LDL-C Values Research Articles

Abstract 11524: Ezetimibe Consistently Reduces LDL-C with Little Interindividual Variability in 14,970 Patients Post-ACS

Introduction: Ezetimibe (EZE) added to statin further reduces LDL-C and CV events. Prior studies demonstrated large inter-individual variability in LDL-C reduction with statins. Whether similar variability exists with EZE has not been reported in a large study. Methods: We assessed the placebo (PBO)-adjusted LDL-C reduction from randomization to 4 months in IMPROVE-IT, a double-blind RCT of EZE vs placebo (PBO) added to simvastatin (SIMVA) post-ACS. Inter-individual variation in % LDL-C reduction was calculated via rank-ordered subtraction of PBO/SIMVA from EZE/SIMVA. Patients not on study drug or with missing LDL-C values at either timepoint were excluded. Using the overall distribution of PBO-adjusted LDL-C reductions with EZE, we modelled the % of patients anticipated to achieve guideline-recommended LDL-C targets at 4 months with the addition of EZE across a range of baseline LDL-C values. Results: In 14,970 pts, the median baseline LDL-C in both groups was 80 mg/dL (IQR 65-96). The median change from baseline at 4 months was -37% (IQR -20% to -51%) in the EZE/SIMVA arm and -14% (IQR +7% to -31%) with PBO/SIMVA ( Panel A ). The PBO-adjusted median change in LDL-C at 4 months with EZE/SIM was -23% with low variability (IQR -19 to -27%; Panel A) . Based on this distribution, modelling predicts that fewer than half of patients would achieve the U.S. and European targets of <70 and <55 mg/dL when the baseline LDL-C is >91 mg/dL and >72 mg/dL, respectively, with the addition of EZE to statin therapy ( Panel B ). Conclusions: Addition of EZE to statin therapy results in a consistent median 23% reduction in LDL-C, with 75% of patients achieving at least a 19% reduction. The distribution of LDL-C reduction can be used to estimate how likely a patient will be to achieve guideline LDL-C targets with the addition of EZE to statin therapy.

Abstract 9936: Impact of Lipids on Cardiovascular Disease in Healthy Individuals Without Dyslipidemia and with a Low Burden of Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis)

Introduction: The association between lipids and CVD among healthy persons without dyslipidemia is incompletely defined. Objectives: To determine the cross-sectional associations of lipids with subclinical atherosclerosis and 10-year incident CVD events among healthy participants with a low burden of cardiovascular risk factors. Methods: The analysis included 1,204 participants from the Multi-Ethnic Study of Atherosclerosis, who had no prior CVD events and were without current smoking, hypertension (BP ≥130/80 mmHg or antihypertensive use), diabetes (fasting glucose ≥126 mg/dl or glucose-lowering drug use), and dyslipidemia (LDL-C ≥160 mg/dl, HDL-C <40 mg/dl, TC ≥240 mg/dl, TG ≥150 mg/dl, or lipid-lowering drug use) at baseline. Multivariable relative risk regression and Cox proportional-hazard regression were used in the analyses for subclinical atherosclerosis (presence of carotid plaque and/or coronary artery calcium) and CVD, respectively. Results: At baseline, participants’ median (IQR) age was 54 (49-62) years, mean LDL-C, TC, and HDL-C values were 112.1, 188.0, and 57.9 mg/dl, and median TG was 83.0 mg/dl. Subclinical atherosclerosis was presented in 43% of (n=522) participants. A 1-SD higher LDL-C, TC, non-HDL-C, TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C was associated with a 6-9% higher prevalence of subclinical atherosclerosis (all p<0.05). Over 10 years, 42 CVD events were recorded. For every 1-SD higher LDL-C (23.4 mg/dl), HDL-C (13.5 mg/dl), and non-HDL-C (25.3 mg/dl), HRs (95%CIs) for 10-year incident CVD events were 1.40 (1.01-1.96), 0.63 (0.41-0.96), and 1.44 (1.02-2.02). Similar associations with CVD were also observed for TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C. TG was not associated with any outcome. ( Table 1 ) Conclusions: Except for TG, all lipids were associated with atherosclerosis and/or incident CVD, demonstrating a continuum of risk for lipids with subclinical atherosclerosis and CVD among healthy persons without dyslipidemia.

