Lipoprotein Measurements Research Articles

A Pilot Study of the Total Cholesterol/High-Density Lipoprotein Ratio as a Prognostic Indicator of Hyperlipidemia-Related Diseases in Dogs and Cats

In veterinary medicine, the significance of high-density lipoprotein (HDL) measurements is not as well documented as it is in humans. The HDL level can be measured in dogs as well and, through referring to the normal range, it is possible to find out what this means in relation to various endocrine diseases and hyperlipidemia diseases. The aim of this study is to measure the HDL levels in dogs with various conditions and to evaluate whether the total cholesterol (TC)-to-HDL ratio is effective as a prognostic indicator in various hyperlipidemia and endocrine diseases, which is significant since it is the first trial in dogs. Through a retrospective study design, sixteen client-owned dogs and cats visiting a local private practice were divided into three groups: five dogs without hyperlipidemia or metabolic disease (Group 1), eight dogs with Cushing’s, hypothyroidism, and gallbladder sludge (Group 2), and three cats, including one with diabetes, one with a urinary disorder, and one healthy cat (Group 3). In two dogs, the TC/HDL values were between 2 and 3; in two dogs, the values were between 3 and 4; and in two dogs, the values were between 4 and 5. In three dogs, the TC/HDL values were between 5 and 6 and in three dogs the ratio values were between 6 and 7. The other value was higher than 8. Except for two dogs that showed lower values than 3, all dogs in Group 1 and Group 2 had concurrent endocrine disease. This means that TC/HDL values can be an excellent indicator of endocrine disease in dogs as well. In cats, although it is a very small batch of samples, a high TC/HDL value of 9 points was shown in the cat that had diabetes mellitus. However, for more statistically significant results, a larger sample group for further investigation is needed.

A novel classification of dyslipidaemia through the analysis of five million lipid profiles: an unsupervised machine learning approach

Abstract Background Dyslipidemia encompasses a wide range of lipoprotein disorders categorised through two classifications (Fredrickson-Levy [FL] or Sniderman).(1,2) However, both classifications are criticised for relying on incomplete knowledge of lipoprotein metabolism, especially with the emergence of novel treatment options and variations in individual treatment responses.(3) Clustering, an unsupervised machine learning (ML) algorithm that can process a wide range of variables, has the potential to unmask patient groups with distinct molecular profiles and unique therapeutic targets that can inform more effective prevention strategies for cardiovascular disease (CVD).(4) Aim We aimed to use unsupervised ML algorithms to discover intrinsic dyslipidaemia categories from lipoprotein measurements, recognise the necessary components of lipid panels for classification, and analyse the similarities between the newly formed clusters, FL and Sniderman classifications. Methods Lipid profiles of 5,080,248 patients were obtained from the ‘Very Large Database of Lipids’ database. This yielded up to 78 blood components per patient, including at least 31 lipoprotein variables. The analysis involved unsupervised K-means clustering with optimised values for K and the subset of variables, determined in an unsupervised manner using a suitable measure of complexity. We then interpreted our clusters using probabilistic decision trees to provide compact and interpretable representations. Finally, we compared the clusters with Sniderman and FL categories. Results In a completely unsupervised fashion, we identified 14 clusters that could be matched to Sniderman categories. The confusion matrix showed total agreement of 76% (see Figure 1, left panel), relative Cohen’s kappa of 0.78 (the relative version captures accuracy on categories containing smaller numbers of patient profiles) and an accuracy of 96% on the small Type III class. Similar results were observed when matching to FL types. We accurately represented our clusters using probabilistic decision trees of small depth (see Figure 2). We discovered that the data had low intrinsic dimension and a manifold-like structure in which the different clusters could be illustrated (see Figure 1, right panel). Specifically, only 3 variables were needed to obtain our classification: apolipoprotein b, total cholesterol and triglycerides. Conclusion We showed that completely unsupervised ML techniques can uncover dyslipidaemia categories in lipoprotein profiles from a large patient population. The categories largely align with existing classifications based on prior knowledge of lipoprotein metabolism. Furthermore, few lipoprotein variables were required for categorisation (low-dimension data), which could aid in determining which lipoproteins should be measured in a clinical setting. Further analysis of the differences between ML clusters and traditional classifications is needed, which may enhance CVD risk management.

