Higher Serum Total Cholesterol Research Articles

High serum total cholesterol levels is a risk factor of ischemic stroke for general Japanese population: The JPHC study

BackgroundHigh serum total cholesterol levels represent a risk factor of ischemic stroke in Western countries. However, this association has not been thoroughly investigated in Asian populations where the incidence of stroke is high. MethodsParticipants were 11,727 men and 21,742 women aged 40–69 years, all free of cardiovascular disease and cancer at baseline. During the median 12-year follow-up, we documented 612 ischemic stroke (293 lacunar infarction, 107 large-artery occlusive infarctions, and 168 embolic infarctions). ResultsExcess risk of ischemic stroke was observed in men with serum total cholesterol levels of ≥6.21mmol/L than those with the lowest category (<4.65mmol/L), but not in women. The multivariable hazard ratios (HRs) and 95% confidence interval (95% CI) were 1.63 (1.14–2.35) for men and 1.03 (0.69–1.55) for women. The corresponding HRs of large-artery occlusive infarction were 2.86 (1.31–6.27) for men and 0.75 (0.28–2.01) for women. Serum total cholesterol levels were not associated with risk of lacunar or embolic infarction for either sex. ConclusionsHigh serum total cholesterol is a risk factor of ischemic stroke, specifically large-artery occlusive infarction for Japanese men.

Sex-specific association of ACAT-1 rs1044925 SNP and serum lipid levels in the hypercholesterolemic subjects

BackgroundAcyl-CoA:cholesterol acyltransferase (ACAT) is a key enzyme in cellular cholesterol homeostasis and in atherosclerosis. The cellular cholesterol efflux correlated with serum high-density lipoprotein cholesterol (HDL-C) concentrations has shown to be impaired in hyperlipidemic mice. The present study was carried out to clarify the association of ACAT-1 rs1044925 single nucleotide polymorphism (SNP) and serum lipid levels in the hyperlipidemic subjects.MethodsA total of 821 unrelated subjects (hyperlipidemia, 476; normolipidemia, 345) aged 15-80 were included in the study. Genotyping of the ACAT-1 rs1044925 SNP was performed by polymerase chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and then confirmed by direct sequencing.ResultsThere was no significant difference in the genotypic and allelic frequencies of ACAT-1 rs1044925 SNP between the normolipidemic and hyperlipidemic subjects. The levels of total cholesterol (TC), HDL-C and apolipoprotein (Apo) AI in hyperlipidemic subjects were different between the AA and AC/CC genotypes in male but not in female (P < 0.05-0.01), the C allele carriers had higher serum TC, HDL-C and ApoAI levels than the C allele noncarriers. The association of genotypes and serum HDL-C and ApoAI levels in hyperlipidemia was found mainly in the male subjects with hypercholesterolemia but not in those with hypertriglyceridemia. There were no significant differences in serum lipid levels between the AA and AC/CC genotypes in the normolipidemic subjects.ConclusionsThe present study shows that the C allele carriers of ACAT-1 rs1044925 SNP in male hyperlipidemic subjects had higher serum TC, HDL-C and ApoAI levels than the C allele noncarriers. There is a sex (male)-specific association of ACAT-1 rs1044925 SNP and serum HDL-C and ApoAI levels in the hypercholesterolemic subjects.

Risk Assessment for Cardiovascular Diseases in Male Workers: Comparing KOSHA Guidelines and the Framingham Risk Score System

Objectives: This study aimed to investigate the 10-year risk of cardiovascular disease (CVD) by Framingham risk score (FRS) who classified as “healthy group”by Korean Occupational Safety and Health Agent (KOSHA)’ s cardiovascular risk assessment. Methods: The subjects of this study were 1,781 male workers in a large steel company. Health status was obtained periodically through medical examinations and questionnaires. We assessed cardiovascular risk using KOSHA guidelines and calculated the 10-year risk of cardiovascular disease using the Framingham risk score for those categorized to the “healthy group”by KOSHA guideline. A closer examination of cardiovascular risk factors was performed in 62 subjects paradoxically placed in the “healthy group”by KOSHA guidelines and the“ high- risk group”by FRS. Results: Among the “healthy group”by KOSHA’s cardiovascular risk assessment, 230(15.8%) subjects had more than 3 CVD risk factors and 62(4.2%) subjects were high risk group (more than 20%) in 10-years risk of CVD by Framingham risk score. Modifiable risk factors included cigarette smoking (96.8%), high serum total cholesterol (82.3%), high serum triglyceride (66.1%), insufficient physical activity (66.1%), and obesity (58.1%). Conclusions: Among subjects with normal blood pressure, it seems that KOSHA guidelines underestimate CVD risk, identified by the Framingham risk score. For the effective prevention and management of CVD, modifiable risk factors, such as cigarette smoking, dyslipidemia, and obesity, need to be constructively controlled.

