Higher Mean Total Cholesterol Research Articles

The effects of ART on the dynamics of lipid profiles in Chinese Han HIV-infected patients: comparison between NRTI/NNRTI and NRTI/INSTI.

This article aimed to compare the prevalence of dyslipidemia and determine risk factors associated with lipid levels in a cohort of HIV-infected patients receiving two different antiretroviral therapy (ART) regimens, nucleoside reverse transcriptase inhibitor/non-nucleoside reverse transcriptase inhibitor (NRTI/NNRTI) and nucleoside reverse transcriptase inhibitor/integrase strand transfer inhibitor (NRTI/INSTI). This longitudinal study analyzed 633 HIV-infected patients with complete blood lipid profile records for at least 1 year at the ART clinic of Zhongnan Hospital of Wuhan University, China, from June 2018 to March 2021. Demographic and clinical data, including age, gender, body weight, height, current/former/non-smoker, current drinker, diabetes mellitus, hypertension, were extracted from electronic medical records. Laboratory tests included hematology, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), Lipoprotein(a) and CD4 cell count. The observation duration of this study was a maximum of 33 months. Data comparisons were performed using the Chi-square test, Student's t-test and Mann-Whitney U test. Generalized linear mixed-effects model (GLMM) and value of p < 0.05 were used to determine factors associated with serum lipid profiles. In this study, the effect of the NNRTIs group on the lipid profile over time was mainly an increase in TC and HDL-C, while a decrease in TC/HDL-C and LDL/HDL-C. However, the INSTIs group had higher mean TC and lower HDL-C compared to the NNRTIs group, with significantly increased levels of TC, TG, HDL-C, and LDL-C. In the analysis of dyslipidemia rates, there were significant differences in the prevalence of abnormal TG and TC/HDL-C in HIV-infected patients receiving two different ART regimen groups during different follow-up periods. Dyslipidemia, defined as hypercholesterolemia, hypertriglyceridemia, and low HDL-C, was more prevalent in the INSTIs group, with a higher risk of developing hypertriglyceridemia and a higher TC/HDL-C ratio compared to the NNRTIs group. GLMM analysis suggested significantly higher TG values in the INSTIs group (estimated 0.36[0.10, 0.63], SE 0.14, p = 0.008) compared to the NNRTIs group, even after adjusting for other covariates. In addition, GLMM analysis also showed that age, gender, BMI, CD4 count, and ART duration were associated with dyslipidemia. In conclusion, treatment with both commonly-used ART regimens can increase the mean values of lipid profiles and the risk of dyslipidemia. The findings indicated that TG values were significantly higher in the INSTIs group than in HIV-infected patients receiving the NNRTIs regimens. Longitudinal TG values are independently associated with the clinical types of ART regimens.Clinical Trial Number: ChiCTR2200059861.

S-29-6: ELECTROCARDIOGRAPHIC ABNORMALITIES AMONG NEWLY PRESENTING HYPERTENSIVE PATIENTS: REPORT FROM CARDIOVASCULAR RISK PREDICTION REGISTRY

Background: Cardiovascular diseases (CVDs) have become a significant public health concern globally. Standard electrocardiography (ECG) remains an essential diagnostic procedure for cardiovascular risk stratification in hypertension. The co-existence of electrocardiographic abnormalities with hypertension is associated with an increased risk of cardiovascular morbidity and mortality. Data showing electrocardiographic abnormalities among newly diagnosed hypertensives in this environment is limited. Objective: To provide the spectrum of ECG abnormalities among newly presenting hypertensive patients seen at the University College Hospital, Ibadan. Design and method: This observational study was conducted using data from the Cardiovascular Risk Prediction (CRP) registry domiciled at University College Hospital (UCH). Data collection spanned from 2019 to 2022. New patients presenting with hypertension at the cardiology clinic were received and assessed, and cardiovascular risk factors were stratified to identify cardiovascular morbidity and mortality indicators. All participants underwent standard 12 lead ECG. Fasting venous blood was collected to assess serum electrolytes, urea, creatinine, and lipid panels. Statistical Analysis was performed using Statistical Package for Social Sciences (SPSS) version 21. Results: Six hundred and twelve participants comprising 49.7% of women with a mean age of 53.66 ± 15.5 years with complete ECG interpretations were analyzed. A third of the participants had Left ventricular hypertrophy (LVH), with one in ten having strain patterns. About 19%, 10.6%, and 1.8% of participants presented with conduction abnormalities, left atrial enlargement (LAE), and atrial fibrillation, respectively. Mean age, blood pressure parameters, and QT/QTc intervals were comparable in both sexes. Compared to women, men had higher mean urea (29.81 ± 14.1 vs 26.45 ± 11.3 mg/dl;p &lt; 0.002) and creatinine (1.21 ± 0.6 vs 0.94 ± 0.4 mg/dl; p &lt; 0.0001)) and greater proportion of conduction abnormalities (22.1% vs 15.9%;p = 0.05), LVH(36.9% vs 27.6%;p = 0.014), LVH plus strain pattern(13.4% vs 7.0%;p = 0.009), and LAE (13.5% vs 0.7%;p = 0.019). Women were heavier with higher mean total cholesterol (191.75 ± 44.5 vs. 179.92 ± 47.9 mg/dl; p &lt; 0.004) and LDL cholesterol (121.83 ± 37.6 vs. 114.35 mg/dl; p = 0.21). Participants with LVH had higher mean Systolic (146.87 ± 24.7 vs142.19 ± 23.1 mmHg; p = 0.023) and diastolic blood pressure (91.15 ± 16.5 vs 85.97 ± 13.4mmHg; &lt; 0.0001),creatinine (1.15 ± 0.7 vs 1.04 ± 0.41 mg/dl; p = 0.017) and QTc interval (483 ± 83.5 vs 463.81 ± 55.6; ms p &lt; 0.007) and coexisted with LAE compared with those without LVH. Conclusion: Left ventricular hypertrophy was the predominant abnormality in the studied population. Abnormal ECG findings were more common in men, and those with LVH had more cardiovascular risk than women. Early identification and management of these risks are essential in preventing cardiovascular morbidity and mortality.

