Median Triglyceride Research Articles

An omega-3 fatty acid plasma index ≥4% prevents progression of coronary artery plaque in patients with coronary artery disease on statin treatment

Background and aimsHigher blood levels of the omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been associated with fewer cardiovascular events and lower mortality in prospective studies. Our aim was to determine a target level of EPA and DHA to prevent progression of coronary artery plaque. Methods218 subjects with stable coronary artery disease on statins were randomized to high-dose EPA and DHA (3.36 g daily) or no omega-3 for 30 months. Coronary plaque volume was measured by coronary computed tomographic angiography. Plasma phospholipid levels of EPA, DHA and total fatty acids were measured by gas chromatography mass spectrometry. The omega-3 fatty acid index was calculated as EPA+DHA/total fatty acid. ResultsMean (SD) age was 62.9 (7.8) years; mean (SD) LDL-C level 78.6 (27.3) mg/dL and median triglyceride level 122 mg/dL. Subjects assigned to EPA and DHA had increased plasma EPA and DHA levels variably from 1.85% to 13.02%. Plasma omega-3 fatty acid index ≥4% prevented progression of fibrous, noncalcified, calcified and total plaque in nondiabetic subjects whereas those in the lowest quartile (<3.43%) had significant progression of fibrous, calcified and total plaque. No difference was observed in diabetic subjects. ConclusionsEPA and DHA added to statins prevented coronary plaque progression in nondiabetic subjects with mean LDL-C <80 mg/dL, when an omega-3 index ≥4% was achieved. Low omega-3 index <3.43% identified nondiabetic subjects at risk of coronary plaque progression despite statin therapy. These findings highlight the importance of measuring plasma levels of omega-3 fatty acids early and at trial conclusion. Targeting an omega-3 index ≥4% maximizes cardiovascular benefit.

The association of religious affiliation with cholesterol levels among South Asians: the Mediators of Atherosclerosis in South Asians Living in America study

BackgroundSouth Asians have disproportionately high rates of cardiovascular disease. Dyslipidemia, a contributing factor, may be influenced by lifestyle, which can vary by religious beliefs. Little is known about South Asian religions and associations with dyslipidemia.MethodsCross-sectional analyses of the MASALA study (n = 889). We examined the associations between religious affiliation and cholesterol levels using multivariate linear regression models. We determined whether smoking, alcohol use, physical activity, and dietary pattern mediated these associations.ResultsMean LDL was 112 ± 32 mg/dL, median HDL was 48 mg/dL (IQR:40–57), and median triglycerides was 118 mg/dL (IQR:88–157). Muslims had higher LDL and triglycerides, and lower HDL, while participants with no religious affiliation had lower LDL and higher HDL. The difference in HDL between Muslims and those with no religious affiliation was partly explained by alcohol consumption.ConclusionsReligion-specific tailoring of interventions designed to promote healthy lifestyle to reduce cholesterol among South Asians may be useful.

Trends in Lipids, Obesity, Metabolic Syndrome, and Diabetes Mellitus in the United States: An NHANES Analysis (2003-2004 to 2013-2014).

The aim of this study was to estimate frequency and prevalence of obesity, metabolic syndrome, and diabetes mellitus in US adults. Data were extracted from the National Health and Nutrition Examination Survey (NHANES; 2003-2004 to 2013-2014) (n = 32,188). The frequency and prevalence of diabetes mellitus, metabolic syndrome, obesity (BMI ≥ 30 kg/m2 ), and abdominal obesity were calculated and extrapolated to the US adult population. Average levels of high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were also assessed. Mean HDL-C remained constant over the study in men (~48 mg/dL) and women (~58 mg/dL). A downward trend was observed for median TG levels in men (122 mg/dL, 2003-2004; 98 mg/dL, 2013-2014) and women (110 mg/dL, 2003-2004; 90 mg/dL, 2013-2014). The estimated frequency of obesity increased by 20.4 million, and the estimated frequency of diabetes increased by 9 million, affecting 21.2 million (10%) and 30.2 million (13%) US adults, respectively. The estimated frequency (and prevalence) of metabolic syndrome was unchanged at ~50 million (23%). The frequency and prevalence of key cardiovascular risk factors, particularly diabetes and obesity, continue to increase in US adults and represent a substantial clinical burden. More effective preventive interventions are required to reduce the rising prevalence of obesity and its metabolic sequelae.

EFFICACY OF INSULIN, HEPARIN AND FENOFIBRATE COMBINATION TREATMENT IN SEVERE HYPERTRIGLYCERIDEMIA: DOUBLE CENTER EXPERIENCE.