Serum total and HDL cholesterol and risk of prostate cancer.

Studies suggest a decreased risk of high-grade prostate cancer in men with lower circulating total cholesterol and that statins may protect against aggressive disease. Confirmation in additional populations and examination of associations for lipoprotein subfractions are needed. We examined prostate cancer risk and serum total and HDL cholesterol in the ATBC Study cohort (n=29,093). Cox proportional hazards models were used to estimate the relative risk of total (n=2,041), non-aggressive (n=829), aggressive (n=461), advanced (n=412), and high-grade (n=231) prostate cancer by categories of total and HDL cholesterol. After excluding the first 10years of follow-up, men with higher serum total cholesterol were at increased risk of overall (≥240 vs. <200mg/dl: HR=1.22, 95% CI 1.03-1.44, p-trend=0.01) and advanced (≥240 vs. <200mg/dl: HR=1.85, 95% CI 1.13-3.03, p-trend=0.05) prostate cancer. Higher HDL cholesterol was suggestively associated with a decreased risk of prostate cancer regardless of stage or grade. In this population of smokers, high serum total cholesterol was associated with higher risk of advanced prostate cancer, and high HDL cholesterol suggestively reduced the risk of prostate cancer overall. These results support previous studies and, indirectly, support the hypothesis that statins may reduce the risk of advanced prostate cancer by lowering cholesterol.

Screening for diabetes using monitoring guidance in schizophrenia patients treated with second-generation antipsychotics: A 1-year follow-up study

Second-generation antipsychotics (SGAs) tend to induce weight gain, dyslipidemia and diabetes mellitus. For those reasons, patients treated with SGAs should receive appropriate monitoring to avoid morbidity and mortality associated with cardiovascular disease. We conducted a one-year follow-up study using Japanese blood glucose monitoring guidance in schizophrenia patients treated with SGAs to evaluate the detection capability of the guidance in real clinical settings and to assess the importance of longitudinal monitoring. This retrospective cohort study included schizophrenia patients receiving at least one SGA, who were enrolled during June 2008-January 2009 at multiple sites and who had both baseline data and follow-up monitoring data at month 12. After one-year follow-up, the probable diabetes type (fasting blood glucose is higher than 125 mg/dL, casual blood glucose is higher than 179 mg/dL, or glycosylated hemoglobin (Hb(A1c)) is greater than 6.4%) was detected in 30 (8%) of the patients, and the pre-diabetes type (fasting blood glucose is 110-125 mg/dL, or casual blood glucose is 140-179 mg/dL, or Hb(A1c) is 6.0-6.4%) in 65 (17.4%) out of the total of 374 patients. During the follow-up period, 1.5% of patients had advanced from the normal (fasting blood glucose is less than 110 mg/dL, casual blood glucose is less than 140 mg/dL, or Hb(A1c) is less than 6.0%) to probable diabetes type and 42.4% had progressed from the pre-diabetes to probable diabetes type. Predictive factors for worsening of the diabetic state were a family history of diabetes, and high serum total-cholesterol and triglyceride levels at baseline. Not only cross-sectional baseline screening but also longitudinal follow-up screening is important to detect glucose abnormalities in patients treated with SGAs.

Antioxidative and hypolipidemic effects of lactic acid bacteria from pickled Chinese cabbage

Pickled cabbage is a popular Chinese traditional food. The present study was explored to characterize effects of lactic acid bacteria (LAB) isolated from the pickled cabbages on activities of antioxidant enzymes and hypolipidemia in normal and hyperlipidemic mice. 28 LAB strains were isolated from pickled cabbage, and two strains with high acid tolerance and bile salt resistance were screened. The strains were identified to be Lactobacillus plantarum (lab 1) and Lactobacillus brevis (lab 2) by the API 50CHL identification kit. They were given to normal and hyperlipidemic mice by ig.28 d continually. Activities of superoxide dismutase enzyme (SOD), glutathione peroxidase (GSH-px) in liver and kidney tissues of the LAB-treated mice were increased, while change in catalase (CAT) was insignificant. Differences of SOD levels between the lab 2-treated normal diet group and the normal control group was significant (p<0.05, p<0.01). Levels of serum total cholesterol (TC), total triglycerides (TG) and low-density lipoprotein cholesterol (LDL-c) were decreased and high-density lipoprotein cholesterol (HDL-c) level was higher in the LAB-treated groups. Compared with the high fat food control group, serum TC and TG levels were significant decrease (p<0.01), HDL-c level was significant increase (p<0.05) in lab 2-treated and lab 1+lab 2-treated high fat diet groups. However, the strains cannot decrease the blood glucose level of hyperglycemic mice. The result indicates that the strains have the potentials of enhancing activities of antioxidant enzymes and relieving hyperlipidemia-induced oxidative stress, which also suggested that Chinese pickled cabbage is the beneficial resources of probiotics. Key words: Lactic acid bacteria, antioxidant effect, hypolipidemia, Chinese pickled cabbage.

