A case of montelukast induced hypercholesterolemia, severe hypertriglyceridemia and pancreatitis

Montelukast sodium is a leukotriene inhibitor, and competitively antagonizes cys-LT1 receptor and used widely and effectively in treating allergic rhinitis, bronchial asthma and allied respiratory conditions. This case report outlines a rare case of montelukast induced hypercholesterolemia, severe hypertriglyceridemia and acute pancreatitis in a 22 years old male patient. The patient was taking 10 mg oral montelukast daily for allergic rhinitis. Although his symptoms improved considerably, after 2 months of therapy, he experienced unusual weight gain and got admitted with severe pain abdomen. Clinical and other relevant investigation findings revealed the presence of acute pancreatitis with associated hypercholesterolemia and severe hypertriglyceridemia. There were no evidences of any other possible hereditary, surgical, metabolic, infective, organic or other pathologic causes giving rise to these conditions. De-challenge was done and the patient was treated conservatively resulting in reversal of the diseased state. Naranjo adverse drug reaction probability scale suggested that it was 'probable' that oral administration of montelukast was responsible for the acute pancreatitis associated with hypercholesterolemia and severe hypertriglyceridemia. There is only a singular and confirmed reported case of montelukast induced hypertriglyceridemia from India. For patients taking montelukast for a long duration, routine lipid profile monitoring should be done, and if these patients present with symptoms of epigastric and periumbilical pain with vomiting, provisions for screening acute pancreatitis might be warranted.

Plasma total cholesterol level and some related factors in northern Iranian people

BACKGROUND

In middle age people, hypercholesterolemia (HC) has been included as a risk factor for cardiovascular disease.

OBJECTIVES

The main objective of this study was to evaluate the prevalence of HC and some related factors in the north of Iran.

MATERIALS AND METHODS

This was a population-based cross-sectional study that enrolled 1995 subjects (997 males and 998 females) in 25-65 year age using stratified cluster sampling. Interviewers recorded the data using a multidimensional questionnaire including anthropometric indexes. Plasma cholesterol was measured in the morning after a 12-hour fast and determined by an auto-analyzer. HC was defined by a total plasma total cholesterol level over 200 mg/dl. The SPSS.16 software was used to analyze data.

RESULTS

The mean age of the participant was 44.2 years and mean ± SD plasma total cholesterol level in men and women was 196.7 ± 39.11 and 209.4 ± 42.9, respectively. Generally, the prevalence of HC was 50.4% with a significant differences between men (44.7%) and women (57%) (P < 0.05). The mean plasma total cholesterol levels were significantly differenced among age groups, location area, BMI, and waist circumferences (P < 0.001). Women gender (OR = 1.64), 55-65 years old (OR = 2.79), BMI ≥40 kg/m(2) (OR = 10.0), and abdominal obesity (OR = 2.47) were associated with increased risk of HC (P = 0.001 and 95%CI for all).

CONCLUSION

HC is one of the most health problems in the northern Iran and it is more common in women than in men. General and abdominal obesity are the most common risk factors for HC.

Treatment of a patient with congenital analbuminemia with atorvastatin and albumin infusion

Congenital analbuminemia is a rare autosomic recessive inherited disorder characterized by low plasma albumin and hypercholesterolemia, which may increase cardiovascular risk. Patients are essentially asymptomatic, apart from ease of fatigue, minimal ankle oedema and hypotension. There is no accepted strategy for safely treating both hypercholesterolemia and analbuminemia in order to eventually decrease the atherosclerotic risk. We report a case of congenital analbuminemia (1.0 g/dL)

in a 38-year-old male with hypercholesterolemia (range: 406-475 mg/dL) and severe arterial dysfunction [no brachial artery flow-mediated dilation (FMD)]. Long-term, cholesterol-lowering treatment with atorvastatin was associated with the appearance of peripheral edema. Two-months of infusion with albumin improved FMD (7%) and reduced serum cholesterol (273 mg/dL), supporting the hypothesis of a compensatory role of hypercholesterolemia. Statin treatment, together with periodical albumin infusions, may contribute to the safe reduction of cardiovascular risk.

Comparative study of tomato and tomato paste supplementation on the level of serum lipids and lipoproteins levels in rats fed with high cholesterol

BACKGROUND

Hypercholesterolemia is one of the risk factors of cardiovascular diseases. Increased blood cholesterol affects general health and increases mortality due to cardiovascular disease. Poor nutrition increases LDL cholesterol and decreases LDL receptor activities in the liver. Scientists have shown that consumption of antioxidants can reduce hypercholesterolemia and proved benefits of fruit and vegetables. Tomato reduces oxidative stress by increasing serum total antioxidant level.

OBJECTIVES

This study compared the tomato and tomato paste supplementation on the level of serum lipids and lipoproteins in rats fed with high cholesterol.

MATERIALS AND METHODS

In this study, four male rat groups (10 rats per group) were used. Control group received basal diet, second group received basal diet and 2% cholesterol (Chol), third and fourth groups received basal diet, 2% cholesterol tomato and tomato paste respectively (20 percent of the diet) for a month. Then serum TC, LDL, HDL and TG were measured.

RESULTS

Results showed that in Chol group, all lipids increased significantly (P < 0.05) except HDL compared to the control group. Tomato and tomato paste supplementation decreased TC, LDL and TG concentration significantly (P < 0.05) compared to Chol group. Tomato paste had the higher effect on lipids decreasing than tomato.

CONCLUSIONS

Decreases of TC, LDL and TG may be related to tomato antioxidant effect. This course in human required more investigations.

Increased circulatory RAS activity can be inhibited by statins in patients with hypercholesterolemia

OBJECTIVE

The objective of this paper is to investigate a profile on circulatory renin-angiotensin system (RAS) activity in hypercholesterolemic (HC) patients treated with statins.

METHODS

Eighteen primary HC patients and 18 sex- and age-matched healthy adults were included in this study as controls. Total cholesterol (TC), triglyceride (TG), LDL-C, blood glucose, angiotensin-converting enzyme (ACE) activity, and angiotensin II (Ang II) levels were measured before and four and eight weeks after beginning statin treatment in the HC group. Similar measurements were taken in the control group at baseline.

RESULTS

At baseline, TC, TG and LDL-C levels, as well as ACE activity and Ang II concentrations, were significantly higher in the HC group than in the control group. Based on the baseline data collection of 36 participants, there were significant positive correlations between ACE activity and TC (r = 0.54) or LDL-C (r = 0.51), and between Ang II level and TC (r = 0.34) or LDL-C (r = 0.27). TC, LDL-C, Ang II (35.46 ± 14.49 vs 71.10 ± 20.47 pg/ml, p < 0.05) levels and ACE activity (108.9 ± 51.9 vs 180.1 ± 71.3 U/L, p < 0.05) were decreased in HC patients eight weeks after starting statin treatment. In HC patients, RAS activity correlated positively with TC and LDL-C levels before and after treatment.

CONCLUSIONS

In HC patients, lowering serum cholesterol with statins is associated with decreased circulatory RAS activity.

Hypercholesterolemia and in-vivo coronary plaque composition in patients with coronary artery disease: a virtual histology - intravascular ultrasound study

BACKGROUND AND OBJECTIVES

Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease.

SUBJECTS AND METHODS

Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (≥200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209).

RESULTS

Hypercholesterolemic patients were younger (59.7±13.3 years vs. 62.6±11.5 years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23±0.85 mm(3)/mm vs. 1.02±0.80 mm(3)/mm, p=0.029) as well as percent necrotic core volume (20.5±8.5% vs. 18.0±9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4±10.5% vs. 18.4±11.3%, p=0.019) and necrotic core area (1.63±1.09 mm(2) vs. 1.40±1.20 mm(2), p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037).

CONCLUSION

Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.

