sdLDL Levels Research Articles

Assessment of Metabolic Profile and Ischemia-modified Albumin Level in Patients with Alopecia Areata: A Case-Control Study.

Background:Alopecia areata (AA) is an autoimmune-mediated hair follicle disorder. In the literature, there is no study evaluating metabolic syndrome and levels of ischemia-modified albumin (IMA) which is proposed as an oxidative stress biomarker in patients with AA.Aims:The aim was to investigate the presence of metabolic syndrome and the levels of IMA, small dense low-density lipoprotein (sd-LDL), and visfatin levels in AA patients.Settings and Design:A hospital-based cross-sectional study was undertaken among AA patients and controls.Subjects and Methods:Thirty-five patients with AA and 35 sex-, age-, and body mass index-matched healthy controls were enrolled. Clinical and laboratory parameters of metabolic syndrome were examined in all participants. Furthermore, IMA, sd-LDL, and visfatin levels were assessed and analyzed with regard to disease pattern, severity and extent, severity of alopecia tool score, duration, and recurrence.Results:The median IMA and adjusted IMA levels were significantly increased compared with controls (P<0.05 and P=0.002, respectively). Patients with pull test positivity displayed higher levels of adjusted IMA levels (P<0.05). In AA group, there was a positive correlation between adjusted IMA and waist circumference (r=0.443, P=0.008), adjusted IMA and triglyceride levels (r=0.535, P=0.001), and adjusted IMA and sd-LDL levels (r=0.46, P<0.05). We observed no statistically significant difference in fasting blood glucose and lipid profile, sd-LDL, and visfatin levels of the patients and healthy controls.Conclusions:AA patients and controls have similar metabolic profile. Raised levels of adjusted IMA levels may be associated with antioxidant/oxidant imbalance and with risk of cardiovascular disease.

Investigation of galectin-3, lipocalin 2, retinol binding protein (RBP), small dense low-density lipoprotein (sdLDL) in patients with hirsutism.

IntroductionHirsutism is defined as excessive terminal hair in androgen-dependent areas in women. Adipose tissue is no longer regarded as a storage site for triglycerides or as a source of free fatty acids but is currently emerging as a key constituent of energy metabolism secreting numerous enzymes, cytokines, growth factors, and hormones.AimTo evaluate serum levels of galectin-3 (Gal3), lipocalin-2 (LCN2), retinol binding protein (RBP), and small dense low-density lipoprotein (sdLDL) in patients with hirsutism and patients co-presenting with polycystic ovary syndrome (PCOS) and hirsutism.Material and methodsThe study included 90 patients that were divided into three groups: (I) patients with idiopathic hirsutism (IH) (n = 30), (II) PCOS patients with hirsutism (H-PCOS) (n = 30), and (III) the control group (n = 30). Informed consent was obtained from each participant. Idiopathic hirsutism was scored using the modified Ferriman-Gallwey (mFG) scoring system and the diagnosis of PCOS was established based on the modified Rotterdam criteria. Human Gal3, LCN2, RBP, and sdLDL levels were analysed using a commercially available double-antigen sandwich enzyme-linked immunosorbent assay.ResultsNo significant difference was found between the three groups with regard to serum Gal3, LCN2, RBP, and sdLDL levels (p > 0.05). Median values were higher in the H-PCOS group than in the other two groups: body weight (median: 76.5 kg) (p < 0.001), waist circumference (median: 82.5 cm) (p = 0.001).ConclusionsNo significant correlation was found between the adipokines that play a role in the aetiology of numerous diseases and some mediators of the lipid metabolism and hirsutism.

Hubungan antara jenis asupan karbohidrat dan lemak dengan kadar small dense low density lipoprotein pada pasien penyakit jantung koroner

Background: small dense Low Density Lipoprotein (sdLDL) was the most atherogenic lipoprotein. Its influenced by internal and external factors including food consumption. Indonesian people mostly take a diet of high carbohydrate (CH) and fried food that believed to correlate with higher sdLDL level and predisposed to Coronary Heart Disease (CHD). There were 2 types of CH based on the processing ways, refined and non-refined CH.Objectives: The study’s purpose was to prove the correlation between different types of CH and fat intake with the sdlDL level in CHD patients.Methods: cross sectional in CHD patients hospitalized at Dr Kariadi hospital. The sdLDL and others lipid profile examined. The type and amount of CH and fat intakes per-day were collect from an interview using semi-quantitative food frequency questionnaire (SQFFQ) and food models. Pearson and Spearman test used for bivariate analysis. Confounding factors age, gender, physical activity, diabetes mellitus and smoking were analyzed. Variables with p&lt;0,25 was included in multivariate analysis using linear regression test.Results: There were 30 samples with CHD came with acute coronary syndrome (ACS). Mean of total CH intake per day was 267.75 gram. Mean of percentage of CH from total calories per day was 55.93%. This number was higher than advised which is 30-130 gram or &lt;45% of total calorie per day. Mean of refined and non-refined CH intake was 161.80 and 57.81 gr/day. The total CH mostly from refined CH (76%) rather than non-refined. Mean of fat intake was 68 gr/day (32.76% of total energy per day), and the mean of sdLDL level was 26,54 mg/dl. Correlation between refined CH vs non-refined CH with the sdLDL levels (r=0.328; p=0.077 vs r=-0.184;p=0.331). Correlation between fat intake and sdLDL levels (r=0.44;p=0.15). Multivariate analysis was analyzing refined CH fat intake and age with sdLDL level (r=0,28;p=0,13 vs r=0.45;p=0.01 vs r=-0.15;p=0.44). There is significant correlation between fat intake and sdLDL levels with r=0.45Conclusion: There was a significant correlation between fat intake and sdLDL levels in CHD patients. There is no significant correlation between refined and non-refined carbohydrates with sdLDL levels in CHD patients.

