Lower Low-density Lipoprotein Levels Research Articles

Serum Levels of Adiponectin Are Strongly Associated with Lipoprotein Subclasses in Healthy Volunteers but Not in Patients with Metabolic Syndrome.

Metabolic syndrome (MS) is a widespread disease in developed countries, accompanied, among others, by decreased adiponectin serum levels and perturbed lipoprotein metabolism. The associations between the serum levels of adiponectin and lipoproteins have been extensively studied in the past under healthy conditions, yet it remains unexplored whether the observed associations also exist in patients with MS. Therefore, in the present study, we analyzed the serum levels of lipoprotein subclasses using nuclear magnetic resonance spectroscopy and examined their associations with the serum levels of adiponectin in patients with MS in comparison with healthy volunteers (HVs). In the HVs, the serum levels of adiponectin were significantly negatively correlated with the serum levels of large buoyant-, very-low-density lipoprotein, and intermediate-density lipoprotein, as well as small dense low-density lipoprotein (LDL) and significantly positively correlated with large buoyant high-density lipoprotein (HDL). In patients with MS, however, adiponectin was only significantly correlated with the serum levels of phospholipids in total HDL and large buoyant LDL. As revealed through logistic regression and orthogonal partial least-squares discriminant analyses, high adiponectin serum levels were associated with low levels of small dense LDL and high levels of large buoyant HDL in the HVs as well as high levels of large buoyant LDL and total HDL in patients with MS. We conclude that the presence of MS weakens or abolishes the strong associations between adiponectin and the lipoprotein parameters observed in HVs and disturbs the complex interplay between adiponectin and lipoprotein metabolism.

Comparative Effects of Fermented and Unfermented Parkia biglobosa Bean Seeds in Diabetic Induced Experimental Rats

Aims: The present work investigates the hypoglycemic effect of fermented seeds of Parkia biglobosa (PB, African locust beans) in alloxan-induced diabetic rats. Its effect was compared with that of unfermented Parkia biglobosa.
 Methodology: In order to assess the hypoglycemic effects of the fermented seeds on experimental animals, fasting blood sugar (FBS), total cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were determined. The microbiota analysis of the fecal sample was also determined.
 Result: Alloxan administered to the rats significantly increased the FBS of the test animals. However, dietary supplementation with fermented PB for three weeks ameliorated the FBS of the rats like that of the unfermented group. The animals fed with fermented Parkia biglobosa gained weight like those fed with unfermented Parkia biglobosa. High levels of HDL and low levels of LDL were observed in animals treated with fermented Parkia biglobosa compared with low levels of HDL and high levels of LDL observed in animals treated with unfermented Parkia biglobosa.
 Conclusion: The results of this present study demonstrate that both fermented and unfermented seeds of Parkia biglobosa exert a hypoglycemic effect. Hence, Parkia biglobosa has an anti-diabetic property with fermented form seemingly better.

Quantitative or qualitative biomolecular changes in blood serum composition induced by childhood obesity: A Fourier transform infrared examination

Childhood obesity (CO) negatively affects one in three children and stands as the fourth most common risk factor of health and well-being. Clarifying the molecular and structural modifications that transpire during the development of obesity is crucial for understanding its progression and devising effective therapies. The study was indeed conducted as part of an ongoing CO treatment trial, where data were collected from children diagnosed with CO before the initiation of non-drug treatment interventions. Our primary aim was to analyze the biochemical changes associated with childhood obesity, specifically focusing on concentrations of lipids, lipoproteins, insulin, and glucose. By comparing these parameters between the CO group (n = 60) and a control group of healthy children (n = 43), we sought to elucidate the metabolic differences present in individuals with CO. Our biochemical analyses unveiled lower LDL (low-density lipoproteins) levels and higher HDL (high-density lipoproteins), cholesterol, triglycerides, insulin, and glucose levels in CO individuals compared to controls. To scrutinize these changes in more detail, we employed Fourier transform infrared (FTIR) spectroscopy on the serum samples. Our results indicated elevated levels of lipids and proteins in the serum of CO, compared to controls. Additionally, we noted structural changes in the vibrations of glucose, β-sheet, and lipids in CO group. The FTIR technique, coupled with principal component analysis (PCA), demonstrated a marked differentiation between CO and controls, particularly in the FTIR region corresponding to amide and lipids. The Pearson test revealed a stronger correlation between biochemical data and FTIR spectra than between 2nd derivative FTIR spectra. Overall, our study provides valuable insights into the molecular and structural changes occurring in CO.

