Coronary Heart Disease Factors Research Articles

Comprehensive Analysis of the Correlation between Estrogen Levels, Homocysteine, and Lipid Profiles in Postmenopausal Women with Coronary Heart Disease

Objective: To investigate the correlation between estrogen levels, blood homocysteine, and blood lipids in postmenopausal female patients with coronary heart disease. Methods: This study selected 50 postmenopausal female patients with coronary heart disease from Northeast Normal University Hospital (observation group). The data collection period extended from June 2021 to June 2023. Simultaneously, 50 healthy patients with no history of coronary heart disease were selected during the same period as the control group. Physical examinations were conducted for all participants. Estrogen levels, blood homocysteine, and blood lipid levels were tested in both groups. Results: Compared to the control group, the observation group exhibited higher levels of follicle-stimulating hormone (FSH), total cholesterol (TC), and homocysteine (Hcy), and lower levels of high-density lipoprotein cholesterol (HDL-C; P < 0.05). Pearson correlation analysis revealed a negative correlation between estradiol (E2) levels and changes in Hcy, TC, and low density lipoprotein cholesterol (LDL-C) levels (P < 0.01). Multivariate analysis indicated that E2 serves as a protective factor against coronary heart disease in postmenopausal women. Decreased E2 levels, LDL-C, and Hcy were identified as independent risk factors for coronary heart disease in women (P < 0.05). Conclusion: A declining trend in estrogen levels among postmenopausal women has implications for their blood lipid levels and is closely associated with the development of chronic complications of menopause.

Is residential exposure to oil refineries a novel contextual risk factor for coronary heart disease?

Despite a multi-decade decrease in cardiovascular disease, geographic disparities have widened, with excess mortality concentrated within the United States (U.S.) South. Petroleum production and refining, a major contributor to climate change, is concentrated within the U.S. South and emits multiple classes of atherogenic pollutants. We investigated whether residential exposure to oil refineries could explain variation in self-reported coronary heart disease (CHD) prevalence among adults in southern states for the year 2018, where the majority of oil refinery activity occurs (Alabama, Mississippi, Louisiana, Arkansas, Texas, New Mexico, and Oklahoma). We examined census tract-level association between oil refineries and CHD prevalence. We used a double matching method to adjust for measured and unmeasured spatial confounders: one-to-n distance matching and one-to-one generalized propensity score matching. Exposure metrics were constructed based on proximity to refineries, activities of refineries, and wind speed/direction. For all census tracts within 10 km of refineries, self-reported CHD prevalence ranged from 1.2% to 17.6%. Compared to census tracts located at ≥5 km and <10 km, one standard deviation increase in the exposure within 5 km of refineries was associated with a 0.33 (95% confidence interval: 0.04, 0.63) percentage point increase in the prevalence. A total of 1119.0 (123.5, 2114.2) prevalent cases or 1.6% (0.2, 3.1) of CHD prevalence in areas within 5 km from refineries were potentially explained by exposure to oil refineries. At the census tract-level, the prevalence of CHD explained by exposure to oil refineries ranged from 0.02% (0.00, 0.05) to 47.4% (5.2, 89.5). Thus, although we cannot rule out potential confounding by other personal risk factors, CHD prevalence was found to be higher in populations living nearer to oil refineries, which may suggest that exposure to oil refineries can increase CHD risk, warranting further investigation.

Evaluating the Role of Fibrinogen as an Independent Risk Factor in Coronary Heart Disease

Evaluating the Role of Fibrinogen as an Independent Risk Factor in Coronary Heart Disease

Multiplicative and additive interactions between risk factors for coronary heart disease

Multiplicative and additive interactions between risk factors for coronary heart disease

Serum lipoprotein(a) and reclassification of coronary heart disease risk; application of prediction in a cross-sectional analysis of an ongoing Iranian cohort

IntroductionRecent studies have introduced elevated lipoprotein(a) (Lp(a)) as a risk factor for coronary heart disease (CHD). This study investigated whether the addition of Lp(a) as a novel biomarker to the Framingham Risk Score (FRS) model improves CHD risk prediction.MethodsThe study included 1101 Iranian subjects (443 non-diabetic and 658 diabetic patients) who were followed for 10 years (2003–2013). Lp(a) levels and CHD events were recorded for each participant.ResultsThe Net Reclassification Index (NRI) after adding Lp(a) to the FRS model was 19.57% and the discrimination slope was improved (0.160 vs. 0.173). The Akaike Information Criterion (AIC), a measure of model complexity, decreased significantly after adding Lp(a) to the FRS model (691.9 vs. 685.4, P value: 0.007).ConclusionsThe study concluded that adding Lp(a) to the FRS model improves CHD risk prediction in an Iranian population without making the model too complex. This could help clinicians to better identify individuals who are at risk of developing CHD and to implement appropriate preventive measures.

