Cholesterol Measurements Research Articles

Cholesterol measurement – unexpected results in a commutable EQA program

Most Australian laboratories quote cholesterol reference intervals as recommended by the Australian Heart Foundation (e.g., <4.0 mmol/L for patients at high risk of cardiovascular disease). The RCPAQAP provides a Liquid Serum Chemistry Program sourced from consenting male and female haemochromatosis patients presenting for therapeutic venesection. Where possible, serum from individual male and female patients are pooled over successive collections. We report on some unexpected method differences in the 2019, 2020 and 2021 Liquid Serum Chemistry Programs.

Heterogeneity of Treatment Effects for Intensive Blood Pressure Therapy by Individual Components of FRS: An Unsupervised Data-Driven Subgroup Analysis in SPRINT and ACCORD

BackgroundFew studies have answered the guiding significance of individual components of the Framingham risk score (FRS) to the risk of cardiovascular disease (CVD) after antihypertensive treatment. This study on the systolic blood pressure intervention trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes blood pressure trial (ACCORD-BP) aimed to reveal previously undetected association patterns between individual components of the FRS and heterogeneity of treatment effects (HTEs) of intensive blood pressure control.MethodsA self-organizing map (SOM) methodology was applied to identify CVD-risk-specific subgroups in the SPRINT (n = 8,773), and the trained SOM was utilized directly in 4,495 patients from the ACCORD. The primary endpoints were myocardial infarction (MI), non-myocardial infarction acute coronary syndrome (non-MI ACS), stroke, heart failure (HF), death from CVD causes, and a primary composite cardiovascular outcome. Cox proportional hazards models were then used to explore the potential heterogeneous response to intensive SBP control.ResultsWe identified four SOM-based subgroups with distinct individual components of FRS profiles and the CVD risk. For individuals with type 2 diabetes mellitus (T2DM) in the ACCORD or without diabetes in the SPRINT, subgroup I characterized by male with the lowest concentrations for total cholesterol (TC) and high-density lipoprotein (HDL) cholesterol measures, experienced the highest risk for major CVD. Conversely, subgroup III characterized by a female with the highest values for these measures represented as the lowest CVD risk. Furthermore, subgroup II, with the highest systolic blood pressure (SBP) and no antihypertensive agent use at baseline, had a significantly greater frequency of non-MI ACS under intensive BP control, the number needed to harm (NNH) was 84.24 to cause 1 non-MI ACS [absolute risk reduction (ARR) = −1.19%; 95% CI: −2.08, −0.29%] in the SPRINT [hazard ratio (HR) = 3.62; 95% CI: 1.33, 9.81; P = 0.012], and the NNH of was 43.19 to cause 1 non-MI ACS (ARR = −2.32%; 95% CI: −4.63, 0.00%) in the ACCORD (HR = 1.81; 95% CI: 1.01–3.25; P = 0.046). Finally, subgroup IV characterized by mostly younger patients with antihypertensive medication use and smoking history represented the lowest risk for stroke, HF, and relatively low risk for death from CVD causes and primary composite CVD outcome in SPRINT, however, except stroke, a low risk for others were not observed in ACCORD.ConclusionSimilar findings in patients with hypertensive with T2DM or without diabetes by multivariate subgrouping suggested that the individual components of the FRS could enrich or improve CVD risk assessment. Further research was required to clarify the potential mechanism.

Exercise training worsens cardiac performance in males but does not change ejection fraction and improves hypertrophy in females in a mouse model of metabolic syndrome

