data suggest that non-HDL-c, ApoB and oxidized LDL-c levels could be considered as an important part of these patients' evaluation allowing for a more accurate estimation of CV risk and hopefully better management of these high-risk patients.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2003
Bradyarrhythmia requiring permanent pacing after heart transplantation remains a common problem. ... more Bradyarrhythmia requiring permanent pacing after heart transplantation remains a common problem. Sinus node dysfunction is the most common indication, and late onset of atrioventricular (AV) block has rarely been reported. We report the case of a patient who developed advanced AV block at 41 months after transplantation. Right bundle branch block with progressive increase of QRS complex duration was noted in serial electrocardiograms. At the time of late AV block development, the patient did not have acute rejection and coronary angiogram was normal. The mechanism of late onset of AV block is unclear, but it may be caused by progressive conduction.
Objectives: 1.Evaluate the evolutionary profi le of blood pressure before and after intervention.... more Objectives: 1.Evaluate the evolutionary profi le of blood pressure before and after intervention. 2.Determine the level of observance before and after intervention. 3.Compare the level of knowledge and practices before and after intervention. Methods: We carried out a non-randomized control trial from October 2016 to June 2017 at the outpatient cardiology clinic of the Yaoundé Central Hospital, in Cameroon. We included adults with essential, uncontrolled hypertension. Every week during three months, educative sessions added to daily phone calls and text messages were done. Blood pressure, drug compliance, knowledge regarding hypertension, level of physical activity were evaluated at baseline and after intervention. The student test was used to compare data before and after intervention. A p value < 0.05 was statistically signifi cant. Results: Overall, 17 participants with a mean age of 56.24 ± 8.14 years and an average duration of hypertension of 11.17 ± 9 years completed the intervention. SBP decreased by 30mmHg, DBP dropped by 11mmHg. Level of knowledge increased by 36.47%, adherence to treatment by 88.24% and drug compliance by 81.44%. Energy expenditure related to physical activity increased in 100% of participants with a mean improvement of 625.41 MET. All patients were satisfi ed. Conclusion: Therapeutic group education increased adherence to treatment and BP control amongst uncontrolled hypertensive patients in sub Saharan Africa.
We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occ... more We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occlusion-reperfusion in controls and those rabbits (11 in each group) fed a 1% high cholesterol diet with or without 10% fish oil supplementation for one week. Acute coronary occlusion for 10 minutes was induced by ligating the marginal branch of the left circumflex coronary artery. The vessels were then reperfused for 1 hour. The cholesterol and fish oil treated rabbits had the lowest malondialdehyde levels both in the ischemic and non-ischemic (normal) areas, the least increase of malondialdehyde level in the ischemic area, and the highest 6-keto-PGF1 alpha/thromboxane B2 ratio in the non-ischemic area after reperfusion among the 3 groups. These rabbits had the highest myocardial superoxide dismutase levels both in the ischemic and normal areas, and the least decrease of superoxide dismutase level in the ischemic area. These data suggest that rabbits fed a high cholesterol diet with fish oil supplementation had an attenuated lipid peroxidation, which reflected a reduced free radical generation during a short-term coronary occlusion followed by reperfusion.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2001
To investigate the clustering of insulin resistance syndrome with hyperinsulinemia, hypertriglyce... more To investigate the clustering of insulin resistance syndrome with hyperinsulinemia, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, hypertension, and obesity, we conducted this cross-sectional study and analyzed the patterns of conditional independence among these five elements. Fasting insulin, lipid profiles, blood pressure, and anthropometric data from 2165 Taiwanese older than 35 years in the Chin-Shan community were examined. The cut-off points of these five factors (all binary variables) were defined. The hierarchical log-linear regression with nested effects model was applied to fit this higher-order contingency table of five variables, and likelihood ratio (chi2) statistics were used to test the goodness of fit. Hyperinsulinemia was independently correlated with obesity (odds ratio [OR] 5.7, 95% confidence interval [CI] 4.5-7.3), low HDL (OR 2.3, 95% CI 1.8-2.9), and hypertriglyceridemia (OR 1.6, 95% CI 1.2-2.2). Hypertriglyceridemia was significantly a...
