Triglyceride In Group Research Articles

Estimated ASCVD risk according to statin use in US adults with borderline triglycerides: Results from National Health and Nutrition Examination Survey (NHANES) 2007–2014

BackgroundElevated triglycerides (TGs) are associated with atherosclerotic cardiovascular disease (ASCVD). Despite statin therapy, many US adults have borderline or elevated TG levels. Not characterized is the ASCVD risk associated with borderline TG levels in statin users, including the estimated number of adults who will sustain ASCVD events. MethodsWe studied 4986 US adults (weighted to 113 million) aged 40–74 from the National Health and Nutrition Examination Surveys 2007–2014. The proportion of persons at low (<5%), borderline (5-<7.5%), intermediate (7.5-<20%), and high (≥20%) 10-year ASCVD risk among those on statins was quantified for low (<70 ​mg/dL, 70-<100 ​mg/dL), borderline (100-<135 ​mg/dL and 135-<150 ​mg/dL), borderline high (150-<200 ​mg/dL), and elevated (≥200 ​mg/dL) TGs. Multiple logistic regression examined these TG categories in relation to high risk status. ResultsOverall, 18.6% of participants had TG ​< ​70 ​mg/dL, 24.2% TG 70-<100 ​mg/dL, 22.0% TG 100-<135 ​mg/dL, 6.2% TG 135-<150 ​mg/dL, 15.0% TG 150-<200 ​mg/dL, and 14.0% TG ​≥ ​200 ​mg/dL. Mean 10-year ASCVD risk for these groups were 5.6%, 6.9%, 7.8%, 10.3%, 9.6% and 10.8%, respectively (p ​< ​0.0001). One-fifth or more of statin users with TGs over 135 ​mg/dL were at ≥ 20% 10-year ASCVD risk and ≥60% of persons in all TG groups were at borderline or higher ASCVD risk. Compared to those with TGs <70 ​mg/dL, multiple logistic regression showed odds ratios of 3.1 to 4.6 (p ​< ​0.05 to p ​< ​0.01) for those in TG groups ≥135 ​mg/dL in the overall sample, but 3.4 to 8.1 (p ​< ​0.05 to p < 0.01) for those in TG groups of ≥100 ​mg/dL in statin users, despite adjustment including HDL-C. ConclusionMany US adults with borderline levels of TGs are at elevated ASCVD risk despite statin therapy, suggesting the need first for greater lifestyle modification efforts, and when indicated, evidence-based therapies known to reduce this residual ASCVD risk.

The triglyceride-lowering effects of PCSK9 inhibitor differ in patients with different baseline triglyceride levels

To investigate the triglyceride (TG)-lowering effects of PCSK9 inhibitor in patients with in different baseline triglyceride levels. Between February, 2019 and March, 2020, a total of 59 patients were treated with PCSK9 inhibitor (Evolocumab) in 5 hospitals, including Nanfang Hospital, Guangdong Provincial People's Hospital, First Affiliated Hospital of Sun Yat-sen University, Foshan Nanhai District People's Hospital and Yulin First People's Hospital. According to baseline triglyceride levels, the patients were divided into normal TG group (&lt; 1.70 mmol/L, n=24), mild hypertriglyceridemia group (1.70-2.29 mmol/L, n=11), moderate hypertriglyceridemia group (2.30-5.63 mmol/L, n=13), and severe hypertriglyceridemia group (≥5.64 mmol/L, n=11), and the changes in TG level after the treatment were compared among the 4 groups. In the groups with normal and mildly elevated baseline TG level, the patients did not show significant changes in TG levels after the treatment. In patients with moderately and severely elevated baseline TG levels, treatment with PCSK9 inhibitor significantly reduced their TG levels (P &lt; 0.005). PCSK9 inhibitor has a significant TG-lowering effect in patients with moderate to severe hypertriglyceridemia but not in patients with only mildly elevated baseline TG level.

2030-P: The Efficacy of Laparoscopic Sleeve Gastrectomy in Severely Obese Patients with Varying Serum Triglyceride Levels

