Lipoprotein Cholesterol Values Research Articles

Prevalence and management of hypercholesterolemia in France, the Esteban observational study.

Hypercholesterolemia is a major risk factor for cardiovascular diseases. However, its management in everyday clinical practice is often suboptimal. The aims of the Esteban study were to estimate the prevalence of hypercholesterolemia and to describe its management in France in 2015.Esteban is a cross-sectional, publicly funded survey, representative of the French population. Data were collected using questionnaires and biological and clinical examinations in 3021 adults aged 18-74.The lipid-lowering treatments were obtained by matching the individual data of the subjects included in the Esteban survey with data from the Système national de données de santé. Hypercholesterolemia was defined as either a low density lipoprotein cholesterol value higher than the goal set in the European Society of Cardiology/European Atherosclerosis Society guidelines as a function of individual cardiovascular risk level, or at least 1 delivery of lipid-lowering treatment. Adherence was defined by the proportion of days covered by the lipid-lowering treatment in the 6 months preceding clinical examination. Prevalence of hypercholesterolemia in France was 23.3% (27.8% in men, 19.0% in women). Mean low density lipoprotein cholesterol was 3.38 mmol/l in French participants. Among them, 7.2% were treated (8.5% of men, 5.8% of women), while 16.1% of adults went untreated (19.3% of men, 13.2% of women). Only 29.7% of secondary prevention adults had a delivery of lipid-lowering treatments in the 6 months preceding clinical examination. Fewer than 1 in 3 treated adults were adherent, i.e. more than 80% of days covered by a treatment. This proportion reached 37.4% in the high-risk group, with no significant difference of adherence in people with or without a personal history of cardiovascular disease in this group.This study showed that hypercholesterolemia is a common metabolic disease in France, affecting 23.3% of the population. Lipid-lowering prescriptions diverged greatly from current recommendations, with less than a third of eligible patients being treated.

Abstract 17323: Personalizing Cholesterol Management Therapy Using Electronic Medical Records and Machine Learning

Introduction: Optimal statin treatment decisions for primary prevention of atherosclerotic cardiovascular disease (ASCVD) rely on shared decision-making between patient and provider. We sought to develop a machine learning-based algorithm to personalize cholesterol treatment decisions using electronic medical record (EMR) data. Methods: We included EMR data for adults aged 40 to 79 with no prior ASCVD or statin therapy from an outpatient Northern California system between January 1, 2009 and December 31, 2018 with at least two visits at least 1 year apart and at least two low density lipoprotein cholesterol (LDL-C) values. The outcome was the LDL-C measured closest to one year after a patient’s second visit. We modeled four different treatment decisions: no statin use, low-intensity statin use, moderate-intensity statin use, and high-intensity statin use. We trained weighted-K-nearest-neighbor (wKNN) regression models to identify similar patients using each line of therapy to a candidate patient. The algorithm compared outcomes of these similar patients and recommended the treatment which predicted the lowest LDL-C after one year. Results: Our study cohort consisted of 50,911 patients (age 54.6 ± 9.84 years, baseline LDL-C 122 ± 34.2 mg/dL, follow-up LDL-C 121 ± 35.9 mg/dL) including 54% female, 47% Non-Hispanic White, 32% Asian, and 7.5% Hispanic patients. Among 8,551 test patients visiting in 2015 or later, 96.9%, 3.08%, and 0.05% were recommended to begin high-intensity, moderate-intensity, and low-intensity statins, respectively. With these recommendations, the LDL-C values at 1-year follow-up were predicted to be 21.5 ± 43.5 mg/dL (17.6%) lower per patient, on average (Figure). Conclusions: EMR-trained wKNN models are able to determine patient LDL-C trajectories under different lines of statin therapy. Machine learning models leveraging real-world datasets may provide useful statin therapy treatment recommendations for primary ASCVD prevention.

