Dyslipidemia and cardiovascular disease risk among the MASHAD study population

Risk factors for diabetic foot ulcer in diabetic patients at the Tehran diabetes clinic: a case-control study

Background and objective

: Diabetic foot ulcer (DFU) is one of the main health challenges of diabetes complications worldwide. A wide range of factors may increase the risk of DFU. This study aimed to investigate the risk factors of DFU among diabetic patients.

Methods

This case-control study was conducted on 800 diabetic patients at the Tehran diabetes clinic of the Endocrinology and Metabolism Research Institute in Iran. The case group included 400 diabetic patients diagnosed with DFU, while the control group included 400 diabetic patients without DFU. Data were collected through medical records, validated questionnaires, and clinical examinations. The association between factors and the risk of DFU was analyzed using both crude and adjusted logistic regression models, adjusting for confounders based on a directed acyclic graphs.

Results

The final adjusted model demonstrated significant direct associations between the risk of DFU with a longer duration of diabetes, a history of previous DFU, peripheral neuropathy, retinopathy, high blood pressure, severe kidney function loss, and good foot self-care. However, there were significant inverse associations between DFU risk with female gender, higher education levels, being married, use of oral diabetes drugs, higher hemoglobin levels, and high physical activity.

Conclusions

The risk of DFU was significantly associated with the following factors: diabetes duration, previous DFU history, peripheral neuropathy, retinopathy, blood pressure, kidney function, foot self-care, gender, education levels, marital status, diabetes drugs, hemoglobin levels, and physical activity. Further studies, especially ones in multicenter cohorts with a special focus on novel risk factors, are warranted to expand on our findings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01582-z.

Ellagic acid-loaded chitosan nanoparticles as an approach for mitigating oxidative stress and liver damage in Poloxamer-407-induced hyperlipidemia in mice: Development and optimization through 3 level full factorial design

The primary cause of atherosclerosis and cardiovascular disorders is hyperlipidemia. Ellagic Acid (EA) is a naturally occurring polyphenol found in fruits and nuts. This medication has garnered attention due to its possible therapeutic benefits, encompassing the treatment of hyperlipidemia. In this study, ellagic acid was incorporated into a nanocarrier system using chitosan, a biodegradable polymer, via an ionotropic gelation technique, aiming to enhance its solubility and bioavailability. The effects of ellagic acid-loaded chitosan nanoparticles (EA-CS-NPs) were evaluated in a hyperlipidemic mouse model induced by poloxamer 407 (PL-407). Administration of a single intraperitoneal dose of 300 mg/kg body weight of PL-407 resulted in the induction of hyperlipidemia. The mice were grouped into five groups: Control, PL-407, EA-free drug, blank CS-NPs, and EA-CS-NPs. Serum analysis included the measurement of liver function biomarkers, lipid profiles, and liver antioxidant capacity. Additionally, a histopathological evaluation of liver tissue was performed. This study showed that PL-407 treatment increased hepatic oxidative stress and serum lipid biomarkers, with significant liver tissue changes in hyperlipidemic mice. EA-CS-NPs exerted the most protective effects, improving hepatic antioxidant capacity, serum lipid profile, and hepatic histological changes, highlighting their potential as a therapeutic approach for hyperlipidemia.

Lipid-Lowering Effects of Alpha-Mangostin: A Systematic Review and Meta-Analysis in Hyperlipidemic Animal Models

Hyperlipidemia is a major risk factor for cardiovascular and metabolic diseases. Although pharmacologic treatments are effective, their adverse effects have spurred interest in natural alternatives. Alpha-mangostin (AM), a xanthone from Garcinia mangostana, has shown lipid-lowering effects in animal studies, but its overall efficacy remains unclear. This systematic review and meta-analysis, conducted in accordance with PRISMA 2020 guidelines, evaluated AM's impact on lipid profiles in hyperlipidemic animal models. Databases including Scopus, PubMed, ScienceDirect, Cochrane Library, and Web of Science were searched for relevant controlled studies. Nine studies (N = 226 animals) met inclusion criteria, reporting data on triglycerides (TG), total cholesterol (TC), LDL-C, and HDL-C. Risk of bias, assessed using the Cochrane RoB 2 tool, was generally low-to-moderate. Meta-analysis using a random-effects model revealed that AM significantly reduced TG, TC, and LDL-C, while increasing HDL-C. Stronger effects were observed at doses <50 mg/kg/day. Subgroup and sensitivity analyses confirmed robustness and highlighted the influence of species, region, and treatment duration. These findings suggest that AM is a promising lipid-lowering agent in animal models. Further clinical trials are needed to validate efficacy in humans and determine optimal dosing.

Switching Therapy to the Second Brand of Generic Atorvastatin: A 6-Month Retrospective Cohort, Real-World Study

INTRODUCTION

High levels of low-density lipoprotein-cholesterol (LDL) is a major risk factor for cardiovascular diseases. While treatment with atorvastatin is beneficial, the original atorvastatin may be cost prohibitive to some patients. Currently, a second brand of generic atorvastatin is available on the market. This study aimed to evaluate the effectiveness of the second generic brand of atorvastatin.

METHODS

This was a retrospective cohort study conducted at Khon Kaen University Hospital, Thailand. The inclusion criteria were adult patients who received either Xarator® (original atorvastatin; Pfizer Pharmaceuticals, Puerto Rico) or Atorvastatin Sandoz® (Lek Pharmaceuticals, Slovenia) for at least 3 months prior to switching therapy to the second brand: Lipostat® (Siam Pharmaceutical, Thailand). The study period was between 1 April 2022 and 30 June 2023. The primary outcome of this study was a change in LDL 6 months after switching therapy from either the original (Xarator®) or generic atorvastatin (Atorvastatin Sandoz®).

RESULTS

There were 683 patients who switched therapy from the original atorvastatin (Xarator®), and 1044 patients who switched therapy from generic atorvastatin (Atorvastatin Sandoz®), for a total of 1727 patients. Regarding LDL levels, switching therapy from original atorvastatin (Xarator®) resulted in a slightly lower but not significant decrease in LDL at 6 months (- 0.96 mg/dL; 95% CI of - 3.20, 1.28), while switching therapy from generic atorvastatin (Atorvastatin Sandoz®) led to significantly lower LDL at - 3.30 mg/dL (95% CI of - 5.25, - 1.36). The original (Xarator®) and generic atorvastatin (Atorvastatin Sandoz®) group also resulted in a significantly lower estimated glomerular filtration rate at - 0.90 and - 1.21 mL/min/1.73 m2, respectively, from baseline.

CONCLUSIONS

The second generic atorvastatin (Lipostat®) resulted in comparable outcomes on LDL compared with the original (Xarator®), but significantly lower LDL levels than another generic atorvastatin (Atorvastatin Sandoz®) 6 months after switching therapy. However, renal function should be closely monitored.

Combined exposure to night work and noise in relation to hyperglycemia among long-term night workers: a nationwide population-based prospective cohort study

OBJECTIVES

This study investigated the association between combined exposures and hyperglycemia incidence, as well as the dose-response relationship between the duration of night work and hyperglycemia among long-term night workers.

METHODS

In this prospective cohort study, 12 716 night workers from the nationwide population were recruited. Hyperglycemia incidence was based on the one-year change in fasting blood glucose levels. Occupational noise exposure was defined as exposure to 8-hour time-weighted average sound levels of ≥85 decibels. Personal factors, including body mass index, and work-related factors, like monthly night work duration, were assessed. Multivariable logistic and linear regression models were used to explore the association.

RESULTS

In the multivariate logistic analyses, each additional day of night work was associated with an increased risk of hyperglycemia [adjusted odds ratio 1.05, 95% confidence interval (CI) 1.02-1.07]. In the normal fasting glucose group, each additional day of night work was associated with a linear increase of +0.07% (95% CI +0.03% - +0.12%) in the change in fasting glucose levels, and noise exposure was associated with a linear increase of +1.34% (95% CI +0.55% - +2.12%) increase in fasting glucose levels. Furthermore, the population exposed to noise and working ≥10 days of night work had a significantly higher increase of fasting glucose levels (β +5.71%, 95% CI +4.48% - +6.95%), with significant interaction effects (P for interaction <0.01).

CONCLUSIONS

The possible dose-response relationship between duration of night work and changes in fasting glucose levels was found. The combined exposure to night work and noise posed a higher risk for hyperglycemia than exposure to night work alone.

Impact of night sentry duties on cardiometabolic health in military personnel

This article examines the study by Lin et al, which explores the effects of night sentry duties on cardiometabolic health in military personnel. The research identifies significant correlations between the frequency of night shifts and negative cardiometabolic outcomes, such as elevated resting pulse rates and lowered levels of high-density lipoprotein cholesterol. These outcomes underscore the health risks linked to partial sleep deprivation, a common challenge in military environments. The editorial highlights the clinical significance of these findings, advocating for the implementation of targeted health interventions to mitigate these risks. Strategies such as structured sleep recovery programs and lifestyle modifications are recommended to improve the health management of military personnel engaged in nocturnal duties. By addressing these issues, military health management can better safeguard the well-being and operational readiness of its personnel.

Cardiac arrhythmia following acute myocardial infarction: a retrospective analysis of 27,648 hospitalized patients in a tertiary heart hospital

Arrhythmia frequently complicates acute myocardial infarction (AMI) and contributes to high morbidity and mortality. We aimed to investigate the prevalence, risk factors, and impact of cardiac arrhythmias in AMI patients at a tertiary heart hospital. This retrospective observational study included AMI patients who were admitted between January 1991 and May 2022. Patients' data were analyzed and compared according to the absence or presence of cardiac arrhythmias post-AMI. We hypothesized that arrhythmias are associated with higher mortality following AMI. During the study, 27,648 patients were hospitalized with AMI, of whom 2118 (7.7%) developed arrhythmia. Patients who developed arrhythmia had a higher average age compared to those without arrhythmia (57.2 vs. 54.8 years, p=0.001), and a larger proportion were male compared to female patients (85.2% vs. 14.8%, p=0.001). Atrial fibrillation was observed in 383 patients (18.1%). Ventricular tachycardia was found in 461 (21.8%), and ventricular fibrillation occurred in 526 patients (24.8%). Complete heart block was developed in 286 (13.5%) patients, 1st-degree atrioventricular (AV) block in 36 (1.7%), 2nd-degree AV block in 138 (6.5%), left bundle branch block in 81 (3.8%), and right bundle branch block in 118 (5.6%). The rate of β-blocker use has increased in the arrhythmias group at discharge compared to the on-admission rate (55.7% vs. 32.5%). However, it remained sub-optimal. Arrhythmias were associated with longer hospital stays and five times higher hospital mortality than the non-arrhythmia group. Multivariable logistic regression analysis indicated that arrhythmia was associated with increased mortality risk three times following AMI (adjusted odds ratio 3.01; 95% confidence interval 2.42-3.75, p=0.001). Almost one-tenth of patients hospitalized with AMI in Qatar developed arrhythmia with variable outcomes; however, the in-hospital mortality remained high. Addressing the risk factors and optimizing the prevention and treatment of AMI and arrhythmias is crucial to improving clinical outcomes. This study may underestimate the incidence of arrhythmias post-AMI as it did not report all types.