The importance, consequences and treatment of psychosocial risk factors in heart disease: less conversation, more action!

Psychosocial factors play asignificant role in the incidence and prognosis of cardiovascular disease with arapidly increasing body of knowledge, as acknowledged by their inclusion in the European Society of Cardiology cardiovascular prevention guideline since 2012. Nevertheless, psychosocial risk is not consistently assessed, acknowledged and treated in daily clinical practice. Therefore, adopting amultidimensional approach that encompasses biological, psychological, and social factors is crucial for understanding the dynamic nature of cardiovascular health and disease, delivering patient-centred care, and developing effective interventions to ultimately enhance health and satisfaction with contemporary medicine and care. The current review summarises the state-of-the-art evidence for screening and treating psychological risk factors in coronary heart disease, heart failure, and atrial fibrillation in the context of cardiac rehabilitation, along with accompanying recommendations. The limited adoption of routine screening, despite longstanding recommendations, highlights the importance of prioritising the implementation and expansion of routine screening in primary and secondary prevention. To advance psychosocial treatment, astandardised and personalised approach including comprehensive education, physical exercise, and psychosocial support with afocus on patient-reported outcomes is crucial. Treating heart and mind together has the potential to decrease psychosocial risk while enhancing the prognosis and quality of life, therefore delivering true patient-centred care.

The Benefit of Nutrition in Coronary Heart Disease

Coronary heart disease (CHD) is a condition of the coronary arteries that supply the heart. It is a narrowing of one or more coronary arteries. It is caused by atherosclerosis which is due to the action of fatty deposits of cholesterol. When blood flow is slowed by a blocked artery, the myocardium is no longer properly oxygenated. Coronary heart disease represents a major socio-economic challenge. In addition to genetics, the main risk factors for coronary heart disease are lack of physical activity, smoking, alcohol abuse and poor diet. The mortality rate linked to CD in the world and in Algeria is 34%. Our study involved 40 patients taken at random. It was carried out by collecting biological, clinical and anthropometric data collected during consultations. Our objective was to show the benefit of diet in the prevention of modifiable risk factors (hypertension, diabetes, dyslipidemia, obesity, sedentary lifestyle, smoking and alcohol) and compare our results with those found in the literature.

Carob Extract (Ceratonia siliqua L.): Effects on Dyslipidemia and Obesity in a High-Fat Diet-Fed Rat Model.

Dyslipidemia and obesity are recognized as two of the major global health issues and main risk factors for coronary heart disease and cerebrovascular disease. In recent years, carob has shown certain antioxidant and anti-dyslipidemic potential. In this study, Wistar rats were fed with a standard and cholesterol-enriched diet and treated orally with carob extract and simvastatin for four weeks. After sacrifice, blood samples were collected for biochemical analysis, and liver tissue was taken for histological and immunohistochemical assessment. Weight gain was significantly higher in groups fed with cholesterol-fortified granules; total cholesterol was found to be significantly lower in the hypercholesterolemic groups treated with simvastatin and simvastatin/carob combined regimens compared with hypercholesterolemic animals treated with saline (p < 0.05). The same was true for low-density lipoprotein cholesterol and the LDL/HDL ratio (p < 0.05). Adiponectin was remarkably higher in animals treated with simvastatin compared to all other groups (p < 0.05). Leptin was significantly lower in groups treated with carob and simvastatin compared to the hypercholesterolemic group treated with saline (p < 0.05). Carob/simvastatin co-administration reduced hepatocyte damage and improved liver morphology. A study confirmed the anti-dyslipidemic, anti-obesity, and hepatoprotective potential of carob pulp alone or in combination with simvastatin in the treatment of high-fat diet-fed rats.

