Mean Serum High-density Lipoprotein Cholesterol Research Articles

Evaluating the safety and efficacy of a polyherbal Unani formulation in dyslipidaemia-a prospective randomized controlled trial

Ethnopharmacological relevanceUnani System of Medicine offers treatment for obesity and dyslipidaemia. Jawarish Falafili (JF) is a Unani polyherbal pharmacopoeial preparation. It has been used in the treatment of obesity for a long time. Dyslipidaemia is a recognised modifiable risk factor for hypertension, ischemic heart disease and stroke. Limitations of the current conventional therapy have provided scope for research of a potential drug in this medical condition. It was hypothesised that JF may ameliorate dyslipidaemia in human participants.Aim of the study: The main objective of this study was to evaluate the safety and efficacy of the JF. Materials and methodsThis was a prospective randomized, active-controlled, open-label and parallel-group study. We randomized 74 participants of dyslipidaemia into treatment (n = 38) and control (n = 36) groups. Of them, 30 participants in each group completed the trial. The participants of any sex aged between 30 and 60 years, with serum total cholesterol (TC) ≥200 mg/dl and/or serum triglycerides (TG) ≥150 mg/dl and/or low-density lipoprotein cholesterol (LDL-C) level ≥130 mg/dl and/or high-density lipoprotein cholesterol (HDL-C) level <40 mg/dl were enrolled in this study. The participants of the treatment group were treated with JF (10 gm/day) once and atorvastatin (20 mg/day) was given to the control group for 90 days once at night daily. ResultsWe observed a significant reduction (treatment group versus control group) in mean serum TC by 22.89% versus 19.36%, TG by 29.90% versus 23.26% and LDL-C by 29.16% versus 27.92% from baseline (p < 0.05). But the change in mean serum HDL-C levels post-treatment was insignificant in both groups (p > 0.05). On intergroup comparison, the magnitude of the difference of mean TC, TG, LDL-C and HDL-C levels between the groups was not statistically significant (p > 0.00.05). ConclusionsThis study concluded that JF and atorvastatin were equally effective in controlling dyslipidaemia. They were tolerated well by all participants and found safe during the course of treatment.

Role of Serum Retinol Binding Protein 4 (RBP4) Concentration in Patients with Primary Hypertension: A Case-control Study

Introduction: Serum Retinol Binding Protein 4 (RBP4), an adipokine that transports vitamin A from the liver to other tissues, is reported to be elevated in hypertensive subjects. Positive correlation between RBP4 and cardiovascular risk factors has been noted in a few studies. Aim: To evaluate serum RBP4 levels in newly diagnosed primary hypertensive cases and non hypertensive controls and to correlate serum RBP4 levels with lipid profile. Materials and Methods:This case-control study was conducted at the Department of Biochemistry in collaboration with the Department of Medicine, from August 2019 to June 2020 in MKCG Medical College and Hospital, Berhampur, Odisha, India. A total of 51 newly diagnosed primary hypertensive patients and 51 healthy age and sex-matched individuals between the ages of 18 to 50 years were enrolled in the study. Systolic and Diastolic Blood Pressure (SBP and DBP) were measured in both cases and controls.Serum RBP4 was measured by Enzyme-Linked Immunosorbent Assay (ELISA) and other biochemical parameters were measured by TBA120FR autoanalyser. Result: The mean age for controls was 36.98±8.7 years and that in cases was 39.00±8.4 years. Proportion of males was higher (56.8%) than females (43.2%). The mean systolic blood pressure in the case group was significantly higher as compared to the control group. The cases had a higher level of serum RBP4 (31.82 mg/L) compared to the control groups (15.5 mg/L) RBP4 (p&lt;0.001). The cases had a higher level of mean serum triglyceride (196.20±67.81 mg/dL) and lower level of mean serum High-Density Lipoprotein cholesterol (HDLc) (37.53±11.90 mg/dL) as compared to the control groups which had a mean triglyceride of 104.25±39.89 mg/dL and HDLc of 57.18±10.73 mg/dL (p&lt;0.001). The serum RBP4 level positively correlated with SBP (r=0.644, p&lt;0.001), DBP (r=0.444, p&lt;0.001), serum triglycerides (r=0.649, p&lt;0.001), and negatively correlated with HDLc (r=-0.313, p=0.025). Conclusion: A high serum RBP4 level was found in the newly diagnosed hypertensive cases as compared to normotensive controls. A significant positive correlation was observed between RBP4 with systolic and diastolic blood pressure along with triglyceride levels. A significant negative correlation was observed between RBP4 with HDLc.

