Plasma lipoproteins, apoproteins and cardiovascular disease in type 2 diabetic patients. A nine-year follow-up study. Comparison of the effects of simultaneous administration of vitamin C and omega-3 fatty acids on lipoproteins, apo A-I, apo B, and malondialdehyde in hyperlipidemic patients. Dietary fat saturation affects apolipoprotein AII levels and HDL composition in postmenopausal women. Effects of pistachios on cardiovascular disease risk factors and potential mechanisms of action: a dose-response study. ApoE polymorphism and fish oil supplementation in subjects with an atherogenic lipoprotein phenotype. Effects of soluble fiber (Plantago ovata husk) on plasma lipids, lipoproteins, and apolipoproteins in men with ischemic heart disease. Prevention of atherosclerosis in patients living with HIV Effect of weight reduction on the distribution of apolipoprotein A-I in high-density lipoprotein subfractions in obese non-insulin-dependent diabetic subjects. Dietary unsaturated fatty acids in type 2 diabetes: higher levels of postprandial lipoprotein on a linoleic acid-rich sunflower oil diet compared with an oleic acid-rich olive oil diet. EFFECTS OF SOY CONSUMPTION ON SERUM LIPIDS AND APOPROTEINS IN PERITONEAL DIALYSIS PATIENTS: A RANDOMIZED CONTROLLED TRIAL Fibrates increase human apolipoprotein A-II expression through activation of the peroxisome proliferator-activated receptor. Influence of supplementation with N-3 fatty acids on different coronary risk factors in men--a placebo controlled study. Beneficial effects of a soy-based dietary supplement on lipid levels and cardiovascular risk markers in type 2 diabetic subjects. Paraoxonase Enzyme Activity Is Enhanced by Zinc Supplementation in Hemodialysis Patients Effect of a new HMG-CoA reductase inhibitor, atorvastatin, on lipids, apolipoproteins and lipoprotein particles in patients with elevated serum cholesterol and triglyceride levels. Vitamin E modifies neither fructosamine nor HbA1c levels in poorly controlled diabetes. The effect of red grape seed extract on serum paraoxonase activity in patients with mild to moderate hyperlipidemia. A controlled study of consumption of beta-glucan-enriched soups for 2 months by type 2 diabetic free-living subjects. Effects of metformin on dyslipoproteinemia in non-insulin-dependent diabetes mellitus. Fish oil supplementation versus gemfibrozil treatment in hyperlipidemic NIDDM. A randomized crossover study. Plasma cholesteryl ester synthesis, cholesteryl ester transfer protein concentration and activity in hypercholesterolemic women: effects of the degree of saturation of dietary fatty acids in the fasting and postprandial states. Metformin-induced changes in serum lipids, lipoproteins, and apoproteins in non-insulin-dependent diabetes mellitus. Egg consumption as part of an energy-restricted high-protein diet improves blood lipid and blood glucose profiles in individuals with type 2 diabetes. Effects of vitamin D on cardiovascular disease risk factors in polycystic ovary syndrome women with vitamin D deficiency Effects of Poly-Bioactive Compounds on Lipid Profile and Body Weight in a Moderately Hypercholesterolemic Population with Low Cardiovascular Disease Risk: A Multicenter Randomized Trial Soluble fibre (Plantago ovata husk) reduces plasma low-density lipoprotein (LDL) cholesterol, triglycerides, insulin, oxidised LDL and systolic blood pressure in hypercholesterolaemic patients: A randomised trial.
BACKGROUND AND AIM To evaluate the role of lipoprotein abnormalities as risk factors for macroangiopathy in Type 2 diabetes . METHODS AND RESULTS This prospect i ve nine-year follow-up study involved 113 Type 2 diabetic patients ( 50 men and 63 women , mean age 66.9 + /- 9.9 years ) , 37 of whom had clinical signs of coronary heart disease ( CHD ) and cerebrovascular disease ( CVD ) at baseline . During the follow-up , 32 patients died : 17 of CHD , five of CVD , and 10 of non-vascular causes . The patients who died because of vascular disease were more frequently smokers , and had baseline symptoms of vascular disease ; they were also significantly different from the other patients insofar as they were older , and had higher fasting plasma glucose levels , lower fasting C-peptide levels , and lower apoprotein ( apo ) AII , apo CII , apo CIII and apo E levels . Univariate analysis showed that baseline symptoms of vascular disease , current smoking , age , high fasting plasma glucose levels , low fasting C-peptide levels , and low apo AII , apo CII , apo CIII and apo E levels [ but not cholesterol , triglyceride , high-density lipoprotein (HDL)-cholesterol or qualitative low-density lipoprotein or HDL abnormalities ] were associated with cardiovascular mortality . Multivariate analysis showed that only age , smoking , glycated hemoglobin ( HbA1c ) and fasting C-peptide levels were significant independent determinants of macrovascular death . CONCLUSIONS In Type 2 normolipidemic diabetic patients , only age , smoking , HbA1c and fasting C-peptide levels are independent vascular risk factors . The differences in apo concentrations between patients with and without vascular disease may reflect qualitative abnormalities in plasma lipoproteins related to vascular disease BACKGROUND Control of hyperlipidemia is vital in patients with cardiovascular disease ( CVD ) .  