Low-density Lipoprotein Values Research Articles

Estimating Changes in Weight and Metabolic Parameters Before and After Treatment With Cariprazine: A Retrospective Study of Electronic Health Records

Weight gain and associated negative cardiometabolic effects can occur as a result of mental illness or treatment with second-generation antipsychotics (SGAs), leading to increased rates of morbidity and mortality. In this analysis, we evaluated the effect of the SGA cariprazine on weight and metabolic parameters in a real-world, retrospective, observational dataset. Electronic health records from the Optum Humedica database (October 1, 2014-December 31, 2020) were analyzed during the 12-month period before starting cariprazine (baseline) and for up to 12 months following cariprazine initiation; approved and off-label indications were included. Body weight trajectories were estimated in the overall patient cohort and at 3-, 6-, and 12-month timepoints (primary objective). Changes in hemoglobin A1c (HbA1c), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides were also evaluated (secondary objectives). Percentages of patients with clinically relevant shifts in body weight, total cholesterol, and fasting triglycerides were also determined. Discontinuation rates for metabolic regulating medications were calculated. Average predicted values were estimated by linear mixed-effects regression models. A total of 2,301 patients were included; average duration of follow-up was 133.7 days. Average predicted weight change for patients during the cariprazine overall follow-up period was +2.4 kg, with predicted weight changes of +0.8 kg (n=811), +1.1 kg (n=350), and +1.4 kg (n=107) at months 3, 6, and 12, respectively. Overall, the majority of patients did not experience clinically significant (≥7%) weight gain (82.8%) or loss (90.5%) after starting cariprazine. Average predicted HbA1c levels (n=189) increased during baseline (0.15%/year) and decreased during cariprazine treatment (-0.2%/year). Average predicted triglyceride levels (n=257) increased during baseline (15.0 mg/dL/year) and decreased during cariprazine treatment (-0.7 mg/dL/year). Predicted LDL (n=247) and HDL (n=255) values decreased during baseline (-7.3 and -1.1 mg/dL/year, respectively); during cariprazine treatment, LDL increased by 5.6 mg/dL/year and HDL decreased by -0.6 mg/dL/year. During follow-up, most patients did not shift from normal/borderline to high total cholesterol (<240 to ≥240 mg/dL; 522 [90.2%]) or fasting triglyceride (<200 to ≥200 mg/dL; 143 [88.8%] patients) levels; shifts from high to normal/borderline levels occurred in 44 (61.1%) patients for total cholesterol and 38 (57.6%) patients for fasting triglycerides. After starting cariprazine, the discontinuation rate per 100 patient-years was 60.4 for antihyperglycemic medication and 87.4 for hyperlipidemia medication. These real-world results support short-term clinical trial findings describing a neutral weight and metabolic profile associated with cariprazine treatment and they expand the dataset to include long-term follow-up.

Dietary supplementation with a mixture of Dunaliella salina and Spirulina enhances broiler performance by improving growth, immunity, digestive enzymes and gut microbiota

The aim of this study is to evaluate the effect of Dunaliella salina and Spirulina (D + S) mixture on performance, carcass yield, kidney and liver markers, lipid profile, and immune responses of fattening chicks. Two hundred broiler chicks at 7 days old were distributed into 5 experimental groups, 5 replicates each with 8 chicks each. Group 1 was fed on only basal diet; group 2 was fed with basal diet and 0.50 g/kg (D + S); group 3 was fed with basal diet and 1.00 g/kg (D + S); group 4 was fed with basal diet and 1.50 g/kg (D + S); and group 5 was fed with basal diet supplemented with 2.00 g/kg (D + S). The additive mixture (D + S) consisted of (1 D. salina: 1 Spirulina). The experiment lasted for 6 wk. The results demonstrated significantly improved better live body weight, body weight gain, and feed conversion ratio (P<0.01) for groups that received (D + S) at levels of 1.0 and 1.5 g/kg diet compared to other groups at 6 wk of age. There was no significant influence of different levels of dietary feed additives on feed intake or carcass traits. The lipid profile was improved through a reduction of total cholesterol and low-density lipoprotein (LDL) values and increasing high-density lipoprotein (HDL) values, as well as the immune response, which was improved through increasing values of complement 3, immunoglobulin M (IgM), and immunoglobulin G (IgG) in the birds treated with (D + S) compared to the control group. The inclusion of all levels of (D + S)/kg decreased triglyceride, while total protein, albumen, and globulin values (P<0.05 or P<0.01) were higher compared to other groups. The inclusion of the different levels of (D + S)/kg improved liver function, whereas aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were lower than in other groups (P<0.001). The lowest values of creatinine, urea, and uric acid were noted in birds fed a diet supplemented with 1.50 g (D + S)/kg. Antioxidant levels were improved through increasing values of catalase (CAT) and reduced glutathione (GSH) enzymes in the treated birds with (D + S) compared with the control chicks. Furthermore, digestive enzymes and microbial content were improved in broiler checks fed on diet supplemented with (D + S) compared to the control group. In conclusion, supplementing broiler chicks with a dietary D. salina and Spirulina combination increased their productive performance, immunity, kidney and liver function, lipid profile, and digestive enzymes.