Association between proprotein convertase subtilisin/kexin 9 (PCSK9) and lipoprotein subclasses in children with type 1 diabetes mellitus: Effects of glycemic control

Background and aimsDyslipidemia in type 1 diabetes mellitus (T1DM) is characterised by altered distributions of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses. Recent studies suggested that proprotein convertase subtilisin/kexin 9 (PCSK9) may contribute to the development of dyslipidemia in T1DM. In this cross-sectional study, we investigated the association between PCSK9 and lipoprotein subclasses in young T1DM patients, with respect to glycemic control. MethodsPlasma PCSK9 and lipoprotein subclasses were determined in 207 patients with T1DM (106 boys and 101 girls), aged 13.9 ± 3.0 years and treated by intensive insulin therapy. ResultsPlasma PCSK9 levels significantly increased with worsening of glycemic control (p < 0.001). T1DM patients with poor glucoregulation had the highest proportion of small, dense LDL (sdLDL) and smaller HDL particles, as well. PCSK9 was positively associated with markers of glucose homeostasis and serum lipid parameters only in patients with suboptimal/poor glucoregulation. In well-controlled T1DM, plasma PCSK9 level was inversely associated with a relative proportion of sdLDL particles (p < 0.01) and this association remained significant in multivariate analysis. In T1DM patients with suboptimal/poor glycemic control, PCSK9 was positively associated with the proportion of the smallest HDL3c particles (p < 0.001), but negatively with HDL size (p < 0.05). ConclusionsThe extent of achieved metabolic control modifies the association between PCSK9 and lipoprotein subclasses in T1DM. Further investigations are needed to reveal whether the observed effects of glycemic control on PCSK9 and sdLDL levels have causal consequences on CVD risk in young patients with T1DM.

Small dense LDL cholesterol in human subjects with different chronic inflammatory diseases

Background and aimsChronic inflammatory diseases (CID) are associated with a profound increase in cardiovascular (CV) risk resulting in reduced life expectancy. However, LDL-cholesterol is reported to be low in CID patients which is referred to as the “LDL paradoxon”. The aim of the present study was to investigate whether LDL-particles in CID exhibit an increased content of the highly atherogenic small-dense LDL subfraction (sdLDL). Methods and resultsIn this prospective, single center, observational study we enrolled 141 patients with CID (RA n = 59, inflammatory bowel disease (IBD) n = 35, ankylosing spondylitis (SpA) n = 25, Psoriasis n = 22) in 2011 through 2013 to evaluate sdLDL levels before as well as 6 and 26 weeks after initiation of different anti-cytokine therapies (anti-TNFα, anti-IL-6R antibodies). sdLDL levels were compared to 141 healthy individuals in a case control design. Compared to healthy controls, all CID patients displayed a significantly higher sdLDL content within the LDL cholesterol fraction: RA 35.0 ± 9.2% (p < 0.001), SpA 42.5 ± 10.5% (p < 0.001), IBD 37.5 ± 7.1% (p < 0.001), Psoriasis 33.6 ± 4.6% (p < 0.01). Furthermore, the sdLDL/LDL ratio was significantly higher in male compared to female RA subjects (p < 0.05). Neither anti-TNFα nor anti-IL6R medication altered sdLDL levels despite a significant improvement of disease activity. ConclusionIn several different chronic inflammatory disease entities, LDL-cholesterol is shifted toward a pro-atherogenic phenotype due to an increased sdLDL content which might in part explain the LDL paradoxon. Since premature CV disease is a major burden of affected patients, specifically targeting lipid metabolism should be considered routinely in clinical patient care. Clinical trialsRegistration at German Clinical Trial Register (DRKS): DRKS00005285.

