Low-density Lipoprotein Cholesterol Measurement Research Articles

Comparison of the Japan Society of Clinical Chemistry reference method and CDC method for HDL and LDL cholesterol measurements using fresh sera

ObjectivesIn 2009, the Japan Society of Clinical Chemistry (JSCC) recommended a reference method for the measurement of serum high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels. This automated method uses cholesterol esterase-cholesterol dehydrogenase to measure cholesterol levels in fractions obtained after ultracentrifugation and dextran sulfate/magnesium chloride precipitation. In the present study, using fresh samples, we compared the LDL-C and HDL-C levels measured using this method with those measured using the traditional Centers for Disease Control and Prevention (CDC)-beta-quantification (BQ) method. Designand methods: Using both the JSCC and CDC-BQ methods, LDL-C/HDL-C levels were measured in 47 non-diseased and 126 diseased subjects, whose triglyceride levels were lower than 11.29 ​mmol/L (1000 ​mg/dL). ResultsFor LDL-C, the equation of the line representing the correlation between the two methods was y ​= ​0.991x + 0.009 ​mmol/L; r ​= ​0.999; and Sy/x ​= ​0.025 ​mmol/L, where x is the mean LDL-C level measured using the CDC-BQ method. Similarly, for HDL-C, the equation of the line representing the correlation between the two methods was y ​= ​0.988x + 0.041 ​mmol/L, r ​= ​0.999, and Sy/x ​= ​0.019 ​mmol/L, where x is the mean HDL-C level measured using the CDC-BQ method. ConclusionsThe JSCC method agreed with the CDC-BQ method in cases of both non-diseased and diseased subjects, including those with dyslipidemia.

PENGARUH PEMBERIAN SARI TOMAT (Solanum lycopersicum L) DAN INSULIN TERHADAP KADAR GLUKOSA, KADAR LDL, KADAR KOLESTEROL DAN BERAT BADAN LAHIR TIKUS PUTIH STRAIN WISTAR (Rattus Norvegicus) BUNTING DENGAN MODEL DIABETES MELLITUS TIPE 2

Diabetes Mellitus is a chronic disease caused by abnormal working insulin, insulin secretion or both so that the body tends to have high glucose levels. Type 2 diabetes mellitus can cause elevated levels of LDL and cholesterol. Risks obtained by fetuses with type 2 diabetes can be in the form of macrosomia due to hyperglycemia and hyperinsulin in the body of the fetus. Insulin is the first choice pharmacological therapy for type 2 DM that can be given during pregnancy. Non-pharmacological therapy as recommended by the World Health Organization (WHO) on a healthy diet by increasing consumption of fruits and vegetables. Good fruit consumed for pregnant women with diabetes mellitus (DM) type 2 is tomatoes (Solanum lycopersicum L). The purpose of this study was to determine the administration of tomato extract (Solanum lycopersicum L) and insulin can affect glucose levels, LDL levels, cholesterol levels and birth weight of white wistar galur (Rattus norvegicus) pregnant women with type 2 diabetes mellitus models. experimental design using the pre post test only control group design and post test only control group design. Termination was done on the 17th day of pregnancy and then followed by measurements of LDL levels, cholesterol and birth weight. Data analysis using the One Way Anova test and Kruskal Wallis then continued with the Post Hoc test using. The results showed that there were significant differences between glucose levels, LDL levels, cholesterol levels and BW born in the insulin treatment group and the tomato juice treatment (p value = 0.00 <α = 0.05). The conclusion of giving insulin and tomato juice affects a decrease in glucose levels, LDL levels, cholesterol levels and birth weight.

Long-Term Levels of LDL-C and Cognitive Function: The CARDIA Study.

