Comparison of lipid parameters to predict cardiovascular events in Japanese mild-to-moderate hypercholesterolemic patients with and without type 2 diabetes: Subanalysis of the MEGA study

Relationships of multidimensional factors to self-management in patients with diabetes: A Cross-sectional, correlational study

Poor self-management in patients with diabetes is a consistent issue, leading to diabetes complications. The purpose of this study was to examine the relationships of demographic, cognitive, psychological, social, and physiological factors to self-management in patients with diabetes. In this cross-sectional, correlational study, data were collected from 98 patients through REDCap in 2023. Multiple regression analysis was used to address the study purpose. In the sample, adherence to adequate self-management was poor. Knowledge, self-efficacy, and body mass index (BMI) were associated with overall diabetes self-management. Self-efficacy and BMI were associated with diet and exercise. Knowledge and self-efficacy were associated with blood glucose testing. No factors were associated with smoking and foot care. In conclusion, different factors were associated with different types of self-management, but BMI and self-efficacy were associated with most types of self-management. Clinicians and researchers can target BMI, self-efficacy, and knowledge to improve self-management in patients with diabetes.

Effects of Meditation Intervention on Self-management in Adult Patients With Type 2 Diabetes: A Systematic Literature Review and Meta-analysis

BACKGROUND

Diabetes complications are prevalent and cause adverse effects on the physical, psychological, and economic status of adult patients with type 2 diabetes. Meditation may positively affect self-management and, in turn, reduce diabetes complications. However, the systematic examination of the effects of meditation without additional components on self-management in this population have been rarely examined.

PURPOSE

The aim of this study was to examine the effects of meditation interventions on self-management (ie, control of glucose, blood pressure, cholesterol, and obesity and self-management) among adult patients with type 2 diabetes in randomized controlled trials.

METHODS

In this systematic review and meta-analysis, 6 electronic databases were searched using major keywords of meditation , diabetes , and self-management during March 2022.

RESULTS

Eight studies (9 articles) using mindfulness-based meditation were included. The meta-analysis showed that meditation improved hemoglobin A 1c (effect size = -0.75; 95% confidence interval, -1.30 to -0.21; P = .007) but not fasting blood glucose. Only a few studies examined meditation effects on other types of self-management (eg, blood pressure, body mass index, cholesterol, diet, exercise, foot care, and monitoring of blood glucose), and the effects were inconsistent. In 1 study, meditation improved diabetes self-management.

CONCLUSIONS

Mindfulness-based meditation reduced hemoglobin A 1c levels in adult patients with type 2 diabetes but did not consistently improve other types of self-management in a few studies examined. This may imply the need for additional intervention components to improve different types of self-management. Further studies are needed to examine the effects of different types of meditations with additional components on different types of self-management.

Non-HDL-cholesterol in dyslipidemia: Review of the state-of-the-art literature and outlook

Dyslipidemia refers to unhealthy changes in blood lipid composition and is a risk factor for atherosclerotic cardiovascular diseases (ASCVD). Usually, low-density lipoprotein-cholesterol (LDL-C) is the primary goal for dyslipidemia management. However, non-high-density lipoprotein cholesterol (non-HDL-C) has gained attention as an alternative, reliable goal. It encompasses all plasma lipoproteins like LDL, triglyceride-rich lipoproteins (TRL), TRL-remnants, and lipoprotein a [Lp(a)] except high-density lipoproteins (HDL). In addition to LDL-C, several other constituents of non-HDL-C have been reported to be atherogenic, aiding the pathophysiology of atherosclerosis. They are acknowledged as contributors to residual ASCVD risk that exists in patients on statin therapy with controlled LDL-C levels. Therefore, non-HDL-C is now considered an independent risk factor or predictor for CVD. The popularity of non-HDL-C is attributed to its ease of estimation and non-dependency on fasting status. It is also better at predicting ASCVD risk in patients on statin therapy, and/or in those with obesity, diabetes, and metabolic disorders. In addition, large follow-up studies have reported that individuals with higher baseline non-HDL-C at a younger age (<45 years) were more prone to adverse CVD events at an older age, suggesting a predictive ability of non-HDL-C over the long term. Consequently, non-HDL-C is recommended as a secondary goal for dyslipidemia management by most international guidelines. Intriguingly, geographical patterns in recent epidemiological studies showed remarkably high non-HDL-C attributable mortality in high-risk countries. This review highlights the independent role of non-HDL-C in ASCVD pathogenesis and prognosis. In addition, the need for a country-specific approach to dyslipidemia management at the community/population level is discussed. Overall, non-HDL-C can become a co-primary or primary goal in dyslipidemia management.