Most studies support that saturated fatty acid replacement with polyunsaturated fatty acids (PUFA... more Most studies support that saturated fatty acid replacement with polyunsaturated fatty acids (PUFAs) may reduce the risk of cardiovascular diseases (CVDs) and put emphasis on the effects of N-3 PUFAs. The reported relationships between N-6 PUFAs and CVD risks vary. We aimed to examine the associations between N-6 PUFA concentrations and CVD risks. In this community-based prospective cohort study on CVD-free patients at baseline (N = 1835, age: 60.6 ± 10.5 years, women: 44.5%), we measured the fatty acid concentrations in the blood using gas chromatography. Four hundred twentyfour participants developed CVDs during follow up. The total N-6 PUFA concentration was inversely associated with the CVD risk, with a 48% lower risk in the highest N-6 PUFA concentration quartile (hazard ratio = 0.52; P for trend <0.001). The estimated population attributable risk of N-6 PUFAs indicated that approximately 20.7% of CVD events would have been prevented if the plasma N-6 PUFA concentration had been higher than the median value. The total N-6 PUFA concentration presented the highest net reclassification improvement (NRI = 7.2%, P = 0.03) for predicting incident CVD. Further studies on N-6 PUFAs, diet habits, and their relationships with healthcare are warranted.
We studied myocardial injury during acute coronary occlusion-reperfusion and atherosclerosis in r... more We studied myocardial injury during acute coronary occlusion-reperfusion and atherosclerosis in rabbits fed a high cholesterol diet with or without fish oil supplementation. New Zealand white male rabbits were divided into 3 groups. Eight control rabbits fed with laboratory standard rabbit chow were group I. In addition to the standard chow, 15 rabbits fed with a 1% cholesterol-enriched diet for 6 weeks were group II, and 10 rabbits fed with a 1% cholesterol-enriched and 10% fish oil supplemented diet for 6 weeks were group III. Acute coronary occlusion was induced by ligating the marginal branch of the left circumflex coronary artery for 1 h, followed by reperfusion for 4 h. Myocardial injury was assessed by tissue creatine kinase activities and amino-nitrogen concentrations from the ischemic (infarct) and nonischemic (normal) myocardium, and the infarct area/risk area ratios of the left ventricle. The surface area of the atherosclerotic lesions of the aorta and pulmonary artery was measured by planimeter. There was significantly more myocardial loss of creatine kinase and amino-nitrogen in the cholesterol-fed rabbits than the controls (p less than 0.01 and 0.02, respectively). The cholesterol and fish oil-treated rabbits had a nonsignificant reduction in myocardial loss of both agents as compared to their corresponding cholesterol-fed ones. The same trend was also found in the infarct area/risk area ratio. Fish oil treated rabbits had a good effect on the reduction of atherosclerotic lesions and tissue cholesterol levels in the aorta and pulmonary artery, but not in the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)
Statins inhibit cholesterol biogenesis and modulate atheroma inflammation to reduce cardiovascula... more Statins inhibit cholesterol biogenesis and modulate atheroma inflammation to reduce cardiovascular risks. Promoted by immune and non-immune cells, serum C-reactive protein (CRP) might be a biomarker suboptimal to assess inflammation status. Although it has been reported that statins modulated inflammation via microRNAs (miRNAs), evidence remains lacking on comprehensive profiling of statin-induced miRNAome alterations in immune cells. We recruited 19 hypercholesterolemic patients receiving 2 mg/day pitavastatin and 15 ones receiving 10 mg/day atorvastatin treatment for 12 weeks, and performed microarray-based profiling of 1733 human mature miRNAs in peripheral blood mononuclear cells (PBMCs) before and after statin treatment. Differentially expressed miRNAs were determined if their fold changes were >1.50 or <0.67, after validated using quantitative polymerase chain reaction (qPCR). The miRSystem and miTALOS platforms were utilized for pathway analysis. Of the 34 patients aged 63.7 + − 6.2 years, 27 were male and 19 were with coronary artery disease. We discovered that statins induced differential expressions of miR-483-5p, miR-4667-5p, miR-1244, and miR-3609, with qPCR-validated fold changes of 1.74 (95% confidence interval, 1.33-2.15), 1.61 (1.25-1.98), 1.61 (1.01-2.21), and 1.68 (1.19-2.17), respectively. The fold changes of the four miRNAs were not correlated with changes of low-density-lipoprotein cholesterol or CRP, after sex, age, and statin type were adjusted. We also revealed that RhoA and transforming growth factor-β signaling pathways might be regulated by the four miR-NAs. Given our findings, miRNAs might be involved in statin-induced inflammation modulation in PBMCs, providing likelihood to assess and reduce inflammation in patients with atherosclerotic cardiovascular diseases.