Severe hypertriglyceridemia (SH), which calls for a triglyceride (TG) level above 1000 mg/dL, remains an important health issue. While some data exist to offer combination of heparin, insulin and fenofibrate as a reasonable treatment option, safety and benefits of this therapy have not been accurately weighted, largely due to the limited sample size of the relevant studies. Assess the efficacy and safety of the heparin, insulin and fenofibrate combination in the treatment of patients with SH. Patients aged ≥18 years with TG level above 1000 mg/dL and adequate organ function were included. Triglyceride levels were measured immediately before the treatment and on the 3rd and 6th days of the treatment. Treatment dosage, duration, response and side effects were assessed. Patients with hypertriglyceridemia presenting with acute pancreatitis were treated additionally with lipid apheresis. A total of 42 patients were included. Of these, 85.8% came to medical attention with some kind of secondary hypertriglyceridemia causes. The baseline median TG value of the cases was 2141.0 mg/ dL (1026-12250). There were 6 patients (14.3%) with acute pancreatitis at presentation. In patients without pancreatitis, with administration of insulin infusion, unfractionated heparin infusion and fenofibrate capsule, median TG values decreased to 921 mg/ dL (190-6400) on the 3rd day and to 437 mg/ dL (112-1950) on the 6th day of the treatment (p<0.0001, Friedman test). Potential toxicities related to insulin, heparin and fenofibrate combination treatment including hypoglycemia, hemorrhage, rise in creatine kinase levels, hepato - and nephrotoxicity were not observed. In this trial involving patients with SH, our data suggest that insulin, heparin and fenofibrate combination therapy was safe and effective.

Uric Acid and GGT Have Causal Relations with Abdominal Obesity: A Real-Life Research in Turkish Population with 1214 Diabetics

Aim: We compared the waist circumferences (WC) of 1214 diabetics with various parameters in real-life conditions. Patients and Method: The study was carried out by reviewing the anthropometric measurements and biochemical analyzes of diabetics and they were analyzed due to WC status of the patients. Results: Mean total cholesterol level was 204.6 ± 47.1 mg/dL in patients with normal WC and 211.6 ± 45.6 mg/dL in patients with increased WC (p = 0.015). Total cholesterol was found to be a risk factor for WC enlargement (OR: 1.003, 95% CI: 1.001 - 1.006, p = 0.015). HDL-cholesterol appeared to be a risk factor for the increase in WC (OR: 1.005, CI: 1.001 - 1.010, p = 0.029). Median triglyceride level was 158 (41 - 975) mg/dL in the normal WC group, while it was 176 (22 - 1379) mg/dL in the patients with increased WC (p < 0.001). Triglyceride was observed as a risk factor for WC increase (OR: 1.002, 95% CI: 1.001 - 1.003, p = 0.004). The serum uric acid level was 4.75 ± 1.6 mg/dL in the normal WC group, while it was 5.09 ± 1.5 mg/dL in the increased WC group (p = 0.002). Serum uric acid level was appeared as a risk factor for increased WC (OR: 1.162, 95% CI: 1.057 - 1.276, p = 0.002). The median serum GGT level was 27 (7 - 174) mg/dL in WC normal group and 28 (8 - 730) mg/dL in increased WC diabetics (p = 0.029). Serum GGT level was a risk factor for increased WC (OR: 1.162, 95% CI: 1.001 - 1.010, p = 0.029). Conclusion: We have demonstrated that the measurement of WC has an important role in diabetes management and is related with inflammatory parameters such as uric acid and GGT.

The Association of Triglyceride/HDL Ratio with In-hospital Mortality in Adult Patients Admitted for Acute Coronary Syndrome in Manila Doctors Hospital

Background: Studies showed that the triglyceride/HDL ratio is a predictor of long-term mortality and (CV) events. However, the association of the triglyceride/HDL ratio to in-hospital mortality in acute coronary syndrome (ACS) patients is less studied. This study aimed to determine the association of triglyceride/ HDL ratio taken within four days of admission on in-hospital mortality in adult patients admitted for ACS. Methodology: This was a retrospective cohort study involving adult patients admitted for ACS in Manila Doctors Hospital from January to December 2015. Only patients with lipid profile determination within four days of admission were included. The triglyceride/HDL ratio was computed and compared between survivors and non-survivors until discharge or death. Results: There were 132 ACS patients included in the study, with 11 in-hospital mortality. The median total cholesterol level was 170.15mg/dL (IQR 139.21– 201.08); median LDL was 117.94mg/dL (IQR 85.07- 150.81); median HDL was 40.80mg/dL (IQR 34.80- 53.56) and median triglycerides was 127.88mg/dL (IQR 91.60- 185.85). The triglyceride/HDL ratio of ACS patients was elevated at 3.31 (IQR 2.25- 5.13). In patients with elevated triglyceride/HDL ratio (³2.067), the odds ratio (OR) for total mortality was 0.48 (95% CI 0.13-1.76) and the OR for CV mortality was 0.66 (95% CI 0.16-2.74), both of which were not statistically significant. Conclusion: Patients with ACS have deranged lipid parameters and elevated triglyceride/HDL ratio. However, there was no evidence of association of elevated triglyceride/HDL ratio with in-hospital mortality.

Juvenile dermatomyositis: is periodontal disease associated with dyslipidemia?