PEMERIKSAAN TINGKAT sdLDL SERUM SEBAGAI PETANDA DIAGNOSTIK STENOSIS KORONER (Serum sdLDL Level as A Diagnostic Marker of Coronary Stenosis)

Small dense LDL (sdLDL) is the LDL which particles are small and dense, it is pro-atherogenic. Increased levels of serum sdLDL areassociated with an increased risk of coronary stenosis. The aim of this study was to examine the diagnostic value of sd LDL in coronarystenosis. An analytical observational study with cross sectional approach was conducted at the Department of Clinical Pathology, MedicalFaculty of Diponegoro University/Dr. Kariadi Hospital and the Unit of Cardiac diseases during the period of March-October 2013. Thesubjects were 39 patients suspected of suffering a coronary stenosis. The diagnosis of coronary stenosis, degree of stenosis and numberof vascular stenosis was established at the time of cardiac catheterization. SdLDL assessment used a test kit. The statistical analysis usedwere unpaired t-test, Spearman correlation test, ROC analysis and diagnostic test. LDL levels in stenosis subjects, 35.4±9.01 mg/dL weresignificantly higher compared to levels in subjects that had no stenosis, 20.7±7.10 mg/dL (p&lt;0.001; unpaired t-test). Correlation testresults showed a correlation between levels of serum sdLDL with severe degree of stenosis (correlation coefficient -0.64, p &lt;0.001) and amoderate positive correlation between the number of vascular stenosis (Coefficient correlation 0.46; p=0.003; Spearman Correlation'sTest). The area under the curve of ROC was 0.9 (p &lt;0.001). The cut off levels sdLDL were used to detect stenosis. The results showeda sensitivity of 85.2%, specificity of 75%, positive predictive value of 88.5%, negative predictive value of 69.2% and accuracy of 82%.Levels of serum sdLDL were associated with severe to extensive stenosis degree, and showed a good diagnostic value, thus, it can beused for screening to determine the presence of coronary stenosis.

Measured Versus Calculated Small Dense LDL-Cholesterol and Cardiometabolic Traits in a South African Population.

Small-dense low density lipoprotein (sdLDL) is increasingly viewed as a marker for evaluating atherogenic risk, however its clinical uptake is hampered by the cumbersomeness of available methods. Consequently, a number of alternative methods for the estimation of sdLDL have been developed and none have been tested in a population from Africa. We evaluated an equation to estimate sdLDL-C from classic lipid parameters in South Africans. This is a cross-sectional study involving 1550 participants in which direct measurement of sdLDL in 237 participants was performed using a homogeneous enzymatic assay. Their mean age (standard deviation, SD) was 54.2 (14.7) years. 156 (65.8%) were normotolerant, 29 (12.2%) prediabetes, 17 (7.2%) screen detected diabetes and 35 (14.8%) known diabetes. Measured sdLDL values ranged from 0.17 to 3.39 versus-1.85 to 2.52mmol/L calculated sdLDL. There was a significant positive correlation between the two measurements with a Pearson correlation coefficient of 0.659 (95%CI: 0.581-0.726). In a regression model, the adjusted R2 was 0.440 after adding age, 0.441 after further adding gender, then 0.443 with dysglycemia and lastly 0.447 upon adding body mass index. With the exception of HDL-cholesterol levels that decreased across increasing quintiles of calculated sdLDL, our data showed significant correlations between sdLDL and cardiometabolic risk factors, all p values < 0.0001. In conclusion, this study has shown that calculated sdLDL can be efficiently used to approximate population levels of sdLDL; however the modest correlation indicate that at the individual level, it will poorly approximate true sdLDL levels, with possible implications for risk stratification.

NILAI SMALL DENSE LDL REMAJA DAN KAITANNYA DENGAN LIPID LAINNYA

In Indonesia, coronary heart disease (CHD) as the cause of death is still the highest in number. It is estimated that the numberof deaths is about 535 per 100.000 population. Atherosclerosis represents the main risk factor which could be predicted through thepresence of small dense LDL (sdLDL) in youngsters. To determine the value of sdLDL in youngsters and its correlation with other lipids,a study was conducted cross sectionally in Makassar, from January to August 2006, on 125 youngsters aged 15 to 19 years. Their totalcholesterol, HDL, LDL, TG and ApoB was determined and sdLDL was derived from calculation of LDL/apoB ≤ 1.2. 69 (55.20%) patientsshowed sdLDL value and 56 (44.8%) patients did not show sdLDL value. Statistical calculation showed a significant correlation betweensdLDL and HDL level (p = 0.001), sdLDL and TG level (p = 0.003), and sdLDL and ApoB level (p = 0.036). Percentage of sdLDL valuewas higher in youngsters aged 15 to 19. This proves that the process of atherosclerosis happened early at a young age. Showed by theexistence of sdLDL and therefore sdLDL could be used as a predictor of atherosclerosis which can be prevented if detected earlier.