Age, maturation and serum lipid parameters: findings from the German Health Survey for Children and Adolescents

BackgroundRecommendations on preventive lipid screening among children and adolescents remain controversial. The aim of the study was to assess age and puberty-related changes in serum lipids, including total cholesterol (TC), and high-density (HDL-C) and non-high-density lipoprotein cholesterol (Non-HDL-C).MethodsUsing cross-sectional data from the National Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS 2003–2006; N = 13,676; 1–17 years), changes in distributions of serum lipids were visualized according to sex, age and maturation. Youth aged 10–17 years were classified as prepubescent, early/mid-puberty, and mature/advanced puberty. Multiple linear regressions were used to quantify the impact of pubertal stage on serum lipid levels, adjusted for potential confounding factors.ResultsAmong children 1–9 years mean serum lipid measures increased with age, with higher mean TC and Non-HDL-C among girls than boys. Among children 10–17 years, advanced pubertal stage was independently related to lower lipid measures. Adjusted mean TC, HDL-C and Non-HDL-C was 19.4, 5.9 and 13.6 mg/dL lower among mature/advanced puberty compared to prepubescent boys and 11.0, 4.0 and 7.0 mg/dL lower in mature/advanced puberty compared to prepubescent girls.ConclusionsLipid concentrations undergo considerable and sex-specific changes during physical growth and sexual maturation and significantly differ between pubertal stages. Screening recommendations need to consider the fluctuations of serum lipids during growth and sexual maturation.

1637-P: Role of Initial Combination Therapy on Goal Attainment among Patients with Type 2 Diabetes with High HbA1c

A significant proportion of patients with type 2 diabetes (T2DM) have suboptimal glycemic control which is associated with an increased risk of long-term complications. Clinical guidelines have recommended the use of initial combination therapy, rather than metformin monotherapy, in patients with high HbA1c (≥9%) at diagnosis. However, the adherence to these guideline recommendations and the impact of use of early combination therapy on glycemic goal attainment in the real world is not well known. We conducted a retrospective study using the U.S. Optum Research Database (2010-2015). The study population included T2DM patients aged ≥18 years with a baseline HbA1c of ≥9%. Index date was defined as the first prescription for an antidiabetic agent. Combination therapy was defined as receiving 2 or more antidiabetic classes within 1 month of the index date. During the 2-year follow-up period following the index date, we also compared time to goal attainment (HbA1c of &amp;lt;7%) among patients receiving initial monotherapy vs. initial combination therapy. A total of 13,791 T2DM patients met the inclusion criteria; 34.8% females; mean age: 54 years. Overall 41.4% were initiated on a combination therapy and 58.6% initiated on monotherapy. Patients receiving either treatment were generally similar. Patients receiving combination therapy had a lower mean age (53.0 vs. 54.7), had a higher mean total cholesterol (213 vs. 208 mg/dL) and higher triglyceride (319 vs. 282 mg/dL). The median time to goal attainment was shorter among those on combination therapy vs. monotherapy (318 vs. 372 days). Our study suggests that less than half of newly diagnosed U.S. patients with high HbA1c receive initial combination therapy. Furthermore, those receiving initial combination therapy achieve glycemic goal earlier than patients receiving monotherapy. Disclosure R.M. Klok: Employee; Self; Merck &amp; Co., Inc. Stock/Shareholder; Self; Merck &amp; Co., Inc. T. Gulati: Consultant; Self; Merck &amp; Co., Inc. S. Rajpathak: None. S. Pal: Consultant; Self; Merck &amp; Co., Inc. L. Yang: Employee; Self; Bristol-Myers Squibb Company, Merck &amp; Co., Inc. A. Bandyopadhyay: Consultant; Self; Merck &amp; Co., Inc. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited. Funding Merck &amp; Co., Inc.

