Total Cholesterol High-density Lipoprotein Cholesterol Research Articles

The lipid triad in type 2 diabetes - prevalence and relevance of hypertriglyceridaemia/low high-density lipoprotein syndrome in type 2 diabetes.

Cardiovascular disease is the major cause of morbidity and mortality in type 2 diabetes mellitus. Among the established risk factors, the lipid triad (elevated triglycerides, decreased high-density lipoprotein cholesterol, and small dense low-density lipoprotein cholesterol) is a powerful risk factor for atherosclerosis in type 2 diabetes. The prevalence of hypertriglyceridaemia (HTG) in type 2 diabetes is two to three times higher than in non-diabetics. The Copenhagen Male study, the AMORIS study, and several other trials showed hypertriglyceridaemia to be an independent predictor of coronary heart disease (CHD). HTG may promote risk both directly and indirectly through association with alterations of lipoprotein size and composition. The Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT) demonstrated that raising high-density lipoprotein cholesterol (HDL-C) in patients with low (HDL-C) and low-density lipoprotein cholesterol (LDL-C) is associated with a significant reduction in CHD risk. It was shown in the Diabetes Intervention Study, AFCAPS/TexCAPS, and PROCAM studies that decreased HDL-C and elevated triglycerides are independent risk factors for atherosclerosis, particularly in patients with diabetes mellitus. Several epidemiological studies demonstrated that total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratios or low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratios could be better predictors of atherosclerosis than any single lipid parameter. Intima-media thickness (IMT), a well established marker of early atherosclerosis, is associated with HTG/low HDL-cholesterol. In the Risk factors in IGT for Atherosclerosis and Diabetes (RIAD) study total and HDL-cholesterol were independent determinants of IMT in subjects at risk for type 2 diabetes. Postprandial HTG was also shown to be correlated with increased IMT in type 2 diabetic patients.

C-reactive protein and risk factors for peripheral vascular disease in subjects with Type 2 diabetes mellitus.

To compare the importance of different inflammatory markers and traditional risk factors in predicting peripheral vascular disease (PVD) in patients with Type 2 diabetes mellitus. A cross-sectional analysis of 30 Type 2 diabetic patients with PVD defined by ankle-brachial index (ABI) < 0.9, and 60 Type 2 diabetic patients without PVD (ABI > 1.0). Overnight blood was drawn and sent for study. Longer diabetic duration (15 +/- 8 vs. 10 +/- 7 years, P = 0.007), higher serum creatinine level (0.11 +/- 0.04 vs. 0.09 +/- 0.03 mmol/l, P = 0.001), higher total cholesterol/high-density lipoprotein-cholesterol (TC/HDL-C) ratio (5.2 +/- 1.6 vs. 4.3 +/- 1.1, P = 0.004) and increased hypertension status (70% vs. 52%, P = 0.014) and cerebral infarction (CI) history (23% vs. 3%, P = 0.009) were noted in Type 2 diabetes with PVD. Those with PVD also showed significantly higher serum levels of C-reactive protein (CRP) (median 0.282 vs. 0.102 mg/dl, P < 0.001) and interleukin (IL)-6 (10.6 +/- 1.81 vs 1.6 +/- 4.6 pg/ml, P = 0.001). Multivariate regression analysis showed that higher serum levels of C-reactive protein (CRP), longer diabetic duration, and use of angiotensin converting enzyme inhibitor (ACEI) were independently associated with PVD in Type 2 diabetes mellitus. Type 2 diabetic patients with PVD had longer diabetic duration, higher serum creatinine levels, higher TC/HDL-C ratio, higher hypertension and CI history and higher CRP and IL-6 levels. Only serum CRP level, diabetic duration, and use of ACEI were independently associated with PVD in Type 2 diabetes mellitus.