Changes in cardiovascular risk factors among children and young adults with type 1 diabetes during the COVID-19 pandemic compared to previous years-Results from the German DPV registry

BACKGROUND

The diverse stages of the COVID-19 pandemic led to several social circumstances that influenced daily life and health behavior.

PURPOSE

To evaluate changes in cardiovascular risk factors and physical activity among children and young adults with type 1 diabetes (T1D) during the COVID-19 pandemic in Germany compared to previous years.

METHODS

A total of 32 785 individuals aged 6-21 years at baseline with T1D from the German diabetes patient follow-up (DPV) registry contributed data on 101 484 person-years between 2016 and 2021. The first treatment year of each individual within this period was considered as baseline. Based on trends from 2016 to 2019, we estimated differences in body mass index-SD score (BMI-SDS), blood pressure (BP-SDS), and lipid levels (non-high-density lipoprotein [non-HDL]) between observed and predicted estimates for the years 2020 and 2021 using linear regression analysis standardized for age, diabetes duration, sex, and migratory background. The proportion doing organized sports and smoking cigarettes was analyzed using multivariable logistic regression models.

RESULTS

BMI-SDS increased constantly from 2016 to 2021 without a significant increase above expected values for 2020/2021. Systolic BP-SDS (difference observed vs. expected with 95% confidence interval, 2020: 0.10 [0.07-0.14], 2021: 0.17 [0.14-0.20]) and non-HDL (2020: 2.7 [1.3-4.1] mg/dl, 2021: 4.1 [2.7-5.5] mg/dl) were significantly increased (all p < .001) in both pandemic years. The proportion of subjects participating in organized sports was reduced from over 70% in prepandemic years to 35%-65% in diverse stages/waves of the COVID-19 pandemic. The percentage smoking cigarettes did not change.

CONCLUSIONS

We describe an increase in BP and atherogenic lipid levels coinciding with a reduction in physical activity but no acceleration of the prepandemic increases in BMI-SDS among young people with T1D during the COVID-19 pandemic.

Non-HDL-C and LDL-C/HDL-C are associated with self-reported cardiovascular disease in a rural West African population: Analysis of an array of lipid metrics in an AWI-Gen sub-study

Few studies have compared the utility of serum levels of lipid fractions in cardiovascular disease (CVD) risk assessment in sub-Saharan Africa (SSA). The current study interrogated this question among men and women aged 40-60 years in rural northern Ghana. This was a cross-sectional study in which data was collected on socio-demography, behaviour, health history, anthropometry and lipid levels. Adjusted multivariable logistic regression models were used to assess the association of various lipid metrics with CVD. All tests were considered statistically significant at P<0.05. Data were available for 1839 participants. The prevalence of self-reported CVD was 1.6% (n = 29). Non-HDL-C (median (interquartile range): 2.4 (1.9-3.0) vs 2.0 (1.6-2.5) mmol/L; P = 0.009), LDL-C/HDL-C (1.8 (1.4-2.4) vs 1.5 (1.1-2.6); P = 0.019) and TC/HDL-C (3.3 (2.9-3.9) vs 2.9 (2.4-3.5); P = 0.003) were all significantly higher in participants with self-reported CVD compared to those without. However, after adjusting for socioeconomic status (SES) and meals from vendors in a logistic regression model, only non-HDL-C (odds ratio [95% CIs]): (1.58 [1.05, 2.39]), P = 0.029 and LDL-C/HDL-C levels (odds ratio [95% CIs]): (1.26 [1.00, 1.59]), P = 0.045 remained significantly associated with self-reported CVD. While our findings suggest non-HDL-C and LDL-C/HDL-C measures may be appropriate biomarkers for assessing CVD risk in this population, further studies using established clinical endpoints are required to validate these findings in sub-Saharan Africans.

Remnant cholesterol and the risk of cardiovascular disease in type 2 diabetes: a nationwide longitudinal cohort study

BACKGROUND

Elevated remnant cholesterol (remnant-C) is considered a risk factor for cardiovascular disease (CVD); however, whether this notion applies to the East Asian population with type 2 diabetes (T2D) has not been established. This study investigated the association between remnant-C concentrations and the risk of CVD in Korean patients with T2D.

METHODS

By using the Korean National Health Insurance Service database, 1,956,452 patients with T2D and without atherosclerotic CVD who underwent regular health checks between 2009 and 2012 were included. Cox regression analyses were conducted to assess the association between remnant-C concentrations and incident CVD comprising myocardial infarction (MI) and ischemic stroke.

