The Importance of Maintaining Regular Dietary Patterns to reduce CVD risk
The Importance of Maintaining Regular Dietary Patterns to reduce CVD risk
Cardiovascular disease (CVD) is the leading cause of mortality worldwide. An estimated 17.9 million people died from some form of CVD in 2019, accounting for 32% of all-cause mortality that year1. Associations between diet and risk of cardiovascular complications have long been established, largely relating to alterations in lipid profiles.
For as long as anyone can remember, breakfast has been considered the most important meal of the day. Previous studies2 have shown an association between skipping breakfast and increased CVD risk prompting recommendations that up to 30% of one’s daily energy intake should be consumed during the first meal of the day. It has been reported that over 25% of adults skip breakfast. These individuals are often socioeconomically disadvantaged, shift workers, individuals who work particularly long hours, those who suffer from depression or those with poor health literacy2. Another study3 showed that skipping breakfast, when compared with consuming a high-energy breakfast, was associated with a 1.6x and 2.6x higher probability of non-coronary and general atherosclerosis respectively, when all other CVD risk factor had been controlled. This suggests a close relationship between eating breakfast and reducing CVD risk, however, the mechanisms and magnitude of this relationship are poorly understood.
Small, dense low-density lipoprotein cholesterol (sdLDL-C) is a smaller form of LDL-C which boasts greater propensity for uptake by arterial tissue, increased proteoglycan binding, and increased susceptibility for oxidation4. sdLDL-C concentration is strongly associated with CVD risk, yet once again, the mechanisms of this association remain enigmatic. It is thought that all of the metabolic changes associated with alterations in sdLDL-C concentration collectively contribute to the increased risk of CVD, with the main drivers being its propensity for uptake by arterial tissues and its long circulatory stability4
Skipping breakfast and sdLDL-C
A recent study investigated the relationship between skipping breakfast and the effects on lipid parameters5. In a cohort of around 28’000 people from the Japanese population, this study looked at the several markers, including sdLDL-C, to develop an understanding of the importance of regular dietary patterns for reducing the risk of CVD.
The study participants were divided into two main categories: breakfast eaters and breakfast skippers. These categories were further subdivided to differentiate men and women, over and under 55 years old, and those who eat staple products (rice, pasta, bread, etc.) and those who did not. The participants contributed blood samples which were tested for several cardiovascular biomarkers: Creatinine, Liver ALT, Total Cholesterol, Triglycerides, direct LDL-C, HDL-C and sdLDL-C.
They found that around 26% of men and 16.9% of women skipped breakfast regularly. Of these, most were considered young and had significant increases in concentration of triglycerides, LDL-C and sdLDL-C compared with those who ate breakfast almost every day.
Table 1. Median concentration of triglycerides, LDL-C, and sdLDL-C for breakfast skippers and eaters5
| Analyte | Breakfast Skippers (mg/dL) | Breakfast Eaters (mg/dL) |
| Triglycerides | 103 | 93 |
| LDL-C | 124 | 122 |
| sdLDL-C | 34.7 | 32 |
This investigation also revealed that in this cohort, 20% of men and 27.3% of women did not regularly consume staple foods as part of their diet and had higher median sdLDL-C concentration.
Table 2. Median concentration of sdLDL-C in men and women who eat or skip staple food products in their diet5
| Gender | Staple Skippers (mg/dL) | Staple Eaters (mg/dL) |
| Men | 34.1 | 31.6 |
| Women | 25.8 | 24.7 |
The data from this study supports the finding that individuals who skipped breakfast had higher sdLDL-C concentrations than those who ate breakfast consistently. Skipping breakfast can therefore be associated with troublesome lipid parameters in both genders and all age groups in the Japanese population. This study suggests that eating breakfast every day is crucial to maintain beneficial lipid parameters and reduce the risk of developing CVD.
The data also show that individuals who skipped staple foods in their meals presented with higher concentrations of sdLDL-C and a higher sdLDL-C/LDL-C ratio, in men and postmenopausal women, when compared with those who included staple foods in their meals. It is becoming increasingly common to remove staple foods from one’s diet due to their high carbohydrate content and the prevalence of low-carbohydrate diets. This data exhibits the importance of maintaining a nutritionally balanced diet to help reduce the risk of developing CVD.