Comparison of estimated LDL cholesterol equations with direct measurement

Abstract Aim LDL-cholesterol is one of the most important risk factors for coronary heart disease (CHD). These equations use total cholesterol, HDL and triglycerides measurements. Friedwald equation sometimes shows variatiοn in LDL calculation, mainly in patients with extreme values of triglycerides and LDL cholesterol. The aim of this study is to evaluate the accuracy of 12 well-known equations (Friedewald, Vujovic, Chen, Puavillai, Cordova, Anandaraja, Hattori, Ahmadi, Sampson, Planella, Ephraim, Martin). Methods A sample of 280 patients was studied, of which 33% had CHD history (table 1). The agreement of the equations with measured LDL was calculated both with goodness of fit test (r-Pearson) and test of discrimination (ROC curves). Results The Martin equation showed the best agreement (r=0.955,95% CI:(0.944,0.964)), with similar results given by the Sampson equation (r=0.954). The widely used Friedewald equation seems to fall short with r=0.939 as does the Planella equation (r=0.916), which is the only one that takes Apo-B values into account. Other simple linear equations did not differ greatly in accuracy from the Friedewald equation (table 2). Also in extreme triglycerides values (&amp;gt; 300mg/dl) the Sampson equation showed a better performance (r=0.935) than the Martin equation (r=0.928). Conclusions Equations such as those of Sampson and Martin take into account the interaction between triglycerides and non-HDL cholesterol and appear to be superior to simple linear ones (eg, Friedewald equation) in the accuracy of predicting LDL-cholesterol values even in individuals with elevated VLDL, IDL and non-HDL cholesterol. Further research is needed to verify our results.Descriptive characteristics of the studyCorrelations table

A global perspective on cardiovascular risk factor management in patients with CHD and different educational level: SURF CHD II

Abstract Background Clinical guidelines recommend that patients with established coronary heart disease (CHD) change health behaviors and use medication to control risk factors (RF), eventually reducing cardiovascular risk. Nevertheless, RF management in daily practice is challenging and RF control in secondary prevention remains suboptimal. Patients with low educational level tend to have higher cardiovascular risk. This association varies indifferent contexts, yet research on health inequalities in secondary prevention has focused mostly on high-income countries. Purpose To provide a global picture of health inequalities in RF management in secondary prevention of CHD, by assessing RF recording, target attainment, and treatment by educational level in patients from four world regions. Methods The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II is a clinical audit on RF management, undertaken in patients with CHD during routine outpatient visits. The survey is easy to perform, allowing its use in low-resource centers. We studied RF recording (data availability), attainment of targets defined by guidelines, and treatment (medication and cardiac rehabilitation). RF included smoking, physical activity, waist circumference, blood pressure, LDL, non-HDL cholesterol, triglycerides, and Hba1c (among diabetics). We reported the % of recording, target attainment and treatment in patients with primary/secondary schooling and in those with tertiary education. We assessed differences in RF management by educational level with logistic regression adjusted by age and sex, and stratified by region. Results 13884 patients were enrolled in 29 countries in Europe (N=10255), South-East Asia (SEA) (N=2290), the Americas (N=779) and North Africa and Eastern Mediterranean (N=560). 47.0% of participants had tertiary education, 34.5% had secondary schooling, and 18.6% primary schooling. RF recording ranged from 22.2% (waist circumference) to 93.0% (blood pressure); target attainment from 15.9% (waist circumference) to 76.9% (smoking). 50.5% participated in cardiac rehabilitation. RF information was collected more often in highly educated patients for most RF in the Americas, and for blood pressure and HBa1c in SEA. BMI and waist circumference were more frequently registered among lower-educated participants in Europe and SEA. Highly educated patients were more likely to meet RF targets for smoking in most regions, physical activity in Americas and Europe, LDL in SEA, and Non-HDL cholesterol and Hba1c in SEA and Americas regions. Patients with higher education participated more often in cardiac rehabilitation in all regions except SEA (Figure 1). Conclusions Health inequalities persist in secondary prevention of CHD: highly educated patients are generally more likely to have RF information recorded, have RF levels on target and attend cardiac rehabilitation. However, these associations present specific patterns by RF and region.

