Recent trends in epidemiology of dyslipidemias in India

Evaluation of 13 Formulae for Calculated LDL-C Using Direct Homogenous Assay in a South Indian Population

BACKGROUND

LDL cholesterol (LDL-C) is regarded as a significant therapeutic target and a known risk factor for atherosclerosis. It can be calculated using the results of the other lipid tests or tested directly. Despite its shortcomings, the Friedewald formula is most frequently utilized since it is simple and practical. Until now, several formulae have been proposed for calculating LDL-C; however, their accuracy has not been evaluated across different populations. We sought to evaluate the validity of calculated LDL-C by comparing the findings with values acquired by the direct homogeneous technique, utilizing 13 distinct formulae from the literature.

METHODS

This study was a retrospective observational study conducted for a year at SRIHER, Chennai, Tamil Nadu, India. From the total 25 043 patients who had their serum lipid profile tested, 16 314 participants had their fasting blood sugar and fasting lipid profile measured simultaneously, and they were chosen for the research.

RESULTS

The de Cordova, Chen, Martin/Hopkins (initial), and Teerakanchana equations correlated well with the direct LDL-C assay. When the dataset was stratified according to triglycerides, the Chen and Martin/Hopkins initial equations had the better measurement of agreement compared to other equations. The Martin/Hopkins initial equation outperformed all the other equations when the whole dataset irrespective of the triglyceride population was considered.

CONCLUSIONS

Our study suggests that the Martin/Hopkins initial equation outperformed all the other equations and can be used as an alternative to direct LDL-C measurement in a South Indian population.

Longitudinal associations between ambient PM2.5 exposure and lipid levels in two Indian cities

Background

Exposure to ambient PM2.5 is known to affect lipid metabolism through systemic inflammation and oxidative stress. Evidence from developing countries, such as India with high levels of ambient PM2.5 and distinct lipid profiles, is sparse.

Methods

Longitudinal nonlinear mixed-effects analysis was conducted on >10,000 participants of Centre for cArdiometabolic Risk Reduction in South Asia (CARRS) cohort in Chennai and Delhi, India. We examined associations between 1-month and 1-year average ambient PM2.5 exposure derived from the spatiotemporal model and lipid levels (total cholesterol [TC], triglycerides [TRIG], high-density lipoprotein cholesterol [HDL-C], and low-density lipoprotein cholesterol [LDL-C]) measured longitudinally, adjusting for residential and neighborhood-level confounders.

Results

The mean annual exposure in Chennai and Delhi was 40 and 102 μg/m3 respectively. Elevated ambient PM2.5 levels were associated with an increase in LDL-C and TC at levels up to 100 µg/m3 in both cities and beyond 125 µg/m3 in Delhi. TRIG levels in Chennai increased until 40 µg/m3 for both short- and long-term exposures, then stabilized or declined, while in Delhi, there was a consistent rise with increasing annual exposures. HDL-C showed an increase in both cities against monthly average exposure. HDL-C decreased slightly in Chennai with an increase in long-term exposure, whereas it decreased beyond 130 µg/m3 in Delhi.

Conclusion

These findings demonstrate diverse associations between a wide range of ambient PM2.5 and lipid levels in an understudied South Asian population. Further research is needed to establish causality and develop targeted interventions to mitigate the impact of air pollution on lipid metabolism and cardiovascular health.

Trends in epidemiology of dyslipidemias in India

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. High total cholesterol and its principal subtypes: low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein (NHDL) cholesterol are the most important. Epidemiological and Mendelian randomization studies have confirmed role of raised triglycerides and lipoprotein(a). INTERHEART study reported a significant association of raised ApoB/ApoA1, total-, LDL-, and NHDL-cholesterol in South Asians. Prospective Urban Rural Epidemiology (PURE) study identified raised NHDL cholesterol as the most important risk factor. Regional and multisite epidemiological studies in India have reported increasing population levels of total-, LDL-, and NHDL cholesterol and triglycerides. India Heart Watch reported higher prevalence of total and LDL cholesterol in northern and western Indian cities. ICMR-INDIAB study reported regional variations in hypercholesterolemia (≥200 mg/dl) from 4.6 % to 50.3 %, with greater prevalence in northern states, Kerala, Goa, and West Bengal. Non-Communicable Disease Risk Factor Collaboration and Global Burden of Diseases Studies have reported increasing LDL- and NHDL-cholesterol in India. Studies among emigrant Indians in UK and USA have reported higher triglycerides in compared to Caucasians. Identification of regional variations and trends in dyslipidemias need more nationwide surveys. Prospective studies are needed to assess quantum of risk with CAD incidence.

Familial hypercholesterolemia

Familial hypercholesterolemia is a common genetic disorder of autosomal inheritance associated with elevated LDL-cholesterol. It is estimated to affect 1:250 individuals in general population roughly estimated to be 5 million in India. The prevalence of FH is higher in young CAD patients (<55 years in men; <60 years in women). FH is underdiagnosed and undertreated. Screening during childhood and Cascade screening of family members of known FH patients is of utmost importance in order to prevent the burden of CAD. Early identification of FH patients and early initiation of the lifelong lipid lowering therapy is the most effective strategy for managing FH. FH management includes pharmaceutical agents (statins and non statin drugs) and lifestyle modification. Inspite of maximum dose of statin with or without Ezetimibe, if target levels of LDL-C are not achieved, Bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK9) Inhibitors/Inclisiran can be added.