RESULTS

In total, 50,120 (2.56%) cases of MI and 73,231 (3.74%) cases of ischemic strokes occurred during a median follow-up of 8.1 years. The adjusted hazard ratios for MI and stroke in the highest remnant-C quartile were 1.281 (95% confidence interval [CIs], 1.249-1.314) for MI and 1.22 (1.195-1.247) for ischemic stroke, compared to those in the lowest quartiles. The results were similar, based on stratified analysis by age, sex, use of statin or fibrate, and levels of other cholesterol. The increased risk of CVD in the highest remnant-C quartile was profound in patients who had a longer T2D duration. A remnant-C concentration ≥ 30 mg/dL differentiated patients who were at a higher risk of CVD, compared to patients with a lower concentrations, regardless of whether LDL-C levels were or were not on target at ≤ 100 mg/dL.

CONCLUSION

In Korean patients with T2D, remnant-C was associated with CVD, independent of the LDL-C level or other conventional CVD risk factors. Our finding confirmed evidence of the causal role of remnant-C on CVD, as a residual risk of CVD, in East Asian patients with T2D.

The relationship between body mass index, blood pressure, and atherosclerosis risk factors in type 1 and 2 diabetic patients from northwestern Algeria

Objective. The present work was framed to study the relationship between body mass index (BMI), blood pressure, and atherosclerosis risk factors on the basis of three lipid ratios in type 1 (T1D) and type 2 diabetic (T2D) patients.

Methods. A prospective, comparative, and cross-sectional study was performed at the level of three health facilities in Sidi-Bel-Abbes city (north-western Algeria). Anthropometric parameters, systolic and diastolic blood pressures, and lipid profiles were assessed in adults T1D and T2D patients over a period of eleven months. Individual atherogenic risk factors were estimated based on lipid ratios in relation to corpulence and hypertension.

Results. From the total 237 adult diabetic patients, 90 T1D and 147 T2D ones were involved in the study. Total cholesterol (TC)/high-density lipoprotein (HDL) and triglycerides (TG)/HDL ratios were significantly higher in normal weight T2D comparing to T1D. The TC/HDL ratio was significantly higher (p=0.046) in obese men. Nevertheless, no significant differences were revealed in low-density lipoprotein (LDL)/HDL ratio between T1D and T2D patients. Higher TC/HDL ratios were observed in T2D patients (males and females) with normal blood pressure (systolic blood pressure, SBP ≤13.5 mmHg and diastolic blood pressure, DBP ≤8 mmHg) comparing to T1D patients. Likewise, the LDL/HDL ratio was significantly higher in T2D men with normal DBP (p=0.044).

Conclusion. The lipid ratios constitute good indices while managing diabetes. It is also recommended to screen T1D and T2D patients for hypertension, dyslipidemia, and obesity and initiate the management at early stages to prevent the related complications, such as atherosclerosis, as a priority.

Remnant Cholesterol and Cardiovascular Mortality in Patients With Type 2 Diabetes and Incident Diabetic Nephropathy

CONTEXT

The association between remnant cholesterol (remnant-C) and cardiovascular mortality in patients with type 2 diabetes (T2D) and incident diabetic nephropathy remains unclear.

OBJECTIVE

To examinie the association between remnant-C and cardiovascular mortality in patients with T2D, chronic kidney disease (CKD) stages 3 to 5, and newly diagnosed DN.

METHODS

This study determined the baseline lipid profile and searched for deaths with cardiovascular disease (CVD) within 2 years of baseline among 2282 adults enrolled between January 1, 2015 and December 31, 2016, who had T2D, CKD stages 3 to 5, and newly diagnosed DN. Adjusted logistic regression models were used to assess the associations between lipid, especially remnant-C concentration (either as continuous or categorical variables), and risk of cardiovascular mortality.

RESULTS

In multivariable-adjusted analyses, low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR], 1.022; 95% CI, 1.017-1.026, per 10 mg/dL), high-density lipoprotein cholesterol (HDL-C) (OR, 0.929; 95% CI, 0.922-0.936, per 5 mg/dL), non-HDL-C (OR, 1.024; 95% CI, 1.021-1.028, per 10 mg/dL), and remnant-C (OR, 1.115; 95% CI, 1.103-1.127, per 10 mg/dL), but not triglycerides were associated with cardiovascular mortality. Atherogenic dyslipidemia (triglycerides > 150 mg/dL [1.69 mmol/L] and HDL-C < 40 mg/dL in men or < 50 mg/dL in women) was also associated with cardiovascular mortality (OR, 1.073; 95% CI, 1.031-1.116). Remnant-C greater than or equal to 30 mg/dL differentiated patients at a higher risk of cardiovascular mortality from those with lower concentrations, especially with interaction with LDL-C level greater than 100 mg/dL: The highest risk was found in patients with higher levels both of remnant-C and LDL-C (OR, 1.696; 95% CI, 1.613-1.783).

