Improvements In Low-density Lipoprotein Cholesterol Research Articles

Abstract 4131775: Effectiveness of Lipid-lowering therapy with Bempedoic Acid plus Ezetimibe in a Real-world Cohort

Introduction: Bempedoic acid and the combination with ezetimibe (BA+EZE) have demonstrated low-density lipoprotein cholesterol (LDL-C) lowering in clinical trials of adults with primary hyperlipidemia at high risk for or with cardiovascular disease. The impact of BA+EZE on LDL-C outcomes in a real-world cohort has not been studied. Aim: To evaluate the effectiveness of BA+EZE on LDL-C reduction and goal achievement using real-world data. Methods: This was a retrospective cohort study using deidentified electronic health records and linked claims data. Adult patients were included if they had a pharmacy claim for BA+EZE from March 1, 2020 to March 15, 2024 (date of first pharmacy claim = index date ), had ≥1 baseline LDL-C lab result on or within 6 months prior to the index date, and ≥2 LDL-C lab results post-index, including 1 lab result 12 months post-index (±60 days). Patients with documented use of ezetimibe on or within 6 weeks prior to index were excluded. For all patients with available valid lab results, LDL-C was determined at baseline (the value closest to but not after the index date), 3 months (±30 days), 6 months (±60 days) and 12 months (±60 days). Results: A total of 615 BA+EZE patients were identified (mean age 62±11 years, 52% women). At baseline, 64% had evidence of statin use in the prior 12 months and the mean LDL-C was 131±52 mg/dl. Figure 1 shows the change in the proportion of patients achieving LDL-C control at index, 3-, 6-, and 12-months post-index. The proportion of patients achieving LDL-C <100 mg/dL more than doubled from index (30%) to 3 months (67%), and was sustained through 12 months (55%). At 12 months, there were fewer patients with LDL-C ≥130 mg/dL (24% vs 47% at index). The mean LDL-C reduction was 28% at 3 months (to 94±47 mg/dL), 27% at 6 months (96±44 mg/dL), and 22% at 12 months (102±47 mg/dL) (p<0.0001 for all vs index). Conclusion: Patients who initiated BA+EZE showed early and sustained improvements in LDL-C. Future research should consider the impact of time on therapy and adherence on LDL-C control.

Low-Density Lipoprotein Cholesterol Improvement Is Greater After Laparoscopic Sleeve Gastrectomy as Compared with Laparoscopic Gastric Bypass—a Registry-Based Study with 1-Year Follow-Up

Low-Density Lipoprotein Cholesterol Improvement Is Greater After Laparoscopic Sleeve Gastrectomy as Compared with Laparoscopic Gastric Bypass—a Registry-Based Study with 1-Year Follow-Up

Influence of Lactobacillus rhamnosus Supplementation on the Glycaemic Index, Lipid Profile, and Microbiome of Healthy Elderly Subjects: A Preliminary Randomized Clinical Trial.

Aging is a time-dependent complex biological process of organisms with gradual deterioration of the anatomical and physiological functions. The role of gut microbiota is inevitable in the aging process. Probiotic interventions improve gut homeostasis and support healthy aging by enhancing beneficial species and microbial biodiversity in older adults. The present preliminary clinical trial delves into the impact of an 8-week Lactobacillus rhamnosus intervention (10 × 109 CFU per day) on the glycaemic index, lipid profile, and microbiome of elderly subjects. Body weight, body fat, fasting blood glucose, total cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein (LDL) are assessed at baseline (Week 0) and after treatment (Week 8) in placebo and probiotic groups. Gaussian regression analysis highlights a significant improvement in LDL cholesterol in the probiotic group (p = 0.045). Microbiome analysis reveals numeric changes in taxonomic abundance at various levels. At the phylum level, Proteobacteria increases its relative frequency (RF) from 14.79 ± 5.58 at baseline to 23.46 ± 8.02 at 8 weeks, though statistically insignificant (p = 0.100). Compared to the placebo group, probiotic supplementations significantly increased the proteobacteria abundance. Genus-level analysis indicates changes in the abundance of several microbes, including Escherichia-Shigella, Akkermansia, and Bacteroides, but only Butyricimonas showed a statistically significant level of reduction in its abundance. Probiotic supplementations significantly altered the Escherichia-Shigella and Sutterella abundance compared to the placebo group. At the species level, Bacteroides vulgatus substantially increases after probiotic treatment (p = 0.021). Alpha and beta diversity assessments depict subtle shifts in microbial composition. The study has limitations, including a small sample size, short study duration, single-strain probiotic use, and lack of long-term follow-up. Despite these constraints, the study provides valuable preliminary insights into the multifaceted impact of L. rhamnosus on elderly subjects. Further detailed studies are required to define the beneficial effect of L. rhamnosus on the health status of elderly subjects.