BackgroundMetabolic syndrome (MetS) refers to a cluster of co-existing cardio-metabolic risk factors, including visceral obesity, dyslipidemia, hyperglycemia with insulin resistance, and hypertension. As there is a close link between MetS and cardiovascular diseases, we aimed to investigate the sex-based differences in MetS-associated heart failure (HF) and cardiovascular response to regular exercise training (ET).MethodsHigh-fat diet-fed male and female APOB-100 transgenic (HFD/APOB-100, 3 months) mice were used as MetS models, and age- and sex-matched C57BL/6 wild-type mice on standard diet served as healthy controls (SD/WT). Both the SD/WT and HFD/APOB-100 mice were divided into sedentary and ET groups, the latter running on a treadmill (0.9 km/h) for 45 min 5 times per week for 7 months. At month 9, transthoracic echocardiography was performed to monitor cardiac function and morphology. At the termination of the experiment at month 10, blood was collected for serum low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol measurements and homeostatic assessment model for insulin resistance (HOMA-IR) calculation. Cardiomyocyte hypertrophy and fibrosis were assessed by histology. Left ventricular expressions of selected genes associated with metabolism, inflammation, and stress response were investigated by qPCR.ResultsBoth HFD/APOB-100 males and females developed obesity and hypercholesterolemia; however, only males showed insulin resistance. ET did not change these metabolic parameters. HFD/APOB-100 males showed echocardiographic signs of mild HF with dilated ventricles and thinner walls, whereas females presented the beginning of left ventricular hypertrophy. In response to ET, SD/WT males developed increased left ventricular volumes, whereas females responded with physiologic hypertrophy. Exercise-trained HFD/APOB-100 males presented worsening HF with reduced ejection fraction; however, ET did not change the ejection fraction and reversed the echocardiographic signs of left ventricular hypertrophy in HFD/APOB-100 females. The left ventricular expression of the leptin receptor was higher in females than males in the SD/WT groups. Left ventricular expression levels of stress response-related genes were higher in the exercise-trained HFD/APOB-100 males and exercise-trained SD/WT females than exercise-trained SD/WT males.ConclusionsHFD/APOB-100 mice showed sex-specific cardiovascular responses to MetS and ET; however, left ventricular gene expressions were similar between the groups except for leptin receptor and several stress response-related genes.

Mitochondrial respiratory chain dysfunction alters ER sterol sensing and mevalonate pathway activity

Mitochondrial dysfunction induces a strong adaptive retrograde signaling response; however, many of the downstream effectors of this response remain to be discovered. Here, we studied the shared transcriptional responses to three different mitochondrial respiratory chain inhibitors in human primary skin fibroblasts using QuantSeq 3′-RNA-sequencing. We found that genes involved in the mevalonate pathway were concurrently downregulated, irrespective of the respiratory chain complex affected. Targeted metabolomics demonstrated that impaired mitochondrial respiration at any of the three affected complexes also had functional consequences on the mevalonate pathway, reducing levels of cholesterol precursor metabolites. A deeper study of complex I inhibition showed a reduced activity of endoplasmic reticulum–bound sterol-sensing enzymes through impaired processing of the transcription factor Sterol Regulatory Element-Binding Protein 2 and accelerated degradation of the endoplasmic reticulum cholesterol-sensors squalene epoxidase and HMG-CoA reductase. These adaptations of mevalonate pathway activity affected neither total intracellular cholesterol levels nor the cellular free (nonesterified) cholesterol pool. Finally, measurement of intracellular cholesterol using the fluorescent cholesterol binding dye filipin revealed that complex I inhibition elevated cholesterol on intracellular compartments. Taken together, our study shows that mitochondrial respiratory chain dysfunction elevates intracellular free cholesterol levels and therefore attenuates the expression of mevalonate pathway enzymes, which lowers endogenous cholesterol biosynthesis, disrupting the metabolic output of the mevalonate pathway. We conclude that intracellular disturbances in cholesterol homeostasis may alter systemic cholesterol management in diseases associated with declining mitochondrial function.

No association of BMI and body adiposity with cardiometabolic biomarkers among a small sample of reindeer herders of sub-Arctic Finland

ABSTRACT The rising global obesity rate is alarming due to its real health and socioeconomic consequences. Finland, like other circumpolar regions, is also experiencing a rise in obesity . Here we assess BMI, body adiposity, and measures of cardiometabolic health among a small population of reindeer herders in sub-Arctic Finland. We collected anthropometric and biomarker measures at two different time points: October 2018 (N = 20) and January 2019 (N = 21) with a total of 25 unique individuals across the data collection periods (ages 20–64). Anthropometric measures included height, weight, age, and body composition. Biomarkers included measures of cholesterol, fasting glucose, HDL cholesterol, LDL cholesterol, and triglyceride levels. Over 70% of this sample was classified as “overweight” and “obese” as categorised by BMI and 64% classified as “overfat” based on body fat percentage. However, there was no significant relationship between BMI and body fat percentage with any of the measured biomarkers. Although the sample size is small, the results of this study suggest there might not be a strong correlation between BMI, body adiposity, and cardiometabolic health indices within this population – a pattern that has been documented elsewhere. However, further study is needed to confirm this lack of a correlation.

