Document Type : Original Article(s)
Authors
- Artem Neverovskyi 1
- Volodymyr Chernyavskyi 2
- Vadym Shypulin 3
- Lesia Hvozdetska 4
- Victoriya Tishchenko 4
- Tetyana Nechypurenko 4
- Nataliia Mikhn`ova 4
1 PhD Candidate, Department of Internal Medicine №1, Bogomolets National Medical University, Kyiv, Ukraine
2 Professor, Department of Internal Medicine №1, Bogomolets National Medical University, Kyiv, Ukraine
3 Professor, Head of the Department, Department of Internal Medicine №1, Bogomolets National Medical University, Kyiv, Ukraine
4 Associate Professor, Department of Internal Medicine №1, Bogomolets National Medical University, Kyiv, Ukraine
Abstract
BACKGROUND: Reduction of cardiovascular risk (CVR) is based on the correction of risk factors, especially dyslipidemia. Due to the limiting factors of conventional lipid-lowering medications, the investigation of alternative approaches is necessary.METHODS: The present open, comparative, randomized, and parallel investigation was conducted on 77 patients. Participants were of both sexes, 40-74 years-of-age, and had dyslipidemia. The participants were divided into 2 groups; the treatment group (n = 41) received a combination of Lactobacillus plantarum and simvastatin 20 mg once a day, and the control group (n = 36) received simvastatin 20 mg once a day. The trial included 5 visits; screening on the first 2, and treatment on the next 3 (on weeks 4, 8, and 12). On visits 1, 3, 4, and 5, the lipid profile was evaluated and CVR was calculated using 5 tools.RESULTS: The combination treatment led to a more pronounced decrease in total cholesterol (TC) and low-density lipoproteins (LDL) after 8 weeks (P = 0.002 and 0.016, respectively), that persisted after 12 weeks (P < 0.001 and 0.002, respectively). Reduction in TC and LDL by ³ 20% was observed more predominantly in the treatment group. A significant reduction was observed in CVR in the treatment group according to the Prospective Cardiovascular Münster (PROCAM) score (P = 0.004). Reduction of CVR by ³ 20% was mostly observed as a result of prescribing combination therapy according to the Framingham Risk Score (70.7%; P = 0.003), 2013 ACC/AHA ASCVD Risk Calculator (51.2%; P = 0.035), PROCAM (65.9%; P < 0.001), and WHO CVD risk chart (56.1%; P = 0.012).CONCLUSION: Additional supplementation with Lactobacillus plantarum was more effective in the reduction of TC, LDL, and CVR according to PROCAM and the attainment of treatment goals regarding lipid profile and CVR levels.
Keywords
- Mensah GA, Roth GA, Fuster V. The global burden of cardiovascular diseases and risk factors: 2020 and beyond. J Am Coll Cardiol 2019; 74(20): 2529-32.
- World Health Organization cardiovascular disease risk charts: Revised models to estimate risk in 21 global regions. Lancet Glob Health 2019; 7(10): e1332-e1345.
- Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1736-88.
- Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: Epidemiological update 2016. Eur Heart J 2016; 37(42): 3232-45.
- Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M, et al. European society of cardiology: Cardiovascular disease statistics 2017. Eur Heart J 2018; 39(7): 508-79.
- Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41(1): 111-88.
- Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376(9753): 1670-81.
- Hajifathalian K, Ueda P, Lu Y, Woodward M, Ahmadvand A, Aguilar-Salinas CA, et al. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk): A pooled analysis of prospective cohorts and health examination surveys. Lancet Diabetes Endocrinol 2015; 3(5): 339-55.
- D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation 2008; 117(6): 743-53.
- Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002; 105(3): 310-5.
- Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73(24): e285-e350.
- Lye HS, Rusul G, Liong MT. Removal of cholesterol by lactobacilli via incorporation and conversion to coprostanol. J Dairy Sci 2010; 93(4): 1383-92.
