Mean Low Density Research Articles

Efficacy of online japanese intensive cardiac rehabilitation for secondary prevention for coronary artery disease: a comprehensive program including exercise, nutrition, mindfulness, and group support

Abstract Background/Introduction While comprehensive programs for cardiac rehabilitation are recommended for patients with coronary artery disease (CAD), systematic programs including nutrition, stress-management, and behavior change have not been clearly established. Purpose To comprehensively change the lifestyle of patients with CAD as secondary prevention, we developed an online based educational program "intensive cardiac rehabilitation for Japanese patients with CAD (J-ICR)" modifying ICR, a regimen covered by health insurance in the United States, to the program that has affinity with Japanese. Methods Online J-ICR program is set up as sessions for maintenance-phase CAD patients using an online application. J-ICR has 12 sessions held weekly for 3 hours per session, total 36 hours, aimed to integrate 4 components: 1) exercise guidance based on exercise prescription which contain aerobic exercise, resistance training, and multi-component exercise through online platforms, 2) dietary education focusing on "the Japan Diet", 3) stress management utilizing mindfulness, and 4) group support to enhance patient and medical-staff interaction. Twenty-two participants were randomly separated to Early Phase group and Late phase group. For verification of the efficacy of this program, we survey the adherence to the program and compared the changes in risk factor of CAD at 3 months defining Early phase group as intervention group and Late phase group as control. (Fig.1). Results After excluding 3 participants who withdrawn to participate, the remaining 19 participants were conducted the evaluation and 10 participants were in intervention group and 9 participants in control group, respectively. As for patient characteristics, the mean age was 66 years old, and all participants were male. History of CVD was comprising 8 cases of myocardial infarction and 15 cases of angina pectoris. As for the risk factors of CVD, there were not significant differences in mean low density lipoprotein (LDL) cholesterol (Intervention group 71.5mg/dl vs Control group 83.4mg/dl; p=0.12) or systolic blood pressure (SBP) (126mmHg vs 130mmHg; p=0.40) at base line between two groups. The average participating rate in program was 93.8% and there was no dropped out participant during the program in investigation group. After 3months, LDL cholesterol was not significantly decreased in both groups (mean reduction of Intervention group -0.3mg/dl, p=0.93 and control group -3.8mg/dl, p=0.43, respectively). However, there was significant reduction of SBP in intervention group (mean reduction 5.6mmHg, p=0.02) but in control group (mean reduction 2.4mmHg, p=0.42). (Fig.2). Conclusions This randomized controlled study showed the good adherence of J-ICR program and it suggested that J-ICR program has the effect on lowering systolic blood pressure at 3 months. Longer follow up data and the results of more participants are warranted to clarify the efficacy in real world prevention of CVD.

Growth performance, Haematological and Serum biochemistry of broilers fed diets containing Vitex doniana leaf meal

This experiment was conducted to investigate the growth performance, haematological and serum biochemistry indices of broilers fed diets containing Vitex doniana leaf meal (VDLM). A total of 120 unsexed broilers were allocated to four treatments of T1, T2, T3 and T4 and replicated three times with ten birds per replicate in a Completely Randomized Design. The birds in each treatment were fed with diets containing 0.0, 2.5, 5.0 and 7.5% VDLM respectively. Growth performances, packed cell volume, red blood cell count, haemoglobin, white blood cell count, lymphocytes, neutrophils, mean corpuscular volume, mean corpuscular haemoglobin concentration, platelet count, aspartate amino transaminase, alanine amino transaminase, alkaline phosphate, high density lipoprotein, low density lipoprotein, cholesterol, albumin, globulin, urea, glucose, total protein and creatinine were evaluated. Growth performance results showed that there were significant differences (P<0.05) in all the measured parameters except feed cost. The result of the experiment showed that there were significant differences (P<0.05) in all the heamatological and serum biochemistry parameters at starter and finisher phases, except for haemoglobin and mean corpuscular haemoglobin concentration which were not significantly different (P>0.05) at the starter phase. Growth performances of broilers fed control diets were better than the other treatment diets. Mean corpuscular haemoglobin, platelet count and low density lipoprotein decreased progressively while mean corpuscular volume, neutrophils, alanine amino transaminase, aspartate amino transaminase and creatinine increased progressively with increase in the inclusion of VDLM at the finisher phase. At the finisher phase, haemoglobin, packed cell volume and glucose decreased progressively while high density lipoprotein increased progressively with increase in VDLM. The results show that VDLM reduced the growth performance but improved the heamatological and serum biochemistry of broiler at lower levels of inclusion.

