Low-density Lipoprotein Cholesterol Cholesterol Levels Research Articles

The effect of probiotic fermented milk products on blood lipid concentrations: A systematic review and meta-analysis of randomized controlled trials

AimFermented milk products are suggested as a supplementary therapy to help reduce blood lipid levels. However, the results of clinical studies are conflicting. Data synthesisThis study systematically reviewed 39 randomized controlled trials (n = 2237 participants) to investigate the effect of probiotic fermented milk products on blood lipids. A meta-analysis was performed using random effects models, with weighted mean differences (WMDs) and 95% confidence interval (CI). Statistically significant reductions in blood low-density lipoprotein cholesterol (LDL-C) (WMD: −7.34 mg/dL, 95% CI: from −10.04 to −4.65, and P < 0.001) and total cholesterol (TC) concentrations (WMD: −8.30 mg/dL, 95% CI: from −11.42 to −5.18, and P < 0.001) were observed. No statistically significant effect of probiotic fermented milk was observed on blood high-density lipoprotein cholesterol (HDL-C) and triacylglycerol (TAG) levels. The effect on TC and LDL-C level was more pronounced in men, and a greater reduction in TAG was observed in trials with longer interventions (≥8 weeks) as compared to their counterparts. ConclusionsAvailable evidence suggests that probiotic fermented milk products may help to reduce serum TC and LDL-C cholesterol levels, particularly in men and when they are consumed for ≥8 weeks.

Cholesterol and Alzheimer's Disease Risk: A Meta-Meta-Analysis.

Background: Alzheimer’s disease (AD) is the most common subtype of dementia. In the last ten years, the relationship between cholesterol and AD has been investigated. Evidence suggests that cholesterol is associated with AD and represents promising targets for intervention. However, the causality of these associations is unclear. Therefore, we sought to conduct a meta-meta-analysis to determine the effect of cholesterol on the development AD. Then, we assessed the effect of serum levels of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglycerides (TG), on AD risk. Methods: A systematic search of meta-analyses was conducted. Scopus, Web of Science, Science direct, PubMed and Google academic system databases were reviewed. Results: We found 100 primary studies and five meta-analyses to analyze the relationships between cholesterol and AD. The total effect of cholesterol on risk of AD was significant and heterogeneous. Subgroup analysis shows that LDL-C levels influence the development of AD. However, non-significant effects of HDL-C, TC and TG levels on AD were found. Conclusions: These results strengthen the evidence that LDL-C cholesterol levels increase risk for AD. More initiatives to investigate the relationship between cholesterol and AD are needed.

PCSK9 and inflammation: role of shear stress, pro-inflammatory cytokines, and LOX-1.

PCSK9 degrades low-density lipoprotein cholesterol (LDL) receptors and subsequently increases serum LDL cholesterol. Clinical trials show that inhibition of PCSK9 efficiently lowers LDL cholesterol levels and reduces cardiovascular events. PCSK9 inhibitors also reduce the extent of atherosclerosis. Recent studies show that PCSK9 is secreted by vascular endothelial cells, smooth muscle cells, and macrophages. PCSK9 induces secretion of pro-inflammatory cytokines in macrophages, liver cells, and in a variety of tissues. PCSK9 regulates toll-like receptor 4 expression and NF-κB activation as well as development of apoptosis and autophagy. PCSK9 also interacts with oxidized-LDL receptor-1 (LOX-1) in a mutually facilitative fashion. These observations suggest that PCSK9 is inter-twined with inflammation with implications in atherosclerosis and its major consequence-myocardial ischaemia. This relationship provides a basis for the use of PCSK9 inhibitors in prevention of atherosclerosis and related clinical events.

Anacetrapib, a New CETP Inhibitor: The New Tool for the Management of Dyslipidemias?

