Non-fasting Total Cholesterol Research Articles

Sex differences in cholesterol and triglyceride levels among hospitalized adolescents and young adults with eating disorders.

To determine sex differences in cholesterol and triglyceride levels among adolescents and young adults hospitalized for medical complications of eating disorders. A retrospective electronic medical record review of patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical stabilization, between 2012 and 2020, was conducted. Non-fasting total cholesterol and triglycerides were collected; however, LDL and HDL levels were not available. Among 83 males and 441 females, mean ± SD age was 15.5 ± 2.8 years, 64.1% had anorexia nervosa, and admission percent median body mass index was 87.3 ± 13.9. The proportion of males and females with high total cholesterol (13.3% vs. 18.1%, Cramer's V = 0.05, p = .28) and high triglyceride levels (9.6% vs. 8.1%, Cramer's V = 0.02, p = .63) did not differ. Mean total cholesterol levels were higher in females compared to males (F 169.6 ± 41.1 mg/dL vs. M 154.5 ± 45.1 mg/dL, Cohen's d = 0.36, p = .003), although a majority were within the normal range. In adjusted linear regression models, male (compared to female) sex (B = -14.40, 95% CI -24.54, -4.27) and higher percent median body mass index (B = -0.33, 95% CI -0.60, -0.06) were associated with lower total cholesterol levels in adjusted models (R2 = 0.04). Building on prior work showing equally severe complications of eating disorders in males compared to females, we did not find sex differences in those presenting with high total cholesterol or triglycerides. Future research is needed to understand the pathophysiology and role of dyslipidemia in acute malnutrition, and the impact of nutritional rehabilitation and weight restoration. We found that the proportion of male and female adolescents and young adults hospitalized for medical complications of an eating disorder with high total cholesterol did not significantly differ. Although average total cholesterol levels were higher in female compared to male patients with eating disorders, a majority of these levels remained within the normal range. Patients with more severe malnutrition had a higher risk of elevated total cholesterol levels. Clinicians should consider monitoring cholesterol levels in young people hospitalized for restrictive eating disorders.

Screening for familial hypercholesterolaemia; extending a role for blood programs in promoting public health

Abstract Background Familial hypercholesterolaemia (FH) is a genetic disorder characterized by high levels of cholesterol with evidence of coronary arterial disease at an early age. The prevalence of FH has been recently reported as 1/200 to 1/250 in the general population and although early identification and treatment is recommended (2019 ESC/EAS Guidelines for the Management of Dyslipidaemias), the disorder is largely underdiagnosed in asymptomatic individuals.1 A number of blood programs has recognised the opportunity that blood donation provides to identify ostensibly healthy individuals who might be unaware of risks to their health. These programs have included, along with mandated serological testing, such assays as non-fasting total cholesterol (TC) and haemoglobin A1C. They have also taken steps to notify individuals whose results suggest risk for cardiovascular disease or diabetes. Purpose Since our blood donation program has a long history of providing donors information about their TC, we tested whether some donors with elevated TC met the criteria for FH. Methods We reviewed unlinked total non-fasting cholesterol results from volunteers donating between 2015 and June 2019. Cholesterols were measured on a chemistry analyzer system (Beckman Coulter AU680) on residual blood after routine testing for infectious disease markers. For volunteers donating more than once, we included only their highest TC recording. TC was classified by American Heart Association (AHA) 2020 Goal Metrics as high, if ≥240 mg/dL (6.2 mmol/L) in donors ≥20 years of age and ≥200 (5.1 mmol/L) in donors <20 years of age. 2 We applied the United States Center for Disease Control Cooperative MEDPED diagnostic criteria for FH. Using these criteria, FH is diagnosed when TC exceeds 270 mg/dL (7.0 mmol/L) in individuals less than 20, 290 mg/dL (7.5 mmol/L) in individuals 20 to 29, 340 mg/dL (8.8 mmol/L) in individuals 30 to 39, and 360 mg/dL (9.3 mmol/L) in individuals 40 years of age and older. 3 Results There were 432,389 unique donors during the study period. The overall prevalence of high cholesterol, 11.1% and the prevalence of FH 0.24% are similar to published data for the general population. As shown in the table, the prevalence of FH was highest in blood donors 20 to 29 years of age and was lower in those over 30 years, while the prevalence of high TC was higher in older age groups. Conclusion There is a subset of blood donors, at all ages who can be identified as satisfying familial hypercholesterolaemia criteria that could benefit from additional evaluation and family screening. A sizeable proportion of blood donors have high cholesterol despite not having FH. Funding Acknowledgement Type of funding sources: None.

Perfluoroalkyl substance mixtures and cardio-metabolic outcomes in highly exposed male workers in the Veneto Region: A mixture-based approach.