It is uncertain if long-term levels of low-density lipoprotein-cholesterol (LDL-C) affect cognition in middle age. We examined the association of LDL-C levels over 25 years with cognitive function in a prospective cohort of black and white US adults. Lipids were measured at baseline (1985-1986; age: 18-30 years) and at serial examinations conducted over 25 years. Time-averaged cumulative LDL-C was calculated using the area under the curve for 3,328 participants with ≥3 LDL-C measurements and a cognitive function assessment. Cognitive function was assessed at the Year 25 examination with the Digit Symbol Substitution Test [DSST], Rey Auditory Visual Learning Test [RAVLT], and Stroop Test. A brain magnetic resonance imaging (MRI) sub-study (N = 707) was also completed at Year 25 to assess abnormal white matter tissue volume (AWMV) and gray matter cerebral blood flow volume (GM-CBFV) as secondary outcomes. There were 15.6%, 32.9%, 28.9%, and 22.6% participants with time-averaged cumulative LDL-C <100 mg/dL, 101-129 mg/dL, 130-159 mg/dL, and ≥160 mg/dL, respectively. Standardized differences in all cognitive function test scores ranged from 0.16 SD lower to 0.09 SD higher across time-averaged LDL-C categories in comparison to those with LDL-C < 100 mg/dL. After covariate adjustment, participants with higher versus lower time-averaged LDL-C had a lower RAVLT score (p-trend = 0.02) but no differences were present for DSST, Stroop Test, AWMV, or GM-CBFV. Cumulative LDL-C was associated with small differences in memory, as assessed by RAVLT scores, but not other cognitive or brain MRI measures over 25 years of follow-up.

A plasma lipid signature predicts incident coronary artery disease

BackgroundDyslipidemia is a hallmark of cardiovascular disease but is characterized by crude measurements of triglycerides, HDL- and LDL cholesterol. Lipidomics enables more detailed measurements of plasma lipids, which may help improve risk stratification and understand the pathophysiology of cardiovascular disease. MethodsLipidomics was used to measure 184 lipids in plasma samples from the Malmö Diet and Cancer – Cardiovascular Cohort (N = 3865), taken at baseline examination. During an average follow-up time of 20.3 years, 536 participants developed coronary artery disease (CAD). Least absolute shrinkage and selection operator (LASSO) were applied to Cox proportional hazards models in order to identify plasma lipids that predict CAD. ResultsEight plasma lipids improved prediction of future CAD on top of traditional cardiovascular risk factors. Principal component analysis of CAD-associated lipids revealed one principal component (PC2) that was associated with risk of future CAD (HR per SD increment =1.46, C·I = 1.35–1.48, P < 0.001). The risk increase for being in the highest quartile of PC2 (HR = 2.33, P < 0.001) was higher than being in the top quartile of systolic blood pressure. Addition of PC2 to traditional risk factors achieved an improvement (2%) in the area under the ROC-curve for CAD events occurring within 10 (P = 0.03), 15 (P = 0.003) and 20 (P = 0.001) years of follow-up respectively. ConclusionsA lipid pattern improve CAD prediction above traditional risk factors, highlighting that conventional lipid-measures insufficiently describe dyslipidemia that is present years before CAD. Identifying this hidden dyslipidemia may help motivate lifestyle and pharmacological interventions early enough to reach a substantial reduction in absolute risk.

The effect of 6-gingerol on biochemical and histological parameters in cholesterol-induced nonalcoholic fatty liver disease in NMRI mice

Fatty liver contains a range of clinical symptoms, including the accumulation of fat in the liver parenchyma and it varies from a simple steatosis to non-alcoholic steatohepatitis and cirrhosis. Using natural therapies has always been a great concern for such health-related diseases. Herein, 6-gingerol, as a natural compound, was applied to treat non-alcoholic fatty liver induced in NMRI mice. The assessment included histological studies of the liver along with measurement of biochemical parameters, including insulin, glucose, adiponectin, leptin, HDL-C (high-density lipoprotein cholesterol), LDL-C (low-density lipoprotein cholesterol), VLDL-C (very low-density lipoprotein cholesterol), Aspartate transaminase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), SOD (superoxide dismutase), and catalase. The results demonstrated that treatment with 6-gingerol (800 mg/kg) modified the fatty liver indices by significantly reducing (p<0.001) the levels of triglyceride, cholesterol, LDL-C, and VLDL-C, glucose, insulin, insulin resistance, and leptin, whereas this treatment notably increased (p<0.001) the levels of liver antioxidant enzymes, HDL-c, and adiponectin. Therefore, 6-gingerol, in a dose-dependent mode, showed capability of improving non-alcoholic fatty liver and could offer a reliable remedy.

Is data mining approach a best fit formula for estimation of low-density lipoprotein cholesterol?