LDL-C calculated by Friedewald, Martin-Hopkins, or NIH equation 2 versus beta-quantification: pooled alirocumab trials

Accurate assessment of LDL-C levels is important, as they are often used for treatment recommendations. For many years, plasma LDL-C levels were calculated using the Friedewald equation, but there are limitations to this method compared with direct measurement via beta-quantification (BQ). Here, we assessed differences between the Friedewald, Martin-Hopkins, and NIH equation 2 methods of calculating LDL-C and the “gold standard” BQ method using pooled phase 3 data with alirocumab. All randomized patients were included irrespective of the treatment arm (n = 6,122). We compared pairs of LDL-C values (n = 17,077) determined by each equation and BQ. We found that BQ-derived LDL-C values ranged from 1 to 397 mg/dl (mean 90.68 mg/dl). There were strong correlations between Friedewald-calculated, Martin-Hopkins–calculated, and NIH equation 2–calculated LDL-C with BQ-determined LDL-C values (Pearson's correlation coefficient = 0.985, 0.981, and 0.985, respectively). Importantly, for BQ-derived LDL-C values ≥70 mg/dl, only 3.2%, 1.4%, and 1.8% of Friedewald-calculated, Martin-Hopkins–calculated, and NIH equation 2–calculated values were <70 mg/dl, respectively. When triglyceride (TG) levels were <150 mg/dl, differences between calculated and BQ-derived LDL-C values were minimal, regardless of the LDL-C level (<40, <55, or <70 mg/dl). However, when TG levels were >150 mg/dl, NIH equation 2 provided greater accuracy than Friedewald or Martin-Hopkins. When TGs were >250 mg/dl, inaccuracies were seen with all three methods, although NIH equation 2 remained the most accurate. In conclusion, LDL-C calculated by any of the three methods can guide treatment decisions for most patients, including those treated with proprotein convertase subtilisin/kexin type 9 inhibitors.

Клініко-лабораторні та генетичні паралелі у хворих з гетеро- та гомозиготними сімейними гіперхолестеринеміями в Україні

The aim – clinical, laboratory and genetic parallels of patients with hetero- and homozygous familial hypercholesterolemia (FH) in Ukraine.Materials and methods. 231 FH patients were included in the Ukrainian FH Registry: 8 children (under 18 years of age) and 223 adult patients (197 heterozygous FH (HeFH) patients, 26 homozygous FH (HoFH) patients, verified according to DLCN criteria). The patients underwent general clinical, laboratory, instrumental examinations and genetic testing.Results and discussion. Among HeFH patients against the background of early manifestation of atherosclerosis, the male patients were more likely to have coronary heart disease and peripheral atherosclerosis, xanthomatosis and higher DLCN scores against an increase in % obesity and hypertension among HeFH women on the background of significantly lower DLCN. In the HoFH patients despite the inclusion of mostly reproductive aged females in the Registry, it is among women the most severe variants of FH were registered. They were characterized by a predominance of coronary heart disease, MI, xanthomatosis, the need for myocardial revascularization and prosthetic heart valves on the background of higher DLCN scores, cholesterol, LDL-C and ApoB values ​​up to 1.7±0.2 g/L and Lp (a) up to 119.5±31.4 nmol/L. In HoF patients and the most severe variants of the clinical course, who had levels of «statin naive» cholesterol and LDL above 20 mmol/L a more significant increase in these values were found: ApoB average 3.2±1.1 (maximum – 4.72) g/L and Lp (a) to 121.5±41.5 (maximum – 163) nmol/L and reduction of apoA1 level to 0.9±0.1 g/L.Conclusions. HeFH patients retain gender features of the risk factors profile, which corresponds to the main gender-related trends revealed by the Ukrainian population study with a predominance of coronary heart disease, peripheral atherosclerosis and xanthomatosis on the background of higher scores on DLCN in men. HoFH patients showed a reverse trend, namely among women – the predominance of coronary heart disease, myocardial infarction, xanthomatosis and the need for revascularization on the background of a higher score on DLCN. The cohort of HoFH women revealed the most severe FH cases with LDL-C &gt; 20 mmol/L, which was accompanied in 100 % of cases by early development of coronary heart disease and the need for myocardial revascularization, despite young age (36.5±3.9) and preserved reproductive function. According to HoFH patients genetic testing, pathogenetic mutations were detected in 72.3 % of women and 55.5 % of men (92.3 % in LDLR and 7.7 % in apoB). In the cohort of the most severe patients with LDL and LDL cholesterol &gt; 20 mmol/L, genetic mutations were detected in 100 %

Novel insights into the management of German patients with very high cardiovascular risk eligible for PCSK9 inhibitor treatment: baseline characteristics from the PERI-DYS study

