Dyslipidemia Research Articles

Pancreatitis Secondary to Dyslipidemia: An Understudied Condition

Dyslipidemia (DL), defined by dysregulated levels of lipids in the bloodstream, is an ever-growing problem in modern society. In addition to those with congenital defects in lipid metabolism, the pervasive nature of high-fat and high-calorie diets in modern industrialized societies has led to a meteoric increase in its incidence. Patients who suffer from this condition subsequently are at a higher risk of developing other co-morbid conditions, most notably diabetes mellitus and coronary artery disease. This review explores another arguably lesser-known consequence of DL, pancreatitis, which is an inflammatory disease of the pancreas. The goal of this article is to review the intersection of these two conditions by briefly highlighting the proposed pathophysiology and exploring the impact of DL (specifically hypertriglyceridemia) on acute, acute recurrent, and chronic pancreatitis. This paper additionally examines the long-term risks of developing pancreatic cancer in patients with pancreatitis secondary to DL and presents unique clinical scenarios that result in DL-associated pancreatitis. Finally, we discuss potential treatment options for hypertriglyceridemia which can potentially mitigate the risk of DL-associated pancreatitis.

Hepatitis B small surface protein hijacking Bip is initial and essential to promote lipid synthesis

To date, the molecular pathogenic mechanisms between HBsAg and liver metabolic disorders have not been fully understood. To explore the overall effects of HBsAg on liver tissues from HBV transgenic mice, proteome, interactome, and signal pathway analysis were employed to uncover the underlying mechanisms. Bioinformatics analysis of 191 differentially expressed proteins suggested that HBV upregulated the expression of multiple enzymes involved in lipid synthesis, and small HBs (SHBs) caused lipid accumulation in cells. Further studies showed that SHBs bound to binding immunoglobulin protein (Bip), which normally functions in cell homeostasis against the unfolded protein response (UPR) signaling via occupying inositol-requiring enzyme 1 (IRE1). Hijacking Bip by SHBs alleviated the inhibition of post-endoplasmic reticulum (ER) signaling and sequential activation of the IRE1 downstream transcription factors involved in lipid synthesis, such as spliced X-box binding protein 1 (sXBP1) and sterol regulatory element-binding protein 1 (SREBP1), leading to lipid metabolism disorder. The restoration of Bip can alleviate ER stress, and block the sequential post-ER signaling caused by SHBs. This study revealed a new pathway through which SHBs promote lipid disorder, and suggests that Bip may serve as a novel target for intervention in HBV related liver diseases. SignificanceIn this study, we found a new pathway promoting the lipid disorder by SHBs through quantitative proteomics studies, and Bip may serve as a novel target for intervention in HBV related liver diseases. These findings highlight a novel role of SHBs in regulating cell lipid metabolism and provide an insight into the relationship between HBV infection and liver fatty disorders, which may serve as a potential therapeutic target for intervention of HBV related liver diseases.

Healthcare dashboard technologies and data visualization for lipid management: A scoping review

BackgroundLipid disorders significantly increase cardiovascular disease (CVD) risk, the leading cause of mortality worldwide. Effective lipid management is critical for improving health outcomes. Traditional screening methods face challenges due to data complexity and the need for timely decision-making. Data visualization and dashboard technologies offer clear, actionable insights and supporting informed decision-making. This study investigates the use of these technologies in lipid management and their impacts on the quadruple aim of healthcare.MethodsThis scoping review followed the Joanna Briggs Institute (JBI) approach, focusing on studies involving dashboard technologies or data visualization in lipid management. A comprehensive search across multiple databases (Embase, Web of Science, PubMed, Scopus, CINAHL) and gray literature was conducted, including English-language publications from 2014 to 2024. Data were analyzed using quantitative descriptive and qualitative content analysis to evaluate the key features, clinical applications, and outcomes.ResultsTwenty-seven studies met the inclusion criteria, primarily focusing on dashboard utilization by physicians for managing diabetes and CVD, utilizing electronic medical records and clinical guidelines. Key analysis methods included comparing key performance indicators (KPIs) (85.2%) and trend analysis (74.1%). Lipid management workflows emphasized prevention (88.9%) and treatment planning (77.8%). Interventions included care packages (comprehensive sets of interventions for patient care), decision support systems, web-based tools, and mobile health solutions. Regarding Quadruple Aim outcomes: 12 studies focused on improving population health (8 positive, 4 no change), 9 on clinical outcomes (5 positive, 4 no change), 6 on provider work life (5 positive), 5 on patient experience (positive changes in education and time management), and 2 on cost reduction (1 positive, 1 negative).ConclusionsDashboards are important tools in managing lipid disorders in managing lipid disorders, integrating with educational tools, collaborative care models, and decision support systems. Although they are effective in enhancing population health and clinical experiences, their impact on patient outcomes and cost reduction requires further exploration. Future research should focus on detailed evaluations of dashboard impacts on patient outcomes and cost-effectiveness, emphasizing precision prevention of chronic diseases.