Higher D-lactate levels are associated with higher prevalence of small dense low-density lipoprotein in obese adolescents.

Childhood obesity is associated with insulin resistance (IR), increased levels of small dense low-density lipoprotein (sd-LDL) as well as with augmented hepatic de novo lipogenesis, which implies increased triose phosphate fluxes that may lead to increased methylglyoxal (MG) and its catabolic end product D-lactate. We hypothesized that obese adolescents have increased D-lactate serum levels associated with high incidence of sd-LDL. This is a cross-sectional study where the anthropometric characteristics, atherogenic dyslipidemia complex, sd-LDL (Lipoprint, Quantimetrix) and D-lactate (kinetic enzymatic analysis) were explored in 30 lean vs. 30 obese adolescents (16 females and 14 males per group) without metabolic syndrome (MetS). Endothelial function by flow-mediated dilation (FMD, by ultrasound) and arterial lesion by carotid intima media thickness (CIMT, by ultrasound) were also measured. The mean age of participants was 16.8 ± 1.4 years. Obese adolescents had a body mass index of 32.7 ± 3.8 vs. 21.8 ± 2.1 in lean participants. The obesity group showed higher D-lactate levels: 6.2 ± 3.0 vs. 4.5 ± 2.5 μmol/L, higher levels of insulin: 15 (9.6-23.5) vs. 7.9 (6.5-10.5) μIU/mL; triglyceride (TG): 1.46 (1.1-1.8) vs. 0.84 (0.6-1.2) mmol/L; non-high-density lipoprotein-cholesterol (NON-HDL-C): 2.8 ± 0.9 vs. 2.3 ± 0.7 mmol/L; total cholesterol (TC)/HDL-C) index: 2.9 ± 0.7 vs. 2.4 ± 0.5; TG/HDL-C index: 2.2 (1.5-2.8) vs. 1.1 (0.8-1.8); %LDL-3: 4.2 ± 4.07 vs. 1.9 ± 2.7; smaller LDL size: 270.6 ± 3 vs. 272.2 ± 1.1 Å. D-lactate correlated positively with LDL-2: r = 0.44 and LDL-3 (sd-LDL): r = 0.49 and negatively with large LDL-1: r = -0.48 and LDL size: r = -0.46; (p<0.05, p<0.01, p<0.001 and p<0.0001, respectively). Obese adolescents showed higher CIMT: 0.51 ± 0.08 vs. 0.46 ± 0.08 mm and lower FMD: 20.3% ± 6.7% vs. 26.0% ± 9.3%. Obese adolescents display subclinical signs of IR and endothelial dysfunction. Higher serum sd-LDL levels correlated positively with D-lactate levels. These findings suggest an association between atherogenic dyslipoproteinemia and whole body MG fluxes already detectable in apparently healthy obese adolescents.

The effect of nutritional intervention on the lipid profile and dietary intake of adolescents with juvenile systemic lupus erythematosus: a randomized, controlled trial.

Objective This study sought to evaluate the effects of a nutritional intervention on the lipid metabolism biomarkers associated with cardiovascular risk, and their variation over time, in juvenile systemic lupus erythematosus (JSLE) patients. This study also investigated the relationships between these biomarkers and dietary intake, nutritional status, disease variables, and medication used. Methods A total of 31 10- to 19-year-old female adolescents with JSLE for at least six months were analyzed. The participants were randomly allocated to two groups: nutritional intervention or control. The intervention group received verbal and printed nutritional instructions once per month over nine months. Before and after the intervention, the participants underwent assessments of anthropometry; dietary intake; physical activity; socioeconomic status; total cholesterol and fractions; triglycerides; apolipoprotein A (Apo A-I); apolipoprotein B (Apo B); paraoxonase (PON) activity (a) and amount (q); myeloperoxidase (MPO); and small, dense LDL-c (sdLDL) particles. Results After nine months, we found significant reductions in the calorie, carbohydrate, total fat, saturated fat, and trans fat intakes in the intervention compared with the control group over time. The PONa/HDL-c ratio increased by 3.18 U/ml/mg/dl in the intervention group and by 0.63 U/ml/mg/dl in the control group ( p = 0.037). Unlike the intervention group, the sdLDL levels of the control group worsened over time ( p = 0.018). Conclusion The present study detected a reduction in calorie and fat intake, which indicates an improvement of HDL-c function and possible protection against cardiovascular risk for the intervention group.