Evaluation of genetic variants related to lipid levels among the North Indian population

Background: A heavy burden of cardiometabolic conditions on low- and middle-income countries like India that are rapidly undergoing urbanization remains unaddressed. Indians are known to have high levels of triglycerides and low levels of HDL-C along with moderately higher levels of LDL-C. The genome-wide findings from Western populations need to be validated in an Indian context for a better understanding of the underlying etiology of dyslipidemia in India. Objective: We aim to validate 12 genetic variants associated with lipid levels among rural and urban Indian populations and derive unweighted and weighted genetic risk scores (uGRS and wGRS) for lipid levels among the Indian population. Methods: Assuming an additive model of inheritance, linear regression models adjusted for all the possible covariates were run to examine the association between 12 genetic variants and total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C among 2,117 rural and urban Indian participants. The combined effect of validated loci was estimated by allelic risk scores, unweighted and weighted by their effect sizes. Results: The wGRS for triglycerides and VLDL-C was derived based on five associated variants (rs174546 at FADS1, rs17482753 at LPL, rs2293889 at TRPS1, rs4148005 at ABCA8, and rs4420638 at APOC1), which was associated with 36.31 mg/dL of elevated triglyceride and VLDL-C levels (β = 0.95, SE = 0.16, p < 0.001). Similarly, every unit of combined risk score (rs2293889 at TRPS1 and rs4147536 at ADH1B) was associated with 40.62 mg/dL of higher total cholesterol (β = 1.01, SE = 0.23, p < 0.001) and 33.97 mg/dL of higher LDL-C (β = 1.03, SE = 0.19, p < 0.001) based on its wGRS (rs2293889 at TRPS1, rs4147536 at ADH1B, rs4420638 at APOC1, and rs660240 at CELSR2). The wGRS derived from five associated variants (rs174546 at FADS1, rs17482753 at LPL, rs4148005 at ABCA8, rs4420638 at APOC1, and rs7832643 at PLEC) was associated with 10.64 mg/dL of lower HDL-C (β = -0.87, SE = 0.14, p < 0.001). Conclusion: We confirm the role of eight genome-wide association study (GWAS) loci related to different lipid levels in the Indian population and demonstrate the combined effect of variants for lipid traits among Indians by deriving the polygenic risk scores. Similar studies among different populations are required to validate the GWAS loci and effect modification of these loci by lifestyle and environmental factors related to urbanization.

Comparison of the effectiveness of lifestyle interventions and multi-interventional therapy on biochemical parameters of metabolic syndrome among women

BACKGROUND

Metabolic syndrome is one of the emerging health issues in developing countries. It includes diabetes, high blood pressure, obesity, and elevated blood cholesterol. This study aimed to compare the effects of two different types of interventions: multi-interventional therapy (MIT) and lifestyle interventions (LIs) on high-density lipoprotein (HDL), triglycerides, and fasting blood sugar (FBS) among women with metabolic syndrome.

MATERIALS AND METHODS

The study used a quasi-experimental nonequivalent control group design with two experimental groups and one control group. This study was conducted among self-help group women from nine area development societies (ADS) in a selected area in South India from March 1, 2019, to February 28, 2020. Women (aged between 35 and 55 years) with metabolic syndrome were recruited by multistage sampling (N = 220) and randomly assigned into three groups: (a) control, (b) MIT (intervention 1), and (c) LIs (intervention 2). Reflexology foot massage, dietary modification, moderate-intensity exercise, and structured education were given to the MIT group and dietary modification, moderate-intensity exercise, and structured education were given to the LI group for 12 weeks. The control group received routine care. A demographic and clinical data sheet is used to collect the basic information. Biochemical variables (HDL, triglycerides, and FBS) were assessed before and after the intervention. The data obtained from the study were computed using a frequency distribution to describe the demographic characteristics, and a Chi-square (x2) test was conducted to find the homogeneity. Both parametric and nonparametric tests were conducted for the comparison of the effectiveness of different methods of interventions on biochemical parameters of metabolic syndrome.

RESULTS

Women who received MIT and LI had significantly lower values of HDL, triglycerides, and FBS after the treatment from baseline and compared with the control group. The study found a significant improvement in the biochemical parameters in the MIT group as compared to the control group and the LI group (<0.001).

CONCLUSION

Paired t-test shows significant improvement in HDL, triglycerides, and FBS (P < 0.001) in both the LI and MIT groups. In case of triglycerides, MIT was found to be more effective (P < 0.001). Both MIT and LIs can be considered interventions for reducing triglycerides and FBS and increasing HDL.

Recalibration of Framingham risk for a local population of Sri Lanka

BACKGROUND

Cardiovascular Diseases (CVD) account for the highest number of deaths and disability globally and within Sri Lanka. A CVD risk prediction tool is a simple means of early identification of high-risk groups which is a cost-effective preventive strategy, especially for resource-poor countries. Distribution of risk factor levels varies in different regions even within the same country, thus a common risk estimation tool for the country may give false local predictions. Since there are few published data related to Sri Lanka the aim of this study was to recalibrate the Framingham equation according to the local risk factor profile of a population in the Kurunegala region in Sri Lanka.

