Impaired Lipid Profile Research Articles

SERUM LIPID PROFILE ABNORMALITIES IN β THALASSEMIA MAJOR PATIENTS IN KARACHI.

Objective: The aim of this study was to assess the lipid profile in beta thalassemia major patients and observeits correlation with age and gender.Methods: In this cross sectional study, conducted during 2013, 70 βTM patients ( 38 males and 32 females)with mean age 19.92 who were undergoing periodic blood transfusions and desferrioxime as chelating agentwere recruited. 70 controls of matched age and gender were also included in the study. Lipid profile was done byenzymatic colorimetric method on Micro lab 300 (Merck & Co Germany) and statistical comparison was done byusing student’s t test on SPSS: 17Results: βTM patients showed significantly lowered blood cholesterol (105.5 ±19.2 mg/dl), LDL (44.23±19.4 mg/dl) and HDL( 33±4.9 mg/dl) in comparison with controls (P value> 0.001) while TAG was level found to be increased(140.2±27 mg/dl) in comparison to normal healthy controls.Conclusion: The mechanisms that may account for these findings are increased erythropoiesis and cholesterolconsumption along with iron overload and oxidative stress in βTM patients. Awareness of these findings is helpfulto avoid unnecessary evaluation and clinical consequences of impaired lipid profile in patients with β thalassemiamajorKeywords: Beta thalassemia major (βTM), Lipid profile.

The prevalence of high blood pressure as one of cardiovascular risk factors among women with polycystic ovary syndrome

Background Polycystic ovary syndrome (PCOS) is one of the commonest endocrinopathy diagnosed among women mainly at reproductive age. For the first time it was described by Stein and Leventhal in 1935 and defined by two of the three findings: irregular menses (oligo-/amenorrhoea), hyperandrogenism or polycystic ovaries appearance on ultrasound, provided that other causes of androgen excess and dysovulation are excluded. PCOS is very often associated with infertility, endometrium cancer, obesity, insulin resistance, impaired glucose metabolism, higher risk for type 2 diabetes, high blood pressure, impaired lipid profile, mental illnesses and non-alcoholic liver steatosis. The presence of some of mentioned conditions may exacerbate the risk of cardiovascular events in women with PCOS [1, 2]. The main goal of our study was to assess the frequency of hypertension among women with PCOS. Material and methods Retrospective analysis of medical records of 213 women, age 17–42 (mean 25 ± 6 years). Results Twenty-two women (10%) in examined group suffered from hypertension. The incidence of elevated blood pressure was higher among women with insulin resistance (p = 0.006). Prevalence odds ratio (OR) of arterial hypertension in the group with hyperprolactinaemia was 0.15 (confidence interval [CI] 0.06–0.37) and in the group with insulin resistance (OR) 1.05 (CI 0.61–1.83). Conclusion The prevalence of hypertension among women with PCOS is higher when compared with healthy women at the same age. Thus, due to the young age of enrolled patients, it seems reasonable to recommend extension of the diagnostics of PCOS with blood pressure assessment.

Impact of red blood cells count on the relationship between high density lipoproteins and the prevalence and extent of coronary artery disease: a single centre study [corrected

We have hypothesized that high red blood cells (RBC) count can potentially play an atheroprotective role in patients with coronary atherosclerosis. We, therefore, have investigated the relationship between high density lipoproteins cholesterol (HDL-C) and RBC levels in patients undergoing coronary angiography. Coronary artery disease (CAD) is a major cause of mortality. Impaired lipid profile represents a major risk factor for atherosclerosis. High density lipoprotein (HDL) is a key factor in atherosclerosis disease development. RBC can mimic HDL's reverse cholesterol transportation with a potential atheroprotective role. Coronary angiography has been evaluated in 3,534 patients. Fasting samples were collected for haematology and lipids levels assessment. Coronary disease was defined for at least 1 vessel stenosis >50 %. Patients were divided according to HDL-C and RBC tertiles. Lower HDL-C was significantly associated to the prevalence of CAD (84.8 vs 78.5 vs 67.3 %, p ≤ 0.001; adjusted OR [95 % CI] = 1.55 [1.3-1.8], p < 0.001) and severe CAD (30 % vs 30 % vs 24.4 %, p = 0.002; adjusted OR [95 % CI] = 1.08 [1.01-1.16], p = 0.02), this relationship was maintained even dividing our population according to RBC tertiles (p < 0.001).In conclusion, HDL-C levels are directly related to RBC count and inversely to the prevalence and extent of coronary disease. Higher RBC levels can reduce the risk of CAD in patients with lower HDL-C levels, suggesting an important atheroprotective role.