Prediction of LDL in hypertriglyceridemic subjects using an innovative ensemble machine learning technique

Abstract Objectives Determining low-density lipoprotein (LDL) is a costly and time-consuming operation, but triglyceride value above 400 (TG&gt;400) always requires LDL measurement. Obtaining a fast LDL forecast by accurate prediction can be valuable to experts. However, if a high error margin exists, LDL prediction can be critical and unusable. Our objective is LDL value and level prediction with an error less than low total acceptable error rate (% TEa). Methods Our present work used 6392 lab records to predict the patient LDL value using state-of-the-art Artificial Intelligence methods. The designed model, p-LDL-M, predicts LDL value and class with an overall average test score of 98.70 %, using custom, hyper-parameter-tuned Ensemble Machine Learning algorithm. Results The results show that using our innovative p-LDL-M is advisable for subjects with critical TG&gt;400. Analysis proved that our model is positively affected by the Hopkins and Friedewald equations normally used for (TG≤400). The conclusion follows that the test score performance of p-LDL-M using only (TG&gt;400) is 7.72 % inferior to the same p-LDL-M, using Hopkins and Friedewald supported data. In addition, the test score performance of the NIH-Equ-2 for (TG&gt;400) is much inferior to p-LDL-M prediction results. Conclusions In conclusion, obtaining an accurate and fast LDL value and level forecast for people with (TG&gt;400) using our innovative p-LDL-M is highly recommendable.

Prevalence of familial hypercholesterolemia in patients with acute coronary syndrome

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim &amp;lt;br /&amp;gt;&amp;lt;/strong&amp;gt;To investigate the prevalence of familial hypercholesterolemia in patients with acute coronary syndrome (ACS).&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;The study included fifteen patients with first or repeated ACS and treated/nontreated dyslipidaemia admitted to the Department of Cardiovascular Diseases of Clinical Hospital Centre Osijek between 1 January 2020 and 1 January 2021. The cut-off value of low-density lipoprotein (LDL)-C was 4.5mmol/L as a possible cut-off value for familial hypercholesterolemia presence. Data were collected from medical history and during patient&amp;amp;rsquo;s follow-up.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Included patients that fulfilled criteria were predominantly male &amp;amp;ndash; 14 (93%), mean age 61 years. The median level of LDL cholesterol at admission because of ACS was 5.14 mmol/L, whereas the follow-up level after one year was 2.27 mmol/L (p=0.001). At first follow-up, 7 (46%) patients were treated with atorvastatin 80 mg or rosuvastatin 40 mg, 3 (20%) atorvastatin 80mg + ezetimibe 10mg, 2 (13%) with rosuvastatin 40 mg+ ezetimibe 10 mg, other patients were treated with a lower dose of statin or ezetimibe. According to LDL-C profile and by calculating the&amp;lt;br /&amp;gt;Dutch Lipid Clinic Network Score, one (of 15) patient was categorized as having definite familial hypercholesterolemia and two (of 15) as having probable familial hypercholesterolemia leading to the use of triple hypolipidemic therapy (statin+ezetimibe+PCSK9 inhibitor) in 2 (13%) patients (one female and one male).&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;LDL-C level of 4.5 mmol/L and higher represents an indication for screening for familial hypercholesterolemia in patients with ACS. The prevalence of familial hypercholesterolemia in ACS, estimated by the Dutch Lipid Clinic Network Score, could be higher than previously reported.&amp;lt;/p&amp;gt;

The Impact of the COVID-19 Pandemic in The Netherlands on Primary Healthcare Use and Clinical Outcomes in Persons with Type 2 Diabetes