Efek suplementasi kombinasi bawang putih, jahe merah, dan beras ragi merah (BJR-22) terhadap kadar kolesterol LDL pasien stroke dengan dislipidemia

Background: Stroke is the second leading cause of death worldwide, a significant contributor to disability, and the leading cause of stroke prevention by controlling risk factors. Dyslipidemia is a high risk of plaque buildup in the cell wall. An alternative search must be performed to prevent recurrent stroke events and to improve survival without disability. Nutraceuticals such as garlic (Allium sativum), red ginger (Zingiber officinale Roxb. var. rubrum Rosc.), and red yeast rice (Monascus purpureus) contain active compounds that inhibit HMG-CoA activity and limit the rate of cholesterol synthesis.Objectives: To analyze the effect of red ginger, garlic, and red yeast rice on low-density lipoprotein cholesterol (LDL-C) levels in ischemic stroke patients with dyslipidemia.Methods: Quasi-experimental research was conducted in a double-blinded manner. The study was conducted on outpatients at the Neurology Clinic of Dr. Kariadi Hospital Semarang, Central Java, from September to December 2022. Forty subjects with ischemic stroke and dyslipidemia were divided into intervention (20 subjects) and control (20 subjects) groups using consecutive sampling techniques. The intervention was conducted for 30 days. The intervention group received supplementation with a combination of garlic 225 mg, red ginger 125 mg of red ginger, 250 mg of 3x/day and statin for 30 days, while the control group received a placebo and statin. Lipid profile measurements were conducted at the Central Lab of Dr. Kariadi Hospital, Semarang, India. Data were analyzed using Fisher-Exact, Wilcoxon, and paired t-tests at a 95% CI.Results: The average LDL level before intervention was 152,0 ± 58,54, and after the intervention was 89,0 ± 27,07 (mg/dL). Before the intervention, The intermediate cholesterol level was 207,6 ± 37,6 to 164,5 ± 45,58. There was a significant improvement in LDL-C (p= 0,000) and cholesterol (p= 0,001).Conclusion: Supplementation with a combination of garlic, red ginger, and red yeast rice is effective in reducing LDL cholesterol levels

Vegetarian Dietary Patterns and Cardiometabolic Risk in People With or at High Risk of Cardiovascular Disease

Plant-based diets are known to improve cardiometabolic risk in the general population, but their effects on people at high risk of cardiovascular diseases (CVDs) remain inconclusive. To assess the association of vegetarian diets with major cardiometabolic risk factors, including low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and body weight in people with or at high risk of CVDs. This meta-analysis was registered before the study was conducted. Systematic searches performed included Embase, MEDLINE, CINAHL, and CENTRAL from inception until July 31, 2021. Eligible randomized clinical trials (RCTs) that delivered vegetarian diets in adults with or at high risk of CVDs and measured LDL-C, HbA1c or SBP were included. Of the 7871 records screened, 29 (0.4%; 20 studies) met inclusion criteria. Two reviewers independently extracted data including demographics, study design, sample size, and diet description, and performed risk of bias assessment. A random-effects model was used to assess mean changes in LDL-C, HbA1c, SBP, and body weight. The overall certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Mean differences between groups in changes (preintervention vs postintervention) of LDL-C, HbA1c, and SBP; secondary outcomes were changes in body weight and energy intake. Twenty RCTs involving 1878 participants (range of mean age, 28-64 years) were included, and mean duration of intervention was 25.4 weeks (range, 2 to 24 months). Four studies targeted people with CVDs, 7 focused on diabetes, and 9 included people with at least 2 CVD risk factors. Overall, relative to all comparison diets, meta-analyses showed that consuming vegetarian diets for an average of 6 months was associated with decreased LDL-C, HbA1c, and body weight by 6.6 mg/dL (95% CI, -10.1 to -3.1), 0.24% (95% CI, -0.40 to -0.07), and 3.4 kg (95% CI, -4.9 to -2.0), respectively, but the association with SBP was not significant (-0.1 mm Hg; 95% CI, -2.8 to 2.6). The GRADE assessment showed a moderate level of evidence for LDL-C and HbA1c reduction. In this study, consuming a vegetarian diet was associated with significant improvements in LDL-C, HbA1c and body weight beyond standard therapy in individuals at high risk of CVDs. Additional high-quality trials are warranted to further elucidate the effects of healthy plant-based diets in people with CVDs.

Updates in the management of pediatric dyslipidemia.

