Combination Of Hypertriglyceridemia Research Articles

Lipid profile of obese children with metabolic syndrome

Relevance. Disorders of lipid metabolism are closely related to abdominal (visceral) obesity and MS in adolescence, as well as the development of early cardiovascular complications in adulthood.The purpose of the study: to Study the features of the blood lipid spectrum in obese children, depending on the presence of signs of MS.Materials and methods: 483 obese children (SDS BMI ≥ 2.0) (349 boys and 234 girls) aged from 5 to 16 years were. I group — 237 children (145 boys and 92 girls) with MS (IDF, 2007), II group — 246 children (140 boys and 106 girls) with obesity without signs of MS. The examination included anamnesis collection, anthropometry, blood PRESSURE measurement, ultrasound examination of the abdominal organs, biochemical examination of blood serum and lipid profile.Results. Change in lipid profile were detected in 76.8% of children in I group and 43.9% of children in II group have 38,0% of children in I group the changes on a single metric, the 35.6% of children two, and 3.0% — three and more indicators, whereas in II group the most frequently recorded changes of only one (36,2%), at least two indicators (7,7%). In I group children, there was a significant increase in TG, the atherogenicity coefficient, and a decrease in HDL cholesterol. 53.6% of children of I group and only 8.5% of children of II group had an increase in the level of TG, and 52.8% and 24.0% of children had a decrease in HDL levels, respectively. The combination of hypertriglyceridemia and hypo-α-lipoproteidemia was diagnosed exclusively in I group (27.0%), of which boys –62.5%, girls –31.5%. In I group the frequency of hyperglyceridemia and hypo-α-lipoproteinemia regardless of age was significantly higher than II group, while in both groups a higher frequency compared to hyperglyceridemia had Hypo-α-lipoproteinemia. In II group, children under 10 years of age also had lipid profile disorders-hypo-α-lipoproteidemia in 27.8%, hypertriglyceridemia‑11,1%. An increase in the level of TG in children with signs of NAFLD in I group was diagnosed not only more often than in children without it, but also in comparison with children of II group. 46,5% of children in I group with NAFLD and 58.4% without it had a decrease in HDL cholesterol; in II group, these values were 15.7% and 17.6%, respectively. In I group, the combination of hypertriglyceridemia and Hypo-α-lipoproteidemia was observed in 28.9% of children with NAFLD and 22,5% of children without it; in II group, they were registered separately. Regardless of the group, 48,7% of children who were obese for 1–2 years and 60,1% of children with a disease duration of 5 years or more had lipid profile disorders. Violations of one component had 31,6% and 31.1% of children, respectively, the frequency of violations of two or more components as the duration of the disease significantly increased — from 17.1% to 29.0%.Conclusions. In half of children with MS, lipid metabolism disorders are detected in the form of an increase in the level of TG (53.6%) and a decrease in HDL (52.8%), which is significantly higher than in children with uncomplicated obesity (8.5% and 24.0%). Exclusively in children with MS, there is a combination of hypertriglyceridemia and hypo-α-lipoproteinemia (27%). In 28% of obese children under 10 years of age, hypo-α-lipoproteidemia was detected, in 11% — hypertriglyceridemia, which indicates that dyslipidemia is formed in them at a young age and progresses with the duration of the disease, and its early manifestation is a violation of the excretion of tissue cholesterol due to a decrease in HDL levels. The presence of a combination of MS and NAFLD in obese children is a prognostically unfavorable risk factor for the formation and progression of more pronounced disorders of lipid metabolism. Installed deterioration of the lipid spectrum of blood serum as the duration of obesity, manifested by a reliable increase in the frequency of combined violations of two or more indicators that indicates a need for complex treatment and preventive measures at earlier stages of the disease (first 1–2 years) to reduce the risk of formation of MS and atherogenic complications in the future.