The apoB/apoA-I ratio is better than the cholesterol ratios to estimate the balance between plasma proatherogenic and antiatherogenic lipoproteins and to predict coronary risk

The apolipoprotein B (apoB)/apoA-I ratio represents the balance of proatherogenic and antiatherogenic lipoproteins. The purpose of this study was to determine whether the apoB/apoA-I ratio was superior to any of the cholesterol ratios - total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C), low-density lipoprotein cholesterol (LDL-C)/HDL-C and non-HDL-C/HDL-C - in predicting the risk of coronary disease. Moreover, we examined whether any lipids, lipoproteins or cholesterol ratios add significant predictive information beyond that provided by the apoB/apoA-I ratio. Plasma lipids, lipoproteins, apoB, and apoA-I were measured in 69,030 men and 57,168 women above 40 years of age. After a mean follow-up of 98 months, 1183 men and 560 women had died from a myocardial infarction in this prospective apolipoprotein-related mortality risk (AMORIS) study. High apoB and a high apoB/apoA-I ratio were strongly related to increased coronary risk, while high apoA-I was inversely related to risk. The apoB/apoA-I ratio was superior to any of the cholesterol ratios in predicting risk. This advantage was most pronounced in subjects with LDL-C levels <3.6 mmol/l. Addition of lipids, lipoproteins or any cholesterol ratio to apoB/apoA-I in risk models did not further improve the strong predictive value of apoB/apoA-I. These results indicate that the apoB/apoA-I ratio is at present the best single lipoprotein-related variable to quantitate coronary risk. Given the additional advantages apolipoproteins possess - fasting samples are not required, apoB/apoA-I is a better index of the adequacy of statin therapy than LDL-C, and the measurement of apoB and apoA-I are standardized, whereas LDL-C and HDL-C are not - there would appear to be considerable advantage to integrating apolipoproteins into clinical practice.

Hypocholesterolemic Effect of Biophytum sensitivum Leaf Water Extract

The present study was undertaken to investigate the possible hypocholesterolemic effect of water extract of leaves of Biophytum sensitivum in three groups (of six each) of male albino rabbits: group I of healthy controls, group II of untreated hypercholesterolemic rabbits, and group III of hypercholesterolemic rabbits treated with the water extract. Hypercholesterolemia was initially induced in the group II and III rabbits by feeding cholesterol at a dose of 100 mg/kg body weight/day for 1 week. Subsequently, for 4 weeks, the group II rabbits continued to receive the above dose of cholesterol, while the group III rabbits were given the plant extract (200 mg/kg body weight/day) along with the above dose of cholesterol for four weeks. Group I rabbits were given groundnut oil only at a dose of 1ml/kg body weight. In group II, serum total cholesterol (TC) showed a nearly five-fold rise from initial value of 53.6 ± 7 mg/dl to 286.3 ± 22 mg/dl. In group III, there was an increase only until the third week from 52.6 ± 7 mg/dl to 170.8 ± 12 mg/dl, after which TC started decreasing and came down to 146.3 ± 13 mg/dl by the end of the 5th week. A similar effect on the other lipid parameters was also observed. The treatment not only prevented the elevation of serum triglycerides, very low density lipoprotein plus low density lipoprotein cholesterol (VLDLc + LDLc), and the ratios of total cholesterol to high density lipoprotein cholesterol (TC/HDLc) and (VLDLc + LDLc)/HDLc, but also brought down most of these values. Blood glucose levels were not significantly altered. The study shows that the extract has significant hypocholesterolemic effect.

Cigarette smoking, blood pressure and serum lipids and lipoproteins in middle-aged women.

The relationship of cigarette smoking with blood pressure and serum lipids and lipoproteins was studied in the 3934 middle-aged women aged 40 to 59 years. After adjusting age, body mass index (BMI), alcohol intake and physical activity scores, the mean systolic and diastolic blood pressures (SBP and DEP, respectively) did not indicate dose-dependent relationships. The largest significant mean differences in SBP (4.6 mmHg), DBP (3.9 mmHg), high density lipoprotein cholesterol (HDL-C) (9.6 mg/dL), ratio of total cholesterol to HDL-C (TC/HDL-C) (0.8), triglycerides (TG) (22.9 mg/dL) and the logarithmic transformation of TG (Log TG) (0.26) were found between the non-smokers and smokers. When age, BMI, alcohol intake and physical activity scores were included in the forward stepwise multiple regression analyses, there were negative relationships found for cigarette smoking and SBP, DBP and HDL-C and positive relationships for cigarette smoking and TC/HDL-C, TG, Log TG and low density lipoprotein cholesterol. Although the results are somewhat variable, the present study shows cigarette smoking is negatively associated with SBP and DBP and unfavorably associated with serum lipids and lipoproteins in middle-aged women.