Cholesteryl ester transfer protein (CETP) inhibitors significantly increase serum high-density lipoprotein cholesterol (HDL) cholesterol levels and decrease low-density lipoprotein cholesterol (LDL) cholesterol concentration. However, three drugs of this class failed to show a decrease of cardiovascular events in high-risk patients. A new CETP inhibitor, anacetrapib, substantially increases HDL cholesterol and apolipoprotein (Apo) AI levels with a profound increase of large HDL2 particles, but also pre-β HDL particles, decreases LDL cholesterol levels mainly due to increased catabolism of LDL particles through LDL receptors, decreases lipoprotein a (Lp(a)) levels owing to a decreased Apo (a) production and, finally, decreases modestly triglyceride (TRG) levels due to increased lipolysis and increased receptor-mediated catabolism of TRG-rich particles. Interestingly, anacetrapib may be associated with a beneficial effect on carbohydrate homeostasis. Furthermore, the Randomized EValuation of the Effects of Anacetrapib Through Lipid-modification (REVEAL) trial showed that anacetrapib administration on top of statin treatment significantly reduces cardiovascular events in patients with atherosclerotic vascular disease without any significant increase of adverse events despite its long half-life. Thus, anacetrapib could be useful for the effective management of dyslipidemias in high-risk patients that do not attain their LDL cholesterol target or are statin intolerable, while its role in patients with increased Lp(a) levels remains to be established.

Dyslipidemia associated with subclinical hypothyroidism in Eastern Nepal

Objectives: The present study was conducted aiming to investigate lipid profile in patients with subclinical hypothyroidism as compared to age and sex matched controls.Methods: The study population consisted of total 80 subjects; 40 patients (cases) and 40 controls. Serum free tri-iodothyronine (fT3) and free thyroxine (fT4) were estimated by microplate competitive enzyme immunoassay, and thyroid stimulating hormone (TSH) measured by sandwich enzyme immunoassay. Lipid profile tests: Total Cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol were estimated by enzymatic methods and low density lipoprotein cholesterol (LDL) was calculated by Friedewald’s formula.Results: Significant differences were observed between lipid parameters in case Vs controls: total cholesterol (4.9±1.1 Vs 4.3±1.0 mmol/L, P=0.03), triglycerides (1.9±0.7 Vs 1.6±0.6 mmol/L, P=0.02) and LDL cholesterol levels (3.5±1.1 Vs 2.9±0.9 mmol/L, P=0.02). In case Vs controls no significant differences were observed between HDL Cholesterol (1.1±0.2 Vs 1.1±0.7 mmol/L, P=0.07), VLDL (0.9±0.4 Vs 0.8±0.3 mmol/L, P=0.1) and Cholesterol/HDL ratio (4.48±1.40 Vs 4.06±0.89, P=0.118). Elevated TSH level were found in cases Vs controls (12.42±7.08 Vs 2.69±0.20 mIU/L, P=0.01) which was statistically significant. The subjects on control group were euthyroid, however increased fT3 (3.9±0.8Vs 4.6±0.8 pmol/L, P=&lt;0.01) and fT4 (17.1±3.9Vs 21.2±.3.7 pmol/L, P=&lt;0.01) values were observed in controls than cases, which was statistically significant.Conclusion: The results of the present study suggest that cases of subclinical hypothyroidism are at risk of dyslipidemia as compared to controls. Large population based studies are needed to generalize these findings and establish the therapeutic guidelines for implementing lipid lowering agents in subclinical hypothyroidism.Asian Journal of Medical Science, Volume-5(3) 2014: 22-25http://dx.doi.org/10.3126/ajms.v5i3.9251

Usefulness of lipid apheresis in the treatment of familial hypercholesterolemia.

