Triglyceride Levels In Patients Research Articles

Ketonuria as an Indicator of Improvement of Renal Function in Patients with Type 2 Diabetes Receiving SGLT2 Inhibitor Treatment.

We investigated the potential association between ketonuria during treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors and its renoprotective effect in patients with type 2 diabetes. We included 192 patients who had received SGLT2 inhibitors for more than 6 months. After propensity score matching, 52 patients each were allocated into groups with or without ketonuria, respectively. The estimated glomerular filtration rate exhibited a significant improvement only in subjects with ketonuria (without ketonuria: mean difference, -0.02 mL/min/1.73 m2 [95% confidence interval (CI), -3.87 to 3.83 mL/min/1.73 m2] vs. with ketonuria: mean difference, 6.81 mL/min/1.73 m2 [95% CI, 3.16 to 10.46 mL/min/1.73 m2]; P<0.001). Improvement in estimated glomerular filtration rate at 6 months was associated with female sex and lower baseline body weight, blood pressure, and triglyceride levels in patients with ketonuria. In conclusion, the presence of ketonuria was associated with the renoprotective effect of SGLT2 inhibitors, and female sex and the absence of metabolic syndrome components may serve as additional indicators of these medications' substantial renoprotective effects in individuals with ketonuria.

Residual Cardiovascular Risk: Role of Remnants Cholesterol, Monocyte/HDL Ratio and Lipoprotein Ratios on Personalized Cardiovascular Prevention.

Cardiovascular diseases represent the leading cause of death in the world and are subject to limitations in prevention strategies despite the use of very effective drugs. The concept of residual risk (RR) is intrinsically related to that of global risk of which it represents a very significant percentage. In the cardiovascular field, the term RR refers to the probability of incurring a major cardiovascular event, despite adequate control of the risk factors present in the individual patient. A significant portion of the RR in the cardiovascular field results from the underestimation of additional risk factors not subjected to adequate intervention such as, for example, triglyceride levels in patients treated for the presence of hypertension and/or hypercholesterolemia. The control of the RR therefore appears as an essential condition for the effective reduction of the global risk profile and is based on an integrated intervention that combines all the different prevention strategies derived from the available evidence and capable of interacting on the basis of a strengthening reciprocal between lifestyle and pharmacological and nutraceutical intervention methods.

RNA-based therapies targeting APOC3 lower triglyceride levels in patients with hypertriglyceridaemia.

RNA-based therapies targeting APOC3 lower triglyceride levels in patients with hypertriglyceridaemia.

Drug target Mendelian randomization supports apolipoprotein C3-lowering for lipoprotein-lipid levels reductions and cardiovascular diseases prevention

Background and aimsInhibitors of apolipoprotein C-III (apoC3) are currently approved for the reduction of triglyceride levels in patients with Familial Chylomicronemia Syndrome. We used drug target Mendelian randomization (MR) to assess the effect of genetically predicted decrease in apoC3 blood protein levels on cardiometabolic traits and diseases. MethodsWe quantified lifelong reductions in apoC3 blood levels by selecting all genome wide significant and independent (r2<0.1) single nucleotide polymorphisms (SNPs) in the APOC3 gene region ±1 Mb, from three genome-wide association studies (GWAS) of apoC3 blood protein levels (deCODE, n = 35,378, Fenland, n = 10,708 and ARIC, n = 7213). We included the largest GWASes on 18 cardiometabolic traits and 9 cardiometabolic diseases as study outcomes. ResultsA one standard deviation lowering in apoC3 blood protein levels was associated with lower triglycerides, apolipoprotein B, low-density lipoprotein cholesterol, alanine aminotransferase, and glomerular filtration rate as well as higher high-density lipoprotein cholesterol levels. ApoC3 lowering was also associated with lower risk of acute pancreatitis (odds ratio [OR] = 0.91 95% CI = 0.82 to 1.00), aortic stenosis (OR = 0.82 95% CI = 0.73 to 0.93), and coronary artery disease (OR = 0.86 95% CI = 0.80 to 0.93), and was associated with increased parental lifespan (0.06 95% CI = 0.03–0.09 years). These results were concordant across robust MR methods, the three protein datasets and upon adjustment for APOA1, APOA4 and APOA5 using a multivariable MR framework. ConclusionsThese results provide evidence that apoC3 lowering could result in widespread benefits for cardiometabolic health and encourage the launch of trials on apoC3 inhibition for coronary artery disease prevention.

