Fasting Hypertriglyceridemia Research Articles

Associations between a common variant near the MC4R gene and serum triglyceride levels in an obese pediatric cohort.

Polymorphisms near the MC4R gene may be related to an increased risk for obesity, but studies of variations in this gene and its relation to cardiometabolic profiles and food intake are scarce and controversial. The aim of this study is to evaluate the influence of the variants rs12970134 and rs17782313 near the MC4R gene in food intake, binge eating (BE) behavior, anthropometric parameters, body composition, metabolic profile, and cardiometabolic risk factors in obese children and adolescents. This is a cross-sectional study that included obese children and adolescents. We evaluated anthropometric, metabolic parameters and cardiometabolic risk factors, including hypertension, impaired fasting glucose, hypertriglyceridemia, and low HDL-cholesterol. BE was assessed through the BE scale, and a 24-h recall was used to evaluate total caloric intake and percentage of macronutrients and types of dietary fat. The MC4R variants rs12970134 and rs17782313 were genotyped using TaqMan assay. To assess the magnitude of risk, a logistic regression adjusted for Z-BMI, age, and gender was performed, adopting the significance level of 0.05. The study included 518 subjects (52.1 % girls, 12.7 ± 2.7 years old, Z-BMI = 3.24 ± 0.57). Carriers of the variant rs17782313 exhibit increased triglyceride levels (108 ± 48 vs. 119 ± 54, p = 0.034) and an increased risk of hypertriglyceridemia (OR 1.985, 95 % CI 1.288-3.057, p = 0.002). There was no association of the SNP rs12970134 with clinical, metabolic, or nutritional parameters. The variant rs12970134 and rs17782313 did not influence food intake or the presence of BE. The variant rs17782313 is associated with an increased risk of hypertriglyceridemia in obese children and adolescents.

Whole Body Vibration: An Effective Treatment for Painful Diabetic Neuropathy

Introduction:Painful diabetic neuropathy is a common complication of diabetes that affects multiple aspects of patients’ lives, severely limiting daily functions and quality of life. The aim of this case study was to evaluate the efficacy of whole body vibration (WBV) to reduce pain and thereby improve quality of life, walking speed, and general clinical characteristics. Methods: A 63-year-female with type-2 diabetes and seven years of pain symptoms volunteered for a 12-week WBV intervention receiving 12-minutes of WBV per day, three days per week. Pain severity and its interference in daily life, 0-10 Numeric Rating Scale to assess pain immediately before and after WBV, quality of life, walking speed, body composition, general clinical characteristics and medication usage were assessed. Results: Pain severity and interference decreased by approximately 5.0 points post-intervention reducing the participant’s pain levels from borderline severe to very mild. Pain levels immediately prior to and following WBV exposure decreased every week and continued to decrease throughout the intervention. The participant indicated at baseline that her foot pain had a significant impact on her ability to take part in leisure activities, made her physically dependent on others for help, significantly affected her relationships and her role in the family and significantly impaired her ability to perform activities of daily life. Post-intervention, she was able to take part in leisure activities, no longer felt dependent on others, improved her relationships and her role in the family and was now able to easily perform daily tasks. Her walking speed also improved by 13.7% thereby reducing her risk of death. Other beneficial changes included weight loss (15.91 kg) and decreases in fasting glucose, hypertriglyceridemia, lower limb and feet swelling, and hypertension while decreasing her daily intake of pain and diabetes medications. Conclusion: WBV was effective at safely reducing pain and improving health related outcomes in our participant.

Meal preparation and cleanup time and cardiometabolic risk over 14 years in the Study of Women's Health Across the Nation (SWAN)