Lipid apheresis is used to treat patients with severe hyperlipidemia by reducing low-density lipoprotein cholesterol (LDL-C). This study examines the effect of apheresis on the lipid panel and cardiac event rates before and after apheresis. An electronic health record screen of ambulatory patients identified 11 active patients undergoing lipid apheresis with 10/11 carrying a diagnosis of FH. Baseline demographics, pre- and postapheresis lipid levels, highest recorded LDL-C, cardiac events, current medications, and first apheresis treatment were recorded. Patients completed a questionnaire and self-reported risk factors and interest in alternative treatment. There were significant reductions in mean total cholesterol (−58.4%), LDL-C (−71.9%), triglycerides (−51%), high-density lipoprotein (HDL) cholesterol (−9.3%), and non-HDL (−68.2%) values. Thirty-four cardiac events were documented in 8 patients before apheresis, compared with 9 events in 5 patients after apheresis. Our survey showed a high prevalence of statin intolerance (64%), with the majority (90%) of participants indicating an interest in alternative treatment options. Our results have shown that lipid apheresis primary effect is a marked reduction in LDL-C cholesterol levels and may reduce the recurrence of cardiac events. Apheresis should be compared to the newer alternative treatment modalities in a randomized fashion due to patient interest in alternative options.

Evaluation of Serum HDL and LDL levels in Type II Diabetes Mellitus

&#x0D; Introduction: Diabetes mellitus is a type of metabolic disorder characterized by hyperglycemia resulting from defect in insulin secretion, insulin action or both. This study intended to compare High Density Lipoprotein Cholesterol (HDL) and Low Density Lipoprotein Cholesterol (LDL) profile between type II diabetic and non-diabetic subjects and also find the correlation between HDL and LDL cholesterol in type II diabetic.&#x0D; &#x0D; Methods: The study was conducted on 100 total subjects out of which experimental group with 50 subjects of known Type II Diabetes mellitus and control group with 50 subjects.&#x0D; &#x0D; Results: The result of the present study suggests that fasting blood sugar and LDL cholesterol levels were increased but HDL cholesterol level was reduced in type II diabetic subjects when compared to controls.&#x0D; &#x0D; Conclusion: The estimation of HDL cholesterol and LDL cholesterol in type II diabetes mellitus is very useful as it may serve as a useful parameter to monitor the prognosis of the patient.

Lipid Profiles and Prevalence of Dyslipidemia in Korean Adolescents

Background: The aim of this study is to investigate the distribution of plasma cholesterol and triglyceride levels as well as the preva lence of dyslipidemia among Korean adolescents. Methods: We analyzed data for 3,045 adolescents aged 10-18 years (1,622 boys and 1,423 girls) who participated in the Korea National Health and Nutrition Examination Surveys from 2007 to 2010. Results: The mean values of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipopro tein cholesterol (HDL-C) were 159, 89, 89, and 52 mg/dL, respectively. Plasma cholesterol levels were significantly higher in girls than those in boys (162.1 mg/dL vs. 155.6 mg/dL, P < 0.0001). The 90th percentile values of total cholesterol, triglycerides, and LDLC were 192, 149, 117 mg/dL for boys, and 195, 147, 119 mg/dL for girls. The 10th percentile value of HDL-C was 38 mg/dL for boys and 40 mg/dL for girls. Triglyceride, LDL-C cholesterol levels increased, whereas plasma HDL-C levels decreased with increasing the body mass index (P < 0.0001) in both genders. Total cholesterol levels significantly increased with increasing the body mass in dex, especially in boys (P < 0.0001). The prevalence of dyslipidemia was 25.2% for boys and 21.7% for girls; this value significantly increased with overweight (37-40%) and obesity (53-56%). Independent predictors (odds ratio) of dyslipidemia were age (1.49), overweight (2.06), and obesity (5.11) for boys; overweight (1.95) and obesity (3.22) for girls. Conclusion: Adolescent dyslipidemia is strongly associated with obesity. Lipid screening for overweight or obese youths should be emphasized. Further, longitudinal studies examining the impact of childhood obesity and dyslipidemia on subsequent cardiovascular diseases are needed. (Endocrinol Metab 27:208-216, 2012)

Evaluation of a pharmacist-managed diabetes medication therapy adherence clinic.