The effect of quince leaf (Cydonia oblonga miller) decoction on testes in hypercholesterolemic rabbits: a pilot study

Current medical literature lacks any evidence of the protective effects of quince leaf on testes. Therefore, the aim of the present study was to assess the effect of quince (Cydonia oblonga Miller) leaf decoction on testicular injury and impaired spermatogenesis induced by hypercholesterolemia in rabbits. Eleven mature New Zealand white male rabbits were randomly divided into three groups: group 1 (hypercholesterolemia, n=3), group 2 (hypercholesterolemia plus quince treatment, n=6), and group 3 (control, n=2). Groups 1 and 2 received a cholesterol-enriched diet for six weeks. Group 2 received C. oblonga leaf decoction as drinking supplement as well. After six weeks, a normal diet was substituted in groups 1 and 2 for another six weeks. Group 3 (control group) was maintained throughout the study on a regular diet. At the end of the 12(th) week, the left testes of the animals were resected for light microscopic study with particular attention to the maturity of germ cells in seminiferous tubules using Johnsen's score. Increase in intertubular connective tissue and diameter of vessels, abundant spermatogonia and primary spermatocytes along the reduced germinal epithelium were noted in all rabbits of the group 1. The remaining animals in groups 2 and 3 had no significant changes in their testicular sections. The mean Johnsen's score of group 1 (4.20 ± 1.92) was significantly lower than that of group 2 (7.33 ± 0.52) and group 3 (7.05 ± 0.07). (P=0.01). In conclusion, quince leaf decoction (C. oblonga Miller) protected rabbit testes and spermatogenesis from damage induced by hypercholesterolemia.

[Dyslipemia in diabetics treated with statins. Results of the DYSIS study in Spian]

BACKGROUND AND OBJECTIVE

Type 2 diabetes mellitus (DM2) is characterized by carrying a high cardiovascular risk. This situation underscores the importance of intensively treating the risk factors present in diabetic patients, notably dyslipemia. The treatment with cholesterol-lowering drugs may be especially effective to reduce the cardiovascular risk in diabetic patients. Therefore, LDL-cholesterol is a priority target in the lipid management of these patients. This study analyzes the alterations in the lipid profile of diabetic patients receiving treatment with statins, which therefore may contribute to persistent cardiovascular risk in such individuals.

PATIENTS AND METHODS

The DYSIS (Dyslipidemia International Study) is an international, observational trial analyzing the lipid profile of patients treated with statins and followed-up on in outpatient clinics by primary care physicians and specialists. This study is referred to the data on the diabetic patients.

RESULTS

Of the total patients enrolled in the DYSIS, the present study included 3703 patients, 39% being diabetics. A total of 59.2% of diabetics showed LDL-C out of goal; triglyceride elevation was observed in 43.6% and 36.4% showed low HDL-C. In diabetics patients with coronary heart disease, 31% had uncontrolled levels of all three lipid parameters. The prevalence of out of goal LDL-C in diabetic patients with metabolic syndrome was close to 60%; 39.8% had low levels of HDL-C and 46,6% high levels of triglycerides. In addition, 57% of diabetic patients with obesity showed LDL-C out of control, despite statins treatment.

CONCLUSIONS

Cardiovascular diseases remain the main cause of morbidity-mortality in patients with DM2. The results of the present study show that in diabetic patients the degree of control is very limited with regard to LDL-cholesterol. More than half of diabetic patients treated with statins had LDL-cholesterol out of goal. The level of dyslipidemia control was low, despite statins treatment. Therefore, the detection of atherogenic dyslipidemia may point to the advisability of using combination therapy for dyslipidemia in diabetic patients.

Treatment of dyslipidemia in chronic kidney disease: Effectiveness and safety of statins

Several cardiovascular (CV) risk factors may explain the high rate of CV death among patients with chronic kidney disease (CKD). Among them both traditional and uremia-related risk factors are implicated and, moreover, the presence of kidney disease represents “per se” a multiplier of CV risk. Plasma lipid and lipoprotein profiles are changed in quantitative, but above all in qualitative, structural, and functional ways, and lipoprotein metabolism is influenced by the progressive loss of renal function. Statin therapy significantly reduces cholesterol synthesis and both CV morbidity and mortality either directly, by reducing the lipid profile, or via pleiotropic effects; it is supposed to be able to reduce both the progression of CKD and also proteinuria. These observations derive from a post-hoc analysis of large trials conducted in the general population, but not in CKD patients. However, the recently published SHARP trial, including over 9200 patients, either on dialysis or pre-dialysis, showed that simvastatin plus ezetimibe, compared with placebo, was associated with a significant low-density lipoprotein cholesterol reduction and a 17% reduction in major atherosclerotic events. However, no benefit was observed in overall survival nor in preserving renal function in patients treated. These recent data reinforce the conviction among nephrologists to consider their patients at high CV risk and that lipid lowering drugs such as statins may represent an important tool in reducing atheromatous coronary disease which, however, represents only a third of CV deaths in patients with CKD. Therefore, statins have no protective effect among the remaining two-thirds of patients who suffer from sudden cardiac death due to arrhythmia or heart failure, prevalent among CKD patients. The safety of statins is demonstrated in CKD by several trials and recently confirmed by the largest SHARP trial, in terms of no increase in cancer incidence, muscle pain, creatine kinase levels, severe rhabdomyolysis, hepatitis, gallstones and pancreatitis; thus confirming the handiness of statins in CKD patients. Here we will review the latest data available concerning the effectiveness and safety of statin therapy in CKD patients.

Establishment of reference intervals in Indian population

The central role of the laboratory scientist is to aid the clinician, in interpreting observed values, by providing relevant reference values in a convenient and practical form. In India, reference values used in laboratories have been established in the western population. But these can be questioned due to differences in genetic load, lifestyle, and diet. This review highlights the approach for establishing reference values in our population using the IFCC guidelines and our observations from our data as compared to the reported values in our laboratory.

A rabbit model for studying hypocholesterolemic effect of drugs and hypocholesterolemic effect of extracts of garlic (Allium sativum)

An experimental model of hypercholesterolemic rabbits suitable for studying the hypocholesterolemic effect of compounds was developed. Rabbits were made hypercholesterolemic by oral administration of cholesterol (100mg/kg body weight/day) suspended in groud nut oil by gastric intubation (Ryle's tube). Cholesterol can be given to rabbits from 10 days to 6 months depending on the degree of hypercholesterolemia required and duration of study of hypocholesterolemic effect. In one month cholesterol feeding experiment, the serum cholesterol level in normal controls (not given cholesterol) was 67±11.3 mg/dl and in cholesterol fed animals 191.3±70.6 mg/dl. In 2 months experiment, besides hypercholesterolemia, abnormal serum lipid profile and increase in lipid content in liver, heart and aorta were also seen. To such animals when water and methanol extracts of garlic were given along with cholesterol, there was significant decrease in serum cholesterol level. The advantage of this method over the method in which cholesterol is mixed with diet to induce hypercholesterolemia is that exactly same and calculated amount of cholesterol can be given for each animal. This minimises the variations in serum cholesterol levels in different animals.

Hypercholesterolemia among apparently healthy university students

BACKGROUND

Hypercholesterolemia (HC) is a major risk factor in the development of coronary heart disease (CHD). Serum cholesterol is directly related to complications and mortalities associated with heart diseases. There are a few studies that describe HC among youths in the Arab Gulf countries. We sought to evaluate HC among young healthy university students to assess their risk of developing CHD.

METHODS

Lipid profile of 166 students between the ages of 16-30 years (Mean: 20.49±2.96) were examined and blood glucose, total protein, albumin, thyroid stimulating hormone (TSH) and the inflammation marker high sensitivity CRP (hsCRP) were determined. Each volunteer filled a questionnaire about her/his lifestyle and personal and family medical histories and height and weight were measured to determine body mass index (BMI). The data were analyzed using SPSS version 17. Chi-Square was used to determine the relation between categorical variables. A p-value <0.05 was considered statistically significant.

RESULTS

According to the American Heart Association criteria, 44 (26.5%) students were identified with primary hypercholesterolemia (PHC) in the first testing round. After proper health counseling, the same tests were repeated after 2-3 weeks in all 44 hypercholesterolemic students. We found only 26 (15.6%) of them to be hypercholesterolemic. There was a significant relation between high total cholesterol (TC) and high TC/HDLC, as well as high or very high hsCRP and high TC/HDLC (both, p<0.001). Males tend to have higher TC/HDLC and hsCRP than females (both p0.002 and 0.005, respectively). Family history of CHD was found in 8 students and obesity was recorded in 5 volunteers.