Clinical features of ST-segment elevation myocardial infarction in patients receiving welfare public assistance in urban area of Japan

BackgroundAn increase in the rate of relative poverty and the number of welfare recipients is a serious social problem in Japan. A recent overseas survey demonstrated that lack of health insurance was associated with increased in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study is to investigate the clinical features of STEMI patients who receive welfare public assistance in Japan. MethodsWe enrolled 525 STEMI patients who were hospitalized in our hospital from 2010 to 2019. We divided patients into groups of patients receiving welfare public assistance (WPA group, N = 67) and groups of patients not receiving welfare public assistance (non-WPA group, N = 458). Patient characteristics, clinical outcome, and cardiac function on transthoracic echocardiography were compared. ResultsWPA group were younger than non-WPA group (61.2 ± 10.9 years VS 64.5 ± 13.3 years, p = 0.03). The prevalence of smoking was higher in WPA group compared to non-WPA group (91.0% VS 81.1% p = 0.04) and high-density lipoprotein cholesterol value of WPA group was lower than in non-WPA group (43.2 ± 9.9 mg/dl vs 47.1 ± 12.8 mg/dl, p = 0.005).Ventricular arrhythmia on admission was significantly more frequent in WPA group (11.9% VS 4.8%, p = 0.02). In acute and chronic phase, left ventricular ejection fraction in WPA group was lower than non-WPA group (in acute phase 46.6 ± 10.7% vs 53.3 ± 8.6% p = 0.001, in chronic phase 48.7 ± 10.1% vs 55.3 ± 9.4%, p = 0.008). ConclusionSTEMI patients receiving welfare public assistance had poorer control of coronary risk, increased risk of fatal arrhythmia, and reduced systolic function than those not receiving welfare public assistance. It is necessary to have a system that can strengthen lifestyle management, such as diet and smoking cessation for the purpose of improving the prognosis of welfare recipients after AMI.

Comparison between different diagnostic scores for the diagnosis of familial hypercholesterolemia: assessment of their diagnostic accuracy in comparison with genetic testing

Abstract Background The Dutch Lipid Clinic Network Score (DLCN) is a useful score to guide the physician to the diagnosis of familial hypercholesterolemia (FH). However, some concerns have been pointed out about its diagnostic accuracy in pediatric population; so, other scores such as Simon Broome (SB) and US MedPed Program have been tested and currently used. Aim To test the different diagnostic and predictive accuracy between those three scores (DLCN, SM and MedPed) in relation to positivity of genetic test. Methods We enrolled 25 pediatric patients aged <18 yo referred to our Chieti and Rome lipid clinics for the clinical suspicion of FH. We performed the genetic analysis for searching pathogenetic mutations for FH (NGS by Lipid in Code, LIPIGEN study). Differently from the others, DLCN provides a numerical data as a diagnostic score; thus, to uniform the three scores, we chose to define subjects with a DLCN score ≥6 as likely FH, while subjects with a lower value were defined as unlikely FH. Furthermore, we calculated the SB and the MedPed score, as previously demonstrated, defining the subjects as likely or unlikely FH. Therefore, we analyzed the diagnostic accuracy of those scores in relation to FH mutation data (positive or negative). Results We recruited 25 patients, 13 males (52%), mean age of 11.8 years. Sixteen patients (64%) resulted positive for the genetic mutation The DLCN showed a sensitivity of 43%, specificity of 66%, a positive predictive value (PPV) of 0.7 and a negative predictive value (NPV) of 0.4. SB showed a sensitivity of 68%, specificity of 55%, a PPV of 0.73 and NPV of 0.5. The MedPed score showed a sensitivity of 68%, specificity of 44%, a PPV of 0.68 and NPV of 0.44. Furthermore, we elaborated a ROC curve of low-density lipoprotein cholesterol (LDL-C) values with respect to the positivity of the FH genetic test: the value that showed the best diagnostic accuracy was 190 mg / dL (sensitivity 68.8% and specificity 75%), while the value of 116.5 mg/dL demonstrated a sensitivity of 100% but with a specificity of 11%. Conclusions Our work demonstrates that none of the three scores tested has an optimal diagnostic accuracy with respect to the diagnosis of FH in the pediatric population. By comparison, SB demonstrates the best sensitivity and the best specificity. In addition, the LDL-C value of 190 mg / dL provides the best diagnostic accuracy against the diagnosis of FH in the pediatric population. Further data and studies will be needed to improve the diagnostic performance of these scores, in order to refer pediatric patients to the genetic test, for an early confirmation in order to refer pediatric patients to the genetic test, for an early FH diagnosis confirmation. Funding Acknowledgement Type of funding source: None

DA VINCI study: Change in approach to cholesterol management will be needed to reduce the implementation gap between guidelines and clinical practice in Europe

DA VINCI study: Change in approach to cholesterol management will be needed to reduce the implementation gap between guidelines and clinical practice in Europe

PCSK9 inhibitors for in-hospital treatment of patients with acute coronary syndrome and severe lipid metabolism disorders