Cinnamon Polyphenols Ameliorate the Dysregulation of Cardiac Energy and Autophagic Homeostasis in Rats with Diabetic Cardiomyopathy via the mTOR/PGC1α Pathway

Background Inflammation mediated by hyperglycemia, lipid metabolism disorders, abnormal myocardial energy metabolism, myocardial cell damage, and changes in ventricular structure are important mechanisms in the occurrence and development of diabetic cardiomyopathy (DCM). Cinnamon polyphenols (CP) are extracted from the traditional Chinese medicine cinnamon, which is believed to have cardioprotective effects and has been used in China for hundreds of years. Purpose This study aimed to investigate the therapeutic effects of CP on DCM and its possible mechanisms. Methods The DCM model was established by a single intraperitoneal injection of 85 mg/kg 1% streptozotocin in rats. The treatment group was orally administered 135 mg/kg CP for 28 consecutive days, a dosage verified by experiments on AC16 myocardial cells and detecting liver and kidney injury markers. Results CP could reduce high blood sugar, high blood lipids, left ventricular mass index, levels of myocardial injury markers, adenosine diphosphate (ADP), and cyclic adenosine monophosphate (cAMP) in the model group. It also improved weight loss, and increased myocardial adenosine triphosphate (ATP), adenosine monophosphate (AMP), phosphocreatine (PCr), and ATP/ADP, AMP/ATP, and PCr/ATP ratios. The expression of p-mTOR/mammalian target of rapamycin (mTOR), p62, and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) in the myocardium of the CP group was enhanced, while the expression of LC3II/LC3I was inhibited. Conclusion CPs can alleviate myocardial damage by reducing blood sugar, blood lipids, and abnormal autophagy levels while promoting the restoration of myocardial energy metabolism homeostasis.

What is proven in the treatment of lipid disorders?

Cardiovascular diseases are still the leading global cause of mortality. Modifiable cardiovascular risk factors have been well-defined for many years and are amenable to multimodal treatment. The scope of pharmaceutical interventions targeting atherogenic lipoproteins in general and low-density lipoprotein (LDL)-cholesterol concentrations in particular, has significantly broadened over the last years, leading to an intensification of appropriate treatment targets, which are not sufficiently achieved in the clinical routine. Current prevention guidelines issued by the European Society for Cardiology (ESC) define patient cohorts according to their individual cardiovascular risk, which results in arisk-adapted lipid-lowering treatment. The aim is to avoid overtreatment of patients with a low or moderate risk and undertreatment of patients with a high or very high risk. In addition to secondary prevention in patients with an already established cardiovascular disease, primary prevention uses age-adapted risk stratification algorithms to assess the 10-year risk, e.g., systematic coronary risk evaluation 2 (SCORE2), SCORE2-older persons (SCORE2-OP) and the lifetime risk, e.g., lifetime-perspective cardiovascular disease model (LIFE-CVD) as the foundation for therapeutic decision making. Special patient groups with known elevated cardiovascular risk (familial hypercholesterolemia, diabetes mellitus, chronic kidney disease) are stratified by incorporating disease-specific parameters and are treated according to defined lipid-lowering targets.

Dysbetalipoproteinemia: focus on a neglected lipid disorder.