Purpose: To investigate the metabolic improvements in obese patients with different serum triglyceride (TG) levels after laparoscopic sleeve gastrectomy (LSG). Methods: 118 severely obese patients [body mass index (BMI)&amp;gt;35kg/m2] underwent LSG with complete information of follow-up for 3 and 6 months were analyzed. Patients were divided into two groups based on their different baseline serum levels of TG. Results: The metabolic parameters (BMI, NC, WC, HC, WHR, blood pressure, liver function, blood glucose, blood lipids, insulin resistance, HbA1c, and UA) of the normal and higher TG groups were significantly improved after surgery. Patients with normal TG had better improvement in BMI and WC compared with higher TG patients in both 3 and 6 months. After adjustment for age and gender, ΔWC positively correlated with ΔBMI (r=0.446, P&amp;lt;0.001), creatinine level (ΔCr, r=0.365, P=0.005) in the normal group in 3 months follow-up. In 6 months after LSG, ΔWC positively correlated with ΔBMI (r=0.657, P&amp;lt;0.001) and ΔCr (r=0.442, P=0.009) while ΔWC negatively correlated with the change in eGFR level (ΔeGFR, r=-0.374, P=0.009) in the normal group. In addition, multivariate linear regression analysis showed that decreased ΔWC levels significantly correlated with ΔBMI (β=1.333, R2 =0.259, P&amp;lt;0.001) and ΔCr (β=0.336, R2 =0.160, P=0.005) both in 3 months and 6 months after LSG. Conclusion: LSG can effectively improve metabolic disorders. Moreover, there were differences in weight loss between the normal and high TG groups after LSG, indicating that the baseline TG level can be used to predict short-term weight loss after LSG. Disclosure G. Li: None. Y. Huang: None. J. Zhang: None. X. Wang: None. C. Qian: None. X. Cheng: None. S. Qu: None. Funding National Key Research and Development Program of China (2018YFC1314100); National Natural Science Foundation of China (81970677); Shanghai Pujiang Program (2019PJD040); Shanghai Committee of Science and Technology (18411951803, 17DZ1910603)

Abstract P489: Association of Fasting Triglyceride Levels With Long-Term Competing Risks for Cause-Specific Cardiovascular Disease Events Among Middle-aged White and Black Men and Women

Introduction: Hypertriglyceridemia is common and reflects poor metabolic health, but conflicting data exist regarding the independent association of triglycerides (TG) and cardiovascular disease (CVD). In addition, whether elevated TG are associated with differential long-term risks for CVD subtypes and whether this varies by sex and race, is not well-established. Therefore, we sought to examine the incidence of coronary heart disease, stroke, or heart failure in white and black US men and women by baseline TG levels. Methods: We included individual-level pooled data from 5 population-based cohorts and stratified middle-aged participants (index ages 40-59 years) who were free of CVD at baseline by sex and race. We categorized fasting TG levels as optimal (&lt;100 mg/dL), intermediate (100 to 150 mg/dL), or elevated (&gt;150mg/dL). We performed 1) Irwin’s restricted mean to estimate years lived free of and with CVD and 2) competing Cox models (adjusted for age, education, smoking, obesity, hypertension, diabetes, total cholesterol, and HDL-cholesterol) to estimate joint cumulative risks for CVD events (overall and by subtype) and non-CVD death. Results: Among the 20,406 participants, 26% were black and 55% were women. Elevated TG was associated with significantly fewer healthy years lived free of CVD in all race-sex groups (p&lt;0.05 compared with optimal TG). Overall, competing cumulative incidence of CVD as well as non-CVD death was higher in intermediate and elevated TG subgroups compared with the optimal TG group. After adjustment for other risk factors, elevated TG were not associated with risks for any CVD subtype in black adults; among whites, elevated TG were associated with risk for stroke as a first event in men, and with all CVD subtypes in women (TABLE) . Discussion: Using pooled individual-level data from 5 large cohorts of middle-aged individuals, we observed differential competing risks by sex and race group for CVD subtypes associated with elevated TG. White women especially may have independent risk from elevated TG.

Triglyceride is an independent predictor of type 2 diabetes among middle-aged and older adults: a prospective study with 8-year follow-ups in two cohorts

BackgroundAlthough there is abundant evidence indicating the connection between triglyceride and type 2 diabetes mellitus (T2DM), few reports or cohort studies confirm that high TG concentration may predict the incidence of T2DM independently. Thus, we studied the association between triglyceride (TG) and T2DM in a male-dominated, middle and older aged cohort, Tianjin General Hospital Cohort. And we further verified our results in the China Health and Retirement Longitudinal Study (CHARLS).MethodsWe conducted an 8-year retrospective cohort study (2009–2017) with 7241 participants who were free from T2DM at baseline. Three groups were constructed based on baseline TG levels (normal, borderline-high, and high). We used a Cox proportional hazards model to evaluate the relationship between TG and T2DM after adjusting for possible risk factors. A Kaplan–Meier survival analysis was performed to compare the incidence of T2DM among subjects in each TG group. We also tested the association between TG and T2DM in the CHARLS cohort.ResultsIn Tianjin General Hospital Cohort, 7241 participants (male 75.8%, female 24.2%) were included, mean age was 61.49 ± 13.85 years at baseline. The cumulative incidence of T2DM in our cohort study was 8.6% (9.2% in men and 6.6% in women). Compared with the normal TG group, the hazard ratios in the borderline and high group were 1.30 (95% CI 1.04–1.62) and 1.54 (95% CI 1.24–1.90). The Kaplan–Meier survival analysis indicated that higher TG levels may predict higher onset of T2DM. These results were verified in the CHARLS cohort, the hazard ratio with T2DM (95% CI) for logTG was 3.94 (2.64–5.87).ConclusionsOur findings suggest that the TG level may be an independent risk factor and predictor for T2DM.

