Serum Cholesterol Levels In Patients Research Articles

The Prognostic Implications of Perioperative Serum Cholesterol Levels in Patients With Gastric Cancer.

Although cholesterol is an important indicator of nutritional status, it is also involved in cancer progression. In this study, we investigated the clinical significance of the dynamics of perioperative total cholesterol (T-Cho) levels in patients with gastric cancer (GC). A total of 212 patients with pathological stage II/III disease who underwent gastrectomy between 2004 and 2020 were enrolled in this retrospective study. The preoperative and postoperative serum T-Cho levels were measured in these patients. Increased serum T-Cho levels were significantly correlated with low preoperative serum albumin levels (p<0.001). Patients with increased serum T-Cho levels after surgery had significantly lower overall and recurrence-free survival rates (p=0.030 and p=0.013, respectively; log-rank test). Cox proportional hazards model revealed that increased serum T-Cho levels (p=0.040), advanced pathological stage (p<0.001), and the provision of adjuvant chemotherapy (p=0.006) were independent prognostic factors for recurrence-free survival in patients with GC. Increased serum T-Cho levels after gastrectomy may be an independent prognostic factor in patients with GC.

Perbedaan Derajat Keparahan Penyakit Berdasarkan Skor Psoriasis Area and Severity Index (PASI) Terhadap Profil Lipid pada Psoriasis Vulgaris

Psoriasis vulgaris is a chronic systemic autoimmune disease that affects skin, joint, nail and other organ with clinical manifestation well-defined erythematous plaques with thick silvery scales. Psoriasis vulgaris is associated with dyslipidemia include elevated level of total cholesterol, LDL and triglyceride serum and decreased HDL serum levels. Psoriasis Area and Severity Index (PASI) is an examination to assess the severity of psoriasis vulgaris and mostly used in clinical practice and research. Purpose: To determine differences in disease severity based on PASI scores on lipid profiles in psoriasis vulgaris patients. Methods: This research is an observational analytic study with cross sectional research design conducted at Dr. Moewardi General Hospital Surakarta from February to March 2022. The total number of subjects was 25 patients with psoriasis vulgaris. All data were analyzed using SPSS version 21 application (IBM Corp. Chicago, USA). Bivariate analysis with parametric independent T test and Mann-Whitney test were used to determine the differences of total cholesterol, LDL, triglyceride and HDL serum level between PASI &lt;10 and PASI ≥10 with p&lt;0,05 considered significant. Results: Patients with PASI &lt;10 had mean value of total cholesterol levels 187,53±26,39, LDL levels 128,24±28,37, triglyceride levels 115,88±61,74 and HDL levels 46,29±11,98 while in patients with PASI ≥10 had value of total cholesterol levels 218,75±34,92 (p=0,020), LDL levels 145,63±35,76 (p=0,201), triglyceride levels 201,88±158,04 (p=0,215) and HDL levels 44,13±11,36 (p=0,672). There is a significant difference between the severity of the disease based on the PASI score on total serum cholesterol levels in psoriasis vulgaris patients. Conclusion: There was a significant difference between PASI score &lt;10 and PASI score ≥10 on total serum cholesterol levels in patients with psoriasis vulgaris.

Relationship between periodontal status and dyslipidemia in patients with type 2 diabetic nephropathy and chronic periodontitis: A cross-sectional study.