The COVID-19 pandemic has had a significant impact on healthcare systems worldwide, including the postponing or canceling of appointments and procedures for type 2 diabetes (T2D) care by general practitioners (GPs) in the Netherlands. The aim of this study was to investigate the impact of the COVID-19 pandemic on primary healthcare use and clinical measurements for people with T2D. Additionally, we aimed to determine if changes were observed among specific risk groups: (1) persons 70 years or older, or below 70 years, (2) patients who were meeting their HbA1c targets and those who were not, and (3) patients with high-risk and non-high-risk T2D. This retrospective cohort study among persons with T2D was conducted using data from the DIAbetes MANagement and Treatment (DIAMANT) data infrastructure, deriving data from electronic medical records of Dutch GPs. The study assessed GP visit counts, and counts and values of clinical measurements, including hemoglobin A1c (HbA1c), body mass index (BMI), low-density lipoprotein (LDL) cholesterol, and systolic blood pressure (SBP). Adjusted negative binomial (NB) regression and generalized estimating equations (GEE) models were used to estimate GP visit counts and population averages of clinical measurements, respectively, comparing 2019 (pre-pandemic) with 2020 (during the pandemic). Changes in specific groups were examined by stratifying outcomes for the aforementioned subgroups. The cohort consisted of 182,048 patients with T2D (47% female, mean age 69 ± 13 years) on 1 March 2019, of which 168,097 persons (92%) still contributed follow-up data in 2020. We observed an increase in total GP visits in 2020, with an adjusted rate ratio (RR) of 1.09 (95% CI 1.08–1.09). The frequency increased for office visits (RR 1.06; 1.06–1.07) and phone calls (RR 1.33; 1.31–1.35) but remained stable for home visits (RR 1.02; 0.99–1.04). On both population and individual levels, HbA1c values increased in 2020 by 1.65 (1.59–1.70) mmol/mol compared to 2019. Observed changes in 2020 for BMI, LDL, and SBP values were also statistically significant but small. Subgroup stratifications showed higher scores of all clinical measurements in younger persons (&lt;70 years), those who met their HbA1c target, and non-high-risk T2D patients than their respective high-risk subgroups. During the first year of the COVID-19 pandemic in the Netherlands, changes in primary healthcare use were observed among persons with T2D, with an increase in GP office visits and phone calls and a decreased number of clinical measurements and GP home visits. HbA1c levels increased among patients with T2D in 2020. Further research is necessary to determine the impact of the COVID-19 pandemic on long-term clinical outcomes and (long-term) T2D complications.

The Effect of Ethanol Ants Nest Extract on Profil Lipid Mice Model Obesity with Type 2 Diabetes

The Ants Nest plant (Myrmecodia pendans) is known to have the potential to reduce blood glucose cholesterol, LDL (Low-Density Lipoprotein), and HDL (High-Density Lipoprotein) in obese patients with Type 2 Diabetes (T2D) because it contains high flavonoid and tannin content that can prevent oxidative stress and inhibit the work of pancreatic β cells, α-glucosidase work, Glut-2, and lipase enzymes. This study aims to study the effect of the management of Ethanol Ants Nest Extract (EANE) on changes in the cholesterol, LDL, and HDL levels of obese rats with T2D. The extraction of the ants nest was carried out using the maceration method with ethanol solvent. Cholesterol, LDL, and HDL values will be obtained through the CHOD PAP. The rats were divided into 6 groups, namely: KNo (standard control), KN (T2D obesity), KP (T2D obesity given metformin), P1, P2, and P3 (T2D obesity given ethanol extract of ant nest 150mg/KgBW/day, 300mg/KgBW/day, and 600mg/KgBW/day for 14 days by gastric sonde). Induction of DM model using streptozocin and nicotinamide. Data were analyzed using Paired T-test and continued by using One-way ANOVA. There was a decrease in cholesterol, LDL, and HDL after 14 days of intervention, which was highest in the P3 group with cholesterol, LDL, and HDL of 64,06 ± 1,97 mg/dl (p &lt; 0.0001), 44,56 ± 2,22 mg/dl (p &lt; 0.0001), and 45,33 ± 2,56 mg/dl (p &lt; 0.0001). The treatment of ethanol extract from ants nest has an effect in reducing cholesterol, LDL, and HDL.

Influence of the Type of Disability and Sporting Discipline on Lipid Profile in a Cohort of Italian Paralympic Athletes