ObjectiveTo determine whether baseline levels and longitudinal changes in meal preparation and cleanup time are associated with changes in cardiometabolic risk factors in midlife women. MethodsSubjects were 2755 midlife women enrolled in the Study of Women's Health Across the Nation, a multi-ethnic, longitudinal cohort study in the United States. The five diagnostic components of the metabolic syndrome and meal preparation/cleanup time were assessed repeatedly across 14years of follow-up (spanning 1996–2011) at seven U.S. sites. Mixed-effects logistic and ordered logistic models tested associations between meal preparation/cleanup time and odds of meeting criteria for metabolic syndrome and its individual diagnostic components. ResultsWomen who spent more time preparing and cleaning up meals at baseline, or demonstrated greater increases in this activity, had greater increases over time in their odds of having metabolic syndrome and in the number of metabolic syndrome components for which they met criteria. Adjusted associations were observed between meal preparation/cleanup time and hypertension, impaired fasting glucose, hypertriglyceridemia, and low high-density lipoprotein cholesterol, but not abdominal obesity. ConclusionsIn midlife women, greater meal preparation/cleanup time is associated with the development of an adverse cardiometabolic risk profile. Public health interventions should place greater emphasis on cooking healthfully, not just cooking frequently.

Abstract 13452: Serum Apolipoprotein B-48 levels Are Significantly Correlated with Plaque Score of Carotid Arteries

Introduction: Fasting hypertriglyceridemia is a “residual risk” factor for atherosclerotic cardiovascular diseases and related to postprandial hypertriglyceridemia (PHTG). Intestine-derived lipoproteins such as chylomicrons and chylomicron remnants (CM-Rs), which contain one apolipoprotein(apo) B-48 molecule per one particle, are accumulated in patients with PHTG. Basic studies showed that CM-R had an atherogenic nature and apoB-48 molecule was observed in atherosclerotic plaque twice as many as apoB-100 molecule histologically. We established a CLEIA for measuring serum apoB-48 concentrations and reported that high apoB-48 concentrations correlated with the prevalence of dyslipidemia, diabetes mellitus, metabolic syndrome, chronic kidney disease and coronary heart disease. Hypothesis: We investigated whether serum apoB-48 concentration correlated with subclinical carotid atherosclerosis. Methods: A total of 163 subjects who received ultrasonography of carotid arteries in Osaka University were enrolled. Blood pressure (BP) at the supine position and serum concentrations of apoB-48, plasma glucose, HbA1c, TC, TG HDL-C and LDL-C were measured. Intima-media thickness (IMT) of carotid arteries was measured and plaque score (PS) were calculated in all subjects. Results: All subjects were classified into 4 groups by apoB-48 concentration quartiles: 1st (0-2.2 μg/mL, n=41), 2nd (2.3-3.5 μg/mL, n=39), 3rd (3.6-6.7 μg/mL, n=42) and 4th quartile (≧6.8 μg/mL, n=41), respectively. TG concentrations, prevalence of high BMI (≧25), max-IMT and PS were increased as apoB-48 concentrations were increased. Max-IMT and PS had significant correlations with age, eGFR, systolic BP, log-TG and log-apoB-48 levels and a multiple regression analysis indicated that the age, eGFR, and log-apoB-48 concentrations (p<0.05) were a significant determinant of an increased max-IMT and PS. In subjects whose TG concentrations were <150 mg/dL, max-IMT and PS were significantly higher in subjects of the 4th quartile than those of other quartiles. Conclusions: High serum apoB-48 concentrations strongly correlated with increased max-IMT and PS, indicating that the accumulated CM-Rs might be one of the increased risk for subclinical carotid atherosclerosis.

Factors associated with postprandial lipemia and apolipoprotein A-V levels in individuals with familial combined hyperlipidemia.

BackgroundAlterations in postprandial metabolism have been described in familial combined hyperlipidemia (FCH); however, their underlying mechanisms are not well characterized. We aimed to identify factors related to the magnitude of postprandial lipemia and apolipoprotein (apo) A-V levels in subjects with FCH.MethodsFCH cases (n = 99) were studied using a standardized meal test. Abdominal obesity was assessed using the waist to hip ratio (WHR). A linear regression model was performed to investigate the variables associated with the triglycerides incremental area under the curve (iAUC). Independent associations between metabolic variables and apo A-V iAUC were also investigated in a randomly selected subgroup (n = 44). The study sample was classified according to the presence of fasting hypertriglyceridemia (≥150 mg/dL) and abdominal obesity (WHR ≥0.92 in men and ≥0.85 in women) to explore differences in parameters.ResultsThe fasting apo B-48 levels (r = 0.404), and the WHR (r = 0.359) were independent factors contributing to the triglycerides iAUC (r2 = 0.29, P < 0.001). The triglycerides iAUC was independently associated with the apo A-V iAUC (r2 = 0.54, P < 0.01). Patients with both hypertriglyceridemia and abdominal obesity showed the most robust triglycerides and apo A-V postprandial responses.ConclusionsIn patients with FCH the fasting apo B-48 level is the main factor associated with postprandial lipemia. Abdominal obesity also contributes to the magnitude of the postprandial response.The triglycerides postprandial increment is the principal factor associated with the apo A-V postprandial response.