Patient adherence to prescribed medication regimens is important in diabetes care to prevent or delay microvascular and macrovascular complications such as retinopathy, nephropathy and myocardial infarction. In Penang Hospital, Malaysia, pharmacists collaborate with physicians in diabetes care through a pharmacist-managed Diabetes Medication Therapy Adherence Clinic (DMTAC) in the Endocrine Clinic, in operation since 2006. To evaluate the effectiveness of the pharmacist-managed DMTAC program in improving glycaemic control, lipid parameters and patients' medication adherence. A retrospective study among patients enrolled in the DMTAC program was conducted between September 2007 and December 2008. Data was included from patients with a glycosylated haemoglobin (HbA1c) >8% and who had completed eight visits with the pharmacists. Medical records and DMTAC forms that provided patients' demographics, medication regimens, adherence and laboratory parameters as well as pharmacists' interventions were reviewed. HbA1c, fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL), triglycerides (TG) and high-density lipoprotein cholesterol (HDL) were evaluated. Documented data of patients' adherence to medication regimen [Modified Morisky Medication Adherence Score (MMMAS); high adherence if score >8, medium adherence if score 6 to <8 and low adherence if score <6] was also evaluated. A total of 43 patients (53.5% females; 46.5% Malays, 44.2% Chinese and 9.3% Indians) were included in the analysis. A mean reduction in HbA1c of 1.73% (p<0.001), mean reduction in FBG of 2.65mmol/l (p=0.01) and mean reduction in LDL cholesterol of 0.38mmol/l (p=0.007) were achieved. The difference in TG and HDL cholesterol were not significant. Patients' adherence to medication regimens improved significantly with an increase in the mean MMMAS score from 7.00 to 10.84 (p<0.001) after completion of the DMTAC program. The pharmacist-managed DMTAC program resulted in significant improvements in HbA1c, glucose and LDL cholesterol levels as well as medication adherence in patients with diabetes.

Alterations in Lipids and Adipocyte Hormones in Female-to-Male Transsexuals

Testosterone therapy in men and women results in decreased high-density lipoprotein cholesterol (HDL) and increased low-density lipoprotein cholesterol (LDL). We sought to determine whether testosterone therapy has this same effect on lipid parameters and adipocyte hormones in female-to-male (FTM) transsexuals. Twelve FTM transsexuals provided a fasting lipid profile including serum total cholesterol, HDL, LDL, and triglycerides prior to and after 1 year of testosterone therapy (testosterone enanthate or cypionate 50–125 mg IM every two weeks). Subjects experienced a significant decrease in mean serum HDL (52 ± 11 to 40 ± 7 mg/dL) (P < .001). The mean LDL (P = .316), triglyceride (P = .910), and total cholesterol (P = .769) levels remained unchanged. In a subset of subjects, we measured serum leptin levels which were reduced by 25% but did not reach statistical significance (P = .181) while resistin levels remained unchanged. We conclude that testosterone therapy in FTM transsexuals can promote an increased atherogenic lipid profile by lowering HDL and possibly reduce serum leptin levels. However, long-term studies are needed to determine whether decreases in HDL result in adverse cardiovascular outcomes.

Effect of Rosuvastatin Compared with Other Statins on Lipid Levels and National Cholesterol Education Program Goal Attainment for Low-Density Lipoprotein Cholesterol in a Usual Care Setting