CONCLUSION

The results necessitate further studies in determining the cause of PHC. We predict a genetic element contributing to the high percentage of PHC in the current study.

Factors of compliance in patients with hypercholesterolemia using rosuvastatin in primary care

BACKGROUND

In order to evaluate the factors of compliance with a lipid lowering therapy, a prospective observational study of patients with hypercholesterolemia using rosuvastatin was carried out.

METHODS

A total of 2,607 patients who were newly prescribed rosuvastatin were enrolled from 32 family physicians in Korea from March 2009 to December 2009. Of them, 301 patients were excluded due to incomplete data or follow-up compliance data. The patients were regularly observed to ascertain the compliance associated with rosuvastatin at intervals of 12 and 24 weeks. We collected risk factors for the compliance using a structured questionnaire. The criteria for evaluating compliance are to measure clinic attendance, to assess the continuity of therapy, and to calculate the percentage of doses taken.

RESULTS

Among a total of 2,306 patients, the degree of compliance was 54.1%. According to logistic regression analysis, the factors for compliance with the lipid lowering drug included old age (odds ratio [OR], 2.68; 95% confidence interval [CI], 2.09 to 3.45), frequent exercise (OR, 1.76; 95% CI, 1.43 to 2.18), previous statin therapy (OR, 4.02; 95% CI, 3.22 to 5.01), hypertension (OR, 1.80; 95% CI, 1.48 to 2.19), diabetes mellitus (OR, 2.20; 95% CI, 1.69 to 2.87), concomitant medication (OR, 2.28; 95% CI, 1.88 to 2.77), and high coronary heart disease (CHD) risk category (OR, 1.82; 95% CI, 1.39 to 2.38). The compliance decreased with high low density lipoprotein cholesterol levels (OR, 0.20; 95% CI, 0.16 to 0.26).

CONCLUSION

The compliance of patients using rosuvastatin was 54.1% in primary care. The factors related to higher compliance were old age, regular exercise, previous statin therapy, concomitant medication, presence of hypertension or diabetes, and higher CHD risk level.

Neoadjuvant hormonal therapy use and the risk of death in men with prostate cancer treated with brachytherapy who have no or at least a single risk factor for coronary artery disease

BACKGROUND

Neoadjuvant hormone therapy (NHT) use is associated with an increased risk of all-cause mortality (ACM) in men with a history of coronary artery disease (CAD)-induced congestive heart failure (CHF) or myocardial infarction (MI). However, its effect in men with no or at least a single risk factor for CAD stratified by prostate cancer (PCa) aggressiveness is unknown.

OBJECTIVE

To assess whether NHT use affects the risk of ACM in men with low-, intermediate-, and high-risk PCa treated with brachytherapy who have no or at least a single risk factor for CAD.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective study cohort consisted of 5411 men with low-risk PCa (prostate-specific antigen [PSA] <10 ng/ml, Gleason score 6, and clinical stage T1-T2a); 4365 men with intermediate-risk PCa (PSA 10-20 ng/ml or Gleason score <8 or clinical stage <T3); and 1360 men with localized or locally advanced, high-risk PCa consecutively treated in a community-based, multi-institutional setting between 1991 and 2006. CAD risk factors included at least a history of diabetes mellitus, hypercholesterolemia, or hypertension. The median follow-up for men with low-, intermediate-, and high-risk PCa were 4.1, 4.4, and 4.6 yr, respectively.

INTERVENTIONS

Men were treated with or without a median duration of 4 mo of NHT followed by brachytherapy with or without supplemental external-beam radiation therapy (EBRT).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Cox regression multivariable analyses were performed to assess whether NHT use affected the risk of ACM in men with low-, intermediate-, and high-risk PCa, adjusting for age; year of brachytherapy; supplemental EBRT use; the presence of CAD risk factors; treatment propensity score; and known PCa prognostic factors, including pretreatment PSA level, biopsy Gleason score, and clinical stage.

RESULTS AND LIMITATIONS

NHT use was associated with a significantly increased risk of ACM in men with low-risk PCa (adjusted hazard ratio [HR]: 1.27; 95% confidence interval [CI], 1.07-1.51; p<0.01) but not in men with intermediate-risk (adjusted HR: 1.13; 95% CI, 0.96-1.35; p=0.15) or high-risk PCa (adjusted HR: 0.86; 95% CI, 0.66-1.13; p=0.28). Using an interaction model for the low-risk group, NHT use was associated with a significantly increased risk of ACM in the subgroup of men with at least a single CAD risk factor (adjusted HR: 1.36; 95% CI, 1.07-1.74; p=0.01) but not for men with no CAD risk factors (adjusted HR: 1.19; 95% CI, 0.95-1.51; p=0.13).

CONCLUSIONS

For men with no or at least a single risk factor for CAD, NHT use is associated with an increased risk of ACM in the setting of low-risk but not intermediate- or high-risk PCa. This effect is driven by the subgroup of men with at least a single risk factor for CAD. These results warrant prospective validation given the widespread use of NHT for prostate downsizing prior to brachytherapy.

Regulation and deregulation of cholesterol homeostasis: The liver as a metabolic "power station"

Cholesterol plays several structural and metabolic roles that are vital for human biology. It spreads along the entire plasma membrane of the cell, modulating fluidity and concentrating in specialized sphingolipid-rich domains called rafts and caveolae. Cholesterol is also a substrate for steroid hormones. However, too much cholesterol can lead to pathological pictures such as atherosclerosis, which is a consequence of the accumulation of cholesterol into the cells of the artery wall. The liver is considered to be the metabolic power station of mammalians, where cholesterol homeostasis relies on an intricate network of cellular processes whose deregulations can lead to several life-threatening pathologies, such as familial and age-related hypercholesterolemia. Cholesterol homeostasis maintenance is carried out by: biosynthesis, via 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGR) activity; uptake, through low density lipoprotein receptors (LDLr); lipoprotein release in the blood; storage by esterification; and degradation and conversion into bile acids. Both HMGR and LDLr are transcribed as a function of cellular sterol amount by a family of transcription factors called sterol regulatory element binding proteins that are responsible for the maintenance of cholesterol homeostasis through an intricate mechanism of regulation. Cholesterol obtained by hepatic de novo synthesis can be esterified and incorporated into apolipoprotein B-100-containing very low density lipoproteins, which are then secreted into the bloodstream for transport to peripheral tissues. Moreover, dietary cholesterol is transferred from the intestine to the liver by high density lipoproteins (HDLs); all HDL particles are internalized in the liver, interacting with the hepatic scavenger receptor (SR-B1). Here we provide an updated overview of liver cholesterol metabolism regulation and deregulation and the causes of cholesterol metabolism-related diseases. Moreover, current pharmacological treatment and novel hypocholesterolemic strategies will also be introduced.

Relation between Body Humors and Hypercholesterolemia: An Iranian Traditional Medicine Perspective Based on the Teaching of Avicenna

BACKGROUND

Cardiovascular diseases are among the most important causes of morbidity and mortality in the world. One of the important risk factors of cardiovascular disease is hyperlipidemia especially high levels of serum cholesterol. Due to the importance of hypercholesterolemia, being a serious condition, various treatments are used to control it, regardless of the cause, most of treatments, focused on reducing the level of serum lipids. This study aims to determine various view points for hypercholesterolemia in Iranian traditional medicine.

METHODS

We used several Iranian traditional medicine resources and literatures; then based on these texts; a pilot study was designed to assess their effects in 10 patients with high plasma cholesterol. The sign and symptoms in main digestive organs (Stomach and liver) were also evaluated.

RESULTS

Some patients showed hepatic temperament but all patients had gastric temperament.

CONCLUSION

With reference to Iranian traditional medical texts and literatures, the organs involved in the process of digestion, particularly the stomach and the liver play the most important role. Yet the proper function of stomach as the first step involved in the digestion chain should be emphasized.