Pediatric dyslipidemias increase the risk of atherosclerosis and clinical cardiovascular disease and are the leading cause of morbidity and mortality. Lifestyle modifications and pharmacotherapies have measurably improved abnormal lipids and reduced cardiovascular events. The review will focus on current standards of care and investigative medications with the potential to improve cardiovascular health in children and adults. Lifestyle interventions and statins remain cornerstones in the treatment of pediatric hyperlipidemias. Bile acid sequestrants and ezetimibe continue to be used in the pediatric population as well. In recent years, successful clinical trials have approved use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in children with familial hypercholesterolemia. Use of angiopoietin-like protein 3 (ANGPTL3) inhibitors is also promising as it causes marked improvement in low-density lipoprotein cholesterol with safe side effect profiles. Additional medications undergoing pediatric clinical trials include inclisiran, bempedoic acid, and lomitapide. Recent advances in pharmacotherapy, especially for treatment of familial hypercholesterolemia, greatly impact treatment of dyslipidemias in children. Despite the overall progress in the development of these medications, therapies targeted towards treating hypertriglyceridemia have lagged behind. Continuing research for the treatment of pediatric dyslipidemias remains an important endeavor to reduce the risk of atherosclerosis and future cardiovascular events in children.

Lipid-lowering efficacy and safety of alirocumab in a real-life setting in France: Insights from the ODYSSEY APPRISE study

BackgroundRecently, a multicentre, prospective, single-arm, phase 3b, open-label trial was conducted to determine the safety and efficacy of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in a real-life setting. This study enrolled patients at high cardiovascular risk, with heterozygous familial hypercholesterolaemia (HeFH) or non-familial hypercholesterolaemia (non-FH). Results showed that alirocumab was well tolerated and resulted in a clinically significant reduction in low-density lipoprotein cholesterol (LDL-C). AimThis ancillary analysis aimed to describe the characteristics of the French patients enrolled in the study, the main results observed in this population according to their familial hypercholesterolaemia status, and adherence to treatment. MethodsFrench data were analysed separately from the original dataset of the study. ResultsAmong 215 French patients in the ODYSSEY APPRISE trial, 63.7% had non-FH, with a mean LDL-C concentration of 5.0±1.8mmol/L at baseline. The mean duration of alirocumab exposure was 72.4±42.5 weeks, with only 48.4% of patients receiving statins concomitantly. At week 12, a mean reduction in LDL-C of 56.5±17.8% was observed: 51.2±22.8% in HeFH; 59.5±13.2% in non-FH. This improvement in LDL-C started from week 4 and remained stable and sustained until week 120 in both populations. The overall incidence of severe treatment-emergent adverse events (TEAEs) was 33.5%. The most frequent TEAEs were myalgia (15.8%) and asthenia (15.3%). No tolerance or efficacy differences were observed between patients with or without established coronary artery disease or other cardiovascular disease, whatever the age of these events or considering the concomitant use of other lipid-lowering therapies. ConclusionsIn the French setting, alirocumab was well tolerated, safe and highly effective at reducing LDL-C. These findings support the use of alirocumab to manage hypercholesterolaemia in patients at high cardiovascular risk.

Efficacy and safety of hybutimibe in combination with atorvastatin for treatment of hypercholesteremia among patients with atherosclerotic cardiovascular disease risk equivalent: A multicenter, randomized, double-blinded phase III study.

BackgroundTo evaluate the safety and efficacy of hybutimibe plus atorvastatin for lipid control in hypercholesterolemia patients with atherosclerotic cardiovascular disease risk equivalent.MethodsIn this double-blind phase III study, we 1:1 randomly assigned 255 hypercholesterolemia patients with atherosclerotic cardiovascular disease to receive hybutimibe plus atorvastatin or placebo plus atorvastatin. The primary endpoint was the rate of change of plasma low-density lipoprotein-cholesterol (LDL-C) level at 12 weeks from baseline. The secondary endpoints were plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), non-HDL-C, apoprotein (Apo) B, and 2-, 4-, 8-, and 12-week Apo A1 levels change rate and rates of change of plasma LDL-C levels at 2, 4, and 8 weeks from baseline.ResultsFrom April 2016 to January 2018, 128 in the hybutimibe plus atorvastatin group and 125 in the atorvastatin group were included in modified intention-to-treat (mITT) analysis. After 12 weeks of treatment, LDL-C level changed from 2.61 mmol/L (±0.30) at baseline to 2.18 mmol/L (±0.45) in the hybutimibe plus atorvastatin group and from 2.58 (±0.31) mmol/L to 2.40 (± 0.46) mmol/L in the atorvastatin group (P < 0.0001), in mITT. The change rate in the hybutimibe plus atorvastatin group was significantly higher than that in the atorvastatin group (P < 0.0001); the estimated mean rates of change were −16.39 (95% confidence interval: −19.04, −13.74) and −6.75 (−9.48, −4.02), respectively. Consistently, in per-protocol set (PPS) analysis, the rate of change of LDL-C in the hybutimibe plus atorvastatin group was significantly higher than that in atorvastatin group. Significant decreases in the change rates of non-HDL-C, TC, and Apo B at 2, 4, 8, and 12 weeks (all P < 0.05) were observed for hybutimibe plus atorvastatin, while the differences were not significant for HDL-C, TG, and Apo-A1 (all P > 0.05). During the study period, no additional side effects were reported.ConclusionsHybutimibe combined with atorvastatin resulted in significant improvements in LDL-C, non-HDL-C, TC, and Apo B compared with atorvastatin alone. The safety and tolerability were also acceptable, although additional benefits of hybutimibe plus atorvastatin were not observed compared with atorvastatin alone in HDL-C, TG, and Apo-A1.

