Author + information
- Darrell Ellsworth,
- Kimberly A. Mamula,
- Heather L. Blackburn,
- Renata Engler and
- Marina Vernalis
Metabolic dysfunction characterized by insulin resistance (IR) is an important risk factor for developing type 2 diabetes and coronary artery disease (CAD). The Lipoprotein Insulin Resistance (LP-IR) score, derived from measures of lipoprotein subclass particle concentration and size, is a new measure for assessing IR and identifying patients with increased risk for developing diabetes. Lifestyle modification interventions are known to mediate CAD risk through traditional measures such as blood pressure, lipids, and BMI; however, the effects of dietary stringency on IR and molecular drivers of the LP-IR score are unclear.
Patients with CAD or significant CAD risk factors participated in 1 of 2 clinical lifestyle interventions differing in dietary stringency: 1) an intensive non-randomized program with a strict vegetarian diet (n=90 subjects with 90 matched controls) and 2) a moderate randomized trial following a Mediterranean-style diet (n=90 participants, 58 controls). Changes over 1 year in lipoprotein profiles, LP-IR score, and traditional CAD risk factors were assessed by Wilcoxon Signed Rank tests.
Participants in the intensive lifestyle intervention had poorer baseline cardiovascular health (significantly higher BMI, total cholesterol, triglycerides, LP-IR) than patients in the moderate program. Both interventions led to weight loss (-8.9%, intensive program; -2.6%, moderate program; P<0.001) and a significant decrease in LP-IR score (-13.3%, intensive; -7.9%, moderate; P<0.01) compared to respective controls over one year. Of the six lipoprotein parameters that comprise the LP-IR score, only large VLDL/chylomicrons decreased significantly in patients compared to controls in both programs (-26.3%, intensive; -13.7%, moderate; P<0.05).
Lifestyle modification including a Mediterranean diet is comparable to a stringent intervention with a vegetarian diet for improving insulin resistance defined by LP-IR. Significant reductions in large VLDL/chylomicrons may drive improvement in IR irrespective of dietary stringency.
Poster Hall B1
Sunday, March 15, 2015, 9:45 a.m.-10:30 a.m.
Session Title: Statins, Cholesterol Guidelines and Lifestyle
Abstract Category: 21. Prevention: Clinical
Presentation Number: 1178-118
- 2015 American College of Cardiology Foundation