Anti-hypercholesterolemic and anti-atherosclerotic effects of polarized-light therapy in rabbits fed a high-cholesterol diet

The effects of polarized-light therapy (PLT) on high-cholesterol diet (HCD)-induced hypercholesterolemia and atherosclerosis were investigated in comparison with that of lovastatin in rabbits. Hypercholesterolemia was induced by feeding male New Zealand white rabbits with 1% cholesterol in diet for 2 weeks and maintained with 0.5% cholesterol for 6 weeks, followed by normal diet for 2 weeks for recovery. Lovastatin (0.002% in diet) or daily 5-min or 20-min PLT on the outside surface of ears was started 2 weeks after induction of hypercholesterolemia. Hypercholesterolemic rabbits exhibited great increases in serum cholesterol and low-density lipoproteins (LDL) levels, and finally severe atheromatous plaques formation covering 57.5% of the arterial walls. Lovastatin markedly reduced both the cholesterol and LDL, but the reducing effect (47.5%) on atheroma formation was relatively low. By comparison, 5-min PLT preferentially decreased LDL, rather than cholesterol, and thereby potentially reduced the atheroma area to 42.2%. Notably, 20-min PLT was superior to lovastatin in reducing both the cholesterol and LDL levels as well as the atheromatous plaque formation (26.4%). In contrast to the increases in blood alanine transaminase and aspartate transaminase following lovastatin treatment, PLT did not cause hepatotoxicity. In addition, PLT decreased platelets and hematocrit level. The results indicate that PLT attenuates atherosclerosis not only by lowering blood cholesterol and LDL levels, but also by improving blood flow without adverse effects. Therefore, it is suggested that PLT could be a safe alternative therapy for the improvement of hypercholesterolemia and atherosclerosis.

Experimentally-Induced Metabolic Acidosis Does not Alter Aortic Fatty Streak Formation in High-Cholesterol Fed Rabbits

OBJECTIVES

Cardiovascular disease causes a major clinical problem in patients with end stage renal disease. Since metabolic acidosis is very common in patients with end stage renal disease, we aimed to investigate the effect of experimentally-induced metabolic acidosis on serum lipid profile and aortic fatty streak (FS) formation in normal and high-cholesterol fed rabbits.

MATERIALS AND METHODS

Twenty-four male rabbits were divided into four groups (n=6 each): (1) normal diet (ND): (2) hypercholesterolemic diet (HCD) (1%): (3) ND plus acidemic diet: (4) HCD plus acidemic diet. Metabolic acidosis was induced by adding 0.75% NH4Cl in drinking water. After 4 weeks, blood samples were taken and thoracic aortae were dissected for histological examinations.

RESULTS

Results showed that in the animals who received NH4Cl, metabolic acidosis was successfully induced. Serum total cholesterol and low density lipoprotein (LDL) concentrations in HCD groups were significantly higher than ND groups (P<0.05) and acidosis did not significantly change serum lipid levels neither in ND nor in HCD animals (P>0.05). Histological examination of aortae showed higher mean average grades of pathological evaluation in HCD than ND groups (2.1±0.16 vs. 0±0; P<0.05). Acidosis did not further increase FS formation in HCD groups (P >0.05).

CONCLUSION

In this model of experimentally-induced metabolic acidosis, acidosis could not increase FS formation in HCD animals and it seems that it does not interfere in progression of atherosclerosis process.

Effect of rosuvastatin on systemic blood pressure in patients with hypercholesterolemia

OBJECTIVE

To investigate whether rosuvastatin reduces blood pressure (BP) in patients with hypercholesterolemia.

METHODS

The present study investigated the effect of rosuvastatin on lipids and clinical parameters in 25 patients with a mean (± SD) age of 58.4±10.6 years over a three-month period.

RESULTS

Rosuvastatin (2.5 mg/day to 5.0 mg/day) reduced systolic BP from 136.3±13.1 mmHg to 130.8±10.7 mmHg (P<0.01), along with a significant reduction in serum low-density lipoprotein cholesterol level (P<0.01). The patients were divided into two groups: 13 responders whose BP decreased by >5 mmHg with rosuvastatin treatment and 12 nonresponders who showed a BP reduction of ≤5 mmHg. Baseline systolic BP was significantly higher in responders than nonresponders (143.6±9.6 mmHg versus 128.4±11.9 mmHg, respectively; P<0.01). Responders also had a lower serum concentration of high-sensitivity C-reactive protein compared with nonresponders (0.11±0.07 mg/dL versus 0.40±0.28 mg/dL; P<0.01). The extent of BP reduction was positively correlated with baseline systolic BP (r=0.585; P=0.0021) but not with the reduction of low-density lipoprotein cholesterol level. Among the patients with baseline systolic BP >130 mmHg, all 11 responders (138.3 mmHg) were nonsmokers, while five of six nonresponders (145.7 mmHg) were smokers.

CONCLUSION

Rosuvastatin had an additive antihypertensive effect in patients with poorly controlled hypertension that was independent of its lipid-lowering effect, which may be related to an inflammatory mechanism.

Efficiency of black cumin seeds on hematological factors in normal and hypercholesterolemic rabbits

BACKGROUND

Hypercholesterolemia is among the most common health problems treated with traditional remedies. Nigella sativa (NS) is an effective plant for treating hypercholesterolemia. However, the effects of this herb on hematologic factors and hemostasis system have not been elucidated. This study was designed to investigate the effects of NS on these factors in both normal and hypercholesterolemic rabbits.

METHODS

In this research, twenty rabbits were randomly distributed into four groups of five. The groups received four different diets, namely normal, normal + NS (5%), hypercholesterolemic (1% cholesterol), and hypercholesterolemic (1% cholesterol) + NS (5%), for 8 weeks. After this period, WBC (white blood cell), RBC (red blood cell), HTC (hematocrit), HGB (hemoglobin content), PLT (platelet), fibrinogen (FIB) and factors VII (F VII) were measured.

RESULTS

Using NS significantly increased PLT count in the normal group. In addition, it significantly decreased WBC counts in the hypercholesterolemic group (P < 0.05). However, dietary use of NS did not have any effects on other hematologic factors including RBC, HTC, HGB, FIB, and F VII (P < 0.05).

CONCLUSION

Increased PLT numbers might cause enhanced coagulation. The achieved results call for more research on the effects of various diets (hypercholesterolemic and normal diet) supplemented with NS on different coagulation factors and hemostasis system.

Low Density Lipoprotein Cholesterol Target Goal Attainment Rate and Physician Perceptions about Target Goal Achievement in Korean Patients with Diabetes

BACKGROUND

This study aims to investigate the discrepancy between clinicians' perceptions and actual achievement rates of low density lipoprotein cholesterol (LDL-C) in Korean patients with diabetes according to updated American Diabetes Association (ADA)/American College of Cardiology Foundation (ACC) recommendations.

METHODS

This is a multi-center, retrospective, non-interventional, observational study. Diabetic patients aged 18 years or older were eligible if they had been diagnosed with hypercholesterolemia or were receiving a lipid-lowering therapy between May 2010 and August 2010. The information was obtained by reviewing medical records and using a self-completed questionnaire to examine physician perceptions.

RESULTS

A total of 2,591 subjects who satisfied the inclusion criteria were enrolled. Highest-risk and high-risk patients accounted for 61.9% and 38.1% of the patients, respectively. Although most (96.3%) underwent a statin monotherapy or a statin-based combination therapy, just 47.4% of patients attained the LDL-C target. However, the physicians' perceptions on target achievement rate (70.6%) were different from the actual results (47.4%). Many patients (65.3%) remained on the starting doses of statins, despite evidence of poor achievement of lipid goals.

CONCLUSION

Only less than half of patients with diabetes attained the LDL-C goal. The surveys showed that poor physician performance might be due to the lack of recognition on ADA/ACC consensus causing a low LDL-C target attainment rate. Therefore, changes in doctor perception are needed to attain target LDL-C level and reduce cardiovascular risk in Korean patients with diabetes.

An Interesting Case of Familial Homozygous Hypercholesterolemia-A Brief Review. Indian J Clin Biochem. 2012;27:309-313. [PMID: 26405394 DOI: 10.1007/s12291-011-0165-8]

Familial hypercholesterolemia (FH) is a form of primary hyperlipoproteinemia, is an autosomal co-dominant disorder, characterized by an increase in serum LDL cholesterol concentrations, presence of xanthomas and premature atherosclerosis. Homozygous familial hypercholesterolemia is of rare occurence in which approximately 1 in 1 million persons in the general population are affected. Here we report an interesting case of familial homozygous hypercholesterolemia for its classical presentation and rarity.

