Improvements In High-density Lipoprotein Cholesterol Research Articles

Efficacy and Safety of Pemafibrate, a Novel Selective PPARα Modulator in Chinese Patients with Dyslipidemia: A Double-Masked, Randomized, Placebo- and Active-Controlled Comparison Trial.

Pemafibrate substantially lowers serum triglyceride (TG) levels and increases high-density lipoprotein cholesterol (HDL-C) levels primarily in Japan, but it has not been evaluated in China. We aimed to confirm the efficacy and safety of pemafibrate in Chinese patients with hypertriglyceridemia and low HDL-C levels by comparing placebo and fenofibrate. A multicenter, double-masked trial was conducted in China involving 344 patients with high TG and low HDL-C levels randomly assigned to one of four groups: pemafibrate 0.2 mg/d, pemafibrate 0.4 mg/d, fenofibrate 200 mg/d, or placebo for 12 weeks. The primary endpoint was the percentage change in fasting TG levels. The percentage change in TG levels from baseline was -34.1%, -44.0%, -30.5%, and 6.5% in the pemafibrate 0.2 mg/d, pemafibrate 0.4 mg/d, fenofibrate 200 mg/d, and placebo groups, respectively. Pemafibrate 0.4 mg/d significantly reduced TG levels compared with that in both placebo (p＜0.0001) and fenofibrate groups (p=0.0083). Significant improvements in HDL-C, remnant cholesterol, and apolipoprotein A1 levels were also observed with both doses of pemafibrate than with the placebo. Pemafibrate showed significantly smaller changes in alanine aminotransferase, aspartate aminotransferase, and serum creatinine levels than those with fenofibrate. In Chinese patients, pemafibrate exhibited superior efficacy in improving TG levels and enhanced hepatic and renal safety compared to fenofibrate. Thus, pemafibrate may represent a promising therapeutic option for dyslipidemia in Chinese patients.

Synergistic effects of ursodeoxycholic acid, and quercetin on liver function and systemic inflammation in non-alcoholic fatty liver disease and atrial fibrillation patients

Background. Non-alcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) co-occur with signifi­cant clinical implications, necessitating therapeutic strategies that address the multifaceted nature of these conditions. This study evaluated the efficacy of standard treatment alone versus combined treatments with ursodeoxycholic acid (UDCA) and quercetin in patients with NAFLD and AF, focusing on improvements in liver function, lipid profile, systemic inflammation, and fibrosis markers. Aim: to evaluate and compare the efficacy of standard treatment alone versus standard treatment combined with ursodeoxycholic acid with and without quercetin in patients with non-alcoholic fatty liver disease and concurrent atrial fibrillation. Materials and methods. In a prospective, randomi­zed, controlled trial, 127 patients with diagnosed NAFLD and concurrent AF were enrolled. They were divided into three groups: group 1 — standard treatment (n = 42), group 2 — standard treatment plus UDCA (n = 44), and group 3 — standard treatment plus UDCA and quercetin (n = 41). The primary outcomes included changes in liver function tests (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase, alkaline phosphatase), lipid profile (total cholesterol, low- and high-density lipoprotein cholesterol (HDL-C), triglycerides), and non-invasive liver fibrosis scores (NFS, FIB-4). Secondary outcomes focused on systemic inflammation markers (C-reactive protein, galectin-3, soluble ST2) and fibronectin levels. Results. All treatment groups showed significant improvements in liver function tests and lipid profiles. Group 3 exhibited the most substantial reductions in ALT, AST, and improvements in HDL-C, indicating enhanced hepatoprotective and lipid-modulating effects. Systemic inflammation markers and fibronectin levels decreased significantly in groups receiving UDCA and quercetin, with the most pronounced effects observed in group 3, suggesting potent anti-inflammatory and anti-fibrotic action. Additionally, significant improvements in NFS and FIB-4 scores in group 3 highlight the anti-fibrotic potential of combining UDCA and quercetin with standard treatment. Conclusions. The addition of UDCA and quercetin to standard treatment for patients with NAFLD and AF significantly improves liver function, lipid metabolism, and reduces systemic inflammation and fibrosis, compared to standard treatment alone. These findings suggest a synergistic effect of UDCA and quercetin, offering a promising therapeutic strategy for managing the complex interplay between NAFLD and AF.

Intermittent energy restriction vs. continuous energy restriction on cardiometabolic risk factors in patients with metabolic syndrome: a meta-analysis and systematic review.

