Low High-density Lipoprotein Cholesterol Research Articles

High-density lipoprotein functionality in cholesterol efflux in early childhood is related to the content ratio of triglyceride to cholesterol

Cholesterol efflux capacity (CEC), commonly measured as a useful risk marker of atherosclerotic cardiovascular disease, depends on high-density lipoprotein (HDL) functionality and its concentration. We defined the relative HDL functionality in cholesterol efflux, not influenced by HDL concentration, as the ratio of measured CEC to standardized CEC (stCEC) based on HDL-cholesterol (HDL-C) of each individual using the curve regression equation obtained from the correlation. HDL-C, CEC, and CEC/stCEC levels in the < 28-day-old participants (neonates) were significantly low compared to those of the ≥ 28-day-old participants, indicating that the low CEC levels in the neonates depend on not only lower HDL-C but also lower HDL functionality. The low level of CEC/stCEC was remarkable in neonates born at < 34 weeks of gestation and did not improved to the reference level (1.000) until the infantile period. The relatively low or high CEC/stCEC ratios in neonates and infants were associated with lower or higher HDL-TG and HDL-TG/HDL-C ratio, respectively. However, no apparent effect of HDL-TG and HDL-TG/HDL-C ratio on CEC/stCEC was observed in the ≥ 1-year-old participants, indicating that HDL functionality in cholesterol efflux could be associated with the various HDL particles with various lipid compositions, but not just with HDL-TG and HDL-TG/HDL-C ratio.

Association between the Korean Healthy Diet Score and Metabolic Syndrome: Effectiveness and Optimal Cutoff of the Korean Healthy Diet Score.

Although the prevalence of metabolic syndrome has increased among Koreans, the specific health benefits of the Korean Healthy Diet score remain unexplored. This study aimed to evaluate the association between the Korean Healthy Diet score and metabolic syndrome and to identify the optimal cutoff of the Korean Healthy Diet score for reducing metabolic syndrome prevalence. This cross-sectional study used data from 11,403 participants of the seventh and eighth Korea National Health and Nutrition Examination Survey. The Korean Healthy Diet score was calculated based on adherence to 13 dietary components. A logistic regression analysis was used to determine the association between the Korean Healthy Diet score and metabolic syndrome, as well as to identify the optimal cutoff values for the Korean Healthy Diet score. The average Korean Healthy Diet score was significantly lower in participants with metabolic syndrome than in those without metabolic syndrome (5.03 vs. 5.14, p = 0.016). A one-point increase in the Korean Healthy Diet score was associated with a reduction in metabolic syndrome prevalence (odds ratio: 0.95, 95% confidence interval: 0.91-0.98). The optimal cutoff for the Korean Healthy Diet score was identified as >7 points, particularly showing significantly decreased prevalence of hypertriglyceridemia and low high-density lipoprotein cholesterol. The Korean Healthy Diet score was inversely associated with metabolic syndrome prevalence, and the identified optimal cutoff values can serve as a practical tool for public health interventions aimed at reducing the risk of metabolic syndrome.

The Influence of Remnant Cholesterol on Cardiovascular Risk and Mortality in Patients with Non-Functional Adrenal Incidentalomas and Mild Autonomous Cortisol Secretion: A Retrospective Cohort Study.

Background: Increased cardiovascular risk has been described in individuals with adrenal incidentalomas. The aim of the present study is to assess the effect of remnant cholesterol (RC) on the cardiovascular risk and mortality of patients with adrenal incidentalomas. Methods: A retrospective cohort study was conducted with patients with adrenal incidentalomas between 2001 and 2024. One hundred thirty-seven patients (mean age of 61.2 ± 11.5 years; 56.6% women) with non-functioning adrenal incidentalomas and with mild autonomous cortisol secretion (MACS) (cortisol post-dexamethasone suppression test ≥1.8 µg/mL) were included. The patients were divided into two groups using 30 mg/dL as the cut-off for RC. Logistic regression models were used to study the impact of RC on major adverse cardiovascular events and mortality (MACEs). Results: Patients with RC ≥ 30 mg/dL exhibited a higher prevalence of type 2 diabetes mellitus (T2D) (p < 0.001), lower HDL-C (p < 0.001) and LDL-C (p = 0.025) levels, a higher frequency of treatment with statins (p = 0.032), and a higher rate of non-fatal major cardiovascular events (p = 0.038) and MACEs (p = 0.038). Patients with MACS showed no differences in RC or complications during the follow-up. The relative risk of high RC was 2.65 (1.04-6.77) for cardiovascular events and 2.27 (1.05-4.92) for MACEs, with p < 0.05 in both cases. The only variables independently affecting MACEs were age ([odds ratio] OR = 1.13 [p = 0.004]), female sex (OR = 0.20; p = 0.016), LDL-C (OR = 1.02; p = 0.029), and RC (OR = 1.06; p = 0.014). T2D and HDL-C were not independently associated with MACEs. Conclusions: RC ≥30 mg/dL in patients with adrenal incidentalomas was associated with a higher prevalence of T2D, lower HDL-C levels, and a higher risk of MACEs. MACS was not associated with RC or MACEs during the follow-up.