Correlation of Atherogenic Indices and IMA with Glycaemic Control in Diabetic Patients with and without Dyslipidemia

Atherosclerosis is one of the most common major complications associated with type 2 diabetes mellitus. Recent research suggests that the major culprits are modified proteins like LDL and albumin. Hence, this study focuses on the analysis of small dense LDL (sd LDL), oxidised LDL (ox LDL) and ischemia modified albumin (IMA) in type 2 diabetes mellitus patients with and without dyslipidemia and compare with healthy subjects. Further, correlate atherogenic indices (ox LDL/HDL and sdLDL/HDL) with glycated haemoglobin in these groups. 90 subjects aged between 30-60 years of both the genders were divided into 3 groups namely diabetic dyslipidemia (Group1), diabetic non dyslipidemia (Group2) and normal (group3). Serum lipid profile, ox LDL and IMA were estimated by spectrophotometric methods, sd LDL by calculation and glycated Hb by HPLC. Ox LDL showed an apparent increase in diabetics (group 1and 2) compared to normal. Though sd LDL levels in diabetic patients remained normal, the values doubled in dyslipidemic diabetics. sd LDL/HDL ratio was significantly high in both group1and 2 compared to normal. Furthermore, there was a significant positive correlation of this ratio with glycated Hb in both groups of diabetes. Serum IMA also increased significantly in diabetes with dyslipidemia compared to non dyslipidemic diabetics. The study highlights the fact that in diabetics, oxidatively modified proteins like LDL and albumin may increase with hyperglycemia even before dyslipidemia sets in. Hence, ox LDL and sd LDL may be included in the battery of extended lipid profile to monitor cardiovascular complications in diabetes.

Chronic kidney disease stage affects small, dense low-density lipoprotein but not glycated low-density lipoprotein in younger chronic kidney disease patients: a cross-sectional study.

ABSTRACTBackgroundSmall, dense low-density lipoprotein (sd-LDL) and glycated LDL (g-LDL) have been associated with cardiovascular disease (CVD) in chronic kidney disease (CKD) in patients >60 years of age. Since young adult and paediatric patients have shorter exposure to Framingham-type risk factors, our study aims to determine whether younger CKD patients exhibit the same sd-LDL and g-LDL pattern.MethodsAfter ethics board approval, this cross-sectional study was conducted at two universities with 44 patients (mean ± standard deviation age 12.6 ± 4.9, range 2–24 years) with CKD stage of 1–5. Laboratory parameters studied were Cystatin C (CysC), CysC estimated glomerular filtration rate (eGFR) (calculated from the Filler formula), sd-LDL, g-LDL and albumin. Lipid samples were measured for sd-LDL and g-LDL using ELISA. Non-linear correlation analysis was performed to determine the relationship between g-LDL, sd-LDL and eGFR. Clinical Trials Registration is at clinicaltrials.gov, NCT02126293, https://clinicaltrials.gov/ct2/show/NCT02126293.ResultsTriglycerides, but not total cholesterol and calculated LDL, were associated with CKD stages (ANOVA P = 0.0091). As in adults, sd-LDL was significantly associated with CKD stages (ANOVA P = 0.0133), CysC eGFR (r = −0.6495, P < 0.00001), and body mass index (r = −0.3895, P = 0.0189), but not with age. By contrast, there was no significant correlation between g-LDL and CKD stages or CysC eGFR (P = 0.9678).ConclusionsOur study demonstrates that only triglycerides and sd-LDL were associated with CKD stages in this young cohort without confounding Framingham-type CVD risk factors. While larger studies are needed, this study suggests that lowering sd-LDL levels may be a potential target to ameliorate the long-term CVD risks in paediatric CKD patients.

Small, dense LDL: an update.

In this review, we summarize the latest findings on small, dense LDL (sdLDL) atherogenic particles, including their associations with other biomarkers. Increased sdLDL levels have been reported not only in different metabolic disorders such as diabetes, obesity and metabolic syndrome, but also in patients with rheumatoid and psoriatic arthritis as well as hypothyroidism. A wide range of lipid-lowering, as well as other drug classes, including novel antidiabetic agents and nutraceuticals, exert favourable effects on these atherogenic particles. The 'gold standard' methodology for the assessment of sdLDL has not been established yet. However, the association between sdLDL and several biomarkers could facilitate their assessment. Estimation of sdLDL in daily clinical practice may help with the identification of patients at high cardiovascular risk and further contribute in directing specific interventions to prevent and/or decrease such risk.

