Complete Lipid Profile Research Articles

Contemporary Management of Dyslipidemia in High-Risk Patients: Targets Still Not Met

Purpose Our objective was to evaluate treatment patterns and the attainment of current National Cholesterol Education Program (NCEP)-recommended lipid targets in unselected high-risk ambulatory patients. Methods Between December 2001 and December 2004, the prospective Vascular Protection and Guidelines Oriented Approach to Lipid Lowering Registries recruited 8056 outpatients with diabetes, established cardiovascular disease (CVD), or both, who had a complete lipid profile measured within 6 months before enrollment. The primary outcome measure was treatment success, defined as the achievement of LDL-cholesterol < 2.6 mmol/L (100 mg/dL) according to NCEP guidelines. We examined patient characteristics and use of lipid-modifying therapy in relation to treatment outcome, which included the recently proposed optional LDL-cholesterol target (<1.8 mmol/L [70mg/dL]) for very high-risk patients. Results Overall, 78.2% of patients were treated with a statin and 51.2% had achieved the recommended LDL-cholesterol target. Treatment success rate was highest in diabetic patients with CVD (59.6%), followed by nondiabetic patients with CVD (51.8%), and lowest (44.8%) in diabetic patients without CVD ( P < .0001). Compared with untreated patients, those on statins were more likely to achieve target (34.4% vs 55.9%, P < .0001). Of the patients who failed to meet target, only 9.9% were taking high-dose statin, while 29.3% were not prescribed any statin therapy. Among very high-risk patients, 20.8% attained the optional LDL-cholesterol goal. In multivariable analysis, advanced age, male sex, diabetes, coronary artery disease, coronary revascularization, and use of statin were associated with treatment success (all P < .0001). Conclusion Despite the well-established benefits of available lipid-modifying drugs, current management of dyslipidemia continues to be suboptimal, with a substantial proportion of patients failing to achieve guideline-recommended lipid targets. There remains an important opportunity to improve the quality of care for these high-risk patients.

Comparison of different cellular models measuring in vitro the whole human serum cholesterol efflux capacity

Fu5AH rat hepatoma cells and cAMP (cyclic AMP)-pretreated J774 mouse macrophages are commonly used as models for SR-BI (scavenger receptor class B type I) and ABCA1 (ATP binding cassette transporter 1)-mediated free cholesterol efflux to whole serum, respectively. However, the responsiveness of Fu5AH, control or cAMP pretreated J774 cells to the various lipids and HDL (high-density lipoprotein)-parameters from both normo- and dyslipidaemic subjects has never been compared within the same study. Fifty-eight men were classified into four groups: type IIa hypercholesterolaemic (n = 12), type IIb dyslipidaemic (n = 13), type IV hypertriglyceridaemic (n = 18) and normolipidaemic (n = 15) were recruited. A complete lipid profile including prebeta-HDL was performed. Cholesterol efflux from Fu5AH cells as well as from control or cAMP pretreated J774 cells were measured; the difference between these two latter values being taken as the ABCA1-mediated efflux. The Fu5AH and the control J774 cells delivered cholesterol to mature HDLs, especially to phospholipid (PL)-rich HDL. Using cAMP pretreated cells, the ABCA1-dependent efflux was highly sensitive to prebeta-HDL, which appeared to be a factor in determining the efflux. Consistent with the dependence of the SR-BI-mediated efflux on HDL-PL levels, which are not different between groups, all sera displayed similar efflux capacities from the Fu5AH cells. Conversely, in accordance with their high prebeta-HDL levels, the ABCA1-dependent efflux highlighted the efficiency of type IV sera. Two complementary cellular models providing SR-BI and ABCA1-dependent efflux should be used to measure the capacity of a biological fluid which contains a wide variety of components to promote cholesterol efflux.

