Changes In Lipid Values Research Articles

Predictors of elevations in fasting lipid levels in adults with epilepsy on a modified Atkins diet

BackgroundKetogenic diet therapies can improve seizure control in patients with drug-resistant epilepsy (DRE). The current study investigated whether dietary fat composition is associated with elevations in serum lipid levels in adults with epilepsy who began a modified Atkins diet (MAD). MethodsAdults with DRE were instructed to follow the MAD. Food records collected at baseline and follow-up were analyzed to extract median daily macro- and micronutrient composition. Total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, triglyceride (TG), high-density lipoprotein (HDL) cholesterol, non-HDL and TC/HDL ratio were measured at baseline and follow-up. ResultsStudy participants initiating MAD showed higher fat intake at 1 month (p<0.001) and 2 months (p<0.001) and lower carbohydrate intake at 1 month (p<0.001) and 2 months (p<0.001) compared to baseline. Study participants also showed higher intake of cholesterol (p<0.001), saturated fatty acid (p<0.001) and monounsaturated fatty acid (p<0.001) over time. Following MAD initiation, study participants showed significant increases in levels of TC (p = 0.007), LDL (p<0.001), and non-HDL (p = 0.009) over time. Dietary intake variables, including cholesterol and fat subtypes, were significantly associated with difference in 1 month TC and LDL levels from baseline but not absolute 1 month lipid values. In a sub-analysis, participants with baseline dyslipidemia showed smaller changes in lipid values during diet use. ConclusionsAdults with DRE starting MAD increased fat intake, particularly saturated and monounsaturated fat subtypes, and reduced carbohydrate intake. Changes in TC and LDL levels 1 month after MAD initiation are associated with dietary intake of cholesterol and fat.

Physical Activity Evaluation Using Activity Trackers for Type 2 Diabetes Prevention in Patients with Prediabetes.

Background: Prediabetes is a reversible condition, but lifestyle-changing measures, such as increasing physical activity, should be taken. This article explores the use of Fitbit activity trackers to assess physical activity and its impact on prediabetic patient health. Methods: Intervention study. In total, 30 volunteers (9 males and 21 females), aged 32–65 years, with impaired glucose levels and without diabetes or moving disorders, received Fitbit Inspire activity trackers and physical activity recommendations. A routine blood check was taken during the first and second visits, and body composition was analyzed. Physical activity variability in time was assessed using a Poincare plot. Results: The count of steps per day and variability differed between patients and during the research period, but the change in total physical activity was not statistically significant. Significant positive correlations between changes in lipid values, body mass composition, and variability of steps count, distance, and minutes of very active physical activity were observed. Conclusions: When assessing physical activity, data doctors should evaluate not just the totals or the medians of the steps count, but also physical activity variability in time. The study shows that most changes were better linked to the physical activity variability than the total count of physical activity.

Treatment initiation or switch to BIC/FTC/TAF - real-world safety and efficacy data from two HIV centers in Romania.

Development of highly active antiretroviral therapy marked an important step forward in the management of people living with HIV and fixed dose combinations are now available to be used as modern antiretroviral regimens. The single-tablet regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) was recently approved in Europe and included in international guidelines and recommendations. It became available in Romania in early 2021. We present the real-world results from a retrospective analysis of patients initiating BIC/FTC/TAF in two HIV centers in Romania. This retrospective analysis included patients treated with BIC/FTC/TAF (first-line or switch) in two HIV centers in Romania, one in Bucharest and one in Iași. We collected data on baseline patient characteristics, reasons for initiation of BIC/FTC/TAF and preliminary clinical and laboratory efficacy, safety and tolerability data. All assessments had been performed according to local practice. Statistical analyses were mostly descriptive and association analysis was performed to assess changes in laboratory parameters from baseline to data cut-off (October 2021). In total, 122 patients were initiated on BIC/FTC/TAF in routine clinical practice from February to October 2021 in the two HIV centers, either as first-line or switch. The majority of patients were male (71%). The median age at baseline was 35.0 years (IQR 32.0-50.8 years). Overall, 91 patients (75%) were treatment-experienced and the most frequent reason for switch was treatment simplification (79%). The mean ± standard deviation follow-up duration on treatment with BIC/FTC/TAF was 101.6 ± 64.2 days until the cut-off date for this analysis. We found no significant changes in lipid values, blood glucose or liver enzymes, coupled with a significant decrease in viral load (p=0.001). A low number of adverse events occurred during the treatment period (n=4): two cases of fatigue and two gastrointestinal reactions. No patient discontinued BIC/FTC/TAF and the overall tolerability was good. The insights of the first report on BIC/FTC/TAF use in routine clinical practice in Romania provide an overview of effectiveness and safety to local clinicians treating this patient population.

