Treatment Of Lipid Abnormalities Research Articles

The Diagnosis and Treatment of Lipid Abnormalities in Pediatric Patients

The Diagnosis and Treatment of Lipid Abnormalities in Pediatric Patients

The Dynamics of Cardiovascular Risk-An Analysis of the Prospective Urban Rural Epidemiology (PURE) Poland Cohort Study.

Background: The purpose of this study was to analyze the major cardiovascular risk (CVR) factors and their trends in the study population. Methods: The results of subjects in the Polish Prospective Urban and Rural Epidemiological Study (PURE) study group were interpreted. CVR was calculated for each participant according to the Systematic Coronary Risk Evaluation (SCORE2) scale or the Systematic Coronary Risk Evaluation-Older Persons (SCORE2-OP) scale. Data from the beginning of the analysis (2013) and nine years later (2022) were included. In addition, the use of lipid-lowering therapy (LLT) and meeting the low-density lipoprotein cholesterol (LDL-c) target criterion at the beginning and end of the study were analyzed. Results: Patients in the high and very high CVR groups who had abnormal LDL-c results accounted for 64% and 91% of their group in 2013 and 70% and 92% in 2022, respectively. Conclusions: Regardless of age, patients using LLT at the start of the analysis had a greater increase in future CVR, especially if they had lipid abnormalities at the start of the study. This may be due to reverse causality and multimorbidity in these patients, highlighting the importance of appropriate treatment of lipid abnormalities.

Association between homocysteine levels and hyperlipidemia prevalence as well as all-cause mortality of hyperlipidemia patients in the US population: results from NHANES database.

Several studies have investigated the correlation between blood lipids and homocysteine, but no clear conclusions have been defined yet. Therefore, we utilized data from National Health and Nutrition Examination Survey (NHANES) to explore the correlation between serum homocysteine (Hcy) levels and hyperlipidemia, which is determined by the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). We believe this study can provide a scientific basis for the prevention and treatment of lipid abnormalities. The data used in this study were sourced from NHANES 1999-2006, linked with National Death Index mortality data from January 1999 to December 2019. We employed logistic regression to assess the associations between Hcy levels and the presence of hyperlipidemia. Additionally, survival analysis using Kaplan-Meier estimate and Cox proportional hazards regression model was conducted to evaluate the associations between Hcy levels and all-cause mortality in the hyperlipidemia population. (1) A total of 13,661 subjects were included in the study. There were statistically significant differences in Hcy levels across different groups based on gender, age, race, marital status, education level, hypertension status, diabetes status, and Body Mass Index (BMI) (P < 0.05). (2) In the overall population, hyperhomocysteinemia (HHcy) was associated with an increased risk of high-TC hyperlipidemia (P < 0.05). Subgroup analysis by gender showed that HHcy in females was associated with an increased risk of dyslipidemia (OR = 1.30, 95% CI: 1.07-1.59, P < 0.05) and high-LDL-C hyperlipidemia (OR = 1.30, 95% CI: 1.00-1.68, P < 0.05). In addition, subgroup analysis by age revealed that HHcy in middle-aged people was associated with an increased risk of high-TC hyperlipidemia (OR = 1.21, 95% CI: 1.03-1.41, P < 0.05) and high-LDL-C hyperlipidemia (OR = 1.23, 95% CI: 1.06-1.43, P < 0.05). (3) HHcy was consistently associated with an increased mortality risk in the hyperlipidemia population (HR = 1.49, 95% CI: 1.35-1.65, P < 0.05). There was positive correlation between Hcy levels and the presence of hyperlipidemia. In the overall population, HHcy was associated with an increased risk of high-TC hyperlipidemia. Among females, HHcy is linked to an increased risk of dyslipidemia and high-LDL-C hyperlipidemia. In middle-aged people, HHcy was associated with an elevated risk of high-TC hyperlipidemia and high-LDL-C hyperlipidemia. In addition, HHcy increased the all-cause mortality rate in hyperlipidemia patients.