Effect of the AADE7 Self-Care Behaviors Framework on Diabetes Education Management in a Shared Care Model.

Diabetes self-management education (DSME) provides diabetic patients with knowledge of diabetes, requires attention and recording of dietary habits, and increases the frequency and accuracy of blood glucose monitoring. DSME also achieves better blood glucose control, thus benefiting diabetic patients and reducing the risk of diabetes complications. However, few studies have systematically examined whether DSME follows AADE 7 Self-Care Behaviors (AADE7™). Therefore, this study aimed to investigate the control effect of AADE7™-based management on laboratory test indicators of diabetic patients. The patients with diabetes who received shared care management in our hospital between June 2014 and April 2022 were analyzed retrospectively. According to the process of outpatient consultation, each patient received health education provided by diabetes education nurses and dietitians after consultation. Health education was a process from assessment to health guidance. The basic information of all patients was recorded, and AADE7™ behavior assessment and health education session were conducted through interviews. A total of 13,650 were given shared care management, requiring more than 6 follow-up visits per year, as well as health education. It was reassessed annually according to AADE standards. The impact of the patients' behavior change after the AADE7™-based management on the relevant test indicators was observed. After eight years of intervention, a total of 8319 samples were obtained after excluding the outliers. Stepwise regression analysis was performed, and the results showed that, with other conditions held constant, a greater number of days per week to follow a healthy diet, to take hypoglycemic medication as prescribed, to monitor blood glucose, and to exercise and higher education level were associated with lower levels of glycosylated hemoglobin. The change from drinking to nondrinking was associated with lower triglycerides. If low blood glucose was monitored, patients who reviewed and took immediate action showed lower levels of low-density lipoprotein, urine microalbumin, and urine microalbumin/creatinine ratio compared with those without review and immediate action. Significance tests for each term showed P value <0.05. The AADE7™ framework is a tool supporting patient-centered self-management and education. In the AADE7™ standards, successful self-management is considered as a key outcome in the care of patients with diabetes and related diseases. This tool can effectively improve patient compliance and increase the rate of blood glucose compliance rates in patients with diabetes and therefore is worthy of clinical promotion.

Association Between Smoking and Lipid Profile in Men Aged 35 to 70 Years: Dose-Response Analysis.

Dyslipidemia is linked to various health complications, including cardiovascular disease and inflammation. This study aimed to assess the association between smoking and lipid profile in the Tabari cohort population. Data from the Tabari Cohort Study involving 4,149 men were analyzed. A standardized questionnaire collected smoking history, while blood samples measured lipid levels and anthropometric measurements were recorded. Statistical analysis utilized chi-square tests and logistic regression, adjusting for potential confounders. The prevalence of smoking was 893 (21.52%; urban: 20.6%, mountainous: 23.8%, significant level: .024). The adjusted odds ratio (OR) of low high-density lipoprotein (HDL) among smokers 1.48 (95% confidence interval [CI]: 1.25-1.77, p < .001) was the same as non-smokers. The adjusted OR of high low-density lipoprotein (LDL) in men with 1 to 10, 11 to 20, and more than 20 cigarettes per day was 0.95 (95% CI: 0.73-1.25), 1.30 (95% CI: 0.99-1.71), and 2.64 (95% CI: 1.32-5.27) and low HDL was equal to 1.34 (95% CI: 1.06-1.68), 1.61 (95% CI: 1.26-2.05), and 2.24 (95% CI: 1.13-4.42) compared with non-smokers, respectively. The study findings indicate that smoking is associated with lower HDL levels, even after adjusting for potential confounders. The odds of low HDL and high LDL increases with higher smoking intensity. The low HDL and high LDL levels in individuals smoking over 20 cigarettes/day, respectively, show a 2.24-fold and a 2.64-fold increased odds compared to non-smokers. These findings highlight the importance of smoking cessation in relation to lipid profiles and related health risks.