The relationship between payer type and lipid outcomes in response to clinical lifestyle interventions in youth with dyslipidemia

BackgroundPayer-type (government-sponsored health coverage versus private health insurance) has been shown to influence a variety of cardiovascular disease outcomes in adults. However, it is unclear if the payer-type impacts the response to a lifestyle intervention in children with dyslipidemia.MethodsWe analyzed data prospectively collected from patients under the age of 25 years who were referred to a large regional preventive cardiology clinic from 2010 to 2016 in Massachusetts. We compared baseline high density lipoprotein cholesterol (HDL-C), triglycerides (TG), non-HDL-C, and low density lipoprotein cholesterol (LDL-C) by payer-type. Further, we analyzed the change in lipid values in response to a clinic-based multidisciplinary intervention over a nearly six-year period by payer-type with multi-variable adjusted linear regression models. We also tested for effect modifications by age, sex, race, and body mass index (BMI) category.ResultsOf the 1739 eligible patients (mean age 13 years, 52% female, 60% overweight and obese, 59% White), we found that patients with government-sponsored coverage (n = 354, 20%) presented to referral lipid clinic with lower HDL-C (− 3.5 mg/dL [1.0], p < 0.001) and higher natural log-transformed TG (+ 0.14 [0.04], p < 0.001) as compared to those with private insurance; however, the association was attenuated to the null after additionally adjusting for BMI category (− 1.1 [0.9], p = 0.13, and + 0.05 [0.04], p = 0.2 for HDL-C and natural log-transformed TG, respectively). We found no difference in baseline LDL-C between payer-types (+ 3.4 mg/dL [3.0], p = 0.3). However, longitudinally, we found patients with private insurance and a self-reported race of White to have a clinically meaningful additional improvement in LDL-C, decreasing 12.8 (5.5) mg/dL (p = 0.02) between baseline and first follow-up, as compared to White patients with government-sponsored health coverage, after adjusting for age, sex, time between visits, and baseline LDL-C.ConclusionsOur results suggest that youth with government-sponsored coverage are referred with poorer lipid profiles than those with private insurance, although this is largely explained by higher rates of overweight and obesity in the government-sponsored health coverage group. White patients with private insurance had substantially better improvement in LDL-C longitudinally, suggesting that higher socioeconomic status facilitates improvement in LDL-C, but is less beneficial for HDL-C and triglyceride levels.

Efficacy and Safety of Atorvastatin in Dyslipidemic Patients at Tertiary Care Hospital

Aims: The objective of the study was to assess the safety, effectiveness and Adherence of morning versus evening atorvastatin administration in dyslipidemic Patients. Settings and design: A comparative study conducted at KLE’s Dr. Prabhakar Kore Charitable Hospital & Medical Research Centre; Department of Medicine; Belagavi, Karnataka, India. Methods and material: Patients who were prescribed atorvastatin 40 mg p.o. daily by their physician were interviewed by clinical pharmacist for study enrolment. Patients were excluded if they had any history diseases or medication known to effect serum lipid levels, blood samples were collected after overnight fasting period and serum lipid levels were measured at 4th and 8th week. Statistical analysis used: Paired t-test; SPSS version 20.0 Results: 85 male patients (83.3%) and 17 (16.6%) female patients with a mean ± S.D. age of 56.72 ± 10.09 years were enrolled into the study. All patients were receiving atorvastatin in the evening, after four week the same patients were changed to morning dose. No significant change in lipid values measured were found between morning and evening administration after 8 weeks. There were no difference in the incidence of clinical adverse reactions among the morning and evening regimen. Conclusions: Atorvastatin 40 mg was found to be safe and effective regardless of the time of drug administration i.e. morning versus evening without much change in the levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. On the contrary, significant adherence levels increased with morning administration than evening which may contribute to increase in compliance.