Dyslipidemia is the most frequent cardiovascular (CV) risk factor in able-bodied athletes and is frequently undertreated, resulting in an underestimated risk of atherosclerosis-related diseases. Data on lipid profile in Paralympic athletes are lacking. Our study aimed to identify the prevalence of dyslipidemia and the influence of disability type and sporting discipline in Paralympic athletes. We evaluated 289 athletes who participated in the Paralympic Games from London 2012 to Beijing 2022. All athletes underwent clinical/physical evaluation, blood tests, and body composition analysis. They were divided into different groups based on sports disciplines and disability type (spinal cord injuries [SCIs] and non-SCIs [NSCIs]). Among the Paralympic athletes, 34.6% had a low-density lipoprotein (LDL) level ≥115mg/100ml. They were older (38.1 ± 9.2 vs 30.6 ± 9.6, p=0.001) and had a higher CV risk. Athletes with SCI showed similar total cholesterol and triglycerides, higher LDL (110.9 ± 35.2 vs 102.7 ± 30.6mg/100ml, p=0.03) and lower high-density lipoprotein (HDL) (53.6 ± 13.6 vs 60.5 ± 15.4mg/100ml, p=0.001) than those with NSCI. Endurance athletes had lower LDL, the highest HDL, and the lowest triglycerides and LDL/HDL ratio compared with other sports disciplines. A mean follow-up of 61.5 ± 30.5months was available in 47% athletes, and 72.7% of the athletes with dyslipidemia continued to present altered LDL values at follow-up. In conclusion, dyslipidemia is the most common CV risk factor in the Paralympics, affecting 35% of athletes, with only mild lipid changes over a medium-term time. The type of disability and sporting discipline has an impact on lipids, improving HDL and reducing LDL, with a better profile observed in NSCI and endurance athletes.

Predicting acute ischemic stroke using the revised Framingham stroke risk profile and multimodal magnetic resonance imaging.

Patients with transient ischemic attacks (TIA) have a significant risk of developing acute ischemic strokes (AIS), emphasizing the critical need for hierarchical management. This study aims to develop a clinical-imaging model utilizing multimodal magnetic resonance imaging (mMRI) and the revised Framingham Stroke Risk Profile (FSRP) to predict AIS and achieve early secondary prevention. mMRI scans were conducted on patients with symptomatic intracranial atherosclerotic disease (ICAD) to assess vascular wall features and cerebral perfusion parameters. Based on diffusion-weighted imaging (DWI), patients were divided into two groups: TIA and AIS. Clinical data were evaluated to calculate the FSRP score. Differences in clinical and imaging characteristics between the groups were analyzed, and a predictive model for AIS probability in patients with ICAD was established. A total of 112 TIA and AIS patients were included in the study. The results showed that the AIS group had higher proportions of FSRP-high risk, hyperhomocysteinemia, and higher value of low-density lipoprotein (LDL), standardized plaque index (SQI), and enhancement rate (ER) compared to the TIA group (p < 0.05). Mean transit time (MTT) and time to peak (TTP) in the lesion area were significantly longer in the AIS group (p < 0.05). Multivariate analysis identified FSRP-high risk (p = 0.027) and high ER (p = 0.046) as independent risk factors for AIS. The combined clinical and mMRI model produced an area under the curve (AUC) of 0.791 in receiver operating characteristic (ROC) analysis. The constructed nomogram model combining clinical and mMRI features demonstrated favorable clinical net benefits. FSRP-high risk and high ER were confirmed as independent risk factors for AIS. The combined prediction model utilizing clinical and imaging markers effectively predicts stroke risk in symptomatic ICAD patients.

The effect of propolis addition to the laying-hen diet on performance, serum lipid profile and liver fat rate.

The aim of this study was to evaluate the effect of propolis (P) on performance, egg quality parameters, serum lipid profile, some liver enzymes and liver fat ratio. One-hundred-and-twenty Lohmann (LSL) laying hens were divided into five groups, and each group consisted of six subgroups. The control group was fed basal diet. The other groups were fed high-energy (HE) diets to induce fatty liver syndrome, and 0, 100, 200 and 300 mg kg of propolis were supplemented with high-energy feeds. During the 8-week trial, feed and water were given adlibitum. It was determined that egg production and feed conversion ratio were decreased in the high-energy feed group without the addition of propolis. The highest egg production was found in HE 100 and HE 200 mg kg of P groups. It was found that liver fat ratios were higher in the group fed with HE 0 mg kg of P feed () than other groups. But the addition of P decreased the liver fat rate significantly. The highest very low density lipoprotein (VLDL), triglyceride (TG) and low-density lipoprotein (LDL) values were found for the HE 0 mg kg of P group. The addition of 200 mg kg of P to high-energy feed increased glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) values. In conclusion, high-energy feed adversely affected egg production and liver fat ratio, but the addition of 100 or 200 mg kg of propolis improved egg production and decreased liver fat ratio.