Association between total cholesterol levels and all-cause mortality among newly diagnosed patients with cancer

We aimed to determine the association between cholesterol values and the risk of all-cause mortality in newly diagnosed patients with cancer in a large-scale longitudinal cohort. Newly diagnosed patients with cancer were reviewed retrospectively. Cox proportional hazards regression models determined the association between baseline levels of total cholesterol (TC), triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol and the risk of all-cause mortality. A restricted cubic spline curve was used to identify the association between total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol with the risk of death on a continuous scale and to present the lowest values of lipid measurements associated with death. The median follow-up duration of the study was 5.77 years. Of the 59,217 patients with cancer, 12,624 patients were expired. The multivariable adjusted hazard ratio (aHR) for all-cause mortality in patients with cancer with 1st–5th (≤ 97 mg/dL) and 96th–100th (> 233 mg/dL) in TC levels was 1.54 (95% CI 1.43–1.66) and 1.28 (95% CI 1.16–1.41), respectively, compared to 61st–80th (172–196 mg/dL). The TC level associated with the lowest mortality risk in the multivariable model was 181 mg/dL. In comparison with LDL-C levels in the 61st–80th (115–136 mg/dL), the multivariable aHR for all-cause mortality in cancer patients with LDL-C levels in the 1st-5th (≤ 57 mg/dL) and 96th–100th (> 167 mg/dL) was 1.38 (95% CI 1.14–1.68) and 0.94 (95% CI 0.69–1.28), respectively. The 142 mg/dL of LDL cholesterol showed the lowest mortality risk. We demonstrated a U-shaped relationship between TC levels at baseline and risk of mortality in newly diagnosed patients with cancer. Low LDL levels corresponded to an increased risk of all-cause death.

A Family with Familial Hypobetalipoproteinemia Caused by a c.1468C>T in APOB.

We herein report the first family of Japanese individuals with familial hypobetalipoproteinemia caused by the c.1468C>T mutation in apolipoprotein B (APOB). A 13-year-old boy with extremely low levels of low-density lipoprotein (LDL) cholesterol (24 mg/dL) was referred to our hospital. The patient had no secondary causes of hypobetalipoproteinemia. His father and grandmother also exhibited low LDL cholesterol levels. A genetic analysis confirmed that they all had this variant in APOB (c.1468C>T). None of the patients exhibited atherosclerotic cardiovascular diseases or any other complications associated with low LDL cholesterol levels, including fatty liver, neurocognitive disorders, and cerebral hemorrhaging.

Comparison Between Healthy Plant-Based Diets and Unhealthy Plant-Based Diets and Their Health Impacts

A plant-based diet (PBD), also known as a vegetarian diet, has become a popular topic in recent years. Numerous research studies have investigated the advantageous aspects of adhering to a healthful PBD. Compared to the typical omnivorous diet, a healthful PBD, consisting of whole grains, fruits, and vegetables, can help protect individuals from Type II Diabetes (T2D), cardiovascular diseases (CVD), cancer, and high blood pressure. This is primarily because PBD are rich in dietary fiber, micronutrients, polyphenols, and low in harmful saturated fatty acids. One of the key features of metabolic syndrome is insulin resistance, which leads to an increase in blood glucose levels. Insulin resistance can potentially trigger the development of CVD and T2D. Transitioning to a healthful PBD can reduce the risk of insulin resistance. Additionally, the risk of CVD can be reduced by replacing animal fats (saturated fatty acids) with vegetable fats (monounsaturated fatty acids), as MUFAs help lower low-density lipoprotein levels in cells. Dietary fibers play a significant role in promoting healthier body indexes. They slow down food movement in the intestine and facilitate the excretion process. Fiber can also reduce the risk of obesity by maintaining a better body mass index. However, it's important to note that not all PBD are healthy, and an irrational PBD can worsen one's physical condition.

Is It Ever Wise to Edit Wild-Type Alleles? Engineered CRISPR Alleles Versus Millions of Years of Human Evolution.

The tremendous burden of lipid metabolism diseases, coupled with recent developments in human somatic gene editing, has motivated researchers to propose population-wide somatic gene editing of PCSK9 (proprotein convertase subtilisin/kexin type 9) within the livers of otherwise healthy humans. The best-characterized molecular function of PCSK9 is its ability to regulate plasma LDL (low-density lipoprotein) levels through promoting LDL receptor degradation. Individuals with loss-of-function PCSK9 variants have lower levels of plasma LDL and reduced cardiovascular disease. Gain-of-function variants of PCSK9 are strongly associated with familial hypercholesterolemia. A new therapeutic strategy delivers CRISPR/Cas9 (clustered regularly interspaced short palindromic repeats; CRISPR-associated protein 9) specifically to liver cells to edit the wild-type alleles of PCSK9 with the goal of producing a loss-of-function allele. This direct somatic gene editing approach is being pursued despite the availability of US Food and Drug Administration-approved PCSK9 inhibitors that lower plasma LDL levels. Here, we discuss other characterized functions of PCSK9 including its role in infection and host immunity. We explore important factors that may have contributed to the evolutionary selection of PCSK9 in several vertebrates, including humans. Until such time that more fully understand the multiple biological roles of PCSK9, the ethics of permanently editing the gene locus in healthy, wild-type populations remains highly questionable.

