Prevalence Of Low High-density Lipoprotein Cholesterol Research Articles

Abnormal HDL lipid and protein composition following pediatric cancer treatment: an associative study

BackgroundLong-term childhood cancer survivors (CCS) are at high risk of having dyslipidemia including low high density lipoprotein cholesterol (HDL-C). However, little is known about the prevalence of low HDL-C and the impact of therapy exposure on HDL composition early after treatment is terminated.MethodsThis associative study included 50 children and adolescents who had completed their cancer treatments (< 4 years). Clinical characteristics (demographic, diagnosis, treatment, anthropometric parameters), fasting plasma lipids, apoliporoteins (Apo) A-I and composition of HDL fractions (HDL2 and HDL3) were assessed. Data were stratified according to the presence of dyslipidemia and median doses of therapeutic agents and compared using Fisher exact or Mann–Whitney tests. Univariate binary logistic regression analyses were carried out to evaluate the associations between the clinical and biochemical characteristics and having low HDL-C. Composition of HDL2 and HDL3 particles was assessed in a sub-group of 15 patients and compared to 15 age- and sex-matched healthy controls using Wilcoxon paired test.ResultsOf the 50 pediatric cancer patients included in this study (mean age: 11.30 ± 0.72 y; mean time since end of treatment: 1.47 ± 0.12 y; male: 38%), 8 had low HDL-C (16%), all of which were adolescent at diagnosis. Higher doses of doxorubicin were associated with lower HDL-C and Apo A-I levels. In hypertriglyceridemic patients and compared to normolipidemics, triglycerides (TG) content was greater in HDL2 and HDL3 fractions whereas esterified cholesterol (EC) content was lower in HDL2. Enrich TG content of HDL3 and lower EC of HDL2 was found in patients exposed to ≥ 90 mg/m2 doxorubicin. Factors positively associated with the risk of having low HDL-C were age, being overweight or obese and exposure to doxorubicin ≥ 90 mg/m2. Compared to healthy controls, a sub-group of 15 patients showed higher TG and free cholesterol (FC) content of HDL2 and HDL3 and lower EC content in HDL3.ConclusionsOverall, we found abnormalities in HDL-C and Apo A-I levels and in HDL composition early after pediatric cancer treatment that are influenced by age, overweight or obesity status and exposure to doxorubicin.

Prevalence of low high-density lipoprotein among young adults receiving antiretroviral therapy in Zambia: An opportunity to consider non-communicable diseases in resource-limited settings.

BackgroundWith the introduction of effective antiretroviral therapy (ART), people living with HIV (PLWH) are surviving longer and are at risk for developing metabolic abnormalities that contribute to cardiovascular disease (CVD). In Sub-Saharan Africa (SSA), there is a paucity of epidemiological data on lipid profiles among young adults receiving ART. This study aimed to estimate the prevalence of low high-density lipoprotein cholesterol (HDL-c), a cardioprotective lipid class, and whether it differed by age among adults on ART in Livingstone, Zambia.MethodsFrom April to December 2019, we conducted a cross-sectional study of 597 PLWH [n = 58 aged 18–24 years (young adults); n = 539 aged ≥25 years (adults)] on ART for ≥6 months. Data collected included demographic and lifestyle information, anthropometrics, viral load (VL), CD4 count, blood pressure, lipid profiles and fasting/random blood glucose. Clinical measures were defined as: low HDL-c [<1.0 mmol/L for men, <1.3 for women], increased waist circumference (WC) [≥94 cm for men, ≥80 cm for women], high triglycerides (TG) [≥1.7 mmol/l], and virological failure (VF) [VL ≥1000 copies/μl]. We used logistic regression to examine the association between age and low HDL-c after adjusting for multiple variables.ResultsAmong the young adults, 60% (35/58) were women, median (25th, 75th percentile) age 21 years (18, 23), and median time on ART 116 months (60, 144). Among adults, 63% (342/539) were women, median age 46 years (40, 53) and median time on ART 108 months (60, 144). Young adults had a lower CD4 count compared to adults (median, 492 vs. 568 cells/μL, p = 0.010) and higher prevalence of VF (29% vs. 17%, p = 0.016). In young adults, prevalence of low HDL-c was significantly higher than in adults (63 vs. 38%, p<0.001). A high proportion of young adults (75%) and adults (58%) with low HDL-c were on dolutegravir (DTG)-based ART regimens. After adjusting for sex, duration on ART, WC, body mass index, ART regimen, VF, CD4 count, low density lipoprotein cholesterol, blood pressure and smoking, young adults were significantly more likely than adults to have low HDL-c (odds ratio 2.93; 95% confidence interval 1.46–5.86).ConclusionLow HDL-c is highly prevalent among young adult with HIV in SSA independent of other risk factors for metabolic derangements. Lipid abnormalities among young PLWH may contribute to the early development of cardiovascular diseases in this population. This highlights the need to consider low HDL-c in the quest to reduce CVD risk among young adults on ART in SSA.