Influence of HbA1c and BMI on Lipid Trajectories in Youths and Young Adults With Type 1 Diabetes.

To assess the influence of HbA1c and BMI (measured as BMI z score [zBMI]) on LDL, HDL, and non-HDL trajectories as youths with type 1 diabetes age into early adulthood. Dynamic, retrospective cohort study examining changes in lipid values in 572 youths with type 1 diabetes followed longitudinally for a median of 9.3 years. Through longitudinal modeling, we describe the relationship of HbA1c and zBMI on lipid values as subjects age after adjusting for other relevant factors, including lipid-lowering medication use. The median number of lipid assessments was 7 (range 2-39). Every 1% increase in HbA1c was associated with an ∼2-6 mg/dL increase in LDL levels, with a greater increase in LDL levels as subjects progressed from prepubertal to postpubertal age ranges. A 1-SD increase in BMI was associated with a mean LDL increase of 2.1 mg/dL when subjects were 10 years old and increased to a mean of 8.2 mg/dL when subjects were 19 years old. The association between changes in HbA1c level and zBMI and changes in non-HDL levels as youths aged were similar to the associations found with LDL. The influence of HbA1c and zBMI on HDL levels was small and not dependent on age. Changes in HbA1c level and zBMI modestly impact LDL and non-HDL cholesterol and have greater impacts as children age. Addressing elevations in HbA1c and zBMI as children enter into adolescence and beyond may lead to improvements in lipid levels.

Changes in coronary heart disease risk profiles of HIV patients in Zimbabwe over 9 months: a follow-up study.

Dyslipidemia, hypertension, inflammation, and coronary heart disease (CHD) are adverse events in human immunodeficiency virus (HIV)-infected patients even if they are receiving antiretroviral therapy (ART). Yet, data on CHD risk induced by HIV or ART in sub-Saharan Africa are limited. The aim of this longitudinal study was to describe changes in CHD risk profiles measured by lipids, inflammatory markers, and Framingham scores among HIV-positive patients previously reported from Harare, Zimbabwe. Patients were grouped into ART-experienced patients (n=147) and ART-naïve patients (n=23) and followed up for 9 months. Generalized least squares random-effects modeling was applied to explain changes in total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, TC/HDL ratio, myeloperoxidase, highly sensitive C-reactive protein, and Framingham scores over the 9-month period. Independent variables included age, sex, monthly earning, body mass index, systolic blood pressure (SBP), diastolic blood pressure, duration of HIV diagnosis, duration of ART, viral load, and CD4 count. In ART-experienced patients, there was a substantial decrease in TC over time, ART-negative patients showed a significant increase in TC and HDL over time, and the increase in TC was associated with high viral load and low duration of HIV diagnosis, while increase in HDL was associated with young age, low body mass index, and low SBP. Framingham risk scores increased with time in ART-positive patients, and the change was positively correlated with age, sex, high SBP, and low HDL. There was no association between calculated CHD risk (TC/HDL ratio or Framingham score) and changes in levels of inflammatory markers (myeloperoxidase and highly sensitive C-reactive protein) in any of the patient groups. In conclusion, ART-experienced HIV-positive patients show changes in lipid values over time that makes it necessary to include lipid monitoring in order to reduce any risk of long-term CHD.