South Asians and Cardiovascular Risk

Case presentation: A 36-year-old nonsmoking, normotensive South Asian man presented to the emergency department of a community hospital with retrosternal chest pain of &60 minutes’ duration. His 12-lead ECG demonstrated 10 mm of ST-segment elevation in leads V2 through V6, and he received fibrinolytic therapy within 90 minutes of symptom onset. His pain resolved, but his ST segments only partially normalized; he had a peak creatine kinase of 4564 IU/L, and he showed signs of early heart failure. LDL cholesterol was 135 mg/dL, HDL 32 mg/dL, triglycerides 20 mg/dL, and total cholesterol 206 mg/dL; his body mass index (BMI) was 24 kg/m2. Cardiac catheterization demonstrated severe and diffuse triple-vessel disease, including occlusion of the proximal left anterior descending artery, as well as moderate left ventricular dysfunction. While in the hospital, he was diagnosed with new-onset type 2 diabetes mellitus and subsequently underwent uncomplicated coronary bypass surgery. South Asians are individuals whose ethnic roots originate from the Indian subcontinent, a large geographic area that includes India, Pakistan, Sri Lanka, Nepal, and Bangladesh. Collectively, South Asians represent one fifth of the global population. In North America, more than 2 million South Asians reside in the United States and almost 1 million in Canada. It is important to recognize that the term “South Asian” refers to a heterogeneous population, with important differences in diet, culture, and lifestyle among different South Asian populations and religions. Multiple studies of migrant South Asian populations have, however, confirmed a 3- to 5-fold increase in the risk for myocardial infarction and cardiovascular death as compared with other ethnic groups.1–3 In an analysis of age-standardized coronary heart disease (CHD) mortality in Canada over a 15-year period, South Asians had the highest CHD mortality compared with individuals of Chinese and European descent.4 In …

PRELIMINARY EVALUATION OF BLOOD LIPID PROFILES IN CAPTIVE WESTERN LOWLAND GORILLAS (GORILLA GORILLA GORILLA)

Published serum cholesterol values in captive western lowland gorillas (Gorilla gorilla gorilla) are much higher than human ranges, with a national mean of 7.36 mmol/L (284 mg/dl, n = 863). Complete blood lipid profiles were examined in 15 captive gorillas. High-density lipoprotein (HDL) was found to decrease more rapidly with age than total cholesterol, resulting in an increasing ratio of cholesterol HDL with age. The ratio of apolipoprotein B to apolipoprotein Al also increased with age. Establishment of a database of blood lipid values for captive gorillas with correlative analysis of animals with known atherosclerosis status may help to identify sensitive predictors of coronary heart disease risk.

Comparing lipid profiles of college students to national recommendations

Coronary heart disease (CHD) is the number one killer in America. Though older populations have been widely studied, scant information is available on lipid profiles of college-aged persons. It is important to establish if CHD risk factors are present in this younger population. Study participants (n=478) were from an introductory nutrition course at the Univ. of New Hampshire. Complete lipid profiles were available for 411 of the 478 subjects; 145 were males (35.3%) and 266 were females (64.7%). Blood samples were obtained after an 8–12 hour fast via fingerstick and processed using the Cholestech LDX System. Mean age of males was 20.4 ± 2.72 y and females was 19.79 ± 2.41 y. Mean BMI for males (25.1 ±3.85 kg/m2) was significantly higher than mean BMI for females (22.68 ±3.41 kg/m2) (p<0.01). Mean total cholesterol and triglycerides were not significantly different between genders and were within the low risk parameter of NCEP ATP III guidelines. Mean HDL-C and LDL-C for males and females also were within NCEP ATP III’s low risk parameters, however female values were significantly better than male. Mean HDL-C for females and males were 58.67 ±12.95 mg/dL and 44.67 ±12.74 mg/dL, p<0.01, respectively. Mean LDL-C for females and males was 109.3 ±33.85 mg/dL and 121.05 ±39.36 mg/dL, p<0.01, respectively. The mean values for HDL-C and LDL-C in the male population are approaching the NCEP ATP III borderline values, < 40 mg/dL and < 130 mg/dL. HDL-C and LDL-C are independent risk factors for CHD. The data suggests that females have significantly better lipid profiles than the males even at college age. Supported in part by Office of Sustainability, NH Agricultural Experiment Station #11R571.

Thyroid status influence on adiponectin, acylation stimulating protein (ASP) and complement C3 in hyperthyroid and hypothyroid subjects