SUBFRACTIONS OF ATHEROGENIC APOB-LIPOPROTEIDES IN PATIENTS WITH SEVERE HYPERCHOLESTEROLEMIA

Aim . To investigate on the relation of lipoproteide (a) (Lpa), subfractions of intermediate density lipoproteides (IDL) and low density lipoproteides (LDL) with the probability of familial hypercholestrolemia diagnosis (FHE). Material and methods . Totally, 114 patients included, with severe hypercholesterolemia (LDL-C &gt;4,9 mM/L), with no known coronary heart disease and not taking hypolipidemic therapy. For the probability assessment of FHE, Dutch Lipid Clinics Network criteria were applied. Lipid profile parameters were measured by enzymatic method; Lpa — by immune enzyme method; lipoproteides subfractions — with the Lipoprint® system (Quantimetrix, USA). Results . All patients were selected to subgroups in accordance with the Dutch criteria: I group — with low FHE probability (3-5 points, n=86) and II — with definite and porobable FHE (≥6 points, n=28). Patients from II group had higher atherogenic apoB100-containing lipoproteides (a) levels — 25,5±27,8 and 42,8±41,5 mg/dL (р=0,014), small dense subfractions of LDL — sdLDL: 2,3±3,7 and 7,1±10,1 mg/dL (р&lt;0,01) and IDL-C — 26,6±9,7 and 37,0±10,7 mg/dL (р&lt;0,0001). Monofactorial analysis revealed positive correlation of FHE presence with Lpa (r=0,261, p=0,005), IDL-A (r=0,212, p=0,024), IDL-В (r=0,256, p=0,006), IDL-С (r=0,324, p&lt;0,001), large subfractions of LDL-2 (r=0,218, p=0,020), sdLDL (r=0,362, p=0,0001) and negative correlation with the low density cholesterol (HDL-C) (r=-0,174, p=0,012); however, by the multifactorial analysis the negative correlation was noted only for Lpa (r=0,230, р=0,005) and IDL-С (r=0,411, p=0,009). Combination of the Lpa concentrations ≥30 mg/dL and sdLDL ≥2 mg/dL in relation to Lpa &lt;30 mg/dL and sdLDL &lt;2 mg/dL, as well as Lpa ≥30 mg/dL and IDL-С ≥30 mg/dL in relation with Lpa &lt;30 mg/dL and IDL-С &lt;30 mg/dL significantly increases the probability of FHE diagnostics (odds ratio =11,3 (95% confidence interval 2,9-43,7), р&lt;0,001, and odds ratio =9,0 (95% confidence ratio 2,3-34,9), р=0,002), respectively. Conclusion . In the patients with definite and probable FHE diagnosis, there is significantly increased concentration of the most atherogenic apoB100-containing lipoproteides: Lpa, IDL-C and sdLDL, and the levels of sdLDL ≥2 mg/dL or IDL-C ≥30 mg/dL together with hyperlipoproteidemia (a) increase the chance of FHE verification.

Clinical Utility of Small Dense LDL Cholesterol in Metabolic Syndrome

The metabolic syndrome (syndrome X, Insulin resistance syndrome) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease (CVD) and diabetes mellitus (DM). The rising prevalence of overweight and obesity in India has a direct correlation with the increasing prevalence of obesityrelated co-morbidities, hypertension, the metabolic syndrome, dyslipidemia, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Small dense low density lipoprotein (sdLDL) also represents a marker for diagnosis and severity of the metabolic syndrome. Additionally, it has been suggested that the sdLDL/LDL ratio correlates with various parameters associated with MS rather than the LDL-C or sdLDL-C levels, thus possibly representing a more useful clinical indicator. Total 72 symptomatic cases of either sex, age between 20-80 yrs were recruited, of which, 38 were with MS and 34 were with metabolic syndrome with type 2 DM (MSwT2DM). The lipids and lipoproteins, including sdLDL by homogeneous assay, were determined in controls, MS and T2DM patients. In this study, the mean value of total cholesterol was higher in MS (142.88 ± 7.15) and MSwT2DM (171.16 ± 11.36) compared to normal subjects (109.41 ± 4.97) which was found statistically significant (p<0.001). The mean sdLDL level and sdLDL/HDL ratio of three groups, there was significant difference in sdLDL level and sdLDL/HDL ratio among the groups, there was different and higher mean sdLDL level in both case groups as compared to normal control group. Furthermore, mean sdLDL level was also found significantly (p<0.001) different and higher in MSwT2DM as compared to MS. It is concluded that LDL particle size such as sdLDL concentration has a positive correlation in increase in MS and diabetes mellitus in comparison to normal subjects.

The Association Between Small Dense Low Density Lipoprotein and Coronary Artery Disease in North Indian Patients.

