Ratio Of Total Cholesterol Research Articles

Activity of serum paraoxonase 1, lipid profile and atherogenic indexes in diabetic induced rats treated with alpha lipoic acid

Background: Paraoxonase 1 (PON1) is an enzyme attached to high density lipoprotein (HDL-C) which has antioxidant and anti-atherogenic activities. Objectives: In this study, we investigated the effects of alpha lipoic acid on PON1 activity, lipid profile and atherogenic index as well as correlation between PON1 activities and HDL-C in diabetic rats. Materials and Methods: Thirty adult male rats were distributed in three experimental groups in this study. Control (group I), diabetic (group II) and diabetic animals treated with alpha lipoic acid (group III) group. Diabetes mellitus was induced in rats in groups II and III by a single dose of alloxan monohydrate (100 mg/kg; subcutaneous) and then treatment was performed with administration of alpha lipoic acid (100 mg/kg intraperitoneally) in group III for 6 weeks. Blood samples were collected from animals to measure the levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL-C), HDL-C, PON1 activity and correlation the between HDL-C and atherogenic index by PON1. Results: Statistical analysis showed that alpha lipoic acid significantly (P<0.05) inhibited the increase of TG, TC, LDL-C, VLDL, atherogenic index, atherogenic coefficient (AC), and cardiac risk ratio (CRR) when compared to diabetic rats in group II. HDL-C level was increased by alpha lipoic acid. The activity of PON1 was significantly (P<0.05) decreased in diabetic rats and treatment with alpha lipoic acid increased the PON1 activity. Moreover, the activity of PON1 correlated positively with HDL-C and negatively with AC, CRP 1 and CRP2. Conclusions: This study demonstrated that the administration of alpha lipoic acid can improve PON1 activity, lipid metabolism, atherogenic index and is able to reduce the risk of coronary artery diseases and atherosclerosis in diabetic rats.

The Effect of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibition on Sterol Absorption Markers in a Cohort of Real-World Patients.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is expressed in multiple tissues, including the small intestine. The effect of PCSK9 inhibition on cholesterol absorption is not known. Measure serum cholesterol absorption markers before and after initiation of PCSK9 inhibitors. Single-center retrospective cohort of patients administered evolocumab and alirocumab between July 2015 and January 2017. Paired t tests were used to compare mean serum cholesterol marker concentrations, and ratios to total cholesterol, before and after PCSK9 inhibitor initiation. Analyses were repeated for those taking and not taking statins and taking or not taking ezetimibe at both initiation and follow-up, for each PCSK9 inhibitor, and based on follow-up time (<60, 60-120, and >120 days). There were 62 possible participants, 34 were excluded for lack of data or unknown PCSK9 inhibitor initiation date. Average follow-up was 92.5 days. Mean campesterol (before 3.14 μg/mL, 95% CI: 2.79-4.38 μg/mL; after 2.09 μg/mL, 95% CI: 1.87-2.31 μg/mL; P < .0001), sitosterol (before 2.46 μg/mL, 95% CI: 2.23-2.70 μg/mL; after 1.62 μg/mL, 95% CI: 1.48-1.75 μg/mL; P < .0001), and cholestanol (before 3.25 μg/mL, 95% CI: 3.04-3.47 μg/mL; after 2.08 μg/mL, 95% CI: 1.96-2.21 μg/mL; P < .0001) all significantly decreased at follow-up. There was no significant change in absorption marker to total cholesterol ratios. Findings were not influenced by statin or ezetimibe use or nonuse, which PCSK9 inhibitor was prescribed, or time to follow-up. Proprotein convertase subtilisin/kexin type 9 inhibition was associated with decreased cholesterol absorption markers.

Sex-Specific Associations of Risk-Based Alcohol Drinking Level with Cardiovascular Risk Factors and the 10-Year Cardiovascular Disease Risk Scores.