Hypertriglyceridemia in an outpatient department – Significance as an atherosclerotic risk factor

BackgroundAlthough a relationship between elevated triglycerides (TG) and cardiovascular diseases is generally accepted, its extent is still discussed. This retrospective study analyzed the incidence of cardiovascular events (CVE) and pancreatitis as well as the therapeutic regimen in patients being treated for hypertriglyceridemia (HTG) at an outpatient department. MethodsThe cohort included 183 patients with mild and 49 patients with severe HTG; subgroups were formed and compared according to gender, presence of metabolic vascular syndrome (MVS) and lipid values. ResultsPatients in this study seem to have had CVE at younger age than reported event rates in the general population. TG levels, rates of CVE and pancreatitis were reduced in all groups during therapy, which could be linked to use of omega-3 fatty acids and fibrates. Patients with persisting severe HTG as a result of incompliance showed massive risk for pancreatitis. ConclusionAlthough no significant association between TG levels and CVE could be established, the combination of HTG and other cardiovascular risk factors such as MVS seems to be especially dangerous. The lipid-lowering drug therapy appeared to be effective with respect to CVE and pancreatitis incidence.

Lipid Nutrition and Healthy Aging

Bioactive food factors are considered to be critical for health promotion and play an important role in the prevention of lifestyle-related diseases. Metabolic syndrome, a typical common disease, is a cluster of metabolic disorders, such as abdominal obesity, the combination of hypertriglyceridemia and lower level of HDL, hypertension and diabetes mellitus, that contribute to increased cardiovascular morbidity and mortality. In addition, the incidence of metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) is closely linked with the increase in inflammation and the disorders of lipid metabolism. The pathogenesis of metabolic syndrome and related diseases is complicated. However, food factors have been recognized as contributing factors in the development and prevention of these diseases. Provocative evidence profoundly supports the preventive role of dietary bioactive lipids, polyphenols and other food ingredients. Recent studies suggest the central role of nuclear transcription factors in the pathogenesis of obesity and NAFLD. The goal of the present symposium is to enhance our understanding of cellular and molecular effects of bioactive food factors against obesity related pathogenesis.

LOW-DENSITY LIPOPROTEIN SUBFRACTIONS AND VARYING DEGREE OF CORONARY STENOSIS

Aim.To investigate whether low and intermediate density lipoprotein (LDL, IDL) subfractions are associated with a degree of angiographically verified coronary atherosclerosis, as well as with other biochemical risk factors of coronary heart disease (CHD), and hypertriglyceridemia (HTG) in particular.Material and methods.The study included 129 patients (76 men and 53 women), aged 33–75 years, who were referred for coronary angiography. All participants were divided into three groups by the degree of coronary artery (CA) stenosis: 0–20%, 21–70%, and >70%. LDL and IDL subfractions were measured with the Lipoprint LDL System (electrophoresis in 3% polyacrylamide gel).Results.All groups were similar by the levels of lipid and apoprotein parameters. The levels of high-sensitive C-reactive protein and glucose, as well as HOMA-IR index, were higher in Group 3 patients. In most cases of severe CA stenosis, small dense LDL particles were detected. In HTG patients, higher levels of small dense LDL3 particles were registered only together with the CA stenosis of at least 21–70%.Conclusion.The findings on lipoprotein subfractions, obtained with the Lipoprint LDL System, have demonstrated that in patients with verified coronary atherosclerosis, there is a link between the levels of more atherogenic small dense LDL3 particles, the degree of CA stenosis, and blood TG levels. The combination of HTG and high LDL3 levels could be considered an additional marker of severe CA atherosclerosis.

The Weight of Tissue Plasminogen Activator Dose in Overweight Patients With Strokes

See related article, page 1615–1620 Obesity is a widespread problem, particularly in the cardiovascular disease and stroke population. The combination of hypertriglyceridemia, glucose intolerance, and inflammation is linked with increased production of the primary inhibitor of endogenous thrombolysis, plasminogen activator inhibitor-1, leading to deficient thrombolysis in overweight patients. Enhanced fibrin crosslinking has been shown to be, at least partially, responsible for delayed clot lysis among obsesses. Moreover, body mass index was directly associated with fibrinogen, Factor VII, plasminogen activator inhibitor-1 and tissue plasminogen activator (tPA) antigen, von Willebrand factor, and viscosity. In contrast, body mass index itself had no impact on in-hospital mortality in patients undergoing primary percutaneous coronary interventions for acute myocardial infarction. Obese patients with acute myocardial infarction have a lower risk for in-hospital, 6-month, and 12-month mortality and cardiovascular events than patients with a normal body mass index.1 This “obesity paradox” may be explained by the fact that obese patients were younger at presentation. tPA dose for stroke (0.9 mg/kg alteplase, maximum 90 mg) was chosen based on small dose-escalation studies. This body weight-based dose has …