Efficacy and safety of rosuvastatin therapy in children and adolescents with familial hypercholesterolemia: Results from the CHARON study

Heterozygous familial hypercholesterolemia (HeFH) is an autosomal dominant disorder leading to premature atherosclerosis. Guidelines recommend initiating statins early to reduce low-density lipoprotein cholesterol (LDL-C). Studies have evaluated rosuvastatin in children aged ≥10 years, but its efficacy and safety in younger children is unknown. Children with HeFH and fasting LDL-C >4.92 mmol/L (190 mg/dL) or >4.10 mmol/L (>158 mg/dL) with other cardiovascular risk factors received rosuvastatin 5 mg daily. Based on LDL-C targets (<2.85 mmol/L [<110 mg/dL]), rosuvastatin could be uptitrated to 10 mg (aged 6-9 years) or 20 mg (aged 10-17 years). Treatment lasted 2 years. Changes in lipid values, growth, sexual maturation, and adverse events (AEs) were assessed. The intention-to-treat analysis included 197 patients. At 24 months, LDL-C was reduced by 43, 45, and 35% vs baseline in patients aged 6-9, 10-13, and 14-17 years, respectively (P < .001 for all groups). Most AEs were mild. Intermittent myalgia was reported in 11 (6%) patients and did not lead to discontinuation of rosuvastatin treatment. Serious AEs were reported by 9 (5%) patients, all considered unrelated to treatment by the investigators. No clinically important changes in hepatic biochemistry were reported. Rosuvastatin treatment did not appear to adversely affect height, weight, or sexual maturation. In HeFH patients aged 6-17 years, rosuvastatin 5-20 mg over 2 years significantly reduced LDL-C compared with baseline. Treatment was well tolerated, with no adverse effects on growth or sexual maturation.

Effect of fibrate treatment on liver function tests in patients with the metabolic syndrome

BackgroundFibrates are used especially in patients with hypertriglyceridaemia, a feature of the metabolic syndrome. Elevated LFTs are often observed in these patients perhaps related to fatty infiltration.AimWe wished to study changes seen in LFTs (GGT, ALT and ALP) following fibrate therapy and then determine associated factors.MethodsThis was a retrospective observational study in which data was collected from case notes of patients started on fibrates (n = 118, 2002–2008) in the lipid clinic at Good Hope Hospital and pre/post-fibrate lipid and LFT values were obtained. All biochemistry was performed on the Roche P-Unit using supplied reagents. Statistical analyses included t tests and regression analyses (factorised when quartiles were compared).ResultsOf the study population 106 patients were on fenofibrate; the remaining on bezafibrate. Significant lowering of GGT (p < 0.0001), ALT (p = 0.0014) and ALP (p < 0.0001) levels were observed following fibrate treatment. Baseline lipid (cholesterol, triglycerides and HDL) concentrations, alcohol intake, length of treatment, gender, concurrent statin treatment and diabetes did not correlate with these changes in LFT in a multiple regression analysis. Higher pre-fibrate GGT (p < 0.0001), ALT (p < 0.0001) and ALP (p < 0.0001) concentrations were associated with larger decreases in each of these tests respectively with the highest 2 quartiles (GGT > 57 IU/l, ALT > 34 IU/l and ALP > 94 IU/l) significantly different to the lowest quartile. The above associations remained significant even when the regression analyses were corrected for changes in lipid values (which did not show an association).ConclusionsFibrate treatment led to improvements in LFT, the greatest benefit seen in patients with higher baseline LFT values. It appears that baseline and changes in lipid values post fibrate treatment were not associated with change in LFT.

Abstract P168: Clinical Benefit of Reduction in LDL and Triglycerides: Meta-Analyses of Major Coronary Events