Statin adherence in patients enrolled in the disease management program for coronary artery disease – comparison between patients’ and general practitioners’ self-reports and patient records

IntroductionPatients with coronary artery disease (CAD) should take a statin daily for secondary prevention. However, statin adherence in patients with CAD is low. This study investigated the proportion of adherent patients enrolled in the disease management program for CAD (DMP-CAD). Adherence was examined by comparing patients’ self-reports, general practitioners’ (GPs) self-reports, and prescription data.MethodsBetween October 2019 and March 2020, all patients enrolled in the DMP-CAD in three GP practices in Germany were invited to participate in the study. Participants completed a questionnaire on the tolerability of statins. Further, prescription data from patient records, low-density lipoprotein (LDL) levels, and GPs’ assessment of statin adherence were examined. The Medication Possession Ratio (MPR) served as a measurement tool for adherence.ResultsSeventy-four patients were included. MPR showed high statin adherence for most patients (83.8%). However, GPs did not reliably identify non-adherence in their patients. Generally, the mean LDL values were above the guideline recommendations (97.7 ± 27.9 mg/dl), with higher values in the non-adherent (123.6 ± 42 mg/dl) than in the adherent group (93.1 ± 22 mg/dl). Non-adherent patients were more likely to be employed (41.7% vs. 11.3%).DiscussionPatients in this study showed high statin adherence. However, the LDL target value was often not reached. Therefore, GPs should take advantage of the good adherence of their patients and try to lower LDL levels by adjusting the dosage and/or changing the statin prescribed. Future studies should investigate typical characteristics of non-adherent patients in DMP-CAD so that GPs can target these patient groups and improve their adherence.

Association of angiotensin-converting enzyme I/D polymorphism and apolipoprotein B with cardiometabolic abnormalities among young adults: a pilot study from Delhi

BackgroundAngiotensin-converting enzyme (ACE) gene polymorphism and elevated apolipoprotein B (apoB) are important risk factors for several cardiometabolic abnormalities. However, much less attention has been given to the relationship between these risk factors and cardiometabolic abnormalities among young adults. Considering this gap, the present study explored the association of ACE I/D polymorphism and apoB with cardiometabolic abnormalities among young adults of Delhi, India.MethodsThis cross-sectional study was conducted among young adults (aged 18–30) of either sex residing in Delhi, India. A total of 330 individuals were invited to participate in the study, and data on the socio-demographic variables were collected using a pre-tested interview schedule. Somatometric and physiological measurements were obtained using standard protocols. However, blood sample collection and biochemical and genetic analyses could successfully be performed for 178 individuals. Fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels were estimated using Erba XL-640 biochemical analyzer. LDL and TG values were used to calculate apoB levels. Genotyping for ACE I/D polymorphism was performed by allele-specific PCR amplification followed by electrophoresis. Statistical analysis was done using SPSS v.20.ResultsACE I/D polymorphism was not found to be associated with hypertension, obesity, and abnormal FBG, TG, and HDL levels. However, DD and ID genotypes and D allele, with II as the reference genotype, significantly reduced the risk for high TC (OR, p value = 0.14, 0.01*; 0.29, 0.04*; 0.22, < 0.01*, respectively) and high LDL (OR, p value = 0.17, 0.03*; 0.20, 0.03*; 0.19, < 0.01*, respectively). Except for abnormal FBG, the prevalence of all the studied cardiometabolic abnormalities was significantly higher in the 4th quartile of apoB when compared to other quartiles. Linear regression model revealed a significant positive association of apoB levels with diastolic blood pressure, studied obesity parameters, TC, TG, and LDL levels.ConclusionThe D allele of ACE I/D polymorphism was not associated with most of the studied cardiometabolic abnormalities in the present study. Further, the association of high apoB with cardiometabolic abnormalities hints toward the importance of apoB in the early diagnosis of CVDs.

Predictive value of low-density lipoprotein cholesterol/remnant cholesterol coordination on cardiovascular and cerebrovascular events in elderly patients with hypertension

