Low Levels Of High-density Cholesterol Research Articles

Gut microbiota of obese and diabetic Thai subjects and interplay with dietary habits and blood profiles.

Obesity and type 2 diabetes mellitus (T2DM) have become major public health issues globally. Recent research indicates that intestinal microbiota play roles in metabolic disorders. Though there are numerous studies focusing on gut microbiota of health and obesity states, those are primarily focused on Western countries. Comparatively, only a few investigations exist on gut microbiota of people from Asian countries. In this study, the fecal microbiota of 30 adult volunteers living in Chiang Rai Province, Thailand were examined using next-generation sequencing (NGS) in association with blood profiles and dietary habits. Subjects were categorized by body mass index (BMI) and health status as follows; lean (L) = 8, overweight (OV) = 8, obese (OB) = 7 and diagnosed T2DM = 7. Members of T2DM group showed differences in dietary consumption and fasting glucose level compared to BMI groups. A low level of high-density cholesterol (HDL) was observed in the OB group. Principal coordinate analysis (PCoA) revealed that microbial communities of T2DM subjects were clearly distinct from those of OB. An analogous pattern was additionally illustrated by multiple factor analysis (MFA) based on dietary habits, blood profiles, and fecal gut microbiota in BMI and T2DM groups. In all four groups, Bacteroidetes and Firmicutes were the predominant phyla. Abundance of Faecalibacterium prausnitzii, a butyrate-producing bacterium, was significantly higher in OB than that in other groups. This study is the first to examine the gut microbiota of adult Thais in association with dietary intake and blood profiles and will provide the platform for future investigations.

Non-Alcoholic Fatty Liver Disease among Type-2 Diabetes Mellitus Patients in Abha City, South Western Saudi Arabia.

The objective of this study was to determine the prevalence and the factors associated with non-alcoholic fatty liver disease (NAFLD) among type-2 diabetes mellitus (T2DM) patients in Abha City, Southwestern Saudi Arabia. Using a cross-sectional study design, a representative sample of 245 T2DM patients were recruited from all primary healthcare centers in Abha city. A detailed medical history as well as laboratory investigations were done. NAFLD was diagnosed using abdominal ultrasound examination. The overall prevalence of NAFLD was 72.8% (95% CI: 66.6%–78.1%). In a multivariable regression analysis, the risk of NAFLD was significantly higher among overweight T2DM patients (aOR = 6.112, 95% CI: 1.529–4.432), Obese (aOR = 10.455, 95% CI: 2.645–41.326), with high ALT of more than 12 IU/L (aOR = 2.335, 95% CI: 1.096–5.062), moderate diet-compliant patients (aOR = 2.413, 95% CI: 1.003–5.805) and poor diet-compliant patients (aOR = 6.562, 95% CI: 2.056–20.967). On the other hand, high HDL (high density cholesterol) (in mg/dL) was a protective factor for NAFLD (aOR = 0.044, 95% CI: 0.005–0.365). It was concluded that NAFLD is a common association of T2DM. Increasing BMI (Body mass index), lower HDL level, and poor dietary control are significant factors associated with NAFLD among T2DM patients. Health education to improve dietary control and avoid excessive weight gain, testing for NAFLD among diabetic patients, especially those with abnormal BMI and HDL, are recommended for early detection and to ensure optimal levels of HDL.

Prevalence of dyslipidemia among the diabetic patients in southern Bangladesh: A cross-sectional study