Omega-3 fatty acids ( n-3FAs ) have desirable effects on serum triglyceride ( TG ) levels , thrombosis , and arrhythmia , but lead to increases in serum low-density lipoprotein ( LDL ) and apo-B as well . OBJECTIVE To determine and compare the effects of administration of n-3FAs , vitamin C ( VitC ) and n-3FAs + VitC on the serum levels of LDL , apoB , other serum lipids , and malondialdehyde ( MDA ) . The present study was performed in Tehran University of Medical Sciences from 2000 to 2001 . DESIGN In a double-blind , placebo trial of parallel design , 68 hyperlipidemic patients [ total cholesterol ( TC ) and TG greater than 200 mg/dL ] were r and omly assigned to receive daily 500 mg VitC , 1 g n-3FAs , 500 mg VitC + 1 g n-3FAs , or placebo ( control ) for 10 weeks . Fasting blood sample s were collected at the beginning and at the end of the period . TG , TC , LDL-cholesterol-C ( LDL-C ) , and high-density lipoprotein-cholesterol ( HDL-C ) were measured enzymatically , VitC and MDA colorimetrically , and apo-B and apo-A-I immunoturbidometrically . The pattern of food consumption , socio-economic , and anthropometric indices were determined ; there was no significant change in these indices during the study . RESULTS There was a significant difference in the blood VitC level at the end of the study in comparison to the initial value in the VitC ( p = 0.001 ) and VitC + n-3FAs ( p = 0.027 ) groups . Similarly , the serum TG level at the end of study was significantly different from the initial value in the n-3FAs group ( p = 0.002 ) and also from the final value in the control group ( p = 0.013 ) . In the VitC group , there was a significant decrease in TC ( p = 0.004 ) , apo-B ( p = 0.005 ) , and MDA ( p = 0.015 ) at the end of study as compared to the respective initial values . There was also a significant increase in blood VitC compared to the control value ( p = 0.018 ) and a significant decrease in MDA compared to the n-3FAs group ( p = 0.034 ) . At the end of study , in the n-3FAs group , there was a significant ( p = 0.04 ) and a marginally significant decrease ( p = 0.05 ) , respectively , in TG/HDL and apo-B levels as compared to the initial values , and the TG/HDL ratio showed a significant decrease as compared to the control group ( p = 0.047 ) . CONCLUSION Simultaneous administration of n-3FAs and VitC had no beneficial effects on the lipid profile of hyperlipidemic patients , but 1 g purified n-3FAs daily for 10 weeks is a beneficial supplement for decreasing TG without any increase in LDL-C , apo-B or MDA . Administration of 500 mg VitC for more than 10 weeks might decrease significantly TC and apo-B in hyperlipidemic patients Increased HDL-cholesterol levels have been associated with lower coronary heart disease ( CHD ) risk . However , HDL are heterogeneous lipoproteins , and particles enriched in apolipoprotein ( Apo ) AII have been associated with increased CHD risk . We examined the effect of dietary intervention on HDL composition in 14 postmenopausal women subjected to two consecutive diet periods , i.e. , an oleic acid sunflower oil diet followed by a palmolein diet , each lasting 4 wk . The linoleic acid was kept at 4 % total energy and the cholesterol intake at 400 mg/d . The palmolein diet increased serum total cholesterol ( TC ) ( P < 0.001 ) , phospholipids ( P < 0.001 ) , Apo AII ( P < 0.001 ) , HDL cholesterol ( P < 0.05 ) , HDL lipids ( P < 0.05 ) , HDL proteins ( P < 0.01 ) and the HDL total mass ( P < 0.05 ) . The HDL cholesterol/Apo AI ratio was increased 22.0 % ( P < 0.05 ) , whereas the HDL cholesterol/Apo AII and the Apo AI/Apo AII ratios were decreased 19.4 % ( P < 0.01 ) and 30.4 % , ( P < 0.001 ) , respectively . When the effects of the dietary intervention were examined according to the cholesterolemia status ( < or > 6.2 mmol/L ) , the most significant changes ( P < 0.001 ) were related to Apo AII levels . Moreover , a significant dietary oil by cholesterol level interaction was found for Apo AII and the HDL cholesterol/Apo AII ratio . In summary , a palmolein diet increased TC and HDL cholesterol compared with oleic acid sunflower oil diet ; however , the increase in Apo AII but not in Apo AI suggests the impairment of reverse cholesterol transport and potentially an increase in CHD risk . This effect was more marked in women with serum TC > 6.2 BACKGROUND  Nut consumption lowers cardiovascular disease ( CVD ) risk . Studies are lacking about the effects of pistachios , a nutrient-dense nut , on CVD risk factors , dose-response relations , and lipid-lowering mechanisms . OBJECTIVE We evaluated the effects of 2 doses of pistachios , added to a lower-fat diet , on lipids and lipoproteins , apolipoprotein (apo)-defined lipoprotein subclasses , and plasma fatty acids . To investigate the mechanisms of action , we measured cholesteryl ester transfer protein and indexes of plasma stearoyl-CoA desaturase activity ( SCD ) . DESIGN In a r and omized crossover controlled-feeding study , 28 individuals with LDL cholesterol > or = 2.86 mmol/L consumed 3 isoenergetic diets for 4 wk each . Baseline measures were assessed after 2 wk of a typical Western diet . The experimental diets included a lower-fat control diet with no pistachios [ 25 % total fat ; 8 % saturated fatty acids ( SFAs ) , 9 % monounsaturated fatty acids ( MUFAs ) , and 5 % polyunsaturated fatty acids ( PUFAs ) ] , 1 serving/d of a pistachio diet ( 1 PD ; 10 % of energy from pistachios ; 30 % total fat ; 8 % SFAs , 12 % MUFAs , and 6 % PUFAs ) , and 2 servings/d of a pistachio diet ( 2 PD ; 20 % of energy from pistachios ; 34 % total fat ; 8 % SFAs , 15 % MUFAs , and 8 % PUFAs ) . RESULTS The 2 PD decreased ( P < 0.05 compared with the control diet ) total cholesterol ( -8 % ) , LDL cholesterol ( -11.6 % ) , non-HDL cholesterol ( -11 % ) , apo B ( -4 % ) , apo B/apo A-I ( -4 % ) , and plasma SCD activity ( -1 % ) . The 1 PD and 2 PD , respectively , elicited a dose-dependent lowering ( P < 0.05 ) of total cholesterol/HDL cholesterol ( -1 % and -8 % ) , LDL cholesterol/HDL cholesterol ( -3 % and -11 % ) , and non-HDL cholesterol/HDL cholesterol ( -2 % and -10 % ) . CONCLUSIONS Inclusion of pistachios in a healthy diet beneficially affects CVD risk factors in a dose-dependent manner , which may reflect effects on SCD The study assessed the efficacy of fish oil supplementation in counteracting the classic dyslipidemia of the atherogenic lipoprotein phenotype ( ALP ) . In addition , the impact of the common apolipoprotein E ( apoE ) polymorphism on the fasting and postpr and ial lipid profile and on responsiveness to the dietary intervention was established . Fifty-five ALP males ( aged 34 to 69 years , body mass index 22 to 35 kg/m(2 ) , triglyceride [ TG ] levels 1.5 to 4.0 mmol/L , high density lipoprotein cholesterol [ HDL-C ] < 1.1 mmol/l , and percent low density lipoprotein [LDL]-3 > 40 % total LDL ) completed a r and omized placebo-controlled crossover trial of fish oil ( 3.0 g eicosapentaenoic acid/docosahexaenoic acid per day ) and placebo ( olive oil ) capsules with the 6-week treatment arms separated by a 12-week washout period . In addition to fasting blood sample s , at the end of each intervention arm , a postpr and ial assessment of lipid metabolism was carried out . Fish oil supplementation result ed in a reduction in fasting TG level of 35 % ( P<0.001 ) , in postpr and ial TG response of 26 % ( TG area under the curve , P<0.001 ) , and in percent LDL-3 of 26 % ( P<0.05 ) . However , no change in HDL-C levels was evident ( P=0.752 ) . ANCOVA showed that baseline HDL-C levels were significantly lower in apoE4 carriers ( P=0.035 ) . The apoE genotype also had a striking impact on lipid responses to fish oil intervention .  