Interaction of Gut Microbiota and High‐Sodium, Low‐Potassium Diet in Altering Plasma Triglyceride Profiles Revealed by Lipidomics Analysis

High sodium and low potassium (HNaLK) intake increases the risk of cardiovascular disease (CVD) and metabolic syndrome. The authors investigate if the dietary minerals interact with the gut microbiota to alter circulating lipid profiles, implicated in CVD and metabolic syndrome. Plasma samples from Wistar rats fed a control or HNaLK diet with or without antibiotic treatment (n=7 each, a total of 28) are subjected to lipidomics analysis. Lipidomic data are then analyzed using statistical and bioinformatics tools, which detect numerous lipid species altered by the treatments, and consistently demonstrated interactions between the gut microbiota and the HNaLK diet in altering circulating lipids, mainly triglycerides (TGs). Two distinct TG groups differentially regulated by antibiotic treatment are identified. One group (cluster 1), representing the majority of TG species detected, is downregulated, whereas the other group (cluster 2) is upregulated by antibiotic treatment. Interestingly, cluster 2 TGs are also regulated by the diet. Cluster 2 TGs exhibit greater carbon-chain length and double-bond content and include TGs composed of very-long-chain polyunsaturated fatty acids, associated with reduced diabetes risk. The HNaLK diet interacts with gut bacteria to alter plasma lipid profiles, which may be related to its health effects.

Triglyceride Level Is an Independent Risk Factor in First-Attacked Neuromyelitis Optica Spectrum Disorders Patients.

Objective: To investigate prospective associations between triglyceride (TG) level and prognosis of first-attacked patients with neuromyelitis optica spectrum disorders (NMOSD).Methods: This retrospective study included 196 patients newly diagnosed with NMOSD from June 2014 to December 2018. Data of clinical parameters, including age of onset, sex, BMI, blood lipid levels, anti-aquaporin-4 status, serum glucose level, therapy regimens, comorbidities, initial Expanded Disability Status Scale (EDSS), relapses, and outcomes were collected. We used logistic regression models to examine the associations among relevant clinical factors and outcomes, and statistical analyses were performed using the SPSS 23.0 software.Results: Compared with the high TG group, residual EDSS was relatively lower in the normal TG group (median 1.0 vs. 2.0, P = 0.002). In the univariate analysis, TG level was positively correlated with outcomes (OR 1.75, 95% CI 1.18–2.60, P = 0.005) and relapses (OR 1.57, 95% CI 1.07–2.31, P = 0.02). Our stratified analysis suggested that patients with normal BMI (OR 4.90, 95% CI 2.10–11.44, P = 0.001) were closely correlated with poor recovery owing to increased TG level. In the multivariate analysis, a statistically significant association still existed between TG level and outcomes (OR 3.44, 95% CI 1.02–11.64; P = 0.040) after adjusting for various variables.Conclusions: In first-attacked NMOSD patients, TG level was positively associated with poor recovery. Early monitoring and treatment of elevated TG level in NMOSD patients are important.

Electroacupuncture Versus Aerobic Interval Training on Liver Functions in Patients with Nonalcoholic Fatty Liver

Background: Nonalcoholic fatty liver disease (NAFLD) is considered one of the most common and most important conditions affecting the liver, because of its increasing prevalence all over the world. It is usually associated with elevated liver enzymes and ranges from simple steatosis to liver cirrhosis. This study was conducted to compare the effects of electroacupuncture (EA) versus aerobic interval training (AIT) exercise and how they affect liver functions in people suffering from nonalcoholic fatty liver. Methods: This study was carried out on 50 female patients suffering from NAFLD with age ranging from 30 to 55 years; they were randomly divided into two equal groups: group A received (EA) stimulation at points of liver 3 (LR3), liver 14 (LR14), gall bladder 34 (GB34), and stomach 36 (ST36), whereas group B received AIT exercise. All patients in both groups A and B received 3 sessions per week for 6 weeks (receiving noninterrupted 18 sessions) in addition to their standard medications. Evaluation of all patients in both groups A and B was carried out before and after the treatment program by measuring the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglycerides (TGs), and C-reactive protein (CRP). Results: There is a significant decrease (p < 0.05) of ALT, AST, TGs, and CRP within each group, A and B, after 6 weeks of treatment sessions. A significant difference post-treatment was found between both groups in ALT, AST, and TGs (p < 0.05). However, there was no significant difference in CRP (p > 0.05) between both groups post-treatment. Conclusions: It can be concluded that both EA and AIT exercise are potent modalities that improve liver functions in people with NAFLD with better effect toward EA.