Abstract 11448: Secondary Quantitative Data Analysis of Active Commuting Infrastructure and Coronary Heart Disease in the United States

Background: It is established in modern scientific literature that physical inactivity is a significant risk factor for coronary heart disease. Implementing active commuting modalities like walking, cycling, and taking public transportation into daily living has been shown to increase physical activity. Prior research has shown the built environment influences the feasibility and likelihood of active commuting behavior. This begs the question of how the prevalence of coronary heart disease is impacted by available active commuting infrastructure. Purpose: Objective investigation of the relationship between active commuting infrastructure and age-adjusted prevalence of coronary heart disease, and associated cardiovascular risk factors in American cities. Methods: A quantitative secondary data analysis examining active commuting infrastructure via WalkScore, BikeScore, and TransitScore were correlated with and regressed against both risk factors for and age-adjusted prevalence of coronary heart disease. The sample included the top 150 most populated cities in the United States. Results: Better active commuting infrastructure has a strong inverse relationship with coronary heart disease prevalence and associated risk factors including hypertension, hyperlipidemia, and obesity. There are some limitations with conclusions that can be drawn from TransitScore and WalkScore due to lack of linearity in the data. Biking infrastructure has the most robust inverse correlation against coronary heart disease (R = -0.355, R 2 = 0.126, p = &lt;0.001, B co-efficient = 6.995, CI = [6.425, 7.485]). Conclusion: Investing in active commuting infrastructure, particularly promoting cycling, could be a population level method of primary prevention to decrease the morbidity and mortality due to coronary heart disease in American cities.

Abstract 15818: Association of Clonal Hematopoiesis of Indeterminate Potential With Incident Heart Failure With Preserved Ejection Fraction

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP) is the age-related expansion of blood cells with somatic mutations, most commonly in DMNT3A , TET2 , and ASXL1 . CHIP is a risk factor for coronary heart disease as well as heart failure (HF). Experimental HF models suggest a role of CHIP pro-inflammatory myeloid cells on cardiac dysfunction via fibrotic remodeling and hypertrophy. However, whether CHIP associates with incident HF with preserved ejection fraction (HFpEF), HF with reduced ejection fraction (HFrEF), or both is currently unknown. Hypothesis: We hypothesized that CHIP is more strongly related to HFpEF than HFrEF. Methods: We studied a multiethnic sample of postmenopausal women without prevalent HF from the Women’s Health Initiative (WHI). Whole genome sequencing was performed through the NHLBI TOPMed Program, and CHIP was detected based on 74 pre-specified myeloid driver mutations. Participants were followed through March 2020 with physician adjudication of HFrEF and HFpEF. Cox models tested the association of CHIP with incident HFpEF and HFrEF with adjustment for demographic/clinical risk factors and inverse probability weighting to account for the TOPMed sampling scheme. Results: Among 5,214 women, the mean age was 62 years, and 7.8% had CHIP. Over a median follow-up of 15 years, age-adjusted HFpEF incidence rates were 5.86 (95%CI 5.63-6.10) vs. 3.72 (95%CI 3.68-3.77) per 1,000 person-years among CHIP carriers vs. non-carriers. After multivariable adjustment, CHIP was associated with a 42% increased risk of incident HFpEF (HR 1.42, 95%CI 6-91%; P =0.02). In contrast, there was no evidence of association between CHIP and HFrEF ( Table 1 ). HFpEF was more strongly associated with TET2 CHIP (HR 2.50, 95%CI 1.54-4.06; P &lt;0.001) than with DNMT3A or ASXL1 ( Table 1 ). Conclusions: CHIP, especially TET2 CHIP, is associated with incident HFpEF. This finding has potential precision medicine implications for HFpEF prevention and treatment.

The role of fibrinolysis in the development of prediabetes-associated coronary heart disease: a focus on the plasminogen activator inhibitor -1 and its potential use as a predictive marker in diet-induced prediabetes.