Objective: The primary objective of the analysis was to characterize the multivariate relationship between changes in LDL-C, HDL-C and triglycerides (TG) and risk for major coronary events after treatment with statins, fibrates or niacin. Methods: Randomized controlled trials that compared statin, fibrate or niacin treatment with placebo, usual care, or active control and that reported on major coronary events were identified by a literature search, prior meta-analyses and review articles. The dependency of the odds-ratio between active and control arm on the differences in on-treatment LDL-C, HDL-C and TG was determined using a meta-regression analysis. Differences in the risk reduction per unit change in lipid values between drug classes (fibrates, statins and niacin) and drugs within a class were evaluated. Differences in risk reduction per unit change in lipid values for certain patient groups such as diabetes, males, elderly, prior CHD were also evaluated. Results: A total of 70 trials were identified and included in the meta-analysis. The meta-analysis found a significant contribution of lowering TG on top of reducing LDL-C to the risk reduction for a major coronary event after treatment with statins, fibrates or niacin (p&lt;0.001). The risk reduction for major coronary events was estimated to be 18.5% [14.1 to 22.7%] for every 1 mmol/L (38.7 mg/dL) reduction in LDL-C and 27.5% [15.7 to 37.7%] for every 1 mmol/L (88.6 mg/dL) reduction in TG. The reduction in TG was found to explain most (84%) of the risk reduction for treatment with fibrates. For statins, the reduction in LDL-C was found to explain most (71%) of their benefit, but the reduction in TG was found to provide a statistically and clinically significant contribution to their overall risk reduction. The risk reduction per unit change in LDL-C and TG was not dependent on age, gender, diabetes and prior CHD and was not different between fibrates and statins. Conclusions: A significant additional risk reduction is expected by providing a reduction in TG on top of LDL-C changes. The independent effect of TG and LDL-C lowering supports the role for treatment combinations such as statins and fibrates that impact LDL-C and TG differentially.

Cardiovascular residual risk assessment in patients undergoing therapy: A combined structural and functional approach

While imaging of coronary artery calcium (CAC) and carotid intima media thickness (CIMT) is being increasingly used for cardiac risk stratification, residual risk after treatment has relied on changes in lipid values. Unfortunately, there is no clear relationship between post-treatment lipids and event reduction, as evidenced by the persistently high event rates despite significant lipid modification. A new approach, combining changes in subclinical atherosclerosis with inflammatory and endothelial function parameters of disease activity, may offer a better alternative. Imaging technologies include CAC, CIMT, MRI, molecular imaging, and coronary CT angiography. High-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 are the most commonly used inflammatory markers. Endothelial function techniques include venous occlusion plethysmography, ultrasound flow-mediated dilation, pulse wave and contour analysis, peripheral arterial tonometry, and digital thermal monitoring. This article presents the various modalities and combinations of imaging and activity/endothelial function, as well as clinical recommendations and testing intervals.

Extended-release niacin reduces LDL particle number without changing total LDL cholesterol in patients with stable CAD

The importance of the number of circulating low-density lipoprotein (LDL) cholesterol particles, in addition to total LDL level, has been increasingly recognized. The effects of extended-release niacin (ERN) on LDL particle numbers have not been studied. To evaluate ERN's effects on LDL particle numbers. Fifty-four patients with stable coronary artery disease (CAD) and well-controlled LDL levels were randomly assigned to 3 months of ERN (1 g/day) or placebo in addition to their baseline medications. Lipoprotein particle number was analyzed by proton nuclear magnetic resonance spectroscopy at baseline and after 3 months. Compared to baseline, the addition of ERN had no significant effect on total LDL cholesterol levels; however, ERN decreased the number of medium and small LDL particles (P < .005). After 3 months, ERN decreased the number of medium and small LDL particles compared to placebo-treated patients (P < .05). ERN raised HDL cholesterol levels by 2.7%, significantly increased the number of large HDL particles (P < .001), and decreased the number of small HDL particles (P = .027) compared to placebo. There were no significant changes in lipid values or particle numbers in the placebo-treated patients. In patients with stable coronary artery disease and well-controlled LDL cholesterol levels, ERN reduced the number of circulating particles of the more atherogenic subtypes of LDL, despite having no effect on total LDL cholesterol levels. ERN also favorably altered the number of HDL particles. ERN-induced alterations in lipoprotein particle numbers may contribute to its anti-atherosclerotic effects, and these effects may not be evident from the standard lipid profile.