Comparison between statistical and machine learning methods to detect the hematological indices with the greatest influence on elevated serum levels of low-density lipoprotein cholesterol

IntroductionElevated levels of low-density lipoprotein-cholesterol (LDL-C) is a significant risk factor for the development of cardiovascular diseases (CVD)s. Furthermore, studies have revealed an association between indices of the complete blood count (CBC) and dyslipidemia. We aimed to investigate the relationship between CBC parameters and serum levels of LDL. MethodIn a prospective study involving 9704 participants aged 35–65 years, comprehensive screening was conducted to estimate LDL-C levels and CBC indicators. The association between these biomarkers and high LDL-C (LDL-C≥130 mg/dL (3.25 mmol/L)) was investigated using various analytical methods, including Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Neural Network (NN), and Support Vector Machine (SVM) methodologies. ResultThe present study found that age, hemoglobin (HGB), hematocrit (HCT), platelet count (PLT), lymphocyte (LYM), PLT-LYM ratio (PLR), PLT-High-Density Lipoprotein (HDL) ratio (PHR), HGB-LYM ratio (HLR), red blood cell count (RBC), Neutrophil-HDL ratio (NHR), and PLT-RBC ratio (PRR) were all statistically significant between the two groups (p<0.05). Another important finding was that red cell distribution width (RDW) was a significant predictor for higher LDL levels in women. Furthermore, in men, RDW-PLT ratio (RPR) and PHR were the most important indicators for assessing the elevated LDL levels. ConclusionThe study found that sex increases LDL-C odds in females by 52.9 %, while age and HCT increase it by 4.1 % and 5.5 %, respectively. RPR and PHR were the most influential variables for both genders. Elevated RPR and PHR were negatively correlated with increased LDL levels in men, and RDW levels was a statistically significant factor for women. Moreover, RDW was a significant factor in women for high levels of HDL-C.The study revealed that females have higher LDL-C levels (16 % compared to 14 % of males), with significant differences across variables like age, HGB, HCT, PLT, RLR, PHR, RBC, LYM, NHR, RPR, and key factors like RDW and SII.

12626 Non-high-density Lipoprotein Cholesterol For Detecting Dyslipidemia Among Korean Adolescents

Abstract Disclosure: H. Nam: None. E. Kang: None. Y. Rhie: None. K. Lee: None. Objectives: Non-high-density lipoprotein (HDL) cholesterol is an alternative method to assess dyslipidemia. We aimed to assess the validity of non-HDL cholesterol for detecting dyslipidemia among Korean adolescents. Methods: Data for 6,989 adolescents aged 10 to 19 years (3,684 boys and 3,305 girls), were obtained from the Korean National Health and Nutrition Examination Surveys. Dyslipidemia was defined by having one of the followings; total cholesterol ≥200 mg/dL, triglyceride ≥130 mg/dL, low-density lipoprotein (LDL) cholesterol ≥130 mg/dL, or HDL cholesterol &amp;lt;40 mg/dL. Non-HDL cholesterol ≥145 mg/dL was used to detect dyslipidemia based on National Heart, Lung, and Blood Institute 2011. Results: The overall prevalence of dyslipidemia were 27% and 37% among Korean adolescents based on calculated and measured LDL cholesterol level, respectively. The prevalence of non-HDL cholesterol level ≥145 mg/dL were 7.1% and 8.5% in teenage boys and girls, respectively. Dyslipidemia was found in 97.1% and 97.7% of boys and girls with high non-HDL level, respectively. High non-HDL cholesterol level especially detected high measured LDL-cholesterol level with a sensitivity of 96.3%, and a specificity of 96.3%, and a sensitivity of 95.2%, and a specificity of 97.1%, in teenage boys and girls. Using non-HDL cholesterol was more detected high LDL-cholesterol level compared to using total cholesterol alone in teenage boys and girls. Conclusions: Screening dyslipidemia using non-HDL cholesterol level was more useful than using total cholesterol level alone, especially in detecting high LDL cholesterol level. Non-HDL cholesterol was not required fasting and was appeared to be a reliable screening test also in adolescents. Presentation: 6/1/2024

8702 Age-Sex Differences in Global Burden of Ischemic Heart Disease Attributable to High LDL in the Last 3 Decades:Global, Regional, National Variations, Age Dynamics, and Implications for Global Health

Abstract Disclosure: V. Adedara: None. K. Maddineni: None. A. Dekhne: None. M. Chinthapalli: None. G. Potluri: None. A. Parisapogu: None. K. Markandu: None. H. Desai: None. Background: Ischemic Heart Disease (IHD) stands as the foremost cause of mortality globally, contributing to 9.6 million deaths. Elevated levels of low-density lipoprotein cholesterol (LDL-C) consistently feature among the risk factors associated with IHD. Methods: Employing the Global Burden of Disease framework, we computed mortality and DALYs linked to IHD attributable to LDL-C, stratified by age-sex, year, and covering 204 countries and territories during the period from 1990 to 2019. Non-fatal health outcomes were estimated using DISMOD MR 2.1, Bayesian meta-regression tool for epidemiological modelling. Results were expressed in absolute counts and age-standardized rates (ASR) per 100,000 person-years. Results: The total number of deaths attributed to IHD due to elevated LDL-C increased from 2.5 million (95% Uncertainty Interval: 2-3.1 million) in 1990 to 3.7 million (95% UI: 2.8-4.8 million) in 2019. Concurrently, DALYs increased from 60.4 million (95% UI: 50.4-70.7 million) in 1990 to 84.9 million (95% UI: 69.5-101.3 million) in 2019. In terms of ASR, the annual percentage change (APC) in death rates decreased by 36%, and DALY rates decreased by 32% from 1990 to 2019. Regionally, East Asia exhibited the highest increase in APC in death counts by 191%, followed by Commonwealth Low-Income countries at 164%, and Oceania at 160% during the same period. Conversely, the Commonwealth High-Income region experienced the highest decrease at 41%. Males displayed higher APC in death (48% vs. 44%) and DALYs (42% vs. 38%) compared to females over the last three decades. In terms of ASR, males observed a higher decrease compared to females. In 2019, the age group 80-84 years had the highest number of deaths at 534,079 (264,177-813,898), while DALYs were most pronounced in the 55-59 year age group, reaching 10.6 million (8.9-12.3 million). Conclusion: IHD remains a significant global health challenge, with high LDL-C levels being a crucial modifiable risk factor. Age-sex disparities in the burden of IHD are evident, driven by variations in LDL-C metabolism, hormonal changes, and lifestyle factors. Recognizing and addressing these disparities is essential for developing effective prevention and treatment strategies tailored to different populations and age groups. Presentation: 6/2/2024