BackgroundThyroid abnormalities (hyperthyroid and hypothyroid) are accompanied by changes in intermediary metabolism including alterations in body weight, insulin resistance and lipid profile. The aims of this study were to examine plasma ASP, its precursor C3 and adiponectin in hyperthyroid and hypothyroid subjects as compared to controls.MethodsA total of 99 subjects were recruited from endocrinology/out-patient clinics: 46 hyperthyroid subjects, 23 hypothyroid subjects and 30 control subjects. Subjects were evaluated for FT4, FT3, TSH, glucose, insulin, complete lipid profile and the adipokines: adiponectin, acylation stimulating protein (ASP) and complement C3.ResultsHyperthyroidism was associated with a 95% increase in adiponectin (p = 0.0002), a 47% decrease in C3 (p < 0.0001), no change in ASP and increased ASP/C3 ratio (p = 0.0012). Hypothyroidism was associated with a 31% increase in ASP (p = 0.008). Adiponectin and C3 correlated with FT3 (r = 0.383, p = 0.004 and r = -0.277, p = 0.007, respectively) and FT4 (r = 0.464, p = 0.003 and r = -0.225, p = 0.03, respectively). ASP correlated with TSH (r = 0.202, p = 0.04). Adiponectin did not correlate with either ASP or C3, only ASP and C3 correlated (r = -0.197, p = 0.05). Adiponectin was negatively correlated with BMI, total cholesterol and plasma triglyceride, while C3 was positively correlated with BMI and total cholesterol. Surprisingly, adiponectin was positively correlated with insulin (r = 0.293, p = 0.02) and HOMA-IR (r = 0.373, p = 0.003) while C3 was negatively correlated with glucose (r = -0.242, p = 0.022, insulin (r = -0.184, p = 0.05) and HOMA-IR.ConclusionThese changes suggest that thyroid disease may be accompanied by changes in adipokines, which may contribute to the phenotype expressed.

Dyslipidemia Prevalence, Treatment, and Control in the Multi-Ethnic Study of Atherosclerosis (MESA)

To assess the implementation challenge facing the Third Report of the Adult Treatment Panel (ATP III) of the National Cholesterol Education Program, we determined the prevalence, treatment, and control of dyslipidemia, including ethnic and gender differences, in persons free of known clinical cardiovascular disease (CVD). In addition, this report provides information about the presence of coronary artery calcium (CAC) across groups defined by risk and recommendations for the use of lipid-lowering drugs. The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of 6814 persons aged 45 to 84 years who were free of clinical CVD at baseline (2000-2002). Participants with complete fasting lipid profiles (n=6704) were evaluated for CVD risk and self-reported use of lipid-lowering therapy. CAC was assessed by CT. Drug treatment thresholds and goals were defined according to ATP III. Models were constructed to adjust for age, clinic site, risk factors, socioeconomic characteristics, and healthcare access variables with the use of Poisson regression. Overall, 29.3% (1964/6704) had dyslipidemia, among whom lipid-lowering drug therapy was reported by 54.0% (1060/1964). Control to ATP III goal was observed in 75.2% (797/1060) of participants with treated dyslipidemia and 40.6% (797/1964) of participants with dyslipidemia. Men were more likely than women to qualify for drug therapy and less likely to be treated and controlled. Relative to non-Hispanic whites, Chinese Americans were less likely to qualify for drug treatment, but no differences in treatment and control rates were observed. Black and Hispanic Americans had prevalence of dyslipidemia that was comparable to that of non-Hispanic whites but were less likely to be treated and controlled. Ethnic disparities were attenuated substantially by adjustment for healthcare access variables; however, the gender disparities persisted despite adjustment for risk factors, socioeconomic characteristics, and healthcare access variables. Control of dyslipidemia was achieved less commonly in the CVD high- and intermediate-risk groups than in the low-risk group. Among high-risk individuals, 19.7% of those who did not qualify for lipid-lowering drug treatment had CAC >400. The proportion of drug treatment-qualifying persons who were not treated differed by presence and severity of CAC, with 48.0%, 46.8%, and 39.6% of eligible persons with no CAC, with CAC >0 and <400, and with CAC >400 not receiving treatment, respectively (P for difference=0.04). Dyslipidemia is common among persons without CVD. The quality of care for dyslipidemia is suboptimal in general and variable by CVD risk group, ethnicity, and gender. The utility of incorporating CAC screening into the risk stratification and treatment process should be investigated in light of the substantial proportions of persons with CAC who are currently classified as not requiring treatment. Research and quality improvement programs are needed to optimize management of dyslipidemia.

Effect of garlic oil as antiatherogenic on intiation and development of atherosclerosis induced experimentally by oxidative stress in rabbit

This study searched the microscopical effects of garlic oil at a dose of 50 mg daily for 60 days on tissues of heart , liver, and kidney in female rabbits. The results revealed hyperatrophy in cardiac myocyte, acute cell swelling in hepatocyte and epithelial cells that lined renal tubules. Complete lipid profile was also described. The study also proved that garlic oil had a good antioxidant effects toward the meliorating progression of atherumatous lesion. Antioxidative effects also explained by significant reduction in lipid profile parameters (except an elevation in HDL-C), as well as elevation in tissue GSH and reduction of tissue MDA, as compared with control group. One more result , this study was suggest on the therapeutic efficiency of garlic oil and vitamin E for 15 days after exposure to hydrogen peroxide for 60 days. The therapeutic effects interpret within the significant reduction in the level of total cholesterol, triglyceride, LDL-C, VLDL-C, atherogenic index and significant increase in the level of HDL-C. In addition to significant increase in the level of GSH and significant decrease in the level of MDA. The histopatholgical changes, reveled less reduction in atherosclerotic lesions. This study concluded that garlic oil have a capability to decrease the level of lipid profile as antiatherogenic. In addition, the ability to decrease the level of lipid peroxidation MDA, and to increase the level of GSH as antioxidant.