BackgroundAssociation between periodontal disease and dyslipidemia was recently reported in healthy adults. However, a systematic evaluation of concomitant periodontal diseases and lipid profile was not carried out in juvenile dermatomyositis (JDM).A cross-section study was performed in 25 JDM patients and 25 healthy controls, assessing demographic data, periodontal evaluation, fasting lipoproteins and anti-lipoprotein lipase antibodies. Disease parameters, laboratorial tests and treatment were also evaluated in JDM patients.ResultsThe mean current age was similar in patients and controls (11.5 ± 3.75 vs. 11.2 ± 2.58 years,p = 0.703). Regarding lipid profile, the median triglycerides [80(31–340) vs. 61(19–182)mg/dL,p = 0.011] and VLDL[16(6–68) vs. 13(4–36)mg/dL,p = 0.020] were significantly higher in JDM patients versus controls. Gingival vasculopathy pattern was significantly higher in the former group (60% vs. 0%,p = 0.0001), as well as the median of gingival bleeding index (GBI) [24.1(4.2–69.4) vs. 11.1(0–66.6)%,p = 0.001] and probing pocket depth (PPD) [1.7(0.6–2.4) vs.1.4(0–2.12)mm,p = 0.006]. Comparison between JDM patients with and without dyslipidemia revealed that the median of dental plaque index (PI) [100(26.7–100) vs. 59(25–100)%,p = 0.022], PPD[1.9(0.6–2.4) vs. 1.4(1.2–1.8)mm,p = 0.024] and clinical attachment level (CAL) [1.31(0.7–1.7) vs. 0.8(0.6–1.7)mm,p = 0.005] were significantly higher in patients with dyslipidemia. Further analysis between JDM patients with and without gingivitis revealed that the median of current age [12.4 (8.3–18.4) vs. 9.2 (5.5–17.5) years, p = 0.034] and disease duration [7.09 ± 3.07 vs. 3.95 ± 2.1 years, p = 0.008] were significantly higher in the former group.ConclusionOur study showed that gingival inflammation seems to be related to dyslipidemia in JDM patients, suggesting underlying mechanisms for both complications.

ESR2 gene G1730A variant is associated with triglycerides level and myocardial infarction in young men but not in women

ObjectivesThe aim of the study was to investigate the role of estrogen receptor type 2 gene (ESR2) variant G1730A in myocardial infarction (MI) in young age. MethodsGenotyping was performed with restriction fragments length polymorphism method in 158 patients (79.1% men) with MI aged <50 years (studied group) and in control groups: 150 healthy individuals aged <50 years (63.3% men) and 202 patients (64.3% men) with MI aged ≥50 years. ResultsThe AA genotype of ESR2 G1730A variant was significantly more frequent in men with MI aged <50 comparing to men with MI aged ≥50 (21.6% vs. 8.4%, P = 0.004) and to healthy young men (21.6% vs. 11.6%, P = 0.048). There was statistically significant difference between AA genotype and GA + GG genotypes male carriers with MI aged <50 in median triglyceride (TG) level (2.0 vs. 1.7 mmol/l respectively, p = 0.023). ConclusionsOur findings suggest a possible role of ESR2 G1730A variant as the risk factor of MI in a young age not as an independent but a potential risk factor associated with TG level in men but not in women.

CIRCULATING LOW-DENSITY LIPOPROTEIN CHOLESTEROL IS INVERSELY CORRELATED WITH N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE IN VERY ELDERLY HOSPITALIZED PATIENTS

Objective: Our studies on human adipocytes suggest that natriuretic peptides (NP) may affect plasma cholesterol levels by inhibiting PCSK9 expression, a key regulator of low-density lipoprotein receptor (LDLR). To test this hypothesis in a real-life clinical setting, we evaluated associations between NT-proBNP and cholesterol in very elderly hospitalized patients. Design and method: Cross sectional study on 288 very elderly admitted to our Internal Medicine and Geriatrics Department for medical conditions. NT-proBNP, total cholesterol (TC), HDL cholesterol (HDL-c) and triglycerides (TG) were collected after stabilization of the acute illness. Patients were taking no lipid-lowering drugs. Calculated LDL-cholesterol (cLDL) was used for the analyses. NT-proBNP was analyzed both as a continuous and as a discrete variable (NT-proBNP tertiles). Results: Mean age was 87.7 ± 6.2 years with female prevalence (57.3%). Median NT-proBNP: 2949 (1005–7335) pg/ml; mean TC: 145.1 ± 40.3 mg/dl; mean HDL-c: 38.4 ± 18.6 mg/dl; median TG: 100 (75–129) mg/dl; mean cLDL: 84.0 ± 29.5 mg/dl. We found a negative correlation between NT-proBNP and both TC and cLDL (ρ = −0.157; p = 0.008 and ρ = −0.166; p = 0.005, respectively), while no correlations emerged between NT-proBNP and HDL (ρ = −0.065; p = 0.275) or triglycerides (ρ = −0.009; p = 0.874). These associations were also confirmed for NT-proBNP tertiles (Figure 1). The inverse association between NT-proBNP and cLDL was maintained even after adjusting for sex, albumin, hemoglobin and cognitive impairment. Conclusions: We found an inverse association between NT-proBNP and LDL cholesterol levels, that remained statistically significant even after adjusting for covariates such as albumin, a common indicator of malnutrition or hepatic failure. Our real-life clinical study supports the possible direct role of NP on cholesterol metabolism, as suggested by our laboratory studies.