Correlation of Serum Zinc with Blood Pressure in Hypertensive Individuals

Background: Hypertension is one of the leading causes of mortality and morbidity worldwide. Trace elements deficiencies are believed to be related with development of hypertension and associated complications. Objective: To explore the correlation of serum zinc with blood pressure in hypertensive individuals. Methods: This study was conducted at the Department of Laboratory Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2020 to February 2021. A total of 100 adult subjects were selected purposively, among them 50 were diagnosed cases of hypertension and 50 were normotensive healthy adults as control group. Their blood pressure (BP) was measured and body mass index (BMI) was calculated accordingly. Serum zinc and serum lipid profile [Total Cholesterol (TC), High Density Lipoprotein- Cholesterol (HDL-C), Low Density Lipoprotein- Cholesterol (LDL-C) and Triglyceride (TG)] of the study subjects were measured. Data were analyzed and compared by statistical tests. Results: The mean(±SD) age was 46.9±12.7 years in hypertensive patients and 43.1±8.5 years in control group. Male subjects were predominant in both groups. Majority of the hypertensive patients were found over-weight. Mean(±SD) levels of serum TC, LDL-C, TG were significantly high (p<0.05) and mean serum HDL-C level was significantly low (p=0.018) in hypertensive group. Mean(±SD) serum zinc level was significantly low (p=0.020) in hypertensive group. In hypertensive group, serum zinc had significant negative correlation with systolic blood pressure [SBP (r= - 0.620, p<0.001)] and diastolic blood pressure [DBP (r= - 0.446, p=0.001)]. Conclusion: The serum zinc level is significantly low in hypertensive individuals. Serum zinc has a negative correlation with systolic and diastolic blood pressures in hypertensive individuals.

Anti-inflammatory effect of statin is continuously working throughout use: a prospective three time point 18F-FDG PET/CT imaging study.

No data exist whether statins have robust anti-inflammatory effects of atherosclerotic plaques primarily during the early treatment period or continuously throughout use. This prospective three time point 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) study of the carotid artery assessed anti-inflammatory effects of statin during the early treatment period (initiation to 3months) and late treatment period (3months to 1year) and their correlation with lipid and inflammatory profile changes during a year of therapy. Nine statin-naïve stable angina patients with inflammatory carotid plaques received 20mg/day atorvastatin after undergoing initial 18F-FDG PET/CT scanning of carotid arteries and ascending thoracic aorta, and then completed serial 18F-FDG PET/CT imaging at 3 and 12months whose data were analyzed. The primary outcome was the inter-scan percent change in target-to-background ratio (ΔTBR) within the index vessel. At 3months of atorvastatin treatment, mean serum low-density lipoprotein cholesterol (LDL-C) level decreased by 36.4% to < 70mg/dL (p = 0.001) and mean serum high-density lipoprotein cholesterol level increased to > 40mg/dL (p = 0.041), with both maintained with no further reduction up to 1year (p = 0.516 and 0.715, respectively) while mean serum high sensitivity C-reactive protein level only numerically decreased (p = 0.093). The index vessel ΔTBR showed continuous plaque inflammation reduction over 1year, by 4.4% (p = 0.015) from the initiation to 3rd months and 6.2% (p = 0.009) from 3rd months to 1 year, respectively, without correlation with lipid profile changes. The ΔTBR of the bilateral carotid arteries and ascending aorta also continuously decreased from 3months to 1year. Three time point 18F-FDG PET/CT imaging demonstrates that statin's anti-inflammatory effect continues throughout its use up to 1year, even though yielding stable below-target plasma LDL-C levels at 3months.