Stability and changes in metabolically healthy overweight or obesity and risk of future diabetes: Niigata wellness study.

Stability and changes in obesity and metabolic health status from a baseline period and longitudinally investigated their impact on predicting future diabetes were assessed. Studied were 27,478 Japanese individuals without diabetes. Metabolically healthy (MH) was indicated by having ≤1 among impaired fasting glucose, hypertension, hypertriglyceridemia and low HDL cholesterol concentration. Metabolically abnormal (MA) was indicated by having ≥2 of those metabolic abnormalities. A cut-off value of BMI 25.0 defined overweight or obesity (O) or normal weight (NW). Hazard ratio (HR) for diabetes for a 6-year period was investigated after changes in phenotypes were assessed during the previous 2 years. Compared with maintaining MH-NW, transitioning to MH-O from MH-NW resulted in a multivariate-adjusted HR of 1.96 (95% CI: 1.18, 3.25) for diabetes. With a stable MH-O the HR for diabetes was 2.59 (2.00, 3.34) while change from MH-O to MH-NW resulted in an HR of 1.30 (0.61, 2.76). Transitioning to MA-O from MH-O was associated with an HR of 7.09 (5.41, 9.30). With a stable MA-O the risk of diabetes was substantially elevated with an HR of 12.5 (10.5, 14.9). Examining the transitory nature of apparently benign or unhealthy obese phenotypes was effective for differentiating high-risk individuals for future diabetes.

A novel potent and selective pparalpha agonist, k-877, ameriolates both fasting and postprandial hypertriglyceridemia

A novel potent and selective pparalpha agonist, k-877, ameriolates both fasting and postprandial hypertriglyceridemia

Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder

Bipolar disorder (BD) is associated with significant morbidity and mortality due to comorbid general medical conditions, particularly cardiovascular disease. This study is the first report of the Brazilian Research Network in Bipolar Disorder (BRN-BD) that aims to evaluate the prevalence and clinical correlates of cardiovascular risk factors among Brazilian patients with BD. A cross-sectional study of 159 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROMAN) in São Paulo and the Bipolar Disorder Program (PROTAHBI) in Porto Alegre. Clinical, demographic, anthropometric, and metabolic variables were systematically assessed. High rates of smoking (27%), physical inactivity (64.9%), alcohol use disorders (20.8%), elevated fasting glucose (26.4%), diabetes (13.2%), hypertension (38.4%), hypertriglyceridemia (25.8%), low HDL-cholesterol (27.7%), general (38.4%) and abdominal obesity (59.1%) were found in the sample. Male patients were more likely to have alcohol use disorders, diabetes, and hypertriglyceridemia, whereas female patients showed higher prevalence of abdominal obesity. Variables such as medication use pattern, alcohol use disorder, and physical activity were associated with selected cardiovascular risk factors in the multivariable analysis. This report of the BRN-BD provides new data regarding prevalence rates and associated cardiovascular risk factors in Brazilian outpatients with BD. There is a need for increasing both awareness and recognition about metabolic and cardiovascular diseases in this patient population.