Hidroksi Metil Glutaril Coenzyme-A (HMG CoA) Reduktase Inhibitor and New Onset Diabetes Mellitus: A Review of Correlation and Clinical Implication

Treatment of lipid abnormalities with HMG CoA reductase inhibitor (statin) has been used for diabetic and non diabetic patients. Various studies have describe increased risk of new onset diabetes associated with statin therapy. This review aims to explain potential mechanism that related to diabetogenic effect of statin. This research was created by collecting literature that relevant to the topic. The types of literature used are clinical trials, meta analyzes and systematic reviews between 2013 until 2021. HMG CoA reductase is the target of statin therapy and the acting of this enzyme is inhibited by statin in competitive way. In vivo and in vitro studies reveal that statin reduce synthesis of mevalonate pathway and increase cholesterol transport that influence B cell function and decrease of insulin sensitivity and insulin secretion by multiple mechanism. Recent genetic study suggest that increased risk of type 2 diabetes mellitus pathway explained by gene variant target for LDL cholesterol lowering drugs. Accumulating evidence from several statin studies suggest that pravastatin is the least diabetogenic statin. Simvastatin, atorvastatin and rosurvastatin are more diabetogenic statin. The used of statin in clinical practice should concerned about benefit on cardiovascular while still considering the possible risk of developing type 2 diabetes mellitus. Regular monitoring of patients glycemic control is mandatory

Extended lipid profile and urine albumin-creatinine ratio in type 2 diabetes mellitus

Background: Diabetes is a chronic metabolic disorder and has become the one of the most challenging global health problem of 21 st centuary. Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We aimed to research association between extended lipid profile and urine albumin-creatinine ratio (UACR), hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus. Methods: A hospital based cross- sectional study was conducted on 48 patients with type 2 diabetes mellitus. All patients fasting blood glucose (FBG), HbA1c, total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), apolipoprotein-A (apo-A), apolipoprotein-B (apo-B), lipoprotein (a){Lp(a)} and urine-albumin creatinine ratio (UACR) evaluated. Patients taking steroids, any renal disease other than diabetic nephropathy and patients of uncontrolled hypertension were excluded from study. Based on UACR level patients were divided into three sub groups: normal (&lt;30 mg/g), microalbumiuria (30-300 mg/g) and macroalbuminuria (&gt;30 mg/g). Comparison between three subgroups of UACR and extended lipid profile was made using non parametric test (Kruskal Willis Test). Fisher’s exact test was used to explore the association between UACR and extended lipid profile. Result: 20.8% patients had UACR&lt;30 mg/g, 54.2% patients had UACR:30-300 mg/g, 25.0% patients had UACR:≥300 mg/g; 62.5% patients had Lipoprotein(a): &lt;30 mg/dl and 37.5% patients had Lipoprotein(a): &gt; 30 mg/g. Significant association was found between UACR and Lipoprotein(a): · 100.0% of the patients with [UACR: &lt;30 mg/g] had [Lipoprotein-a: &lt;30mg/dL]. · 57.7% of the patients with [UACR: 30-300 mg/g] had [Lipoprotein-a: &lt;30 mg/dL]. · 42.3% of the patients with [UACR: 30-300 mg/g] had [Lipoprotein-a: ≥30 mg/dL]. · 41.7% of the patients with [UACR: &gt;300 mg/g] had [Lipoprotein-a: &lt;30 mg/dL]. · 58.3% of the patients with [UACR: &gt;300 mg/g] had [Lipoprotein-a: ≥30 mg/dL]. Conclusion: The study showed that diabetic nephropathy resulting in raised UACR has significant association with increased lipoprotein (a) and consequently increased risk of atherosclerotic cardiovascular disease (ASCVD). Since Lipoprotein(a) investigation is not widely available, accessible and has varied estimation technique, UACR can be used as a marker of risk for ASCVD in place of Lipoprotein(a) in type 2 DM.