Association of lipid profile test values, type-2 diabetes mellitus, and periodontitis.

Objective:A two-way relationship between diabetes and periodontal disease has been suggested; whereas obesity and impaired lipid profile are risk factors for type-2 diabetes mellitus. This study examined the relationship between lipid profile, oral glucose tolerance test (OGTT) with periodontal health/disease dependent variables in healthy, diabetic and impaired glucose tolerance subjects.Materials and Methods:120 patients were selected for the study and were determined to be periodontally healthy or diseased. All these patients underwent biochemical tests for OGTT and Lipid profile analysis and data was compared using Z-test.Results:The OGTT results deteriorated with deteriorating periodontal condition. A similar correlation was also observed between worsening lipid profile test values, OGTT score, and periodontal condition.Conclusion:This study indicates that hyperlipidemia may be one of the factors associated with periodontitis and that periodontitis may itself lead to abnormal serum lipid levels. Therefore, in addition to effects on diabetes, periodontitis may contribute to elevated serum lipid levels and therefore potentially to systemic disease arising from chronic hyperlipidemia.

Successful treatment of a patient with obesity, type 2 diabetes and hypertension with the paleolithic ketogenic diet

Introduction: Metabolic syndrome is a major public health problem affecting at least 20% of the world’s adult population. Components of the metabolic syndrome include obesity, impaired glucose metabolism, hypertension and altered lipid profile. Currently, medical treatment relies on drugs. A major problem is that patients with long-standing disease are excessively medicated because of an increase in the number of symptoms over time. A few clinical studies indicate that low-carbohydrate diets, including the paleolithic as well as the ketogenic diet, may be beneficial in the treatment of conditions associated with the metabolic syndrome. Case Report: Herein, we present a case of patient with metabolic syndrome successfully treated with the paleolithic ketogenic diet. While on the diet the patient was able to discontinue eight medicines, lost weight, showed a continuous improvement in glucose parameters and her blood pressure normalized. Currently, the patient is on the paleolithic ketogenic diet for 22 months, free of symptoms and side effects. Conclusion: We conclude that the paleolithic ketogenic diet was

Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review

Adult growth hormone deficiency (GHD) is a well defined clinical condition, which is characterized by abnormal body composition, impaired physical activity and decreased quality of life. In addition, in recent years, growing interest has been shown towards cardiovascular risks in adult patients affected by GHD. In this regard, GHD is widely known to be associated with increased mortality, likely due to the increase of risk factors, such as central obesity, impaired lipid and glucose profiles and other less-known risk factors, such as inflammatory cytokines, endothelial dysfunction and oxidative stress. However, very few papers have recently discussed this topic. In this review, the aim is to clarify this issue by discussing evidence regarding the effects of adult GHD on metabolic and cardiovascular profiles.

CYP7A1 gene polymorphism located in the 5' upstream region modifies the risk of coronary artery disease.