Lipoprotein(a) cardiovascular disease risk not captured by low density lipoprotein cholesterol and apolipoprotein B

Abstract Background Elevated lipoprotein(a) affects 1 in 5 individuals and is considered a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis (AVS). However, lipoprotein(a) measurements are not widely implemented in clinical practice. Low-density lipoprotein (LDL) cholesterol and apolipoprotein B (ApoB) measurements include contributions from lipoprotein(a), yet whether these measurements can replace measurements of lipoprotein(a) in assessing cardiovascular disease risk from this causal risk factor is unknown. Purpose We tested the hypotheses that lipoprotein(a) risk of ASCVD and AVS is captured by LDL cholesterol or ApoB. Methods We included 70,189 individuals from a prospective contemporary cohort study of the general population. Mediated risk by LDL cholesterol and ApoB in the association between lipoprotein(a) and risk of ASCVD and AVS was examined using four-way decomposition analyses stratified by statin treatment at baseline. Results During a median follow-up of 10.8 years, 7,127 developed ASCVD and 1,516 AVS. Per 50 mg/dL higher lipoprotein(a), multivariable adjusted hazard ratios were 1.22 (95% CI: 1.18-1.26) for ASCVD and 1.36 (1.28-1.46) for AVS. In individuals without statin use, LDL cholesterol mediated 19% (15%-24%) of the risk of ASCVD from lipoprotein(a) and 7.7% (1.5%-14%) of the risk of AVS from lipoprotein(a) (Figure 1). Corresponding values for ApoB were 14.0% (11%-18%) and 6.6% (2.8%-10%). In statin users (n=9,570), LDL cholesterol did not mediate risk of ASCVD from lipoprotein(a) but mediated 8.0% (0.8%-15%) of the risk of AVS from lipoprotein(a). Correspondingly, ApoB mediated 9.8% (2.2%-17%) of the risk of ASCVD and 4.2% (0.4%-8.0%) of the risk of AVS from lipoprotein(a). Conclusion Lipoprotein(a) risk of ASCVD and AVS is not adequately captured by LDL cholesterol and ApoB. Therefore, lipoprotein(a) measurement is needed in all individuals to capture the cardiovascular disease risk from this causal risk factor.

Advanced lipid testing in children: a call for pediatric reference intervals

Abstract Introduction Abnormal serum lipid levels in childhood are associated with dyslipidemia and increased risk of cardiovascular disease in adulthood. High prevalence of childhood obesity in the US has increased concerns about the adverse effects of abnormal lipids in children, prompting recommendations for universal lipid screening in adolescents. While specialized analysis of lipoproteins by nuclear magnetic resonance (NMR) has been predominately used in adults with risk factors for CVD, our laboratory also receives pediatric samples for NMR testing, most commonly associated with diagnostic codes for hyperlipidemia and/or abnormal weight gain. Currently adult-based reference ranges for the NMR lipoprotein measurements are used in children. The objective of this pilot study was to compare lipoprotein profiles of healthy adults and children and to assess the impact of reference intervals for children on clinical interpretation of pediatric results. Methods Serum samples were collected from 60 healthy children, ages 1 – 17 years, and 148 healthy adults, ages 19 – 64 years old. NMR lipoprotein analysis was performed using the Axinon lipoFIT by NMR assay on a 600 MHz NMR (Bruker). Statistical analysis was conducted in Excel and GraphPad Prism. Reference intervals (RIs) were determined in EP Evaluator as the central 95% interval. Results The levels of atherogenic low-density lipoprotein particle number (LDL-P) and small LDL-P (sLDL-P) were significantly lower in children compared to adults: 783±222 vs 1212±412 nmol/L and 302±142 vs 498±306 nmol/L, respectively (p<0.00001). Additionally, LDL size (LDL-s) was significantly larger in children than adults (21.23±0.29 vs 21.06±0.44 nm, p=0.006), reflecting prevalence of less dense LDL-P in the former group. Pediatric samples also had lower number of anti-atherogenic high-density lipoprotein particles (HDL-P) compared to adults: 29.4±4.6 vs 33.5±4.6 µmol/L, p<0.00001. The significant differences in the number and size of lipoprotein particles between adults and children implies that currently used adult reference intervals might not be appropriate for evaluating pediatric NMR samples. Therefore, we estimated RIs for our heathy pediatric and adult cohorts and applied these RIs to our retrospective data of 618 samples from children 1-17 years old, which were submitted for NMR lipoprotein testing in recent years. The analysis showed that using the adult RIs, 37% and 27% of pediatric samples would not flag for abnormally elevated LDL-P and sLDL-P, respectively; but they would be flagged based on the RI derived from our pediatric cohort. Moreover, 12% pediatric samples flagged for low HDL-P would have normal HDL-P levels if pediatric RIs are used instead of adult RIs. Conclusions Use of adult reference intervals in children may result in misclassification of lipid status and underestimation or overestimation of dyslipidemia and CVD risk in children. This pilot study highlights the need for pediatric reference intervals to guide interpretation of advanced lipid testing in children.