The antiatherogenic, renal protective and immunomodulatory effects of purslane, pumpkin and flax seeds on hypercholesterolemic rats

BACKGROUND

Atherosclerosis remains one of the leading causes of death all over the world. Flax, pumpkin and purslane seeds are rich sources of unsaturated fatty acids, antioxidants and fibers, known to have antiatherogenic activities.

AIMS

This study was to examine the efficiency of using either flax/pumpkin or purslane/pumpkin seed mixture (components of ω-3 and ω-6) on hyperlipidemia, kidney function and as immunomodulators in rats fed high cholesterol diets.

MATERIALS AND METHODS

40 male albino rats were divided into four groups: control group, hypercholesterolemic rats, fed the balanced diet supplemented with cholesterol at a dose level of 2 g/100 g diet; the other two groups of animals fed the same previous hypercholesterolemic diet supplemented with either flax/pumpkin seed mixture or pumpkin/purslane seed mixture at ratio of (5/1) (ω-3 and ω-6).

RESULTS

The present study showed that 2% cholesterol administration caused a significant increase in total cholesterol, total lipids, and triacylglycerol in both serum and liver. Serum phospholipids, LDL-C, and atherogenic index AI also significantly increased compared to control group. Cholesterol-enriched diet significantly increased serum urea, creatinine, sodium and potassium levels as well as significantly increased serum IgG and IgM compared to healthy control. Consumption of flax/pumpkin or purslane/pumpkin seed mixtures by hypercholesterolemic rats resulted in a significantly decrement in lipid parameters and significant improvement in IgG and IgM levels as compared with hypercholesterolemic rats.

CONCLUSION

Our results suggests that both flax/pumpkin and purslane/pumpkin seed mixtures had anti-atherogenic hypolipidemic and immunmodulator effects which were probably mediated by unsaturated fatty acids (including alpha linolenic acid) present in seed mixture.

Vascular Dysfunction in Short-Term Hypercholesterolemia despite the Absence of Atherosclerotic Lesions

INTRODUCTION

The atherosclerotic effect of hypercholesterolemia on the vascular function is well-known. However, limited studies were done on the effect of hypercholesterolemia without atherosclerotic lesion on the vascular compliance. The aim of this study was to investigate the effects of hyperlipidemia induced by cholesterol rich diet on vessel function in isolated rat aorta in the absence of atherosclerotic lesion.

METHODS

Male wistar rats were randomly divided into 3 groups of 6 animals in each. The rats in normal control group were fed a standard laboratory diet and two other groups were fed a high fat diet for 36 days. A group of high fat fed rats was treated orally with Lovastatin started at day of 16 and continued for last 20 days of the experimental period. At the end of the experiment, inferior vena cava blood was collected to measure the lipid levels and the thoracic aorta was excised and used for isolated vessel preparation and histological study.

RESULTS

The results of this study indicated that high-cholesterol diet significantly increased total cholesterol and LDL levels in serum (p<0.001). The increase in the serum levels of cholesterol was associated with a profound reduction of endothelium dependent vasodilatation of the thoracic aorta. However, in histopathological study no atherosclerotic lesion was observed. Short-term treatment by Lovastatin (10 mg/kg/day) produced a significant reduction (p<0.05) in the level of total cholesterol and LDL. The endothelium-dependent vasodilatation was improved significantly (P<0.01) by Lovastatin as an anti-hyperlipidemic drug.

CONCLUSION

Hypercholesterolemia is associated with endothelial dysfunction in aorta, despite the absence of atherosclerotic lesions.

Prevalence of dyslipidemia among Iranian patients with idiopathic tinnitus

BACKGROUND

Tinnitus is a sense of sound perception in absence of an external source which can affect life quality. Different conditions may lead to tinnitus including metabolic disorders such as dyslipidemia. The aim of this study was to investigate the prevalence of dyslipidemia among Iranian patients with idiopathic tinnitus.

METHODS

This was a cross-sectional study in which prevalence of dyslipidemia in fasting state and its subclasses were assessed in 1043 tinnitus patients aged 12-90 years who referred to Rasool Akram Hospital, Tehran, Iran, 2006-2009. Data was summarized by SPSS software version 17 and one sample t-test and Chi-Square test were applied to analyze the results. P less than 0.05 were considered significant.

RESULTS

The most prevalent type of dyslipidemia was hypercholesterolemia with the frequency of 14.4% followed by low HDL-C with the frequency of 12.8%. Mean of total cholesterol, HDL-C, LDL-C and triglyceride levels in all patients were not greater than general population.

CONCLUSIONS

Based on the results of the present study, there might be no need to check the serum lipid profile in tinnitus patients. We recommend further studies to assess both fasting and postprandial serum lipid profile in patients with idiopathic tinnitus. Simultaneous investigation of their dietary intake is also suggested.

Protective effects of Morus alba leaves extract on ocular functions of pups from diabetic and hypercholesterolemic mother rats

Phytotherapy is frequently considered to be less toxic and free from side effects than synthetic drugs. Hence, the present study was designed to investigate the protective use of crude water extract of Morus alba leaves on ocular functions including cataractogenesis, biochemical diabetic and hypercholesterolemic markers, retinal neurotransmitters and retinopathy of rat pups maternally subjected to either diabetes and/or hypercholesterolemia. Application of crude water extract of Morus alba resulted in amelioration of the alterations of maternal serum glucose, LDL, HDL, total cholesterol and creatine phosphokinase activity as well as retinal neurotransmitters including acetylcholine (ACE), adrenaline (AD), nor-adrenaline (NAD), serotonin (5-HT), histamine (HS), dopamine (DA) and gamma amino butyric acid (GABA). The retina of pups of either diabetic and/or hypercholesterolemia mothers exhibited massive alterations of retinal neurotransmitters. The alterations of retinal neurotransmitters were correlated with the observed pathological alterations of retinal pigmented epithelium, photoreceptor inner segment and ganglion cells and increased incidence of DNA fragmentation and apoptosis cell death. However, protection with Morus alba extract led to amelioration of the pathological alterations of retinal neurons and estimated neurotransmitters. Furthermore, a striking incidence of cataract was detected in pups of either diabetic and/or hypercholesterolemic mothers. Highest cataractogenesis was observed in pups of combined -treated groups. Our data indicate that experimental maternal diabetes alone or in combination with hypercholesterolemia led to alteration in the ocular structures of their pups, with an increasing incidence of cataract and retinopathy, and the effects of the extract might be attributed to the hypoglycaemic, antihypercholesterolemic and anti-oxidative potential of flavonoids, the major components of the plant extract.

Antihyperlipidemic and antioxidant effects of the mixture of ginseng radix and crataegi fructus: experimental study and preliminary clinical results

The mixture of Ginseng Radix and Crataegi Fructus (Gen-CF) was developed to increase the pharmacological effect of ginseng in the treatment of hypercholesterolemia and prevention of cardiovascular disease. This study evaluated the effects of Gen-CF on serum lipids of hypercholesterolemic rats in vivo, as well as its antioxidant activities in vitro, and explored its clinical effects on patients with hypercholesterolemia. In vitro, Gen-CF displayed 1,1-diphenyl-2-picrylhydrasyl and superoxide radical scavenging activities, and inhibited hemolysis induced by 2,2'-azobis-2-amidinopropane dihydrochloride in a dose-dependent manner. In vivo, Gen-CF significantly inhibited the increases of total cholesterol, low-density lipoprotein cholesterol and triglyceride in high cholesterol-diet and Triton WR-1339 models. It also significantly inhibited the decrease of high-density lipoprotein cholesterol in these models. In the clinical trial, Gen-CF significantly lowered total cholesterol, low-density lipoprotein cholesterol, triglyceride, total lipid and phospholipid, with no adverse events, including hepatic or renal toxicity. The data suggest that Gen-CF has the potential to treat hypercholesterolemia and prevent cardiovascular disease.