Inflammatory Markers and Serum Lipids in Idiopathic Dilated Cardiomyopathy

Coronary microcirculation is impaired in idiopathic dilated cardiomyopathy (IDC), possibly because of endothelial dysfunction. High-density lipoproteins (HDLs) have the potential to regulate endothelial function and modulate inflammation and the innate immune response. This study investigated whether reduced HDLs, concomitantly with the activation of inflammation, are associated with IDC. Fifty-five patients with IDC, without evidence of other organ or systemic, chronic, or recurrent diseases, were compared with 55 healthy controls for HDLs and complete lipid profiles, C-reactive protein, C3 and C4 complement fractions, soluble intercellular adhesion molecule-1 and soluble endothelial leukocyte adhesion molecule-1, haptoglobin, and ceruloplasmin. Patients with IDC differed from controls, with lower HDL levels, lower apolipoprotein A-I and A-II levels, and higher triglyceride levels, but not on total and low-density lipoprotein cholesterol, apolipoprotein B, or lipoprotein(a). In addition, all measured inflammation markers were significantly greater in patients with IDC than in controls and were negatively correlated with HDLs. A strong and independent association with IDC was found for age, soluble intercellular adhesion molecule-1, and HDLs that, when categorized as <40 or >40 mg/dl, showed the strongest association (prevalence odds ratio 0.10, p <0.0005) with the disease. In conclusion, the data here reported on reduced HDLs and increased endothelial inflammatory activation and the linear negative correlation between HDLs and inflammation markers, particularly soluble intercellular adhesion molecule-1, could suggest a role for HDLs in the endothelial-microvascular dysfunction seen in IDC.

Different Effect of Statins on Platelet Oxidized-LDLReceptor (CD36 and LOX-1) Expressionin Hypercholesterolemic Subjects

Hydroxymethyl-glutaryl-CoA-reductase inhibitors (statins) reduce cardiovascular mortality by decreasing cholesterol as well as by non-lipid-related actions. Oxidized low-density lipoproteins (ox-LDL) are pro-atherogenic molecules and potent platelet agonists. CD36 and lectin-like ox-LDL receptor-1 (LOX-1) are specific ox-LDL receptors also expressed in platelets. This study was planned to address whether treatment with atorvastatin 10 mg/day, pravastatin 40 mg/day or simvastatin 20 mg/day could affect platelet CD36 and LOX-1 expression. Twenty-four patients for each treatment were evaluated after 3, 6, and 9 days and at 6 weeks for complete lipid profile (chromogenic), ox-LDL (ELISA), platelet P-selectin (P-sel), CD36, LOX-1 (FACS), and intracellular citrullin recovery (iCit) (HPLC). Data show hyperactivated platelets (P-sel absolute values, percent variation in activated cells, all p < 0.001), and CD36 and LOX-1 overexpression (all p < 0.001) in patients at baseline. P-sel, CD36, and LOX-1 were significantly decreased by atorvastatin and simvastatin (all p < 0.01) and related with iCit increase (r = 0.58, p < 0.001) and platelet-associated ox-LDL (r = 0.51, p < 0.01) at 9 days. Pravastatin reduced LOX-1 and P-sel (p < 0.05) at 6 weeks in relation with decreased LDL and ox-LDL (r = 0.39, p < 0.01 and r = 0.37, p < 0.01, respectively). These data suggest that atorvastatin and simvastatin reduce platelet activity by exposure of CD36 and LOX-1 before significant LDL reduction, whereas pravastatin action is detected later and in relation with LDL and ox-LDL lowering. Rapid and consistent reduction of CD36 and LOX-1 could be considered a direct anti-atherothrombotic mechanism related to the role of ox-LDL in platelet activation, platelet-endothelium interactions, and NO synthase activity.

