Abstract
BackgroundHelminths may protect against cardiometabolic risk through effects on inflammation and metabolism; their treatment may be detrimental to metabolic outcomes.MethodsIn a cluster-randomized trial in 26 Ugandan fishing communities we investigated effects of community-wide intensive (quarterly single-dose praziquantel, triple-dose albendazole) vs standard (annual single-dose praziquantel, biannual single-dose albendazole) anthelminthic treatment on metabolic outcomes, and observational associations between helminths and metabolic outcomes. The primary outcome, homeostatic model assessment of insulin resistance (HOMA-IR), and secondary outcomes (including blood pressure, fasting blood glucose, lipids) were assessed after 4 years' intervention among individuals aged ≥10 years.ResultsWe analyzed 1898 participants. Intensive treatment had no effect on HOMA-IR (adjusted geometric mean ratio, 0.96 [95% confidence interval {CI}, .86–1.07]; P = .42) but resulted in higher mean low-density lipoprotein cholesterol (LDL-c) (2.86 vs 2.60 mmol/L; adjusted mean difference, 0.26 [95% CI, −.03 to .56]; P = .08). Lower LDL-c levels were associated with Schistosoma mansoni (2.37 vs 2.80 mmol/L; −0.25 [95% CI, −.49 to −.02]; P = .04) or Strongyloides (2.34 vs 2.69 mmol/L; −0.32 [95% CI, −.53 to −.12]; P = .003) infection. Schistosoma mansoni was associated with lower total cholesterol (4.24 vs 4.64 mmol/L; −0.25 [95% CI, −.44 to −.07]; P = .01) and moderate to heavy S. mansoni infection with lower triglycerides, LDL-c, and diastolic blood pressure.ConclusionsHelminth infections improve lipid profiles and may lower blood pressure. Studies to confirm causality and investigate mechanisms may contribute to understanding the epidemiological transition and suggest new approaches to prevent cardiometabolic disease.Clinical Trials RegistrationISRCTN47196031.
Highlights
Non-communicable diseases accounted for 72.3% of deaths globally in 2016 [1]
Further studies to confirm causality and investigate mechanisms will contribute to understanding the epidemiological transition and may suggest new approaches to prevent cardiometabolic disease
Dyslipidaemia, which results in atherosclerosis, is the leading risk factor for myocardial infarction [3] and stroke [4]
Summary
Ischaemic heart disease and cerebrovascular disease are the highest contributors to this mortality and morbidity [1] Metabolic disorders such as type 2 diabetes (T2D) and dyslipidaemia are important cardiovascular disease risk factors. Lipids are utilised by and involved in mediation of immune processes; inflammation may influence lipid levels in the circulation [7] Modulation of these inflammatory processes may delay the development of T2D and atherosclerosis. Helminth infection may influence cardiometabolic risk through effects on inflammation and metabolism. Lower LDL-cholesterol levels were observed in S. mansoni (2.37 vs 2.80 mmol/L, -0.25 [-0.49,-0.02] p=0.04) and Strongyloides infected (2.34 vs 2.69mmol/L, -0.32 [-0.53,-0.12] p=0.003) participants compared with uninfected. Participants with moderate to heavy S. mansoni infection had lower triglycerides, LDL-cholesterol and diastolic blood pressure levels
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