To assess sex-specific associations between risk-based alcohol drinking levels and the 10-year cardiovascular disease (CVD) risk scores and cardiovascular (CV) risk factors. Data from 9,995 Koreans (4,249 men, 5,746 women), aged 40 to 79years who did not have CVD and participated in the 2011 to 2013 Korea National Health and Nutrition Examination Survey, were used to assess risk-based alcohol drinking levels in the past year (no drinking, drinking at low risk, and drinking at risk) categorized by the National Institute on Alcohol Abuse and Alcoholism, components of the 10-year CVD risk scores using the Adult Treatment PanelIII risk score and the 10-year hard atherosclerotic CVD risk score, CV risk factors, and confounding factors (age, smoking status, body mass index, educational attainment, income level, and physical activity). Drinking levels had positive associations with blood pressure and levels of glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C) and inverse associations with levels of low-density lipoprotein cholesterol and non-HDL-C and ratio of total cholesterol (TC) to HDL-C in men, while higher drinking levels were associated with higher HDL-C levels and lower ratio of TC to HDL-C in women after adjusting for confounding factors (p for trend<0.001). With respect to the 10-year CVD risk scores, higher drinking levels were associated with lower scores in both sexes (p for trend<0.001). Risk-based drinking levels were more likely to have dose-dependent associations with CV risk factors in men than in women and had inverse relationships with 10-year CVD risk in both men and women.

Assessment of the Relationship Between Serum Prostate-Specific Antigen Level and Serum Fasting Glucose, Total Cholesterol and Neutrophil-Lymphocyte Ratio in Men Aged 50-70 Years with Prostate-Specific Antigen Level 0-10 ng/mL without Prostate Cancer Diagnosis

Assessment of the Relationship Between Serum Prostate-Specific Antigen Level and Serum Fasting Glucose, Total Cholesterol and Neutrophil-Lymphocyte Ratio in Men Aged 50-70 Years with Prostate-Specific Antigen Level 0-10 ng/mL without Prostate Cancer Diagnosis

The Joint Effects of Smoking and Alcohol Drinking on Lipid-Related Indices among Chinese Males-Comparing Exercise and Non-Exercise Groups

ABSTRACTBackground: Smoking and drinking are two predisposing factors for dyslipidemia. Exercise has been proposed as a strategy to improve the blood lipids. However, it remains unclear how smoking and drinking jointly affect blood lipids and whether exercise influences their effects. Objectives: To evaluate the effects of smoking and drinking, either alone or in combination, on lipid-related indices in both exercise and non-exercise groups among Chinese men. Methods: This study was conducted in a health examination center between 2015 and 2016. A sample of 6,179 male subjects was divided into exercise and non-exercise groups. Logistic and linear regression analyses were used to calculate the odds ratios for abnormal lipid-related indices and correlation coefficients between smoking/drinking and lipid-related indices. Results: In the study population, the percentage of stable smokers and stable drinkers was 46.3% (2,860/6,179) and 77.6% (4,795/6,179), respectively. An increased smoking amount was significantly associated with an elevated triglyceride (TG) level and a decreased high-density lipoprotein cholesterol (HDL-C) level. Heavier smokers had higher odds ratios for high TG and low HDL-C. Heavier drinkers had higher levels of total cholesterol (TC), TG, and HDL-C and higher odds ratios for high TC and high TG but lower odds ratio for low HDL-C. The exercise group had lower TG levels and higher HDL-C levels than did the non-exercise group. Conclusions: Both heavier smoking and heavier drinking were associated with poorer TG levels, and the results suggest that drinking may be helpful for HDL-C. Exercise may relieve the negative effects of smoking and drinking.

Replication of a Gene-Diet Interaction at CD36, NOS3 and PPARG in Response to Omega-3 Fatty Acid Supplements on Blood Lipids: A Double-Blind Randomized Controlled Trial

BackgroundModulation of genetic variants on the effect of omega-3 fatty acid supplements on blood lipids is still unclear. MethodsIn a double-blind randomized controlled trial, 150 patients with type 2 diabetes (T2D) were randomized into omega-3 fatty acid group (n = 56 for fish oil and 44 for flaxseed oil) and control group (n = 50) for 180 days. All patients were genotyped for genetic variants at CD36 (rs1527483), NOS3 (rs1799983) and PPARG (rs1801282). Linear regression was used to examine the interaction between omega-3 fatty acid intervention and CD36, NOS3 or PPARG variants for blood lipids. FindingsSignificant interaction with omega-3 fatty acid supplements was observed for CD36 on triglycerides (p-interaction = 0.042) and PPAGR on low-density lipoprotein-cholesterol (p-interaction = 0.02). We also found a significant interaction between change in erythrocyte phospholipid omega-3 fatty acid composition and NOS3 genotype on triglycerides (p-interaction = 0.042), total cholesterol (p-interaction = 0.013) and ratio of total cholesterol to high-density lipoprotein cholesterol (p-interaction = 0.015). The T2D patients of CD36-G allele, PPARG-G allele and NOS3-A allele tended to respond better to omega-3 fatty acids in improving lipid profiles. The interaction results of the omega-3 fatty acid group were mainly attributed to the fish oil supplements. InterpretationThis study suggests that T2D patients with different genotypes at CD36, NOS3 and PPARG respond differentially to intervention of omega-3 supplements in blood lipid profiles.