Impact of pemafibrate on lipid profile and insulin resistance in hypertriglyceridemic patients with coronary artery disease and metabolic syndrome.

This study examined the effects of pemafibrate, a selective peroxisome proliferator-activated receptor α agonist, on the serum biochemical parameters of male patients with coronary artery disease and metabolic syndrome (MetS). This was a post hoc analysis of a randomized, crossover study that treated hypertriglyceridemia with pemafibrate or bezafibrate for 24weeks, followed by a crossover of another 24 weeks. Of the 60 patients enrolled in the study, 55 were male. Forty-one of 55 male patients were found to have MetS. In this sub-analysis, male patients with MetS (MetS group, n = 41) and those without MetS (non-MetS group, n = 14) were compared. The primary endpoint was a change in fasting serum triglyceride (TG) levels during pemafibrate therapy, and the secondary endpoints were changes in insulin resistance-related markers and liver function parameters. Serum TG levels significantly decreased (MetS group, from 266.6 to 148.0mg/dL, p < 0.001; non-MetS group, from 203.9 to 97.6mg/dL, p < 0.001); however, a percent change (%Change) was not significantly different between the groups (- 44.1% vs. - 51.6%, p = 0.084). Serum insulin levels and homeostasis model assessment of insulin resistance significantly decreased in the MetS group but not in the non-MetS group. %Change in liver enzyme levels was markedly decreased in the MetS group compared with that in the non-MetS group (alanine aminotransferase, - 25.1% vs. - 11.3%, p = 0.027; gamma-glutamyl transferase, - 45.8% vs. - 36.2%, p = 0.020). In conclusion, pemafibrate can effectively decrease TG levels in patients with MetS, and it may be a more efficient drug for improving insulin resistance and liver function in such patients.

Efficacy and Safety of Pemafibrate Extended-Release Tablet: a Phase 3, Multicenter, Randomized, Double-Blind, Active-Controlled, Parallel-Group Comparison Trial.

Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator that lowers serum triglyceride levels and increases high-density lipoprotein cholesterol levels, is approved for treating dyslipidemia as twice-daily immediate-release (IR) tablets. A once-daily extended-release (XR) tablet has also been developed. We aimed to confirm the non-inferiority of XR (0.2 or 0.4 mg/day; once daily) to IR (0.2 mg/day; twice daily) in lowering triglyceride levels in patients with hypertriglyceridemia. This phase 3, multicenter, randomized, double-blind study included patients with fasting triglycerides ≥ 200 mg/dL who received IR (0.2 mg/day) or XR (0.2 or 0.4 mg/day). The primary efficacy endpoint was the percentage change in fasting triglyceride levels from baseline to 4, 8, and 12 weeks. Common treatment effects at weeks 4 through 12 were compared between groups using repeated analysis of covariance. In 356 randomized patients, fasting triglyceride levels decreased by 48.0%, 43.8%, and 48.0% with IR 0.2, XR 0.2, and XR 0.4 mg/day, respectively, confirming the non-inferiority of both XR regimens to IR. The proportion of patients who achieved fasting triglycerides ＜150 mg/dL was 45.7%, 37.4%, and 51.7%, while the percentage change of triglycerides in the subgroup with baseline triglycerides ≥ 500 mg/dL was -59.3%, -52.2%, and -66.3% with IR 0.2, XR 0.2, and XR 0.4 mg/day, respectively. XR (0.2 and 0.4 mg/day) was non-inferior to IR (0.2 mg/day). XR 0.4 mg/day demonstrated a more potent triglyceride-lowering effect than XR 0.2 mg/day and should be considered for patients with high triglyceride levels.