Association Between Plasma Trans-Fatty Acid Concentrations and Measures of Glucose Homeostasis and Cardiovascular Risk Factors in Adults in NHANES 1999-2000.

There is limited evidence on the association between plasma trans-fatty acids (TFAs) and cardiometabolic risk factors. Therefore, we examined the association between plasma TFA concentrations and glucose homeostasis and cardiovascular (CV) risk factors in adult Americans from the 1999 to 2000 National Health and Nutrition Examination Survey participants. Derivatized TFAs were separated by capillary gas chromatography. Of the 1678 participants, 46.5% were men. The mean age was 50.5 years overall, with no significant difference between men and women ( P = .101). In age-, sex- and race-adjusted analyses, mean waist circumference, fat-free mass, fat mass, C-peptide, insulin, hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), serum triglycerides (TGs), and total cholesterol (TC) increased across increasing quarters of TFAs (for all P < .001), while mean serum high-density lipoprotein cholesterol decreased across increasing quarters of plasma TFAs ( P < .001). In multivariable adjusted linear regressions, there remained significant positive associations between all plasma TFAs and body mass index, waist circumference, fat-free mass, fat mass, C-peptide, insulin, fasting blood glucose, HOMA-IR, HbA1c, TGs, low-density lipoprotein cholesterol, and TC ( P < .001). In conclusion, our findings support a possible association between plasma TFAs concentrations and measures of glucose homeostasis and several CV risk factors.

Telomere Length Is Associated With Cardiometabolic Factors in US Adults.

Telomere length (TL) has been associated with age-related health outcomes. We investigated the relationship of TL with cardiometabolic risk profile in adult Americans. We used the National Health and Nutrition Examination Surveys for 1999 to 2002, accounting for complex sampling and survey design. Of the 8892 eligible participants, 47.8% (n = 4123) were men. Mean serum high-density lipoprotein cholesterol concentrations significantly increased across increasing TL quarters ( P = .013), and mean fat mass, fat-free mass, hemoglobin A1c (HbA1c), and C-reactive protein significantly decreased across increasing TL quarters (all P < .001) in men. Only HbA1c levels significantly decreased across increasing TL quarters ( P = .041) in women. Males in the upper quarter of TL had lower (38%) odds of prevalent metabolic syndrome compared with those in the lower quarter ( P < .001). These results support the hypotheses that cardiometabolic factors are related to TL, especially in men.

Efficacy and safety of nicotinamide in the management of hyperphosphatemia in pediatric patients on regular hemodialysis.

Hyperphosphatemia is a common problem in patients with end-stage renal disease (ESRD) who are on maintenance hemodialysis (HD) and contributes to the development of secondary hyperparathyroidism and cardiovascular complications. Nicotinamide (NAM) has been shown in some studies to inhibit intestinal and renal sodium/phosphorus co-transporters and reduce serum phosphorus levels. We have therefore evaluated the efficacy and safety of NAM as adjunctive therapy to calcium-based phosphate binders to control hyperphosphatemia in hemodialysis patients. Sixty pediatric HD outpatients were randomly divided into two equally sized groups (30 children each). One group received calcium-based phosphate binder (control group), and the other received both the calcium-based phosphate binder + NAM at a dose of 100mg twice or three times daily (nicotinamide group). Both groups were followed for a 6-month period. Over the 6-month treatment period, children in the NAM group showed a significant decline in the levels of serum phosphorus (p = 0.0001), serum calcium-phosphorus (Ca × P; p = 0.0001) product and parathyroid hormone (p = 0.02) versus baseline values and those of the control group. After 6 months of NAM treatment, the mean serum high-density lipoprotein cholesterol levels had increased significantly (p = 0.01), and the median serum triglyceride levels had decreased (p = 0.009). There was no significant change in any of these parameters among the children of the control group. The major adverse events associated with the NAM therapy were diarrhea, flushing and nausea. The addition of NAM to therapy with phosphate binders is effective in lowering phosphorus levels and has a beneficial effect on the lipid profile with only mild side effects.