Effects of Fish‐Oils on Markers of Hepatic Steatosis and Cholesterol Homeostasis in C57BL/6 Mice

Non‐alcoholic fatty liver disease (NAFLD), characterized by hepatic lipid accumulation exceeding 7% of total liver mass, is the most prevalent liver disease in America. Recent evidence proposes that altered cholesterol metabolism during NAFLD may drive the liver disease progression to non‐alcoholic steatohepatitis (NASH). In this cholesterol‐focal model of NASH, imbalances in cholesterol homeostasis promotes genes that stimulate de novo lipogenesis and chronic inflammation. Emerging evidence; however, has shown diets rich in fish‐oils have strong inhibitory effects on hepatic triglyceride accumulation and this may be due in part to restoring cholesterol homeostasis as determined by the total cholesterol to free cholesterol ratio. Therefore, the purpose of this study was to determine the effects of fish‐oils on markers of hepatic steatosis and cholesterol homeostasis in C57BL/6 mice. In our study, male C57BL/6 mice were randomly assigned to four dietary groups based on percentage and type of dietary fat for 32 weeks: 10% lard (LFL), 10% fish‐oil (LFFO), 41% lard (HFL), and 41% fish‐oil (HFFO). A two‐way factorial ANOVA was performed to identify significant (p&lt;0.05) differences between fat amount (low‐fat vs. high‐fat) and fat type (lard vs. fish‐oils) on markers of hepatic steatosis, cholesterol homeostasis, and dyslipidemia. At the end of 32 weeks (Table 1), the HFL group was significantly heavier (p&lt;0.001) than the other diet groups, despite for no significant difference between groups for average calories consumed per week. When compared to HFFO, mice in the HFL group showed higher hepatic total lipid percentage and triglyceride concentration by 89% (p&lt;0.001) and 1.4‐fold (p&lt;0.001), respectively. No significant difference was observed between LFL and LFFO for body mass, hepatic lipid percentage, hepatic cholesterol, net glucose AUC, plasma insulin, plasma glucose, or HOMA‐IR. HFFO mice showed a 3‐fold (p&lt;0.001) lower hepatic total cholesterol and 5‐fold (p&lt;0.001) lower hepatic free cholesterol, as well as a 43% (p&lt;0.001) lower free cholesterol:total cholesterol ratio when compared to HFL mice. This may be due to improved insulin sensitivity bolstered by fish‐oils, as HFFO mice showed 2.2‐fold (p&lt;0.001) lower HOMA‐IR, 30% (p&lt;0.001) lower net glucose AUC, 1.3‐fold (p&lt;0.001) lower plasma insulin, and 43% (p&lt;0.001) lower plasma glucose when compared to HFL mice. Based on previous studies and our data taken together, we believe that the improvements in hepatic steatosis in mice consuming a diet high in fish‐oils was due to collective improvements in insulin sensitivity and a lower free cholesterol:total cholesterol ratio. In summary, fish‐oils improved hepatic lipid profiles that were associated with cholesterol homeostasis and insulin sensitivity.Support or Funding InformationR21 NS090282‐01This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Avocado consumption and risk factors for heart disease: a systematic review and meta-analysis

Nutrients in avocados are associated with cardiovascular benefits. The aim of this study was to determine the effect of avocado intake on cardiovascular disease (CVD) risk with the use of a systematic review and meta-analysis. MEDLINE, Cochrane Central, and Commonwealth Agricultural Bureau abstracts were searched from 1946 through September 2017 for publications on avocado intake and CVD risk. All designs except for cross-sectional studies that evaluated avocado intake were included. Two investigators independently screened citations and extracted data. Random-effects models meta-analysis was used when ≥3 studies reported the same outcome. Of 18 eligible studies (481 subjects), 7 studies compared avocado intake with no intake, 3 studies compared avocado plus monounsaturated fat intake with a control, and 8 studies reported data for qualitative synthesis. In 7 studies, avocado intake significantly increased HDL cholesterol (summary net change: 2.84 mg/dL; 95% CI: 0.18, 5.49 mg/dL), with significant heterogeneity. This remained consistent in sensitivity and subgroup analyses. There was no significant difference between avocado intake and the control for the outcomes of serum total cholesterol (TC), LDL cholesterol, triglycerides (TGs), ratios of TC to HDL cholesterol and LDL cholesterol to HDL cholesterol, and body weight. In qualitative synthesis, there was no significant difference between groups for blood glucose (2 studies), homeostasis model assessment (1 of 2 studies), oxidized LDL (2 studies), high-sensitivity C-reactive protein (2 studies), or apolipoprotein B (2 studies) or, in 1 study each, for body mass index, systolic and diastolic blood pressure, arterial compliance, fibrinogen, interleukin 6, tumor necrosis factor α, and serum nitric oxide. No studies reported incident clinical outcomes of CVD, including myocardial infarction, stroke, and other clinical endpoints. Avocado intake resulted in no difference in serum TC, LDL-cholesterol, and TG concentrations, but it did increase serum HDL-cholesterol concentrations, with significant heterogeneity. The association between avocado intake and CVD risk should be confirmed by well-conducted prospective observational studies or long-term trials.