Innovative Non-Enzymatic Electrochemical Quantification of Cholesterol.

The use of the Liebermann–Burchard reaction in this study has been explored in the development of a simple, reliable, and robust quantitative electrochemical method to assay cholesterol, and hence provide a good alternative to colorimetric methods. The optimization of batch mode operation for electrochemical oxidation of cholesterol in the Liebermann–Burchard reagents included the applied potential and acidic volume. Tested using chronoamperometry, the developed method showed a high sensitivity (14.959 μA mM−1) and low detection limit (19.78 nM) over a 0.025–3 mM concentration range, with remarkable linearity (R2 = 0.999), proving an analytical performance either higher or comparable to most of the cholesterol sensors discussed in literature. The influence of possible interfering bioactive agents, namely, glucose, uric acid, ascorbic acid, KCl and NaCl, has been evaluated with no or negligible effects on the measurement of cholesterol. Our study was directed at finding a new approach to chemical processing arising from the use of external potential as an additional level of control for chemical reactions and the transfer of electrons between surfaces and molecules. Finally, the optimized method was successfully applied for the determination of cholesterol content in real blood samples.

Optimism and Lipid Profiles in Midlife: A 15-Year Study of Black and White Adults

Optimism is associated with better cardiovascular health, yet little is known about the underlying mechanisms and whether protective relationships are consistently observed across diverse groups. This study examines optimism's association with lipid profiles over time and separately among Black and White men and women. Data were from 3,206 middle-aged adults in the Coronary Artery Risk Development in Young Adults study. Optimism was measured in 2000-2001 using the Revised Life Orientation Test. Triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol measurements were obtained at 5-year intervals through 2015-2016. Linear mixed models evaluated relationships between optimism and lipids, adjusting for covariates, including prebaseline lipids. Subgroup differences were examined using interaction terms and stratification. All analyses were conducted in 2020. Higher optimism was associated with both lower baseline total cholesterol (β= -2.33, 95% CI= -4.31, -0.36) and low-density lipoprotein cholesterol levels (β= -1.93, 95% CI= -3.65, -0.21) and a more rapid incremental increase in both markers over time (total cholesterol: β=0.09, 95% CI=0.00, 0.18; low-density lipoprotein cholesterol: β=0.09, 95% CI=0.01, 0.16). No associations were apparent with baseline triglycerides, high-density lipoprotein cholesterol, or changes in either lipid over time. Tests for interaction only found evidence of heterogeneous associations with baseline triglyceride levels, but stratified models hinted at stronger protective associations with baseline levels of total cholesterol and low-density lipoprotein cholesterol among White women. Optimism may help diverse individuals establish healthy total cholesterol and low-density lipoprotein cholesterol levels before midlife. Although associations were largely consistent across subgroups, stronger associations among White men and White women highlight a need to study optimism's health impact in diverse samples.

Comparison of the antisclerotic effect of hydroalcoholic extracts of Ocimum basilicum and Otostegia persica with quinacrine by inhibition of phospholipase A2 in male Wistar rats.

Objective:Hypercholesterolemia is now considered a major risk factor for development of atherosclerosis. The phospholipase A2 superfamily of enzymes has causal involvement in atherosclerosis. Atherosclerosis is one of the main causes of mortality in developed countries and in some developing countries such as Iran. The present study was designed to investigate the antihypercholesterolemic and antiatherogenic potentiality of ethanolic extracts of Ocimum basilicum (O. basilicum) and Otostegia persica (O. persica) in high-fat diet-induced hypercholesterolemic rats. Materials and Methods:In this study, 35 male rats were randomly divided into 1 normal diet and 4 high-fat diet groups. After two months of high-fat diet, measurement of cholesterol and LDL showed a significant difference between the groups. The 5 groups were as follows: Healthy rats receiving physiological serum, hypercholesterolemic rats without any treatment, hypercholesterolemic rats receiving quinacrine (30 mg/kg), hypercholesterolemic rats treated with extract of O. persica (300 mg/kg), and hypercholesterolemic rats treated with O. basilicum extract (300 mg/kg). Treatment was carried out for 40 days and finally, blood samples were collected and examined for cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, C-reactive protein, phospholipase A2, and interleukin-6 levels.Results:Treatment of hypercholesterolemic rats with ethanolic extracts of O. persica and O. basilicum did not cause significant changes in cholesterol, triglyceride and LDL or HDL levels. They caused a significant decrease in the levels of inflammatory factors of IL-6, PLA2 and CRP (p <0.05).Conclusion:Ethanolic extracts of O. persica and O. basilicum have antisclerotic effects by reducing the inflammatory factors and PLA2 activity.