Background. 7-Alpha cholesterol hydroxylase (CYP7A1), the first enzyme of classic conversion pathway leading from cholesterol to bile acids synthesis, is encoded by CYP7A1 gene. Its single nucleotide polymorphisms (SNPs) influence serum lipid levels and may be related to impaired lipid profile leading to coronary artery disease (CAD). The aim of the present study was to analyze the possible association between the rs7833904 CYP7A1 polymorphism and premature CAD. Material and Methods. Serum lipid levels and rs7833904 SNP were determined in 419 subjects: 200 patients with premature CAD and 219 age and sex matched controls. Results. The A allele carrier state was associated with CAD (OR = 1.76, 95% CI; 1.14–2.71, P = 0.014). The effect was even stronger in the male subgroups (OR = 2.16, 95% CI; 1.28–3.65, P = 0.003). There was no effect in the females. Risk factors of CAD and clinical phenotype of atherosclerosis were not associated with genotype variants of the rs7833904 SNP. Lipid profiles also did not differ significantly between individual genotypes. Conclusion. The CYP7A1 rs7833904 polymorphism may modify the risk of CAD. This effect is especially strong in male subjects. The studied polymorphism does not significantly influence serum lipid levels, in the present study.

Deranged Serum Fasting Lipid Profile in Children and Adolescent with Thalassemia Major

Introduction: Serum fasting lipid profile has been studied in various clinical spectrum of β-thalassemia syndrome. Premature cardiac impairment in thalassemia major (TM) appears primarily due to iron accumulation and oxidative injury; however it might be a sequel of abnormal lipoprotein concentrations. Recent studies revealed impaired lipid profile and atherosclerosis in TM as an emerging complication in patients with prolonged survival. As these children are at risk of premature atherosclerosis, sub clinical atherosclerosis probably begins early in their life might evolve into coronary heart diseases in later life.The rational of this prospective cross sectional study is to analyze the serum fasting lipid profile in cardiovascular disease free thalassemia major patients and to establish any correlation with age, gender, hematological parameters, liver enzymes and serum ferritin.Method: The study group comprises of thirty six patients with β-thalassemia major, who were enrolled from March 2012 to March 2014. Fasting blood lipid levels (total lipid, cholesterol, triglycerides, HDL and LDL-cholesterol), liver function test and serum ferritin were measured in all study participants on Hitachi 912 through photometric assay (for lipid profile and liver function test) and by immunoturbidity methodology for serumferritin. Hematological parameters were determined by Cell Dyne Ruby (Abbot, Architect, USA). Patients were stratified in two groups, age ≤ 15 years and >15 years, to determine the possible lipid profile distinction in relation to increasing age.Results: Of the 36 patients, 17 were males (15.5±5.9 years) and 19 were females (10.1±4.5 years) with the mean age of 12.69±5.85 (range 5-24) years. Mean hemoglobin was 7.4±1.9gm/dl with the hematocrit of 23.1±5.7% while serum ferritin was markedly elevated 4699.7±3089ng/ml. The mean total lipid, cholesterol and triglycerides levels were 494.7 ± 114.5, 90.3 ±23.9 and 150.5±95.1 mg/dl respectively. High triglycerides were detected in 36.1%. While HDL cholesterol and LDL cholesterol were markedly low 17.7±9.2 and 42.3±22.0 mg/dl respectively. The mean total cholesterol to HDL ratio was significantly elevated, 6.21± 3.06 (normal <5.0). In addition, total-cholesterol to HDL-cholesterol ratios were increased irrespective of gender, that is 6.0±2.0 and 6.4± 3.8 in males and females respectively (P=0.6). Data analysis revealed that 22.2% females and 13.8% males had high triglyceride levels (P=0.05). No statistically significant difference was noted in two stratified age groups in respect to lipid profile (table-1).We established positive correlation of elevated total bilirubin with cholesterol, HDL and LDL cholesterol (P<0.05). Cholesterol ratio was also significantly high in patients with hemoglobin > 8gm/dl (P<0.05). Low HDL cholesterol was correlated positively with LDL cholesterol levels. While no significant correlation of serum lipid could be established with age, gender, high ferritins and with liver enzymes.Conclusion: Our study revealed that lipid profile impairment is not unusual in β-thalassemia major patients irrespective of age. Considerable deficiency of high density cholesterol and significantly high total-cholesterol to HDL-cholesterol ratio may strongly be associated with occurrence of coronary heart disease in later life. We propose that lipid profile should be regularly done in these patients particularly those with hemoglobin > 8gm/dl and high total bilirubin levels. Whilst total to HDL ratio, underlines as a significant diagnostic marker for future cardiac events in these patients.Keywords: β-thalassemia major, triglyceride, HDL-cholesterol, LDL-cholesterol.Table 1:Comparative analysis of serum lipid profile in relation to ageParametersAge ≤15 yearsn= 24Age >15 yearsn= 12P- valueTotal lipid515.7± 121.1452.9 ±90.60.1 *Cholesterol95.0±17.680.9±32.10.09 *Serum triglyceride168.1 ± 109.7115.2± 40.10.1 *HDL cholesterol19.4±10.214.4± 5.90.1 *LDL cholesterol43.1±19.940.9±26.60.7 *Cholesterol ratio6.3± 3.46.0 ±2.10.8 **Not significant DisclosuresNo relevant conflicts of interest to declare.