Thirty year trends in cardiovascular risk factors prevalence among Siberian adolescents (1989-2019)

Abstract Background Aim of the study was to assess trends of cardiovascular risk factors among Siberian adolescents during the last 30 years including period of Russian reforms (1989-2019). Methods Seven cross-sectional surveys of representative samples of school children aged 14-18 since 1989 (every 5 years) were carried out. Body mass index (BMI), systolic and diastolic blood pressure, serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured. Self-reported smoking and physical activity rates were obtained. To define overweight the sex- and age-specific IOTF cutoffs for BMI were used. Hypertension (HT) and lipid disorders were revealed according to international criteria. Results Prevalence of high TC significantly decreased from 22 to 4% (p &amp;lt; 0,01) in males and from 32 to 17% (p &amp;lt; 0,05) in females. High LDL-C showed similar trends. Prevalence of low HDL-C was stable with some fluctuations. In the period of Russian reforms (1989-1999) the prevalence of overweight significantly decreased from 12% in boys and from 14% in girls in 1989 to 4% in 1999 (p &amp;lt; 0,01). Since 2003 rapid increasing of overweight was observed. Trends of HT have shown double decreasing during the reform period and stabilization in the post-reform time. So, since 2003 discordant trends in HT and overweight were revealed. Physical activity was stably low in boys (49-55%) and girls (83-73%). Average weekly screen time doubled from 15 (2009) to 30 h/w (2019), p &amp;lt; 0,05. Cigarette smoking rates in boys dramatically decreased from 45% (1989) to 3% (2019), in girls - from 19% to 5% (p &amp;lt; 0,01). Smoking of electronic devices was registered in 2019: 6% among boys and 3% among girls. Conclusions Obtained data indicate on trends to reduction in CVD risk profile among Siberian adolescents during the period of Russian reforms. Discordant trends of HT and overweight were revealed. The study was supported by RFBR grant 19-013-00800. Key messages Long time changes in cardiovascular risk profile among Siberian adolescents were registered. Against the background of a decrease in combustible smoking among adolescents, electronic smoking began to register.

6-Year trends in lipids among adults in Shenzhen, China.

There may be a beneficial effect on lipid levels in Shenzhen in recent years. In this study, we aimed to examine trends in serum lipids in population in Shenzhen between 2009 and 2015. We enrolled 2210 adults aged 18-70 years from two independent cross-sectional studies conducted in 2009 and 2015. Blood lipid profiles, such as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), were measured. Chi-square test, t-test and multivariate logistic regression analysis were applied for data analysis. From 2009 to 2015, mean LDL-C declined from 3.05±0.76 mmol/L in 2009 to 2.27±0.75 mmol/L in 2015 (P<0.001). Similarly, a significant 7.09% decrease in the prevalence of high LDL-C was observed over the same period (P<0.001). There was an increasing trend in the prevalence of low HDL-C among adults in Shenzhen (P<0.001). A no-significant increase in prevalence of dyslipidemia was also observed over this 6-year interval (P=0.139). The prevalence of dyslipidemia was closely related with increasing age, male gender, current smoker, diabetes, obesity and overweight. This study shows a favourable downward trend in LDL-C concentration in Shenzhen. However, more intense strategies are needed to control dyslipidemia.