Comparative efficacy of non-statin lipid-lowering therapies in patients with hypercholesterolemia at increased cardiovascular risk: a network meta-analysis

Objective Network meta-analysis was used to derive estimates of the relative efficacy of inclisiran, evolocumab, alirocumab, bempedoic acid, and ezetimibe in patients with hypercholesterolemia and/or at increased cardiovascular risk due to elevated low-density lipoprotein cholesterol taking maximum tolerated dose statins. Methods Clinical trials published through February 2021 comparing percent change from baseline in low-density lipoprotein cholesterol were identified via a systematic review. Bayesian network meta-analyses were performed for patients with atherosclerotic cardiovascular disease and/or high cardiovascular risk on maximally tolerated statins in the base case, which included 23 trials. Results Results from the base-case analyses demonstrated that inclisiran, evolocumab, and alirocumab provide superior efficacy over placebo, bempedoic acid, and ezetimibe in terms of reduction in low-density lipoprotein cholesterol. Inclisiran was also comparable to alirocumab (mean difference: 0.78% [95% CrI: −8.35, 9.88]) and evolocumab (8.16%, [95% CrI: −1.82, 18.49]). Findings of a scenario which also included trials conducted in patients with heterozygous familial hypercholesterolemia were consistent with the base case. There was evidence of statistical heterogeneity across the included trials, roughly equivalent to variation of 5–10% change in low-density lipoprotein cholesterol, suggesting that any differences between treatments that were greater than 5–10% are generalizable. Conclusions This study provides insight regarding the comparative efficacy of drugs for which no head-to-head trials exist and suggests that inclisiran, alirocumab, and evolocumab are expected to provide similar clinically meaningful improvements in low-density lipoprotein cholesterol in patients with hypercholesterolemia on maximally tolerated statins who are at increased cardiovascular risk.

Differences in hypercholesterolemia patient management in secondary and primary care: lessons learned from the German PROCYON survey

Abstract Background In Germany, cardiovascular (CV) disease was the leading cause of mortality (39% of all deaths), responsible for 340,000 deaths in 2014 (1). Considering its role as a major risk factor for CV disease, awareness for hypercholesterolemia in clinical practice seems insufficient. Purpose The purpose of the present survey was to identify patients' journey differences between primary and secondary prevention in patients with hypercholesterolemia. Methods PROCYON was a two-part online survey on disease perception, awareness, burden, and management of hypercholesterolemia consisting of a patient survey (PROCYON A) and a healthcare practitioner (HCP) survey (PROCYON B). The survey included over 5,000 patients with and without prior CV events as well as 109 HCPs (general practitioners, internists, cardiologists) involved in primary and secondary prevention. Results 71% of the HCPs consider low-density lipoprotein cholesterol (LDL-C) as “very important” to assess a patients CV risk and 96% acknowledge a “causal relationship” between CV risk and LDL-C levels. Despite the theoretical awareness of LDL-C as a risk factor, 58% of the secondary prevention patients were initially diagnosed with hypercholesterolemia only while hospitalized due to a CV event, indicating insufficient translation of LDL-C awareness into clinical screening routine. General practitioners (GP) and internists are the main point of contact for patients with hypercholesterolemia after the diagnosis. In primary and even in secondary prevention, cardiologists play a minor role in hypercholesterolemia patient care (cardiologist vs. GP/internist ratio 1:5), the majority of patients are managed by their general practitioners and internists and (cardiologist vs. GP/internist ratio 2:3) (Table 1). The frequency of LDL-C control assessments is lower in primary prevention patients compared to secondary prevention (Table 2). In primary prevention, only 43% of the patients are on a lipid lowering therapy compared to 87% in secondary prevention. From the point of diagnosis, LDL-C levels improved at least to some extent in only 30% of the primary prevention patients and 51% of the secondary prevention patients. Of the patients without LDL-C improvement who are on drug therapy, 53% (primary prevention) and 39% (the secondary prevention) are still on their initial treatment since diagnosis. Conclusion(s) Major differences in relation to assessment intervals, treatment initiation, and specialist care were identified between primary and secondary prevention populations, reflecting a major focus in secondary prevention with respect to primary prevention. The high percentage of patients on secondary prevention diagnosed after the first CV event reflects the need to improve preventive screening. It is essential to identify measures to increase LDL-C risk awareness, improve screening efforts and efficient LDL-C reduction in order to prevent future CV events in both populations. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novartis Pharma GmbH