Hyperhomocysteinemia (HHCYS) has been associated with systolic heart failure. However, it is stil... more Hyperhomocysteinemia (HHCYS) has been associated with systolic heart failure. However, it is still unknown that serum homocycsteine level was useful in predicting the outcome in patients with diastolic dysfunction. We conducted a cohort study to determine if HHCYS was associated with poor prognosis in diastolic dysfunction patients. The Chin-Shan Community Cardiovascular Cohort (CCCC) study was designated to investigate the trends of cardiovascular morbidity and mortality in a community. Individuals who were 35 years and above were enrolled. Participants were categorized by homocysteine concentration quartiles. We used multivariate Cox proportional hazards models to calculate the hazard ratio (HR) of the 4th quartiles versus the 1st quartile. Area under the receiver-operating characteristic (ROC) curve was to compare prediction measures. A total of 2020 participants had completed the echocardiography examination, and 231 individuals were diagnosed as diastolic dysfunction. A total 75 participants had died during follow-up period. HHCYS was found to be significantly associated with poor prognosis. The adjusted HR for homocysteine level was 1.07 (95% confidence interval [CI], 1.01-1.14). Participants in the highest quartile had a 1.90 (95% CI, 0.88-4.12, P for trend, .026) fold risk for all cause death, compared with those in the lowest quartiles. The HR was 1.88 (95% CI, 1.07-3.29) using 11.11 mmol/L as cut point for hyperhomocysteine. HHCYS was significantly associated with poor prognosis in diastolic dysfunction participants in the community. Abbreviations: CAD = coronary artery disease, CCCC = Chin-Shan Community Cardiovascular Cohort, CI = confidence interval, HCY = homocysteine, HHCYS = hyperhomocysteinemia, HR = hazard ratio, LVH = left ventricular hypertrophy, ROC = receiveroperating character.
We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occ... more We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occlusion-reperfusion in controls and those rabbits (11 in each group) fed a 1% high cholesterol diet with or without 10% fish oil supplementation for one week. Acute coronary occlusion for 10 minutes was induced by ligating the marginal branch of the left circumflex coronary artery. The vessels were then reperfused for 1 hour. The cholesterol and fish oil treated rabbits had the lowest malondialdehyde levels both in the ischemic and non-ischemic (normal) areas, the least increase of malondialdehyde level in the ischemic area, and the highest 6-keto-PGF1 alpha/thromboxane B2 ratio in the non-ischemic area after reperfusion among the 3 groups. These rabbits had the highest myocardial superoxide dismutase levels both in the ischemic and normal areas, and the least decrease of superoxide dismutase level in the ischemic area. These data suggest that rabbits fed a high cholesterol diet with fish oil supplementation had an attenuated lipid peroxidation, which reflected a reduced free radical generation during a short-term coronary occlusion followed by reperfusion.