A-227 One Step Toward Implementation of Advanced Lipoprotien Testing in Children: A Pilot Study on Pediatric Reference Ranges

Abstract Background Abnormal serum lipid levels in childhood are associated with dyslipidemia and increased risk of cardiovascular disease in adulthood. High prevalence of childhood obesity in the US has increased concerns about the adverse effects of abnormal lipids in children, prompting recommendations for universal lipid screening in adolescents. While specialized analysis of lipoproteins by nuclear magnetic resonance (NMR) has been predominately used in adults with risk factors for CVD, our laboratory also receives pediatric samples for NMR testing, most commonly associated with diagnostic codes for hyperlipidemia and/or abnormal weight gain. Currently adult-based reference ranges for the NMR lipoprotein measurements are used in children. The objective of this pilot study was to compare lipoprotein profiles of healthy adults and children and to assess the impact of reference intervals for children on clinical interpretation of pediatric results. Methods Serum samples were collected from 60 healthy children, ages 1 - 17 years, and 148 self-identified healthy adults, ages 19 - 64 years old. NMR lipoprotein analysis was performed using the Axinon lipoFIT by NMR assay on a 600 MHz NMR (Bruker). Statistical analysis was conducted in Excel and Graph Pad Prism. Reference intervals (RIs) were determined in EP Evaluator as the central 95% interval. Results The levels of atherogenic low-density lipoprotein particle number (LDL-P) and small LDL-P (sLDL-P) were significantly lower in children compared to adults: 783±222 vs 1212±412 nmol/L and 302±142 vs 498±306 nmol/L, respectively (p<0.00001). Additionally, LDL size (LDL-s) was significantly larger in children than adults (21.23±0.29 vs 21.06±0.44 nm, p=0.006), reflecting prevalence of less dense LDL-P in the former group. Pediatric samples also had lower number of anti-atherogenic high-density lipoprotein particles (HDL-P) compared to adults: 29.4±4.6 vs 33.5±4.6 µmol/L, p<0.00001. The significant differences in the number and size of lipoprotein particles between adults and children implies that currently used adult reference intervals might not be appropriate for evaluating pediatric NMR samples. Therefore, we estimated RIs for our heathy pediatric and adult cohorts and applied these RIs to our retrospective data of 618 samples from children 1-17 years old, which were submitted for NMR lipoprotein testing in recent years. The analysis showed that using the adult RIs, 37% and 27% of pediatric samples would not flag for abnormally elevated LDL-P and sLDL-P, respectively; but they would be flagged based on the RI derived from our pediatric cohort. Moreover, 12% pediatric samples flagged for low HDL-P would have normal HDL-P levels if pediatric RIs are used instead of adult RIs. Conclusions Use of adult reference intervals in children may result in misclassification of lipid status and underestimation or overestimation of dyslipidemia and CVD risk in children. This pilot study highlights the need for pediatric reference intervals to guide interpretation of advanced lipid testing in children.

Clinical Diagnostic Significance of Combined Measurement of Lipoprotein(a) and Neck Circumference in Patients with Coronary Heart Disease.

The study aimed to explore the clinical diagnostic significance of lipoprotein(a) [Lp(a)] and neck circumference (NC) in patients with coronary heart disease (CHD). This cross-sectional study was conducted at Chengde Central Hospital from September 2021 to June 2023, enrolling 791 patients with suspected CHD who underwent selective coronary angiography (CAG). Patients were categorized into CHD and non-CHD groups based on the severity of arterial narrowing. Subsequently, the diagnostic value of Lp(a) combined with NC in patients with CHD was assessed using receiver operating characteristic (ROC) curves. Based on the results of multivariate logistic regression, a nomogram was constructed, and its clinical applicability was validated using decision curve analysis (DCA) and clinical impact curve (CIC). Multivariate logistic regression proved that high Lp(a) and high NC are risk factors for CHD, with OR of 1.836 (95% CI: 1.282-2.630) and 1.383 (1.0.978-1.955), respectively. Patients in the high NC or Lp(a) group exhibited a higher prevalence of multi-vessel disease. The area under the ROC curve (AUC) of the predictive model combining high Lp(a) and high NC was 0.710 (95% CI: 0.670-0.751) and also demonstrated good calibration (Hosmer-Lemeshow goodness-of-fit test P value=0.494). The DCA and CIC confirmed the clinical utility of the nomogram developed to predict CHD based on the combination of high Lp(a) and high NC. The levels of Lp(a) and NC exhibit a significant correlation with the presence of CHD, and their combined assessment holds specific clinical value in the diagnosis of CHD.

