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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atherosclerosis is a common underlying cause of cardiovascular disease &#40;CVD&#41;&#46; The American Heart Association reported that the prevalence of atherosclerosis is expected to increase by 18&#37; by 2030&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Dyslipidemia&#44; characterized by high levels of lipids &#40;cholesterol&#44; triglycerides&#44; or both&#41;&#44; is one of the main risk factors for atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> However&#44; a low level of high-density lipoprotein cholesterol &#40;HDL-C&#41; is considered an independent risk factor for CVD&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Low HDL-C levels are inversely associated with cardiovascular risk and are a critical risk factor for estimating the 10-year risk of CVD&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Nevertheless&#44; the relevance of HDL-C as an independent CVD risk factor when other lipids are normal is unclear&#46; The atheroprotective properties of HDL-C include its ability to mediate macrophage cholesterol efflux&#44; antioxidant and anti-inflammatory properties&#44; and nitric oxide promoting activity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> However&#44; HDL particles are complex and heterogeneous in composition and function&#44; and HDL-C level may not be an independent modifiable and causal CVD-specific risk factor&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Additionally&#44; naturally or pharmacologically induced high HDL-C was not associated with reduced CVD risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As mentioned&#44; HDL-C has antioxidant properties&#46; Oxidative stress is defined as an imbalance between antioxidant factors and the production of reactive oxygen species &#40;ROS&#41; in favor of the latter&#44; which results in oxidative damage&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Oxidative stress is thought to play a part in the pathogenesis of atherosclerosis&#44; and HDL-C can potentially slow the development of atherosclerosis&#46; Assessment of total antioxidant capacity &#40;TAC&#41; and total oxidant status &#40;TOS&#41; has been used to assess oxidant and antioxidant systems since&#44; biologically&#44; overall oxidant status may be more appropriate than the measurement of a single antioxidant&#46; Moreover&#44; the oxidative stress index &#40;OSI&#41;&#44; defined as the TOS&#47;TAC ratio&#44; as an indicator of oxidative stress&#44; reflects the balance between oxidant and antioxidant agents&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">These oxidative stress parameters are studied by Karabacak et al&#46; in an analysis published in this issue of the <span class="elsevierStyleItalic">Journal</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Their study aimed to analyze the favorable effects of HDL-C on the oxidative stress of patients with different HDL-C levels&#46; The authors compared patients with low and high HDL-C and a group of matched controls with normal HDL-C&#44; analyzing several oxidative stress parameters &#40;TAC&#44; TOS&#44; OSI&#44; total thiol levels&#44; and arylesterase &#91;ARES&#93; activity&#41;&#46; The authors reported that ARES activity and total thiol levels were significantly higher in patients with high HDL-C compared to those with low HDL-C&#46; At the same time&#44; TAC&#44; TOS&#44; OSI&#44; uric acid&#44; and gamma-glutamyltransferase were higher in low HDL-C patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Establishing connections between known risk factors is a promising tool for identifying important molecules or signatures to improve current clinical biomarkers used for risk assessment&#44; stratification&#44; and therapeutic approaches&#46; The study by Karabacak et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> presents some limitations&#44; which are acknowledged by the authors&#44; the most important being the small sample size&#44; single-center data&#44; and a single time point of assessment&#46; Overall&#44; this paper contributes to knowledge improvement by showing a relationship between oxidative stress and low HDL-C&#44; highlighting the correlation between these modifiable risk factors&#46; A future follow-up study of these patients may help us to better understand the impact of the relationship between oxidative stress and low HDL-C and the role it plays as a risk factor for CVD&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">Supported by <span class="elsevierStyleGrantSponsor" id="gs1">CIMAGO</span> &#8211; Center of Investigation on Environment&#44; Genetics and Oncobiology&#44; Faculty of Medicine&#44; University of Coimbra&#44; Portugal&#44; by <span class="elsevierStyleGrantSponsor" id="gs2">Funda&#231;&#227;o para a Ci&#234;ncia e a Tecnologia</span> &#40;FCT&#41;&#44; Portugal &#40;Strategic Projects UID&#47;NEU&#47;04539&#47;2013 and UID&#47;NEU&#47;04539&#47;2019&#41;&#44; and <span class="elsevierStyleGrantSponsor" id="gs3">COMPETE-FEDER</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs3">POCI-01-0145-FEDER-007440</span>&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Editorial comment
Oxidative stress and high-density lipoprotein cholesterol: Cause or consequence?
Stress oxidativo e colesterol de lipoproteínas de alta densidade – causa ou consequência?