296 Trends in plasma lipids, lipoproteins and dyslipidemias in French adults, 1996-2007

The management of dyslipidemias remains a priority of preventive cardiology. The aim of this work was to assess lipids, lipoproteins and dyslipidemias trends between 1996 and 2007 in France. Two representative surveys of the general population were carried out in Northern, in North-Eastern and in Southwestern areas of France in 1996-97 (n=3508) and in 2006-07 (n=3597). Men and women aged 35 to 64 years were included. The investigators recorded all the cardiovascular risk factors and a blood sample was drawn. Data have been rectified with the respective original populations to study a 10-year trend in the measured parameters. From 1996 to 2007, a significant 5.7% decrease in LDL-cholesterol (C) levels was observed in adults aged 35-64 years (p<0.001). During this same period a significant 7.8% increase in triglycerides was observed (p<0.001). LDL-C variation was more striking in subjects treated with a lipid-lowering drug, with a 17.6% reduction (p<0.001). Lipid-lowering drug prevalence increased significantly from 10.4% to 12.5% between the two periods (p=0.004). In 1996-97, 33.7% of the dyslipidemic subjects were treated with statins and 71.8% in 2006-07. In 2006-07, atorvastatin was the most commonly prescribed statin (35.8% of all statins) whereas the most common fibrate was fenofibrate (87.2% of all fibrates). A decrease in most of dyslipidemias (LDL-C >4.1 mmol/L or triglycerides ≥2.3 mmol/L or HDL-C <1.05 mmol/L in men or <1.3 mmol/L in women) has also been observed at a 10-year interval. On the other hand, we observed a significant increase in the combination of hypertriglyceridemia with high LDL-C. This study shows a favorable trend in LDL-C and dyslipidemias in France. The significant decrease in LDL-C observed among all the subjects and more particularly among subjects treated with lipid-lowering drugs should be incentive for physicians to support the management of all adults.

Maternal mid-pregnancy serum triglyceride levels and neonatal birth weight

Although disturbances in maternal glucose metabolism and resultant fetal hyperinsulinemia are known to significantly impact fetal overgrowth, it has been suggested that other fuels such as lipids and amino acids may be the determinants of fetal growth in nondiabetics. Maternal serum lipid levels increase in mid to late pregnancy; and in women with gestational diabetes, elevated triglycerides were significantly associated with birth weight corrected for gestational age. Although the role of maternal hyperlipidemia in fetal growth is not known, maternal fasting serum triglyceride levels at 24 to 32 weeks of Pregnancy were shown to be significantly and positively associated with neonatal weight at term,independent of maternal prepregnancy obesity, weight gain during pregnancy, or mid-pregnancy plasma glucose levels (either fasting or postprandial) in Japanese and white women. The aim of the present study was to determine the relationship between maternal mid-pregnancy serum lipid levels and neonatal birth weight in our region. Fasting levels of serum triglycerides and total cholesterol were evaluated in 108 consenting consecutive women who attended for prenatal care with a singleton pregnancy between 24 to 34 weeks and who had abnormal results on the glucose challenge test (plasma glucoseN140 mg/dL) and normal results from the oral 100 g 3-hour glucose tolerance test. Women with antiphospholipid antibody syndrome, hypertension, or thyroid disorder were excluded. The relationship between mid-pregnancy triglyceride and total cholesterol values and neonatal birth weight was determined according to fasting glucose, body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) and pregnancy weight gain—with 95 mg/dL, 25, and 10 kg as the cut-off values, respectively. The relative risk of having heavier babiesweighing 3.5 kg or greater was 2 (95% CI, 0.9–4.2) for women with hypertriglyceridemia and 2.6 (95% CI, 0.78–8.4) when controlled for fasting glucose, BMI, and pregnancy weight gain. When studied together, the combination of hypertriglyceridemia, fasting hyperglycemia, and higher BMI was a significant predictor of heavier neonates. It is important to note that the higher relative risk for heavier babies in women with hypertriglyceridemia persisted even when the variables such as greater BMI, greater pregnancy weight gain, and hyperglycemia were accounted for. With a combination of greater BMI and fasting hyperglycemia, women with hypertriglyceridemia had a much higher relative risk for heavier babies (RR 9.7; 95% CI, 1.7–62.6).