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.

Effect of Avocado Consumption on Risk Factors of Cardiovascular Diseases: A Systematic Review and Meta-Analysis.

High cholesterol levels are a significant risk factor for heart disease, the leading cause of death worldwide. Lowering cholesterol plays a crucial role in maintaining good health. One approach to reducing cholesterol is through dietary modifications, and avocados have been recognized as a potential food choice for this purpose. Avocados are rich in monounsaturated fatty acids (MUFAs), fiber, and plant sterols, which have cholesterol-lowering effects. Incorporating avocados into a low-fat diet can be beneficial. This study design followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and conducted databases in Cochrane, SCOPUS, PubMed, and Web of Science up until May 2023, combining keywords related to avocados and cardiovascular diseases (CVDs). The study focused on randomized clinical trials (RCTs) and excluded observational studies, meta-analyses, surveys, abstracts, and reviews. Seven RCTs were included in the study, all reporting total cholesterol (TC) levels. The findings of the study showed that individuals who followed an avocado diet experienced reduced TC levels compared to those who followed a habitual diet or a low-fat diet. The avocado group exhibited lower TC levels compared to the control group in both the habitual diet and low-fat diet subgroups. When considering high-density lipoprotein (HDL) levels, the control group had higher HDL levels than the avocado group in the habitual diet subgroup, while the avocado group had higher HDL levels than the control group in the low-fat diet subgroup. In both the habitual diet and low-fat diet subgroups, the avocado group had lower levels of low-density lipoprotein (LDL) compared to the control group. The study concluded that incorporating avocados into the diet can be a beneficial dietary strategy for individuals aiming to lower their cholesterol levels and promote heart health. The avocado diet was associated with decreased LDL levels, but it did not significantly impact triglyceride (TG) levels or fasting glucose levels. Systolic blood pressure values showed minimal changes with the avocado diet.

Effectiveness of Atorvastatin in Treatment of Obese Patients with Dyslipidaemia

Background: Numerous comorbidities, such as type 2 diabetes mellitus, hypertension, dyslipidemia, and cardiovascular (CV) disease are all made more likely by obesity. A higher mortality rate in the general population is strongly correlated with a high body mass index (BMI). In patients who are at high risk of experiencing an atherosclerotic CV event, the use of statins lowers mortality and recurrent adverse cardiac events across a broad range of cholesterol levels. Therefore, statin therapy is advised for secondary prevention in all high-risk patients, including those with obesity. Objectives: There is evidence to support the primary prevention of coronary artery disease, morbidity, and mortality using statins for lipid modifications. The purpose of this study is to ascertain the immediate impact of atorvastatin on the lipid profile in obese Jordanian patients. Methods: According to NCEP ATP III criteria, 200 overweight and obese patients with hypercholesterolemia were included. They received treatment for 2 months after being randomly divided into 3 groups based on the dosage of atorvastatin: 10, 20, and 40 mg/day. Results: With all atorvastatin doses, there was a significant desirable increase in high-density lipoprotein (HDL), and significant reduction in total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), and very low-density lipoprotein (VLDL). Conclusion: In dyslipidemic obese patients, short-term atorvastatin therapy resulted in lower levels of TC, TG, LDL, and VLDL as well as a desirable increase in HDL.

New Loss-of-Function Mutations in PCSK9 Reduce Plasma LDL Cholesterol.

Lower plasma levels of LDL (low-density lipoprotein) cholesterol (LDL-C) can reduce the risk of atherosclerotic cardiovascular disease. The loss-of-function mutations in PCSK9 (proprotein convertase subtilisin/kexin type 9) have been known to associate with low LDL-C in many human populations. PCSK9 genetic variants in Chinese Uyghurs who are at high risk of atherosclerotic cardiovascular disease due to their dietary habits have not been reported. The study involved the whole-exome and target sequencing of college students from Uyghur and other ethnic groups in Xinjiang, China, for the association of PCSK9 loss-of-function mutations with low plasma levels of LDL-C. The mechanisms by which the identified mutations affect the function of PCSK9 were investigated in cultured cells using biochemical and cell assays. The causal effects of the identified PCSK9 mutations on LDL-C levels were verified in mice injected with adeno-associated virus expressing different forms of PCSK9 and fed a high-cholesterol diet. We identified 2 PCSK9 mutations-E144K and C378W-in Chinese Uyghurs with low plasma levels of LDL-C. The E144K and C378W mutations impaired the maturation and secretion of the PCSK9 protein, respectively. Adeno-associated virus-mediated expression of E144K and C378W mutants in Pcsk9 KO (knockout) mice fed a high-cholesterol diet also hampered PCSK9 secretion into the serum, resulting in elevated levels of LDL receptor in the liver and reduced levels of LDL-C in the serum. Our study shows that E144K and C378W are PCSK9 loss-of-function mutations causing low LDL-C levels in mice and probably in humans as well.