Conversion From Cyclosporine Microemulsion to Tacrolimus-Based Immunoprophylaxis Improves Cholesterol Profile in Heart Transplant Recipients With Treated but Persistent Dyslipidemia: The Canadian Multicentre Randomized Trial of Tacrolimus vs Cyclosporine Microemulsion

Tacrolimus improves lipid profile in renal and liver transplant recipients. The impact of conversion from cyclosporine microemulsion (Neoral) to tacrolimus (Prograf) in a large randomized study of stable heart transplant recipients with treated but persistent mild dyslipidemia is reported. One hundred twenty-nine long-term (>or=12 months) cyclosporine microemulsion-treated heart transplant recipients with low-density lipoprotein cholesterol >2.5 mmol/liter and/or a total cholesterol/high-density lipoprotein cholesterol ratio >4 were recruited for the study. Complete lipid profile was assessed before (baseline) and after 6 months of treatment with either cyclosporine microemulsion maintenance (n=64) or tacrolimus conversion (n=65). At 6 months, tacrolimus-converted patients exhibited a greater decrease in total cholesterol (from 5.51 +/- 0.16 to 4.88 +/- 1.22 mmol/liter [tacrolimus], vs 5.61 +/- 1.36 to 5.38 +/- 0.87 mmol/liter [cyclosporine]; p = 0.0078). This decrease in cholesterol was caused largely by a decrease in low-density lipoprotein cholesterol (-0.41 +/- 0.54 [tacrolimus] vs -0.13 +/- 0.55 [cyclosporine]; p=0.0018). There were no changes in high-density lipoprotein cholesterol and triglyceride levels, but apolipoprotein B therapy was reduced in tacrolimus-converted vs cyclosporine-maintained patients (p=0.0003). By 6 months, 23.7% of tacrolimus- vs 6.7% of cyclosporine-treated patients met the target lipid levels for high-risk patients (p=0.0094). Conversion from cyclosporine to tacrolimus resulted in decreases in blood urea nitrogen, creatinine, and uric acid without any changes in glucose, HbA(1C), and insulin levels. Conversion from cyclosporine microemulsion- to tacrolimus-based immunoprophylaxis resulted in decreased cholesterol, apolipoprotein B, urea, creatinine, and uric acid without any clinically evident perturbation of glucose metabolism in stable heart transplant recipients with treated but persistent mild dyslipidemia.

Effects of ethanolic extract of Iris germanica on lipid profile of rats fed on a high-fat diet

Ethanolic extract of Iris germanica rhizomes was investigated for hypolipidemic activity. Iris germanica belong to the family Iridaceae and has been used to treat liver and spleen ailments in traditional system of medicine. Two groups of Wistar rats were fed with high-fat diet and ethanolic extract of Iris germanica were administered orally in one group of rats, while other received saline for 10 weeks. Complete lipid profiles of experimental animals were determined by assessing serum levels of total lipids, triglycerides, cholesterol, high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol. Results indicate that ethanolic extract of Iris germanica significantly lowered the lipid components especially, the cholesterol and triglycerides.

Adiponectinemia in Visceral Obesity: Impact on Glucose Tolerance and Plasma Lipoprotein and Lipid Levels in Men

The present study examined the associations between a major adipokine, adiponectin, and adiposity indices as well as metabolic risk variables in a sample of 190 untreated asymptomatic men. Anthropometric measurements and a complete fasting plasma lipoprotein and lipid profile were obtained, and subjects underwent an oral glucose tolerance test. Fasting plasma adiponectin concentrations were determined by an ELISA. Although all adiposity and adipose tissue (AT) distribution indices were negatively correlated with plasma adiponectin levels (-0.14 </= r </= -0.32; P < 0.04), multiple regression analyses revealed that visceral AT accumulation was the only independent predictor of adiponectin levels, with 10% of its variance explained by visceral AT (P < 0.0001). Comparison of obese men with similar body mass index values (>/=30 kg/m(2)) but who markedly differed in their level of visceral AT (< vs. >/=130 cm(2); n = 15) revealed significant differences in adiponectin levels (7.0 +/- 3.0 vs. 11.1 +/- 4.9 microg/ml; P < 0.02 for men with high vs. low visceral AT, respectively). Finally, when men were stratified into tertiles of visceral AT and further classified on the basis of the 50th percentile of adiponectin levels (</= vs. >8.8 microg/ml), a 3 x 2 ANOVA revealed an independent contribution of adiponectin on the variation of high-density lipoprotein cholesterol levels (P < 0.002) and of the glucose area (P < 0.02). These results support the notion that adiponectin concentration is influenced to a greater extent by visceral than sc obesity. Furthermore, adiponectin predicts glucose tolerance and plasma high-density lipoprotein cholesterol levels in a manner that is partly independent from the contribution of visceral adiposity.