Different perspectives of patients and physicians on LDL-C target achievement in the treatment of hypercholesterolemia: results on secondary prevention from the German PROCYON survey

Abstract Background Lowering low-density lipoprotein cholesterol (LDL-C) in hypercholesterolemia patients at very high cardiovascular (CV) risk is essential in preventing future CV events. However, LDL-C targets often remain unattained. Purpose The purpose of the present survey was to identify possible reasons for insufficient LDL-C target achievement despite the availability of efficacious lipid lowering drugs in the clinical setting of hypercholesterolemia management in secondary prevention patients in Germany. Methods PROCYON was an online survey with over 5,000 participants on disease perception, awareness, burden, and management of hypercholesterolemia consisting of a patient survey (PROCYON A) and a healthcare practitioner (HCP) survey (PROCYON B). To quantify patient self-activation, the PAM-13 Patient Activation Measure by Insignia Health was incorporated. Results on 1,696 patients in secondary prevention are presented. Results Most post-CV event patients do not achieve their LDL-C target. HCPs assume patients' poor adherence to medication and lifestyle adaptions to be the most important reason (Figure 1). However, this contradicts the patients' perception. Accordingly, 87% of the patients are on a lipid lowering therapy and 81% of them have stated to take their medication regularly. They rank their medication for LDL-C reduction as equally important as that for other diseases. In contrast, HCPs think that 46% of their patients do not take hypercholesterolemia seriously. However, HCPs also believe, that LDL target attainment is still “important” or “very important” to 81% of their patients. This is in line with the patients' perception: 84% of the patients consider reaching their target as “important” or “very important”. PAM-13 results underline these results: 60% of the patients are already activated and want to gain control over their disease (PAM-13 level 3 of 4) and 12% reach highest self-activation levels (level 4 of 4). The HCP remains the major source of information for 77% of the patients and only 42% reach out for online resources. The importance of educating patients on adherence is acknowledged by all HCPs. Therefore, 71% express their desire of educational material. With respect to LDL-C levels, 49% of the patients reported no improvement. Of the patients under treatment without LDL-C improvement, only 23% take more than one drug, and 47% reported a change of dose. Furthermore, collaboration between GPs and specialists (cardiologists, diabetologists, lipidologists) was not evident. Conclusion Although secondary prevention patients are motivated to pursue their LDL-C targets, HCPs consider patient adherence as major reason for failure. Instead, the survey indicated that therapeutic strategies are not fully exhausted and there is space for treatment improvement either by dose escalation or addition of further lipid lowering drugs. Furthermore, patient education and specialist collaboration could improve patient management. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novartis Pharma GmbH Figure 1

LDL Cholesterol Reduction Variability with Different Types and Doses of Statins in Monotherapy or Combined with Ezetimibe. Results from the Spanish Arteriosclerosis Society Dyslipidaemia Registry.

Low-density lipoprotein (LDL) cholesterol reduction by statin therapy is dose-dependent, varies among different statins, and has wide inter-individual variability. The present study aimed to compare mean LDL cholesterol reduction and its variability achieved with different doses of the three statins most frequently used in monotherapy or combined with ezetimibe in a real clinical setting. Of 5620 cases with primary hypercholesterolemia on the Spanish Arteriosclerosis Society Registry, 1004 with non-familial hypercholesterolemia and complete information on drug therapy and lipid profile were included. The lowest mean percentage LDL cholesterol reduction was observed with simvastatin 10mg (32.5 ± 18.5%), while the highest mean percentage LDL reduction was obtained with rosuvastatin 40mg (58.7 ± 18.8%). As to combined treatment, the lowest and highest mean percentage LDL cholesterol reductions were obtained with simvastatin 10mg combined with ezetimibe (50.6 ± 24.6%) and rosuvastatin 40mg combined with ezetimibe (71.6 ± 11.1%), respectively. Factors associated with a suboptimal response were male sex, lower age, body mass index, and baseline LDL cholesterol levels. Combined treatment was associated with less variability in LDL cholesterol reduction (OR 0.603, p < 0.001). In a real clinical setting, rosuvastatin was superior to the other statins in lowering LDL cholesterol, both as monotherapy or combined with ezetimibe. Factors associated with a suboptimal response in LDL cholesterol decline were male sex, age, body mass index, and baseline LDL cholesterol levels. Combined treatment was associated with less variability in LDL cholesterol improvement.

Wand Stretching Exercise Decreases Abdominal Obesity Among Adults With High Body Mass Index Without Altering Fat Oxidation.