Ana Cristina Gonçalvesa,b,c,d
a Laboratory of Oncobiology and Hematology (LOH) and University Clinic of Hematology, Faculty of Medicine (FMUC), University of Coimbra, Portugal
b Coimbra Institute for Clinical and Biomedical Research (iCBR) – Group of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra (FMUC), Portugal
c Center for Innovative Biomedicine and Biotecnology (CIBB), Coimbra, Portugal
d Clinical Academic Center of Coimbra, CACC, Coimbra, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atherosclerosis is a common underlying cause of cardiovascular disease &#40;CVD&#41;&#46; The American Heart Association reported that the prevalence of atherosclerosis is expected to increase by 18&#37; by 2030&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Dyslipidemia&#44; characterized by high levels of lipids &#40;cholesterol&#44; triglycerides&#44; or both&#41;&#44; is one of the main risk factors for atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> However&#44; a low level of high-density lipoprotein cholesterol &#40;HDL-C&#41; is considered an independent risk factor for CVD&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Low HDL-C levels are inversely associated with cardiovascular risk and are a critical risk factor for estimating the 10-year risk of CVD&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Nevertheless&#44; the relevance of HDL-C as an independent CVD risk factor when other lipids are normal is unclear&#46; The atheroprotective properties of HDL-C include its ability to mediate macrophage cholesterol efflux&#44; antioxidant and anti-inflammatory properties&#44; and nitric oxide promoting activity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> However&#44; HDL particles are complex and heterogeneous in composition and function&#44; and HDL-C level may not be an independent modifiable and causal CVD-specific risk factor&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Additionally&#44; naturally or pharmacologically induced high HDL-C was not associated with reduced CVD risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As mentioned&#44; HDL-C has antioxidant properties&#46; Oxidative stress is defined as an imbalance between antioxidant factors and the production of reactive oxygen species &#40;ROS&#41; in favor of the latter&#44; which results in oxidative damage&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Oxidative stress is thought to play a part in the pathogenesis of atherosclerosis&#44; and HDL-C can potentially slow the development of atherosclerosis&#46; Assessment of total antioxidant capacity &#40;TAC&#41; and total oxidant status &#40;TOS&#41; has been used to assess oxidant and antioxidant systems since&#44; biologically&#44; overall oxidant status may be more appropriate than the measurement of a single antioxidant&#46; Moreover&#44; the oxidative stress index &#40;OSI&#41;&#44; defined as the TOS&#47;TAC ratio&#44; as an indicator of oxidative stress&#44; reflects the balance between oxidant and antioxidant agents&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">These oxidative stress parameters are studied by Karabacak et al&#46; in an analysis published in this issue of the <span class="elsevierStyleItalic">Journal</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Their study aimed to analyze the favorable effects of HDL-C on the oxidative stress of patients with different HDL-C levels&#46; The authors compared patients with low and high HDL-C and a group of matched controls with normal HDL-C&#44; analyzing several oxidative stress parameters &#40;TAC&#44; TOS&#44; OSI&#44; total thiol levels&#44; and arylesterase &#91;ARES&#93; activity&#41;&#46; The authors reported that ARES activity and total thiol levels were significantly higher in patients with high HDL-C compared to those with low HDL-C&#46; At the same time&#44; TAC&#44; TOS&#44; OSI&#44; uric acid&#44; and gamma-glutamyltransferase were higher in low HDL-C patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Establishing connections between known risk factors is a promising tool for identifying important molecules or signatures to improve current clinical biomarkers used for risk assessment&#44; stratification&#44; and therapeutic approaches&#46; The study by Karabacak et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> presents some limitations&#44; which are acknowledged by the authors&#44; the most important being the small sample size&#44; single-center data&#44; and a single time point of assessment&#46; Overall&#44; this paper contributes to knowledge improvement by showing a relationship between oxidative stress and low HDL-C&#44; highlighting the correlation between these modifiable risk factors&#46; A future follow-up study of these patients may help us to better understand the impact of the relationship between oxidative stress and low HDL-C and the role it plays as a risk factor for CVD&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">Supported by <span class="elsevierStyleGrantSponsor" id="gs1">CIMAGO</span> &#8211; Center of Investigation on Environment&#44; Genetics and Oncobiology&#44; Faculty of Medicine&#44; University of Coimbra&#44; Portugal&#44; by <span class="elsevierStyleGrantSponsor" id="gs2">Funda&#231;&#227;o para a Ci&#234;ncia e a Tecnologia</span> &#40;FCT&#41;&#44; Portugal &#40;Strategic Projects UID&#47;NEU&#47;04539&#47;2013 and UID&#47;NEU&#47;04539&#47;2019&#41;&#44; and <span class="elsevierStyleGrantSponsor" id="gs3">COMPETE-FEDER</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs3">POCI-01-0145-FEDER-007440</span>&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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