Pathophysiology and Treatment of Lipid Abnormalities in Cerebrotendinous Xanthomatosis: An Integrative Review.

Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive disorder caused by pathogenic variants in CYP27A1, leading to a deficiency in sterol 27-hydroxylase. This defect results in the accumulation of cholestanol and bile alcohols in various tissues, including the brain, tendons and peripheral nerves. We conducted this review to evaluate lipid profile abnormalities in patients with CTX. A search was conducted in PubMed, Embase and the Virtual Health Library in January 2023 to evaluate studies reporting the lipid profiles of CTX patients, including the levels of cholestanol, cholesterol and other lipids. Elevated levels of cholestanol were consistently observed. Most patients presented normal or low serum cholesterol levels. A decrease in chenodeoxycholic acid (CDCA) leads to increased synthesis of cholesterol metabolites, such as bile alcohols 23S-pentol and 25-tetrol 3-glucuronide, which may serve as surrogate follow-up markers in patients with CTX. Lipid abnormalities in CTX have clinical implications. Cholestanol deposition in tissues contributes to clinical manifestations, including neurological symptoms and tendon xanthomas. Dyslipidemia and abnormal cholesterol metabolism may also contribute to the increased risk of atherosclerosis and cardiovascular complications observed in some CTX patients.

Effects of Hypolipidemic Drugs on Psoriasis.

Psoriasis is a chronic, systematic, inflammatory disease in which multiple metabolic and immunologic disturbances lead to lipid abnormalities, impaired glucose tolerance, metabolic syndrome, diabetes mellitus, atherosclerosis, hypertension, ischemic heart disease, and numerous metabolic disorders. In clinical practice, the most commonly used drugs in the treatment of lipid abnormalities are statins and fibrates. Statins are characterized by pleiotropic effects such as antioxidant, anti-inflammatory, anticoagulant, and antiproliferative. They work by reducing the concentrations of low-density lipoprotein (LDL), total cholesterol, and triglycerides and stabilizing atherosclerotic plaque. Fibrates are medications, which help to lower triglycerides, LDL, very low-density lipoprotein (VLDL) levels and increase lower high-density lipoprotein (HDL). In recent years, many new drugs were found to normalize the lipid profile in patients with psoriasis: glitazones (pioglitazone, troglitazone), and glucagon-like peptide-1 (GLP-1) receptor agonists. Pioglitazone improves the lipid profile, including the decrease of triglycerides, fatty acids, and LDL, as well as the increase of HDL. Glucagon-like peptide 1 (GLP-1) analogs decrease modestly low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides. The purpose of this study is to assess the current state of knowledge on the effect of different hypolipidemic treatments on the course of psoriasis. The study includes literature from medical databases PubMed and Google Scholar. We were browsing PubMed and Google Scholar until the beginning of December. The systematic review includes 41 eligible original articles.