Variation in Child Serum Cholesterol and Prevalence of Familiar Hypercholesterolemia: The Health Oriented Pedagogical Project (HOPP).

Early stages of atherosclerosis may develop in childhood due to hyperlipidemia. The aims are to investigate the prevalence of familiar hypercholesterolemia in 6 to 12-year-old children and to study the deviation in cholesterol measures. Anthropometric data and venous blood were collected from children participating in the Health Oriented Pedagogical Project (HOPP). Out of 18 children with TC > 6.0 mmol/L, 15 were tested genetically and none diagnosed with FH. The prevalence of TC > 6.0 mmol/L declined from 1.3% in 2015 to 0.5% in 2016. The mean TC was 4.30 mmol/L both years, which is lower than in earlier studies. Usage of a single TC measurement and a threshold of TC > 6.0 mmol/L in screening children for FH, may not be a good screening strategy. While lipid values have a good reliability across 2 measurements, there are variations in individual TC levels across 1 year.

Total serum cholesterol level in patients with major depressive disorder: Simple yet undermined

Human brain cholesterol acts as structural components of cellular membrane, synapse and dendrite formation.Researchers have found a possible association between low serum cholesterol levels and mood disorders though the literature from India in this regard is limited. To estimate serum levels of total cholesterol in patients with major depressive disorder. 75 patients of MDD were compared with equal number of age and sex matched controls. 5 ml of fasting sample of blood was obtained in a plain vacutainer to analyse total cholesterol level by Cholesterol oxidase-peroxidase method. Statistical analysis: The obtained results were tabulated and analyzed by multiple logistic regression analysis, independent t-test, Chi-square test and area under the curve. The mean level of cholesterol in cases (158.85±61.22 mg/dL) which was significantly lower compared to the controls (182.71±40.98 mg/dL) with P &lt;0.01. The symptoms of MDD negatively correlated with lower serum cholesterol level with odds ratio of 0.99. There was statistically significant lower level of cholesterol in the MDD group below 140 mg/dL compared to the control group with P &lt;0.001. As the measurement of total serum cholesterol is simple and cost effective, it can be used as an important biochemical marker for MDD.

Low Plasma Potassium and High Iron Levels Increased the Risk of Dyslipidemia among Non-Diabetic Taxi-Motorbike Drivers Living and Working in Cotonou, Benin

Non-traditional cardiovascular risk factors such as iron and potassium may play a role in lipid metabolism. However, information on this association is lacking in populations of Benin. This study evaluated the associations between plasma iron and potassium levels and risk of dyslipidemia among taxi-motorbike drivers (TMDs) in Cotonou. We conducted a cross-sectional study on 134 males TMDs aged ≥20 years old, of whom 39 (29.1%) had dyslipidemia. Plasma biochemistry including measurements of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), iron, and potassium were performed. Dyslipidemia was defined as any or combinations of the following: TC > 5.2 mmol/L, LDL-C > 3.4 mmol/L, TG > 1.7 mmol/L, and HDL-C rd tertile (>18.8 μmol/L) to the 1st tertile of plasma iron (nd tertile (4.4 - 4.8 μmol/L) to the 1st tertile (nd and 3rd tertiles to the 1st tertile of plasma potassium were 0.19 (0.04 - 0.87, p = 0.032) and 0.14 (0.02 - 0.93, p = 0.043). In conclusion, our study shows that higher plasma iron and low potassium levels are significant predictors of dyslipidemia in TMDs. As such, the findings have public health implications for predicting and preventing dyslipidemia and associated cardiometabolic diseases. However, longitudinal studies are needed to determine if disturbances in iron and potassium levels, even within the normal range, are precursors or consequences of dyslipidemia.