The aim of this study was to investigate the association between periodontitis and total serum cholesterol level in patients with type 2 diabetic nephropathy (T2DN). Periodontitis is now recognized as the sixth complication of diabetes and can also affect other complications of diabetes, including nephropathy and coronary artery diseases. Studies have considered dyslipidemia as a risk factor for exacerbation of periodontitis. A total of 119 T2DN patients with chronic periodontitis were included in this observational study. Participants were stratified into the Normal (serum total cholesterol <5.17 mmol/L, n=89) and the Dyslipidemia groups (serum total cholesterol ≥5.17 mmol/L, n=30). Participants completed a validated questionnaire that collected information on oral hygiene behaviors and knowledge of oral health and underwent a clinical oral examination. The number of remaining teeth, probing depth (PD), clinical attachment level (CAL), and bleeding index (BI) was recorded. Physical examination and laboratory tests (fasting plasma glucose, serum glycosylated hemoglobin (HbA1c), total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglyceride, and high-sensitivity C-reactive protein levels) were performed. Means of CAL and BI were significantly higher in the Dyslipidemia group compared with the Normal group. In the Dyslipidemia group, PD and percent of sites with PD ≥4 mm were positively correlated with urinary albumin/creatinine ratios; PD and percent of sites with PD ≥4 and PD ≥5 mm were positively correlated with HbA1c level; a number of remaining teeth were negatively correlated with serum LDL-C level. After adjusting for age, gender, body mass index, smoking, FPG, and serum HbA1c and triglyceride levels, BI was found to be positively associated with dyslipidemia in T2DN patients with periodontitis. T2DN patients with chronic periodontitis had a 2.355-fold higher risk of developing dyslipidemia, implying an important relationship between periodontitis and blood lipid control among T2DN patients.

Total serum cholesterol level in patients with major depressive disorder: Simple yet undermined

Human brain cholesterol acts as structural components of cellular membrane, synapse and dendrite formation.Researchers have found a possible association between low serum cholesterol levels and mood disorders though the literature from India in this regard is limited. To estimate serum levels of total cholesterol in patients with major depressive disorder. 75 patients of MDD were compared with equal number of age and sex matched controls. 5 ml of fasting sample of blood was obtained in a plain vacutainer to analyse total cholesterol level by Cholesterol oxidase-peroxidase method. Statistical analysis: The obtained results were tabulated and analyzed by multiple logistic regression analysis, independent t-test, Chi-square test and area under the curve. The mean level of cholesterol in cases (158.85±61.22 mg/dL) which was significantly lower compared to the controls (182.71±40.98 mg/dL) with P &lt;0.01. The symptoms of MDD negatively correlated with lower serum cholesterol level with odds ratio of 0.99. There was statistically significant lower level of cholesterol in the MDD group below 140 mg/dL compared to the control group with P &lt;0.001. As the measurement of total serum cholesterol is simple and cost effective, it can be used as an important biochemical marker for MDD.

Association of Serum Cholesterol Levels With Peripheral Nerve Damage in Patients With Type 2 Diabetes

Lowering serum cholesterol levels is a well-established treatment for dyslipidemia in patients with type 2 diabetes (T2D). However, nerve lesions in patients with T2D increase with lower serum cholesterol levels, suggesting that lowering serum cholesterol levels is associated with diabetic polyneuropathy (DPN) in patients with T2D. To investigate whether there is an association between serum cholesterol levels and peripheral nerve lesions in patients with T2D with and without DPN. This single-center, cross-sectional, prospective cohort study was performed from June 1, 2015, to March 31, 2018. Observers were blinded to clinical data. A total of 256 participants were approached, of whom 156 were excluded. A total of 100 participants consented to undergo magnetic resonance neurography of the right leg at the Department of Neuroradiology and clinical, serologic, and electrophysiologic assessment at the Department of Endocrinology, Heidelberg University Hospital, Heidelberg, Germany. Quantification of the nerve's diameter and lipid equivalent lesion (LEL) load with a subsequent analysis of all acquired clinical and serologic data with use of 3.0-T magnetic resonance neurography of the right leg with 3-dimensional reconstruction of the sciatic nerve. The primary outcome was lesion load and extension. Secondary outcomes were clinical, serologic, and electrophysiologic findings. A total of 100 participants with T2D (mean [SD] age, 64.6 [0.9] years; 68 [68.0%] male) participated in the study. The LEL load correlated positively with the nerve's mean cross-sectional area (r = 0.44; P < .001) and the maximum length of a lesion (r = 0.71; P < .001). The LEL load was negatively associated with total serum cholesterol level (r = -0.41; P < .001), high-density lipoprotein cholesterol level (r = -0.30; P = .006), low-density lipoprotein cholesterol level (r = -0.33; P = .003), nerve conduction velocities of the tibial (r = -0.33; P = .01) and peroneal (r = -0.51; P < .001) nerves, and nerve conduction amplitudes of the tibial (r = -0.31; P = .02) and peroneal (r = -0.28; P = .03) nerves. The findings suggest that lowering serum cholesterol levels in patients with T2D and DPN is associated with a higher amount of nerve lesions and declining nerve conduction velocities and amplitudes. These findings may be relevant to emerging therapies that promote an aggressive lowering of serum cholesterol levels in patients with T2D.