Antioxidant and phytochemical profiling of ethanol leaf extract of Ficus pachyneura and derived fractions

A total of 16, 18-weeks old chickens with mean weight 1.99±0.12 kg (1.85-2.30kg) were used to compare the serum biochemical characteristics of four chicken genotypes (breeds/strains) from south-eastern part of Nigeria. The chickens were grouped based on their genotypes (breeds/strain) in a Completely Randomized Design for the four-week study. The genotypes (breeds) considered were Black Australorp (BA), Isa Brown (IB), Noiler (NOI) and Local chicken (LC) at 4 chickens per genotype. At the end of the experiment, four (4) birds per genotype were drawn and their blood samples analysed for serum biochemical studies. The mean total cholesterol (TC), triaceylglycerol (TAG) and very low density lipoprotein cholesterol (VLDL-C) concentrations of local chicken (LC) were significantly (P < 0.05) higher than the Isa brown (IB) values. Similarly, the mean blood urea nitrogen (BUN) concentrations of LC was significantly (P < 0.05) higher than the Noiler value. The mean high density lipoprotein cholesterol (HDL-C) of black Australorp (BA) was significantly (P < 0.05) higher than the value of Noiler but showed no significant (p > 0.05) difference when compared to the values of IB and LC. There were however no significant (p > 0.05) variations in the mean low density lipoprotein cholesterol (LDL-C), total bilirubin, direct bilirubin, indirect bilirubin and creatinine concentrations among all the breeds investigated. In conclusion, the results obtained in this study will be helpful in creating a baseline data on biochemical profiles of indigenous and exotic chicken breeds in Nigeria which in turn can be used for assessing the health status of these birds, improving desirable breeds/traits and designing appropriate breeding strategies for indigenous poultry birds in the country.

Evaluations of the effect of genetic variations on the serum renal function markers, bilirubin and lipid profile of laying domestic fowls

A total of 16, 18 weeks old chickens with mean weight 1.99±0.12 kg (1.85-2.30kg) were used to compare the serum biochemical characteristics of four chicken genotypes (breeds/strains) from south-eastern part of Nigeria. The chickens were grouped based on their genotypes (breeds/strain) in a Completely Randomized Design for the four-week study. The genotypes (breeds) considered were Black Australorp (BA), Isa Brown (IB), Noiler (NOI) and Local chicken (LC) at 4 chickens per genotype. At the end of the experiment, four (4) birds per genotype were drawn and their blood samples analysed for serum biochemical studies. The mean total cholesterol (TC), triaceylglycerol (TAG) and very low density lipoprotein cholesterol (VLDL-C) concentrations of local chicken (LC) were significantly (P < 0.05) higher than the Isa brown (IB) values. Similarly, the mean blood urea nitrogen (BUN) concentrations of LC was significantly (P < 0.05) higher than the Noiler value. The mean high density lipoprotein cholesterol (HDL-C) of black Australorp (BA) was significantly (P < 0.05) higher than the value of Noiler but showed no significant (p > 0.05) difference when compared to the values of IB and LC. There were however no significant (p > 0.05) variations in the mean low density lipoprotein cholesterol (LDL-C), total bilirubin, direct bilirubin, indirect bilirubin and creatinine concentrations among all the breeds investigated. In conclusion, the results obtained in this study will be helpful in creating a baseline data on biochemical profiles of indigenous and exotic chicken breeds in Nigeria which in turn can be used for assessing the health status of these birds, improving desirable breeds/traits and designing appropriate breeding strategies for indigenous poultry birds in the country..

Non-flow limiting non-culprit plaque characteristics in patients presenting with STEMI versus NSTEMI

Abstract Background Non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) are often considered distinct clinical entities. Although differences in culprit plaque characteristics have been described extensively, less is known about differences in non-culprit (NC) plaque characteristics. Purpose To compare plaque characteristics of fractional flow reserve (FFR)-negative NC lesions as assessed by optical coherence tomography (OCT) in STEMI and NSTEMI patients. Methods PECTUS-obs is a prospective, observational study in which 438 patients presenting with STEMI or NSTEMI underwent OCT of any intermediate FFR-negative NC lesion (defined as a FFR >0.80) after treatment of the infarct related artery. Quantitative and qualitative OCT analyses were performed by an independent core laboratory. A high risk plaque (HRP) was defined as the presence of ≥2 of the following prespecified criteria: 1) a lipid arc ≥90°, 2) a minimal fibrous cap thickness <65 µm, or 3) either cap rupture or thrombus presence. In the present sub-analysis, lesion-level plaque characteristics were compared between patients presenting with STEMI versus NSTEMI while accounting for within-patient clustering and correcting for prespecified clinical variables (age, history of myocardial infarction, diabetes, and estimated glomerular filtration rate (eGFR)). Results Among 420 patients with at least one analyzable OCT, 217 (51.7%) presented with STEMI and 203 (48.3%) with NSTEMI. Patients with STEMI were younger (mean age 62±10 vs 65±11 years, p=0.004) and less frequently had diabetes (11.1% vs 18.2%, p=0.037) and hypercholesterolemia (31.8% vs 41.6%, p=0.038). Baseline mean eGFR (84±19 vs 75±19 ml/min, p<0.001) and low density lipoprotein-cholesterol levels (3.2±1.2 vs 2.9±1.2, p=0.010) were higher in STEMI patients with fewer of these patients using lipid lowering therapy (18.9% vs 33.0%, p<0.001) before enrollment. A total of 494 NC lesions were analyzed, which were equally distributed in number and location between groups. The mean fractional flow reserve was 0.89±0.05 and was comparable between groups (p=0.26). Patients with STEMI had a smaller minimal lumen area (2.56±1.48 vs 2.84±1.58 mm2, p=0.031) and minimal lumen diameter (1.47±0.44 vs 1.55±0.45 mm, p=0.026) with a subsequent larger percentage area stenosis (64±15 vs 61±17%, p=0.022). Lipid plaques were more common in STEMI patients (81.7% vs 70.7%, p=0.006) and the maximal lipid arc more frequently was ≥90º (79.0% vs 69.0%, p=0.018). There was no difference in the presence of plaque ruptures (8.3% vs 11.2%, p=0.31) or HRP (32.9% vs 29.3%, p=0.40), whereas macrophage accumulation was more prevalent in STEMI patients (27.8% vs 18.2%, p=0.040). Conclusions FFR-negative NC lesions in patients with STEMI have smaller luminal dimensions, and more frequently harbor lipid plaques and macrophage accumulation. No difference was observed in the prevalence of HRP or plaque rupture.

Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial.

To compare the long term efficacy and safety of rosuvastatin with atorvastatin treatment in adults with coronary artery disease. Randomised, open label, multicentre trial. 12 hospitals in South Korea, September 2016 to November 2019. 4400 adults (age ≥19 years) with coronary artery disease. Participants were assigned to receive either rosuvastatin (n=2204) or atorvastatin (n=2196) using 2×2 factorial randomisation. The primary outcome was a three year composite of all cause death, myocardial infarction, stroke, or any coronary revascularisation. Secondary outcomes were safety endpoints: new onset diabetes mellitus; hospital admissions due to heart failure; deep vein thrombosis or pulmonary thromboembolism; endovascular revascularisation for peripheral artery disease; aortic intervention or surgery; end stage kidney disease; discontinuation of study drugs owing to intolerance; cataract surgery; and a composite of laboratory detected abnormalities. 4341 of the 4400 participants (98.7%) completed the trial. Mean daily dose of study drugs was 17.1 mg (standard deviation (SD) 5.2 mg) in the rosuvastatin group and 36.0 (12.8) mg in the atorvastatin group at three years (P<0.001). The primary outcome occurred in 189 participants (8.7%) in the rosuvastatin group and 178 (8.2%) in the atorvastatin group (hazard ratio 1.06, 95% confidence interval 0.86 to 1.30; P=0.58). The mean low density lipoprotein (LDL) cholesterol level during treatment was 1.8 mmol/L (SD 0.5 mmol/L) in the rosuvastatin group and 1.9 (0.5) mmol/L in the atorvastatin group (P<0.001). The rosuvastatin group had a higher incidence of new onset diabetes mellitus requiring initiation of antidiabetics (7.2% v 5.3%; hazard ratio 1.39, 95% confidence interval 1.03 to 1.87; P=0.03) and cataract surgery (2.5% v 1.5%; 1.66, 1.07 to 2.58; P=0.02). Other safety endpoints did not differ between the two groups. In adults with coronary artery disease, rosuvastatin and atorvastatin showed comparable efficacy for the composite outcome of all cause death, myocardial infarction, stroke, or any coronary revascularisation at three years. Rosuvastatin was associated with lower LDL cholesterol levels but a higher risk of new onset diabetes mellitus requiring antidiabetics and cataract surgery compared with atorvastatin. ClinicalTrials.gov NCT02579499.

Flame Characteristics and Abnormal Combustion of Methane Port Injection and Isooctane Direct Injection with Injection Timings Considered

Natural gas (NG) is a low-carbon fuel that can achieve low carbon emissions and high efficiencies. However, the low mean molecular mass and low energy density of methane result in low engine performance, and blending methane with gasoline is an effective way of improving the performance of NG engines. In this study, flame characteristics (including abnormal combustion) and engine performance are optically studied under methane port injection and isooctane direct injection conditions. The results indicate that the addition of isooctane can significantly increase the power output of NG engines. Under partial-load conditions, the minimum ignition advance for best IMEP is delayed with the addition of isooctane because of the higher flame speed of isooctane, and isooctane addition primarily improves the turbulent flame propagation rather than the initial flame formation. As for the isooctane injection timing, the indicated mean effective pressure (IMEP) first increases and then decreases with the delay in isooctane injection. The hot spots in the flame images confirm that late injection results in isooctane inhomogeneity, which reduces the engine’s thermal efficiency. At high loads, the low energy density of methane can lower the knocking intensity, even in the presence of auto-ignition at a speed of 120.7 m/s. The knocking pressure can lead to the ejection of oil droplets, which can increase the flame speed in the subsequent cycle.

Comparison of umbilical cord blood lipid profiles between appropriate and small for gestational age newborns with their mothers’ lipid profiles: a case-control study from tertiary care centre of Karnataka