High Prevalence of Low High-Density Lipoprotein Cholesterol Concentrations and Other Dyslipidemic Phenotypes in an Iranian Population

This study was designed to determine the prevalence of different atherogenic dyslipidemic phenotypes, especially decreased serum high-density lipoprotein cholesterol (HDL-C) in an Iranian population and its relationship to other coronary artery disease (CAD) risk factor. The prevalence of lipid abnormalities was assessed in 2941 people, including 1396 males and 1545 females, aged more than 20 years. The population is representative of Iranian urban adults living in northwestern Iran. In addition to isolated forms of hypertriglyceridemia, hypercholesterolemia, and hypoalphalipoproteinemia, some dyslipidemic phenotypes including hypertriglyceridemia/low high-density lipoprotein (HDL) combination, mixed dyslipidemias, and severe dyslipidemias were assessed. The most prevalent abnormality was low HDL cholesterol (HDL-C; 73% including 63% for men and 93.3% for women). Hypertriglyceridemia (>150 mg/dL) was the second most prevalent abnormality (40.6%). Increased total cholesterol (>200 mg/dL) was observed in 35.4% of the subjects. The combination of hypertriglyceridemia and low HDL-C was observed in 9.9% of the population. Fifty eight percent of the low HDL-C cases were not accompanied with hypertriglyceridemia, and 24.4% of hypertriglyceridemic subjects had low HDL-C. Among subjects younger than 30 years, 19% had hypercholesterolemia, 13% had isolated low HDL-C less than 35 mg/dL, and 63% had HDL-C less than 40 mg/dL. Unexpectedly, except for the hypertriglyceridemia/low HDL-C pattern, which was more common in males, the other abnormal lipid profiles were more common in females. The prevalence of dyslipidemia, especially low HDL cholesterol, in Iranian adults is very high. Urgent preventive programs and changes in lifestyle are needed in this area.

Apolipoprotein E and lipoprotein lipase gene polymorphisms interaction on the atherogenic combined expression of hypertriglyceridemia and hyperapobetalipoproteinemia phenotypes

The combination of hypertriglyceridemia (hyperTG) and hyperapobetalipoproteinemia (hyperapoB) is associated with an increased coronary artery disease (CAD) risk. Apolipoprotein (apo) E and lipoprotein lipase (LPL) genes are involved in the catabolism of triglycerides (TG)-rich apoB-containing lipoproteins (VLDL). Several apoE and LPL gene variants affecting CAD risk, plasma TG or apoB concentrations have an allelic frequency of >5% in the general population. This study examined the combined effect of frequent apoE and LPL gene polymorphisms on the expression of hyperTG and hyperapoB. ApoE (E2, E3, and E4) and LPL (D9N, N291S, G188E, and P207L) were genotyped and fasting lipid profiles were assessed among 1,441 French-Canadian subjects. Multivariate analyses were performed to estimate the relationship between apoE and LPL gene variants and the risk of hyperTG (TG>1.7 mmol/l) and hyperapoB (apoB>0.9 g/l). Compared to apoE3 carriers, the apoE4 allele significantly increased the risk of expressing the "hyperTG/hyperapoB" phenotype [odds ratio (OR)=1.95; p=0.014]. This risk was significantly exacerbated (OR=4.69; p=0.017) by the presence of frequent deleterious LPL gene variants in this population. The apoE2 allele was negatively associated with hyperTG/hyperapoB (OR=0.49; p=0.002) in the absence of a deleterious LPL gene variant. These results suggest that epistasis is a phenomenon to consider while assessing the CAD risk associated with gene variants or the effect of frequent alleles on high-risk lipid profiles.

