High Frequency Of Dyslipidemia Research Articles

Lipodystrophy, lipid profile changes, and low serum retinol and carotenoid levels in children and adolescents with acquired immunodeficiency syndrome

Objective To assess serum retinol and levels of carotenoids in children and adolescents with acquired immunodeficiency syndrome (AIDS) and to correlate low serum retinol and carotenoid levels with the presence of lipodystrophy, lipid profile changes, lipid peroxidation, and insulin resistance. Methods A cross-sectional, controlled observational study was carried out with 30 children and adolescents with AIDS (mean age 9.1 y) receiving antiretroviral therapy (median length of treatment 28.4 mo), including 30 uninfected healthy controls matched for age and gender. Clinical and laboratory assessments were performed to determine nutritional status, presence of lipodystrophy, serum concentrations of retinol, β-carotene, lycopene, lipid profile (high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols), lipid peroxidation (thiobarbituric acid-reactive substances), glycemia, and serum insulin (homeostasis model assessment for insulin resistance, cutoff point >3). Statistical analysis was done with chi-square test and Student's t test. Results Lipodystrophy was observed in 53.3% of patients with AIDS, and dyslipidemia was detected in 60% and 23% of subjects with human immunodeficiency virus and control subjects, respectively ( P = 0.004). A higher prevalence of retinol deficiency (60% versus 26.7%, P = 0.009) and β-carotene deficiency (23.3% versus 3.3%, P = 0.026) was found in the group with human immunodeficiency virus than in the control group. No correlation was found for low retinol and β-carotene levels, changes in lipid and glucose metabolism, or lipodystrophy in children and adolescents with AIDS. Conclusion Despite the high frequency of dyslipidemia, lipodystrophy, and retinol and β-carotene deficiencies, it was not possible to demonstrate a correlation of these findings with lipid peroxidation and insulin resistance. More studies are needed to investigate the causes of retinol and β-carotene deficiencies in this population and the clinical consequences of these findings.

Hypercholesterolemia in undiagnosed non-insulin-dependent diabetes in southern Taiwan.

The purpose of this study was to investigate the prevalence of hypercholesterolemia among subjects having diabetes and glucose intolerance, according to the guidelines of the National Cholesterol Education Program (Adult Treatment Panel II, ATP II). This survey consisted of 2090 subjects (856 men, 1234 women) aged 30 years or more from the Sun-Ming district of Kaohsiung city. Glucose tolerance status was ascertained for both medical history and a 75-g oral glucose tolerance test according to World Health Organization criteria. Frequency of elevated total cholesterol in female subjects with abnormal glucose tolerance is significantly greater than in those with normal glucose tolerance (NGT). However, only male subjects with undiagnosed NIDDM (UDDM) had a statistically higher rate of hypercholesterolemia than those with NGT. Of UDDM individuals, 68% have total cholesterol level between 200 and 239 mg/dl and two or more risk factors for heart disease or evidence of coronary heart disease or total cholesterol > or = 240 mg/dl or high-density lipoprotein (HDL) cholesterol < or = 35 mg/dl. Such individuals should have their low-density lipoprotein (LDL) cholesterol measured. Using the ATP II, LDL cholesterol levels warranting dietary treatment for hypercholesterolemia would be expected in 76% of UDDM. Due to the high prevalence of coronary heart disease in diabetic patients, investigation of blood lipid levels and coronary heart disease risk factors should be routine in these patients, and treatment strategies should include management of lipid disorders and the many other risk factors. A high frequency of dyslipidemia was found among UDDM group in our study. Early detection of undiagnosed diabetic patients is also very important in decreasing the prevalence of coronary heart disease.