Background:With the change in the National Cholesterol Education Program ATP III guidelines, the risk of developing atherosclerosis has been now focused on total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Different treatment modalities are now targeted at lowering LDL cholesterol values. Hence greater emphasis is now led on the accurate and precise measurement of LDL cholesterol. Beta-quantification, though, is the best reference method for LDL cholesterol estimation, it has the disadvantage of being inconvenient in our routine practice. The new generation direct homogenous assay is now the method of choice. But being more expensive, various calculated methods have now been developed. This study is an attempt to compare different calculated formula with direct cholesterol assessment and to find out the best one.Materials and Methods:We compared LDL cholesterol measured by direct homogenous assay with the data mining approach (DM) and another calculated formula [Friedewald's Formula (FF) and Anandaraja Formula (AF)] in 266 samples with age greater than 18 years. Enrolled participants were divided into seven groups based upon their TG levels. Mean, percentage difference, and the correlation coefficient was assessed between calculated and direct LDL. Bland–Altman analysis was done to see the agreement between calculated vs direct LDL. All formulas were assessed among various TG levels with direct LDL by the Wilcoxon sign rank test.Result:1% level of significance was found between calculated and direct LDL with TG < 600 mg/dl. Mean and the percentage difference between direct and calculated LDL was lowest with the DM approach. Bland–Altman plot shows the best agreement of the DM approach with direct LDL.Conclusion:This study indicates that the DM approach is closer to direct LDL compared to FF & AF.

Impact of Adoption of Directly Measured Low-Density Lipoprotein-Cholesterol (LDL-C) on Targets of Lipid Control and Its Comparison With Friedewald Formula-Calculated LDL Cholesterol in People With Type-2 Diabetes Mellitus

Objectives: The accurate and precise measurement of low-density lipoprotein-cholesterol (LDL-C) is important in the assessment of atherosclerotic cardiovascular disease risk (ASCVD) in people with diabetes mellitus. This study is aimed at comparing directly measured LDL-C with Friedewald formula (FF)-calculated LDL-C (c-LDL-C) in people with type-2 diabetes. Methods: Fasting lipid profiles of 1905 people with type-2 diabetes, whose LDL-C was estimated by direct LDL assay, were chosen for the study. In the same group, LDL-C was calculated with FF. Correlation and agreement between these methods were analyzed at various strata of triglycerides (TGs). The possibility of misclassifying people at various levels of LDL-C targets proposed in literature was calculated. Results: The mean LDL-C levels were lower in the c-LDL-C group across various TG strata. A significant correlation was found between c-LDL-C and direct LDL-C for all the study samples ( r = 0.948, P &lt; .001) and across all TG strata. Analysis of agreement showed a positive bias for direct LDL-C which increased at higher strata of TGs. c-LDL-C underestimated ASCVD by misclassifying people at various LDL-C target levels. Conclusion: There is a difference between direct LDL-C and c-LDL-C values in people with diabetes and this may result in misclassifying ASCVD especially at lower levels of LDL-C and higher levels of TGs.

Comparison of LDL-cholesterol estimated by various formulae with directly measured LDL-cholesterol in a tertiary care centre of Maval Taluka

Introduction: Low-density Lipoprotein Cholesterol (LDL-C) concentration in blood gives indication of cardiovascular disease risk. LDL-C may vary at various strata of Triglycerides and in metabolic diseases like Diabetes Mellitus. Measurement of LDL-C directly on laboratory instruments is the best method but is costly. It can also be estimated using various formulae. Our study involves the comparison of LDL-C measured directly with LDL-C estimated by calculations using various formulae. Materials and Methods: Lipid profile data was collected from Central Clinical Laboratory of MIMER Medical College and hospital, Talegaon Dabhade. Serum LDL-C values were estimated by calculation from Triglycerides (TG), Total Cholesterol (TC) and High-density lipoprotein cholesterol (HDL-C) values, using Friedewald’s, Cordova and Cordova, Vujovic, Anandaraja, Puavillai, and Hattori formula. Data of Direct LDL-C and LDL-C estimated by various formulae were compared and correlated at various levels of TG. Result: Puavillai formula correlates the best with Direct LDL-C at TG