This is a systematic review and meta-analysis to compare the efficacy of intermittent energy restriction (IER) vs. continuous energy restriction (CER) on weight loss, body composition, blood pressure, and other cardiometabolic risk factors in patients with metabolic syndrome (MetS) risk factors. We searched and screened PubMed, Embase, Cochrane Library, and Web of Science from inception to May 8, 2022 for randomized controlled trials. Two review authors independently selected studies, extracted data, assessed quality and risk of bias and cross-checked extracts to resolve discrepancies when required. We expressed effect size as mean difference (MD) and 95% confidence interval (CI). The major outcome was the improvement of MetS risk factors, including changes in waist circumference (WC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), blood pressure (BP), and fasting plasma glucose (FPG) levels. The secondary outcomes were body weight (BW), body mass index (BMI), body fat (BF), fat free mass (FFM), hip circumference (HC), fasting insulin (FINs), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-c). The meta-analysis included 16 articles (20 trials) with a total of 1,511 participants. All studies had a low risk of bias for random sequence generation. The IER and CER intervention equally improved MetS risk factors WC (MD = -0.47, 95% CI [-1.19, 0.25]), TG (MD = -0.02 mmol/L, 95% CI [-0.11, 0.07]), FPG (MD = -0.02 mmol/L, 95% CI [-0.10, 0.05]) and BP (systolic blood pressure: MD = 0.93 mmHg, 95% CI [-2.74, 4.61]; diastolic blood pressure: MD =1.15 mmHg, 95% CI [-0.24, 2.55]), but HDL-c (MD = 0.03 mmol/L, 95% CI [0.01, 0.05]) was significant improved in IER when compared with CER. For second outcomes, BW (MD = -0.8 kg, 95% CI [-1.26, -0.33]), BF (MD = -0.75 kg, 95% CI [-1.73, -0.13]) and FFM (MD = -0.49 kg, 95% CI [-0.92, -0.05]) were also significant improved in IER, and not for other outcomes. Both IER and CER could improve MetS biomarkers, but IER was more effective than CER in the improvement of HDL-c only. For secondary outcomes, IER was also more effective for BW, BF and FFM, but there were no differences in effects for other outcomes.

Effects of the different Tai Chi exercise cycles on patients with essential hypertension: A systematic review and meta-analysis.

The main treatment for essential hypertension at this stage is pharmacotherapy. Long-term pharmacotherapy is costly with some side effects. Tai Chi, a bright star in traditional Chinese arts, relaxes both mind and body and has been shown to relax blood vessels and lower blood pressure. This study aimed to systematically review the therapeutic effectiveness of the Tai Chi exercise cycle on blood pressure and cardiovascular risk factors of patients with essential hypertension. Searching CNKI, VIP, CBM, PubMed, EBSCO, Embase, Cochrane Library, and Web of Science to collect randomized controlled trials about Tai Chi exercise in the treatment of patients with essential hypertension according to the inclusion and exclusion criteria. The search time ranged from the date of database construction to December 2022. The Cochrane risk-of-bias tool was used to evaluate the included trials. The meta-analysis was performed with RevMan5.3 and Stata12.0 software. According to the meta-analysis, compared with the controls, Tai Chi exercise with a cycle of more than 12 weeks may be better for the reduction of systolic blood pressure (SBP) [MD = -11.72, 95% CI (-15.52, -7.91)] and diastolic blood pressure (DBP) [MD = -4.68, 95% CI (-7.23, -2.12)], as well as increasing the content of nitric oxide (NO) [MD = 0.99, 95% CI (0.69, 1.28)]. The blood lipid metabolism ability may also be improved after more than 12 weeks of Tai Chi exercise, total cholesterol (TC) [SMD = -0.68, 95% CI (-0.89, -0.46), triglyceride (TG) [SMD = -0.84, 95% CI (-1.25, -0.43)], low-density lipoprotein cholesterol (LDL-C) [SMD = -1.58, 95% CI (-2.29, -0.86)]. However, the improvement of high-density lipoprotein cholesterol (HDL-C) [SMD = 0.54, 95% CI (0.28, 0.79)] was better with a less than 12 weeks exercise cycle. A subgroup analysis for exercise frequency and time showed that the exercise frequency should preferably be more than or equal to 5 times per week for patients with hypertension, and for patients with hypertension plus hyperlipidemia, the exercise frequency less than 5 times per week with exercise time less than 60 min each day may be more beneficial. The meta-analysis indicated that a more than 12 weeks Tai Chi exercise cycle with less than 60 min each time and more than 5 times per week may be more beneficial in blood pressure reduction, NO level increasing and blood lipid metabolism improving in the comparison with the other exercise cycles. For patients with hypertension plus hyperlipidemia, exercise frequency of less than 5 times per week may be better. [http://www.crd.york.ac.uk/prospero], identifier [CRD42022352035].

Antidiabetic and antioxidative effects of Lepisanthes fruticosa fruit seed extract in type 2 diabetic experimental rats