Cardiovascular disease incidence and its predictors among school teachers in Peninsular Malaysia: a prospective cohort study

Cardiovascular disease (CVD) caused substantial morbidity among occupationally active populations. However, data regarding the longitudinal burden of CVD were limited, particularly among school teachers. The objectives of our study were to estimate the incidence rate of CVD and determine its predictors among school teachers in Peninsular Malaysia through a prospective cohort study. We followed 14,046 eligible school teachers recruited between 2013 and 2014 until 31st December 2021. We accessed three computerised, country-level registries to determine incident CVD cases during the study period from 2013 to 2021. Baseline sociodemographic, lifestyle, work-related and clinical characteristics were recorded. Cox proportional hazard regression models with adjusted hazard ratio and 95% confidence interval were reported. With a median follow-up of 7.71 yr, we observed 209 incident CVD cases (or 195.7 CVD cases per 100,000 person-years). Male gender, age ≥40 yr old, Indian or others ethnicity (as compared to Chinese), family history of CVD, laboratory-confirmed diabetes mellitus, self-reported hypertension, high low-density lipoprotein cholesterol and high triglyceride were predictors for incident CVD among school teachers. Neither work-related nor lifestyle factors were significantly associated with incident CVD. Screening at-risk teachers for diabetes mellitus, hypertension or dyslipidemia is recommended to delay the onset or progression of CVD.

Diet and the gut microbiota profiles in individuals at risk of chronic heart failure - A review on the Asian population

BACKGROUND AND OBJECTIVES

Chronic Heart Failure (CHF) is one of the leading cardiovascular diseases (CVDs), particularly in the Asian population. Individuals with specific health risks, such as obesity, type 2 diabetes, hypertension, dyslipidemia, and coronary artery disease (CAD), are more susceptible to developing CHF. Current evidence is limited to understanding the link between gut microbiota dysbiosis and CHF. Therefore, this review aims to explore the potential connection between dietary patterns, gut microbiota, and its metabolites in individuals at risk of CHF in the Asian population.

METHODS AND STUDY DESIGN

A literature review of cross-sectional studies was conducted using primary keywords such as "Asian", "obesity", "type 2 diabetes", "hypertension", "dyslipidemia", "coronary artery disease", and "chronic heart failure". There was no restriction on sample size.

RESULTS

Several gut microbiotas were found to correlate with CHF risk factors. There were increased levels of Prevotella, Klebsiella, Romboutsia, Catenibacterium, Clostridium, Holdemanella, Ruminococcus, Coprococcus, Parabacteroides, Bacteroides, Lachnoclostridium, Streptococcus, and Megamonas, while decreased levels of Oscillibacter, Bifidobacterium, Lactobacillus, Akkermansia, Roseburia, Faecalibacterium, Pseudobutyrivibrio, and Eubacterium were reported. These microbiota shifts were linked to increased TMAO production and impaired short-chain fatty acids (SCFAs) production. Dietary intake and microbial metabolites were also identified as contributors to the gut microbiota associated with CHF.

CONCLUSIONS

A potential link exists between the gut microbiota profile and CHF risk factors, possibly mediated by microbial metabolites. Dietary patterns may influence CHF-associated gut microbiota and me-tabolites. Future research is needed to investigate how dietary modifications can modulate gut microbiota and its metabolites in CHF patients.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and pulmonary function: evidence from NHANES 2007-2012

Background

This research aims to explore the potential association between lung function and the ratio of non-high-density lipoprotein cholesterol (NHL) to high-density lipoprotein cholesterol (NHHR). Previous research has shown that lipid metabolism imbalance is closely linked to cardiovascular disease, however, there is a lack of information regarding its impact on lung function.

Methods

This research used information from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2007 to 2012, including a large-scale sample of 9,498 adults aged 20 years and older. A cross-sectional study employing multivariable regression models was aimed at examining the relevance between NHHR and indicators of lung function (FEV1, FVC, and FEV1/FVC). Adjustments were made for a wide range of confounding factors, encompassing race, gender, age, BMI, smoking status, physical activity, diabetes, alcohol consumption, and education level. Data analysis included categorizing NHHR into quartiles and using trend tests to evaluate dose-response relationships between NHHR quartiles and lung function. Sensitivity analyses were conducted by excluding participants with asthma and COPD to ensure the reliability of the results.

Results

The results manifested a significant correlation between decreased FEV1 and FVC values and elevated NHHR, most notably within the highest quartile of NHHR (Q4), where the association was most pronounced. Additionally, trend test results indicated a significant linear negative correlation between NHHR and both FEV1 and FVC. However, the correlation between FEV1/FVC and NHHR showed a nonlinear U-shaped pattern. Suggesting differential impacts of NHHR on various lung function indicators. The findings' robustness was shown by sensitivity analysis, which revealed that even after omitting people with asthma and COPD, the negative correlation between NHHR and FEV1 and FVC remained significant.

Conclusion

This research emphasizes the significance of tracking lipid levels in evaluating respiratory health and offers early evidence in favor of NHHR as a probable biomarker for respiratory function. Further longitudinal research has occasion to prove the causal relationship between NHHR and lung function and to explore its underlying biological mechanisms.

Glycemic control and associated factors among type 2 diabetes patients attending at Dessie comprehensive specialized hospital outpatient department

Effective glycemic control is essential for managing diabetes-related complications. While studies in Ethiopia have shown poor glycemic control based on fasting blood glucose levels, further research using the glycated hemoglobin (HbA1c) test is necessary. This study aimed to evaluate glycemic control and identify associated factors among patients with type 2 diabetes. A hospital-based cross-sectional study was conducted from February 1 to March 30, 2023, involving 465 type 2 diabetes patients. Socio-demographic and clinical data were collected using a semi-structured questionnaire through consecutive sampling. Laboratory tests, including glycated hemoglobin, fasting blood sugar, renal function, and lipid profiles, were performed. Data analysis was carried out using Epi-data version 4.6.0.4 and SPSS version 26, employing descriptive statistics and binary logistic regression. Multivariable analysis was performed on variables with P < 0.25. The results were presented using numbers, frequencies, and tables. Approximately 73.5% (95% CI = 69.5, 77.4) of the patients demonstrated poor glycemic control. Factors associated with poor glycemic control were lack of formal education (AOR = 4.94, 95% CI = 2.99, 8.15), obesity (AOR = 5.32, 95% CI = 2.02, 14.04), overweight (AOR = 3.77, 95% CI = 1.65, 8.63), high total cholesterol (AOR = 7.79, 95% CI = 4.44, 13.66), and a diabetes duration of more than 10 years (AOR = 3.32, 95% CI = 1.87, 5.89). The research highlights a significant proportion of diabetic patients with inadequate glycemic control, which is associated with factors such as education level, BMI, total cholesterol, and the duration of diabetes. Addressing these factors through personalized management strategies is essential for improving glycemic control and reducing complications.

Ameliorative Effect of Rauwolfia vomitoria Ethanol Extract on the Erectile Dysfunction Complicated with Coronary Artery Disease: An In-Vivo and Molecular Docking Approach

Erectile dysfunction in men may result as a side effect of the use of serotonin reuptake inhibitors such as paroxetine. Enzymes like phosphodiesterase 5 (PDE-5) and arginase are promising therapeutic targets for managing erectile dysfunction while creatinine kinase-myocardial band (CK-MB) serves as a marker for coronary artery disease. To manage these conditions, it is necessary to seek options in medicinal herbs. Rauwolfia vomitoria (RV) is a plant that has been used as an aphrodisiac but the inhibitory mechanism against these enzymes remain unclear. The study used in-vivo enzymatic biomarkers and molecular docking approach to better understand their inhibitory mechanism. Forty-eight adult male Wistar rats were divided into six groups of eight rats: naive control, paroxetine (PXT, 10 mg/kg), PXT+sildenafil citrate (4 mg/kg), PXT + RVE (12.5, 25 and 50 mg/kg). Exposure to PXT lasted for twenty-one days, and treatment with sildenafil citrate and RVE took place for the next seven days. On day twenty-nine, the rats were sacrificed under anaesthesia and various biochemical assays (PDE-5, Arginase, nitric oxide (NO) were carried out on penile tissue homogenate while CK-MB, lipid profile and testosterone were assayed in the serum of rats. This study also employed gas chromatography -flame ionization detection (GC-FID) to identify the phytoconstituents in RV. From our findings, PXT significantly increased PDE-5, Arginase activities with a concomitant decrease in NO concentration. Rauwolfia vomitoria extract (RVE) decreased the activities of the penile PDE 5 and arginase activities, and increased NO concentrations in dose-dependent ways (12.5, 25, and 50 mg/kg body weight). RVE showed an increase in testosterone and a decrease in CK-MB activities. Moreover, the result of lipid profile revealed the significant reversal of the changes caused by PXT administration, indicating the potential of the extract in ameliorating paroxetine-induced dyslipidemia. All of the phytochemicals found by GC-FID docked against PDE-5 had the lowest binding energies ( - 9.4 to -7.0 kcal/mol) when likened to that of sildenafil citrate ( - 7.4 kcal/mol). The phytochemicals were also docked against arginase which released the lowest binding energy between -10.5 and -9.0 kcal/mol when compared with sildenafil citrate ( - 9.4 kcal/mol). This study is relevant in the design of new treatment option for ED and coronary artery disease.