Dysbetalipoproteinemia: focus on a neglected lipid disorder.

Abstract 4120131: Absence of standard modifiable risk factors (SMuRF-less) among 5002 Middle Eastern patients with atherosclerotic cardiovascular disease: (Interim analysis from the Jo-SMuRF Study)

Introduction: A growing number of patients develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of standard modifiable risk factors i.e. hypertension (HTN), type 2 diabetes (T2D), dyslipidemia (DSL), and cigarette smoking (SMuRF-less). There is scarcity of studies on prevalence and clinical profiles of SMuRF-less patients in the Middle Ease (ME). Aim: To study the prevalence and clinical features of ME patients with ASCVD who are SMuRF-less vs. those with ≥ 1 SMuRFs, presence of other risk factors and utilization of secondary preventive medications in the 2 groups, and one year survival. Methods: Clinical details of adult patients with ASCVD who participated in 5 previous registries were analyzed according to the absence or presence of ≥ 1 SMuRFs. Results: Of the 5002 patients included in the analysis, 676 (13.5%) were SMuRF-less and 4326 (86.5%) had ≥ 1 SMuRFs. Prevalence of the 4 SMuRFs in the whole cohort was 53.5% HTN, 47.8% T2D, 40.2% smoking, and 37.5% DSL, and the SMuRF group was 61.9%, 55.2%, 46.5%, and 43.4%, respectively. Compared with the SMuRFs group, patients in the SMuRFless group were younger (mean age 52±11.4 years vs. 56.3±11.5 years, respectively, p<0.001) and more likely to be women than men (38.6% vs. 27.9%, p<0.0001). Furthermore, SMuRF-less patients had lower mean body mass index, and less prevalence of metabolic syndrome, heart failure, and family history of ASCVD. Utilization of secondary cardiovascular prevention medications was significantly less in the SMuRF -less group than those with SMuRFs; dual antiplatelet therapy (36.4% vs. 69.5%), statins (66.3% vs. 87.4%), B blockers (57.5% vs. 70.5%), and renin-angiotensin inhibitors (35.2% vs. 55.3%, respectively, all p<0.001. Of the subgroup with one year follow up after percutaneous coronary intervention (N=2641), mortality rate was not different in the 2 groups; 1.4% vs. 1.8%, p=0.98. Conclusions: In this first study of SMuRFs in ASCVD patients in the Middle East, SMuRF-less patients account for nearly 14% of the studied cohort. These patients were younger, had less comorbid disease, received less guidelines-recommended prevention medication, and had same one year event rate compared with patients who have SMuRFs.

Unveiling the metabolic challenges in pulmonary arterial hypertension: Insights into thyroid, glycemic, lipid, and bone disorders