An effect of one meal a day among the patients with Medo Dushti (dyslipidemia): a case series

Abstract Introduction: Dyslipidemia poses a significant risk of cardiovascular diseases globally, often attributed to high cholesterol levels. Ayurveda correlates dyslipidemia with Medo Dushti, indicating that poor digestion and metabolism lead to excessive lipid accumulation. Ayurvedic texts, notably Acharya Charaka, advocate Ekaashana Bhojana (one meal a day) for promoting Sukha Parinama Karanam (easy digestion and assimilation) and improving metabolism. Materials and Methods: The aim of this study was to evaluate the impact of “one-meal-a-day” practice on the management of dyslipidemia. Four patients were selected who strictly adhered to the regimen for 10 days. Serum cholesterol and triglyceride levels were monitored before and after the intervention to assess its effectiveness. Results: Following the 10-day regimen, profound decreases in serum cholesterol and triglyceride levels were observed in all participants. This suggests a notable improvement in management of dyslipidemia through “one meal a day” practice. Conclusion: The findings of this study highlight the efficacy of “one-meal-a-day” practice in managing dyslipidemia. By promoting improved digestion, assimilation, and metabolism, this Ayurvedic approach offers a promising avenue for reducing total cholesterol and triglyceride levels in patients with dyslipidemia. Further research with larger sample sizes and longer intervention durations is warranted to validate these results and establish the long-term benefits of this therapeutic approach.

A lipidomic approach to bisphenol F-induced non-alcoholic fatty liver disease-like changes: altered lipid components in a murine model.

Bisphenol A (BPA), a typical environmental endocrine disruptor, is an "obesogen" that can induce lipid accumulation in the liver. Highly similar in structure to BPA, bisphenol F (BPF) is becoming the dominant BPA substitute on the market, which attracts more and more attention due to its potential adverse effects. Recently, BPF exposure is found to cause non-alcoholic fatty liver disease (NAFLD)-like changes; however, the underlying toxic effects remain poorly understood. Therefore, in the current study, we focused on BPF-mediated lipid homeostasis, especially the alterations of lipid components and metabolism. In human serum, the BPF levels in healthy controls and NAFLD patients were assessed by ELISA, and BPF-induced disturbance of lipid metabolism was evaluated in mouse model via non-targeted lipomic methods with ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry. It suggested that BPF exposure was positively correlated with NAFLD severity and triglyceride level in patients. Based on the relationships, lipid metabolites were assessed in mouse livers between control and BPF-treated group, and it revealed that twenty-six lipid metabolites (including phospholipids, sphingolipids, and glycerides) were significantly changed in mouse livers. Phosphatidylcholine, phosphatidylethanolamine, and diglyceryl ester levels were lower than those in the control mice; hexose ceramide content in sphingolipids markedly increased in BPF-treated mouse livers. Noteworthily, the glycerophospholipid metabolic pathway was found to be the most pronounced in BPF-induced disturbance of lipid metabolism. Therefore, the current study, for the first time, is deciphering the BPF-induced lipid metabolic disturbance, which may provide novel intervention strategies for BPF-induced NAFLD-like changes.

The immediate effects of Porang-processed rice (Amorphophallus muelleri) on triglyceride levels in patients with type 2 diabetes mellitus and dyslipidemia