EFFECT OF OXIDATIVE STRESS ON LIPID PROFILE AND BLOOD PARAMETERS TO A SAMPLE OF STUDENTS AT UNIVERSITY OF ZAKHO DURING EXAMES

Worry, anxiety through Study and preparative to exam may lead to mental stress. Mental stress may contribute to oxidative stress in the body which is the change in balance between oxidants and antioxidants.&#x0D; In this study a concentration of Malondialdehyde (MDA) as a lipid oxidation biomarker, lipid profile and some blood parameters like Minmum Inhibitory dilution (MID) were estimated in twenty chemistry and biology students at the day of exam as Stress Condition (SC) compared with the same parameters which obtained from the same students during the university vacation after a month of doing the latest exam as non-Stress Condition (nSC).&#x0D; A significant increase in MDA (p=0.0019), Total Cholesterol (p&lt;0.05), Triglyceride (p&lt;0.05), Low Density Lipoprotein LDL-Cholesterol (p&lt;0.05), Very Low density lipoprotein VLDL-cholesterol (p&lt;0.05) and A significant decrease in High - Density Lipoprotein HDL - Cholesterol (p&lt;0.05), HDL-Cholesterol to total cholesterol ratio(p=0.0012) in stress condition were observed when compared with “non-stress” conditions. Also there were high significant decreases in lymphocyte and minimum inhibitory dilution (MID) (p=0.0001, p&lt;0.0001 respectively) and significant increases in granulocyte and platelets (PLT) (P=0.0113, P=0.0031 respectively) in stress condition compared to non-stress condition. Whereas no significant changes in total WBCs and RBCs in stress and non-stress conditions.&#x0D; These results suggested that during university examinations when students are under mental stress or psychiatric disorder may put them at risk of developing inflammatory disorders like atherosclerosis and/or coronary arteries disorders.

Association between the TIMD4-HAVCR1 variants and serum lipid levels, coronary heart disease and ischemic stroke risk and atorvastatin lipid-lowering efficacy.

Little is known about the association of the TIMD4 (T-cell immunoglobulin and mucin domain 4 gene)-HAVCR1 (hepatitis A virus cellular receptor 1) variants and lipid metabolism, the risk of coronary heart disease (CHD) and ischemic stroke (IS). The present study aimed to determine the TIMD4-HAVCR1 variants, their haplotypes and gene–environment interactions on serum lipid levels, the risk of CHD and IS, and the lipid-lowering efficacy of atorvastatin in a southern Chinese Han population. Genotypes of three variants in 622 controls, 579 CHD, and 546 IS patients were determined by the Snapshot technology. Atorvastatin calcium tablet (20 mg/day) was given in 724 hyperlipidemic patients for 8 weeks after genotyping. The rs12522248 genotypic and allelic frequencies were different between controls and patients, and were associated with the risk of CHD and IS. The rs1501908G-rs12522248T-rs2036402T haplotype was associated with an increased risk of CHD; the G-C-T haplotype was associated with lower risk of CHD; and the C-C-C haplotype was associated with an increased risk of IS. Variants and their haplotypes in controls were associated with triglyceride (rs1501908), low-density lipoprotein cholesterol (LDL-C, rs1501908, G-T-T), high-density lipoprotein cholesterol (HDL-C, rs12522248, C-C-C) and the ratio of total cholesterol (TC) to HDL-C (C-C-C). Interactions of rs1501908- and rs2036402-alcohol (HDL-C); rs1501908- and rs12522248-high body mass index (hBMI, ≥24 kg/m2; TC); and TIMD4-HAVCR1 variants-atorvastatin on several lipid parameters were detected. Interactions of rs12522248TC/CC-hBMI, G-T-T-, and C-C-C-smoking on the risk of CHD; and C-C-C-smoking, C-C-C-, and G-C-T-hBMI on the risk of IS were also observed. These findings suggest that the TIMD4-HAVCR1 variants may be the genetic risk factors for CHD and IS.