Lipid profile and prevalence of dyslipidemia in urban women of Jaipur district, Rajasthan, India

Purpose – The purpose of this study is to investigate the lipid profile and prevalence of dyslipidemia, as serum lipid levels have a major contribution in the development of cardiovascular diseases, in adult urban women of Jaipur district, Rajasthan, India. Design/methodology/approach – A house-to-house survey was done in four urban locations, and 501 women in the age group of 35-70 years were enrolled in the study. A general questionnaire was used to gather background information and general health status. Fasting blood samples were collected to determine the level of serum triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol. Dyslipidemia was assessed based on the criteria given in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP ATP-III). Findings – Mean age of the women was 45.63 ± 9.91 years. Population mean levels of TC, LDL-C, HDL-C and TGs were 183.9 ± 15.3, 111.8 ± 18.0, 44.0 ± 6.2 and 140.6 ± 30.9 mg/dl, respectively. Prevalence of overweight and obesity was 33.9 and 18.7 per cent, respectively. Of a total of 500 subjects, 13.8 per cent had TC = 200 mg/dl, 12.6 per cent had LDL = 130 mg/dl, 85.4 per cent had HDL-C &lt; 50 mg/dl and 23.0 per cent had TG = 150 mg/dl. An increase in serum lipids was most prominent in the 40-59 year age group. Originality/value – High prevalence of overweight and obesity was observed in the community. Prevalence of low HDL-C was very high among the subjects.

Composition of Metabolic Syndrome Among Korean Adults in a Lifestyle Modification Intervention

ObjectivesThe aim of this study was to examine the composition of metabolic syndrome (MetS) components among middle-aged and older Koreans. MethodsA total of 263 participants (age 40 + years) in a lifestyle modification intervention program who met the MetS definition of National Cholesterol Education Program (NCEP) – Adult Treatment Panel (ATP) III criteria were included in the study. The frequent patterns and clustering of MetS components were investigated. Clustering of changes in individual components, through a lifestyle modification intervention, was also identified. All characteristics were stratified by and compared between sexes. ResultsApproximately 80% of the participants had three of five MetS risk factors at baseline. The prevalence of each risk differed by sex. MetS composition patterns that do not include low high-density lipoprotein (HDL) cholesterol were more noticeable in men because of the low prevalence of low HDL cholesterol. In women, with higher prevalence of low HDL cholesterol, more patterns that include low HDL cholesterol were observed. The most common combination was “elevated blood pressure + abdominal obesity + impaired fasting glucose” in both sexes. Clustering of MetS risks was also found with most of the frequent combinations of MetS components. Through the lifestyle intervention, the greatest change was observed in HDL cholesterol among men and blood pressure among women. Triglycerides and HDL cholesterol were likely to be improved with blood pressure in men and abdominal obesity in women. ConclusionDifferences in the prevalent patterns of MetS compositions were observed prior to and after the intervention, along with during-intervention changes. It is recommended that intervention strategies and guidelines for MetS management consider the MetS composition patterns for effectiveness.

Improvement in High-Density Lipoprotein Cholesterol Levels in Argentine Indian School Children after Vitamin D Supplementation

Background/Aims: Low vitamin D levels correlate with dyslipidemia, but limited data exist on indigenous children. The objective was to determine whether vitamin D supplementation improves high-density lipoprotein cholesterol (HDL-C) levels among Koya children. Methods: A prospective 1-year study evaluated a treated cohort of 70 (38 males) children aged 10.3 ± 2.1 years who received 5,000 U of vitamin D weekly during 8 weeks, and a control group of 20 (8 males) children aged 9.2 ± 1.1 years who did not receive vitamin D. Results/Conclusions: At baseline, 18 (20%) had severe vitamin D deficiency (<10 ng/ml), 66 (73.3%) had deficiency (10 to <20 ng/ml), and 6 (6.6%) had insufficiency (20 to <30 ng/ml). At baseline, there was no significant difference in the prevalence of hypovitaminosis D between groups. After 1 year, the prevalence of severe vitamin D deficiency decreased from 20 to 0%, and that of insufficiency increased from 6 to 19% (p < 0.001) only in the treated group. The prevalence of low HDL-C also decreased in the treated group only (35.7-5.7%; p < 0.01). Multiple linear regression analysis showed that treated children improved HDL-C levels by 4 mg/dl (R²: 0.13) adjusted for confounding factors, suggesting that vitamin D supplementation among Indian children improved HDL-C levels.

