Lipid Testing Research Articles

Evaluation of 13 Formulae for Calculated LDL-C Using Direct Homogenous Assay in a South Indian Population.

LDL cholesterol (LDL-C) is regarded as a significant therapeutic target and a known risk factor for atherosclerosis. It can be calculated using the results of the other lipid tests or tested directly. Despite its shortcomings, the Friedewald formula is most frequently utilized since it is simple and practical. Until now, several formulae have been proposed for calculating LDL-C; however, their accuracy has not been evaluated across different populations. We sought to evaluate the validity of calculated LDL-C by comparing the findings with values acquired by the direct homogeneous technique, utilizing 13 distinct formulae from the literature. This study was a retrospective observational study conducted for a year at SRIHER, Chennai, Tamil Nadu, India. From the total 25 043 patients who had their serum lipid profile tested, 16 314 participants had their fasting blood sugar and fasting lipid profile measured simultaneously, and they were chosen for the research. The de Cordova, Chen, Martin/Hopkins (initial), and Teerakanchana equations correlated well with the direct LDL-C assay. When the dataset was stratified according to triglycerides, the Chen and Martin/Hopkins initial equations had the better measurement of agreement compared to other equations. The Martin/Hopkins initial equation outperformed all the other equations when the whole dataset irrespective of the triglyceride population was considered. Our study suggests that the Martin/Hopkins initial equation outperformed all the other equations and can be used as an alternative to direct LDL-C measurement in a South Indian population.

Lili-Hics trial: Efficacy of the lipid test in liver hydatid cyst surgery.

Bile leakage is a common complication following liver surgeries, particularly in the cases of liver hydatid cyst operations. Currently, there is no adequate method which could be utilized to prevent this complication effectively. Our study aimed to assess the efficacy of the biliary lipid test (BLT) in reducing biliary complications after hydatid cyst surgery. We retrospectively included patients who underwent open liver hydatid cyst surgery between January 2011 and January 2024. The study encompassed 122 patients, with 41 males and 81 females, ranging in age from 18 to 79 years. In the BLT group, a lipid solution was injected transcystically after cholecystectomy. The BLT was performed on 65 patients, while 57 patients did not undergo the test. Following the transcystic injection of the lipid solution, orifices at the site of lipid droplets that became visible were ligated with 5.0 prolene sutures. A total of 200 leak sites were sutured. Remarkably, none of the patients in the BLT group experienced postoperative bile leakage lasting longer than one week. Consequently, a shorter hospital stay was observed in this group. Transcystic injection of the lipid solution with distal clamping effectively demonstrated leak sites, and suturing these sites prevented postoperative bile leakage. Our study demonstrates the effectiveness of the LIpid test in LIver Hydatid Cyst Surgery (Lili-Hics) in reducing biliary complications following hydatid cyst surgery.

Retinal thickness changes in preobese and obese patients without hyperglycemia: Optical coherence tomography study

PurposeTo evaluate retinal thickness changes by optical coherence tomography in preobese and obese patients without hyperglycemia. MethodsThis comparative cross-sectional study was conducted on 55 normal (18.5–24.9 kg/m2), 42 preobese (25–29.9 kg/m2), 34 obese (>30 kg/m2), a total of 131, according to body mass index (BMI) value at the time of examination. All participants were examined in the internal medicine department and fasting serological biochemical and lipid tests were performed, and those with hyperglycemia were excluded from the study. All participants underwent a full ophthalmological examination and sectoral examination of the retina with optical coherence tomography. ResultsThe study included 55 right eyes of 55 normal, 42 of 42 preobese, and 34 of 34 obese, age- and sex-matched participants, without hyperglycemia. The mean BMI of the normal group was 22.3 ± 1.3, 26.8 ± 1.3 in the preobese group, and 33.2 ± 4.2 in the obese group. Central foveal thickness (normal 229.8 ± 20.1 µm, preobese 234.7 ± 18.8 µm and obese 222.0 ± 23.4 µm, P:0.031) and mean inferior (normal 280.7 ± 55.8 µm, preobese 296.7 ± 11.1 µm and obese 285.3 ± 9.9 µm) thickness in the 3 mm The Early Treatment Diabetic Retinopathy Study (ETDRS) circle was significantly higher in the preobese group and significantly lower in the obese group. Mean nasal, temporal, and superior thickness in the 3 mm ETDRS circle and peripapillary retinal nerve fiber layer was higher in the preobese group and lower in the obese group but this difference was statistically not significant. ConclusionThe fact that preobesity, which is not accompanied by hyperglycemia, causes an increase in the thickness of the central macular regions and obesity causes thinning of the retina, supports that lipid metabolism in the body alone can affect retinal thickness changes and retinal neurodegeneration.