AimDiabetic dyslipidemia is one of the major risk factors for cardiovascular disease which has a vast mortality rate throughout the world. Early detection and treatment of dyslipidemia can avoid risk for cardiovascular disorder in diabetic patients. This study was conducted to determine the prevalence of and pattern of dyslipidemia in diabetic patients. Materials and methodsThis cross sectional study was performed in several specialized diabetic hospital of Noakhali, a southern district of Bangladesh. All known cases of diabetes mellitus were evaluated for their lipid profile. A total number of 1008 patients were included in the study having 683 (67.8%) female and 325 (32.2%) male subjects. ResultsThe prevalence of dyslipidemia among the male subjects was 73% while among female subjects 71%. Among diabetic males the percentage of high serum Cholesterol, high serum TG (Triglyceride), low HDL (High density cholesterol) and high LDL (Low density cholesterol) was 35.69%, 44.31%, 50.15% and 72.92% respectively, whereas the female had the percentage at 35.29%, 40.85%, 49.49% and 70.57% respectively. ConclusionMajority portion of the study subjects were dyslipidemic. The most prevalent pattern among both male and female was high level of LDL and low level of HDL. The prevalence of dyslipidemia in Bangladesh is significantly high, which indicates the urgency of lifestyle intervention strategies to prevent and manage this important health problem and risk factor.

Influence of vegetarian diet to the factors associated with metabolic syndrome

Metabolic syndrome (MS) is a condition that increases type 2 diabetes and cardiovascular disease that are associated with abdominal obesity, low high-density cholesterol (HDL), high serum triglycerides and elevated fasting glucose levels. Influence of vegetarian diet to these parameters has demonstrated, but the results are debatable. Aim was to explain how vegetarian diet is related to specific body composition and blood biochemical characteristics associated with MS. This study was conducted in 2013 in Estonia. All participants filled in questionnaire, gave a blood sample and their body composition was measured by using dual-energy X-ray absorptiometry. The level of total cholesterol, low-density cholesterol (LDL), HDL, apolipoprotein B (APOB), apolipoprotein A-1 (APOA1), triglycerides, glucose, haemoglobin A1c, and insulin level in blood were measured and fasting homeostatic model assessment of insulin resistance (HOMA-IR) was calculated. The study comprised of 68 vegetarians (mean practice time of 7.3±4.7y) and 103 omnivores. Both groups were matched by sex and age. Omnivores had higher levels of total-cholesterol and APOA1 (p<.001 both) than vegetarians. Higher levels of LDL (p=.002) and APOB (p=.003) in all omnivores groups and in men (p=.003 and .002, respectively) appeared, as insulin (p=.023) and HOMA (p=.048) were greater in women. Lower levels of body mass index (BMI; p<.001) and higher ratios of total-cholesterol/HDL (p=.019); APOB/APOA1 (p=.026); LDL/HDL (p=.021) only in men vegetarians compared to omnivores emerged. Results of multivariate linear regression analyses also showed lover values of BMI, total-cholesterol, LDL, APOB, APOA1 and insulin in vegetarians but all these parameters were similarly influenced by lower BMI. In conclusion the vegetarian diet improves lipid metabolism by reducing the BMI.

Metabolic Dyslipidemia and Risk of Coronary Heart Disease in 28,318 Adults With Diabetes Mellitus and Low-Density Lipoprotein Cholesterol

The risk of future coronary heart disease (CHD) in subjects with diabetes and "metabolic dyslipidemia" (high triglyceride [TGs] and low high-density cholesterol levels) remains a matter of concern. Little is known regarding the risk of CHD for this phenotype with low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dl. We analyzed a diabetes cohort of 28,318 members (aged 30 to 90 years) of Kaiser Permanente Northern California during 2002 to 2011 (192,356 person-years [p-y] follow-up), with LDL-C levels <100 mg/dl and without known CHD. We compared the incidence and hazard ratios (HRs) for CHD events in groups using Cox models: normal high-density lipoprotein (HDL) and TG (reference; n = 7,278, 25.7%); normal HDL and high TG (≥ 150 mg/dl; n = 4,484,15.8%); low HDL (≤ 50 mg/dl for women and ≤ 40 mg/dl for men) and normal TG (n = 4,048, 14.3%); low HDL and high TG (metabolic dyslipidemia; n = 12,508, 44%). Patients with metabolic dyslipidemia had the highest age-adjusted CHD events/1,000 p-y (12.7/1,000 p-y and 19.0/1,000 p-y for women and men, respectively). After multivariate adjustment for age, gender, ethnicity, hypertension, smoking, statin use, duration of diabetes, and hemoglobin A1c, we observed an increased CHD risk in women (HR 1.35, 95% confidence interval 1.14 to 1.60) and men (HR 1.62, 95% confidence interval 1.43 to 1.83) with metabolic dyslipidemia compared to those with normal HDL and TG. Even in subjects with an LDL-C <100 mg/dl, presence of metabolic dyslipidemia in adults with diabetes is associated with an increased risk of CHD. In conclusion, effective CHD prevention strategies are needed for adults with diabetes and metabolic dyslipidemia.