Pathogenesis of coronary artery disease (CAD) is multi-factorial and several conventional risk factors have been ascribed; LDL-C being one of theimportant risk factor. However Indian population studies with established CAD often show LDL levels within normal range in patients with proven CAD. We hypothesized that Small dense low density lipoprotein (sdLDL) being more atherogenic might correlate more strongly to the occurrence and severity of CAD. The aim of the study was to evaluate the association between serum small dense LDL level and angiographically documented coronary artery disease. This is a cross sectional case control study in whichsdLDL were measured in 126 patients with CAD and in 64 patients without CAD. Total cholesterol, HDL Cholesterol, LDL cholesterol and triglycerides were measured by standard methods along with other traditional risk factors. Direct quantitative measurement of sdLDL was done by enzymatic analysis. Mean sdLDL level was higher in patients with coronary stenosis than patients without coronary stenosis (16.3±6.8 vs. 10.1±5.7mg/dL respectively, (p<0.001). There was significant correlation between mean sdLDL and severity of CAD as assessed by syntax score with mean sdLDL level in low, intermediate and high syntax score being 15.0±5.8, 20.1±6.7 and 22.7±7.3mg/dL respectively (p value <0.001). A cut off value of 10.02mg/dL was associated with presence of CAD (95% CI 0.82-0.93, p<0.001) using ROC curve. In conclusion Indian patients with established CAD have higher sdLDL levels compared to individuals without CAD despite having comparable LDL levels.

Elevated Lipoprotein(a) Cncentration and Presence of Subfractions of Small Dense Low Density Lipoproteins as Independent Factors of Risk of Ischemic Heart Disease

To study relation of lipoproteina - Lp(a) and subfractional composition of apoB containing lipoproteins to the presence of ischemic heart disease (IHD). Manerial and methods. Parameters of lipid spectrum, Lp(a), and subfractions of apoB containing lipoproteins were determined in blood serum of 187 patients with known data of instrumental examination. Lp(a) concentration was not linked to any of risk factors, levels total cholesterol (TC), low and high density lipoprotein CH, and subfractions of lipoproteins. In total group triglyceride (TGG) level correlated with content of small dense LDL (sdLDL) (r=0.445, <0.0001) and mean dimension of LDL particles (r=-0.424, p<0.0001). This correlation was absent in the subgroup with Lp(a) more or equal 30 mg/dl and was strengthered among patients with normal Lp(a) level. In total group presence of IHD was associated with sex (r=0.325, p<0.0001), Lp(a) concentration (r=0.271, p=0.0001), and level of triglycerides (r=0.159, p=0.030). In multiple regression analysis levels of TG, Lp(a) and sdLDL were selected as factors independently associated with presence of IHD. Detection of subfractions sdLDL>2 mg/dl in blood plasma (atherogenic profile B), as well as lowering of concentration of large LDL subfractions significantly increased probability of IHD presence in patients with elevated Lp(a) concentration Lp(a) concentration. Lp(a) is an independent factor of risk of coronary atherosclerosis more significant than shifts in subfractional composition of apoB containing lipoproteins. In patients with Lp(a) concentration less or equal 30 mg/dl subfractions of sdLDL were directly related to TG. Level of sdLDL and large lipoproteins of intermediate density are directly related to the presence of IHD. Large LDL correlates with concentration of HDL DL C and probably is cardioprotective. sdLDL content>2 mg/l or hypertriglyceridemia (TG>1.7 mmol/l) significantly increase chances of detection of confirmed IHD in patients with elevated Lp(a).

Atherogenic Lipoproteins in Subclinical Hypothyroidism and Their Relationship with Hepatic Lipase Activity: Response to Replacement Treatment with Levothyroxine.

Qualitative lipoprotein changes, such as an increase in fasting remnants, are reported in subclinical hypothyroidism (SCH). It was hypothesized that such changes are due to reduced hepatic lipase (HL) activity in SCH: HL is an enzyme regulated by thyroid hormones, and is involved in the degradation of triglyceride (TG)-rich remnants. This study aimed to quantify remnant-like lipoproteins (RLP), small dense LDL (sdLDL), and HL activity in women with SCH, and to assess these parameters after levothyroxine replacement therapy. This was an observational cross-sectional study with a subsequent longitudinal follow-up. Findings in women with thyrotropin levels >4.5 mIU/L (SH group) were compared with age- and body mass index (BMI)-matched euthyroid women (control group). In addition, a subgroup analysis was undertaken in SCH women who chose to receive levothyroxine treatment (0.9 μg/kg/day) for 6 months. RLP was quantified by measuring cholesterol (RLP-C) and triglycerides (RLP-TG) after immunoaffinity chromatography, and sdLDL by automated standardized methods; HL activity was measured in post-heparin plasma. The SCH group included 37 women; 29 women were included in the control group. In addition, 22 women with SCH were included in the subgroup analysis (levothyroxine treatment). Significantly higher RLP values were observed in the SCH group than in the control group: RLP-C (median [range], mg/dL): 20.3 (5.8-66.8) versus 10.2 (2.7-36.3), p = 0.005; RLP-TG (mg/dL): 26.3 (3.2-123.3) versus 12.1 (2.5-61.6), p = 0.033. HL activity (mean ± standard deviation [SD], μmol free fatty acid/mL post-heparin plasma.h)-9.83 ± 4.25 versus 9.92 ± 5.20, p = 0.707-and sdLDL levels (mg/dL)-23.1 ± 10.7 versus 22.6 ± 8.4, p = 0.83-were similar. After levothyroxine, RLP-C decreased-21.5 (5.8-66.8) versus 17.2 (4.1-45.6), p = 0.023-and HL increased-9.75 ± 4.04 versus 11.86 ± 4.58, p = 0.012-in the subgroup of SCH women. No changes in sdLDL were observed. Women with SCH have higher RLP levels than matched controls do, but their RLP-C levels decrease significantly following levothyroxine therapy. Furthermore, HL activity also increases after levothyroxine therapy and can be interpreted as a possible explanation for the decrease in RLP-C.