THE PREDICTIVE VALUE OF NEWLY DEFINED CHA2DS2-VASC-HSF SCORE FOR SEVERITY OF CORONARY ARTERY DISEASE IN NON ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

ABSTRACT Background: CHADS2 and CHA2DS2-VASc scores are widely used in clinical practice and include similar risk factors for the development of coronary artery disease (CAD). It is known that factors comprising the newly defined CHA2DS2-VASC-HSF score promote atherosclerosis and are associated with severity of CAD [1] . Aim: To investigate the association of CHA2DS2-VASc-HSF score with severity of Coronary Artery Disease as assessed by Syntax Score (SxS) in patients with Non ST Segment Elevation Myocardial Infarction. Subjects and methods: A total of 50 patients with NSTEMI (37 males and 13 females, their age ranged from 35 to 77 years old with a mean age of 57.8 years old) who underwent coronary angiography were included in our study. The patients were divided into 2 groups according to SxS score (SxS ≤22 and SxS < 22(. Results : This study showed a statistically significant positive correlation between CHA2DS2-VASC-HSF score and Syntax score I of patients. There is a statistically significant positive correlation between CHA2DS2-VASC-HSF score and serum cholesterol levels of patients. A statistically significant positive correlation was found between CHA2DS2-VASC-HSF score and serum LDL levels of patients. Our study also showed a statistically significant negative correlation between CHA2DS2-VASC-HSF score and ejection fraction (EF%) of patients. Conclusions: A newly defined CHA2DS2-VASC-HSF score predicts the severity of atherosclerosis in patients with NSTEMI. Keywords : CHA2DS2-VASC-HSF score, severity, syntax score, coronary artery disease, NSTEMI

Cholesterol levels of Japanese dyslipidaemic patients with various comorbidities: BioBank Japan.

BackgroundControlling serum cholesterol is critical to prevent cardiovascular disease in patients with dyslipidaemia. Guidelines emphasise the need to select treatment for dyslipidaemia based on specific patient profiles; however, there is little information about the serum cholesterol levels of patients in each profile in Japan. Therefore, we aimed to describe the serum cholesterol levels and prevalence of uncontrolled cases in Japanese patients with dyslipidaemia.MethodsWe included data for patients with dyslipidaemia between 2003 and 2007 from the BioBank Japan Project (66 hospitals). Then, we reported their serum cholesterol levels by age, body mass index, glycaemic control (glycated haemoglobin A1c), blood pressure, smoking, drinking, comorbidity and medication profiles.ResultsWe included 22,189 male and 21,545 female patients. The mean serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG) and non-HDL-C levels in males were 117.4 mg/dL, 51.0 mg/dL, 187.6 mg/dL and 153.6 mg/dL, respectively; the corresponding levels in females were 129.5 mg/dL, 60.5 mg/dL, 144.9 mg/dL and 157.9 mg/dL, respectively. In both males and females, the LDL-C levels were the highest in the following profiles: age 19–44 years, body mass index 18.5–22 kg/m2, glycated haemoglobin A1c <6.0%, never smoker, chronic respiratory disease as a comorbidity and no medication use.ConclusionsThese data provide details of serum cholesterol levels by risk-factor profile in patients with dyslipidaemia and could add evidence of treatment decisions.