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular diseases (CVD). However, the onset of T2DM is preceded by prediabetes, which is associated with sedentary lifestyles and consumption of high-calorie diets. Studies have shown that impaired glucose homeostasis creates an environment for developing T2DM-related complications. Using a high-fat-high-carbohydrate diet-induced prediabetes animal model, this study sought to assess the risk factors of coronary heart disease (CHD) in diet-induced prediabetes and identify biomarkers that can be used for early detection of prediabetes-associated CHD. Male Sprague Dawley rats were randomly grouped into two groups and were kept on different diets for 20 weeks (n = 6 in each group). One group was fed standard rat chow to serve as a non-prediabetes (NPD) control, while the other group consumed a high-fat-high-carbohydrate diet to induce prediabetes (PD). Post induction, the homeostasis model assessment- insulin resistance (HOMA-IR) and glycated haemoglobin (HbA1c) was used to test for insulin resistance. Body weight, mean arterial pressure (MAP), resting heart rate (HR), inflammatory cytokines (C-reactive protein (CRP), tumor necrosis factor (TNF-α), interleukin-6 (IL-6)), lipids (total cholesterol (TC), triglyceride (TG), lipoproteins (HDL, LDL, VLDL)), endothelial function (endothelial nitric oxide (eNOS), endothelin -1 (ET-1)), fibrinolysis (plasminogen activator inhibitor-1 (PAI-1)) were all measured to assess the risk of CHD. All data were expressed as means ± S.E.M. Statistical comparisons were performed with Graph Pad. Instat Software using Student's two-sided t-test. The Pearson correlation coefficient and linear regression were calculated to assess the association. The value of p < 0.05 was considered statistically significant. There was significant insulin resistance accompanied by significantly increased HbA1c and body weight in PD compared to NPD. Simultaneously, there was a significant increase in inflammatory cytokines in PD compared to NPD. This was accompanied by significantly increased TG and VLDL and endothelial dysfunction in PD. The association between HOMA-IR and PAI-1 was insignificantly positive in NPD, whereas a significantly strong positive association was observed in PD. There is a positive correlation between insulin resistance and PAI-1 during prediabetes; therefore, suggesting that prediabetes increases the risk of developing vascular thrombosis. The current therefore study warrants further investigation on PAI-1 and other markers of fibrinolysis for the early detection of thrombosis and risk of CHD in prediabetes.

Association Between Interleukin-6 Gene Polymorphism and Severity of Coronary Artery Disease in Patients with Diabetes.

Previous studies have identified diabetes as a risk factor for coronary heart disease. This study determined the correlation between the IL-6 gene -572 G/C polymorphism and the incidence and severity of coronary heart disease in patients with diabetes. One hundred four patients with diabetes who were admitted to our hospital from January 2019 to December 2020 were retrospectively enrolled in the current study. These patients were divided into a diabetes only group (group A, 27 patients) and a diabetes complicated by coronary heart disease group (group B, 77 patients). Seventy patients in the latter group were further divided into low, medium, and high Syntax score groups based on coronary angiography results. A correlation analysis between IL-6, blood lipids, and the IL-6 -572 G/C gene levels was performed. The serum IL-6 level in patients with the IL-6-572G/C-GG genotype was higher than patients with the GC and CC genotypes. In patients with diabetes, the presence of the IL-6-572G/C-GG and GC genotypes was associated with a significantly increased risk of developing coronary heart disease. Patients with the IL-6-572G/C-GG genotype and diabetes were shown to have more severe coronary artery lesions compared to patients with the CC genotype. Moreover, the G allele of the IL-6-572G/C gene was linked to a higher risk of coronary heart disease and more severe coronary artery lesions in patients with diabetes compared to the C allele. The IL-6-572G/C gene polymorphism is associated with the incidence and severity of coronary heart disease in patients with diabetes.

Asthma and incident coronary heart disease: an observational and Mendelian randomisation study.

Observational studies suggest asthma is a risk factor for coronary heart disease (CHD) and sex modifies the risk, but they may suffer from methodological limitations. To overcome these, we applied a "triangulation approach", where different methodologies, with different potential biases, were leveraged to enhance confidence in findings. First, we conducted an observational study using UK medical records to match asthma patients 1:1, by age, sex and general practitioner (GP) practice, to the general population. We measured the association between asthma and incident CHD (myocardial infarction: hospitalisation/death) by applying minimal sufficient adjustment: model 1, smoking, body mass index, oral corticosteroids, atopy and deprivation; model 2, additionally adjusting for healthcare behaviour (GP consultation frequency). Second, we conducted a Mendelian randomisation (MR) study using data from the UK Biobank, Trans-National Asthma Genetic Consortium (TAGC) and Coronary Artery Disease Genome-wide Replication and Meta-analysis consortium (CARDIoGRAM). Using 64 asthma single nucleotide polymorphisms, the effect of asthma on CHD was estimated with inverse variance-weighted meta-analysis and methods that adjust for pleiotropy. In our observational study (n=1 522 910), we found asthma was associated with 6% increased risk of CHD (model 1: HR 1.06, 95% CI 1.01-1.13); after accounting for healthcare behaviour, we found no association (model 2: HR 0.99, 95% CI 0.94-1.05). Asthma severity did not modify the association, but sex did (females: HR 1.11, 95% CI 1.01-1.21; males: HR 0.91, 95% CI 0.84-0.98). Our MR study (n=589 875) found no association between asthma and CHD (OR 1.01, 95% CI 0.98-1.04) and no modification by sex. Our findings suggest that asthma is not a risk factor for CHD. Previous studies may have suffered from detection bias or residual confounding.