Therapeutic perspectives in hyperlipidemic patients with diabetes mellitus

Reprint requests: Abhimanyu Garg, MBBS, MD, Assistant Professor of Internal Medicine and Clinical Nutrition, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9052 Supported in part by the Veterans Administration, by grants (HL-29252, MOl-RROOW from the National Institutes of Health, by the Southwestern Medical Foundation, and by the Moss Heart Foundation of Dallas, Texas. Coronary heart disease (CHD) remains the leading cause of death in patients with both Type I, insulin-dependent diabetes mellitus (IDDM), as well as for patients with Type II, noninsulin-dependent diabetes mellitus (NIDDM). Patients with diabetes mellitus have a high frequency of dyslipidemia, which, along with hyperglycemia, hypertension, and obesity (particularly in NIDDM), may be an important contributing factor to accelerated atherosclerosis.’ Although the information available on the relative importance of various CHD risk factors in patients with diabetes mellitus is limited, it appears that hypertension and nephropathy may be the major risk factors in IDDM,*s3 whereas dyslipidemia seems to be the most important risk factor in NIDDM.Since the presence of multiple risk factors may increase the overall risk for CHD in an additive or perhaps a synergistic manner, therapeutic strategies should put equal emphasis on controlling hyperglycemia, dyslipidemia, and hypertension. Most IDDM patients who maintain good glycemic control have normal levels of lipids and lipoproteins; some may even have subnormal levels of VLDL and LDL, and increased levels of HDL-cholesterol.7~8 However, marked hypertriglyceridemia with chylomicronemia may be observed in some patients with poor glycemic control. The dyslipidemia in most of these patients may simply respond to intensive insulin therapy8 and, therefore, hypolipidemic drugs may not be justified. It has been noted, however, that IDDM patients with microalbuminuria or early incipient nephropathy may have relatively higher levels of plasma triglycerides, VLDL-cholesterol, LDL-cholesterol, and apolipoprotein B, and lower levels of HDL-cholesterol, than those without microalbuminuria.g*lo With progression of diabetic nephropathy, the dyslipidemia is reported to worsen. Therefore, those patients prone to develop nephropathy may deserve special attention for lowering lipids and lipoproteins. Since experience with hypolipidemic drugs is virtually nonexistant in IDDM patients, dietary therapy should be stressed to control dyslipidemia in most patients. In contrast to patients with IDDM, NIDDM patients have a high frequency of dyslipidemia. Although prevalence of dyslipidemia in NIDDM undoubtedly varies among different populations, most studies indicate a twoto three-fold increase over nondiabetic individuals.4~“*12 C ha racteristic lipoprotein abnormalities in NIDDM patients include hypertriglyceridemia, or elevated levels of VLDL and low levels of HDL.‘* Although most population studies do not document elevated levels of LDL-cholesterol in NIDDM patients, abnormalities in the metabolism as well as composition of LDL particles may make an important contribution to atherogenesis. There is increasing evidence that elevated triglyceride levels, which are consistently associated with an elevated VLDL-cholesterol, appear to be an independent risk factor in NIDDM patients.5,6’” Therefore, the therapeutic target in NIDDM patients should be non HDL-cholesterol, which includes both VLDL and LDL, and not just LDL-cholesterol alone.13 Several studies indicate that the presence of diabetes mellitus in women eliminates their protection against CHD,‘* and therefore we propose that the goals of therapy may be similar for both men and women. In NIDDM patients, maximal reduction in cholesterol levels may be indicated to minimize CHD risk. The minimal goal of therapy in NIDDM patients may be a non HDLcholesterol level of less than 4.14 mmol/L (160 mgldl), the ideal goal being 3.36 mmol/L (130 mg/dl). l3 In patients with low levels of HDL-cholesterol

Management of Dyslipidemia in NIDDM

Coronary heart disease is the leading cause of death among patients with non-insulin-dependent diabetes mellitus (NIDDM). NIDDM patients have a high frequency of dyslipidemia, which along with obesity, hypertension, and hyperglycemia may contribute significantly to accelerated coronary atherosclerosis. Because risk factors for coronary heart disease are additive and perhaps multiplicative, even mild degrees of dyslipidemia may enhance coronary heart disease risk. Therefore, therapeutic strategies for management of NIDDM should give equal emphasis to controlling hyperglycemia and dyslipidemia. The National Cholesterol Education Program recently issued guidelines for treatment of hyperlipidemia in adults including diabetic patients. Because of the unique features of diabetic dyslipidemia, however, we suggest that certain modifications in these guidelines be made to meet specific needs of diabetic patients. For example, therapeutic goals for serum cholesterol reduction should be lower in diabetic patients than in nondiabetic subjects. Particular emphasis should be given to weight reduction in NIDDM patients. In some diabetic patients, monounsaturated fatty acids may be a better replacement for saturated fatty acids than carbohydrates. The target for cholesterol lowering should include both very-low-density lipoprotein and low-density lipoprotein (LDL) (non-high-density lipoprotein) rather than LDL alone. To obtain a substantial reduction of cholesterol levels, drug therapy may be required in many patients. However, first-line drugs for nondiabetic patients (nicotinic acid and bile acid sequestrants) may be less desirable in NIDDM patients than hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors and even fibric acids. In fact, HMG CoA reductase inhibitors may be the drugs of choice for NIDDM patients with elevated LDL cholesterol and borderline hypertriglyceridemia, whereas gemfibrozil appears preferable for NIDDM patients with severe hypertriglyceridemia.