CONCLUSION

In patients with T2D, CKD stages 3 to 5, and incident DN, remnant-C was associated with a higher risk of death with CVD. Different from the general population, the interaction of remnant-C and LDL-C was associated with the highest risk of cardiovascular mortality.

A large remaining potential in lipid-lowering drug treatment in the type 2 diabetes population: A Danish nationwide cohort study

AIM

To assess lipid-lowering drug (LLD) use patterns during 1996-2017 and examine lipid levels in relation to the use of LLDs and prevalent atherosclerotic cardiovascular disease (ASCVD).

METHODS

Using a nationwide diabetes register, 404 389 individuals with type 2 diabetes living in Denmark during 1996-2017 were identified. Individuals were followed from 1 January 1996 or date of type 2 diabetes diagnosis until date of emigration, death or 1 January 2017. Redemptions of prescribed LLDs were ascertained from the nationwide Register of Medicinal Products Statistics. Data on lipid levels were sourced from the National Laboratory Database since 2010. LLD coverage was calculated at any given time based on the redeemed amount and dose. Trends in lipid levels were estimated using an additive mixed-effect model. Low-density lipoprotein cholesterol (LDL-C) goal attainment was assessed based on recommended targets by the 2011, 2016 and 2019 guidelines for management of dyslipidaemias.

RESULTS

LLD use has decreased since 2012 and only 55% of those with type 2 diabetes were LLD users in 2017. A decline in levels of total cholesterol and LDL-C, and an increase in triglycerides, was observed during 2010-2017. Annual mean levels of LDL-C were lower among LLD users compared with non-users (in 2017: 1.84 vs. 2.57 mmol/L). A greater fraction of LLD users achieved the LDL-C goal of less than 1.8 mmol/L compared with non-users (in 2017: 51.7% and 19%, respectively). Among LLD users with prevalent ASCVD, 26.9% and 55% had, as recommended by current 2019 European guidelines, an LDL-C level of less than 1.4 mmol/L and less than 1.8 mmol/L, respectively, in 2017.

CONCLUSIONS

LLD use and LDL-C levels are far from optimal in the Danish type 2 diabetes population and improvement in LLD use could reduce ASCVD events.

Optimum biscuit from Musa sapientum L. and Vigna unguiculata L. composite flour: effect on pancreatic histology, biochemical and hematological parameters of diabetic rats

This study investigated the effect of consumption of an optimum biscuit from composite flour of Musa sapientum L. ('banana cochon') and Vigna unguiculata L. (cowpea) on the pancreatic histology, biochemical and hematological parameters of streptozotocin-induced diabetic Wistar rats. The optimum biscuit was evaluated for its chemical properties and glycaemic index. The weekly fasting blood glucose level, food intake and weight of the rats were recorded. The effect of 28 days' consumption of different percentages of optimum biscuit with/without Metformin was also evaluated on the pancreatic histology, biochemical and hematological parameters of rats. Results showed that, the optimum biscuit is rich in minerals (potassium, magnesium and calcium), dietary fibre (9.4%) and is a low glycaemic index product (50.91%). Also, the optimum biscuit significantly lowered/maintained the blood glucose level of diabetic rats even though the weekly weights of the rats were reduced while food intake increased. Nonetheless, the hematological parameters of the treated diabetic rats were significantly (P < 0.05) improved when compared to the untreated diabetic rats groups. With the exception of total serum protein, other biochemical parameters such as serum creatinine, urea, alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase and bilirubin in the treated diabetic groups were significantly (P < 0.05) reduced or closer to those of non-diabetic rats. The serum cholesterol, triglyceride, low-density lipoprotein levels were significantly (p < 0.05) reduced while the HDL level significantly increased in treated diabetic groups. Histological examination of the pancreas showed that treatment of diabetic groups with optimum biscuit was able to slow down the destruction (protection) of beta-cells. Thus, optimum biscuit could be used to improve the health status during the management and prevention of complications in diabetic patients.

Predictive Value of the Triglyceride to High-Density Lipoprotein Cholesterol Ratio for All-Cause Mortality and Cardiovascular Death in Diabetic Patients With Coronary Artery Disease Treated With Statins