Eco-friendly synchronous spectrofluorimetry coupled with chemometrics for simultaneous determination of ezetimibe and propranolol in pharmaceutical formulations and spiked plasma samples

In this study, synchronous fluorescence spectroscopic methods coupled with chemometric techniques were developed and evaluated for the simultaneous quantification of ezetimibe and propranolol, two commonly prescribed cardiovascular drugs. Both drugs exhibit overlapping native fluorescence, posing a challenge for their selective determination. To address this, chemometric models including partial least squares (PLS) and genetic algorithm-based variable selection (GA) were constructed using a calibration dataset based on a 52 factorial design resulting in 25 synthetic mixtures. The developed method has been optimized to account for factors such as solvent composition, micellar systems, and excitation/emission wavelengths that affect the fluorescence signals. The PLS and GA-PLS models were validated using an independent test set of 13 samples based on central composite design revealing the GA-PLS model provided improved quantitative performance with relative root mean square error of prediction (RRMSEP) values of 1.3939 and 1.0005 % for ezetimibe and propranolol, respectively, compared to 2.2502 and 2.3526 % for the PLS models. Hence, the GA-PLS models were successfully applied for the determination of ezetimibe and propranolol in pharmaceutical formulations and spiked plasma samples. Furthermore, the greenness and blueness of the proposed methods were compared against reported HPLC procedures using the AGREE and BAGI tools, revealing a greener analytical footprint for the developed method and higher analytical practicability posing as an environmental-friendly alternative to the standard HPLC technique.

Impact of Elevated Low-Density Lipoprotein and the Risk of Acute Coronary Syndrome in Rheumatoid Arthritis: A Retrospective Study

Objective To analyze the effect of hyperlipidemia on the risk of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA). Methods This is a retrospective cohort study from 171 hospitals in the Hospital Corporation of America database, consisting of 1,942 individuals with RA who were retrospectively followed from the year 2020 to 2023. The primary outcome was the incidence of ACS, which included ST elevation myocardial infarction, type 1 non-ST elevation myocardial infarction, and unstable angina. The primary exposure was hyperlipidemia. Odds ratios (ORs) were obtained to ascertain the relationship between ACS (ST elevation myocardial infarction, non-ST elevation myocardial infarction type 1, and unstable angina) and hyperlipidemia (low-density lipoprotein, or LDL > 100 mg/dL). Results A total of 31 patients had the primary outcome of ACS. In addition, 463 patients had the primary exposure of elevated LDL (hyperlipidemia). The risk of physician-diagnosed ACS was significantly greater in participants with RA who additionally had hyperlipidemia when compared to participants who had RA without hyperlipidemia (OR: 3.88; 95% confidence interval (CI): 1.90-7.93, p < 0.01). Conclusion Hyperlipidemia is associated with an increased risk of ACS in patients with RA.

Cluster-Based Analysis of Lipid Profiles and Inflammation in Association With Cardiovascular Disease Incidence and Mortality: A 17.5-Year Longitudinal Study

Cardiovascular mortality is a leading cause of global deaths, with aging, dyslipidemia, and inflammation recognized as key risk factors. This study aimed to identify distinct cardiovascular risk profiles using cluster analysis based on lipid profiles and inflammatory markers in a large cohort of middle-aged Korean adults. Our analysis included 8115 participants without cardiovascular disease (CVD) at baseline from the Korean Genome and Epidemiology Study. We applied the K-means clustering algorithm to conduct a cluster analysis of six normalized variables: age, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and CRP. Multivariable Cox proportional-hazard regression analysis was performed to assess the hazard ratio with 95% confidence interval for CVD incidence, CVD mortality, major adverse cardiac event (MACE) mortality, and all-cause mortality. Four clusters were identified based on age, lipids (TC, TG, HDL-C, non-HDL-C), and CRP. Cluster 1 (older age, high CRP) and cluster 2 (high TC, non-HDL-C, insulin resistance) had the highest risks for new-onset CVD, while cluster 1 had the highest risks for all-cause and cardiovascular mortality. Cluster 3 (high HDL-C) showed a lower CVD risk, while cluster 4 (younger age, favorable lipid profile) had the lowest risk across all outcomes. This study highlighted the combined impact of aging, dyslipidemia, and inflammation on CVD risk. The clusters with older age and high inflammation or dyslipidemia had the highest cardiovascular risks, emphasizing the importance of managing these factors in high-risk populations.

Lipids dysregulation in diseases: core concepts, targets and treatment strategies

Lipid metabolism is a well-regulated process essential for maintaining cellular functions and energy homeostasis. Dysregulation of lipid metabolism is associated with various conditions, including cardiovascular diseases, neurodegenerative disorders, and metabolic syndromes. This review explores the mechanisms underlying lipid metabolism, emphasizing the roles of key lipid species such as triglycerides, phospholipids, sphingolipids, and sterols in cellular physiology and pathophysiology. It also examines the genetic and environmental factors contributing to lipid dysregulation and the challenges of diagnosing and managing lipid-related disorders. Recent advancements in lipid-lowering therapies, including PCSK9 inhibitors, ezetimibe, bempedoic acid, and olpasiran, provide promising treatment options. However, these advancements are accompanied by challenges related to cost, accessibility, and patient adherence. The review highlights the need for personalized medicine approaches to address the interplay between genetics and environmental factors in lipid metabolism. As lipidomics and advanced diagnostic tools continue to progress, a deeper understanding of lipid-related disorders could pave the way for more effective therapeutic strategies.

Joint association of TyG index and LDL-C with all-cause and cardiovascular mortality among patients with cardio-renal-metabolic disease

Both triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, and low-density lipoprotein cholesterol (LDL-C) are independent risk factors for long-term prognosis among patients with cardio-renal-metabolic (CRM) disease. However, the co-exposures of TyG index and LDL-C to mortality is unclear. The aim of this study is to investigate the joint effects and risk stratification of the TyG index and LDL-C on all-cause and cardiovascular mortality in CRM patients. We analyzed CRM patients from the National Health and Nutrition Examination Survey (NHANES) database (1999-2018), calculating TyG index as Ln[fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2] and using multivariable Cox regression models to assess the joint effects of TyG index and LDL-C on all-cause and cardiovascular mortality. The interaction between the TyG index and LDL-C to mortality was also evaluated. During a median follow-up of 7.6 years, 22.8% and 8.4% of patients died from all-cause and cardiovascular causes, respectively. Among patients with LDL-C < 2.6 mmol/L, no significant differences were observed in all-cause and cardiovascular mortality when comparing higher TyG index to the lowest tertile (T1). Specifically, the hazard ratio (HR) for all-cause mortality in the second (T2) and third tertiles (T3) were 0.81 (95% confidence interval(CI): 0.59-1.09) and 0.87 (95%CI: 0.62-1.22), respectively, with a P for trend of 0.468. For cardiovascular mortality, the HR for T2 and T3 compared to T1 were 0.80 (95%CI: 0.48-1.32) and 0.72 (95%CI: 0.45-1.15), respectively, with a P for trend of 0.173. However, elevated TyG index was related to markedly increased risk of all-cause and cardiovascular mortality in patients with LDL-C ≥ 2.6 mmol/L. Specifically, for all-cause mortality, HR for T2 and T3 compared to T1 were 1.01 (95%CI: 0.79-1.28) and 1.38 (95%CI: 1.07-1.79), respectively, with a P for trend of 0.009. For cardiovascular mortality, the HR was 1.09 (95% CI: 0.72-1.65) for T2 and 1.80 (95% CI: 1.18-2.75) for T3, with a P for trend of 0.005. Interactive analysis also demonstrated that a significant association of TyG index and LDL-C with the risk of all-cause (P for interaction = 0.011) and cardiovascular (P for interaction = 0.050) mortality was observed. The findings highlight that elevated TyG index can significantly increase the risk of all-cause and cardiovascular mortality only among CRM patients with LDL-C ≥ 2.6 mmol/L, but not among patients with LDL-C < 2.6 mmol/L.

Evaluating the discriminatory capacity of traditional and novel anthropometric indices in cardiovascular disease risk factors, considering sex differences

OBJECTIVE

Cardiovascular disease (CVD) rates are rising rapidly worldwide, making it crucial to implement simple and effective screening measures to identify individuals at increased risk for CVD risk factors. This study aims to examine the relationship between innovative anthropometric indices and the occurrence of cardiovascular risk factors among the population of Mashhad, located in northeastern Iran, over a ten-year follow-up period.

METHODS

In this cohort study, a total of 9704 individuals aged 35-65 years were recruited at baseline, with 7560 individuals completing the study. Anthropometric indices were measured and calculated using standardized methods. After a 10-year follow-up, the incidence of hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and metabolic syndrome (MetS) and their association with each anthropometric index were determined using Cox regression analysis. Receiver operating characteristic (ROC) analysis was employed to assess the predictive capacity of each index for the CVD risk factors.

RESULTS

We found that WHtR exhibited the strongest association with various CVD risk factors. However, the predictive capacity of BMI was higher than other indices in DM and MetS (AUCs: 0.69 and 0.78, respectively). Moreover, BMI, WHtR, and BRI showed equal discriminatory power to predict HTN (AUCs: 0.61). Our analysis indicated that Iranian individuals with a BMI of more than 24.71, 26, and 25.2 kg/m2 are at a 54%, 88%, and 121% increased risk for the development of HTN, DM, and MetS over 10 years; respectively.

CONCLUSION

In this study, BMI was identified as the most powerful predictor of CVD risk factors among the anthropometric indices examined. These findings support previous research indicating that BMI is a valuable screening tool for identifying individuals at higher risk of developing CVDs and associated conditions.

The Effect of Metabolic Bariatric Surgery on Cardiovascular Risks: A Prospective Study Measuring Antibodies to Apolipoprotein A-1

BACKGROUND

Obesity is a chronic disease associated with other associated medical problems, including atherogenic dyslipidemia. Metabolic bariatric surgery (MBS) has been shown to reduce long-term cardiovascular risk (CVR). Anti-ApoA-1 antibodies (AAA1) are independently associated with cardiovascular disease, which remains a major cause of death in individuals with obesity. This study aimed to determine the effect of MBS on anti-ApoA-1 antibodies. We also looked for changes in lipid parameters, insulin resistance, inflammatory profile, and percentage of total weight loss (%TWL).

METHODS

We assessed 72 patients before surgery and 12 months postoperatively. Clinical history and measurements of body mass index (BMI), lipid profile (including non-HDL cholesterol, TG/HDL-C ratio, TG-Gly index, total cholesterol to HDL ratio), AAA1, CRP, fasting plasma glucose (FPG), HbA1c, and HOMA-IR were measured/calculated at each point.