Abstract P307: Differences in Cardiovascular Disease Burden, Screening, Education, and Care by Clinic Type in the 2022 Health Center Patient Survey (HRSA)

Background: Persons experiencing homelessness (PEH) have a 2-3-fold risk for cardiovascular disease (CVD) mortality. Evidence has repeatedly shown elevated chronic disease burden, reduced access to care, and lower utilization of medication to control CVD risk factors in this setting. Migrant communities also experience reduced access to care and the impacts from deferring care. There are targeted, federally-funded health clinics in place for both settings. However, these systems are frequently overwhelmed and limited by their scope of care to primary care. There is scarce evidence on differences between access, quality, and experiences of care delivered relative to other safety-net models. Method: The 2022 Health Center Patient Survey (HCPS) was collected on behalf of the Health Resources and Services Administration (HRSA). The HCPS is a nationally-representative, three-staged, sample-based survey collected via 1:1 interviews with clinic patients. The survey assessed sociodemographics, health conditions and behaviors, access to and utilization of care, and patients’ experiences with comprehensive services they received at HRSA-funded health centers, including: community health centers (CHC), healthcare for the homeless (HCH) clinics, migrant health centers (MHC), and public housing primary care (PHPC) clinics. A total of 103 unique awardees and 318 health center sites were recruited, and 4,414 patient interviews were completed. Investigators analyzed patient characteristics and multiple survey items related to AHA’s Essential 8 metrics for differences across clinic type. Results: MHC and HCH clinics had fewer elderly patients (~7%) than CHC and PHPC clinics (~17%). There were differences across sex, race, and ethnicity across all four clinic types. Cardiovascular disease history ranged from 4.9% (MHC) to 14.7% (HCH). Reported 7-day physical activity measures, average sleep below 7 hours per day, and Lifetime smoking (>100 cigarettes; OR=4.2, p<0.001) were all greatest among HCH patients. Fewer HCH and MHC patients reported ever having or recent lipid tests (both p<0.001). HCH patients were more likely to report hypertension (p=0.003), but less likely to report receiving nutrition advice (all p<0.05). MHC patients were less likely to be prescribed hypertension medication (p=0.044) and HCH patients were less likely to be taking medication even if it was prescribed (p<0.001). Adjustment for differences in age or CVD history were able to explain some observed differences, but increased the magnitude of other disparities. Conclusion: CVD burden differs across the various HRSA funding mechanisms for clinics, as do demographics and multiple metrics of health behaviors and biomarkers of cardiovascular health. Greater disease burden in HCH and MHC patients is likely compounded by increased risk factors and under performance in providing health education interventions.

Effect of Adding Apolipoprotein B Testing on the Prevalence of Dyslipidemia and Risk of Cardiovascular Disease in the Korean Adult Population.

Traditional lipid parameters-including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C (calculated as TC minus HDL-C)-have long been used as indicators of cardiovascular disease (CVD) risk. The laboratory records of 9604 Korean adults who underwent traditional lipid panel tests (TC, TG, and HDL), as well as ApoB testing, were analyzed to evaluate the prevalence of dyslipidemia and high CVD risk (utilizing the NCEP ATP III criteria for traditional lipid panels and various ApoB test cutoffs recommended by international guidelines (145 mg/dL, 130 mg/dL, and 100 mg/dL)). The overall prevalence of dyslipidemia, as determined by traditional lipid panel criteria, was 27.4%. Utilizing the ApoB cutoffs of 145 mg/dL, 130 mg/dL, and 100 mg/dL resulted in prevalence figures of 5.3%, 11.0%, and 36.3%, respectively. The concordance in dyslipidemia classification between traditional lipid tests and ApoB at cutoffs of 145 mg/dL, 130 mg/dL, and 100 mg/dL was 78.4%, 81.3%, and 74.7%, respectively. Up to 17.5% of participants, based on an ApoB cutoff of ≥100 mg/dL, exhibited isolated high ApoB in the absence of traditional lipid test anomalies. Incorporating ApoB testing could enhance the identification of Koreans at high CVD risk.