Medical Complications After Spinal Cord Injury: Spasticity, Pain, and Endrocrine/Metabolic Changes

Recognition and proper management of medical complications after spinal cord injury (SCI) will improve both quality of life and health. Spasticity often interferes with comfort, function, and quality of life after SCI. Spasticity can be effectively reduced by various therapies that may be applied by the pyramid approach, starting with nonpharmacologic and noninvasive methods before proceeding to treatments with systemic medications, intrathecal administration of drugs, or nerve blocks by injection of chemicals. Pain is also a common complaint after SCI but has multiple causes, and consequently diverse treatment approaches are needed. Accurate classification of pain in persons with SCI is essential to select the appropriate management and to evaluate results of treatment. In recent years, two classification systems have emerged that address nociceptive and neuropathic pain and, to various extent, categorize pain according to its location. Based on the specific pain type, different treatment strategies are subsequently selected. The abnormalities in carbohydrate and lipid metabolism in persons with SCI are atherogenic. Disorders of carbohydrate metabolism occur with increased frequency in persons with SCI compared to those who are able-bodied. Persons with SCI generally have adverse body composition changes (increased adiposity and decreased lean tissue mass) and are less active than the general population, which are the determinants of insulin resistance. The deterioration in carbohydrate handling is associated with insulin resistance and compensatory hyperinsulinemia. Patients with the greatest neurological deficits (complete tetraplegia) have worse carbohydrate tolerance and higher plasma insulin levels than other neurological subgroups. A low serum HDL cholesterol level is an independent risk factor for coronary heart disease, and the prevalence of low serum HDL cholesterol levels is greater in persons with SCI than in those who are able-bodied. Individuals with complete, higher lesions tend to have lower levels of serum HDL cholesterol. However, men with SCI had lower serum HDL cholesterol levels than able-bodied control participants, but women with SCI did not have an adverse lipid profile. A relationship exists between insulin resistance and HDL cholesterol: the greater the insulin resistance, the lower the serum HDL cholesterol level. An indirect relationship has been demonstrated between abdominal circumference and serum HDL cholesterol levels and a direct relationship with serum triglycerides. Increased cardiopulmonary fitness has been shown to favorably affect the lipid profile. Persons with SCI should have a complete lipid profile at least once every 5 years and therapeutic intervention with diet and/or exercise should be begun, if indicated.

Plasma lipoprotein Lp(a), markers of haemostasis and inflammation, and risk and severity of coronary heart disease.

Elevated plasma (Lp(a)) levels may represent an independent risk factor for atherothrombotic complications but the relation between Lp(a) levels and the extent of coronary artery disease (CHD) has been discussed controversially. Little is known about potential atherothrombogenic mechanisms of Lp(a). Case-control study. We assessed the relationship between plasma Lp(a) and angiographically defined CHD, evaluating the severity of coronary atherosclerosis by three different scores. A total of 312 patients with stable angina aged 40-68 years with at least one coronary stenosis > 50% were studied. A group of 479 voluntary blood donors matched for age and sex served as controls. A complete lipid profile and a large number of markers of coagulation, fibrinolysis and inflammation were measured. Plasma levels of Lp(a) were significantly higher in patients (14.8 mg/dl; 5.4-47.1 mg/dl; median/interquartile range) than in controls (9.7 mg/dl; 3.5-25.3) (P<0.0001). In a logistic regression model, the fully adjusted Odds Ratio for CHD was 3.3 (95% confidence interval (CI) 1.8-5.6, P<0.0001) for patients in the upper quartile of the Lp(a) distribution compared to the bottom quartile. There was no appreciable association between Lp(a) and apolipoproteins, markers of haemostasis, fibrinolysis and inflammation and the severity of CHD. These results indicate that elevated plasma Lp(a) levels may be an independent risk factor for CHD but unrelated to the severity and extension of CHD. Furthermore, there is no good evidence that the presumed link between Lp(a) and CHD is mediated by increased levels of markers of inflammation, or interference with markers of fibrinolysis or coagulation.

Lipid profile, BMI, body fat distribution, and aerobic fitness in men with metabolic syndrome.