Background: Treatment of hyperlipidemic patients with fish oil results in an increase in plasma L... more Background: Treatment of hyperlipidemic patients with fish oil results in an increase in plasma LDL cholesterol despite a marked decrease in the LDL precursor, VLDL. Objective: We studied the relation between VLDL composition and LDL concentrations. Design: Fourteen hypertriglyceridemic patients were treated with encapsulated fish oil (containing 1.45 g eicosapentaenoic acid and 1.55 g docosahexaenoic acid/d) for 4 wk. Venous blood samples were collected before and after treatment. Eleven normolipidemic subjects served as a control group. Results: Fish oil effectively lowered plasma lipid and apolipoprotein (apo) E concentrations in the hypertriglyceridemic patients, whereas apo B concentrations increased. The lipid and apolipoprotein content of VLDL decreased, whereas LDL cholesterol and LDL apo B increased. Fractionation of VLDL by heparinaffinity chromatography showed that before treatment hypertriglyceridemic patients had more VLDL in the 0.05-mol NaCl/L subfraction and less in the 0.20-mol/L subfraction than did control subjects (P < 0.05), whereas the subfraction distribution pattern was normalized after fish-oil treatment. Nevertheless, plasma concentrations of the 0.05-mol NaCl/L subfraction were decreased and those of the 0.20-mol/L subfraction were increased in hypertriglyceridemic patients after fish-oil treatment (P < 0.05). Fish-oil treatment both enhanced VLDL binding and lowered LDL binding to fibroblasts. Conclusion: Treatment of hypertriglyceridemic patients with fish oil caused differential effects on VLDL subfractions and decreased LDL binding to fibroblast receptors, which may have contributed to the paradoxical increase in LDL-cholesterol concentrations.
1. Myocardial thromboxane Az production increases in patients with pacing-induced ischaemia and c... more 1. Myocardial thromboxane Az production increases in patients with pacing-induced ischaemia and correlates with a decrease in myocardial lactate extraction. The release of myocardial thromboxane AZ before any lactate production was observed in patients with unstable angina. This study was proposed to clarify whether the early thromboxane AZ release contributed to the ongoing myocardial ischaemia and to determine which metabolites can be attributed to the thromboxane Az release. Thirtyfive patients with chest pain and positive treadmill exercise test underwent atrial pacing to the predicted maximal heart rate. The pacing was maintained at this peak rate for lOmin, then ceased. Blood samples of the ascending aorta and coronary sinus were drawn simultaneously at rest, at 2 and 10 rnin of peak-pacing, and 5 and 10 rnin after termination of the pacing; samples were used for analyses of lipid profiles, prostacyclin, thromboxane Az, lactate and lipid peroxides on plasma and lowdensity lipoprotein particles. 2. Wenty out of 35 patients who displayed pacinginduced ischaemia were documented by electrocardiographic evidence of ST depression >2 mm developing after 2 min of peak-pacing [ischaemic group, STA(+)]. They had (i) negative fractional lactate extraction; (ii) pacing-induced decreases of plasma thromboxane A2 levels in the coronary sinus blood (564+57 versus 479 +47 ng/l, Px0.05) at 2 rnin of peak-pacing; the data increased at 10 rnin of peak-pacing (564 & 57 versus 620 f 60 ng/l, P<O.O5), then returned to baseline levels at 5 and 10 min post-pacing; (iii) significantly increased lipid peroxides on low-density lipoprotein of the coronary sinus blood at 2 and 10min of peakpacing (each P<O.OOl), as well as at 5 rnin post-pacing (P < 0.05); (iv) significant correlation between thromboxane A2 levels and lipid peroxides on low-density lipoprotein of the coronary sinus blood samples. 3. In STA(+) patients, myocardial thromboxane synthesis changed before lactate production and correlated with the increase of lipid peroxides on low-density lipoprotein of the coronary venous blood. This implies that lipid peroxides on lowdensity lipoprotein participate in thromboxane production and play a determinative role in pacing-induced ischaemia.