A293 PREVALENCE OF METABOLIC ASSOCIATED STEATOTIC LIVER DISEASE AND ITS IMPACT ON ADVERSE OUTCOMES IN PRIMARY BILIARY CHOLANGITIS PATIENTS

Abstract Background Metabolic associated steatotic liver disease (MASLD) is highly prevalent among Canadians, thus making coexistence with other liver diseases inevitable. Primary biliary cholangitis (PBC) is the most common autoimmune liver disease diagnosed in one out of 1,000 women above 40. The impact of concomitant MASLD on liver outcomes in patients with PBC is unclear. Aims We aimed to determine the prevalence of MASLD among patients with PBC and the association between concomitant liver disease and adverse liver outcomes. Methods PBC patients diagnosed between 1984 and 2023 and followed up at the University of Alberta with vibration-controlled transient elastography data available were included. MASLD was diagnosed if the Controlled Attenuation Parameter ≥288 dB/min with at least one cardio-metabolic criteria, based on elevated body mass index, blood pressure, and abnormal glycemic and lipid tests. Proportions were compared using chi-square, medians – Mann-Whitney test. We utilized a Cox hazards regression model to calculate hazard ratios and determine associations between MASLD and the development of cirrhosis or decompensation, need for liver transplant, or death. Results A total of 115 patients (87.0% females, age at diagnosis 52.3±11.5 years) followed over a median duration of 11.0 [range 0.1-39.7] years) were included. The prevalence of MASLD (33.0% [n=38]) was higher in females than males (35.0%[n=35] vs. 20.0%[n=3]; p=0.249). The prevalence of cirrhosis at diagnosis was twice as high among PBC patients with MASLD than those without (26.3%[n=10] vs. 13.0%[n=10]; p=0.076). No difference was observed in the frequency of decompensation at diagnosis (8.8%[n=3] vs. 6.3%[n=4]; p=0.638). Cirrhosis frequency (50.0% vs. 50.6%; p=0.948) and decompensation (38.2% vs.37.1%; p=0.912) over the course of the disease were similar between PBC patients with and without MASLD. There was no association between MASLD and development of cirrhosis (HR0.51, 95%CI 0.23-1.13; p=0.095), decompensation (HR0.81, 95%CI 0.37-1.76; p=0.596), liver transplantation (HR0.72, 95%CI 0.19-2.72; p=0.628), or death (HR0.69, 95%CI 0.22-2.16; p=0.519). PBC patients with MASLD have comparable event-free (median 10.7 [3.1-30.8] vs. 10.7 [0.1-23.3] years; p=0.684) and overall survival (median 11.3 [3.2-39.7 vs. 10.7 [0.1-23.3] years; p=0.456). Conclusions Every third patient with PBC had MASLD, which tended to be more prevalent among females. We did not observe any significant differences in the development of adverse liver outcomes between patients with PBC and concurrent MASLD in comparison to those without. Studies with larger sample sizes are necessary to further explore the potential impact of MASLD on liver outcomes. Funding Agencies None

Measuring Costs of Cardiovascular Disease Prevention for Patients with Familial Hypercholesterolemia in Administrative Claims Data.

Familial hypercholesterolemia is a common genetic condition that significantly increases an individual's risk of cardiovascular events such as heart attack, stroke, and cardiac death and is a candidate for population-wide screening programs. Economic analyses of strategies to identify and treat familial hypercholesterolemia are limited by a lack of real-world cost estimates for screening services and medications for reducing cardiovascular risk in this population. We estimated the cost of lipid panel testing in patients with hyperlipidemia and the cost of statins, ezetimibe, and PCKS9 inhibitors in patients with familial hypercholesterolemia from a commercial claims database and report costs and charges per panel and prescription by days' supply. The mean cost for a 90-day supply for statins was $183.33, 2.3 times the mean cost for a 30-day supply at $79.35. PCSK9 inhibitors generated the highest mean costs among medications used by patients with familial hypercholesterolemia. Lipid testing and lipid-lowering medications for cardiovascular disease prevention generate substantial real-world costs which can be used to improve cost-effectiveness models of familial hypercholesterolemia screening and care management.