Obesity, impaired glucose tolerance, type 2 diabetes, hyperlipidemia, hypertension, and insulin resistance are wellknown components of metabolic syndrome and are associated to increased cardiovascular morbidity. The present study aimed to evaluate the relationships between cardiorespiratory fitness, body fat distribution, and selected coronary heart disease risk factors. A total of 22 untrained subjects affected by one or more features of metabolic syndrome and without clinical history of cardiovascular disease were studied. Nondiabetic subjects underwent an oral glucose tolerance test for glucose and insulin measurement; fasting glucose and insulin were measured in diabetic patients. Complete lipid profile, thyroid hormones, and thyroid-stimulating hormone were measured in all subjects. Basal energy expenditure and cardiorespiratory fitness were measured using a K4 analyzer. Cardiorespiratory fitness ( VO(2max)/kg) was assessed using a treadmill graded exercise test. Peak aerobic capacity ( VO(2max)/kg) was predicted by body fat distribution, insulin sensitivity index, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol ( p<0.001). A significant relationship was found between cardiorespiratory fitness ( VO(2max)/kg) and body mass index (BMI), insulin sensitivity index, and LDL cholesterol ( r=0.60, p<0.05; r=0.66, p<0.01 and r=0.54, p<0.05, respectively). Data demonstrated that aerobic fitness is related to metabolic parameters and to body fat distribution, and suggest that its modification may improve well-known predictors of coronary artery disease.

Prograf decreases plasma cholesterol in heart transplant recipients with treated but persisting mild dyslipidemia: The Canadian multicenter randomized trial of prograf versus neoral

Abstract Background: Despite optimal use of lipid-lowering agents, most heart transplant recipients (htx) exhibit persisting dyslipidemia not satisfying the current guidelines. We have initiated a prospective study of Neoral maintenance versus (vs) conversion to Prograf immunoprophylaxis in stable htx exhibiting persistent dyslipidemia despite optimal treatment with lipid-lowering agents. Methods: One hundred and twenty-nine stable htx, aged 56.7±10.1 years (mean±SD) and 77.9±42.2 months post-op. were randomized to continue on Neoral (n=64) or switch to Prograf (n=65). Complete lipid profile was measured at baseline (bsl) and after 1, 3 and 6 months (6 mo). Hemostatic parameters (fibrinogen, factor VII, VIII, von Willebrand) and proinflammatory markers (hsCRP, homocysteine, sICAM, sVCAM, MCP-I, TPA, PAI-1) were measured at bsl and at 6 mo. Results: The Prograf-treated group exhibited a significant greater decrease in total cholesterol [5.51±1.16 (bsl) vs 4.88±1.22 mmol/L, (6 mo): Prograf; 5.61±1.36 (bsl) vs 5.38±0.87 mmol/L (6 mo): Neoral, p=0.002]. The Prograf group also yielded a significant decrease in LDL-cholesterol [3.10±0.8 (bsl) vs 2.72±0.88 mmol/L (6 mo); p=0.01], and cholesterol/HDL ratio [4.73±1.48 (bsl) vs 4.15±1.36 (6 mo); p=0.02]. The decrease in cholesterol was maximum at one month post-switch. For patients treated with Prograf, the change in plasma creatinine from baseline to month 6 [-6.97±25.29 μmol/L] was significantly greater than for patients who remained on Neoral [+1.13±19.53 μmol/L] [p=0.01]. Blood glucose remains stable in the Prograf-treated patients [5.96±1.60 vs 6.01±1.87 mmol/L, p=0.5]. Conclusions: This large prospective conversion study showed that Prograf provides a significant decrease in total, LDL-cholesterol and cholesterol/HDL ratio as well as an improvement in renal function. These provide a rationale for the use of Prograf in cardiac transplant patients with treated but persisting dyslipidemia.

Prograf decreases plasma cholesterol in heart transplant recipients with treated but persisting mild dyslipidemia: the canadian multicenter randomized trial of prograf versus neoral