A Comparative Study of the Levels of Heat Shock Protein 70, Some Biochemical and Hormonal in the Blood of Cows Suffering from Follicular Cystic Ovarian and Endometritis

Twenty- four reproductive systems of Frisian cross breed cows, aged between (3-5years) were obtained from Basrah abattoir during the period of (2nd March 2020 - 30th June, 2020). They were divided into 3 groups of cows with ovarian follicular cystic (n=8), cows with endometritis (n = 8), and healthy cows (n=8) depending on clinical signs. The main gall of this paper compare and report the different values of heat shock protein 70 (HSP70), some biochemical and hormonal levels in those cows in the native Basrah climate. Samples of blood were collected from all cows subjected to this study and serum was harvested from each individual sample by centrifugation. Heat shock protein 70 (Hsp70), total protein (TP), albumin(Alb), globulin, total cholesterol (Cho), triglyceride (TG), low density lipo-protein(LDL), aspartate aminotransferase (AST), cortisol, testosterone, thyroid stimulation hormone (TSH), thyroxin (T4) and triiodothyronine hormones(T3) were measured in serum samples. Results revealed a significant increase (p≤0.05) in the level of Hsp70, and thyroid stimulation hormones (TSH) of cows with two pathological cases (endometritis and follicular cysts) compared with those healthy cow. Significant decrease (p≤0.05) in the measurement of total protein, albumin, globulin, thyroxin (T4), triiodothyronine (T3) hormones, cholesterol, triglyceride, and low density lipoprotein (LDL) in cows having those two genital diseases compared with normal cows. The results also were revealed a significant increase (p≤0.05) in the level of testosterone hormone in cows with follicular cystic ovarian case compared with endometritis case and control ones. Finally, significant increase (p≤0.05) in cortisol hormone level and aspartate aminotransferase (AST) activity in cows with endometritis case compared with the control one and follicular cystic ovarian cases.

Effect of Antiepileptic Drugs on Serum Lipid Profile among Children with Epilepsy at a Tertiary Care Hospital, Chennai, India

Introduction: An arsenal of Antiepileptic Drugs (AED) is used in the management of childhood seizure disorders. Most of them are taken long-term. These drugs have the potential to cause hyperlipidemia by inducing the P450 enzyme system. The alteration in lipid profile caused by long-term use of antiepileptic drugs in children needs to be studied to reduce the risk of future atherosclerosis. Aim: To analyse the effect of antiepileptic drugs on serum lipid profile in children with epilepsy in a tertiary care. Materials and Methods: This prospective descriptive study was conducted in the Outpatient and Inpatient Wards of the Department of Paediatrics and Neurology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from February 2017 to September 2017. The study involved a total of 155 children, who were on monotherapy antiepileptic drugs for atleast 6 months (33 on phenytoin, 42 on phenobarbitone, 20 on levetiracetam, 20 on carbamazepine, 40 on sodium valproate). A corresponding numbers of children, who attended the General Outpatient Department for acute upper respiratory tract and were otherwise healthy, were included as controls. A blood sample (3 mL) was drawn after an overnight fast for serum glucose, liver enzymes, total cholesterol, High Density Lipoprotein-Cholesterol (HDL-C), Low Density LipoproteinCholesterol (LDL-C), Very Low Density Lipoprotein (VLDL) cholesterol and Triglycerides (TG) measurement. Chi-square test was performed to find out the significance of association and independent t-test was used to compare the mean between various groups. Results: Cytochrome P450 (CYP) enzyme inducers like carbamazepine, phenytoin and phenobarbitone significantly modified serum lipids in epileptic children when compared to healthy controls. In children on long-term phenytoin monotherapy, mean cholesterol levels were significantly higher in the cases compared to controls (156.73±31.93 mg/dL vs 105.03±8.60 mg/dL, p-value &lt;0.0001), significantly elevated triglycerides (123.48±25.99 mg/dL vs 87.88±12.16 mg/dL, p-value &lt;0.0001), and HDL-C level was significantly lower (44.52±10.14 mg/ dL vs 56.73±12.56 mg/dL, p-value &lt;0.0001) than in controls. Phenobarbitone use was associated with significantly higher levels of cholesterol (164.97±34.41 mg/dL vs 107.76±9.28 mg/dL, p-value &lt;0.0001), LDL (155.27±28.55 mg/dL vs 93.36±6.81 mg/ dL, p-value &lt;0.0001), and triglycerides (125.55±42.19 mg/dL vs 86.30±8.12 mg/dL, p-value &lt;0.001) and lower HDL (46.30±9.47 mg/dL vs 57.73±14.41 mg/dL, p-value &lt;0.0001). Levetiracetam was not associated in significant alteration in both liver enzymes and lipid profile (p-value &gt;0.05). Carbamazepine monotherapy was associated with higher levels of cholesterol (180.50±28.06 mg/dL vs 112.15±13.55 mg/dL, p-value &lt;0.0001), LDL (138.85±22.55 mg/dL vs 82.45±12.12 mg/dL, p-value&lt;0.0001) and triglycerides (142.80±9.48 mg/dL vs 85.40±6.29 mg/dL, p-value &lt;0.0001) when compared to healthy controls. There was no alteration in lipid profile in valproate monotherapy. Valproate monotherapy was associated with significant increase in levels of SGOT and SGPT when compared to mean levels (40.35±11.208 (IU/L), and 40.70±8.809 (IU/L), respectively) observed in other AEDs and significant increase in SGPT levels when compared to healthy controls (36.50±10.61(IU/L) in cases vs 40.70±8.81 (IU/L) in controls). Conclusion: Levetiracetam did not produce significant changes in the serum lipid profile and liver enzymes and appears to be safe to use in children for long-term epilepsy management especially in children with baseline deranged lipid profile.