Background and Aims: Studies have highlighted the role of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio on subsequent cardiovascular events. However, the association of the TG/HDL-C ratio with survival outcomes in diabetic patients with coronary artery disease (CAD) treated with statins remains unknown. This study aimed to assess the predictive value of the TG/HDL-C ratio for all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins. Methods: The data of patients with type 2 diabetes and angiographically-confirmed CAD who were undergoing statin therapy and visited Tianjin Chest Hospital between January 2016 and September 2016 were retrospectively collected. The patients were categorized based on the baseline TG/HDL-C ratio tertile. Kaplan-Meier analysis and multivariate Cox proportional hazard regression were applied to assess the role of the TG/HDL-C ratio in predicting all-cause mortality and cardiovascular death. Results: A total of 2,080 patients were included. During the 4-year follow-up, 209 patients died, 136 of whom from cardiovascular death. The Kaplan-Meier analyses showed that an increased TG/HDL-C ratio was associated with an increased risk of all-cause mortality (P < 0.001) and cardiovascular death (P < 0.001). The multivariate cox hazard regression analysis revealed a similar effect of the TG/HDL-C ratio on the risk of all-cause mortality (P = 0.046) and cardiovascular death (P = 0.009). The role of the TG/HDL-C ratio in predicting all-cause mortality and cardiovascular death was similar among all subgroups (P > 0.050). For all-cause mortality, the TG/HDL-C ratio significantly improved the C-statistic from 0.799 to 0.812 (P = 0.018), and the net reclassification index (NRI) and integrated discrimination index (IDI) were 0.252 (95% CI: 0.112-0.392; P < 0.001) and 0.012 (95% CI: 0.003-0.022; P = 0.012), respectively. Similarly, for cardiovascular death, the TG/HDL-C ratio significantly improved the C-statistic from 0.771 to 0.804 (P < 0.001), and the NRI and IDI were 0.508 (95% CI: 0.335-0.680; P < 0.001) and 0.033 (95% CI: 0.015-0.050; P < 0.001). Conclusion: TG/HDL-C ratio might be useful for predicting all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins.

Perbedaan Hemoglobin Terglikosilasi (Hba1c) terhadap Profil Lipid Pasien Rumah Sakit Islam Surabaya

ABSTRAK Latar Belakang : Diabetes melitus merupakan penyakit metabolik dengan karakteristik hiperglikemia sebagai akibat kelainan sekresi insulin maupun kerja insulin. Diabetes sebagai salah satu penyebab dislipidemia sekunder, sehingga pengelolaan glukosa darah merupakan pencegahan primer timbulnya komplikasi penyakit kardiovaskular. Hasil Riskesdas tahun 2018, prevalensi diabetes melitus yang didiagnosis dokter pada penduduk di semua umur sebesar 3,4% di Kota Surabaya.Tujuan : Penelitian ini untuk mengetahui perbedaan profil lipid pada level HbA1C normal, prediabetes dan diabetes melitus.Metode : Penelitian cross sectional, teknik pengambilan sampel dengan simple random sampling dari data rekam medis pasien rawat jalan di Rumah Sakit Islam Surabaya  dari 1 Januari tahun 2018 sampai dengan 31 Desember 2019 berusia 35-80 tahun dan mendapat pemeriksaan HbA1c, kolesterol, trigliserida dan LDL-kolesterol pada waktu yang sama dan terdokumentasi lengkap pertama sekali sehingga diperoleh besar sampel 73 data pasien. Uji Anova one way digunakan untuk mengetahui perbedaan rata-rata kolesterol, trigliserida dan LDL-kolesterol berdasarkan HbA1C.Hasil : Hasil penelitian menunjukkantidakada perbedaan yang signifikan rata-rata kolesterol, dan LDL-kolesterol dengan tingkatan HbA1C (p>0,05), ada perbedaan yang signifikan rata-rata trigliserid dengan HbA1C normal, prediabetes, dan diabetes (p=0,01). Hasil multiple comparison dengan metode Tukey HSD menunjukkan perbedaan signifikan rata-rata trigliserid  pada HbA1C normal dengan diabetes (p=0,039) dan prediabetes dengan diabetes (p=0,044).Kesimpulan :Perbedaan rata-rata trigliserida signifikanpada HbA1Ckategorinormal dan prediabetes dengan diabetes, pentingnya mengendalikanglukosa darah untuk mencegahkomplikasi kardiovaskuler pada penderita diabetes melitus yang dapat dilakukan melalui pemantauan mandiri glukosa darah, pola hidup sehat, aktivitas fisik secara teratur, terapi nutrisi medis sesuai kebutuhan, menurunkan berat badan bagi yang mengalami obesitas, tidak merokokdan intervensi obat anti hiperglikemia jika dibutuhkan.Kata Kunci : diabetes, HbA1C, kolesterol, trigliserid, LDL-kolesterol. ABSTRACT  Background :Diabetes melitus is a metabolic disease characterized by hyperglicemia as a result of abnormal insulin secretion and insulin action. Diabetes is a cause of secondary dislipidemia, so that diabetes melitus monitoring is a primary deterrent to cardiovascular complication. Riskesdas 2018 said that the prevalence of doctors' diagnosed diabetes in the population at all age 3.4% in Surabaya.Objective : This study is to find out the difference in lipid profiles on normal HbA1Clevels, pre-diabetes and diabetes mellitusMethod: Cross-sectional study, the sampling technique used was simple random sampling fromoutpatient medical recordsthe Surabaya Islamic hospital's from 1st of January 2018 to 31st December 2019 aged 35-80 years and checked for HbA1C, cholesterol, triglyceride and LDL-cholesterol at the same and firsttime documented. Sample sizes of 73 data analized with One Way Anova test was used to identify differences in mean cholesterol, triglyceride and LDL-cholesterol based Hba1C.Results :The results showed that there was no significant difference mean cholesterol and mean LDL-cholesterol with HbA1C levels (p> 0.05), there were significant differences mean the triglyceride with normal HbA1C levels, pre-diabetes, and diabetes (p= 0.01). Multiple comparason results using Tukey HSD methods showed that there was significant differences mean the triglycerid on normal HbA1C levels with diabetes (p= 0.039) and the mean triglyceride ebetween hba1c prediabetesand diabetes (p= 0.044).Conclusions: The mean difference trigliseride signifnificant in normal HbA1C levels and pre-diabetes with diabetes.The importantce of controlling blood glucose to prevent cardiovasculer complication in people with diebetes mellitus can be done through education on independent monitoring of blood glucose, healthy lifestyle, reguler physical activity, medical nutrition therapy according to the needs, lost weight for those who are obese, do not smoke and  anti-hyperglicemia drug intervention if needed.