Association between serum C-peptide as a risk factor for cardiovascular disease and high-density lipoprotein cholesterol levels in nondiabetic individuals.

ObjectiveObjective: Although serum C-peptide has increasingly received attention as a new and important risk factor for cardiovascular disease (CVD), the potential mechanisms remain unclear. This study aimed to investigate the association between serum C-peptide as a risk factor for CVD and high-density lipoprotein cholesterol (HDL-C) levels.MethodsThe present study included 13,185 participants aged ≥20 years. Serum C-peptide and HDL-C levels were measured according to a standard protocol. Stratified analysis of covariance was used to compare serum HDL-C levels between different quartiles of serum C-peptide levels. Logistic regression analysis was used to determine the association between serum C-peptide and HDL-C levels. Cox proportional hazard regression analysis was conducted to determine the hazard ratio of serum HDL-C for CVD-related mortality.ResultsThe results of the ANCOVA analysis showed a significant linear trend between the mean serum HDL-C level and the different quartiles of serum C-peptide. Compared to the first quartile (25th percentile), the second, third, and fourth quartiles had gradual reduction in serum HDL-C levels. Logistic regression analyses showed a strong negative association between serum C-peptide levels and HDL-C levels; the p value for the linear trend was <0.001. In men, compared with the lowest quartile of the serum C-peptide level, the relative risk was 1.75, 2.79, and 3.07 for the upper three quartiles of the serum C-peptide level. The relative risk was 1.60, 2.61, and 3.67 for women. The results of the survival analysis showed that serum HDL-C levels were negatively associated with CVD-related death in both men and women.ConclusionSerum C-peptide as a risk factor for CVD was significantly and negatively associated with serum HDL-C levels in individuals without diabetes. These findings suggest that serum C-peptide levels association with CVD death can be caused, at least in part, by the low serum HDL-C level.

Protective Effect of Peanut (Arachis hypogaea L) and Its Combination with Propranolol on Dyslipidemia in Isoproterenol Induced Cardiotoxic Rats