Comparative study of cord blood lipid profile in relation to gestational age, birth weight, and sex

Objectives: The objective of the study was to compare the cord blood lipid levels in healthy newborns according to gestational age (GA), weight, and sex. Methods: This study included 1000 healthy term and preterm neonates after obtaining parental consent at birth. The GA was confirmed using New Ballard Score. Fenton’s growth charts were utilized to classify study subjects as appropriate for GA, small for GA, and large for GA at birth. Lipid profile was measured by enzymatic colorimetric method. Serum low-density lipoprotein-cholesterol (LDL-C) was calculated by Friedewald’s formula. Results: Preterm neonates with GA of 28–36 weeks had higher mean total cholesterol, LDL, very LDL, and triglycerides levels than term neonates in contrast to their mean high-density lipoprotein (HDL) levels which was significantly lower as compared to that of term neonates. A statistically significant decline in all lipid fractions was observed with an increase in birth weight from &lt;1.5 kg to ?2.5 kg. Females had higher lipid fractions in comparison to male neonates; however, only the difference in HDL levels was statistically significant (p&lt;0.001). Conclusion: Low birth weight neonates exhibit higher lipid levels at birth giving scope for future research and regular follow-up of these high-risk neonates.

Metabolic control, ApoE genotypes, and dyslipidemia in children, adolescents and young adults with type 1 diabetes

Limited data is available on the factors influencing the lipid profiles and the prevalence of dyslipidemia in children, adolescents and young adults with type 1 diabetes. We aimed at assessing the influences of metabolic control and ApoE genotypes on lipid profiles and the prevalence of dyslipidemia in children, adolescents and young adults with type 1 diabetes. Children, adolescents and young adults with type 1 diabetes from our nationwide cohort attending the annual check-up were prospectively included. Data on metabolic control and expanded lipid profiles were collected, and ApoE genotyping performed. Test for homoscedasticity of continuous variables was followed by ANOVA and Welch's ANOVA tests, and Chi-square test was used for categorical variables with Kruskal-Wallis test as a control. 467 patients were included in the data analysis: 226 female (48.4%), mean age 14.71 ± 5.09 years and diabetes duration 6.74 ± 4.54 years. Mean HbA1c was 61 ± 5 mmoL/mol (7.71 ± 1.22%), with no gender-related differences. Females had higher mean total cholesterol (p < 0.001), LDL-C (p = 0.005), HDL-C (p < 0.001), non-HDL-C (p = 0.003), and ApoB levels (p < 0.001). 26.3% of participants had LDL-C levels above the type 1 diabetes LDL-C-goal of 2.6 mmoL/L, and 19.5% had elevated/borderline-elevated lipoprotein(a) (Lp(a)). HbA1c levels were positively related to higher levels of LDL-C (p = 0.0070) and Lp(a) (p = 0.0020). Participants with ApoE4(e3/e4) allele had higher levels of LDL-C (p = 0.010), independently of HbA1c. Females and subjects with suboptimal metabolic control had more adverse lipid profiles. ApoE4(e3/e4) alleles were associated with significantly higher LDL-C levels, independently of HbA1c.

Prevalence, patterns, and associations of dyslipidemia among Sri Lankan adults—Sri Lanka Diabetes and Cardiovascular Study in 2005–2006

Dyslipidemia is a major risk factor for cardiovascular disease. Prevalence patterns and determinants of dyslipidemia in Sri Lanka are unkown. We aimed to determine the prevalence and correlates of dyslipidemia among Sri Lankan adults. A nationally representative sample was recruited by multistage random cluster sampling in Sri Lanka Diabetes and Cardiovascular Study, a cross-sectional study. Data collected by an interviewer-administered questionnaire, physical examination, anthropometric measurements lipid analysis from take 12-hour fasting blood samples were used. Among 4451 participants 60.5% were women and mean age was 46years. Mean (standard deviation) total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), triglycerides (TGs), and TC/HDLC levels were 206.7mg/dL (±43.5), 46.8mg/dL (±10.6), 135.5mg/dL (±37.6), 121.7mg/dL (±66.8), and 4.6 (±1.1), respectively. Women had higher mean TC, HDLC, LDLC, and TG values compared to men across all age groups. Mean TC, LDLC, and TGs increased with age in both genders; 77.4% of participants had some form of dyslipidemia. Low HDLC was the commonest type (49.6%) of dyslipidemia. Increasing age, female sex, living in urban sector, high body mass index, central obesity, diabetes, hypertension, insufficient physical activity, and smoking were associated with having some form of dyslipidemia. Three in four Sri Lankan adults have some form of dyslipidemia. Physical inactivity, obesity, hypertension, and diabetes are the leading modifiable risk factors.