Serum magnesium in the metabolically-obese normal-weight and healthy-obese subjects

BackgroundGiven that hypomagnesemia is related with hyperglycemia, hypertension, hypertriglyceridemia, and insulin resistance, the objective of this study was to determine whether serum magnesium levels are associated with the metabolically obese normal weight (MONW) and the metabolically healthy obese (MHO) phenotypes. MethodsPopulation-based cross-sectional study that enrolled 427 subjects, men and non-pregnant women aged 20 to 65years, to participate in the study. Subjects were allocated into groups with and without obesity; among non-obese individuals, the subgroup of MONW subjects was compared with a control group of healthy normal-weight individuals. Among obese individuals, the subgroup of MHO subjects was compared with a control group of obese subjects who exhibited at least one metabolic abnormality. In the absence of obesity, the presence of fasting hyperglycemia, insulin resistance, hypertriglyceridemia, and/or hypertension defined the presence of MONW phenotype. In the absence of hypertension, insulin resistance and metabolic abnormalities of fasting glucose and triglycerides levels, the phenotypically obese subjects were defined as MHO individuals. ResultsThe sex-adjusted prevalence of MONW and MHO phenotypes was 40.8% and 27.9%. The multivariate logistic regression model adjusted by family history of diabetes, age, body mass index, and waist-circumference, showed a positive association between hypomagnesemia and the MONW phenotype (OR 6.4; 95%CI 2.3–20.4) and negative relationship between serum magnesium and the MHO phenotype (OR 0.32; 95%CI 0.17–0.61). ConclusionsOur results show that hypomagnesemia is positively associated with the presence of MONW phenotype, and the normomagnesemia negatively with the MHO phenotype.

Insulin secretion is increased in non‐diabetic subjects with fasting hypertriglyceridaemia

The elevation of triglycerides is strongly linked with insulin resistance, but it has not been evaluated in relationship to insulin secretion. The aim of this study was to determine whether hypertriglyceridaemia is associated with abnormal insulin secretion. A cross-sectional study was carried out. Eligible subjects, apparently healthy men and non-pregnant women aged 20-65 years were recruited. According to the triglyceride levels, subjects were allocated in the groups with hypertriglyceridaemia and normotriglyceridaemia. Hypertriglyceridaemia was defined by serum triglyceride levels ≥150 mg/dL. Insulin secretion was evaluated by the first phase of insulin secretion (1st PIS) and the second phase of insulin secretion (2nd PIS). A regression linear analysis was performed to evaluate the association between hypertriglyceridaemia (independent variable) and the first and second phase insulin secretion (dependent variables). A total of 247 apparently healthy subjects were enrolled; 113 (45.7%) with hypertriglyceridaemia and 134 (54.3%) in the control group. The simple regression linear analysis showed a significant association between hypertriglyceridaemia and the 1st PIS [B = 207.0; 95% confidence interval (CI) 33.5-380.5, p = 0.02] and the 2nd PIS (B = 48.7; 95% CI 9.2-88.2, p = 0.01). A multiple regression linear analysis adjusted by age, sex, body mass index and waist circumference was performed showing that fasting hypertriglyceridaemia remained significantly associated with the 1st PIS (B = 184.3; 95% CI 13.0-355.7, p = 0.03) and the 2nd PIS (B = 43.1; 95% CI 4.2-81.9, p = 0.03). The results of this study show that hypertriglyceridaemia is associated with the increase of the 1st PIS and the 2nd PIS in apparently healthy subjects.

Index of Suspicion

An 18-year-old girl presents with nighttime fevers to 39°C for 8 days. She complains also of headache, myalgia, and rash during the fevers. Eighteen days ago, she removed a tick from her neck after attending a festival in the northeastern United States. One week ago, she presented to her pediatrician with a sore throat and rash. She was hyponatremic (sodium, 129 mEq/dL) and was started on doxycycline for presumed Rocky Mountain spotted fever (RMSF). Her condition has not improved. She admits to multiple unprotected sexual encounters and cocaine abuse. The girl appears weak. Her vital signs include temperature of 38.7°C; heart rate, 84 beats per minute; respiratory rate, 20 breaths per minute; and blood pressure, 113/73 mm Hg. A salmon-colored macular rash is present on her trunk and proximal extremities. She also exhibits dermatographia. There are no mucosal lesions. The liver is enlarged to 2.5 cm beyond the rib margin, and she has right upper quadrant tenderness. Her muscles are tender to deep palpation in all four extremities. She is able to bear weight but refuses to ambulate due to bilateral lower extremity myalgia and arthralgia. A CBC demonstrates a normochromic, normocytic anemia, and leukocytosis with a left shift. ESR and CRP are elevated at 109 mm/hour and 19.8 mg/dL, respectively. A mild transaminitis is present. Ultrasonography reveals a mildly enlarged and echogenic liver. Small pleural and pelvic effusions are present on CT scan. A bone marrow biopsy and a glycosylated ferritin fraction are obtained. A clinical diagnosis is made. An 11-year old Hispanic boy who had poststreptococcal reactive arthritis (PSRA) and rheumatic fever (RF) diagnosed at age 6 years has been symptom-free while taking oral penicillin (PCN). Two months ago, he developed lemon-sized, reddish, painful subcutaneous nodules that were warm to touch on both lower extremities and revealed acute …