LIPID PROFILE AND ITS ABNORMALITIES IN NEWLY DIAGNOSED TYPE 2 DIABETICS: AN OBSERVATIONAL STUDY

Background: Diabetes is characterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. We aimed to research association between serum lipid profile and blood glucose, hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus.&#x0D; Material and methods: A cross-sectional study was carried out to determine the lipid profile levels in newly diagnosed type 2 diabetics in the Department of General Medicine in Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India from March 2019 to February 2020. A total of 200 newly diagnosed type 2 diabetics were enrolled in our study.&#x0D; Results: In our study, 96 (48.0%) participants had normal serum triglycerides levels which is &lt;150 mg/dl whereas 104 (52.0%) participants had an abnormal level of serum triglycerides. Among the 104 (52.0%) participants with abnormal triglycerides, 30.5% had borderline high levels (150-199mg/dl), 19.5% had high levels (200-499 mg/dl) and 2% participants had very high triglycerides (≥500 mg/dl. In our study, among the 200 participants, 142 (71%) participants had desirable total Cholesterol levels of &lt;200mg/dl, 51 (25.5%) had borderline high levels of 200- 239mg/dl and 7 (3.5%) had high total cholesterol levels of ≥240mg/dl and 31% of participants had near optimal levels of LDL, 35.5% had borderline high levels of LDL, 12% had high levels of LDL and 1% had very high levels of LDL.&#x0D; Conclusions: Deranged lipid profiles are quite prevalent in type 2 diabetics with females having higher triglyceride levels. Recognition of such elevated triglyceride levels in even newly diagnosed type 2 diabetics will help in better prevention of associated cardiovascular disease.&#x0D; Keywords: Cardiovascular disease, Hypertriglyceridemia, Type 2 diabetes, Lipid profile

Estimation of Cardiovascular Risk Factors &amp; Their Relative Impact in Diabetic Mellitus-2 Adult Patients’ in Mnazi Mmoja Hospital - Zanzibar

Diabetes is characterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. We aimed to estimate the cardiovascular risk factors and their correlation with type 2 diabetes mellitus (T2DM) in Zanzibar (Mnazi MMoja Hospital) hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorders and cerebrovascular accident in patients with T2DM.&#x0D; Methods: The study populations were those patients who presented themselves at Mnazi Mmoja hospital with T2DM, and who are within the age bracket of 18 to 45 years. Fasting blood glucose (FBG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels were evaluated. Pearson’s correlation studies were performed between the variables of blood glucose and serum lipid profiles and also within the lipid profile parameters.&#x0D; Results: TC, TG, LDL-C mean levels were significantly higher in diabetics compared with the control subjects p&lt; 0.05. The HDL-C was however lower in diabetics compared with the controls. Also, the mean FBG, TC, TG, and LDL-C were significantly higher in female diabetic subjects compared to the male counterparts p&lt; 0.05. A positive correlation was observed between FBG and TC, TG and LDL-C (r=0.643 p=0.0021; r=0.679, p=0.0001; r=0.534, p=0.0091 respectively) while HDL-C showed a negative correlation (r= -0.799, p= 0.0021). TC also showed a positive correlation with TG and LDL-C (r=0.590, p=0.0021; r= 0.628, p=0.0001) and negative correlation with HDL-C ( r=-0.670, p=0.0041).&#x0D; Conclusion: There is an influence of gender on cardiovascular disease risk factors with more of the females seriously at risk. Measurement of serum lipid profile should be introduced to the management plan of diabetes mellitus. There is an urgent need for the establishment of regional and national training courses for diabetic educators and also the creation of new evidence-based management plan for diabetics in Zanzibar for a better healthcare.

Cardiovascular diseases risk factors among adult diabetic patients in eastern Ethiopia.

ObjectiveThe aim of this study was to determine the magnitude of cardiovascular disease risk factors among adult diabetic patients at Hiwot Fana Specialized University Hospital and Jugal Hospital, eastern Ethiopia.MethodsAn institutional based cross sectional study was conducted on a total of 416 study participants (age ≥18 years) from February to March 2017. Data were collected using: structured questionnaires, measurements of weight, height, and blood pressure, and laboratory examination of blood lipids (total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein cholesterol) and fasting blood glucose. Data were analyzed using SPSS version 16.0 software packages. The association of cardiovascular disease risk factors with diabetes type, age, and sex was assessed by chi-square test.ResultThe mean age of study participants was 52 years and 44% were male. Dyslipidemia (90.6%), physical inactivity (76%), and hypertension (62.7%) were the most common cardiovascular disease risks factors identified among diabetic patients. It was also observed that 68.5% of the study participants had uncontrolled blood glucose level. Hypertension was significant in patients over 65 compared to those ≤65 years of age (p < 0.023). Females were considered to be significantly physically inactive compared to males (p < 0.001).ConclusionDyslipidemia is the most common risk factor of CVD in individuals with Types 1 and 2 diabetes mellitus. Identification and treatment of lipid abnormalities is very important. Controlling hypertension among older patients and lifestyle modification among female diabetic patients are also recommended.