7279 Survodutide and Semaglutide Both Induce Weight Loss but Show Different Effects on Food Preference and Dyslipidemia in the Free Choice Diet-induced Obese Hamster Model

Abstract Disclosure: F. Briand: Employee; Self; Physiogenix. R. Augustin: Employee; Self; Boehringer Ingelheim. K. Bleymehl: Employee; Self; Boehringer Ingelheim. T. Zimmermann: Employee; Self; Boehringer Ingelheim. T. Klöckener: Employee; Self; Boehringer Ingelheim. T. Klein: Employee; Self; Boehringer Ingelheim. Introduction: Semaglutide, a GLP-1 receptor agonist, and survodutide, a GCGR/GLP-1R dual agonist, have demonstrated significant weight loss in patients with obesity. To test whether this weight loss is associated with changes in food preference and improvement in dyslipidemia, we evaluated semaglutide and survodutide in the free choice diet-induced obese and dyslipidemic hamster, a model with a human-like lipoprotein metabolism. Methods: Obesity and dyslipidemia were induced with a 20-week free choice diet, which presents hamsters with a choice between control chow diet or high fat/cholesterol diet, and normal water or 10% fructose water. Obese hamsters were then kept on this free choice diet and treated subcutaneously once daily with vehicle, semaglutide 15 nmol/kg or survodutide 15 nmol/kg for 5 weeks. Results: Compared with vehicle, semaglutide and survodutide led to a 17% and 11% body weight reduction, respectively (both p&amp;lt;0.001 vs vehicle). Compared to vehicle, both chow diet and high fat diet intakes were significantly lower during the first week of semaglutide treatment, but then returned to baseline values. However, semaglutide significantly increased normal water intake and reduced fructose-enriched water intake during the whole treatment period (both p&amp;lt;0.001). Survodutide had a different effect, as it did not alter chow diet and normal water intakes, but significantly reduced high fat diet and fructose-enriched water intakes during the 5-week treatment period. Semaglutide and survodutide significantly reduced plasma insulin levels and the HOMA-IR index of insulin resistance (both p&amp;lt;0.01 vs. vehicle). Both semaglutide and survodutide significantly reduced plasma total cholesterol levels by 24% and 41%, respectively (both p&amp;lt;0.001). This hypocholesterolemic effect led to lower HDL-cholesterol levels (-25%, p&amp;lt;0.001) but unchanged LDL-cholesterol levels for hamsters treated with semaglutide. In contrast, in hamsters treated with survodutide, cholesterol lowering was observed in all lipoprotein fractions, including LDL-cholesterol (-39%, p&amp;lt;0.001). Conclusion: Semaglutide and survodutide both induce weight loss and lower HOMA-IR, but have different effects on food preference and dyslipidemia in the obese hamster model; such effects may be attributed to the GCGR agonism of survodutide. These preclinical data highlight the potential metabolic benefits of the GCGR/GLP-1R dual agonist survodutide for the treatment of obesity and related metabolic comorbidities. Presentation: 6/3/2024

The joint effect of cumulative metabolic parameters on the risk of type 2 diabetes: a population-based cohort study

Background and aimsThis study aimed to examine the cumulative effects of body mass index (BMI), body roundness index (BRI), pulse pressure (PP), triglycerides (TG), high-density lipoprotein cholesterol (HDL) and fasting plasma glucose (FPG) on Type 2 diabetes (T2D) morbidity.MethodsA total of 78,456 participants aged older than 45 years were extracted from basic public health services in China. During the 2-year follow-up, 6,942 individuals had developed T2D. The binary logistic regression models and multinomial logistic regression models were conducted to investigate the effects of cumulative metabolic parameters on incident T2D, prediabetes regression and progression.ResultsWe found statistically deleterious impacts of exposure to high cumulative BMI, BRI, PP, TG and low cumulative HDL on T2D morbidity and prediabetes progression. Compared to the group with low cumulative of all five parameters, the adjusted ORs for new-onset T2D for participants presenting with 1–2, 3, and 4–5 elevated metabolic parameters were 1.41(1.31,1.52), 1.93(1.74,2.13) and 2.21(1.94,2.51), respectively. There was additive interaction between FPG level and cumulative metabolic parameters with T2D. Compared with participants with the lowest quartile of FPG and low cumulative of all 5 parameters, those with the highest quartile of FPG and high cumulative of 4–5 parameters had a 14.63 [95% CI (12.27, 17.42)] higher risk of incident T2D.ConclusionsParticipants with more numbers of high-cumulative metabolic parameters were associated with a higher risk of incident T2D and prediabetes progression. A high level of normal FPG could enhance these risks.