Fast regression of carotid intima-media thickness and cardiovascular risk factors in patients pre- and post-bariatric surgery

Purpose: Obesity is associated with cardiovascular risk factors (CVRFs), such as hypertension, hypertriglyceridemia, and low levels of high-density cholesterol (HDL-C). In obese patients with a body mass index (BMI) of ≥40 kg/m2 or 35-40 kg/m2 associated with CVRFs, bariatric surgery promove significant weight loss and showed reduction on CVRFs. Carotid intima-media thickness (C-IMT) is widely acept as an indicator of atherosclerosis, and used to be correlated with severals CVRFs. Our objective was to correlate C-IMT with CVRFs before (baseline data) and after surgery, and to observe whether weight loss is followed by a regression of C-IMT.

Association Between Quantity of Liver Fat and Cardiovascular Risk in Patients With Nonalcoholic Fatty Liver Disease Independent of Nonalcoholic Steatohepatitis

The association between quantity of liver fat and the presence of metabolic syndrome needs to be assessed systematically. We aimed to determine the association between the quantity of liver fat and the presence of the metabolic syndrome in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD), independent of nonalcoholic steatohepatitis (NASH). We recruited 146 patients with well-characterized biopsy-proven NAFLD and 50 individuals without NAFLD (controls) to participate in a case-control study at the NAFLD Translational Research Unit at the University of California San Diego. Liver fat was quantified in patients with NAFLD and controls using an advanced magnetic resonance imaging-based biomarker, the proton-density-fat-fraction (MRI-PDFF). Patients with NAFLD were divided into groups based on whether they were above or below the median MRI-PDFF value (15.4% in patients with NAFLD); the MRI-PDFF value for controls was less than 5%. The primary outcome was the presence of the metabolic syndrome using Adult Treatment Panel III criteria without and with adjustment for the presence of NASH. Compared with NAFLD patients with MRI-PDFF values below the median, and compared with controls, NAFLD patients with MRI-PDFF values above the median were more likely to have abdominal obesity (P < .0001), lower levels of high-density cholesterol (P < .0001), higher levels of triglycerides (P < .0001), and higher fasting glucose levels (P < .001). Compared with NAFLD patients with MRI-PDFF values below the median, NAFLD patients with MRI-PDFF above the median were more likely to have the metabolic syndrome (60.3% vs. 44.4%; P < .04), independent of biopsy-detected NASH. Increased liver fat content in patients with NAFLD is associated with increased rates of the metabolic syndrome, independent of NASH. There appears to be an association between the quantity of liver fat and the risk for cardiovascular disease in patients with NAFLD.

Metabolic syndrome and chronic kidney disease in an adult Korean population: results from the Korean National Health Screening.