PP.06.32] VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND ITS CORRELATION WITH DECLINE IN KIDNEY FUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objective: Blood pressure variability (BPV) is associated with poorer outcomes in patients with diabetes. Research on the characteristics of visit-to-visit BPV and its prognostic implications is limited. This study aimed to determine the value of BPV, associated factors of systolic BPV and its correlation with decline in kidney function in patients with type 2 diabetes mellitus (T2DM). Design and method: This was a 10-year retrospective cohort study of 333 patients with T2DM at a primary care clinic. Blood pressure (BP) at every follow up visit from 2005 to 2014 were captured. BPV was defined as the standard deviation of the BP readings. Decline in kidney function was expressed as the annual rate of decline in estimated glomerular filtration rate (eGFR). Factors associated with visit-to-visit systolic BPV was determined using Pearson's correlation coefficient and independent t-test. Independent association of decline in annual eGFR rate was determined using multivariate linear regression analysis. Results: This study involved 112 male patients (33.6%) and 221 female patients (66.4%). The mean age of patients at baseline was 57.8 ± 9.5 years old. By the end of study period, the mean duration of years of diabetes was 15.9 ± 6.2 years and 298 (89.5%) of patients had co-morbid hypertension. The mean visit-to-visit systolic BPV was 12.7 ± 3.1 mmHg. Higher systolic BPV was found in patients who were older, females, with co-morbid hypertension, more frequent clinic visits, higher mean systolic BP, higher mean total cholesterol and users of antihypertensive medications. The mean annual decline in eGFR rate in this study was −0.78 ± 1.60 ml/min/1.73m2. Independent factors associated with decline in kidney function were systolic BPV, longer duration of diabetes and use of diuretics. Conclusions: The visit-to-visit standard deviation of BPV in patients with T2DM is 12.7 mmHg. Systolic BPV is an independent risk factor associated with decline in kidney function. Hence visit-to-visit BPV is an important additional target to reduce decline in kidney function in patients with T2DM.

Effects of Periodontal Disease and Periodontal Treatment on the Lipid Profile: A Sri Lankan Study

ABSTRACT Aims To compare the blood lipid levels of periodontitis group (of different severities) with a nonperiodontitis group and to evaluate any influence of periodontal treatment in altering blood lipid levels. Materials and methods The study sample consisted of 83 patients with periodontitis in the “test” group and a matched “control” group of 40, free of periodontitis according to predetermined selection criteria. All subjects underwent periodontal assessments and blood lipid estimation prior to treatment planning, following which they received active periodontal treatment/oral prophylaxis. Twelve weeks after treatment, periodontal reevaluations were carried out and blood lipids were reassessed for preand posttreatment comparisons. Results Increases in lipid levels were observed in the periodontitis group compared to the nonperiodontitis group at baseline. The test group had 5% higher mean total cholesterol than the control group at pretreatment/preintervention (albeit not significant: Student's t), while low-density lipoprotein cholesterol (LDL-Ch) was 6.6% higher in the test group than the control group (95% confidence interval). Mean triglycerides (Tri-G) were 5.7% higher in the control group than the test group, yet without statistical significance. All types of lipids in both the groups had decreased following periodontal therapy, while Tri-G levels demonstrated an opposite effect. Conclusion Patients with generalized severe periodontitis had higher LDL-Ch values than those with generalized mildmoderate periodontitis. Periodontal care was effective in lowering unfavorable serum lipids. Prompt control of periodontal inflammation would minimize development of deep periodontal infection and cardiovascular risk. How to cite this article Tilakaratne A, Perera WKL, Amaratunga EAAP, Sivakanesan R. Effects of Periodontal Disease and Periodontal Treatment on the Lipid Profile: A Sri Lankan Study. Int J Experiment Dent Sci 2016;5(2):127-132. Source of support University of Peradeniya Sri Lanka (Research Grant Number RG/2009/40/D).

Consumption of takeaway meals and risk markers for coronary heart disease, type 2 diabetes, and obesity in children aged 9–10 years: a cross-sectional study