Dyslipidemia and abdominal obesity: an assessment in three general populations

Several studies show a relationship between abdominal obesity and cardiovascular diseases, partially mediated through an altered metabolism of dyslipidemia. The present study was aimed at testing the robustness of this association across three contrasted populations and at assessing the performances of abdominal obesity as a screening tool for dyslipidemia. Data were drawn from three population health surveys recently conducted in two regions of a developed country (Switzerland, mostly of Caucasian origin, n = 2650) and in a less developed country (Seychelles, Indian Ocean, mostly of black descent, n = 806). Dyslipidemia was defined as a ratio of total cholesterol to high-density lipoprotein cholesterol (TC-HDL) greater than 5. Two anthropometric circumference measurements, waist-to-hip ratio (WHR) and waist circumference (WC), were used to define abdominal obesity either as WHR ⩾ 0.9 in men and WHR ⩾ 0.8 in women or as WC ⩾ 94 cm and WC ⩾ 80 cm, respectively. A consistent direct association between abdominal obesity and dyslipidemia (odds ratios varying from 1.85 to 4.56) was found in the three populations, independently of gender, age, body mass index, blood pressure, and smoking. This consistency across ethnicities and environments strengthens the hypothesis of a common etiopathological mechanism. The sensitivity for detecting dyslipidemia was generally higher for abdominal obesity, based on either WHR or WC, than for criteria based on the other risk factors under study. In addition, the sensitivity was higher in the study populations with a low prevalence of dyslipidemia (Swiss women and Seychellois of both sexes) than in the others. These findings support that WHR and WC may be useful as simple and inexpensive screening tools to select individuals eligible for more sophisticated and costly serum lipid determinations, especially in developing countries.

Risk profile for chronic diseases of life-style in older black South Africans. The BRISK Study

This paper describes the risk-factor profile for chronic diseases of life-style in the older black population of Cape Town and compares it with risk profiles in other South African ethnic groups. A hundred and sixty-eight men and women aged 60 years and over from formerly designated black areas of Cape Town were sampled in 1990. Laboratory diagnosis of hyperlipidaemia and clinical measurements of blood pressure and body mass index were carried out and reported incidences of smoking and dietary intake were recorded. A low risk profile was found in the sample: Total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) levels were low and high-density lipoprotein cholesterol/total cholesterol (HDLC/TC) ratios high, with approximately 90% of the sample having protective ratios > 20%. Hypertension was found in 25.7% of men and 48.7% of women. Of the hypertensives, only 53.5% were on anti-hypertensive medication. A high prevalence of obesity was found in the women (51.3%). Smoking rates were 47.3% in men and 28.3% in women. Dietary information showed that the group consumed an essentially prudent diet. Men had higher cholesterol intakes (300mg) than women (I75mg), while women consumed significantly more carbohydrates as a source of energy than men (p 0.05). It is concluded that the study population is at lower risk for chronic diseases of life-style than other ethnic groups in South Africa, but it is uncertain whether the low rates will continue in future generations.

THE RELATIONSHIP BETWEEN FITNESS, PHYSICAL ACTIVITY, AND CORONARY RISK FACTORS IN JAPANESE-AMERICAN AND NATIVE JAPANESE CHILDREN 1352

Past research has shown that US has one of the highest death rates due to cardiovascular disease (CVD) while Japan has one of the lowest mortality rates due to CVD. The purpose of this investigation was to examine differences in cardiovascular fitness, activity levels and coronary risk factors (CRF) in Japanese-American children (JA) age [horizontal bar over]X = 9.78 ± 1.4 years in comparison to age and sex-matched Japanese children (J) age[horizontal bar over]X = 10.2 ± 1.4 years living in Japan. Fitness was determined using a GXT to determine maximum oxygen uptake (VO2 max) and anaerobic threshold (AT). Polar heart rate monitors were used to determine mean heart rates (HR) during a three day period. CRF were determined using a Stanbio Premiere filter photometer used to assess serum lipoproteins following a 12-hour fast. All data were collected using the same equipment analyzed by the same investigators in both US and Japan. Results showed no significant differences between groups in VO2 max, AT and HR. JA children had significantly higher triglycerides (TG) (p<.01) and Total Cholesterol/High Density Lipoprotein Cholesterol (TC/HDL-C) than J children. For the entire sample, VO2 max was inversely correlated with TG (r = -.46, p<.05). There were no other significant correlations between any other measures of fitness and any serum lipoproteins. Our results suggest significant differences do exist between JA and J children with regard to several CRF. In both groups of children, VO2 max was the only fitness variable significantly and inversely correlated with serum lipids, specifically TG.