BackgroundThis study was aimed to examine the prevalence of metabolic syndrome (MS) and chronic kidney disease (CKD), and the association between MS and its components with CKD in Korea.MethodsWe excluded diabetes to appreciate the real impact of MS and performed a cross-sectional study using the general health screening data of 10,253,085 (48.86±13.83 years, men 56.18%) participants (age, ≥20 years) from the Korean National Health Screening 2011. CKD was defined as dipstick proteinuria ≥1 or an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2.ResultsThe prevalence of CKD was 6.15% (men, 5.37%; women, 7.15%). Further, 22.25% study population had MS (abdominal obesity, 27.98%; hypertriglyceridemia, 30.09%; low high-density cholesterol levels, 19.74%; high blood pressure, 43.45%; and high fasting glucose levels, 30.44%). Multivariate-adjusted analysis indicated that proteinuria risk increased in participants with MS (odds ratio [OR] 1.884, 95% confidence interval [CI] 1.867–1.902, P<0.001). The presence of MS was associated with eGFR<60 mL/min/1.73 m2 (OR 1.364, 95% CI 1.355–1.373, P<0.001). MS individual components were also associated with an increased CKD risk. The strength of association between MS and the development of CKD increase as the number of components increased from 1 to 5. In sub-analysis by men and women, MS and its each components were a significant determinant for CKD.ConclusionsMS and its individual components can predict the risk of prevalent CKD for men and women.

Metabolic syndrome in rheumatoid arthritis: role of adiponectin (preliminary results)

The clinical value of the disorders and diseases integrated within the metabolic syndrome (MS) is in the combination of traditional risk factors for cardiovascular diseases (CVD), which significantly accelerates the development of cardiovascular events (CVEs). The detection rate for MS in patients with rheumatoid arthritis (RA) is shown to be higher than in the controls regardless of the diagnostic criteria for MS. At present, there are confusing data on the role of adipokins in RA. Objective: to determine the rate of MS and its components in RA patients and the association of the level of adipokin (adiponectin) with the components of MS in relation to the duration of RA. Subjects and methods: The investigation enrolled 69 RA patients divided into two groups: 1) 34 patients with early-stage ( 2-year) RA. Results. MS occurred in 12 (17.4%) of the 69 patients with RA. There was central (abdominal) obesity in 37 (53.6%) patients with RA, hypertension in 29 (42%), low high-density cholesterol levels in 20 (29%), hyperglycemia in 11 (15.9%), and hypertriglyceridemia in 10 (14.5%). According to the presence or absence of MS, the patients were divided into 2 groups: 1) 12 patients with MS; 2) 57 without MS. In the patients with RA and MS, the duration of the disease was shorter; DAS28 and CDAI were higher than in those without MS: 15.4 [7; 24] months versus 51.8 [6; 72] months; DAS28 was 5.8 [4.9; 6.7] scores versus 5.1 [4.5; 5.8] scores; CDAI: 34.8 [21.8; 41.4] scores versus 24.2 [18; 31] scores, respectively (p 2-year RA group displayed no relationship between adipokins, activity markers, and metabolic disturbances. Conclusion. The preliminary results suggest the high rate of MS in patients with a high level of early RA disease activity untreated with disease-modifying antirheumatic drugs, thus determining the high risk of CVEs just at disease onset. The role of adiponectin in the development of MS, CVEs in rheumatic diseases remains to be solved, which is the subject of further investigations. It is possible that normalization of adiponectin concentrations may promote reductions in the incidence of CVD, mortality rates due to atherosclerosis-induced CVEs, and the prevalence of MS and insulin resistance.

Clinical Characteristics and Smoking Cessation

Objectives: Tobacco smokers with a history of depression are less likely to successfully quit smoking than smokers who are not depressed. There is a need for a greater understanding of the link between tobacco dependence and depression. The aim of this study was to evaluate differences in clinical characteristics and smoking cessation program outcomes for depressed and not depressed males and females. Methods: In this 52-week study, smokers (N=211; 135 women and 76 men, 101 depressed smokers and 110 nondepressed smokers) were recruited from a hospital-based smoking cessation program that consisted of pharmacotherapy combined with cognitive therapy. Smoking cessation was measured by breath carbon monoxide concentration. The instruments applied were a self-questionnaire, the Fagerström test for Nicotine Dependence, Diagnostic Interview for Research for Depressive Disorder, and Alcohol, Smoking, and Substance Involvement Screening Test. Laboratory measures were serum glucose, total cholesterol, high-density cholesterol, triglycerides, and tumor necrosis factor-α. Results: Depressed male smokers used more cigarettes daily, presented more alcohol consumption, lower levels of high-density cholesterol, higher levels of tumor necrosis factor-α than depressed and nondepressed female smokers (P<0.05). However, depressed and nondepressed female smokers were more worried about weight gain and presented lower body mass index (kg/m2) than men.