Comparison of Effects of Morning Versus Evening Administration of Ezetimibe/Simvastatin on Serum Cholesterol in Patients with Primary Hypercholesterolemia

Ezetimibe, a first-in-its-class inhibitor of cholesterol absorption, is an effective agent for combined use with statins to achieve low-density lipoprotein cholesterol (LDL-C) goals. Ezetimibe in combination with simvastatin as a single-tablet formulation has proven to be highly effective in reducing serum LDL-C through the dual inhibition of cholesterol absorption and biosynthesis. The effect of time of administration on efficacy of this combination therapy has not been evaluated. To compare the effects of morning versus evening administration of ezetimibe/simvastatin on serum cholesterol levels of patients with primary hypercholesterolemia. In this multicenter, open-label, randomized, 2-sequence, 2-period crossover study, patients with primary hypercholesterolemia randomly received ezetimibe/simvastatin 10 mg/20 mg once daily, either in the morning (within 1 hour of breakfast) or in the evening (within 1 hour of dinner) for 6 weeks. Data on 171 patients (87 in the morning administration group and 84 in the evening administration group) were analyzed. A significant reduction (p ≤ 0.001) in the total cholesterol, triglyceride, high-density lipoprotein cholesterol, LDL-C, apo-lipoprotein B, and high-sensitivity C-reactive protein (hs-CRP) from baseline was achieved after each treatment. Noninferiority of morning administration versus evening administration was shown in the percentage reduction of the LDL-C level from baseline (difference, -1.62%; 90% CI -4.94 to 1.70). No significant difference was found between groups with respect to the percentage of changes in other lipid parameters from baseline. Furthermore, there was no significant difference in the percentage of change in hs-CRP as an antiinflammatory marker between the morning and evening administration groups. The frequency of adverse events was similar between groups. Morning administration of ezetimibe/simvastatin 10 mg/20 mg is noninferior to evening administration with respect to LDL-C-lowering ability.

Triglycerides and total serum cholesterol in rotator cuff tears: do they matter?

ObjectiveIn this study, the serum triglycerides and total serum cholesterol levels in patients with rotator cuff tear were determined.DesignFrequency-matched case-control study.SettingUniversity teaching hospital.Participants240 individuals who were operated on at our...

Aortic calcifications in familial hypercholesterolemia: Potential role of the low-density lipoprotein receptor gene

We have previously reported premature, extensive aortic calcifications in patients with homozygous familial hypercholesterolemia (hmzFH) due to mutations in the low-density lipoprotein receptor gene (LDL-R). The objective of this study was to measure the degree of aortic calcification in heterozygous FH (htzFH) compared to both hmzFH and controls. We hypothesized that the LDL-R gene may contribute to aortic calcifications in a gene-dosage effect. Patients with htzFH due to the French Canadian mutation (Delta15 kb del. null allele) were selected. All patients underwent computed tomographic scan to measure vascular calcification. We used 22 hmzFH patients from our previous study and patients undergoing computed tomographic virtual colonoscopy as controls. Mean age for htzFH was 50 +/- 15 years; initial cholesterol level before treatment was 10.45 +/- 1.73 mmol/L. Major cardiovascular events occurred in 9 of 17 patients. A strong correlation between age and calcium score was found (r = 0.72, P = .0016). There was a strong correlation between the cholesterol-year score (an index of lifelong cholesterol burden) and the aortic calcium score (r = 0.62, P = .0105). Aortic calcifications in htzFH subjects occurred later than in hmzFH patients, but much earlier than in controls, suggesting a gene-dosage effect of LDL-R mutations and aortic calcium deposition. Aortic calcification was observed in patients with htzFH but presented at a later time and were less extensive than in hmzFH (34 vs 14 years, respectively). Because aortic calcifications may be partly independent of serum cholesterol levels in patients with familial hypercholesterolemia, implications for screening and the timing of treatment initiation may need reassessment.