The prevalence, awareness, and treatment of lipid abnormalities in Iranian adults: Surveillance of risk factors of noncommunicable diseases in Iran 2016

Hypercholesterolemia is one of the modifiable risk factors for atherosclerosis and cardiovascular diseases. Prevention and treatment of hypercholesterolemia and other lipid abnormalities require reliable data regarding the current prevalence of these abnormalities in the country. This study aims to determine the current prevalence, awareness, and treatment of lipid abnormalities in Iran. We planned to recruit 31,050 individuals who are 18years old and above and take blood samples from individuals who are 25years and above as representative sample at national and provincial levels in 2016. In practice, we recruited 21,293 Iranian adult aged more than 25years through a systematic random sampling from 30 provinces of Iran. Sociodemographic, anthropometric, and lifestyle data and history of cardiometabolic diseases were gathered. Serum total cholesterol, high-density lipoprotein-cholesterol (HDL-C), triglyceride, low-density lipoprotein-cholesterol (LDL-C), and non-HDL-C were investigated. The prevalence of lipid abnormalities, awareness, treatment, and achievement to non-HDL-C and LDL-C goals were determined based on National Cholesterol Education Program Adult Treatment Panel III criteria. In this representative Iranian adult population, 80.0% had at least one lipid abnormality, 69.2% had low HDL-C, 39.5% had high non-HDL-C, 28.0% had hypertriglyceridemia, and 26.7% hypercholesterolemia. Of those with hypercholesterolemia, 74.2% were aware of their lipid abnormality. Only 22.0% and 36.5% of the study population met the desired level of non-HDL-C and LDL-C, respectively. Low HDL-C is the main lipid abnormality in adult Iranian population. The majority of the population did not meet the desired level of non-HDL-C and LDL-C. Public health preventive policies should be made and implemented to better manage dyslipidemia.

Hypolipidaemic Effects of Gymnema sylvestre on High Fat Diet Induced Dyslipidaemia in Wistar Rats.

Hyperlipidaemia is a well known risk factor for cardiovascular diseases. Lifestyle modification can be the initial step to reduce cholesterol levels. There are various drugs which are used to control dyslipidaemia. Treatment of lipid abnormalities is a lifelong battle. Moreover, the safety and effectiveness of long term lipid lowering treatment are questionable. Gymnema Sylvestre (GS) is a well known herb with various medicinal properties. To explore the hypolipidaemic activity of GS leaves extract. Adult healthy female wistar rats, 30 in number, divided into five groups, weighing 150- 200 g were used. Dyslipidaemia was induced in rats by feeding them on high fat diet for four weeks. For the next four weeks GS extract was used as test drug while Atorvastatin was used as standard drug. Blood sample was collected for estimation of lipid profile on day 0, week 4 and week 8. Data was recorded as mean±SEM (Standard error of mean). Paired t-test and one way Analysis of Variance (ANOVA) followed by Dunnett's post hoc test was used for comparison. A p-value <0.05 was considered statistically significant. SPSS Statistics 20 (IBM software) was used for the analysis. Feeding rats with high fat diet for four weeks led to obesity and dyslipidaemia in rats. GS at both the doses (100mg/kg and 200mg/kg) significantly improved the lipid profile. Total Cholesterol (TC), Triglycerides (TG), Very Low Density Lipoprotein (VLDL) and Low Density Lipoprotein (LDL) values reduced significantly while that of High Density Lipoprotein (HDL) increased significantly. GS 200 mg/kg was found more effective than GS 100 mg/kg. GS improved the value of lipid profile significantly but the effect was found inferior to Atorvastatin. From the present study it can be concluded that GS possess an effective hypolipidaemic effect. Hence it can be included as an add on therapy in dyslipidaemia after further confirmatory studies.