Is lipoprotein(a) measurement important for cardiovascular risk stratification in children and adolescents?

BackgroundElevated lipoprotein (Lp(a)) levels are associated with increased risk of atherosclerotic processes and cardiovascular events in adults. The amount of Lp(a) is mainly genetically determined. Therefore, it is important to identify individuals with elevated Lp(a) as early as possible, particularly if other cardiovascular risk factors are present. The purpose of the study was to investigate whether, in a population of children and adolescents already followed for the presence of one or more cardiovascular risk factors (elevated blood pressure (BP), and/or excess body weight, and/or dyslipidemia), the measurement of Lp(a) can be useful for better stratifying their risk profile.MethodsIn a sample of 195 children and adolescents, height, body weight, waist circumference and systolic (SBP) and diastolic (DBP) BP were measured. Body Mass Index (BMI) and SBP and DBP z-scores were calculated. Plasma Lp(a), total cholesterol, high-density lipoprotein (HDL), triglycerides, glucose, insulin, uric acid and creatinine were assessed. Low-density lipoprotein (LDL) cholesterol was calculated with the Friedewald formula. High Lp(a) was defined as ≥ 75 nmol/L and high LDL cholesterol as ≥ 3.37 mmol/L.ResultsOur sample of children and adolescents (54.4% males, mean age 11.5 years) had median LDL cholesterol and Lp(a) values equal to 2.54 (interquartile range, IQR: 2.07–3.06) mmol/L and 22 (IQR: 7.8–68.6) nmol/L respectively. 13.8% of children had LDL cholesterol ≥ 3.37 mmol/L and 22.6 Lp(a) values ≥ 75 nmol/L. Lp(a) values were higher in children of normal weight than in those with excess weight (p = 0.007), but the difference disappeared if normal weight children referred for dyslipidemia only were excluded from the analysis (p = 0.210). 69.4% of children had normal Lp(a) and LDL cholesterol values and only 6.2% showed both elevated Lp(a) and LDL cholesterol levels. However, 16.6% of the sample, despite having normal LDL cholesterol, had elevated Lp(a) values. Multivariable analyses showed a significant association of LDL cholesterol both with Lp(a) values, and with the presence of elevated Lp(a) levels. For each mmol/L increase in LDL cholesterol the risk of having an elevated Lp(a) value increased by 73%. There was an inverse correlation between BMI z-score and Lp(a). Neither BP z-scores, nor other biochemical parameters were associated with Lp(a).ConclusionsIn our population more than one out of five children had elevated Lp(a) values, and in about 17% of children elevated Lp(a) values were present in the absence of increased LDL cholesterol. Our results suggest that Lp(a) measurement can be useful to better define the cardiovascular risk profile in children and adolescents already followed for the presence of other cardiovascular risk factors such as elevated BP, excess body weight and high LDL cholesterol.

ADLM Guidance Document on the Measurement and Reporting of Lipids and Lipoproteins.

The accurate measurement of blood lipids and lipoproteins is crucial for the clinical management of atherosclerotic disease risk. Despite progress in standardization, there are still significant variations in pre-analytical requirements, methods, nomenclature, and reporting work flows. The guidance document aims to improve standardization of clinical lipid testing work flows. It provides recommendations for the components of the lipid panel, fasting requirements, reporting of results, and specific recommendations for non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein(a) [Lp(a)], apolipoprotein B (apo B), point-of-care lipid testing, and LDL subfraction testing. Lipid panels should always report non-HDL-C and LDL-C calculations if possible. Fasting is not routinely required except in specific cases. Modern equations should be utilized for LDL-C calculation. These equations allow for LDL-C reporting at elevated concentrations of triglycerides and obviate the need for direct measured LDL-C in most cases.

Symptoms and coronary risk factors predictive of adverse cardiac events in chest pain patients in an Asian emergency department: the need for a local prediction score.