Serum cholesterol levels do not influence outcome or recovery in acute ischemic stroke

Objective: To examine the influence of admission serum cholesterol levels (SCL) on severity of initial neurological deficit, neurological outcome at month 3 and neurological recovery in patients with acute first-ever ischemic stroke.Methods: Prospectively collected data from 889 consecutive patients with first-ever acute ischemic stroke were retrospectively analysed. Patients who suffered a recurrent ischemic stroke (n=22) or died (n=30) during the follow-up period were excluded from this study. Age, gender, arterial hypertension, diabetes mellitus, smoking, stroke etiology, SCL and severity of neurological deficit, using the National Institute of Health Stroke Scale (NIHSS), at presentation (NIHSS0) and after 3 months (NIHSS1), were assessed. Neurological recovery was defined as difference in NIHSS score (ΔNIHSS), according to ΔNIHSS=NIHSS0 − NIHSS1.Results: Data from 837 patients (66% men, age: 62 ± 14 years) were analysed. NIHSS1 was 2.3 ± 1.8 and ΔNIHSS was 3.4 ± 3. Clinically insignificant correlations between SCL and NIHSS0 (r=−0.13, p=0.0002), NIHSS1 (r=−0.09, p=0.001) and ΔNIHSS (r=−0.1, p=0.03) were evident. Multivariate binary logistic regression analysis revealed smoking (p=0.008), stroke etiology (p=0.023) and NIHSS0 (p<0.001) but not age, gender, arterial hypertension, diabetes mellitus or SCL as predictors for ΔNIHSS.Conclusion: Our data suggest that SCL in patients with acute ischemic stroke are not associated with neurological deficit on admission, outcome or neurological recovery.

Behavioral effects of dietary cholesterol in rats tested in experimental models of mild stress and cognition tasks

Abnormalities in serum cholesterol levels of patients with mood disorders have been identified in epidemiological studies. However, evidence for an influence of dietary cholesterol on behavioral models is poor. Here, we investigated the behavioral changes of Wistar male rats fed a 2% cholesterol-enriched diet for 2 months in experimental models of depression and anxiety, such as the forced swim test (FST) paradigm and the novelty-induced grooming sampling test (NGT). The correlation between behavioral depression and impaired cognitive capacity was also examined testing rats in the Morris water maze (MWM) task one day after the FST. Different groups of rats fed various dietary regimens, were subjected to acute or repeated treatment (14 days) with clomipramine hydrochloride (50 or 25 mg/kg), diazepam (1 mg/kg) or with the peripheral benzodiazepine receptors (PBRs) antagonist, isoquinoline PK11195 (1 mg/kg) injected intraperitoneally (i.p.). Rats fed the cholesterol-enriched diet showed a significant decrease of grooming score in the NGT and of immobility time in the FST in comparison to animals fed a standard diet. Furthermore, the anxiolytic and antidepressant effects of diazepam and clomipramine were not affected by the different diets. Only after repeated treatment, PK11195 impaired the performance of animals fed a standard diet in the FST, and exhibited an anxiolytic-like profile in animals fed either the cholesterol-enriched or the standard diet. The improved performance in the FST was followed by a better learning performance in the acquisition phase of the MWM. These results suggest that effects of cholesterol-enriched diet on the behavioral reaction of rats in experimental models of mild stress may involve PBRs. They deserve attention in order to clarify the clinical correlation between plasma cholesterol levels and mood disorders in humans.

Genetic variation and antipsychotic drug effects on serum lipids.

Evaluation of: Smith RC, Segman RH, Golcer Dubner T, Pavlov V, Lerer B: Allelic variation in ApoC3, ApoA5, and LPL genes and first and second generation antipsychotic effects on serum lipids in patients with schizophrenia. Pharmacogenomics J. DOI: 10.1038/sj.tpj.6500474 (2007) (Epub ahead of print) [1] . Some newer antipsychotic drugs may raise serum lipid levels, but it is not known whether specific genetic variants affect an individual's susceptibility to this. In 189 schizophrenia patients treated with either first- or second-generation antipsychotic drugs, Smith and colleagues analyzed drug-by-genotype interaction effects on serum cholesterol and triglyceride levels using five polymorphisms in three genes that affect serum lipids: APOC3, APOA5 and LPL. Three interactions involving the APOA5 -1131 T/C polymorphism remained significant after adjustment for multiple testing; the rarer C allele was associated with higher serum cholesterol levels in patients treated with first-generation antipsychotics, and lower levels in those treated with clozapine or olanzapine. This article emphasizes aspects of their study which illustrate points that may be useful in planning future pharmacogenetic studies.