Abstract Background Frequent consumption of takeaway meals is associated with increased risks of coronary heart disease, type 2 diabetes, and obesity in adults, but little is known about such risks in childhood. This study aimed to assess whether consumption of takeaway meals is linked to chronic disease in childhood. Methods A cross-sectional study of UK schoolchildren aged 9–10 years (Year 5) was carried out in a sample of 85 primary schools in London, Birmingham, and Leicester, with a high prevalence of ethnic minority pupils (black African-Caribbean or South Asian). All children in Year 5 classes were invited to participate. Children self-reported their frequency of consumption of takeaway meals, completed a 24 h dietary recall, had anthropometric measurements taken, and provided a fasting blood sample. Analyses were done with multilevel linear modelling allowing for clustering at school level. Ethics approval was obtained and written informed consent secured for all participants. Findings Among 3679 invited children, 2529 participated (69% response rate), of whom 1948 (77%) had complete data (1023 girls, 52%). They included similar numbers of children of white European (n=475), black African-Caribbean (496), South Asian (495), and other ethnic origins (482); 499 (26%) never or hardly ever consumed a takeaway meal, 894 (46%) did so less than once per week, and 555 (28%) once or more per week. In analyses adjusted for age, sex, month, school, ethnic group, and socioeconomic status, children who reported eating a takeaway meal once or more per week had higher mean total cholesterol and LDL cholesterol, by 0·09 mmoL/L (95% CI 0·01–0·18) and by 0·10 mmoL/L (0·02–0·18), respectively, than did children who never or hardly ever ate a takeaway meal; their mean fat mass index was also higher (by 5·06%, 95% CI 0·53–9·79). Mean total cholesterol, LDL cholesterol, and fat mass index in the never or hardly ever group were 4·44 mmoL/L, 2·58 mmoL/L, and 2·01 kg/m 5 , respectively. Children who reported more frequent consumption of takeaway meals had substantially higher intakes of energy, fat (percent of energy), and saturated fat (percent of energy), and lower starch, protein, and micronutrient intakes. Interpretation Frequent consumption of takeaway meals in childhood is common and is associated with higher intakes of saturated fat and higher concentrations of LDL cholesterol. This research adds to growing evidence of the adverse health effects of takeaway meals. Funding This research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (South London) and by grants from Diabetes UK and the Wellcome Trust.

Disparities in lipid control and statin drug use among diabetics with noncoronary atherosclerotic vascular disease vs those with coronary artery disease

Diabetes mellitus (DM), coronary artery disease (CAD), and noncoronary atherosclerotic vascular diseases (NCVDs) have similar risks of cardiovascular events and similar recommendations for lipid control. There are limited data regarding lipid control in diabetic patients with NCVD in current clinical practice. To assess current day practice of lipid control in patients with DM with NCVD vs those with CAD. We retrospectively identified 3336 patients with DM and known atherosclerotic vascular disease between January 2009 and March 2012. We compared demographic variables, lipid levels, and statin use in diabetics with CAD alone vs diabetics without CAD but with one or more NCVD. There were 234 patients in DM with NCVD group and 3102 patients in DM with CAD group. The DM with NCVD group had a higher mean total cholesterol (152±40 vs 146±42mg/dL; P=.019) and mean low-density lipoprotein (LDL; 86±35 vs 80±34mg/dL; P=.04) with only 70% of patients achieving LDL of <100mg/dL (compared with 80% in the DM with CAD group; P<.001). Statin use was 100% in CAD vs 75% in NCVD group (P<.001). In addition to limited use of more potent statins in the NCVD group, there was also a significantly lower dose of statins used overall. Our study demonstrates lower use and less aggressive application of statins among diabetics with NCVD compared with diabetics with CAD, resulting in higher mean LDL and total cholesterol in the NCVD group.

Abstract 290: Comparison of Lipid Control in Patients with Coronary versus Peripheral Arterial Disease

Objectives: Patients with Peripheral artery disease (PAD) have similar cardiovascular morbidity and mortality as those with established coronary artery disease (CAD). Thus the recommended LDL goal is &lt; 100 mg/dl for both CAD and PAD patients. This study assesses the degree of lipid control and statin drug use in CAD and PAD patients in current clinical practice. Methods: We did a retrospective chart review of patients with a diagnosis of PAD, CAD and both PAD and CAD seen at our institution between Jan 2009 to March 2012. Demographic data, lipid levels and statin use were compared between CAD, PAD and PAD &amp; CAD groups. To enable comparison of the doses of various statins, we used statin potency unit where 1 potency unit = 10mg of Simvastatin. Results: There were a total of 11498 subjects in the chart review (CAD-9879, PAD-623, both PAD &amp; CAD -996). PAD patients were younger with more females &amp; lower BMI compared to CAD and both PAD &amp; CAD groups (Table 1). Mean LDL level in the PAD group was 93.4±35.5 mg/dL, CAD group was 82.7±33.1 mg/dL and both PAD &amp; CAD group was 80.5±31.0 mg/dL. Although all groups had a mean LDL of &lt; 100mg/dL, significantly fewer number of PAD patients achieved target LDL &lt;100 mg/dl and LDL &lt;70 mg/dl, as compared to CAD and combined group (Table 1). The PAD group had significantly higher mean total cholesterol and mean LDL levels as compared to the CAD group and combined PAD &amp; CAD group (Table 1). The mean HDL and mean triglyceride (TG) levels in PAD group were significantly higher than the CAD and combined PAD &amp; CAD group. The PAD patients had significantly greater use of less potent statins than the CAD and PAD &amp; CAD groups which was not compensated for by a higher mean dose of the lower potency statins (Table 1). PAD patients were receiving significantly lower mean potency unit of statins as compared to PAD and combined CAD and PAD group (Table 1). Conclusion: Even though both PAD and CAD groups had mean LDL &lt; 100mg/dL, we found that lipid control assessed by absolute mean lipid levels were significantly better in patients with CAD and combined PAD &amp; CAD group. Thus, our study indicates that physicians tend to be more aggressive with lipid control in patients with a diagnosis of CAD when compared to patients with PAD alone.