Association between Serum Lipid Profile and Glycated Hemoglobin in Pre-diabetic Individuals

Background: Pre-diabetes is a condition in which the blood glucose level is above normal but below the diagnostic threshold for diabetes mellitus. Impaired lipid profile i.e dyslipidemia is commonly associated with CVD in type 2 diabetes and can also occur in pre-diabetics. Material and Method: The present study was conducted on 50 patients with no sign and symptoms of diabetes mellitus with HbA1c level between 5.7%–6.4%. Pre-diabetic individuals were categorized into 2 groups according to their fasting blood sugar level, FBS?110 mg/dl as normal and for impaired fasting glucose between 110–125 mg/dl. HbA1c was analyzed by high pressure liquid chromatography (Biorad D10). Fasting blood sugar and lipid profile were analyzed on Vitros 250 dry chemistry fully autoanalyzer. Result: There was no significant difference in total cholesterol, triglyceride, HDL-c, VLDL, LDL, TC/HDL and LDL/HDL in patients with normal and impaired fasting glucose level with HbA1c between 5.7%–6.4% Conclusion: Relationship between high risk range of HbA1c (5.7% - 6.4%) and CVD mortality is still not clear. Studies on large population are required to find out whether estimation of lipid profile in pre-diabetic should be used routinely or not in pre-diabetic patients..

Distinct role of estrogen receptor-alpha and beta on postmenopausal diabetes-induced vascular dysfunction

Estrogen is known to influence vascular functions and insulin sensitivity, but the relative contribution of estrogen receptor (ER) isoforms in postmenopausal diabetes-induced vascular dysfunction is unclear. The aim of the present study was to delineate the distinct role of estrogen receptor-α and beta β on the vascular function in ovariectomized diabetic rats. Age matched 60 female sprague dawley rats (200–250g) were divided in nine groups. Bilateral ovariectomy was performed and streptozotocin was used to induce experimental diabetes. Rats were administered with 10μg/kg; s.c. of a nonselective estrogen receptor agonist, 17-β estradiol (E2), selective ER-α agonist (4,4′,4″-(4-propyl-[1H] pyrazole-1,3,5-triyl) tris phenol (PPT) and selective ER-β agonist, 2,3-bis(4-hydroxyphenyl)-propionitrile (DPN) for 4weeks after STZ injection. Treatment with selective ER-α agonist and E2 improved the impaired glycemic and lipid profile in ovariectomized diabetic rats, however selective ER-β agonist did not show any effect. Vascular endothelial dysfunction was assessed by acetylcholine and sodium nitroprusside-induced endothelium dependent and independent relaxation in isolated rat aortic ring preparation as well as by electron microscopy of thoracic aorta. Further, serum thiobarbituric acid reactive substances, tumour necrotic factor-alpha and interleukin-1 beta and C-reactive protein were estimated to assess oxidative stress and vascular inflammation. Treatment with ER-α agonist markedly and E2 partially improved vascular function and endothelial integrity along with reduction in serum TBARS and inflammatory cytokines. However, ER-β agonist did not show any improvement in vascular functions, oxidative stress or inflammation. These findings suggest that selective targeting of ER-α receptors results in vasculoprotection in the state of hypoestrogenicity and diabetes.