Changes in lipid and carbohydrate metabolism under mTOR- and calcineurin-based immunosuppressive regimen in adult patients after liver transplantation

BackgroundCardiovascular disease is a leading cause of long-term mortality after liver transplantation (LT). Life long immunosuppression harbors the risk of metabolic alterations. We aimed to analyze the impact of calcineurin (CNI)-only containing regimen (group A) compared to mTOR-containing regimen (group B) on lipid and carbohydrate metabolism. Patients/methods92 adult patients after LT, University of Mainz (group A—78 patients, group B—14 patients; 65 M/27 F; mean age 59+/−10.2years; mean time from LT 5.8+/−5years). Clinical data, comorbidities, and medication were assessed. Fasting lipid profile including small dense LDLs (sdLDL) and oral glucose tolerance tests were performed. ResultsGroup B had significantly higher levels of total cholesterol (TC), LDL-cholesterol (LDL-C), triglycerides (TG) and sdLDL, with persistence of higher TC, TG, sdLDLs (mg/dl) after exclusion of patients under lipid lowering medication. Concentrations above the upper limits of normal were found: for LDL-C in 9% of group A/35.7% of group B (p=0.016); for TG: in 32.1% of group A/92.9% in group B (p=0.0001). A positive correlation between time since LT (years) and sdLDL (mg/dl) was found in group B (p=0.018). In patients without previously known diabetes, NODAT and impaired glucose tolerance developed in 27.9% of group A/44.4% of group B (n.s.). ConclusionPatients under mTOR-containing regimen are at higher risk to develop dyslipidemia with increased atherogenic sdLDLs compared to patients under CNI-only-containing regimen and display more frequently a dysglycemic status, with uncertain relevance for long-term cardiovascular risk. A careful monitoring after LT is needed to identify early metabolic risk and manage this appropriately.

A Study of the Extended Lipid Profile including Oxidized LDL, Small Dense LDL, Lipoprotein (a) and Apolipoproteins in the Assessment of Cardiovascular Risk in Hypothyroid Patients.

Hypothyroidism is one of the most common metabolic disorders associated with dyslipidemia which poses a higher risk of Coronary Artery Disease (CAD) in such patients. Biochemical markers which can pick up the risk promptly are becoming imperative now-a-days and thus the assessment beyond the conventional lipid profile is the need of the hour. To assess the association of non-conventional lipid parameters like small dense Low Density Lipoprotein (sd LDL), oxidized Low Density Lipoprotein (ox LDL), Apolipoprotein A (Apo A1), Apolipoprotein B (Apo B) and Lipoprotein (a) {Lp(a)} in hypothyroid patients and compare their values with the conventional lipid parameters such as Total Cholesterol (TC), Triglyceride (TG), Low-Density Lipoprotein Cholesterol (LDL-C) and High-Density Lipoprotein Cholesterol (HDL-C). One hundred and thirty clinically proven patients of hypothyroidism aged 20-60 years and equal number of age and gender matched healthy individuals were included in this case control study. Serum sd LDL, ox LDL, Apo A1, Apo B, Lp (a), lipid profile, Thyroid Stimulating Hormone (TSH), Free Triiodothyronine (FT3) and Free Tetraiodothyronine (FT4) levels were measured in both the groups. The data was recorded and analysed on SPSS system. The results of cases and controls were compared by student t-test and one-way ANOVA. All the parameters were correlated with TSH by Pearson's correlation. We found significantly high levels of sd LDL, ox LDL, Apo B, Lp (a), TC, TG, LDL-C in cases as compared to the controls. Ox LDL has shown maximum correlation with serum TSH (p<0.0001, r=0.801) followed by sd LDL (p<0.0001, r=0.792), Apo B (p<0.001, r=0.783) and LDL-C (p<0.001, r=0.741). Moreover, ox LDL and sd LDL were found to be increased in normolipidemic hypothyroid patients thereby giving a strong supportive evidence that estimation of these parameters can become fundamental in prompt identification of the high risk patients of CAD in hypothyroid population. Non-conventional lipid parameters appear to be better markers for the assessment of cardiovascular risk in hypothyroidism and might help in the designing of the effective treatment protocols and areas of intervention by the clinicians as well as researchers.