Aim. To assess the efficacy and safety of PCSK9 inhibitor alirocumab as part of a combination lipid-lowering therapy in patients with acute coronary syndrome (ACS).Material and methods. This prospective, open-label, single-center activetreatment study included 13 patients hospitalized due to ACS. The main inclusion criterion was nonachievement of target low-density lipoprotein cholesterol (LDL-C) values (<1,4 mmol/L) with high-intensity statin therapy prior to ACS. During the first 30 days after ACS, all patients received therapy with atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day in combination with alirocumab 150 mg/ml (Praluent) administered by subcutaneous injection. Lipid and biochemical profiles were monitored. The first injection of the PCSK9 inhibitor was performed on days 3-5 of hospitalization, the second — after 2 weeks.Results. On admission, the median LDL-C was 4,3 [3,5;5,3] mmol/L. A day after administration, there was a decrease in LDL-C by 41,9% (median 2,5 [1,8;3,2] mmol/L; p=0,001) without a negative effect on high-density lipoproteins (HDL-C) (median 1,2 [0,8;1,4] mmol/L; p=0,270). Before the next injection, LDL-C decreased by another 8% (median 2,3 [1,1;4,1] mmol/L). A day after the second injection, a decrease in LDL-C from the baseline values was 69,8% (median 1,3 [0,7;1,5] mmol/L; p=0,010). Strengthening lipid-lowering therapy with a PCSK9 inhibitor within 30 days after ACS did not lead to clinical and biochemical deterioration.Conclusion. The use of subcutaneous 150-mg injections of alirocumab 2 times a week 30 days after ACS in patients who did not reach target LDL-C values with statin therapy, leads to a 69% decrease in LDL-C from baseline values and is safe.

Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany

ObjectivesFacing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health effective and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs. Study designAll analyses are based on a comprehensive data set from 249 children with obesity and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program. MethodsCost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in health care expenditures were modeled on existing research, using estimates of health care costs associated with juvenile obesity and remission thresholds of obesity-related disease. ResultsOn average, participants achieved a 0.19-unit reduction in the body mass index standard deviation score, showed reduction in their blood pressure values (systolic = −1.76 mmHg, diastolic = −2.82 mmHg), and showed improvement in their high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol values (HDL = +1.31 mg/dL, LDL = –4.82 mg/dL). The intervention costs were 1799€ per participant, and the benefits of avoided future health care costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3–7.0%. ConclusionsThis study shows that a multicomponent obesity intervention, such as the CHILT, not only results in weight loss and improves important health parameters but also is cost-effective.

Comparison of low-density lipoprotein cholesterol level calculated using the modified Martin/Hopkins estimation or the Friedewald formula with direct homogeneous assay measured low-density lipoprotein cholesterol.

IntroductionLow-density lipoprotein cholesterol (LDL-C) represents the primary lipoprotein target for reducing cardiovascular risk (CV). The aim of our study is to compare the direct and the calculated LDL-C levels in the range below 1.8 mmol/l and 2.6 mmol/l depending on triglycerides, and to evaluate the variation in remnant lipoprotein cholesterol.Material and methodsWe investigated 14 906 lipid profiles from fasting blood samples of Hungarian individuals with triglycerides < 4.5 mmol/l. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and direct LDL-C were measured by the enzymatic assay. We calculated LDL-C by Friedewald’s formula (F-LDL-C) and by using the new Martin/Hopkins estimation (MH-LDL-C).ResultsFor F-LDL-C below 1.8 mmol/l, MH-LDL-C was 58% between 1.8 and 2.59 mmol/l when TG was in the range 2.3–4.5 mmol/l. For F-LDL-C below 2.6 mmol/l, the MH-LDL-C concordance was 73% in the same TG range (2.3–4.5 mmol/l. If MH-LDL-C was less than 1.8 mmol/l or between 1.8 and 2.59 mmol/l, the difference between non-HDL-C (TC – HDL-C = AC: atherogenic cholesterol) and (MH)LDL-C was less than 0.8 mmol/l in the TG range below 2.3 mmol/l. The remnant lipoprotein cholesterol values were on average 0.5 mmol/l lower by the Martin/Hopkins estimation compared to the Friedewald’s calculation if the TG was above 2.3 mmol/l.ConclusionsThe Friedewald equation tends to underestimate LDL-C levels in very high and high-risk settings. Our analysis supports the conclusion that in Hungarian patients, LDL-C estimation using the Martin/Hopkins formula, which is validated by the beta-quantification method, yields a more accurate LDL-C value than that calculated by the Friedewald formula.