The effects of two fixed hormonal replacement therapy protocols on blood lipid profile

Hormonal Replacement Therapy (HRT) is known to be accompanied by changes in blood lipid profile. The present prospective cohort study compared the blood lipid profile of healthy post-menopausal women treated with either (a) a preparation containing a fixed regimen of estradiol, estriol and norethisterone acetate (EENA, marketed under the trade name Trisequens); (b) a fixed protocol of conjugated equine estrogen and medroxyprogesterone acetate (CEEMPA, marketed under the trade name Premaril Plus); or with (c) a concurrent group which underwent no treatment. Blood lipid profiles (total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglycerides (TG)) were performed at the beginning of the study and at 3-month intervals, for 9 months. The EENA-treated women showed a significant and profound decrease in TC and LDL-C when compared with their initial values, with the control group, and with the CEEMPA group. The CEEMPA group showed an increase in HDL-C values and a decrease in LDL-C values when compared with their initial values and with the control group, but no increase was shown when compared with an EENA group. There was a favorable decrease in the TC HDL-C and LDL-C HDL-C ratios in both treatment protocols. As the primary goal of prevention of coronary artery disease is total cholesterol reduction, the EENA protocol seems to be preferred.

Dependency of arterial compliance on circulating neuroendocrine and metabol factors in normal subjects

Reduced arterial compliance is now recognized as a feature of hypertension. Similarly, metabolic factors such as insulin, catecholamines and lipids are also associated with hypertension. This study explores the possibility that these neuroendocrine and metabolic factors may separately influence arterial compliance. Proximal compliance (aorta and large arteries) and distal compliance (small arteries and arterioles) were measured in 57 volunteers (30 hypertensive and 27 normotensive subjects, mean age 45 years). Compliance was quantified by analysis of arterial pulse wave contours obtained intraarterially together with hemodynamic estimates. Proximal compliance correlated with plasma insulin (r = −0.49; p < 0.001), norepinephrine (r = −0.50; p < 0.002), triglycerides (r = −0.39; p < 0.01), total cholesterol (r = −0.33; p = 0.02) and high-density lipoprotein cholesterol (HDL) (r = 0.37; p < 0.02). Similarly, distal compliance correlated with insulin (r = −0.37; p < 0.02), triglycerides (r = −0.39; p < 0.01), total cholesterol (r = −0.38; p < 0.01) and HDL (r = 0.51, p < 0.002). Patients with reduced compliance (<1.65 ml/mm Hg; n = 30), when compared with those with normal compliance (≥1.65 ml/mm Hg; n = 27), had higher levels of insulin (15 ± 2 vs 10 ± 1 μU/ml; p < 0.005), plasma renin activity (1.9 ± 0.2 vs 1.5 ± 0.2 ngAngl/ml/hour; p < 0.001), triglycerides (145 ± 66 vs 108 ± 51 mg/dl; p < 0.05), total cholesterol (229 ± 47 vs 204 ± 41 mg/dl; p < 0.05) and tower HDL levels (46.6 ± 2.1 vs 51.1 ± 2.0 mg/dl; p = 0.1). These findings suggest that such humoral factors as catecholamines, the renin system, lipids and insulin may be linked to the morphologic changes that decrease the compliance of the proximal and distal portions of the arterial circulation.

Risk factors for ischemic stroke: a case control analysis.

Case control analysis of 204 patients with acute ischemic stroke revealed the matched pair odds ratio (and 95% confidence limits) for hypertension, ECG abnormality, heart disease of any type, diabetes, smoking and alcohol intake to be 3.95 (2.5, 6.2), 2.1 (1.4, 3.1), 2.1 (1.4, 3.2), 1.7 (1.1, 2.6), 1.8 (1.1, 2.8) and 1.5 (0.86, 2.6), respectively. Except alcohol intake, the other factors were statistically significant. Hemoglobin, packed cell volume (hematocrit), serum cholesterol, triglycerides and low-density lipoprotein cholesterol levels were not found to be significant. High-density lipoprotein (HDL) cholesterol and uric acid were significantly lower and the ratio of total cholesterol to HDL cholesterol (TC/HDL) was higher among stroke patients. The risk was considerably higher when there was any combination of hypertension, heart disease and HDL cholesterol level lower than 45 mg/dl. Logistic regression revealed hypertension, heart disease of any type, lower HDL cholesterol and uric acid and higher ratio of TC/HDL to be significant factors.