Abstract 5144: Extended-Release Niacin Reduces LDL-C Particle Number Even In The Absence Of Changes In Total LDL-C Levels

Introduction: The importance of the number of circulating low-density lipoprotein cholesterol (LDL-C) particles, in addition to the total level of LDL-C is increasingly recognized. The effects of Extended Release Niacin (ERN) on LDL-C particle number have not been studied. The primary objective of this study was to evaluate ERN’s effects on LDL-C particle number. ERN’s effect on high-density lipoprotein cholesterol (HDL-C) particle number was a secondary objective. Hypothesis : In patients with stable coronary artery disease (CAD) and LDL-C at goal, the addition of ERN will favorably alter LDL-C particle number. Methods: 60 patients with stable CAD and well-controlled LDL-C levels were randomly assigned to 3 months of ERN (1g/d) or placebo in addition to their baseline medications. Particle number was analyzed by proton nuclear magnetic resonance spectroscopy at baseline and after 3 months. Results: Baseline and follow up lipid values are shown in Table . Compared to baseline, while ERN had no significant effect on total LDL-C levels, it significantly decreased the mean number of medium and small very small LDL-C particles (p=0.005). The percent change in each of these particle numbers was significantly greater in the ERN group compared to placebo as well (p&lt;0.05 for each) ERN therapy raised HDL-C levels and also significantly shifted from small to large HDL-C particles (p&lt;0.001). There were no significant changes in lipid values or particle numbers in the placebo-treated patients ( Table ). Conclusion: In patients with stable CAD and well-controlled LDL-C levels, ERN significantly reduced the number of circulating particles of the more atherogenic subtypes of LDL-C, despite having no effect on total LDL-C levels. ERN also favorably altered particle numbers of HDL-C. These findings suggest that ERN-induced alterations in particle number may contribute to its anti-atherosclerotic effects, and that these effects may not be evident from the standard lipid profile.

Reaching Target Lipid Levels in Patients at High Risk of Cardiovascular Event: The Experience of a Canadian Tertiary Care Lipid Clinic

To determine the proportion of high risk patients followed at a tertiary care lipid clinic who met recommended lipid targets and to identify predictors of reaching goal lipid levels. A retrospective cohort study of 502 high risk patients followed between 1983 and 2003. Clinical and demographic data and fasting lipid profiles were extracted from each patient's first two clinic visits as well as the most recent visit. All patients in this study were at high risk of cardiovascular events due to dyslipidemia. At "Visit 1", only 55 (11.0%) of patients were at target TC/HDL-C < 4.0, and 97 (19.3%) of patients met target LDL-C < 2.5 mmol/l. At "Visit 3", 229 (45.8%) patients reached TC/HDL-C target, and 216 (43.2%) patients were at LDL-C target. The mean change in lipid values between Visit 1 and Visit 3 was significant (p = 0.0002) for LDL-C and (p < 0.0001) for TC/HDL-C. The use of statins, niacin, or salmon oil were all significantly associated with reaching TC/HDL-C target and LDL-C target, as well male gender, diabetes mellitus and peripheral vascular disease were also associated with reaching LDL-C target. Increasing age and lower body mass index were associated with reaching goal TC/HDL-C. The mean absolute changes in lipid values were significant and median lipid levels approached target levels in patients followed at specialized clinic, however the majority of high risk patients are not meeting goal lipid levels.

Design and Rationale of the ARBITER 6 Trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol)-6-HDL and LDL Treatment Strategies in Atherosclerosis (HALTS)

Recent evidence on the use of statin therapy indicates the potential for ultra-low levels of LDL-C to provide greater protection from recurrent coronary heart disease events. Guidelines for the treatment of lipid disorders were revised to indicate that an LDL-C treatment goal of 70 mg/dl was optional (NCEP ATPIII). In these same guidelines, low levels of HDL-C are also suggested but not specifically proscribed as a target of therapy. Recently ARBITER 2 (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 2) has provided the first evidence of the potential of raising HDL-C with extended release niacin when added to statin monotherapy in secondary prevention. However, whether this approach would be superior to a strategy in which lower concentrations of LDL-C are targeted is unknown. ARBITER 6-HALTS ( HDL and LDL Treatment Strategies) will be a randomized, parallel group, open-label study comparing HDL-C and LDL-C focused strategies of lipid treatments for their effects on atherosclerosis. Up to 400 subjects will be assigned to either intensified LDL-C lowering therapy with ezetimibe or HDL-C raising therapy with extended-release niacin. The primary endpoint is the mean change in the intima-media thickness of the common carotid artery after 14 months. Secondary endpoints include the change in lipid values and lipid subfractions, drug discontinuation due to adverse effects, change in quality of life, and a composite endpoint consisting of all major adverse cardiovascular events. ARBITER 6-HALTS will guide clinicians on whether a lipid treatment strategy of raising HDL-C or further LDL-C reduction is superior in the secondary prevention of coronary heart disease.