Positive Association of the JAG1 rs1327235 Genotype with Coronary Artery Disease in Men, the Tampere Adult Population Cardiovascular Risk Study

Aims: The intronic single nucleotide polymorphism rs1327235 (A>G) close to the JAG gene has been implicated to be involved in blood pressure physiology in a genome-wide association study. We wanted to study whether it was associated with hypertension and coronary artery disease (CAD) in the Tampere adult population cardiovascular risk study. Materials and Methods: We analyzed a Finnish periodic health examination cohort of 191 men with diagnosed hypertension and 295 controls. Samples were genotyped for the JAG1 rs1327235 polymorphism using Competitive Allelic Specific PCR (KASP). The incidence of CAD was determined by self-report and the National Hospital Discharge Registry (HILMO). Results: There was no association between the JAG1 rs1327235 genotypes with hypertension at the age of 50 years. However, when the subjects were followed to the age of 60 years, those with the genotype GG had a higher prevalence of CAD (17.9%), compared with the A-allele (9.7%) (p = 0.036). When prevalence of CAD was adjusted by body mass index and total cholesterol, the OR for GG genotype was 2.19 (p = 0.029, confidence interval 1.084 - 4.429) compared with A-allele carriers. In addition, the GG genotype was associated with higher total cholesterol and low-density lipoprotein-cholesterol values, compared with the A-allele. Conclusions: Our findings suggest that the variations in JAG1 rs1327235 may be involved in CAD and cholesterol metabolism.

The new prognostic factor for pulmonary embolism: The ratio of monocyte count to HDL cholesterol.

Aim of this study is to investigate effectiveness of the monocyte to HDL cholesterol ratio in patients diagnosed with pulmonary embolism for predicting intra-hospital mortality. A total of 269 patients diagnosed with pulmonary embolism in the emergency clinic were included in the study. Study was conducted retrospectively. Pulmonary Embolism Severity Index (PESI), Monocyte count and high density lipoprotein cholesterol (HDL) values were determined. MHR values of the patients were calculated. SPSS 26 package program was used to investigate the effectiveness of MHR in predicting mortality. Mean age of the patients was 64.51±12.4years. PESI, Number of monocytes and MHR were significantly higher in the group with mortality than the group without mortality (p<.05). HDL values were significantly lower (p<.05) in mortality group. Sensitivity of MHR 19 cut off value was 89.3%, and its specificity was 82.0%. Use of predictors for mortality estimation in patients diagnosed with acute pulmonary embolism is important for faster administration of treatment modalities. We think MHR values can be used as a strong predictor according to the hemogram parameters and biochemical results.

Monocyte High Density Lipoprotein Cholesterol Ratio as a New Prognostic Factor for Mesenteric Embolism.

To determine the effectiveness of the ratio of monocyte count to high density lipoprotein cholesterol in predicting in-hospital mortality. Descriptive study. Intensive Care Unite, Adana Numune Research and Training Hospital, Turkey, from January 2018 to December 2019. Patients admitted to the intensive care unit with the diagnosis of mesenteric embolism were included in the study. Monocyte count and high-density lipoprotein cholesterol (HDL) values were determined. Monocyte HDL Ratio (MHR) values of the patients were calculated. SPSS 26 package programme was used to investigate the effectiveness of MHR in predicting mortality. The mean age of the 81 patients was 69.9 ±10.6 years. In the group with mortality, the number of monocytes and MHR were significantly higher than the group without mortality (p<0.05). In the mortality group, HDL value was significantly lower (p<0.05) than the non-mortality group. Sensitivity of the MHR cutoff value of 19 was 81.8%, positive predictive value was 96.4%, specificity value was 97.9%, negative predictive value was 88.7%. For patients diagnosed with acute mesenteric embolism, the use of predictors in terms of mortality estimation is very important for the faster implementation of treatment modalities. MHR value can be used as a strong predictor. Key Words: Mesenteric embolism, Monocyte, HDL cholesterol, MHR, Mortality.