This study aimed to evaluate the prevalence of thyroid, glycemic, lipid and metabolic bone disorders among adult patients with pulmonary arterial hypertension (PAH). MethodsThis was an observational cross-sectional clinical study with patients with PAH, matched by sex and age with a control group without PAH. All individuals were enrolled into a clinical assessment, metabolic workup, thyroid ultrasound, and bone densitometry protocol. ResultsThe PAH group included 35 participants (34 females, 46 ± 15.5 years), and the control group, 40 (39 females, 41.8 ± 13.1 years). There was no difference in body mass index (BMI) between PAH and control group (27.5 ± 5.9 and 26.9 ± 4.3 kg/m2, respectively, p = 0.63; 95 % CI: −1.8, 2.94), neither in physical activity time per week (60.3 ± 103.3 and 98.9 ± 137.6, respectively, p = 0.17; 95 % CI: −95.23, 18.06). Although there was no difference in the prevalence of insulin resistance between the PAH (51.4 %) and the control group (47.5 %), p = 0.74, patients with PAH had a higher median of glycated hemoglobin (A1c) than the control group (6.1 % and 5.57 %, respectively, p = 0.006; 95 % CI: −0.14, 1.22). PAH group presented lower mean total cholesterol (170.46 ± 35.51 mg/dL) and median LDL-cholesterol [105 (83–129) mg/dL, median (P25–P75)] levels than the control group [192.1 ± 34.44 mg/dL, p = 0.009; 95 % CI = −37.76, 5.52 and 121.6 (97–145) mg/dL, p = 0.012; 95 % CI: −34.08, 0.77, respectively]. It was found a higher prevalence of hypothyroidism (22.9 %) in PAH group than in control group (2.5 %), p = 0.007. We found hyperparathyroidism (HPT) among 8 patients of PAH group (23 %), but none in the control group. Considering bone mineral density disorders, 12 patients from PAH group presented low bone mass, osteopenia, or osteoporosis (34 %), and 8 individuals in the control group (20 %), p = 0.032, which represented a 2.13 higher relative risk for those conditions for the former group. The patients with HPT presented a higher creatinine level (0.98 ± 0.12 mg/dL) than the PAH patients with normal parathyroid hormone (0.76 ± 0.14 mg/dL), p = 0.0004; 95 % CI: 0.12, 0.33. The PAH group also presented lower total hip (-0.15 ± 1.25) and femoral neck (−0.14 ± 1.07) bone mineral density (BMD) Z-scores than the control group (0.50 ± 1.13, p = 0.021; 95 % CI: −0.18, −0.027 and 0.35 ± 0.94, p = 0.038; 95 % CI: −0.16, −0.01, respectively). ConclusionIn this cohort, the findings of higher A1c levels, hypothyroidism prevalence, lower LDL and total cholesterol levels, and a higher prevalence of hyperparathyroidism, as well as lower total hip and femoral neck BMD Z-scores in the PAH group, compared to the control group and highlighting the dysregulation of various metabolic pathways in patients with HAP, suggesting the need for targeted interventions to enhance patient care. Additionally, they underscore the importance of gaining a deeper understanding of the mechanisms driving these changes and their potential pathophysiological connections to the disease.

Abstract 4112869: Development of a Sitosterolemia Risk Prediction Scale (SRPS): A Screening Tool

Introduction: Sitosterolemia, a hereditary disorder marked by elevated plant sterol levels, presents diagnostic challenges due to its similarity to other lipid disorders. The development of the Sitosterolemia Risk Prediction Scale (SRPS) aims to address this by synthesising genetic, clinical, and dietary data into a coherent risk assessment model. Research Question: We propose that a structured risk scale, integrating diverse factors known to affect sitosterolemia, can significantly improve the accuracy of predicting the disorder. The SRPS is hypothesised to facilitate early detection and inform targeted interventions. Aim: The primary aim is to conceptualise and outline the SRPS, which categorises individuals into risk categories based on a point system reflecting genetic predispositions, clinical symptoms, dietary habits, and response to treatments. This scale seeks to enhance the clinical identification of sitosterolemia, promoting timely and personalised management strategies. Methods: A detailed table was generated to present the SRPS, categorising risk factors into genetic, clinical, dietary, and response to treatment. This innovative method allowed for the efficient synthesis and visualisation of complex data. Results: The SRPS table methodically organizes risk factors into low (0-2 points), moderate (3-5 points), and high (6+ points) categories. This stratification guides further diagnostic actions, ranging from exploring alternative causes of hyperlipidemia to necessitating comprehensive genetic and lipid analyses. Conclusion: The SRPS represents an innovative framework for assessing sitosterolemia risk, highlighting the potential benefits of integrating genetic, clinical, and dietary information. It further underscores the importance of a multifactorial approach in the early detection and management of sitosterolemia.

Abstract 4134922: Trends in Coronary Artery Disease-Related Mortality in Adults with Hyperlipidemia in the United States: A CDC WONDER Database Analysis