Automated Multiplex LC-MS/MS Assay for Quantifying Serum Apolipoproteins A-I, B, C-I, C-II, C-III, and E with Qualitative Apolipoprotein E Phenotyping.

Direct and calculated measures of lipoprotein fractions for cardiovascular risk assessment suffer from analytical inaccuracy in certain dyslipidemic and pathological states, most commonly hypertriglyceridemia. LC-MS/MS has proven suitable for multiplexed quantification and phenotyping of apolipoproteins. We developed and provisionally validated an automated assay for quantification of apolipoprotein (apo) A-I, B, C-I, C-II, C-III, and E and simultaneous qualitative assessment of apoE phenotypes. We used 5 value-assigned human serum pools for external calibration. Serum proteins were denatured, reduced, and alkylated according to standard mass spectrometry-based proteomics procedures. After trypsin digestion, peptides were analyzed by LC-MS/MS. For each peptide, we measured 2 transitions. We compared LC-MS/MS results to those obtained by an immunoturbidimetric assay or ELISA. Intraassay CVs were 2.3%-5.5%, and total CVs were 2.5%-5.9%. The LC-MS/MS assay correlated (R = 0.975-0.995) with immunoturbidimetric assays with Conformité Européenne marking for apoA-I, apoB, apoC-II, apoC-III, and apoE in normotriglyceridemic (n = 54) and hypertriglyceridemic (n = 46) sera. Results were interchangeable for apoA-I ≤3.0 g/L (Deming slope 1.014) and for apoB-100 ≤1.8 g/L (Deming slope 1.016) and were traceable to higher-order standards. The multiplex format provides an opportunity for new diagnostic and pathophysiologic insights into types of dyslipidemia and allows a more personalized approach for diagnosis and treatment of lipid abnormalities.

Lipid profile abnormalities seen in T2DM patients in primary healthcare in Turkey: a cross-sectional study.

BackgroundDiabetes is characterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. We aimed to research association between serum lipid profile and blood glucose, hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus.MethodsFasting blood glucose (FBG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG) and glycated haemoglobin (HbA1c) levels were evaluated. A hepatic ultrasound was performed for every diabetic to evaluate hepatosteatosis. The study was done from January 2014 to June 2014 among 132 patients with T2DM who were admitted to outpatient clinic of Family Medicine department in a university hospital. The patients whose taking multi-vitamin supplementation or having hepatic, renal or metabolic bone disorders (including parathyroid related problems) were excluded from the study for the reason that those conditions might affect the carbohydrate and lipid metabolism in diabetes. Test of significance was calculated by unpaired student’s t test between cases and controls. Correlation studies (Pearson’s correlation) were performed between the variables of blood glucose and serum lipid profile. Significance was set at p<0.05.ResultsResults of serum lipid profile showed that the mean values for TC, TG, HDL and LDL in female patients were 227.6 ± 57.7 mg/dl, 221.6 ± 101.1 mg/dl, 31.5 ± 6.7 mg/dl and 136.5 ± 43.7 mg/dl, respectively. The mean values for TC, TG, HDL and LDL in male patients were 219.1 ± 34.7 mg/dl, 250.0 ± 100.7 mg/dl, 30.2 ± 7.4 mg/dl and 125.7 ± 21.4 mg/dl, respectively. Significantly higher mean serum levels of TC, TG and LDL and significantly lower mean serum levels of HDL were noted in patients with diabetes (p<0.001). FBG showed significant positive correlation with TC (p<0.05) and TG (p<0.05). Significant correlations were observed between serum levels of TC, TG, LDL and hepatosteatosis and HbA1c (p<0.05).ConclusionsThe study showed widespread lipid abnormalities in the course of diabetes triggered dyslipidemia as hypercholesterolemia, hypertriglyceridemia, elevated LDL and decreased HDL. This study proposes the predominance of hyperlipidemia over increased prevalence of diabetic dyslipidemia.