RESULTS

MBS significantly improved BMI, %TWL, lipids, anti-ApoA-1 antibodies, CRP, HBA1c, FBG, and HOMA-IR. Baseline AAA1 antibodies were positive in 38.9% and were associated with higher CRP levels, total cholesterol, LDL-C, total cholesterol to HDL ratio, and non-HDL cholesterol. One year after MBS, there was a significant reduction in anti-ApoA-1 antibodies (p < 0.001). Furthermore, there was a significant postoperative correlation between anti-ApoA-1 antibodies with total cholesterol. Also, there were significant correlations between HBA1C (%), TG-Gly index, and HOMA-IR.

CONCLUSIONS

Antibodies to apolipoprotein A-1 levels are significantly reduced following MBS. Furthermore, there was a notable improvement in the HBA1C, CRP, and lipid profile.

Diabetes Mellitus and Hyperlipidemia Status Among Hypertensive Patients in the Community and Influencing Factors Analysis of Blood Pressure Control

To evaluate the prevalence of type 2 diabetes mellitus (T2DM) and hyperlipidemia in hypertensive patients in South China and assess the relationship between these comorbidities and blood pressure control to develop targeted strategies for hypertension management. Data from the 2020 Guangzhou National Basic Public Health Service Program were analyzed using Chi-square tests, t-tests, and logistic regression with R 4.1.2. Among 275,789 hypertensive patients, the blood pressure control rate was 51.51%. The prevalence of T2DM and hyperlipidemia comorbidities was 12.79%, with 12.78% for T2DM alone, 33.54% for hyperlipidemia alone, and 40.89% with no comorbidities. Blood pressure control rates significantly differed by comorbidity (p < 0.05): 52.84% for those without T2DM/hyperlipidemia, 54.18%, 49.25% for T2DM or hyperlipidemia alone, and 50.52% for both conditions. Multivariate analysis indicated a lower blood pressure control rate in patients with hyperlipidemia alone (OR = 1.144) or both T2DM and hyperlipidemia (OR = 1.082), and a higher rate in those with T2DM alone (OR = 0.936). Subgroup analysis revealed that males, older age, higher education, obesity, alcohol use, lack of physical activity, and poor medication adherence were associated with lower control rates. This study found a high prevalence of diabetes and hyperlipidemia among hypertensive patients in Guangzhou. Additionally, hypertensive patients with hyperlipidemia had poorer blood pressure control compared to other diabetic patients. Key factors such as obesity, being overweight, and unhealthy lifestyle choices significantly impact blood pressure management in this population. Therefore, comprehensive measures should be implemented to integrate lipid management into community health efforts and to effectively control blood pressure levels among hypertensive patients.

The association between age at menarche (AAM) and cardiovascular disease (CVD) risk factors in the MASHAD cohort study

Age at menarche may be associated with cardiovascular disease risk factors in different ethnic groups. The purpose of this study was to identify the association of cardiovascular disease (CVD) risk factors with age at menarche (AAM) in Mashhad, the second biggest city in Iran. This was a cross- sectional study based on cohort data of 2353 women (35-65 years) from Mashhad, Iran for whom the age at menarche was reported. Baseline demographic, anthropometric data, and biochemical profiles were also collected. The levels of depression and anxiety were evaluated using a validated Persian version of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Multiple logistic regression models were used to examine the association between age at menarche with CVD risk factors. Anthropometric parameters, short stature, prevalence of diabetes, and CVD risk were significantly higher in women who were younger at menarche (AAM) in comparison to women with an older AAM. Women with a menstruating age of 11 years had a significantly higher weight (P < 0.001), higher BMI (P < 0.001), lower waist circumference (WC) (P = 0.004), higher hip circumference (HC) (P < 0.001) and higher waist-to-thigh ratio (WTR) (P < 0.001) than women with an AAM of ≥ 15 years. University-educated women and employed women were most likely to have menarche at ≥ 15 years (P < 0.001 and P = 0.012 respectively. In girls who menstruated at age ≤ 11 years old, the odds of having a BMI > 28.7 kg/m2, WC > 96 cm, HC > 105 cm and WTR > 61.96 were higher than girls who menstruated at 13 years old. The odds of height > 155 cm was higher in girls with menarche age of ≥ 15 than 13 years and the odds of having depression scores greater than 12 was lower in menarche age group of ≥ 15 years. The girls with menstruation age of 12 years had higher odds of having diabetes mellitus and HC > 105 cm than girls with menstruation age of 13 years. The odds of demi span exceeded 74 cm and height > 155 cm were higher in girls with menarche age of 14 than 13 years. AAM may be a useful factor to identify women at greater risk of CVD to implement appropriate preventive measures.

Achillea millefolium capsule improved liver enzymes and lipid profile compared to placebo in patients with type 2 diabetes: a double-blind randomized clinical trial

BACKGROUND

The therapeutic properties of Achillea Millefolium (AM) in regulating blood lipids and liver enzymes have been proven in studies. Considering the abnormal lipid levels and elevated liver enzymes in diabetic patients, this study was conducted to investigate the effect of AM on the lipid profile and serum level of liver enzymes in type 2 diabetic (T2D) patients.

METHODS

In this 90-day double-blind clinical trial study, 60 eligible diabetic patients were enrolled and divided into intervention and control (each 30 patients) groups. The intervention group received AM capsules (dose of 500 mg/day) for 3 months, and the control group received placebo capsules during the same period. Blood was taken from patients on day 0 and day 90. The serum levels of liver enzymes and lipid profiles of patients were measured at baseline and on day 90. The obtained values were analyzed and compared between two control and treatment groups and within each group.

RESULTS

AM oral supplementation caused a significant decrease in alanine aminotransferases (ALT; from 28.79 ± 10.99 to 24.41 ± 6.84, p = 0.017) and aspartate aminotransferases (AST; from 24.28 ± 7.91 to 18.76 ± 6.77, p = 0.007). A significant reduction in the levels of serum lipids such as triglyceride (TG; from 161.7 ± 77.18 to 147.3 ± 66.79, p = 0.045), low-density lipoprotein (LDL; from 98.90 ± 35.67 to 80.86 ± 32.10, p = 0.001), and total cholesterol (TC; from 168.3 ± 47.46 to 150.1 ± 38.77, p = 0.006) was noted in AM group. According to these results, after the intervention, the mean of all variables (except HDL) in the two groups had a significant difference (P < 0.05).

CONCLUSION

The study showed that the 3-month treatment of T2D patients with 500 mg/day AM capsules led to the reduction of liver enzymes and the regulation of blood lipids in them.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20230612058459N1 Registered on 2023-06-24.

Exploration of phytochemical components, bioactivity based fractionation, and in silico HMG-CoA reductase inhibitory effect of Euphorbia dendroides chloroform extract

The chloroform extract of leaves of E. dendroides L, reduced the levels of lipid profile in rats with hypercholesterolaemia to near-normal levels. Additionally, it significantly decreased the amount of malondialdehyde (MDA). In addition, the extract augmented the levels of superoxide dismutase (SOD) and glutathione peroxidase (GSHPx) in the hypercholesterolemic treated rats. The docking results verified the binding mechanism of isolated compound as HMG-CoA reductase inhibitor. The identified compound has the essential pharmacophoric features of Simvastatin. Furthermore, the ADMET profile of an isolated terpene was computed and compared to that of simvastatin as a reference medication. This compound demonstrated a favourable absorption rate of 90.44, which is similar to that of simvastatin (94. 63). Additionally, it demonstrated better CNS penetration and lower excretion rates than simvastatin, resulting in a longer duration of action. It also has an extensive therapeutic window and better selectivity towards cancer cells in opposition to normal cells.

Antisense Oligonucleotides in Dyslipidemia Management: A Review of Clinical Trials

INTRODUCTION

Elevated serum total cholesterol levels, very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, or a decreased serum high-density lipoprotein cholesterol concentration characterize dyslipidemia. Antisense Oligonucleotide therapy in dyslipidemia targets apolipoprotein B (ApoB), an essential component of low-density lipoprotein (LDL) associated with atherosclerosis development.

AIM

This review aims to critically evaluate the efficacy and safety of this group of medications in mitigating dyslipidemia in at-risk individuals and its potential role in advancing personalized medicine in the management of dyslipidemias.

METHODS

A detailed search was conducted from multiple databases adhering to the PRISMA guidelines. Clinical trials and randomized controlled trials on antisense oligonucleotides for management of dyslipidemias were included, excluding non-English studies, case reports and all forms of reviews. Data was screened, with duplicates removed, and key findings were synthesized using a narrative approach.

RESULTS AND CONCLUSION

The potential of antisense oligonucleotides (ASOs) to treat dyslipidemia and other disorders has attracted much interest. Several studies and clinical trials have been conducted on the safety and tolerability of ASOs for dyslipidemia. Although statins are the mainstay management of hypercholesterolemia, there is evidence from clinical trials that ASOs can even be more effective with little to no side effects. Novel therapeutic approaches such as antisense oligonucleotides (ASOs) offer tailored therapeutic alternatives. ASOs such as Mipomersen and Volanesorsen provide additional treatment options for patients with inherited lipid abnormalities by lowering certain atherogenic lipoproteins such as apo B and ApoC-III, respectively.

Vanillic acid as a promising intervention for metabolic syndrome: Preclinical studies

Metabolic syndrome is a clustering of metabolic abnormalities and anthropometric factors that increase the risk of cardiovascular disease and type 2 diabetes mellitus. As the search for effective treatments intensifies, attention has turned towards natural substances with potential medicinal benefits. Among them, vanillic acid, a phenolic acid present in many plants, has attracted some attention due to its wide range of biological activities. This review aimed to provide an in-depth summary of the potential therapeutic use of vanillic acid in metabolic syndrome. The potential mechanisms of action of vanillic acid, including its anti-oxidant, anti-inflammatory, and hypolipidemic properties, are discussed. The effect of vanillic acid on glucose homeostasis, insulin sensitivity, and adipocyte activity is also addressed. The effect of vanillic acid on lipid metabolism, including the control of lipid synthesis, breakdown, and transport, is also reviewed. The emerging evidence for the beneficial effects of vanillic acid in animal models, in vitro studies, and preliminary clinical studies is also highlighted. The data suggests that vanillic acid has the potential to ameliorate metabolic syndrome. However, further preclinical and clinical research is needed to determine the specific mechanisms of action, appropriate dose, and subsequent advantages of vanillic acid. A more comprehensive understanding of the therapeutic potential of vanillic acid could pave the way for developing innovative techniques for preventing and treating metabolic syndrome and its implications.