Lepisanthes fruticosa (Roxb) Leenh or locally known as ceri Terengganu is an underutilised fruit species from the Sapindaceae family. The species was previously identified as a potent antioxidant source, but scientific information is still lacking and limited to in vitro. Therefore, the present study aimed to investigate the in vivo antidiabetic and antioxidative effects of L. fruticosa fruit seed extract (LFSE) in a high-fat diet, streptozotocin (HFD/STZ)-induced Sprague Dawley rats. After 8 weeks of HFD feeding, a low-dose STZ (35 mg/kg body weight) was injected to induce type 2 diabetes mellitus (T2DM). Two dosages of LFSE (300 and 600 mg/kg body weight) were orally administered to diabetic rats for 4 weeks. High dosage LFSE (600 mg/kg body weight) showed a more pronounced effect in anti-hyperglycemic activities as indicated by both sub-chronic and acute studies. The glucose-lowering ability of LFSE was supported by its improved serum insulin level (40%) as compared to diabetic control. LFSE (600 mg/kg) also resulted in a significant (P<0.05) increase in superoxide dismutase (SOD) (20%) and catalase (CAT) (43%) activities, with a significant (P<0.05) decrease in lipid peroxidation (28%) as compared to diabetic control. With regard to lipid profile, low dosage LFSE (300 mg/kg) led to a significant (P<0.05) improvement in high-density lipoprotein cholesterol (HDL-c) (39%). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of LFSE showed the presence of various phytochemicals with antidiabetic and antioxidant properties, with α-kojibiose, genistein-7,4'-di-O-β-D-glucoside and soyacerebroside II being the predominant ones. The findings may suggest that L. fruticosa fruit seed extract is potential in reducing hyperglycaemia and enhancing antioxidant status in HFD/STZ-induced diabetic rats. Therefore, it can be concluded that L. fruticosa fruit species may be considered as a promising candidate for a new and safe alternative remedy for the prevention and treatment of T2DM.

The effect of a siamese pumpkin and tuna-based powder (CHAGURO) diet in improving chol/HDL ratios in prediabetes individuals with dyslipidemia: a randomised trial

Background: The study aimed to examine the effect of administering CHAGURO (a product of the combination of siamese pumpkin and tuna-based powder) on the lipid profile in prediabetes individuals with dyslipidemia. Methods: The experimental trial was conducted with two intervention groups, with each group receiving a dose of 7.5g/70kg body weight (BW)/day (low dose) and 15g/70kg BW/day (high dose) for 60 days. Respondents in each group ranged in age from 30 to 60 years old. Prediabetes was defined as fasting blood sugar levels of 100-125 mg/dL, while cholesterol levels of 200 mg/dL was considered dyslipidemia. The mean baseline HbA1c level for all subjects was 5.5%. Respondents were randomized into intervention groups using simple randomization. Pre-test and post-test measurements were performed for body mass index (BMI), physical activity (using IPAQ-SF), hemoglobin A1c (HbA1c), lipid profile, blood pressure, and food intake (using SQ-FFQ). Statistical analyses performed included descriptive tests, independent and paired T-tests, and analysis of variance (ANOVA). Results: Compared to the baseline, HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides in the two groups did not improve significantly by 60 days. For lipid variables, a significant improvement in the cholesterol/high-density lipoprotein (chol/HDL) ratios were observed when compared against the baseline for the two groups. When comparing the changes between groups, 7.5 g of CHAGURO showed a larger improvement in HDL-C (mean differences: 1.86 mg/dL; 95% CI: -0.86-4.59), compared to 15 g of CHAGURO (mean differences: -3.62 mg/dL; 95% CI: -7.53-0.28). A significant (p<0.05) decrease in the chol/HDL ratio was observed in the 7.5 g CHAGURO group (mean differences: -0.20 mg/dL; 95% CI: -0.39-(-0.01)). Conclusions: CHAGURO can be a functional food alternative to improve the condition of prediabetes people with dyslipidemia. Trial registration: Dr. Sardjito General Hospital (KE/FK/0951/EC/2020), 27/08/2020

Effect of the addition of thiazolidinedione to sodium-glucose cotransporter 2 inhibitor therapy on lipid levels in type 2 diabetes mellitus: a retrospective study using Korean National Health Insurance Service data

Background: Dyslipidemia is common in patients with type 2 diabetes mellitus (T2D) and contributes to an increased risk of cardiovascular disease. Previous studies have shown that treatment with thiazolidinediones (TZDs) and sodium-glucose cotransporter-2 inhibitors (SGLT2-i) may help to improve dyslipidemia in T2D patients. In this study, we investigated whether patients treated with TZD and SGLT2-i showed greater improvement in high-density lipoprotein cholesterol (HDL-C) levels than those treated with only SGLT2-i.Methods: From the National Health Insurance Service database of Korea, we extracted all patients who first received SGTL2-i from 2014 to 2016. Propensity score matching was performed to balance the two groups: group A (SGTL2-i and TZD, regardless of other antidiabetic medications) and group B (SGTL2-i only without TZD, regardless of other antidiabetic medications). Posttreatment HDL-C levels were compared by the Student t-test.Results: In total, 1,400 T2D patients (700 in each group) were matched by propensity score matching. There was a significant posttreatment increase in HDL-C in group A (49.54±20.03 to 51.6±12.92 mg/dL, P=0.007), but not in group B (49.14±13.52 to 49.1±2.15 mg/dL, P=0.937). Group A also showed significantly higher posttreatment HDL-C levels than group B (51.4±12.92 vs. 49.1±12.15 mg/dL, P<0.001). Regarding the secondary endpoints, posttreatment triglyceride levels were lower (P<0.001), but total cholesterol (P=0.131) and low-density lipoprotein cholesterol levels (P=0.054) were not different after treatment.Conclusions: The combination of SGTL2-i and TZD may be more effective in ameliorating dyslipidemia in T2D patients than SGLT2-i alone. However, further studies are needed to confirm this finding.