The efficacy and safety of Simvastatin in the treatment of lipid abnormalities in diabetes mellitus

Introduction:Notable lipid abnormalities in DM include elevated LDL-C which have been reported to be the prevalent lipid abnormality in DM and elevated total cholesterol levels. Although the Statins are widely used in the management of lipid abnormalities, their effects on the lipid abnormalities in Nigerians with DM has not been extensively evaluated.Objective:This report sets out to determine the effect of Simvor, a brand of Simvastatin in Nigerians with DM and abnormal lipid profiles.Materials and Methods:A total of 300 diabetic patients with abnormal lipid profile who were treatment naοve for lipid disorders were longitudinally recruited for the study. They were managed with Simvastatin (Simvor) in doses ranging from 20-40 mg alongside dietary counseling and exercise recommendation.Results:The mean age (SD) of the study subjects was 58.4 (10 years). The male; female ratio was 99:211. The proportions of lipid abnormalities for LDL-C, TCHOL, HDL-C and TG were 87%, 45%, 53% and 7% respectively. Following Simvastatin (Simvor) treatment, the mean LDL-C value was reduced by 16%, TCHOL by 23%, TG by 6% and HDL-C increased by 10%. Simvastatin (Simvor) was generally well tolerated and no cardiovascular events were noted in the study subjects during the period of the study.Conclusion:Simvastatin (Simvor) was effective and well tolerated in the management of lipid disorders in Nigerians with DM.

Guidelines for screening and monitoring of cardiometabolic risk in schizophrenia: systematic evaluation

Metabolic and cardiovascular health problems have become a major focus for clinical care and research in schizophrenia. To evaluate the content and quality of screening guidelines for cardiovascular risk in schizophrenia. Systematic review and quality assessment of guidelines/recommendations for cardiovascular risk in people with schizophrenia published between 2000 and 2010, using the Appraisal of Guidelines for Research and Evaluation (AGREE). The AGREE domain scores varied between the 18 identified guidelines. Most guidelines scored best on the domains 'scope and purpose' and 'clarity of presentation'. The domain 'rigour of development' was problematic in most guidelines, and the domains 'stakeholder involvement' and 'editorial independence' scored the lowest. The following measurements were recommended (in order of frequency): fasting glucose, body mass index, fasting triglycerides, fasting cholesterol, waist, high-density lipoprotein/low-density lipoprotein, blood pressure and symptoms of diabetes. In terms of interventions, most guidelines recommended advice on physical activity, diet, psychoeducation of the patient, treatment of lipid abnormalities, treatment of diabetes, referral for advice and treatment, psychoeducation of the family and smoking cessation advice. Compared across all domains and content, four European guidelines could be recommended. Four of the evaluated guidelines are of good quality and should guide clinicians' screening and monitoring practices. Future guideline development could be improved by increasing its rigour and assuring user and patient involvement.

Whether to Retest the Lipids of HIV-Infected Patients: How Much Does Fasting Bias Matter?

This paper aids in the diagnosis and treatment of lipid abnormalities by enhancing understanding of lipid values among HIV-infected patients. An elicited loss function highlights the importance of true low-density lipoprotein (LDL) cholesterol. In clinical settings, total cholesterol, high-density lipoprotein cholesterol, and triglycerides are often measured. Interpreting the resulting values can be problematic because of uncertainty due to the unknown period of fasting before the patient's blood was drawn. This results in uncertainty in the LDL cholesterol values, which are often calculated from other lipid values rather than measured directly. To model true LDL cholesterol, a four-level Bayesian hierarchical model is analyzed using Markov chain Monte Carlo techniques and elicited prior distributions. In turn, this yields expected-loss-minimizing treatment decisions for individual patients.