Suboptimal glycaemic control enhances the risk of impaired prothrombotic state in youths with type 1 diabetes mellitus

To estimate markers of prothrombotic state and endothelial dysfunction in youths with type 1 diabetes mellitus (T1DM) and investigate possible associations with anthropometric/demographic data, glycaemic control and lipid profile. In a cross-sectional design, we recruited 155 youths with T1DM and determined levels of plasminogen activator inhibitor-1-antigen (PAI-1-Ag), von Willebrand factor-antigen (vWF-Ag), fibrinogen (FB), lipids and glycosylated haemoglobin (HbA1c). Of all the participants, 76 (49%) had increased levels of at least one of prothrombotic factors. Suboptimal glycaemic control was associated with a worse lipid profile and an eightfold increased risk of elevated vWF-Ag levels. Higher vWF-Ag concentrations were also correlated with impaired lipid profile and increased HbA1c values, whereas PAI-1-Ag was positively correlated only with triglyceride levels. After adjustment for potential confounders, only HbA1c contributed independently to the variation in vWF-Ag levels. Impaired prothrombotic state and consequently endothelial dysfunction are present in youths with T1DM, representing a cumulative risk factor for future cardiovascular disease (CVD). Achievement and maintenance of euglycaemia and normolipidaemia are crucial to decelerate progress of this process.

Filaggrin Deficiency Leads to Impaired Lipid Profile and Altered Acidification Pathways in a 3D Skin Construct

Mutations in the filaggrin (FLG) gene are strongly associated with common dermatological disorders such as atopic dermatitis. However, the exact underlying pathomechanism is still ambiguous. Here, we investigated the impact of FLG on skin lipid composition, organization, and skin acidification using a FLG knockdown (FLG-) skin construct. Initially, sodium/hydrogen antiporter (NHE-1) activity was sufficient to maintain the acidic pH (5.5) of the reconstructed skin. At day 7, the FLG degradation products urocanic (UCA) and pyrrolidone-5-carboxylic acid (PCA) were significantly decreased in FLG- constructs, but the skin surface pH was still physiological owing to an upregulation of NHE-1. At day 14, secretory phospholipase A2 (sPLA2) IIA, which converts phospholipids to fatty acids, was significantly more activated in FLG- than in FLG+. Although NHE-1 and sPLA2 were able to compensate the FLG deficiency, maintain the skin surface pH, and ensured ceramide processing (no differences detected), an accumulation of free fatty acids (2-fold increase) led to less ordered intercellular lipid lamellae and higher permeability of the FLG- constructs. The interplay of the UCA/PCA and the sPLA2/NHE-1 acidification pathways of the skin and the impact of FLG insufficiency on skin lipid composition and organization in reconstructed skin are described.

Pre-hypertension and hypertension in college students in Kuwait: a neglected issue.

Objective:To determine the proportion of pre-hypertension and hypertension in college students in Kuwait and their related risk factors.Materials and Methods:A total of 803, randomly selected students aged 17 to 23 years (346 male, 457 female) from different colleges in Kuwait, were included in the study between 2009 and 2010. Systolic and diastolic blood pressure measurements were taken by trained personnel. Pre-hypertension was defined as systolic pressure between 120 and 139 mm Hg or diastolic pressure between 80 and 89 mm Hg. Risk factor measurements that were determined, included smoking, body mass index (BMI), and family history of hypertension. Blood samples were collected and impaired glucose tolerance (IGT) and lipid profile levels were determined.Results:There were no hypotensive students. Normotensives constituted 53.5% (n = 430), pre-hypertensives formed 39.5% (n = 317), and hypertensive students comprised of 7% (n = 56). The overall proportions of hypertension and pre-hypertension were higher among male students (85.7 and 64.4%) than female students (14.3 and 35.6%), respectively. Hypertensive and pre-hypertensive students versus normotensive students had significantly higher levels of BMI-based obesity, smoking, glycated hemoglobin (HbA1c), and IGT. Also, hypertensive and pre-hypertensive, compared to normotensive students, had significantly higher proportions (21.4, 18.3, and 4.0%, respectively) of risky high-density lipoprotein (HDL) level (< 1 mg / dL), cholesterol (7.1, 3.8, and 1.4%, respectively), and triglycerides (TG) (17.9, 9.1, and 7.9%, respectively) where p was< 0.001, 0.016, and 0.051, respectively.Conclusion:Hypertensive and pre-hypertensive students showed elevated levels of lipids and BMI-based obesity more than normotensive students. TG, HDL, HbA1c, and cholesterol appeared to influence pre-hypertension.