Does glucomannan supplementation exert profitable effects on serum lipid profile in adults? A systematic review and meta-analysis

Considering dyslipidemia's impact on cardiovascular disease and even chronic illnesses and the beneficial effect of glucomannan on dyslipidemia, this study aimed to examine how glucomannan affects lipid profile parameters thoroughly. Using standard keywords, the databases Scopus, PubMed, Embase, Web of Science databases, and Google Scholar were searched from inception to December 2024. Based on our finding, glucomannan significantly reduced total cholesterol (TC) (SMD: -2.26; 95 % CI: -2.98, -1.55, p <0.001), low-density lipoprotein cholesterol (LDL-C) levels (SMD: -2.57; 95 % CI: -3.41, -1.74; p<0.001), but not effect on high-density lipoprotein cholesterol (HDL-C) (SMD: -0.33; 95 % CI: -0.70, 0.03, p=0.075), and triglyceride (TG) (SMD: -0.16; 95 % CI: -0.59, 0.27, p =0.473). However, these significant decreases are not clinically important. Therefore, glucomannan only can be considered as an adjunctive therapeutic approach in managing dyslipidemia.

An upward trend of dyslipidemia among adult population in Vietnam: Evidence from a systematic review and meta-analysis

INTRODUCTION

It is critical to assess the progress toward achieving the national goal of reducing premature mortality from non-communicable diseases (NCDs) by one-third by 2030 in Vietnam. This study aimed to examine the pooled prevalence of dyslipidemia among the Vietnamese adult population.

METHOD

Five databases, PubMed, Web of Science, Embase, CINAHL, Google Scholar, and local peer-reviewed journals were searched from inception to May 2024 without language restrictions. Pooled percentages of all dyslipidemia indicators were derived by random-effect model meta-analysis. We also estimated the pooled crude odds ratio and confidence interval (CI) for factors associated with dyslipidemia and calculated Hedges's g standardized mean for each dyslipidemia component.

RESULTS

Sixty-nine studies were identified as relevant for systematic review, with 41 studies included in the meta-analysis. The overall prevalence of having at least one component of dyslipidemia was 49 % (95%CI = 38%-60 %), and figures for high total cholesterol, elevated triglycerides, increased low-density lipoprotein-cholesterol and low high-density lipoprotein-cholesterol were 31 % (95%CI = 25 %; 37 %), 38 % (95%CI = 31 %; 44 %), 21 % (95%CI = 12 %; 32 %), 23 % (95%CI = 16 %; 30 %), respectively. The pooled percentage of overall dyslipidemia was higher in males, in the Southeast region and in studies reported in Vietnamese than those in English. Having diabetes, hypertension, abdominal obesity and overweight/obesity were significantly positively associated with dyslipidemia.

CONCLUSION

The prevalence of dyslipidemia was substantially high and increased in the Vietnamese adult population. Findings from this up-to-date review reinforce the necessity of effective implementation of NCDs prevention to achieve the national goal.

Early Prognostic Instrumental and Laboratory Biomarkers in Post-MI

BACKGROUND

Post-myocardial infarction (MI) changes have been frequently reported in the literature and are associated with determining the prognosis.

AIMS

The aim of this study is to find a prognosis marker for the favorability of determination of the medium-term outcomes in patients with acute MI.

OBJECTIVES

MI patients' prognosis is poorly understood and requires further elaboration.

MATERIALS AND METHODS

A single center, cross-sectional cohort study involved 211 patients' medical history with acute MI, for the period 2014-2019, had been evaluated retrospectively for 76 parameters. The data was collected from the Republic Rehabilitation Mordovian Hospital. The described measurement units were used in the local laboratories to describe the values. The descriptive values were expressed in the mean average and standard deviation. For statistical analysis, descriptive statistics, t-test independent by groups and dependent by numerical variables for repeated analysis for the same patients, multinomial logistic regression, Pearson's correlation coefficient, ROC analysis, and for clarification purposes, diagrams and bar figures were used. For performing the statistical analysis, the SPSS program, version 28 was used.

RESULTS

Descriptive statistics showed a proportion of men to females 7:3. The mean age of the MI patients was 61.50 years (Std. Dev. ± 10.68), and the mean height of the sample was 171.00 cm (Std. Dev. ± 7.20). The mean body weight of the sample is 83.62 kg (Std. Dev. ± 12.35), and the body mass index (BMI) is 29.02 kg/m2 (Std. Dev. ± 5.07). The total hospitalization days are 14.79 (Std. Dev. ± 3.41). The mean heart rate (HR) beat per minute (bpm) was 79.03 (Std. Dev. ± 15.63), and the mean blood pressure was 138.53/84.09 mmHg (Std. Dev. ± 28.66/12.79). On the complete blood count (CBC), the mean level of the hemoglobin (Hb) 136.33 g/l (Std. Dev. ± 15.29), the mean level of the leukocytes (WBC) 8.76 /μl (Std. Dev. ± 2.77), the mean level of the red blood cells (RBC) 4.55 /μl (Std. Dev. ± 0.52), the mean level of the relative value of the lymphocytes 24.46 % (Std. Dev. ± 9.015), and the mean level of the thrombocytes 207.87 /μl (Std. Dev. ± 64.035). The mean erythrocytes segmentation rate (ESR) is 18.99 mm/hr (Std. Dev. ± 12.16). The regression analysis demonstrated that the dependent variable, complication, in particular, pericarditis, and the independent factor, concomitant disease, in particular, chronic heart failure, has a significant regression coefficient of 29.101 at p <0.05. Furthermore, the dependent variable, complication, in particular, pneumonitis, and the independent factor, concomitant disease, particularly, arrhythmia, have a significant regression coefficient of 21.937 at p <0.05.

CONCLUSION

An elevated level of CPK-MB/LDH/Troponin I is linked to the development of arrhythmia. Patients with other medical conditions experience high diastolic blood pressure and an enlargement of the right ventricle. The early complication observed after MI is the formation of a left ventricular aneurysm. Complications arise due to low levels of potassium and calcium. Chronic Kidney Disease (CKD) contributes to the End-Diastolic Size (EDS) of the Left Ventricle (LV), Troponin I, and creatine phosphokinase-MB (CPK-MB). Advanced CKD patients have a hypertrophic left ventricle and persistently elevated post-myocardial Infarction (MI) cardiac biomarkers (CPKMB/ LDH/Troponin I) due to impaired kidney detoxification. Therefore, prolonged elevation of MI biomarkers can be an indicative of severe MI or kidney function impairment due to the chronic mild elevation in the MI biomarkers. Pericarditis development is related to the pre-existence of chronic heart failure. Moreover, pneumonitis development is related to the pre-existence of arrhythmia. Others: Hypertensive patients do not exhibit a significant increase in calcium levels, indicating that it is not a reliable biomarker in this patient population. Additionally, gender plays a crucial role in the development of ischemic heart disease, including myocardial infarction.

Comprehensive Mendelian randomization analysis of low-density lipoprotein cholesterol and multiple cancers

PURPOSE

The aim of this study was to investigate the causal relationship between low-density lipoprotein cholesterol (LDL-C) and five cancers (breast, cervical, thyroid, prostate and colorectal) using the Mendelian Randomization (MR) method, with a view to revealing the potential role of LDL-C in the development of these cancers.

METHODS

We used gene variant data and disease data from the Genome-Wide Association Study (GWAS) database to assess the causal relationship between LDL-C and each cancer by Mendelian randomisation analysis methods such as inverse variance weighting and MR-Egger. Specifically, we selected Proprotein convertase subtilisin/kexin type 9 (PCSK9) and 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), genes associated with LDL-C levels, as instrumental variables, extracted the corresponding single nucleotide polymorphism (SNP) data and analysed the associations of these SNPs with five cancers.In addition, sensitivity analyses and heterogeneity tests were performed to ensure the reliability of the results.

RESULTS

The analyses showed that when using HMGCR gene, LDL-C were significantly and positively associated with breast (OR:1.200, 95% CI:1.082-1.329, p = 0.001), prostate (OR:1.198, 95% CI:1.050-1.366, p = 0.007), and thyroid cancers (OR:8.291, 95% CI:3.189- 21.555, p = 0.00001) were significantly positively correlated, whereas they were significantly negatively correlated with colorectal cancer (OR:0.641, 95% CI:0.442-0.928, p = 0.019); the results for cervical cancer were not significant (p = 0.050). When using the PCSK9 gene, LDL-C levels were significantly and positively associated with breast (OR:1.107, 95%:CI 1.031-1.187, p = 0.005) and prostate (OR:1.219, 95%:CI 1.101-1.349, p = 0.0001) cancers, but not with cervical (p = 0.294), thyroid cancer (p = 0.759) and colorectal cancer ( p = 0.572).

CONCLUSION

Analyses using both the HMGCR and PCSK9 genes have shown that LDL-C may be a potential risk factor for breast and prostate cancer, while analyses of the HMGCR gene have also suggested that LDL-C may increase the risk of thyroid cancer and decrease the risk of colorectal cancer.

Healthcare professionals' perspectives on the use of PCSK9 inhibitors in cardiovascular disease: an in-depth qualitative study

AIMS

Injectable medicines such as PCSK9 inhibitors are increasingly used to manage risk factors for cardiovascular events with little information around the perceptions of healthcare professionals (HCPs) on the administrative and clinical practicalities. The aim was to identify the facilitators and barriers on the use of injectable therapies with cardiovascular benefits through interviews with HCPs.

METHODS AND RESULTS

Qualitative interviews were conducted in the UK (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. A total of 38 HCPs were interviewed, 19 in each country composing of physicians (n = 18), pharmacists (n = 10), nurses (n = 9), and pharmacy technician (n = 1). Four themes emerged: (i) clinicians' previous experiences with injectable therapies, (ii) challenges with patients' behaviours and beliefs, (iii) clinicians' knowledge of injectable therapies and therapeutic inertia, and (iv) organizational and governance issues. The behaviour and beliefs from HCPs focused on facilitating behaviour change as well as the poor interdisciplinary working and collaboration. Therapeutic inertia was raised where physicians either lacked awareness of injectable therapies or were unwilling to prescribe them. The importance of facilitating patient education on injection techniques was highlighted, while organizational and governance issues identified the lack of guidance to inform practice. Clear pathways are required to identify those who were eligible for injectable therapies as well as on how injectables should be prescribed.