1. Myocardial thromboxane Az production increases in patients with pacing-induced ischaemia and c... more 1. Myocardial thromboxane Az production increases in patients with pacing-induced ischaemia and correlates with a decrease in myocardial lactate extraction. The release of myocardial thromboxane AZ before any lactate production was observed in patients with unstable angina. This study was proposed to clarify whether the early thromboxane AZ release contributed to the ongoing myocardial ischaemia and to determine which metabolites can be attributed to the thromboxane Az release. Thirtyfive patients with chest pain and positive treadmill exercise test underwent atrial pacing to the predicted maximal heart rate. The pacing was maintained at this peak rate for lOmin, then ceased. Blood samples of the ascending aorta and coronary sinus were drawn simultaneously at rest, at 2 and 10 rnin of peak-pacing, and 5 and 10 rnin after termination of the pacing; samples were used for analyses of lipid profiles, prostacyclin, thromboxane Az, lactate and lipid peroxides on plasma and lowdensity lipoprotein particles. 2. Wenty out of 35 patients who displayed pacinginduced ischaemia were documented by electrocardiographic evidence of ST depression >2 mm developing after 2 min of peak-pacing [ischaemic group, STA(+)]. They had (i) negative fractional lactate extraction; (ii) pacing-induced decreases of plasma thromboxane A2 levels in the coronary sinus blood (564+57 versus 479 +47 ng/l, Px0.05) at 2 rnin of peak-pacing; the data increased at 10 rnin of peak-pacing (564 & 57 versus 620 f 60 ng/l, P<O.O5), then returned to baseline levels at 5 and 10 min post-pacing; (iii) significantly increased lipid peroxides on low-density lipoprotein of the coronary sinus blood at 2 and 10min of peakpacing (each P<O.OOl), as well as at 5 rnin post-pacing (P < 0.05); (iv) significant correlation between thromboxane A2 levels and lipid peroxides on low-density lipoprotein of the coronary sinus blood samples. 3. In STA(+) patients, myocardial thromboxane synthesis changed before lactate production and correlated with the increase of lipid peroxides on low-density lipoprotein of the coronary venous blood. This implies that lipid peroxides on lowdensity lipoprotein participate in thromboxane production and play a determinative role in pacing-induced ischaemia.
Heart rate trajectory patterns integrate information regarding multiple heart rate measurements a... more Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were enrolled in a prospective investigation of cardiovascular risk factors and outcomes from 1990 to 2013. The primary outcome was all-cause mortality, and the secondary outcome was a composite of coronary artery disease and cerebrovascular accidents. The following trajectory patterns were identified: stable, 61%; decreased, 5%; mildly increased, 32%; and markedly increased, 2%. During follow-up (median, 13.9 years), 557 participants died and 217 experienced secondary outcomes. The adjusted hazard ratios of primary and secondary outcomes for participants with a markedly increased trajectory pattern were 1.80 (95% CI [1.18-2.76]) and 1.45 (95% CI [0.67-3.12]), respectively, compared to those for participants with a stable trajectory pattern. A markedly increased heart rate trajectory pattern may be associated with all-cause mortality risks. Heart rate trajectory patterns demonstrated the utility of repeated heart rate measurements for risk assessment.
Background: Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c) level... more Background: Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c) levels, although the cardiovascular disease (CVD) risk could be better reflected by other lipid parameters. This study aimed at comparing a comprehensive lipid profile between patients with type 2 diabetes mellitus (T2DM) with LDL-c concentration within and above target. Methods: A comprehensive lipid profile was characterized in 96 T2DM patients. The European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2016 and 2019 Guidelines for the Management of Dyslipidemias were used to define LDL-c targets. Results: In this population, only 28.1 and 16.7% of patients had mean LDL-c levels within target, as defined by the 2016 and 2019 guidelines, respectively. Applying the 2016 guidelines criteria, in patients with LDL-c within target, 22, 25 and 44% presented non-high-density lipoprotein cholesterol (non-HDL-c), Apolipoprotein B (ApoB) and oxidized LDL-c levels above the recommended range, respectively, whereas according to the 2019 guidelines criteria, 50, 39 and 44% of the patients with LDL-c within target had elevated high-density lipoprotein cholesterol (HDL-c), ApoB and oxidized LDL-c levels, respectively. LDL-c was strongly correlated with non-HDL-c (r = 0.850), ApoB (r = 0.656) and oxidized LDL-c (r = 0.508). Similarly, there was a strong correlation between non-HDL-c with both ApoB (r = 0.808) and oxidized LDL-c (r = 0.588). Conclusions: These findings emphasize the limitations of only considering LDL-c concentration for cardiovascular (CV) risk assessment. Targeting only LDL-c could result in missed opportunities for CV risk reduction in T2DM patients. These data suggest that non-HDL-c, ApoB and oxidized LDL-c levels could be considered as an important part of these patients' evaluation allowing for a more accurate estimation of CV risk and hopefully better management of these high-risk patients.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2003
Bradyarrhythmia requiring permanent pacing after heart transplantation remains a common problem. ... more Bradyarrhythmia requiring permanent pacing after heart transplantation remains a common problem. Sinus node dysfunction is the most common indication, and late onset of atrioventricular (AV) block has rarely been reported. We report the case of a patient who developed advanced AV block at 41 months after transplantation. Right bundle branch block with progressive increase of QRS complex duration was noted in serial electrocardiograms. At the time of late AV block development, the patient did not have acute rejection and coronary angiogram was normal. The mechanism of late onset of AV block is unclear, but it may be caused by progressive conduction.