METHOD

A cross-sectional study was conducted with the participation of 1 102 persons from the Kurunegala Regional Director of Health Services area and the data was collected using an interviewer-administered questionnaire, anthropometric, blood pressure, and biochemical measurements. CVD risk was estimated using Framingham original and recalibrated CVD risk assessment methods. Current CVD mortality and morbidity data and the recalibration method conducted by the method described by Wilson and colleagues were used for calculations.

RESULTS

Original and recalibrated Framingham CVD risk scores predicted 55.5% (N = 612) and 62.3% (N = 687) to be having less than 10% CVD risk respectively. Further, the original and recalibrated CVD Risk Scores predicted 2.2% (N = 24) and 1.8% (N = 20) to be having CVD risk more than 40% respectively.

CONCLUSION

These findings show an over prediction of the CVD risk with the original Framingham risk calculations which signifies the importance of development of a region-specific risk prediction tool using local risk factor data in Sri Lanka which will prevent unnecessary expenditure to manage people without risk of CVD.

Status and correlates of non-communicable diseases among children and adolescents in slum and non-slum areas of India's four metropolitan cities

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

Lipid profile abnormalities & 10 yr risk of CVD assessment among adult in North East India: A cross-sectional study

Background & objectives

In India, lifestyle changes have contributed to increase in the number of people suffering from lipid profile abnormalities, which is a major risk factor for coronary artery diseases. The present study was aimed to estimate the prevalence of lipid profile abnormalities and 10 yr risk of cardiovascular disease (CVD) among the adult population in west Tripura district and to study the association of lipid profile abnormalities and increased CVD risk with sociodemography, body mass index (BMI), hypertension, random blood sugar (RBS) and haemoglobin level.

Methods

This cross-sectional study was conducted amongst 445 adults of 20 to 60 yr of age from a randomly selected block in west Tripura district. The 10 yr risk of CVD was estimated using the Framingham Risk Assessment Tool.

Results

The study revealed that overall 83.4 per cent adult population had lipid profile abnormalities, with 22.2, 42 and 70.3 per cent of participants having hypercholesterolaemia, hypertriglyceridaemia and low high-density lipoprotein level, respectively. Gender (P=0.02) and BMI (P<0.001) were the significant determinants of dyslipidaemia. Only 3.8 per cent of participants had intermediate or high risk of CVD, with all of them being males. Gender, age, occupation and RBS were significantly associated with increased CVD risk.

Interpretation & conclusions

The study revealed a high burden of lipid profile abnormalities in the study population, with males having more risk of CVD. Hence, periodic screening of lipid profile abnormalities and risk of CVD should be incorporated at the primary care level to combat the CVD epidemic in India.

Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17)

BACKGROUND

Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and inter-regional variations.

METHODS

The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines.

FINDINGS

A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1.

INTERPRETATION

The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India.

FUNDING

Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Prevalence of familial hypercholesterolemia in a country-wide laboratory network in Pakistan: 10-year data from 988, 306 patients

INTRODUCTION

Familial hypercholesterolemia (FH) is a modifiable risk factor for premature coronary heart disease but is poorly diagnosed and treated. We leveraged a large laboratory network in Pakistan to study the prevalence, gender and geographic distribution of FH.

METHODOLOGY

Data were curated from the Aga Khan University Hospital clinical laboratories, which comprises of 289 laboratories and collection points spread over 94 districts. Clinically ordered lipid profiles from 1st January 2009 to 30th June 2018 were included and data on 1,542,281 LDL-C values was extracted. We used the Make Early Diagnosis to Prevent Early Death (MEDPED) criteria to classify patients as FH and reported data on patients with low-density liporotein -cholesterol (LDL-C) ≥ 190 mg/dL. FH cases were also examined by their spatial distribution.

RESULTS

After applying exclusions, the final sample included 988,306 unique individuals, of which 24,273 individuals (1:40) had LDL-C values of ≥190 mg/dL. Based on the MEDPED criteria, 2416 individuals (1:409) had FH. FH prevalence was highest in individuals 10-19 years (1:40) and decreased as the patient age increased. Among individuals ≥40 years, the prevalence of FH was higher for females compared with males (1:755 vs 1:1037, p < 0.001). Median LDL-C for the overall population was 112 mg/dL (IQR = 88-136 mg/dL). The highest prevalence after removing outliers was observed in Rajan Pur district (1.23% [0.70-2.10%]) in Punjab province, followed by Mardan (1.18% [0.80-1.70%]) in Khyber Pakhtunkhwa province, and Okara (0.99% [0.50-1.80%]) in Punjab province.

CONCLUSION

There is high prevalence of actionable LDL-C values in lipid samples across a large network of laboratories in Pakistan. Variable FH prevalence across geographic locations in Pakistan may need to be explored at the population level for intervention and management of contributory factors. Efforts at early diagnosis and treatment of FH are urgently needed.