Characterization of lipid profile in coronary heart disease patients in Sudan

Dear Editor, Although the burden of cardiovascular disease (CVD) states is stabilizing in high-income countries, in low-to-middle-income countries it continues to rise.1 Lifestyle, environmental and genetic factors play an important role in coronary heart disease (CHD) development.2 Previous studies have shown that blacks have one of the highest rates of coronary artery disease in the world.3 However, Caucasians generally have higher mean total cholesterol (TC) concentrations than do populations of Asian or African origin.4 Hospital based case control study was design to study lipid profile in coronary heart disease patients in Sudan. Among the total population studied (104 cases and 105 controls) 53.1% were male, 45% were from Northern Sudan and 72.7% were residing in urban areas. About 26.8% of the most infected age group was less than 40 years, 22% had strong family history of CHD, 42.6% had hypertension and 41.6% had diabetes mellitus. Smoking and alcohol consumption are very low among population represent 18.2% and 5.3%, respectively. Lipid profiles were analyzed using standard enzymatic methods on a MINDRAY BS-200 analyzer (MINDRAY, Shenzhen, China). General linear model and correlation between serum biochemical profiles were performed using SPSS15.0. The results showed that Sudanese patients had significantly lower TC and LDL-C levels and non-significantly lower triglycerides, HDL-C and VLDL levels compared with controls (Table 1). Age has a significant (p < 0.05) effect on LDL-C, while sex, race or ethnic, family history, residence, smoking, alcohol consumption has no significant (p < 0.05) effect on lipid profiles. Hypertension has no significant (p < 0.05) effect on lipid profiles, while diabetes mellitus has a significant (p < 0.05) effect on total cholesterol, and LDL-C (data not shown). Among patients TC was significantly (p < 0.05) and positively correlated with LDL and HDL, while VLDL was positively correlated with triglycerides. In contrast, triglycerides and VLDL were negatively correlated with LDL and HDL similarly VLDL was positively correlated with triglycerides (Table 2). In control group total cholesterol was significantly (p < 0.05) and positively correlated with triglycerides, LDL and VLDL. Triglyceride was negatively correlated with HDL and positively with VLDL and HDL was negatively correlated with LDL and VLDL (Table 2). Blacks had nominally higher adjusted HDL-C levels, and significantly lower triglyceride levels than whites.5 African ancestry was significantly associated with decreased total cholesterol, LDL-C and triglycerides.6 These observed associations between African ancestry and several lipid traits are consistent with the general tendency of individuals of African descent to have healthier lipid profiles compared to European–Americans.6 Our results confirm a high prevalence of conventional risk factors of coronary heart disease as well as the association between these factors with lipid profiles in Sudanese population. However, sample size used was very small of the general population, other studies using large sample size were needed to provide more accuracy and predictive value of coronary heart disease risk factors. Table 1 Baseline characteristics and risk factors for coronary heart disease in cases and controls subjects. Table 2 Correlation coefficient matrixes of cholesterol, triglycerides, and lipoprotein indices in case and control population.

Prevalence and pattern of dyslipidemia in a rural community in Southern Nigeria

Background: Cardiovascular disease is a leading cause of morbidity and mortality world -wide. Dyslipidemia is a major risk factor for cardiovascular diseases, which can be identified and managed appropriately. Objective: The objective of the following study was to determine the prevalence and pattern of dyslipidemia in a rural community in Southern Nigeria. Materials and Methods: A cross -sectional study among members of Udo community in Ovia south -west local government area of Edo State. Questionnaires were administered to willing participants. Data obtained were age, sex, body mass index (BMI), blood pressure (BP). Fasting blood samples were collected to determine blood sugar and serum lipid levels. Results: A total of 161 apparently healthy adults were involved in the study (60 men and 101 women) with a mean age of 48 ± 16.6 years. Hypertension was observed in 31 (19.3%), elevated fasting blood sugar in 7 (4.3%) and 30 (18.6%) were obese. The prevalence of elevated total cholesterol (TC), low density lipoprotein cholesterol (LDL -C), triglycerides (TGs) and low high density lipoprotein cholesterol (HDL -C) was 31.7%, 18.6%, 8.7% and 10.6% respectively. TC and LDL -C correlated positively with age, BMI and BP. Mean TC, LDL -C and TG levels was higher in obese participants compared with those with normal BMI. Hypertensive participants had higher mean TC and LDL -C than those with normal BP. Conclusion: Elevated TC was the most common form of dyslipidemia in this study while high TGs were the least. Low HDL -C was not common in this population of rural dwellers.