Cholesterol Efflux Capacity

High-density lipoprotein cholesterol (HDL-C) levels represent a robust and well-integrated biomarker of cardiovascular risk. The prevalence of low HDL-C is high and likely to increase in coming years in parallel with the epidemic of obesity and type 2 diabetes mellitus. However, the clinical efficacy of raising plasma HDL-C levels to achieve cardiovascular risk reduction has been difficult to prove. Recently published outcomes trials involving the addition of niacin or dalcetrapib to standard low-density lipoprotein cholesterol reduction therapy failed to demonstrate clinical benefit despite increases in HDL-C.1,2 Furthermore, genetic variants associated with increased HDL-C, thus conferring lifelong exposure to higher circulating levels, are not consistently associated with improved vascular outcomes.3 These findings have reinforced the idea that changes in HDL-C levels are an inadequate surrogate for therapeutic use. See accompanying article on page 1696 The notion of HDL functionality has circulated in the field for years based on known heterogeneity in lipid content, protein cargo, and size across HDL particles.4 For example, assays that quantify apoptotic pathway activation, endothelial vasomotor effects, and antioxidant properties have suggested HDL functional impairment in cardiometabolic disease states.5–7 Although the relative mechanistic contributions of HDL-mediated atheroprotection remain unclear, the role of HDL in macrophage reverse cholesterol transport is thought to play a key role. This pathway involves efflux of cholesterol from macrophages (such as those within atherosclerotic plaque) to HDL acceptor particles for ultimate return to the liver and biliary excretion.8 Animal studies have suggested that flux through this pathway is a better predictor of the atherosclerotic impact of various genetic and pharmacological perturbations than static, mass-based quantification of circulating HDL-C.9 Rothblat et al10 pioneered methodologies allowing assessment of the cholesterol efflux capacity of human serum or HDL, the basic premise of which is that …

Trends in serum lipids among US youths aged 6 to 19 years, 1988-2010.

For more than 20 years, primary prevention of coronary heart disease has included strategies intended to improve overall serum lipid concentrations among youths. To examine trends in lipid concentrations among youths from 1988-1994 through 2007-2010. Cross-sectional analysis of serum lipid concentrations among 16,116 youths aged 6 to 19 years who participated in the nationally representative National Health and Nutrition Examination Survey during 3 time periods: 1988-1994, 1999-2002, and 2007-2010. Among all youths, mean serum total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C); and among adolescents only, low-density lipoprotein cholesterol (LDL-C) and geometric mean triglyceride levels. Trends in adverse lipid concentrations are reported for TC levels of 200 mg/dL and greater, non-HDL-C levels of 145 mg/dL and greater, HDL-C levels of less than 40 mg/dL, LDL-C levels of 130 mg/dL and greater, and triglyceride levels of 130 mg/dL and greater. Among youths aged 6 to 19 years between 1988-1994 and 2007-2010, there was a decrease in mean TC (from 165 mg/dL [95% CI, 164-167] to 160 mg/dL [95% CI, 158-161]; P < .001) and a decrease in the prevalence of elevated TC (from 11.3% [95% CI, 9.8%-12.7%] to 8.1% [95% CI, 6.7%-9.5%]; P = .002). Mean HDL-C significantly increased between 1988-1994 and 2007-2010, but the prevalence of low HDL-C did not change. Mean non-HDL-C and prevalence of elevated non-HDL-C both significantly decreased over the study period. In 2007-2010, 22% (95% CI, 20.3%-23.6%) of youths had either a low HDL-C level or high non-HDL-C, which was lower than the 27.2% (95% CI, 24.6%-29.7%) in 1988-1994 (P = .001). Among adolescents (aged 12-19 years) between 1988-1994 and 2007-2010, there was a decrease in mean LDL-C (from 95 mg/dL [95% CI, 92-98] to 90 mg/dL [95% CI, 88-91]; P = .003) and a decrease in geometric mean triglycerides (from 82 mg/dL [95% CI, 78-86] to 73 mg/dL [95% CI, 70-76]; P < .001). Prevalence of elevated LDL-C and triglycerides between 1988-1994 and 2007-2010 also significantly decreased. Between 1988-1994 and 2007-2010, a favorable trend in serum lipid concentrations was observed among youths in the United States but almost 1 in 10 had elevated TC in 2007-2010.