Clinical assessment is pivotal in diagnosing acute coronary syndrome. Our study aimed to identify clinical characteristics predictive of major adverse cardiac events (MACE) in an Asian population and to derive a risk score for MACE. Patients presenting to the emergency department (ED) with chest pain and non-diagnostic 12-lead electrocardiograms were recruited. Clinical history was recorded in a predesigned template. Random glucose and direct low-density lipoprotein measurements were taken, in addition to serial troponin. We derived the age, coronary risk factors (CRF), sex and symptoms (ACSS) risk score based on multivariate analysis results, considering age, CRF, sex and symptoms and classifying patients into very low, low, moderate and high risk for MACE. Comparison was made with the ED Assessment of Chest Pain Score (EDACS) and the history, electrocardiogram, age, risk factors, troponin (HEART) score. We also modified the HEART score with the CRF that we had identified. The outcomes were 30-day and 1-year MACE. There were a total of 1689 patients, with 172 (10.2%) and 200 (11.8%) having 30-day and 1-year MACE, respectively. Symptoms predictive of MACE included central chest pain, radiation to the jaw/neck, associated diaphoresis, and symptoms aggravated by exertion and relieved by glyceryl trinitrate. The ACSS score had an area under the curve of 0.769 (95% confidence interval [CI]: 0.735-0.803) and 0.760 (95% CI: 0.727-0.793) for 30-day and 1-year MACE, respectively, outperforming EDACS. Those in the very-low-risk and low-risk groups had <1% risk of 30-day MACE. The ACSS risk score shows potential for use in the local ED or primary care setting, potentially reducing unnecessary cardiac investigations and admission.

Pengaruh Pemberian Fraksi n-Heksan Ekstrak Etanol Daun Kelor (Moringa oleifera L.) Terhadap Kadar Low-Density Lipoprotein (LDL) Tikus Jantan Galur Sprague dawley

Introduction: Moringa leaves are a plant that has many benefits. Moringa leaf ethanol extract contains several chemical compounds, such as alkaloids, flavonoids, phenolics, triterpenoids, and tannins. Flavonoids function to reduce total cholesterol and LDL cholesterol. Objectives: Study This aims to determine the effect of giving fraction-hexane ethanol extract of Moringa leaves (Moringa oleifera L.) against the rate of low-density lipoprotein (LDL) on male rat strain Sprague Dawley given high-fat feed. Methods: This research uses a pre-test and post-test control group design. Thirty-six male white mice Sprague Dawley were given high-fat meals and then divided into six groups: group I was the standard group; Group II, the negative control, was assigned CMC Na 1%. Group III, the positive control, was given 10 mg of simvastatin. Groups IV, V, and VI were given the n-hexane fraction of the ethanol extract of the leaves Moringa (FHDK) with successive doses of 3.722 mg/kg BW; 7.444 mg/kg BW, and 14,888 mg/kg BW, which had previously been screened for phytochemicals. Results: The results of the phytochemical screening of the n-hexane fraction showed it was positive for containing alkaloids, flavonoids, tannins, and beta-sitosterol. Based on level measurements of low-density lipoprotein (LDL) in test animals measured before (pre-test) and after 14 days of intervention (post-test). The results showed that the n-hexane fraction of Moringa leaf ethanol extract was able to reduce LDL levels in groups IV, V, and VI respectively by as much as29,95 % ± 5,13; 75,61 % ± 8,63 and88,22 % ± 5.75. Simvastatin (group 3) amounted to 89,13 % ± 5.88. Based on statistical analysis after this LSD test showed that group VI could reduce LDL levels comparable to group III (Sig.0.792 &gt; 0.05) Conclusion: This research concludes that the n-hexane fraction of the ethanol extract of Moringa leaves can reduce LDL levels with an optimal dose of 14.888 mg/kgBB in mice, which is comparable to 10 mg simvastatin.

Correlation Between Elevated Lipoprotein(a) and Carotid Plaque in Asymptomatic Individuals

Background: Carotid plaque formation is a major global health issue and contributes in pathogenesis of vascular diseases. Lipoprotein(a), similar to low-density lipoprotein, may influence atherogenesis by promoting inflammation and thrombosis. However, the association between lipoprotein(a) levels and presence of carotid plaques has been debated. This study investigated the correlation between these parameters.Methods: We retrospectively analyzed 4,896 individuals who underwent lipoprotein(a) measurement and carotid ultrasonography at Gangnam Severance Hospital between January 2017 and December 2022. The relationship between lipoprotein(a) levels and the presence of carotid plaques was evaluated using logistic regression analysis adjusted for factors such as age, sex, hypertension (HTN), dyslipidemia, and diabetes mellitus (DM).Results: Among the 4,896 enrolled participants, those with carotid plaques were older, more likely to be men, and had a higher prevalence of HTN, DM, and dyslipidemia. The analysis showed a significant association between the presence of carotid plaques and a level of lipoprotein(a) ≥50 mg/dL in both univariable (unadjusted odds ratio=1.508, &lt;i&gt;p&lt;/i&gt;&lt;0.001, 95% confidence interval: 1.192–1.907) and multivariable (adjusted odds ratio=1.335, &lt;i&gt;p&lt;/i&gt;=0.029, 95% confidence interval: 1.030–1.731) models.Conclusion: Elevated lipoprotein(a) level emerged as an independent risk factor for carotid plaque formation, emphasizing the need for integrated risk assessment. Targeting lipoprotein(a) could enhance preventive strategies against cerebrovascular events. Therefore, further research is warranted to elucidate this disease’s underlying mechanisms and evaluate therapeutic interventions.