Fat, Sugar, Whole Grains and Heart Disease: 50 Years of Confusion.

During the 1970s some investigators proposed that refined carbohydrates, especially sugar and a low intake of dietary fiber, were major factors in coronary heart disease (CHD). This suggestion was eclipsed by the belief that an excess intake of saturated fatty acids (SFA) was the key dietary factor, a view that prevailed from roughly 1974 to 2014. Findings that have accumulated since 1990 inform us that the role of SFA in the causation of CHD has been much exaggerated. A switch from SFA to refined carbohydrates does not lower the ratio of total cholesterol to HDL-cholesterol in the blood and therefore does not prevent CHD. A reduced intake of SFA combined with an increased intake of polyunsaturated fatty acids lowers the ratio of total cholesterol to HDL-cholesterol; this may reduce the risk of CHD. The evidence linking carbohydrate-rich foods with CHD has been steadily strengthening. Refined carbohydrates, especially sugar-sweetened beverages, increase the risk of CHD. Conversely, whole grains and cereal fiber are protective. An extra one or 2 servings per day of these foods increases or decreases risk by approximately 10% to 20%.

Cardiovascular risk stratification in new-onset diabetes by qrisk2 risk score and conventional risk score within 3 months of diagnosis of diabetes

Aims: This study aims to assess the cardiovascular disease (CVD) risk by QRISK2 score and conventional risk score in new-onset diabetes without a history of heart disease or stroke, to find out if patients with diabetes have similar risk of coronary artery disease (CAD) as people with established CAD and to compare the conventional and QRISK2 score for the prediction of CVD. Materials and Methods: A cross-sectional study was conducted at Bhilai over 1 year in 183 newly detected diabetic patients (89 males and 94 females) aged 40–70 years. The probable risk factors were determined by cross-tabulation of cardiometabolic parameters with the 10-year cardiovascular risk level using the QRISK2-2016 and the conventional major risk markers. Results: The mean age in males was 53.5 ± 9.7 years and in females was 54.2 ± 10.1 signifying no gender differences. Mean body mass index in the most of the individuals in both sexes were either in the pre-obese or obese range. The mean value of high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), non-HDLc, total cholesterol and HDLc (total cholesterol/HDLc) ratio was found to be higher in females than in the males. In the conventional risk group, 67.7% of individuals with new-onset diabetes were in high-risk category, 28.9% were in moderate-risk category and 3.2% in low-risk category. The QRISK2 score in new-onset diabetes was 68.8% in high-risk category, 31.1% were in moderate-risk category and none in the low-risk category. Conclusion: Risk stratification is essential for the primary prevention of CVD risks in patients with diabetes as patients with new-onset diabetes cannot be categorised as CAD risk equivalent.

Elevated inflammatory Lp-PLA2 and IL-6 link e-waste Pb toxicity to cardiovascular risk factors in preschool children

Cardiovascular toxicity of lead (Pb) manifests primarily as an effect on blood pressure and eventual increased risk of atherosclerosis and cardiovascular events. Therefore, we investigated vascular inflammatory biomarkers and cardiovascular effects of Pb-exposed children. A total of 590 children (3-7 years old) were recruited from Guiyu (n=337), an electronic waste (e-waste)-exposed group, and Haojiang (n=253), a reference group, from November to December 2016. We measured child blood Pb levels (BPbs), and systolic and diastolic blood pressure. Pulse pressure was calculated for the latter two. Serum biomarkers including lipid profiles and inflammatory cytokines, and plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) were detected. Unadjusted regression analysis illustrated that higher ln-transformed BPb associated with lower systolic blood pressure and pulse pressure. After adjustment for various confounders, the relational degree of lnBPb and blood pressure measures became slightly attenuated or not significant. Elevated BPb was associated with higher Lp-PLA2, interleukin (IL)-6, triglycerides (TG) and lower high-density lipoprotein (HDL). Lp-PLA2 remained inversely associated with pulse pressure and HDL, but positively with ratios of total cholesterol to HDL (Tc/HDL) and low-density lipoprotein to HDL (LDL/HDL). IL-6 was associated negatively with systolic blood pressure, pulse pressure and HDL, and positively associated with TG, Tc/HDL and LDL/HDL. The mediation effect of biomarkers on the association of BPb with pulse pressure was insignificant except for Lp-PLA2. Available data supports the conclusion that e-waste-exposed children with higher BPbs and concomitant abnormal measures of cardiovascular physiology have an augmented prevalence of vascular inflammation, as well as lipid disorder.