Background: Cardiotoxicity can be developed due to prolonged use of higher doses of some drugs, exposure to some chemicals, toxins or infectious agents and also by some disease conditions. Natural plant food such as peanut (Arachis hypogaea L.) may have free radical scavenging and lipid lowering activity, thereby, can be used for the prevention and management of heart disease. Objective: To observe the protective effect of peanut (Arachis hypogaea L) and its combined action with propranolol on dyslipidemia in Isoproterenol induced cardiotoxic rats. Methods: This experimental study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka from January to December, 2012. Twenty Wistar albino rats, age 85-100 days, weighing 120 to 150g (initial body weight) were included in the experimental group (Group B, with peanut). They were further sub-divided into group B1 (isoproterenol treated group after peanut treatment), and group B2 (isoproterenol treated group after combined treatment of peanut and propranolol). Age and weight matched 30 Wistar albino rats without any peanut supplementation was taken as control (group A) and divided into three sub-groups, group A1 (baseline control), group A2 (isoproterenol treated control) and group A3 (isoproterenol treated control after propranolol treatment). Each subgroup consisted of 10 rats. After taking final body weight all the rats were sacrificed on 22nd day. Blood was collected from heart and supernatant serum was preserved in deep freeze until analysis. For assessment of lipid profile status, serum total cholesterol (TC), low density lipoprotein cholesterol (LDL- C) and high density lipoprotein cholesterol (HDL-C) were estimated by standard method. The statistical analysis was done by one way ANOVA and Bonferroni test as applicable. Results: In this study, percent change from initial body weight to final body weight was significantly (p&lt;0.01) lower both in isoproterenol treated group after peanut treatment and in isoproterenol treated group after combined treatment of peanut and propranolol as compared to that of baseline control. Again, this value was almost similar and the difference was not statistically significant between isoproterenol treated group after peanut treatment and isoproterenol treated group after combined treatment of peanut and propranolol. Again, the mean serum TC (p&lt;0.01) and LDL-C (p&lt;0.05) were significantly lower in isoproterenol treated group after peanut treatment and isoproterenol treated group after combined treatment of peanut and propranolol in comparison to those of isoproterenol treated control group. Moreover, the mean serum HDL-C was significantly (p&lt;0.01) higher in isoproterenol treated group after combined treatment of peanut and propranolol, in comparison to that of isoproterenol treated control group. Furthermore, the mean serum TC and LDL-C were non significantly higher and serum HDL-C was significantly (p&lt;0.01) higher in isoproterenol treated group after combined treatment of peanut and propranolol when compared to those of isoproterenol treated group after peanut treatment. Conclusion: The present study revealed that peanut alone can maintain blood lipid level by decreasing TC and LDL-C levels and by increasing HDL-C level in isoproterenol induced cardiotoxic rats. However, the combined therapy of peanut with propranolol showed synergistic effect on preventing dyslipidemia. DOI: http://dx.doi.org/10.3329/jbsp.v8i2.18655 Bangladesh Soc Physiol. 2013, December; 8(2): 58-64

Serum YKL-40 levels as a novel marker of inflammation and endothelial dysfunction in patients with pseudoexfoliation syndrome

To evaluate serum levels of YKL-40 in patients with pseudoexfoliation syndrome (PEX) in comparison with those of age- and sex-matched healthy subjects. Forty patients with PEX (PEX group) and 40 age- and sex-matched control subjects (control group) were enrolled in the study. An enzyme immunoassay method using the commercially available test MicroVue YKL-40 was used to measure serum YKL-40 concentration. Systolic and diastolic blood pressures, serum levels of high sensitivity C-reactive protein (hsCRP), total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglycerides were also examined. The mean age was 54.4±7.6 (ranging 41-65) years in each group. The mean serum YKL-40 level of the PEX group was significantly higher than that of the control group (P<0.001). In addition, the mean serum HsCRP, total cholesterol, LDL, and triglycerides levels were significantly higher, and mean serum HDL level was significantly lower in the PEX group than in the control group (all P<0.001, excluding both P=0.002 for triglycerides and HDL levels). Further, the mean systolic and diastolic blood pressures were significantly higher in the PEX group than in the control group (P₁=0.001 and P₂=0.01, respectively). We have shown a relationship between PEX and elevated serum levels of YKL-40. We imply that a better understanding of the role of YKL-40 in the pathogenesis of endothelial dysfunction and atherosclerosis is necessary to develop new therapies for preventing or treating PEX. Further studies are warranted to clarify the clinical relevance of these findings.

Khat chewing and cardiovascular risk profile in a cohort of Yemeni patients with angiographically documented coronary artery disease

ObjectiveWe sought to explore the prevalence of khat chewing and cardiovascular risk profile in a cohort of Yemeni patients with angiographically documented coronary artery disease (CAD).MethodsWe enrolled 100 consecutive Yemeni...