The effect of a siamese pumpkin and tuna-based powder (CHAGURO) diet in improving chol/HDL ratios in prediabetes individuals with dyslipidemia: a randomised trial

Background: The study aimed to examine the effect of administering CHAGURO (a product of the combination of siamese pumpkin and tuna-based powder) on the lipid profile in prediabetes individuals with dyslipidemia. Methods: The experimental trial was conducted with two intervention groups, with each group receiving a dose of 7.5g/70kg body weight (BW)/day (low dose) and 15g/70kg BW/day (high dose) for 60 days. Respondents were randomized into intervention groups using simple randomization. Before and after the intervention, pre-test and post-test examinations were performed, factors examined included hemoglobin A1c (HbA1c), lipid profile, blood pressure, food intake with the SQ-FFQ (Semi Quantitative-Food Frequency Questionnaire) interview, body mass index (BMI), and physical activity using International Physical Activity Questionnaires-Short Form (IPAQ-SF). During the intervention, blood pressure and BMI data were taken before and after the study. Statistical analysis included descriptive tests, independent and paired T-tests, and analysis of variance (ANOVA). Results: Compared to the baseline, HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides in the two groups did not improve significantly by 60 days. For lipid variables, a significant improvement in the cholesterol/high-density lipoprotein (chol/HDL) ratios were observed when compared against the baseline for the two groups. When comparing the changes between groups, 7.5 g of CHAGURO showed a larger improvement in HDL-C (mean differences: 1.86 mg/dL; 95% CI: -0.86-4.59), compared to 15 g of CHAGURO (mean differences: -3.62 mg/dL; 95% CI: -7.53-0.28). A significant (p<0.05) decrease in the chol/HDL ratio was observed in the 7.5 g CHAGURO group (mean differences: -0.20 mg/dL; 95% CI: -0.39-(-0.01)). Conclusions: CHAGURO can be a functional food alternative to improve the condition of prediabetes people with dyslipidemia. Trial registration: Dr. Sardjito General Hospital (KE/FK/0951/EC/2020), 27/08/2020

The effect of a siamese pumpkin and tuna-based powder (CHAGURO) diet in improving HbA1c, HDL-C, and chol/HDL ratios in prediabetes individuals with dyslipidemia: a randomised trial

Background: The study aimed to examine the effect of administering CHAGURO (a product of the combination of siamese pumpkin and tuna-based powder) on the lipid profile in prediabetes individuals with dyslipidemia. Methods: The experimental trial was conducted with two intervention groups, with each group receiving a dose of 7.5g/70kg body weight (BW)/day (low dose) and 15g/70kg BW/day (high dose) for 60 days. Respondents were randomized into intervention groups using simple randomization. Before and after the intervention, pre-test and post-test examinations were performed, factors examined included hemoglobin A1c (HbA1c), lipid profile, blood pressure, eating intake with the SQ-FFQ (Semi Quantitative-Food Frequency Questionnaire) interview, body mass index (BMI), and physical activity using InternationalPhysical Activity Questionnaires-Short Form (IPAQ-SF). During the intervention, blood pressure and BMI data were taken before and after the study. Statistical analysis included descriptive tests, independent and paired T-tests, and analysis of variance (ANOVA). Results: Compared to the baseline, HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides in the two groups did not improve significantly by 60 days. For lipid variables, a significant improvement in the cholesterol/high-density lipoprotein (chol/HDL) ratios were observed when compared against the baseline for the two groups. When comparing the changes between groups, 7.5 g of CHAGURO showed a larger improvement in HDL-C (mean differences: 1.86 mg/dL; 95% CI: -0.86-4.59), compared to 15 g of CHAGURO (mean differences: -3.62 mg/dL; 95% CI: -7.53-0.28). A significant (p<0.05) decrease in the chol/HDL ratio was observed in the 7.5 g CHAGURO group (mean differences: -0.20 mg/dL; 95% CI: -0.39-(-0.01)). Conclusions: CHAGURO can be a functional food alternative to improve the condition of prediabetes people with dyslipidemia. Trial registration: Dr. Sardjito General Hospital (KE/FK/0951/EC/2020), 27/08/2020

Women\u2019s outcomes following mixed-sex, women-only, and home-based cardiac rehabilitation participation and comparison by sex