5588571 DYSLIPIDEMIA IN TRANSFUSION-DEPENDENT-THALASSEMIA PATIENTS AND ITS CORRELATION WITH SERUM VITAMIN D LEVEL

Background: Studies showed that transfusion dependent thalassemia (TDT) patients may develop premature atherosclerosis due to chronic hemolysis, iron deposition in blood vessels and dyslipidemia. Serum lipids abnormalities have been reported in TDT increasing the risk for premature atherosclerosis and other cardiovascular complications. Iron overload and oxidative stress are the main contributing factors to dyslipidemia in TDT patients. Few studies revealed that vitamin D is associated with favorable lipid profile in children and had relation to total cholesterol, low-density lipoproteins (LDL), high-density lipoprotein (HDL) level and triglyceride (TG) levels. However, its role in patients with TDT needs to be determined. Aim: To investigate the correlation between serum lipid profile and dyslipidemia with serum vitamin D level in TDT patients. Methods: This cross-sectional observational study conducted at Pediatric Hematology Unit, Cairo University Children Hospital included 50 children aged 3-18 years diagnosed with TDT and 30 apparently healthy unrelated age and sex matched children as a control group. Subjects were enrolled after obtaining willingly informed consents from parents. Vitamin D (25-OHD) level was measured using HPLC-UV method and 10-12 hour overnight fasting serum lipid profile including total cholesterol, HDL, LDL, and triglyceride (TG) were performed using automated chemistry analyzer Cobas C 311. Atherogenic index of plasma (AIP), an index composed of TG and HDL-C, was measured. Results: TDT patients had significantly lower cholesterol, HDL and LDL and higher TG levels compared to control group (p=0.00 for all parameters respectively). The median AIP was significantly higher in TDT patients compared to control group (0.36 vs -0.08 respectively with p=0.00). Vitamin D deficiency and insufficiency (defined as 25-OH D3 level less than 20 ng/ml and 20-29 ng/ml respectively) were evident in 20% and 24% of TDT patients respectively. Mean Vitamin D level among TDT patients was 33.91 ng/ml. Vitamin D had a statistically significant negative correlation with total cholesterol (r = -0.288, p = 0.010), LDL (r = -0.287, p = 0.010), and HDL (r = -0.280, p = 0.012) but had no significant correlation with TG (p = 0.379). Lower hemoglobin and hematocrit levels were associated with lower total cholesterol, LDL and HDL levels (p=0.00 for all parameters respectively) and with higher TG (p=0.00). No correlation was evident between serum ferritin level and any of lipid profile parameters. Conclusion: Serum lipid abnormalities in TDT patients includes hypocholesterolemia, decreased HDL, LDL and increased TG levels Measurement of serum lipid profile may help in early detection of cardiovascular complications such as premature atherosclerosis among these patients. AIP may serve as an additional indicator of dyslipidemia. Our results reinforce previous reports of vitamin D deficiency in TDT patients and demonstrate its correlation with dyslipidemia. Key words: Thalassemia- Dyslipidemia- Lipid profile- Vitamin D.

PCSK9 Inhibitor Use and Outcomes Using Concomitant Lipid-Lowering Therapies in the Veterans Health Administration