Link of Video Abstract: https://youtu.be/HSObtemRZ0M Background: Diabetes Mellitus (DM) is a major cause of death and disability worldwide. Diabetes mellitus is related to metabolic disorders in glucose and lipid levels. Porang tubers contain glucomannan, a substance with many health benefits, such as ameliorating blood glucose and lipid profiles, and has been processed as many food products, such as porang-processed rice (PR). This study investigated the immediate effects of PR on triglyceride levels compared to white rice (WR) in patients with diabetes mellitus (DM) and dyslipidemia. Methods: It was a randomized clinical study with an experimental pre-and post-test control group design held from October to November 2021 in Diponegoro National Hospital, Semarang, Indonesia. A total of 24 study subjects were selected by consecutive sampling. The inclusion criteria were (1) patients diagnosed with diabetes mellitus (DM) or who have been consuming routine oral antidiabetic drugs and (2) have signed the written informed consent. These subjects were divided into 2 groups, i.e., the treatment group (n=12) and the control group (n=12). The treatment group was given a porang rice (PR) diet of 300 grams, 3 times a day, for 5 days. The control group will consume a white rice (WR) diet for 5 days. Triglyceride levels were measured and compared between both groups before and after the treatment. Triglyceride levels were measured using venous blood sampling. All subjects were still consuming routine medications during the study. Results: There were no differences in participants' baseline demographic and clinical characteristics. At pre-treatment, there was no significant difference in triglyceride levels between the group with PR and WR (201.5 ± 102.29 vs 220.8 ± 92.08; respectively, p=0.564). At post-treatment, there was no significant difference in triglyceride levels between the group with PR and that with WR (200.0 ± 90.67 vs 224.3 ± 88.03; respectively, p=0.513). However, there was a larger decrease of triglyceride levels (Δtriglyceride) in a group with PR compared to that with WR (29.4 ± 22.81 vs 12.6 ± 7.12; p=0.016). Conclusion: There were no significant differences in the triglyceride levels before and after porang-processed rice (PR) or white rice (WR) in patients with DM and dyslipidemia. However, there was a larger decrease in triglyceride levels (Δtriglyceride) in a group with PR compared to that with WR. If confirmed by further studies, porang-processed rice might have the role of nutraceutical plants in stabilizing lipid profiles, especially triglyceride levels, in patients with DM and dyslipidemia.

Proteomic and Global DNA Methylation Modulation in Lipid Metabolism Disorders with a Marine-Derived Bioproduct.

Dyslipidemia is a significant risk factor for cardiovascular disease and stroke. Our recent findings showed that RCI-1502, a bioproduct derived from the muscle of the European S. pilchardus, has lipid-lowering effects in the liver and heart in high-fat diet (HFD) fed mice. In the present follow-up study, we investigated the therapeutic potential of RCI-1502 on gene expression and DNA methylation in HFD-fed mice and in patients with dyslipidemia. Using LC-MS/MS, we identified 75 proteins in RCI-1502 that are primarily involved in binding and catalytic activity and which regulate pathways implicated in cardiovascular diseases. In HFD-fed mice, RCI-1502 treatment significantly reduced the expression of cardiovascular disease-related genes, including vascular cell adhesion molecule and angiotensin. RCI-1502 also decreased DNA methylation levels, which were elevated in HFD-fed mice, to levels similar to those in control animals. Furthermore, peripheral blood leukocyte DNA from dyslipidemic patients exhibited higher DNA methylation levels than healthy individuals, suggesting a potential association with cardiovascular risk. Serum analysis also revealed that RCI-1502 treatment regulated cholesterol and triglyceride levels in patients with dyslipidemia. Our findings appear to suggest that RCI-1502 is an epigenetic modulator for the treatment of cardiovascular diseases, specifically in individuals with dyslipidemia.