A review of Chest Pain in Nigerian Hypertensive Patients Presenting to the Out–Patient's Clinic of a Teaching Hospital.

In a prospective 6–month study, chest pain was reviewed in hypertensive man above 40 years and post menopausal women on antihypertensive therapy. The subjects were made up of 230 volunteers made up of 101 males and 129 females. Their mean age was 54.5 + 10 years (males 51.3 + 8.9 years vs. female 53.3 + 9.8 years). Forty seven percent of subjects admitted to pain as being located in the retrosternal area, in 38% it was cited at the precordial area and the remainder (9%) cited the pain on the right side of the chest and 6% submamary. Twenty six percent and 22% of subjects described pain as being pressure like or dull consecutively. In 42% of patients pain was aggravated by exertion, in 32% of subjects pain had no aggravating factor, 14% and 3% had pain aggravated by hunger and the use of non steroidal anti-inflammatory agents. In the remaining 9% pain was aggravated by breathing particularly during the inspiratory phase of respiration. The relieving factors described include rest in 34%, analgesia in (25%), change of position in 4% and antacid in 12%. In the remaining 25% no relieving factor was identified. Pain radiation was described was mainly to the epigastrium. Based on the symptoms, 11% had all the three parameters of pain description suggestive of angina pectoirs. 5% of patients had symptom suggestive of atypical angina and 17% had just one character present and considered non cardiac. The difference in serum cholesterol level in patients described as having classic angina and atypical were statistically significantly higher than those in subjects who did not complain of chest pain. Patients with atypical chest pain had the highest blood pressure; those with non cardiac pain had the highest WHR while those with no pain had the highest BMI. A proper approach to patients with chest pain irrespective of how trivial it may seem, should include a careful description and characterization of the chest pain, careful and a thorough physical examination. A rational and judicious utilisation of facilities should be employed carrying out the available investigations and possibly following chest pain protocols. . Keywords : Chest pain, Hypertension, teaching Hospital Nigerian Journal of Health and Biomedical Science Vol. 6 (1) 2007: pp. 58-62

The effect of biliary sphincterotomy on serum cholesterol level in postcholecystectomy patients: a pilot study.

Cholesterol, in the form of bile salts, is reabsorbed from the small intestine via the enterohepatic circulation. Biliary sphincterotomy increases the delivery of bile to the terminal ileum. If the absorptive capacity is exceeded, cholesterol excretion may increase, resulting in a decrease in serum cholesterol levels and improvement in serum lipid profiles. To determine the effect of biliary sphincterotomy on serum cholesterol levels in patients without biliary obstruction. Postcholecystectomy patients with type III biliary sphincter of Oddi dysfunction (disabling pancreatobiliary-type pain with normal liver function tests and bile duct diameter) who underwent biliary sphincterotomy were identified retrospectively from the endoscopic retrograde cholangiopancreatography database. Baseline (pre-endoscopic retrograde cholangiopancreatography) laboratory investigations (including cholesterol) were obtained for all patients. The effect of sphincterotomy on total cholesterol levels was noted in all patients who returned for subsequent procedures (temporary pancreatic stent removal or evaluation of recurrent symptoms), and also in the subgroup of patients with baseline hypercholesterolemia (higher than 5.18 mmol/L). In the present pilot study, the performance of biliary sphincterotomy was associated with a reduction in total serum cholesterol levels in postcholecystectomy patients without biliary obstruction. This was statistically significant in patients with a baseline cholesterol level higher than 5.18 mmol/L. A possible effect on low- and high-density lipoprotein concentrations was not evaluated. The influence of dietary changes and exercise were not accounted for. A prospective, controlled study involving a larger series of patients is required to determine whether biliary sphincterotomy lowers cholesterol levels and improves lipid profiles.