2967 Post Prandial Lipemia: A Potential Diagnostic Modality for NAFLD

INTRODUCTION: Clinically, NAFLD encompasses a broad spectrum of hepatic derangements ranging from fat accumulation (steatosis) to severe inflammation and fibrosis (NASH, nonalcoholic steatohepatitis) that can lead to cirrhosis and subsequently to hepatocellular carcinoma. NAFLD is now more common than alcoholic liver disease owing to the rapid rise in the prevalence of obesity, and NAFLD is the most common cause of abnormal liver function tests. METHODS: Twenty consecutive Patients with age range 30-60 yrs attending our OPD during the years 2014-2016 with ultrasonographically proven hepatic steatosis and satisfying following criteria were selected: Alcohol intake less than 20 g/day, absence of autoimmune hepatitis (on the basis of clinical findings, raised globulin, AST/ALT ratio), absence of viral hepatitis (on the basis of serology for viral markers of HBV, HCV), absence of history of intake of any hepatotoxic drug. RESULTS: Considering the fasting lipid profile, difference was observed between the groups in serum TG (177.15 ± 16.18 VS 128.3 ± 22.4), total cholesterol (221.45 ± 31.26 vs 179.35 ± 26.59) and HDL (42.2 ± 6.13 vs 49.8 ± 4.39). The difference found was statistically significant (P &lt; 0.001). Summing up for the cases, a higher value was recorded for alkaline phosphatise which was statistically not significant. The postprandial lipemic response of the subjects were estimated using serum triglyceride (TG) level measurement considering the same being the most dynamic parameter considering fat challenge. The serial estimations of TG at 2 hourly interval have also shown a significant difference in serum TG levels between cases and control groups with (P &lt; 0.001). In order to calculate the magnitude of lipaemia, the Area under the curve (AUC) was calculated for the two groups using trapezoid rule, which showed a statistically significant (P &lt; 0.001) between the two groups (1814.20 ± 166.46 vs 1341.25 ± 153.36). CONCLUSION: We have observed that all subjects from the case group have had a TG surge of greater than 240 mg% as opposed to the healthy controls, this difference could possibly serve as a useful tool provided a standardized diet challenge is implemented prior to test.

Whey Protein Combined with Low Dietary Fiber Improves Lipid Profile in Subjects with Abdominal Obesity: A Randomized, Controlled Trial

Abdominal obesity is associated with elevated postprandial triglycerides (TG), an independent risk factor for cardiovascular diseases. Previous studies show that whey protein (WP) and dietary fiber may separately reduce postprandial TG. However, few studies have investigated the long-term effects of WP and dietary fiber on postprandial TG. We aimed to investigate the separate and combined long-term effects of WP and dietary fiber from wheat bran on postprandial TG and markers of lipid metabolism in subjects with abdominal obesity. We conducted a 12-week, double-blind, randomized, controlled, parallel intervention study. In a 2 × 2 factorial design, 73 adults were randomized to receive 60 g/day of either WP hydrolysate or maltodextrin (MD) combined with high-fiber wheat bran products (HiFi; 30 g dietary fiber/day) or low-fiber refined wheat products (LoFi; 10 g dietary fiber/day). A high-fat meal test was conducted before and after the intervention. Sixty-five subjects were included in the final analyses. There were no differences between intervention groups in postprandial TG assessed as incremental area under the curve (iAUC). WP-LoFi had reduced postprandial TG assessed as total area under the curve (tAUC) and reduced fasting TG compared with all other groups, and reduced fasting apolipoprotein B-48 compared with MD-LoFi. There were no changes in lipoprotein lipase activity. Total cholesterol and apolipoprotein B-100 were reduced after WP intake compared with MD. Total cholesterol was increased after HiFi intake compared with LoFi. In conclusion, intake of WP in combination with low-fiber cereal products for 12 weeks had beneficial effects on postprandial TG tAUC and fasting TG, but not on postprandial TG iAUC in subjects with abdominal obesity. Combining WP with high-fiber wheat bran products did not improve lipid profile.

Association Analysis of Hyperlipidemia with the 28-Day All-Cause Mortality of COVID-19 in Hospitalized Patients