A comparison of metabolic health parameters in ICSI-conceived and naturally conceived adolescents

Research questionAre there differences in the cardiometabolic health of ICSI-conceived adolescents compared with a control group, taking parental risk factors into account? DesignICSI-conceived adolescents (n = 272), their mothers (n = 273) and naturally conceived control adolescents (n = 273) and their mothers (n = 273) provided a blood test and answered a health-related questionnaire. The adolescents also attended a physical examination. ResultsICSI-conceived males showed significantly higher mean weight (72.6 ± 15.1 versus 67.7 ± 12.6 kg, P = 0.005), body mass index (BMI) (22.2 ± 3.7 versus 21.0 ± 3.2 kg/m2, P = 0.007) and waist circumference (79.1 ± 11.6 versus 74.5 ± 8.7 cm, P < 0.001). The mean values for weight and BMI were also significantly higher in the ICSI parents. In the ICSI-conceived females significant differences in high-density lipoprotein cholesterol (1.5 ± 0.3 versus 1.6 ± 0.3 mmol/l, P = 0.033) and triglyceride values (1.1 ± 0.5 versus 1.0 ± 0.4 mmol/l, P = 0.013) were observed. ICSI mothers also had significantly higher triglycerides (P = 0.002), higher glutamate pyruvate transaminase/alanine aminotransferase (P < 0.001) and higher alkaline phosphatase values (P < 0.001). ConclusionsIncreased values for weight were found in the male and differences in lipid parameters in the female ICSI-conceived adolescents, which were reflected in the values of their parents. Adjustment for parental risk factors generally attenuated the differences between the ICSI and the control groups, but did not completely remove them. Whether these observed differences are clinically relevant for the future health of the participants requires further study. To increase knowledge in this area, future studies should also include parental data.

Hypolipidemic and Hypoglycaemic Effect of Wholemeal Bread with Amaranth (Amaranthus dubius Mart. ex Thell.) on Sprague Dawley Rats.

The effect of consuming breads made with wheat flour and Amaranth (Amaranthus dubius Mart. ex Thell.) wholemeal flour on Sprague Dawley rats with hyperlipidaemia and hyperglycaemia induced through feeding was studied. Four diets were provided: control (CD: Ratarina®), commercial bread (CBD), bread with 100 g·kg−1 (ABD10) and 200 g·kg−1 (ABD20) amaranth flour. Zoometric and blood chemistry parameters were measured before and after consuming the diets. A completely random factorial design of 2 × 4 × 2 was used. The factors were blood lipids and glucose level (normal, N and elevated, E), diet (CD, CBD, ABD10 and ABD20) and sex (female, F and male, M). The rats consuming ABD10 and ABD20 diets presented the lowest glucose values, although with no differences (p > 0.05) between the groups of elevated blood lipids and glucose rats (E). Triglyceride concentrations decreased in ABD10 and ABD20 treatments in comparison with CD, elevated blood lipids and glucose (E) rats, while ABD10 rats showed lower total cholesterol level than normal (N) rats. The high-density lipoprotein cholesterol values increased in the ABD10 and ABD20 groups (p < 0.05), while it did lower for very low-density lipoprotein cholesterol and cardiac risk index (p < 0.05). In ABD10 and ABD20 treatments, the abdominal circumference decreased in both sexes (p < 0.05) between weeks 23 and 31. In conclusion, consumption of bread with amaranth improved lipid profiles of rats and could help to prevent metabolic and cardiovascular diseases.

Is it possible to predict the complexity of peripheral artery disease with atherogenic index?

Lower extremity peripheral artery disease develops mainly due to atherosclerosis and occurs as a result of the systemic atherosclerotic process. Increased triglyceride (TG) and decreased high density lipoprotein cholesterol (HDL-C) values increase atherosclerosis risk. With regard to this information, TG/HDL-C ratio is used as the atherogenic index. The aim of the present study was to evaluate the role of TG/HDL-C ratio to predict the complexity of disease in patients with peripheral artery disease. Patients who were diagnosed with peripheral artery disease and admitted to our clinic between August 2013 and August 2019 were included in this study retrospectively. Patients were divided into two groups based on angiographic evaluations with TransAtlantic Inter-Society Consensus-II classification. Those with TASC A-B lesions were included in Group 1 and those with TASC C-D lesions constituted Group 2. The mean ages of Group 1 (n = 314) and Group 2 (n = 98) patients were 56.1 ± 9.3 and 58.4.1 ± 8.1 years, respectively. The frequency of male gender and coronary artery disease was significantly higher in Group 2 (p = 0.043, p = 0.001, respectively). In Group 2, triglyceride and TG/HDL-C ratios were significantly high, while HDL-C was significantly low (p = 0.022, p < 0.001, p = 0.010, respectively). The multivariate logistic regression analysis performed to evaluate the parameters in predicting the angiographic complexity of peripheral artery disease showed that coronary artery disease (OR: 1.009 CI 95%: 1.003-1.021 p = 0.016) and TG/HDL-C ratio (OR: 5.385 CI 95%: 2.553-9.357 p = 0.001) were independent predictors for complexity. ROC analysis revealed that the cut-off value of TG/HDL-C was 2.9 (AUC = 0.670, p < 0.001) with 75.5% sensitivity and 56.7% specificity. It is possible to predict the angiographic complexity of peripheral artery disease with TG/HDL-C ratio, also known as atherogenic index, which is easily obtained by routine biochemical parameters.