Abstract Background The reasons why patients are treated or not with PCSK9 inhibitors (PCSK9i) are incompletely understood. In Germany, access to PCSK9i is limited by local regulations and many high-risk cardiovascular patients do not receive these therapies. The PERI-DYS study aims to describe and compare two groups of dyslipidaemia patients at very high CV risk: those treated with PCSK9i compared with patients qualifying for but not treated with PCSK9i. Methods Observational study with up to 2000 consented patients, documented mainly by office-based cardiologists or physicians in lipid ambulances with data extracted from patient charts. Lipid lowering treatment (LLT) at enrolment includes ongoing PCSK9i use, newly initiated PCSK9i, statins, ezetimibe, and lipoprotein apheresis. Patients are followed for up to 3 years, with visits every 6±2 months to record LLT (drugs, dosing), other CV medications, lipid and glucose values, blood pressure, clinical events (major adverse cardiac and cerebrovascular events) and adverse drug reactions. Results As of 05 March 2021, 1488 patients have been enrolled across 70 sites. The majority of patients (91.5%) had heterozygous familial or non-familial hypercholesterolemia or mixed dyslipidaemia. At enrolment, 49.4% of patients were receiving PCSK9i (35.4% ongoing and 14.0% newly treated). Among PCSK9i users, the majority were receiving evolocumab 140 mg (n=567, 38.1% of all enrolled patients). There were no major differences in demographics and non-lipid lowering medication, with the exception of more females in the PCSK9i group. The estimated untreated LDL-C based on “back-calculation” was higher in patients who were on ongoing PCSK9i therapy than in those not on PCSK9i or newly treated with PCSK9i (Table 1). Physician-reported statin intolerance was much more common in the two PCSK9i groups compared with the non-PCSK9i group (67% versus 14%). Patients in the PCSK9i groups received fewer concomitant statins. Mean on-treatment total cholesterol and LDL-C were considerably lower in patients who were on ongoing PCSK9i compared to non-PCSK9i. Overall, nicotinic acid, fibrates, cholestagel, and omega-3 fatty acids were rarely used (data not shown). Conclusions Patients treated with PCSK9i and those qualifying for but not treated with PCSK9i had similar baseline characteristics, but the former had higher estimated untreated LDL-C values and a higher rate of statin intolerance. Ongoing follow-up will determine the prognostic importance of these findings. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Amgen GmbH Germany

Clinical Deep Data Accumulation System (CLIDAS) reveals lipid paradox in guideline-defined high risk Japanese patients after PCI

Abstract Background Japanese clinical guidelines recommend a stratification of the risks and LDL-cholesterol (LDL-C) treatment goals for patients with coronary artery disease after percutaneous coronary intervention (PCI), i.e. &amp;lt;100 mg/dL for normal risk patients and &amp;lt;70 mg/dL for high risk patients; however, less is known about the association between baseline LDL-C values and long-term prognosis. Purpose To investigate the association between LDL-C goals and baseline LDL-C levels in relation to major adverse cardiovascular events (MACE) among high-risk patients after PCI, using a real-world database. Methods We developed the Clinical Deep Data Accumulation System (CLIDAS) that acquires clinical data directly from hospital information system, and implemented the system in 6 university hospitals and the national cardiovascular center in Japan. The CLIDAS database accumulates data regarding patient background, laboratory data, prescriptions, electrocardiogram, echocardiogram, PCI report, and long-term prognosis. We retrospectively analyzed 8540 consecutive patients who underwent PCI during April 2014 and March 2020 in participating hospitals, and classified them into the normal risk group (n=3712, 43%) and the high risk group [n=4828, 57%, with any of acute coronary syndrome (ACS), familial hypercholesterolemia (FH), or diabetes with additional risk factor(s)], for which LDL-C goals are &amp;lt;100 mg/dL and &amp;lt;70 mg/dL, respectively, according to the Japanese Atherosclerosis Society guidelines or the diagnosis and prevention of atherosclerotic cardiovascular diseases. The primary outcome was the time to first occurrence of MACE, a composite of cardiovascular death, stroke, myocardial infarction, and coronary revascularization in associations with baseline LDL-C levels and patient background. Results Proportion of male (77% vs. 77%) and age (71±11 vs. 70±11) were similar between 2 groups. The prevalence of ACS at the index PCI (0% vs. 62%), FH (0% vs. 2%), hypertension (61% vs. 86%), diabetes (11% vs. 67%), dyslipidemia (73% vs. 84%), hemodialysis (4% vs. 9%), peripheral artery disease (5% vs. 9%), smoking (16% vs. 30%), and prescription of statins (79% vs. 86%) were significantly higher in the high risk group. Among patients in the high risk group, but not in the normal risk group, baseline LDL-C &amp;lt;70 mg/dL was paradoxically associated with higher risk of MACE (P&amp;lt;0.0001 by Log-rank test) (Figure). The Cox proportional hazard model confirmed that the high risk group (risk ratio 1.54, 95% CI [1.31–1.81]), baseline LDL-C &amp;lt;70mg/dL (risk ratio 1.44, 95% CI [1.18–1.75]), baseline age (risk ratio 1.36, 95% CI [1.28–1.45] per 10 year), and prescription of statins (risk ratio 0.80, 95% CI [0.66–0.96]) were significantly associated with the risk of MACE in this population. Conclusion The CLIDAS real-world database revealed that baseline low LDL-C paradoxically associated with an increased risk of MACE among guideline-defined high risk patients after PCI. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jichi Medical University, Tochigi, Japan, and Kowa