Variation in APOL1 Contributes to Ancestry-Level Differences in HDLc-Kidney Function Association.

Low levels of high-density cholesterol (HDLc) accompany chronic kidney disease, but the association between HDLc and the estimated glomerular filtration rate (eGFR) in the general population is unclear. We investigated the HDLc-eGFR association in nondiabetic Han Chinese (HC, n = 1100), West Africans (WA, n = 1497), and African Americans (AA, n = 1539). There were significant differences by ancestry: HDLc was positively associated with eGFR in HC (β = 0.13, P < 0.0001), but negatively associated among African ancestry populations (WA: −0.19, P < 0.0001; AA: −0.09, P = 0.02). These differences were also seen in nationally-representative NHANES data (among European Americans: 0.09, P = 0.005; among African Americans −0.14, P = 0.03). To further explore the findings in African ancestry populations, we investigated the role of an African ancestry-specific nephropathy risk variant, rs73885319, in the gene encoding HDL-associated APOL1. Among AA, an inverse HDLc-eGFR association was observed only with the risk genotype (−0.38 versus 0.001; P = 0.03). This interaction was not seen in WA. In summary, counter to expectation, an inverse HDLc-eGFR association was observed among those of African ancestry. Given the APOL1 × HDLc interaction among AA, genetic factors may contribute to this paradoxical association. Notably, these findings suggest that the unexplained mechanism by which APOL1 affects kidney-disease risk may involve HDLc.

Association of Carotid Intima-media Thickness and Cardiovascular Risk Factors in Women Pre- and Post-bariatric Surgery

Obesity is associated with cardiovascular risk factors (CVRFs), such as hypertension, hypertriglyceridemia, and low levels of high-density cholesterol (HDL-C). In obese patients with a body mass index (BMI) of >or=40 kg/m2 or 35-40 kg/m2 associated with CVRFs, weight loss may be achieved more effectively by bariatric surgery on reducing several CVRFs. Carotid intima-media thickness (C-IMT) is an indicator of early atherosclerosis, and may be correlated with CVRFs. Our objective was to correlate C-IMT with CVRFs before (baseline data) and after surgery, and to observe whether weight loss is followed by a regression of C-IMT. Eighteen women who had undergone bariatric surgery participated in this study. Assessments were carried out on the baseline date, and 3, 6, and 12 months after surgery. Some of the CVRFs analyzed were: total cholesterol (TC) levels, HDL-C, triglycerides to HDL-C ratio (TG/HDL-C) and fasting plasma glucose. C-IMT was measured by B-mode ultrasound. A positive correlation was found between C-IMT and age and triglyceride level (p=0.002 and p=0.02, respectively). Six months after surgery, we found a significant reduction in C-IMT (p<0.05), which was significantly correlated with TG level and systolic pressure (p<0.05). The weight loss achieved with bariatric surgery resulted in regression of C-IMT. This regression could be observed 6 months following surgery, with an additional benefit at 12 months. Also, this finding was correlated with a reduction in triglyceride levels and systolic blood pressure.

ABCA1 polymorphisms and prognosis after myocardial infarction in young patients

High-density cholesterol (HDL) levels are affected by genetic influences and certain behaviors. Low levels of HDL-C are considered as an independent risk factor for premature coronary heart disease. In patients with Tangier disease, characterised by low HDL levels, mutations in the ATP binding cassette transporter have been described. We have analysed three polymorphisms of the ABCA1 gene (-477C/T, R219 K, and I883M) in a cohort of young male survivors of myocardial infarction in order to know their influence in long-term prognosis. In premature heart disease, knowing prognosis factors is specially relevant.