Anthocyanins as Adjuvant Treatment for Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis.

Recent studies suggest a role for anthocyanins in the treatment of non-alcoholic fatty liver disease (NAFLD). The purpose of the present review was to assess the effect of anthocyanins as an adjuvant treatment in patients with NAFLD. The literature search was conducted on MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), the Web of Science, and Scopus without language or time limits up to March 27, 2024. The primary outcomes included the severity of liver fibrosis and the level of liver transaminases. Secondary outcomes included obesity and lipid profile assessments. Standardized mean differences (SMDs) with 95% CIs were calculated for numerical outcomes. Five studies were included. The pooled effect sizes showed lower levels of liver fibrosis and liver transaminases in the anthocyanin group, but the difference was nonsignificant and small in size. The same result was obtained with anthropometric measurements of total cholesterol, low-density lipoprotein, and serum triglycerides, where effect sizes ranged from negligible to medium in magnitude but were all nonsignificant. The anthocyanin group showed a significantly lower body fat percentage (SMD = -0.41 (95%CI: -0.76; -0.06), P = 0.021). Currently, no evidence is available on the efficacy of anthocyanins in improving liver fibrosis or dyslipidemia in patients with NAFLD. There is limited evidence that anthocyanins can lower body fat percentages, but the effect was not reflected in the pooled results of other obesity indices. The few available clinical trials showed several limitations and variations regarding the doses of anthocyanins. Future clinical trials should avoid the limitations of the current studies and provide evidence supporting or refuting the use of anthocyanins in NAFLD patients.

Mediterranean Diet Adherence and Risk of All-Cause Mortality in Women

Higher adherence to the Mediterranean diet has been associated with reduced risk of all-cause mortality, but data on underlying molecular mechanisms over long follow-up are limited. To investigate Mediterranean diet adherence and risk of all-cause mortality and to examine the relative contribution of cardiometabolic factors to this risk reduction. This cohort study included initially healthy women from the Women's Health Study, who had provided blood samples, biomarker measurements, and dietary information. Baseline data included self-reported demographics and a validated food-frequency questionnaire. The data collection period was from April 1993 to January 1996, and data analysis took place from June 2018 to November 2023. Mediterranean diet score (range, 0-9) was computed based on 9 dietary components. Thirty-three blood biomarkers, including traditional and novel lipid, lipoprotein, apolipoprotein, inflammation, insulin resistance, and metabolism measurements, were evaluated at baseline using standard assays and nuclear magnetic resonance spectroscopy. Mortality and cause of death were determined from medical and death records. Cox proportional hazards regression was used to calculate hazard ratios (HRs) for Mediterranean diet adherence and mortality risk, and mediation analyses were used to calculate the mediated effect of different biomarkers in understanding this association. Among 25 315 participants, the mean (SD) baseline age was 54.6 (7.1) years, with 329 (1.3%) Asian women, 406 (1.6%) Black women, 240 (0.9%) Hispanic women, 24 036 (94.9%) White women, and 95 (0.4%) women with other race and ethnicity; the median (IQR) Mediterranean diet adherence score was 4.0 (3.0-5.0). Over a mean (SD) of 24.7 (4.8) years of follow-up, 3879 deaths occurred. Compared with low Mediterranean diet adherence (score 0-3), adjusted risk reductions were observed for middle (score 4-5) and upper (score 6-9) groups, with HRs of 0.84 (95% CI, 0.78-0.90) and 0.77 (95% CI, 0.70-0.84), respectively (P for trend < .001). Further adjusting for lifestyle factors attenuated the risk reductions, but they remained statistically significant (middle adherence group: HR, 0.92 [95% CI, 0.85-0.99]; upper adherence group: HR, 0.89 [95% CI, 0.82-0.98]; P for trend = .001). Of the biomarkers examined, small molecule metabolites and inflammatory biomarkers contributed most to the lower mortality risk (explaining 14.8% and 13.0%, respectively, of the association), followed by triglyceride-rich lipoproteins (10.2%), body mass index (10.2%), and insulin resistance (7.4%). Other pathways, including branched-chain amino acids, high-density lipoproteins, low-density lipoproteins, glycemic measures, and hypertension, had smaller contributions (<3%). In this cohort study, higher adherence to the Mediterranean diet was associated with 23% lower risk of all-cause mortality. This inverse association was partially explained by multiple cardiometabolic factors.