The burgeoning cardiovascular disease epidemic in Indians - perspectives on contextual factors and potential solutions

Cardiovascular diseases (CVD) are the leading cause of death and disability in India. The CVD epidemic in Indians is characterized by a higher relative risk burden, an earlier age of onset, higher case fatality and higher premature deaths. For decades, researchers have been trying to understand the reason for this increased burden and propensity of CVD among Indians. It can partly be explained by population-level changes and the remaining by increased inherent biological risk. While increased biological risk can be attributed to phenotypic changes caused by early life influences, six major transitions can be considered largely responsible for the population-level changes in India-epidemiological, demographic, nutritional, environmental, social-cultural and economic. Although conventional risk factors explain substantial population attributable risk, the thresholds at which these risk factors operate are different among Indians compared with other populations. Therefore, alternate explanations for these ecological differences have been sought and multiple hypotheses have been proposed over the years. Prenatal factors that include maternal and paternal influences on the offspring, and postnatal factors, ranging from birth through childhood, adolescence and young adulthood, as well as inter-generational influences have been explored using the life course approach to chronic disease. In addition to this, recent research has illustrated the importance of the role of inherent biological differences in lipid metabolism, glucose metabolism, inflammatory states, genetic predispositions and epigenetic influences for the increased risk. A multifaceted and holistic approach to CVD prevention that takes into consideration population-level as well as biological risk factors would be needed to control the burgeoning CVD epidemic among Indians.

Aluminum as a Possible Cause Toward Dyslipidemia

Aluminum, the third most abundant metal present in the earth's crust, is present almost in all daily commodities we use, and exposure to it is unavoidable. The interference of aluminum with various biochemical reactions in the body leads to detrimental health effects, out of which aluminum-induced neurodegeneration is widely studied. However, the effect of aluminum in causing dyslipidemia cannot be neglected. Dyslipidemia is a global health problem, which commences to the cosmic of non-communicable diseases. The interference of aluminum with various iron-dependent enzymatic activities in the tri-carboxylic acid cycle and electron transport chain results in decreased production of mitochondrial adenosine tri-phosphate. This ultimately contributes to oxidative stress and iron-mediated lipid peroxidation. This mitochondrial dysfunction along with modulation of α-ketoglutarate and L-carnitine perturbs lipid metabolism, leading to the atypical accumulation of lipids and dyslipidemia. Respiratory chain disruption because of the accumulation of reduced nicotinamide adenine di-nucleotide as a consequence of oxidative stress and the stimulatory effect of aluminum exposure on glycolysis causes many health issues including fat accumulation, obesity, and other hepatic disorders. One major factor contributing to dyslipidemia and enhanced pro-inflammatory responses is estrogen. Aluminum, being a metalloestrogen, modulates estrogen receptors, and in this world of industrialization and urbanization, we could corner down to metals, particularly aluminum, in the development of dyslipidemia. As per PRISMA guidelines, we did a literature search in four medical databases to give a holistic view of the possible link between aluminum exposure and various biochemical events leading to dyslipidemia.

Is iron status associated with markers of non-communicable disease in adolescent Indian children?

BACKGROUND

High body iron status has been associated with non-communicable diseases (NCD) like diabetes (high fasting blood glucose, FBG), hypertension (HTN) or dyslipidaemia (high total cholesterol, TC) in adults, but this has not been examined in adolescent children. This is relevant to iron supplementation and food iron fortification programs that are directed at Indian children.

METHODS

The association of NCD with Serum Ferritin (SF) was examined using logistic additive models, adjusted for confounders such as age, body mass index, C-Reactive Protein, haemoglobin and sex, in adolescent (10-19 years old) participants of the Indian Comprehensive National Nutrition Survey. The interaction of these associations with wealth and co-existing prediabetes was also examined. A scenario analysis was also done to understand the impact of iron fortification of cereals on the prevalence NCD among adolescents.

RESULTS

The odds ratio (OR) of high FBG, HTN and TC were 1.05 (95% CI: 1.01-1.08), 1.02 (95% CI: 1.001-1.03) and 1.04 (95% CI: 1.01-1.06) respectively for every 10 µg/L increase in SF. The odds for high TC increased with co-existing prediabetes. The scenario analysis showed that providing 10 mg of iron/day by fortification could increase the prevalence of high FBG by 2-14% across states of India. Similar increments in HTN and TC can also be expected.

CONCLUSIONS

High SF is significantly associated with NCD in adolescents, dependent on wealth and co-existing prediabetes. This should be considered when enhancing iron intake in anaemia prevention programs, and the NCD relationship with body iron stores should be studied.

Prevalence and factors associated with dyslipidemia in Bangladeshi adults

BACKGROUND

Dyslipidemia is one of the modifiable risk factors for cardiovascular disease and a leading cause of morbidity and mortality worldwide. This study was designed to estimate the prevalence and factors associated with dyslipidemia in Bangladeshi adults.

METHODS

A total of 603 participants aged ≥ 18 years were recruited in the study. Serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were analyzed using enzymatic colorimetric methods. Dyslipidemia was defined based on serum lipids levels following the standard guidelines by National Cholesterol Education Program Adult Treatment Panel III. Multivariate logistic regression analysis was applied to evaluate risk factors associated with dyslipidemia.

