Low High-density Lipoprotein Levels Research Articles

Association of healthy beverage index with circadian rhythm and quality of sleep among overweight and obese women: a cross-sectional study.

Circadian rhythm is a behavioral, physiological, and molecular change with a cycle length of approximately 24h. Changes to the circadian rhythm can result in sleep difficulty. The healthy beverage index (HBI) is a holistic concept for evaluating the quality of overall beverage intake and its association with health-related outcomes in nutritional epidemiological studies. This study aimed to assess the relationship of HBI with circadian rhythm and sleep quality among overweight/obese women. The current study was conducted among 208 overweight and obese women between 18-48years in Tehran, Iran. We evaluated potential HBI with a valid food frequency questionnaire. Following standard procedures, trained personnel assessed anthropometric measures, blood samples, and other baseline characteristics. The Pittsburgh Sleep Quality Index and the morning-eveningness questionnaire were applied to evaluate sleep quality and circadian rhythm respectively. The mean (SD) BMI for this study was 30.8 (4.2) kg/m2. We observed that subjects in the least tertile had significantly high levels of triglyceride (p = 0.04) and low-density lipoprotein (p = 0.009). High-density lipoprotein was significantly different across the tertiles (p = 0.003). After adjusting for potential covariates, subjects in the second tertile of HBI had 5.07 odds of having the worst quality of sleep as compared to those in the third tertile, p < 0.05. We also observed a significant inverse association between the HBI and the "moderately evening type" participants (OR 0.86; 95% CI 0.68-0.99; p: 0.02) after adjusting for potential confounders. Healthy beverage consumption may have the potential of improving sleep quality among overweight and obese subjects. Level IV, evidence obtained from a descriptive study.

Diabetic Nephropathy in Children with Type 1 Diabetes Mellitus with Vitamin D Deficiency and Dyslipidemia as Associated Risk Factors

Background: Diabetic nephropathy (DN) is one of the most common and significant chronic complications associated with diabetes mellitus (DM). Vitamin D (VD) deficiency is linked to poor control of diabetes and its complications including the microvascular one such as DN. Dyslipidemia is believed to play a role in DN progression. Objective: The aim of this article is to estimate the prevalence of DN in children and adolescents with type 1 DM and its association with VD deficiency and dyslipidemia as risk factors. Materials and Methods: We conducted a cross-sectional study over a period of 6 months on 45 patients (children and adolescents) who attended the Pediatric Endocrinology Clinic of the National Diabetic Center/Al-Mustansiriyah University in Baghdad city, Iraq. The age of study participants ranged from 10 to 17 years, with the duration of type 1 DM of 5 years or more. Data including age, gender, duration of diabetes, daily insulin dose per kilogram body weight, growth measurements, and blood pressure (BP) were reported. A venous blood sample was collected for glycated hemoglobin (HbA1c), lipid profile, VD level, whereas a urine sample was collected for albumin-to-creatinine ratio. Two of the three specimens were obtained within a 3–6-month period due to variability in urinary albumin excretion. Results: The majority of diabetic children (71.1%) had DN. There were no significant differences in age, gender, duration of diabetes, body mass index (BMI), and BP between patients with diabetes and nephropathy and those with only diabetes. Both insulin dose and the HbA1c levels were significantly greater in diabetic patients with nephropathy (P-value 0.018 and 0.04, respectively) compared with diabetic patients without nephropathy. Insufficient and deficient VD levels were significantly higher among diabetic patients with nephropathy, whereas the sufficient level was higher among diabetic patients without nephropathy (P = 0.020). Diabetic patients with nephropathy had significantly higher levels of triglyceride, low-density lipoprotein (LDL), very LDL but lower high-density lipoprotein levels than diabetic patients without nephropathy (P-values 0.004, 0.047, 0.024, and 0.030 respectively). Conclusion: DN was not significantly associated with age, gender, disease duration, BMI, and BP of patients. Patients with DN need higher doses of insulin therapy and had higher HbA1c levels. VD deficiency is linked to a higher risk of DN. Patients with nephropathy had more significant dyslipidemia than patients without nephropathy.

Corneal arcus and low serum high-density lipoproteins

We report two cases with dense corneal arcus with abnormally low levels of serum high-density lipoproteins. One case with arcus senilis had a history of corneal clouding since youth but no systemic associations. The other case had an arcus juvenilis with anemia and hepatosplenomegaly but an absence of renal involvement. The genetic analysis of this case was performed and was suggestive of lecithin-cholesterol aminotransferase deficiency.