CONCLUSION

If medicine optimization is to be achieved, there need to be structured processes in place to identify eligible patients and the development of educational material.

Mediating Effects of Serum Lipids and Physical Activity on Hypertension Management of Urban Elderly Residents in China

Background/Objectives: Investigating the importance and potential causal effects of serum lipid biomarkers in the management of hypertension is vital, as these factors positively impact the prevention and control of cardiovascular disease (CVD). Methods: We surveyed 3373 urban residents using longitudinal data from the CHARLS database, collected between 2015 and 2020. Pearson correlation methods were employed to explore the relationships among the numerical variables. A logistic regression model was utilized to identify the risk factors for hypertension. The dose-effect relationship between serum lipids and BP was assessed using restricted cubic splines (RCS). Additionally, piecewise structural equation modeling (PiecewiseSEM) was conducted to further elucidate the direct and indirect pathways involving individual body indices, serum lipids, and PA on BP responses at different levels of physical activity (PA). Results: The four serum lipids showed significant differences between hypertensive and non-hypertensive residents (p < 0.05). All lipids, except for HDL cholesterol, demonstrated extremely significant positive correlations with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p < 0.001). All serum lipid variables were significantly associated with the incidence of hypertension. Specifically, triglycerides (bl_tg), HDL (bl_hdl), and low-density lipoprotein LDL cholesterol were identified as significant risk factors, with odds ratios (ORs) of 1.56 (95% CI: 1.33-1.85, p < 0.001), 1.16 (95% CI: 1.02-1.33, p < 0.05), and 1.62 (95% CI: 1.23-2.15, p < 0.001), respectively. Conversely, cholesterol (bl_cho) was a protective factor for hypertension, with an OR of 0.60 (95% CI: 0.42-0.82, p < 0.01). PA showed weak relationships with blood pressure (BP); however, PA levels had significant effects, particularly at low PA levels. The four serum lipids had the most mediating effect on BP, especially under low PA level conditions, while PA exhibited a partly weak mediating effect on BP, particularly under high PA level conditions. Conclusions: Serum lipids have significant nonlinear relationships with BP and PA levels exert different influences on BP. The significant mediating effects of serum lipids and the weak mediating effects of PA on individual body indices related to SBP and DBP demonstrate significant differences across varying levels of PA, highlighting the importance of low PA levels in hypertension management. This study could provide valuable recommendations and guidance in these areas.

Acute and sub-acute toxicity study of aqueous and methanol root extract of Tetracera alnifolia in male albino rats

The aim of this study was to assess the acute and sub-acute toxicity of aqueous and methanol extracts of the root of Tetracera alnifolia as well as the effects on some biochemical parameters in albino rats as many plants used in traditional medicine lack scientific and clinical evidence to support a better understanding of their safety and efficacy. Phytochemical screening and proximate analysis of the pulverised root of Tetracera alnifolia was carried out using previously reported protocol. Sub-acute toxicity study of each extract was done for 28 days followed by organs function tests and histopathology studies of the liver, kidney and heart. Evaluation of lipid profile and oxidative stress marker to ascertain the effect of each extract on lipid peroxidation and their antioxidant property was done after administration of 200 mg/Kg body weight of each extract for a period of thirty-five days. Acute toxicity study of each extract gave oral LD50 (rat) of greater than 5000 mg/kg body weight with no signs of toxicity. Sub-acute toxicity study showed both extracts were non-toxic to the liver, kidney, heart and blood at doses between 200 and 3000 mg/Kg body weight assessed by the respective organ function tests, hematological parameters, and histopathology study. However, higher doses seem toxic to the liver particularly at 5000 mg/kg B. W due to increase in plasma AST, ALT and ALP activities accompanied with reduced protein and albumin concentrations. Effects of each extracts at 200 mg/Kg body weight on some biochemical parameters revealed no significant difference in lipid profile parameters and no lipid peroxidation. Each extract may possess antioxidant property due to increase in catalase activity. The result from this research may help validate the safety of the oral use of this plant in traditional medicine.

Relevance of combined influence of nutritional and inflammatory status on non-alcoholic fatty liver disease and advanced fibrosis: A mediation analysis of lipid biomarkers

BACKGROUND AND AIM

This study aimed to investigate the relationship between advanced lung cancer inflammation index (ALI) and non-alcoholic fatty liver disease (NAFLD) and advanced liver fibrosis (AF).

METHODS

A total of 5642 individuals from the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2020 were examined. Limited cubic spline regression model, and weighted logistic regression were employed to determine if ALI levels were related to the prevalence of NAFLD and AF. Additionally, a mediating analysis was conducted to investigate the role of lipid biomarkers, such as total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), in the effects of ALI on the prevalence of NAFLD and AF.

RESULTS

After adjusting for potential confounders, a significant positive association was found between ALI with NAFLD and AF prevalence. Compared with those in ALI Tertile 1, participants in Tertile 3 had higher odds of NAFLD prevalence (odds ratio [OR]: 3.16; 95% confidence interval [CI]: 2.52-3.97) and AF (OR: 3.17; 95% CI: 2.30-4.36). Participants in both Tertile 2 and Tertile 3 had lower odds of developing AF (P for trend = 0.005). Moreover, we discovered a nonlinear association between ALI and NAFLD. An inflection point of 74.25 for NAFLD was identified through a two-segment linear regression model. Moreover, TC and HDL-C levels mediated the association between ALI and NAFLD by 10.2% and 4.2%, respectively (both P < 0.001).

CONCLUSION

Our findings suggest that higher ALI levels are positively associated with an increased prevalence of NAFLD and AF, partly mediated by lipid biomarkers.

Therapeutic and pharmacological applications of extracellular vesicles and lipoproteins

In recent years, various approaches have been undertaken to eliminate lipoproteins co-isolated with extracellular vesicles, as they were initially regarded as contaminating entities. However, novel discoveries are reshaping our perspective. In body fluids, these distinct particles not only co-exist, but also interactions between them are likely to occur. Extracellular vesicles and lipoproteins can associate with each other, share cargo, influence each other's functions, and jointly have a role in the pathomechanisms of diseases. Additionally, their association carries important implications for therapeutic and pharmacological aspects of lipid-lowering strategies. Extracellular vesicles and lipoprotein particles may have roles in the elimination of each other from the circulation. The objective of this minireview is to delve into these aspects. Here, we show that under certain physiological and pathological conditions, extracellular vesicles and lipoproteins are 'partners' rather than 'strangers' or 'rivals'.

Multifaceted Role of Apolipoprotein C3 in Cardiovascular Disease Risk and Metabolic Disorder in Diabetes

Apolipoprotein C3 (APOC3) plays a critical role in regulating triglyceride levels and serves as a key predictor of cardiovascular disease (CVD) risk, particularly in patients with diabetes. While APOC3 is known to inhibit lipoprotein lipase, recent findings reveal its broader influence across lipoprotein metabolism, where it modulates the structure and function of various lipoproteins. Therefore, this review examines the complex metabolic cycle of APOC3, emphasizing the impact of APOC3-containing lipoproteins on human metabolism, particularly in patients with diabetes. Notably, APOC3 affects triglyceride-rich lipoproteins and causes structural changes in high-, very low-, intermediate-, and low-density lipoproteins, thereby increasing CVD risk. Evidence suggests that elevated APOC3 levels-above the proposed safe range of 10-15 mg/dL-correlate with clinically significant CVD outcomes. Recognizing APOC3 as a promising biomarker for CVD, this review underscores the urgent need for high-throughput, clinically feasible methods to further investigate its role in lipoprotein physiology in both animal models and human studies. Additionally, we analyze the relationship between APOC3-related genes and lipoproteins, reinforcing the value of large-population studies to understand the impact of APOC3 on metabolic diseases. Ultimately, this review supports the development of therapeutic strategies targeting APOC3 reduction as a preventive approach for diabetes-related CVD.

Managing Dyslipidemia in Children: Current Approaches and the Potential of Artificial Intelligence

Dyslipidemia is abnormal lipid and lipoprotein levels in the blood, influenced mainly by genetics, lifestyle, and environmental factors. The management of lipid levels in children involves early screening, nonpharmacological interventions such as lifestyle modifications and dietary changes, nutraceuticals, and pharmacological treatments, including drug therapy. However, the prevalence of dyslipidemia in the pediatric population is increasing, particularly among obese children, which is a significant risk factor for cardiovascular complications. This narrative review analyzes current literature on the management of dyslipidemia in children and explores the potential of artificial intelligence (AI) to improve screening, diagnosis, and treatment outcomes. A comprehensive literature search was conducted using Google Scholar and PubMed databases, focusing primarily on the application of AI in managing dyslipidemia. AI has been beneficial in managing lipid disorders, including lipid profile analysis, obesity assessments, and familial hypercholesterolemia screening. Deep learning models, machine learning algorithms, and artificial neural networks have improved diagnostic accuracy and treatment efficacy. While most studies are done in the adult population, the promising results suggest further exploring AI management of dyslipidemia in children.

Cardiovascular Diseases and Metabolic Medications in the Lebanese Population: A Post Hoc Analysis from a Nationwide Cross-Sectional Study

OBJECTIVE

This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients' subgroups.

METHODS

A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, lifestyles, comorbidities, and medication use. Logistic regression models were employed to analyze the data and determine associations between CVD and metabolic drugs. Stratification analyses were performed based on diabetes and dyslipidemia status.