BackgroundPerfluoroalkyl substances (PFAS) have been consistently associated with cardio-metabolic traits. Occupational exposures to multiple PFAS with health outcomes have been poorly investigated. The aim of the present study was to examine these associations among former workers involved in PFAS production. MethodsWe considered 232 male ex-employees who had worked in a factory (Trissino, Veneto Region, Italy), which produced PFAS and other chemicals during 1968–2018. Out of twelve serum PFAS, only four (PFOA, PFOS, PFHxS, and PFNA) were quantifiable in at least 50% of samples. Non-fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. The associations between serum PFAS mixture and considered outcomes were assessed through linear regression mixed models and Weighted Quantile Sum (WQS) regression, adjusting for potential confounders. ResultsPFOA was detected at the highest level, with a median concentration (in ng/mL) of 80.8 (min-max: 0.35–13,033), followed by PFOS (median: 8.55, min-max: 0.35–343), PFHxS (median: 6.8, min-max: 0.35–597) and PFNA (median: 0.8, min-max: 0.35–5). We observed that each A quartile increase in the WQS index was positively associated with the levels of TC (β: 8.41, 95% IC: 0.78–16.0), LDL-C (β: 8.02, 95% IC: 1–15.0) and SBP (β: 3.21, 95% IC: 0.82–5.60). No association of serum PFAS concentration on HDL cholesterol and DBP emerged. WQS analyses revealed a major contribution of PFNA and PFHxS for the cholesterol levels, although PFOA reported the highest concentration. PFOA and PFOS emerged as chemicals of concern regarding the association with SBP. ConclusionsThe results showed a clear association between serum PFAS levels and markers of cardiovascular risk and support the importance of clinical surveillance of cardiovascular risk factors in population with a high exposure to PFAS, especially in the occupational setting.

Screening of Dyslipidemia and Obesity among Children in Zagazig University Hospitals

Background: Westerners are well aware of plasma lipid problems, which are becoming increasingly important in the Middle East. The European Expert Panel has advocated universal screening as a preferable approach of hypercholesterolemia screening as a part of the primary preventive effort. Objective: To assess the relation between dyslipidemia and its risk factors; age and body mass index. Patients and Methods: A cross-sectional study that included 357 of children who visited the Pediatrics General Outpatient Clinic at Zagazig University Hospitals. All subjects were subjected to full history taking, general examination, anthropometric measurements, blood pressure, and laboratory investigations including: non-fasting and fasting lipid profiles. Results: Non-fasting total cholesterol (TC) of ≥ 200 was (14.3%) and < 200 was (85.7%). Non-fasting (LDL) of ≥ 130 was (16.8%) and <130 was (83.2%). HDL category of < 40 was (61.3%) and ≥ 40 was (38.7%). There was no statistically significant difference between age, sex and lipid profiles. There was statistically significant positive correlation between non-fasting triglycerides (TG) and non-fasting HDL and non-fasting non-HDL-C. Conclusion: Obesity was associated with the prevalence of at least one abnormal lipid level. This highlights the importance of paying greater attention to the prevention of cardiovascular disease and obesity in children from an early age.

Per- and polyfluoroalkyl substances (PFAS) and non-fasting total cholesterol serum levels among New Jersey volunteer firefighters

BACKGROUND AND AIM: Increased serum levels of some PFAS have been reported among firefighters compared to the general population; we previously found increased levels of perfluorododecanoic acid (PFDoA), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) among a group of volunteer firefighters. PFAS exposure has been associated with adverse health outcomes in humans including dyslipidemia (i.e., abnormal amount of lipids in the blood). Previous studies of career firefighters have found an inverse or null relationship between serum PFAS levels and serum cholesterol. This association is less studied among volunteer firefighters. We examined whether serum PFAS levels among members of a volunteer department are associated with non-fasting total serum cholesterol levels. METHODS: The Firefighters Cancer Prevention Study (CAPS) enrolled consenting participants from a large suburban New Jersey fire department who completed a survey and provided blood samples. Serum was tested for 11 PFAS and non-fasting total cholesterol serum levels; PFAS detected in 50% of respondents were included (perfluorooctanesulfonic acid (PFOS), perfluorooctanoicacid (PFOA), PFNA, perfluorohexanesulfonic acid (PFHxS), PFDA, and PFDoA)). Serum PFAS and cholesterol levels were log transformed and their associations assessed using linear regression. Each PFAS was modeled separately adjusting for age, sex, education, and firefighter service years. RESULTS:The 135 study participants were majority male (94.8%) and non-Hispanic white (91.1%). Their average cholesterol level was 187.9 mg/dL. There was no association observed between the six PFAS serum concentrations and the non-fasting total cholesterol serum levels. The effect estimates for the association between PFAS and cholesterol ranged from -0.01 (95% CI (-0.07, 0.06) for PFHxS to 0.08 (-0.02, 0.17) for PFDoA. CONCLUSIONS:Consistent with findings in career firefighters, we did not observe significant positive associations between PFAS serum levels and total serum cholesterol. Further research is needed to explore associations between PFAS serum levels, cholesterol, and other health outcomes among volunteer firefighters. KEYWORDS: PFAS, Occupational Exposures, Occupational Epidemiology