Non-HDL-C in Conjunction to LDL-C is associated with Incidence of Chronic Coronary Syndrome in Clinical Settings

Background: The biggest cause of death and a major contributor to disability globally is coroner's artery disease (CAD). Chronic coronary syndrome (CCS) is a term that can be used to describe a wide variety of CAD clinical manifestations in clinical settings. Non-HDL-C is advised as a routine component of lipid analysis for risk assessment in patients with elevated plasma TGs. Conflicting results have been yielded as Non-HDL-C is a better marker comparing LDL-C.Objective: The purpose of this study is to find out the relationship of Non-HDL-C levels with the incidence of CCS in conjunction with LDL-C testing in a clinical setting. Methods: Observational analytical research with a cross-sectional design was conducted in Muhammadiyah Palembang Hospital from October to December 2019. Simple random sampling techniques were used to select 89 patients who met the study's inclusion and exclusion criteria. Non-HDL-C and LDL-C calculations based on routine lipid testing. The Chi-Square test with a significant p-value <0,005 was used for bivariate analysis.Results: There is a statistically significant association between non-HDL-C levels and the incidence of CCS (p=0,001), as well as a significant association between LDL-C and CCS incidents (p=0,009). Conclusion: Non-HDL-C provide additional benefits in identifying CAD risk factors in outpatients with CCS patient as well as LDL-C

Optimization of time interval for the measurement of plasma lipids for cardiovascular disease risk assessment

ABSTRACT Background Lipid testing for atherosclerotic cardiovascular disease (ASCVD) risk is often performed every 4–6 years, but we hypothesized that the optimum time interval may vary depending on baseline risk. Research Design and Methods Using lipid values and other risk factors from the National Health and Nutrition Examination Survey (NHANES) (n = 9,704), we calculated a 10-year risk score with the pooled-cohort equations. Future risk scores were predicted by increasing age and projecting systolic blood pressure (SBP) and lipid changes, using the mean-percentile age group change in NHANES for SBP (n = 17,329) and the Lifelines Cohort study for lipids (n = 133,540). The crossing of high and intermediate-risk thresholds were calculated by time to determine optimum intervals for lipid testing. Results Time to crossing risk thresholds depends on baseline risk, but the mean increase in the risk score plateaus at 1% per year for those with a baseline 10-year risk greater than 15%. Based on these findings, we recommend the following maximum time intervals for lipid testing: baseline risk < 15%: 5-years, 16%: 4-years, 17%: 3-years, 18%: 2-years, and 19%: ≤1-year. Conclusions Testing patients for lipids who have a higher baseline risk more often could identify high-risk patients sooner, allowing for earlier and more effective therapeutic intervention.

Association of sleep duration and physical exercise with dyslipidemia in older adults aged 80 years and over in China

Objective: To explore the impact of sleep duration, physical exercise, and their interactions on the risk of dyslipidemia in older adults aged ≥80 (the oldest old) in China. Methods: The study subjects were the oldest old from four rounds of Healthy Aging and Biomarkers Cohort Study (2008-2009, 2011-2012, 2014 and 2017-2018). The information about their demographic characteristics, lifestyles, physical examination results and others were collected, and fasting venous blood samples were collected from them for blood lipid testing. Competing risk model was used to analyze the causal associations of sleep duration and physical exercise with the risk for dyslipidemia. Restricted cubic spline (RCS) function was used to explore the dose-response relationship between sleep duration and the risk for dyslipidemia. Additive and multiplicative interaction model were used to explore the interaction of sleep duration and physical exercise on the risk for dyslipidemia. Results: The average age of 1 809 subjects was (93.1±7.7) years, 65.1% of them were women. The average sleep duration of the subjects was (8.0±2.5) hours/day, 28.1% of them had sleep duration for less than 7 hours/day, and 27.2% had sleep for duration more than 9 hours/day at baseline survey. During the 9-year cumulative follow-up of 6 150.6 person years (follow-up of average 3.4 years for one person), there were 304 new cases of dyslipidemia, with an incidence density of 4 942.6/100 000 person years. The results of competitive risk model analysis showed that compared with those who slept for 7-9 hours/day, the risk for dyslipidemia in oldest old with sleep duration >9 hours/day increased by 22% (HR=1.22, 95%CI: 1.07-1.39). Compared with the oldest old having no physical exercise, the risk for dyslipidemia in the oldest old having physical exercise decreased by 33% (HR=0.67, 95%CI: 0.57-0.78). The RCS function showed a linear positive dose-response relationship between sleep duration and the risk for hyperlipidemia. The interaction analysis showed that physical exercise and sleep duration had an antagonistic effect on the risk for hyperlipidemia. Conclusion: Physical exercise could reduce the adverse effects of prolonged sleep on blood lipids in the oldest old.

Prunus mume extract and choline treatment in patients with non-alcoholic fatty liver disease estimated by b-mode ultrasonography and hepatorenal index.