Decreased Coenzyme Q10 Concentration in Plasma of Children with Cystic Fibrosis

Coenzyme Q10 (CoQ10) is an effective lipophilic antioxidant and protects against lipid peroxidation by scavenging radicals. Patients with cystic fibrosis generally have fat malabsorption; thus, we hypothesized that overall plasma CoQ10 concentration in pediatric patients with cystic fibrosis might be diminished. Because these patients have increased oxidative stress due to chronic pulmonary inflammation, we also assumed that the oxidized form of CoQ10 might be relatively increased. The total plasma CoQ10 levels and the oxidized and reduced form were measured by high-performance liquid chromatography in 30 children with cystic fibrosis (mean FEV1 % predicted = 88.5% +/- 18.7%) and 30 age-matched controls. Total plasma CoQ10 levels were significantly lower in the cystic fibrosis group as compared with the control group (0.87 +/- 0.42 micromol/L and 1.35 +/- 0.39 micromol/L, respectively; P < 0.001). When correcting for the lower serum cholesterol level in patients with cystic fibrosis, this difference remained significant: the CoQ10/cholesterol ratio (micromol/mol) was 268.8 +/- 136.7 and 334.0 +/- 102.9 in patients and controls, respectively (P < 0.05). However, the CoQ10 redox status was identical in patients and controls (86.4% +/- 7.1% and 85.4% +/- 7.3%, respectively). We found that the overall plasma CoQ10 concentration is lower in patients with cystic fibrosis, probably because of fat malabsorption. The CoQ10 redox status was not disturbed, indicating that CoQ10 could still be adequately regenerated in this group of patients with cystic fibrosis with mild-to-moderate pulmonary disease.

Threats, opportunities, and statins in the modern management of heart failureThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

This editorial refers to ‘Prognostic significance of serum cholesterol levels in patients with idiopathic dilated cardiomyopathy’† by M. Christ et al., on page 691 Effective management of heart failure is becoming increasingly complex. Polytherapy, both pharmacological and device-based, should now be the standard practice for the management of most patients with heart failure.1 This requires considerable medical expertise, training, and organization of care. Unfortunately, although heart failure is a highly malignant and treatable condition, its management is poorly resourced and organized compared with cancer.2,3 Further developments in the provision of care for patients with heart failure carry threats and opportunities. One important threat is that the complex polypharmacy could lead to more confusion, more adverse drug effects, and more drug interactions. For instance, even though spironolactone has been shown to be effective in clinical trials, and to save lives, its use without proper monitoring may increase mortality. Another threat is the perception among some health care providers and research sponsors that new treatments are unlikely to improve much on the existing therapy for heart failure. Despite the success of properly managed treatment, the prognosis of heart failure remains poor. Twenty years ago, the 2-year mortality of heart failure with relatively mild symptoms was about 35% and for patients with relatively severe symptoms about 70%.1 Modern treatment has reduced these figures, respectively, to about 10 and 20% ( Figure 1A–C ). Figure 1 ( A–C ) Summary of the effects of pharmacological and device therapy on all-cause 2-year mortality.1 The … *Corresponding author. Tel: +44 1482 624 084; fax: +44 1482 624 085. E-mail address : j.g.cleland{at}hull.ac.uk