Comparison Between Non-High-Density Lipoprotein Cholesterol and Low-Density Lipoprotein Cholesterol to Estimate Cardiovascular Risk Using a Multivariate Model

BACKGROUND

Although studies exist comparing low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (HDL-C) in the development of cardiovascular disease (CVD), most have limitations in the mathematical models used to evaluate their prognostic power adjusted for the other risk factors (cardiovascular risk).

OBJECTIVE

The aim of this study was to compare LDL-C and non-HDL-C in patients with CVD to determine whether both parameters predict CVD similarly.

METHODS

A cohort of 1322 subjects drawn from the general population of a Spanish region was followed between 1992 and 2006. The outcome was time to CVD. Secondary variables were gender, age, hypertension, diabetes, personal history of CVD, current smoker, body mass index, LDL-C, and non-HDL-C. Two CVD prediction models were constructed with the secondary variables, with only the lipid parameter varying (non-HDL-C or LDL-C). In the construction of the models, the following were considered: multiple imputation, events per variable of 10 or more, and continuous predictors as powers. The validation was conducted by bootstrapping obtaining the distribution of the C statistic (discrimination) and the probabilities observed by smooth curves. These results were compared in both models using graphical and analytical testing.

RESULTS

There were a total of 137 CVD events. The models showed no differences in the distributions of the C statistic (discrimination, P = .536) or in the calibration plot.

CONCLUSIONS

In our population, LDL-C and non-HDL-C were equivalent at predicting CVD. More studies using this methodology are needed to confirm these results.

Serum triglycerides as a risk factor for cardiovascular diseases in type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies

Objective

The importance of triglycerides (TG) level as a risk factor for cardiovascular diseases (CVD) has been extensively investigated in the general population; however, their relationship in patients with type 2 diabetes mellitus (T2DM) is uncertain. We aimed to assess the association of TG with CVD in T2DM individuals.

Research design and methods

We searched bibliographic databases for studies published until June 2018, reporting on the relationship between TG and CVD in T2DM people. A random-effects model with inverse variance weighting was used to compute pooled estimates of the most fully adjusted risk ratios (RR) and corresponding 95% confidence intervals (CI) according to TG categories, unit TG, and logarithm (log) of TG for CVD.

Results

A total of 31 studies were included, involving 132,044 T2DM patients with 10,733 incident cardiovascular events. The pooled RR (95% CI) of CVD for an increase in baseline TG, log TG by 1-mmol/l and categorized in the highest vs. the lowest TG in T2DM were 1.06 (1.02, 1.09), 1.30 (1.18, 1.42) and 1.30 (1.16, 1.46), corresponding to a CVD risk increase of 6%, 30% and 30%, respectively. The pooled RR (95% CI) of CVD for per 1-mmol/L TG increment in eight studies and TG categories in three studies were 1.03 (0.98, 1.08) and 1.39 (0.92, 2.1) in T2DM patients adjusted for other lipids parameter, respectively.

Conclusions

In T2DM patients, an elevated triglyceride level cannot serve as an independent marker for an increased risk of cardiovascular events, but still, the higher serum TG levels tend to be associated with increased risks of CVD.

Electronic supplementary material

The online version of this article (10.1186/s12933-019-0851-z) contains supplementary material, which is available to authorized users.