Perfluoroalkyl substance mixtures and cardio-metabolic outcomes in highly exposed male workers in the Veneto Region: a mixture-based approach

BACKGROUND AND AIM: Perfluoroalkyl substances (PFAS) have been consistently associated with cardio-metabolic traits, associations of combined exposures to multiple PFAS with health outcomes in highly exposed populations have been poorly investigated. The aim of the present study was to examine these associations in male workers. METHODS: We considered a population of 232 male employees who had worked in a factory located in Trissino (Veneto, Italy), which produced PFAS and other chemicals during 1968-2018. Twelve serum PFAS were measured by HPLC-MS during 2018-2020; four (PFOA, PFOS, PFHxS and PFNA) were quantifiable in at least 50% of samples. Non-fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. The associations between PFAS mixtures and each outcome were assessed through weighted quantile sum (WQS) regression model, taking into account potential confounders. RESULTS:Among the PFAS, PFOA was detected at the highest level, with a median concentration of 80.75 ng/mL and maximum levels up to 13,000 ng/mL. We observed that each quartile increase in the WQS index was associated with an increase in the levels of TC (β: 9.05, 95% IC: 2.04-16.05), LDL-C (β: 6.79, 95% IC: 0.51-13.07) and SBP (β: 2.64, 95% IC: 0.49-4.79). No effect of PFAS exposure on HDL cholesterol and DBP emerged. WQS analyses revealed a major contribution of PFNA and PFHxS for the cholesterol levels, although the main exposure was due to PFOA. PFOS and PFOA emerged as chemicals of concern regarding the association with SBP. CONCLUSIONS:We found strong positive association between a mixture of four PFAS and total cholesterol levels in particular. Within the mixture PFNA and PFHxS were the most influential. Further work will adjust for other possible confounding factors and apply other approaches to assess chemical mixtures. KEYWORDS: PFAS, Mixtures, Cardiovascular disease, Chemical exposures, Occupational exposures

Impact of menopause on the associations between high exposures to perfluoroalkyl substances and lipid profile: a mixture-based approach

BACKGROUND AND AIM: During their reproductive years, females show lower serum PFAS concentrations than males, most likely due to menstrual excretion, previous childbirth with transplacental transfer of PFAS and breastfeeding. Also, females in pre-menopause age have lower levels of low-density lipoprotein cholesterol (LDL-C) and higher levels of high-density lipoprotein cholesterol (HDL-C) compared to males. So far, little is known of the impact of menopause on dose-response relationships. Given the possible role of estrogens in regulating lipid metabolism, there can be an interaction and the aim of our study is to evaluate if the associations of PFAS and serum lipids changes with aging, comparing women in pre- and post-menopausal age groups. METHODS: A cross-sectional analysis was conducted among highly exposed women, 14,155 mostly pre-menopausal and 4,165 mostly post-menopausal women, based on a cut-off of 50 years. Associations between four PFAS (PFOA, PFOS, PFHxS and PFNA) and non-fasting serum total cholesterol (TC), HDL-C and LDL-C, were assessed through weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) models, adjusting for potential confounders. RESULTS:We observed that each PFAS in the WQS index was associated with an increase in the levels of TC in both groups, and pre-menopausal women showed a larger increase of TC per quartile increase of PFAS mixture (4.63, 95% CI 3.46-5.79) than post-menopausal women (β:1.84, 95% CI 0.30-3.38), mainly driven by the effect on LDL-C. WQS analyses revealed a major contribution of PFOS and PFNA to the association with cholesterol levels, although the larger contrast being in PFOA for both groups. CONCLUSIONS:Investigations of combined exposures to four PFAS showed a strong positive association with all three serum lipid parameters. The large differences between pre- and post-menopausal women may reflect complex relationships between PFAS, estrogens and cholesterol. Analysis on menopausal timing are ongoing. KEYWORDS: PFAS, Mixtures, Chemical exposure, Female

Compatibility between an overnight fasting and random cholesterol tests in Asians