Protective effect of probucol on liver injury induced by carbon tetrachloride in rats. Hepatol Int. 2011;5:899-905. [PMID: 21484128 DOI: 10.1007/s12072-011-9256-0]

AIM

To explore protective effect of probucol on liver injury induced by carbon tetrachloride (CCl4) in rats.

METHODS

We used CCl4 to induce a rat model of liver injury. Some of those rats were treated with an oral administration of probucol. Liver function, blood lipid, liver tissue malondialdehyde (MDA), superoxide dismutase (SOD), and degree of liver fibrosis were analyzed.

RESULTS

Probucol significantly decreased the elevation of serum aspartate transaminase, total bile acid, alkaline phosphatase and cholesterol, and improved liver histopathological changes (including fatty infiltration, inflammation cell infiltration, and fibrosis), decreased liver tissue MDA level, and increased liver tissue SOD level in liver injury rats.

CONCLUSIONS

For the first time, we demonstrated that probucol has protective effect against liver injury in animal experiment. The antioxidant action of probucol may play an important role in its hepatoprotective mechanism. Probucol also can reduce serum cholesterol. Thus, probucol may have the potential use in clinical liver diseases in which oxidative stress may be present, especially for the patients with hypercholesterolemia.

Improvement of lipid profile and antioxidant of hypercholesterolemic albino rats by polysaccharides extracted from the green alga Ulva lactuca Linnaeus

Sulfated polysaccharides from Ulva lactuca were extracted in hot water and precipitated by ethanol then orally gavaged to rats fed on a hypercholesterolemic diet for 21 days to evaluate the antihypercholesterolemic and antioxidant actions. Atorvastatine Ca (Lipitor) was used as a reference drug. The intragastric administration of U. lactuca extract to hypercholesterolemic rats caused significant decrease of serum total lipids, triglycerides, total cholesterol, LDL-cholesterol and vLDL-cholesterol levels. Whereas, HDL-cholesterol concentration was markedly increased by 180%. Aqueous extract showed a significant ameliorative action on elevated atherogenic index, creatine kinase and lactate dehydrogenase activities of hypercholesterolemic group. Furthermore, serum activities of transaminases and alkaline phosphatase were also improved. High fat diet intake caused a highly significantly elevated serum urea, creatinine concentration. These effects were reversed by oral administration of U. lactuca extract. Sulfates polysaccharides extract of U. lactuca ameliorate hepatic enzymatic (catalase, glutathione peroxidase and superoxide dismutase), non-enzymatic (reduced glutathione & total thiol) antioxidant defenses and thiobarbituric acid reactive substances. In conclusion, the tested U. lactuca polysaccharides extract has potent hypocholesterolemic and antioxidant effects in experimentally-induced hypercholesterolemic animal model.

A retrospective study on the efficacy of a ten-milligram dosage of atorvastatin for treatment of hypercholesterolemia in type 2 diabetes mellitus patients

Background

There have been few clinical studies on 10 mg atorvastatin as a starting dosage for treatment of hypercholesterolemia in type 2 diabetes mellitus (T2DM) patients. This retrospective study aims to evaluate the efficacy of 10 mg dosage of atorvastatin in clinical setting.

Methods

One hundred five enrolled patients with high levels of low density lipoprotein cholesterol (LDL-C, > 100 mg/dL) took 10 mg atorvastatin. After 6 months, they were divided into 'Responder group' (LDL-C < 100 mg/dL) and 'Non-responder group' (LDL-C ≥ 100 mg/dL), and the response rate was calculated. Thereafter, we subdivided the 'Responder group' into Maintenance (10 mg), Reduced dosage (5 mg), and Discontinuance group (0 mg). The 'Non-Responder group' was subdivided into Maintenance (10 mg) and Double dosage group (20 mg). After consecutive 6 months, the response rates of each 10 mg Maintenance groups were compared to those of the other groups, respectively.

Results

Following the first 6 months, the response rate of 10 mg fixed dosage was 74.3%. In the 'Responder group', response rates of 10 mg, 5 mg and Discontinuance groups following 6 months were 52.6%, 53.1%, and 12.5%, respectively. In the 'Non-responder group', response rates of 10 mg and 20 mg groups were 28.6% and 50.0%. Baseline LDL-C levels and body mass index (BMI) of 'Responder group' were significantly lower than those of 'Non-responder group' (P = 0.004, respectively).

Conclusion

Hypercholesterolemia treatment with 10 mg, fixed dosage of atorvastatin was effective in three quarters of the subjects during the first 6-month treatment; however, a significant number of patients with high LDL-C levels and/or BMI require higher starting and maintenance dosage.

Hypocholesterolemic effects of Auricularia auricula ethanol extract in ICR mice fed a cholesterol-enriched diet

The cholesterol-lowering properties of Auricularia auricula are commonly attributed to the presence of polysaccharides based on previous research. The present study was designed to investigate the effects of ethanol extract of A. auricula (AAE) on hypercholesterolemia in ICR mice. AAE contained more than 16% (g/g) polyphenolic compounds, excluding other interfering factors such as polysaccharides, water-soluble fibre and protein. Thirty-six mice were randomly assigned to three groups (n = 12). The experimental group was fed cholesterol-enriched diet (CED) with oral administration of AAE (150 mg/kg/d b.w.) for 8-week, normal control group and CED control group received either a regular diet (RD) or CED along with oral administration of equal volume distilled water. Serum lipid profiles and antioxidant status were measured in addition to fecal neutral cholesterol and bile acids. AAE showed a remarkable hypocholesterolemic effect, improving antioxidant status, decreasing the level of total cholesterol and atherosclerosis index, increasing the level of high-density lipoprotein cholesterol and fecal excretion of bile acids. No apparent effects on serum triglycerides, low-density lipoprotein cholesterol, fecal excretion of neutral cholesterol and feeding efficiency were observed among all groups. These results indicated that A. auricula functional components, which prevented hypercholesterolemia contained polyphenolic compounds, in addition to polysaccharides.

Effects of Phyllanthus reticulatus on lipid profile and oxidative stress in hypercholesterolemic albino rats

OBJECTIVE

This study was designed to investigate the effect of Phyllanthus reticulatus on lipid profile and oxidative stress in hypercholesterolemic albino rats.

MATERIALS AND METHODS

Hypercholesterolemia was induced in albino rats by administration of atherogenic diet for 2 weeks. Experimental rats were divided into different groups: normal, hypercholesterolemic control and P. reticulatus treated (250 and 500 mg/kg body weight doses for 45 days). After the treatment period of 45(th) day triglyceride, VLDL-cholesterol, HDL-cholesterol, total cholesterol (TC), LDL-cholesterol and oxidative stress (protein carbonyl) were assayed and compared with hypercholesterolemic control.

RESULTS

The aqueous extract of P. reticulatus (250 mg and 500 mg/kg) produced significant reduction (P < 0.05) in triglyceride, VLDL-cholesterol, total cholesterol (TC), LDL-cholesterol and oxidative stress (protein carbonyl) while increased HDL-cholesterol in atherogenic diet-induced hypercholesterolemic rats at the end of the treatment period (45 days). However, the reduction in the above parameters was comparable with hypercholesterolemic control. Thus, aqueous extract of P. reticulatus is effective in controlling TC, lipid profile and oxidative stress in hypercholesterolemic animals.

CONCLUSION

The results suggest the aqueous extract of P. reticulatus can be utilized for prevention of atherosclerosis in hypercholesterolemic patients.

Risk factors for senile corneal arcus in patients with acute myocardial infarction

PURPOSE

To investigate the association between senile corneal arcus and atherosclerosis risk factors in patients with recent acute myocardial infarction.

METHODS

In this cross sectional study, atherosclerosis risk factors including fasting blood sugar, total cholesterol and triglyceride levels were measured in 165 patients with recent (less than three months' duration) acute myocardial infarction. Slitlamp examination was performed to detect corneal arcus. Associations between senile corneal arcus and atherosclerosis risk factors were assessed.

RESULTS

Overall, 165 patients including 100 male and 65 female subjects with mean age of 62±10.3 years were evaluated. In 122 patients (74%), variable degrees of corneal arcus were observed. The presence of corneal arcus was significantly associated with age (P = 0.03) and high levels of total cholesterol (over 200 mg/dl, P < 0.01). After adjusting for age, arcus was not associated with sex (P = 0.10), hypertriglyceridemia (P = 0.09), fasting blood sugar (P = 0.06), or systemic hypertension (P = 0.08).

