Abstract
BackgroundWe aimed to comprehensively evaluate lipoprotein profile including lipid particle size following a lifestyle intervention in metabolic syndrome (MetS) volunteers and to assess the associations between lipoprotein subfractions and carotid-intima-media-thickness (CIMT) – a surrogate indicator of atherogenesis.Methods100 participants (50–70 years) from the RESOLVE trial, underwent a one-year follow-up beginning with a three-week residential program combining high exercise volume (15-20 h/week), restrictive diet (-500 kcal/day), and education. For baseline references, 40 aged-matched healthy controls were recruited. Independent associations between subfractions of lipoproteins and CIMT were evaluated using a generalized estimating equations model accounting for variation in correlations between repeated measures. The lipoprotein subfractions profile was assessed using Lipoprint® electrophoresis allowing to separate: the very low-density lipoprotein (VLDL) fraction, then the intermediate-density lipoprotein (IDL) C, B and A, the low-density lipoprotein (LDL) with subfractions 1 and 2 as large LDL and subfractions 3 to 7 as small dense LDL (sdLDL), and the high density lipoprotein (HDL) subfractions categorized into large, intermediate, and small HDL. Apolipoproteins A1 and B were also measured.Results78 participants completed the program. At baseline, apolipoproteins B/A1, VLDL, sdLDL and small HDL were higher in MetS than in healthy controls; IDL, LDL size, large and intermediate HDL were lower. Despite time-related regains during the follow-up, lipoprotein subfractions traditionally involved in cardiovascular risk, such as sdLDL, improved immediately after the residential program with values closest to those of healthy controls. CIMT improved throughout the lifestyle intervention. Using a generalized estimating equations model, none of the subfractions of lipoproteins nor apolipoproteins were linked to CIMT.ConclusionsLipoprotein subfractions traditionally involved in CVR, decreased after the 3-week residential program. During a 12 month follow-up, the time-related regains remained closer to the values of healthy controls than they were at baseline. CIMT improved throughout the lifestyle intervention. However, we failed to demonstrate a link between some lipoprotein subfractions and the atherogenicity directly measured from the wall thickness of arteries (CIMT). Further investigations are required to explore the atherogenicity of lipoprotein subfractions.Trial registrationNCT00917917
Highlights
Cardiovascular disease is the main cause of morbidity and mortality in individuals with metabolic syndrome (MetS) [1]
A low level of high-density lipoprotein cholesterol (HDL) is regarded as a sensitive discriminator of atherogenicity and is one among the five criteria selected by the International Diabetes Federation (IDF) to characterize MetS [3]
ApoB/A1, very low-density lipoprotein (VLDL), small dense LDL (sdLDL) and small HDL were higher in MetS than in healthy controls; intermediate-density lipoprotein (IDL), low-density lipoprotein cholesterol (LDL) size, large and intermediate HDL were lower in MetS than in healthy controls (Figure 1)
Summary
Cardiovascular disease is the main cause of morbidity and mortality in individuals with metabolic syndrome (MetS) [1]. Cardiovascular disease risk factors (CVR) include an excess of body fat, promoting dyslipidemia, with reduced high-density lipoprotein cholesterol (HDL) and increased low-density lipoprotein cholesterol (LDL) [2]. The relationship between lipoprotein profiles and atherogenesis has a strong clinical focus. Detection of CVR may prevent a later diagnosis of cardiovascular disease by using strategies such as lifestyle interventions [13,14]. The Framingham score [15], commonly used to estimate the CVR, may not permit the early risk detection available from profiling the lipoprotein subfractions. We aimed to comprehensively evaluate lipoprotein profile including lipid particle size following a lifestyle intervention in metabolic syndrome (MetS) volunteers and to assess the associations between lipoprotein subfractions and carotid-intima-media-thickness (CIMT) – a surrogate indicator of atherogenesis
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