Early introduction of exercise prevents insulin resistance in postnatal overfed rats.

Early childhood obesity increases the risk of developing metabolic diseases. We examined the early introduction of exercise in small-litter obese-induced rats (SL) on glucose metabolism in the epididymal adipose tissue (AT) and soleus muscle (SM). On day 3 post-birth, pups were divided into groups of ten or three (SL). On day 22, rats were split into sedentary (S and SLS) and exercise (E and SLE) groups. The rats swam three times/week carrying a load for 30 min. In the first week, they swam without a load; in the 2nd week, they carried a load equivalent to 2% of their body weight; from the 3rd week to the final week, they carried a 5% body load. At 85 days of age, an insulin tolerance test was performed in some rats. At 90 days of age, rats were killed, and blood was harvested for plasma glucose, cholesterol, and triacylglycerol measurements. Mesenteric, epididymal, retroperitoneal, and brown adipose tissues were removed and weighed. SM and AT were incubated in the Krebs-Ringer bicarbonate buffer, 5.5 mM glucose for 1 h with or without 10 mU/mL insulin. Comparison between the groups was performed by 3-way ANOVA followed by the Tukey post-hoc test. Sedentary, overfed rats had greater body mass, more visceral fat, lower lactate production, and insulin resistance. Early introduction of exercise reduced plasma cholesterol and contained the deposition of white adipose tissue and insulin resistance. In conclusion, the early introduction of exercise prevents the effects of obesity on glucose metabolism in adulthood in this rat model.

Evaluation of a visiting credentialled diabetes educator program in remote western Queensland, Australia.

Within western Queensland (WQ), Australia, diabetes is the leading cause of potentially preventable hospitalisations and, in some areas, diabetes prevalence is up to 20%. To address inequity of access to diabetes-related services in remote areas of WQ, a visiting credentialled diabetes educator program (VCDEP) was developed. Using a fly-in, fly-out model of service delivery and supporting telehealth services, upskilling of rural primary healthcare professionals occurred and credentialled diabetes educator (CDE) accessibility increased in WQ. This study objectively measured the impact of the VCDEP. Practice report data from five representative VCDEP practices and five non-VCDEP practices were analysed using Pearson Chi-squared tests to ascertain associations in reporting of blood pressure (BP), HbA1c, estimated glomerular filtration rate (eGFR), total cholesterol, microalbumin, body mass index (BMI) and foot and eye examinations, as well as improvements in BP, HbA1c, eGFR, total cholesterol, microalbumin and BMI measures at two set date points. In practices involved in the VCDEP, aggregated data indicated significant increases in reporting of HbA1c (P ≤ 0.001), eGFR (P ≤ 0.001), total cholesterol (P = 0.022) and foot assessments (P = 0.015). In contrast, aggregated data from practices not involved in the VCDEP identified significant decreases in the reporting of BP and eye examinations between October 2019 and March 2021 (P = 0.034 and P = 0.007 respectively). Decreases in reporting of HbA1c, eGFR, microalbumin, BMI and foot examinations were also found, although these did not reach statistical significance. Concernedly, across practices overall, HbA1c levels have risen, with a significant increase in the percentage of people with diabetes having a HbA1c >53 mmol/mol (7%) and >86 mmol/mol (10%) in March 2021 compared with October 2019 (P = 0.012 and P < 0.001 respectively). Reporting of key diabetes indicators is greater among practices participating in the VCDEP than among practices not involved in the VCDEP. Further investigation and resource provision are required to address rising HbA1c levels in rural WQ, with a particular focus on the impacts of health literacy, social determinants of health and workforce challenges.