Individuals with an apoE2 allele displayed a marked reduction in postpr and ial incremental TG response ( TG incremental area under the curve , P=0.023 ) and a trend toward an increase in lipoprotein lipase activity relative to non-E2 carriers . In apoE4 individuals , a significant increase in total cholesterol and a trend toward a reduction in HDL-C relative to the common homozygous E3/E3 profile was evident . Our data demonstrate the efficacy of fish oil fatty acids in counteracting the proatherogenic lipid profile of the ALP but also that the apoE genotype influences responsiveness to this dietary treatment BACKGROUND New dietary strategies to reduce cardiovascular disease ( CVD ) risk include the addition of fiber to the diet . The effect of soluble-fiber consumption derived from Plantago ovata husk on lipid risk factors in patients with CVD is unknown . OBJECTIVE We compared the effects of soluble fiber ( P. ovata husk ) with those of insoluble fiber ( P. ovata seeds ) on plasma lipid , lipoprotein , and apolipoprotein ( apo ) concentrations within a CVD secondary prevention program . DESIGN In a r and omized , crossover , controlled , single-blind design , 28 men with CVD ( myocardial infa rct ion or stable angina ) and an LDL-cholesterol concentration < /=3.35 mmol/L consumed for 8 wk , under controlled conditions , a low-saturated-fat diet supplemented with 10.5 g P. ovata husk/d or 10.5 g P. ovata seeds/d . Fasting plasma lipid concentrations and polymorphisms of genes involved in lipid metabolism , such as apo A-IV , apo E , and fatty acid-binding protein , were measured . RESULTS Plasma triacylglycerol decreased ( 6.7 % ; P < 0.02 ) , the ratio of apo B 100 to apo A-I decreased ( 4.7 % ; P < 0.02 ) , and apo A-I increased ( 4.3 % ; P < 0.01 ) in the P. ovata husk consumers . Compared with the intake of insoluble fiber , the intake of P. ovata husk increased HDL-cholesterol concentrations by 6.7 % ( P = 0.006 ) and decreased the ratio of total to HDL cholesterol and of LDL to HDL cholesterol by 10.6 % ( P = 0.002 ) and 14.2 % ( P = 0.003 ) , respectively . CONCLUSION In the secondary prevention of CVD , P. ovata husk intake induces a more beneficial effect on the cardiovascular lipid risk-factor profile than does an equivalent intake of insoluble fiber Investigational product : Rosuvastatin ( Crestor ® ; Astra Zeneca ) . Active ingredients : Rosuvastatin ( 5 mg ) . Study title : Prevention of Atherosclerosis in Patients Living with HIV . Phase of study : Phase III . Aims : Primary aim : To assess whether rosuvastatin therapy could slow the progression of the carotid intima-media thickness ( C-IMT ; as measured by the change in the mean IMT of the near and far walls of the distal common carotid arteries ) over 2 years in HIV-infected patients ( HIV-IP ) . Secondary aims : To assess whether rosuvastatin therapy could reduce highly sensitive C reactive protein ( hs-CRP ) inflammatory marker that is increased in HIV-IP . To assess the effect of rosuvastatin therapy on serum lipid levels ( total cholesterol [ TC ] , low-density lipoprotein [ LDL ] cholesterol , high-density lipoprotein [ HDL ] cholesterol and triglycerides [ TG ] ) and apolipoproteins ( APO A1 , APO B and APO B/A1 ) . To assess the safety of rosuvastatin in HIV-IP through the evaluation of clinical laboratory analyses ( liver function tests and creatine kinase ) and adverse events ( AEs ) . Study design : Two-year r and omized , double-blind , placebo-controlled , parallel group study . Planned sample size : 320 HIV-IP . Summary of eligibility criteria : HIV-IP who are aged between 30 and 60 years , with a CD4 count . greater than 200 cells/mm3 . Patients must be stable on combination antiretroviral therapy ( cART ) for at least 12 months and have a 10-year CVD risk of less than 20 % ( using the Framingham risk score ) . Number of study centers : One . Duration of treatment : Two years ( 5 mg rosuvastatin or placebo once daily ) . Dose and route of administration : Oral rosuvastatin ( 5 mg ) once daily . The incidence of cardiovascular disease ( CVD ) in HIV-IP is at least three times higher than in the general population and further increases each year with combination anti-retroviral therapy ( cART ) . The carotid atherosclerosis progression rate is 10 times higher in HIV-IP than in uninfected individuals . The aim of this study is to assess whether therapy with 5 mg rosuvastatin could : 1 ) Slow the progression in the mean IMT of the distal common carotid arteries over two years in HIV-IP . 2 ) Change the concentration in the inflammatory marker – hs-CRP , which is increased in HIV-IP . 3 ) Change the concentrations of TC , LDL cholesterol , HDL cholesterol , TG , apolipoproteins ( APO ) B , APO A1 and APO B/A1 . 4 ) Be administered safely in the study population . Pharmacological intervention with rosuvastatin will be evaluated in a double-blind , placebo-controlled , r and omized clinical trial in HIV-IP treated with cART not matching the published selection criteria for lipid-lowering therapy . For the first time , this study will investigate anti-inflammatory and anti-atherogenic effects of a pharmacological lipid-lowering agent in HIV-IP that may lead to the reduction of CVD High-density lipoprotein ( HDL ) plays an important role in the process of reverse cholesterol transport , which may become suboptimal with increasing body fatness . HDL cholesterol that is reduced in obese subjects paradoxically decreases during weight reduction . To determine how weight reduction affects HDL subclasses that are involved in reverse cholesterol transport , we studied HDL from obese diabetic subjects before and after energy restriction within background diets high in either carbohydrate or monounsaturated fatty acids ( MUFAs ) .  