BackgroundDespite women’s greater need for cardiac rehabilitation (CR), they are less likely to utilize it. Innovative CR models have been developed to better meet women’s needs, yet there is little controlled, comparative data assessing the effects of these models for women. This study compared outcomes in women electing to participate in mixed-sex, women-only, or home-based CR, and a matched sample of men.MethodsIn this retrospective study, electronic records of CR participants in Toronto who were offered the choice of program model between January 2017 and July 2019 were analyzed; clinical outcomes comprised cardiorespiratory fitness, risk factors and psychosocial well-being. These were assessed at intake and post-6-month program and analyzed using general linear mixed models.ResultsThere were 1181 patients (727 women [74.7% mixed, 22.0% women-only, 3.3% home-based]; 454 age and diagnosis-matched men) who initiated CR; Cardiorespiratory fitness among women was higher at initiation of mixed-sex than women-only (METs 5.1 ± 1.5 vs 4.6 ± 1.3; P = .007), but no other outcome differences were observed. 428 (58.9%) women completed the programs, with few women retained in the home-based model limiting comparisons. There were significant improvements in high-density lipoprotein cholesterol (P = .001) and quality of life (P = .001), and lower depressive symptoms (P = .030) as well as waist circumference (P = .001) with mixed-sex only. VO2peak was significantly higher at discharge in mixed-sex than women-only (estimate = 1.67, standard error = 0.63, 95% confidence interval = 0.43–2.91).ConclusionParticipation in non-gender-tailored women-only CR was not advantageous as expected. More research is needed, particularly including women participating in home-based programs.

Mixed Effects of Neighborhood Revitalization on Residents’ Cardiometabolic Health

Despite the growing recognition of the importance of neighborhood conditions for cardiometabolic health, causal relationships have been difficult to establish owing to a reliance on cross-sectional designs and selection bias. This is the first natural experiment to examine the impact of neighborhood revitalization on cardiometabolic outcomes in residents from 2 predominantly African American neighborhoods, one of which has experienced significant revitalization (intervention), whereas the other has not (comparison). The sample included 532 adults (95% African American, 80% female, mean age=58.9 years) from 2 sociodemographically similar, low-income neighborhoods in Pittsburgh, PA, with preintervention and postintervention measures (2016 and 2018) of BMI, diastolic and systolic blood pressure, HbA1c, and high-density lipoprotein cholesterol and covariates. Data were collected in 2016 and 2018 and analyzed in 2020. Difference-in-difference analyses showed significant improvement in high-density lipoprotein cholesterol in intervention residents relative to that in the comparison neighborhood (β=3.88, 95% CI=0.47, 7.29). There was also a significant difference-in-difference estimate in diastolic blood pressure (β=3.00, 95% CI=0.57, 5.43), with residents of the intervention neighborhood showing a greater increase in diastolic blood pressure than those in the comparison neighborhood. No statistically significant differences were found for other outcomes. Investing in disadvantaged neighborhoods has been suggested as a strategy to reduce health disparities. Using a natural experiment, findings suggest that improving neighborhood conditions may have a mixed impact on certain aspects of cardiometabolic health. Findings underscore the importance of examining the upstream causes of health disparities using rigorous designs and longer follow-up periods that provide more powerful tests of causality.

Anti-Interleukin-17 Therapy of Severe Psoriatic Patients Results in an Improvement of Serum Lipid and Inflammatory Parameters’ Levels, but Has No Effect on Body Composition Parameters

BACKGROUND: Psoriasis is frequently accompanied by metabolic syndrome. Effect of anti-tumor necrosis factor therapies on increases in body weight is well-known. Data on the effects of interleukin-17 inhibitors are limited. Authors determined the effect of anti-interleukin-17 therapies on the body composition and serum lipid and inflammatory parameters among severe psoriatic patients. METHODS: Thirty-five severe psoriatic patients were enrolled. Twenty-two received secukinumab and 13 received ixekizumab as their 2nd-or 3rd-line biological treatment. Before treatment initiation and 6 months later, laboratory examinations measuring metabolic and inflammatory panels and body composition analyses were performed. RESULTS: After 6 months, a significant reduction was observed in psoriasis area severity index (p < 0.001) from 18 to 0, in c-reactive protein (p < 0.001) from 6.6 to 4.00 mg/L, in low-density lipoprotein-cholesterol (p = 0.004) from 3.69 to 3.19 mmol/L, and an improvement in high-density lipoprotein-cholesterol (p = 0.022) from 1.31 to 1.40 mmol/L. Median baseline body mass index was 32.80 kg/m2. The body composition parameters did not show any significant changes. CONCLUSIONS: Anti-interleukin-17 therapy of severe psoriatic patients does not cause significant changes in body composition parameters. Improvements in the lipid and inflammatory parameters might have a beneficial effect on patients’ cardiometabolic status. This effect might be detectable in high-risk obese psoriatic patients.

Effects of catheter-based renal denervation on glycemic control and lipid levels: a systematic review and meta-analysis.