Association between serum alanine and aspartate aminotransferase and blood pressure: a cross-sectional study of Chinese freshmen

BackgroundHigh blood pressure is a well-recognized risk factor for cardiovascular events, and the incidence of hypertension is increasing among young people. This study investigated the relationship between ALT and AST levels and hypertension among freshmen in China.MethodsThis cross-sectional study was conducted in the Anhui Province from September to November 2018. A total of 3114 freshmen underwent a physical examination including testing of biochemical indicators and a standardized questionnaire.ResultsThe overall prevalence of elevated ALT and AST were 6.8% and 2.3% among freshmen. The mean ALT and AST levels were higher in males (22.59 ± 21.98 vs.12.62 ± 10.30 U/L; 23.55 ± 12.24 vs. 20.02 ± 5.75 U/L, respectively). The prevalence of hypertension was significantly higher in men (16.1%) than in women (1.9%). The mean values of BMI, SBP, DBP, TC, TG, and LDL-C were found to be increased with elevated levels of serum ALT and AST in the quartiles (P for trend < 0.05). After adjusting for covariates, the risk of hypertension was significantly higher in the highest ALT quartile than in the lowest quartile (OR (95% CI) of 1.681 (1.028, 2.751) in males; 2.802 (1.102, 7.124) in females). A strong linear relationship was found between serum ALT levels and the odds of hypertension after adjustment for potential confounders only in total population and females (P for trend < 0.05).ConclusionsThese findings suggest that ALT level is significantly associated with hypertension both in male and female freshmen.

SUBOPTIMAL CONTROL OF CHOLESTEROL LEVELS AMONG INDIVIDUALS WITH FAMILIAL HYPERCHOLESTEROLEMIA AND SEVERE HYPERCHOLESTEROLEMIA IN ONTARIO, CANADA

SUBOPTIMAL CONTROL OF CHOLESTEROL LEVELS AMONG INDIVIDUALS WITH FAMILIAL HYPERCHOLESTEROLEMIA AND SEVERE HYPERCHOLESTEROLEMIA IN ONTARIO, CANADA

Metabolic Changes in SARS-CoV-2 Infection: Clinical Data and Molecular Hypothesis to Explain Alterations of Lipid Profile and Thyroid Function Observed in COVID-19 Patients.

It seems that during SARS-CoV-2 infection, total cholesterol, LDL-C, and HDL-C values decrease and lipids could play a fundamental role in viral replication. Moreover, it has been shown that SARS-CoV-2 infection could influence thyroid function. We performed a retrospective analysis of 118 hospitalized patients with COVID-19, comparing pre-infection lipid profile (53 patients) and thyroid-stimulating hormone (TSH) values (45 patients) to those measured on admission. Our aim was to evaluate whether SARS-CoV-2 infection could be involved in thyroid and lipid profile alterations and study possible correlations with disease severity and clinical outcome. Median baseline values at the admission time were: total cholesterol at 136.89 ± 42.73 mg/dL, LDL-C 81.53 ± 30.35 mg/dL, and HDL-C 32.36 ± 15.13 mg/dL; and triglycerides at 115.00 ± 40.45 mg/dL, non-HDL-C 104.53 ± 32.63 md/dL, and TSH 1.15 ± 1.08 μUI/mL. Median values of pre-infection total cholesterol, HDL-C, and TSH were significantly higher than those measured at the admission time (p value < 0.05). The C-reactive protein (CRP) negatively correlated with LDL-C (p = 0.013) and HDL-C (p = 0.05). Our data underline a possible impact of SARS-CoV-2 infection on thyroid function. Moreover it suggests a possible relation between COVID-19 and the lipid profile with a negative correlation between CRP, LDL-C, and HDL-C values, proposing the hypothesis that lipid lowering could follow the rising of the COVID-19 inflammatory state.