Background: Fetal malnutrition and fetal growth restriction results in dysfunctions of neuroendocrine system, pancreas and adipose-tissue; finally increasing the food intake and decreasing energy use. This results in an increase in adipose deposition and insulin-resistance and ultimately increasing chances of adult metabolic-diseases. This study makes an effort to compare and contrast the lipid-profiles of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA)newborns correlating and with their mother’s lipid-profiles. Methods: This was a case-control study, conducted in the Departments of Pediatrics and OBG of Karwar Institute of Medical Sciences,Karwar, Karnataka,India over a period of twelve months(January-2021 to January-2022). With 500neonates, 357appropriate for gestational age (AGA) and 143 small for gestational age(SGA) babies were included for the study as controls and cases for their lipid profiles using their cord-blood. Results: here, we found that SGA-babies had lower gestational age (37.40±1.01 weeks) at birth compared to AGA-babies (39.22±1.05 weeks) which was statistically significant. The mean Total Cholesterol (TC) level (84.47±27.39 mg/dl) was higher in SGA-babies compared to AGA-babies (56.87±32.28 mg/dl) and this difference was statistically highly significant (p value&lt;0.0001). The mean very low density lipoprotein (VLDL) level (14.10±10.67 mg/dl) was higher in SGA-babies than AGA-babies (7.17±3.69 mg/dl) with p value&lt;0.0001 (highly significant). The mean low density lipoprotein (LDL) level (38.74±19.85 mg/dl) was higher in SGA-babies compared to AGA-babies (25.63±14.15 mg/dl) and this difference was statistically significant (p value&lt;0.0001). The mean high density lipoprotein (HDL) levels of AGA and SGA-babies were comparable with low statistical significance (26.70±14.90 mg/dl of SGA; 24.45±9.567 mg/dl of AGA, p value 0.095). Conclusions: Levels of all lipids were observed to be higher in SGA babies than in AGA babies. Mothers who gave birth to SGA babies were found to have statistically significant high VLDL levels.

A Study on the Evaluation of Serum Uric Acid in Patients with Essential Hypertension

ABSTRACT Background: Hyperuricemia can lead to nephrolithiasis and gout. It is an essential indicator of diseases like metabolic syndrome, cardiovascular disease, diabetes mellitus, and chronic renal disease. It indicates that hyperuricemia is associated with the risk of cardiorenal disease and new-onset hypertension. In older hypertensive patients, hyperuricemia is an essential indicator of cardiovascular risk for the development of hypertension. Methodology: A facility-based case-control study to identify the relationship between serum uric acid levels and hypertension, the relation between severity and duration of hypertension and the serum uric acid levels, and the relation between duration of hypertension and serum uric acid levels at tertiary care hospital. Sample size: 400; 200 cases and 200 controls. Adult male and female patients &gt;18 years of age diagnosed as hypertensive according to JNC VII classification for hypertension were included. Patients with comorbidities are excluded. The method of uric acid estimation was done by the VITROS URIC Slide method. Results: The mean total cholesterol of cases was 159.18 ± 20.16, and controls were 125.21 ± 21.12. The mean high density lipoproteins (HDL) among cases was 36.33 ± 5.08, and controls were 45.64 ± 5.90. The mean low density lipoproteins (LDL) among cases was 124.99 ± 20.03, and controls were 104.48 ± 12.48. The mean triglycerides among cases was 172.58 ± 31.40, and controls were 131.21 ± 21.50. The mean serum uric acid level among males in the cases group was 6.1 ± 1.79, and among males in the control group, it was 5.2 ± 1.3. The mean serum uric acid level among females in the case group was 6.2 ± 1.92, and among the control group, it was 5.3 ± 1.1. The unpaired t-test was used and was statistically significant with a P value &lt; 0.0001 among the above parameters. Conclusion: The study had a direct relationship between hyperuricemia and hypertension. Also, there is a positive correlation between the severity of hypertension and serum uric acid levels and higher hypertension of longer duration when compared to lesser duration.

Comparative Study of Remnant Cholesterol, Some Lipid Fractions and FBS Level in Overweight and Obese Participants in South East Nigeria

Background: Obesity is one of the characteristics of metabolic disorders, it has been linked to cardiovascular diseases. Remnant cholesterol has been proposed to be a link between obesity and coronary heart disease, thus a risk factor for the development of cardiovascular disease in obese people. We compared the level of calculated non-fasting remnant cholesterol, fasting and non-fasting lipid profile and fasting blood sugar in overweight, obese and normal weight participants in Nnewi, a town in South East Nigeria.&#x0D; Methods: In this cross-sectional study, a total of 90 apparently healthy obese, overweight and normal weight participants who met the inclusion criteria were randomly enrolled. They were grouped using their body mass index of 18.5 to 24.9 kg/m2 (normal weight), 25 to 29.9 kg/m2 (overweight) and ≥30 kg/m2 (obese). The parameters were analyzed using standard methods.&#x0D; Results: Our results shows that there was progressive increase of remnant cholesterol among the group, this increase has no statistical difference (p&gt;0.05) in the mean calculated remnant cholesterol (mmol/l) between the obese (0.72±0.4), overweight (0.68±0.46), and normal weight (0.50±0.28) participants. The mean fasting Very Low Density Lipoprotein (VLDL) and Triglyceride (TG) (mmol/l) were significantly higher (p&lt;0.05) in overweight compared to normal weight participants (0.76±0.31 vs. 0.47±0.22) and (1.72±0.60 vs. 1.09±0.51) and obese participants (0.82±0.23 vs. 0.47±0.22) and (1.85±0.59 vs. 1.09±0.51) when compared to normal weight participants respectively. FBS levels (mmol/l) were significantly lower in normal weight participants when compared to overweight participants (3.45±0.79 vs. 4.46±1.82) and obese participants (3.46± 0.79 vs. 4.94±1.26).&#x0D; Conclusion: The results obtained from this study demonstrated a progressive increase in the level of remnant cholesterol which was not statistically significant among apparently healthy individuals across the group. Furthermore we did not observed Remnant cholesterol as a sole predictor to obesity which will lead to cardiovascular diseases, with the rising prevalence of obesity in developing country as well as its associated complications and risks.