As an emerging interventional technique to treat resistant hypertension, renal denervation (RDN) has also attracted considerable attention due to its potential beneficial effects on glucose and lipid metabolism. Given that inconsistent results were documented among studies, we aimed to perform a systematic review and meta-analysis to elaborate on this issue. The PubMed, EMBASE, Web of Science (SCI) and ClinicalTrials.gov databases were comprehensively searched from their inception date to June 18, 2020, for relevant clinical studies evaluating the efficacy of RDN on glucose and lipid levels. The outcomes of interest were changes in fasting glucose, insulin, C-peptide, hemoglobin A1C (HbA1C), homeostatic model assessment-insulin resistance (HOMA-IR), cholesterol and triglyceride (TG) levels before versus after RDN and also RDN versus the control group. The mean differences (MDs) of the outcomes measured before versus after RDN and RDN versus the control group were pooled by a randomized effects model. Heterogeneity was quantified with Chi-square (χ2) and inconsistency index (I2). Assessment of publication bias was performed by the funnel plot and Egger's test. A total of 1600 studies were initially identified. Nineteen of the identified studies (six randomized controlled studies, one non-randomized controlled studies and 12 observational cohort studies) involving 2245 subjects were included in the final analysis. No significant change was observed after RDN in fasting glucose (weighted mean difference [WMD] - 0.19mmol/L; 95% CI - 0.37, 0.00mmol/L), insulin (standardized mean difference [SMD] - 0.01; 95% CI - 0.41, 0.39), C-peptide (SMD - 0.05; 95% CI - 0.30, 0.21), HbA1C (SMD - 0.05; 95% CI - 0.17, 0.07), HOMA-IR (SMD - 0.29; 95% CI - 0.72, 0.14), total cholesterol (TC) (WMD - 0.11mmol/L; 95% CI - 0.37, 0.15mmol/L), and low-density lipoprotein cholesterol (LDL-C) levels (WMD - 0.18mmol/L; 95% CI - 0.59, 0.24mmol/L) during follow-up. Changes in fasting glucose, insulin, HbA1C and TC levels in RDN groups were not significantly different from those in the control group. High-density lipoprotein cholesterol (HDL-C) and TG were slightly improved after RDN (WMD 0.07mmol/L, 95% CI 0.01, 0.14mmol/L; WMD - 0.26mmol/l, 95% CI - 0.51, - 0.01mmol/L, respectively). The funnel plot and Egger's test demonstrated the absence of potential publication bias. Catheter-based RDN appeared to have no impact on glucose metabolism. There was a statistically significant but clinically negligible improvement in HDL-C and TG levels based on the current evidence. Future research with more rigorous designs is warranted to draw definitive conclusions. The protocol of this meta-analysis was registered on PROSPERO (CRD42020192805). ( https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=192805 ).

Bempedoic Acid and Ezetimibe for the Treatment of Hypercholesterolemia: A Systematic Review and Meta-Analysis of Randomized Phase II/III trials.

A systematic literature search was conducted to identify randomized controlled trials (RCTs) comparing bempedoic acid and ezetimibe, versus placebo or ezetimibe alone, to 30 August 2020. A meta-analysis was conducted to investigate the efficacy of bempedoic acid and ezetimibe on lipid parameters and highly sensitive C-reactive protein (hsCRP) levels in patients with hypercholesterolemia or established atherosclerotic cardiovascular disease (ASCVD). Mean differences (MDs) or relative risk (RR) with their corresponding 95% confidence intervals (CIs), using random-effects models, were used to provide pooled estimates. A total of three phase II and III RCTs, comprising 388 patients, of whom 49.2% were treated with bempedoic acid and ezetimibe, and 197 controls, were identified. The duration of treatment was 12 weeks. Bempedoic acid and ezetimibe significantly reduced low-density lipoprotein cholesterol (MD - 29.14%, 95% CI - 39.52 to - 18.76; p<.001), total cholesterol (MD - 15.78%, 95% CI - 20.84 to - 10.72; p=0.01), non-high-density lipoprotein cholesterol (MD - 18.36%, 95% CI - 24.60 to - 12.12; p=0.01), and hsCRP levels (MD - 30.48%, 95% CI - 44.69 to - 16.28; p=0.04). No significant effects on triglycerides (MD - 8.35%, 95% CI - 16.08 to - 0.63; p=0.72) and improvement in high-density lipoprotein cholesterol (MD 1.63%, 95% CI - 4.03 to 7.28; p=0.92) were observed with the fixed-dose combination therapy. Regarding safety, bempedoic acid and ezetimibe combination was associated with a non-significant increased risk of drug-related adverse events (RR 1.61, 95% CI 0.86-2.35) and overall adverse events (RR 1.16. 95% CI 0.97-1.35); however, the incidence of discontinuation of therapy (RR 0.75, 95% CI 0.35-1.49) was lower. This review found bempedoic acid and ezetimibe significantly lowered lipid parameters, attenuated hsCRP levels, and had an acceptable safety profile for the treatment of hypercholesterolemia and ASCVD.

Effects of walking training on risk markers of cardiovascular disease in individuals with chronic spinal cord injury