Abstract 14313: Machine Learning for Prediction of Low Density Lipoprotein Cholesterol in Fasting and Non-fasting Patients With and Without HIV Infection

Background: Low-density lipoprotein cholesterol (LDL-C) is commonly estimated from total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) using predefined equations which assume fixed or varying relationships between these parameters and may under- or overestimate LDL-C. Machine learning (ML) algorithms allow prediction of complex non-linear relationships. We, therefore, sought to investigate the utility of ML to predict LDL-C in comparison with two widely-used methods (Friedewald and Hopkins). Methods: We identified 7397 direct LDL-C (4716 HIV, 2060 uninfected controls) measurements in the Women's Interagency HIV Study (WIHS), a prospective study of women with and without HIV undergoing serial assessments. We trained and optimized 5 ML methods (linear regression, random forest, gradient boosting machine, support vector machine, and neural networks) to predict LDL-C using TC, HDL-C, and TG in 80% of the measurements and tested model performance in a holdout test set (20% of the measurements). Results: Overall, the support vector machine model had the best performance characteristics, outperforming Friedewald’s and Hopkins methods with higher R 2 , lower root mean square error and lower mean absolute error. The support vector machine model performance remained superior in participant subgroups with and without HIV and those with non-fasting measurements. Model performance parameters for the test dataset are shown in the Figure. Conclusions: A support vector machine learning model predicts directly measured LDL-C more accurately than Friedewald and Hopkins methods, especially in non-fasting patients with HIV. Further studies are needed to provide external validation.

Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70–100 years: a contemporary primary prevention cohort

Findings of historical studies suggest that elevated LDL cholesterol is not associated with increased risk of myocardial infarction and atherosclerotic cardiovascular disease in patients older than 70 years. We aimed to test this hypothesis in a contemporary population of individuals aged 70-100 years. We included in our analysis individuals (aged 20-100 years) from the Copenhagen General Population Study (CGPS) who did not have atherosclerotic cardiovascular disease or diabetes at baseline and who were not taking statins. Standard hospital assays were used to measure LDL cholesterol. We calculated hazard ratios (HRs) and absolute event rates for myocardial infarction and atherosclerotic cardiovascular disease, and we estimated the number needed to treat (NNT) in 5 years to prevent one event. Between Nov 25, 2003, and Feb 17, 2015, 91 131 individuals were enrolled in CGPS. During mean 7·7 (SD 3·2) years of follow-up (to Dec 7, 2018), 1515 individuals had a first myocardial infarction and 3389 had atherosclerotic cardiovascular disease. Risk of myocardial infarction per 1·0 mmol/L increase in LDL cholesterol was augmented for the overall population (HR 1·34, 95% CI 1·27-1·41) and was amplified for all age groups, particularly those aged 70-100 years. Risk of atherosclerotic cardiovascular disease was also raised per 1·0 mmol/L increase in LDL cholesterol overall (HR 1·16, 95% CI 1·12-1·21) and in all age groups, particularly those aged 70-100 years. Risk of myocardial infarction was also increased with a 5·0 mmol/L or higher LDL cholesterol (ie, possible familial hypercholesterolaemia) versus less than 3·0 mmol/L in individuals aged 80-100 years (HR 2·99, 95% CI 1·71-5·23) and in those aged 70-79 years (1·82, 1·20-2·77). Myocardial infarction and atherosclerotic cardiovascular disease events per 1000 person-years for every 1·0 mmol/L increase in LDL cholesterol were highest in individuals aged 70-100 years, with number of events lower with younger age. The NNT in 5 years to prevent one myocardial infarction or atherosclerotic cardiovascular disease event if all people were given a moderate-intensity statin was lowest for individuals aged 70-100 years, with the NNT increasing with younger age. In a contemporary primary prevention cohort, people aged 70-100 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and atherosclerotic cardiovascular disease and the lowest estimated NNT in 5 years to prevent one event. Our data are important for preventive strategies aimed at reducing the burden of myocardial infarction and atherosclerotic cardiovascular disease in the growing population aged 70-100 years. None.