ObjectiveThis study aimed to determine the association of hyperlipidemia with clinical endpoints among hospitalized patients with COVID-19, especially those with pre-existing cardiovascular diseases (CVDs) and diabetes.MethodsThis multicenter retrospective cohort study included all patients who were hospitalized due to COVID-19 from 21 hospitals in Hubei province, China between December 31, 2019 and April 21, 2020. Patients who were aged < 18 or ≥ 85 years old, in pregnancy, with acute lethal organ injury (e.g., acute myocardial infarction, severe acute pancreatitis, acute stroke), hypothyroidism, malignant diseases, severe malnutrition, and those with normal lipid profile under lipid-lowering medicines (e.g., statin, niacin, fenofibrate, gemfibrozil, and ezetimibe) were excluded. Propensity score matching (PSM) analysis at 1:1 ratio was performed to minimize baseline differences between patient groups of hyperlipidemia and non-hyperlipidemia. PSM analyses with the same strategies were further conducted for the parameters of hyperlipidemia in patients with increased triglyceride (TG), increased low-density lipoprotein cholesterol (LDL-C), and decreased high-density lipoprotein cholesterol (HDL-C). Mixed-effect Cox model analysis was performed to investigate the associations of the 28-days all-cause deaths of COVID-19 patients with hyperlipidemia and the abnormalities of lipid parameters. The results were verified in male, female patients, and in patients with pre-existing CVDs and type 2 diabetes.ResultsOf 10 945 inpatients confirmed as COVID-19, there were 9 822 inpatients included in the study, comprising 3513 (35.8%) cases without hyperlipidemia and 6309 (64.2%) cases with hyperlipidemia. Based on a mixed-effect Cox model after PSM at 1:1 ratio, hyperlipidemia was not associated with increased or decreased 28-day all-cause death [adjusted hazard ratio (HR), 1.17 (95% CI, 0.95-1.44), P =0.151]. We found that the parameters of hyperlipidemia were not associated with the risk of 28-day all-cause mortality [adjusted HR, 1.23 (95% CI, 0.98-1.55), P = 0.075 in TG increase group; 0.78 (95% CI, 0.57-1.07), P = 0.123 in LDL-C increase group; and 1.12 (95% CI, 0.9-1.39), P = 0.299 in HDL-C decrease group, respectively]. Hyperlipidemia was also not significantly associated with the increased mortality of COVID-19 in patients accompanied with CVDs or type 2 diabetes, and in both male and female cohorts.ConclusionOur study support that the imbalanced lipid profile is not significantly associated with the 28-day all-cause mortality of COVID-19 patients, even in those accompanied with CVDs or diabetes. Similar results were also obtained in subgroup analyses of abnormal lipid parameters. Therefore, hyperlipidemia might be not a major causative factor for poor outcome of COVID-19, which provides guidance for the intervention of inpatients during the epidemic of COVID-19.

In Vitro Evaluation of the Polymerization Properties of N-Butyl Cyanoacrylate/Iodized Oil Mixtures for Lymphatic Interventions

PurposeTo evaluate polymerization of N-butyl cyanoacrylate (NBCA)/iodized oil mixtures for lymphatic interventions in vitro. Materials and MethodsPolymerization times of different NBCA/iodized oil mixtures (ratios of 1:0–1:7) were investigated in a static and dynamic experimental setup (performed in a lymph flow model in a silicone tube). Eight lymphatic samples with different triglyceride (TG) concentrations (low TGs, < 50 mg/dL; medium TGs, approximately 100–400 mg/dL; high TGs, > 700 mg/dL) were investigated. Morphologic changes during NBCA polymerization were monitored and recorded by video. Statistical analysis was performed with intergroup comparisons (Kruskal–Wallis test) and multiple regression analysis. ResultsStatic experiments showed increasing polymerization times with increasing concentrations of iodized oil as well as increasing concentrations of TGs. In the low-TG group, polymerization time increased from 14 s at a 1:1 ratio of NBCA to iodized oil to 1,336 s at a 1:7 ratio; times in the medium-TG group increased from 21 s (1:1) to 2,546 s (1:7), and those in the high TG group increased from 168 s (1:1) to 16,530 s (1:7). In dynamic experiments, prolongation of polymerization time was less pronounced. For low- and medium-TG groups, total occlusion of the silicon tube was observed in all cases during the embolization procedure at between 26 seconds (1:1 ratio) and 52 seconds (1:7). In the high-TG group, polymerization took considerably longer (between 43 s [1:1] and 467 s [1:7]) or failed completely. ConclusionsPolymerization time of NBCA/iodized oil in lymph seems to be prolonged by increasing iodized oil and TG concentrations.

Impact of dyslipidemia on 24-h urine composition in adults without urolithiasis

PurposesTo evaluate the influence of dyslipidemia on 24-h urine composition in adults who were non-stone formers (NF).MethodsSamples for 24-h urine composition were analyzed from 584 NF adults without urolithiasis in a national six-city-based epidemiologic study. The samples were divided into groups based on total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). The groups were compared based on demographic data and each component of 24-h urinalysis.ResultsThe numbers of participants in high TG, high TC, high LDL, and low HDL were 106, 175, 147, and 59, respectively. The high TG group had increased urinary excretions of oxalate [mean difference (MD) = 0.032 mmol, 95% confidence interval (CI): 0.000–0.065] and potassium (MD = 4.298 mmol, 95%CI: 0.182–8.414). Increased urinary excretion of calcium (MD = 0.531 mmol, 95%CI: 0.061–1.001), sodium (MD = 41.561 mmol, 95%CI: 9.179–73.942), and chloride (MD = 45.209 mmol, 95%CI: 12.118–78.299) were found in the high TC group. Interestingly, the high LDL group had a decreased urinary excretion of calcium (MD = − 0.573 mmol, 95%CI: -1.048 to − 0.097), oxalate (MD = − 0.038 mmol, 95%CI: -0.07 to − 0.006), sodium (MD = − 53.285 mmol, 95%CI: -85.823 to − 20.748), and chloride (MD = − 55.809 mmol, 95%CI: -89.035 to − 22.583). Increased urinary excretions of citrate (MD = 0.455 mmol, 95%CI: 0.076–0.835) and magnesium (MD = 0.697 mmol, 95%CI: 0.244–1.149) were found in the low HDL group.ConclusionsThe present study first investigated the effects of dyslipidemia on 24-h urinalysis in NF adults. Of note, high LDL and low HDL were found to be adversely related to kidney stone formation. However, people with high TG and high TC should be cautious of getting kidney stones.