ACUTE PANCREATITIS IN PATIENTS WITH SEVERE HYPERTRIGLYCERIDEMIA IN A MULTI-ETHNIC MINORITY POPULATION

To investigate the prevalence and predictors of hypertriglyceridemic acute pancreatitis (HTG-AP) in a multi-ethnic minority population. A retrospective, cross-sectional study from 2003 to 2013 of 1,157 adults with a serum triglyceride (TG) level ≥1,000 mg/dL comparing baseline characteristics and risk factors between those with and without HTG-AP. Mean study population age was 49.2 ± 11.5 years; 75.6% were male, 31.6% African American, 38.4% Hispanic, 22.7% Caucasian, 5.7% Asian, and 1.6% Pacific Islander. Prevalence of HTG-AP was 9.2%. Patients with HTG-AP were significantly younger (41.3 years vs. 50.0 years; P<.001) than those without HTG-AP. Excessive alcohol intake (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.5 to 6.0; P<.001), gallstone disease (OR, 3.9; 95% CI, 1.4 to 10.8; P = .008), and TG >2,000 mg/dL (OR, 4.8; 95% CI, 3.1 to 7.4; P<.001) remained significant independent risk factors. TG levels for patients with HTG-AP were higher (median TG, 2,394 mg/dL; interquartile range [IQR], 1,152 to 4,339 mg/dL vs. median TG, 1,406 mg/dL; IQR, 1,180.7 to 1,876.5 mg/dL). TG levels >2,000 mg/dL were associated with higher incidence of AP (22% vs. 5%). Patients with TG levels <2,000 mg/dL and no risk factors had prevalence of 2% compared to 33.6% with one risk factor and TG >2,000 mg/dL. Patients with HTG-AP had higher incidence of diabetic ketoacidosis at admission (7.5% vs. 2.5%; P = .004). TG level ≥2,000 mg/dL is associated with higher HTG-AP prevalence in ethnic minorities. Presence of excessive alcohol intake and/or gallstones further accentuates risk. AP = acute pancreatitis; CT = computed tomography; DM = diabetes mellitus; HbA1c = hemoglobin A1c; HIV = human immunodeficiency virus; HTG = hyper-triglyceridemia; HTG-AP = hypertriglyceridemic acute pancreatitis; ROC = receiver operating characteristic; TG = triglyceride.

N-terminal pro B-Type natriuretic peptide is inversely correlated with low density lipoprotein cholesterol in the very elderly

Background and aimsLaboratory studies on human adipose tissue and differentiated adipocytes indicate that natriuretic peptides (NPs) affect lipid metabolism and plasma cholesterol. Few previous clinical studies in non-elderly populations found associations between NPs in the physiological range and cholesterol. Aim: evaluate the association between NT-proBNP and lipid profile in very elderly hospitalized patients characterized by a wide range of NT-proBNP levels. Methods and resultsCross-sectional study on 288 very elderly patients hospitalized for medical conditions, in which increased NT-proBNP levels are very common. NT-proBNP, total cholesterol (TC), HDL cholesterol (HDLc) and triglycerides were collected just few days before discharge. Patients taking lipid-lowering drugs and patients with an admission diagnosis of acute heart failure were excluded. Calculated LDL-cholesterol (LDLc) was used for the analyses. Mean age: 87.7 ± 6.2 years; female prevalence (57.3%). Median NT-proBNP: 2949 (1005–7335) pg/ml; mean TC: 145.1 ± 40.3 mg/dl; mean HDLc: 38.4 ± 18.6 mg/dl; median triglycerides: 100 (75–129) mg/dl; mean LDLc: 84.0 ± 29.5 mg/dl. We found negative correlations between NT-proBNP and both TC and LDLc (Rho = −0.157; p = 0.008 and Rho = −0.166; p = 0.005, respectively), while no correlations emerged between NT-proBNP and HDLc (Rho = −0.065; p = 0.275) or triglycerides (Rho = −0.009; p = 0.874). These associations were confirmed considering NT-proBNP tertiles. The inverse association between NT-proBNP and LDLc was maintained even after adjusting for confounding factors. ConclusionOur real-life clinical study supports the hypothesis that NPs play a role on cholesterol metabolism, given the association found between LDLc and NT-proBNP even in very elderly patients where NT-proBNP values are often in the pathological range.