Cholesterol and COVID-19: Findings from lipid profile of patients with SARS-COV-2 infection.

Background and Aims: At the moment COVID-19 is the most relevant global health problem. It seems that during SARS-CoV-2 infection total cholesterol (TC), LDL-C, and HDL-C values decrease. In our clinical practice we frequently observed alterations of the lipid profile in patients with COVID-19. This study aims to evaluate whether SARS-CoV-2 infection could be actually involved in the determining of lipid profile alterations, and to study the possible correlation of TC, LDL-C, HDL-C lowering and disease severity and/or clinical outcome.

Association between body mass index changes and other risk factors for cardiovascular disease in patients with type 2 diabetes mellitus

Objectives: To investigate the association between body mass index (BMI) changes and other risk factors for cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Methods: Based on the T2DM cohort in rural communities of Zhejiang province, baseline and follow up information of height, weight, blood pressure, glycated hemoglobin (HbA1c), TC, TG, LDL-C and HDL-C of the T2DM patients were collected. After excluding those who died during the follow-up period, lost follow-up or had incomplete information, a total of 8 953 T2DM patients were included in the final analysis. Multiple linear regression and Cox proportional hazards regression models were used for analysis. Results: At baseline survey, 40.97% of the T2DM patients were overweight and obese. Compared with those with normal BMI, the SBP, DBP and TG level were significantly higher, while HDL-C level was significantly lower in the overweight and obese T2DM patients (P<0.01). During the follow-up period, the blood glucose control rate in the patients increased by 15%, and the levels of HbA1c decreased in the patients with different BMI changes at different degrees. Compared with the patients who kept normal BMI, the HbA1c level decrease had a smaller range, while the SBP and DBP increase had a larger range in the patients with persistent overweight and obesity, and their substandard rates of HbA1c, SBP, DBP, TG, HDL-C levels were 1.142 (1.057-1.233) times, 1.123 (1.055-1.196) times, 1.220 (1.128-1.320) times, 1.400 (1.282-1.528) times and 1.164 (1.069-1.267) times higher. The changes of blood pressure, blood lipids and other related indicators in the patients whose BMI became abnormal were similar to those of the patients with persistent overweight and obesity; Compared with the patients whose BMI were kept normal, the differences in changes and substandard rate of blood glucose level, blood pressure level in the patients whose BMI became normal were not significant (P>0.05). The change value of BMI was positively correlated with the change value of SBP, DBP, TG and LDL-C, while negatively correlated with the change value of HDL-C (P<0.05). Conclusions: Abnormal changes in BMI are associated with the adverse changes of blood glucose level, blood pressure, and blood lipids level and other cardiovascular disease risk factors. Keeping normal BMI would benefit the positive outcome of cardiovascular adverse factors.

Relationship between platelet indices and lipid status in chronic hookah consumption

Hookah smoking is a growing trend, both in the world and in Bosnia and Herzegovina. The aim of this study was to determine the value of platelet indices in hookah smokers and find out associations with lipid profile. Cross-sectional study included 60 students (30 chronic hookah smokers and 30 non-smokers). The complete blood count (erythrocytes, leukocytes, platelets, hemoglobin, hematocrit, erythrocyte and platelet indices), lipid parameters (total cholesterol, triglycerides, LDL-C, HDL-C) were determined. The platelet count, mean platelet volume and MPV/Platelets ratio were statistically significantly higher in chronic hookah consumers in the student population than in the control group (p &lt;0.001). In addition, platelet count was in significant positive correlation with values of total cholesterol, LDL-C and negative correlation with value of HDL-C, while there was a significant negative correlation between mean platelets volume, and MPV/Platelets ratio with HDL cholesterol levels in chronic hookah smokers (p &lt;0.05). These findings suggest that chronic hookah consumption could be associated with the development of atherosclerotic changes in blood vessels, which could lead to the development of long-term consequences on the cardiovascular system's function.

Prevalence of Atherosclerotic Cardiovascular Disease, Heart Failure, and Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus: A Primary Care Research Network-based Study.