Genetic variant of V825I in the ATP-binding cassette transporter A1 gene and serum lipid levels in the Guangxi Bai Ku Yao and Han populations

BackgroundSeveral genetic variants in the ATP-binding cassette transporter A1 (ABCA1) gene have associated with modifications of serum high-density lipoprotein cholesterol (HDL-C) levels and the susceptibility for coronary heart disease, but the findings are still controversial in diverse racial/ethnic groups. Bai Ku Yao is an isolated subgroup of the Yao minority in southern China. The present study was undertaken to detect the possible association of V825I (rs2066715) polymorphism in the ABCA1 gene and several environmental factors with serum lipid levels in the Guangxi Bai Ku Yao and Han populations.MethodsA total of 677 subjects of Bai Ku Yao and 646 participants of Han Chinese were randomly selected from our previous stratified randomized cluster samples. Polymerase chain reaction and restriction fragment length polymorphism assay combined with gel electrophoresis were performed for the genotyping of V825I variant, and then confirmed by direct sequencing.ResultsThe levels of serum total cholesterol (TC), HDL-C, apolipoprotein (Apo) AI and ApoB were lower in Bai Ku Yao than in Han (P < 0.01 for all). The frequency of G and A alleles was 57.4% and 42.6% in Bai Ku Yao, and 57.7% and 42.3% in Han (P > 0.05); respectively. The frequency of GG, GA and AA genotypes was 33.7%, 47.4% and 18.9% in Bai Ku Yao, and 33.4%, 48.6% and 18.0% in Han (P > 0.05); respectively. There was no difference in the genotypic and allelic frequencies between males and females in the both ethnic groups. The subjects with AA genotype in Bai Ku Yao had higher serum TC levels than the subjects with GG and GA genotypes (P < 0.05). The participants with AA genotype in Han had lower serum HDL-C and ApoAI levels than the participants with GG and GA genotypes (P < 0.05 for each), but these results were found in males but not in females. Multivariate linear regression analysis showed that the levels of TC in Bai Ku Yao and HDL-C and ApoAI in male Han were correlated with genotypes (P < 0.05 for all). Serum lipid parameters were also correlated with sex, age, body mass index, alcohol consumption, and blood pressure in both ethnic groups (P < 0.05-0.001).ConclusionThe present study suggests that the V825I polymorphism in the ABCA1 gene is associated with male serum HDL-C and ApoAI levels in the Han, and serum TC levels in the Bai Ku Yao populations. The difference in the association of V825I polymorphism and serum lipid levels between the two ethnic groups might partly result from different ABCA1 gene-enviromental interactions.