Background: Coronary artery disease (CAD), related to high blood lipid levels, is a significant contributor to adult mortality in the United States. This study examines the patterns of CAD-related deaths associated with high lipid levels in adults aged 25 and above, with a specific focus on variations related to geography, gender, and race/ethnicity from 1999 to 2020. Methods: This study employed a comprehensive retrospective analysis using death certificate data from the CDC WONDER database, covering 21 years from 1999 to 2020. We calculated age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) per 100,000 persons, categorized by year, gender, race/ethnicity, and geographic regions. This approach ensured a robust and reliable analysis of the trends in CAD-related deaths associated with high lipid levels. Results: Between 1999 and 2020, CAD in individuals with high levels of lipids resulted in 407,667 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (40.1%) and at home (37.3%). The AAMR for CAD in individuals with high lipid levels increased from 4.1 in 1999 to 12.1 in 2020, showing an AAPC of 4.44 (95% CI: 3.69 to 5.48, p < 0.000001). Men had a higher AAMR (12.4) than women (5.6), and both sexes experienced significant increases over time. Disparities in AAMRs by race/ethnicity revealed the highest rates among Whites (8.9), followed by American Indians/Alaska Natives (8.6), Blacks (7.3), Hispanics (6.5), and Asians/Pacific Islanders (5.9). The most significant increase was observed in Blacks (AAPC: 5.07, p < 0.000001). This detailed breakdown of the disparities in CAD mortality rates among different racial and ethnic groups provides a clear picture of the health inequalities that need to be addressed. Conclusion: This study emphasizes the discrepancies in CAD mortality related to high lipid levels among adults in the United States based on race, gender, and geographic location. The consistent rise in AAMRs between 1999 and 2020 emphasizes the necessity for specific public health interventions to tackle these increasing inequalities.

Abstract 4120854: Case Report: Elevated HDL in Familial Hyper-Alpha-Lipoproteinemia: Atheroprotective or Atherogenic?

Introduction: Familial hyper-alpha-lipoproteinemia (HALP) is a heterogenous genetic lipid disorder that is found in only 8% of the population and manifests as elevated HDL levels above the 90 th percentile. HALP is due to mutations in various genes including cholesteryl ester transfer protein (CETP), hepatic lipase, or apolipoprotein C-III (APOC3). While epidemiological studies have noted an inverse relationship between high HDL and the development of coronary artery disease, recent data have shown a lack of causal atheroprotective effects. We present a case of a patient with significantly elevated HDL and peripheral vascular disease. Case Description: Patient is a 64-year-old female with past medical history of peripheral artery disease with occlusion of the left femoral artery and popliteal arteries status post angioplasty, hypertension, type 2 diabetes, alcohol use, and CKD Stage 4 who presented to the advanced lipid clinic for management of elevated lipoproteins. Patient’s laboratory data was significant for total cholesterol (TC) of 375 mg/dL, a high-density lipoprotein (HDL) of >200 mg/dL, triglycerides (TG) of 66 mg/dL, and a low-density lipoprotein (LDL) of 175 mg/dL. Further testing revealed elevated apolipoprotein A-I of 231 mg/dL. Patient was subsequently initiated on a high intensity statin with improvement in her lipid panel with a TC of 247 mg/dL, HDL of 133 mg/dL, TG of 50 mg/dL, and LDL of 106 mg/dL, with plan for further uptitration of lipid therapy to target LDL <70 mg/dL. Discussion: CETP exchanges cholesteryl esters from HDL for TG, making HDL smaller and more TG-rich. Studies have shown that in vitro addition of CETP and hepatic lipase, which hydrolyzes phospholipids and TG, into CETP-deficient patients led to the development of very small HDL particles that were able to remove cholesterol from lipid laden macrophages. Conversely, larger HDL molecules seen in CETP-deficient patients did not have such anti-atherogenic properties. In addition to recognizing HALP in the setting of elevated HDL, it is also important to exclude secondary causes of elevated HDL, such as primary biliary cirrhosis and high-dose niacin. Genetic testing should also be considered.

Abstract 4134873: Olezarsen for Hypertriglyceridemia in Patients at High Cardiovascular Risk - A Systematic Review and Meta Analysis