A-217 Estimation of the Prevalence and the Patterns of Dyslipidemia in the Korean population

Abstract Background Dyslipidemia is one of the four major risk factors for the development of cardiovascular disease, along with hypertension, smoking, and diabetic mellitus. This countrywide study aimed to determine the prevalence and patterns of dyslipidemia and to describe their characteristics using data from the Korean population visiting local clinics. Methods We retrospectively reviewed the lipid profiles (total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), and triglycerides (TG)) and fasting plasma glucose (FPG) test results from Korean patients visiting local clinics during December 2023. Dyslipidemia was defined as having one or more of TC ≥200 mg/dl, LDLC ≥100 mg/dl, HDLC &amp;lt;40 mg/dl for males and &amp;lt;50 mg/dl for females, or TG ≥150 mg/dl (National Cholesterol Education Program, Adult Training Program III, 2002). Glucose levels are considered hyperglycemic if blood glucose ≥126 mg/dl. The subjects comprised 1,232 patients who visited 57 local clinics nationwide were included. Lipid profile tests (except LDLC) and FPG were performed on Hitachi008AS automatic biochemistry analyzer and the LDLC test was calculated by the Friedewald equation. Data for TG ≥400 mg/dL were excluded. Results The study subject population comprised 610 males and 622 females aged 2 to 91 years. The overall prevalence of dyslipidemia was 53.3% (657/1,232), with 49.3% (301/657) males and 57.2 (356/657) females (p&amp;lt;0.001). TC, LDLC, and TG were high in 14.5% (95/657), 33.9% (184/657), and 23.6% (223/657) of patients, respectively; HDLC was low in 28.0% (155/657). The prevalence of dyslipidemia by age group was as follows: 2 to 19 years (36.4%, 4/11); 20 to 29 years (66.7%, 12/18); 30 to 39 years (52.5%, 52/99); 40 to 49 years (61.5%, 131/213); 50 to 59 years (57.0%, 167/293); 60 to 69 years (50.1%, 168/335); 70 to 79 years (48.4%, 91/188); 80 years or older, (42.7%, 32/75). There was a difference in the prevalence of dyslipidemia between the age group under 50 and the age group over 50 (p&amp;lt;0.001). The prevalence of dyslipidemia among males and females was TC (72.6% vs 28.4%), HDLC (55.4% vs 44.6%), LDLC (53.8% vs 46.2%), TG (42.6% vs 57.4%), respectively (p&amp;lt;0.001). Thirteen of the 1,232 patients had dyslipidemia accompanied by hyperglycemia. Seven of them had mixed dyslipidemia (including raised TC, LDLC, and TG (n=4), raised TG &amp; Low HDLC (n=2), raised TC and LDLC (n=1)). Conclusions The prevalence of dyslipidemia in Korean patients visiting local clinics was 53.3% and differed by gender, age group, and lipid profile. Considering that the prevalence of dyslipidemia is higher in diabetic patients compared to patients without diabetes, additional studies targeting a large number of patients are needed to promote disease prevention and control.

A-224 Non HDL Cholesterol: could be e new cardiovascular disease risk stratification factor?

Abstract Background A worldwide study demonstrated that among all modifiable risk factors of Cardiovascular Disease (CVD) to the abnormal cholesterol levels is attributable the highest risk of events. LDL-C is considered the most important lipoprotein risk factor. Some recent epidemiologic studies have suggested that non-HDL cholesterol (N-HDL-C) may be superior to LDL-C for identifying CVD risk. N-HDL-C is easily calculated from a lipid profile and represents all apolipoprotein B containing lipoproteins. Recent guidelines recommend LDL-C as a primary indicator and non-HDL-C as secondary. Moreover, cholesterol ratios are useful to stratification; the TC/HDL-C is associated with morbidity and mortality in the general population; in addition, several studies have stated that high triglycerides (TG) levels and low HDL-C are associated with increased risk and could function as atherogenic index. Methods 11399 samples were analyzed on Atellica Solution for the determination of Total Cholesterol (TC), D-LDL-C, HDL-C and TG. In the absence of clinical parameters, based on the desirable levels recommended by the guidelines, CVD risk was evaluated by assigning a cut-off of 100 and 130 mg/dL for D-LDL-C and N-HDL-C respectively Results Patients cohort mean (±SD) for CT, D-LDL, HDL, TG and N-HDL-C are 180 mg/dL (±43.2), 113 mg/dL (± 38.5), 51.7 mg/dL (±15.6), 116 mg/dL (±73.8), 128 mg/dL (±39.5) respectively. Of the examined patients, the 57.7% were outpatients, 21.8% of infectious diseases and 12.6% of the cardiovascular department. Data about D-LDL-C and N-HDL-C comparison, evaluated on discordant patients, are shown in table 1. Conclusions The data obtained from evaluation would seem to confirm hypothesis according to which non-HDL cholesterol would have a greater power in the identification of CVD risk because of cholesterol ratios are suggestive of increased risk for patients with an LDL-C&amp;lt;100 and N-LDL-C&amp;gt;130 mg/dL. Further studies assessing CVD risk, not only through laboratory data, are necessary to confirm this supposition.