RationaleWe designed a wand-based muscle stretching (WE) exercise program, which has become increasingly popular in physical therapy and has been used for elderly patients with adhesive capsulitis. However, studies regarding the effects of WE training on abdominal obesity and measures of cardiovascular risk factors among overweight/obese adults aged ≥55 years are rare.PurposeThe objective of this study is to evaluate the effects of a 15-week wand stretching exercise program on waist circumference and cardiovascular risk factors in sedentary adults aged 55–70 years.MethodsA total of 124 participants were randomly assigned to either participate in wand stretching exercise (WE) over a 15-week period or a control group (n = 62 each). Sixty participants in the WE group (26 overweight and 34 obese) and 51 in the control group (29 overweight and 22 obese) completed the study. The WE program included wand-assisted muscle stretching exercise on both the upper body and lower body for 40 min per day, 5 days per week, whereas the control group maintained their sedentary lifestyle.ResultsNo significant improvements were observed in plasma glucose, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR) after exercise training. Compared with the control group, the WE group had more significant reductions in waist circumference among participants with a body mass index (BMI) < 25 kg/m2 (−2.6 cm, 95% CI: −4.19 to −0.97 cm, d = 0.48) and BMI > 25 kg/m2 (−2.5 cm, 95% CI: −4.1 to −0.9 cm, d = 0.59) (both P < 0.01). Furthermore, within groups, a significant increase in % fat free mass was observed after WE training. The basal metabolic rate was slightly increased, but the fat oxidation rate remained unaltered in the WE group. Improvements in low-density lipoprotein cholesterol to high-density lipoprotein cholesterol were minimal after WE. Significant reductions in high-sensitivity C-reactive protein were observed after WE only for participants with a BMI <25 kg/m2.ConclusionThe results suggest redistribution of a carbon source from the abdominal region to challenged skeletal muscle, following prolonged WE training. This abdominal fat reducing outcome of the WE is unlikely to be associated with fatty acid oxidation.

Leptin gene polymorphism (rs 7799039;G2548A) is associated with changes in lipid profile during a partial meal-replacement hypocaloric diet.

Some studies have demonstrated a positive association of the rs7799039 genetic variant of the LEP gene with energy intake and metabolic parameters. The present study aimed to analyse the effects of the rs7799039 genetic variant of the LEP gene on metabolic parameters after weight loss secondary to a partial meal-replacement (pMR) hypocaloric diet. We conducted a non-randomised, single-treatment study in 122 obese subjects with body mass index (BMI)>35kgm-2 . The subjects were treated with two intakes of a normocaloric hyperproteic formula during 12weeks. Anthropometric parameters and biochemical profile were measured at basal time and after 12weeks. The variant genetic variant (rs7799039) of the LEP gene was assessed by a real-time polymerase chain reaction. We recruited 122 subjects [26 GG (21.3%), 59 GA (29.5%) and 37 AA (30.3%)]. The mean (SD) age of the all group was 59.4(6.3)years (range 45-63years) and the mean (SD) BMI was 39.3(2.8)kgm-2 (range 36.2-45.1kgm-2 ). After the pMR hypocaloric diet, body weight, BMI, fat mass, waist circumference, fasting insulin, homeostasis model assessment for insulin resistance and blood pressure decreased in both genotypes. All of these improvements were similar in both genotypes. Moreover, after dietary intervention, only subjects without an A allele showed a significant improvement in triglycerides (GG versus GA+AA) [mean (SD) -15.3(6.4)mgdL-1 versus -3.7(4.3)mgdL-1 : P=0.02], total cholesterol [-25.0(5.3)mgdL-1 versus -8.1(3.5)mgdL-1 : P=0.02] and low-density lipoprotein-cholesterol [-20.7(4.2)mgdL-1 versus -5.4(2.3)mgdL-1 : P=0.01]. Subjects with an A allele of the rs7799039 variant in the LEPR gene showed a significant improvement in low-density lipoprotein-cholesterol and triglycerides levels after weight loss secondary to a pMR hypocaloric diet.