The Effect of the Blood Cupping Therapy on High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL) in Hypercholesterol Patients

Introduction: Hypercholesterol is a high cholesterol level in the blood. Blood cupping therapy is a techniqueof excreting metabolic waste in the blood through the skin. The study aimed to measure any effect of bloodcupping therapy to HDL and LDL cholesterol. Method: It was a Quasi-Experimental study using humansas research subjects. Non random consecutive sampling. Patiens with hypercholesterol after 12 hours offasting were treated with blood cupping, 9 points. Research subjects were 51 men divided into three groups,the cupping group only consisted of 17 men, the drug group without cupping consisted of 17 men, andthe cupping and drug consisted 17 men. Collecting data from third of the groups as pre and post data.The data were analyzed by Mann Whitney, Wilcoxon and Kruskal Wallis. The research took place at theLaboratory of Biochemistry, Universitas Jember. Results: Measurement of HDL cholesterol on the cuppinggroup was pretest=33.03±3.73; posttest=37.58±6.54; p=0.000. The drug group was pretest=33.40±3.18;posttest=33.56±3.50; p=0.788. The cupping and drug group was pretest=34.32±3.38; posttest=37.61±2.01;p=0.002. Kruskal Wallis test on pretest group was 0.534 and on posttest group was 0.002. Measurement ofLDL cholesterol on the cupping group was pretest=154.70±39.68; posttest=123.89±41.86; p=0.000. Thedrug group was pretest=151.24±44.17; posttest=151.24±44.17; p=0.019. The cupping and drug group waspretest=147.48±62.66; posttest=105.57±57.94; p=0.001. Kruskal Wallis test on pretest group was 0.439and on posttest group was 0.082. This means that there was no difference in the average pretest and posttestLDL levels in the cupping, drug, cupping and drug groups. Conclusion: The intervention of blood cuppingtherapy can increase HDL cholesterol level, and reduce LDL cholesterol level. Further research needs to bedone to measure the potential prevention of atherosclerosis.

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

Role of Bempedoic Acid in Dyslipidemia Management.

Statins remain the preferred agent to reduce low-density lipoprotein cholesterol (LDL-C) and lower atherosclerotic cardiovascular disease (ASCVD) risk. Additional nonstatin agents are recommended to further lower LDL-C among patients at high-risk of ASCVD or those with heterozygous familial hypercholesterolemia, despite statin therapy. Patients unable to tolerate recommended doses of statin therapy due to adverse effects, including statin-associated muscle symptoms, may also require additional nonstatin agents to lower LDL-C and ASCVD risk. Bempedoic acid is a first-in-class, once-daily oral agent, recently approved as monotherapy and in combination with ezetimibe, as an adjunct to maximally tolerated statin therapy in patients with ASCVD or heterozygous familial hypercholesterolemia who require additional LDL-C lowering. Its novel mechanism is reported to avoid adverse muscle symptoms associated with statins. The effectiveness and safety of bempedoic acid and bempedoic acid/ezetimibe combination have been reported in multiple phase 2 and 3 trials. In this review, we report the lipid-lowering effects associated with bempedoic acid, and the safety profile from multiple clinical trials. Based on available data, bempedoic acid significantly lowers LDL-C and other atherogenic lipoprotein measures, and high-sensitivity C-reactive protein when added to background lipid-lowering therapy in patients with and without statin intolerance. Overall safety of bempedoic acid seems to be comparable to placebo, except for increased serum uric acid and tendon rupture. Ongoing clinical trials assessing the long-term safety and cardiovascular outcomes will provide additional insight into the role of bempedoic acid as an adjunct lipid-lowering medication.

Low-Density Lipoprotein Cholesterol and Adverse Cardiovascular Events After Percutaneous Coronary Intervention