Hypolipidaemic Effects of High Resistant Starch Sago and Red Bean Flour- based Analog Rice on Diabetic Rats

INTRODUCTION

Sago analog rice had known as an example of food with high resistant starch. Recent research shows that sago analog rice and red bean flour also had a low glycemic index (GI). However, Identification of hypolipidaemic mechanism based on the nutrigenomic analysis remains unknown.

AIM

This study aims to determine the effects of hypolipidaemic in diabetic rats with analog rice treatment.

MATERIAL AND METHODS

Thirty-five male Wistar rats were divided into 5 groups with different food treatment, such as standard dietary food (STD) group, and four groups of diabetic rats with standard dietary food (STDD), mentik wangi rice diet (MWRD), sago analog rice (SARD) and sago analog rice with 10% red bean flour (SARKBD). Lipid profile was observed every week for a month. Measurement of insulin and blood glucose was performed twice at the beginning and end of treatment. Atherogenic index (AI) was also investigated. Then, the pancreas was collected for histological analysis.

RESULTS

SARD group showed the highest effect of decreasing the total cholesterol (47.74%) which followed by SARKBD (34.62%). The triglyceride level in SARD group was also significantly decreased (31.14%), followed by SARKBD (19.32%). However, the HDL increase in SARD (48.66%), followed by SARKBD (36.00%). The LDL level in SARD and SARKBD group were significantly decreased, respectively 32.89% and 22.19%. SARD atherogenic index levels lower than SARKBD; 1.00 and 2.06.

CONCLUSION

The improvement of insulin resistance by SARD and SARKBD were generated by role of resistant starch through the mechanism of bile acid binding, insulin sensitivity escalation and SCFA effect.

Increased malondialdehyde vs. reduced sirtuin 1 in relation with adiposity, atherogenicity and hematological indices in metabolic syndrome patients with and without prediabetes

BACKGROUND

Sirtuin 1 (SIRT 1) and malondialdehyde (MDA) were implicated in metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) pathophysiology.

AIMS AND METHODS

This cross-sectional study aimed to investigate both SIRT 1 and MDA in 30 lean healthy control, 31 normoglycemic MetS subjects and 30 MetS-Pre/T2DM drug naïve. C orrelation studies were established for both biomarkers with adiposity indices [conicity index (CI), waist circumference (WC), weight-to-height (WHtR) ratio, weight-to-hip (WHR) ratio, hip circumference (HC), and body adiposity index (BAI)], hematological indices [red cell distribution width (RDW), mean platelet volume (MPV), platelet-to-lymphcyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR)] and atherogenicity indices (atherogenicity index of plasma (AIP = log₁₀TG/HDL-C ratio), TC/HDL-C and LDL-C/HDL-C ratios].

RESULTS

SIRT1 levels (ng/mL) were markedly lower in both MetS groups (2.12 ± 0.06 and 2.32 ± 0.19, respectively, vs. controls 4.73 ± 0.15; P < 0.05). Conversely, a gradual increase in MDA levels (μM) was attained (MetS 72 ± 3.3 and MetS pre-T2DM 81 ± 6.1 vs. controls 62 ± 3.5; P > 0.05). A significant inverse MDA-SIRT1 relationship was observed (P = 0.006). SIRT1 correlated inversely with all the studied adiposity (WC: P < 0.001, HC: P < 0.001, WHR: P < 0.001, C-index: P < 0.001, BAI: P < 0.001) and atherogenicity indices (AIP: P < 0.001, TC/HDL-C: P < 0.001, LDL-C/HDL-C: P < 0.001) as well as MPV (P < 0.01). Whereas MDA directly with WHtR, CI and BAI (WC: P < 0.01, HC: P < 0.05, BMI: P < 001, WHtR: P < 0.001, C-index: P < 0.005, BAI: P < 0.01).

CONCLUSION

The substantial variations and correlations emphasize a potential molecular role of SIRT1 and MDA in the pathophysiology of MetS and pre/T2DM.

Cross-sectional correlates of paraoxonase 1 and soluble intercellular adhesion molecule-1 in metabolic syndrome patients with and without diabetes

BACKGROUND

Paraoxonase 1 (PON1) and soluble intercellular adhesion molecule-1(sICAM-1) are intricately involved in metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) pathophysiology. This study aimed to investigate PON1 and sICAM-1 plasma levels in addition to correlating them with adiposity, atherogenicity and hematological indices in T2DM and MetS.

METHODS

This cross-sectional study composed of 28 healthy lean subjects (control), 29 normoglycemic MetS subjects and 30 MetS-Pre/T2DM.