Objective: To explore the predictive value of serum low-density lipoprotein cholesterol/residual cholesterol (LDL-C/RC) coordination on major adverse cardiovascular events (MACE) in elderly hypertensive patients. Methods: This is a prospective cohort study. Elderly hypertensive patients hospitalized in Beijing Anzhen Hospital from June 2018 to June 2020 were prospectively enrolled. According to the coordination of baseline LDL-C/RC, patients were divided into four groups: low LDL-C and low RC (LDL-C<2.6 mmol/L, and RC<0.62 mmol/L), low LDL-C and high RC (LDL-C<2.6 mmol/L, and RC≥0.62 mmol/L), high LDL-C and low RC (LDL-C≥2.6 mmol/L, and RC<0.62 mmol/L), and high LDL-C and high RC (LDL-C≥2.6 mmol/L, and RC≥0.62 mmol/L). Patients were followed up until June 2022. The primary outcome was MACE, including non-fatal acute coronary syndrome, non-fatal acute heart failure, non-fatal stroke and death. Kaplan-Meier survival analysis was used to evaluate MACE among the four groups, and Cox regression analysis was performed to evaluate the related factors of MACE. Results: A total of 847 hypertensive patients were enrolled. There were 453 males (53.5%), mean age was (72.4±8.8) years. There were 207, 162, 263, 215 patients in the low LDL-C and low RC, low LDL-C and high RC, high LDL-C and low RC and high LDL-C and high RC group, respectively. During a median follow-up of 37 months, 196 patients (23.1%) had MACE, including 77 cases (9.1%) of ACS, 56 cases (6.6%) of acute heart failure, 34 cases (4.0%)of non-fatal stroke, 29 cases(3.4%) of all-cause mortality, and 16 cases (1.9%) of cardiovascular death. Risk of MACE of the four groups was significantly different (log-rank P<0.001). Compared with low LDL-C and low RC groups, high LDL-C and high RC groups had the highest incidence of MACE (HR=2.237, 95%CI 1.328-3.783, P=0.004), followed by low LDL-C and high RC groups (HR=1.745, 95%CI 1.220-2.527, P=0.003) and high LDL-C and low RC groups (HR=1.393, 95%CI1.048-1.774, P=0.022). In addition, the risk of nonfatal ACS among the four groups was also statistically significant (P=0.037), while the risk of nonfatal acute heart failure, nonfatal stroke, all-cause mortality and cardiovascular death were similar (all P>0.05). Multivariate Cox regression analysis showed that age (HR=1.271), duration of hypertension (HR=1.339), diabetes (HR=1.415), hyperlipidemia (HR=1.348), serum creatinine (HR=1.263), N-terminal pro-B-type natriuretic peptide (HR=1.316), LDL-C (HR=1.205), RC (HR=1.302), low LDL-C and high RC (HR=1.745), high LDL-C and low RC (HR=1.393), high LDL-C and high RC (HR=2.237) were independently associated with the occurrence of MACE. Conclusion: The coordination of LDL-C/RC affects the risk of MACE in elderly hypertensive patients, and the risk of MACE is the highest in patients with high LDL-C and high RC.

Development of Direct LDL Measurement by LDL Precipitation Combined with Sandwich ELISA Using In-House-Generated mAbs.

One of the major risk factors for the progression of cardiovascular diseases is a high blood level of low-density lipoprotein (LDL), so progression of the disease may be prevented by lowering the plasma LDL. Evaluation and monitoring of LDL concentrations are therefore necessary. Friedewald's equation is a calculation method that is currently used routinely to estimate plasma LDL concentrations in hospital laboratories. However, this method cannot be applied to samples with a high concentration of triglyceride (TG). To overcome this limitation, this study aimed to develop direct LDL measurements using in-house generated monoclonal antibodies against human LDL in combination with LDL precipitation using heparin-containing citrate buffer pH 5.04. The method was applied to measure the LDL concentration in 208 randomized samples from Suranaree University of Technology Hospital. The mean values obtained from the developed method and the hospital laboratory were 126.6 ± 43.1 mg/dL and 123.2 ± 42.3 mg/dL, respectively. Linear regression analysis showed a high correlation between these two methods (r = 0.8491, p < 0.0001). High concentrations of TG, total cholesterol, and HDL have no influence on the LDL values obtained by this method. In this study, we offer an alternative technique for the direct measurement of plasma LDL. Further development for more convenient and easy use can now be undertaken.

Chronic liver disease is not associated with statin prescription in a primary care cohort.

Statins have historically been underutilized in patients with chronic liver disease (CLD). We sought to investigate the association between CLD and statin prescription in a primary care setting. Our retrospective cohort study identified primary care patients with a low-density lipoprotein value and more than one office visit from 2012 through 2018. Indication for statin therapy was determined using the Third Adult Treatment Panel criteria prior to November 2016 and the American College of Cardiology and American Heart Association guidelines thereafter. Indication for statin prescription and statin therapy by year was determined. Patients with CLD were identified using ICD-9/10 diagnosis codes. In total, 2119 individuals with an indication for statin therapy were identified. Of these individuals, 354 (16.7%) had CLD. Alcoholic and nonalcoholic fatty liver disease comprised 44.9% and 28.5% of the CLD population, respectively; 27.7% had cirrhosis. There was no difference in the prevalence of statin prescriptions when comparing patients with a CLD diagnosis to those without one (57.9 vs 59.9%, p = 0.48). A diagnosis of CLD was also not significantly associated with statin prescription when adjusting for other covariates (odds ratio (OR) 1.02; 95% confidence interval (CI) 0.78-1.33). An alanine aminotransferase level greater than 45 U/L significantly reduced the odds of a statin prescription (OR 0.62; 95% CI 0.44-0.87). Overall, the presence of a CLD diagnosis was not associated with attenuated statin utilization compared to those without a CLD diagnosis. Nevertheless, adherence to guideline indicated statin therapy remains suboptimal and efforts to increase statin utilization in this high-risk population remain prudent.