The aim of this study was to find the difference between the liver function test (LFT) and hepatorenal index (HRI), before and after the administration of Prunus mume (PM) and choline i.e., to find the predictors of the non-alcoholic fatty liver disease (NAFLD) severity according its HRI, during the three-month follow-up period. LFT, glucose, and lipid tests were determined in 168 NAFLD patients, at baseline and after three-month drug treatment. HRI was calculated by Image J software analyzing the ultrasound images, and according its value, 3 groups of NAFLD were formed. The HRI at baseline (1.3598±0.1744) and after 3 months therapy (1.3061±0.1923) differs significantly (p<0.0001). Plasma glucose (FPG) (p<0.0001), glycated hemoglobin (HbA1c) (P=0.002), alanine aminotransferase (ALT) (p<0.0001), aspartate aminotransferase (AST) (P=0.0006), gamma-glutamil transferase (γ-GT) (P=0.0053), high density lipoprotein cholesterol (HDL-Ch) (p<0.0001) and triglycerides (P=0.041) differ significantly, too. HRI is positively correlated with: HbA1c (P=0.035), ALT (P=0.002), AST (P=0.003), γ-GT (P=0.043), and triglycerides (P=0.002) and inversely correlated with HDL-Ch (P=0.011). In multiple regression results (standard coefficient and p-value), the independent predictors for HRI in NAFLD patients were: HbA1c (0.1443, 0.0004), ALT (0.001142, 0.0081), triglycerides (0.0431, 0.0235) and γ-GT (0.001376, 0.0329). Three-month administration of PM and choline have beneficial effects on the regulation of glucose and lipid metabolism (HDL-Ch), and on LFT. This plant extract significantly reduces the levels of FPG, HbA1c, ALT, AST, γ-GT, triglycerides and increases HDL-Ch. The triglycerides, ALT, γ-GT and HbA1c are positive independent predictors for the severity of NAFLD.

Assessment of Low-density Lipoprotein Cholesterol Levels and Non-invasive Vascular Health in School-aged Children: A Study in Ogasa District, Shizuoka Prefecture.

The present study assessed low-density lipoprotein cholesterol (LDL-C) levels in school-aged children from the Ogasa District of Shizuoka Prefecture and evaluated the utility of non-invasive vascular tests, namely flow-mediated dilation (FMD) and intima-media thickness (IMT), in pediatric patients with familial hypercholesterolemia (FH). We analyzed the lipid test results of 8,568 students screened for prevention of lifestyle-related diseases and 78 children under 15 years old with cholesterol levels exceeding 220 mg/dL who visited Chutoen General Medical Center. We examined the LDL-C distribution from school-age screenings and conducted FMD and IMT assessments on those meeting the 2022 Pediatric FH Guidelines criteria. Among the screened students, 186 (2.2%) exhibited LDL-C levels above 140 mg/dL, including 123 fourth-graders (2.8%) and 63 first-year junior high students (1.5%). The mean LDL-C level across all students was 90.0 mg/dL (standard deviation: 21.3 mg/dL), with the 95th percentile at approximately 125.0 mg/dL. Of the 78 children who visited the hospital, 65 met the FH diagnostic criteria. In children ≥ 10 years old, no significant IMT differences were observed between the Definitive and Probable FH groups and the Possible FH group; however, a significant difference in the FMD percentage was noted between these groups (9.9% [8.1%-11.9%] vs. 14.2% [11.6%-16.3%], P=0.003). Our findings highlight the LDL-C distribution in FH screening and suggest a potential reduction in FMD in pediatric FH patients ≥ 10 years old. These results emphasize the importance of initiating pharmacological interventions in school-aged children to maintain optimal LDL-C levels for lifelong cardiovascular health.