RESULTS

The overall prevalence of dyslipidemia was 89% with no significant difference between male (90.1%) and female (85.7) subjects. The prevalence of hypertriglyceridemia was 51.7%, hypercholesterolemia 41.6%, high LDL 43.9% and low HDL 78.8%. When participants were classified into healthy control, hypertensive and diabetic groups, the lipid levels and prevalence of lipid abnormalities were higher in hypertensive and diabetic groups compared to the control group. Low HDL level was the main prevalent dyslipidemia among study subjects. The prevalence of isolated hypertriglyceridemia, isolated hypercholesterolemia, and isolated low HDL-C was 24.7%, 14.7%, and 25.5%, respectively. Mixed hyperlipidemia was prevalent in 26.9% of the participants. According to the logistic regression analysis, significant associated factors of dyslipidemia were increased age, overweight, general and abdominal obesity, hypertension, diabetes and inadequate physical activity.

CONCLUSIONS

This study shows a high prevalence of dyslipidemia in Bangladeshi adults. Important risk factors of dyslipidemia are increased age, overweight, general and abdominal obesity, diabetes, hypertension and low physical activity. Our results suggest that awareness-raising programs are required to prevent and control dyslipidemia among Bangladeshi adults.

Risk factors for cardiovascular disease in a healthy young population: Family matters

Background

India faces an epidemic of cardiovascular disease (CVD). This study sought the effect of family history of CVD and/or its risk factors (CVD-risk) on the presence of risk factors for CVD, in a healthy young college population.

Methods

Blood pressure (BP), heart rate (HR), anthropometric variables, fasting blood sugar and lipid fractions were measured in two hundred healthy individuals (163 men and 37 women), aged 17-22 years. Data were analysed to elicit effect of CVD-risk on measured parameters.

Results

All but one subject, had family history of a CVD-risk. Men with family history of coronary heart disease had higher diastolic BP (79.24 ± 7.7 vs 75.99 ± 7.49 mmHg, p = 0.007) and triglycerides (118.66 ± 57.98 vs 85.82 ± 50.89 mg/dL, p < 0.0001) compared with those without similar family history. Men with family history of hypertension (HTN) had higher diastolic BP (78.75 ± 7.15 vs 75.84 ± 8.37 mmHg, p = 0.019) and low-density lipoprotein (86.24 ± 25.38 vs 78.21 ± 17.93 mg/dL, p = 0.019), as well as lower high-density lipoprotein (50.27 ± 8.4 vs 53.96 ± 10.38 mg/dL, p = 0.019). Women with family history of diabetes mellitus had lower high-density lipoproteins (49.89 ± 8.05 vs 59.53 ± 11.44, p = 0.006). Family history of dyslipidaemia was associated with significantly higher triglycerides (146.14 ± 46.19 vs 98.44 ± 56.19 mg/dL, p = 0.002) in men and in subjects across sex. HDL was contrarily higher, in women with family history of cerebrovascular accident/HTN and men with family history of coronary heart disease/HTN. The proportion of pre-HTN, overweight/obese, impaired fasting glucose and borderline high triglycerides was 88.3%, 36.8%, 11% and 38.7% in men and 64.9%, 37.8%, 18.9% and 48.7% in female subjects.

Conclusion

Young adults with a family history of CVD-risk already have an incomplete/atypical CVD risk profile.

An experimental study of rosuvastatin's analgesic effect and its interaction with etoricoxib, tramadol, amlodipine, and amitriptytline in albino mice

Background

Statins are the mainstay for the treatment of dyslipidemia. Recently, rosuvastatin has also been demonstrated to possess analgesic properties in animal studies. The present study has been planned to further confirm the analgesic activity of rosuvastatin, etoricoxib, tramadol, amlodipine, and amitriptyline and study the interaction of rosuvastatin with the above-mentioned analgesics. The objective of the study was to confirm the analgesic activity of rosuvastatin and determine the minimum analgesic dose of rosuvastatin, etoricoxib, tramadol, amlodipine and amitriptyline and to study the analgesic effect of combination of subanalgesic doses of rosuvastatin with sub-analgesic doses of etoricoxib, tramadol, amlodipine, and amitriptyline.

Method

After IAEC approval, the study was carried out in albino mice in two phases. In phase I, the analgesic effect of rosuvastatin, etoricoxib, tramadol, amlodipine, and amitriptyline was confirmed by using tail-flick and writhing methods. In phase II, analgesic effect of combinations of subanalgesic dose of rosuvastatin with subanalgesic dose of etoricoxib, tramadol, amlodipine, and amitriptyline was studied.

Results

Minimal analgesic dose of rosuvastatin, etoricoxib, tramadol, amlodipine, and amitriptyline was observed as 5, 20, 10, 5, and 10 mg/kg, respectively. In phase II, combination of subanalgesic dose of rosuvastatin 2.5 mg/kg with subanalgesic doses of etoricoxib (10 mg/kg), tramadol (5 mg/kg), amlodipine (2.5 mg/kg), and amitriptyline (5 mg/kg), demonstrated synergistic analgesic activity.