Ciprofibrate Treatment Decreases Non-high Density Lipoprotein Cholesterol and Triglycerides and Increases High Density Lipoprotein Cholesterol in Patients With Frederickson Type IV Dyslipidemia Phenotype

The combination of hypertriglyceridemia and low high density lipoprotein (HDL) cholesterol is one of the most common lipid abnormalities. Thus, the aim of this study was to determine the effects of ciprofibrate on lipid profile in patients with Frederickson's type IV dyslipidemia phenotype. Seventy-five patients with type IV dyslipidemia were assigned at random to 1 of 2 therapeutic options: group A (control), American Heart Association (AHA) Step II diet and physical activity; and group B, AHA diet, physical activity, and ciprofibrate 100 mg daily for 8 weeks. The lipid profile of all patients was determined at baseline and after therapeutic intervention. Patients in group B (treated with ciprofibrate) compared with group A (control) had significantly higher reductions in total cholesterol (downward arrow 14.2% vs. downward arrow 4.8%; P < 0.02), triglycerides (downward arrow 38.0% vs. downward arrow 21.6%; P < 0.007), very low density lipoprotein cholesterol (downward arrow 38.0% vs. downward arrow 21.6%; P < 0.007), non-HDL cholesterol (downward arrow 20.5% vs. downward arrow 7.1%; P < 0.007), and total cholesterol/high density cholesterol ratio (downward arrow 25.6% vs. downward arrow 9.4%; P < 0.01). The ciprofibrate group had a significantly higher increase in HDL cholesterol levels compared with the other group (upward arrow 25.0% vs. upward arrow 9.6%, P < 0.02). Ciprofibrate treatment effectively reduced triglyceride-rich particles and non-HDL cholesterol, and significantly increased HDL cholesterol, proving its effectiveness in patients with low HDL cholesterol and type IV Frederickson's hyperlipidemia.

Plasminogen Activator Inhibitor-1 4G/5G Polymorphism and Risk of Stroke

Impaired fibrinolytic function secondary to elevated plasminogen activator inhibitor-1 (PAI-1) levels has been implicated in ischemic stroke. PAI-1 levels are determined by genetic factors and environmental factors, triglyceride levels in particular. The aim of this study was to investigate the common functional 4/5 guanosine (4G/5G) polymorphism in the promoter region of the PAI-1 gene and the risk of stroke. A nested case-control study design was applied, using baseline data for 2 independent cohorts obtained at population-based surveys in northern Sweden. In study A, there were 113, and in study B, there were 275 individuals without major concomitant disease at baseline who later experienced a first-ever stroke. Blood samples obtained at baseline were analyzed for potential risk factors, including the 4G/5G polymorphism of the PAI-1 gene. The 4G allele of the PAI-1 polymorphism was associated with an increased risk of future ischemic stroke in both studies (odds ratio [OR] of 4G homozygosity, 1.87; 95% CI, 1.12 to 3.15 in study A; OR of 4G homozygosity, 1.56; 95% CI, 1.12 to 2.16 in study B). Individuals with the combination of hypertriglyceridemia and 4G homozygosity were at the greatest risk of developing stroke. Multiple logistic regression analysis identified 4G homozygosity, systolic blood pressure, and diabetes as independent predictors of ischemic stroke. Identical findings in 2 independent studies strongly suggest a true and clinically important association between PAI-1 4G/5G genotype and risk of future ischemic stroke. The observed modification of the genotype effect by triglycerides may be interpreted as a gene-environment interaction.

Plasminogen activator inhibitor-1: a common denominator in obesity, diabetes and cardiovascular disease

A classical perspective of cardiovascular risk does not adequately account for all of the cardiovascular events associated with obesity and diabetes. The combination of hypertriglyceridemia, glucose intolerance and inflammation is linked with increased production of the primary inhibitor of endogenous thrombolysis, plasminogen activator inhibitor-1 (PAI-1). Recent data suggest that PAI-1 contributes directly to the complications of obesity, including type 2 diabetes, coronary arterial thrombi, and may even influence the accumulation of visceral fat. Therefore, direct inhibition of PAI-1 might not only provide a new therapeutic strategy for reducing cardiovascular risk, but may also have beneficial effects on obesity and insulin resistance.