Risk for metabolic syndrome in a group of overweight children from South-East Romania

The present study aims to identify and analyse the cardiometabolic risk factors associated with the metabolic syndrome in overweight children and adolescents. The study group included 163 overweight children and adolescents, average age: 13.02 ± 3.42 years. The following evaluations were performed: anthropometrical measurements, blood pressure measurements, biochemical tests investigating the lipid and carbohydrate metabolism. Metabolic syndrome was identified in 48 subjects (29.4%). The risk to develop MS was found to be higher in males and within the 13-18 age group. The most common cardiometabolic risk factors were abdominal obesity (75.5%) and high blood pressure (41.1%), followed by low HDL-cholesterol (35%), increased fasting blood glucose (23.3%) and hypertriglyceridemia (17.8%.). The variables under analysis exhibited significant correlations with the number of metabolic syndrome diagnosis criteria. The metabolic syndrome prevalence in the paediatric population affected by excess body weight has reached high values in our geographical area. It is thus justified to initiate screening activities for the early detection and adequate treatment of the modifiable cardiometabolic risk factors, contributing to the prevention of long-term complications.

Diverse Immunophenotypic Abnormalities in Adult Patients with Hemophagocytic Lymphohistiocytosis

AbstractAbstract 3267 Background:Adult hemophagocytic lymphohistiocytosis (aHLH) is a rare, aggressive, often lethal disease presenting with cytopenias and infections. By contrast, pediatric HLH is a relatively homogeneous, familial condition, with 75% response rate. The hypercytokinemia that drives hemophagocytosis in aHLH may result from one or more overactive/overgrown lymphocyte subpopulations that may or may not be clonal. Very few detailed observations characterizing such populations exist. We present immunophenotypic abnormalities in 12 patients with aHLH diagnosed following the 2004 Histiocyte Society Criteria. Methods:Clinical and laboratory records of all patients clinically and/or pathologically diagnosed to have aHLH at Vancouver General Hospital were reviewed. Those fulfilling the 2004 Histiocyte Society Criteria for HLH, and had flow cytometry performed were further analyzed. The following markers were used: CD2, 3, 4, 5, 7, 8, 10, 16, 19, 20, 22, 23, 38, 45, 56, 57, 79b, FMC7, kappa and lambda. Results:Of the 29 patients with hemophagocytosis, 12 had confirmed aHLH and immunophenotyping data available (table-1). There were 4 males and 8 females; the median age was 57 years (21–76 years). Fever and splenomegaly were seen in 10 and 5 patients, bicytopenia and pancytopenia in 6 patients each while hyperferritinemia (>500ug/L), hypofibrinogenemia (<1.5g/L), fasting hypertriglyceridemia (>3mmol/L) and hemophagocytosis were seen in 12, 7, 8 and 12 patients respectively. In terms of triggering or predisposing factors, 5 patients had evidence of EBV infection, 1 had both EBV and CMV infections, and 1 had CMV infection. The remaining five patients had sarcoidosis, adult onset Still’s disease, acute respiratory failure with sepsis and pulmonary emboli, and rheumatoid arthritis with Felty’s syndrome and sepsis. One patient received treatment for Still’s disease (no. 12), 4 patients (no. 1, 7, 9 and 11) were palliated and 6 patients (no. 2–6, 8) were treated with etoposide-based therapy as per the HLH 2004 protocol. One patient was lost to follow up (no.10). The patient treated for Still’s disease (no.12) and two of 6 patients (no. 2, 3) on the HLH 2004 protocol achieved complete remission. All four patients who were palliated (nos. 1, 7, 9, 11) died. Immunophenotyping was done on bone marrow (n= 11) or blood (n= 1) specimens. The median lymphocyte percentage was 15 (range 3–70). All 12 patients showed abnormal lymphocyte populations (table-1). Six patients showed T-cell abnormalities including increased numbers of either Th2 (T-helper type II) or double negative T-cells or of CD8+ T-cells. Four patients had increased numbers of CD56+ cells (in contrast to reduced or absent NK activity reported in the literature), and two patients had polyclonal increase in B-cells. There was no correlation of underlying/precipitating factors, diagnostic clinical or laboratory parameters, type of treatment received or treatment response, with the type of Immunophenotypic abnormalities.Table–1:Immunophenotypic Abnormalities in Adult Patients with Hemophagocytic LymphohistiocytosisPatientCD2CD3CD4CD5CD7CD8CD56CD19/20Immunophenotypic Abnormality1991580804510151Increased Th2 (helper T-cell type II) cells (80%)2801570801510152Increased Th2 (helper T-cell type II) cells (65%)390901530752555Increased double negative T-cells (65%)4989325919680142Increased CD8+ cells (80%)5959385095905<5Increased CD8+ cells (90%)6958811896387222.4Increased CD8+ cells (87%)76235251790327513Increased CD56+ cells (75%)*8902323303700.8Increased CD56+/16+ cells (70%)97943265978303415Increased CD56+/16+/57+ cells (34%)10866335597936406.4Increased CD56+/16+ cells (40%)11616145575828842Increased B-cells polyclonal (42%)127070457045251020Increased B-cells polyclonal (20%)*Half of these cells were CD2+; the other half CD2–. Conclusions:Diverse immunophenotypic abnormalities were seen in patients with aHLH; the type of aberrant phenotype had no relationship to either clinical or laboratory findings, underlying/predisposing factors or to the response to treatment. This finding confirms the varied pathogenetic mechanisms leading to hemophagocytosis, and prompts further investigations into their role in aHLH. Disclosures:No relevant conflicts of interest to declare.

