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      Circulating Very Long‐Chain Saturated Fatty Acids and Heart Failure: The Cardiovascular Health Study

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          Abstract

          Background

          Circulating very‐long‐chain saturated fatty acids ( VLSFAs) are integrated biomarkers of diet and metabolism that may point to new risk pathways and potential targets for heart failure ( HF) prevention. The associations of VLSFA to HF in humans are not known.

          Methods and Results

          Using a cohort study design, we studied the associations of serially measured plasma phospholipid VLSFA with incident HF in the Cardiovascular Health Study. We investigated the associations of time‐varying levels of the 3 major circulating VLSFAs, lignoceric acid (24:0), behenic acid (22:0), and arachidic acid (20:0), with the risk of incident HF using Cox regression. During 45030 person‐years among 4249 participants, we identified 1304 cases of incident HF, including 489 with preserved and 310 with reduced ejection fraction. Adjusting for major HF risk factors and other circulating fatty acids, higher levels of each VLSFAs were associated with lower risk of incident HF ( P trend≤0.0007 each). The hazard ratio comparing the highest quintile to the lowest quintile was 0.67 (95% confidence interval, 0.55–0.81) for 24:0, 0.72 (95% confidence interval, 0.60–0.87) for 22:0 and 0.72 (95% confidence interval, 0.59–0.88) for 20:0. The associations were similar in subgroups defined by sex, age, body mass index, coronary heart disease, and diabetes mellitus. Among those with ejection fraction data, the associations appeared similar for those with preserved and with reduced ejection fraction.

          Conclusions

          Higher levels of circulating VLSFAs are associated with lower risk of incident HF in older adults. These novel associations should prompt further research on the role of VLSFA in HF, including relevant new risk pathways.

          Clinical Trial Registration

          URL: https://www.clinicaltrials.gov. Unique identifier: NCT00005133.

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          Most cited references22

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          Epidemiology and risk profile of heart failure.

          Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. HF represents a considerable burden to the health-care system, responsible for costs of more than $39 billion annually in the USA alone, and high rates of hospitalizations, readmissions, and outpatient visits. HF is not a single entity, but a clinical syndrome that may have different characteristics depending on age, sex, race or ethnicity, left ventricular ejection fraction (LVEF) status, and HF etiology. Furthermore, pathophysiological differences are observed among patients diagnosed with HF and reduced LVEF compared with HF and preserved LVEF, which are beginning to be better appreciated in epidemiological studies. A number of risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes, among others, have been identified that both predict the incidence of HF as well as its severity. In this Review, we discuss key features of the epidemiology and risk profile of HF.
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            Applying Cox regression to competing risks.

            Two methods are given for the joint estimation of parameters in models for competing risks in survival analysis. In both cases Cox's proportional hazards regression model is fitted using a data duplication method. In principle either method can be used for any number of different failure types, assuming independent risks. Advantages of the augmented data approach are that it limits over-parametrisation and it runs immediately on existing software. The methods are used to reanalyse data from two well-known published studies, providing new insights.
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              An overview of sphingolipid metabolism: from synthesis to breakdown.