The Different Phenotypes of Polycystic Ovary Syndrome: No Advantages for Identifying Women with Aggravated Insulin Resistance or Impaired Lipids

According to the classification of polycystic ovary syndrome (PCOS) published by the Androgen Excess Society (AES), 10 different phenotypes of the condition are possible. The question remains of whether using these phenotypes might enable us to identify women with impaired insulin resistance or an impaired lipid profile among patients with PCOS. A prospective cohort analysis was performed of 313 women with diagnosed PCOS and 80 control individuals. The screening panel included a physical examination, weight and height measurement, ultrasonography of the ovaries, and hormone, glucose, lipid, and insulin resistance measurements. There were no statistically significant differences in insulin resistance parameters between the different phenotypes. There were no statistically significant differences in body mass index (BMI) in any of the groups, but BMI showed the best correlation with insulin resistance in all women with PCOS and controls. Sex hormone-binding globulin (SHBG) was inversely correlated with insulin resistance in women with PCOS and controls. High-density lipoprotein (HDL) was negatively correlated with insulin resistance, and free testosterone was positively correlated with it, only in women with PCOS. Using the different phenotypes described in the AES classification shows no advantages for identifying women with aggravated insulin resistance or impaired lipid profile among patients with PCOS.

Is the effect of high fat diet on lipid and carbohydrate metabolism related to inflammation?

Obesity is an emerging health problem in world wide countries. High fat diet (HFD), which is the main cause of obesity, induces inflammation and affects both lipid and carbohydrate metabolism. This study investigates the effect of inflammation induced by HFD on lipid and carbohydrate metabolism. This study involves two parts, in vivo and in vitro. In the in vivo part, adult male albino rats were fed a HFD for 8 and 14 weeks. After each feeding period, the following parameters were measured (body weight, blood glucose levels, oral glucose tolerance, serum insulin, insulin resistance, total cholesterol, HDLc, LDLc, triglycerides, free fatty acids, neutrophils percentage and serum CRP levels) in addition to pancreas tissue histopathology. In the in vitro part, insulin release from isolated perfused pancreas preparations was measured. Pancreas preparations were isolated from adult male albino rats fed a HFD for 16 weeks. Feeding rats a HFD for 8 and 14 weeks induced inflammation, impaired lipid profile and carbohydrate metabolism. Feeding rats a HFD for 16 weeks increased in vitro glucose-stimulated insulin release. HFD induces inflammation which plays an important role in the impairment of lipid and carbohydrate metabolism.

Type 2 Diabetes Mellitus-Induced Hyperglycemia in Patients with NAFLD and Normal LFTs: Relationship to Lipid Profile, Oxidative Stress and Pro-Inflammatory Cytokines