Correlation of metabolic syndrome with urinary stone composition

To determine the correlation between metabolic syndrome and the distribution of stone components in patients with urolithiasis. Between January 2007 and December 2010, renal or ureteral stones were collected from 712 patients (432 males, 280 females) who underwent surgical intervention at three hospitals in South Korea. Metabolic syndrome was defined according to the latest definition of the International Diabetes Federation, using ethnicity- and sex-specific cut-off values for central obesity. Patients were assessed by factors used in metabolic syndrome. All urinary stones were analyzed using infrared spectrophotometry and categorized according to their main component. The patients' mean age was 55.9 years (range 19-93 years). Of the 712 patients, 347 (48.7%; 205 males, 142 females) had a diagnosis of metabolic syndrome. Calcium oxalate (71.5%), uric acid (15.3%), carbonate apatite (8.0%) and struvite (4.1%) calculi were found as the main stone components. Overall, the proportion of uric acid calculi was markedly higher in patients with rather than without metabolic syndrome (19.6 vs 11.2%; P=0.002). However, the proportion of calcium oxalate, carbonate apatite and struvite calculi did not differ between the two groups. The multivariable-adjusted odds ratio for uric acid calculi according to the metabolic syndrome components indicated that the presence of metabolic syndrome was associated with a 93% increased odds ratio of uric acid calculi compared with the absence of metabolic syndrome. Impaired fasting glucose and hypertriglyceridemia were independent risk factors for uric acid calculi. Metabolic syndrome is associated with a significantly increased risk of uric acid calculi development, especially those with impaired fasting glucose and hypertriglyceridemia.