Body Composition Assessment by Bioelectrical Impedance Analysis in Prediction of Cardio-Metabolic Risk Factors: Tehran Lipid and Glucose Study (TLGS)

Background:We aimed at evaluating the best body mass index (BMI) and percent body fat (PBF) cutoffs related to cardio-metabolic risk factors and comparing the discriminative power of PBF and BMI for predicting these risk factors.Methods:In this cross-sectional study in phase V (2012–2015), 1271 participants (age ≥ 20 yr; 54.3% women) were enrolled. Bioelectrical impedance analysis (BIA) was used to estimate PBF. Joint Interim Statement criteria were used for defining metabolic syndrome (MetS). We compared PBF with BMI through logistic regression and area under the curve of the receiver operating characteristic (ROC) curve. Percent body fat cutoff points were > 25 in men and >35 in women.Results:Percent body fat and BMI cutoff points for predicting MetS were 25.6% and 27.2 kg/m2 in men and 36.2% and 27.5 kg/m2 in women, respectively. There were no significant differences between BMI and PBF area under the ROC curves for predicting MetS and its components, except for abdominal obesity in men and low high-density lipoprotein (HDL) in women in favor of BMI. Logistic regression analysis indicated that BMI in women was better for predicting MetS and its components, except for abdominal obesity. Moreover, BMI was equal or superior to PBF in men, except for low HDL and high triglyceride levels.Conclusion:Comparison of PBF with BMI showed that the use of PBF is not significantly better than BMI in predicting cardio-metabolic risks in the general population.

Metabolic Syndrome in Post-Pulmonary Tuberculosis-Associated Obstructive Airway Disease: A Cross-Sectional Analytical Study

BackgroundThe aim of this study is to assess the prevalence of metabolic syndrome in tuberculosis-associated obstructive airway disease (TOPD) patients, as well as the association of its components with the severity of airflow obstruction.MethodologyIn this cross-sectional analytical study, we evaluated the clinical profile, spirometry, waist circumference, blood pressure, lipid profile, fasting plasma glucose, and the association of each component with the severity of airflow obstruction.ResultsThe prevalence of metabolic syndrome in TOPD was found to be was 25.77% (95% confidence interval = 18.11-35.28) among study participants. Reduced high-density lipoprotein was the deranged component and was associated with increased severity in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II compared to GOLD stage IV.ConclusionsThe prevalence of metabolic syndrome in TOPD has a severe impact on patients’ treatment, outcomes, and complications. However, in our study, tuberculosis-associated metabolic syndrome was the same as the general population. Low high-density lipoprotein levels were associated with the severity of the airflow obstruction.

An unusual case of familial hyperlipidemia with statin induced rhabdomyolysis

Familial hypercholesterolemia (FH), also known as Type 2 familial dyslipidemia is a genetic disorder characterized by high levels of low-density lipoprotein (LDL) cholesterol in the blood. Elevated LDL cholesterol levels leads to ischemic heart disease in younger age group. FH is well known to cause deposition of cholesterol in muscle tendons causing tendon xanthomas which present as nodules over Achilles' tendon. Familial hypercholesterolemia is treated with high dose of statins to bring down the LDL cholesterol. We hereby report an unusual case of familial hypercholesterolemia with very high LDL levels (504 mg/dl) and tendon xanthomas who developed statin induced rhabdomyolysis due to consumption of high doses of statins. Patient had consumed both atorvastatin and rosuvastatin by mistake which led to rhabdomyolysis. A clinician must look out for this complication in any patient who is started on high dose of statins. Anticipation of this complication, patient education and periodic checking of muscle enzyme creatine phosphokinase (CPK) and serum creatinine in a patient on high dose statins helps in tackling this complication effectively.

Impact of Physical Activity on Adiposity and Risk Markers for Cardiovascular and Metabolic Disease.