Health-Related Quality of Life and Influencing Factors in Coronary Heart Disease Based on the Scale QLICD-CHD (V2.0): A Cross-Sectional Study.

Coronary heart disease (CHD) is difficult to cure, so more attention should be paid to improving patients' health-related quality of life (HRQoL). This paper focuses on identifying factors that affect HRQoL. Overall, 189 in-patients with coronary heart disease were investigated at the Affiliated Hospital of Guangdong Medical University between 2015 and 2016. The scale Quality of Life Instruments for Chronic Diseases-Coronary heart disease (QLICD-CHD V2.0) was used to evaluate HRQoL and collect demographic information. Medical records were applied to collect patients' clinical indicators. A simple correlation analysis, Student's t-test, and a one-way analysis of variance were first performed to filter factors that might associate with HRQoL, and multiple linear regression was applied to finally identify related factors. Findings from multiple linear regression showed that the total score was related to family economy, treatment, indirect bilirubin, and albumin with regression coefficient B=5.209, -6.615, 0.378, and 0.548, respectively. The physical functions were related to treatment, albumin, globular proteins, chloride, and red blood cell count with B=-9.031, 1.000, 0.612, 1.320, and 5.161, respectively. The psychological function was in association with family economy, clinical course, serum phosphorus, and percentage of lymphocyte population with B=7.487, 6.411, -16.458, and 0.090, respectively. The social function was associated with family economy, blood urea nitrogen, serum creatinine, and platelet distribution width with B=7.391, 1.331, -0.060, and -0.929, respectively. The special module was in association with treatment, indirect bilirubin, and serum calcium with B=-7.791, 0.414, and 23.017, respectively. Clinical indicators including albumin, globular proteins, chloride, red blood cell count, serum phosphorus, percentage of lymphocyte population, blood urea nitrogen, serum creatinine, platelet distribution width, indirect bilirubin, and serum calcium, as well as socio-demographic factors including the family economy, clinical course, and treatment, may affect coronary heart disease patients' HRQoL.

Age at job initiation and risk of coronary heart disease: findings from the UK biobank cohort study

BackgroundCommencing work at an early age has been linked to various risk factors for coronary heart disease (CHD), such as shift work and intensive job strain. However, the relationship between starting work too early and CHD risk remains largely unclear. We examined the association between age at job initiation and the risk of CHD.MethodsUK Biobank participants aged 38 to 70 years without cardiovascular disease who provided data on their age at job initiation were included. The primary outcome was CHD, which was ascertained using hospital and death records. The hazard ratios (HRs) and 95% confidence interval (CIs) for the association between age at job initiation and CHD were calculated using multivariable Cox regression.ResultsOf the 501,971 participants, 114,418 eligible participants were included in the final analysis. The median age at job initiation was 19.0 years. During the mean follow-up of 12.6 years, 6,130 (5.4%) first CHD events occurred. We observed that age at job initiation was inversely associated with CHD (HR 0.98, 95% CI 0.97–0.99), and the association was potentially J-shaped. The HRs for the < 17-year, 17–18-year, and 19–21-year age groups were 1.29 (95%CI 1.18–1.41), 1.12 (95% CI 1.03–1.22) and 1.05 (95% CI 0.97–1.14), respectively, compared with those of the ≥ 22-year group.ConclusionsAge at job initiation was associated with incident CHD, which was independent of socioeconomic status. Participants who commenced employment before the age of 19 years exhibited a higher risk of developing CHD later in adulthood.