Biomarkers of cardiometabolic health and nutritional status in individuals with positive celiac disease serology.

Celiac disease (CD) is an autoimmune disorder characterized by damage to the intestinal mucosa and nutrient malabsorption in severe cases. However, it remains unclear whether nutrient deficiencies and other adverse health effects are prevalent in individuals with positive CD serology identified through screening studies. The objective was to determine whether biomarkers of cardiometabolic health and nutritional status differ between those with positive and negative CD serology identified in a screening study of Canadian adults. Participants ( n=2832) were from the Toronto Nutrigenomics and Health Study and the Toronto Healthy Diet Study. Individuals were screened for CD-specific anti-tissue transglutaminase autoantibodies. Lipid profiles as well as concentrations of six carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein, lycopene, and zeaxanthin), three tocopherols (α-tocopherol, δ-tocopherol, and γ-tocopherol), retinol, ascorbic acid, and 25-hydroxyvitamin D were cross-sectionally compared between those with positive and negative CD serology using general linear mixed models. Individuals with positive CD serology ( n=23) had significantly lower levels of HDL-cholesterol ( p=0.008) and apolipoprotein-AI ( p=0.02), a higher ratio of total cholesterol to HDL-cholesterol ( p=0.006), and a higher apolipoprotein-B/AI ratio ( p=0.03) than those with negative CD serology. Positive CD serology was also associated with significantly lower concentrations of retinol ( p=0.006) in fully adjusted models. Those with positive CD serology had lower serum 25-hydroxyvitamin D in unadjusted models ( p=0.01), but not in fully adjusted models ( p=0.08). Individuals with undiagnosed CD may have unfavorable lipid profiles and be at elevated risk for inadequacy of certain fat-soluble vitamins, but not widespread nutrient deficiencies.

Prediction of basal glycaemia dynamics during treatment with 6-month lipid-lowering therapy in patients at high risk of cardiovascular disease

Background. A major meta-analysis has confirmed the ability of statins to exert both diabetogenic and hyperglycaemic effects. To date, practical recommendations for predicting glucose dynamics during lipid-lowering therapy have not been developed.&#x0D; Aims. Identify the combination of factors that can predict changes in basal glycaemia during 6-month lipid-lowering therapy in patients at high risk of cardiovascular disease.&#x0D; Methods. This study reports on 50 patients with diabetes or impaired glucose tolerance, and 18 patients with coronary artery disease without disorders of carbohydrate metabolism. Of note, 29 of the 50 diabetic or glucose intolerant patients had documented ischaemic heart disease (stable angina). Patients were randomised into three groups: Gr.1 (n=33, atorvastatin therapy), Gr.2 (n=17, atorvastatin in combination with ezetimibe) and Gr.3 (n=18, rosuvastatin therapy). After treatment for 24 weeks, we assessed lipid profile dynamics, metabolism of glucose/insulin and the HOMA-IR index. Multivariate analysis was then performed to identify factors that predicted increases in basal glycaemia.&#x0D; Results. All of the included patients completed 24 weeks of treatment (N=68). Lipid-lowering effect was significant in all three groups, and overall, target LDL cholesterol level was achieved in 50% of patients (n=34). In Gr.2, basal glucose level increased from 5.5(5.36.6) to 6.3(5.67.8) mmol/l (p=0.0014), which was accompanied by an increase in HOMA-IR (p=0.024). No significant change in basal glycaemia was observed in Grs.1 and 3. Moreover, an increase in the basal glycaemia was observed in 48.5% of patients in Gr.1, 70.6% in Gr.2 and 44.4% in Gr.3. Multivariate discriminant analysis across all patient groups revealed a canonical linear discriminant function that included the following factors: baseline basal glucose levels, total cholesterol levels, triglycerides and ratio of LDL/HDL cholesterol. Sensitivity and specificity of the model accounted for 75%; 51 out of the 68 cases were correctly classified when predicting the dynamics of basal glucose during lipid-lowering therapy.&#x0D; Conclusions. Our data demonstrate the ability to predict the dynamics of the basal glycaemia during lipid-lowering therapy. This may allow for a new way to identify patients at high risk of statin-related increases in glycaemia.