The main aim of the present study was to investigate the impact of physical activity (PA) on adiposity and for cardiovascular and metabolic disease risk markers (CMDRMs). In total, 55 adults (33 lean [L] and 22 overweight/obesity [O/O]) visited the laboratory on two occasions. During the first session, body composition and anthropometric measurements were taken as well as resting blood pressure (BP). Free-living PA intensity was monitored using an ActiGraph accelerometer, which the participants wore for a period of 6 days. During the second visit, blood samples for the analysis of disease risk markers were obtained from the participants in the morning after overnight fasting (≥10 hr). There was no significant difference between groups in the percentage of time spent in PA levels (54.5% ± 1.2% and 54.9% ± 2.1% for L and O/O, respectively). Although, the O/O group was within recommended PA level, they had higher leptin, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and high-sensitivity C-reactive protein (hsCRP) levels than the L group (all p < .01). The O/O group had higher levels of triglycerides, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) and lower levels of high-density lipoprotein (HDL; all p < .01). Interestingly, vigorous activity was positively correlated with HDL (r = .30, p < .05) and negatively with LDL (r = −.26, p = .05) levels and the arachidonic acid to eicosapentaenoic acid (ARA/EPA) ratio (r = −.30, p < .05). Only the O/O group had elevated CMDRMs. However, vigorous activity may improve health-related blood lipids such as HDL, LDL, and ARA/EPA ratio. Regardless of body composition status, low active participants were more likely to have higher level of leptin and hsCRP. Further exploration of the beneficial effects of vigorous exercise on adiposity and CMDRMs is warranted.

Abstract MP20: Global Burden Of Elevated Low-density Lipoprotein Cholesterol, 1990-2020: Findings From The Global Burden Of Disease Study 2020

We evaluated low-density lipoprotein (LDL) cholesterol patterns at the population level and quantified associated cardiovascular disease (CVD) morbidity and mortality for the Global Burden of Disease (GBD) 2020 study. Using all available high-quality data, we estimated the CVD burden attributable to elevated LDL (relative to the theoretical minimum risk exposure level of 1.3-1.7 mmol/L) by age, sex, country, and year among adults &gt;25 years from 1990 - 2020. We used a spatiotemporal Gaussian process regression to estimate LDL mean and microdata to estimate standard deviation (SD) and characterize the global LDL distribution. In a meta-regression, we pooled data from 52 randomized control trials to estimate the relative risks for ischemic heart disease (IHD) and ischemic stroke. These were then used to calculate the population attributable fraction and the burden attributable to elevated LDL. We report SD and 95% uncertainty intervals (UI) in brackets. From 1990 to 2020, LDL levels measured in mmol/L increased globally from 1.4 [0.4] to 1.7 [0.4] in males, and from 1.5 [0.4] to 1.8 [0.5] in females. The highest LDL levels over the 30-year period were observed in high-income countries and Central and Eastern Europe and Central Asia. Sub-Saharan Africa had the lowest LDL levels. In 2020, a third (2.9 million [95% UI: 1.2-4.5 million]) and a fifth (1.5 million [919,750-2.1 million]) of deaths due to IHD and ischemic stroke, respectively, were attributable to elevated LDL. The estimated number of deaths and disability-adjusted life-years (DALYs) attributable to high LDL increased since 1990 reaching 4.5 million [2.6 - 6.2] deaths and 91.8 million [53.6 - 127] DALYs in 2020. More DALYs from elevated LDL were experienced by men than women (52.8 [29.7 - 73.4] vs 39 [23.9 - 53.5] million). Over the study period, the global all-age rates for deaths and DALYs per 100,000, remained unchanged at 58 [34-80] and 1,177 [688-1,629], respectively. Age-standardized deaths and DALYs due to high LDL levels decreased from 90 [55-123] to 57 [34-79] deaths per 100,000 and from 1,657 [981-2,251] to 1,610 [650-1,532] DALYs per 100,000. Age-standardized DALYs attributable to high LDL cholesterol were highest in Eastern Europe, Central Asia and North Africa and the Middle East. The lowest levels were observed in high-income Asia Pacific and Andean Latin America. The CVD burden attributable to LDL is increasing globally. In 2020, a fifth of CVD deaths and DALYs were associated with LDL. Differences between the trends of all-ages and age-standardized rates suggest that the LDL burden has been driven partially by population growth and aging. Measurement and estimation error must be considered when interpreting these trends. In addition to safe and cost-effective pharmacological and behavioral interventions, novel population level strategies are needed to reduce the LDL burden.