Lipoprotein (a) in Cardiovascular Risk Assessment and Management in Diabetes Mellitus

Lipoprotein (a) [Lp(a)] is an independent and genetically-determined risk factor for coronary heart disease (CHD) and stroke that is not changed by alterations in lifestyle factors. It is now recommended by Canadian and other national lipid guidelines to be measured once in a person’s lifetime as part of overall assessment for cardiovascular risk, along with family history; presence of hypercholesterolemia; Type 2 diabetes (T2DM); hypertension; and smoking. The presence of elevated Lp(a) confers additional risk to the already high cardiovascular risk in individuals with T2DM. This review summarizes the nature and association of Lp(a) with elevated cardiovascular disease (CVD) risk; the increased cardiovascular risk in individuals with T2DM; potential therapies to lower Lp(a); whether or not to measure Lp(a); and recommendations on how to respond to the finding of elevated Lp(a) in a patient with T2DM.

Dyslipidemia and its predictors among adult workers in eastern Ethiopia: An institution-based cross-sectional study.

Dyslipidemia is a modifiable major risk factor for coronary heart disease. Although, the prevalence of dyslipidemia in high-income countries has been well documented, there is dearth of information about the dyslipidemia among working adults in sub-Saharan African countries including Ethiopia. Therefore, this study aimed to determine the magnitude of dyslipidemia and its associated factors among Haramaya University employees, in Eastern Ethiopia. A cross-sectional study was conducted among 1,200 university employees aged 20 to 60 years. Study participants were selected using a simple random sampling method. Data were collected face-to-face interview using a semi-structured questionnaire. Dyslipidemia was defined as unhealthy levels of one or more lipid profile such as high-density lipoprotein, low-density lipoprotein, triglycerides or total cholesterol. Data were entered into Epidata version 3.1 and analyzed using STATA version 16.1 software. Modified Poisson regression with robust variance was used to estimate adjusted prevalence ratios (APR) with its 95% confidence intervals. Statistical significance was declared at P-value < 0.05. Of 1,164 participants, 59.6% participants had at least one lipid abnormality (i.e., 57.9% among men and 61.5% among women). Of which, 36.8% had high total cholesterol (TC), 21.6% had low high density lipoprotein cholesterol (HDL-c), 22.4% had high low density lipoprotein cholesterol (LDL-c), and 32.6% had high triglyceride (TG). We found that overweight/obesity, sedentary behavior, alcohol consumption, having hypertension and age 45 and above years were significant predictors of dyslipidemia. However, those who served fruit and vegetables more than five per day had significantly reduced prevalence ratio of dyslipidemia. The high prevalent dyslipidemia among university employees is an important public health problem. Hence, tailored interventions to reduce overweight/obesity, hypertension, alcohol consumption and low fruit and vegetable intake have paramount importance to tackle dyslipidemia particularly among older age.

Dyslipidemias and Obesity

The studies that initially suggested the association between obesity, dyslipidemia and coronary heart disease were population-based studies, in which the predictive factors for coronary heart disease were investigated. In a later study of this same Framingham group, it was suggested that obesity was an independent risk marker for coronary artery disease. Other reports showed that also in obese individuals the elevation of the fraction of low-density lipoprotein-LDL and the reduction of the fraction of high-density lipoproteinHDL had a positive correlation with the risk of coronary heart disease. It was also observed that triglyceridemia would have a positive correlation with the risk of coronary heart disease. Hypertriglyceridemia in the obese results from greater synthesis and less removal of triglyceride-rich lipoproteins. In the obese individual, the greater supply of free fatty acids supplied to the liver promotes the greater production of very low-density lipoprotein particles-VLDL cholesterol rich in triglycerides. The hyperinsulinemia observed in metabolic syndrome contributes to the increased formation of these particles in the hepatocyte. For the treatment of dyslipidemia associated with obesity, the patient should receive guidance to lose weight, through an adequate diet and physical exercises. Regarding the diet, there is a controversy about which carbohydrate content it should contain, since, once the fat content is decreased, an increase in the carbohydrate content may occur, favoring hyperinsulinism and postprandial hyperglycemia. In individuals undergoing a strict weight losing diet, a transient phase of increased triglyceride and total cholesterol levels and decreased HDL-cholesterol levels may occur. In some cases, it is necessary to use lipid-lowering medications, the choice of which will depend on the type of lipid alteration found and the patient's response to treatment