Abstract B022: Metabolic and immunologic effects of the fasting mimicking diet in cancer patients

Abstract Background: The fasting mimicking diet (FMD), a plant-based, low-calorie, low-protein, low-carbohydrate diet, modulates systemic metabolism and anticancer immunity, and displays anticancer activity in many preclinical tumor models. However, safety, metabolic, and activity data in the clinical setting are lacking. Methods: At Fondazione IRCCS Istituto Nazionale dei Tumori, a prospective study is ongoing to assess feasibility, tolerability, and metabolic effects of the FMD in cancer patients (pts) following a 5-day FMD (700 Kcal on day 1 and 300 kCal on days 2-5) every 21-28 days. This study is enrolling pts with any cancer type (except for small cell lung cancer), stage, and concomitantly administered anticancer treatment. Main exclusion criteria are: insulin-dependent diabetes, severe comorbidities, BMI &amp;lt;20 kg/m2, recent unintentional weight loss &amp;gt;5%. We are regularly collecting blood and urine samples before FMD initiation and at diet completion to measure diet-induced changes of metabolites and growth factors. Here we report data on metabolic modifications detected in 38 pts after the first FMD cycle, and preliminary peripheral blood immunomonitoring in selected cases. Results: 38 pts were enrolled from January 2017 to July 2017. 29 had advanced disease, and 34 were receiving concomitant anticancer therapy at study enrollment. The most represented tumor types were breast (14), prostate (4), pancreatic (4), and lung (5) cancer. All pts completed at least one cycle of FMD, and no G3-G4 adverse event (AE) were reported. After the first FMD cycle, median glycemia was reduced by 15% (p&amp;lt;0.001), plasma IGF-1 levels by 27% (p&amp;lt;0.001), and insulin levels by 34% (p&amp;lt;0.001), while median triglyceride, total cholesterol, and uric acid levels increased by 31.4% (p=0.014), 11% (p&amp;lt;0.001), and 80% (p&amp;lt;0.001), respectively; finally, average urine ketone body levels were raised from 0.38 mg/dl (range 0-10) to 62 mg/dl (range 20-100). In 4 pts (3 breast, 1 lung) enrolled in the study, we preliminarily evaluated by 10-color cytofluorimetry the frequency and activation state of immune cell subsets in peripheral blood mononuclear cells before (day 0) and at the end (day 5) of the first FMD cycle. Our analyses revealed a rapid and marked decrease of monocytic myeloid-derived suppressor cells (MDSC)(CD11b+CD33+LINnegCD14+HLA-DRneg), mirrored by a concomitant increase of activated T cells (CD3+CD25+PD-1dim) and cytolytic NK cells (CD3negCD16+CD56dim). Granulocytic MDSC (CD11+CD33+LNnegHLA-DRnegCD15+) were also reduced in 3 pts, while the 4th patient experienced an increase of these cells due to the administration of granulocyte colony-stimulating factor (G-CSF). Conclusions: This interim analysis suggests that our FMD scheme induces remarkable modifications in systemic metabolism and immunity in a heterogeneous population of cancer pts. These data provide initial insights into the metabolic modulation mediated by FMD in clinical setting, pointing to a potential contribution of this approach in reestablishing effective antitumor immunity in cancer patients. Citation Format: Filippo de Braud, Claudio Vernieri, Veronica Huber, Agata Cova, Paola Squarcina, Monica Milano, Giovanni Fucà, Valter Longo, Licia Rivoltini. Metabolic and immunologic effects of the fasting mimicking diet in cancer patients [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr B022.

Spectrophotometry and Ultracentrifugation for Measurement of Plasma Lipids in Dogs with Diabetes Mellitus.

BackgroundThere are conflicting reports of plasma lipoprotein lipid content in dogs with diabetes mellitus (DM).ObjectivesTo determine lipoprotein lipid content of plasma of dogs with DM by spectrophotometry and ultracentrifugation; to compare lipoprotein lipid content in diabetic and healthy dogs; and to quantify apolipoprotein B‐100 (ApoB) in dogs with DM.Animals22 dogs with DM and 9 healthy dogs.MethodsCross‐sectional study. Triglyceride (TG), total cholesterol (TC), and high‐density lipoprotein cholesterol (HDL‐C) concentrations were measured by spectrophotometry. Very low‐density lipoprotein cholesterol (VLDL‐C) and low‐density lipoprotein cholesterol (LDL‐C) concentrations were calculated after ultracentrifugation. Non‐HDL‐C cholesterol was calculated by subtracting HDL‐C from TC. ApoB was quantified by ELISA. The Mann‐Whitney test was used for comparison of median lipoprotein concentrations, and Spearman's correlation was used to assess associations between ApoB and lipoprotein fractions.ResultsAll values are reported in mg/dL. Median TG (122), TC (343.5), HDL‐C, (200), VLDL‐C, (27) LDL‐C (68), non‐HDL‐C (114), and ApoB (320) were significantly higher in dogs with DM, compared to healthy dogs (57, 197, 168, 12, 16, 31, and 258, respectively, P‐values 0.0079, <0.001, 0.029, 0.011, <0.001, <0.001, 0.025, respectively). A significant association was found between ApoB and LDL‐C (Spearman's rho = 0.41, P = 0.022) and between ApoB and non‐HDL‐C (Spearman's rho = 0.40, P = 0.027).Conclusions and Clinical ImportanceDyslipidemia of dogs with DM is characterized by pronounced increases in LDL‐C and non‐HDL‐C concentrations, although all lipoprotein fractions are significantly increased. Knowledge of specific lipoprotein fraction alterations in dogs with DM can enhance treatment options for diabetic dyslipidemia in dogs.