Increased residual cardiovascular risk in patients with diabetes and high versus normal triglycerides despite statin-controlled LDL cholesterol.

AimTo determine whether high triglycerides (TG) in the presence of statin‐controlled LDL‐C influence the risk of cardiovascular disease (CVD) among patients with diabetes in real‐world clinical practice.Materials and methodsWe identified adults with diabetes from the Southern California and Pacific Northwest regions of Kaiser Permanente. We included patients undergoing statin therapy with LDL‐C from 40‐100 mg/dL who were not undergoing other lipid‐lowering therapies and had a prior diagnosis of atherosclerotic CVD or at least one other CVD risk factor. We grouped patients into high TG (200‐499 mg/dL; n = 5542) or normal TG (<150 mg/dL, n = 22 411) from January 2010 through December 2016 to compare incidence rates and rate ratios of first non‐fatal myocardial infarction (MI), non‐fatal stroke, unstable angina and coronary revascularization. We adjusted multivariable analyses for age, sex, race/ethnicity, smoking status, blood pressure, HbA1c, serum creatinine, presence of ischaemic heart disease and study site.ResultsAdjusted rate ratios for the four outcomes were all statistically significantly different. The incidence rate for non‐fatal MI was 30% higher in the high TG group (rate ratio, 1.30; 95% CI, 1.08‐1.58; P = 0.006). The rate was 23% higher for non‐fatal stroke (1.23, 1.01‐1.49, P = 0.037), 21% higher for coronary revascularization (rate ratio, 1.21; 95% CI, 1.02‐1.43; P = 0.027) and was, non‐significantly, 33% higher for unstable angina (rate ratio, 1.33; 95% CI, 0.87‐2.03; P = 0.185).ConclusionsDespite statin‐controlled LDL‐C levels, CV events were greater among patients with diabetes and high TG levels. Because we controlled for cardiometabolic risk factors, it is likely that the difference in TG levels contributed to the excess risk observed in patients with high TGs.

Association of ABCC2 polymorphism and gender with high-density lipoprotein cholesterol response to simvastatin.

The clinical benefits of lipid-lowering therapy with statins are widely recognized.However, the lipid-lowering efficacy of statins shows significant differences between individuals. ABCC2 has been demonstrated to contribute to the transmembrane transport of the substrate compounds. The ABCC2 SNPs may be important factors that affect individual differences in clinical drug response. The aim of this study was to evaluate the association of rs717620 of ABCC2 with treatment response to simvastatin in a Chinese Han population. A total of 318 subjects were medicated with simvastatin 20mg/day for 12 weeks after enrollment. Venous blood was obtained before and after simvastatin treatment for measurement of blood lipid profile. Subjects were classified into high-response and low-response groups depending on whether their lipid profile change was higher or lower than median change values. The ABCC2 SNP rs717620 was genotyped from blood samples with a snapshot assay. A total of 12 weeks of treatment with simvastatin significantly decreased low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TGs) and significantly increased high-density lipoprotein cholesterol (HDL-C; p < 0.05). In multivariate analysis, there were no significant genetic effects of SNP rs717620 on the incidence of high- or low-response patients among TC, TG and LDL-C groups. However, rs717620 A-allele and female gender are significantly associated with the risk of low-response of HDL-C elevation after simvastatin treatment. ABCC2 rs717620 and female gender may be related to the low-effect of simvastatin treatment on the HDL-C level in the Chinese Han population. Female Chinese patients with hyperlipidemia carrying rs717620 GA/AA genotypes might have reduced benefit from simvastatin treatment.

Increased Cardiovascular Risk in Hypertriglyceridemic Patients With Statin-Controlled LDL Cholesterol.