Body weight , blood glucose , total cholesterol , and LDL cholesterol decreased after 8 and 12 weeks of weight reduction . With the very-low-fat diet , HDL cholesterol decreased significantly at 8 weeks , but recovered to initial levels after 12 weeks as body weight began to stabilize . Plasma apolipoprotein A-I ( apo A-I ) decreased substantially and significantly at 8 and 12 weeks with both diets , and was reflected in the reduction of apo A-I in HDL subclasses alpha1 , alpha2 , pre-beta1 , and pre-beta2 + pre-beta3 . The calculation of the percentage distribution of apo A-I among HDL species showed that only the proportion of pre-beta1-HDL decreased , whereas alpha2-HDL increased . This led to a significant increase in the alpha1 + alpha2/pre-beta ratio , ie , the ratio of the large cholesterol " storage " or " sink " HDL to the HDL " shuttle " fraction considered to be the initial acceptor of cell cholesterol . These data suggest that despite the reduction in HDL cholesterol and apo A-I , the redistribution of apo A-I in pre-beta1-HDL and alpha-HDL observed with weight reduction appears to revert to the pattern that we have previously reported in lean as opposed to overweight subjects OBJECTIVE The present study was undertaken to examine the effect of a polyunsaturated fat diet compared with an isocaloric Mediterranean-style monounsaturated fat diet . RESEARCH DESIGN AND METHODS This was a r and omized 2-week crossover study on either a high-polyunsaturated or a high-monounsaturated fat diet in 11 well-controlled diabetic men . Blood was taken fasting and for up to 8 h after a high fat meal . Lipoproteins were isolated by sequential ultracentrifugation . Apolipoprotein ( apo ) B48 and apo B100 were separated by PAGE . Fatty acids were analyzed by gas-liquid chromatography RESULTS Fasting blood glucose and insulin levels were significantly higher on the linoleic acid diet compared with the oleic acid diet ( P < 0.01 and P < 0.002 , respectively ) . Plasma cholesterol and LDL cholesterol levels were also significantly higher on the linoleic acid diet ( P < 0.001 ) . Likewise , fasting chylomicron apo B48 and apo B100 ( P < 0.05 ) and postpr and ial chylomicron and VLDL apo B48 and B100 ( P < 0.05 ) were also higher on the linoleic acid diet . CONCLUSIONS This study suggests that , in type 2 diabetes , an oleic acid-rich Mediterranean-type diet versus a linoleic acid-enriched diet may reduce the risk of atherosclerosis by decreasing the number of chylomicron remnant particles ♦ Background : Lipid abnormalities , particularly high serum concentration of lipoprotein(a ) [ Lp(a ) ] , are one of the major risk factors for cardiovascular disease ( CVD ) in peritoneal dialysis ( PD ) patients . The present study was design ed to investigate the effects of soy consumption on serum lipids and apoproteins , especially Lp(a ) , in PD patients . ♦ Methods : This study was a r and omized clinical trial in which 40 PD patients ( 20 males , 20 females ) were r and omly assigned to either the soy or the control group . Patients in the soy group received 28 g/day textured soy flour ( containing 14 g of soy protein ) for 8 weeks , whereas patients in the control group received their usual diet , without any soy . At baseline and the end of week 8 of the study , 5 mL of blood was collected from each patient after a 12- to 14-hour fast and serum triglyceride , total cholesterol , low density lipoprotein-cholesterol ( LDL-C ) , high density lipoprotein-cholesterol ( HDL-C ) , apoprotein B100 ( apo B100 ) , apoprotein AI ( apo AI ) , and Lp(a ) were measured . ♦ Results : In the present study , serum Lp(a ) concentrations were above the normal range in 86 % of the PD  patients . Mean serum Lp(a ) concentration was reduced significantly , by 41 % , in the soy group at the end of week 8 compared to baseline ( p < 0.01 ) ; the reduction was also significant compared to the control group ( p < 0.05 ) . During the study , mean serum Lp(a ) concentration did not change significantly in the control group . There were no significant differences between the two groups in mean changes in serum triglyceride , total cholesterol , HDL-C , LDL-C , apo B100 , or apoAI . ♦ Conclusion : The results of our study indicate that soy consumption reduces serum Lp(a ) concentration , which is a risk factor for cardiovascular disease in peritoneal dialysis patients In view of the evidence linking plasma high density lipoprotein (HDL)-cholesterol levels to a protective effect against coronary artery disease and the widespread use of fibrates in the treatment of hyperlipidemia , the goal of this study was to analyze the influence of fibrates on the expression of apolipoprotein ( apo ) A-II , a major protein constituent of HDL . Administration of fenofibrate ( 300 mg/d ) to 16 patients with coronary artery disease result ed in a marked increase in plasma apo A-II concentrations ( 0.34 + /- 0.11 to 0.45 + /- 0.17 grams/liter ; P < 0.01 ) . This increase in plasma apo A-II was due to a direct effect on hepatic apo A-II production , since fenofibric acid induced apo A-II mRNA levels to 450 and 250 % of control levels in primary cultures of human hepatocytes and in human hepatoblastoma HepG2 cells respectively . The induction in apo A-II mRNA levels was followed by an increase in apo A-II secretion in both cell culture systems . Transient transfection experiments of a reporter construct driven by the human apo A-II gene promoter indicated that fenofibrate induced apo A-II gene expression at the transcriptional level . Furthermore , several other peroxisome proliferators , such as the fibrate , Wy-14643 , and the fatty acid , eicosatetraynoic acid ( ETYA ) , also induced apo A-II gene transcription . Unilateral deletions and site-directed mutagenesis identified a sequence element located in the J-site of the apo A-II promoter mediating the responsiveness to fibrates and fatty acids . This element contains two imperfect half sites spaced by 1 oligonucleotide similar to a peroxisome proliferator responsive element ( PPRE ) . Cotransfection assays showed that the peroxisome proliferator activated receptor ( PPAR ) transactivates the apo