Ability of Nontraditional Risk Factors and Inflammatory Biomarkers for Cardiovascular Disease to Identify High Cardiometabolic Risk in Adolescents: Results From the LabMed Physical Activity Study

PurposeThen objective of this study was to evaluate the ability of several nontraditional cardiometabolic and inflammatory biomarkers in identifying high cardiometabolic risk in adolescents. MethodsA cross-sectional study was conducted with 529 Portuguese adolescents (267 girls) aged 14.3 ± 1.7 years. A clustered cardiometabolic risk score (body fat percentage, systolic blood pressure, ratio of total cholesterol to high-density lipoprotein cholesterol, triglycerides, homeostatic model assessment of insulin resistance, and negative values of cardiorespiratory fitness) was computed. The nontraditional cardiometabolic biomarkers assessed were complement factors (C3 and C4), C-reactive protein (CRP), fibrinogen, leptin, white blood cells (WBCs), albumin, interleukin-6, and a clustered score of inflammatory biomarkers (InflaScore) (C3, C4, CRP, fibrinogen, and leptin). ResultsReceiver operating characteristic curves analyses showed that C3, C4, CRP, fibrinogen, leptin, and the InflaScore were able to present discriminatory ability in identifying an unfavorable cardiometabolic profile in both girls and boys (p < .01 for all). Logistic regression analyses showed that C3, C4, CRP, fibrinogen, leptin, the InflaScore (in both sexes), and WBC (boys) were associated with high cardiometabolic risk, independent of age, pubertal stage, socioeconomic status, or adherence to a Mediterranean diet (p < .05 for all). ConclusionsC3, C4, CRP, fibrinogen, and leptin were associated with high cardiometabolic risk in both sexes and WBC in boys. In addition, the clustered inflammatory biomarkers seem to have a better diagnostic accuracy in identifying an unfavorable cardiometabolic profile than single biomarkers. Such biomarkers may have utility in motivating health professionals, public health workers, and adolescents' families toward lifestyle changes, improving prevention efforts early in life.

The effect of lipid levels on patient-reported outcomes in patients with rotator cuff tears

BackgroundLipid disorders could be associated with the prevalence and outcomes of rotator cuff diseases. This study aimed to learn how levels of various types of lipids influence the patient-reported outcomes of patients with rotator cuff tears (RCTs).MethodsData from a cohort study of 135 patients with RCTs were used. The outcome measures included Western Ontario Rotator Cuff (WORC) index, American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form, Single Assessment Numeric Evaluation, visual analog scale for pain and satisfaction, and Veterans RAND 12-Item Health Survey (VR-12). Multivariable random-effects models were built to examine how total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein, and ratio of total cholesterol to HDL influence each outcome, controlling for covariates.ResultsAfter adjusting for age, gender, surgery, smoking, and baseline outcome values, patients with triglycerides >150 mg/dL had significantly higher pain visual analog scale (β = 5.86; P = .017) and lower VR-12 physical component summary (β = −2.71; P = .002) scores. Patients with low HDL had significantly worse WORC (β = 132.26; P = .020) and ASES (β = −7.05; P = .005) scores, more pain (β = 6.69; P = .024), and less satisfaction (β = −6.53; P = .008). The ratio of total cholesterol to HDL was associated with worse WORC (β = 58.46; P = .006) and ASES scores (β = −2.74; P = .002), more pain (β = 4.49; P < .001), and worse VR-12 physical component summary score (β = −1.03; P = .017).ConclusionsDyslipidemia may decrease the improvement of patient-reported outcomes in patients undergoing treatment for RCTs; high triglycerides and low HDL may have the most impact.

Usefulness of 99mTc-DTPA galactosyl human serum albumin liver scintigraphy for evaluating hepatic functional reserve after Kasai procedure

Background/purposeWe investigated whether 99mTc-DTPA galactosyl human serum albumin (GSA) liver scintigraphy could help evaluate post-Kasai procedure hepatic functional reserve in order to inform therapeutic strategies, including liver transplantation. MethodsGSA scintigraphy was performed post-Kasai procedure. Patients were classified as having favorable (native liver survival) or poor (liver transplantation or death) prognoses. The clearance index (HH15), receptor index (LHL15), and time at which cumulative liver radioactivity reached 85% of heart plus liver activity (T0.85) were compared to laboratory data and prognosis. ResultsGSA scintigraphy was performed 106 times on 35 patients. T0.85 correlated well with laboratory variables associated with liver function (platelet count, international normalized ratio of prothrombin time, serum albumin, total cholesterol, and cholinesterase). HH15 correlated moderately and LHL15, poorly. HH15 and T0.85 values were significantly higher in the poor-prognosis than in the favorable-prognosis group, and LHL15 was significantly lower. The T0.85 cutoff value (6.25min) corresponded with division into prognosis groups, and had high sensitivity (0.78) and specificity (0.83). ConclusionsHepatic functional reserve post-Kasai procedure can be evaluated using the GSA scintigraphy T0.85 value. A value consistently >6.25min indicates the need for liver transplantation. Type of studyDiagnostic Test. Level of evidenceLevel III.