              Sphingolipids constitute a class of lipids defined by their eighteen carbon amino-alcohol backbones which are synthesized in the ER from nonsphingolipid precursors. Modification of this basic structure is what gives rise to the vast family of sphingolipids that play significant roles in membrane biology and provide many bioactive metabolites that regulate cell function. Despite the diversity of structure and function of sphingolipids, their creation and destruction are governed by common synthetic and catabolic pathways. In this regard, sphingolipid metabolism can be imagined as an array of interconnected networks that diverge from a single common entry point and converge into a single common breakdown pathway. In their simplest forms, sphingosine, phytosphingosine and dihydrosphingosine serve as the backbones upon which further complexity is achieved. For example, phosphorylation of the C1 hydroxyl group yields the final breakdown products and/or the important signaling molecules sphingosine-1-phosphate, phytosphingosine-1-phosphate and dihydrosphingosine-1-phosphate, respectively. On the other hand, acylation of sphingosine, phytosphingosine, or dihydrosphingosine with one of several possible acyl CoA molecules through the action of distinct ceramide synthases produces the molecules defined as ceramide, phytoceramide, or dihydroceramide. Ceramide, due to the differing acyl CoAs that can be used to produce it, is technically a class of molecules rather than a single molecule and therefore may have different biological functions depending on the acyl chain it is composed of. At the apex of complexity is the group of lipids known as glycosphingolipids (GSL) which contain dozens of different sphingolipid species differing by both the order and type of sugar residues attached to their headgroups. Since these molecules are produced from ceramide precursors, they too may have differences in their acyl chain composition, revealing an additional layer of variation. The glycosphingolipids are divided broadly into two categories: glucosphingolipids and galactosphingolipids. The glucosphingolipids depend initially on the enzyme glucosylceramide synthase (GCS) which attaches glucose as the first residue to the C1 hydroxyl position. Galactosphingolipids, on the other hand, are generated from galactosylceramide synthase (GalCerS), an evolutionarily dissimilar enzyme from GCS. Glycosphingolipids are further divided based upon further modification by various glycosyltransferases which increases the potential variation in lipid species by several fold. Far more abundant are the sphingomyelin species which are produced in parallel with glycosphingolipids, however they are defined by a phosphocholine headgroup rather than the addition of sugar residues. Although sphingomyelin species all share a common headgroup, they too are produced from a variety of ceramide species and therefore can have differing acyl chains attached to their C-2 amino groups. Whether or not the differing acyl chain lengths in SMs dictate unique functions or important biophysical distinctions has not yet been established. Understanding the function of all the existing glycosphingolipids and sphingomyelin species will be a major undertaking in the future since the tools to study and measure these species are only beginning to be developed (see Fig 1 for an illustrated depiction of the various sphingolipid structures). The simple sphingolipids serve both as the precursors and the breakdown products of the more complex ones. Importantly, in recent decades, these simple sphingolipids have gained attention for having significant signaling and regulatory roles within cells. In addition, many tools have emerged to measure the levels of simple sphingolipids and therefore have become the focus of even more intense study in recent years. With this thought in mind, this chapter will pay tribute to the complex sphingolipids, but focus on the regulation of simple sphingolipid metabolism.
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                Author and article information

                Contributors
                rozenl@uw.edu , rozenl@u.washington.edu
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                24 October 2018
                06 November 2018
                : 7
                : 21 ( doiID: 10.1002/jah3.2018.7.issue-21 )
                : e010019
                Affiliations
                [ 1 ] Department of Medicine Cardiovascular Health Research Unit University of Washington Seattle WA
                [ 2 ] Department of Biostatistics University of Washington Seattle WA
                [ 3 ] Department of Epidemiology University of Washington Seattle WA
                [ 4 ] School of Medicine Wake Forest University Winston Salem NC
                [ 5 ] Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle WA
                [ 6 ] Department of Internal Medicine University of New Mexico Albuquerque NM
                [ 7 ] Institute for Urban Health New York Academy of Medicine New York NY
                [ 8 ] Department of Health Services University of Washington Seattle WA
                [ 9 ] Kaiser Permanente Washington Health Research Institute Seattle WA
                [ 10 ] Friedman School of Nutrition Science & Policy Tufts University Boston MA
                Author notes
                [*] [* ] Correspondence to: Rozenn N. Lemaitre, PhD, MPH, University of Washington, 1730 Minor Ave, Ste 1360, Seattle, WA 98101. E‐mails: rozenl@ 123456uw.edu ; rozenl@ 123456u.washington.edu
                Article
                JAH33598
                10.1161/JAHA.118.010019
                6404213
                30608197
                f049b68c-7cf7-46fc-b6f0-0fdeedef83f1
                © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 10 August 2018
                : 14 September 2018
                Page count
                Figures: 1, Tables: 3, Pages: 8, Words: 6367
                Funding
                Funded by: National Heart, Lung, and Blood Institute (NHLBI)
                Award ID: R01‐HL085710
                Award ID: R01‐HL094555
                Award ID: U01HL080295
                Award ID: U01HL130114
                Funded by: Office of Dietary Supplements
                Funded by: National Institute of Neurological Disorders and Stroke (NINDS)
                Funded by: National Institute on Aging (NIA)
                Award ID: R01AG023629
                Categories
                Original Research
                Original Research
                Epidemiology
                Custom metadata
                2.0
                jah33598
                06 November 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.4 mode:remove_FC converted:13.12.2018

                Cardiovascular Medicine
                epidemiology,fatty acid,heart failure
                Cardiovascular Medicine
                epidemiology, fatty acid, heart failure

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