A-II promoter through this AII-PPRE . Gel retardation assays demonstrated that PPAR binds to the AII-PPRE with an affinity comparable to its binding affinity to the acyl coA oxidase (ACO)-PPRE . In conclusion , in humans fibrates increase plasma apo A-II concentrations by inducing hepatic apo A-II production . Apo A-II expression is regulated at the transcriptional level by fibrates and fatty acids via the interaction of PPAR with the AII-PPRE , thereby demonstrating the pivotal role of PPAR in controlling human lipoprotein metabolism Recent epidemiological studies have shown some beneficial health effects of the long chain ( n-3 ) polyunsaturated fatty acids found in fatty fish . Although the results of these studies are often ambiguous and inconclusive , they have prompted many intervention trials to study the effects of n-3 fatty acids ( FA ) on the cardiovascular risk profile . However screening of the literature revealed that many of the beneficial effects of fish ( oil ) were obtained in intervention studies which had several serious shortcomings in their design . Therefore we started a placebo controlled r and omised trial with increasing doses of n-3FA ( respectively 0 ; 1.12 ; 2.24 and 3.37 g n-3 FA/day ) and in order to have a maximum compliance this study was done in healthy monks . Fifty eight subjects took the fish oil capsules during 12 months and were thereafter followed for another 6 months . We could n't detect any effect of n-3 FA supplementation on total cholesterol , HDL cholesterol , LDL cholesterol , apo A1 , Lp(a ) , HbA1C , glucose , fibrinogen , factor VIII , antithrombin III , plasminogen activator inhibitor , tissue plasminogen activator and von Willebr and factor concentration , on bleeding time or on systolic or diastolic blood pressure . A pronounced significant dose dependent decrease of triglyceride levels was seen , while a slight but statistical significant decrease of apo B levels was observed in the highest fish oil dose . As the importance of triglycerides in the pathogenesis of atherosclerosis is still under discussion , the clinical relevance of these finding is not clear at the moment . It seems therefore improbable that the anti-atherosclerotic action of n-3 FA is due to an effect on the lipid , apoprotein , coagulation or fibrinolysis parameters as measured in our study . Hence further research must be focused on other parameters ( prostagl and ins ) which can be influenced by n-3 FA and which probably play an equally important role in the atherosclerotic process OBJECTIVE Consumption of soy protein has recently been shown to improve the blood lipid levels in nondiabetic subjects . The purpose of this study was to evaluate if a dietary supplement of soy protein , isoflavones , and cotyledon fiber ( Abalon ) affects cardiovascular risk markers , blood glucose , and insulin levels in type 2 diabetic subjects . RESEARCH DESIGN AND METHODS Twenty type 2 diabetic subjects participated in a crossover trial . They were r and omized to double-blind supplementation for 6 weeks with Abalon ( soy protein [ 50 g/day ] with high levels of isoflavones [ minimum 165 mg/day ] and cotyledon fiber [ 20 g/day ] ) or placebo ( casein [ 50 g/day ] and cellulose [ 20 g/day ] ) , separated by a 3-week wash-out period . RESULTS The results are expressed as means + /- SD . The percentage mean treatment difference between Abalon and placebo demonstrated significantly lower mean values after Abalon for LDL cholesterol ( 10 + /- 15 % , P < 0.05 ) , LDL/UHDL ratio ( 12 + /- 18 % , P < 0.05 ) , apolipoprotein ( apo ) B100 ( 30 + /- 38 % , P < 0.01 ) , triglycerides ( 22 + /- 10 % , P < 0.05 ) , and homocysteine ( 14 + /- 21 % , P < 0.01 ) , whereas the total cholesterol value tended to be less significant but still lower ( 8 + /- 15 % , P < 0.08 ) . No change occurred in HDL cholesterol , apo B100/apo A1 ratio , plasminogen activator inhibitor 1 , factor VIIc , von Willebr and factor , fibrinogen , lipoprotein(a ) , glucose , HbA1c , or 24-h blood pressure . CONCLUSIONS These results indicate beneficial effects of dietary supplementation with Abalon on cardiovascular risk markers in type 2 diabetic subjects . This improvement is seen even in individuals with near-normal lipid values Background and Aims : Patients on maintenance hemodialysis ( HD ) face an increased risk of atherosclerosis , a crucial problem and the leading cause of cardiovascular morbidity and mortality . This study was design ed to evaluate the effects of zinc supplementation on paraoxonase ( PON ) enzyme activity in patients on HD . Methods : This double-blind r and omized controlled trial was conducted from June 2005 to June 2007 . Sixty HD patients were enrolled and divided into two groups : treatment ( case ) and control . The treatment and control groups were treated with 100 mg/day zinc or placebo , respectively , for 2 months . Serum zinc concentration was measured by atomic absorption spectrophotometry . PON activity  was evaluated by spectrophotometric method . Lipid profile  was determined using commercial kits , and apolipoprotein AI ( Apo-AI ) and B ( Apo-B ) levels were measured by commercial immunoturbidimetric kits . Results : In the case group , there was no significant change in the serum total cholesterol ( TC ) , triglyceride ( TG ) , low-density lipoprotein ( LDL ) , and Apo-B levels , while the serum levels of high-density lipoprotein ( HDL ) , Apo-AI , and PON activity were significantly increased ( p = 0.02 ) . In the control group , although significant increases were observed in the serum levels of TC , TG , and Apo-B ( p = 0.009 , 0.019 , and 0.001 , respectively ) , the serum PON activity was significantly decreased ( p = 0.025 ) and the serum levels of HDL , LDL , and Apo-AI were not changed . At the end of intervention period , the serum level of Apo-AI and PON activity were significantly higher in the case group . Conclusions : Zinc supplementation increased both the activity of PON and the serum level of Apo-AI in the HD patients The effects of atorvastatin ( lipitor ) on cholesterol-rich and triglyceride-rich lipoproteins were evaluated in this multicenter trial . Following a 6-week baseline period , 47 patients with elevated cholesterol and triglyceride levels were treated with atorvastatin 10 mg once daily ( QD ) for the initial 12 weeks ( Period 1 ) increasing to 20 mg QD for the following 12 weeks ( Period 2 ) . At both the 10 and 20 mg doses , atorvastatin treatment result ed in significant reductions compared to pretreatment levels in low-density lipoprotein cholesterol ( LDL-C ) , total cholesterol ( TC ) , very low-density lipoprotein cholesterol ( VLDL-C ) , apolipoprotein ( apo ) B , apoB in LDL ( LDL-apo B ) , apo B in VLDL ( VLDL-apo B ) , lipoprotein (Lp)B , lipoprotein B-complex ( LpBc ) , triglycerides ( TG ) , low-density lipoprotein triglycerides ( LDL-TG ) , very low-density lipoprotein triglyceride ( VLDL-TG ) , high-density lipoprotein triglycerides ( HDL-TG ) , and apo C-III .  