The Role of Postprandial Very-Low-Density Lipoprotein ­in the Development of Atrial Remodeling in Metabolic Syndrome

Abstract

Background: Negatively charged very-low-density lipoprotein (VLDL-χ) in metabolic syndrome (MetS) patients exerts cytotoxic effects on endothelial cells and atrial myocytes. Atrial cardiomyopathy, manifested by atrial remodeling with a dilated diameter, contributes to atrial fibrillation pathogenesis and predicts atrial fibrillation development. The correlation of VLDL-χ with atrial remodeling is unknown. This study investigated the association between VLDL-χ and the remodeling of left atrium.Methods: Consecutively, 87 MetS and 80 non-MetS individuals between 23 and 74 years old (50.6% men) without overt cardiovascular diseases were included in the prospective cohort study. Blood samples were collected while fasting and postprandially (at 0.5, 1, 2, and 4 hours after a unified meal). VLDL was isolated by ultracentrifugation; the percentile concentration of VLDL-χ (%) was determined by ultra-performance liquid chromatography. The correlations of left atrial diameter (LAD) with variables including VLDL-χ, LDL-C, HDL-C, triglycerides, glucose, and blood pressure, were analyzed by multiple linear regression models. A hierarchicallinear model was conducted to test the independencies of each variable’s correlation with LAD.Results: The mean LAD was 3.4 ± 0.5 cm in non-MetS subjects and 3.9 ± 0.5 cm in MetS patients (P< 0.01). None of the fasting lipid profiles were associated with LAD. VLDL-χ, BMI, waist circumference, hip circumference, and blood pressure were positively correlated with LAD (all P<0.05) after adjustment for age and sex. Significant interactions between VLDL-χ and blood pressure, waist circumference, and hipcircumference were observed. When adjusted for obesity- and blood pressure-related variables, 2-hour postprandial VLDL-χ (mean 1.30 ± 0.61%) showed a positive correlation with LAD in MetS patients. Each 1% VLDL-χ increase was estimated to increase LAD by 0.23 cm.Conclusions: Postprandial VLDL-χ is associated with atrial remodeling particularly in the MetS group. VLDL-χ is a novel biomarker and may be a therapeutic target for atrial cardiomyopathy in MetS patients.Trial registration: ISRCTN 69295295. Retrospectively registered 9 June 2020.

Left Atrial Cardiomyopathy – A Challenging Diagnosis

“…Several risk factors for the development of AF as well as structural and electrical remodeling in terms of a possible LACM have been described. LACM may occur as a result of amyloidosis, hereditary muscular dystrophies, congestive heart failure, AF, obstructive sleep apnea, drugs, alcohol, myocarditis, genetic repolarization disturbances, aging, hypertension, obesity, diabetes mellitus, valvular heart disease ( 9 , 127 , 141 – 143 ) ( Figure 7 ).…”

Association of Lipid Composition and Unsaturated Fatty Acids of VLDL with Atrial Remodeling in Metabolic Syndrome

“…Emerging evidence shows the pathogenic roles of very low-density lipoproteins (VLDL) in the pathogenesis of atrial remodeling, progression and thromboembolic complications in AF [13][14][15]. In our previous studies, the in vivo effects of VLDL extracted from patients with MetS were examined in mice were informed to continue ordinary medicine including statins (the MetS-on statin group).…”

“…VLDL isolation and lipid pro ling for lipidome analysis All study subjects were instructed to fast before last midnight until 20 mL venous blood draws were completed and collected in BD VACUETTE® EDTA tubes (Becton, Dickinson and Company, Franklin Lakes, NJ, USA) for subsequent VLDL isolation as described previously [14]. Brie y, the blood samples were centrifuged, separated from blood cells, and plasma was maintained for high-speed centrifugation at 10,000 rpm for 1 h to remove the upper chylomicrons.…”