A Cross Sectional Study of Lipid Profile In Ultrasonography-diagnosed Fatty Liver

ABSTRACT: Objective: The aim of this study is to conduct a descriptive cross sectional study to observe the relationship of lipid profile with fatty liver, as diagnosed by ultrasonography. Methodology: Study population consisted of 105 persons (50 females &amp; 55 males) who were having non-alcoholic fatty liver disease, as diagnosed by ultrasonography. Serum lipid profile reports of the study population was tabulated and compared with grade I, II &amp; III of ultrasonography-diagnosed fatty liver. Result: Grade I (mild) non-alcoholic fatty liver disease was seen in 84.7 %, grade II (moderate) in 13.3 % and grade III (severe) in 1.9% cases. Mean age of the study population was 48.3 years ranging from 25 years (minimum) to 79 years (maximum). Dyslipidemia was found in more than two thirds of our study population. Total cholesterol, triglyceride and low-density lipoprotein were increased in 67.6%, 65.7% and 67.6% respectively. High-density lipoprotein was decreased in 60.9% cases. Mean value of total cholesterol, triglyceride, low-density lipoprotein and high-density lipoprotein were 233.5 gm/dl, 215.5 gm/dl, 148.7 gm/dl and 32.5 gm/dl respectively. When lipid profiles were compared with fatty liver, significant positive correlation was seen between non-alcoholic fatty liver disease with increased serum cholesterol, increased triglyceride, increased low-density lipoprotein &amp; decreased serum high-density lipoprotein. P value was &lt;0.001 in all the cases. Different grades of non-alcoholic fatty liver disease and individual lipid components showed no significant correlation. Conclusion: This study showed more than two thirds of ultrasonography-diagnosed non-alcoholic fatty liver had abnormal lipid profile. So, safe and non-invasive ultrasonography is very useful for screening and early detection of dyslipidemia in patients.

Investigation the impact of liraglutide on the thyroid function tests

Aim: Liraglutide is a once-daily glucagon-like peptide-1 receptor agonist (GLP‑1 RA) which is an incretin hormone secreted from intestinal L cells in response to nutritional intake and stimulates glucose-dependent insulin secretion, decreases hepatic glucagon secretion, slows gastric emptying, provides a feeling of satiety and is the first GLP‑1 RA to be indicated for weight loss treatment for obesity. The impact of liraglutide on thyroid function tests is unknown and to the best of our knowledge, there are no studies on this regard. Our aim is to compare thyroid function tests, other biochemical and hemogram parameters before and 6 months after liraglutide treatment.&#x0D; Material and Methods: The patients, 18-65 years old, who used liraglutide for at least 6 months due to obesity treatment between January 2021 and January 2023 in Burdur State Hospital were included.&#x0D; Results: There were 51 patients (39 female, 12 male) using liraglutide without thyroid disease during the study period. Twelve patients discontinued liraglutide use before the 6th month of treatment was completed. Weight, body mass index (BMI), fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), low-density lipoprotein (LDL), triglyceride and thyroid-stimulating hormone (TSH) values were significantly lower at the 6th month of treatment. Free thyroxine (FT4) and free triiodothyronine (FT3) values were similar. and there was no difference other biochemical and hemogram parameters between before and 6 months after treatment&#x0D; Conclusion: We found a significant decrease in TSH values and improvement in metabolic parameters, but no change in thyroid hormone levels.

Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population-Based Cohort Study.

Background Atherosclerotic disease is an important contributor to adverse outcomes in patients with atrial fibrillation (AF). There is limited recognition of the association between statin use and stroke rates in AF. We aimed to quantify the association between statin use and stroke rate in AF. Methods and Results Using linked administrative databases in Ontario, Canada, we conducted a population-based retrospective cohort study of patients, aged ≥66 years, diagnosed with AF between 2009 and 2019. We used cause-specific hazard regression to determine the association of statin use with stroke rate. We developed a second model to further adjust for lipid levels in the subset of patients with available measurements in the year before AF diagnosis. Both models adjusted for age, sex, heart failure, hypertension, diabetes, stroke/transient ischemic attack, vascular disease, and P2Y12 inhibitors at baseline, plus anticoagulation as a time-varying covariate. We studied 261 659 qualifying patients (median age, 78 years; 49% women). Statins were used in 142 834 (54.6%) patients, and 145 673 (55.7%) had lipid measurement(s) in the preceding year. Statin use was associated with lower stroke rates, with adjusted hazard ratios of 0.83 (95% CI, 0.77-0.88; P<0.001) in the full cohort and 0.87 (95% CI, 0.78-0.97; P=0.01) when adjusting for lipid data. Stroke rates increased in a near-linear manner as low-density lipoprotein values increased >1.5 mmol/L. Conclusions Statins were associated with lower stroke rates in patients with AF, whereas higher low-density lipoprotein levels were associated with higher stroke rates, highlighting the importance of vascular risk factor treatment in AF.