Atorvastatin 10 and 20 mg QD also result ed in significant increases in high-density lipoprotein cholesterol ( HDL-C ) , apo AI , and LpAII : B : C : D : E. Due to its unique ability to normalize both cholesterol-rich and triglyceride-rich particles , atorvastatin is a promising c and i date for monotherapy in a broad range of patients including those with varying degrees of hypercholesterolemia and hypertriglyceridemia OBJECTIVE To examine the effects of vitamin E on total serum protein glycation ( fructosamine ) , hemoglobin glycation ( HbA1c ) , and serum levels of glucose , total cholesterol , triglycerides , LDL-C , HDL-C , apolipoprotein A1 and apolipoprotein B. MATERIAL AND METHODS Sixty poorly controlled diabetic patients were r and omly assigned to receive either 1200 mg/day of vitamin E or identical placebo capsules during a two month period following a double blind cross-over design with a four week wash-out period between regimens . RESULTS Seven patients were excluded from the study because of reasons not related to the medication . In the remaining 53 patients , the levels of serum glucose , fructosamine , HbA1c , total cholesterol , HDL-C , LDL-C , Apo A1 and Apo B did not vary significantly with vitamin E as compared with placebo . CONCLUSIONS No significant effects of vitamin E on any of the parameters evaluated were observed in poorly controlled diabetic patients CONTEXT AND OBJECTIVE Red grape seed extract ( RGSE ) contains oligomeric proanthocyanidin complexes as a class of flavonoids . These compounds are potent antioxidants and exert many health-promoting effects . This study aim ed to determine the effects of RGSE on serum levels of triglycerides ( TG ) , total cholesterol ( TC ) , high-density lipoprotein cholesterol ( HDL-C ) , low-density lipoprotein cholesterol ( LDL-C ) , apolipoprotein AI ( apo-AI ) levels and paraoxonase ( PON ) activity in patients with mild to moderate hyperlipidemia ( MMH ) . DESIGN AND SETTING S A r and omized double-blind placebo-controlled clinical trial was conducted at Shahid-Modarres Hospital ( Tehran , Iran ) and Tabriz University of Medical Sciences . Seventy MMH patients were r and omly assigned to receive treatment ( 200 mg/day of RGSE ) or placebo for eight weeks . RESULTS Significant elevation in serum levels of apo-AI ( P = 0.001 ) , HDL-C ( P = 0.001 ) and PON activity ( P = 0.001 ) and marked decreases in concentrations of TC ( P = 0.015 ) , TG ( P = 0.011 ) and LDL-C ( P = 0.014 ) were found in the cases . PON activity was significantly correlated with apo-AI ( r = 0.270 ; P < 0.01 ) and HDL-C ( r = 0.45 ; P < 0.001 ) . Significant differences between the RGSE and control groups ( before and after treatment ) for TC ( P = 0.001 ) , TG ( P = 0.001 ) , PON ( P = 0.03 ) , apo-AI ( P = 0.001 ) and LDL-C ( P = 0.002 ) were seen . CONCLUSION It is possible that RGSE increases PON activity mostly through increasing HDL-C and apo-AI levels in MMH patients . It may thus have potential beneficial effects in preventing oxidative stress and atherosclerosis in these patients Type 2 diabetes is associated with a higher cardiovascular risk and there has been a growing interest in using dietary intervention to improve lipid profile and glucose control . The present work aims at analysing the effects of the enrichment of a normal diet with beta-glucan ( 3.5 g/d ) in free-living type 2 diabetic subjects for 2 months , using a palatable soup . This trial was a parallel , placebo-controlled , double-blinded r and omised study performed in fifty-three type 2 diabetic subjects . During a 3-week run-in period , subjects daily consumed a ready meal control soup ( without beta-glucan ) . For the following 8 weeks , subjects were r and omly assigned to consume daily either a control soup or a beta-glucan soup .  Changes in lipid profile ( total cholesterol ( TC ) , HDL- and LDL-cholesterol ( HDLc and LDLc ) , apo B and TAG ) and in glucose control ( HbA1c and fasting glucose ) were measured . There was no significant alteration in lipid profile in the two groups ( TC , HDLc , LDLc and apo B ) . TAG decreased significantly in the beta-glucan group compared with the control group ( - 0.12 ( SD 0.38 ) v. 0.12 ( SD 0.44 ) mmol/l , P = 0.03 ) . HbA1c and fasting glucose were not reduced in any group . A single daily ingestion of 3.5 g beta-glucan , as required by official dietary recommendations , for 8 weeks did not change the lipid profile and HbA1c in type 2 diabetic subjects . To improve the metabolic profile of type 2 diabetic subjects in the long term , the quantity , the food vectors and the tolerability of beta-glucan products may be re-evaluated A 12-week double-blind placebo-controlled trial to study the effects of metformin on lipoprotein concentration and composition was performed in forty patients with NIDDM and hyperlipoproteinemia . A significant decrease occurred in VLDL-apo B and all lipid components of VLDL , indicating a decreased number of circulating VLDL , while LDL-apo B was unchanged . Moreover in VLDL the relative TG content increased , the cholesterol content decreased , while in LDL the TG content decreased and the cholesterol content increased , indicating a change in the particle distribution over the spectrum VLDL-IDL-LDL . The initially enhanced TG-content in HDL was reduced . While a reduction in VLDL is observed with all methods improving glucose control the observed compositional changes in VLDL and LDL have not been described before and may be a specific