Pregnancy Induced Hypertension and Lipid Profile of Obese and Normal Weight Pregnant Women. A Comparative Study

Maternal dyslipidemia and hypertension are risk factors and correlated with the pregnancy complications which creates serious biochemical and physiological effects on neonatal outcome. It was concluded that different variables such as systolic and diastolic blood pressure serum cholesterol, triglyceride, low density lipoproteins and High density lipoproteins levels (140±11.13, 90±21.9, 169±12.31, 146±2.10, 170±11.10, 49±12.10) and (200±10.12, 100±21.19, 226±10.13, 200±12.11, 230±14.13, 37±16.19) of Group H and Group N have a significant changes (&lt;0.005) as compared to the control Group N (122±1.3, 80±2.9, 120±23,130±21, 115±10, 42±20).

Prevalence of Obesity Among Adults in Jordan: National Survey

Background Obesity is a national and global public health problem in terms of morbidity, mortality, and economic burden. In 2014, 5% of deaths worldwide were attributable to obesity, with an estimated economic impact of 2.8% of the global gross domestic product. A survey in 2008 showed a high prevalence of overweight and obesity among adults in Jordan. Objective This study aimed to determine the prevalence of obesity, assess its trends, and identify the factors and comorbidities associated with this condition. Methods A multipurpose national household survey was conducted among Jordanian adults over 4 months in 2017. Data were collected using a structured validated questionnaire. Obesity was defined according to the International Diabetes Federation criteria. Results This study included 4056 adults (1193 men, 29.4%; 2863 women, 70.6%). Their age ranged from 18 to 90 years, with a mean age of 43.8 (SD 14.2) years. According to the International Diabetes Federation criteria, the age-standardized prevalence of obesity was 60.4% in men and 75.6% in women. After adjusting for age, the odds of obesity in 2017 were twice the odds in 2008 in men (odds ratio [OR] 1.98) and women (OR 1.96). In the multivariate analysis, age, place of living, and marital status were significantly associated with obesity in men and women. Obesity was significantly associated with increased odds of diabetes mellitus (OR 2.1 for men; OR 2.9 for women), hypertension (OR 2.4 for men; OR 2.5 for women), elevated triglyceride levels (OR 2.5 for men; OR 4.2 for women), and low high-density lipoprotein levels (OR 2.2 for men; OR 2.1 for women) after adjusting for age. Conclusions The prevalence of obesity is high in Jordan, and this condition is associated with other metabolic abnormalities. Well-defined programs to manage, control, and prevent obesity as well as intersectoral action are urgently required to reverse current trends in Jordan.

Evaluation Of Lipid Profile In Thyroid Dysfunction

Thyroid hormones play an important role in the regulation of lipid metabolism. Subclinical hypothyroidism is defined as a slight increase in thyroid-stimulating hormone (TSH) with normal levels of thyroxine (T4). Hypothyroidism could be associated with altered lipid panels. This study aimed at evaluating the association between hypothyroidism and altered lipid profile. Data of 54 patients with subclinical hypothyroidism and 54 healthy individuals were collected from SBMCH laboratory. The participants belong to the age group of 20-50 years. Patients with TSH in the range of 4.2 to 10 mU/L, and T4 in the range 0.8 to 2.8 ng/dL were ruled out as hypothyroid. Control had a normal TSH ranging from 0.5 to 4.2 mU/L. The total serum cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels were examined in both groups and the results were recorded. Participants with hypothyroidism had significantly higher LDL and lower HDL levels than the control group irrespective of age group and gender (P-value &lt;0.001), but no difference in TG and TC levels (P-value &lt;0.05) were observed. The prevalence of dyslipidemia and hypothyroidism was only significant in females (P-value =0.009). There was significant correlation between the prevalence of dyslipidemia and hypothyroidism regardless of gender (P-value =0.04). Hypothyroidism is associated with dyslipidemia, and biochemical screening for dyslipidemia is recommended in all patients with subclinical hypothyroidism.