Type 2 diabetes mellitus is associated with dyslipdemia, insulin resistance and non alcoholic fatty liver disease. The purpose of the current study was to assess whether type 2 diabetes mellitus-induced hyperglycemia has an effect on the lipid profile and release of oxidative stress markers and inflammatory mediators in patients with non alcoholic fatty liver disease and normal liver function tests which may in turn lead to enhancing the pathogenicity of this liver disease. For this purpose, one hundred and five outpatients, matched in age and weight, were classified into two groups: the first group consisted of patients with non alcoholic fatty liver disease and the second group consisted of patients with non alcoholic fatty liver disease in conjunction with hyperglycemia due to the presence of type 2 diabetes mellitus. In all patients, lipid profile, oxidative stress, and inflammatory mediators were assessed by measuring serum concentrations of triglycerides, low density lipoprotein, hydrogen preroxide, malondialdehyde, tumor necrosis factor-alpha and interleukin-6, respectively. In the studied population, it was found that the presence of type 2 diabetes mellitus-induced hyperglycemia significantly impaired lipid profile, and significantly enhanced the formation of hydrogen preroxide and malondialdehyde as well as significantly increased the release of tumor necrosis factor-alpha and interleukin-6 in the second group of patients. In addition, plasma glucose level showed significant positive correlation with hydrogen peroxide, malondialdehyde, tumor necrosis factor-alpha and interleukin-6. From the previous results, it was concluded that the presence of type 2 diabetes mellitus-induced hyperglycemia results in significant increase in lipid profile, oxidative stress markers and inflammatory mediators in patients with non alcoholic fatty liver disease and normal liver function tests. For this reason, further research studies may be essential to evaluate the benefit of adding suitable antioxidant and anti-inflammatory drugs to the treatment regimen for this group of patients. In addition, regular monitoring of blood glucose levels and liver function tests should be advised to this category of patients to reduce liver fat deposition and avoid the development of non alcoholic steatohepatitis, cirrhosis or liver cancer and their related complications.

Prevalence of dyslipidemia and obesity among college students in Kuwait

Objective: The purpose of this study was to determine the prevalence of elevated levels of lipids and obesity among college students in Kuwait. Subjects and Method: A sample of 484 students (35.74% male and 64.26% female), aged 20.35±1.33 years, were chosen randomly from the College of Basic Education, Kuwait, during the period between the beginning of March 2009 till mid January 2010. Data were collected, using a predesigned interviewing schedule that contained information related to age, gender, history of hypertension, family history of hypertension and diabetes and the smoking habits. Also, their weight, height and waist circumference were measured. Laboratory measurements such as impaired glucose tolerance test and lipid profile were investigated. Data analysis was done using the SPSS version 17 for Windows. The study was approved by the National Ethical Committee of health researches. Results: The overall proportion of both dyslipidemia, based on both hypercholesterolemia and hypertriglycemia, as well as hypertriglycemia were significantly higher among males above 18 years of age, when compared with their female counterparts or those less than 18 years aged-male students. Males showed higher proportions of risky HDL level ( 30, were more than those of females in both age groups. As regards waist circumference-based obesity, it was found that the proportions of females were more significantly higher than those of males in both age groups. Hypertension was more significantly noticed among males in comparison with their female counterparts in both age groups (p<0.001). There was no statistically significant difference between both sexes as regards fasting blood glucose and postprandial blood glucose. However, males had higher levels of HbA1c than had females (p=0.021). Conclusion: Prevalence of elevated levels of lipids and BMI-based obesity was higher among males than females in the college students. These results suggest the involvement of obesity and both elevated lipid levels and hypertension among males. More screening should be performed especially for overweight/obese adolescent/adult students for the risk of dyslipidemia. The research project was funded by the Public Authority of Applied Education and Training, Kuwait.

A Rare Case of Hypertension

A 61-year-old female was referred to our hypertension centre for uncontrolled hypertension. She had been previously diagnosed with type 2 diabetes mellitus and impaired serum lipid profile. At admission, she assumed β-adrenoceptor antagonists (β-blockers) and calcium antagonists; she had uncontrolled blood pressure levels and she presented with a recent episode of headache associated with syncope and showed negative cerebral CT. Examinations performed in our hypertension outpatient clinic (physical examination, blood biochemistry, instrumental diagnosis and screening for secondary hypertension) had negative outcomes. Average blood pressure on three different determinations was above the normal values. A modification in antihypertensive therapy was performed with no results. During a follow-up visit, the patient lost consciousness. She was promptly transferred to the Cardiac Intensive Care Unit. During the following diagnostic iter (cerebral CT and urinary catecholamine levels based on a 24-hour sample), cerebral MRI evidenced malformation of Arnold Chiari type I. The neurological surgery consultant advised surgical procedure with occipital decompression technique. One year later the patient underwent surgical intervention. The patient actually reports suboptimal control of blood pressure. To date, no episode of transitory coma has occurred.