ROSUVASTATINE TREAMENT IN A BIG UKRAINIAN COHORT OF PATIENTS WITH TYPE 2 DIABETES

Objective: Diabetes mellitus (DM) remains one of the most important cardiovascular risk factors significantly worsening the prognosis in patients with hypertension and dyslipidemia. The leading role among drugs for the treatment of such patients is played by statins with their powerful influence on the development and progression of atherosclerosis and its complications. We used the OZIRKA study database and performed additional subanalysis to study the effects of rosuvastatin in patients with diabetes and dyslipidemia. To study the effect of Ozalex (rosuvastatin) on lipid and cholesterol levels in patients with lipid metabolism disorders and hypercholesterolemia and DM. Design and method: A prospective open population study on a primary care level. Recruitment of patients was conducted from March to December 2019. The analysis of the study data was conducted from June to November 2020. All patients attended in total 3 visits. Results: A total of 20,000 patients from all over Ukraine were included in the study. The full follow-up period was completed by 18,100 patients, of whom 17,530 had all the necessary data, and they were included in the final analysis. The mean follow-up period was 2.2 months. Approximately 13% of patients included in the study had DM type 2. We observed a significant reduction in total cholesterol, LDL and triglyceride levels in patients with diabetes. In addition, there was a tendency to increase the level of HDL in this group of patients. In general, it can be noted that there was a significant improvement in lipid profile in patients with diabetes - the level of total cholesterol decreased by 28%, LDL cholesterol by 34%, and triglycerides by 24%. Administration of rosuvastatin did not impair glucose control in any way in the group of patients with DM, moreover, even in the group of people without DM there was no negative effect of rosuvastatin on fasting glucose level. Conclusions: In general, we can recommend rosuvastatin in a dose of 10 to 20 mg as an optimal start of statin therapy at the stage of primary care for patients with DM.

Correlation between the degree of leukoaraiosis and hyperlipidemia in post-ischemic stroke patients

Leukoaraiosis is a neurological imaging in the periventricular area and the centrum semiovale. This condition occurs due to abnormalities in the small blood vessels in the brain that lead to hypoxia. It is often observed in patients with ischemic stroke and accompanied by risk factors for hyperlipidemia. This study aimed to evaluate the correlation between the degree of leukoaraiosis and hyperlipidemia in post-ischemic stroke patients. A cross-sectional study retrospectively was conducted on post-ischemic stroke patients who underwent brain MRI (magnetic resonance imaging) on T2 and FLAIR (fluid-attenuated inversion recovery) sequence at the Department of Radiology, Dr. Sardjito General Hospital, Yogyakarta, from January 2021 to March 2022. A total of 36 patients were involved in this study. The leukoaraiosis of patient was examined by brain MRI. Degree of the leukoaraiosis was determined based on Fazekas classification. Serum cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and triglyceride levels of patients were then examined. The data obtained were then analyzed using Spearman correlation test. A positive correlation was observed between the degree of leukoaraiosis and triglyceride level (p = 0.042; r = 0.292) and age (p= 0.004; r = 0.464). However, no correlation was observed between the degree of leukoaraiosis and cholesterol, HDL, and LDL (p&gt;0.05). In conclusion, the leukoaraiosis degree is correlated with serum triglyceride levels and age in post-ischemic stroke patients.

Association of SLC11A1 polymorphisms with anthropometric and biochemical parameters describing Type 2 Diabetes Mellitus

Diabetes, a leading cause of death globally, has different types, with Type 2 Diabetes Mellitus (T2DM) being the most prevalent one. It has been established that variations in the SLC11A1 gene impact risk of developing infectious, inflammatory, and endocrine disorders. This study is aimed to investigate the association between the SLC11A1 gene polymorphisms (rs3731864 G/A, rs3731865 C/G, and rs17235416 + TGTG/− TGTG) and anthropometric and biochemical parameters describing T2DM. Eight hundred participants (400 in each case and control group) were genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) and amplification-refractory mutation system-PCR (ARMS-PCR) methods. Lipid profile, fasting blood sugar (FBS), hemoglobin A1c level, and anthropometric indices were also recorded for each subject. Findings revealed that SLC11A1–rs3731864 G/A, –rs17235416 (+ TGTG/− TGTG) were associated with T2DM susceptibility, providing protection against the disease. In contrast, SLC11A1–rs3731865 G/C conferred an increased risk of T2DM. We also noticed a significant association between SLC11A1–rs3731864 G/A and triglyceride levels in patients with T2DM. In silico evaluations demonstrated that the SLC11A2 and ATP7A proteins also interact directly with the SLC11A1 protein in Homo sapiens. In addition, allelic substitutions for both intronic variants disrupt or create binding sites for splicing factors and serve a functional effect. Overall, our findings highlighted the role of SLC11A1 gene variations might have positive (rs3731865 G/C) or negative (rs3731864 G/A and rs17235416 + TGTG/− TGTG) associations with a predisposition to T2DM.

