Free Fatty Acids Are Independently Associated with All-Cause and Cardiovascular Mortality in Subjects with Coronary Artery Disease

Pilz, Stefan; Scharnagl, Hubert; Tiran, Beate; Seelhorst, Ursula; Wellnitz, Britta; Boehm, Bernhard O.; Schaefer, Jürgen R.; März, Winfried

doi:10.1210/jc.2006-0195

Cited by 178 publications

(132 citation statements)

References 38 publications

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“…16,17 The significant reduction in the plasma FFA concentration by BREE supplementation, partly, corresponded with previous studies that the BREE supplement significantly reduced total-C and FFA concentrations in the db/db mice. 8 …”

Section: Discussionsupporting

confidence: 86%

Randomized Double-Blind Placebo-Controlled Trial of Powdered Brassica rapa Ethanol Extract on Alteration of Body Composition and Plasma Lipid and Adipocytokine Profiles in Overweight Subjects

Jeon

Kim²,

Shin³

et al. 2013

Journal of Medicinal Food

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We evaluated the effects of Brassica rapa ethanol extract (BREE) on body composition and plasma lipid profiles through a randomized, double-blind, and placebo-controlled trial in overweight subjects. Fifty-eight overweight participants (age 20-50 years, body mass index23.0-24.9) were randomly assigned to two groups and served BREE (2 g/day) or placebo (starch, 2 g/day) for 10 weeks. Body compositions, nutrients intake, plasma lipids, adipocytokines, and hepatotoxicity biomarkers were assessed in all subjects at baseline and after 10 weeks of supplementation. The plasma total cholesterol (total-C) concentration was significantly increased after 10 weeks compared to the baseline in both groups. However, BREE supplementation significantly increased the high-density lipoprotein cholesterol (HDL-C) concentration and significantly reduced the total-C/HDL-C ratio, free fatty acid, and adipsin levels after 10 weeks. No significant differences were observed in body compositions, fasting blood glucose, plasma adipocytokines except adipsin, and aspartate aminotransferase and alanine aminotransferase activities between before and after trial within groups as well as between the two groups. The supplementation of BREE partially improves plasma lipid metabolism in overweight subjects without adverse effects.

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Section: Discussionsupporting

confidence: 86%

Randomized Double-Blind Placebo-Controlled Trial of Powdered Brassica rapa Ethanol Extract on Alteration of Body Composition and Plasma Lipid and Adipocytokine Profiles in Overweight Subjects

Jeon

Kim²,

Shin³

et al. 2013

Journal of Medicinal Food

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“…However, there are several plausible mechanisms by which FFA might cause CV disease and death [65][66][67][68][69][70][71]. Furthermore, an increase in plasma FFA leads to endothelial activation, inflammation and thrombosis which may initiate early vascular abnormalities that promote atherosclerosis [72][73][74][75][76][77].…”

Section: Hypertriglyceridemia As a Major Component Of Atherogenic Dysmentioning

confidence: 99%

Hypertriglyceridemia: a too long unfairly neglected major cardiovascular risk factor

Tenenbaum

Klempfner

Fisman

2014

Cardiovasc Diabetol

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The existence of an independent association between elevated triglyceride (TG) levels, cardiovascular (CV) risk and mortality has been largely controversial. The main difficulty in isolating the effect of hypertriglyceridemia on CV risk is the fact that elevated triglyceride levels are commonly associated with concomitant changes in high density lipoprotein (HDL), low density lipoprotein (LDL) and other lipoproteins. As a result of this problem and in disregard of the real biological role of TG, its significance as a plausible therapeutic target was unfoundedly underestimated for many years. However, taking epidemiological data together, both moderate and severe hypertriglyceridaemia are associated with a substantially increased long term total mortality and CV risk. Plasma TG levels partially reflect the concentration of the triglyceride-carrying lipoproteins (TRL): very low density lipoprotein (VLDL), chylomicrons and their remnants. Furthermore, hypertriglyceridemia commonly leads to reduction in HDL and increase in atherogenic small dense LDL levels. TG may also stimulate atherogenesis by mechanisms, such excessive free fatty acids (FFA) release, production of proinflammatory cytokines, fibrinogen, coagulation factors and impairment of fibrinolysis. Genetic studies strongly support hypertriglyceridemia and high concentrations of TRL as causal risk factors for CV disease. The most common forms of hypertriglyceridemia are related to overweight and sedentary life style, which in turn lead to insulin resistance, metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM). Intensive lifestyle therapy is the main initial treatment of hypertriglyceridemia. Statins are a cornerstone of the modern lipids-modifying therapy. If the primary goal is to lower TG levels, fibrates (bezafibrate and fenofibrate for monotherapy, and in combination with statin; gemfibrozil only for monotherapy) could be the preferable drugs. Also ezetimibe has mild positive effects in lowering TG. Initial experience with en ezetimibe/fibrates combination seems promising. The recently released IMPROVE-IT Trial is the first to prove that adding a non-statin drug (ezetimibe) to a statin lowers the risk of future CV events. In conclusion, the classical clinical paradigm of lipids-modifying treatment should be changed and high TG should be recognized as an important target for therapy in their own right. Hypertriglyceridemia should be treated.