Serum lipid trajectories in the years before a lymphoma diagnosis

We conducted a case-control study of patients from the Clinical Practice Research Datalink in the United Kingdom to describe the trajectories of serum lipid in the years before a diagnosis of lymphoma. Study participants had at least one cholesterol measurement. Multilevel, multivariable linear longitudinal models were fit to examine the adjusted trajectories of serum lipid levels in the years before lymphoma diagnosis. Overall, 11,969 cases of non-Hodgkin lymphoma, 473 of Hodgkin lymphoma, and 61,894 controls were selected. Mean cholesterol levels in the years before the index date showed a more pronounced decrease in the 4 years before lymphoma diagnosis than in controls. Triglycerides levels were unrelated to case status. This research is the first to replicate the results of a similar study conducted in the United States while adjusting for more potential confounders. The newly described different behavior of cholesterol and triglycerides suggests a potential role of cholesterol in lymphomagenesis.

Bariatric Surgery Leads to a Reduction in Antibodies to Apolipoprotein A-1: a Prospective Cohort Study

PurposeAutoantibodies against apolipoprotein A-1 have been associated with cardiovascular disease, poorer CV outcomes and all-cause mortality in obese individuals. The impact of bariatric surgery (BS) on the presence of circulating anti-apoA-1 IgG antibodies is unknown. This study aimed to determine the effect of bariatric surgery on auto-antibodies titres against Apolipoprotein A-1 (anti-apoA-1 IgG), looking for changes associated with lipid parameters, insulin resistance, inflammatory profile and percentage of excess body mass index loss (%EBMIL).Materials and MethodsWe assessed 55 patients (40 women) before, 6 and 12 months post-operatively. Baseline and post-operative clinical history and measurements of body mass index (BMI), serum cholesterol, triglycerides, high- and low-density lipoprotein cholesterol (HDL-C and LDL-C), apoA-1, highly sensitive C-reactive protein (hsCRP), fasting glucose (FG), glycated haemoglobin (HbA1c) and HOMA-IR were taken at each point. Human anti-apoA-1 IgG were measured by ELISA.ResultsThe mean age of participants was 50 years. BS significantly improved BMI, %EBMIL triglycerides, HDL-C, apoA-1, hsCRP, HBA1c, FG and HOMA-IR. Baseline anti-apoA-1 IgG seropositivity was 25% and was associated with lower apoA-1 and higher hsCRP levels. One year after BS, anti-apoA-1 IgG seropositivity decreased to 15% (p = 0.007) and median anti-apoA-1 IgG values decreased from 0.70 (0.56–0.84) to 0.47 (0.37–0.61) AU (p < 0.001). Post-operative anti-apoA-1 IgG levels were significantly associated with a decreased post-surgical %EBMIL at 1 year.ConclusionBariatric surgery results in significant reduction in anti-apoA-1 IgG levels, which may adversely influence weight loss. The exact mechanisms underpinning these results are elusive and require further study before defining any clinical recommendations.Graphical abstract

The influence of menopause and cardiorespiratory fitness on lipoprotein particles in midlife women.