Lipoprotein (a) measurement: potential for personalized cardiovascular disease management in a patient with acute myocardial infarction.

Lipoprotein (a) measurement: potential for personalized cardiovascular disease management in a patient with acute myocardial infarction.

Evaluation of a Lipid Profile in Normoglycemic and Pre-diabetic Saudi Office Employees in Makka Region: A Case-Control Study.

Diabetes mellitus (DM) poses a significant health challenge worldwide. The impact of a sedentary lifestyle in predicting and managing complications of diabetes represents an urgent need for health strategies. The objective of this study was to evaluate the lipid profile among normoglycemic and prediabetic Saudi office workers. The research was a case-control study carried out in Makkah al-Mukarramah (Kingdom of Saudi Arabia, KSA).Seventy-five office worker volunteers between the ages of 19 and 45 years were recruited for the study. The participants were divided into two groups: a control group of non-diabetic normal subjects (NGT) and prediabetic subjects with impaired fasting plasma glucose and/or impaired glucose tolerance (IGT), based on the American Diabetes Association recommendations. Measurements of glucose, hemoglobin A1C (HbA1C), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were performed using standard procedures and commercial kits. Statistical analysis was performed to compare the lipid profile in the two groups, and a P-value of <0.05 was considered statistically significant. A proportion (58.7%) of the office workers are prediabetics; prediabetic office workers had higher total cholesterol compared to the controlgroup (p < 0.05). Triglyceride levels were higher in office workers with prediabetes compared to the normoglycemic group (p < 0.05). LDL levels were elevated in the prediabetic office workerscompared to the control group (p < 0.05). Office employees with prediabetes exhibit elevated levels of cholesterol, triglycerides, and LDL. The disturbance in lipid profile may be linked to impaired glucose tolerance in individuals with a sedentary lifestyle, such as office workers.

The therapeutic effect of alcoholic extract of Fumaria parviflora on high-fat diet-induced nonalcoholic fatty liver in rats: an animal experiment.

Nonalcoholic fatty liver disease (NAFLD) is a growing problem with a significant burden. Lifestyle modification is the recommended treatment, but researchers are exploring other options. This study focused on the effects of Fumaria parviflora (FP) extracts on NAFLD induced by a high-fat diet in rats. Thirty-five 10-week-old male Wister-Albino rats were divided into seven groups: normal diet control, high fat diet control, high fat diet with oral normal saline gavage, high fat diet with oral Atorvastatin gavage, and three groups receiving high fat diet with FP extract in 200mg/kg, 400mg/kg, and 700mg/kg.Blood samples of rats were used for the measurement of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP).1×1cm Liver biopsies were taken, stained with Trichrome Stain (Masson) and Hematoxylin and eosin (H&E) stain for evaluation by a pathologist. Lab results showed that FP extract inhibits weight gain, has positive effects on triglyceride and alkaline phosphatase levels, and reduces hepatocyte ballooning and inflammation in rats. FP extract may lower liver enzymes and have a positive impact on triglyceride, LDL, and HDL levels in rats with NAFLD.

Lipoprotein(a) testing in lipid clinics across the UK: Results of a national survey

Lipoprotein(a) is an independent risk factor for cardiovascular disease and its use is recommended in national and international guidelines for cardiovascular disease risk stratification. We undertook a survey to understand the availability and application of lipoprotein(a) measurement across UK lipid clinics. Fifty-three out of an estimated 200 lipid clinics (27%) provided responses. Eighty-one percent of 53 clinics had access to lipoprotein(a) measurement. Twenty-seven clinics disclosed the number of lipoprotein(a) tests ordered annually with approximately half of the clinics (52%) requesting 0-250 tests per year. Sixty percent measured lipoprotein(a) once per patient and the leading indication was a personal or family history of premature history of cardiovascular disease in those <60 years old. Sixty-three percent of clinics that provided comments with lipoprotein(a) results graded cardiovascular risk as per the HEART UK consensus statement. Sixty percent of clinics performed family cascade testing on lipoprotein(a) results ≥200 nmol/L. Lipoprotein(a) was reported in nmol/L, mg/dL, or mg/L by 48%, 24%, and 28% of responding clinics, respectively. National effort is required to provide universal access to lipoprotein(a) measurement and to harmonise the clinical application of this data.