A-223 Direct LDL or not Direct-LDL, that is the question

Abstract Background Management of Cardiovascular Disease (CVD) risk is dependent on Low Density Lipoprotein Cholesterol (LDL-C) levels; therefore LDL-C serves as the marker for the assessment of CVD risk and the focus of lipid lowering treatment. The gold standard reference method for measurement of LDL-C is beta-quantification. We compared calculated LDL-C with Friedewald (F-LDL-C), Martin-Hopkins (M-LDL-C) and Sampson (S-LDL-C) equations versus LDL-C directly measured (D-LDL-C). In CVD management also cholesterol ratios are evaluated. TC/HDL is associated with morbidity and mortality in the general population. Furthermore, several studies have stated that high triglycerides (TG) levels and low HDL-C (TG/HDL ratio) could function as an atherogenic index. Methods 11399 samples were analyzed on Siemens Atellica Solution® for the lipid profile determination measuring Total Cholesterol (TC), D-LDL-C, HDL-C and TG. In the absence of additional clinical parameters, based on desirable levels for LDL-C recommended by guidelines, CVD risk was evaluated by assigning to LDL-C a cut-off of 100 mg/dL. In presence of misclassifications, we used two other parameters to assess LDL-C results: TG/HDL-C ratio and CT/HDL-C. Results Patients cohort had a mean age of 57.7 (±16.8) years of which 53% (age=58.6, ±15.9) were males and 47% (age=56.5, ±17.8 years) were females. Of these, the 57.7% were outpatients and 42.3% inpatients (42.1% of infectious diseases - 24.4% of the cardiovascular department). Data about LDL-C misclassification and ratio data parameters are shown in table 1. Discordant patients for D-LDL-C vs F-LDL-C are 8.5%, that of D-LDL-C vs M-LDL-C are 7.7% and D-LDL-C vs S-LDL-C are 7.2%. Conclusions Is known that LDL plays a central role in the pathogenesis of atherosclerosis. Accurate estimation of LDL-C is a fundamental point for the stratification of CVD risk and the achievement of the therapeutic goal; however, we are still uncertain about the best and accurate way to measure it.

Longitudinal associations of dietary fiber and its source with 48-week weight loss maintenance, cardiometabolic risk factors and glycemic status under metformin or acarbose treatment: a secondary analysis of the March randomized trial

AimsTo examine longitudinal and dose-d ependent associations between dietary fiber intake and various clinical outcomes over 48 weeks of pharmacological treatment in T2DM patients.MethodsIn this secondary analysis, we used data from the MARCH trial, which was designed to compare the efficacy of acarbose or metformin monotherapy as the initial therapy in Chinese patients newly diagnosed with T2DM. Dietary data were obtained using a 24-h dietary recall method to evaluate the intakes of dietary fiber from different sources as well as the carbohydrate-to-fiber ratio.ResultsA total of 551 newly-diagnosed patients with T2DM complete dietary records (286 in the acarbose group and 265 in the metformin group) were included. Higher intake of total fiber and whole grain fiber was positively associated with better β‐cell function, insulin sensitivity and postprandial glycemic control under acarbose treatment. Higher intake of legume fiber was associated with better glycemic control under both acarbose and metformin treatment but with better weight loss only under metformin treatment. A high-carbohydrate–low-fiber diet was associated with worse glycemic control and lower HDL-C under acarbose treatment but with higher insulin sensitivity and better weight loss under metformin treatment.ConclusionsThe notable effects of various dietary fibers when combined with different oral glucose-lowering medications should be considered to maximize therapeutic benefit.

A-338 Assessing the Technical and Analytical Performance of Point of Care Testing Devices for Blood Lipids Measurements

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of death worldwide, causing over 17 million deaths each year. According to the World Health Organization (WHO), 85% of CVD deaths are due to heart disease and strokes, and over 75% occur in low- and middle-income countries (LMICs). Early detection and treatment are key to preventing consequences of CVD. Point-of-care testing (POCT) devices require minimal laboratory infrastructure and can be used to screen hard-to-reach populations for CVD risk. These devices are increasingly used in traditional care settings including hospitals and primary healthcare, and in non-traditional settings such as pharmacies. Although POCT devices offer fast and convenient testing, the analytical performance of these devices must produce accurate and reliable results, and have technical suitability for use. Several POCT devices for total cholesterol (TC) and other blood lipids are commercially available, however, the operational and analytical performance of these devices is not fully known. Methods Eight POCT devices for blood lipids were used in this study. For the technical assessment, a checklist was developed and applied, outlining the operational functionality and environmental conditions of the devices. Some relevant technical parameters in this checklist included requirements for temperature/humidity and power/voltage, storage conditions, and assay/test time. The analytical performance was assessed for parameters, such as accuracy and imprecision, using paired whole blood and serum donor samples for TC. In addition, these analytical parameters were assessed for serum High Density Lipoprotein-cholesterol (HDL-c) and Low Density Lipoprotein-cholesterol (LDL-c) samples on seven POCT devices. All samples were representative of a clinically relevant concentration range for TC, HDL-c, and LDL-c. Accuracy was compared to reference values obtained by the CDC reference measurement procedures. Results The mean bias for TC ranged among devices from -8.17% to 11.99% for whole blood and -7.89% to 7.02% for serum, respectively. The mean imprecision for TC in whole blood ranged from 1.94% to 11.63%, and in serum from 1.72% to 12.70%. The mean bias for serum HDL-c samples ranged from -7.33% to 17.36%, and for serum LDL-c samples from -20.92% to 5.04%. The mean imprecision for serum HDL-c samples ranged from 2.39% to 24.27% and for serum LDL-c samples ranged from 3.14% to 18.33%. For three of the eight devices, about 25% of the whole blood measurements and 50% of the serum measurements were reported outside of the measurement range and not included in the assessment. Comparing these non-reports with the reference values of these samples indicate that all of the reference values for whole blood and about 80% of the reference values for serum were actually within the measurement range of the device. Conclusions The technical assessment was helpful in building screening capacity in areas with limited laboratory infrastructure. The analytical assessment indicates notable differences in accuracy and precision for lipids measured in whole blood and serum, with serum measurements being more likely within performance requirements used by CDC's standardization programs. Additional studies to assess other devices and/or analytes, and future work to assist manufacturers improve the analytical performance of POCT devices are needed.