Cardiovascular risk reduction with integrated care: results of 8 years follow up

BackgroundCare groups organize integrated cardiovascular risk management programs in primary care for high risk patients. Results of long term cardiovascular risk management are scarce. The aim was to describe changes in low density lipoprotein cholesterol, systolic blood pressure and smoking between 2011 and 2018 in patients participating in an integrated program for cardiovascular risk management organized by a care group in the Netherlands.AimTo explore whether long-term participation in an integrated cardiovascular risk management program could lead to the improvement of 3 important risk factors for cardiovascular disease.MethodsA protocol was developed for delegated practice nurse activities. A multidisciplinary data registry was used for uniform registration. The care group organized annual education for general practitioners and practice nurses on cardiovascular topics and regular meetings for practice nurses only to discuss complex patient cases and implementation issues. From 2015 onwards, the care group started with practice visitations to discuss performance and support practices with organizing integrated care.ResultsIn patients eligible for primary prevention as well as for secondary prevention similar trends were observed: lipid modifying and blood pressure lowering medication increased, mean low density lipoprotein cholesterol and mean systolic blood pressure decreased, patients on target for low density lipoprotein cholesterol and systolic blood pressure increased and the proportion of non-smokers with both low density lipoprotein cholesterol and systolic blood pressure on target increased. Improved registration between 2011 and 2013 was partly responsible for the sharp increase of patients on target for low density lipoprotein cholesterol and systolic blood pressure.ConclusionIn patients participating in an integrated cardiovascular risk management program, we saw annual improvements in 3 important cardiovascular risk factors between 2011 and 2018.

CORD BLOOD LIPID PROFILE IN PRETERM AND TERM NEWBORNS: A HOSPITAL BASED COMPARATIVE STUDY FROM NORTH KANARA REGION OF INDIA

Introduction: Background: Cardiovascular diseases are common cause of moertality in developed countries and also are rising trend in developing countries. It has its roots in adverse fetal environment; which lead to adult diseases like Coronary artery diseases in later life. Aim: The objective of this study was to compare &amp; contrast the lipid profiles in term and preterm neonates. Materials and Methods: a case-control study was conducted in departments of Pediatrics &amp; Obstetrics of Karwar Institute of Medical Sciences, Karwar, Karnataka of India over a period of 10 months. 500 deliveries were recruited randomly which met the inclusion criteria after informed written consent;babies were divided into Comparison group 1 (Preterm gestation of &lt;37weeks gestational age)&amp; comparison group 2 (term gestation of &gt;37 weeks gestational age).Cord blood lipd-profiles of these babies were compared &amp; studied. Results: Out of 500 babies studied,there were 197 preterm (&lt;37weeks gestational age) &amp; 409 term babies (&gt;37 weeks gestational age) babies.The Mean gestational age was 39.55±1.11 weeks for term babies &amp; 34.50 ± 2.77 weeks for preterm babies.The mean TC level (73.76±27.98 mg/dL) was higher in comparison group 1(preterms) compared to comparison group 2(term)babies(62.60 ± 34.20mg/dL) and this difference was statistically very significant(P=0.003). The mean low density lipoprotein(LDL) level (35.54 ± 20.96mg/dL) was more higher in comparison group 1(preterms) compared to comparison group 2(term)babies (27.89 ± 15.62 mg/dL) and this difference was statistically very significant(P=0.001). The mean very low density lipoprotein(VLDL) level (11.12 ± 5.13mg/dL) was more higher in comparison group 1(preterms) compared to comparison group 2(term)babies (8.68 ± 7.55 mg/dL) and this difference was statistically very significant(P=0.003).The mean Triglycerides(TGs) levels of comparison group 1(preterms) &amp; comparison group 2(term)babies were comparable with no statistical significance(42.63 ± 25.80mg/dL of preterm babies ; 42.43 ± 28.10mg/dL of term babies;P=0.948).The mean High density lipoprotein(HDL) levels of comparison group 1(preterms comparison) &amp; comparison group 2(term)babies were comparable with low statistical significance(26.37 ± 13.65mg/dLof reterm babies ; 24.78 ± 10.76mg/dL of term babies;P=0.218). Conclusion: Levels of most lipid components were observed to be higher in preterm babies compared to term babies.