Reach-Out: A Family-Based Diabetes Prevention Program for African American Youth

Objective: To pilot test and assess the feasibility of a culturally grounded approach to adolescent overweight and diabetes prevention.Study Design: Reach-Out, a family-based nutrition and exercise program for overweight African American youth aged 9 to 12 years and their families, is led by lay health leaders and conducted in a community setting on Chicago's south side (Illinois). Age-appropriate interactive sessions focus on skills building, problem solving, and setting goals during 14 weekly sessions, with monthly meetings thereafter. Pre-post comparisons were made for 29 families (62 subjects) using physical (body mass index [BMI], blood pressure, waist circumference), biochemical (glucose, insulin, lipid levels) and behavioral data. Statistical analyses included mixed-effects linear models and logistic regression. ResultsChildren's mean BMI z score fell from 2.46 at baseline to 2.38 at 14 weeks and 2.39 at 1 year (p =.02), while parents' BMI remained stable. Children reported increased walking (p = 0.07) and exhibited a corresponding rise in mean serum high-density lipoprotein cholesterol from 49.4 to 54.2 (p <.001). Qualitative assessment showed that participants enjoyed the program but felt the program could be improved by making the sessions even more interactive. Conclusion: A community-based program for overweight minority youth and families can successfully address overweight, with the potential to decrease diabetes risk in youth.

Lipid profiles and trans fatty acids in serum phospholipids of semi-nomadic Fulani in northern Nigeria.

The Fulani are semi-nomadic pastoralists of West Africa whose diet, culture, and economy are centred on cattle. Previous studies have shown that the Fulani of northern Nigeria derive 50% of their total calories from fat and 30% of their calories from milk, cheese, yogurt, and butter oil that contain significant amounts of trans fatty acids (TFAs), primarily vaccenic acid, which raise total serum cholesterol and low-density lipoproteincholesterol (LDL-C), and lower high-density lipoprotein-cholesterol (HDL-C). The study was conducted to know how the consumption of relatively large amounts of dairy products by adult Fulani affected the TFA content of their serum phospholipids. Blood samples were collected from 22 male and 29 female Fulani, aged 35-60 years, who were living in rural areas of Gombe state in northeastern Nigeria. The total serum phospholipid fraction was isolated, and its fatty acid composition was determined. Surprisingly, vaccenic acid was not detected, and three other TFAs--18:1-t6, 18:1-t9, and 18:2-t9,t12--together accounted for only 0.16% of the total fatty acid. The mean serum total cholesterol, LDL-C, and triglyceride concentrations of the subjects were within the normal range for populations in developed countries; however, at 32 mg/dL, the mean serum HDL-C concentration of the Fulani males was slightly below the lower limit of the reference range. No correlations were observed between the total TFA percentage or that of the three individual TFAs and any of the parameters of the serum lipid profile. These findings indicate that, with respect to TFAs at least, the fatty acid pattern of the serum phospholipids of Fulani pastoralists does not reflect the high TFA content of their traditional diet. Despite the consumption of rumenic acid-rich dairy products, for unknown reasons, the semi-nomadic Fulani manage to maintain a low level of TFAs in their blood and a relatively healthful serum lipid profile. While the mechanism that accounts for this disconnect between the consumption of TFAs by Fulani pastoralists and the proportion of TFAs in their serum phospholipids is obscure, possibilities include discrimination against rumenic acid during the process of triglyceride synthesis and chylomicron synthesis in the intestine and the preferential oxidation of TFAs by Fulani the people compared to other ethnic groups.

