Endothelial-Vasoprotective Effects of High-Density Lipoprotein Are Impaired in Patients With Type 2 Diabetes Mellitus but Are Improved After Extended-Release Niacin Therapy
Open accessAbstract
Background— High-density lipoprotein (HDL)–raising therapies are currently under intense evaluation, but the effects of HDL may be highly heterogeneous. We therefore compared the endothelial effects of HDL from healthy subjects and from patients with type 2 diabetes mellitus and low HDL (meeting the criteria for metabolic syndrome), who are frequently considered for HDL-raising therapies. Moreover, in diabetic patients, we examined the impact of extended-release (ER) niacin therapy on the endothelial effects of HDL. Methods and Results— HDL was isolated from healthy subjects (n=10) and patients with type 2 diabetes (n=33) by sequential ultracentrifugation. Effects of HDL on endothelial nitric oxide and superoxide production were characterized by electron spin resonance spectroscopy analysis. Effects of HDL on endothelium-dependent vasodilation and early endothelial progenitor cell–mediated endothelial repair were examined. Patients with diabetes were randomized to a 3-month therapy with ER niacin (1500 mg/d) or placebo, and endothelial effects of HDL were characterized. HDL from healthy subjects stimulated endothelial nitric oxide production, reduced endothelial oxidant stress, and improved endothelium-dependent vasodilation and early endothelial progenitor cell–mediated endothelial repair. In contrast, these beneficial endothelial effects of HDL were not observed in HDL from diabetic patients, which suggests markedly impaired endothelial-protective properties of HDL. ER niacin therapy improved the capacity of HDL to stimulate endothelial nitric oxide, to reduce superoxide production, and to promote endothelial progenitor cell–mediated endothelial repair. Further measurements suggested increased lipid oxidation of HDL in diabetic patients, and a reduction after ER niacin therapy. Conclusions— HDL from patients with type 2 diabetes mellitus and metabolic syndrome has substantially impaired endothelial-protective effects compared with HDL from healthy subjects. ER niacin therapy not only increases HDL plasma levels but markedly improves endothelial-protective functions of HDL in these patients, which is potentially more important. Clinical Trial Registration— clinicaltrials.gov. Identifier: NCT00346970.
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In patients with diabetes mellitus, coronary disease, chronic renal insufficiency, cardiovascular risk factors and disorders, the function of HDL is impaired.
“In patients with diabetes mellitus, coronary disease, chronic renal insufficiency, cardiovascular risk factors and disorders, the function of HDL is impaired [9, 61, 70–74].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [61]
Unlike HDL from healthy subjects, HDL from patients with CHD, kidney disease or diabetes mellitus have no protective vascular effects or may even cause paradoxical harmful effects.
“Unlike HDL from healthy subjects, HDL from patients with CHD, kidney disease or diabetes mellitus have no protective vascular effects or may even cause paradoxical harmful effects [55, 56, 61, 70, 71, 75, 76].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [61]
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- Authors
- Sorrentino, S. A., Besler, C., Rohrer, L., Meyer, M., Heinrich, K., Bahlmann, F. H., Mueller, M., Horváth, T., Doerries, C., Heinemann, M., Flemmer, S., Markowski, A., Manes, C., Bahr, M. J., Haller, H., von Eckardstein, A., Drexler, H., & Landmesser, U.
- Affiliations
- University of Zurich (CH)
- From Klinik für Kardiologie und Angiologie (S.A.S., C.B., M. Meyer, M. Mueller, T.H., C.D., M.H., S.F., A.M., C.M., H.D., U.L.), Klinik für Nieren- und Hochdruck-erkrankungen (S.A.S., F.H.B., H.H.), and Klinik für Gastroenterologie, Hepatologie, and Endokrinologie (A.M., M.J.B.), Medizinische Hochschule Hannover, Hannover, Germany; Cardiovascular Center, University Hospital Zürich, Zürich, Switzerland (C.B., M. Meyer, K.H., M. Mueller, C.D., C.M., U.L.); and Institute of Clinical Chemistry (L.R...
- Venue
- Circulation
- Published
- 2010-01-05
- Volume
- 121
- Issue
- 1
- Pages
- 110-122
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1980243442
- Cited by
- 402
- References
- 53
- Citations by year
- 2026: 11 · 2025: 8 · 2024: 23 · 2023: 15 · 2022: 13 · 2021: 8 · 2020: 19 · 2019: 26 · 2018: 24 · 2017: 28 · 2016: 21 · 2015: 24 · 2014: 42 · 2013: 48 · 2012: 27
- FWCI
- 20.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- European Commission
- National Research Foundation
- Deutsche Forschungsgemeinschaft
- Topics
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- high-density lipoprotein, type 2 diabetes, extended-release niacin, endothelial function, endothelial nitric oxide, superoxide production, endothelium-dependent vasodilation, endothelial progenitor cells, endothelial repair, metabolic syndrome, HDL-raising therapy
- MeSH terms
- Aged, Animals, Hypolipidemic Agents, Cells, Cultured, Delayed-Action Preparations, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Free Radicals, Humans, Lipoproteins, HDL, Male, Mice, Inbred C57BL, Mice, Mutant Strains, Mice, Nude, Middle Aged, Peroxidase, Niacin, Nitric Oxide, Superoxides, Vasodilation, Lipid Peroxidation, NADPH Oxidases, Metabolic Syndrome, Endothelial Cells, Mice
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