Prevalence of Chronic Kidney Disease in Nonalcoholic Fatty Liver Disease Patients.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. It is not only associated with liver-related mortality and morbidity but is a multisystem disease that affects multiple extra-hepatic organ systems, such as the kidneys and cardiovascular system. Our study was conducted to evaluate the possible relationship between NAFLD and the risk of chronic kidney disease (CKD) development. This is a comparative cross-sectional study. The study was conducted on 100 patients who were diagnosed with NAFLD by abdominal ultrasound, CKD was diagnosed either by estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2 or by the presence of albuminuria (albumin creatinine ratio >30 mg/g).These patients were classified into two groups, the CKD group and the non-CKD group, and the two groups were compared according to different parameters. The data were collected, presented, and statistically analyzed with the computer program IBM SPSS Statistics version 23. Among 100 NAFLD patients, there were 19 patients developed CKD diagnosed either by eGFR or by the presence of albuminuria. These CKD patients were older, have abdominal obesity, higher body mass index, higher cholesterol level, higher low-density lipoprotein level, higher triglycerides levels, higher systolic and diastolic blood pressure, and higher fatty liver index and a higher degree of fatty liver by ultrasound. Our current study suggests that NAFLD may be associated with a high risk of CKD.

Evaluation Of Lipid Profile In Thyroid Dysfunction

Thyroid hormones play an important role in the regulation of lipid metabolism. Subclinical hypothyroidism is defined as a slight increase in thyroid-stimulating hormone (TSH) with normal levels of thyroxine (T4). Hypothyroidism could be associated with altered lipid panels. This study aimed at evaluating the association between hypothyroidism and altered lipid profile. Data of 54 patients with subclinical hypothyroidism and 54 healthy individuals were collected from SBMCH laboratory. The participants belong to the age group of 20-50 years. Patients with TSH in the range of 4.2 to 10 mU/L, and T4 in the range 0.8 to 2.8 ng/dL were ruled out as hypothyroid. Control had a normal TSH ranging from 0.5 to 4.2 mU/L. The total serum cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels were examined in both groups and the results were recorded. Participants with hypothyroidism had significantly higher LDL and lower HDL levels than the control group irrespective of age group and gender (P-value &lt;0.001), but no difference in TG and TC levels (P-value &lt;0.05) were observed. The prevalence of dyslipidemia and hypothyroidism was only significant in females (P-value =0.009). There was significant correlation between the prevalence of dyslipidemia and hypothyroidism regardless of gender (P-value =0.04). Hypothyroidism is associated with dyslipidemia, and biochemical screening for dyslipidemia is recommended in all patients with subclinical hypothyroidism.

Body mass index was linked with multi-cardiometabolic abnormalities in Chinese children and adolescents: a community-based survey

BackgroundEvidence on how body mass index (BMI) influence cardiometabolic health remains sparse in Chinese children and adolescents, especially in south China. We aim to investigate the effect of overweight and/or obesity on high blood pressure (HBP), dyslipidemia, elevated serum uric acid (SUA) and their clustering among children and adolescents in an island in South China.MethodsUsing multi-stage cluster sampling method, 1577 children and adolescents aged 7–18 in Hainan province, south China, participated in the survey. The association between body mass index and cardiometabolic indexes were explored. Overweight and obesity were classified according to criteria of World Health Organization for children and adolescents aged 5 to 19. Restricted cubic spline models were used to examine the possible non-linear association between BMI and cardiometabolic profiles. Multivariable logistic regression models were fitted to examine the effect size of BMI on cardiometabolic disorders including HBP, elevated SUA and dyslipidemia. Comorbidity of at least two cardiometabolic abnormalities (HBP, dyslipidemia, elevated SUA) was defined as clustering of cardiometabolic risk factors.ResultsComparing with normal weight and underweight subjects, overweight/obese youths had higher levels of BP, SUA, triglyceride, low-density lipoprotein but lower level of high-density lipoprotein. Overweight/obese youth had higher risk of dyslipidemia (OR:2.89, 95%CI: 1.65–5.06), HBP (OR:2.813, 95%CI: 1.20–6.59) and elevated SUA (OR: 2.493, 95%CI: 1.45–4.27), respectively, than their counterparts. The sex-, age-adjusted prevalence of abnormalities clustering was 32.61% (95% CI: 20.95% to 46.92%) in overweight/obesity group, much higher than in the under/normal weight group (8.85%, 95%CI: 7.44% to 10.48%).ConclusionExcess adiposity increased the risk of elevated serum uric acid, serum lipids, blood pressure and their clustering among children and adolescents in south China.

Native and Oxidized Low-Density Lipoproteins Increase the Expression of the LDL Receptor and the LOX-1 Receptor, Respectively, in Arterial Endothelial Cells.