Cardiovascular risk factors and all-cause mortality in older age (15-year cohort study)

Cardiovascular diseases (CVD) occupy a leading position in the structure of all-cause mortality. Prospective and interventional studies have identified the major risk factors for CVD and shown their associations with the risk of cardiovascular outcomes and all-cause death. The impact on the individual risk of death may vary by age, sex, study design, and may be population-specific. We aimed to study the contribution of major CVD risk factors to the 15-year risk of all-cause death in the Russian (Siberian) population cohort aged 45–69 years.Material and methods. A random population sample (men and women 45–69 years old, n = 9360) was examined at baseline in 2003–2005 (Novosibirsk, Russian branch of the HAPIEE project) and re-examined twice in 2006–2008 and 2015–2018. Current analysis included individuals without baseline CVD (n = 8087), the average follow-up period – 15.6 (SD 0.69) years. The fatal events were registered based on death certificates from the Population Registration Bureau (ZAGS), and using the data received at serial examinations and postal interview. We analyzed the association between CVD risk factors and all-cause death using multivariate Cox regression.Results. In a cohort aged 45–69, in the adjusted model, 15-year risk of all-cause death was positively associated with age (HR = 1.08; 95 % CI 1.07–1.09), male sex (HR = 1.46; 95 % CI 1.24–1.71), hypertension (HT) (HR = 1.39; 95 % CI 1.25–1.55), smoking (HR = 2.37; 95 % CI 2.08–2.70), high WHR (HR = 1.19; 95 % CI 1.06–1.33), and type 2 diabetes (T2DM) (HR = 1.52; 95 % CI 1.34–1.73), and it was negatively associated with elevated total cholesterol (TC) or LDL-C in blood. In age- and sex-adjusted model, the risk was additionally associated with high triglycerides (HTG), obesity and elevated fasting plasma glucose (FPG). In men, the risk of death was independently associated with age, HT, smoking, low HDL-C, high WHR, and T2DM. In women, the risk of death was independently associated with age, HT, T2DM smoking, and, in age-standardized models, obesity, high WHR, and hyperglycemia.Conclusions. In a population cohort of 45 years and older, among CVD risk factors male sex, HT, smoking, central obesity, and T2DM independently contributed to the risk of all-cause death. Among lipid parameters, low HDL-C and high TG levels increased the risk of death in men. Associations between cardiovascular risk factors and the risk of all-cause death in older people have the patterns specific for older age; these features are important to take into account in a strategy to reduce mortality in the population.

Does Adopting Western Low-density Lipoprotein Cholesterol Targets Expose Indians to a Higher Risk of Cardiovascular Events? Expert Opinion From the Lipid Association of India.