PP.01.27] DYSLIPIDEMIA IN HYPERTENSIVE PATIENTS UNDERGOING 24-HOURS AMBULATORY BLOOD PRESSURE MONITORING

Objective: Hypertension and dyslipidemia represent two of the most relevant modifiable cardiovascular risk (CVR) factors and they often coexist. The aim of our study was to evaluate the characteristics of the lipid profile of a large unselected hypertensive population referred to our Centre, to underline the magnitude of this association and possible lacks in the management of dyslipidemia. Design and method: Retrospective study on 1440 hypertensives referred to our Hypertension Centre between 2010 and 2015. Inclusion criteria were age >=18 years, a 24-hour ambulatory blood pressure monitoring (ABPM) and a complete lipid profile: total cholesterol (TC), HDL cholesterol (HDL-c) and triglycerides (TG). Dyslipidemia was defined by the presence of at least one of these characteristics: TC >=200 mg/dl, calculated LDL cholesterol (cLDL) values higher than those recommended based on individual CVR, HDL-c<40 mg/dl in men and <50 mg/dl in women, TG >=150 mg/dl. Results: Mean age: 55.9 ± 13.4 years. Male sex: 823 (57.2%). Overweight/obese: 68%. Smokers: 18.1%. Diabetics: 10.7%. Dyslipidemia: 82.6%. Patients with peripheral arterial disease (PAD): 23,7%. Mean eGFR: 75.0 ± 15.6 ml/min/1.73m2. Mean TC: 205.9 ± 39.7 mg/dl. Mean HDL-c: 51.8 ± 13.7 mg/dl. Median TG: 111 mg/dl (82–157). Mean cLDL: 129.2 ± 34.5 mg/dl. Drug therapy: 19% (statins 87.6%, ezetimibe 6.2%, others 2.2%). At target cLDL: 39% (all patients), 42.9% (treated patients). Females were less controlled, despite the same treatment rate with lipid-lowering drugs. Diabetics were also less controlled, despite a higher rate of treatment with lipid-lowering drugs. Patients with PAD not treated with lipid-lowering drugs were 78.3%. TG>=150 mg/dl: 28% (all patients), 33% (treated patients). Low HDL-c (according to sex): 28.3%. Statins frequencies: simvastatin (34.1%), atorvastatin (27.8%), rosuvastatin (13.2%), pravastatin (10.3%), others (2.2%). High intensity statins were taken only by 2% of treated patients. The hypertensives controlled by therapy were 29.9% and patients with both controlled hypertension and cLDL were only 12%. Conclusions: Our data show the frequent association between hypertension and dyslipidemia. Patients with at least one alteration of the lipid profile were often untreated with lipid-lowering drugs, even in the presence of increased CVR. Whenever treated, they received low-medium intensity statins and they often did not reach their therapeutic goals.

Triglyceride concentrations in neonatal foals: Serial measurement and effects of age and illness

Few studies have evaluated the effects of age and illness on serum triglyceride concentrations in neonatal foals. The objectives of this study were to evaluate triglyceride concentrations in neonatal foals and their dams through serial measurement immediately postpartum and at 1–2 days and 10–12 days of age, as well as to measure them in sick foals.Serially measured serum triglycerides in seven healthy foals varied with age. Median (range) triglyceride concentrations were 28mg/dL (12–50mg/dL), 89mg/dL (51–264mg/dL), and 60mg/dL (28–135mg/dL) immediately postpartum, at 1–2 days of age, and 10–12 days of age, respectively (P<0.001). Triglyceride concentrations varied hourly by up to 117mg/dL in individual foals. The dams had lower triglycerides (median, 20mg/dL; range, 12–49mg/dL) than the foals, once foals were >24h old. Sick foals <24h old had lower triglycerides than sick foals aged 1–7 days (median, 41mg/dL [range, 16–116]; median, 110mg/dL [range, 24–379mg/dL]; P<0.001). Age and triglyceride concentration showed a non-linear association independent of foal health status (P=0.01). Sick foals with positive bacterial cultures had higher triglycerides than those with negative cultures (median, 111mg/dL [range, 10–379mg/dL] and median 53mg/dL [range, 17–271mg/dL], respectively; P=0.033). Nonsurvivors had higher triglycerides than survivors (median, 116mg/dL [range, 41–379mg/dL] and median, 55mg/dL [range, 10–311mg/dL], respectively; P=0.04). In conclusion, triglycerides were highest in healthy neonatal foals aged 1–2 days, and in nonsurviving sick foals and those with positive bacterial cultures. Age was associated with triglyceride concentration regardless of health status.