As the first large scale study of its kind, this analysis provides clear insight into the increased risk of CVD associated with not only skipping breakfast, but failing to maintain a nutritionally balanced diet. The major limitation of this analysis is that it only includes individuals from the Japanese population and the same affects may not be seen in populations from other ethnicities. Therefore, further in-depth analysis is required to confirm these findings in other ethnicities
Randox sdLDL-C Assay
The Randox sdLDL-C assay employs the clearance method which displays good correlation with the gold standard in sdLDL-C quantification, giving laboratories increased confidence in their results first time, every time. Supplied as liquid ready-to-use reagents, this this test can be applied to a wide range of clinical chemistry analysers, producing results in as little as 10 minutes. Relevant controls and calibrators are also available from Randox as part of the Acusera range.
Randox sdLDL-C Assay Key Features
- Direct, automated test for convenience and efficiency.
- Rapid analysis results can be produced in as little as ten minutes, facilitating faster patient diagnosis and treatment plan implementation.
- Liquid ready-to-use reagents for convenience and ease of use.
- Applications available detailing instrument specific settings for a wide range of clinical chemistry analysers.
- sdLDL-C controls and calibrator available.
References
- World Health Organization. Cardiovascular Diseases. World Health Organization. Published June 11, 2021. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
- Ofori-Asenso R, Owen AJ, Liew D. Skipping Breakfast and the Risk of Cardiovascular Disease and Death: A Systematic Review of Prospective Cohort Studies in Primary Prevention Settings. Journal of Cardiovascular Development and Disease. 2019;6(3):30. doi:https://doi.org/10.3390/jcdd6030030
- Uzhova I, Fuster V, Fernández-Ortiz A, et al. The Importance of Breakfast in Atherosclerosis Disease. Journal of the American College of Cardiology. 2017;70(15):1833-1842. doi:https://doi.org/10.1016/j.jacc.2017.08.027
- Rizvi AA, Stoian AP, Janez A, Rizzo M. Lipoproteins and cardiovascular disease: An update on the clinical significance of atherogenic small, dense LDL and new therapeutical options. Biomedicines. 2021;9:1579. doi:https://doi.org/10.3390/biomedicines9111579
- Arimoto M, Yamamoto Y, Imaoka W, et al. Small dense low-density lipoprotein cholesterol levels in breakfast skippers and staple food skippers. Journal of Atherosclerosis and Thrombosis. 2023;30. doi:https://doi.org/10.5551/jat.64024
For more information on our sdLDL-C assay or any of our other products, please contact us at: marketing@randox.com
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The Randox bile acids test utilises an advanced enzyme cycling method which displays outstanding sensitivity and precision when compared to traditional enzymatic based tests. The Randox 5th Generation Bile Acids test is particularly useful in paediatrics where traditional bile acids tests are affected by haemolytic and lipaemic samples.
A superior assay from Randox, the vanadate oxidation method offers several advantages over the diazo method, including less interference by haemolysis and lipaemia, which is particularly evident for infant and neonatal populations.
The Randox Fructosamine assay utilises the enzymatic method which offers improved specificity and reliability compared to conventional NBT-based methods. The Randox enzymatic method does not suffer from non-specific interferences unlike other commercially available fructosamine assays.
Soluble transferrin receptor (sTfR) is a marker of iron status. In iron deficiency anaemia, sTfR levels are significantly increased, however remain normal in the anaemia of inflammation. Consequently, sTfR measurement is useful in the differential diagnosis of microcytic anaemia.