effect of metformin To compare the impact of dietary fish oil supplementation ( FO , 22 ml daily , containing 4.6 g of n-3 ( omega-3 ) fatty acids , equalling 14.4 mmol ) on carbohydrate and lipid metabolism with that of conventional lipostatic therapy ( Gemfibrozil ( G ) , 900 mg daily , equalling 3.6 mmol ) on hyperlipidemic non-insulin dependent diabetes mellitus ( NIDDM ) , 10 patients were selected for a r and omized , short-time , cross-over study . Each patient was treated for a duration of 2 weeks , with an individual washout period of 8 weeks . Metabolic variables and intravenous glucose tolerances ( 1.2 mmol/kg body weight , t = 30 min ) were determined on days 1 and 15 of each treatment period . Plasma lipid concentrations were identical at baseline , but were reduced more markedly following G as against FO exposure ( % change vs. baseline : total cholesterol ( chol ) , - 13**/-6 * ( G vs FO : p = 0.05 ) ; total triglycerides ( TG ) , -39**/-18 * * ( p < 0.05 ) ; APO B , -17**/- 10 * ( N.S. ) ; LDL-chol , -15**/0 ( p < 0.02 ) ; VLDL-chol , -50***/- 34 * * * ( N.S. ) ; VLDL-TG , -44***/-27 * * ( N.S. ) ; ( p vs. baseline : * < 0.05 , * * < 0.01 , * * * < 0.001 ) . Total-HDL , HDL2 , HDL3 and APO A were not influenced by either FO or G. Neither FO nor G induced a change in intravenous glucose tolerances or associated basal and incremental concentrations of insulin and C-peptide . We concluded , based on short-time applications , that ( a ) neither treatment affected the carbohydrate metabolism in patients with NIDDM , and ( b ) a greater hypolipidemic efficacy had to be assigned to Gemfibrozil than to fish oil . It would therefore appear that Gemfibrozil acts as a useful lipostatic pharmacologic compound , whilst fish oil could serve as a potential ingredient of a prudent cardio-protective diet which favours the low plasma triglyceride concentrations found in NIDDM patients Hypercholesterolemic women ( n = 19 ) sequentially maintained on a long-term saturated ( SAT ) or a polyunsaturated ( PUFA ) fatty acid-rich diet , respectively  , were studied in the fasting state and after a meal rich in SAT or PUFA . When apo B-containing lipoprotein was excluded from plasma the in vitro HDL-14C-cholesterol esterification rate was identical for the saturated ( SAT ) and polyunsaturated ( PUFA ) fatty acid diets , and did not increase during the postpr and ial period . Rates of transfer of 14C-cholesteryl ester to apo B-containing lipoproteins from HDL were also similar for both diets in the fasting state and increased to the same extent in the postpr and ial period in parallel with the rise in plasma triglycerides . When transfer data were related to the plasma concentration of apo B , the gain of cholesteryl ester by the triglyceride-containing particles ( VLDL + LDL ) also increased in the postpr and ial period to a similar extent for both diets . Cholesteryl ester transfer protein ( CETP ) concentration measured by radioimmunoassay was similar during both experimental diets , although greater in the postpr and ial period for the PUFA diet . The rate limiting factor for CETP-mediated transfer of HDL-derived cholesteryl ester ( CE ) was the plasma triglyceride concentration , that is , the content of triglycerides per lipoprotein particle and the quantity of TG-containing particles ( VLDL + LDL ) . In contrast , the fatty acid composition of these particles had less effect on CETP-mediated CE transfer Forty patients with NIDDM and hyperlipoproteinemia were selected for a 12-week double-blind placebo-controlled trial to study the effects of metformin on lipoprotein concentration and composition . A significant decrease occurred in VLDL-apo B and all lipid components of VLDL , indicating a decreased number of circulating VLDL , while LDL-apo B was unchanged . Moreover in VLDL the relative TG content increased , the cholesterol content decreased , while in LDL the TG content decreased and the cholesterol content increased , indicating a change in the particle distribution over the spectrum VLDL-IDL-LDL . The initially enhanced TG-content in HDL was reduced . While a reduction in VLDL is observed together with improving glucose control irrespective of the applied method , the observed compositional changes in VLDL and LDL have not been described before and seem to be metformin-specific The role of dietary cholesterol in people with diabetes has been little studied . We investigated the effect of a hypoenergetic high-protein high-cholesterol ( HPHchol ) diet compared to a similar amount of animal protein ( high-protein low-cholesterol , HPLchol ) on  plasma lipids , glycaemic control and cardiovascular risk markers in individuals with type 2 diabetes . A total of sixty-five participants with type 2 diabetes or impaired glucose tolerance ( age 54·4 ( sd 8·2 ) years ; BMI 34·1 ( sd 4·8 ) kg/m2 ; LDL-cholesterol ( LDL-C ) 2·67 ( sd 0·10 ) mmol/l ) were r and omised  to either HPHchol or HPLchol . Both hypoenergetic dietary interventions ( 6 - 7 MJ ; 1·4 - 1·7 Mcal ) and total carbohydrate : protein : fat ratio of 40:30:30 % were similar but differed in cholesterol content ( HPHchol , 590 mg cholesterol ; HPLchol , 213 mg cholesterol ) . HPHchol participants consumed two eggs per d , whereas HPHchol participants replaced the eggs with 100 g of lean animal protein . After 12 weeks , weight loss was 6·0 ( sd 0·4 ) kg ( P < 0·001 ) . LDL-C and homocysteine remained unchanged . All the subjects reduced total cholesterol ( - 0·3 ( sd 0·1 ) mmol/l , P < 0·001 ) , TAG ( - 0·4 ( sd 0·1 ) mmol/l , P < 0·001 ) , non-HDL-cholesterol ( HDL-C , - 0·4 ( sd 0·1 ) mmol/l , P < 0·001 ) , apo-B ( - 0·04 ( sd 0·02 ) mmol/l , P < 0·01 ) , HbA1c ( - 0·6 ( sd 0·1 ) % , P < 0·001 ) , fasting blood glucose ( - 0·5 ( sd 0·2 ) mmol/l , P < 0·01 ) , fasting insulin ( - 1·7 ( sd 0·7 ) mIU/l , P < 0·01 ) , systolic blood pressure ( - 7·6 ( sd 1·7 ) mmHg , P < 0·001 ) and diastolic blood pressure ( - 4·6 ( sd 1·0 ) mmHg ; P < 0·001 ) . Significance was not altered by diet , sex , medication or amount of weight loss . HDL-C increased on HPHchol ( + 0·02 ( sd 0·02 ) mmol/l ) and decreased on HPLchol ( - 0·07 ( sd 0·03 ) mmol/l , P < 0·05 ) . Plasma folate and lutein increased more on HPHchol ( P < 0·05 ) . These results suggest that a high-protein energy-restricted diet high in cholesterol from eggs  improved glycaemic and lipid profiles , blood pressure and apo-B in individuals with type 2 diabetes Background : Vitamin D deficiency is prevalent among women , including patients with polycystic ovary syndrome ( PCOS ) . Some studies have suggested that vitamin D may have a role in cardiovascular disease ( CVD ) . There is very limited data on the vitamin D effect on CVD risk factors in women with PCOS and vitamin D deficiency . Aim : To investigate the effect of cholecalciferol on CVD risk factors in PCOS women with vitamin D deficiency . Methods : The study was a r and omized , placebo-controlled , double blinded trial . Fifty PCOS women with vitamin D deficiency ( vitamin D , no.