Objective To investigate the effects of an 8-week walking training program on glycemic control, lipid profile, and inflammatory markers in individuals with chronic spinal cord injury (SCI). Design A pilot, single-group, pretest-posttest study. Setting A neuromuscular research laboratory. Participants Eleven participants with chronic SCI. Intervention An 8-week walking training program using a treadmill, a body weight-supported system, and an assistive gait training device. Outcome Measures Levels of glycated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), and interleukin-6 were assessed before and after the walking training. Results Following the walking training, there was a statistically significant decrease in HbA1c level (P<0.01) of uncertain clinical significance. The lipid profile improved after training, as shown by a statistically and clinically significant increase in HDL-C level (P<0.01) and a statistically significant decrease in LDL-C level (P<0.1) of no clinical significance. The ratio of LDL-C to HDL-C was significantly reduced (P<0.01). In regard to inflammatory markers, concentrations of IL-6 showed a significant reduction after training (P=0.05) of unknown clinical significance, while those of CRP trended to decrease (P=0.13). Conclusion The findings of this pilot study suggest that an 8-week walking training program may produce favorable changes in risk markers of cardiovascular disease in individuals with chronic SCI as shown by clinically meaningful improvements in HDL-C, and small changes in the right direction, but uncertain clinical significance, in HbA1c, LDL-C and IL-6. A randomized controlled trial is needed to compare the effects of walking training on these outcome measures with those of other exercise modalities suitable for this population, and to see if more prolonged exercise exposure leads to favorable parameters of significant size to justify the exercise modality.

Effects of Basal Insulin on Lipid Profile Compared to Other Classes of Antihyperglycemic Agents in Type 2 Diabetic Patients.

The lipid profile represents a driver of cardiovascular risk in type 2 diabetes. The effect of chronic insulin therapy on cholesterol levels is unclear. We aim to evaluate the effect of basal insulin on lipid profile compared to other classes of antihyperglycemic agents in type 2 diabetic patients. We performed a meta-analysis of randomized controlled trials reporting changes of lipid parameters in type 2 diabetic patients randomly assigned to basal insulin or other classes of anti-hyperglycemic agents. The levels of total (TC) and low-density lipoprotein cholesterol (LDL-C) appeared to be significantly reduced by therapies with glucagon-like peptide-1 receptor agonists (GLP-1RA) in comparison to basal insulin (mean difference [MD] -3.80; 95% CI [-6.30 to -1.30] mg/dL, P < .001 and -4.17; 95% CI [-6.04 to -2.30] mg/dL, P < .0001), whereas no difference was detected between basal insulin and dipeptidyl peptidase-4 inhibitors (DPP4-I) or standard therapy (sulfonylurea ± metformin). Thiazolidinediones (TZD) produced a significant improvement in high-density lipoprotein cholesterol (HDL-C) (MD 3.55; 95% CI: 0.55 to 6.56 mg/dL, P = .02) but were associated with an increase in TC and LDL-C (MD 16.20; 95% CI: 9.09 to 23.31 mg/dL, P < .001 and 5.19: 95% CI: -3.00 to 13.39 mg/dL, P = .21). Basal insulin was superior to standard therapy in triglyceride reduction (MD 3.8; 95% CI: 0.99 to 6.63 mg/dL, P = .008). GLP-1RA were superior to basal insulin in the control of TC and LDL-C. Basal insulin effectively reduced serum triglycerides. TZD led to improvement in HDL-C. DPP4-I and standard therapy did not have any significant effect on lipid levels.

Inter-individual variation in response to resistance training in cardiometabolic health indicators.

Previously collected data of men and women (39-73years, 135 trained, 73 non-trained controls) were pooled for analysis. Measurements were taken twice before training to estimate individual day-to-day variations and measurement errors (n=208). The individual responsiveness to the 21-week RT in cardiometabolic health indicators (ie, systolic blood pressure, high-density lipoprotein cholesterol (HDL-C), cholesterol and triglycerides) was determined. Body composition was estimated by bioimpedance and dietary intake according to 4-day food diaries. Metabolic responses to RT seemed to be highly individual, and both beneficial and unfavorable changes were observed. Large inter-individual variations in training response were not explained by a subject's age, sex, body composition, or nutritional status, with the exception of improvements in HDL-C, which were associated with simultaneous decreases in body fat in older women. The incidence of metabolic syndrome diminished following RT. This study showed that RT could improve some specific metabolic health indicators beyond normal day-to-day variations, especially in blood lipid profile. Further studies are needed to elucidate genetic and other mechanisms underlining the heterogeneity of RT responses. This knowledge may be useful in providing individually tailored exercise prescriptions as part of personalized preventative health care.

Effect of short-term naturopathy and yoga intervention on anthropometric variables, lipid profile and thyroid profile in obese hypothyroid patients: a randomised controlled trial

Background: Hypothyroidism reflects decreased thyroid function and is one of the most common conditions seen in clinical practice. Practice of naturopathy and yoga has shown improvement in anthropometric variables and lipid profile in obesity and other chronic diseases. So, the aim of this study was to find out the effect of naturopathy and yoga in obese hypothyroid patients.Methods: A total of 60 subjects, of which 29 males (age 44.2±7.0 years) and 31 females (age 40.6±7.4 years) with body mass index (BMI), ≥30 were randomly assigned to case group (n=30) and wait list control group (n=30). The subjects of case group underwent naturopathy and yoga intervention for 10 days. Anthropometric variables, viz., body weight, BMI, waist circumference (WC) and hip circumference, serum lipid profile, and serum thyroid profile were assessed at 1st day (pre), at the end of 10 day (post).Results: The result showed a significant reduction in body weight, BMI, WC, total cholesterol, low density lipoprotein-cholesterol (LDL-C) and thyroid stimulating hormone (TSH) along with significant improvement in high density lipoprotein-cholesterol (HDL-C) in case group compared with control group in independent samples t test. Significant reduction in body weight, BMI, total cholesterol, LDL-C and TSH were observed in case group unlike in control group in student's paired t test.Conclusions: Reduction in the body weight, BMI and improvement in serum lipid profile and serum thyroid profile in case group subjects compared to control group suggest that naturopathy and yoga have therapeutic and protective effects in the management of obese hypothyroid patients.