BackgroundReal-world data on use of PCSK9 inhibitors (PCSK9-Is), with or without statins and/or ezetimibe, and associated outcomes, can inform more effective prescribing. The objective was to evaluate clinical effectiveness and safety of PCSK9-Is within the Veterans Health Administration (VHA). MethodsIn this retrospective cohort study, we included Veterans who had at least one outpatient prescription for alirocumab and/or evolocumab filled within VHA between August 21, 2015, and September 30, 2020. Analyses included 4 mutually exclusive subgroups: PCSK9-I alone, PCSK9-I+statin, PCSK9-I+ezetimibe, and PCSK9-I+statin+ezetimibe subgroups. Primary outcomes included medication possession ratio, persistence, and low-density lipoprotein (LDL). ResultsAmong Veterans in the analytical cohort (n = 2428), 36.2% were on PCSK9-I monotherapy; 24.0% received a PCSK9-I+statin; 27.4% were on a PCSK9-I+ezetimibe; and 12.4% received triple therapy, that is, PCSK9-I+statin+ezetimibe. The mean medication possession ratio (standard deviation [SD]) for PCSK9-I monotherapy was 83.8% (13.3) compared to 84.3% (11.2) with PCSK9-I+statin therapy, 87.1% (10.1) with PCSK9-I+ezetimibe therapy, and 85.8% (11.7) with triple therapy. The percentage of patients who discontinued PCSK9-I in the monotherapy subgroup was 12.3% vs 9.5%, 6.6%, and 7.4% in the concomitant statin, ezetimibe, and triple-therapy subgroups, respectively (p = .002 among the groups). Mean LDL level was greater in the PCSK9-I monotherapy subgroup (85.6 mg/dL) compared with the concomitant statin (66.5 mg/dL), ezetimibe (65.7 mg/dL), and triple-therapy subgroups (68.1 mg/dL). ConclusionsVeterans showed good adherence and/or persistence with PCSK9-I regimens. On average, those receiving concomitant therapy with a statin and/or ezetimibe achieved significantly lower LDL levels.

Association between plasma PCSK9 levels and lipid profile in patients with Parkinson's disease and comparison with healthy subjects.

Background: Up to know, limited and contradictory results have been published about the role of prognostic values of lipid profile and proprotein convertase subtilisin/kexin type 9 (PCSK9) in Parkinson's disease (PD). The aim of the present study is to investigate the role of lipid profile and PCSK9 in patients with PD and compare it with healthy individuals. Methods: In this case-control study, 31 individuals diagnosed with PD were compared with 31 healthy individuals. The lipid profile and PCSK9 of research participants were measured and the resulting data were analyzed using SPSS software. The P-values smaller than 0.05 were considered significant. Results: The mean age of participants in the PD and control group was 56.9 ± 8.8 and 53.7 ± 10.1 years, respectively (P > 0.050). 27 individuals (87.1%) in the PD group and 13 individuals (41.9%) in the control group were men. Low-density lipoprotein (LDL) level (84.2 ± 24.9 ml/dl vs. 105.5 ± 16.8, P < 0.001), high-density lipoprotein (HDL) level (45.5 ± 8.7 ml/dl vs. 51.1 ± 9.5 ml/dl, P < 0.001), and total cholesterol (155.3 ± 31.2 ml/dl vs. 192.8 ± 32.5 ml/dl, P < 0.001) were lower and triglyceride (TG) level was higher in the PD group (133.3 ± 79.3 ml/dl vs. 131.2 ± 58.6 ml/dl, P = 0.900) compared with the control group. PCSK9 level was higher in the PD group, but no significant difference was found (141.6 ± 70.0 vs. 129.7 ± 51.0 ng/ml, P = 0.500) compared to healthy subjects. Moreover, there was no relation between PCSK9 and severity of PD. Conclusion: Our findings showed that individuals with PD had lower levels of HDL, LDL, and total cholesterol compared with the control group. However, higher concentrations of PCSK9 were observed in patients with PD compared with healthy volunteers.

Effects of Early Risperidone Treatment on Metabolic Parameters in Socially Isolated Rats-Implication of Antipsychotic Intervention across Developmental Stages of Schizophrenia.

Second-generation antipsychotics (SGAs) is thought responsible for the metabolic abnormalities of schizophrenic patients, however, some untreated schizophrenic patients had already developed problems with glucose metabolism. The present study examined the hypothesis that schizophrenia itself but not risperidone, an extensively employed SGA, is accountable for metabolic abnormalities. A 56-day risperidone regimen (1 mg/kg/day) was employed for rats of social isolation rearing (SIR) beginning at different developmental stage (28 or 56 days after weaning, i.e., adolescent and young adulthood, respectively). Metabolic parameters including body weight, systolic blood pressure (SBP), triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and plasma glucose were measured at baseline, 28, and 56 days of the regimen. Oral glucose tolerance test (OGTT) was performed at the end of the regimen. Insulin function was evaluated by area under the curve (AUC) of OGTT, homeostasis model assessment-insulin resistance (HOMA-ir), and Matsuda index. Our results demonstrated that: (i) SIR rats presented higher body weight, plasma triglyceride, and HOMA-ir than social controls. (ii) Higher insulin resistance was specifically presented in young adult rather than adolescent SIR rats. (iii) Adolescent drugged rats showed a lower level of LDL in day 28 of the regimen than young adult. Risperidone led to a lower LDL level in only young adult IR rats in day 56 than undrugged rats. (iv) SIR-induced dysregulation of insulin can be reversed by chronic risperidone treatment beginning at adolescence but not young adulthood. Our findings support the primary role of schizophrenia in metabolic abnormalities and risperidone appear beneficial when administered earlier.