Objectives: 1.Evaluate the evolutionary profi le of blood pressure before and after intervention.... more Objectives: 1.Evaluate the evolutionary profi le of blood pressure before and after intervention. 2.Determine the level of observance before and after intervention. 3.Compare the level of knowledge and practices before and after intervention. Methods: We carried out a non-randomized control trial from October 2016 to June 2017 at the outpatient cardiology clinic of the Yaoundé Central Hospital, in Cameroon. We included adults with essential, uncontrolled hypertension. Every week during three months, educative sessions added to daily phone calls and text messages were done. Blood pressure, drug compliance, knowledge regarding hypertension, level of physical activity were evaluated at baseline and after intervention. The student test was used to compare data before and after intervention. A p value < 0.05 was statistically signifi cant. Results: Overall, 17 participants with a mean age of 56.24 ± 8.14 years and an average duration of hypertension of 11.17 ± 9 years completed the intervention. SBP decreased by 30mmHg, DBP dropped by 11mmHg. Level of knowledge increased by 36.47%, adherence to treatment by 88.24% and drug compliance by 81.44%. Energy expenditure related to physical activity increased in 100% of participants with a mean improvement of 625.41 MET. All patients were satisfi ed. Conclusion: Therapeutic group education increased adherence to treatment and BP control amongst uncontrolled hypertensive patients in sub Saharan Africa.
We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occ... more We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occlusion-reperfusion in controls and those rabbits (11 in each group) fed a 1% high cholesterol diet with or without 10% fish oil supplementation for one week. Acute coronary occlusion for 10 minutes was induced by ligating the marginal branch of the left circumflex coronary artery. The vessels were then reperfused for 1 hour. The cholesterol and fish oil treated rabbits had the lowest malondialdehyde levels both in the ischemic and non-ischemic (normal) areas, the least increase of malondialdehyde level in the ischemic area, and the highest 6-keto-PGF1 alpha/thromboxane B2 ratio in the non-ischemic area after reperfusion among the 3 groups. These rabbits had the highest myocardial superoxide dismutase levels both in the ischemic and normal areas, and the least decrease of superoxide dismutase level in the ischemic area. These data suggest that rabbits fed a high cholesterol diet with fish oil supplementation had an attenuated lipid peroxidation, which reflected a reduced free radical generation during a short-term coronary occlusion followed by reperfusion.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2001
To investigate the clustering of insulin resistance syndrome with hyperinsulinemia, hypertriglyce... more To investigate the clustering of insulin resistance syndrome with hyperinsulinemia, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, hypertension, and obesity, we conducted this cross-sectional study and analyzed the patterns of conditional independence among these five elements. Fasting insulin, lipid profiles, blood pressure, and anthropometric data from 2165 Taiwanese older than 35 years in the Chin-Shan community were examined. The cut-off points of these five factors (all binary variables) were defined. The hierarchical log-linear regression with nested effects model was applied to fit this higher-order contingency table of five variables, and likelihood ratio (chi2) statistics were used to test the goodness of fit. Hyperinsulinemia was independently correlated with obesity (odds ratio [OR] 5.7, 95% confidence interval [CI] 4.5-7.3), low HDL (OR 2.3, 95% CI 1.8-2.9), and hypertriglyceridemia (OR 1.6, 95% CI 1.2-2.2). Hypertriglyceridemia was significantly a...
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Papers by Yuan-Teh Lee