Abstract 10769: Circulating Branched-Chain Amino Acids, Incident Cardiovascular Disease, and Mortality in the African American Study of Kidney Disease and Hypertension

Introduction: Branched-chain amino acids (BCAAs), i.e., leucine, isoleucine, and valine, are involved in glucose regulation, immunity, and cell signaling. Higher circulating BCAAs were associated with incident cardiovascular disease (CVD) in the general population which may be mediated by insulin resistance. BCAA’s role in CVD in the absence of diabetes is unclear. Hypothesis: BCAAs are associated with cardiovascular outcomes in non-diabetic chronic kidney disease (CKD), a highly prevalent condition that substantially alters circulating metabolites and elevates CVD risk. Methods: In the African American Study of Kidney Disease and Hypertension (AASK), we conducted serum metabolomic profiling and assessed associations between BCAAs and risks for incident CVD (hospitalization for nonfatal myocardial infarction, cardiac revascularization, heart failure, stroke, or cardiovascular death), cardiovascular death, and all-cause mortality using multivariable Cox regression. Results: In 962 participants (mean age 56 years, 39% women, mean glomerular filtration rate [GFR] 48 ml/min/1.73m 2 , mean fasting blood glucose 94 mg/dl, mean low density lipoprotein cholesterol [LDLc] 137 mg/dl), BCAAs were minimally correlated with GFR, proteinuria, C-reactive protein, LDLc, or blood glucose. During follow-up (median 7.4 years), there were 192 CVD events (myocardial infarction or revascularization, n=57; stroke, n=74; heart failure, n=74) and 220 deaths of which 54 were cardiovascular deaths. Adjusted for covariates, no association was found between BCAAs and incident CVD, but higher BCAAs were associated with lower cardiovascular death (per doubling BCAA, HR=0.52, 95%CI 0.31-0.87; p=0.013 for isoleucine; HR=0.30, 95%CI 0.13-0.68, p=0.004 for leucine, HR=0.39, 95%CI 0.16-0.94, p=0.04 for valine). Associations were unchanged accounting for all-cause death as competing risk using Fine-Gray modeling. Leucine and isoleucine were associated with lower all-cause mortality (HR=0.57, 95%CI 0.36-0.96, p=0.035 for leucine; HR=0.70, 95%CI 0.49-1.00, p=0.049 for isoleucine). Conclusions: In African Americans with non-diabetic CKD, higher circulating BCAAs were associated with lower cardiovascular death, lower mortality, but not incident CVD.

Impact of weight loss on cardiac function: improvement in left ventricular global longitudinal strain following metabolic surgery

Abstract Introduction Obesity leads to an increased risk of cardiovascular disease (CVD) morbidity and mortality and is associated with the metabolic risk factors such as hypertension, diabetes mellitus, hyperlipidemia [1]. Metabolic surgery has been proven to be the most effective long term weight management tool and has known benefits in CVD prevention [2]. Global longitudinal strain (GLS) is an effective quantitative measurement of left ventricular (LV) function that is also a powerful predictor of future CVD events and mortality [3]. The impact of metabolic surgery on LV structure and function is unknown. Purpose This study investigated the changes in cardiac structure and function after metabolic surgery, including GLS. To our knowledge there has not been a study investigating this relationship previously reported. Methods Consecutive patients undergoing metabolic surgery at our center between March 2005 and February 2019 were recruited. Patients with transthoracic echocardiographic imaging (TTE) pre and post metabolic surgery (May 2005 to January 2019) were included. Electronic medical records were searched to obtain demographic, surgical and clinical data. GLS was calculated with Velocity Vector Imaging (VVI, Siemens, v2.0, Pennsylvania, USA). Averaged GLS values were derived from 4 chamber, 2 chamber and 3 chamber calculations. Results 398 patients with pre- and post-operative cardiac imaging were included. Please see Table 1 for the baseline demographics of our study population. The mean age was 60.0 years with 70% being female. There were significant rates of CVD risk factors such as: hypertension (76.4%), diabetes mellitus (58.8%) and hyperlipidemia (76.4%). The clinical and echocardiographic changes noted post metabolic surgery are detailed in Table 2. Along with decreases in weight post operatively, there were significant improvements in the markers of CVD risk factors such as mean blood pressure (134/75 to 129/72 mmHg, p value &amp;lt;0.001), mean gylcated hemoglobin levels (7.0 to 6.1%, p value &amp;lt;0.001) and mean low density lipoprotein (LDL) levels (97.7 to 88.2 mg/dl, p value &amp;lt;0.001). There were a number of statistically significant positive changes in the left ventricular structure and function. The mean LV ejection fraction increased from 56.3% to 57.4% (p=0.008); left ventricular mass decreased from 238.2 g to 179.3 g (p value &amp;lt;0.001), and both septal and posterior wall thicknesses decreased significantly (p value &amp;lt;0.001). The LV mass indexed to body surface area (BSA) also decreased from 93.5 g/m2 to 83.1 g/m2. The average global LV GLS was −15.7% pre-operatively, improving significantly to −17.9% post-operatively (p&amp;lt;0.001). Conclusion Our study has shown for the first time the impact of metabolic surgery on ventricular structure and function, with reduction in LV mass and improvement in LV GLS. These novel findings lends further support to the cardiovascular benefits of metabolic surgery. Funding Acknowledgement Type of funding sources: None.