This study aims to assess the prevalence of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD), and their combined presence in type 2 diabetes (T2D) patients in primary care for whom the 2019 ADA/EASD consensus update "Management of Hyperglycemia in Type 2 Diabetes" recommends GLP-1 receptor agonists (GLP-1RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-I) as first-line medications after metformin. Data were obtained in 2015 from Intego, a morbidity registration network of 111 general practitioners (GPs) working in 48 practices and including 123 261 registered patients. Of 123 261 patients, 9616 had T2D. Of these patients, 4200 (43.7%) presented with ASCVD and/or CKD and/or HF. Specifically, 3348 (34.8%) patients had ASCVD, 388 (4.0%) had heart failure, and 1402 (14.6%) had CKD. Compared to patients without any of these comorbidities, patients with at least 1 of these conditions were older (69.7 ±12.6 vs. 63.1±12.5 years), had higher LDL-C values (104.2±35.8 mg/dl vs. 97.2±37.7) and less frequently achieved the systolic blood pressure target of 140 mm Hg (53 vs. 61%) (all p<0.001). Comorbid patients also had significantly more other comorbidities, such as dementia or cancer; received more recommended medications, such as statins; and received less metformin. Most patients with HF (325; 3.4%) had ASCVD (114; 1.2%), CKD (76; 0.8%), or both (135; 1.4%). In total, 478 patients with CKD (5.0%) also had ASCVD. At the primary care level, 44% of T2D patients suffer from ASCVD, CKD, and/or HF, and thus qualify for GLP-1RA or SGLT2-I therapy.

Association between Berlin Questionnaire Index and lipid profile.

Objective:This study aimed to evaluate the association between the Berlin questionnaire index and the lipid profile, according to gender.Method:This is a cross-sectional study. The group investigated was composed of the Bahiana School of Medicine and Public Health (EBMSP) employees by a sequential non-probabilistic sampling. Study design: The data were obtained by applying a validated questionnaire and collecting laboratory blood samples at the Outpatient Clinics of EBMSP.Results:The total sample consisted of 94 employees, 21 of whom were excluded because they had not been submitted to blood collection. The sample profile evaluation had a total of 73 employees and obtained the following results in the study: the female was the most prevalent with (54.8%); the age ranged from 18 to 65 years, with a mean 38 ± 10.6 years; in men with positive Berlin (with respiratory sleep disorder), higher values of total cholesterol and LDL-c, and lower HDL-c were observed when compared to men without respiratory sleep disorder, as follows: total cholesterol (202 ± 19 vs. 180±40; p=0.040); LDL-c (137± 17 vs. 113 ± 34; p=0.048); lower HDL-c (37 ± 6 vs. 42,5 ±8; p=0.047). While in women, no significant change was observed among those with positive Berlin when compared with those with negative Berlin.Conclusion:The findings of this study showed that men with positive Berlin (with a respiratory sleep disorder) had higher values of total cholesterol, LDL-c, and lower HDL-c when compared to men without a respiratory sleep disorder.

Evaluation of LDL goal achievement in statin consumption, south east of Iran

Lipid goal achievement and statin consumption were estimated at extreme/very-high/high/moderate and low cardiovascular risk categories. In the cross-sectional study, 585 patients treated with statin therapy referring to the heart clinic of Birjand were recruited. Patients were classified and examined LDL-C values and the proportion reaching targets according to the American Association of Clinical Endocrinologists guideline. Three patterns of statin use (high/moderate/low-intensity statin therapy) in all patients were examined and attainments of LDL-C goal in cardiovascular risk groups have been demonstrated. Over half the populations (57.6%) were in the very-high CVD risk group. The results showed that the proportion of patients meeting total LDL-C goal values according to the guidelines was 43.4%. The frequency of patient had achievement LDL goal lower in high-intensity pattern (N = 13, 2.3%), compared with moderate (N = 496, 86.1%) and low-intensity patterns (N = 67, 11.6%). In general, LDL-C goal achievement was greatest with moderate-intensity statin use. LDL-C reduction after statin consumption was estimated about one-third of the studied population. It seems likely that the achievement of a therapeutic target for serum lipids such as LDL-C improved is far more cost-effective and would be able to reach the target LDL as well changing the type and intensity of statins.

