Effects of cardiovascular lifestyle change on lipoprotein subclass profiles defined by nuclear magnetic resonance spectroscopy.
Effects of cardiovascular lifestyle change on lipoprotein subclass profiles defined by nuclear magnetic resonance spectroscopy.
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DOI：
10.1186/1476-511x-8-26
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发表时间：
2009-06-29
影响因子：
4.5
通讯作者：
Ellsworth DL
中科院分区：
文献类型：
--
作者：
Decewicz DJ;Neatrour DM;Burke A;Haberkorn MJ;Patney HL;Vernalis MN;Ellsworth DL
降低低密度脂蛋白（LDL）胆固醇是心血管疾病患者临床管理的主要目标，但传统的胆固醇水平可能无法准确反映血脂谱的真实致动脉粥样硬化性。转运胆固醇和甘油三酯的脂蛋白颗粒的大小和浓度可以为准确评估心血管风险提供额外的信息。本研究评价了通过核磁共振（NMR）光谱测定的参与前瞻性、非随机生活方式改变计划的患者血浆脂蛋白谱的变化，该计划旨在逆转或稳定冠状动脉疾病（CAD）的进展，以提高我们对心脏病患者脂蛋白管理的理解。生活方式干预在导致冠心病风险的脂蛋白亚类发生显著变化方面有效。对LDL颗粒总数（-8.3%，p < 0.05，与匹配对照相比）、小密度LDL颗粒（-9.5%，p < 0.05）和LDL颗粒大小（+0.8%，p < 0.05）有明显的有益作用。同样，参与者在传统的CAD风险因素如体重指数（-9.9%，p < 0.01），总胆固醇（-5.5%，p < 0.05），身体健康（+37.2%，p < 0.01）和未来CAD风险（-7.9%，p < 0.01）方面也有显着改善。男性和女性对所有临床相关变量的反应不同，男性在脂蛋白致动脉粥样硬化性方面获益更大。血脂和脂蛋白对生活方式改变的反应不受降脂药物的影响。在有动机参与的高危患者中，强化的生活方式改变计划可以有效地改变传统的CAD危险因素和血浆脂蛋白亚类，并可能降低心血管事件的风险。与女性相比，男性脂蛋白亚类的改善更为明显。
Low-density lipoprotein (LDL) cholesterol lowering is a primary goal in clinical management of patients with cardiovascular disease, but traditional cholesterol levels may not accurately reflect the true atherogenicity of plasma lipid profiles. The size and concentration of lipoprotein particles, which transport cholesterol and triglycerides, may provide additional information for accurately assessing cardiovascular risk. This study evaluated changes in plasma lipoprotein profiles determined by nuclear magnetic resonance (NMR) spectroscopy in patients participating in a prospective, nonrandomized lifestyle modification program designed to reverse or stabilize progression of coronary artery disease (CAD) to improve our understanding of lipoprotein management in cardiac patients. The lifestyle intervention was effective in producing significant changes in lipoprotein subclasses that contribute to CAD risk. There was a clear beneficial effect on the total number of LDL particles (-8.3%, p < 0.05 compared to matched controls), small dense LDL particles (-9.5%, p < 0.05), and LDL particle size (+0.8%; p < 0.05). Likewise, participants showed significant improvement in traditional CAD risk factors such as body mass index (-9.9%, p < 0.01 compared to controls), total cholesterol (-5.5%, p < 0.05), physical fitness (+37.2%, p < 0.01), and future risk for CAD (-7.9%, p < 0.01). Men and women responded differently to the program for all clinically-relevant variables, with men deriving greater benefit in terms of lipoprotein atherogenicity. Plasma lipid and lipoprotein responses to the lifestyle change program were not confounded by lipid-lowering medications. In at risk patients motivated to participate, an intensive lifestyle change program can effectively alter traditional CAD risk factors and plasma lipoprotein subclasses and may reduce risk for cardiovascular events. Improvements in lipoprotein subclasses are more evident in men compared to women.