Hematological and Anthropometric features of patients with Knee Osteoarthritis

Objectives:Osteoarthritis (OA) is leadingcauseof decline in physical activity. The study objectiveswere to evaluate hematological and anthropometric features in knee OA. Methodology: This case control study from March 2019 to August 2019 on patients attending general outpatient department ofNaz MemorialHospital Karachi. Patients above 18 years of either gender, diagnosed as either knee OA on X-ray knee were included. Patients with positive family history,heavy lifting workers, and women on hormonal replacement therapy were excluded. SPSS version 23.0 was used for data analysis. Chi-square test was applied OA and control group keeping p-value of &lt;0.05 as significant. Results:From 100 OA patients, 22 were below 50 years, 37 between 51-60, 31 patients between 61-70 and 10 patients above 71. Mean age of patients was 56.77 ± 11.26 years. Mean BMI of OA and control group was 30.24 ± 8.98 kg/m2 and 26.64 ± 6.24 kg/m2 (p-0.04). Mean hemoglobin of OA and control group were 11.20 ± 1.24 gm/ dl and13.3 ± 2.24 gm/dl (p-0.04). Mean total cholesterol of OA and control group was 158.34 ± 47.83 mg/dl and 137.25 ±51.22 mg/dl (p-0.05). Mean low density lipoprotein of OA and control group was 123.78 ± 27.29 mg/dl and 111.31 ± 24.39 mg/dl (p-0.05). Conclusion: Age, obesity, hemoglobin, total cholesterol, low density lipoprotein and blood glucose was found to be substantially higher among OA patients when compared with that of controls. Females and older aged patients with bilateral joint involvement were reportedly more frequently with OA. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 682-687

Prevalence of coronary calcium deposits in Sheehan's syndrome patients on long term replacement treatment.

Sheehan's Syndrome (SS) is one of the most important causes of hypopituitarism in developing countries with patients having varying degrees and severity of anterior pituitary hormone deficiency including growth hormone deficiency (GHD). SS is characterized by increased clustering of metabolic and proinflammatory risk factors predisposing them to increased cardiovascular morbidity and mortality. Coronary calcium deposits (CCD), a marker for significant coronary atherosclerosis, is used for evaluation in asymptomatic individuals of global cardiac risk to develop events related to coronary heart disease (CHD). This study therefore aimed to evaluate the prevalence of coronary artery disease in patients with SS appropriately replaced for pituitary hormone deficiencies but untreated for GHD. Thirty patients previously diagnosed with SS and stable on a conventional replacement treatment for at least 6months before the study and thirty age and Body Mass Index (BMI) matched controls were enrolled in this observational study. The subjects underwent detailed clinical, biochemical, and hormone analysis. Coronary multidetector computed tomography was performed in 19 SS patients and 19 healthy participants by a 16-row multislice scanner. Non contrast acquisitions were performed to detect coronary calcifications. Calcium was quantified by the Agatston score (AS) in all subjects. AS > 10 indicates increased CHD risk. The mean (± SD) age was 38.30 ± 10.73years and the diagnostic delay was 11.35 ± 4.74years. Patients with SS had significantly higher mean triglyceride, total cholesterol, and low density lipoprotein (LDL) cholesterol and lower HDL cholesterol concentrations on conventional replacement therapy. The prevalence of CCD was significantly higher in patients of SS compared to controls (42.1% vs. 5.3%; P = 0.023). The presence of CCD and AS > 10 were detected in 42.1% and 31.6% of patients respectively. The presence of significant calcification (Agatston score > 10) was documented in 75% of patients (6/8) of the SS patients with CCD compared to none in the control group (P = 0.019). (Left anteriordescending, 1; left circumflex, 2; right coronary artery, 2 and posterior descending, 1) CONCLUSION: Since coronary artery calcium is an independent predictor of CHD events, the presence of significant prevalence of CCD in patients with SS compared to healthy matched controls, undermines the importance of early risk stratification of SS individuals with plethora of conventional cardiovascular risk factors that are at relatively high risk to avoid the adverse vascular consequences.

Lipid Profile in Postmenopausal Diabetic Female.

Background and Aims: Postmenopausal diabetic female are at increased risk of cardiovascular disease. The objective of this study was to study their lipid profile and prevalence of dyslipidemia and assess relation of control of lipid components with various risk factors.&#x0D; Methods: A cross sectional prospective study conducted at Shahid Gangalal National Heart Centre from 15th July 2020 to 14th October 2020 including 109 postmenopausal diabetic female. Detailed history along with clinical examination were conducted. Fasting lipid profile and other relevant investigations were obtained.&#x0D; Results: Mean age of participants was 63.48±9.26 years. Mean age of menopause was 48.59±1.88 years. A total of 37 (33.9%) were hypertensive, 17 (15.6%) were smoker, 67 (61.5%) were physically inactive. A total of 91 (83.5%) were non-vegetarian. Thirty eight (34.9%) had their blood sugar controlled with hemoglobin A1c of &lt;7%. The mean total cholesterol and high density lipoprotein were 5.21±0.97 mmol/l and 1.02±0.13 mmol/l. Similarly mean triglyceride and low density lipoprotein were 2.24±0.75 mmol/l and 3.04±0.12 mmol/l. Dyslipidemia was present in 82.6%. Significant correlation of control of blood sugar with total cholesterol control status (R=0.28, P=0.01), low density lipoprotein control status (R=0.38, P=0.01), high density lipoprotein control status (R=0.36, P=0.04) and triglyceride control status (R=0.30, P=0.04) were seen.&#x0D; Conclusion: Dyslipidemia was common in post menopausal diabetic female. Blood sugar control status showed significant correlation with lipid profile parameters. A good sugar control and evaluation for lipid abnormalities is recommended in postmenopausal diabetic female.