Adverse cardiovascular (CV) events have declined in Western countries due at least in part to aggressive risk factor control, including dyslipidemia management. The American and European (Western) dyslipidemia treatment guidelines have contributed significantly to the reduction in atherosclerotic cardiovascular disease (ASCVD) incidence in the respective populations. However, their direct extrapolation to Indian patients does not seem appropriate for the reasons described below. In the US, mean low-density lipoprotein cholesterol (LDL-C) levels have markedly declined over the last 2 decades, correlating with a proportional reduction in CV events. Conversely, poor risk factor control and dyslipidemia management have led to increased CV and coronary artery disease (CAD) mortality rates in India. The population-attributable risk of dyslipidemia is about 50% for myocardial infarction, signifying its major role in CV events. In addition, the pattern of dyslipidemia in Indians differs considerably from that in Western populations, requiring unique strategies for lipid management in Indians and modified treatment targets. The Lipid Association of India (LAI) recognized the need for tailored LDL-C targets for Indians and recommended lower targets compared to Western guidelines. For individuals with established ASCVD or diabetes with additional risk factors, an LDL-C target of <50 mg/dL was recommended, with an optional target of ≤30 mg/dL for individuals at extremely high risk. There are several reasons that necessitate these lower targets. In Indian subjects, CAD develops 10 years earlier than in Western populations and is more malignant. Additionally, Indians experience higher CAD mortality despite having lower basal LDL-C levels, requiring greater LDL-C reduction to achieve a comparable CV event reduction. The Indian Council for Medical Research-India Diabetes study described a high prevalence of dyslipidemia among Indians, characterized by relatively lower LDL-C levels, higher triglyceride levels, and lower high-density lipoprotein cholesterol (HDL-C) levels compared to Western populations. About 30% of Indians have hypertriglyceridemia, aggravating ASCVD risk and complicating dyslipidemia management. The levels of atherogenic triglyceride-rich lipoproteins, including remnant lipoproteins, are increased in hypertriglyceridemia and are predictive of CV events. Hypertriglyceridemia is also associated with higher levels of small, dense LDL particles, which are more atherogenic, and higher levels of apolipoprotein B (Apo B), reflecting a higher burden of circulating atherogenic lipoprotein particles. A high prevalence of low HDL-C, which is often dysfunctional, and elevated lipoprotein(a) [Lp(a)] levels further contribute to the heightened atherogenicity and premature CAD in Indians. Considering the unique characteristics of atherogenic dyslipidemia in Indians, lower LDL-C, non-HDL-C, and Apo B goals compared to Western guidelines are required for effective control of ASCVD risk in Indians. South Asian ancestry is identified as a risk enhancer in the American lipid management guidelines, highlighting the elevated ASCVD risk of Indian and other South Asian individuals, suggesting a need for more aggressive LDL-C lowering in such individuals. Hence, the LDL-C goals recommended by the Western guidelines may be excessively high for Indians and could result in significant residual ASCVD risk attributable to inadequate LDL-C lowering. Further, the results of Mendelian randomization studies have shown that lowering LDL-C by 5-10 mg/dL reduces CV risk by 8-18%. The lower LDL-C targets proposed by LAI can yield these incremental benefits. In conclusion, Western LDL-C targets may not be suitable for Indian subjects, given the earlier presentation of ASCVD at lower LDL-C levels. They may result in greater CV events that could otherwise be prevented with lower LDL-C targets. The atherogenic dyslipidemia in Indian individuals necessitates more aggressive LDL-C and non-HDL-C lowering, as recommended by the LAI, in order to stem the epidemic of ASCVD in India.

Clinical characterization and detection of subclinical atherosclerosis in subjects with extreme hyperalphalipoproteinemia

Introduction and objectivesThe association between HDL cholesterol (HDL-C) levels and death from cardiovascular disease follows a U-shaped pattern, increasing at the extremes. The objective of the study was to characterise a sample of subjects with extreme hyperalphalipoproteinemia (HAE). Material and methods53 cases with HAE were recruited, 24 women (HDL-C > 135 mg/dl) and 29 men (HDL-C > 116 mg/dl). A detailed medical history was taken and questionnaires on adherence to the Mediterranean diet and physical activity were collected. Carotid ultrasounds were performed to detect the presence of suclinical atherosclerosis. ResultsThe most prevalent cardiovascular risk factor (CVRF) was dyslipidemia (64%) with no significant differences between men and women, unlike hypertension (21% in women, versus 55% in men, p = 0.01) and others CVRF, for example, diabetes. 7% of the series had previous cardiovascular disease, women had higher LDL cholesterol (p = 0.002) and HDL-C than men (without significant differences). Plaque was detected in 53% of cases, being more prevalent in men. Patients with plaque were older, drank more alcohol and smoked more (p < 0.05). ConclusionsMen had a higher prevalence of CVRF than women, except for dyslipidemia. Subclinical atherosclerosis occurred in more than half of the series. Age, alcohol consumption and smoking were independently associated with the presence of plaque, however, our data do not show a significant influence of HDL-C levels.

FLI and FIB-4 in diagnosing metabolic dysfunction-associated steatotic liver disease in primary care: High prevalence and risk of significant disease

Introduction and ObjectivesPublic health policies in metabolic dysfunction-associated steatotic liver disease (MASLD) are still lacking. This study aims to estimate the prevalence and severity of MASLD in primary health care (PHC) through non-invasive markers. Patients and MethodsTwo-phase study, including a retrospective (RETR) and a prospective (PROS) one, was carried out in PHC in Brazil. In RETR, metabolic and hepatic profiles of 12,054 patients, including FIB-4, were evaluated. In PROS, 350 patients were randomly selected and submitted to a clinical and nutritional assessment. ResultsRETR (65.4 % women, mean age 55.3 years old): dyslipidemia, hypertension, and type 2 diabetes mellitus (T2DM) present in 40.8 %, 34.3 %, and 12.2 % of the electronic health records, respectively. Fasting glucose >100 mg/dL in 34.5 %, and glycated hemoglobin higher than 5.7 % in 51.5 %, total cholesterol >200 mg/dL and triglycerides >150 mg/dL in 40.8 % and 32.1 %, respectively. Median FIB-4 was of 1.33, 5 % >2.67. No one had MASLD as a diagnostic hypothesis; PROS(71.8 % women, mean age 58 years old): body mass index (BMI) ≥30 kg/m² in 31.8 %. MASLD prevalence (FLI≥ 30 + cardiometabolic features) of 62.1 %; 39.4 % of patients had FLI ≥60, with higher BMI, waist circumference, fasting glucose, triglycerides, AST, ALT and GGT, as well as lower HDL-cholesterol (p < 0.001). FIB-4>1.3 in 40 % and NAFLD Fibrosis Score (NFS)>-1.45 in 59.2 % of steatotic patients. ConclusionsThere is a high prevalence of MASLD in PHC, with a significant risk of liver fibrosis. These findings reinforce we need to develop public policies to defeat MASLD epidemics.