Abstract B92: Serum total and HDL cholesterol and risk of prostate cancer

Abstract Background: There has been growing support for the hypothesis that low cholesterol may protect against prostate cancer with a poorer prognosis. Studies suggest a decreased risk of high-grade prostate cancer in men with lower circulating total cholesterol, and that statin drugs may protect against aggressive prostate cancer. Confirmation of these findings in additional populations and examination of lipoprotein subfractions is needed. We prospectively examined prostate cancer risk and serum total and HDL cholesterol in the ATBC Study cohort. Methods: The ATBC Study was a randomized controlled trial conducted among male smokers in Finland to determine the effects of α-tocopherol and β-carotene supplements on cancer incidence. Fasting blood samples were collected at baseline (1985 — 1988), and total and HDL cholesterol were measured for all participants (n=29,133). Cohort follow-up continues through the Finnish Cancer Registry and the Register of Causes of Death. Cox proportional hazards models were used to estimate the relative risk of overall (n=2,041), high stage (≥ TNM stage III or AJC stage 3; n=412), high grade (Gleason sum ≥ 7; n=231), aggressive (either high stage or high grade; n=461), and non-aggressive (neither high stage nor high grade; n=829) prostate cancer by categories of total (&amp;lt;200, 200 — &amp;lt;240, ≥240 mg/dL) and HDL (&amp;lt;40, 40 — &amp;lt;60, ≥60 mg/dL) cholesterol. Multivariable models adjusted for age, serum α-tocopherol, family history of prostate cancer, education, and urban residence. Further adjustment for the following factors did not alter the results: α-tocopherol and β-carotene supplementation group, serum β-carotene, cigarettes per day, years smoked, physical activity, marital status, and intake of total energy, total fat, fruits and vegetables, red meat, alcohol, vitamin A, vitamin D, and calcium. Results: Men with high serum total cholesterol were at increased risk of prostate cancer, particularly high stage disease (≥240 vs. &amp;lt;200 mg/dl: HR=1.26, 95% CI 0.92 — 1.71, p-trend = 0.03). Stratification by follow-up time showed that the increased risk of prostate cancer for men with higher total cholesterol was limited to cases diagnosed at least 10 years after baseline. After excluding the first 9 years of follow-up, men with higher serum total cholesterol were at an increased risk of overall (≥240 vs. &amp;lt;200: HR=1.22, 95% CI 1.03 — 1.44, p-trend=0.01) and advanced-stage (≥240 vs. &amp;lt;200: HR=1.85, 95% CI 1.13 — 3.03, p-trend=0.05) prostate cancer. Higher HDL cholesterol appeared related to decreased risk of prostate cancer, overall and all clinical subtypes, throughout the follow-up period. Conclusion: In this population of male smokers with a low prevalence of PSA screening, high serum total cholesterol was associated with an increased risk of advanced prostate cancer, but only among cases diagnosed at least 10 years after baseline. Further, there was a suggestion that high HDL cholesterol reduced the risk of all clinical subtypes of prostate cancer. These results support previous studies and, indirectly, support the hypothesis that statin drugs may reduce the risk of prostate cancer with a poorer prognosis by lowering cholesterol concentrations. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B92.

Association of methylenetetrahydrofolate reductase C677T polymorphism and serum lipid levels in the Guangxi Bai Ku Yao and Han populations

BackgroundThe association of methylenetetrahydrofolate reductase (MTHFR) gene polymorphism and serum lipid profiles is still controversial in diverse ethnics. Bai Ku Yao is an isolated subgroup of the Yao minority in China. The aim of the present study was to eveluate the association of MTHFR C677T polymorphism and several environmental factors with serum lipid levels in the Guangxi Bai Ku Yao and Han populations.MethodsA total of 780 subjects of Bai Ku Yao and 686 participants of Han Chinese were randomly selected from our previous stratified randomized cluster samples. Genotyping of the MTHFR C677T was performed by polymerase chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and then confirmed by direct sequencing.ResultsThe levels of serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) AI and ApoB were lower in Bai Ku Yao than in Han (P < 0.05-0.001). The frequency of C and T alleles was 77.4% and 22.6% in Bai Ku Yao, and 60.9% and 39.1% in Han (P < 0.001); respectively. The frequency of CC, CT and TT genotypes was 58.7%, 37.3% and 4.0% in Bai Ku Yao, and 32.6%, 56.4% and 11.0% in Han (P < 0.001); respectively. The levels of TC and LDL-C in both ethnic groups were significant differences among the three genotypes (P < 0.05-0.01). The T allele carriers had higher serum TC and LDL-C levels than the T allele noncarriers. The levels of ApoB in Han were significant differences among the three genotypes (P < 0.05). The T allele carriers had higher serum ApoB levels as compared with the T allele noncarriers. The levels of TC, TG and LDL-C in Bai Ku Yao were correlated with genotypes (P < 0.05-0.001), whereas the levels of LDL-C in Han were associated with genotypes (P < 0.001). Serum lipid parameters were also correlated with sex, age, body mass index, alcohol consumption, cigarette smoking, and blood pressure in the both ethnic groups.ConclusionsThe differences in serum TC, TG, LDL-C and ApoB levels between the two ethnic groups might partly result from different genotypic and allelic frequencies of the MTHFR C677T or different MTHFR gene-enviromental interactions.