Metabolic abnormalities and body composition of HIV-infected children on Lopinavir or Nevirapine-based antiretroviral therapy

BackgroundFew studies have assessed metabolic and body composition alterations in perinatally HIV-infected African children on antiretroviral therapy (ART). We compared metabolic profiles and regional fat of children on ritonavir-boosted lopinavir...

Dyslipidemia among Sudanese Children Undergoing Maintenance Dialysis

Introduction: Dyslipidemia is an established risk factor for atherosclerosis and cardiovascular disease. It is common among children undergoing maintenance dialysis. To our knowledge, this is the first report on the lipid profile of children undergoing maintenance hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) in Sudan. Methods: We studied 17 children on HD, 11 children on CAPD and 28 controls. The levels of total cholesterol (TC), triglycerides (TGD) and high density lipoprotein cholesterol (HDL-C) were measured from fasting serum samples using electrophoresis and low density lipoprotein cholesterol (LDL-C) was then calculated. Results: End stage renal failure (ESRF) children had higher mean TC (193±36 versus 135±17 mg/dl), higher mean TGD (120±38 versus 90±15 mg/dl), higher mean LDL-C (129±32 versus 69±18 mg/dl), and lower mean HDL-C (39±12 versus 49±4 mg/dl) than controls (P=0.00 for all parameters). CAPD patients had higher mean TC (211±39 versus 181±30 mg/dl) and higher LDL-C (145±35 versus 118±25 mg/dl) than controls (P=0.03 for both parameters). The prevalence of dyslipidemia among ESRF patients was 75% while none of the control group had lipid parameters outside the accepted range. Among ESRF patients, 39.3% had TC > 200 mg/dl, 21.4% had TGD > 150 mg/dl, 42.9% had LDL-C > 130 mg/dl, and 35.7% had HDL-C Keywords: Children; Continuous Ambulatory Peritoneal Dialysis; Dyslipidemia; Hemodialysis; Sudan

Abstract 4226: Elevated Levels of Lp(a) Predict Coronary Atherosclerosis as Detected by Coronary Artery Calcium Scanning with Computed Tomography

INTRODUCTION Lipoprotein (a) [Lp(a)] has been established as an independent cardiac risk factor. There is considerable variation among different races and the association between Lp(a) and coronary artery calcium (CAC) is unknown in Asians. METHODS 104 patients (pts) from Jakarta, Indonesia underwent CAC scoring and measurements of various biomarkers including Lp(a) (DAIICHI Pure Chemicals, Japan). Lp(a) &gt;20mg/dl were defined as abnormal; CAC was expressed as Agatston score. Lp(a) values were not normally distributed and Kruskal-Wallis test and median values were used to test Lp(a) levels across CAC ranges (0, 1–100, 101– 400, &gt;400). ROC curve analysis tested the performance of Lp(a) to predict presence of any CAC. RESULTS 53/104 (51%) pts had an abnormal Lp(a) level. Clinical characteristics were similar between the two groups (60% male, 14% DM, 57% HTN, 30% smoker). Pts with abnormal Lp(a) had higher mean total cholesterol (220±48 vs. 199±147, p=0.01), LDL (147±40 vs. 130±38, p =0.02) and Lp(a) level (10.2±5.2 vs. 40.8±5.2, p=0.001) but similar HDL (46±10 vs. 45±9, p=NS) and triglyceride (154±113 vs. 145±95, p=NS) levels. Lp(a) was a good test in predicting presence of CAC as evidenced by an area under the curve (AUC)=0.7 with the optimal cut-point of &gt;17mg/dl (sensitivity 73%, specificity 73%, p&lt;0.001). Kruskal-Wallis analysis showed median Lp(a) levels to be significantly higher across rising CAC ranges: 0=41.5, 1–100=54.9, 101– 400=62.1, &gt;400=64 mg/dl (p=0.026). After adjusting for the above clinical characteristics and biochemical markers in a multivariate logistic regression model Lp(a) levels remained a significant predictor of CAC (p=0.007). CONCLUSION This is the first study to demonstrate a significant relationship between Lp(a) levels and presence of CAC in an Asian population.