Atherosclerotic artery disease is the major cause of death and an immense burden on healthcare systems worldwide. The formation of atherosclerotic plaques is promoted by high levels of low-density lipoproteins (LDL) in the blood, especially in the oxidized form. Circulating LDL is taken up by conventional and non-classical endothelial cell receptors and deposited in the vessel wall. The exact mechanism of LDL interaction with vascular endothelial cells is not fully understood. Moreover, it appears to depend on the type and location of the vessel affected and the receptor involved. Here, we analyze how native LDL (nLDL) and oxidized LDL (oxLDL) modulate the expression of their receptors—classical LDLR and alternative LOX-1—in endothelial cells derived from human umbilical artery (HUAECs), used as an example of a medium-sized vessel, which is typically affected by atherosclerosis. Exposure of HUAECs to nLDL resulted in moderate nLDL uptake and gradual increase in LDLR, but not LOX-1, expression over 24 h. Conversely, exposure of HUAECs to oxLDL, led to significant accumulation of oxLDL and rapid induction of LOX-1, but not LDLR, within 7 h. These activation processes were associated with phosphorylation of protein kinases ERK1/2 and p38, followed by activation of the transcription factor AP-1 and its binding to the promoters of the respective receptor genes. Both nLDL-induced LDLR mRNA expression and oxLDL-induced LOX-1 mRNA expression were abolished by blocking ERK1/2, p-38 or AP-1. In addition, oxLDL, but not nLDL, was capable of inducing LOX-1 through the NF-κB-controlled pathway. These observations indicate that in arterial endothelial cells nLDL and oxLDL signal mainly via LDLR and LOX-1 receptors, respectively, and engage ERK1/2 and p38 kinases, and AP-1, as well as NF-κB transcription factors to exert feed-forward regulation and increase the expression of these receptors, which may perpetuate endothelial dysfunction in atherosclerosis.

Prevalence of metabolic syndrome and its clinical and angiographic profile in patients with naive acute coronary syndrome

Objective: The objective of the study is to evaluate the prevalence of metabolic syndrome (MS) and its clinical and angiographic profile in patients with naive acute coronary syndrome (ACS). Furthermore, this study tried to evaluate the severity of coronary artery disease in patients with and without MS. Methods: This was a single-center, cross-sectional study which prospectively enrolled 500 patients with naive ACS during the period from January 2017 to December 2018 at a tertiary care center in India. They were divided into two groups according to the presence and absence of MS based on revised NCEP ATP III guidelines. The ACS was defined based on the Joint Committee of the American College of Cardiology. After clinical evaluation and investigations, the prevalence of MS in ACS patients was calculated. Results: Prevalence of MS in this study was 46.2% and was more frequent in males (81%) compared to females (19%). Maximum number of patients with MS were between the age group of 40–59 years (55%). Prevalence of diabetes (56.7%), hypertension (58.0%), and smoking (45.88%) were significantly higher in patients with MS (P < 0.001). Most prevalent components of MS were low high-density lipoprotein (HDL) levels, increased blood pressure, fasting blood sugar, and triglyceride levels (P < 0.001). Conclusion: Prevalence of MS was high in patients with ACS and was more often after the age of 40 years and most commonly seen in males. Low HDL levels, increased blood pressure, and blood sugar were most prevalent components in the criteria for MS. Patients with MS tend to have more complex coronary lesions.

Comparison of Lipid Profile in Prediabetic and Non Prediabetic Adult Off-springs of Type 2 Diabetics Patients: A Cross-sectional Study