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Featured Reagent – sPLA₂-IIA
Featured Reagent | sPLA2-IIA
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Benefits
A niche assay from Randox which means that Randox is one of the only manufacturers to offer an sPLA2-llA mass assay in an automated biochemistry format
Applications available detailing instrument-specific settings for the convenient use of the Randox sPLA2-IIA assay on a wide range of clinical chemistry analysers
Complementary controls and calibrators available offering a complete testing package
Automated assay which removes the inconvenience and time consumption associated with traditional ELISA based testing
Excellent correlation coefficient of r = 0.95 when compared against other commercially available methods
Liquid ready-to-use format for convenience and ease of use
Latex enhanced immunoturbidimetric method delivers high performance and confidence in results
NOTE: sPLA2 -IIA Assay – For Research Use Only
Clinical Significance
sPLA2-llA production of fatty acids and biologically active phospholipids plays an important role in platelet, monocyte, and endothelial activation, processes known to be critical steps in atherogenesis.1
Unlike traditional cardiac biomarkers used to predict adverse outcomes in patients with acute coronary syndrome (ACS), sPLA2-llA has been shown to act at multiple pathways involved in atherogenesis, from lipid oxidation to modulation of vascular & inflammatory cell activation and apoptosis.2
Biological Significance of sPLA2-IIA
Key observations through research has found that sPLA2-llA mediated modification of lipoproteins plays a role in the development of atherosclerosis. The surface of both low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) is surrounded by phosphatidylcholine (PC) a type of phospholipid which has been scientifically proven to serve as a good extracellular target for several isoforms of sPLA2-llA. sPLA2-llA works by hydrolysing these phospholipids resulting in the production of free fatty acids and lysophophatidylcholine (LPC) which can generate pro-inflammatory actions, accelerating atherosclerosis.1
Hydrolysis of LDL-C correlates with the production of the more atherogenic, small dense LDL cholesterol (sdLDL-C). The sPLA2-llA -processed low-density lipoprotein (LDL) contains a large amount of lysophospholipids and exhibit the property of “small-dense” or “modified” LDL, which facilitates foam cell formation from macrophages. Research has shown that high plasma levels of sdLDL-C compared to less dense, larger LDL-C create a higher risk of coronary heart disease.
Cardiovascular Disease
Regular cardiovascular screening is important to ensure that cardiac risk factors are detected at the earliest possible stages. Cardiovascular disease (CVD) encompasses a number of diseases of the heart and blood vessels. Four of the main types of CVD include: coronary heart disease (CHD), cerebrovascular disease (CVA), peripheral arterial disease (PAD) and aortic disease. It is vital that at risk patients are diagnosed as quickly and efficiently as possible to ensure effective treatment plan implementation.4
The early diagnosis of CVD aids in reducing the risk of a secondary cardiovascular event and to ensure the patient receives appropriate treatment to prevent premature deaths. Early risk assessment is particularly important in people who are at a greater risk of CVD. This is evaluated through the identification of one or more risk factors including: hypertension, diabetes or hyperlipidaemia. 3 ,5
It is believed that by 2030, almost 23.6 million people will die from CVD, mainly CHD and CVA, and is projected to remain the single leading cause of death. This provides further confirmation that early diagnosis is vital to prevent and reduce the number of deaths attributed to CVD.3
Biological Significance of sPLA2-IIA
Key observations through research has found that sPLA2-llA mediated modification of lipoproteins plays a role in the development of atherosclerosis. The surface of both low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) is surrounded by phosphatidylcholine (PC) a type of phospholipid which has been scientifically proven to serve as a good extracellular target for several isoforms of sPLA2-llA. sPLA2-llA works by hydrolysing these phospholipids resulting in the production of free fatty acids and lysophophatidylcholine (LPC) which can generate pro-inflammatory actions, accelerating atherosclerosis.1
Hydrolysis of LDL-C correlates with the production of the more atherogenic, small dense LDL cholesterol (sdLDL-C). The sPLA2-llA -processed low-density lipoprotein (LDL) contains a large amount of lysophospholipids and exhibit the property of “small-dense” or “modified” LDL, which facilitates foam cell formation from macrophages. Research has shown that high plasma levels of sdLDL-C compared to less dense, larger LDL-C create a higher risk of coronary heart disease.