Recent Western guidelines recommend non-fasting lipid profiles to manage dyslipidaemia. We explored its applicability to an Asian population. We determined the differences between an overnight fasting and non-fasting cholesterol profiles of patients with type-2 diabetes mellitus (T2DM) in Singapore. We studied 470 multi-ethnic Asian adult patients with T2DM and dyslipidaemia from 2 primary care clinics in Singapore. Non-fasting blood specimens were collected within 6 h after their last meal and within 14 days of a fasting specimen. The intraclass correlation coefficient (ICC) was used to compare the intraindividual lipid profiles. An ICC value > 0.75 implies good correlation. The mean age and T2DM duration of the study population were 62.5 years and 9.8 years respectively. Their mean non-fasting period was 2.46 h. The mean differences between non-fasting and fasting total cholesterol (TC), high-density lipoprotein (HDL-C), triglyceride (TG), low-density lipoprotein (LDL-C), and non HDL-C were + 0.04 mmol/l, − 0.001 mmol/l, + 0.48 mmol/l, − 0.15 mmol/l, and − 0.05 mmol/l respectively. The ICC (95% CI) for TC, HDL-C, TG, LDL-C and non-HDL-C were 0.820 (0.788–0.847), 0.873 (0.850–0.893), 0.579 (0.516–0.636), 0.764 (0.723–0.799), and 0.825 (0.794–0.852) respectively. The fasting and non-fasting lipid profiles were similar in our local Asian patients with T2DM taking statin. Their non-fasting lipid profile can be used to assess their cholesterol treatment status.

The associations between perfluoroalkyl substances and lipid profile in an exposed young adult population in the Veneto Region

Background Residents of a large area of the Veneto Region (North-Eastern Italy) were exposed for decades to drinking water contaminated by perfluoroalkyl substances (PFASs). PFASs have been consistently associated with raised serum lipids, mainly in cross-sectional studies and in background exposure contexts, but the shape of the dose-response relationships has been poorly investigated. The objectives of our study were to evaluate the association between serum PFASs and serum lipids and its dose-response shape in a large exposed population.Methods A cross-sectional study was conducted in 16,224 individuals aged 20-39 years recruited in the Regional health surveillance program. 15,720 subjects were analysed after excluding pregnant women (n=327), participants reporting use of cholesterol lowering medications (n=67) or with missing information on the selected covariates (n=110). Twelve serum PFASs were measured by by HPLC-MS; three (PFOA, PFOS and PFHxS) were quantifiable in at least 50% of samples. Non-fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides were measured by enzymatic assays in automated analysers and low-density lipoprotein cholesterol (LDL-C), non-HDL cholesterol and total/HDL cholesterol ratio were calculated. The associations between ln-transformed PFASs and lipids were assessed through generalized additive models using smoothing thin plate splines. Potential confounders of the lipid/PFAS association were selected through directed acyclic graph.Results There were highly significant positive associations between the ln of PFOA, PFOS, and PFHxS and TC, HDL-C, and LDL-C. Significant but nonlinear association between ln PFOA and triglycerides was seen. Each ln-increase in PFOA was associated with an increase of 1.94 mg/dL (95% CI 1.48-2.41) in TC, with 4.99 mg/dL (CI 4.12-5.86) for PFOS and 2.02 mg/dL (CI 1.45-2.58) for PFHxS.Conclusions Investigations of the shape of exposure-response associations using smoothing splines show a positive non-linear association with the largest increases in cholesterol levels occurring at the lowest range of PFAS concentrations.

Associations between perfluoroalkyl substances and lipid profile in a highly exposed young adult population in the Veneto Region

BackgroundResidents of a large area of the Veneto Region (North-Eastern Italy) were exposed for decades to drinking water contaminated by perfluoroalkyl substances (PFAS). PFAS have been consistently associated with raised serum lipids, mainly in cross-sectional studies and in background exposure contexts, but the shape of the dose-response relationships has been poorly investigated. The objectives of our study were to evaluate the association between serum PFAS and serum lipids and their dose-response patterns in a large exposed population. MethodsA cross-sectional study was conducted in 16,224 individuals aged 20–39 years recruited in the regional health surveillance program. 15,720 subjects were analysed after excluding pregnant women (n = 327), participants reporting use of cholesterol lowering medications (n = 67) or with missing information on the selected covariates (n = 110). Twelve PFAS were measured by HPLC-MS in serum; three (PFOA, PFOS and PFHxS) were quantifiable in at least 50% of samples. Non-fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides were measured by enzymatic assays in automated analysers and low-density lipoprotein cholesterol (LDL-C), non-HDL cholesterol and total/HDL cholesterol ratio were calculated. The associations between natural log (ln) transformed PFAS and lipids were assessed through generalized additive models using linear regression and smoothing thin plate splines, adjusted for potential confounders. ResultsThere were strong positive associations between the ln-transformed PFOA, PFOS, and PFHxS and TC, HDL-C, and LDL-C, and between ln PFOA and PFHxS and triglycerides. Each ln-increase in PFOA was associated with an increase of 1.94 mg/dL (95% CI 1.48–2.41) in TC, with 4.99 mg/dL (CI 4.12–5.86) for PFOS and 2.02 mg/dL (CI 1.45–2.58) for PFHxS. ConclusionsInvestigation of the shape of exposure-response associations using splines showed a positive association with the largest increases per unit of PFAS in cholesterol levels occurring at the lower range of PFAS concentrations for each compound.