Background: Hypertriglyceridemia, a common lipid disorder linked to increased risks of cardiovascular diseases and metabolic syndrome, remains a global health challenge. Traditional treatments, though widely used, often have limited efficacy and adverse effects. Olezarsen, a novel antisense oligonucleotide, targets apolipoprotein C-III and shows promise in significantly reducing triglyceride levels. Aim: To conduct a meta-analysis comparing Olezarsen with placebo in patients with hypertriglyceridemia. Methods: We performed an extensive literature search of PubMed, EMBASE, and Cochrane Library databases up to May 2024 to identify studies comparing Olezarsen and placebo in patients with hypertriglyceridemia, irrespective of comorbid cardiovascular disease. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes and standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs) for each. Results: Three randomized controlled trials (RCTs) with a total of 334 participants were included. Olezarsen significantly reduced triglyceride levels at 6 months (SMD: -1.69; 95% CI -2.22 to -1.17; P < 0.00001; Figure ) and 12 months (SMD: -1.64; 95% CI -2.22 to -1.07; P < 0.00001; Figure ). VLDL levels also decreased at 6 months (SMD: -1.95; 95% CI -2.38 to -1.51; P < 0.00001) and 12 months (SMD: -0.83; 95% CI -1.13 to -0.53; P < 0.00001). Lipid profile improvements included reductions in total cholesterol, non-HDL cholesterol, and apoB levels, with increases in HDL cholesterol and apoA-1. Adverse events were comparable between Olezarsen and placebo, although serious adverse events were significantly higher in the Olezarsen group (RR: 2.55; 95% CI 1.17 to 5.58; p = 0.02). Conclusion: Olezarsen demonstrates significant efficacy in reducing triglyceride and VLDL levels while improving overall lipid profiles in hypertriglyceridemia patients. Despite higher rates of serious adverse events, its overall safety profile remains acceptable.

EJPC @ a glance: focus issue on lipid disorders and cardiovascular prevention.

EJPC @ a glance: focus issue on lipid disorders and cardiovascular prevention.

Analysis of the Prevalence of Cardiovascular Risk Factors in Patients with Chronic Hepatitis C

Cardiovascular diseases are the most common and important cause of morbidity, hospitalisation, and mortality in Poland and worldwide. Hence, in recent years there has been a strong emphasis on preventive cardiology, aimed at early identification and prevention of cardiovascular risk factors and lifestyle changes. The main classical risk factors include lipid disorders, hypertension, diabetes, obesity, and smoking. A new non-classical risk factor is HCV infection. The study group consisted of 320 patients with a mean age of 43 years, diagnosed with chronic hepatitis C. In the study group, ischaemic heart disease was diagnosed in 4 patients, representing 1.25%. Six people had a history of ischaemic stroke, representing 1.87% of the study group. Among the subjects, the most common cardiovascular risk factor was hyperlipidaemia (28%); there was no correlation with the severity of liver fibrosis for total cholesterol, LDL fraction, or TG, but more advanced liver fibrosis was observed in patients with low HDL fraction cholesterol values. Hypertension was present in 25% of patients and occurred in patients with more advanced liver fibrosis and steatosis. Diabetes was found in 11,56% of patients, also the mean fasting glucose level was elevated and was associated with more advanced liver fibrosis. The majority of patients were overweight and 32% were diagnosed as obese. The mean CRP value was 1.73 which may indicate moderate -cardiovascular risk. The results obtained may contribute to the awareness of physicians and the attempt to create recommendations for comprehensive - interdisciplinary care of patients chronically infected with HCV, concerning the need for systematic periodic examinations to assess individual cardiovascular risk factors, with the aim of prevention and early prevention of cardiovascular events.

Prevalence of hypercholesterolemia in the elderly and the very elderly members of the Polish population: results of a national cross-sectional representative survey.

Lipid disorders are the most common cardiovascular risk factor among adult population in Poland. However, there is still insufficient epidemiological data for an ever-growing group of older people. The aim was to describe and analyze the epidemiology of lipid disorders among Polish seniors Patients and methods: The random sample of 4101 participants (M = 2136; W = 1965) aged 65-104, equally distributed in age subgroups (65-69, 70-74, 75-79, 80-84, 85-89, and 90(+)-year-old subjects), participated in a cross-sectional, national survey PolSenior. Anthropometric measurements, blood pressure, and blood samples for tests of lipid profile were obtained. 62.4% of Polish seniors (56.1% of men and 66.3% of women) suffered from hypercholesterolemia. TC level was the highest among 65-69-year-olds, both men (206.0 [201.0-210.9] mg/dL) and women (220.6 [215.6-225.6] mg/dL). Women in each age group had a higher TC concentration than men. Also, in terms of LDL-C, the highest level was found in women aged 65-69 years (131.6 [127.2-136.1] mg/dL) and decreased in older age groups to 120.1 [115.2-125.0] mg/dL in women >90 years of age; similar in men: 121.6 [117.3-125.9] mg/dL in 65-69 y. o. and 106.5 [102.5-110.5] mg/dL in the group over 90 years old. In all the respective age groups, LDL-C was higher in women. In the Polish population among the elderly mean serum TC and LDL-C concentrations are higher in women than in men. The results obtained highlight the importance of lipid disorders as a risk factor also among the elderly Poles.