Lipid Profiles, Glycated Hemoglobin, and Diabetes in People Living at High Altitude in Nepal.

This study aimed to describe lipid profiles and the distribution of glycated hemoglobin (HbA1c) in a sample of a high altitude population of Nepal and to explore associations between these metabolic risk variables and altitude. A cross-sectional survey of cardiovascular disease and associated risk factors was conducted among 521 people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. Urban participants (residents at 2800 m and 3620 m) had higher total cholesterol (TC) and triglyceride (TG) than rural participants. A high ratio of TC to high-density lipoprotein-cholesterol (HDL) (TC/HDL ≥ 5.0) was found in 23.7% (95% CI 19.6, 28.2) and high TG (≥1.7 mmol/L) in 43.3% (95% CI 38.4, 48.3) of participants overall. Mean HbA1c levels were similar at all altitude levels although urban participants had a higher prevalence of diabetes. Overall, 6.9% (95% CI 4.7, 9.8) of participants had diabetes or were on hypoglycaemic treatment. There was no clear association between lipid profiles or HbA1c and altitude in a multivariate analysis adjusted for possible confounding variables. Residential settings and associated lifestyle practices are more strongly associated with lipid profiles and HbA1c than altitude amongst high altitude residents in Nepal.

Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study

The relation between dietary nutrients and cardiovascular disease risk markers in many regions worldwide is unknown. In this study, we investigated the effect of dietary nutrients on blood lipids and blood pressure, two of the most important risk factors for cardiovascular disease, in low-income, middle-income, and high-income countries. We studied 125 287 participants from 18 countries in North America, South America, Europe, Africa, and Asia in the Prospective Urban Rural Epidemiology (PURE) study. Habitual food intake was measured with validated food frequency questionnaires. We assessed the associations between nutrients (total fats, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, carbohydrates, protein, and dietary cholesterol) and cardiovascular disease risk markers using multilevel modelling. The effect of isocaloric replacement of saturated fatty acids with other fats and carbohydrates was determined overall and by levels of intakes by use of nutrient density models. We did simulation modelling in which we assumed that the effects of saturated fatty acids on cardiovascular disease events was solely related to their association through an individual risk marker, and then compared these simulated risk marker-based estimates with directly observed associations of saturated fatty acids with cardiovascular disease events. Participants were enrolled into the study from Jan 1, 2003, to March 31, 2013. Intake of total fat and each type of fat was associated with higher concentrations of total cholesterol and LDL cholesterol, but also with higher HDL cholesterol and apolipoprotein A1 (ApoA1), and lower triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ratio of apolipoprotein B (ApoB) to ApoA1 (all ptrend<0·0001). Higher carbohydrate intake was associated with lower total cholesterol, LDL cholesterol, and ApoB, but also with lower HDL cholesterol and ApoA1, and higher triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ApoB-to-ApoA1 ratio (all ptrend<0·0001, apart from ApoB [ptrend=0·0014]). Higher intakes of total fat, saturated fatty acids, and carbohydrates were associated with higher blood pressure, whereas higher protein intake was associated with lower blood pressure. Replacement of saturated fatty acids with carbohydrates was associated with the most adverse effects on lipids, whereas replacement of saturated fatty acids with unsaturated fats improved some risk markers (LDL cholesterol and blood pressure), but seemed to worsen others (HDL cholesterol and triglycerides). The observed associations between saturated fatty acids and cardiovascular disease events were approximated by the simulated associations mediated through the effects on the ApoB-to-ApoA1 ratio, but not with other lipid markers including LDL cholesterol. Our data are at odds with current recommendations to reduce total fat and saturated fats. Reducing saturated fatty acid intake and replacing it with carbohydrate has an adverse effect on blood lipids. Substituting saturated fatty acids with unsaturated fats might improve some risk markers, but might worsen others. Simulations suggest that ApoB-to-ApoA1 ratio probably provides the best overall indication of the effect of saturated fatty acids on cardiovascular disease risk among the markers tested. Focusing on a single lipid marker such as LDL cholesterol alone does not capture the net clinical effects of nutrients on cardiovascular risk. Full funding sources listed at the end of the paper (see Acknowledgments).