Review: Treatment of lipids to reduce cardiovascular risk among people with the metabolic syndrome or type 2 diabetes

he metabolic syndrome is present in approximately 20% of general populations in developed countries and in approximately 80% of people with type 2 diabetes. High triglyceride levels, low high-density cholesterol levels and central obesity are three of the five features of the metabolic syndrome and contribute to the increased risk of cardiovascular disease (CVD) among people with the metabolic syndrome. Lifestyle interventions and treatment with statins reduce risk of CVD but absolute risk of cardiovascular events among high-risk populations remains high. This article reviews the options for treating the atherogenic dyslipidaemia associated with the metabolic syndrome.

Diastolic function impairment and cardiovascular risk factors in postmenopausal hypertensive women. From RI.FA.HY.M. study (risk factors in hypertensive menopausal women)

Diastolic function impairment is the earliest cardiac abnormality in hypertensive patients and may precede left ventricular hypertrophy. The aim of ourt study was to evaluate the correlation between diastolic dysfunction and other cardiovascular risk factors in postmenopausal, hypertensive women. Two hundred consecutive women (mean age 47.5±4 yrs) referred to outpatient laboratory affected by hypertension, were studied. All women were in postmenopausal status and never treated before for hypertension. Mean systolic pressure was 163±15 mmHg, mean diastolic pressure was 97±75 mmHg. 23(11.5%) women were on hormone replacement therapy; 27 women (13.5 %) were smokers. All subjects underwent M-mode 2-dimensional echocardiography and cardiac Doppler. Mitral inflow velocity was recorded with the sample volume at the mitral anulus level; the following measurements were made: peak velocity of early left ventricular filling (E); peak velocity of late ventricular filling (A) and the ratio between early and late flow velocity peaks (E/A). The E/A ratio was then normalized for heart rate. A plasma sample was obtained for each patient in order to measure plasma total cholesterol, high density cholesterol (HDL), and plasma triglyceridemia. We evaluated the correlation between E/A ratio and the following variables: total cholesterol, HDL, triclyceridemia. smoking status, systolic and diastolic blood pressure, body mass index (BMI). Mean values for total cholesterol, HDL and tryglyceridemia were respectively: 199±35 mg/dl; 53±9 mg/dl; 126±47 mg/dl. Mean value of BMI was 27±4. A negative, significant correlation with total cholesterol, (r =-0,15, p<0.05) and a significant, positive correlation with HDL (r = 0.02, p<0.01) were found. No other variable was significantly correlated to E/A.In conclusion in postmenopausal women affected by hypertension, never treated before, high total cholesterol levels and low HDL levels, are associated with an impairment of diastolic function, so it is useful to study left ventricular function in all postmenopausal hypertensive women.

Serum lipids and gallstones: A case-control study

The role of serum lipids in the etiology of cholesterol gallstones and pigment gallstones was assessed in a case-control study. The study included 250 cases with surgically or ultrasonographically confirmed cholecystolithiasis and 526 hospital control patients. The highest gallstone risk was found at low high-density cholesterol levels and high triglyceride levels. An additional weakly negative association was found between total cholesterol level and gallstone risk. These findings were similar for cholesterol gallstones and pigment gallstones. The association between body mass index and gallstone risk disappeared after adjustment for serum lipids in a multivariate analysis. This study confirms previous reports on the association between gallstone risk and serum lipids. The similarity between cholesterol and pigment gallstones with regard to their association with serum lipids indicates that these types of gallstones share more causal factors than previously suggested. The absence of an effect of body mass index independent from serum lipids (as shown by the multivariate analysis) suggests that serum lipids are more closely linked to the pathogenesis of gallstones than obesity.