Long-Term Outcomes of Sleeve Gastrectomy Versus Gastric Bypass.

Extremely obese patients can benefit greatly from bariatric surgery, a common and successful therapeutic procedure for treating obesity and accompanying medical issues. Although sleeve gastrectomy and gastric bypass have already demonstrated their effectiveness in this demographic, long-term results were not stated in the literature. The purpose of this research is to examine the long-term outcomes of sleeve gastrointestinal surgery and gastric bypass. This retrospective, single-center study compares 100 patients aged 25 years and older who visited the gastrointestinal tract surgical unit at Dar El-Fouad Hospital in Cairo, Egypt, between January 1 and August 31, 2019, according to the inclusion and exclusion criteria. The patients underwent either a Roux-en-Y gastric bypass (RYGB-50%) or sleeve gastrectomy (SG-50%) for severe obesity. Follow-up occurred at one year and up to four years following surgery to collect information from the study subjects. Two tools were used to assess BMI, weight loss, complications after surgery, and incidence outcome of comorbidities after the two surgeries. Qualitative data were presented as number and percentage and frequency distribution tables, and every analysis was done at a significance value < 0.05. The average age of patients within the SG group was 43.02 ± 9.19 years, whereas the average age of patients within the RYGB group was 41.02 ± 11.06 years. In addition, 74% of patients were women in both procedures. The BMI mean of the SG group was 43.90 ± 5.78, the BMI mean of the RYGB group was 42.73 ± 5.12, and the main comorbidity in both techniques was joint pain. The mean BMI at one year was 29.70 kg/m2 after SG compared with 28.64 kg/m2 after RYGB. After four years, BMI was regained within the obese range in both techniques - 30.67 kg/m2 and 30.32, respectively. Fewer postoperative complications occurred in SG than in RYGB. RYGB was superior to SG in managing dyslipidemia (DL), hypertension (HT), type 2 diabetes (T2DM), joint pain, and gastroesophageal reflux disease (GERD). There are no significant differences between the SG and RYGB in long-term outcomes regarding BMI before surgery and at follow-up, after four years, while there were statistically significant differences between them after four years than one year after surgery, and both groups showed a significant decrease in weight. However, RYGB shows improvement to some extent in comorbidities within follow-up period, including BMI, T2DM, HT, DL, HT, DL, GERD, and joint pain than SG, but with a higher rate of minor complications, while greater resolution of OSAS occurred in SG. Finally, at four years, there were no discernible variations in BMI between SG and RYGB because the patients' mean BMI was within the obese range once more.

2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP).

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

Metabolic Effects of Loquat Juice (Eriobotrya japonica Lindl Mkarkeb Variety) on Lipid Homeostasis, Liver Steatosis, and Oxidative Stress in Hyperlipidemic Mice Fed a High-Fat-High-Fructose Diet.