- Lew LC, Choi SB, Khoo BY, Sreenivasan S, Ong KL, Liong MT. Lactobacillus plantarum DR7 Reduces Cholesterol via Phosphorylation of AMPK That Down-regulated the mRNA Expression of HMG-CoA Reductase. Korean J Food Sci Anim Resour 2018; 38(2): 350-61.
- Qu T, Yang L, Wang Y, Jiang B, Shen M, Ren D. Reduction of serum cholesterol and its mechanism by Lactobacillus plantarum H6 screened from local fermented food products. Food Funct 2020; 11(2): 1397-409.
- Yao C, Tian W, Song J, Wang J. Antihyperlipidaemic effect of microencapsulated Lactobacillus plantarum LIP-1 on hyperlipidaemic rats. J Sci Food Agric 2020; 100(5): 2007-17.
- Sharma S, Kurpad AV, Puri S. Potential of probiotics in hypercholesterolemia: A meta-analysis. Indian J Public Health 2016; 60(4): 280-6.
- Wang L, Guo MJ, Gao Q, Yang JF, Yang L, Pang XL, et al. The effects of probiotics on total cholesterol: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97(5): e9679.
- Wang G, Huang W, Xia Y, Xiong Z, Ai L. Cholesterol-lowering potentials of Lactobacillus strain overexpression of bile salt hydrolase on high cholesterol diet-induced hypercholesterolemic mice. Food Funct 2019; 10(3): 1684-95.
- Huang CH, Ho CY, Chen CT, Hsu HF, Lin YH. Probiotic BSH Activity and Anti-Obesity Potential of Lactobacillus plantarum Strain TCI378 Isolated from Korean Kimchi. Prev Nutr Food Sci 2019; 24(4): 434-41.
- Geng W, Lin J. Bacterial bile salt hydrolase: An intestinal microbiome target for enhanced animal health. Anim Health Res Rev 2016; 17(2): 148-58.
- Choi SB, Lew LC, Yeo SK, Nair PS, Liong MT.
- Probiotics and the BSH-related cholesterol lowering mechanism: a Jekyll and Hyde scenario. Crit Rev Biotechnol 2015; 35(3): 392-401.
- Shypulin V, Chernyavskyi A, Neverovskyi L. Hypolipidemic efficacy of the probiotic Lactobacillus plantarum in patients with coronary heart disease. Ukrainian Therapeutical Journal 2018; 3(4): 27-33.
- Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J 2018; 39(33): 3021-104.
- Goff DC, Jr., Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(25 Suppl 2): S49-S73.
- Wu Y, Zhang Q, Ren Y, Ruan Z. Effect of probiotic Lactobacillus on lipid profile: A systematic review and meta-analysis of randomized, controlled trials. PLoS One 2017; 12(6): e0178868.
- Park YE, Kim MS, Shim KW, Kim YI, Chu J, Kim BK, et al. Effects of Lactobacillus plantarum Q180 on Postprandial Lipid Levels and Intestinal Environment: A Double-Blind, Randomized, Placebo-Controlled, Parallel Trial. Nutrients 2020; 12(1): 255.
- Reis SA, Conceicao LL, Rosa DD, Siqueira NP, Peluzio MCG. Mechanisms responsible for the hypocholesterolaemic effect of regular consumption of probiotics. Nutr Res Rev 2017; 30(1): 36-49.
- Silverman MG, Ference BA, Im K, Wiviott SD, Giugliano RP, Grundy SM, et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA 2016; 316(12): 1289-97.
- Navarese EP, Robinson JG, Kowalewski M, Kolodziejczak M, Andreotti F, Bliden K, et al. Association between baseline LDL-C level and total and cardiovascular mortality after ldl-c lowering: A systematic review and meta-analysis. JAMA 2018; 319(15): 1566-79.
- Cole TB. Smoking cessation and reduction of cardiovascular disease risk. JAMA 2019;
- (7): 651.
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