Lipoprotein particles may provide better information about cardiovascular risk than standard cholesterol measures for women. Whether lipoprotein subclasses change with menopausal stage is unclear. Given the high prevalence of low cardiorespiratory fitness in midlife women and benefit of cardiovascular disease risk, it is also important to understand the effect of fitness on lipoprotein profiles. This study evaluated the influence of menopausal status and fitness on lipoprotein particles in healthy midlife women. Lipoprotein particles were measured in high- (n = 25) and low- (n = 13) fit perimenopausal and late postmenopausal women, and in high-fit premenopausal (n = 10), perimenopausal (n = 12), and late postmenopausal women (n = 13). There were larger low-density lipoprotein particles (LDL-P; 21.7 ± 0.06 vs. 21.3 ± 0.1 nm, p = 0.002), more large LDL-P (623.1 ± 32.8 vs. 500.2 ± 52.6 nmol/L, p = 0.045), and fewer small LDL-P (145.5 ± 31.4 vs. 311.5 ± 44.7 nmol/L, p = 0.001) in the high-fit group vs. the low-fit group. High-density lipoprotein particles (HDL-P) were larger (10.1 ± 0.1 vs. 9.7 ± 0.1 nm, p = 0.002) in the high-fit group, with more large (14.8 ± 0.7 vs. 11.0 ± 0.9 μmol/L,p = 0.002), medium (12.9 ± 0.8 vs. 8.4 ± 0.9 μmol/L, p = 0.002) HDL-P, and fewer small HDL-P (10.2 ± 1.1 vs. 15.4 ± 1.6 μmol/L, p = 0.009) compared with the low-fit group. High-fit postmenopausal women had more large LDL-P (662.9 ± 47.5 nmol/L) compared with premenopausal women (479.1 ± 52.6 nmol/L, p = 0.035), and more HDL-P (40.2 ± 1.1 µmol/L) compared with premenopausal (34.9 ± 1.5 μmol/L, p = 0.023) and perimenopausal women (35.4 ± 1.3 μmol/L, p = 0.033). High fitness positively influences lipoprotein particles in healthy perimenopausal and late postmenopausal women. In healthy fit women, menopause may not have a large influence on lipoprotein particles. Novelty: In highly fit women, menopause may not have a negative influence on lipoprotein particle subclasses. High fitness is associated with a less atherogenic lipoprotein profile in perimenopausal and late postmenopausal women.

Blood pressure and cholesterol measurements in primary care: cross-sectional analyses in a dynamic cohort

BackgroundGuidelines on cardiovascular risk management (CVRM) recommend blood pressure (BP) and cholesterol measurements every 5 years in men aged ≥40 years and (post-menopausal) women aged ≥50 years.AimTo evaluate CVRM guideline implementation.Design & settingCross-sectional analyses in a dynamic cohort using primary care electronic health record (EHR) data from the Julius General Practitioners’ Network (JGPN) (n = 388 929).MethodTrends (2008–2018) were assessed in the proportion of patients with at least one measurement (BP and cholesterol) every 1, 2, and 5 years, in those with:1. a history of cardiovascular disease (CVD) and diabetes mellitus (DM);2. a history of DM only;3. a history of CVD only;4. a cardiovascular risk assessment (CRA) indication based on other medical history, or;5. no CRA indication.Trends were evaluated over time using logistic regression mixed-model analyses.ResultsTrends in annual BP and cholesterol measurement increased for patients with a history of CVD from 37.0% to 48.4% (P<0.001) and 25.8% to 40.2% (P<0.001). In the 5-year window from 2014–2018, BP and cholesterol measurements were performed respectively in 78.5% and 74.1% of all men aged ≥40 years and 82.2% and 78.5% of all women aged ≥50 years. Least measured were patients without a CRA indication (men 60.2% and 62.4%; women 55.5% and 59.3%).ConclusionThe fairly high frequency of CVRM measurements available in the EHR of patients in primary care suggests an adequate implementation of the CVRM guideline. As nearly all individuals visit the GP at least once within a 5-year time window, improvement of CVRM remains possible, especially in those without a CRA indication.

Cohort profile: Copenhagen Hospital Biobank - Cardiovascular Disease Cohort (CHB-CVDC): Construction of a large-scale genetic cohort to facilitate a better understanding of heart diseases

PurposeThe aim of Copenhagen Hospital Biobank-Cardiovascular Disease Cohort (CHB-CVDC) is to establish a cohort that can accelerate our understanding of CVD initiation and progression by jointly studying genetics, diagnoses, treatments...