Isolated Low Levels of High-Density Lipoprotein Cholesterol Are Associated With an Increased Risk of Coronary Heart Disease

Background— Previous studies have suggested that there is a novel dyslipidemic profile consisting of isolated low high-density lipoprotein cholesterol (HDL-C) level that is associated with increased risk of coronary heart disease, and that this trait may be especially prevalent in Asian populations. Methods and Results— Individual participant data from 220 060 participants (87% Asian) in 37 studies from the Asia-Pacific region were included. Low HDL-C (HDL &lt;1.03 mmol/L in men and &lt;1.30 mmol/L in women) was seen among 33.1% (95% confidence interval [CI], 32.9–33.3) of Asians versus 27.0% (95% CI, 26.5–27.5) of non-Asians ( P &lt;0.001). The prevalence of low HDL-C in the absence of other lipid abnormalities (isolated low HDL-C) was higher in Asians compared with non-Asians: 22.4% (95% CI, 22.2–22.5) versus 14.5% (95% CI, 14.1–14.9), respectively ( P &lt;0.001). During 6.8 years of follow-up, there were 574 coronary heart disease and 739 stroke events. There was an inverse relationship between low HDL-C with coronary heart disease in all individuals (hazard ratio, 1.57; 95% CI, 1.31–1.87). In Asians, isolated low levels of HDL-C were as strongly associated with coronary heart disease risk as low levels of HDL-C combined with other lipid abnormalities (hazard ratio, 1.67 [95% CI, 1.27–2.19] versus 1.63 [95% CI, 1.24–2.15], respectively). There was no association between low HDL-C and stroke risk in this population (hazard ratio, 0.95 [95% CI, 0.78 to 1.17] with nonisolated low HDL-C and 0.81 [95% CI, 0.67–1.00] with isolated low HDL-C). Conclusion— Isolated low HDL-C is a novel lipid phenotype that appears to be more prevalent among Asian populations, in whom it is associated with increased coronary risk. Further investigation into this type of dyslipidemia is warranted.

Increased Prevalence of low High-density Lipoprotein Cholesterol (HDL-C) Levels in Korean Adults: Analysis of the Three Korean National Health and Nutrition Examination Surveys (KNHANES 1998–2005)

ObjectivesHigh-density lipoprotein cholesterol (HDL-C) is an independent risk factor for cardiovascular diseases that has shown a remarkable increase, but little is known about the prevalence of low HDL-C in Korea. This study aimed to evaluate changing trends of low HDL-C prevalence, and indicate other risk factors associated with low HDL-C. MethodsWe selected subjects aged ≥20 years from the Korean National Health and Nutrition Examination Survey (KNHANES) 1998, 2001, and 2005 (n = 7962, 6436, and 6412). The mean level of HDL-C and the prevalence of low HDL-C was calculated, and cardiovascular risk factors associated with low HDL-C, as well as demographic, anthropometric, lifestyle, and nutrition factors, were assessed using the KNHANES 2005 data. ResultsMean HDL-C levels in men and women between KNHANES 1998 and 2005 decreased significantly, from 48.1 to 42.3 and from 51.6 to 47.1 mg/dL, respectively (both p < 0.001). The decrease was slightly less for women compared with men for the same period, and women had higher HDL-C levels at all periods. Covariate-adjusted OR revealed that body mass index, waist circumference, and non-alcohol drinker in both men and women were associated with low HDL-C levels by KNHANES 2005, as were employed and light physical activity in men and low fat intake in women. ConclusionThe prevalence of low HDL-C increased significantly from KNHANES 1998 to 2001 and 2005 (p < 0.001) in both men and women. body mass index, waist circumference, and non-alcohol drinker were identified as associated with low HDL-C in Korean adults.