Evaluation of patient and provider satisfaction with a pharmacist-managed lipid clinic in a Veterans Affairs medical center

Patient and provider satisfaction with a pharmacist-managed lipid clinic in a Veterans Affairs medical center were assessed. All patients at Louis Stokes Cleveland Veterans Affairs Medical Center who were referred to a pharmacist-managed lipid clinic for drug therapy management were mailed a questionnaire addressing overall satisfaction with care provided by the lipid clinic. Chart reviews were performed for patients completing the questionnaire to ascertain lipid-lowering medications used, changes in serum cholesterol levels, and achievement of low-density-lipoprotein (LDL) cholesterol goal. Health care providers referring patients to the lipid clinic were sent an anonymous electronic questionnaire to assess provider satisfaction with the clinic. Responses to the questionnaire were rated on a Likert scale (strongly agree, somewhat agree, neutral, somewhat disagree, strongly disagree). A paired t test was used to assess the percent change in lipid values, and chi-square analysis was used to evaluate the achievement of each patient's LDL cholesterol goal. Surveys were sent to 224 patients and 104 providers. A total of 105 patients (47%) and 49 providers (47%) completed the questionnaire. Most patients and providers expressed satisfaction with the clinic, with 91.4% of patients and 87.8% of providers indicating that they were strongly or somewhat satisfied with the care provided by the pharmacist-managed clinic. Attainment rates of goal LDL cholesterol levels increased from 8.6% at baseline to 53.3% at discharge or the most recent measurement (p < 0.001). Most patients and providers were satisfied with the services provided by the pharmacist-managed lipid clinic. The clinic helped improve patients' LDL cholesterol, total cholesterol, and triglyceride levels.

Plasma C-reactive protein as a marker of cardiac allograft vasculopathy in heart transplant recipients

ObjectivesThis study was initiated to determine whether heart transplant recipients (HTRs) with cardiac allograft vasculopathy (CAV) have increased levels of high-sensitivity C-reactive protein (hsCRP) and to examine whether an increase in hsCRP after heart transplantation predicts the development of CAV. Furthermore, the effect of pravastatin on plasma levels of hsCRP in HTRs was investigated. BackgroundThe relationship between CAV and hsCRP, as well as the effect of statins on hsCRP in HTRs, has not been well established. MethodsOn referral for their annual angiographic control study, 150 consecutive HTRs (mean 6.5 years since transplantation) were included. Plasma levels of hsCRP were measured before angiography and compared with patients with (n = 52) and without (n = 98) CAV. In 49 of these patients, we additionally analyzed hsCRP in blood samples stored from their six-month visit after the transplantation procedure. Furthermore, in a randomized, crossover study, hsCRP was analyzed in 17 male HTRs before and after six weeks of treatment with 20 mg pravastatin. ResultsMedian levels of CRP were elevated among patients with CAV compared with those with normal angiograms [3.86 (1.78 to 7.00) vs. 1.08 (0.72 to 2.13) mg/l, p < 0.001]. Prospectively evaluated hsCRP levels from six months to follow-up were significantly higher among those who developed CAV compared with those with normal angiograms [+2.76 (1.56 to 5.00) vs. +0.07 (−0.57 to 0.41) mg/l, p < 0.001]. On multivariate analysis, the increase in hsCRP was the only significant predictor of CAV. Six weeks of treatment with pravastatin significantly reduced hsCRP levels by 25%, without any relation to changes in lipid values. ConclusionsElevated plasma levels of CRP are associated with angiographic evidence of CAV, and the increase in hsCRP is a strong predictor of development of CAV. Statin treatment reduces levels of hsCRP and should be used in HTRs, regardless of their lipid levels.