BackgroundAfter percutaneous coronary interventions (PCIs), patients remain at high risk of developing late cardiovascular events. Although controlling low-density lipoprotein cholesterol (LDL-C) may improve outcomes after PCI, practice guidelines do not have specific recommendations on LDL-C management for this subgroup. ObjectivesThe purpose of this study was to evaluate LDL-C testing and levels after PCIs, and to assess the association between LDL-C and longer-term cardiovascular events after PCIs. MethodsAll patients who received their first PCI from October 1, 2011, to September 30, 2014, in Ontario, Canada, were considered for inclusion. Patients who had LDL-C measurement within 6 months after PCI were categorized as: <70 mg/dl, 70 to <100 mg/dl, and ≥100 mg/dl. The primary composite outcome was cardiovascular death, myocardial infarction, coronary revascularization, and stroke through December 31, 2016. ResultsAmong 47,884 included patients, 52% had LDL-C measured within 6 months of PCI and 57% had LDL-C <70 mg/dl. After a median 3.2 years, the rates of cardiovascular events were 55.2/1,000 person-years for the LDL-C <70 mg/dl group, 60.3/1,000 person-years for 70 to <100 mg/dl, and 94.0/1,000 person-years for ≥100 mg/dl. The adjusted subdistribution hazard ratios for cardiovascular events were 1.17 (95% confidence interval: 1.09 to 1.26) for LDL-C of 70 to <100 mg/dl, and 1.78 (95% confidence interval: 1.64 to 1.94) for LDL-C ≥100 mg/dl when compared with LDL-C <70 mg/dl. ConclusionsOne in 2 patients had LDL-C measured within 6 months after PCI, and only 57% had LDL-C <70 mg/dl. Higher levels of LDL-C were associated with an increased incidence of late cardiovascular events. Improved cholesterol management after PCI should be considered to improve the outcomes of these patients.

Exploring the effect of vitamin D3 supplementation on surrogate biomarkers of cholesterol absorption and endogenous synthesis in patients with type 2 diabetes—randomized controlled trial

Inverse associations have been reported between serum 25-hydroxyvitamin D [25(OH)D] and circulating cholesterol concentrations in observational studies. Postulated mechanisms include reduced bioavailability of intestinal cholesterol and alterations in endogenous cholesterol synthesis. To explore the effect of daily supplementation with 4000 IU/d vitamin D3 for 24 wk on surrogate biomarkers of cholesterol absorption (campesterol and β-sitosterol) and endogenous synthesis (lathosterol and desmosterol). Ancillary study of The Vitamin D for Established Type 2 Diabetes (DDM2) trial. Patients with established type 2 diabetes (N=127, 25-75 y, BMI 23-42 kg/m2) were randomly assigned to receive either 4000 IU vitamin D3 or placebo daily for 24 wk. Of participants without changes in cholesterol-lowering medications (n=114), plasma surrogate cholesterol absorption and endogenous synthesis biomarker concentrations were measured and merged with available measures of serum LDL cholesterol and HDL cholesterol concentrations. At week 24, vitamin D3 supplementation significantly increased 25(OH)D concentrations (+21.5±13.4 ng/mL) but not insulin secretion rates (primary outcome of the parent study) as reported previously. In this ancillary study there was no significant effect of vitamin D3 supplementation on serum cholesterol profile or surrogate biomarkers of cholesterol absorption and endogenous synthesis. Compared with participants not treated with cholesterol-lowering medications, those who were treated exhibited a greater reduction in plasma campesterol concentrations in the vitamin D3 but not placebo group (P-interaction=0.011). Analyzing the data on the basis of cholesterol absorption status (hypo- versus hyperabsorbers) or cholesterol synthesis status (hypo- versus hypersynthesizers) did not alter these results. Vitamin D3 supplementation for 24 wk had no significant effect on surrogate biomarkers of cholesterol absorption or endogenous synthesis, consistent with the lack of effect on serum cholesterol profile. Vitamin D3 supplementation resulted in greater reduction in campesterol concentrations in participants not using compared with those using cholesterol-lowering medications. Further studies are required.This trial was registered at clinicaltrials.gov as NCT01736865.