Low utilisation of cardiovascular risk reducing therapy in patients with acute coronary syndromes and non-obstructive coronary artery disease

Between 6-25% of patients undergoing coronary angiography for acute coronary syndrome (ACS) have non-obstructive coronary artery disease (NOCAD). One-hundred and eighty patients presenting with an ACS who were taking part in a risk factor modification study and had undergone coronary angiography were examined. We compared baseline characteristics, medical treatment and 12-month outcome in patients with NOCAD (<50% lumen diameter stenosis at coronary angiography) and obstructive CAD (> or = 50% lumen diameter stenosis at coronary angiography). There were 29 (16%) patients with NOCAD and 151 (84%) with obstructive CAD (CAD). Patients with NOCAD were significantly younger, more likely to be female, had higher mean total cholesterol and LDL levels, and fewer received cardiac rehabilitation, treatment with statins, aspirin, ACE inhibitors, beta-blockers or clopidogrel. Over the next 12-months, there was no mortality or myocardial infarction in the NOCAD group compared to 2% in the CAD group, but 14% with NOCAD were readmitted for a cardiovascular cause including 2 patients (7%) who underwent percutaneous coronary intervention (PCI). Patients presenting with ACS and NOCAD may not have a completely benign prognosis, and preventative strategies and therapies such as statins in this group of patients appear to be under-utilised.

Central obesity and coronary risk factors.

A cross-sectional study of 130 Bengalee Hindu men (mean age = 50.3 years; SD = 10.5 years) was undertaken to investigate the relationship of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) with total cholesterol (TC), high density (HDL-C), low density (LDL-C) and very low-density (VLDL-C) lipoprotein cholesterol, fasting plasma glucose (FPG) and triglycerides (FTG). Correlation studies revealed that WHR was significantly correlated (r = 0.245, p < 0.01) with TC. WC and WHR had significant correlations with VLDL-C, FPG and FTG. All subjects were further divided into two groups based on WHR < or = 0.95 (centrally non-obese, CNO) and WHR > 0.95 (centrally obese, CO) following the US Joint National Committee (JNC) guidelines. Students' t-test revealed that CO subjects (n = 83) had a significantly higher mean TC (p < 0.05), VLDL (p < 0.05), FPG (p < 0.01) and FTG (p < 0.05) compared with CNO individuals (n = 47). Results of analysis of variance (ANOVA) of central obesity status (CNO = no, CO = yes) and BMI (BMI tertiles used as a categorical variable) with these metabolic variables revealed that CO status had a significant effect (p < 0.05) on TC, VLDL-C, FPG and FTG. BMI tertiles did not a have significant effect on any of these metabolic variables. There was no significant BMI tertile-central obesity status interaction. It can therefore be concluded that the JNC guidelines of WHR > 0.95 to define central obesity can be used, irrespective of BMI, among this population, to identify individuals who have enhanced metabolic risk factors of coronary heart disease (CHD). Furthermore, it can be routinely used for health promotion purposes among Bengalee men.

Apolipoprotein A-IV polymorphism in Saami and Finns: frequency and effect on serum lipid levels

Apolipoprotein A-IV (apoA-IV) is a glycoprotein constituent of triglyceride-rich and high-density lipoproteins (HDL) and may thus play an important role in lipid metabolism. In Finland two common isoforms (A-IV-1 and A-IV-2) of apoA-IV have been found. The isoforms are the result of the G to T substitution in the third base of the codon 360 in the apoA-IV-2 allele of the apoA-IV gene. The purpose of the study was to determine the apoA-IV allele frequencies in the Saami and the Finns, and to relate the apoA-IV phenotypes to serum lipids. The sample was drawn in connection with a Reindeer Herders' Health Survey performed in northern Finland in 1989. The study group included 248 men with known ethnic origin, Saami and Finns, who lived in the area of the nine northernmost municipalities of Finland. ApoA-IV phenotypes from 71 Saami (both parents Saami) and 177 Finns (both parents Finns) were determined by isoelectric focusing and Western blotting. Serum lipids were determined enzymatically. ApoA-IV allele frequencies in the Saami and the Finns were for A-IV-1 0.894 vs 0.944 and for A-IV-2 0.106 vs 0.056, respectively (χ2-test, P < 0.05). The effect of the apoA-IV phenotype on serum HDL-cholesterol levels differed significantly between the Saami and the Finns (two-way ANCOVA, interaction between ethnicity and apoA-IV phenotype, P < 0.02). In the Saami, HDL-cholesterol levels were significantly higher in the apoA-IV-2/1 than in the apoA-IV-1/1 phenotypes (ANCOVA, P < 0.05). Mean total cholesterol, low-density lipoprotein (LDL)-cholesterol, apolipoprotein B, HDL-cholesterol and triglyceride levels did not differ statistically significantly between the Saami and the Finns. Yet, there was a trend in the Saami of having higher mean total cholesterol, LDL-cholesterol and apolipoprotein B levels than the Finns among the apoA-IV-2/1 phenotypes, while there was only a small difference in these parameters between the Saami and the Finns among the apoA-IV-1/1 phenotypes. In conclusion, the Saami have a higher frequency of the apoA-IV-2 allele than the Finns and most of the other studied populations.