Loquat fruit is consumed for its flavorful taste and a rich array of health-promoting compounds like phenolics, flavonoids, and carotenoids. This study aimed at the biochemical characterization of fresh juice from the Moroccan Mkarkeb variety of loquat and evaluating its effects on lipid homeostasis and liver steatosis in hyperlipidemic mice. The biochemical characterization followed AOAC methods. In vivo study involved hyperlipidemic mice fed a high-fat, high-fructose diet for 6 weeks and treated with loquat juice at 3.5 and 7 mL kg-1 or fenofibrate at 4 mg·kg-1. The concentrations of lipids in plasma, liver, adipose tissue, feces, and bile and blood glucose levels were quantified. Liver steatosis was visually examined and confirmed histologically, and liver injury markers (AST, ALT, ALP, LDH, and TB) were measured. Liver oxidative stress was assessed by measuring MDA content and antioxidative enzyme activities. Our findings indicate that fresh loquat juice is poor in fat and protein and contains moderate sugars with a low energy value (40.82 ± 0.25 kcal/100 g). It is also rich in minerals, vitamin C, phenolic acids, flavonoids, and carotenoids. The juice effectively restored lipid metabolism by enhancing reverse cholesterol transport and lowering LDL-cholesterol, triglycerides, and the atherogenic index. The studied juice decreases blood glucose and prevents weight gain and lipid accumulation in the liver and adipose tissue. The juice prevents lipotoxicity-induced liver injury, corrects toxicity markers, and improves the liver's morphological and histological structures. It also reduces oxidative stress by lowering MDA and activating SOD and catalase. The juice holds high nutritional and medicinal value, potentially preventing lipid disorders and cardiovascular issues.

ANGPTL3 as a target for treating lipid disorders in type 2 diabetes patients

Type 2 diabetes mellitus (T2DM) is a globally prevalent metabolic disorder, and cardiovascular disease (CVD) is a significant cause of mortality and morbidity in diabetic individuals. In addition to hyperglycemia, lipid abnormalities associated with T2DM play a crucial role in the development of CVD complications. Diabetic dyslipidemia is characterized by elevated levels of triglyceride (TG)-rich lipoproteins and small dense low-density lipoprotein (LDL) particles, reduced high-density lipoprotein (HDL) cholesterol, and impaired HDL function. Angiopoietin protein-like 3 (ANGPTL3) is a liver-derived protein that plays a crucial role in regulating plasma lipoprotein metabolism by inhibiting lipoprotein lipase and influencing lipid levels. Inhibiting ANGPTL3 has shown promising effects in promoting HDL-mediated cholesterol reverse transport and reducing the levels of TG-rich lipoproteins and LDL cholesterol. Here, we explore the potential of ANGPTL3 as a therapeutic target for lipid management in T2DM patients.

Concordance Between Biochemical and Molecular Diagnosis Obtained by WES in Mexican Patients with Inborn Errors of Intermediary Metabolism: Utility for Therapeutic Management.

Biochemical phenotyping has been the milestone for diagnosing and managing patients affected by inborn errors of intermediary metabolism (IEiM); however, identifying the genotype responsible for these monogenic disorders greatly contributes to achieving these goals. Herein, whole-exome sequencing (WES) was used to determine the genotypes of 95 unrelated Mexican pediatric patients suspected of having IEiM. They were classified into those bearing specific biochemical abnormalities (Group 1), and those presenting unspecific biochemical profiles (Group 2). The overall concordance between the initial biochemical diagnosis and final genotypic diagnoses was 72.6% (N = 69/95 patients), with the highest concordance achieved in Group 1 (91.3%, N = 63/69), whereas the concordance was limited in Group 2 (23.07%). This finding suggests that previous biochemical phenotyping correlated with the high WES diagnostic success. Concordance was high for urea cycle disorders (94.1%) and organic acid disorders (77.4%). The identified mutational spectrum comprised 83 IEiM-relevant variants (pathogenic, likely pathogenic, and variants of uncertain significance or VUS), including three novel ones, distributed among 29 different genes responsible for amino acid, organic acid, urea cycle, carbohydrate, and lipid disorders. Inconclusive WES results (7.3%, N = 7/95) relied on monoallelic pathogenic genotypes or those involving two VUS for autosomal-recessive IEiMs. A second monogenic disease was observed in 10.5% (N = 10/95) of the patients. According to the WES results, modifications in treatment had to be made in 33.6% (N = 32/95) of patients, mainly attributed to the presence of a second monogenic disease, or to an actionable trait. This study includes the largest cohort of Mexican patients to date with biochemically suspected IEiM who were genetically diagnosed through WES, underscoring its importance in medical management.