Healthcare resource utilization in patients on lipid-lowering therapies outside Western Europe and North America: findings of the cross-sectional observational International ChoLesterol management Practice Study (ICLPS)

BackgroundFew recent large-scale studies have examined healthcare consumption associated with dyslipidemia in countries outside Western Europe and North America.MethodsThis analysis, from a cross-sectional observational study conducted in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America, evaluated avoidable healthcare consumption (defined as ≥1 hospitalization for cardiovascular reasons or ≥1 visit to the emergency room for any reason in the previous 12 months) in patients receiving stable lipid-lowering therapy (LLT). A total of 9049 patients (aged ≥18 years) receiving LLT for ≥3 months and who had had their low-density lipoprotein cholesterol (LDL-C) value measured on stable LLT in the previous 12 months were enrolled between August 2015 and August 2016. Patients who had received a proprotein convertase subtilisin/kexin type 9 inhibitor in the previous 6 months were excluded. Patients were stratified by cardiovascular risk level using the Systematic Coronary Risk Estimation chart for high-risk countries.ResultsThe proportion of patients at their LDL-C goal was 32.1% for very-high risk patients compared with 55.7 and 51.9% for patients at moderate and high cardiovascular risk, respectively. Overall, 20.1% of patients had ≥1 reported hospitalization in the previous 12 months (7.9% for cardiovascular reasons), 35.2% had ≥1 intensive care unit stay and 13.8% visited the emergency room. Avoidable healthcare resource consumption was reported for 18.7% patients overall, and in 27.8, 7.7, 7.7 and 13.2% of patients at very-high, high, moderate and low risk, respectively. Across all risk groups 22.4% of patients not at LDL-C goal and 16.6% of patients at LDL-C goal had avoidable healthcare resource consumption.Being at very-high cardiovascular risk, having cardiovascular risk factors (including hypertension and smoking), and having factors indicating that the patient may be difficult to treat (including statin intolerance, comorbidities and chronic medication), were independent risk factors for avoidable healthcare resource consumption (all p <0.05).ConclusionsHealthcare resource consumption associated with adverse clinical outcomes was observed in patients on stable LLT in countries outside Western Europe and North America, particularly those at very-high cardiovascular risk and those who were difficult to treat.

The effect of synbiotics supplementation on anthropometric indicators and lipid profiles in women with polycystic ovary syndrome: a randomized controlled trial

BackgroundDifferent therapies have been suggested for polycystic ovary syndrome (PCOS), but changes in lifestyle and diet have been considered. Diet and dietary factors can be very effective in modifying the disease. The positive effects of probiotic and synbiotics supplementation on improving lipid profiles and anthropometric indices have been examined in various diseases. This study was conducted to evaluate the effects of synbiotics supplementation on lipid and anthropometric profiles in infertile women with PCOS.MethodsPCOS patients aged 19–37 years old were randomized to receive either synbiotics supplement (n = 50) or placebo (n = 49) for 12 weeks.ResultsConsumption of synbiotics compared to the placebo, resulted in a significant decrease in Low-density lipoprotein cholesterol (LDL) value (Change Mean Difference (CMD): 4.66, 95%CI: 0.20, 9.13) and a significant increase in high-density lipoprotein cholesterol (HDL) (CMD: 1.80, 95%CI: 0.34, 3.26). Although we failed to find a significant effect of synbiotics consumption on total cholesterol (TC) and triglyceride (TG) levels. We did not find differences in anthropometric indices between groups.ConclusionsOverall, 12 weeks of synbiotics supplementation among PCOS women resulted in beneficial effects on LDL and HDL, although it is not yet clear how much our findings are clinically significant and more clinical studies with larger sample sizes are still needed.Trial registrationIranian Registry of clinical Trial, IRCT.ir, ID: IRCT2014110515536N2. Registered on 19 December 2015.Graphical abstract