High serum total cholesterol is a long-term cause of osteoporotic fracture

Risk factors for osteoporotic fractures were evaluated in 1,396 men and women for a period of 20 years. Serum total cholesterol was found to be an independent osteoporotic fracture risk factor whose predictive power improves with time. The purpose of this study was to evaluate long-term risk factors for osteoporotic fracture. A population random sample of men and women aged 25-64 years (the Gothenburg WHO MONICA project, N = 1,396, 53% women) was studied prospectively. The 1985 baseline examination recorded physical activity at work and during leisure time, psychological stress, smoking habits, coffee consumption, BMI, waist/hip ratio, blood pressure, total, HDL and LDL cholesterol, triglycerides, and fibrinogen. Osteoporotic fractures over a period of 20 years were retrieved from the Gothenburg hospital registers. Poisson regression was used to analyze the predictive power for osteoporotic fracture of each risk factor. A total number of 258 osteoporotic fractures occurred in 143 participants (10.2%). As expected, we found that previous fracture, smoking, coffee consumption, and lower BMI each increase the risk for osteoporotic fracture independently of age and sex. More unexpectedly, we found that the gradient of risk of serum total cholesterol to predict osteoporotic fracture significantly increases over time (p = 0.0377). Serum total cholesterol is an independent osteoporotic fracture risk factor whose predictive power improves with time. High serum total cholesterol is a long-term cause of osteoporotic fracture.

High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries

To determine the fraction of individuals with high total serum cholesterol who get diagnosed and effectively treated in eight high- and middle-income countries. Using data from nationally representative health examination surveys conducted in 1998-2007, we studied a probability sample of 79 039 adults aged 40-79 years from England, Germany, Japan, Jordan, Mexico, Scotland, Thailand and the United States of America. For each country we calculated the prevalence of high total serum cholesterol (total serum cholesterol ≥ 6.2 mmol/l or ≥ 240 mg/dl) and the mean total serum cholesterol level. We also determined the fractions of individuals being diagnosed, treated with cholesterol-lowering medication and effectively controlled (total serum cholesterol < 6.2 mmol/l or < 240 mg/dl). The proportion of undiagnosed individuals was highest in Thailand (78%; 95% confidence interval, CI: 74-82) and lowest in the United States (16%; 95% CI: 13-19). The fraction diagnosed but untreated ranged from 9% in Thailand (95% CI: 8-11) to 53% in Japan (95% CI: 50-57). The proportion being treated who had attained evidence of control ranged from 4% in Germany (95% CI: 3-5) to 58% in Mexico (95% CI: 54-63). Time series estimates showed improved control of high total serum cholesterol over the past two decades in England and the United States. The percentage of people with high total serum cholesterol who are effectively treated remains small in selected high- and middle-income countries. Many of those affected are unaware of their condition. Untreated high blood cholesterol represents a missed opportunity in the face of a global epidemic of chronic diseases.

Effect of Apolipoprotein E Gene Polymorphism on Serum Lipid Level Before and After Renal Transplantation

Objective To investigate the effect of apolipoprotein E (ApoE) gene polymorphism on lipid metabolism among renal transplant recipients before and after transplantation. No prisoners or organs from prisoners were used in this study. Methods ApoE gene polymorphism was detected with polymerase chain reaction-restriction fragment length polymorphism; serum lipid levels were measured with biochemical methods. Results Serum lipid levels in the recipients were increased significantly at 3 months after renal transplantation, and further elevated at 6 months and 1 year. The recipients with higher total serum cholesterol (TC) and triglyceride (TG) levels only accounted for 2.9% and 7.6%, respectively, before renal transplantation; but for 28.6% and 46.7%, respectively, at 3 months ( P < .01); 40.0% and 59.0% at 6 months; and 42.9% and 62.9% at 12 months. ApoE gene polymorphism showed no statistical difference in ApoE allele or ApoE genotype between the control and the study groups. The effect of ApoE genotype on serum lipid levels was different between controls and recipients either before or after renal transplantation. The levels of serum TC, TG, low-density lipoprotein cholesterol, ApoB, ApoE were: ε2/2+ ε2/3; ε3/3; ε3/4+ ε4/4 from low to high in controls and recipients before transplantation, but the levels of TG and ApoE reversed among recipients after renal transplantation. Conclusion Renal transplant recipients are liable to develop hyperlipidemia, particularly hypertriglyceridemia among recipients with ApoE genotypes ε2/2 or ε2/3.

Cholesterol in mild cognitive impairment and Alzheimer's disease in a prospective population based study in Germany

Introduction: Animal research and epidemiological studies identified cholesterol as a risk factor for mild cognitive impairment (MCI) and Alzheimer's disease (AD). We therefore investigated the potential impact of plasma total cholesterol (TC) on the development of MCI and AD in a longitudinal study of a representative birth cohort born between 1930 and 1932. Methods: 500 participants of the Interdisciplinary Longitudinal Study on Adult Development and Aging (ILSE) were examined in 1993–1996 (t1), 1997–2000 (t2) and 2005–2008 (t3). Results: Prevalence of MCI increased from 13% to 23% and 29% over time; in addition, 7% of the participants had developed AD at t3. At t1 and t2 MCI patients showed the highest TC level and control subjects the lowest with AD patients occupying an intermediate position. When compared to control subjects, patients with MCI or AD showed a significant decrease of TC levels between t1 and t3. In all examination waves APOE4 carriers showed higher TC levels in comparison to the non-APOE4 carriers. Analyses of variance yielded significant (p&lt;0.05) main effects for diagnosis, presence of an APOE4 allele and time. The interactions time*diagnose and time*diagnose*APOE also reached significance. Conclusion: Our findings confirm the hypotheses that high midlife serum TC constitutes a risk factor for the development of MCI and AD and demonstrate that this effect particularly strikes at the APOE4 carriers. The reduction of TC among the patients could be explained by a disease effect.