PHARMACEUTICAL CARE OF ACNE PATIENTS USING SYSTEMIC RETINOIDS

Aim. The research aims to study of the issue of pharmaceutical care of acne patients when using systemic retinoids.&#x0D; Materials and Methods. The following methods were used: systematic approach, bibliographic, questionnaire survey, statistical, pharmacoeconomic assessment. The objects of the study: relevant information sources; current standards of pharmacotherapy, instructions for medical use of isotretinoin of the State Register of Medicines of Ukraine (n=4), 14th edition of the State Drug Formulary; questionnaires of acne patients who use systemic retinoids (n=53); pharmacy quotes for isotretinoin drugs and laboratory quotes for liver biopsy and lipid testing. The subject of the study: appropriate pharmaceutical care of acne patients when using systemic retinoids.&#x0D; Results and Discussion. The results of the questionnaire showed that, despite high awareness, the practice of patients' compliance with the recommendations regarding the use of isotretinoin needs to be optimized, in particular by means of pharmaceutical care, which was provided in only 30.2% (95CI: 18.3-44.3%) cases according to the patients. As a result of the analysis of current regulatory-legal documents, 6 main guidelines were identified, including 10 key messages of pharmaceutical care. Considering the extremely low level of proper implementation of the Pregnancy Prevention Program when using systemic retinoids (3.7%; 95CI: 0.1-19.0%) and the severity of the consequences of neglecting the recommendations (teratogenic effect), pharmaceutical care should include the issue of effective contraception and pregnancy testing by not only informing but also finding and using other strategies to increase patient compliance with the recommendations, in our opinion. We consider that the discussion with the patient regarding the costs of pharmacotherapy with systemic retinoids (according to the results of our study - from ₴ 17919.20 to ₴ 25307.50), in addition to the cost of isotretinoin (from ₴ 15417.20 to ₴ 21550.00), should include the costs of conducting laboratory control of liver tests (from ₴ 1530.00 to ₴ 2340.00), lipidogram (from ₴ 972.00 to ₴ 1417.50) and meeting some other individual patient needs.&#x0D; Conclusions. Studying the issue of pharmaceutical care when using systemic retinoids allowed to determine the main guidelines (n=6) and key messages (n=10) that pharmacists can focus on during professional communication with acne patients, which makes it possible to increase the effectiveness and safety of pharmacotherapy.

Analysis of the association between lipid panel and hypothyroidism in patients at a private laboratory in Jacutinga – MG

Introduction: The thyroid gland produces the thyroid hormones triiodothyronine (T3) and thyroxine (T4), which regulate metabolism through the transcription of certain genes. Hypothyroidism is characterized by a decrease in the body's metabolic activity due to the low production of important agents for this process, which can cause dyslipidemia. Objective: To analyze the association between hypothyroidism and lipid panel in biological samples from patients treated in a private laboratory in the city of Jacutinga – MG during the year 2022. Material and Method: Data from laboratory reports were collected from patients over 18 years of age who simultaneously carried out TSH, free T4, total cholesterol, HDL-c, LDL-c, VLDL-c and triglycerides tests, and after collected, the data were separated according to the presence or absence of hypothyroidism, based on the reference values for this purpose. The lipid panel of patients with hypothyroidism was also analyzed following reference values. The study variables were age and gender. Results: The study included 470 laboratory reports, where 17.66% were characterized with hypothyroidism and of these, 61.45% were female with a mean age of 51 years and 38.55% were male with a mean age 55 years old. The Total Cholesterol test and the LDL-c test showed an increase in 55,42% and 40,96% patients with hypothyroidism, respectively. Conclusion: it is concluded that females have a higher incidence of cases of hypothyroidism, especially after the age of 50. The incidence of elevated lipid tests was also higher among females.

Primary Care Utilization and Cardiovascular Screening in Adult Survivors of Childhood Cancer

Cardiovascular disease is the leading noncancer cause of premature death among survivors of childhood cancer. Adult survivors of childhood cancer are largely managed by primary care practitioners (PCPs), and health care utilization patterns related to cardiovascular screening are not well described. To examine screening and health care utilization among survivors of childhood cancer at high risk for cardiovascular complications. This multicenter cross-sectional study included participants enrolled in a randomized clinical trial from 2017 to 2021. Abstracted documentation of participants' cancer history, cardiotoxic treatment exposures, and survivorship care plans were obtained from participants' PCPs spanning 2 years preceding trial enrollment. Participants were members of the Childhood Cancer Survivor Study cohort at elevated risk for ischemic heart disease or heart failure, enrolled in a randomized trial focused on improving cardiovascular risk factor control. Data were analyzed from November 2022 to July 2023. Outcomes of interest were numbers of PCP and specialist visits, cardiovascular risk factors (hypertension, dyslipidemia, and diabetes), risk factor screening, and cardiac testing. Multivariable logistic regression assessed characteristics associated with up-to-date cardiac testing at enrollment. Of 347 enrolled participants, 293 (84.4%) had evaluable medical records (median [range] age, 39.9 [21.5-65.0] years; 149 [50.9%] male) and were included in analyses. At baseline, 238 participants (81.2%) had a documented PCP encounter; 241 participants (82.3%) had undergone blood pressure screening, 179 participants (61.1%) had undergone lipid testing, and 193 participants (65.9%) had undergone diabetes screening. A total of 63 participants (21.5%) had echocardiography completed or planned. Only 198 participants (67.6%) had records referencing a cancer history. PCP documentation of prior cardiotoxic exposures was low compared with known exposures, including radiation therapy (103 participants [35.2%] vs 203 participants [69.3%]; P < .001) and anthracycline chemotherapy (27 participants [9.2%] vs 222 participants [75.8%]; P = .008). Few records referenced a need for cancer-related late effects surveillance (95 records [32.4%]). Independent factors associated with cardiac screening included documentation of increased cardiovascular disease risk (odds ratio [OR], 11.94; 95% CI, 3.37-42.31), a late-effects surveillance plan (OR, 3.92; 95% CI, 1.69-9.11), and existing cardiovascular risk factors (OR per each additional factor, 2.09; 95% CI, 1.32-3.31). This cross-sectional study of adult survivors of childhood cancer at increased risk of cardiovascular disease found low adherence to recommended cardiac testing and documentation of risk for these individuals. Improving accuracy of reporting of survivors' exposures and risks within the medical record may improve screening.