Low High Density Lipoprotein Cholesterol: Prevalence and Associated Risk-Factors in a Large French Population

High density lipoprotein-cholesterol (HDL-C) is a strong predictor of cardiovascular risk. We investigated the distribution of HDL-C in a French general population according to age, sex, and the risk factors associated with low HDL-C values. A group of 18,483 men and 22,047 women 16-79 years of age were investigated during a medical check-up. Relevant parameters were studied in three groups according to age and gender-specific percentile classes (≤5th [HDL₅] median and >95th). Gender-specific logistic regression models selected variables associated with HDL₅. Using the National Cholesterol Education Program Adult Treatment Panel III criteria (threshold: 40 mg/dL in men, 50 mg/dL in women) the prevalence of low HDL-C was 11.1% and 26.4% in men and women and it decreased with age. Mean HDL-C levels increased with age. HDL₅ was positively associated with a sedentary lifestyle and deprivation (p < 0.00001) even after adjustment on alcohol consumption and smoking. Abdominal obesity, smoking, hypertriglyceridemia, hyperleucocytosis, and low alcohol consumption were associated with HDL₅ for both genders. The prevalence of low HDL-C was similar to that observed in other Europeans but lower than in the United States. HDL₅ was associated with cardiovascular risk factors, metabolic syndrome, and social deprivation. A prevention policy to increase HDL-C levels should focus on reducing smoking and abdominal obesity, particularly in deprived subjects.

Prevalence of Metabolic Syndrome, Insulin Resistance, Impaired Fasting Blood Glucose, and Dyslipidemia in Uygur and Kazak Populations

This study was designed to evaluate the prevalence of the metabolic syndrome (MetS), impaired fasting blood glucose (IFG), insulin resistance (IR), hypertriglyceridemia (HTG), and low high-density lipoprotein cholesterol (HDL-C) in adult Uygur and Kazak populations. Questionnaires, blood pressure, anthropometric measurement, and fasting glucose were evaluated. The age-adjusted prevalence of MetS and IFG was 3.43- and 1.47-fold higher, respectively, in Uygurs compared with Kazaks. The prevalence of IR and HTG was 1.33- and 2.22-fold higher, respectively, in Uygurs compared with Kazaks. In addition, the prevalence of low HDL-C was 4.05-fold higher in Uygurs compared with Kazaks. These data depicted greater risk for cardiometabolic syndrome in Uygurs compared with Kazaks. In addition, all prevalence with the exception of low HDL-C was greater in men compared with women in both ethnic groups. For body mass index (BMI)<24, 24 to 28, and ≥28 kg/m2, the prevalence of MetS, HTG, and low HDL-C was higher in Uygurs than Kazaks at the same BMI level. For individuals with a BMI between 24 and 28, the prevalence of IR but not IFG was significantly greater in Uygurs than Kazaks. At BMI≥28, neither IFG nor IR was overtly different between the two ethnic groups.

Distinct Ethnic Differences in Lipid Profiles across Glucose Categories

Dyslipidemia coexists with hyperglycemia. However, little is known about the ethnic differences in lipid profiles at comparable glucose tolerance status. The aim was to study ethnic differences in lipid profiles stratified by glucose levels. Data from 31 study cohorts of 12 countries, consisting of 24,760 men and 27,595 women aged 25-74 yr, were compared. The odds ratio for having dyslipidemia was estimated for each ethnic group stratified by glucose categories. Compared with central and northern Europeans, multivariable adjusted odds ratios (95% confidence intervals) for having lower high-density lipoprotein-cholesterol were 4.74 (4.19-5.37), 5.05 (3.88-6.56), 3.07 (2.15-4.40), and 2.37 (1.67-3.35) in Asian Indian men, but 0.12 (0.09-0.16), 0.07 (0.04-0.13), 0.11 (0.07-0.20), and 0.16 (0.08-0.32) in Chinese men who had normoglycemia, prediabetes, and undiagnosed and diagnosed diabetes, respectively. Similar results were obtained for women. The prevalence of low high-density lipoprotein-cholesterol remained higher in Asian Indians (62.8% of the nondiabetic and 67.4% of the diabetic) than in central and northern Europeans (20.3 and 37.3%), Japanese (25.7 and 34.1%), or Qingdao Chinese (15.7 and 17.0%), even in individuals with low-density lipoprotein-cholesterol of less than 3 mmol/liter. There are distinct patterns of lipid profiles associated with ethnicity regardless of the glucose levels, suggesting that ethnic-specific strategies and guidelines on risk assessment and prevention of cardiovascular disease are required.