Conclusion

Rosuvastatin exerts dose-dependent analgesic activity that is synergistic to that of etoricoxib, tramadol, amlodipine, and amitriptyline. If established in clinical studies as well, this finding can lead to the reduction of analgesic dosing in patients already on statins.

High-density lipoproteins may play a crucial role in COVID-19

Background

Lipids play a central role in the virus life cycle and are a crucial target to develop antiviral therapeutics. Importantly, among the other lipoproteins, the ‘good cholesterol’ high-density lipoprotein (HDL) has been widely studied for its role in not only cardiovascular but several infectious diseases as well. Studies have suggested a role of serum lipids and lipoproteins including HDL, total cholesterol (TC), triglycerides (TG), and low-density lipoproteins (LDL) in several viral infections including COVID-19. This disease is currently a major public health problem and there is a need to explore the role of these host lipids/lipoproteins in virus pathogenesis.

Methodology

A total of 75 retrospective COVID-19 positive serum samples and 10 COVID-19 negative controls were studied for their lipid profiles including TC, HDL, LDL, and very-low-density lipoproteins (VLDL), and TG.

Results

Systematic literature search on dyslipidemia status in India shows that low HDL is the most common dyslipidemia. In this cohort, 65% (49) of COVID-19 patients had severely low HDL levels whereas 35% (26) had moderately low HDL and none had normal HDL levels. On the other hand, ~ 96% of samples had normal TC (72) and LDL (72) levels. VLDL and TG levels were also variable. In the controls, 100% of samples had moderately low HDL but none severely low HDL levels.

Conclusion

HDL likely plays a crucial role in COVID-19 infection and outcomes. The causal relationships between HDL levels and COVID-19 need to be studied extensively for an understanding of disease pathogenesis and management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12985-022-01865-4.

Guidelines for dyslipidemia management in India: A review of the current scenario and gaps in research

Cardiovascular Diseases (CVD) have a high disease burden in India. Dyslipidemia, a major CVD risk factor, requires effective management.

Our review describes the appropriateness of the international dyslipidemia guidelines in the Indian context. A systematic search was performed in PubMed, Google Scholar, Cochrane Library and Science Direct to obtain relevant articles.

Dyslipidemia management guidelines by western medical associations are based on their studies, with ethnic minorities underrepresented and biological features of other racial groups inadequately incorporated. The Lipid Association of India (LAI) came up with a consensus statement guided by an expert panel to adapt the western guidelines to Indians. However, absence of Indian guidelines has led to physicians basing treatment on individual preference, contributing to heterogeneity. Our review underscores the need for formulating Indian dyslipidemia management guidelines and CV risk estimation algorithms, highlighting the scope for further research. This could supplement the clinical expertise of LAI and enhance patient experience.

Healthcare worker-based opportunistic screening for familial hypercholesterolemia in a low-resource setting

Background & objective

Heterozygous familial hypercholesterolemia (FHeH) is important risk factor for premature coronary artery disease (CAD). Strategies for its diagnosis and prevalence have not been well studied in India. We performed healthcare worker-based opportunistic screening to assess feasibility for determining its prevalence.

Methods

A healthcare worker was trained in use of Dutch Lipid Clinic Network (DLCN) criteria for diagnosis of FHeH. Successive eligible individuals (n = 3000 of 3450 screened) presenting to biochemistry laboratories of two hospitals for blood lipid measurements were evaluated for FHeH. Cascade screening or genetic studies were not performed. Descriptive statistics are reported.

Results

We included 2549 participants (men 1870, women 679) not on statin therapy. Health worker screened 25–30 individuals/day in 6–10 minutes each. The mean age was 46.2±11y. Variables of DLCN criteria were more in women vs men: family history 51.1 vs 35.6%, past CAD 48.2 vs 20.1%, arcus cornealis 1.1 vs 0.3%, tendon xanthoma 0.3 vs 0.1%, and LDL cholesterol 190–249 mg/dl in 8.5 vs 2.4%, 250–329 mg/dl in 0.7 vs 0% and ≥330 mg/dl in 0.3 vs 0% (p<0.01). Definite FHeH (DLCN score >8) was in 15 (0.59%, frequency 1:170) and probable FHeH (score 6–8) in 87 (3.4%, frequency 1:29). The prevalence was significantly greater in women, age <50y and in those with hypertension, diabetes and known CAD.

Conclusions

Healthcare worker-led opportunistic screening for diagnosis of FHeH using DLCN criteria is feasible in low-resource settings. The results show significant prevalence of clinically detected definite and probable FHeH in the population studied.

Phyto-Enrichment of Yogurt to Control Hypercholesterolemia: A Functional Approach

Cholesterol is essential for normal human health, but elevations in its serum levels have led to the development of various complications, including hypercholesterolemia (HC). Cholesterol accumulation in blood circulation formsplaques on artery walls and worsens the individuals’ health. To overcome this complication, different pharmacological and non-pharmacological approaches are employed to reduce elevated blood cholesterol levels. Atorvastatin and rosuvastatin are the most commonly used drugs, but their prolonged use leads to several acute side effects. In recent decades, the potential benefit of ingesting yogurt on lipid profile has attracted the interest of researchers and medical professionals worldwide. This review aims to give an overview of the current knowledge about HC and the different therapeutic approaches. It also discusses the health benefits of yogurt consumption and highlights the overlooked phyto-enrichment option to enhance the yogurt’s quality. Finally, clinical studies using different phyto-enriched yogurts for HC management are also reviewed. Yogurt has a rich nutritional value, but its processing degrades the content of minerals, vitamins, and other vital constituents with beneficial health effects. The option of enriching yogurt with phytoconstituents has drawn a lot of attention. Different pre-clinical and clinical studies have provided new insights on their benefits on gut microbiota and human health. Thus, the yogurtphyto-enrichment with stanol and β-glucan have opened new paths in functional food industries and found healthy andeffective alternatives for HC all along with conventional treatment approaches.