Introduction: Lipid abnormality is an important modifiable risk factor associated with the type 2 diabetes mellitus and prediabetes. Dyslipidaemia occurring in diabetic patients, has important role in development of macrovascular atherosclerosis and increases the risk of cardiovascular disease. Furthermore, prediabetes has also been found to be associated with an increased risk for cardiovascular disease. Considering the prevalence and increased risk of cardiovascular disease in diabetes, it is becoming necessary to diagnose prediabetic individuals and assess their lipid profile and prevent them from developing overt diabetes and the further complications. Also, data available on lipid abnormalities in prediabetics is relatively less in the Indian population. Aim: To compare lipid profile in prediabetic and non prediabetic adult off-springs of type 2 diabetics and to evaluate the association between lipid profile and prediabetes. Materials and Methods: This cross-sectional study was conducted on 150 healthy young adult (&gt; 18 years) off-springs of type 2 diabetic patients, willing to participate in the study in Government Medical College and Hospital, Miraj from January 2019 to December 2019. All the relevant information was collected by administering a structured case record form. Fasting blood samples were collected and fasting blood glucose level, lipid profile including Total cholesterol (TC), Triglycerides (TG), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL), Very Low-Density Lipoproteins (VLDL), were estimated and compared. Data collected was entered in the Microsoft excel (2010), expressed as frequency and mean. Chi-square test and Fisher’s exact test were applied to observe the association between different study parameters. A p-value &lt;0.05 was considered statistically significant. Results: Prevalence of prediabetes was 17.3% (fasting BLS 100 to 125 mg/dL) in age group of 26 to 30 years (26.67%). It was found that occurrence of prediabetes was more in male participants (25.37%) as compared to female participants (10.84%). Association between gender of the participants and occurrence of prediabetes was found to be statistically significant (p-value=0.019). The association between prediabetes and higher TC levels (mean-204.88±47.99 and 152.46±29.35 mg/dL), lower HDL levels (mean-57.65±4.59 and 66.18±6.02 mg/dL), higher LDL levels (mean-94.77±30.71 and 69.57±17.88 mg/dL), higher VLDL levels (mean-128.08±49.96 and 39.52±39.99 mg/ dL) was found to be statistically significant (p-value&lt;0.05) and the association between prediabetes and higher TG levels (mean-48.65±18.45 and 28.18±9.47 mg/dL) was not significant (p-value=0.056). Conclusion: Total cholesterol, LDL, TG, VLDL were significantly raised, whereas HDL was significantly lower in prediabetic subjects as compared to non prediabetic healthy subjects. The association between prediabetes and higher TC levels, lower HDL levels, higher LDL levels, higher VLDL levels was found to be statistically significant (p-value&lt;0.05) and the association between prediabetes and higher TG levels was not significant (p-value=0.056). So, prediabetic individuals, though asymptomatic have significant dyslipidaemia, that puts them at higher risk for developing cardiovascular disease.

Enzymatic activity of paraoxonase depending on polymorphism Q192R of the PON1 gene in patients with primary open-angle glaucoma

To genotype patients with primary open-angle glaucoma (POAG) by the Q192R polymorphism of the PON1 gene in order to identify their genetic predisposition to dyslipidemia and atherosclerosis, as well as to determe the possibility of correcting the reduced activity of the PON1 enzyme in the examined individuals by the complex drug Cytoflavin. The study included 25 men with advanced POAG, IOP compensated by hypotonic agents, and 20 volunteers without POAG (mean age 63.0±5.4 years). All subjects underwent genotyping by the Q192R polymorphism of the PON1 gene using an analyzer. PON1 activity was assessed by the rate of nitrophenol formation when paraoxone diluted in acetone was added to the blood plasma. At the second stage, patients (of different phenotypes) were prescribed the complex drug Cytoflavin. Homozygous carriers of the 192R allele were found to have significantly lower levels of PON1 activity than homozygous carriers of the Q192 allele. Carriage of the 192R allele may determine an increased risk of atherosclerotic injury in patients with POAG, especially in cases with high levels of atherogenic blood lipoproteins, low levels of high-density lipoproteins, or high levels of peroxidized lipids in the blood. The drug Cytoflavin showed a positive therapeutic effect on oxidative stress and hypercholesterinemia in POAG patients. These findings can be used to determine the atherogenicity of lipoproteins and the progression of glaucomatous optic neuropathy and to optimize the therapy of PAHO.

Ezetimibe- A Novel Add on Treatment Strategy to Achieve Targeted LDL in Patients with Uncontrolled LDL Levels on High Dose Statin Alone