W01-03 - A systematic evaluation and comparison of the guidelines for screening and monitoring of cardiometabolic risk in people with schizophrenia

Metabolic and cardiovascular health problems have become a major focus for clinical care and research in schizophrenia. To evaluate the content and quality of screening guidelines for cardiovascular risk in schizophrenia we performed a systematic review and quality assessment of guidelines/recommendations published between 2000–2010, using the Appraisal of Guidelines for Research and Evaluation (AGREE). AGREE domain scores varied between 18 identified guidelines. Most guidelines scored best on the domains ‘Scope and Purpose’ and ‘Clarity of Presentation’. The domain ‘Rigour of Development’ was problematic in most guidelines, while the domains ‘Stakeholder Involvement’ and ‘Editorial Independence’ scored the lowest. The following parameters were recommended, in order of frequency: fasting glucose, BMI, fasting triglycerides, fasting cholesterol, waist, HDL/LDL, blood pressure, symptoms of diabetes. In terms of interventions most guidelines recommended advise on physical activity, advise on diet psycho-education of the patent, treatment of lipid abnormalities, treatment of diabetes, referral for advise and treatment, psycho-education of family and smoking cessation advice. Compared across all domains and content, 4 European guidelines could be recommended. Four of the evaluated guidelines are of good quality and should guide clinicians’ screening and monitoring practices. Future guideline development could be improved by increasing its rigour and assuring user and patient involvement. Although good guidelines are available research shows that the implementation in daily clinical practice remains poor.

Using Computer-Based Decision Support to Close the “Know–Do” Gap in Lipid-Lowering Therapy

A strange paradox haunts our attempts to prevent ischemic heart disease. Medicine has addressed the relation between serum lipids and atherosclerosis through a series of scientific triumphs. First, epidemiology demonstrated the association between abnormal cholesterol levels and coronary artery disease. Then, physiology and biochemistry elucidated the pivotal role of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase in the synthesis of lipoproteins. Next, pharmacology led to the development of new medications to target that enzyme without the often-unbearable side effects of earlier drugs. And finally, clinical researchers enrolled tens of thousands of patients at hundreds of centers worldwide to prove the efficacy of these treatments and help guide their use. Taken together, these steps represent one of the finest examples of the application of science to understand and ameliorate human disease. Article p 371 But shifting our focus from the successful laboratory or clinical trial site to the population reveals more disappointing data. We physicians fail to diagnose potentially dangerous lipid levels in up to a third of our patients with cardiovascular disease1,2; when the problem is identified, we often do not properly deploy the impressive arsenal of treatments that have been put in our hands. In the United States, fewer than half of those who would benefit from lipid-modifying treatment for coronary heart disease risk reduction are receiving it.3 And of those on therapy, just half of patients actually achieve their cholesterol goals.4 This results in part from poor persistence by physicians in monitoring lipid levels and adjusting therapy accordingly, as well as poor persistence by patients in staying with their prescribed regimens for both economic and noneconomic reasons.5 In summary, despite the wealth of tools available to diagnose and manage this common condition, only a fraction of people who have it are being adequately treated. The …

Clinical Relevance of Non-HDL Cholesterol in Patients With Diabetes

IN BRIEF Patients with type 2 diabetes have high rates of cardiovascular disease(CVD), much of which may be preventable with appropriate treatment of lipid abnormalities. Diabetic dyslipidemia most commonly manifests as elevated triglycerides and low levels of HDL cholesterol, with a predominance of small,dense LDL particles amid relatively normal LDL cholesterol levels. In diabetic patients, non-HDL cholesterol may be a stronger predictor of CVD than LDL cholesterol or triglycerides because it correlates highly with atherogenic lipoproteins. Target goals for LDL and non-HDL cholesterol in patients with diabetes are &amp;lt; 100 and &amp;lt; 130 mg/dl, respectively. Failure to consider the importance of non-HDL cholesterol in type 2 diabetes may result in undertreatment of patients with diabetes.