The Effect of Micronized Fenofibrate on Lipid Profiles of Patients Converted from Gemfibrozil

Although numerous studies have established the efficacy of micronized fenofibrate (MF) and gemfibrozil in improving lipid profiles, there are limited comparative data on the lipid-lowering effects of these two agents. The objective of this study was to evaluate the mean changes in lipid values of hypertriglyceridemic patients crossed over from gemfibrozil to MF. The Medical charts of 21 patients were analyzed retrospectively. Patients were maintained on gemfibrozil 600 mg twice daily for a minimum of 3 months. The patient's last fasting lipid profile on gemfibrozil was compared to the first lipid profile after crossover to MF 200 to 201 mg/day. Patients were excluded if there were alterations in other lipid-lowering therapy during the cross-over or documented non-adherence. The lipid profiles after the crossover showed a significant reduction in triglycerides (56%; P &lt; 0.05) and TC/HDL ratio (38%; P &lt; 0.05) and a significant increase in HDL (22%; P &lt; 0.05). There were nonsignificant changes in other lipid values: TC (-22%; P = 0.058), LDL (+5%; P = 0.866) and LDL/HDL ratio (+6; P = 1.0). The results show that MF had additional favorable effects on triglycerides, HDL, and TC/HDL ratio compared with gemfibrozil. A larger, randomized trial to confirm these effects is warranted.

Lipid disorders and plaque imaging

Electron-beam tomography (EBT) plaque imaging has the potential to fundamentally change the practice of prevention, through application of the following principles: (1) Asymptomatic patients with significant calcified plaque should be considered to have a clinical coronary artery disease risk equivalent. (2) Measurement of nontraditional parameters should be incorporated into the evaluation of patients with calcified plaque. (3) Drug treatment should focus on the asymptomatic patient with subclinical atherosclerosis. (4) Change in plaque rather than change in lipid values should guide treatment.

Comparative effects of Lunelle™ Monthly Contraceptive Injection (medroxyprogesterone acetate and estradiol cypionate injectable suspension) and Ortho-Novum® 7/7/7 oral contraceptive (norethindrone/ethinyl estradiol triphasic) on lipid profiles

As part of a 60-week, open-label, nonrandomized, parallel, controlled study comparing a monthly contraceptive injection containing medroxyprogesterone acetate (MPA) 25 mg and estradiol cypionate (E 2C) 5 mg (Lunelle™ Monthly Contraceptive Injection) and a norethindrone 0.5, 0.75, 1.0 mg/0.035 mg ethinyl estradiol (NET/EE) triphasic oral contraceptive (Ortho-Novum® 7/7/7), a longitudinal examination of lipid profiles was conducted. Lipid parameters were assessed at screening and at weeks 20, 40, and 60 (or the final visit) in 114 women using MPA/E 2C and 93 using NET/EE (lipid analysis population). Extra blood samples were obtained at weeks 21, 22, and 23 in 61 MPA/E 2C users and 51 NET/EE users (index-cycle analysis population) to investigate lipid changes during one cycle of use. In the index-cycle population, median changes from screening to week 60 showed a decrease in apolipoprotein (apo) A-I and apo A-II in both groups. MPA/E 2C users had a decrease in total cholesterol (C), total triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), with maintenance of the total C/HDL-C ratio. NET/EE users showed an increase in total C and LDL-C, with no change in HDL-C or the total C/HDL-C ratio. Within the index cycle (weeks 20 to 23), median changes in lipid values in both MPA/E 2C and NET/EE users were generally greatest during the first week after the injection or the start of the pill pack. The results of this first longitudinal examination of serum lipids in US women using MPA/E 2C confirm earlier findings in women in other countries. However, a direct comparison of the effects of MPA/E 2C and NET/EE on lipid profiles was not possible in this study because of its design and because of the baseline and pharmacokinetic/pharmacodynamic differences between the two contraceptive groups. The results of this analysis showed that, although overall lipid values decreased, including a significant decrease in HDL cholesterol, the maintenance of the total-C/HDL-C ratio suggests that the effect of MPA/E 2C on lipid parameters may not negatively affect CVD risk over 1 year of use. However, these results warrant further investigation, given the nature of this trial.