Drug Insight: statins and stroke

Stroke is the third leading cause of death in the US and a common cause of long-term disability worldwide. Ischemic strokes, which are often atherothrombotic, account for more than 80% of all strokes. Current stroke prevention focuses on optimizing the treatment of modifiable risk factors, such as hypertension, diabetes and dyslipidemia. The epidemiologic association between serum cholesterol levels and adjusted stroke rates is not as strong as the link between serum cholesterol levels and coronary heart disease. Clinical trials of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins), which are potent inhibitors of cholesterol synthesis, have demonstrated, however, a marked reduction in stroke risk in hypercholesterolemic and atherosclerotic individuals, with benefits extending to normocholesterolemic individuals. These findings suggest that statins might have additional effects in stroke protection beyond cholesterol reduction. Because statins inhibit the synthesis of isoprenoid intermediates in the cholesterol biosynthetic pathway, which are important lipid attachments for intracellular signaling molecules, they might have direct noncholesterol-dependent effects on inflammatory and endothelial cells. Here we discuss data from clinical trials assessing the effects of statins on stroke risk, as well as outline the mechanisms underlying the cholesterol-independent effects of statins and provide evidence-based recommendations for stroke prevention, based on achieved serum cholesterol levels in patients at risk of stroke.

Prognostic significance of serum cholesterol levels in patients with idiopathic dilated cardiomyopathy

Previous studies indicate that low cholesterol levels are associated with adverse prognosis in heart failure patients, because elevated lipoprotein levels may negate bacterial endotoxin load induced by gastrointestinal congestion. We examined the prognostic significance of lipid levels in a cohort of 422 patients with idiopathic dilated cardiomyopathy (iDCM) [50+/-12 years, 342 males, 80 females, left ventricular ejection fraction (LV-EF): 31.6+/-10.6%]. During 42 months of follow-up, 86 patients (20.3%) died or received a heart transplant. In univariate Cox regression analysis, reduced LV-EF, high New York Heart Association (NYHA) class, and increased LV end-diastolic diameter (LVEDD) were strong risk factors associated with that endpoint, whereas decreased total cholesterol, HDL-cholesterol, and apoprotein I levels were identified as weak risk predictors. After step-wise multivariable analysis, only LVEDD, NYHA class, and LV-EF emerged as parameters independently contributing to the model predicting risk for death or heart transplantation (P<0.05). Cholesterol levels were positively associated with LV-EF and negatively associated with LVEDD (P<0.05). Circulating sCD14 levels, a marker of endotoxin exposure, were related to cholesterol levels (P<0.05) and LV-EF (P<0.05). Decreased cholesterol levels do not independently predict adverse prognosis in patients with iDCM. Our findings indicate that low cholesterol levels are dependent on the severity of cardiac disease.

MR aortography and serum cholesterol levels in patients with long-term nonspecific lower back pain.

A cross-sectional analysis of the feeding arteries of the lumbar spine and cholesterol levels on patients with long-term nonspecific lower back pain. To evaluate whether occlusion of lumbar and middle sacral arteries or serum cholesterol levels are associated with lower back pain and/or with disc degeneration. Atherosclerosis in the wall of the abdominal aorta usually develops at the ostia of branching arteries and the bifurcation, and may obliterate orifices of lumbar and middle sacral arteries. Obstruction of these arteries causes ischemia in the lumbar spine and may result in back symptoms and disc degeneration. MR aortography and cholesterol blood tests were performed on 51 patients with long-term lower back pain without specific findings (i.e., spinal or nerve root compression) in regular lumbar MR images. The patients ranged from 35 to 70 years of age (mean age, 56 years). Serum cholesterol and low-density lipoprotein (LDL) cholesterol levels were measured. To assess symptoms and disability NASS low back Outcome Instrument was used. Twenty-nine (78%) of 37 men and 11 (77%) of 14 women showed occluded lumbar and/or middle sacral arteries. The prevalence of occluded arteries was 2.5 times more than in subjects of corresponding age group in a Finnish necropsy material. Twenty-three (62%) men and seven (50%) women had significant disc degeneration. Disc degeneration was associated with occluded lumbar/middle sacral arteries (P = 0.035). Patients with occluded arteries or significant disc degeneration did not complain more severe symptoms than those without, whereas patients with above normal serum LDL cholesterol scored higher in neurogenic symptoms (P = 0.031) and complained more often severe pain (P = 0.049) than those with normal LDL cholesterol. The study indicates that lumbar and middle sacral arteries are often occluded in patients with nonspecific long-term lower back pain. Occlusion of these arteries may also be associated with disc degeneration.