CONCLUSION

Our study revealed that corneal arcus is associated with age and hypercholesterolemia in patients with recent acute myocardial infarction. No association was detected with sex, fasting blood sugar, hypertension, and hypertriglyceridemia.

Antihyperlipidemic effect of peucedanum pastinacifolium extract in streptozotocin-induced diabetic rats

INTRODUCTION

Dyslipidemia is one of the most common complications of diabetes mellitus, significantly contributing to cardiovascular morbidity and mortality in diabetic patients. Peucedanum pastinacifolium Boiss. & Hausskn. is commonly used as an antihyperlipidemic vegetable in Iranian folk medicine.

MATERIAL AND METHODS

In this study, we examined a hydroalcoholic extract of the aerial parts of Peucedanum pastinacifolium to determine its lipid-lowering activity in normal and streptozotocin (STZ)-induced diabetic rats. Experimental diabetes mellitus was induced by a single intraperitoneal administration of streptozotocin. Normal and streptozotocin-induced diabetic rats were separated into four groups. The groups were fed with 0, 125, 250 or 500 mg/kg body weight of Peucedanum Pastinacifolium hydroalcoholic Extract (PPE) in aqueous solution for 30 days.

RESULTS

The results show that there were significant (P < 0.05) increases in total serum cholesterol, triglyceride and low-density lipoprotein cholesterol (LDL-C) and a decrease in high-density lipoprotein cholesterol (HDL-C) in streptozotocin-induced diabetic rats. Treatment of diabetic rats with PPE over a period of a month returned these levels close to control levels.

CONCLUSION

These results suggest that PPE has hypolipidemic effects in streptozotocin-induced diabetic rats.

Fenofibrate Reduces Age-related Hypercholesterolemia in Normal Rats on a Standard Diet

Plasma cholesterol is increased in normal aging in both rodents and humans. This is associated with reduced elimination of cholesterol and decreased receptor-mediated clearance of plasma low-density lipoprotein (LDL) cholesterol. The aims of this study were: (1) to determine age-related changes in plasma lipid profiles, and (2) to determine the effect of fenofibrate, an activator of peroxisome proliferator activated receptor alpha (PPAR alpha), on plasma lipid profiles in normal rats on a standard diet. Male Sprague-Dawley (SD) rats (n=15) were fed standard chow and water from 10 to 25 weeks of age. During that period, we measured daily food intake, body weight, fasting and random blood glucose levels, plasma total cholesterol (TC), triglycerides (TG), and free fatty acid (FFA) levels. At 20 weeks of age, all rats were randomly divided into two groups: a fenofibrate group (in which rats were gavaged with 300 mg/kg/day of fenofibrate) and a control group (gavaged with water). Fenofibrate treatment lasted 5 weeks. There were no significant changes in daily food intake, blood glucose, and plasma TG level with age. Body weight, plasma TC, and FFA levels were significantly increased with age. Fenofibrate significantly decreased plasma concentrations of TC and FFA, which had been increased with age. However, fenofibrate did not influence the plasma concentration of TG, which had not increased with age. These results suggest that fenofibrate might have a novel role in preventing age-related hypercholesterolemia in SD rats on a normal diet.

Comparative study of low doses of rosuvastatin and atorvastatin on lipid and glycemic control in patients with metabolic syndrome and hypercholesterolemia

BACKGROUND/AIMS

This multicenter, open-labeled, randomized trial was performed to compare the effects of rosuvastatin 10 mg and atorvastatin 10 mg on lipid and glycemic control in Korean patients with nondiabetic metabolic syndrome.

METHODS

In total, 351 patients who met the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for metabolic syndrome with low-density lipoprotein cholesterol (LDL-C) levels > or = 130 mg/dL were randomized to receive either rosuvastatin 10 mg (n = 173) or atorvastatin 10 mg (n = 178) for over 6 weeks.

RESULTS

After 6 weeks of treatment, greater reductions in total cholesterol (- 35.94 +/- 11.38 vs. - 30.07 +/- 10.46%, p < 0.001), LDL-C (48.04 +/- 14.45 vs. 39.52 +/- 14.42%, p < 0.001), non-high-density lipoprotein cholesterol (- 42.93 +/- 13.15 vs. - 35.52 +/- 11.76%, p < 0.001), and apolipoprotein-B (- 38.7 +/- 18.85 vs. - 32.57 +/- 17.56%, p = 0.002) levels were observed in the rosuvastatin group as compared to the atorvastatin group. Overall, the percentage of patients attaining the NCEP ATP III goal was higher with rosuvastatin as compared to atorvastatin (87.64 vs. 69.88%, p < 0.001). Changes in glucose and insulin levels, and homeostasis model assessment of insulin resistance index were not significantly different between the two groups. The safety and tolerability of the two agents were similar.

CONCLUSIONS

Rosuvastatin 10 mg was more effective than atorvastatin 10 mg in achieving NCEP ATP III LDL-C goals in patients with nondiabetic metabolic syndrome, especially in those with lower NCEP ATP III target level goals.

Oxidative markers, nitric oxide and homocysteine alteration in hypercholesterolimic rats: role of atorvastatine and cinnamon

To investigate the effects of atorvastatin and cinnamon on serum lipid profile, oxidative stress, antioxidant capacity, hepatic enzymes activities, nitric oxide (NO) as well as homocysteine (Hcy) in hypercholesterolemic rats, 48 male albino rats, weighing 130-190 gm were divided into 2 groups, normal group fed on basal rat chow diet (n=12) and high cholesterol group (HCD) were fed on 1% cholesterol-enriched diet for 15 day (n=36). Hypercholesterolemic rats were divided into 3 subgroups (n=12 for each) fed the same diet and treated with atorvastatine (HCD+Atorvastatin) or cinnamon extract (HCD+cinnamon) or none treated (HCD) for 3&6 weeks. Serum triglycerides (TG), Total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), ALT, AST, NO, Hcy, hepatic reduced glutathione (GSH), Malondialdehyde (MDA) and antioxidant enzymes, Superoxide dismutase (SOD) and catalase activity were measured. Results showed that HCD increased significantly TG, TC, LDL-C, ALT, AST, Hcy and hepatic MDA, while lowered significantly antioxidant enzyme activities and NO levels. Atorvastatin therapy significantly increased HDL-C, NO and antioxidant activity while decreased LDL-C, MDA and Hcy concentrations. Serum TG, TC, LDL-C, ALT, AST and hepatic MDA levels were significantly lowered meanwhile, serum HDL, NO values and hepatic antioxidant activities were significantly, higher in cinnamon-treated than untreated group. These results indicate that lipid abnormalities, oxidative injury and hyperhomocystienemia were induced by HCD and this study recommend that administration of atorvastatine or cinnamon provided protection against the lipemic-oxidative disorder and act as hypocholesterolemic, hepatoprotective agent and improve cardiovascular function through modulation of oxidative stress, NO and Hcy.

Correlates of metabolic abnormalities in bipolar I disorder at initiation of acute phase treatment

OBJECTIVE

Treatment of bipolar patients is often complicated by metabolic abnormalities such as obesity, diabetes, and dyslipidemia. We therefore evaluated the prevalence of these abnormalities and their correlates, in bipolar I patients, at the time of commencement of pharmacological treatment for acute mood episodes.

METHODS

The study cohort consisted of 184 bipolar I patients hospitalized for treatment of acute mood episodes. Socio-demographic and clinical variables were noted and metabolic parameters, including body mass index, fasting plasma glucose, fasting total cholesterol, and current treatment(s) for diabetes and/or dyslipidemia were measured before initiating medication(s).

RESULTS

Fifty-six (30.4%) subjects met our criteria for obesity; 80 (43.5%) had hyperglycemia, with 8 (4.3%) receiving anti-diabetic medication; and 38 (20.7%) had hypercholesterolemia, with 2 (1.1%) receiving cholesterol-lowering agents. We found that male sex (chi(2)=5.359, p=0.021), depressed or mixed state versus manic state (chi(2)=4.302, p=0.038), and duration of illness (t=2.756, p=0.006) were significantly associated with obesity. Older age (t=3.668, p<0.001), later age of disease onset (t=2.271, p=0.024), and lower level of educational attainment (beta=-0.531, p=0.001) were associated with hyperglycemia.