To compare, in a usual care setting, the effects of rosuvastatin and other 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) on lipid levels and on goal attainment of low-density lipoprotein cholesterol (LDL) levels from the National Cholesterol Education Program (NCEP) third report of the Adult Treatment Panel (ATP III). Retrospective, longitudinal, cohort study. Managed care medical and pharmacy claims and laboratory database. A total of 8251 patients starting treatment with rosuvastatin, atorvastatin, simvastatin, pravastatin, lovastatin, or fluvastatin from August 1, 2003-September 30, 2004, excluding those who received dyslipidemic therapy in the previous 12 months. Patients with at least one pretreatment and posttreatment lipid level were followed until their initial statin was changed or they reached the end of benefit eligibility or the study period. Percent changes in lipid levels were calculated, and adjusted changes in LDL and goal attainment were evaluated by regression techniques. Absolute and percent reductions in LDL, triglyceride, and total cholesterol levels were significantly greater with rosuvastatin than with other statins (all p<0.05 except for triglyceride reduction vs atorvastatin). After adjustment for age, sex, and baseline LDL, percent LDL reductions still were significantly greater with rosuvastatin than with other statins (p<0.05). Changes in high-density lipoprotein cholesterol were not significant. Goal attainment was higher with rosuvastatin than with other statins after adjustment for age, sex, baseline LDL, risk status, dose, and duration of therapy (p<0.05). Dose-stratified analysis showed that LDL goal attainment was significantly higher with rosuvastatin 10 mg than with atorvastatin 10 or 20 mg. Rosuvastatin was more effective than other statins in reducing LDL, triglyceride (except vs atorvastatin), and total cholesterol levels. Significantly more patients taking rosuvastatin than patients taking other statins attained their LDL goals.

Failure to achieve recommended LDL cholesterol levels by suboptimal statin therapy relates to elevated cardiac event rates

Objectives The majority of patients with myocardial infarction (MI) and hypercholesterolaemia does not achieve guideline recommended low-density lipoprotein cholesterol (LDL) levels. Suboptimal dosages of statins explain this dilemma in most patients. Design and setting We evaluated the relationship between statin treatment quality (optimal: LDL<115 mg/dl, suboptimal: LDL≥115 mg/dl, no statin therapy despite hypercholesterolaemia) and the subsequent incidence of coronary events (coronary death, nonfatal MI, bypass surgery) over a 30 months follow-up in a large cohort of post MI patients with hypercholesterolaemia ( n=2045). Analysis was performed in a nested case–control manner comparing 173 cases with a coronary event and 346 matched controls. Results Patients who developed a coronary event were treated optimally in 11.0%, suboptimally in 43.4% ( p<0.05 vs. optimal treatment) and were untreated in 45.7% ( p<0.001 vs. optimal treatment). Respective numbers in event-free patients were 21.4%, 47.7%, and 30.9%. After adjustment for most potential confounders, including all cardiovascular risk factors and medication, the relative risk of future non-fatal MI and coronary death associated with a suboptimal statin treatment was 2.02 (95% CI 1.04 to 4.18) compared to optimal statin treatment. Moreover, the statin equivalent dose in optimally treated individuals was significantly higher than in suboptimally treated individuals (0.85±0.03 vs. 0.78±0.02, p<0.05). Conclusion In this community-based study, a lipid lowering therapy with statins into the recommended target range of LDL levels may be associated with decreased cardiovascular risk compared to a statin therapy without titrating the LDL level below 115 mg/dl. Thus, the quality of statin treatment was identified as an independent predictor of coronary events in post MI patients.

Comparison of lipid profiles in normal and hypertensive pregnant women

Comparison of lipid profiles in normal and hypertensive pregnant women

Efficacy and safety of ezetimibe co-administered with simvastatin compared with atorvastatin in adults with hypercholesterolemia