Use of supplemental long-chain omega-3 fatty acids and risk for cardiac death: An updated meta-analysis and review of research gaps

Randomized controlled trials (RCTs) assessing use of long-chain omega-3 polyunsaturated fatty acids (LC-OM3), primarily eicosapentaenoic acid, and/or docosahexaenoic acid have shown mixed results. The objectives of the study were to update and further explore the available RCT data regarding LC-OM3 supplementation and risk for cardiac death and to propose testable hypotheses for the mixed results obtained in RCTs regarding supplemental LC-OM3 use and cardiac risk. A literature search was conducted using PubMed and Ovid/MEDLINE for RCTs assessing LC-OM3 supplements or pharmaceuticals with intervention periods of at least 6 months and reporting on the outcome of cardiac death. Meta-analysis was used to compare cumulative frequencies of cardiac death events between the LC-OM3 and control groups, including sensitivity and subset analyses. Fourteen RCTs were identified for the primary analysis (71,899 subjects). In the LC-OM3 arms, 1613 cardiac deaths were recorded (4.48% of subjects), compared with 1746 cardiac deaths in the control groups (4.87% of subjects). The pooled relative risk estimate showed an 8.0% (95% confidence interval 1.6%, 13.9%, P=.015) lower risk in the LC-OM3 arms vs controls. Subset analyses showed numerically larger effects (12.9%-29.1% lower risks, all P<.05) in subsets of RCTs with eicosapentaenoic acid+docosahexaenoic acid dosages >1g/d and higher risk samples (secondary prevention, baseline mean or median triglycerides ≥150mg/dL, low-density lipoprotein cholesterol ≥130mg/dL, statin use <40% of subjects). Heterogeneity was low (I2≤15.5%, P>.05) for the primary and subset analyses. LC-OM3 supplementation is associated with a modest reduction in cardiac death.

Prevalencia de sobrepeso, obesidad y dislipidemia en trabajadores de salud del nivel primario

La dislipidemia y la obesidad constituyen factores modificables de riesgo cardiovascular. El objetivo del estudio fue determinar la prevalencia de sobrepeso, obesidad y dislipidemia en trabajadores de la salud. Estudio transversal, el muestreo fue aleatorio con afijación proporcional y se incluyeron a 123 trabajadores de áreas de la salud. Se evaluaron el índice de masa corporal y perímetro abdominal. Se consideró colesterol total (CT) elevado&gt;200 mg/dl, LDL-C&gt;100 mg/dl, HDL-C bajo (varones HDL-C&lt;40 mg/dl y mujeres HDL-C&lt;50 mg/dl), y triglicéridos ≥150 mg/d. La prevalencia de hipercolesterolemia fue 30,1%, triglicéridos 40,5%, HDL bajo 69,3%, LDL elevado 55,2%, y la dislipidemia global fue 87,7%. La mediana de triglicéridos (p=0,034) y LDL-C fue mayor en varones que mujeres (p=0,038). La LDL-C aumentaron con la edad (p=0,015). La dislipidemia, sobrepeso, obesidad y obesidad abdominal predominaron en las mujeres. La prevalencia de sobrepeso fue 41,1%, obesidad 25,8% y la obesidad abdominal de 37,5%. Se concluye, que la prevalencia de dislipidemia global fue alta y más de la mitad de los trabajadores de la salud presentaron sobrepeso u obesidad y la tercera parte tuvieron obesidad abdominal.

Replacement of Refined Starches and Added Sugars with Egg Protein and Unsaturated Fats Increases Insulin Sensitivity and Lowers Triglycerides in Overweight or Obese Adults with Elevated Triglycerides

Background: Hypertriglyceridemia is a common condition in the United States and is often associated with other metabolic disturbances, including insulin resistance, metabolic syndrome, and a predominance of small dense LDL particles.Objective: The objective of this trial was to evaluate the effects of a combination of egg protein (Epro) and unsaturated fatty acids (UFAs) substituted for refined starches and added sugars on insulin sensitivity (primary outcome) and other cardiometabolic health markers in overweight or obese adults with elevated triglyceride (TG) concentrations.Methods: Subjects with elevated TG concentrations were given test foods prepared by using Epro powder (∼8% of energy) and vegetable oil (∼8% of energy; Epro and UFA condition) or test foods prepared by using refined starch and sugar (∼16% of energy; carbohydrate condition) in a randomized, double-blind, controlled-feeding, crossover trial (3 wk/condition, 2-wk washout). The Matsuda insulin sensitivity index (MISI), fasting lipids, and other cardiometabolic health markers were assessed at baseline and the end of each diet condition. Responses were compared by using repeated-measures ANCOVA.Results: Twenty-five participants [11 men, 14 women; mean ± SEM: age, 46.3 ± 2.4 y; body mass index (in kg/m2), 31.8 ± 1.0] with a median (interquartile range limits) fasting serum TG concentration of 173 mg/dL (159, 228 mg/dL) completed the trial. The MISI value increased 18.1% ± 8.7% from baseline during the Epro and UFA condition and decreased 5.7% ± 6.2% from baseline during the carbohydrate condition (P < 0.001). The disposition index increased 23.8% ± 20.8% during the Epro and UFA condition compared with a decrease of 16.3% ± 18.8% during carbohydrate (P = 0.042) and LDL peak particle size increased 0.12 nm (-0.12, 0.28 nm) with Epro and UFA compared with a decrease of 0.15 nm (-0.33, 0.12 nm) with carbohydrate (P = 0.019). TG and VLDL cholesterol concentrations were lowered by 18.5% (-35.7%, -6.9%) and 18.6% (-34.8%, -7.4%), respectively, after the Epro and UFA condition and by 2.5% (-13.4%, 17.0%) and 3.6% (-12.5%, 16.2%), respectively, after the carbohydrate diet condition (P < 0.002).Conclusions: The replacement of refined carbohydrates with a combination of Epro and UFA increased the MISI value and altered several markers of cardiometabolic health in overweight or obese adults with elevated TG concentrations. This trial was registered at clinicaltrials.gov as NCT02924558.

Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity

BackgroundNon- Alcoholic Fatty Liver (NAFL) is a spectrum of liver diseases (LD) that ranges from benign fatty infiltration of the liver to cirrhosis and hepatic failure. Hepatic ultrasound (US) and serum alanine aminotransferase (ALT) are often used as markers of NAFL. Our aim is to describe prevalence of NAFL and associated findings on ultrasound (US) and biochemical parameters in a population of children and adolescents with obesity at the Children’s Hospital of Eastern Ontario.MethodsChildren with Obesity (BMI >95th percentile) ages 8–17 years presenting to the Endocrinology and Gastroenterology clinics, without underlying LD were prospectively recruited from 2009 to 2012. Fasting lipid profile, HOMA IR) and serum adiponectin levels were measured. NAFL was defined as ALT > 25 and >22 IU/mL (males and females respectively) and/or evidence of fatty infiltration by US. Logistic regression was performed to assess associations.Results97 children with obesity included in the study (Male 43%). Mean age was 12.9 ± 3.2 years (84% were older than 10 y). Mean BMI-Z score was 3.8 ± 1.4. NAFL was identified in 85%(82/97) of participants. ALT was elevated in 61% of patients. Median triglyceride (TG) level was higher in children with NAFL(1.5 ± 0.9 vs. 1.1 ± 0.5 mmol/L, p = 0.01). Total cholesterol, HDL, LDL and Non HDL cholesterol were similar in both groups(p = 0.63, p = 0.98, p = 0.72 and p = 0.37 respectively). HOMA IR was ≥3.16 in 53% of children(55% in those with NAFL and 40% in those without NAFL). Median serum adiponectin was 11.2 μg/ml(IQR 7.3–18.3) in children with NAFL vs. 16.1 μg/ml(IQR 9.0–21.9) in those without NAFL(p = 0.23). Liver US was reported as normal in 30%, mild fatty infiltration in 38%, moderate in 20% and severe in 12%. TG were significantly higher(1.5 mmol/L vs. 1.0 mmol/L, p < 0.01) and HDL-C was lower(1.0 mmol/L vs. 1.1 mmol/L, p = 0.05) in children with moderate and severe NAFL by US. BMI-Z score, HOMA IR, serum adiponectin and HDL levels were not associated with NAFL, however TG were significantly associated(OR = 3.22 (95% CI: 1.01–10.25, p = 0.04)).ConclusionNAFL is highly prevalent in obese children and youth. Elevated TG levels are associated with NAFL; these findings may serve as a noninvasive screening tool to help clinicians identify children with obesity needing liver biopsy and/or more aggressive therapeutic interventions.

Abstract P088: The Association of Religious Affiliation With Cholesterol Levels Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Background: South Asians have disproportionately high rates of cardiovascular disease. Dyslipidemia is a common and contributing factor. Objective: We hypothesized that lifestyle behaviors are influenced by religious beliefs and may be associated with cholesterol levels. We determined the associations between religious affiliation and LDL-cholesterol, HDL-cholesterol, and triglycerides among South Asians in the U.S. Methods: We performed cross-sectional analyses of the 2010-2013 baseline data from the MASALA study (n=906). Using multivariate linear regression models, we examined the associations between self-reported religious affiliation (Hinduism/Jainism, Sikhism, Islam, Other and None) and lipid levels after controlling for age, sex, and cholesterol medication use. We determined whether smoking, alcohol use, physical activity, and dietary pattern would explain the association. Results: The mean age was 55±9 years, 46% were women, and 29% were taking cholesterol medications. The majority of respondents were Hindu and/or Jain (74%), followed by 8% Sikh, 7% Islamic, 6% no religious affiliation, and 5% other (Christian, Buddhist, Zoroastrian, and multiple religious affiliations). The mean LDL was 111±32 mg/dl, median HDL was 48 mg/dl (IQR: 40-57), and median triglycerides was 119 mg/dl (IQR: 88-157). The table shows the associations of religious affiliation with lipid levels in serially adjusted models. The majority of the effect of religious affiliation was attenuated by physical activity for LDL; by alcohol use, physical activity and smoking for HDL; and by alcohol use and physical activity for triglycerides. Conclusions: Islamic religious affiliation was associated with higher LDL, triglycerides and lower HDL, and Hinduism was associated with lower HDL. However, lifestyle behaviors completely explained these associations. Thus, religion-specific tailoring of interventions designed to promote healthy lifestyle changes to reduce cholesterol levels among South Asians may be useful.