Perfluoroalkyl substances and lipid profile in exposed pregnant women in the Veneto Region, Italy

Abstract Background Perfluoroalkyl substances (PFASs) are persistent and widespread environmental pollutants. Residents of a large area of the Veneto Region (North-Eastern Italy) were exposed to high concentrations of PFASs through drinking water from the late-1970s to 2013. PFASs have been consistently associated with raised serum lipids, but only few studies have been conducted among pregnant women, and none has stratified analyses by trimesters of gestation. Our main objective was to evaluate the association between perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) levels and lipid profiles in high-exposed pregnant women. Methods A cross-sectional analysis was conducted in 319 pregnant women (age 14-48 years) recruited in the Regional health surveillance program. Serum PFASs were measured by HPLC-MS/MS. Non-fasting serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured by enzymatic assays in automated analysers, and low-density lipoprotein cholesterol (LDL-C) was calculated. The associations between ln-transformed PFASs (and categorized into quartiles) and lipids were assessed using generalized additive models. Analyses were adjusted for potential confounders and stratified according to pregnancy trimester. Results In the first trimester, plasma concentrations of both PFOA and PFOS were positively associated with TC. However in the third trimester PFOA levels were instead inversely significantly associated with TC and LDL-C levels. Overall, both PFOA and PFOS were positively associated with HDL-C, and PFOA negatively with LDL-C. Conclusions In a small highly exposed population of pregnant women, the associations between PFASs concentrations and lipid profile were modified by trimester of gestation. Patterns late in pregnancy were different to the positive associations with LDL-C generally found. Differential transfer and bioaccumulation of lipids and PFAS in the placenta across gestation might explain our findings. Key messages This study provides evidence of different patterns of PFAS associations with lipids in pregnant women across the trimesters of gestation. The different patterns of association from general population studies sheds light on the role of fetal nutrition during pregnancy affecting both lipids and PFAS in serum.

Comparison of fasting and non-fasting lipid profile in healthy adult population

Lipid profile is done in fasting blood specimen commonly, the reasons being: 1. Triglycerides remain elevated for several hours in postprandial state, 2. Reference range are established for fasting serum lipid profile.This study was proposed to compare the lipid profiles obtained in fasting and non-fasting conditions. If a reliable correlation between fasting and non-fasting lipid profile will be obtained, assay for lipids in non-fasting state may be adopted for clinical evaluation. This might help in reducing the difficulties faced in obtaining the sample in fasting state. This was a cross-sectional study, conducted from October 2011 to October 2013. Total of 200 subjects were included in the study. Two Samples were collected from each individual, one sample after 8-12 hours fasting and second sample in non-fasting state (random sample). Total cholesterol, Triglycerides, HDL-cholesterol were analyzed by standard methods and, LDL-cholesterol was calculated using Friedewald’s formula. Significant increase was observed in non-fasting Triglyceride and VLDL-C as compared to fasting samples in total population, but we observed significant difference in total cholesterol and LDL-C in total population. Significant reduction was observed in HDL-C in non-fasting state as compared to fasting state. Positive correlation was observed between fasting and non-fasting total cholesterol triglyceride, VLDL-C, HDL-C and LDL-C in the total population. Non-fasting sample can be used to measure Total cholesterol and HDL-C. Non-fasting sample can be used to measure triglyceride, VLDL-C and LDL-C provided reference intervals are established in non-fasting state for the same in larger population.

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Cardiovascular risk factors among people living with HIV in rural Kenya: a clinic-based study.