Response to Anti-HCV Therapy in HIV–HCV-Coinfected Patients: Does the Lipid Profile Really have an Effect?

Because high serum low-density lipoprotein (LDL) and total cholesterol concentrations before treatment have been found to be significant positive prognostic factors for a sustained virological response to HCV therapy in monoinfected patients, the aim of this study was to assess this relationship in HIV-HCV-coinfected patients. Pretreatment fasting lipid parameters (in particular total cholesterol, LDL, high-density lipoprotein [HDL], apolipoprotein B [apoB] and triglycerides [TG]) were assessed in 315 patients from the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) HC02-Ribavic therapeutic trial. There was a significant correlation between pretreatment lipid parameters and steatosis (total cholesterol r=-0.23, P<0.0001; LDL r=-0.23, P<0.0001; HDL r=-0.28, P<0.0001; and TG r=0.18, P=0.002), but not with fibrosis. None of these lipid parameters were significant predictors of a sustained virological response to HCV therapy, even after adjustment for the type of interferon treatment and for the main known prognostic factors for a response to HCV therapy. The possible effect of lipid metabolism on virological response is outweighed by other prognostic factors that affect response to HCV therapy in the ANRS HC02-Ribavic study.

Statins in Hypertension: Are They a New Class of Antihypertensive Agents?

High blood pressure is a very common disease in hypercholesterolemic and diabetic patients and contributes to the increase in cardiovascular risk. Inhibitors of 3OH-3methyl-glutaryl-coenzyme A reductase are the most effective and widely used cholesterol-lowering drugs. They significantly reduce the risk of cardiovascular events and death in both primary and secondary prevention of cardiovascular disease. Although the long-term benefit by statin treatment is largely attributed to their cholesterol-lowering action, increasing attention focuses on additional actions called "pleitropic effects" that might explain the cardiovascular protection seen shortly after the initiation of therapy. Very few and small studies have investigated the antihypertensive effect of statins in patients with hypertension associated with hypercholesterolemia, and the results of recently published large statin studies (albeit not designed to answer this question) have attracted the interest on this subject. Many other studies, also not specifically aimed at the evaluation of the statins' antihypertensive effect, have provided information concerning changes in blood pressure during treatment with statins, but severe limitations such as inadequate study design, small or very small sample size, too short of a treatment period, and modification of concomitant antihypertensive therapy have prevented finding a definitive effect on blood pressure. From the available results, it appears consistent that statins may be useful in hypertensives with high serum total cholesterol, in those whose hypertension is not well controlled with antihypertensive agents even without high serum total cholesterol, in hypertensive subjects well controlled with antihypertensives without high serum cholesterol when they have high polymerase chain reaction levels, in those who require preventive measures because of other concomitant cardiovascular risk factors, or when they require secondary prevention. Future research could further characterize the impact of statin use alone or in combination with antihypertensive agents to delay the development of Stage 1 hypertension in prehypertension.

Elevated HDL2-paraoxonase and reduced CETP activity are associated with a dramatically lower ratio of LDL-cholesterol/total cholesterol in a hypercholesterolemic and hypertriglyceridemic patient