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“…Increased plasma FFA concentrations cause endothelial dysfunction, 4 insulin resistance, 5 and endothelial apoptosis. 6 These observations, together with results from epidemiological studies, 7,8 suggest that FFA is involved in atherosclerosis in subjects with insulin resistance. Recently, we have found that FFA-induced endothelial dysfunction is prevented by the inhibition of the renin-angiotensin (Ang) system (RAS) in humans, 9 suggesting that RAS activation by FFA may predominantly contribute to FFA-induced endothelial dysfunction.…”

mentioning

confidence: 95%

Free Fatty Acid Causes Leukocyte Activation and Resultant Endothelial Dysfunction Through Enhanced Angiotensin II Production in Mononuclear and Polymorphonuclear Cells

et al. 2010

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Abstract-Release of free fatty acid (FFA) from adipose tissue is implicated in insulin resistance and endothelial dysfunction in patients with visceral fat obesity. We demonstrated previously that increased FFA levels cause endothelial dysfunction that is prevented by inhibition of the renin-angiotensin system (RAS) in humans. However, the mechanisms for FFA-mediated activation of RAS and the resultant endothelial dysfunction were not elucidated. We investigated effects of elevated FFA on activity of circulating and vascular RAS, angiotensin II-forming activity of leukocytes, and leukocyte activation of normotensive subjects. We showed that increased FFA levels significantly enhanced angiotensin II-forming activity in human mononuclear (mean fold increase: 3.5 at 180 minutes; Pϭ0.0016) and polymorphonuclear (2.0; Pϭ0.0012) cells, whereas parameters of the circulating and vascular RAS were not affected. We also showed that FFA caused angiotensin II-dependent leukocyte activation, which impaired endothelial function partly via increased myeloperoxidase release and presumably enhanced adhesion of leukocytes. We propose that the enhanced production of angiotensin II by FFA in mononuclear and polymorphonuclear cells causes activation of leukocytes that consequently impairs endothelial function. RAS in leukocytes may regulate the leukocyte-vasculature interaction as the mobile RAS in humans. T he levels of circulating free fatty acid (FFA), mainly originating from lipolysis in adipose tissue, are increased in patients with metabolic syndrome and type 2 diabetes mellitus, 1-3 reflecting resistance to the antilipolytic action of insulin. Increased plasma FFA concentrations cause endothelial dysfunction, 4 insulin resistance, 5 and endothelial apoptosis. 6 These observations, together with results from epidemiological studies, 7,8 suggest that FFA is involved in atherosclerosis in subjects with insulin resistance. Recently, we have found that FFA-induced endothelial dysfunction is prevented by the inhibition of the renin-angiotensin (Ang) system (RAS) in humans, 9 suggesting that RAS activation by FFA may predominantly contribute to FFA-induced endothelial dysfunction. This hypothesis appears plausible because of the close relationship between obesity and RAS activity in humans. 10,11 In addition, RAS activation is also associated with enhanced oxidative stress, 12 which is an intermediary mechanism by which FFA adversely alters vascular function. 13 However, although the proatherogenic action of excessive Ang II has been well documented, there is little information regarding the mechanism of RAS activation in individuals with obesity. Indeed, only a few studies have investigated the effects of elevated FFA on RAS activity. 14 The aim of the present study was to investigate effects of elevated FFA on RAS and to elucidate mechanisms for FFA-induced endothelial dysfunction in humans. We also investigated the interaction between FFA and leukocytes, because FFA is involved in leukocyte activation through protein kinase C re...

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Free Fatty Acids Are Independently Associated with All-Cause and Cardiovascular Mortality in Subjects with Coronary Artery Disease

Abstract: FFA levels independently predict all-cause and cardiovascular mortality in subjects with angiographic CAD. A possible diagnostic use of FFAs warrants further studies, but our results may underline the importance of therapeutic approaches to influence FFA metabolism.

Cited by 178 publications

References 38 publications

Randomized Double-Blind Placebo-Controlled Trial of Powdered Brassica rapa Ethanol Extract on Alteration of Body Composition and Plasma Lipid and Adipocytokine Profiles in Overweight Subjects

Randomized Double-Blind Placebo-Controlled Trial of Powdered Brassica rapa Ethanol Extract on Alteration of Body Composition and Plasma Lipid and Adipocytokine Profiles in Overweight Subjects

Hypertriglyceridemia: a too long unfairly neglected major cardiovascular risk factor

Free Fatty Acid Causes Leukocyte Activation and Resultant Endothelial Dysfunction Through Enhanced Angiotensin II Production in Mononuclear and Polymorphonuclear Cells

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