Thyroid stimulating hormone correlates with triglyceride levels but is not associated with the severity of acute ischemic stroke in patients with euthyroidism: a cross-sectional study.

Growing evidence suggests an association between thyroid stimulating hormone (TSH) and severity of acute ischemic stroke (AIS). However, few studies have ruled out the potential influences of abnormal thyroid hormones when assessing this association. This study aimed to investigate the association between TSH levels and the severity of AIS patients with euthyroidism, and to explore the potential mechanism of TSH on this disease by analyzing the correlation of TSH with lipid profiles. This retrospective study consisted of 345 patients with normal T3 and T4 levels admitted for first-ever cerebral ischemic stroke. Baseline data of participant were collecte. Laboratory data, including serum levels of TSH and lipid profiles were measured in our hospital's clinical laboratory on admission. Stroke severity was recorded using the National Institutes of Health Stroke Scale (NIHSS). Associations between TSH levels and disease severity were analyzed with logistic regression analysis. Correlations between TSH and lipid profiles were analyzed with Spearman's rank correlation analysis. Among the 345 patients with AIS, the median age was 63 years (63±12 years), 106 patients (30.7%) were female, 237 (68.7%) patients were mild-severity and 108 (31.3%) patients were severity. Data analysis showed that higher serum TSH levels were associated with the mild severity of patients with AIS (P=0.042 in Kruskal-Wallis test, P=0.025 in logistic regression analysis, and P=0.044 in multiple logistic regression), but not in AIS patients with euthyroidism (P=0.078, P=0.337, respectively). Furthermore, TSH levels were correlated with triglycerides (TG) levels not only in total patients (r=0.135, P=0.012) but also in the patients with euthyroidism (r=0.133, P=0.018). TSH levels are associated with the severity of AIS patients, but not in patients with euthyroidism, predicting that stratified management of TSH may be beneficial in patients with AIS. Moreover, TSH levels are correlated with TG levels in patients with AIS.

Acute pancreatitis due to hypertriglyceridemia: Plasmapheresis versus medical treatment

OBJECTIVE: Hypertriglyceridemia (HTG) is the third-most common cause of acute pancreatitis. Plasmapheresis is an extracorporeal treatment method used for treatment. This study aimed to investigate the efficacy of medical treatment and plasmapheresis in patients with acute pancreatitis due to HTG. METHODS: This was a retrospective cross-sectional study. The patients were divided into two groups according to the treatment they received as those who received only medical treatment and those who performed plasmapheresis with medical treatment. According to the treatment received by the patients; clinical, demographic, and laboratory data, Ranson scores, and bedside index of severity in acute pancreatitis (BISAP) scores, decrease in triglyceride levels in 24 h, length of hospital stay, and outcomes were recorded. RESULTS: Forty-seven patients were included in the study. The level of triglyceride decreases at the 24th h was 59.7% ±17.3% in those who received medical treatment and was 70.4% ±15.1% in those who received plasmapheresis (P = 0.032). Receiver operating characteristic curve analysis was performed to predict the need for plasmapheresis treatment, area under the curve (AUC) value of the triglyceride level was the highest (AUC: 0.822, 95% confidence interval: [0.703–0.940]; P < 0.001), the sensitivity and specificity were 83.3% and 72.4%, respectively, and the cut-off value of triglyceride was accepted as 3079.5 mg/dL. CONCLUSION: Plasma triglyceride levels and BISAP score on admission may help physicians to predict the need for plasmapheresis. Plasmapheresis helps to rapidly reduce triglyceride levels in patients with HTG-associated acute pancreatitis.

Efficacy and adverse effects of insulin versus plasmapheresis in patients with hypertriglyceridemia-3-induced acute pancreatitis: a systematic review and meta-analysis.

