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CMHC PULSE

Cardio Metabolic Health Congress – Official Blog

Lipoprotein(a) Levels and Family History Predict CVD Risk

A myriad of biological and environmental factors can affect an individual’s risk for cardiovascular disease, with the presence of compounding factors elevating the likelihood of CVD development even further. Both elevated lipoprotein(a) and a family history (FHx) of coronary heart disease (CHD) have been individually associated with greater cardiovascular risk. At the same time, lipoprotein(a) is commonly measured in those with a family history of CHD, potentially putting them at an increased risk.Lipoprotein(a) is a small lipoprotein formed in the liver that is associated with strokes, venous thromboembolism, and occlusion of vascular stents and coronary bypass grafts. Similarly, patients with a family history of CHD face an increased risk of cardiovascular disease and are more prone to strokes as well as other cardiac events.

ASCVD, CHD Risk Factors

A new study published in the Journal of the American College of Cardiology aimed to further clarify the independent and joint associations of Lp(a) and FHx with atherosclerotic cardiovascular disease (ASCVD) and CHD among asymptomatic subjects. To determine the aforementioned associations, the study’s authors measured plasma Lp(a) and family history in two cohorts – Atherosclerosis Risk in Communities (ARIC) and the Dallas Heart Study (DHS). Elevated Lp(a) was defined as the highest race-specific quintile. Cox regression models adjusted for cardiovascular risk factors – including diabetes, smoking, systolic blood pressure, and antihypertensive use – were employed to determine the associations between Lp(a) and family history with cardiovascular risk.

Predictors of CVD Risk

In the cohort of 12,149 participants included in the study, a total of 3,114 atherosclerotic cardiovascular disease events were reported during the 21 years of follow-up. Both family history and elevated lipoprotein levels were independently associated with ASCVD, while no Lp(a)-by-FHx interaction was noted.

Compared with participants who had neither FHx nor elevated Lp(a), those with either elevated Lp(a) or FHx were at a higher atherosclerotic cardiovascular disease risk. Meanwhile, participants who presented with both factors had the highest overall risk. The team of researchers reported similar findings observed in the case of coronary heart disease risk; the presence of both elevated Lp(a) and FHx resulted in greater improvement in ASCVD and CHD risk reclassification and discrimination indexes than when either marker was evaluated alone.

The recent study adds to a growing body of literature outlining the significant roles of lipoprotein(a) and family history of premature CHD and CHD at any age in the development of cardiovascular disease. These findings implicate that elevated plasma (Lp)a and FHx can have independent and additive joint associations with cardiovascular risk, which may assist medical professionals with the development of primary prevention therapy protocols and prompt additional investigations. Further clinical trials are needed to elucidate the degree to which family history of CHD and plasma levels of Lp(a) are able to influence cardiovascular disease prevention.

Dairy Intake Linked to Decreased Diabetes, Hypertension Risk 

Characterized by elevated blood pressure, abdominal obesity, elevated triglycerides, low high density lipoprotein cholesterol, and elevated blood glucose, metabolic syndrome (MetS) has been associated with an increased risk of cardiometabolic diseases. Researchers continue to evaluate the role of nutritional behaviors in the development of these conditions, including cardiovascular disease and type 2 diabetes. In particular, diary intake has been studied for its impact on lipid levels, blood pressure, and other risk factors as emerging evidence suggests whole fat and fermented dairy products may influence diverse metabolic pathways.

Although prior research implicates that dairy consumption is associated with a decreased risk of MetS, diabetes, and hypertension, the majority of these studies have been conducted in North American and European populations, limiting the generalizability of their findings. A new international study published online in BMJ Open Diabetes Research & Care reports that a diary-rich diet has the potential to reduce the risk of certain cardiometabolic conditions – including diabetes and high blood pressure – along with several cardiovascular disease risk factors.

Association of Dairy Consumption with Cardiometabolic Conditions

The most recent trial evaluated 147,812 participants aged between 35 and 70 from 21 countries, to verify the generalizability of prior findings and ascertain whether the associations between diary consumption and reduced cardiometabolic disease risk can be found on an international scale. As part of the Prospective Urban Rural Epidemiology (PURE) study, investigators assessed the association between dairy intake and MetS prevalence as well as its components over a median follow-up period of 9.1 years. This included the incidence of hypertension and diabetes in the cohort.

Dietary dairy intake was assessed using Food Frequency Questionnaires and evaluated whether participants consumed milk, yogurt, yogurt drinks, cheese, and dishes prepared with dairy products classified as either full or low fat. The average daily total dairy intake was 179 grams, this included 124.5 grams of full fat and 65 grams of low fat products.

Additionally, the research team collected data on individual personal medical history, prescription medicine use, educational level, smoking status, weight and height measurements, blood pressure, and fasting blood glucose.

Reduced Incidence of Metabolic Syndrome Components

After an average of 9 years of follow-up, 13,640 participants developed hypertension while 5,351 developed diabetes. Over 46,660 subjects had metabolic syndrome, defined as at least 3 of the 5 components. The team’s findings reveal that total dairy and full fat – but not low fat – dairy intakes were associated with a decreased prevalence of most components of metabolic syndrome, especially in countries with typically lower daily dairy consumption.

Compared with participants who did not consume dairy, those who had an intake of at least 2 servings of dairy a day experienced a 24% reduction in metabolic syndrome risk. The risk reduction grew to 28% in participants who consumed full fat dairy products. Similarly, at least 2 servings a day of total dairy were linked to a 12% reduction in the risk of both hypertension and diabetes, while 3 servings contributed to a 13-14% lower risk.

The latest findings indicate the potential benefits of increasing whole fat dairy intake for the reduction of MetS risk and its component factors, as well as for lowering the incidence of hypertension and diabetes. While the recent study proves that prior findings linking dairy consumption to cardiometabolic health implications are generalizable across an international population, further large-scale randomized trials need to be conducted to ascertain the connection between whole fat dairy products and decreased risk of MetS, hypertension, and diabetes.