Expression of Amylin and Preptinin Iraqi Patients with Type 2 Diabetes Mellitus

Diabetes mellitus is one of the most worldwide spread chronic diseases, and its complications are very serious if it is untreated. Type-2 diabetes mellitus (T2DM) is reported to be caused by obesity and sedentary life style. DM plays a role in accelerating the hardening and narrowing of the arteries. Preptin and amylin are pancreatic hormones which participate in glucose homeostasis. In T2DM patientsamylin peptids can be toxic to β-cells of pancreas due to Amyloid deposits within these cells, supporting the idea that islet amyloid might have an important role in the pathogenesis of T2DM.preptin is a peptide hormone that is secreted with insulin and amylin from the pancreatic β-cells.The study planned to investigate the relationship between serum amyline and preptinlevelsin patients with T2DM compared to healthy controls and to study their associations together (preptin and amylin) with serum levels of insulin and HOMA-IR. Sixty-four (64) patients were recruited from the Endocrine Outpatient clinic in Al-Imamain Al-Kadhimain city hospital from March of 2018 to May of 2018. Fasting serum samples were obtained on enrolment. (mean age, (61.73± 8.05) years;mean duration of diabetes, (8.77±2.66) years; mean HbA1c,(8.1 ± 1.7) withT2DM and body mass index (BMI) > 25.1 kg/m2 underwent examination. Age, sex and (BMI) matched with thirty eight(38) healthy controls were also in ruled,Serum preptin and amylin levels were measured by ELISA technique. There was statistically significant difference between patients and controls serum amylin (p=0.023) and preptin (p=0.01).Patients with T2DM had significantly higher blood glucose (p=0.0001), HbA1c (p=0.0001), insulin (p=0.0001), and homeostatic model assessment of insulin resistance (HOMA-IR) (p=0.001)compared to healthy control,while total cholesterol was positively related (p=0.111) triglyceride, low-density lipoprotein cholesterol values were (p<0.001 for each), and significantly lower high-density lipoprotein cholesterol levels compared with the control group (p<0.0001). The preptin level demonstrated a significant positive association with insulin and HOMA-IR compared with healthy control. (for healthy control group: r=0.381,p=0.146, r=0.133,p=0.438)respectively; for T2DM group: (r=0.411,p=0.02, r=0.332,p=0.003), The amylin level also showed a significant positive correlation with insulin and HOMAIR compared with healthy control. (for healthy control group: r= 0.188,p=0.309, r= -0.039,p=0.911) respectively; for T2DM group: (r=0.279,p=0.002, r=0.291,p=0.003),Conclusions: There were significant differences between healthy control and patients with T2DM concerning amylin and preptin levels. Serum Amylin and preptin increase in association with insulin in diabetic conditions. The present study suggests a potential role of amyline and preptin in the pathogenesis of T2DM.

Incidencia de eventos cardiovasculares y cambios en el riesgo estimado y en el tratamiento de la hipercolesterolemia familiar: registro SAFEHEART

Introduction and objectivesThe SAFEHEART study was designed to analyze the situation of familial heterozygous hypercholesterolemia (FHH) and improve knowledge of this disease in Spain. Our objective was to determine the incidence rate of cardiovascular events, the estimated risk of developing an event and its modification, the use of lipid-lowering treatment, and the achievement of low-density lipoprotein cholesterol targets in patients with FHH. MethodsSAFEHEART is a prospective, open, multicenter, nationwide cohort study, with long-term protocol-based follow-up in a population of individuals with molecularly-characterized FHH. We analyzed patients older than 18 years with complete follow-up. ResultsWe included 2648 patients with FHH. The median follow-up was 6.6 (4.8-9.7) years. The overall incidence rate of cardiovascular events was 1.3 events/100 patient-years. After the follow-up, the 10-year estimated risk of developing a cardiovascular event was reduced from 1.6% to 1.3% (P <.001). In the last follow-up, 20.6% and 22.2% of the patients in primary and secondary prevention achieved low-density lipoprotein cholesterol values <100mg/dL and <70mg/dL, respectively. ConclusionsThis study was performed in the largest population of patients with FHH in Spain. We identified the incidence rate of cardiovascular events, the estimated risk of developing a cardiovascular event and its modification, the achievement of low-density lipoprotein cholesterol targets, and the therapeutic management in this population. Although the cardiovascular risk of FHH is high, appropriate treatment reduces the likelihood of an event.Clinical trial registration: http://www.clinicaltrials.gov. Identifier: NCT02693548.