Serum lipid profiles among patients initiating ritonavir-boosted atazanavir versus efavirenz-based regimens.

BackgroundAntiretrovirals used to treat HIV-infected patients have the potential to adversely affect serum lipid profiles and increase the risk of cardiovascular disease which is an emerging concern among HIV-infected patients. Since boosted atazanavir and efavirenz are both considered preferred antiretrovirals a head to head comparison of their effects on serum lipids is needed.AimThe primary objective of the study was to compare the effects of atazanavir (boosted and unboosted) and efavirenz based regimens on serum lipid profiles.Study DesignProspective cohort study nested within three ongoing cohorts of HIV-infected individuals.Study Population and MethodsParticipants initiating either atazanavir or efavirenz based regimens with documented pre- and post-initiation lipid values. Multivariate linear regression was conducted to estimate adjusted mean differences between treatment groups for high density lipoprotein cholesterol (HDL-c), non-HDL-c, and log total cholesterol (TC) to HDL-c ratio outcomes; log-linear regression models were used to estimate differences in prevalence of low HDL-c and desirable TC.ResultsThe final study population was comprised of 380 efavirenz and 281 atazanavir initiators. Both atazanavir and efavirenz users had increases in serum HDL-c and decreases in TC/HDL ratio. In comparison to individuals initiating efavirenz, boosted atazanavir users on average had lower HDL-c (-4.12 mg/dl, p < 0.001) and non HDL-c (-5.75 mg/dl, p < 0.01), but similar declines in TC/HDL ratio.ConclusionBoth efavirenz and atazanavir-based regimens (boosted and unboosted) resulted in similar beneficial declines in the TC/HDL ratio.

High-Density Lipoprotein Cholesterol in HIV-Infected Patients: Evidence for an Association with HIV-1 Viral Load, Antiretroviral Therapy Status, and Regimen Composition

Low high-density lipoprotein-cholesterol (HDL-C) levels have been associated with cardiovascular risk in non-HIV populations. Limited information exists on the prevalence of low HDL-C in HIV- infected patients and related factors remain largely unknown. The aims of this study were to estimate the prevalence and characteristics of low HDL-C levels in HIV-infected patients. A cross-sectional study was performed in consecutive HIV-infected patients cared for in an outpatient HIV clinic on the Mediterranean coast of Spain during a 2-month period (September 15, 2003 to November 15, 2003). HDL-C levels below 40 mg/dL were considered low. We analyzed data from 219 patients, 167 of whom were on antiretroviral therapy. The majority (45.20 %) were on non-nucleoside reverse transcriptase inhibitors (NNRTI); 22.83 % were on treatment with protease inhibitors. The prevalence of low HDL-C levels was 44.74 % (98 of 219 patients). In multivariate analysis, hypertriglyceridemia (triglycerides >150 mg/dL; odds ratio [OR], 5.65; 95% confidence interval [CI], 2.85-11.23; p = 0.0001), HIV-1 RNA viral load greater than 50 copies per milliliter (OR, 3.15; 95% CI, 1.63-6.109; p = 0.001) and antiretroviral therapy with regimens other than NNRTIs-based regimens (OR, 2.17; 95% CI, 1.12-4.16; p = 0.021) were associated with low HDL-C levels. These data indicate that prevalence of low HDL-C among HIV-infected patients from this cohort was very high. Low HDL-C was related to triglyceride levels, HIV-1 RNA viral load and antiretroviral therapy composition. Undetectable viral load and treatment with NNRTIs are protective factors, whereas hypertriglyceridemia is directly associated with low HDL-C levels.

Low high-density lipoprotein-cholesterol is the most prevalent metabolic abnormality for Australian Aboriginal men and women even when lean

The aim of this study was to investigate the relationship of the prevalence and risk of the metabolic syndrome to body mass index (BMI) in Australian Aboriginal people. It was a cross-sectional, secondary analysis of data obtained from population-based screenings in Aboriginal communities in central and northern Australia (913 participants recruited between 1993 and 1997). Forty-one percent of men and 48% of women conformed to the National Cholesterol Education Program definition for the metabolic syndrome (chi2=3.72, P=0.054). The prevalence of low high-density lipoprotein-cholesterol was high in all BMI categories (89 and 95% in men and women, respectively). The prevalence of all other metabolic abnormalities increased linearly with BMI. The metabolic syndrome is highly prevalent in Aboriginal communities and is strongly associated with BMI. Low high-density lipoprotein-cholesterol was the predominant component of the metabolic syndrome across sex groups and BMI strata.