To determine the prevalence of cardiovascular risk factors and their association with antiretroviral therapy (ART) among HIV-infected adults in a rural sub-county hospital in Kenya. This was a descriptive survey of patient charts characterising cardiovascular risk among adult patients (> 18 years) at Ukwala sub-county hospital between June 2013 and January 2015. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios (AOR) for each variable related to cardiovascular risk factors were calculated using logistic regression models. Overall, the prevalence of diabetes mellitus was 0.4%, 0.3% of patients had had a previous cardiovascular event (heart attack or stroke), 40.4% had pre-hypertension, while 10.4% had stage 1 and 2.9% stage 2 hypertension. Up to 14% of patients had elevated non-fasting total cholesterol levels. Factors associated with hypertension were male gender (AOR 1.59, p = 0.0001), being over 40 years of age (AOR 1.78, p = 0.0001) and having an increased waist circumference (OR 2.56, p = 0.0014). Raised total cholesterol was more likely in those on tenofovir disoproxil fumarate (TDF) (AOR 2.2, p = 0.0042), azidothymidine (AZT) (AOR 2.5, p = 0.0004) and stavudine (D4T) -containing regimens (AOR 3.13, p = 0.0002). An elevated prevalence of undiagnosed cardiovascular risk factors such as hypertension and raised total cholesterol levels was found among people living with HIV. There was an association between raised total cholesterol and nucleoside reverse-transcriptase inhibitor (NRTI) -based ART regimens. Our findings provide further rationale for integrating routine cardiovascular risk-factor screening into HIV-care services.

233. Characteristics of Adolescents With PCOS As Diagnosed By The Rotterdam Criteria

Polycystic ovarian syndrome (PCOS) is challenging to diagnose during adolescence. Diagnostic criteria for adults are difficult to apply to adolescents in part because ultrasound criteria are based on adult data. This retrospective study aimed to assess and compare clinical, metabolic, and hormonal characteristics of adolescents diagnosed with PCOS who required ultrasound for diagnosis according to Rotterdam criteria to those of adolescents who did not. Two hundred forty-two females presenting to an outpatient adolescent medicine practice with complaints of irregular menses, hirsutism, or hyperandrogenism from June 2012-June 2016 were evaluated as a part of a quality improvement project. Inclusion criteria for the current study included age 13-25 years, physician diagnosis of PCOS, and availability of at least one laboratory result (n=176). Patients were divided into 3 groups: those diagnosed by clinical or biochemical hyperandrogenism and irregular menstruation (HA/IM, n=148); by hyperandrogenism and polycystic ovary morphology (PCOM) on ultrasound (HA/PCOM, n=10); or by irregular menstruation and PCOM (IM/PCOM, n=18). Data included clinical characteristics (age at evaluation, age at menarche, body mass index (BMI), blood pressure, acne score (range: 0-5), Ferriman-Gallwey (FG) score (range: 0-36), and hormonal measures (FSH, LH, prolactin, TSH, total testosterone, free testosterone, DHEAS, 17-hydroxyprogesterone). Metabolic measures obtained included non-fasting total cholesterol and HDL for those classified as low-risk and HbA1c with fasting total cholesterol, HDL, LDL, triglycerides, insulin, and glucose for those classified as high-risk (BMI > 30 kg/m2 and/or personal/family history of diabetes). Given the non-normal distribution of most measures, statistical comparisons between groups were performed using the non-parametric Wilcoxon rank sum test, with significance adjusted for multiple comparisons at p=0.017. Median age at evaluation was 16.0 years [inter-quartile range (IQR) = 2 years]. Median age at menarche was 12 years (IQR = 2 years). Median BMI for the entire cohort was 28.9 kg/m2; BMI was not significantly different between groups (HA/IM=29.3 kg/m2, HA/PCOM=25 kg/m2, and IM/PCOM=24 kg/m2). Significant differences were found between groups HA/IM and IM/PCOM for median acne scores (2 vs 1, p<0.01), FG scores (6 vs 3, p=0.01), median total testosterone (43 ng/dL vs 30 ng/dL, p<0.01) and free testosterone (7.9 pg/mL vs 5.2 pg/mL, p<0.01). There was a significant difference in median HbA1c for group HA/IM versus IM/PCOM (5.3% vs 5.1%, p=0.01) and a marginally significant difference in median HbA1c for group HA/PCOM versus HA/IM (5.9% vs 5.3%; p=0.04). The majority of adolescents (84%) evaluated did not require ultrasound for diagnosis of PCOS as they had already met 2 of the 3 Rotterdam criteria. Limited differences were found between diagnostic groups. Acne scores, FG scores, and testosterone concentrations were elevated in those with HA as expected. Additionally, those with HA had significantly higher HbA1c and trended towards greater BMIs, suggesting elevated cardiovascular risk in adolescents with HA. Further longitudinal studies looking into future cardiovascular health by PCOS diagnosis type in adolescence should be considered.