Impact of the pre-illness lipid profile on sepsis mortality

PurposeTo determine if baseline lipid levels contribute to the relationship between lipid levels during sepsis and outcomes. Materials and methodsWe conducted a retrospective cohort study at a tertiary-care academic medical center. Multivariable logistic regression models were used to adjust for confounders. Both Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) score-based definitions of sepsis were analyzed. Measurements and main resultsAfter adjusting for patient characteristics and severity of illness, baseline values for both low density lipoprotein (LDL) cholesterol and triglycerides were associated with mortality (LDL cholesterol odds ratio [OR] 0.44, 95% confidence interval [CI] 0.23–0.84, p = .013; triglyceride OR 0.54, 95% CI 0.37–0.78, p = .001) using a SIRS based definition of sepsis. An interaction existed between these two variables, which resulted in increased mortality with higher baseline low density lipoprotein (LDL) cholesterol values for individuals with triglycerides below 208 mg/dL and the opposite direction of association above this level (interaction OR 1.48, 95% CI 1.02–2.16, p = .039). When using a SOFA score-based definition, only triglycerides remained associated with the mortality (OR 0.55, 95% CI 0.35–0.86, p = .008). ConclusionsBaseline lipid values, particularly triglyceride concentrations, are associated with hospital mortality in septic patients.

Expression of Amylin and Preptinin Iraqi Patients with Type 2 Diabetes Mellitus

Diabetes mellitus is one of the most worldwide spread chronic diseases, and its complications are very serious if it is untreated. Type‑2 diabetes mellitus (T2DM) is reported to be caused by obesity and sedentary life style. DM plays a role in accelerating the hardening and narrowing of the arteries. Preptin and amylin are pancreatic hormones which participate in glucose homeostasis. In T2DM patientsamylin peptids can be toxic to β‑cells of pancreas due to Amyloid deposits within these cells, supporting the idea that islet amyloid might have an important role in the pathogenesis of T2DM.preptin is a peptide hormone that is secreted with insulin and amylin from the pancreatic β‑cells. The study planned to investigate the relationship between serum amyline and preptinlevelsin patients with T2DM compared to healthy controls and to study their associations together (preptin and amylin) with serum levels of insulin and HOMA‑IR. Sixty‑four (64) patients were recruited from the Endocrine Outpatient clinic in Al‑Imamain Al‑Kadhimain city hospital from March of 2018 to May of 2018. Fasting serum samples were obtained on enrolment. (mean age, (61.73± 8.05) years;mean duration of diabetes, (8.77±2.66) years; mean HbA1c, (8.1 ± 1.7) with T2DM and body mass index (BMI) &gt; 25.1 kg/m 2 underwent examination. Age, sex and (BMI) matched with thirty eight(38) healthy controls were also in ruled,Serum preptin and amylin levels were measured by ELISA technique. There was statistically significant difference between patients and controls serum amylin (p=0.023) and preptin (p=0.01).Patients with T2DM had significantly higher blood glucose (p=0.0001), HbA1c (p=0.0001), insulin (p=0.0001), and homeostatic model assessment of insulin resistance (HOMA‑IR) (p=0.001)compared to healthy control,while total cholesterol was positively related (p=0.111) triglyceride, low‑density lipoprotein cholesterol values were (p&lt;0.001 for each), and significantly lower high‑density lipoprotein cholesterol levels compared with the control group (p&lt;0.0001). The preptin level demonstrated a significant positive association with insulin and HOMA‑IR compared with healthy control. (for healthy control group: r=0.381,p=0.146, r=0.133,p=0.438) respectively; for T2DM group: (r=0.411,p=0.02, r=0.332,p=0.003), The amylin level also showed a significant positive correlation with insulin and HOMA‑IR compared with healthy control. (for healthy control group: r= 0.188,p=0.309, r= ‑0.039,p=0.911) respectively; for T2DM group: (r=0.279,p=0.002, r=0.291,p=0.003),Conclusions: There were significant differences between healthy control and patients with T2DM concerning amylin and preptin levels. Serum Amylin and preptin increase in association with insulin in diabetic conditions. The present study suggests a potential role of amyline and preptin in the pathogenesis of T2DM