Real-world evidence of the relationship between high triglyceride (TG) levels and cardiovascular (CV) disease (CVD) risk among statin-treated patients with low-density lipoprotein cholesterol (LDL-C) control is lacking. We aimed to compare CVD and mortality risk between patients with high vs normal TGs. Longitudinal observational cohort study. Integrated delivery system. Patients aged ≥45 years whose TG level was either <150 mg/dL (normal) or between 200 and 499 mg/dL (high) in 2010, were taking only statins, had LDL-C values 40 to 100 mg/dL, and had diagnosed CVD. Patients were followed through December 2016. Our primary outcomes were a composite of nonfatal myocardial infarction (MI), nonfatal stroke, unstable angina, coronary revascularization, and all-cause mortality and a second composite adding peripheral revascularization and aneurysm repair. We compared multivariable-adjusted incidence rates and rate ratios (RRs) of the outcomes and their components. A total of 14,481 patients comprised the normal TG group, and 2702 patients were in the high TG group. Multivariable-adjusted incidence of the second composite was 10% greater in the high TG group [50.9/1000 person-years, 95% CI 47.0 to 55.2 vs 46.5, 44.8 to 48.2, RR 1.10, 95% CI 1.00 to 1.20, P = 0.041]. The difference was driven by nonfatal MI (RR 1.20, 95% CI 1.00 to 1.45, P = 0.045), coronary revascularization (RR 1.18, 95% CI 1.00 to 1.40, P = 0.045), and peripheral revascularization (RR 1.56, 95% CI 1.14 to 2.13, P = 0.006). CVD risk in high-risk statin-treated patients with atherosclerotic CVD was associated with high TG levels.

Relationship between nephrolithiasis and dyslipidemia in primary gout patients

Objective To explore the impact of dyslipidemia on uric acid stones by analyzing the relationship between blood lipids and urolithiasis in primary gouty patients. Methods We retrospectively identified patients with nephrolithiasis in primary gout patients who underwent stone chemical analysis, compared with gout patients without nephrolithiasis. The clinical parameters, urine analysis and lipid levels were analyzed. Patients were divided into groups based on serum lipid levels. The groups were compared based on demographic data and stone composition. Correlations were analyzed between serum lipid, urinary pH and uric acid stones. Moreover, the risk factors of uric acid stones were determined by logistic regression analysis. Analysis of variance, t-test, chi-square test, Spearman′s test and Logistic regression were used for statistical analysis. Results ① A total of 144 gout patients were included in study, 48 patients with urolithiasis and 96 patients without urolithiasis. ② Serum lipid levels were significantly lower in urolithiasis group than those patients without urolithiasis including triglyceride (TG) [1.6(0.9, 2.1) mmol/L vs 2.2(1.4, 3.2) mmol/L, Z=2.38, P=0.01], total cholesterol (TC) [(4.4±1.2) mmol/L vs (5.1±1.0) mmol/L, t=5.3, P=0.006]; low density lipoprotein cholesterol(LDL-C) [(2.5±0.9) mmol/L vs (3.2±0.9) mmol/L, t=4.2, P=0.005]. ③ Compared to oxalate stone formers, uric acid stone formers had significantly higher TG [(1.8±0.6) mmol/L vs (0.9±0.5) mmol/L, t=4.9, P=0.001), TC [(4.4±1.1) mmol/L vs (3.8±1.0) mmol/L, t=1.8, P=0.001] and LDL-C [(2.8±0.9) mmol/L vs (2.0±0.7) mmol/L, t=3.5, P=0.045], while the high density lipoprotein (HDL) level was lower [(0.94±0.23) mmol/L vs (1.32±0.41) mmol/L, t=-4.0, P=0.002]. ④ Percentage of uric acid stones in high TG group was higher than normal TG group [85% (17/20 vs 46.4% (13/28) , χ2=7.4, P=0.007], in addition, the percentage of uric acid stones in low HDL group was higher than normal HDL group [(82.1% (23/28) vs 35.0% (7/20) , χ2=11.1, P=0.001]. ⑤ Uric acid stones were significantly correlated with high TG, low LDL and urinary pH(r=0.522, 0.47, -0.212, respectively). Logistic analysis showed risk factors for uric acid stone in primary gouty patients were high TG [OR=2.38, 95%CI(1.41, 13.7); P=0.01] and lower HDL level [OR=0.01, 95%CI(0.01, 0.43); P=0.01]. Conclusion There is a link between dyslipidemia and kidney uric acid stone risk in primary gout patients. Specific alterations in patient′s lipid profile may portend unique aberrations in urine physico-chemistry and uric acid stone risk. Key words: Gout; Kidney; Nephrolithiasis; Dyslipidemia; Body mass index