Hypertriglyceridemia is a common cause of acute pancreatitis (AP). This literature review compared the effectiveness and adverse events of insulin therapy, with or without heparin, and plasmapheresis, in reducing triglyceride levels in patients with hypertriglyceridemia-induced AP. Systematic reviews, meta-analyses, evidence syntheses, editorials, commentaries, protocols, abstracts, theses and preprints were excluded. Review Manager was used to conduct the meta-analysis. The literature search yielded 2765 articles, but only 5 were included in the systematic review and meta-analysis and the total number of participants in the review was 269. From this study's analysis, insulin ± heparin was more successful in reducing triglyceride levels than plasmapheresis (standardized mean difference -0.37, 95% confidence interval [CI] 0.99 to 0.25; P=0.25). Insulin ± heparin therapy had a lower mortality rate than plasmapheresis (risk ratio [RR] 0.70, 95%CI 0.25-1.95). Hypotension, hypoglycemia, and acute renal failure were less common in the plasmapheresis therapy group than in insulin ± heparin therapy (RR 1.13, 95%CI 0.46-2.81, RR 3.90, 95%CI 0.45-33.78, and RR 0.48, 95%CI 0.02-13.98 for hypotension, hypoglycemia, and acute renal failure, respectively). This study found no significant difference in mortality between insulin ± heparin therapy and plasmapheresis used for the reduction in triglyceride levels. It is notable that no substantial differences were observed in the most common side-effects encountered during these therapies, thus indicating non-inferiority.

S50 Insulin Therapy vs Plasmapheresis in Patients With Hypertriglyceridemia-Associated Pancreatitis: A Systematic Review and Meta-Analysis

Introduction: Insulin therapy (IT) and plasmapheresis are used to treat hypertriglyceridemia-associated pancreatitis (HTAP). However, the optimal treatment modality for lowering the triglyceride level in patients with HTAP remains unclear. Therefore, we evaluated the efficacy and safety of IT and plasmapheresis in managing HTAP. Methods: We performed a comprehensive literature search using PubMed, Embase, and Web of Science databases through May 30, 2022, for all studies that compared IT vs. plasmapheresis in patients with HTAP. The primary outcomes were effectiveness (reduction in triglycerides within 24-hours of admission) and clinical outcomes, including hospital length-of-stay (LOS), mortality, acute renal failure (ARF), hypotension, and need for invasive mechanical ventilation (IMV). The secondary outcome was the overall treatment-related adverse events (AEs). Random-effects meta-analysis was conducted, and risk ratio (RR) and mean difference (MD) or standardized mean difference (SMD) for proportional and continuous variables were computed, respectively. For each outcome, forest plot, 95% confidence interval (CI), P-value (< 0.05 considered statistically significant), and I2 statistic ( > 50% considered as significant heterogeneity) were generated. Results: Six studies (1 randomized controlled trial [RCT] and 5 cohort studies) with 302 patients with HTAP (167 on IT vs. 135 on plasmapheresis) were included. Plasmapheresis was more effective than IT in reduction of triglycerides within 24-hours (SMD -0.57; 95% CI -1.02, -0.13; P=0.01, I2=56.8%, Figure 1A). However, LOS (MD -1.96; 95% CI -4.45, 0.54; P=0.12; I2=0%, Figure 1B), mortality (RR 0.68, 95% CI 0.28-1.64, P=0.39, I2=0%, Figure 1C), ARF (RR 0.44, 95% CI 0.06-3.05, P=0.41, I2=84%), hypotension (RR 0.63, 95% CI 0.16-2.52, P=0.51, I2=79%), and need for IMV (RR 0.52, 95% CI 0.12-12.35, P=0.40, I2=80%) were similar between two groups. The treatment-related AEs were significantly lower in IT than plasmapheresis (RR 0.14, 95% CI 0.04-0.51, P=0.003, I2=0%, Figure 1D). Conclusion: Our meta-analysis demonstrated that despite the greater reduction of triglycerides with plasmapheresis compared to insulin therapy, the clinical outcomes, including LOS, mortality, ARF, hypotension, and need for IMV, were comparable with lower treatment-related adverse events with insulin therapy. Future large-scale RCTs are necessary to validate our findings.Figure 1.: Forest plots comparing between insulin therapy and plasmapheresis regarding: (A) the reduction of triglyceride within 24 hours, (B) length of hospital stay, (C) mortality, and (D) treatment-related adverse events.