Prevalence, treatment, and control of severe hyperlipidemia

ObjectiveTo identify the prevalence, treatment, and low-density lipoprotein cholesterol (LDL-C) control of individuals with LDL-C ≥190 ​mg/dL in contemporary clinical practice. MethodsWe included adults (age ≥18 years) with LDL-C ≥190 ​mg/dL, at least one LDL-C level drawn from 255 health systems participating in Cerner HealthFacts database (2000–2017, n ​= ​4,623,851), and a detailed examination within Duke University Health System (DUHS, 2015–2017, n ​= ​267,710). Factors associated with LDL-C control were evaluated using multivariable logistic regression modeling. ResultsThe cross-sectional prevalence of LDL-C ≥190 ​mg/dL was 3.0% in Cerner (n ​= ​139,539/4,623,851) and 2.9% at DUHS (n ​= ​7728/267,710); among these, rates of repeat LDL-C measurement within 13 months were low: 27.9% (n ​= ​38,960) in Cerner, 54.5% (n ​= ​4211) at DUHS. Of patients with follow-up LDL-C levels, 23.6% in Cerner had a 50% of greater reduction in LDL-C, 18.3% achieved an LDL-C <100 ​mg/dL and 2.7% ​< ​70 ​mg/dL. At DUHS, 28.4% had a 50% or greater reduction in LDL-C, 28.4% achieved an LDL-C ≤100 ​mg/dL and 4.4% achieved <70 ​mg/dL. Within DUHS, 71.6% with LDL-C ≥190 ​mg/dL were on any statin during follow-up, but only 28.5% were on a high-intensity statin. In multivariable modeling, seeing a cardiologist (Cerner odds ratio [OR] 1.56, confidence interval [CI] 1.33–1.83; DUHS OR 1.89, 95% CI 1.18–3.01) and having diabetes (Cerner OR 1.34 CI 1.23–1.46; DUHS OR 2.07, CI 1.62–2.65) increased odds of LDL-C control, defined as a ≥50% reduction in LDL-C (at Cerner) or initiation of high intensity statin (at DUHS). Prior atherosclerotic cardiovascular disease (OR 1.19, CI 1.07–1.33), hypertension (OR 1.10, CI 1.03–1.18), African American race (OR 0.79, CI 0.71–0.89), and government (vs. private) insurance (OR 0.90, CI 0.83–0.98) were associated with LDL-C control at Cerner. Female sex was associated with lower odds of appropriate therapy (OR 0.69, CI 0.59–0.81) at DUHS. ConclusionsApproximately 3% of United States adults have LDL-C ≥190 ​mg/dL. Among those with very high LDL-C, rates of repeat measurement within one year were low; of those retested, only about one-fourth met guideline-recommended LDL-C treatment goals.

Reader response: Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage: A prospective study.

Ma et al.1 presented robust epidemiologic evidence in the association of very low levels of low-density lipoprotein cholesterol (LDL-cholesterol) with risk of intracerebral hemorrhage using the data of a huge prospective cohort of Chinese with repeated measures of LDL-cholesterol. Contrasted with the “high cholesterol ischemic heart disease hypothesis,” their result is consistent to support a “very low cholesterol intraparenchymal hemorrhage hypothesis;”2–4 one of them showed a graded excess risk of mortality from intracerebral hemorrhage only among persons with LDL-cholesterol levels of <100 mg/dL2, which supported the finding from Ma's study.1

Lipid-lowering therapy and low-density lipoprotein cholesterol goal attainment after acute coronary syndrome: a Danish population-based cohort study

BackgroundPatients with acute coronary syndrome (ACS) are at high risk of recurrent cardiovascular (CV) event. The European guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/L and early initiation of intensive lipid-lowering therapy (LLT) to reduce CV risk.In order to reduce the risk of further cardiac events, the study aimed to evaluate LDL-C goal attainment and LLT intensity in an incident ACS population.MethodsA cohort study of patients with residency at Funen in Denmark at a first-ever ACS event registered within the period 2010–2015. Information on LLT use and LDL-C levels was extracted from national population registers and a Laboratory database at Odense University Hospital. Treatments and lipid patterns were evaluated during index hospitalization, at 6-month and 12-month follow-up.ResultsAmong 3040 patients with an LDL-C measurement during index hospitalization, 40.7 and 39.0% attained the recommended LDL-C target value (< 1.8 mmol/L) within 6- and 12-month follow-up, respectively. During 6- and 12-month follow-up, a total of 89.2% (20.2%) and 88.4% (29.7%) used LLT (intensive LLT). Of the intensive LLT users, 43.4 and 47.7% reached the LDL-C target value at 6- and 12-month follow-up. The frequency of lipid monitoring was low: 69.5, 77.7 and 53.6% in patients with a first-ever ACS during index hospitalization, 6- and 12-month follow-up, respectively.ConclusionUsing national health registers and laboratory data, a considerably gap was observed between treatment guidelines and clinical practice in the management of dyslipidemia leaving very high-risk patients without adequate lipid management strategy. Therefore, improved lipid management strategies aimed at reaching treatment targets are warranted.