Clinical therapeutic effect of hyperlipidemia of turbid phlegm obstruction pattern/syndrome treated with the different Jin's three-needle therapies

To compare the differences in clinical effects on hyperlipidemia of turbid phlegm obstruction pattern/syndrome treated with the different Jin's three-needle therapies so as to provide a new approach and theoretic evidence for the clinical optimal scheme of acupuncture on hyperlipidemia. A total of 90 patients were randomly divided into education group, electroacupuncture group and catgut embedding group (30 cases in each). The routine health education was given to the education group. On the base of the treatment as the education group, electroacupuncture was applied to the electroacupuncture group for 30 min each time, twice a week; and the catgut embedding was applied to the catgut embedding group at the same acupoints as the electroacupuncture group, once a week. The treatment was given consecutively for 8 weeks in each group. Before and after treatment, the obesity indices [weight, waistline, body mass index (BMI)], blood lipid indices[serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and insulin resistance indices [fasting blood glucose(FBG), fasting plasma insulin(FINS), homeostasis model assessment-estimated insulin resistance (HOMA-IR)] were observed in the three groups before and after treatment. After treatment, in the electroacupuncture group and the catgut embedding group, the results of the obesity indices, e.g. weight, waistline and BMI, the levels of blood lipid, e.g.TC, TG, LDL-C and the insulin resistance indices, e.g. FINS and HOMA-IR were all obviously decreased compared with those before treatment (P<0.05, P<0.01), and the level of HDL-C apparently increased than that before treatment (P<0.01). In the catgut embedding group, FBG was obviously decreased after treatment as compared with that before treatment (P<0.01). After treatment, the improvements in LDL-C and HDL-C in the catgut embedding group were superior to those in the electroacupuncture group (P<0.05). Regarding the obesity indices and insulin resistance indices, the differences were not statistically significant in comparison between the catgut embedding group and the electroacupuncture group (all P>0.05). The total effective rate was 90.0% in the catgut embedding group (27/30) and it was 83.3% (25/30) in the electroacupuncture group, either of them was better than 60.0% (18/30) in the education group , indicating the statistical significance (P<0.01, P<0.05). On the base of health education, either the catgut embedding therapy or electroacupuncture of Jin's three-needle treatment achieves the positive regulation on the abnormal lipid metabolism and insulin resistance. The hypoglycemic effect and the impro-ving effect in LDL-C and HDL-C of the catgut embedding therapy are superior to electroacupuncture.

The relationship between payer type and lipid outcomes in response to clinical lifestyle interventions in youth with dyslipidemia

BackgroundPayer-type (government-sponsored health coverage versus private health insurance) has been shown to influence a variety of cardiovascular disease outcomes in adults. However, it is unclear if the payer-type impacts the response to a lifestyle intervention in children with dyslipidemia.MethodsWe analyzed data prospectively collected from patients under the age of 25 years who were referred to a large regional preventive cardiology clinic from 2010 to 2016 in Massachusetts. We compared baseline high density lipoprotein cholesterol (HDL-C), triglycerides (TG), non-HDL-C, and low density lipoprotein cholesterol (LDL-C) by payer-type. Further, we analyzed the change in lipid values in response to a clinic-based multidisciplinary intervention over a nearly six-year period by payer-type with multi-variable adjusted linear regression models. We also tested for effect modifications by age, sex, race, and body mass index (BMI) category.ResultsOf the 1739 eligible patients (mean age 13 years, 52% female, 60% overweight and obese, 59% White), we found that patients with government-sponsored coverage (n = 354, 20%) presented to referral lipid clinic with lower HDL-C (− 3.5 mg/dL [1.0], p < 0.001) and higher natural log-transformed TG (+ 0.14 [0.04], p < 0.001) as compared to those with private insurance; however, the association was attenuated to the null after additionally adjusting for BMI category (− 1.1 [0.9], p = 0.13, and + 0.05 [0.04], p = 0.2 for HDL-C and natural log-transformed TG, respectively). We found no difference in baseline LDL-C between payer-types (+ 3.4 mg/dL [3.0], p = 0.3). However, longitudinally, we found patients with private insurance and a self-reported race of White to have a clinically meaningful additional improvement in LDL-C, decreasing 12.8 (5.5) mg/dL (p = 0.02) between baseline and first follow-up, as compared to White patients with government-sponsored health coverage, after adjusting for age, sex, time between visits, and baseline LDL-C.ConclusionsOur results suggest that youth with government-sponsored coverage are referred with poorer lipid profiles than those with private insurance, although this is largely explained by higher rates of overweight and obesity in the government-sponsored health coverage group. White patients with private insurance had substantially better improvement in LDL-C longitudinally, suggesting that higher socioeconomic status facilitates improvement in LDL-C, but is less beneficial for HDL-C and triglyceride levels.