The association of hypertriglyceridemia with cardiovascular events and pancreatitis: a systematic review and meta-analysis

BackgroundHypertriglyceridemia may be associated with important complications. The aim of this study is to estimate the magnitude of association and quality of supporting evidence linking hypertriglyceridemia to cardiovascular events and pancreatitis.MethodsWe conducted a systematic review of multiple electronic bibliographic databases and subsequent meta-analysis using a random effects model. Studies eligible for this review followed patients longitudinally and evaluated quantitatively the association of fasting hypertriglyceridemia with the outcomes of interest. Reviewers working independently and in duplicate reviewed studies and extracted data.Results35 studies provided data sufficient for meta-analysis. The quality of these observational studies was moderate to low with fair level of multivariable adjustments and adequate exposure and outcome ascertainment. Fasting hypertriglyceridemia was significantly associated with cardiovascular death (odds ratios (OR) 1.80; 95% confidence interval (CI) 1.31-2.49), cardiovascular events (OR, 1.37; 95% CI, 1.23-1.53), myocardial infarction (OR, 1.31; 95% CI, 1.15-1.49), and pancreatitis (OR, 3.96; 95% CI, 1.27-12.34, in one study only). The association with all-cause mortality was not statistically significant.ConclusionsThe current evidence suggests that fasting hypertriglyceridemia is associated with increased risk of cardiovascular death, MI, cardiovascular events, and possibly acute pancreatitis.Précis: hypertriglyceridemia is associated with increased risk of cardiovascular death, MI, cardiovascular events, and possibly acute pancreatitis

Abstract P198: Is Directly Measured LDL Clinically Equivalent to Calculated LDL

Background: LDL cholesterol can either be calculated or measured directly. Clinical guidelines recommend using calculated LDL to guide therapy, as the evidence base for lipid management is derived almost exclusively from trials using calculated LDL, with direct measurement of LDL being reserved for those not fasting or significant hypertriglyceridemia. Our aim was to determine the clinical equivalence of directly measured LDL and fasting calculated LDL. Design: Eighty-one subjects had at least 1 calculated and direct LDL performed simultaneously; 64 had a repeat lipid assessment after 4 to 6 weeks of therapy, resulting in 145 pairs of calculated and direct LDL. Correlation between direct and calculated LDL was determined using Pearson's correlation coefficient. The relationship between direct and calculated LDL was also evaluated from a clinical perspective. Direct and calculated LDL were considered “clinically concordant” when the difference between calculated and direct LDL fulfilled 3 criteria: 1) &lt; 6% difference (incremental LDL lowering provided by 1 titration of statin dose, e.g. simvastatin 20 to 40 mg), 2) &lt; 10 mg/dL difference, and 3) placement in the same ATP III LDL cut points (e.g. &lt;100, 100-129). Direct and calculated LDL were considered “clinically discordant” when the difference between calculated and direct LDL fulfilled 3 criteria: 1) ≥ 12% difference (incremental LDL lowering provided by 2 statin titration steps, e.g. from simvastatin 20 to 80 mg), 2) ≥ 10 mg/dL difference, and 3) placement in different ATP III LDL cut points. Results: There was significant correlation between direct and calculated LDL(r=0.93). Clinical concordance between calculated and direct LDL was present in 40% of patients. Clinical discordance was noted in 25% of patients. One-third of patients had &gt; 15 mg/dL difference between direct and calculated LDL, while 25% had &gt; 20 mg/dL difference. In 47% of subjects, the difference between direct and calculated LDL at baseline and follow-up changed by a minimum of 10% or 10 mg/dL. Conclusion: Our findings suggest that directly measured LDL is not clinically equivalent to calculated LDL. This puts into question the current recommendation of using direct LDL in situations where calculated LDL would be inaccurate.

Cardiovascular risk profile in a patient with a novel splice site ABCA1 mutation (HDL Chelsea–Modena)

Presentation: A 37 year old man was found to have a very low HDL (0.14mmol/L), total cholesterol 4.1mmol/L and fasting hypertriglyceridaemia (4.4–13.3mmol/L) after a lipid check due to a family history of low HDL. Other vascular risk markers included Lp(a) 484mg/L (RR<300) and homocysteine 29.3μmol/L (RR<15.0)

A hypertriglyceridemic state increases high sensitivity C-reactive protein of Japanese men with normal glucose tolerance