This study compared the efficacy and safety of co-administered ezetimibe + simvastatin with atorvastatin monotherapy in adults with hypercholesterolemia. Seven hundred eighty-eight patients were randomized 1:1:1 to 3 treatment groups; each group was force-titrated over four 6-week treatment periods: (1) 10 mg of atorvastatin as the initial dose was titrated to 20, 40, and 80 mg; (2) co-administration of 10 mg of ezetimibe and 10 mg of simvastatin (10/10 mg) was titrated to 10/20, 10/40, and 10/80 mg of ezetimibe + simvastatin; and (3) co-administration of 10/20 mg of ezetimibe + simvastatin was titrated to 10/40 mg (for 2 treatment periods) and 10/80 mg of ezetimibe + simvastatin. Key efficacy measures included percent changes in low-density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol (HDL) from baseline to the ends of (1) treatment periods 1 and 2 (for LDL cholesterol) comparing co-administration of 10/20 mg and 10/10 mg of ezetimibe + simvastatin with 10 mg of atorvastatin and (2) treatment period 4 (for LDL cholesterol and HDL cholesterol) comparing co-administration of 10/80 mg of ezetimibe + simvastatin with 80 mg of atorvastatin. Baseline LDL and HDL cholesterol levels were comparable between treatment groups. At the end of treatment period 1, the mean decrease of LDL cholesterol was significantly (p ≤0.001) greater for co-administration of 10/10 mg and 10/20 mg of ezetimibe + simvastatin than for 10 mg of atorvastatin. At the end of treatment period 4 and after comparing maximum doses, co-administration of 10/80 mg of ezetimibe + simvastatin was superior to 80 mg of atorvastatin in the percent LDL cholesterol decrease (−59.4% vs −52.5%, p <0.001) and HDL cholesterol increase (12.3% vs 6.5%; p <0.001). All treatments were well tolerated. Thus, a greater LDL cholesterol decrease and HDL cholesterol increase were attained by treating patients with co-administration of ezetimibe and simvastatin than with atorvastatin.

Treating dyslipidemic patients with lipid-modifying and combination therapies.

Updated guidelines from the National Cholesterol Education Program give greater emphasis to lipoproteins other than low-density lipoprotein cholesterol (LDL) than previous guidelines. Although statins remain first-line therapy for most patients to lower LDL, combination therapy is the next logical step in achieving goals in patients with mixed dyslipidemia or elevated LDL despite statin therapy. As the prevalence of diabetes, metabolic syndrome, and atherogenic dyslipidemia rises, the importance of treating the total lipid profile becomes even more crucial. Niacin, fibrates, and bile acid sequestrants are effective in combination with statins in lowering LDL, triglycerides, and total cholesterol levels and increasing high-density lipoprotein cholesterol (HDL). Although combination therapies may increase the risk of myopathy, both fibrate-statin and niacin-statin combinations are considered safe. In addition, niacin-statin therapy reduces atherosclerotic progression and coronary events. New pharmacologic formulations exist that will further affect treatment: a single-tablet combination of lovastatin and extended-release niacin is available, as is ezetimibe, a cholesterol-absorption inhibitor. In all, both HDL and triglyceride levels correlate with cardiovascular risk and should be considered secondary targets of therapy. Combination therapy can be safe and effective and can be constructed to affect all lipoprotein parameters.

Effects of chemotherapy-induced castration on serum lipids and apoproteins in premenopausal women with node-positive breast cancer.

The purpose of this study was to determine the effect of adjuvant chemotherapy on serum lipids and lipoproteins in premenopausal nonmetastatic breast cancer patients. Fifty-nine premenopausal breast cancer patients were treated with adjuvant chemotherapy comprising cyclophosphamide, methotrexate, and 5-fluorouracil. Levels of serum FSH, LH, and estradiol; fasting plasma levels of total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglyceride, and apolipoprotein A-I, A-II, and B levels; and lipoprotein(a) [Lp(a)] were measured before treatment and 12 months after the beginning of chemotherapy. The changes in serum lipids after chemotherapy correlated significantly to changes in menstruation. Total cholesterol, LDL, and HDL cholesterol levels increased significantly only in patients with chemotherapy-induced ovarian dysfunction. Changes in apo B paralleled those in LDL and apo A-I and A-II HDL cholesterol. The serum concentration of Lp(a) increased significantly only in patients who developed permanent amenorrhea. There were no significant changes in triglyceride levels. Chemotherapy per se has no effect on serum lipids unless associated with induction of ovarian dysfunction. Ovarian failure after chemotherapy has an unfavorable effect on serum total and LDL cholesterol, apo B, and Lp(a) levels, but a favorable effect on HDL cholesterol.