Ameliorating Effects of Four-Week Fiber-Multivitamin Combination Treatment on Low-Density Lipoprotein Cholesterol, Total Cholesterol, and Apolipoprotein B Profiles in Hypercholesterolemic Participants

Hyperlipidemia is one of the leading causes of death and requires lipid-lowering treatment to reduce morbidity and mortality. Effective and safe alternative and adjunctive therapies could be beneficial for patients with hyperlipidemia. To assess the effect of a fiber-multivitamin combination product on the lipid parameters low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), total cholesterol (TC), triglyceride (TG), and apolipoprotein B (Apo B) in patients with hypercholesterolemia, we conducted a double-blind, randomized, parallel-group study. Forty-one out of 50 randomized hypercholesterolemic participants recruited between August 2016 and March 2018 completed the trial. The participants were assigned to receive either test product (treatment group, n = 20) or placebo (placebo group, n = 21) for 4 weeks following a 6-week dietary intervention (based on education from a dietitian) run-in period. The primary outcome was LDL-c levels and the secondary outcomes were HDL-c, TC, TG, and Apo B levels. All of the outcomes were measured at baseline and week 4 after the completion of run-in period. Participants in both groups had similar LDL-c levels (142 ± 15.7 vs. 143 ± 19.3 mg/dL). After 4 weeks of exposure to test product, participants in the treatment group demonstrated a 17.25 ± 22.26 reduction in LDL-c (p < .05 vs. placebo). This improvement in LDL-c was accompanied by amelioration in TC and Apo B levels, without any detrimental effects on HDL and TG concentration. Results of the present study suggest that fiber-vitamin combination has potential to be used as an adjunct therapy for the management of hypercholesterolemia.

Impact of SLCO1B1 Pharmacogenetic Testing on Patient and Healthcare Outcomes: A Systematic Review.

Demonstrated improvements in patient outcomes will facilitate the clinical implementation of pharmacogenetic testing. Using the association between solute carrier organic anion transporter family member 1B1 (SLCO1B1) and statin-associated muscle symptoms (SAMSs) as a model, we conducted a systematic review of patient outcomes after delivery of SLCO1B1 results. Using PubMed and Embase searches through December 19, 2017, we identified 37 eligible records reporting preliminary or final outcomes, including six studies delivering only SLCO1B1 results and five large healthcare system-based implementation projects of multipharmacogene panels. Two small trials have demonstrated at least short-term improvements in low-density lipoprotein cholesterol after SLCO1B1 testing among previously statin intolerant patients. Evidence from large implementation projects suggests that SLCO1B1 results may change prescribing patterns for some high-risk patients. No study has reported improvements in SAMSs or cardiovascular events or tracked the economic outcomes of SLCO1B1 testing. Ongoing studies should collect and report outcomes relevant to pharmacogenetics stakeholders.

Effects of vitamin D supplementation on insulin resistance and dyslipidemia in overweight and obese premenopausal women.

IntroductionVitamin D deficiency is a common problem, and it is related to increased risk of obesity, metabolic syndrome, atherosclerosis, and cardiovascular disease. Vitamin D has a beneficial effect on dyslipidemia and insulin secretion. We aimed to investigate the impact of vitamin D3 supplementation on anthropometric and laboratory parameters in overweight and obese premenopausal women.Material and methodsSeventy-two overweight and 50 obese vitamin-D-deficient premenopausal women (mean age: 43.1 ±10.4 years) were included in the study. Baseline mean 25-hydroxyvitamin D [25(OH)D] level was 6.1 (min.–max. = 2.9–15.8) ng/ml in overweight and was 5.6 (min.–max. = 3.0–22.0) ng/ml in obese subjects. At baseline and at the sixth month of supplementation, serum 25(OH)D, intact parathormone (iPTH), calcium, phosphorus, homeostasis model assessment of insulin resistance (HOMA-IR), and lipid profiles were assessed.ResultsFollowing vitamin D3 supplementation in overweight and obese subjects, serum 25(OH)D increased from 6.1 to 34.7 ng/ml and 5.6 to 34.7 ng/ml, respectively (p < 0.001). At the sixth month of supplementation in both overweight and obese subjects, a significant reduction was detected in HOMA-IR (p < 0.001), low-density lipoprotein cholesterol (LDL-C) (p = 0.046, p = 0.044; respectively) and iPTH levels (p ≤ 0.001, p < 0.001; respectively). A negative adjusted correlation was found between changes in 25(OH)D and HOMA-IR (r = –0.581, p < 0.001; r = –0.389, p = 0.005; respectively). A 1 ng/ml increase in serum 25(OH)D level led to a 0.30-fold reduction in HOMA-IR level (p = 0.002).ConclusionsOur results support the effect of vitamin D3 supplementation in HOMA-IR and LDL-C improvement in both obese and overweight subjects. Further studies focused on low serum 25(OH)D levels with insulin resistance and dyslipidemia are needed.

IMPROVEMENT IN LDL IS ASSOCIATED WITH DECREASE IN NON-CALCIFIED PLAQUE VOLUME ON CTA AS MEASURED BY AUTOMATED QUANTITATIVE SOFTWARE

Background: Plaque analysis of coronary CT angiography (CTA) can provide comprehensive quantitative assessment of coronary plaque characteristics. Low density lipoprotein cholesterol (LDL) lowering is associated with plaque regression by IVUS. We tested the hypothesis that improvement in LDL is