Familial Hypercholesterolemia: From Clinical Suspicion to Novel Treatments.

Familial hypercholesterolemia (FH) is the most common monogenic disorder in humans. It affects millions of people globally, increasing the risk of developing cardiovascular disease (CVD) at a younger age due to elevated levels of low-density lipoprotein cholesterol (LDL-C) from birth. While effective traditional and novel treatments are available, the most significant challenge with FH is the lack of timely diagnosis. As a result, many patients remain undertreated leading to an increased risk of CVD. To mitigate risk, initiating early and aggressive LDL-C-lowering therapies is recommended. Moreover, given its autosomal dominant inheritance patterns, it is also recommended to perform cascade lipid and/or genetic testing of all first-degree relatives. This review highlights the importance of early FH diagnosis and available treatment options. Greater awareness and improved screening efforts can help diagnose and treat more individuals, ultimately reducing the CVD risk associated with FH.

Real-World Effectiveness of Statin Therapy in Adult Asthma

Blood lipids affect airway inflammation in asthma. Although several studies have suggested anti-inflammatory effects of statins on asthmatic airways, further studies are needed to clarify the long-term effectiveness of statins on asthma control and whether they are an effective treatment option. To evaluate the long-term effectiveness of statins in the chronic management of adult asthma in real-world practice. Electronic medical record data spanning 28 years, collected from the Ajou University Medical Center in Korea, were used to conduct a retrospective study. Clinical outcomes were compared between patients with asthma who had maintained statin use (the statin group) and those not taking statins, whose blood lipid tests were always normal (the non-statin group). We performed propensity score matching and calculated hazard ratios with 95% CIs using the Cox proportional hazards model. Severe asthma exacerbation was the primary outcome; asthma exacerbation, asthma-related hospitalization, and new-onset type 2 diabetes mellitus and hypertension were secondary outcomes. After 1:1 propensity score matching, the statin and non-statin groups each included 545 adult patients with asthma. The risk of severe asthma exacerbations and asthma exacerbations was significantly lower in the statin group than in the non-statin group (hazard ratios [95% CI]= 0.57 [0.35-0.90] and 0.71 [0.52-0.96], respectively). There were no significant differences in the risk of asthma-related hospitalization or new-onset type 2 diabetes mellitus or hypertension between groups (0.76 [0.53-1.09], 2.33 [0.94-6.59], and 1.71 [0.95-3.17], respectively). Statin use is associated with a lower risk of asthma exacerbation, with better clinical outcomes in adult asthma.

Exploring Utilization and Establishing Reference Intervals for the Apolipoprotein B Test in the Korean Population.

We investigated the reference intervals for Apolipoprotein B (ApoB), a valuable biomarker for cardiovascular diseases, in Korean adults who had undergone health check-ups and showed normal lipid levels under traditional lipid tests, including total cholesterol, triglyceride, and high-density lipoprotein cholesterol, along with ApoB. We compared the findings with different cutoffs for ApoB from international clinical guidelines. Among a total of 264,105 traditional lipid test sets, only 464 (0.2%) included ApoB tests, indicating underutilization of this test in health check-up clinics in Korea. From these 464 samples, 334 ApoB results (164 men and 170 women) with normal traditional lipid test results were used to establish reference intervals. Using the parametric method (mean ± 2 SD), the reference intervals ranged from 46 to 134 mg/dL for men and 49 to 129 mg/dL for women. Employing the non-parametric method (central 95th percentile value), the reference intervals ranged from 50 to 131 mg/dL for men and 51 to 127 mg/dL for women. The prevalence of high ApoB did not significantly differ by sex when considering the established reference intervals for each sex and the cutoffs recommended by international clinical guidelines. This study enhances knowledge on ApoB reference intervals in the Korean population, and it will in aid test result interpretation for clinicians and laboratories.