Background: The lowering of low-density lipoprotein cholesterol (LDL-C) is the primary target of therapy in the primary and secondary prevention of cardiovascular events. Statins are the most prescribed lipid-lowering drugs, but many patients fail to achieve the target low-density lipoprotein (LDL) level with statin alone or at higher doses. The add-on therapy of 'Ezetimibe' to statin monotherapy has resulted in a synergistic effect in reducing LDL levels and achievements of lipid targets. Cholesterol comes from two sources. endogenous and exogenous. Rather than inhibiting one source, it is better to inhibit two sources. While statins inhibit endogenous production, Ezetimibe decreases absorption of cholesterol. Indian patients are also observed to have low HDL which is another risk factor for heart diseases. We aimed to assess the efficacy of the combination of atorvastatin plus ezetimibe in Indian patients with dyslipidemia and to see whether it can reduce LDL levels and Improve HDL and triglyceride levels. Objective: (1) To find out LDL reduction by addition of ezetimibe in combination with statin in Indian patients. (2) To find out increase in HDL levels by adding ezetimibe in combination with statin along with the reduction in triglyceride levels in Indian patients. Methods: The retrospective data from EMR of the patients diagnosed with a high level of LDL and satisfying the study's inclusion criteria were collected. The patients at the baseline were given monotherapy. Those who did not achieve the desired LDL were given treatment with Atorvastatin high dose (40 mg and 80 daily) and were allocated to the add-on therapy with Ezetimibe at 10 mg/day after 3 months. The groups (monotherapy and combined therapy) were compared at baseline and subsequent follow-up visits. Data were analyzed using R studio 1.2.1335 and Microsoft Excel. Statistical significance was considered at p&lt;0.05. Results: The LDL level showed a significant decrease after 18 months from baseline till the subsequent follow-up visits. The reduction observed in the serum concentration of LDL was from 167.95 ± 12.85 mg/dL to 91.9 ± 10.39 mg/dL (p &lt; 0.001) in 40 mg group and from 164.76 ± 9.9 mg/dL to 106.71 ± 17.17 mg/dL (p &lt; 0.001) in 80 mg group. Furthermore, the rate of achieving an LDL level &lt;100 mg/dL increased from 0% to 45.28% in the 40 mg group and from 0% to 35.24% in 80 mg group and showed significantly greater improvement (p = 0.001). Conclusion: Compared with high doses of statin, the combination of statin with Ezetimibe not only achieves targeted serum lipid levels, suggesting that combination therapy should be a priority when statin resistance or poor efficacy occurs with the higher dose of statin monotherapy. Keyword: LDL; HDL; Triglycerides; Atorvastatin; Ezetimibe

Blood pressure variability and neuroplasticity in patients with type 2 diabetes mellitus

Analysis of the role of blood pressure (BP) variability in the formation of neuroplasticity in patients with type 2 diabetes mellitus (DM). 100 patients with type 2 DM were examined, which were divided into groups depending on the presence of cognitive impairment (CI), the control group consisted of 25 people. All examined patients underwent a clinical examination, a standard set of biochemical blood tests, plasma osteopontin levels, 24-hour blood pressure monitoring (ABPM) for 24-26 h MRI of the brain (dynamic contrast and arterial spin marks, proton spectroscopy, tractography). Patients with type 2 diabetes and CI had higher body mass index, blood levels of glycated hemoglobin, glucose, alanine aminotransferase, low-density lipoprotein, triglycerides, total cholesterol, osteopontin, and lower levels of high-density lipoprotein (p≤0.05). The level of osteopontin was higher in patients with overweight, hyperglycemia, dyslipidemia, and in patients with CI in patients with BP variability. When assessing 24-hour blood pressure monitoring (ABPM), a significant difference was found in all standard indicators, while patients with type 2 diabetes were referred to as «non-dipper», in the presence of CI they noted significantly higher values of the index of time and area of stay in the suprathreshold state. BP and variability in SBP and DBP at night, as well as the risk of occult hypertension. A decrease in cerebral blood flow was revealed according to the data of contrast and non-contrast assessment of perfusion in cortical (especially in the frontal lobe) and subcortical (mainly in the putamen) structures, associated with changes in ABPM parameters. Mean SBP and DBP day and night, as well as the index of BP variability, also affect the integrity of the corticospinal, uncinate, lower longitudinal tracts, and arcuate fasciculus. The same parameters change the metabolism of the hippocampus in terms of choline (Cho), creatine (Cr), creatine phosphate (Cr2), as well as the ratio of N-acetylaspartate (NAA)/Cho, NAA/Cr, Cho/Cr. In patients with type 2 diabetes, BP variability contributes to the formation of CI through a pro-inflammatory mechanism (osteopontin), leading to impaired brain vascularization in general, white matter structure, and hippocampal metabolism.