A systematic review and metaanalysis of observational studies on the effects of epigenetic factors on serum triglycerides

Epigenetic modifications might be associated with serum triglycerides (TG) levels. This study aims to systematically review the studies on the relationship between the methylation of specific cytosine-phosphate-guanine (CpG) sites and serum TG levels. This systematic review and meta-analysis study was conducted according to the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic literature search was conducted in Medline database (PubMed), Scopus, and Cochrane library up to end of 2020. All observational studies (cross-sectional, case-control, and cohort) were included. Studies that assessed the effect of DNA methylation of different CpG sites of ABCG1, CPT1A, and SREBF1 genes on serum TG levels were selected. The National Institutes of Health (NIH) checklist was used to assess the quality of included articles. Among 2790 articles, ten studies were included in the quantitative analysis and fourteen studies were included in the systematic review. DNA methylation of ABCG1 gene had significant positive association with TG levels (β = 0.05, 95% CI = 0.04, 0.05, P heterogeneity < 0.001). There was significant inverse association between DNA methylation of CPT1A gene and serum TG levels (β = -0.03, 95% CI = -0.03, -0.02, P heterogeneity < 0.001). DNA methylation of SREBF1 gene was positively and significantly associated with serum TG levels (β = 0.03; 95% CI = 0.02-0.04, P heterogeneity < 0.001). DNA methylation of ABCG1 and SREBF1 genes has positive association with serum TG level, whereas this association is opposite for CPT1A gene. The role of epigenetic factors should be considered in some populations with high prevalence of hypertriglyceridemia.

Evaluating the safety and efficacy of a polyherbal Unani formulation in dyslipidaemia-a prospective randomized controlled trial

ETHNOPHARMACOLOGICAL RELEVANCE

Unani System of Medicine offers treatment for obesity and dyslipidaemia. Jawarish Falafili (JF) is a Unani polyherbal pharmacopoeial preparation. It has been used in the treatment of obesity for a long time. Dyslipidaemia is a recognised modifiable risk factor for hypertension, ischemic heart disease and stroke. Limitations of the current conventional therapy have provided scope for research of a potential drug in this medical condition. It was hypothesised that JF may ameliorate dyslipidaemia in human participants.

AIM OF THE STUDY

The main objective of this study was to evaluate the safety and efficacy of the JF.

MATERIALS AND METHODS

This was a prospective randomized, active-controlled, open-label and parallel-group study. We randomized 74 participants of dyslipidaemia into treatment (n = 38) and control (n = 36) groups. Of them, 30 participants in each group completed the trial. The participants of any sex aged between 30 and 60 years, with serum total cholesterol (TC) ≥200 mg/dl and/or serum triglycerides (TG) ≥150 mg/dl and/or low-density lipoprotein cholesterol (LDL-C) level ≥130 mg/dl and/or high-density lipoprotein cholesterol (HDL-C) level <40 mg/dl were enrolled in this study. The participants of the treatment group were treated with JF (10 gm/day) once and atorvastatin (20 mg/day) was given to the control group for 90 days once at night daily.

RESULTS

We observed a significant reduction (treatment group versus control group) in mean serum TC by 22.89% versus 19.36%, TG by 29.90% versus 23.26% and LDL-C by 29.16% versus 27.92% from baseline (p < 0.05). But the change in mean serum HDL-C levels post-treatment was insignificant in both groups (p > 0.05). On intergroup comparison, the magnitude of the difference of mean TC, TG, LDL-C and HDL-C levels between the groups was not statistically significant (p > 0.00.05).

CONCLUSIONS

This study concluded that JF and atorvastatin were equally effective in controlling dyslipidaemia. They were tolerated well by all participants and found safe during the course of treatment.

Lipoprotein Profile in Populations from Regions of the Russian Federation: ESSE-RF Study

This study aimed to describe the dyslipidemia prevalence and pattern among adult populations from different regions (n = 13) of the Russian Federation (RF). Randomly selected samples (n = 22,258, aged 25-64) were studied according to the ESSE-RF protocol. Lipoprotein parameters were estimated by routine methods. Statistical analyses were performed using R software (v.3.5.1). The overall dyslipidemia prevalence was 76.1% (76.9/75.3% for men/women). In women, total cholesterol (TC) and low-density lipoprotein (LDL)-C levels gradually increased with age (from 4.72 to 5.93 and from 2.76 to 3.79 mmol/L, respectively); in men, they reached a maximum by 45-54 (5.55 and 3.55 mmol/L, respectively) and then decreased. No differences in high-density lipoprotein (HDL)-C in men of different ages were found, but slight decreases in HDL-C and apo AI were observed in women by 55-64 years. No pronounced associations between education and lipid levels in men were observed; higher-educated women showed significantly better lipoprotein profiles. Similar associations between lipids and income level were detected. Women from rural areas had higher TC and triglycerides than urban residents. Regardless of sex, rural residents had higher HDL-C and apo AI, and reduced apo B/apo AI. Conclusion: Information on the peculiarities of dyslipidemia prevalence and lipoprotein profile depending on sex, age, residential place, and socioeconomic status is useful for assessing the global ASCVD risk, and for risk modeling based on national data.