A-205 Optimized Time Interval for the Measurement of Plasma Lipids for Assessing Cardiovascular Disease Risk

Abstract Background The measurement of plasma lipids are used to predict atherosclerotic cardiovascular disease (ASCVD) risk and for the management of lipid-lowering therapy. The general recommendation is that plasma lipids should be measured at least every 5 years, but the ideal time may vary depending on the baseline risk, which we examined in this study. Methods Using lipid values and other risk factors from the National Health and Nutrition Examination Survey (NHANES) (no diabetes, no lipid medications, n = 9704), which is designed to be representative of the US-general population, we calculated a baseline 10-year ASCVD risk with the pooled cohort risk equations (PCE). Future 10-year risk scores were estimated by chronologically increasing age of the subjects and projecting future systolic blood pressure (SBP) and lipid changes, using the mean-percentile age group change in the NHANES population for SBP (no hypertension medications, n = 17 329) and the Lifelines Cohort study for lipids (no CVD or lipid medications, n = 133 540). Crossing high-risk (&amp;gt;20%/10-years; 25% decison limit) and intermediate risk (&amp;gt;7.5%/10-years; 50% decision limit) PCE thresholds were calculated by baseline age to determine the best time intervals for testing lipids. Results As shown in the figure, the likelihood of crossing the intermediate or high-risk threshold depends on the baseline risk. Individuals that are close to one of the risk thresholds are more likely to cross it in the subsequent years. Based on this analysis, we recommend the following time intervals for lipid testing: Baseline risk &amp;lt; 5%/10-year: 5-years, baseline risk 5–15%/10-year: 3-years, baseline risk 16–20%/10-year: 1–2 years. Conclusions More frequent lipid testing than once every 5 years is desirable, because it would identify at risk patients sooner and allow for earlier therapeutic intervention, which has been shown to increase the effectiveness of statin therapy for reducing ASCVD events.

A-203 An Equation based on the Standard Lipid Panel for Calculating Low-Density Lipoproteins-Triglycerides

Abstract Background There is growing evidence that low-density lipoprotein-triglyceride (LDL-TG) may be a better biomarker to define atherosclerotic cardiovascular disease (ASCVD) risk than LDL-cholesterol (LDL-C), which is currently used to stratify risk and as a treatment goal. Because LDL-TG typically requires additional advanced lipid testing, we developed an equation for estimating LDL-TG (eLDL-TG) from the results of the standard lipid panel. Methods Results from a general dyslipidemic population (N = 40 202), which were obtained with beta-quantification (BQ) reference method, were randomly divided into a training and validation datasets and used to develop the equation for estimating LDL-TG shown in Fig. 1A. Association of Sampson-NIH-LDL-C (NIH-LDL-C) and eLDL-TG with ASCVD risk markers was done in the National Heart and Nutrition Examination Survey (NHANES) (N = 37 053) and with ASCVD events in the Atherosclerosis Risk in Communities (ARIC) study (N = 14 749). Results The comparison between eLDL-TG and measured LDL-TG was only modest (R2 = 0.601, slope = 0.611), but eLDL-TG (Fig. 1B) showed better risk stratification than NIH-LDL-C (Fig. 1C) by survival curve analysis in ARIC. Moreover, receiver-operating characteristic (ROC) analysis showed that eLDL-TG was better than all other lipid-marker tests for ASCVD events (AUC: eLDL-TG = 0.633, HDL-C = 0.627, sdLDL-C = 0.621, remnant-cholesterol = 0.613, NonHDL-C = 0.613, TG = 0.603, apoB = 0.598, NIH-LDL-C = 0.590, TC = 0.568). In NHANES, eLDL-TG was more strongly associated with hypertriglyceridemia, obesity, diabetes, metabolic syndrome and increased high-sensitivity C-reactive protein than NIH-LDL-C. Inclusion of eLDL-TG in a Cox-Proportional Hazards Model along with other conventional risk factors (age, sex, race, diabetes, systolic blood pressure, smoking, HDL-C, and total cholesterol) did not further improve risk prediction. Conclusions Like LDL-C, LDL-TG can also be estimated from the results of the standard lipid panel. It is a better univariate risk marker than LDL-C and hence can be useful for initial ASCVD risk stratification.