CONCLUSION

Our finding that metabolic abnormalities are prevalent when initiating acute pharmacological treatment in bipolar I patients indicates that these factors should be integrated into treatment plans at the onset of disease management.

The combination of Ezetimibe and Statin: a new treatment for hypercholesterolemia

The combination of Simvastatin and Ezetimibe allows dual inhibition of both cholesterol production and absorption. This treatment approach allows achieving same low serum cholesterol levels with the administration of much lower doses of statins. This should reduce side effects, compared to statin only therapy, enabling more patients to achieve their LDL cholesterol treatment goals. With ezetimibe/simvastatin therapy, reductions of about 60% from baseline in LDL cholesterol have been shown. Concomitant improvement in other lipid fractions have also been demonstrated. The ezetimibe/simvastatin combination has been well tolerated, with a safety profile similar to that of statin therapy. This article will review clinical experience with ezetimibe/simvastatin combination, commenting upon its place and potential value in the prevention of cardiovascular disease.

Changes in potassium ion channel activity of the Oddi's sphincter smooth muscle cells from hypercholesterolemic rabbits

AIM: To study the changes of the contractile responses and potassium ion channel activity in sphincter of Oddi (SO) from rabbits with hypercholesterolemia (HC), and elucidate the underlying mechanisms responsible for these changes.

METHODS: A total of 24 New Zealand female rabbits were divided randomly into control group (n = 12) and HC group (n = 12). SO muscle rings were dissociated from the rabbits in both groups in vitro. The contractile responses of SO to potassium chloride (KCl) was observed firstly. Then the contractile responses evoked by tetraethylammonium (TEA) and 4-aminopyridine (4-AP) were measured. Western blot was employed to examine the expression of potassium ion channels in tissues of HC and control group.

RESULTS: The contractile forces (induced by 60 mmol/L KCl) of SO tissues from HC and control group were 1.23 ± 0.08 and 1.52 ± 0.11 g, respectively. HC group showed a markedly increased contractile response (t = 5.89, P < 0.05). Compared with that in control group, the ratio of contractile responses induced by TEA (3-8 mmol/L) or 4-AP (8-18 mmol/L) to those induced by 60 mmol/L KCl was decreased significantly in HC group (t = 2.72, P < 0.05; t = 4.71, P < 0.05). Western blot indicated that the protein expression of potassium ion channels of SO tissue was significantly reduced in HC group in comparison with that in control group (0.36 ± 0.06 vs 0.84 ± 0.03, t = 3.18, P < 0.05).

CONCLUSION: The contractile response of SO to KCl increases while the activities of BK_Ca and K_V in SO cells decrease in HC rabbits, which might be one of the reasons why SO dysfunction is caused in the condition of HC.

Effect of hypercholesterolemia on experimental colonic anastomotic wound healing in rats

AIM: To evaluate the mechanical and biochemical parameters of colonic anastomotic healing in hypercholesterolemic rats.

METHODS: Sixty rats were divided into two groups of 30 each according to their dietary regimens. The test group was fed with a high cholesterol-containing diet for two months while the control group had standard diet. These two groups were further divided into three subgroups consisting of ten rats each. After hypercholesterolemia was established, left colon resection and anastomosis were performed in both groups and samples from liver and abdominal aorta were taken to evaluate the systemic effects of hypercholesterolemia. Anastomotic wound healing, blow-out pressures and tissue hydroxyproline levels were evaluated.

RESULTS: The test group had a significant weight gain in two months. Microscopic examination of the abdominal aorta revealed no atherosclerotic change in none of the groups, but liver tissue specimens showed significant steatosis in the test group. Tissue hydroxyproline levels and anastomotic blow-out pressures were significantly lower in the test group than in the controls.

CONCLUSION: Hypercholesterolemia not only increases hydroxyproline levels and blow-out pressures but also worsens anastomotic wound healing.

Relationship between calcium metabolism and calcium oscillation of Oddi's sphincter in hypercholesterolemic rabbits

AIM: To investigate the effect of hypercholesterolemia on calcium oscillation of acutely separated rabbit Oddi's sphincter muscle cells and to explore its mechanisms.

METHODS: Twenty-four New Zealand female rabbits were divided randomly into control group and HC group (12 rabbits each). Sphincter of Oddi's muscle cells were acutely isolated and cultured. The cells were loaded with Fluo-3/AM, and the changes in calcium oscillation were measured by laser scanning confocal microscopy.

RESULTS: Compared with the control group, the amplitude of the Ca²⁺ oscillation fluorescence intensity was significantly increased in the experimental group (6.11±3.1 vs 3.61±0.94, P<0.05). When treated with nifedipine and EDTA, Ca²⁺ oscillation amplitude in hypercholesterolemic group was decreased by 64% to 2.24±0.72. When treated with thapsigargin, it was decreased by 38% to 3.8±1.9.

CONCLUSION: Calcium metabolic disturbance in Oddi's sphincter muscle cells of hypercholesterolemic rabbits may be caused by the malfunctioned CICR pathway of L-type voltage-dependent calcium channels.

Tibolone inhibits aortic atherosclerotic lesionformation in oophorectomized cholesterol-fed rabbits

BACKGROUND

Tibolone is a synthetic steroid effective for the treatment of climacteric symptoms and osteoporosis. Long term treatment with tibolone is associated with a significant decrease in cholesterol levels due to a parallel decrease in high-density lipoprotein. However, the effect of these changes on atherogenesis is not known.

OBJECTIVE

To investigate the effect of tibolone therapy on aorta atherogenesis.

MATERIAL AND METHODS

Thirty-two New Zealand white rabbits were fed cholesterol-rich feed and studied for four months. The rabbits underwent laparotomy and were randomly assigned to four groups. Twenty-four rabbits underwent bilateral ovariectomy; of these, eight received tibolone (group T), eight received estradiol valerate (group E), eight received placebo after sterilization (group C), and eight were sham operated (group S).

RESULTS

After receiving the cholesterol-rich diet, total levels of cholesterol increased in group C from 3.17+/-0.72 mmol/L to 35.36+/-9.01 mmol/L, in group S from 2.88+/-0.9 mmol/L to 28.76+/-9.442 mmol/L, in group E from 1.69+/-0.44 mmol/L to 1.69+/-0.44 mmol/L and in group T from 2.03+/-0.22 mmol/L to 26.33+/-13.45 mmol/L (no significant differences were observed among the groups at the end of the study). At four months, the cholesterol- rich diet caused atherosclerotic lesions in both treated and untreated rabbits, affecting 30.47+/-12.2%, 24.51+/-16.1%, 17.91+/-10.19% and 10.21+/-6.8% of the aortic surface for groups C, S, E and T, respectively (P<0.01 for treated groups).

CONCLUSION

The principal result from this study was that treatment with tibolone in cholesterol-fed ovariectomized rabbits reduces aortic atherosclerotic lesion formation and that this reduction is not related to plasma lipid levels.

Binding and degradation of native and acetylated low density lipoproteins by monocyte derived macrophages of normal and hypercholesterolemic rabbits

Low density lipoprotein (LDL) was isolated from normal rabbits and was modified with acetic anhydride. Blood monocyte derived macrophages from normal and hypercholesterolemic (HC) rabbits were cultured, and on the 8th day the cells were incubated with native and modified LDL to study their binding and degradation. Macrophages from both normal and hypercholesterolemic rabbits express a limited number of receptors for normal plasma LDL whereas they exhibit a large number of receptors for acetyl LDL. There was no significant difference between binding and degradation of acetyl LDL by normal or hypercholesterolemic cells. However, binding and degradation of native LDL by monocytes of hypercholesterolemic cells were significantly less (p<0.0001) in comparison to binding and degradation of native LDL by normal cells indicating that there is a feedback inhibitory pathway in the cell that inhibits the synthesis of LDL receptors in the presence of excess LDL.