RESULTS

The sICAM-1 levels (ng/ml) were markedly higher in the pre/diabetic MetS group (828 ± 250.37 versus controls' 608.62 ± 184; p < 0.05). Conversely, PON1 levels (mlU/ml) were markedly lower in the pre/diabetic MetS group [252,700 (163,950, 362,800) versus controls' 394,900 (212,550, 469,350); p < 0.05]. sICAM-1 correlated directly with all adiposity indices [conicity index (CI), waist circumference (WC), waist-hip ratio (WHR) waist-to-height (WHtR) ratio, hip circumference (HC) and body adiposity index (BAI)] in addition to the atherogenicity index of plasma (AIP). PON1 correlated negatively and significantly with CI, WC, WHR, WHtR and HC but directly with lymphocyte. Significantly, a reciprocal sICAM-1-PON1 relationship was observed in the total population (r = -0.262, p = 0.015).

CONCLUSION

Utility of sICAM-1 and PON1 as surrogate prognostic biomarkers and putative therapeutic targets in the management of diabetes and MetS is strongly suggested.

Effectiveness of a community-based intervention for weight loss on cardiometabolic risk factors among overweight and obese women in a low socio-economic urban community: findings of the MyBFF@home

BACKGROUND

The effectiveness of lifestyle intervention for weight loss on cardiometabolic risk factors among overweight and obese individuals in the community setting remains inconclusive. This study aimed to evaluate the effect of a 6-month weight loss lifestyle intervention on cardiometabolic risk factors among overweight and obese women and the sustainability of the changes in those markers at 12-month follow-up, comparing an intervention group with a control group.

METHODS

A total of 243 participants from MyBFF@home were included in this study. Fasting blood samples at baseline, 6- and 12-month were assessed for fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. The effect of the intervention on cardiometabolic risk markers were investigated within and between study groups using t-test and general linear model (GLM) repeated measure ANOVA.

RESULTS

Results from repeated measures ANOVA showed intervention effect only in TC where significant reduction was found in the intervention group (- 0.26 mmol/L [95% CI: - 0.47 to - 0.06], p < 0.01) compared to the control group (- 0.06 mmol/L [95% CI: - 0.28 to 0.17]) at 12 months. At 6 months, TC was reduced significantly in both groups but only intervention group retained the reduction in maintenance phase while, the level increased significantly in the control group (0.22 mmol/L [95% CI: 0.06 to 0.38]). This attributed to significant increase in TC/HDL-C ratio in the control group during maintenance phase (0.32 [95% CI: 0.15 to 0.50], p < 0.001). The intervention group also showed trend of reduction in FPG at 6 months and further decreased during maintenance phase (- 0.19 mmol/L [95% CI: - 0.32 to - 0.06], p < 0.01). At 6 months HDL-C was maintained in the intervention group but reduced significantly in the control group (- 0.05 mmol/L [95% CI: - 0.10 to - 0.01], p < 0.05). No significant difference was detected in both markers when compared between groups.

CONCLUSIONS

In the context of low socio-economic communities, this study supports that weight loss related lifestyle modifications over a 6-month period could improve selected cardiometabolic risk factors, particularly fasting glucose, TC and HDL-C in overweight and obese women with favourable sustainability over a 12-month period.

Triglyceride to High-Density Lipoprotein Cholesterol Ratio and Cardiovascular Events in Diabetics With Coronary Artery Disease

BACKGROUND

It has been demonstrated that an elevated ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) is a risk factor of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM) and is also found to be associated with cardiovascular events (CVEs) in the general population. However, its prognostic value in patients with T2DM along with CAD remains to be determined.

MATERIALS AND METHODS

A total of 1,447 consecutive patients with T2DM with angiographic-proven stable CAD were enrolled in the present study and followed-up for an average of 20.3 months. The characteristics of all patients including fasting lipid profile were obtained at baseline and multivariate Cox proportional hazards models were constructed using log TG/HDL-C as a predictor variable. The relationships between CVEs and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, TC/HDL-C, LDL-C/HDL-C and apolipoprotein B/ apolipoprotein AI (apoB/apoAI) were also explored.

RESULTS

Compared with patients without CVEs, the ones who experienced CVEs had a higher TG/HDL-C ratio. Univariable regression revealed a significant association of log TG/HDL-C with CVEs (hazard ratio = 2.5, P = 0.015). After adjusting for multiple traditional risk factors of cardiovascular disease, the association was still found (hazard ratio = 2.47, P = 0.047). Moreover, results suggested that the ratios of non-HDL-C, TC/HDL-C, LDL-C/HDL-C and apoB/apoAI were not predictors for CVEs in T2DM.

CONCLUSIONS

In our primary study, data suggested that elevated TG/HDL-C value might be a useful predictor for future CVEs in Chinese patients with T2DM with stable CAD. Further study is needed to confirm our findings.