Can baseline cardiometabolic markers predict the efficacy of carbohydrate restriction in healthy adults? A pilot study

**Background.** Low-carbohydrate diets are frequently used and are effective for improving a range of health outcomes. There is some evidence to suggest that certain individuals will achieve greater results from higher- or lower-carbohydrate diets but at this time there is little evidence to indicate the relative ‘appropriateness’ of diets differing in carbohydrate content for an individual. This study explores associations between baseline and changes in blood measures of cardiometabolic health, relative to carbohydrate allocation. **Methods.** Seventy-seven healthy, non-diabetic participants (25 males, 52 females; mean age: 39 years, range: 25 to 49; mean body mass index (BMI) 27 kg/m2, range: 20-39) participated in a 12-week, randomised, clinical intervention study. Participants completed baseline testing of blood measures and basic anthropometric measures and a lead-in week to identify habitual calorie intake. Participants were assigned to one of three low-carbohydrate diet plans which advised intakes of either 5%, 15%, or 25% of energy derived from carbohydrate, individualised to the participant and standardised for protein, at 1.4 g per kg of body weight (bw) per day. For the final nine weeks of the intervention they were advised to eat ad libitum but to adhere as closely as possible to the carbohydrate energy limit for their treatment group. Participants were instructed to continue habitual exercise patterns. Blood measures of cardiometabolic health (glucose, insulin, c-peptide, total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides (TG)) and anthropometric measures (height, weight, and waist and hip girth) were measured at baseline and at the conclusion of the 12-week dietary intervention. The associations between baseline blood and anthropometric measures and the changes in these measures were made by undertaking multiple linear regression for the baseline measure and treatment group as independent variables with the change in outcome measures as dependent variables. **Results.** There was a greater improvement in participants who had more adverse baseline cardiometabolic measures from a greater carbohydrate restriction, with 7 of 11 measures most benefiting from a very low carbohydrate ketogenic diet (VLCKD) intervention relative to baseline measurements. Only HDL cholesterol reached between-group significance, with every 1 mmol/L higher HDL cholesterol at baseline associated with a 0.5 and 0.2 mmol/L improvement in HDL cholesterol for the moderate-low carbohydrate diet and low-carbohydrate diet groups respectively, and a 0.4 mmol/L worsening for VLCKD (_p_ = 0.0006). **Conclusions.** Overall, there is a consistent association between baseline markers of cardiometabolic health and changes in these markers relative to the amount of carbohydrate included in the diet. However, low HDL cholesterol might be improved most by a moderate restriction of carbohydrate to ~25% of TE when compared to greater carbohydrate restriction. Because most results were not significant due to the small sample size and preliminary nature of this study, further research is required with larger cohorts to investigate this hypothesis further.

Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: A randomised clinical trial.

BackgroundLow-carbohydrate, high-fat (LCHF) diets are useful for treating a range of health conditions, but there is little research evaluating the degree of carbohydrate restriction on outcome measures. This study compares anthropometric and cardiometabolic outcomes between differing carbohydrate-restricted diets.ObjectiveOur hypothesis was that moderate carbohydrate restriction is easier to maintain and more effective for improving cardiometabolic health markers than greater restriction.DesignA total of 77 healthy participants were randomised to a very low-carbohydrate ketogenic diet (VLCKD), low-carbohydrate diet (LCD), or moderate-low carbohydrate diet (MCD), containing 5%, 15% and 25% total energy from carbohydrate, respectively, for 12-weeks. Anthropometric and metabolic health measures were taken at baseline and at 12 weeks. Using ANOVA, both within and between-group outcomes were analysed.ResultsOf 77 participants, 39 (51%) completed the study. In these completers overall, significant reductions in weight and body mass index occurred ((mean change) 3.7 kg/m2; 95% confidence limits (CL): 3.8, 1.8), along with increases in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, (0.49 mmol/L; 95% CL; 0.06, 0.92; p = 0.03), and total cholesterol concentrations (0.11 mmol/L; 95% CL; 0.00, 0.23; p = 0.05). Triglyceride (TG) levels were reduced by 0.12 mmol/L (95% CL; −0.20, 0.02; p = 0.02). No significant changes occurred between groups. The largest improvements in high density lipoprotein cholesterol (HDL-c) and TG and anthropometric changes occurred for the VLCKD group.ConclusionsLow-carbohydrate, high-fat diets have a positive effect on markers of health. Adherence to the allocation of carbohydrate was more easily achieved in MCD, and LCD groups compared to VLCKD and there were comparable improvements in weight loss and waist circumference and greater improvements in HDL-c and TG with greater carbohydrate restriction.