RESULTS

The study found significant associations with CVD among the 2048 participants. Higher scores on the Lebanese Mediterranean Diet Score (LMDS; ORa = 1.06), hypertension (ORa = 1.71), diabetes (ORa = 1.75), dyslipidemia (ORa = 1.89), family history of CVD (ORa = 1.58), and smoking (previous: ORa = 1.63, current: ORa = 2.15) were linked to increased CVD odds. Higher income (intermediate: ORa = 0.64, high: ORa = 0.40) was inversely related to it. A subsequent model that included hypoglycemic and lipid-lowering medications yielded similar results. However, neither hypoglycemic nor lipid-lowering medications demonstrated a significant association with CVD risk. A third regression model was conducted by taking the classes of drugs as an independent variable. Also, the result revealed that all the classes of medication were not associated with the risk of CVD. Stratification by diabetes revealed LMDS and hypertension as risk factors in both groups. Among non-diabetic participants, dyslipidemia (ORa = 2.40), current smoking (ORa = 2.28), and higher income (intermediate: ORa = 0.57, high: ORa = 0.62) were linked to CVD. Among people with diabetes, a family history of CVD (ORa = 2.69) increased the CVD odds, while being an employer (ORa = 0.49) lowered it. Stratification by dyslipidemia showed consistent risk factors, and higher LMDS (ORa = 1.07), diabetes (ORa = 2.14), hypertension (ORa = 1.79), and previous smoking (ORa = 1.95) were linked to CVD without dyslipidemia. Being a female (ORa = 0.52) and having a lower income (ORa = 0.40) were associated with lower CVD odds in those with dyslipidemia. Subgroup analyses showed that medications were not significantly associated with CVD odds among patients with diabetes or hyperlipidemia.

CONCLUSIONS

This study's findings highlight the importance of addressing modifiable risk factors and socioeconomic factors to reduce the burden of CVD. Targeted interventions and longitudinal research are necessary to optimize preventive strategies and improve the management of CVD in individuals using hypoglycemic and hypolipemic agents in low- and medium-income countries.

Analysis of the Influence of Personality Traits on the Level of Knowledge and Health Behaviours of Cardiac Patients

Background/Objectives: Numerous risk factors of cardiac diseases are influenced by health behaviours. An individual's health behaviours, somatic symptoms and even cardiac outcomes can be influenced by their personality. The aim of this study was to analyse the influence of personality traits on the knowledge and health behaviour of cardiac patients. Methods: The study was conducted at the Independent Public Voivodship Hospital in Szczecin on 180 patients in the invasive cardiology wards and the intensive cardiac care unit between July and September 2019. A self-developed questionnaire and the NEO-Five-Factor Inventory-3 (NEO-FFI) and Health Behaviour Inventory (HBI) standardised tools were used. Results: Respondents mostly linked the occurrence of cardiovascular disease with smoking (87.22%) and hypertension (85.56%). A large majority of the respondents (68.44%) knew the correct recommended values for blood pressure. This was also the case for total cholesterol-only 20.56% of the patients did not know the correct levels. Respondents experienced more difficulty in adhering to preventive measures-only 27.22% followed a low-fat diet and only half controlled their weight. The overall HBI scale score was 5.93 sten, which indicates an average score. The most intense personality trait among the respondents was extraversion (5.79), while the least intense was agreeableness (4.12). Neuroticism was found to be negatively correlated (p < 0.05) with healthy eating habits and a positive mental attitude. Extroverts, on the other hand, are more likely to take preventive action. Older and non-working individuals are more likely to exhibit health-promoting behaviours in all HBI categories (p < 0.05). Conclusions: The personality traits that have the greatest impact on health behaviour are extraversion, agreeableness and conscientiousness. Health practises also depend on gender, age and work activity. Further research on more diverse groups is needed.

Exercise improves muscle mitochondrial dysfunction-associated lipid profile under circadian rhythm disturbance

We investigated whether endurance exercise training (EXT) ameliorates circadian rhythm (CR)-induced risk factors by improving skeletal muscle (SKM) mitochondrial biogenesis, reducing oxidative stress, and modulating apoptotic protein expression. We distinguished between regular and shift workers using the National Health and Nutrition Examination Survey (NHANES) and investigated the health problems caused by shift work (CR disturbance) and the potential therapeutic effects of exercise. In our animal study, 36 rats underwent 12 weeks of CR disturbance, divided into regular and irregular CR groups. These groups were further split into EXT (n = 12) and sedentary (n = 12) for an additional 8 weeks. We analyzed SKM tissue to understand the molecular changes induced by CR and EXT. NHANES data were analyzed using SAS 9.4 and Prism 8 software, while experimental animal data were analyzed using Prism 8 software. The statistical procedures used in each experiment are indicated in the figure legends. Our studies showed that CR disturbance increases dyslipidemia, alters circadian clock proteins (BMAL1, PER2), raises apoptotic protein levels, and reduces mitochondrial biogenesis in SKM. EXT improved LDL-C and HDLC levels without affecting muscle BMAL1 expression. It also enhanced mitochondrial biogenesis (AMPK, PGC-1α, Tfam, NADH-UO, COX-I), antioxidant levels (Catalase, SOD1, SOD2), and apoptotic protein (p53, Bax/Bcl2) expression or activity in SKM. We demonstrated that shift work-induced CR disturbance leads to dyslipidemia, diminished mitochondrial biogenesis, and reduced antioxidant capacity in SKM. However, EXT can counteract dyslipidemia under CR disturbance, potentially lowering the risk of cardiovascular disorders.

Risk management of patients with multiple CVDs: what are the best practices?

INTRODUCTION

Managing patients with multiple risk factors for CVDs can present distinct challenges for healthcare providers, therefore addressing them can be paramount to optimize patient care.

AREAS COVERED

This narrative review explores the burden that CVDs place on healthcare systems as well as how we can best optimize the risk management of these patients. Through a comprehensive review of literature, guidelines and clinical studies, this paper explores various approaches to risk management, lifestyle modifications and pharmacological interventions utilized in the management of CVDs. Furthermore, emerging technologies such as machine learning (ML) are discussed, highlighting potential opportunities for future research. By reviewing existing recommendations and evidence, this paper aims to provide insight into optimizing strategies and improving the outcomes for patients with multiple CVDs.

EXPERT OPINION

Optimizing risk factors can have a significant impact on patient outcomes, as such each patient should have a clear plan on how to manage these risk factors to minimize adverse healthcare results.

Comparison between statistical and machine learning methods to detect the hematological indices with the greatest influence on elevated serum levels of low-density lipoprotein cholesterol

INTRODUCTION

Elevated levels of low-density lipoprotein-cholesterol (LDL-C) is a significant risk factor for the development of cardiovascular diseases (CVD)s. Furthermore, studies have revealed an association between indices of the complete blood count (CBC) and dyslipidemia. We aimed to investigate the relationship between CBC parameters and serum levels of LDL.

METHOD

In a prospective study involving 9704 participants aged 35-65 years, comprehensive screening was conducted to estimate LDL-C levels and CBC indicators. The association between these biomarkers and high LDL-C (LDL-C≥130 mg/dL (3.25 mmol/L)) was investigated using various analytical methods, including Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Neural Network (NN), and Support Vector Machine (SVM) methodologies.

RESULT

The present study found that age, hemoglobin (HGB), hematocrit (HCT), platelet count (PLT), lymphocyte (LYM), PLT-LYM ratio (PLR), PLT-High-Density Lipoprotein (HDL) ratio (PHR), HGB-LYM ratio (HLR), red blood cell count (RBC), Neutrophil-HDL ratio (NHR), and PLT-RBC ratio (PRR) were all statistically significant between the two groups (p<0.05). Another important finding was that red cell distribution width (RDW) was a significant predictor for higher LDL levels in women. Furthermore, in men, RDW-PLT ratio (RPR) and PHR were the most important indicators for assessing the elevated LDL levels.

CONCLUSION

The study found that sex increases LDL-C odds in females by 52.9 %, while age and HCT increase it by 4.1 % and 5.5 %, respectively. RPR and PHR were the most influential variables for both genders. Elevated RPR and PHR were negatively correlated with increased LDL levels in men, and RDW levels was a statistically significant factor for women. Moreover, RDW was a significant factor in women for high levels of HDL-C. The study revealed that females have higher LDL-C levels (16 % compared to 14 % of males), with significant differences across variables like age, HGB, HCT, PLT, RLR, PHR, RBC, LYM, NHR, RPR, and key factors like RDW and SII.

Relationship Between Altered Plasma-Free Amino Acid Levels and Hyperuricemia in Dyslipidemia Without and With Hypertension

Background: Investigating the association between plasma-free amino acids (PFAAs) and hyperuricemia (HU) in dyslipidemia (DL) and dyslipidemia with hypertension (DH) is crucial, as it could provide valuable insights into the pathophysiology of these conditions and contribute to the development of targeted prevention and management strategies. Therefore, in this study, we aimed to elucidate the associations between PFAAs and HU in individuals with DL and DH. Methods: We quantified PFAAs and uric acid levels among Japanese healthy subjects (n = 1311; HU, n = 57), subjects with DL (n = 1483; HU, n = 219), and subjects with DH (n = 1159; HU, n = 237). Results: The concentrations of most PFAAs showed significant differences between subjects without and with HU across all groups (p < 0.05 to 0.001). Adjusted logistic regression analyses revealed that certain PFAAs were consistently positively or negatively associated with HU across all groups. Specifically, in the DL group, alanine, tryptophan, and tyrosine showed significant positive associations with HU, while in the DH group, citrulline and glutamate exhibited similar positive associations (p < 0.05 to 0.001). Conversely, threonine in the healthy group (p < 0.05) and glutamine in the DL group (p < 0.05) demonstrated significant inverse associations with HU. Conclusions: This study revealed a potential close relationship between alterations in PFAA profiles and HU in dyslipidemia, without and with hypertension. The findings warrant further research to elucidate the role of altered amino acid and uric acid levels as potential disease biomarkers and therapeutic targets.

An ensemble model for predicting dyslipidemia using 3-years continuous physical examination data

Background

Dyslipidemia has emerged as a significant clinical risk, with its associated complications, including atherosclerosis and ischemic cerebrovascular disease, presenting a grave threat to human well-being. Hence, it holds paramount importance to precisely predict the onset of dyslipidemia. This study aims to use ensemble technology to establish a machine learning model for the prediction of dyslipidemia.

Methods

This study included three consecutive years of physical examination data of 2,479 participants, and used the physical examination data of the first two years to predict whether the participants would develop dyslipidemia in the third year. Feature selection was conducted through statistical methods and the analysis of mutual information between features. Five machine learning models, including support vector machine (SVM), logistic regression (LR), random forest (RF), K nearest neighbor (KNN) and extreme gradient boosting (XGBoost), were utilized as base learners to construct the ensemble model. Area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate the model.