Both fasting and postprandial hypertriglyceridemia have been identified as risk markers for cardiovascular disease. High-sensitivity C-reactive protein (hs-CRP), known to independently predict future cardiovascular disease, has also been reported to be a direct participant in the progression of atherosclerosis. We evaluated whether or not fasting and/or postprandial hypertriglyceridemia influence hs-CRP of men with normal glucose tolerance. According to the triglyceride (TG) level, measured before and 1 and 2 h after a meal tolerance test, subjects were classified into a normotriglyceridemic (NTG) group (n = 86), a postprandial hypertriglyceridemia (PHTG) group (n = 50), or a fasting hypertriglyceridemia (FHTG) group (n = 53). Hs-CRP and HOMA-R were significantly higher in the FHTG group than in the other groups (P < 0.01). The PHTG group had higher hs-CRP than the NTG group (P < 0.05). No significant differences in age, BMI, LDL cholesterol, or carotid intima-media thickness were found in comparison of the three groups. Multivariate linear regression analysis showed that the area under the TG curve (AUC-TG), HbA1c, and BMI were independently correlated with hs-CRP (P < 0.001, P = 0.016, P = 0.032, respectively). Our data suggests that a hypertriglyceridemic state is associated with hs-CRP irrespective of BMI, LDL-C, and HDL-C, indicating that hs-CRP might represent chronic inflammation induced by hypertriglyceridemia in Japanese men with normal glucose tolerance.

Prevalence of metabolic syndrome in the Canadian adult population

Metabolic syndrome refers to a constellation of conditions that increases a person's risk of diabetes and cardiovascular disease. We describe the prevalence of metabolic syndrome and its components in relation to sociodemographic factors in the Canadian adult population. We used data from cycle 1 of the Canadian Health Measures Survey, a cross-sectional survey of a representative sample of the population. We included data for respondents aged 18 years and older for whom fasting blood samples were available; pregnant women were excluded. We calculated weighted estimates of the prevalence of metabolic syndrome and its components in relation to age, sex, education level and income. The estimated prevalence of metabolic syndrome was 19.1%. Age was the strongest predictor of the syndrome: 17.0% of participants 18-39 years old had metabolic syndrome, as compared with 39.0% of those 70-79 years. Abdominal obesity was the most common component of the syndrome (35.0%) and was more prevalent among women than among men (40.0% v. 29.1%; p=0.013). Men were more likely than women to have an elevated fasting glucose level (18.9% v. 13.6%; p=0.025) and hypertriglyceridemia (29.0% v. 20.0%; p=0.012). The prevalence of metabolic syndrome was higher among people in households with lower education and income levels. About one in five Canadian adults had metabolic syndrome. People at increased risk were those in households with lower education and income levels. The burden of abdominal obesity, low HDL (high-density lipoprotein) cholesterol and hypertriglyceridemia among young people was especially of concern, because the risk of cardiovascular disease increases with age.

Angptl4 deficiency decreases serum triglyceride levels in low-density lipoprotein receptor knockout mice and streptozotocin-induced diabetic mice

Angiopoietin-like protein family 4 (Angptl4) has been shown to regulate lipoprotein metabolism through the inhibition of lipoprotein lipase (LPL). In familial hypercholesterolemia (FH), individuals lacking low-density lipoprotein receptor (LDLR) present not only hypercholesterolemia, but also increased plasma triglyceride (TG)-rich lipoprotein remnants, and develop atherosclerosis. In addition, the most common type of dyslipidemia in individuals with diabetes is increased TG levels. We first generated LDLR −/−Angptl4 −/− mice to study the effect of Angptl4 deficiency on the lipid metabolism. Fasting total cholesterol, VLDL-C, LDL-C, HDL-C and TG levels were decreased in LDLR −/−Angptl4 −/− mice compared with LDLR −/−Angptl4 +/+ mice. In particular, post olive oil-loaded TG excursion were largely attenuated in LDLR −/−Angptl4 −/− mice compared with LDLR −/−Angptl4 +/+ mice. We next introduced diabetes by streptozotocin (STZ) treatment in Angptl4 −/− mice and examined the impacts of Angptl4 deficiency. Compared with diabetic Angptl4 +/+ mice, diabetic Angptl4 −/− mice showed the improvement of fasting and postprandial hypertriglyceridemia as well. Thus, targeted silencing of Angptl4 offers a potential therapeutic strategy for the treatment of dyslipidemia in individuals with FH and insulin deficient diabetes.