Household air pollution from biomass-burning cookstoves and metabolic syndrome, blood lipid concentrations, and waist circumference in Honduran women: A cross-sectional study

BackgroundHousehold air pollution from cooking with solid fuels affects nearly 3 billion people worldwide and is responsible for an estimated 2.5 million premature deaths and 77 million disability-adjusted life years annually. Investigating the effect of household air pollution on indicators of cardiometabolic disease, such as metabolic syndrome, can help clarify the pathways between this widespread exposure and cardiovascular diseases, which are increasing in low- and middle-income countries. MethodsOur cross-sectional study of 150 women in rural Honduras (76 with traditional stoves and 74 with cleaner-burning Justa stoves) explored the effect of household air pollution exposure on cardiovascular disease risk factors. Household air pollution was measured by stove type and 24-h average kitchen and personal fine particulate matter [PM2.5] mass and black carbon concentrations. Health endpoints included non-fasting total cholesterol, high-density lipoprotein, calculated low-density lipoprotein, triglycerides, waist circumference to indicate abdominal obesity, and presence of metabolic syndrome (defined by current modified international guidelines: waist circumference ≥ 80 cm plus any two of the following: triglycerides > 200 mg/dL, HDL < 50 mg/dL, systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 85 mmHg, or glycated hemoglobin > 5.6%). ResultsForty percent of women met the criteria for metabolic syndrome. The prevalence ratio [PR] for metabolic syndrome (versus normal) per interquartile range increase in kitchen PM2.5 and kitchen black carbon was 1.16 (95% confidence interval [CI]: 1.01–1.34) per 312 μg/m3 increase in PM2.5, and 1.07 (95% CI: 1.03–1.12) per 73 μg/m3 increase in black carbon. There is suggestive evidence of a stronger effect in women ≥ 40 years of age compared to women < 40 (p-value for interaction = 0.12 for personal PM2.5). There was no evidence of associations between all other exposure metrics and health endpoints. ConclusionsThe prevalence of metabolic syndrome among our study population was high compared to global estimates. We observed a suggestive effect between metabolic syndrome and exposure to household air pollution. These results for metabolic syndrome may be driven by specific syndrome components, such as blood pressure. Longitudinal research with repeated health and exposure measures is needed to better understand the link between household air pollution and indicators of cardiometabolic disease risk.

The cut-off values for non-fasting routine lipid parameters in presumably healthy 9–11-year-old children

Disorders of lipid metabolism cause accelerated atherosclerosis and increase cardiovascular risk, which is why lipid profile screening, especially at a young age, should be widely applied. Aim. The aim of the study was to determine the cut-off points for non-fasting lipid parameters in presumably healthy children aged 9-11 years. Material and methods. The study was performed with the use of blood samples taken in non-fasting state from 289 school children of both sexes (152 girls and 137 boys). Routine lipid profile was assessed: TC, LDL-C, HDL-C, and triglycerides. Laboratory measurements were performed in serum samples using a biochemical autoanalyser. Results. In this study we determined the 97.5 percentile values for TC, LDL-C, and triglycerides and the 2.5 percentile values for HDL-C. The upper cut-offs for TC, LDL-C, and triglycerides were found to be 239 mg/dL, 163 mg/dL, and 284 mg/dL, respectively, and the lower cut-off for HDL-C was 37 mg/dL. Conclusions. The upper range of non-fasting total cholesterol was higher by about 30 mg/dL compared to fasting state for a similar age range; the cut-off points in non-fasting children for LDL-C and TG were also higher. The lower cut-off for HDL-C was similar compared to fasting state for the respective age range. The determination of the non-fasting cut-off values for routine lipid profile in the paediatric population is essential for the proper evaluation of the cardiovascular risk because using the reference values for adults may cause an incorrect interpretation of the laboratory results.

Abstract P093: Correlates of Vascular Health in Children and Adolescents With Dyslipidemia