Fibrinolytic response in subjects with hypertriglyceridemia and low HDL cholesterol

The combination of hypertriglyceridemia and low high-density lipoprotein cholesterol (HDL-C) appears to be an excessively high risk factor for coronary artery disease (CAD). In the Helsinki study, both coronary events and mortality were decreased by gemfibrozil, especially in subjects with low HDL-C and high triglycerides (TG). On the other hand, it is known that high levels of TG can be associated with high levels of circulating plasminogen activator inhibitor (PAI), which is also a possible risk factor for CAD. The aim of the present study was to see: 1) whether the combination of low HDL-C and high TG is associated with a more impaired fibrinolytic response than in either isolated condition, and 2) whether gemfibrozil administration can improve fibrinolysis in patients with both high TG and low HDL-C. Twelve non-obese, non-diabetic subjects (eight men, four women; mean age 55 +/- 13 yrs) with low HDL-C (< 35 mg/dL men; < 45 mg/dL women) and high TG (mean 253.6 +/- 42.6 mg/dL) entered the study (Group A). Additionally fourteen comparable subjects with normal HDL-C were also investigated (Group B), plus 12 comparable subjects with isolated low HDL-C (Group C). Ten healthy people served as the control group. The following plasma fibrinolytic parameters were measured: tissue plasminogen activator antigen, PAI antigen and activity, euglobulin fibrinolytic activity (EFA) on fibrin plates, plasminogen and alpha-2-antiplasmin activities. All except the latter two values were also measured after venous occlusion (vo). In baseline conditions, patients in Groups A and B had higher EFA values before vo and higher PAI-1 antigen and alpha-2-antiplasmin levels after vo than those of controls or the subjects in Group C. The relationship between PAI antigen and PAI activity and TG was not confirmed in our population (n = 48). We also saw no interference due to HDL-C, while there was a significant relationship between EFA before vo and both TG and cholesterol. After gemfibrozil treatment (600 mg bid for 12 weeks), the lipid profiles of subjects with high TG and low HDL-C were significantly improved. There was also a slight reduction of PAI activity after vo, while the PAI-1 antigen had decreased significantly from baseline after vo (56.3 +/- 13 ng/mL before vo; 48.4 +/- 21 ng/mL after vo; P = 0.04). The higher risk of CAD in patients with low HDL-C and high TG might be in part related to impairment of fibrinolysis, which occurs in patients with isolated high TG. The close relationship existing between both TG and cholesterol levels and fibrinolytic activity confirm the key role of this latter process in the development of CAD.

Hypertriglyceridemia and low HDL cholesterol in Japanese patients with NIDDM.

Diabetes is frequently associated with the combination of hypertriglyceridemia and low HDL cholesterol level, a known risk factor for cardiovascular disease. We evaluated the frequency of elevated serum triglyceride and the reduced HDL cholesterol levels in Japanese male NIDDM patients. Hypertriglyceridemia (>1.69 mmol/l) and low HDL cholesterol level (<0.91 mmol/l) were frequently found in Japanese male (NIDDM patients (30.4 and 14.2%, respectively). The combined abnormality, i.e., hypertriglyceridemia with concomitant low HDL cholesterol level, was more common in patients with poor glycemic control. We observed that inpatient diet therapy markedly reduced serum triglyceride but serum HDL cholesterol did not change significantly. This is in marked contrast to primary hypertriglyceridemia, in which HDL cholesterol level generally increases in parallel with a reduction in serum triglyceride level. We discuss the defective removal of triglyceride-rich lipoproteins and ineffective HDL production caused by lipoprotein lipase (LPL) deficiency. We also discuss possible correction of this combined abnormality by certain maneuvers that increase LPL activity.

Microaneurysms in diabetes mellitus.

The structural characteristics of and similarities between retinal, glomerular and conjunctival microaneurysms are detailed. Predisposing factors are reviewed. A combination of hypertriglyceridemia and local rheological factors such as venular stasis or capillary ischaemia frequently leads to the formation of microaneurysms. This combination of factors pertains to some extent in hypertension but more particularly in diabetes.