Thyroid Dysfunction In Metabolic Syndrome In Patients: An Observational Study

Objective: To assess the clinico-demographic profile thyroid dysfunction (TD in patients with metabolic syndrome (MetS). Methods: Research was done at the Medical Department. We included 200 MetS patients in this investigation. Demographics, anthropometric measurements, significant medical (including FPG, serum TG, and HDL-C values from patients' medical records) and surgical history, family history, lifestyle parameters, history of obesogenic medicine use, vital signs, and physical examination details were collected in case report forms at the screening visit. Results: We included 200 MetS patients in this investigation. The baseline demographics of these patients are presented. Of the recruited patients, 60 (30%) had TD, with women being more likely than males. Overt hypothyroidism was detected in 36 of 200 MetS patients and hyperthyroidism in 4. High waist circumference, lowered HDL-C, elevated HOMA-IR, systolic and diastolic blood pressure, fasting hyperglycemia, and TG were seen in TD patients in this research. More women than men had waist circumferences exceeding 80 cm. Conclusion: Metabolic syndrome complications include thyroid problems. High frequency of TD in MetS patients suggests a thyroid-MetS interaction. This investigation will help link TD and MetS in Indian patients. Early identification of TD in MetS may help change disease course with lifestyle modifications.

Clinical Profiles and Risk Factors of Acute Myocardial Infarction in Young Adults: A Cross-Sectional Study in Myanmar.

Introduction Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, with an increasing prevalence of acute myocardial infarction (AMI) among younger populations. Despite this rising trend, there are limited data from Myanmar on the clinical profile and associated risk factors for premature CAD in young adults. This study aims to investigate the clinical characteristics and predisposing risk factors for AMI in individuals aged 40 years and below, contributing to a better understanding of disease patterns in this population. Methods A cross-sectional descriptive study was conducted at the coronary care unit of Yangon General Hospital over a 12-month period from January 1, 2019, to December 31, 2019. A total of 59 young adults, diagnosed with AMI based on the Fourth Universal Definition of Myocardial Infarction, were included. Clinical data, laboratory investigations, and demographic characteristics were collected and analyzed. Results Among the 59 participants, 46 (78%) were male, and smoking was prevalent in 45 (76.3%) cases. Dyslipidemia was common, with 46 (77.9%) exhibiting low high-density lipoprotein (HDL) cholesterol levels and 27 (45.8%) having elevated total cholesterol. Hypertension was observed in 31 (52.5%) patients, and 32 (54.2%) reported a family history of premature atherosclerotic cardiovascular disease. Furthermore, 28 (47.5%) of the cohort were classified as overweight, and 26 (44.1%) demonstrated low levels of physical activity. Chest pain was universally reported by all 59 (100%) patients as the presenting symptom. ST-segment elevation myocardial infarction (STEMI) was the predominant type, affecting 47 (79.6%) patients, with anterior wall involvement in 36 (61%) cases. Conclusion The findings of this study reveal that AMI in young adults is more prevalent among males, with smoking and dyslipidemia being the most significant risk factors. The high prevalence of low physical activity, hypertension, and overweight status further underscores the need for early lifestyle interventions. These results can be directly applied to clinical practice and public health policy in Myanmar by prioritizing smoking cessation programs, improving dyslipidemia management, and promoting physical activity in young populations. Additionally, this study provides a foundation for further research to explore more specific risk factors and paves the way for broader studies focusing on young AMI cases in Myanmar.

Associations of metabolic syndrome and its components with sarcopenia, and the mediating role of insulin resistance: Findings from NHANES database

BackgroundTo investigate the association between metabolic syndrome (MetS) and its components with sarcopenia, and to explore the extent to which insulin resistance (IR) mediates this association, using data from the National Health and Nutrition Examination Survey (NHANES).MethodsWe analyzed cross-sectional data from 15,779 adults in the NHANES from 1999 to 2006 and 2011–2018. Multivariable logistic regression models were used to determine the odds ratios (ORs) between MetS, its components, the number of MetS components, and sarcopenia. Mediation analysis was performed to explore the role of the homeostatic model assessment of insulin resistance (HOMA-IR) in MetS and its components-induced sarcopenia.ResultIn the fully adjusted model, MetS increased the prevalence of sarcopenia by 1.96-fold (95% CI: 1.73–2.22). Among the individual components, central obesity, hypertension, and hyperglycemia were associated with an increased prevalence of sarcopenia. Sarcopenia prevalence also increased linearly with the number of MetS components, with the highest prevalence observed in the presence of all five components (OR: 3.80, 95% CI: 2.79–5.16). Sex-stratified analysis showed that the prevalence of MetS for sarcopenia was higher in males than females. The mediating effects of HOMA-IR on the association between MetS and its components (central obesity, hypertension, and hyperglycemia) with sarcopenia were significant, with mediation effects of 51.7%, 30.7%, 33.2%, and 79.1%, respectively. There was no significant direct association between hyperglycemia and sarcopenia beyond the HOMA-IR pathway.ConclusionMetS and its individual components, excluding hypertriglyceridemia and low high density lipoprotein cholesterol, were associated with a higher prevalence of sarcopenia, especially in males. This association was partially or fully mediated by IR.