Dyslipidemia Among Newly Diagnosed Hypertensives: Pattern and Clinical Correlates

Hypertension and dyslipidemia are closely interrelated. We aim to determine the prevalence of dyslipidemia among newly diagnosed Nigerian hypertensive subjects and its associated clinical correlates. This was a cross-sectional study done at the Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, southwest Nigeria. One hundred sixty-three newly diagnosed hypertensive subjects and 88 controls were recruited and formed the study groups. Relevant history, examinations, and laboratory investigations were performed. Lipid parameters and atherogenic indices were determined. SPSS 16.0 was used for statistical analysis. Hypertensive subjects and controls were well matched in age and gender distribution. Dyslipidemia was more common among the hypertensive subjects. Ninety-six (58.9%) newly diagnosed hypertensive subjects had at least 1 impaired lipid profile. Sixty-seven (41.1%) of them had isolated dyslipidemia, while 29 (17.8%) had combined dyslipidemia. Common patterns of dyslipidemia include low high-density lipoprotein cholesterol (HDL-C), 78 (47.9%); high atherogenic index (total cholesterol/HDL-C), 40 (24.5%) and elevated low-density lipoprotein cholesterol (LDL-C) in 38 (23.3%) subjects. Fasting blood glucose increased as the severity of dyslipidemia increased. A significant proportion of newly diagnosed hypertensive subjects have dyslipidemia. Low HDL-C was the most common type of dyslipidemia in this study. The use of statins and other supportive therapy is therefore justified among newly diagnosed Nigerian hypertensive subjects with isolated or combined dyslipidemia.

Nonalcoholic steatohepatitis is frequently accompanied by metabolic diseases

In a recent issue, van der Poorten et al.1 reported an association of nonalcoholic steatohepatitis (NASH) with liver inflammation and fibrosis independent of insulin resistance and hepatic steatosis as assessed by magnetic resonance imaging. Although this association is already present, the study is important because it provides scientific information on this clinically relevant condition. However, we think that some points should be discussed. First, as shown in Table 1, most of the patients with NASH are overweight or obese. In addition, an important portion of the study participants have other metabolic disturbances (high blood pressure, dyslipidemia, etc.) alone or in combination. It is well known that all components that constitute the metabolic syndrome (MetS) are risk factors for type 2 diabetes mellitus and also prediabetes, namely, impaired fasting glucose and/or impaired glucose intolerance.2 Although both T2DM and impaired glucose tolerance are among the components of MetS,3 plasma insulin and adipokine levels differ according to the degree of glucose dysregulation.4, 5 The same is also true for hypertension or elevated blood pressure and dyslipidemia.6, 7 Second, apart from the thiazolidinediones, no information about the drug use of the subjects could be seen in the text. We know that circulating adipokines and measures of insulin sensitivity are easily affected by medications started for the metabolic problems mentioned above.8, 9, 10 The authors state in their article that the participants were accepted as having MetS according to the Adult Treatment Panel III criteria. The diagnostic criteria can be used clinically with success; however, while designing clinical studies to display mechanistic associations, we have to give ultimate effort to exclude possible confounders that might interfere with the results. Therefore, we would like to ask the authors whether they can present some new results by categorizing the patients with NASH according to metabolic confounders such as type 2 diabetes mellitus, impaired glucose tolerance, blood pressure, and lipid profile. This may provide the readers clearer information related to the mechanism(s) of NASH. Teoman Dogru M.D.*, Cemal Nuri Ercin M.D.*, Gokhan Erdem M.D. , Ilker Tasci M.D. , Alper Sonmez M.D. , Serkan Tapan M.D.§, * Department of Gastroenterology, Gulhane School of Medicine, Etlik, Ankara, Turkey, Department of Internal Medicine, Gulhane School of Medicine, Etlik, Ankara, Turkey, Department of Endocrinology, Gulhane School of Medicine, Etlik, Ankara, Turkey, § Department of Biochemistry, Gulhane School of Medicine, Etlik, Ankara, Turkey.