A female patient (64 years of age; body mass index, 26) had a markedly and relatively low low-density lipoprotein-cholesterol (LDL-C) level (97 mg/dl) despite high serum total cholesterol (TC) (331 mg/dl) and triacylglyceride levels (307 mg/dl). Since the expected LDL-C was 222 mg/dl, there was a significant difference between the calculation and measurement based on direct enzyme assay. Only 30% of serum cholesterol was associated with LDL-C in this patient. To determine the basis for the markedly low LDL-C/TC ratio, we isolated and analyzed lipoproteins from the patient as well as age- and gender-matched controls. The patient had lowered serum CETP activity and elevated paraoxonase activity with GOT and GPT values in the normal range. The very low-density lipoprotein particles from the patient were larger than those of the controls and enriched with lipid and protein, while the LDL from the patient (LDL-P) had a lower particle number and protein content than the controls. The LDL-P was more resistant to cupric ion-mediated oxidation. HDL2 from the patient (HDL2-P) had highly enhanced paraoxonase activity and antioxidant ability. The patient had a 1.5-fold higher level of apolipoprotein (apo) A-I expression in HDL2. ApoA-I in HDL2 and HDL3 from the patient showed no fragmentation, while the control had fragmented bands (17 and 21 kDa) in the HDL. The HDL2-P also had a larger particle size and greater protein content with less lipid content. HDL3-associated cholesteryl ester transfer protein was reduced in the patient, although the particle size was similar to the controls. In conclusion, a patient who had a markedly lower LDL-C/TC ratio despite hyperlipidemia associated with higher paraoxonase activity, higher apoA-I level and lower CETP activity without fragmentation of apoA-I in the HDL fraction is presented. The enhanced antioxidant and anti-inflammatory activity of HDL might contribute to the low LDL-C/TC ratio in this patient.

The metabolic syndrome in overweight epileptic patients treated with valproic acid

To evaluate the presence of metabolic syndrome (MS) in children and adolescents treated with valproate (VPA). One hundred fourteen patients (54 male and 60 female) were studied. These patients were followed from the beginning of therapy for at least 24 months; at the end of follow-up, 46 patients (40.4%) had a considerable increase in body weight, whereas the other patients (59.6%) remained with the same weight. The MS was defined as having at least three of the following: abdominal obesity, dyslipidemia, glucose intolerance, and hypertension. Forty-six patients developed obesity; 20 (43.5%) of 46 patients developed MS. Abnormal glucose homeostasis was identified in 45% of patients. High total serum cholesterol concentrations were noted in 10 (50%), high serum triglyceride concentrations in 7 (35%), and low high-density lipoprotein (HDL) in 15 (75%) of the 20 subjects with MS. However, there were no significant differences in the features of MS between boys and girls with MS. Patients who gain weight during VPA therapy can develop MS with a possible risk of cardiovascular disease.

Influence of Serum Lipids on Clinically Significant versus Nonclinically Significant Macular Edema: SN-DREAMS Report Number 13

Purpose To estimate the prevalence of diabetic macular edema, both clinically significant macular edema (CSME) and nonclinically significant macular edema (non-CSME), and report the associations of dyslipidemia on them. Design A population-based cross-sectional study in India. Participants After all exclusions, 1414 subjects with diabetes underwent an examination. Methods The CSME was defined according to the Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines; stereo digital fundus pairs were studied. The dyslipidemia cases were classified according to the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III). Main Outcome Measures Prevalence of CSME and non-CSME and association of serum lipids with them. Results The prevalence was 31.76% (95% confidence interval [CI], 26.04–37.47) for overall diabetic macular edema, 25.49% (95% Ci, 20.14–30.84) for non-CSME, and 6.27% (95% Ci, 3.29–9.24) for CSME. Univariate analysis identified macroalbuminuria and microalbuminuria, poor glycemic control, high total serum cholesterol, high serum low-density lipoprotein (LDL) cholesterol, and high serum non–high-density lipoprotein (HDL) cholesterol related to non-CSME and CSME (trend chi-square test, P<0.05). Logistic regression analysis (after adjusting variables such as age, gender, body mass index, duration, smoking, hypertension, glycosylated hemoglobin, macroalbuminuria and microalbuminuria, and insulin use) revealed high serum LDL cholesterol (odds ratio [OR], 2.72], high serum non-HDL cholesterol (OR, 1.99), and high cholesterol ratio (OR, 3.08) related to non-CSME, and poor glycemic control (OR, 8.06), microalbuminuria (OR, 14.23), and high serum total cholesterol (OR, 9.09) related to CSME. Conclusions One third of the subjects had diabetic macular edema, and 6% of them showed evidence of CSME necessitating laser photocoagulation. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article. To estimate the prevalence of diabetic macular edema, both clinically significant macular edema (CSME) and nonclinically significant macular edema (non-CSME), and report the associations of dyslipidemia on them. A population-based cross-sectional study in India. After all exclusions, 1414 subjects with diabetes underwent an examination. The CSME was defined according to the Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines; stereo digital fundus pairs were studied. The dyslipidemia cases were classified according to the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III). Prevalence of CSME and non-CSME and association of serum lipids with them. The prevalence was 31.76% (95% confidence interval [CI], 26.04–37.47) for overall diabetic macular edema, 25.49% (95% Ci, 20.14–30.84) for non-CSME, and 6.27% (95% Ci, 3.29–9.24) for CSME. Univariate analysis identified macroalbuminuria and microalbuminuria, poor glycemic control, high total serum cholesterol, high serum low-density lipoprotein (LDL) cholesterol, and high serum non–high-density lipoprotein (HDL) cholesterol related to non-CSME and CSME (trend chi-square test, P<0.05). Logistic regression analysis (after adjusting variables such as age, gender, body mass index, duration, smoking, hypertension, glycosylated hemoglobin, macroalbuminuria and microalbuminuria, and insulin use) revealed high serum LDL cholesterol (odds ratio [OR], 2.72], high serum non-HDL cholesterol (OR, 1.99), and high cholesterol ratio (OR, 3.08) related to non-CSME, and poor glycemic control (OR, 8.06), microalbuminuria (OR, 14.23), and high serum total cholesterol (OR, 9.09) related to CSME. One third of the subjects had diabetic macular edema, and 6% of them showed evidence of CSME necessitating laser photocoagulation.