Results

Experimental results show that the ensemble model achieves superior performance across several metrics, achieving an AUC of 0.88 ± 0.01 (P < 0.001), surpassing the base learners by margins of 0.04 to 0.20. Calibration curves and DCA exhibited good predictive performance as well. Furthermore, this study explores the minimal necessary feature set for accurate prediction, finding that just the top 12 features were required for dependable outcomes. Among them, HbA1c and CEA are key indicators for model construction.

Conclusions

Our results suggest that the proposed ensemble model has good predictive performance and has the potential to become an effective tool for personal health management.

Plasma atherogenicity index is a powerful indicator for identifying metabolic syndrome in adults with type 2 diabetes mellitus: A cross-sectional study

Metabolic syndrome (MetS) is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). Elevated triglyceride (TG) levels and decreased high-density lipoprotein levels (HDL-C) are predisposing factors for the development of ASCVD. Evidence on the association between atherosclerotic index of plasma [AIP = log (TG/HDL-C)] and MetS is limited. Our study aimed to investigate the association between AIP and MetS. This is a cross-sectional study that determines the presence of MetS by assessing anthropometric and biochemical parameters. Multivariate log-binomial regression models were used to analyze the relationship between AIP and MetS risk. To further test the stability of the results, we performed sensitivity analyses in young, non-obese, and normal lipid population. Smoothing plots explored the potential nonlinear relationship between the AIP index for MetS and the estimated potential risk threshold. Predictive power of AIP for MetS using respondent operating characteristic (ROC) curves. The prevalence of MetS was 67.35%. Multivariate logistic regression analysis showed an independent and positive association between AIP and MetS (Per 1 SD increase, PR = 1.31, 95% CI: 1.15-1.47). Sensitivity analysis demonstrated the stability of the results. Smoothing plot showed a nonlinear relationship between AIP and MetS, with an inflection point of 0.66. ROC curve analysis, AIP was an accurate indicator for assessing MetS in type 2 diabetics (AUC = 0.840, 95% CI: 0.819-0.862). AIP is a stable and independently powerful predictor of MetS in T2DM patients. AIP can be used as a simple assessment tool for the early detection of MetS and disease management for the prevention of cardiovascular disease.

Diagnostic accuracy of Cardiochek® PA point-of-care testing (POCT) analyser with a 3-in-1 lipid panel for epidemiological surveys

BACKGROUND

Point-of-care testing (POCT) is commonly used in epidemiological surveys due to its various advantages, such as portability and immediate test results. The CardioChek® PA analyser 3-in-1 lipid panel measures total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol. This study tested the reliability and diagnostic accuracy of the CardioChek® PA analyser using a 3-in-1 lipid panel.

METHODS

A cross-sectional study design with quota sampling was used. A total of 203 respondents aged 18 years and above from a research centre in the Ministry of Health, Malaysia, were recruited. Venous blood was sent to the laboratory and tested with Siemens Atellica CH, while a POCT analyser was used for capillary blood measurements. Intraclass coefficient correlation (ICC) analysis was employed to determine the agreement between capillary and venous blood parameters. The diagnostic performance of the evaluated tests was evaluated using STATA version 12.

RESULTS

The agreement between capillary and laboratory venous blood was moderate (0.64-0.67) for TC and HDL, good (0.75) for LDL and excellent (0.91) for TG). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were as follows: TC, 57.1%, 94.3%, 92.3% and 64.8%; TG, 76.0%, 100%, 100%, and 96.6%; HDL, 96.2%, 83.2%, 47.2% and 99.3%; and LDL, 81.0%, 100%, 100% and 68.3%, respectively.

CONCLUSIONS

The CardioChek® PA analyser showed acceptable diagnostic accuracy for screening high-risk individuals more often in places where laboratories are inaccessible. It could also be used in clinical settings where patients would benefit from swift treatment decisions.

Mediterranean Diet and Ultra-Processed Food Intake in Older Australian Adults-Associations with Frailty and Cardiometabolic Conditions

Dietary patterns contribute to overall health and diseases of ageing but are understudied in older adults. As such, we first aimed to develop dietary indices to quantify Mediterranean Diet Score (MDS) utilisation and Ultra-processed Food (UPF) intake in a well-characterised cohort of relatively healthy community-dwelling older Australian adults. Second, we aimed to understand the relationship between these scores and the association of these scores with prevalent cardiometabolic disease and frailty. Our major findings are that in this population of older adults, (a) pre-frailty and frailty are associated with reduced MDS and increased UPF intake; (b) adherence to MDS eating patterns does not preclude relatively high intake of UPF (and vice versa); and (c) high utilisation of an MDS eating pattern does not prevent an increased risk of frailty with higher UPF intakes. As such, the Mediterranean Diet pattern should be encouraged in older adults to potentially reduce the risk of frailty, while the impact of UPF intake should be further explored given the convenience these foods provide to a population whose access to unprocessed food may be limited due to socioeconomic, health, and lifestyle factors.

Far-infrared irradiation increases the uptake of LDL cholesterol by downregulating PCSK9 through the activation of TRPV4 calcium channels in HepG2 cells

This study investigated the effects of far-infrared (FIR) irradiation on low-density lipoprotein cholesterol (LDL-C) uptake by human hepatocellular carcinoma G2 (HepG2) cells via the regulation of proprotein convertase subtilisin/kexin type 9 (PCSK9). FIR irradiation for 30 min significantly decreased PCSK9 expression (p < 0.01) in HepG2 cells. FIR irradiation substantially increased the low-density lipoprotein receptor (p < 0.0001) and LDL-C uptake (p < 0.01). Activation of transient receptor potential vanilloid (TRPV) channels mimicked the effects of FIR irradiation, significantly decreasing the protein expression of PCSK9 (p < 0.05). Conversely, inhibition of TRP channels using ruthenium red reversed the reduction in PCSK9 protein expression following FIR irradiation (p < 0.01). The specific activation of TRPV4 using 4α-PDD mimicked the effect of FIR irradiation (p < 0.01), whereas PCSK9 reduction by FIR irradiation was significantly reversed by the inhibition of TRPV4 using RN1734 (p < 0.05). These findings implied that FIR irradiation emitted from a ceramic lamp specifically increased TRPV4 activity. These findings provide insights into a novel therapeutic approach using FIR irradiation for LDL-C regulation and its implications for cardiovascular health.

A Comparative Analysis of Low-Density Lipoprotein Cholesterol (LDL-C)-Lowering Activities of Bempedoic Acid, Inclisiran, and PCSK9 Inhibitors: A Systematic Review

Newer drugs, such as bempedoic acid, inclisiran, alirocumab, and evolocumab have recently been introduced for dyslipidemia. This systematic review aims to perform a comparative analysis of these drugs' low-density lipoprotein cholesterol (LDL-C)-lowering activities. The PubMed database was utilized to search for randomized controlled trials. Articles were screened and selected based on specific inclusion and exclusion criteria. The primary outcome of this review is to compare the percentage reduction of LDL-C and apolipoprotein-B, along with the number of reported serious adverse events (SAEs) in trials specific to each drug. A total of 14 studies were included, four for bempedoic acid and alirocumab and three for evolocumab and inclisiran. The maximum percentage reduction in LDL-C and apolipoprotein-B from baseline to 12 weeks was observed with alirocumab, administered at 150 mg subcutaneously twice weekly for 12 weeks, achieving reductions of 72.4% and 57.9%, respectively. Lesser reductions were observed with bempedoic acid, administered at 180 mg once daily orally for 12 weeks. The highest number of SAEs were reported with bempedoic acid (216, 10%) and inclisiran (181, 11%; 175, 11%). This systematic review showed that alirocumab achieved the greatest reductions in LDL-C and apolipoprotein-B and a better safety profile. Newer LDL-C-lowering drugs show promise in improving lipid profiles, patient compliance, and safety. However, these findings are not conclusive, as other factors also influence treatment choice.

Integrative Bioinformatics Approaches to Uncover Hub Genes and Pathways Involved in Cardiovascular Diseases

Cardiovascular diseases (CVD) represent a significant global health challenge resulting from a complex interplay of genetic, environmental, and lifestyle factors. However, the molecular pathways and genetic factors involved in the onset and progression of CVDs remain incompletely understood. Here, we performed an integrative bioinformatic analysis to highlight specific genes and signaling pathways implicated in the pathogenesis of 80 CVDs. Differentially expressed genes (DEGs) were identified through the integrated analysis of microarray and GWAS datasets. Then, hub genes were identified after gene ontology functional annotation analysis and protein-protein internet (PPI) analysis. In addition, pathways were identified through KEGG and gene ontology enrichment analyses. A total of 821 hub genes related to 80 CVDs were identified, including 135 common and frequent CVD-associated genes. TNF, IL6, VEGFA, and TGFB.1 genes were the central core genes expressed in 50% or more of CVDs, confirming that the inflammation is a key pathological feature of CVDs. Analysis of hub genes by KEGG enrichment revealed predominant enrichment in 201 KEGG pathways, of which the AGE-RAGE signaling pathway in diabetic complications was identified as the common key KEGG implicated in 62 CVDs. In addition, the outcomes showed an overrepresentation in pathways categorized under human diseases, particularly in the subcategories of infectious diseases and cancers, which may be common risk factors for CVDs. In conclusion, this powerful approach for in silico fine-mapping of genes and pathways allowed the identification of determinant hubs genes and pathways implicated in the pathogenesis of CVDs which could be employed in developing more targeted and effective interventions for preventing, diagnosing, and treating CVDs. The function of these hub genes in CVDs needs further exploration to elucidate their biological characteristics.

Decoding coffee cardiometabolic potential: Chemical composition, nutritional, and health relationships

Coffee is one of the most consumed beverages worldwide, recognized for its unique taste and aroma and for its social and health impacts. Coffee contains a plethora of nutritional and bioactive components, whose content can vary depending on their origin, processing, and extraction methods. Gathered evidence in literature shows that the regular coffee consumption containing functional compounds (e.g., polysaccharides, phenolic compounds, and melanoidins) can have potential beneficial effects on cardiometabolic risk factors such as abdominal adiposity, hyperglycemia, and lipogenesis. On the other hand, coffee compounds, such as caffeine, diterpenes, and advanced glycation end products, may be considered a risk for cardiometabolic health. The present comprehensive review provides up-to-date knowledge on the structure-function relationships between different chemical compounds present in coffee, one of the most prevalent beverages present in human diet, and cardiometabolic health.