Management of hypertriglyceridemia-induced pancreatitis – A review of updates from the past decade

Hypertriglyceridemia-induced acute-pancreatitis (HTG-AP) is an important etiology of acute pancreatitis (AP). The treatment includes general management of AP with bowel rest, analgesia, and venous thromboembolism prophylaxis. Specific treatment of HTG-AP focuses on reducing serum triglyceride (TG) levels. Various modalities have been used, including heparin infusion, insulin infusion, plasmapheresis, and double filtration plasmapheresis (DFPP). However, the extent to which TG reduction translates into a clinical response remains unclear. This review highlights the emerging evidence on the management of HTG-AP. Insulin therapy and plasmapheresis remain treatment options to reduce TG. DFPP is an emerging treatment modality to reduce TG levels in patients with AP. However, to what extent this translates into a better clinical response is yet to be answered in large and prospective study designs.

Changes in blood lipids in patients with chronic hepatitis B after 48 weeks of tenofovir alafenamide treatment: A prospective real-world clinical study

Background Tenofovir alafenamide (TAF) is a new anti-hepatitis B virus nucleotide analogue that can cause dyslipidaemia in AIDS patients, but the effect of TAF on blood lipids in patients with chronic hepatitis B (CHB) is unknown. This study aimed to evaluate the effect of TAF on blood lipid levels in patients with CHB. Methods One hundred and twenty-one CHB patients were recruited as TAF group, including 69 treatment-naïve patients and 52 patients with nucleoside/nucleotide analogue experience before TAF treatment. All patients were followed up regularly for 48 weeks. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels and the incidence of dyslipidaemia before and after TAF treatment were compared. Results After 48 weeks of TAF treatment, the levels of TC, TGs and LDL-C in TAF group were significantly higher than those in control group. In TAF group, the TC and TG levels were significantly higher than that at baseline. Baseline TC and TGs levels had a significant effect on the incidence of abnormal TC and TG levels after 48 weeks treatment. The LDL-C decreased slightly but not significantly. The proportion of patients with TC abnormalities increased from 20.7% at baseline to 26.3% at week 48, LDL-C abnormalities decreased from 50.4% to 42.5% and TG abnormalities increased from 14.2% to 22.5%. There were no significant differences compared with control group, as well as compared with baseline. Conclusions Tenofovir alafenamide treatment mainly affects the TC and TG level in patients with CHB but has little effect on LDL-C.

A STUDY OF LIPID PROFILE IN ANAEMIA

Objectives:Both anemia and dyslipidemia are widely prevalent public health problems, especiallyin the Indian population. Associationof anemia and dyslipidemias were reported in some individual experimental animals. The study was planned to find thechanges in serum lipid profile in adult Indian patients with anemia. Material and methods:100 cases of anemia (hemoglobin &lt;13 g% in men and &lt;12 g% in women), and 100 age and sex matched healthy controls, in the age group 18-40 years were investigated for any possible changes in serum lipid profile i.e.,triglycerides, total cholesterol, high density lipoprotein cholesterol, very low density lipoprotein cholesterol. Results:The mean cholesterol in patients with anemia was 122.47 ± 29.32 mg/dl, whereas in controls group was 160.43 ± 38.91 mg/dl. The mean serum triglyceride level in patients with anemia was 89.41 ± 33.1532 mg/dl and in control group was 111.45 ± 40.6632 mg/dl. Mean high-density lipoprotein levels were 36.13 ± 12.8132 mg/dl in anemic group and 45 ± 13.032 mg/dl in control group, whereas low-density lipoprotein (LDL) cholesterol level was 70.12 ± 21.64 mg/dl in the anemic group and 100.45 ± 30.8032 mg/dl in control group. VLDL levels were higher in control group (21.96 ± 8.132 mg/dl) compared to the anemic group (18.34 ± 7.6432 mg/dl). Conclusion: Lipoproteins levels were significantly abnormal in anemic as compared to non-anemic subjects.