Diabetic dyslipidemia is a well-known issue, but what about lipoprotein a levels in Type 2 diabetics?

Type 2 DM is a worldwide endemic disease. Dyslipidemia is also a frequent disorder associated with diabetic patients. Lipid profiles can vary in distinct ethnic groups and population. There have been few trials about lipoprotein a (Lpa) levels in type 2 diabetic patients. We investigated serum lipid profiles, Lpa levels and metabolic syndrome findings in type 2 diabetic patients. In this prospective trial, 709 type 2 diabetic patients (407 F; 302 M) and 157 healthy control subjects (91F; 66M) living in the same geographic region were included. The mean age of patients was 53.4 ± 9.2 years. After 12-h overnight fasting, blood samples were obtained for analyzing the serum lipids. The serum total cholesterol, HDL, LDL, and triglycerides levels were measured by glucose enzymatic calorimetric method and apo-B, lipoprotein (a) levels by electrochemiluminescence Immunoassay. All patients were also evaluated for metabolic syndrome by NCEP ATP III criteria.Type 2 diabetic patients had higher serum total cholesterol, LDL cholesterol, triglyceride and apo-B levels and lesser HDL-cholesterol, compared with the control group (p<0.001). The serum Lpa was found to be similar in both type 2 diabetic and control subjects (p=0.519). Of the 709 diabetic patients, 516 (72.9%) had metabolic syndrome. In conclusion, as expected, dyslipidemia and metabolic syndrome was found to be higher in diabetic patients with respect to healthy controls, however, serum Lpa levels were not different in both groups.

Prehypertension Among Middle-Aged and Elderly People in Taiwan: A Five-Year Follow-Up

To evaluate the prevalence of prehypertension among middle-aged and elderly people in Taiwan and to explore the evolutionary changes of blood pressure in 5-year follow-up period. In 2000, people aged over 40 participating in annual health examinations at local health stations in I-Lan County were invited to join the study. Past medical histories were reviewed, physical examinations and serial laboratory tests were performed for participants. All participants were followed in 2005 by a medical record review, telephone survey or personal visit. Subjects with prehypertension were sorted for further analysis. Overall, 1053 people (mean age=64.4+/-11.4 years, 44.4% males) were enrolled in the primary cohort. The prevalence of hypertension and prehypertension was 40.4% and 35.8%, respectively. In 2005, 677 subjects (mean age: 68.8+/-10.4 years, 42.5% males) were successfully followed, which revealed a significant increase of systolic blood pressure (3.7+/-16.8 mmHg, p<0.001), but not diastolic blood pressure (0.3+/-11.5 mmHg, p=0.758) in prehypertensive subjects; however, both systolic blood pressure (14.3+/-17.4 mmHg, p<0.001) and diastolic blood pressure (7.7+/-13.3 mmHg, p<0.001) were significantly increased among normotensive subjects. The cumulative incidence of prehypertensive subjects becoming hypertensive was 31.3%, and those who became hypertensive were significantly older (65.3+/-8.6 vs. 62.2+/-12.3 years, p=0.024), having higher pulse pressure in 2000 (49.6+/-10.6 vs. 45.1+/-11.6 mmHg, p=0.001), serum total cholesterol (214.3+/-31.7 vs. 204.0+/-37.2 mg/dL, p=0.020) and low-density lipoprotein-cholesterol (141.7+/-29.2 vs. 132.7+/-34.7 mg/dL, p=0.042). The prevalence of prehypertension among older Taiwanese was 35.8% and the 5-year cumulative incidence of hypertension from prehypertension was 31.3%. Older prehypertensive subjects with higher pulse pressure, higher serum total cholesterol and higher low-density lipoprotein-cholesterol were more likely to become hypertensive within 5 years.