The effect of fasting status on lipids, lipoproteins, and inflammatory biomarkers assessed after hospitalization for an acute coronary syndrome: Insights from PROVE IT-TIMI 22

Characteristics and prognosis of patients with elevated triglycerides in acute myocardial infarction: observational data from a large database over a 17-year period: High triglycerides in acute myocardial infarction

From a large regional registry, we aimed to address the characteristics and prognosis of patients with elevated triglycerides (TG) among patients hospitalized for an acute myocardial infarction (MI). From the multicenter database of the RICO survey, all consecutive patients hospitalized for an acute MI (2001-2017) and alive at discharge were included. Among the 10,667 patients included, 17.7% had elevated TG. When compared with patients with TG ≤ 200 mg/dL, patients with high TG (>200 mg/dL) were 10 years younger, had a higher BMI, were more frequently men, diabetic, and smokers. At 1-year follow-up, recurrent ischemic events were more frequent in elevated TG patients. In multivariate logistic regression analysis, high TG (OR (95%CI): 1.356 (1.095-1.679)) remained an independent estimate for recurrent ischemic events, even after adjustment for confounding factors. In our large population-based cohort, elevated TG are common in acute MI, and associated with residual risk of recurrent ischemic events, beyond traditional prognostic markers.

An observational study of the occurrence of acute coronary syndrome (ACS) among jordanian patients: Identifying the influence of Ramadan Fasting

Introduction

Patients with Acute Coronary Syndrome (ACS) tend to face several health issues during the Holy month of Ramadan, due to the change in dietary patterns. This study aims to investigate the influence of fasting during Ramadan on the occurrence of ACS.

Methods

The study followed a retrospective observational design, and was conducted in King Abdullah University Hospital (KAUH) of Jordan, during the period of June 06, 2016 to Aug 08, 2016 and May 27, 2017 to July 27, 2017. Data was collected from a sample of 226 male and female patients, aged between 20 and 80 years with major diagnosis of acute coronary syndrome. Therefore, this is a case series of ACS patients.

Results

Findings of the study indicated that, Ramadan fasting is insignificantly related to the occurrence of ACS, since no significant difference was found in the incidence of hypertension (65%), diabetes (51.7%), unstable angina (56.6%) and coronary artery disease (CAD) (57.6%) findings during and after Ramadan respectively. Similar, findings were attained for patients' final diagnosis which had normal Kidney Function Test (KFT) (72.5%), platelets (91.5%), and Ejection Fraction (EF) (64.6%). Also, no significant difference was found between patients' smoking status (61.0%), hospital stay (89.8%) and discharge rate (96.9%).

Conclusion

The study concluded that there is an insignificant association of Ramadan fasting on the cardiac patients and occurrence of acute coronary syndrome.

Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol

Low-density lipoprotein cholesterol (LDL-C) has been recommended as the primary treatment target on lipid management in coronary heart disease (CHD) patients for past several decades. However, even by aggressive LDL-C lowering treatment, patients still present a significant residual risk of major adverse cardiovascular events (MACE). Non-high-density lipoprotein cholesterol (non-HDL-C) contained all the atherogenic lipoproteins, such as chylomicron, very-low density lipoprotein (VLDL), LDL, intermediate density lipoprotein (IDL). Many prospective observation studies have found that non-HDL-C was better than LDL-C in predicting risks of MACE. Since non-HDL-C appears to be superior for risk prediction beyond LDL-C, current guidelines have emphasize the importance of non-HDL-C for guiding cardiovascular prevention strategies and have flagged non-HDL-C as a co-primary therapeutic target. The goals of non-HDL-C were recommended as 30 mg/dl higher than the corresponding LDL-C goals, but the value seemed inappropriate. This review provide evidence for changing lipid management strategy to focus on non-HDL-C and appropriate values for adding to LDL-C goals would be proposed.

The effect of fasting status on lipids, lipoproteins, and inflammatory biomarkers assessed after hospitalization for an acute coronary syndrome: Insights from PROVE IT-TIMI 22

BACKGROUND

For decades, fasting for 8 to 12 hours has been recommended for measurement of lipid profiles. The effect of fasting on low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) has been described in healthy cohorts and those with stable disease states. Recently, guidelines suggested that fasting may not be necessary due to its small effect on lipid measures. Little is known, however, regarding whether the impact of fasting is altered in the setting of an acute coronary syndrome (ACS).

HYPOTHESIS

We hypothesized that the post-ACS period would minimally effect the impact of fasting status on lipid measurements.

METHODS

We evaluated the association of fasting on lipid and other biomarkers at the randomization visit, which occurred at a median of 7 days after the onset of an ACS, as well as during follow-up, in a cohort of 4177 subjects from the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22 (PROVE IT-TIMI 22) trial.

RESULTS

Fasting samples were independently associated with a higher LDL-C of 4.1 mg/dL and apolipoprotein-B 100 of 2.6 mg/dL as well as a lower TG of 21.0 mg/dL and high-sensitivity C-reactive protein of 0.48 mg/dL. The relative difference was 3.8% for LDL-C and -11.3% for TG. Fasting did not change total cholesterol, high-density lipoprotein cholesterol, apolipoprotein A-I, lipoprotein(a), or apolipoprotein C-III.

CONCLUSIONS

Although fasting does impact lipid measurements, the effect on LDL-C is small (about 4 mg/dL), both early after ACS and during follow-up. These data provide support for recent guidelines that no longer advocate for fasting lipid samples, including in the setting of ACS.