Relationship Between Preprocedural Lipid Levels and Periprocedural Myocardial Injury in Patients Undergoing Elective Percutaneous Coronary Intervention

Periprocedural myocardial injury is a predictor of cardiovascular morbidity and mortality after percutaneous coronary intervention. The authors examined the effects of preprocedural lipid levels (low-density lipoprotein, high-density lipoprotein, and triglycerides) in 977 patients with coronary artery disease who underwent elective percutaneous coronary intervention. Elevated cardiac troponin I level (≥5× the upper limit of normal) was used to indicate periprocedural myocardial injury. Serum lipid samples were collected 12 hours preprocedurally. Cardiac troponin I was collected 1, 6, and 12 hours postprocedurally. Correlations between preprocedural lipid levels and postprocedural cardiac troponin I were studied. Low-density lipoprotein levels were less than 70 mg/dL in 70% of patients and greater than 100 mg/dL in only 7.4% of patients; 13% had triglyceride levels greater than or equal to 150 mg/dL, and 96% had high-density lipoprotein levels less than 40 mg/dL. Patients with elevated cardiac troponin I had significantly lower left ventricular ejection fraction than did those with cardiac troponin I levels less than 5× the upper limit of normal (P = .01). Double-and triple-vessel disease were more common in patients with elevated cardiac troponin I (P < .002). Multivariable logistic and linear regression analyses revealed no statistically significant associations between lipid levels and postprocedural cardiac troponin I elevation, possibly because such large proportions of included patients had low levels of low-density lipoprotein (70%) and a history of statin intake (86%). The authors found no association between lipid profile and periprocedural myocardial injury.