Association between periodontitis and the main components of metabolic syndrome

The prevalence of metabolic syndrome (MetS) is increasing worldwide, and itappears to increase independently the risk of cardiovascular disease. Periodontitis hasbeen shown to have an association with the risk of cardiovascular disease.The aim of the present study is to investigate the association between periodontalstatus and the main components of metabolic syndrome, singly, and in combination intype 2 diabetic patients.One hundred and seventy five patients (96 males and 79 females) with type 2diabetes mellitus (T2DM) were enrolled in the study. The following clinicalcharacteristics were reported: age and gender, body mass index (BMI) and bloodpressure. Periodontal status was assessed using periodontal disease index whichincludes plaque, calculus, and periodontal component of the index. An assessment ofserum lipid analytes included estimation of serum triglycerides (TG) and serum highdensity lipoprotein cholesterol (HDL-C).There was a significant difference in mean value of periodontal disease index(PDI) between normotensive and hypertensive diabetic patients (3.31±0.83 vs.3.82±0.65, P&lt;0.001). Also there was a significant difference in PDI between normaland high TG groups (3.49±0.73 vs. 3.81±0.61, P&lt;0.01). There was a significantincrease in TG level in hypertensive compared to normotensive diabetic patients(P&lt;0.01). Only in presence of hypertension and obesity in addition to diabetes thatPDI was significantly increased in comparison with diabetic hypertensive non obesepatients (4.1±0.58 vs. 3.62±0.64, P&lt;0.001). There were no significant differences inTG level between obese and non obese diabetic patients while there was a significantincrease in TG level in patients who were hypertensive obese compared tonormotensive non obese (174.64 ±61.39 vs. 150.80±54.96 respectively, P&lt;0.05).Presence of two or more characteristics of MetS has resulted in a significant increaseof PDI when compared with patients who had only diabetes (P&lt;0.001).In conclusion, hypertension and hypertriglyceridemia as main components ofMetS are singly associated with periodontitis in T2DM and the presence of any twostudied components of MetS in addition to diabetes will attain the worst deteriorationin periodontal status.

Association between periodontitis and the main components of metabolic syndrome

The prevalence of metabolic syndrome (MetS) is increasing worldwide, and itappears to increase independently the risk of cardiovascular disease. Periodontitis hasbeen shown to have an association with the risk of cardiovascular disease.The aim of the present study is to investigate the association between periodontalstatus and the main components of metabolic syndrome, singly, and in combination intype 2 diabetic patients.One hundred and seventy five patients (96 males and 79 females) with type 2diabetes mellitus (T2DM) were enrolled in the study. The following clinicalcharacteristics were reported: age and gender, body mass index (BMI) and bloodpressure. Periodontal status was assessed using periodontal disease index whichincludes plaque, calculus, and periodontal component of the index. An assessment ofserum lipid analytes included estimation of serum triglycerides (TG) and serum highdensity lipoprotein cholesterol (HDL-C).There was a significant difference in mean value of periodontal disease index(PDI) between normotensive and hypertensive diabetic patients (3.31±0.83 vs.3.82±0.65, P&lt;0.001). Also there was a significant difference in PDI between normaland high TG groups (3.49±0.73 vs. 3.81±0.61, P&lt;0.01). There was a significantincrease in TG level in hypertensive compared to normotensive diabetic patients(P&lt;0.01). Only in presence of hypertension and obesity in addition to diabetes thatPDI was significantly increased in comparison with diabetic hypertensive non obesepatients (4.1±0.58 vs. 3.62±0.64, P&lt;0.001). There were no significant differences inTG level between obese and non obese diabetic patients while there was a significantincrease in TG level in patients who were hypertensive obese compared tonormotensive non obese (174.64 ±61.39 vs. 150.80±54.96 respectively, P&lt;0.05).Presence of two or more characteristics of MetS has resulted in a significant increaseof PDI when compared with patients who had only diabetes (P&lt;0.001).In conclusion, hypertension and hypertriglyceridemia as main components ofMetS are singly associated with periodontitis in T2DM and the presence of any twostudied components of MetS in addition to diabetes will attain the worst deteriorationin periodontal status.

Impact of glucose and lipid markers on the correlation of calculated and enzymatic measured low-density lipoprotein cholesterol in diabetic patients with coronary artery disease.

Low-density lipoprotein cholesterol (LDL-C) is widely estimated by Friedewald equation (FE) and Enzymatic test (ET), which are affected by several factors. The aim of this study was to observe the impact of diabetic lipid and glucose patterns on the correlation between FE LDL-C (F-LDL) and ET LDL-C (E-LDL) in patients with coronary artery disease (CAD). A total of 8155 CAD patients were consecutively enrolled and their lipid profiles were measured. The impacts of triglyceride (TG), glycosylated hemoglobin A1c (HbA1c), and high-density lipoprotein cholesterol (HDL-C) on the correlation of F-LDL and E-LDL were examined. The difference value (DV) between F-LDL and E-LDL was compared using ANOVA test. The CAD patients with DM were elder and had higher body mass index, plasma TG compared with those without DM (P<.05 separately). In the whole population, F-LDL was lower than E-LDL but showed a high correlation with E-LDL (r=.970, P=.000). Moreover, as the TG concentrations increased, the DV increased accordingly but the correlation between F-LDL and E-LDL decreased (P<.01). The similar trend was also found in both DM and non-DM patients comparing with different TG groups. However, in patients with DM, there was no significant difference of DV in different HbA1c groups or HDL-C concentrations (P>.05). Although F-LDL might underestimate the value of LDL-C, the correlation between F-LDL and E-LDL was clinically acceptable (r=.97), suggesting the LDL-C values measured by two methods were similarly reliable in CAD patients with or without DM.