Do abnormal screening results for chronic diseases motivate inactive people to start exercising? A community-based prospective cohort study in Changhua, Taiwan

ObjectiveExercise improves health, but illnesses can cause changes in exercise behavior, including starting or stopping. This study investigated the effects of chronic disease screening on inactive individuals' exercise behavior and analyzed the impact of age and chronic disease history on this relationship using stratified analysis. MethodsUsing a community-based prospective observational cohort design and data from the Changhua Community-Based Integrated Screening (CHCIS) dataset from 2005 to 2020, we examined 12,038 people who were screened at least twice and self-reported having never exercised at their first screening. Changes in exercise behavior were classified as “initiating exercise” and “remaining inactive.” We obtained chronic disease screening results from CHCIS records, which included measurements of waist circumference, blood glucose, blood pressure, triglycerides, and high-density lipoproteins. SAS version 9.4 was used for COX proportional hazards regression. ResultsThe findings indicated that abnormal waist circumference and blood pressure increased the likelihood of initiating exercise compared to normal results. Age stratification showed that those aged 40–49 with abnormal results were more likely to start exercising than normal participants, but not those under 40 or over 65. When stratified by chronic disease history, abnormal screening results correlated with exercise initiation only in groups without chronic disease history, except for those with a history of hyperlipidemia. ConclusionsThis is the first study to demonstrate that abnormal screening results may influence exercise initiation in individuals who have never exercised, and this association varies by screening item, age, and disease history.

Changes in soluble LDL receptor and lipoprotein fractions in response to diet in the DIETFITS weight loss study

Circulating levels of the soluble ligand-binding ectodomain of the LDL receptor (sLDLR) that is proteolytically cleaved from the cell surface have been shown to correlate with plasma triglycerides, but the lipid and lipoprotein effects of longitudinal changes in sLDLR have not been examined. We sought to assess associations between changes in sLDLR and detailed lipoprotein measurements between baseline and 6 months in participants in the DIETFITS (Diet Intervention Examining The Factors Interacting with Treatment Success) weight loss trial who were randomly assigned to the low-fat (n = 225) or low-carbohydrate (n = 236) diet arms. sLDLR was assayed using a proteomic procedure, lipids and apoprotein (apo) B and apoAI were measured by standard assays, and lipoprotein particle subfractions were quantified by ion mobility methodology. Changes in sLDLR were significantly positively associated with changes in plasma cholesterol, triglycerides, apoB, large-sized and medium-sized VLDL, and small and very small LDL, and inversely with changes in large LDL and HDL. The lipoprotein subfraction associations with sLDLR were independent of age, sex, diet, and BMI, but all except for large LDL were reduced to insignificance when adjusted for triglyceride change. Principal component analysis identified three independent clusters of changes in lipoprotein subfractions that accounted for 78% of their total variance. Change in sLDLR was most strongly correlated with change in the principal component that was loaded positively with large VLDL and small and very small LDL and negatively with large LDL and HDL. In conclusion, sLDLR is a component of a cluster of lipids and lipoproteins that are characteristic of atherogenic dyslipidemia.

Cryptotanshinone promotes brown fat activity by AMPK activation to inhibit obesity.

Activating brown adipose tissue (BAT) and browning of white adipose tissue (WAT) can protect against obesity and obesity-related metabolic conditions. Cryptotanshinone (CT) regulates lipid metabolism and significantly ameliorates insulin resistance. Adenosine-5'-monophosphate (AMP)-activated protein kinase (AMPK), a receptor for cellular energy metabolism, is believed to regulate brown fat activity in humans. The in vivo study included high-fat-fed obese mice administered orally 200/400 mg/kg/d CT. They were evaluated through weight measurement, the intraperitoneal glucose tolerance test (IPGTT), intraperitoneal insulin tolerance test (IPITT), cold stimulation test, serum lipid (total cholesterol, triglycerides, and low-density lipoprotein) measurement, hematoxylin and eosin staining, and immunohistochemistry. Furthermore, the in vitro study investigated primary adipose mesenchymal stem cells (MSCs) with incubation of CT and AMPK agonists (acadesine)/inhibitor (Compound C). Cells were evaluated using Oil Red O staining, Alizarin red staining, flow cytometry, and immunofluorescence staining to identify and observe the osteogenic versus adipogenic differentiation. Quantitative real-time polymerase chain reaction and the Western blot were used to observe related gene expression. In the diet-induced obesity mouse model mice CT suppressed body weight, food intake, glucose levels in the IPGTT and IPTT, serum lipids, the volume of adipose tissue, and increased thermogenesis, uncoupling protein 1, and the AMPK pathway expression. In the in vitro study, CT prevented the formation of lipid droplets from MSCs while activating brown genes and the AMPK pathway. AMPK activator enhanced CT's effects, while the AMPK inhibitor reversed the effects of CT. CT promotes adipose tissue browning to increase body thermogenesis and reduce obesity by activating the AMPK pathway. This study provides an experimental foundation for the use of CT in obesity treatment.