Prevalence of Low High-Density Lipoprotein Cholesterol in Patients With Documented Coronary Heart Disease or Risk Equivalent and Controlled Low-Density Lipoprotein Cholesterol

Current guidelines identify low-density lipoprotein (LDL) cholesterol as the primary target for cardiovascular prevention but also recognize low high-density lipoprotein (HDL) cholesterol as an important secondary target. This study was conducted to determine the prevalence of low HDL cholesterol in a contemporary ambulatory high-risk population across various LDL cholesterol levels, including patients taking statins. Screening of 44,052 electronic medical records from a primary care practice identified 1,512 high-risk patients with documented coronary heart disease (CHD) or CHD risk equivalents. Low HDL cholesterol (< or =40 mg/dl in men, < or =50 mg/dl in women) was present in 66% of the 1,512 patients. Low HDL cholesterol was prevalent across all LDL cholesterol levels but most prevalent in patients with LDL cholesterol < or =70 mg/dl (79% vs 66% in those with LDL cholesterol 71 to 100 mg/dl and 64% in patients with LDL cholesterol >100 mg/dl, p <0.01). Low HDL cholesterol was equally and highly prevalent in patients taking statins (67%) and those not taking statins (64%) (p = NS). HDL cholesterol and LDL cholesterol levels correlated poorly (R(2) = 0.01), and this was unaffected by gender or statin treatment. In conclusion, in high-risk patients with CHD or CHD risk equivalents, low HDL cholesterol levels remain prevalent despite statin treatment and the achievement of aggressive LDL cholesterol goals.

Aging and the Prevalence of Cardiovascular Disease Risk Factors in Older American Indians: The Strong Heart Study

To describe longitudinal changes in the prevalence of major cardiovascular disease (CVD) risk factors in aging American Indians. Population-based ongoing epidemiological study. The Strong Heart Study is a study of CVD and its risk factors. Standardized examinations were repeated in 1993 to 1995 and again in 1997 to 1999. A diverse cohort of 4,549 American Indians aged 45 to 74 at the initial examinations in 1989 to 1991. Changes in the prevalence of hypertension, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), current smoking, and type 2 diabetes mellitus. The prevalence of hypertension rose rapidly and steadily with aging. A nonsignificant decrease in LDL-C was seen in men, and men and women initially had rapid increases in the prevalence of low HDL-C. The prevalence of smoking decreased, but the prevalence of diabetes mellitus continued to rise for men and women. Overall, unfavorable changes in CVD risk factors were seen in the aging participants and will likely be reflected in worsening morbidity and mortality.

Prevalence of low HDL-cholesterol in patients with cardiovascular risk factors: the ECHOS (Etude du Cholesterol HDL en Observationnel) French Survey

A low concentration of high-density lipoprotein-cholesterol (HDL-C) is an independent risk factor for cardiovascular heart disease (CHD), but little is known about the distribution of HDL-C in France. This study evaluated the prevalence of low HDL-C among a large French population (5232 patients) with other cardiovascular risk factors. Depending on the guidelines used, the prevalence of low HDL-C varied from 8.7% (cutoff value of 35 mg/dl) to 26.9% (National Cholesterol Education Program metabolic syndrome cutoff values). The prevalence of low HDL-C gradually increased with the number of associated risk factors. We identified three independent risk predictors for low HDL-C: hypertriglyceridaemia (HTG), abdominal obesity and gender. Overall, the frequency of HDL-C assessment was very high (>85%) and it was highest in patients with hypercholesterolaemia or a history of CHD. Risk factors more frequently associated with low HDL-C (i.e. HTG, abdominal obesity and type 2 diabetes) were not associated with a more frequent assessment of HDL-C. Our findings indicate that in France, the prevalence of low HDL-C remains relatively high, particularly for patients with obesity and HTG.