Cardiovascular Disease
Regular cardiovascular screening is important to ensure that cardiac risk factors are detected at the earliest possible stages. Cardiovascular disease (CVD) encompasses a number of diseases of the heart and blood vessels. Four of the main types of CVD include: coronary heart disease (CHD), cerebrovascular disease (CVA), peripheral arterial disease (PAD) and aortic disease. It is vital that at risk patients are diagnosed as quickly and efficiently as possible to ensure effective treatment plan implementation.4
The early diagnosis of CVD aids in reducing the risk of a secondary cardiovascular event and to ensure the patient receives appropriate treatment to prevent premature deaths. Early risk assessment is particularly important in people who are at a greater risk of CVD. This is evaluated through the identification of one or more risk factors including: hypertension, diabetes or hyperlipidaemia. 3 ,5
It is believed that by 2030, almost 23.6 million people will die from CVD, mainly CHD and CVA, and is projected to remain the single leading cause of death. This provides further confirmation that early diagnosis is vital to prevent and reduce the number of deaths attributed to CVD.3
References
[1] Secreted phospholipase A2, lipoprotein hydrolysis, and atherosclerosis: integration with lipidomics. Kei, Yamamoto, et al. 7, s.l. : Analytical and Bioanalytical Chemistry, 2011, Vol. 400.
[2] Circulatory secretory phospholipase A2 activity predicts recurrent events in patients with severe acute coronary syndromes. . Mallat, Ziad, Steg, Gabriel and Benessiano, Joelle. 7, s.l. : Journal of the American College of Cardiology, 2005, Vol. 46.
[3] World Health Organization. Cardiovascular Diseases. World Health Organization. [Online] World Health Organization, May 17, 2017. [Cited: August 21, 2018.] https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
[4] National Health Service (NHS). Cardiovascular disease. [Online] September 17, 2018. [Cited: November 30, 2018.] https://www.nhs.uk/conditions/cardiovascular-disease/.
[5] National Institute for Health and Care Excellence (NICE). Cardiovascular disease risk assessment and prevention. [Online] no date. [Cited: ovember 30, 2018.] https://bnf.nice.org.uk/treatment-summary/cardiovascular-disease-risk-assessment-and-prevention.html.
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Adiponectin is a protein hormone secreted by adipocytes with anti-inflammatory and insulin-sensitising properties. It plays an important role in a number of metabolic processes including glucose regulation and fatty acid oxidation. Adiponectin levels are inversely correlated with abdominal visceral fat which have proven to be a strong predictor of several pathologies, including: metabolic syndrome, type 2 diabetes mellitus (T2DM), cancers and cardiovascular disease (CVD). For more information on the importance of testing Adiponectin levels, check out our Adiponectin Whitepaper.
Cystatin C
Cystatin C is an early risk marker for renal impairment. The most commonly run test for renal impairment is Creatinine. Creatinine measurements have proven to be inadequate as certain factors must be taken into consideration, including age, gender, ethnicity etc. The National Institute for Health and Care Excellence (NICE) have updated their guidelines, which now recommends Cystatin C as a more superior test for renal impairment due to its higher specificity for significant disease outcomes than those based on Creatinine. For more information on the importance of testing Cystatin C levels, check out our Cystatin C Whitepaper.
Small-dense LDL Cholesterol (sdLDL-C)
LDL Cholesterol (LDL-C) consists of two parts: the large and buoyant LDL Cholesterol and the small and dense LDL Cholesterol. Whilst all LDL-C transports triglycerides and cholesterol to bodily tissues, their atherogensis varies according to their size. As sdLDL-C is small and dense, they can more readily permeate the arterial wall and are more susceptible to oxidation. Research indicates that individuals with a predominance of sdLDL-C have a 3-fold increased risk of myocardial infarction. It has been noted that sdLDL-C carries less Cholesterol than large LDL, therefore a patient with predominately sdLDL-C particle may require nearly 70% more sdLDL-C particles to carry the same amount of cholesterol as the patient with predominately LDL-C particles. For more information on the importance of testing sdLDL-C levels, check out our sdLDL-C Whitepaper.
These three niche in vitro diagnostics tests developed by Randox scientists can aid in reducing NHS costs due to their higher performance compared to the traditional tests. Randox are constantly striving to improve healthcare worldwide.
For more information on the extensive range of Randox third-party in vitro diagnostic reagents, visit: https://www.randox.com/diagnostic-reagents/ or contact reagents@randox.com.