Risk of Recurrent Coronary Events in Patients With Familial Hypercholesterolemia; A 10-Years Prospective Study.

Background and Aim: Real world evidence on long term treatment of patients with familial hypercholesterolemia (FH) is important. We studied the effects of intensive lipid lowering medication (LLM) and optimized lifestyle in the study TTTFH–Treat To Target FH. Materials and Methods: Adults with a first known total cholesterol of mean (95% CI) 9.8 mmol/L (9.5, 10.1) were included consecutively in their routine consultation during 2006. Of the patients 86.4% had a pathogenic FH-mutation and the remaining were clinically diagnosed. We included 357 patients and 279 met for follow-up after median 10.0 (min 8.1, max 12.8) years. Results: Mean (95% CI) low density lipoprotein (LDL-C) was reduced from 3.9 (3.8, 4.1) to 3.0 (2.9, 3.2). More men than women used high intensity statin treatment, 85.2 and 60.8%, respectively. Women (n = 129) had higher LDL-C; 3.3 mmol/L (3.0, 3.5), than men; (n = 144) 2.8 mmol/L (2.6, 3.0), p = 0.004. Add-on PCSK9 inhibitors (n = 25) reduced mean LDL-C to 2.0 (1.4, 2.6) mmol/L. At enrollment 57 patients (20.4%) had established atherosclerotic cardiovascular disease (ASCVD), and 46 (80.4%) of them experienced a new event during the study period. Similarly, 222 (79.6%) patients had no detectable ASCVD at enrollment, and 29 of them (13.1%) experienced a first-time event during the study period. Conclusion: A mean LDL-C of 3.0 mmol/L was achievable in FH, treated intensively at a specialized clinic with few users of PCSK9 inhibitors. LDL-C was higher (0.5 mmol/L) in women than in men. In patients with ASCVD at enrollment, most (80.7%) experienced a new ASCVD event in the study period. The FH patients in primary prevention had more moderate CV risk, 13% in ten years.

Comparison of the mutation spectrum and association with pre and post treatment lipid measures of children with heterozygous familial hypercholesterolaemia (FH) from eight European countries

Background and aimsFamilial hypercholesterolaemia (FH) is commonly caused by mutations in the LDLR, APOB or PCSK9 genes, with untreated mean low density lipoprotein-cholesterol (LDL-C) concentrations being elevated in APOB mutation carriers, even higher in LDLR mutation and highest in those with a PCSK9 mutation. Here we examine this in children with FH from Norway, UK, The Netherlands, Belgium, Czech Republic, Austria, Portugal and Greece. MethodsDifferences in characteristics and pre- and post-treatment lipid concentrations in those with different molecular causes were compared by standard statistical tests. ResultsData were obtained from 2866 children, of whom 2531 (88%) carried a reported LDLR/APOB/PCSK9 variant. In all countries, the most common cause of FH was an LDLR mutation (79% of children, 297 different), but the prevalence of the APOB p.(Arg3527Gln) mutation varied significantly (ranging from 0% in Greece to 39% in Czech Republic, p < 2.2 × 10−16). The prevalence of a family history of premature CHD was significantly higher in children with an LDLR vs APOB mutation (16% vs 7% p=0.0005). Compared to the LDLR mutation group, mean (±SD) concentrations of pre-treatment LDL-C were significantly lower in those with an APOB mutation (n = 2260 vs n = 264, 4.96 (1.08)mmol/l vs 5.88 (1.41)mmol/l, p < 2.2 × 10−16) and lowest in those with a PCSK9 mutation (n = 7, 4.71 (1.22)mmol/l). ConclusionsThe most common cause of FH in children from eight European countries was an LDLR mutation, with the prevalence of the APOB p.(Arg3527Gln) mutation varying significantly across countries. In children, LDLR-FH is associated with higher concentrations of LDL-C and family history of CHD compared to those with APOB-FH.

The Related Risk Factors of Diabetic Retinopathy in Elderly Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cohort Study in Taiwan.

Diabetic retinopathy (DR), caused by small vessel disease, is the main cause of blindness in persons with diabetes. Taiwan is one of the Asian countries with the highest prevalence rate of DR. The purpose was to investigate the related risk factors of DR in elderly patients with type 2 diabetes mellitus (T2DM), in Lee’s Endocrinology Clinic. 792 T2DM patients over 60 years old were invited to have an outpatient visit at least every three months, and all of them were asked to undergo a standardized interview and collect their blood samples. Significant factors were being female (adjusted hazard ratio (HR): 1.287; 95% CI, 1.082–1.531), higher glycated hemoglobin (HbA1c) (HR: 1.067; 95% CI: 1.016–1.119), higher mean low density of lipoprotein cholesterol (LDL-c) (HR: 1.004; 95% CI: 1.001–1.006), and chewing betel nut (HR: 1.788; 95% CI: 1.362–2.347). This study showed that gender, the behavior of chewing betel nut, HbA1c, and LDL-c are important factors for the development of DR in elderly patients with T2DM. It is suggested that patients should control their HbA1c and LDL-c and quit chewing betel nut to prevent DR. This suggestion applies especially to female patients.