November 2022 Stroke Highlights

HomeStrokeVol. 53, No. 11November 2022 Stroke Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBNovember 2022 Stroke Highlights José Rafael Romero José Rafael RomeroJosé Rafael Romero https://orcid.org/0000-0002-1101-2950 Search for more papers by this author Originally published24 Oct 2022https://doi.org/10.1161/STROKEAHA.122.041383Stroke. 2022;53:3249is related toPrevalence and Predictors of Food Insecurity Among Stroke Survivors in the United StatesIs It About the Destination or About the Journey?Importance of Delayed Reperfusions in Patients With Incomplete ThrombectomyPrevalence and Predictors of Food Insecurity Among Stroke Survivors in the United StatesFood insecurity (FI) may interfere with adequate secondary stroke prevention. Kim-Tenser and colleagues assessed FI prevalence and trends using data from the US National Health and Nutrition Examination Survey survey (1999–2015). Food security was categorized as full, marginal, low, or very low, with the last 2 categories constituting FI. Stroke data were based on self-report. Among 48 242 participants, 1877 reported a stroke. FI was reported in 17% of participants with stroke and 12% of those without stroke. Predictors of FI included Black race, Hispanic ethnicity, low education, low income, non-married status, diabetes, smoking, and obesity. In age-adjusted analysis, FI increased over the study period from 7.8% to 42.1% in stroke survivors, and 8% to 17% in stroke-free participants. This study highlights FI as a growing adverse social determinant of health and modifiable social factor for stroke prevention targeting vulnerable groups. See p 3369.Yield of Dual Therapy with Statin and Ezetimibe in the Treat Stroke to Target TrialAmarenco and colleagues conducted a post-hoc analysis of the Treat Stroke to Target trial which randomized patients to dual therapy (statin and ezetimibe) versus statin monotherapy to achieve target LDL (low-density lipoprotein) <100 or LDL <70 mg/dl and assessed recurrent major cardiovascular events. Patients had ischemic stroke or transient ischemic attack and established atherosclerotic disease (aortic, intra or extracranial large artery or coronary arteries). There were differences in statin intensity between the LDL target groups, and other lipid-lowering treatments were allowed in the monotherapy group. Target LDL levels were achieved in the groups, but there was higher compliance in the dual therapy group. Overall, the dual therapy group targeting LDL <70 mg/dL had lower event rates across all major adverse cardiovascular outcomes, including intracerebral hemorrhage. Although this study suggests a benefit of dual therapy over monotherapy and target of lower LDL levels, confirmatory randomized clinical trials are needed. See p 3260.Importance of Delayed Reperfusions in Patients with Incomplete ThrombectomyIncomplete revascularization after mechanical thrombectomy in acute large vessel occlusion ischemic strokes occurs in a substantial proportion of patients. Mujanovic and colleagues conducted a single-center study to assess the relation of delayed reperfusion (DR) with tissue and functional outcomes after incomplete recanalization with mechanical thrombectomy for the treatment of acute ischemic stroke due to large vessel occlusion. Incomplete recanalization was defined as extended Thrombolysis in Cerebral Infarction (eTICI) score 2a or lower. Patients included also had a follow-up cerebral perfusion study at 24 hours. DR was defined as absence of a focal perfusion delay with values of Tmax≥4 seconds on contrast-enhanced follow-up perfusion imaging within the territory of the initially occluded vessel. Among 566 patients studied, DR occurred in 40.3% patients with incomplete recanalization and in none of the patients with complete recanalization (eTICI 3). DR and persistent perfusion deficits were related to eTICI score with higher DR rates associated with higher eTICI score. DR was related to preserved tissue (ie, no new infarction) while persistent perfusion deficit was related to new infarct on follow-up imaging. In multivariable analysis adjusted for relevant confounders, patients with DR had better functional outcomes regardless of eTICI score achieved (adjusted odds ratio, 2.37 [95% CI, 1.34–4.23]) and lower mortality (adjusted hazard ratio, 0.60 [95% CI, 0.39–0.91]). This study needs replication but suggests that DR is an important measure of tissue fate and correlated with functional outcome. DR may be a relevant marker for patient selection, and potential target for randomized clinical trials in patients with acute ischemic stroke undergoing mechanical thrombectomy. See p 3350. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesPrevalence and Predictors of Food Insecurity Among Stroke Survivors in the United StatesAmytis Towfighi, et al. Stroke. 2022;53:3369-3374Is It About the Destination or About the Journey?Dylan Blacquiere, et al. Stroke. 2022;53:3268-3269Importance of Delayed Reperfusions in Patients With Incomplete ThrombectomyAdnan Mujanovic, et al. Stroke. 2022;53:3350-3358 November 2022Vol 53, Issue 11 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.041383 Originally publishedOctober 24, 2022 PDF download Advertisement SubjectsCerebrovascular Disease/StrokeRevascularization

Prognostic effect of pulmonary hypertension in patients with chronic kidney disease: Univariate and multivariate analyses of factors associated with survival.

BackgroundPrognostic effect of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) is not fully clear yet, this study was designed to elucidate baseline characteristics of CKD patients with different severities of PH, the association between kidney indicators and PH severity, and survival factors in CKD patients with PH.MethodsWe extracted clinical data from electronic medical records of all patients diagnosed with PH in CKD from Jan 2016 to Dec 2020, and those with comorbid conditions causing PH were excluded. CKD stages were defined by estimated glomerular filtration rate thresholds. PH was defined as a systolic pulmonary artery pressure (sPAP) >35 mmHg estimated using echocardiograms. Demographics, clinical data, and test results were analyzed, and all-cause mortality data were obtained.ResultsA total of 137 patients were included in the study. The mean age of the participants was 60 (42.5, 67) years, the mean sPAP was 58 (51, 69.5) mmHg, and 40.9% of the patients were women. Moderate PH group had more patients undergoing dialysis and higher frequency of coronary heart disease. Moderate-severe PH group had higher parathyroid hormone levels and lower low-density lipoprotein levels. Severe PH group had better kidney function parameters and lower serum phosphorus levels. PH severity had no direct relationship with CKD stages. In the univariate analysis, age and PH severity influenced survival. Multivariate analysis also showed independent prognostic effects for age and sPAP. Kaplan-Meyer curve intuitively displayed the survival differences among CKD patients with different PH severity. Predictor values of nomogram identified from survival analyses enabled calculation of death probabilities for CKD with PH patients. Nomogram was validated by ROC analysis.ConclusionsPH begins with early-stage CKD, and PH severity is not related to CKD progression. A higher pulmonary artery pressure and an older age are associated with an increased risk of death.