Alterations in Lipids and Adipocyte Hormones in Female-to-Male Transsexuals

Testosterone therapy in men and women results in decreased high-density lipoprotein cholesterol (HDL) and increased low-density lipoprotein cholesterol (LDL). We sought to determine whether testosterone therapy has this same effect on lipid parameters and adipocyte hormones in female-to-male (FTM) transsexuals. Twelve FTM transsexuals provided a fasting lipid profile including serum total cholesterol, HDL, LDL, and triglycerides prior to and after 1 year of testosterone therapy (testosterone enanthate or cypionate 50–125 mg IM every two weeks). Subjects experienced a significant decrease in mean serum HDL (52 ± 11 to 40 ± 7 mg/dL) (P < .001). The mean LDL (P = .316), triglyceride (P = .910), and total cholesterol (P = .769) levels remained unchanged. In a subset of subjects, we measured serum leptin levels which were reduced by 25% but did not reach statistical significance (P = .181) while resistin levels remained unchanged. We conclude that testosterone therapy in FTM transsexuals can promote an increased atherogenic lipid profile by lowering HDL and possibly reduce serum leptin levels. However, long-term studies are needed to determine whether decreases in HDL result in adverse cardiovascular outcomes.

Combined effects of saturated fat and cholesterol intakes on serum lipids: Tehran Lipid and Glucose Study

Objective This study investigated the combined effect of saturated fat and cholesterol intake on serum lipids among Tehranian adults. Methods In 443 subjects ≥18 y, dietary intake was assessed. Height and weight were measured and body mass index was calculated. Serum cholesterol, triacylglycerol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol levels were calculated. Cholesterol intakes ≥300 mg/d and saturated fat intakes ≥7% of total energy were defined as high intakes. Individuals were categorized into four groups based on cholesterol and saturated fat intakes. Results Subjects' mean age was 40.1 ± 14.6 y; those in whom cholesterol and saturated fat intake was normal had significantly less energy and fat intake than those with high cholesterol and saturated fat intakes ( P < 0.01). Saturated fat intake had a significant effect on serum total and HDL-C levels. Subjects with a normal saturated fat intake had significantly less serum total and HDL-C than those who had high saturated fat intake ( P < 0.01 and P < 0.05, respectively). Adjusting for age, sex, and body mass index, the main effect of cholesterol intake on HDL-C was significant ( P = 0.05). Mean serum HDL-C was lower in subjects who had normal cholesterol intake than in those with high cholesterol intake. Conclusion These results show that cholesterol and saturated fat intakes have no combined effect on serum low-density lipoprotein cholesterol level, whereas cholesterol intake per se affects serum HDL-C level.

Treatment With N-Acetylcysteine in Stable Renal Transplantation

The primary cause of morbidity and mortality in renal transplantation is cardiovascular disease. Increased oxidative stress implies a greater degree of atherogenesis in these patients. N-acetylcysteine (NAC) which has a thiol group that is the source of l-cysteine and reduced glutathione, acts against atherosclerosis via a decrease in apoptosis, vasoconstriction, and endothelial dysfunction. Experimental models have examined the antioxidant effects of NAC during and after ischemia-reperfusion, but few studies have shown an effect in renal transplantation in human beings. In 8 months, we studied the effect of NAC treatment on oxidative stress, lipids, and renal function in 25 patients with stable renal function and no diabetes after transplantation. Data were collected on oxidative parameters: malondialdehyde, glutathione peroxidase, catalase, superoxide dismutase, glutathione reductase, lipid profile, and renal function (creatinine concentration, Cockroft-Gault formula, and Modified Diet in Renal Disease study). There were no significant differences in oxidative profile before and after treatment with NAC. The mean serum high-density lipoprotein cholesterol fraction increased after treatment and showed a significant positive correlation with glutathione peroxidase ( r = 0.495). Serum creatinine concentration decreased, and Cockroft-Gault and Modified Diet in Renal Disease study estimates of renal function increased in the treatment period. In conclusion, NAC treatment in patients with stable renal function after transplantation increased high-density lipoprotein cholesterol and antioxidant molecules in relation to glutathione peroxidase, with a positive influence on renal function.