Control of cardiovascular risk factors in a vascular retinopathy population and its long-term impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Control of cardiovascular risk factors is the cornerstone of secondary prevention. However, in patients with retinopathy of vascular etiology (hypertensive, diabetic or atherosclerotic) the benefit of stricter control of lipid in the long term has been little studied. Methods Prospective study of a cohort of 107 patients who underwent fundus and coronary angiography, of which 42 (39.3%) required percutaneous revascularization. During the follow-up, new cardiovascular events and analytical control of cardiovascular risk factors were recorded. Results Mean age was 75.19 ± 11.53 years. 60.7% were men, 78.5% were hypertensive, 32.7% were diabetic, and dyslipidemia was observed in 57%. Initially, 28% had 1-vessel disease, 14% 2-vessel, 8.4% 3-vessel, and 3.8% left common trunk. 0.9% had diabetic retinopathy, 3.7% had hypertensive retinopathy, 1.9% atherosclerotic, 70.1% had a combination of hypertensive and atherosclerotic retinopathy, and 7.5% signs compatible with all types. Initial and final mean values of LDL-c and HDL-c by type of retinopathy are in Table 1. During follow-up, a significant improvement in LDL-c and HDL-c levels was observed in total patients and in patients with hypertensive and atherosclerotic retinopathy, however globally lipid control was poor and only 18.9% of the total of the sample reached the recommended levels for very high-risk people (&amp;lt;55 LDL-C). Advanced hypertensive retinopathy patients with a greater reduction in LDL-C during follow-up, recorded lower mortality (p = 0.004). Besides, patients with previous percutaneous revascularization showed a greater decrease in LDL levels at the end of follow-up (69.5 ± 26.1 vs 103 ± 41.47; p &amp;lt;0.001); without significant changes in the rest of parameters. Conclusions In patients with vascular etiology retinopathy, long-term lipid control is poor. However, patients with hypertensive retinopathy and a greater reduction in LDL-c had lower long-term mortality. Hypertensive retinopathy Initial Final Sig. LDL-Cholesterol (mg / dl) 102,8+/-35,5 75,65+/-28,9 &amp;lt;0,001 HDL-Cholesterol (mg / dl) 42,1+/-10,3 43,46+/-13,1 0,04 Atherosclerotic retinopathy LDL-Cholesterol (mg / dl) 101,2+/-36,8 79,8+/-32,98 &amp;lt;0,001 HDL-Cholesterol (mg / dl) 42,8+/-11,6 45,73+/-13,9 0,03 Diabetic retinopathy LDL-Cholesterol (mg / dl) 89,1+/-35,8 69,8+/-18 0,73 HDL-Cholesterol (mg / dl) 35,2+/-8,7 31,51+/-12,7 0,73

Massive data screening is a second opportunity to improve the management of patients with familial hypercholesterolemia phenotype

IntroductionFamilial Hypercholesterolemia (FH) is an autosomal dominant disease with an estimated prevalence between 1/200–250. It is under-treated and underdiagnosed. Massive data screening can increase the detection of patients with FH. MethodsStudy population: Residents in the health coverage area (N: 195.000 inhabitants) and with at least one determination of cholesterol linked to low-density lipoproteins (LDLC) carried out between January 1, 2010 and December 30, 2019. The highest LDL-C values were selected. Exclusion criteria: nephrotic syndrome, hypothyroidism, Hypothyroid treatment or triglycerides > 400 mg/dL. Seven algorithms suggestive of Familial Hypercholesterolemia Phenotype (HF-P) were analyzed, selecting the most efficient algorithm that could easily be translated into clinical practice. ResultsBased on 6.264.877 assistances and 288.475 patients, after applying the inclusionexclusion criteria, 504.316 tests were included, corresponding to 106.382 adults and 10.509 < 18 years. The selected algorithm presented a prevalence of 0.62%. 840 patients with HF-P were detected, 55.8% being women and 178 < 18 years old, 9.3% had a history of cardiovascular disease (CVD) and 16.4% had died. 65% of the patients in primary prevention had LDL-C values > 130 mg/dL and 83% in secondary prevention values > 70 mg/dL. A ratio of 7.64 (1–18) patients with HF-P per analytical requesting physician was obtained. ConclusionsMassive data screening and patient profiling are effective tools and easily applicable in clinical practice for the detection of patients with FH.

Mechanism of Huo-Xue-Qu-Yu Formula in Treating Nonalcoholic Hepatic Steatosis by Regulating Lipid Metabolism and Oxidative Stress in Rats.