The Prevalence and Diagnostic Ratio of Familial Hypercholesterolemia (FH) and Proportion of Acute Coronary Syndrome in Japanese FH Patients in a Healthcare Record Database Study.

Background Familial hypercholesterolemia (FH) is a genetic disorder characterized by high levels of low-density lipoprotein cholesterol (LDL-C). Because of underdiagnosis, acute coronary syndrome (ACS) is often the first clinical manifestation of FH. In Japan, there are few reports on the prevalence and diagnostic ratios of FH and the proportion of ACS among FH patients in clinical settings. Methods This retrospective, observational study used anonymized data from electronic healthcare databases between April 2001 and March 2015 of patients who had ≥2 LDL-C measurements recorded after April 2009. The index date was defined as the date of the first LDL-C measurement after April 2009. The primary endpoint was the prevalence of definite or suspected FH; secondary endpoints included the proportion of FH patients hospitalized for ACS, the proportion of patients using lipid-lowering drugs (LLDs), and LDL-C levels. Results Of the 187,781 patients screened, 1547 had definite or suspected FH (0.8%) based on data from the entire period; 832 patients with definite (n = 299, 0.16%) or suspected FH (n = 533, 0.28%) before the index date were identified in the main analysis cohort. LLDs were used in 214 definite FH patients (71.6%) and 137 suspected FH patients (25.7%). Among definite or suspected FH patients with ACS (n = 84) and without ACS (n = 748), 32.1% and 30.1% with definite FH and 3.2% and 2.4% with suspected FH had LDL-C levels < 2.6 mmol/L (<100 mg/dL), respectively. Sixty patients (7.2%) were hospitalized due to ACS at the index date. Conclusions The prevalence of FH in this Japanese cohort of patients with ≥2 LDL-C measurements at hospitals was 0.8%, which is higher than that currently reported in epidemiological studies (0.2–0.5%). Patients with suspected FH, with or without ACS, had poorly controlled LDL-C levels and were undertreated. The proportion of FH patients who were hospitalized due to ACS was 7.2%.

Associations between smoking, glucose metabolism and lipid levels: A cross-sectional study

AimsThe aim of this study was to investigate glucose profiles assessed by oral glucose tolerance tests (OGTT), fasting glucose, and lipid profiles among smokers, ex-smokers and never-smokers. Materials and methodsThe study design used was a cross-sectional analysis of data from several years of the NHANES (National Health and Nutrition Examination Survey) from 2005 to 2014. A total of 12,460 participants with measures of OGTT, triglycerides, LDL-cholesterol and HDL-cholesterol were included for the data analysis. Outcomes were all assessed in an unadjusted and in an adjusted gender analysis. A GLM model was used to assess 2-hour OGTT, fasting plasma glucose, difference between fasting plasma glucose and OGTT, HbA1c, HDL-cholesterol, LDL-cholesterol, and triglyceride in relation to current smoking, ex-smoking and never smoking. The effects were adjusted with covariates: gender, BMI, age, alcohol usage, educational level and ethnicity. ResultsThe OGTT results was lower for the group smoking (−10.1 [−13.2; −7.1], p < 0.001), and no effect was observed from ex-smoking (−2.7 [−5.7; 0.8], p = 0.08). Fasting glucose was not different for smokers (−0.2 [−1.6; 1.2], p = 0.80) or ex-smokers (0.1 [−1.3; 1.5], p = 0.90). For smokers', triglycerides (1.2 [1.1; 1.3], p < 0.001), LDL-cholesterol (7.7 [6.0; 9.3], p < 0.001) were increased and HDL-cholesterol was decreased (−2.1 [−2.8; −1.5], p < 0.001). ConclusionsAlthough this study is cross-sectional and cannot, by the same nature of the design, prove a cause-effect relationship, the present results indicate that cigarette smoking may be associated with factors that are adversely related to the metabolic syndrome. But the evidence from our results are not unanimous pointing in the same direction as 2-hour OGTT measurements are considerably lower in participants smoking.