Hypocholesterolemia in chronic anemias with increased erythropoietic activity

Hypocholesterolemia of unknown etiology has been previously described in various chronic anemias. Few small studies also suggested that those patients have a lower incidence of atherosclerotic events. The aim of our study was to determine the extent of hypocholesterolemia in various types of anemias. We studied 59 patients with chronic anemias associated with high-erythropoietic activity (thalassemia intermedia, congenital dyserythropoietic anemia type I, congenital spherocytosis), 8 patients with low-erythropoietic activity anemias (acquired aplastic anemia, Fanconi anemia, and Diamond Blackfan anemia), and 20 healthy controls. Mean serum cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, hemoglobin, serum ferritin, soluble transferrin receptor (STR), and serum erythropoietin levels were determined in each patient. All patients with chronic anemia and increased erythropoietic activity had hypocholesterolemia, whereas none of those with low erythropoietic activity was hypocholesterolemic. Mean serum cholesterol, HDL cholesterol, and LDL cholesterol levels were found to be significantly lower in the high-erythropoietic activity group (80+/-19 mg/dl; 31+/-10 mg/dl; 35+/-14 mg/dl, respectively) compared with the control group (P<0.001; 0.001; 0.001, respectively) and the low-erythropoietic activity group (P<0.001; 0.001; 0.01, respectively). Significant inverse correlation (R2=0.507) was observed between serum cholesterol and STR levels, which in the absence of iron deficiency reflect bone marrow activity. Taken together, our results imply that hypocholesterolemia accompanies anemias with high-erythropoietic activity. We suggest that the high-erythropoitic activity-associated hypocholesterolemia is due to increased cholesterol requirements by the proliferating erythoid cells. Further studies are needed to elucidate the exact mechanism and the possible clinical consequences of this phenomenon.

Effects of Bezafibrate on HDL2/HDL3 Ratio in Postmenopausal Hypertriglyceridemic Women

The short-term effects of bezafibrate on high-density lipoprotein cholesterol quality and triglyceride-rich lipoprotein metabolism in 186 postmenopausal hypertriglyceridemic women were investigated. Patients were randomized to an untreated group and to bezafibrate (400 mg/d) for 6 months. Fasting lipid concentrations, high-density lipoprotein 2, and high-density lipoprotein 3 levels were measured at baseline and after 3 and 6 months. At 3 months, bezafibrate had significantly decreased mean serum triglycerides and remnant-like particle cholesterol levels (105.7 +/- 43.4 mg/dL and 5.33 +/- 2.1 mg/dL, P < .001, respectively) from baseline values (232.5 +/- 63.9 mg/dL and 9.69 +/- 3.8 mg/dL, respectively). It also maintained lower total cholesterol, low-density lipoprotein cholesterol, triglycerides, and remnant-like particle cholesterol concentrations to 6 months. After 3 months, it significantly increased mean serum high-density lipoprotein cholesterol (55.1 +/- 14.7 vs 64.8 +/- 12.1 mg/dL; P < .0001) and maintained higher high-density lipoprotein cholesterol at 6 months. The high-density lipoprotein 2-high-density lipoprotein 3 ratio was decreased after 3 months of therapy with bezafibrate (2.13 +/- 0.68) from the baseline (2.42 +/- 0.71) (P < .01).

Serum lipids and high density lipoprotein cholesterol in peripheral vascular disease.

Serum lipids and high density lipoprotein (HDL) cholesterol concentrations were measured in 32 patients with peripheral vascular diseases (PVD) and 38 control subjects. Hypertriglyceridaemia (> 1.8 mmol/l) was significantly more common in PVD patients of both sexes than among controls but mean serum triglyceride levels were significantly higher only among males. Hypercholesterolaemia (> 7 mmol/l) was not more common in PVD patients nor did mean serum total cholesterol or HDL cholesterol levels differ significantly from control subjects. The HDL ratio, however, was significantly reduced in both males and females with PVD. These results suggest that expressing the amount of cholesterol carried in HDL in relative terms is a better index of vascular risk than is its absolute concentration. The HDL cholesterol level and the HDL ratio were both significantly lower in controls who smoked than in non-smokers; this may explain the reduced HDL ratio in PVD patients, most of whom were smokers.

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor