Comparison of the Reductions in LDL-C and Non-HDL-C Induced by the Red Yeast Rice Extract Xuezhikang Between Fasting and Non-fasting States in Patients With Coronary Heart Disease

Abstract

Background: Xuezhikang, an extract of red yeast rice, effectively lowers fasting blood lipid levels. However, the influence of Xuezhikang on the non-fasting levels of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) has not been explored in Chinese patients with coronary heart disease (CHD).Methods: Fifty CHD patients were enrolled and randomly divided into two groups (n = 25 each) to receive 1,200 mg/d of Xuezhikang or a placebo for 6 weeks as routine therapy. Blood lipids were repeatedly measured before and after 6 weeks of treatment at 0, 2, 4, and 6 h after a standard breakfast containing 800 kcal and 50 g of fat.Results: The serum LDL-C levels significantly decreased, from a fasting level of 3.88 mmol/L to non-fasting levels of 2.99, 2.83, and 3.23 mmol/L at 2, 4, and 6 h, respectively, after breakfast (P < 0.05). The serum non-HDL-C level mildly increased from a fasting level of 4.29 mmol/L to non-fasting levels of 4.32, 4.38, and 4.34 mmol/L at 2, 4, and 6 h post-prandially, respectively, and the difference reached statistical significance only at 4 and 6 h after breakfast (P < 0.05). After 6 weeks of Xuezhikang treatment, the patients had significantly lower fasting and non-fasting serum levels of LDL-C and non-HDL-C (P < 0.05) than at pretreatment. The LDL-C levels were reduced by 27.8, 28.1, 26.2, and 25.3% at 0, 2, 4, and 6 h, respectively, and the non-HDL-C levels were reduced by 27.6, 28.7, 29.0, and 28.0% at 0, 2, 4, and 6 h, respectively, after breakfast. No significant difference was found in the percent reductions in the LDL-C and non-HDL-C levels among the four different time-points.Conclusions: Six weeks of Xuezhikang treatment significantly decreased LDL-C and non-HDL-C levels, with similar percent reductions in fasting and non-fasting states in CHD patients, indicating that the percent change in non-fasting LDL-C or non-HDL-C could replace that in the fasting state for evaluation the efficacy of cholesterol control in CHD patients who are unwilling or unable to fast.

Molecular Mechanism of the Role of Apigenin in the Treatment of Hyperlipidemia: A Network Pharmacology Approach

“…The VEGFA gene promotes endothelial cell proliferation, cell migration, and apoptotic inhibition [29] and increases angiogenesis and vascular permeability in adipose tissues. VEGFA can decrease lipoprotein lipase (LPL) levels, which correlates inversely with plasma LPL activity [7,30] . In atherosclerosis, when the vascular endothelium is damaged, the body's inflammatory response induces the expression of the TNF gene to form TNF, enhances the local inflammatory response, and leads to the formation of a complex and unstable atherosclerotic plaque [31] .…”

“…VEGFA can decrease lipoprotein lipase (LPL) levels, which correlates inversely with plasma LPL activity. [7,30] In atherosclerosis, when the vascular endothelium is damaged, the body's inflammatory response induces the expression of the TNF gene to form TNF, enhances the local inflammatory response, and leads to the formation of a complex and unstable atherosclerotic plaque. [31] APG maintains the integrity of blood vessels in adipose tissues by reducing the expression of VEGFA and TNF genes and the risk of adipose tissue aggregation and plaque formation in hyperlipidemia.…”

“…The specific low-density lipoprotein C target values in China were formulated in 2014 based on the effectiveness and safety of dyslipidemia treatment and associated economic factors; nevertheless, only a few studies on lipid-lowering drugs, except for the more representative clinical trials of Xuezhikang, have been reported. [5][6][7][8] Apigenin (APG) (Figure 1), a flavonoid, is widely found in vegetables and citrus fruits. [9,10] Flavonoids have a variety of pharmacological activities, such as Supporting information for this article is available on the WWW under https://doi.org/10.1002/cbdv.202200308 anti-arteriosclerosis, anti-cerebral thrombosis, antioxidant, hypoglycemic, anti-inflammatory, anti-parasite, anti-spasm, antibacterial, nerve protection, liver protection, myocardial injury protection, osteoporosis prevention, and anti-tumor effects.…”

“…The American College of Cardiology/ American Heart Association guideline has not yet set the treatment target for hyperlipidemia because there is no report of a randomized controlled trial on the most appropriate target for controlling high lipid levels. The specific low‐density lipoprotein C target values in China were formulated in 2014 based on the effectiveness and safety of dyslipidemia treatment and associated economic factors; nevertheless, only a few studies on lipid‐lowering drugs, except for the more representative clinical trials of Xuezhikang, have been reported [5–8] …”

The accuracy of four formulas for LDL-C calculation at the fasting and postprandial states

“…American researchers compared lipid profiles detected by the VAP method between 10,135 fasting and 5,262 non-fasting (<8 h since last meal) subjects, and found significantly lower LDL-C levels and LDL particles in non-fasting subjects, although percent differences in these parameters were small ( 6 ). Chinese subjects showed a more obvious reduction in LDL-C levels at 2 and 4 h postprandially, for example, about 18% after a daily meal and 28% after a high-fat meal ( 18 , 23 ). Moreover, considering that ultracentrifugation is the reference method for LDL-C measurement, and the VAP method is rapid ultracentrifugation, the reduction of LDL-C levels after a daily meal cannot be ignored, especially in Chinese subjects.…”