Introduction: Impaired vascular function and structure has been associated with cardiovascular risk factors such as elevated levels of Low Density Lipoprotein cholesterol (LDL-C) and triglycerides, depressed High Density Lipoprotein cholesterol (HDL-C), elevated blood pressure (BP) and body mass index (BMI) in children and young adults. These changes can result in premature coronary artery disease. The degree to which these measures predict vascular damage in children and adolescents is less clear. Hypothesis: We hypothesized that commonly used clinical and laboratory measures will predict vascular health as assessed by measures of carotid artery intima-media thickness (CIMT), pulse wave velocity (PWV), and augmentation index (Aix) in at risk youth. Methods: Children and adolescents with dyslipidemia (n=120, 13.1 ± 1.9 years old, 49% female (59 of 120)) were recruited from a pediatric preventive cardiology clinic. Non-fasting total cholesterol, HDL cholesterol, and triglycerides were obtained prior to the clinic visit. LDL-C and non-HDL-C were calculated with the Martin equation. Remnant particles were calculated as: total cholesterol minus (HDL-C + LDL-C). BP, height, weight, and waist circumference (WC) were measured at the clinic visit. WC was measured 2cm above the iliac crest by a single observer. Tobacco smoke exposure history was obtained using a parent questionnaire. PWV and Aix were measured using a SphygmoCor XCEL combined oscillometric and tonometric device. CIMT was measured via B mode ultrasound on the far wall of the left and right common carotid arteries using a semi-automated edge detection software. Multiple linear regression with backwards selection was used to identify the strongest predictors of CIMT, PWV, and normalized Aix. Results: Age (β=0.26; p=0.002), systolic BP (β=0.16; p=0.04), waist-to-height ratio (β=0.24; p=0.01), hemoglobin A1c (β=0.18; p=0.01) and presence of hypertriglyceridemic waist (defined as triglycerides ≥110mg/dL and WC ≥90 percentile) (β=0.28; p=0.006) were the strongest predictors of PWV (R2=0.353). Diastolic BP (β=0.21; p=0.01), waist-to-height percentile (β=0.22; p=0.01), and remnant particles (β=0.21; p=0.01) were the strongest predictors of normalized Aix (R2=0.175). Age (β=0.19; p=0.03), and systolic BP (β=0.28; p=0.002) were the strongest predictors of CIMT (R2=0.138). Triglycerides, history of tobacco smoke exposure, total cholesterol, LDL-C, HDL-C, and non-HDL-C were not predictive of CIMT, PWV, or normalized Aix. Conclusion: BP consistently predicted was the most common predictor of CIMT, PWV, and Aix in children and adolescents with dyslipidemia. Waist-to-height ratio/percentile was also a reliable predictor in both PWV and Aix. BP and abdominal obesity management should be a focus in this at risk population.

Fasting or Non-fasting Lipids for Atherosclerotic Cardiovascular Disease Risk Assessment and Treatment?

Dyslipidemia is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD); however, lipid testing for risk assessment and treatment surveillance has been underutilized. Several factors likely account for this, including the common practice of measuring lipid levels in the fasting state, which often necessitates that patients return for an additional visit. In this review, we evaluate potential advantages and cautions associated with measuring lipids in the non-fasting state. There is similar performance with the use of either fasting or non-fasting total cholesterol and HDL cholesterol in ASCVD risk assessment. Observational studies demonstrate that in comparison to fasting levels, non-fasting triglycerides are approximately 20% higher on average, although the magnitude of difference is subject to substantial inter-patient variability. Higher triglycerides can lead to the under-estimation of low-density lipoprotein cholesterol (LDL-C) by approximately 10mg/dL or more when calculated using the Friedewald equation. This is especially clinically relevant at low LDL-C levels, although a novel validated algorithm for LDL-C estimation largely overcomes this limitation. Non-fasting lipid assessment is reasonable in many clinical circumstances given that ASCVD risk prediction is similar using fasting or non-fasting lipid values and because LDL-C can be accurately estimated using modern methods. Allowing the option for non-fasting lipid assessment can reduce a barrier to lipid testing and can facilitate a more convenient assessment of ASCVD risk with the ultimate potential effect of reducing the global burden of ASCVD. However, certain patients such as those with severe hypertriglyceridemias or high-risk patients being treated to low LDL-C levels may still need fasting lipid panels performed for precise diagnosis and to standardize therapeutic monitoring.

Relationship between 25 hydroxyvitamin D and lipid profile in Lebanese school children.

Limited information is available regarding the association of vitamin D and lipid profile in pediatric populations. The objective of this cross-sectional study is to determine the prevalence of vitamin D deficiency in a large sample of Lebanese schoolchildren and to evaluate the relationship between vitamin D and lipid profile. 969 Lebanese schoolchildren (505 boys and 464 girls) aged 8-18years were recruited from 10 schools of different socioeconomic status (SES). Non-fasting total cholesterol, triglycerides and HDL-Cholesterol (HDL-C) were measured. Non-HDL-C was calculated. The prevalence of 25(OH)D deficiency (level below 20ng/ml) is 56.6% (48.1% in boys, 65.7% in girls). There is no significant relationship between 25(OH)D levels and age. 25(OH)D is inversely correlated with BMI in the total population, and in boys and girls (p<0.0001, p=0.001 and p=0.001, respectively) and is higher in children from high SES schools and during the summer season (p<0.0001 in both cases). 25(OH)D is inversely correlated with triglycerides and non-HDL-C in the total population and in boys and girls (p<0.0001 for all), and positively correlated with HDL-C in the total population and in boys but not in girls (p=0.001, p<0.0001 and p=0.1, respectively). In a multilinear regression analysis, in the overall population, 25(OH)D is independently associated with sex, season, school's SES, BMI, triglycerides and non-HDL-C. In boys, the association with BMI and season is non-significant. An independent relationship is observed between 25(OH)D and cardiometabolic risk factors in the pediatric Lebanese population Further studies are needed to evaluate the long-term consequences of this relationship.