Background: Despite optimal use of lipid-lowering agents, most heart transplant recipients (htx) exhibit persisting dyslipidemia not satisfying the current guidelines. We have initiated a prospective study of Neoral maintenance versus (vs) conversion to Prograf immunoprophylaxis in stable htx exhibiting persistent dyslipidemia despite optimal treatment with lipid-lowering agents.Methods: One hundred and twenty-nine stable htx, aged 56.7±10.1 years (mean±SD) and 77.9±42.2 months post-op. were randomized to continue on Neoral (n=64) or switch to Prograf (n=65). Complete lipid profile was measured at baseline (bsl) and after 1, 3 and 6 months (6 mo). Hemostatic parameters (fibrinogen, factor VII, VIII, von Willebrand) and proinflammatory markers (hsCRP, homocysteine, sICAM, sVCAM, MCP-I, TPA, PAI-1) were measured at bsl and at 6 mo.Results: The Prograf-treated group exhibited a significant greater decrease in total cholesterol [5.51±1.16 (bsl) vs 4.88±1.22 mmol/L, (6 mo): Prograf; 5.61±1.36 (bsl) vs 5.38±0.87 mmol/L (6 mo): Neoral, p=0.002]. The Prograf group also yielded a significant decrease in LDL-cholesterol [3.10±0.8 (bsl) vs 2.72±0.88 mmol/L (6 mo); p=0.01], and cholesterol/HDL ratio [4.73±1.48 (bsl) vs 4.15±1.36 (6 mo); p=0.02]. The decrease in cholesterol was maximum at one month post-switch. For patients treated with Prograf, the change in plasma creatinine from baseline to month 6 [-6.97±25.29 μmol/L] was significantly greater than for patients who remained on Neoral [+1.13±19.53 μmol/L] [p=0.01]. Blood glucose remains stable in the Prograf-treated patients [5.96±1.60 vs 6.01±1.87 mmol/L, p=0.5].Conclusions: This large prospective conversion study showed that Prograf provides a significant decrease in total, LDL-cholesterol and cholesterol/HDL ratio as well as an improvement in renal function. These provide a rationale for the use of Prograf in cardiac transplant patients with treated but persisting dyslipidemia.

Untreated Hypercholesterolemia in an Emergency Department Chest Pain Observation Unit Population

Abstract Objectives: To describe the prevalence of hypercholesterolemia in a predominantly African American, innercity chest pain observation unit (CPOU) patient population, and to estimate the percentage of patients eligible for cholesterol‐lowering therapy as indicated by the 2001 National Cholesterol Education Program guidelines. Methods: A cross‐sectional study design utilizing a convenience sample of patients from a high‐volume urban hospital CPOU. Patients with chest pain suspicious of cardiac etiology who had negative initial electrocardiograms and cardiac markers were assigned to the chest pain protocol. Consenting subjects were screened for hypercholesterolemia through capillary blood point‐of‐care testing with a cutoff of 190 mg/dL. Those who tested positive had four‐hour fasting complete lipid profiles performed by the central laboratory. Results: There were 112 patients enrolled in this study (mean age = 51 years; 57% male; and 83% African American). Elevated values on the screening test were obtained on 28 [25%; 95% confidence interval (95% CI) = 16.9 to 33.0] of these patients. These patients were found to have a mean four‐hour fasting total cholesterol level of 224 mg/dL, a low‐density lipoprotein (LDL) level of 138 mg/dL, a high‐density lipoprotein (HDL) level of 52 mg/dL, and a triglyceride level of 168 mg/dL. Of the patients identified through the screening test, 54% proved eligible for cholesterol‐lowering medications and 91.7% of these patients reported an interest in initiating therapy. Conclusions: In this study, approximately 25% of inner‐city CPOU patients are possible candidates for cholesterol‐lowering interventions. Benefits of initiating therapy during this potential “teachable moment” in a CPOU should be investigated in a subsequent multicenter randomized trial.

Untreated Hypercholesterolemia in an Emergency Department Chest Pain Observation Unit Population

To describe the prevalence of hypercholesterolemia in a predominantly African American, innercity chest pain observation unit (CPOU) patient population, and to estimate the percentage of patients eligible for cholesterol-lowering therapy as indicated by the 2001 National Cholesterol Education Program guidelines. A cross-sectional study design utilizing a convenience sample of patients from a high-volume urban hospital CPOU. Patients with chest pain suspicious of cardiac etiology who had negative initial electrocardiograms and cardiac markers were assigned to the chest pain protocol. Consenting subjects were screened for hypercholesterolemia through capillary blood point-of-care testing with a cutoff of 190 mg/dL. Those who tested positive had four-hour fasting complete lipid profiles performed by the central laboratory. There were 112 patients enrolled in this study (mean age = 51 years; 57% male; and 83% African American). Elevated values on the screening test were obtained on 28 [25%; 95% confidence interval (95% CI) = 16.9 to 33.0] of these patients. These patients were found to have a mean four-hour fasting total cholesterol level of 224 mg/dL, a low-density lipoprotein (LDL) level of 138 mg/dL, a high-density lipoprotein (HDL) level of 52 mg/dL, and a triglyceride level of 168 mg/dL. Of the patients identified through the screening test, 54% proved eligible for cholesterol-lowering medications and 91.7% of these patients reported an interest in initiating therapy. In this study, approximately 25% of inner-city CPOU patients are possible candidates for cholesterol-lowering interventions. Benefits of initiating therapy during this potential "teachable moment" in a CPOU should be investigated in a subsequent multicenter randomized trial.