Effect of Smokeless Tobacco (Maras Powder) on the Epicardial Fat Thickness and Ventricular Repolarization Parameters.

Background and Objectives: Smokeless tobacco (ST) use has recently become an alternative to cigarettes, and it has been concluded that ST is at least as harmful as cigarettes. ST use is thought to play a role in the pathogenesis of arrhythmia by affecting ventricular repolarization. In this study, we aimed to examine the relationships of Maras powder (MP), one of the ST varieties, with epicardial fat thickness and new ventricular repolarization parameters, which have not previously been described. Materials and Methods: A total of 289 male individuals were included in this study between April 2022 and December 2022. Three groups, 97 MP users, 97 smokers, and 95 healthy (non-tobacco), were compared according to electrocardiographic and echocardiographic data. Electrocardiograms (ECG) were evaluated with a magnifying glass by two expert cardiologists at a speed of 50 m/s. Epicardial fat thickness (EFT) was measured by echocardiography in the parasternal short- and long-axis images. A model was created with variables that could affect epicardial fat thickness. Results: There were no differences between the groups regarding body mass index (p = 0.672) and age (p = 0.306). The low-density lipoprotein value was higher in the MP user group (p = 0.003). The QT interval was similar between groups. Tp-e (p = 0.022), cTp-e (p = 0.013), Tp-e/QT (p =0.005), and Tp-e/cQT (p = 0.012) were higher in the MP user group. While the Tp-e/QT ratio did not affect EFT, MP predicted the epicardial fat thickness (p < 0.001, B = 0.522, 95%CI 0.272-0.773). Conclusions: Maras powder may play a role in ventricular arrhythmia by affecting EFT and causing an increase in the Tp-e interval.

Use of the RCOG risk assessment model and biomarkers to evaluate the risk of postpartum venous thromboembolism

BackgroundVenous thromboembolism (VTE) is a leading cause of morbidity and mortality during pregnancy and the puerperium. The vast majority of VTE occurs after childbirth. China has not yet established standard risk assessment model for postpartum venous thromboembolism (VTE), the Royal College of Obstetricians and Gynecologists (RCOG) risk assessment model (RAM) is commonly used in clinic at present. Herein, we aimed to evaluate the validity of the RCOG RAM in the Chinese population and try to formulate a local risk assessment model by combining with other biomarkers for VTE prophylaxis.MethodsThe retrospective study was conducted from January 2019 to December 2021at Shanghai First Maternity and Infant Hospital which has approximately 30,000 births annually, and the incidence of VTE, differences between RCOG-recommended risk factors, and other biological indicators from medical records were evaluated.ResultsThe study included VTE (n = 146) and non-VTE(n = 413) women who examined by imaging for suspicion of postpartum VTE. There was no statistical difference in the incidence rate of postpartum VTE between the low-score group (23.8%) and the high-score group (28%) after stratification by RCOG RAM. However, we found that cesarean section (in the low-score group), white blood cell (WBC) ≥ 8.64*10^9/L (in the high-score group), low-density lipoprotein(LDL) ≥ 2.70 mmol/L, and D-dimer ≥ 3.04 mg/L (in both groups) were highly associated with postpartum VTE. Subsequently, the validity of the RCOG RAM combined with biomarkers as a model for the risk assessment of VTE was estimated and the results showed that this model has good accuracy, sensitivity, and specificity.ConclusionsOur study indicated that the RCOG RAM was not the best strategy for predicting postpartum VTE. Combined with some biomarkers (including the value of LDL and D-Dimer, and WBC count), the RCOG RAM is more efficient when identifying high-risk groups of postpartum VTE in the Chinese population.Trial registrationThis purely observational study does not require registration based on ICMJE guidelines.

Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study

BackgroundInterprofessional primary care (PC) teams are key to the provision of high-quality care. PC providers often ‘share’ patients (eg, a patient may see multiple providers in the same clinic), resulting...