Huo-Xue-Qu-Yu formula (HXQYF) is a prescription consisting of Ginkgo biloba leaf and Paeonia lactiflora Pall. for treating hyperlipidemia and NAFLD in China. Here, we investigated the hepatic and renal function, oxidative stress and lipid metabolism, and potential mechanisms of HXQYF on nonalcoholic fatty liver disease (NAFLD) rat models. NAFLD rat models were induced with high-fat diet (HFD) and 10% fructose water for 18 weeks and orally administered with or without HXQYF simultaneously. The results showed that HXQYF (22.5, 45, 90 mg/kg) significantly improved blood lipid levels via reducing serum TC, TG, LDL-C, and APOB values and elevating HDL-C and APOA1 levels in NAFLD rats. The higher levels of ALT, AST, CR, and BUN in serum induced by HFD were reduced by HXQYF. HE staining showed that HXQYF (90 mg/kg) reduced the accumulation of fat droplets and alleviated inflammatory response in liver cells. Three doses of HXQYF exhibited notable antioxidant effects by elevating SOD, GSH, and CAT activities and decreasing MDA and OH-1 levels in the liver. Furthermore, abnormal lipid metabolism caused by HFD was alleviated by HXQYF, which was associated with the upregulation of PPAR-α, AdipoR2, and CPT1 mRNAs as well as the downregulation of CYP2E1 and SREBP-1c mRNAs in liver tissue. In conclusion, our work verified that HXQYF could reduce the degree of hepatic steatosis, suppress oxidative stress, and attenuate lipid metabolism, thus preventing NAFLD.

CARotid plaqUe StabilizatiOn and regression with evolocumab: Rationale and design of the CARUSO study

While the experience with PCSK9i in patients with coronary artery disease has been wide, and coronary plaque regression has been documented, little is known regarding the role of these drugs on carotid plaque regression. The CARotid plaqUe StabilizatiOn and regression with evolocumab (CARUSO) study is a randomized, single-center, investigator-initiated trial aiming at evaluating carotid plaque morphological stabilization and regression following, respectively, 6 and 12 months of therapy with evolocumab. Asymptomatic patients with uni- or bilateral de novo carotid artery stenosis ≥50% and LDL-C values ≥100 mg/dl despite maximum tolerated lipid lowering therapy (LLT) will be randomized to evolocumab 140 mg s.c. every 2 weeks on top of ongoing LLT, or no additional treatment. 100 patients (50 in each arm) will be enrolled. Serial carotid duplex ultra-sonography will be performed to monitor the carotid plaque morphology and stenosis over time. The primary end point of the study is, (a) carotid plaque morphological stabilization at 6 months, defined as defined as the disappearance of ulcerations and fluffy components and the achievement of a regular plaque morphology with prevalence of fibrous atheroma and/or (b) carotid plaque regression at 12 months, defined as reduction of the entity of the stenosis and/or peak systolic velocity by at least 5%, as compared with baseline. The CARUSO trial will test the superiority of evolocumab on top of ongoing LLT versus ongoing LLT alone regarding carotid plaque morphological stabilization and regression. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Stanovenie LDL-cholesterolu novými rovnicami Martin a Sampson, porovnanie so starým Friedewaldom na reálnych dátach a na umelom súbore

Objective LDL-cholesterol (LDL-C) is determined by methods whose accuracy is significantly affected in various clinical or analytical situations. Two computational methods have recently been described, the Martin equation and the Sampson equation, validity of which compare with the Friedewald equation. Methods LDL-C comparisons determined by the 3 equations were performed on 4 real sets of lipid data, generated in various previous studies, ranging from n = 140 to n = 7 393. We have created an artificial set of data on the extent of 900 members with equally distributed values of TC, HDL-C and TG troughout the commonly found range. Such a data set is independent of the phrase we performed the calculations on our Comparisons were also made on this artificial file. Results The difference between the LDL-C values determined by the different equations gradually increases with decreasing LDL-C levels, both in the subgroup of low TG values and in the subgroups of medium and higher TG values. This applies to all 4 real files as well as to the artificial file. These differences are more visible the larger the file size. For the artificial set, the overall agreement between the LDL-C categories was lowest when comparing the Friedewald and Martin equations (83.1%), higher between the Sampson and Martin equations (88.9%) and highest when comparing the Friedewald and Sampson equations (90.9%). In all 4 real sets, the trends of overestimation and underestimation between the equations were exactly the same as in the artificial set. Conclusion The results of clinical and epidemiological studies are significantly influenced by the method used to determine LDL-C. When comparing the calculation methods for determining LDL-C, it is possible to preferably use the described artificial set.