Physical Fitness Is Inversely Related to Heart Disease Risk: A Factor Analytic Study

We measured cardiorespiratory endurance, muscular strength and endurance, anaerobic run time, coronary risk factors, and dietary habits in male fire fighters (n = 779, ages 18 to 64 years) and performed factor analysis to determine the interrelationships and underlying factor structure of the data set. Principal component analysis produced nine factors (eigenvalues greater than 1.0) accounting for 61% of the total variance. However, the variable loadings were inconsistent, preventing a meaningful interpretation of the factor solution. These problems were solved through the principal axis method of common factor analysis, which revealed three factors (eigenvalues greater than 1.0) accounting for 29% of the total variance. Orthogonal rotation (varimax method), showed Factors 1, 2, and 3 accounting for 52%, 29%, and 19%, respectively, of the common variance. Factor 1, labeled physical fitness capacity (PFC), included age, situps, treadmill performance time, pushups, maximum exercise heart rate, and anaerobic run time. Factor 2, designated coronary risk status (CRS), included body mass index, resting systolic and diastolic blood pressure, triglycerides, and the total cholesterol-high density lipoprotein cholesterol ratio. Factor 3, termed food frequency intake (FFI), included the weekly intake of fried foods, beef, pork, eggs, caffeine, and cheese. Percentage body fat loaded on both PFC and CRS. Measures such as blood pressure, grip strength, resting heart rate, maximum exercise systolic blood pressure, cigarettes smoked per day, and weekly frequency of milk, fish, fowl, and alcohol intake contributed little to the factor solution. Correlation coefficients after oblique rotation showed PFC to be inversely related to CRS (r = -0.48). However, FFI was independent of PFC (r = 0.07) and CRS (r = -0.10).(ABSTRACT TRUNCATED AT 250 WORDS)

Young adult cholesterol as a predictor of familial ischemic heart disease

Family history for ischemic heart disease (IHD) was quantified from 229 questionnaires returned by the parents of young adults who had their total serum cholesterol levels determined as seventh graders in 1972–1973 and again 9 years later. The participants were divided into low- or high-cholesterol groups using quintiles. There were nonsignificant trends for higher prevalence of IHD in the families of individuals, principally the male participants, with persistently high total serum cholesterol levels; an excess of IHD in families of young adults with reduced high-density lipoprotein cholesterol (HDL); and a deficit of IHD in families of high-HDL participants. There was a significant interaction in family history scores between HDL and total cholesterol, such that there was an excess of IHD prevalence in families of individuals with high total cholesterol and low HDL levels, and significantly lower IHD prevalence in families of young adults with high total cholesterol and high HDL levels. Among individuals with low total cholesterol, lower family history scores were found in those with lower HDL levels.

Effects of stilbene components of the roots of Polygonum cuspidatum Sieb. et Zucc. on lipid metabolism.

The effects of the roots of Polygonum cuspidatum SIEB. et ZUCC. (Kojo-kon or Itadori-kon in Japanese) and its stilbene components (resveratrol and piceid) on lipid metabolism in rats and mice (higher animals) were investigated. Resveratrol and piceid inhibited the deposition of triglyceride and cholesterol in the liver of rats fed corn oil-cholesterol-cholic acid mixture. Piceid reduced the serum triglyceride and low density lipoprotein-cholesterol (LDL-ch) levels, and atherogenic index [total cholesterolhigh density lipoprotein-cholesterol (HDL-ch)/HDL-ch] in the oil mixture-fed rats. It was found that intraperitoneal or oral administration of resveratrol or piceid reduced triglyceride synthesis from 14C-palmitate in the liver of mice. In contrast, these stilbene components did not affect hormone-induced lipolysis in fat cells from rat eqididymal adipose tissue.