=24 ; placebo , no.=26 ) aged 20–40 yr , were r and omly assigned to receive 3 oral capsules of 50 , 000 IU vitamin D3 or a placebo ( one capsule every 20 days ) for two months . Serum vitamin D , PTH , lipid profile , apolipoprotein AI ( APO-AI ) , and high sensitive C- reactive protein ( hs-CRP ) were measured at baseline and after treatment . Results : Vitamin D3 therapy in PCOS patients , increased serum vitamin D ( 7.00±2.80 to 22.9±6.14 ng/ml ) , decreased serum total cholesterol ( 196.6±32.8 to 179.1±34.1 mg/dl ) , triglyceride ( 156.8±73.0 to 130.5±56.5 mg/dl ) , and VLDL ( 31.4±14.6 to 26.1 ±11.3 mg/dl ) levels significantly ( p<0.05 ) , but it did not affect serum HDL-cholesterol , LDL-cholesterol , APO-AI , and hs-CRP concentrations . There was no change in variables in the placebo group . Conclusions : Our study showed that vitamin D3 therapy had beneficial effects on some CVD risk factors in PCOS patients with vitamin D deficiency . The trial was registered at I RCT .ir ( I RCT 138904113140N2 ) A dietary supplement ( AP , Armolipid Plus ) that combines red yeast rice extract , policosanol , berberine , folic acid , coenzyme Q10 and asthaxantine can have beneficial effects on cardiovascular disease ( CVD ) biomarkers . The aim of this study was to assess whether the intake of AP , in combination with dietary recommendations , reduces serum low density lipoprotein cholesterol ( LDL-c ) concentrations and other CVD biomarkers in patients with hypercholesterolemia . Eligible patients were recruited from the outpatient clinics of six Spanish hospitals Hospital Virgen del Rocío ( Sevilla ) ; Hospital San Jorge ( Huesca ) ; Hospital San Pedro ( Logroño ) ; Hospital Gregorio Marañón ( Madrid ) , Hospital la Fe ( Valencia ) and Hospital Universitari Sant Joan ( Reus ) as recruiting and coordinating center . 102 participants ( mean age ± SD ; 50.91±11.61 ; 32 men ) with low CVD , with mild-to-moderately elevated LDL-c ( between 3.35 mmol/L and 4.88 mmol/L ) without hypolipemic therapy were r and omized in a double-blind , parallel , controlled , multicenter trial commencing January 2012 and ending December 2012 . Among the exclusion criteria were any concomitant chronic disease , triglycerides ( TG ) > 3.97 mmol/L , pregnant or lactating , and history of CVD . At 12 weeks , compared to placebo , AP reduced LDL-c by −6.9 % , apolipoprotein ( Apo ) B-100 by −6.6 % and total cholesterol/HDL-c ratio by −5.5 % , the ApoB/ApoA1 ratio by −8.6 % , while increasing ApoA1 by + 2.5 % ( p<0.05 ) . AP consumption was associated with modest mean weight loss of −0.93 kg ( 95%CI : -1.74 to -0.12 ; P = 0.02 ) compared with control group while dietary composition remained unchanged in the AP group . The AP product was well tolerated . In conclusion , AP , combined with dietary recommendations , reduced LDL-c levels as well as total cholesterol/HDL-c and ApoB/ApoA1 ratios , while increasing Apo A1 , all of which are improvements in CVD risk indicators . AP is a product which could benefit patients having moderate hyperlipidemia and excess body weight . Trial Registration Clinical Trials.gov UNLABELLED The objective was to evaluate whether the soluble fibre Plantago ovata (Po)-husk improves cardiovascular disease ( CVD ) risk biomarkers including low-density lipoprotein cholesterol ( LDL-C ) . METHODS In a multi-centred , double-blind , placebo-controlled , parallel , r and omised trial conducted in primary care-clinics in Spain , France and Holl and , mild-moderate hypercholesterolaemic patients ( age range : 43 - 67 years ) received 14 g/d of Po-husk ( n=126 ) or placebo ( microcrystalline-cellulose 14 g/d ; n=128 ) in a low saturated fat diet for 8 weeks . Subsequently , if LDL-C remained > or = 3.35 mmol/L [ 130 mg/dL ] , participants proceeded with the fibre plus simvastatin ( 20mg/d ) for further 8 weeks . Lipid profile , blood pressure ( BP ) , insulin , oxidised LDL and some gene polymorphisms involved in CVD risk were measured . RESULTS Relative to placebo , Po-husk reduced plasma LDL-C by -6 % ( P<0.0002 ) , total cholesterol ( TC ) by -6 % , triglycerides ( TG ) by -21.6 % , apolipoprotein ( Apo ) B-100 by -6.7 % , oxidised LDL by a mean of -6.82 U/L ( 95%CI : 3.15 - 10.48 ) , insulin by -4.68 pmol/L ( 95%CI : 0.68 - 8.67 ) and systolic BP by -4.0 mm Hg ( 95%CI ; 1.2 - 6.7 ) ( P<0.05 ) . The TG-lowering effect in the Po-husk group was magnified by variants in plasminogen-activator-inhibitor ( PAI-1 ; rs1799768 ) and fatty acid-binding protein ( FABP-2 ; rs1799883 ) genes . At 16 weeks , the intra-group action of simvastatin ( 20mg/d ) added to Po-husk or placebo was a similar LDL-C reduction . CONCLUSIONS Po-husk , apart from lowering LDL-C , also reduced TG , TG related to certain gene variants , TC , Apo B-100 , oxLDL , insulin-resistance and systolic BP in mild-moderate hypercholesterolaemic individuals . Thus , the target patients to receive Po-husk would be those who present a cluster of various CVD risk factors , such as metabolic syndrome
We conclude that omega-3 fatty acids may be associated with lower inflammatory biomarkers among diabetic and cardiovascular patients .
The purpose of this systematic review and meta- analysis was to investigate omega-3 fatty acids ’ influence on 12 inflammatory biomarkers — LDL , HDL , total cholesterol , TG , HbA1c , Apo AI , Apo AII , Apo B , CRP , TNF-α , glucose , and fasting blood glucose among diabetic and cardiovascular disease ( CVD ) patients .