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Metabolic and inflammatory risk reduction in response to lipid-lowering and lifestyle modification in the medically
Michael P Chu1, Gina Many2, Daniel A Isquith1
1Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States.
Insights
Medically underserved populations have higher atherosclerotic cardiovascular disease (ASCVD) risk. Despite similar treatment results, underserved individuals maintained higher risk factors over two years, indicating a need for improved interventions.
Area of Science:
- Cardiology
- Public Health
- Metabolic Syndrome
Background:
- Medically underserved (US) populations exhibit elevated atherosclerotic cardiovascular disease (ASCVD) risk.
- Limited research has focused on ASCVD risk reduction strategies specifically for US populations.
Purpose of the Study:
- To compare ASCVD risk factors and intervention outcomes between medically underserved (US) and adequately insured (AS) individuals with carotid atherosclerosis.
- To identify potential disparities in ASCVD risk reduction between these groups.
Main Methods:
- The study enrolled 217 subjects with ApoB ≥120 mg/dL and carotid atherosclerosis.
- Subjects received 2-year atorvastatin-based lipid therapies and lifestyle intervention.
- US (n=33) lacked adequate healthcare insurance; AS (n=184) had adequate coverage. Baseline and follow-up metabolic and inflammatory markers were compared.
Main Results:
- At baseline, US individuals had higher systolic blood pressure, fasting glucose, fasting insulin, HOMA-IR, and hsCRP compared to AS individuals.
- Over 2 years, both groups showed similar percentage reductions in LDL-C, triglycerides, and hsCRP.
- Despite similar relative reductions, US individuals maintained significantly higher levels of fasting blood glucose, HOMA-IR, and hsCRP post-intervention.
Conclusions:
- Medically underserved individuals exhibit higher baseline ASCVD risk and persistently higher risk factor levels over two years, even with comparable intervention-induced reductions.
- Findings underscore the critical need for enhanced intervention strategies and implementation methods to effectively reduce ASCVD risk in medically underserved populations.
Introduction:
Medically underserved (US) populations have an increased level of atherosclerotic cardiovascular disease (ASCVD) risk, however, few studies investigated ASCVD risk reduction in US.
Methods:
Of 217 subjects with ApoB ≥120 mg/dL and carotid atherosclerosis (≥15% stenosis by ultrasound) enrolled in the Carotid Plaque Composition by MRI (CPC) study between 2005 and 2011, US (n=33) was defined as those without adequate healthcare insurance, while AS (n=184) included those with adequate healthcare coverage. All subjects received atorvastatin-based lipid therapies and lifestyle intervention for 2 years. Metabolic and inflammatory risk factors were compared between AS and US.
Results:
At baseline, compared to AS, US displayed higher levels of metabolic and inflammatory risk including systolic blood pressure (140±27 vs. 131±18 mmHg, p=0.04), fasting glucose (125±59 vs. 102±22 mg/dL, p=0.03) and fasting insulin (39±33 vs. 28±20 µU/dL, p=0.03) which resulted in higher insulin resistance (HOMA-IR 2.2±0.4 vs. 1.3±0.1, p=0.03), and hsCRP (5.6±1.5 vs. 2.8±0.2 mg/L, p=0.03). Over 2 years of intervention, US and AS showed similar reductions in LDL-C (-10.7% vs. -16% per year, p=0.2), triglycerides (-16.7% vs. -15.9% per year, p=0.4), and hsCRP (-0.11% vs. -0.04% per year, p=0.1). However, US continued to show significantly higher levels of fasting blood glucose (115±6.0 vs. 101±2.0 mg/dL, p=0.03) and HOMA-IR (1.9±0.2 vs. 1.5±0.1, p=0.047), and hsCRP (3.9±0.7 vs. 1.9±0.2 mg/L, p<0.001) than AS following 2 years of interventions.
Conclusions:
US displayed higher ASCVD risk than AS at baseline and over 2 years despite similar reductions following the intervention. These findings highlight the unmet needs for improved intervention strategies and implementation methods for ASCVD risk reduction in US.
Clinical Trial Registration:
NCT00715273 at ClinicalTrials.gov.
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