Factors Determining the Three-Year Dynamics of Lipid Metabolism Indicators in Residents of a Large Industrial Region of Siberia

Aim. To assess the contribution of traditional and socio-economic factors to the development and dynamics of dyslipidemia based on the results of an epidemiological study in a large region of Siberia.

Material and methods. Clinical and epidemiological prospective study of the population 35-70 years old was carried out. At the basic stage, 1600 participants were examined, including 1124 women and 476 men, the prospective stage included 807 respondents (the response was 84.1%). A survey was carried out to find out the state of health (presence of diseases, taking medications), socio-economic status (level of education and income, marital status) and the presence of behavioral risk factors (tobacco and alcohol use).

Results. The proportion of people with hypercholesterolemia increased 1.2 times, low LDL – 1.1 times, and hypertriglyceridemia and low HDL – 1.7 times. In persons with hypertriglyceridemia, the frequency of detected obesity and hypertension decreased by 7.9% and 4.6%, respectively (p = 0.046). Obesity was associated with an increased risk of developing hypercholesterolemia (OR = 1.49, CI: 1.0-2.2), hypertriglyceridemia (OR = 2.14, CI: 1.5-3.0), high LDL cholesterol (OR = 2.16, CI: 1.3-3.6) and low HDL cholesterol (OR = 2.07, CI: 1.5-2.9). The presence of hypertension - with an increased risk of developing hypertriglyceridemia (OR = 2.19, CI: 1.5-3.1) and low HDL (OR = 2.49, CI: 1.8-3.5). Among people with low HDL levels, the number of smokers and drinkers decreased (by 7.0% and 5.7%, respectively), as well as those with obesity by 8.6%. The prevalence of dyslipidemia increased in all socioeconomic groups.

Conclusion. Over 3 years of follow-up, there was a statistically significant increase in the proportion of persons with dyslipidemia in all socio-economic groups. There was a significant decrease in such risk factors as obesity, hypertension, smoking, alcohol consumption and an increase in the number of respondents taking lipid-lowering therapy.

Prevalence and Risk Factors of Dyslipidemia among Type 2 Diabetes Patients at a Referral Hospital, North Eastern Ethiopia

Background

The prevalence of diabetes and its associated complications rising in Ethiopia ranged from 2.0%-6.5%, the primary cause of morbidity and mortality with consequential economic impact. This study aimed to assess the prevalence and risk factors of dyslipidemia among diabetes follow-up patients.

Methods

Institution-based cross-sectional study was conducted at Debre Berhan Referral Hospital from January to March 2020 in 347 Adult type 2 diabetes follow-up patients using a convenient sampling technique. Data were collected by interviews and entered using Epi-data 4.2 and analyzed using SPSS version 25. Factors having a p-value < 0.25 in the bi-variable logistic regression model were entered into a multivariable logistic regression model. Statistical Significance was declared at a p-value ≤ of 0.05.

Results

The prevalence of dyslipidemia among type 2 diabetes patients in this study was 59 %. Significantly associated variables were being female [AOR 2.6 (95% CI 1.2-3.2), P = 0.011], smoking history [AOR 4.1 (95% CI 2-6.8), P = 0.001], Being overweight [AOR 3.5 (95% CI 1.6-7.8), P = 0.002], Being obese [AOR 4.8 (95% CI 1.7-13), P = 0.002].

Conclusion

Prevalence of dyslipidemia was high among diabetic patients, which accounts for 59%. Being female, smoking history, being overweight, and being obese were determinants of dyslipidemia. Patients with poor glycemic control need additional lipid-lowering therapies to prevent secondary Atherosclerotic vascular complications.

LDL-C, NON-HDL-C and APO-B for cardiovascular risk assessment: Looking for the ideal marker

The traditional approach to the management of coronary artery disease (CAD) focuses mainly on low density lipoprotein cholesterol (LDL-C) which is often considered a crucial risk factor for the progression of atherosclerosis. Despite its extensive use in predicting CAD risk, it has become a sub-optimal marker owing to several limitations. Recently, non-high density lipoprotein cholesterol (non-HDL-C) and apolipoprotein-B (Apo-B) have been substantiated to be more reliable predictors of CAD risk. On the basis of available evidence, it is fair to say that non-HDL-C is a more realistic primary target of therapy and can be used for initial screening. In the current scenario, India being a developing country, the population would not be burdened with additional cost of Apo-B estimation as non-HDL-C can be estimated in the non-fasting state which makes it both patient and clinician friendly. Considering this fact, the aim of the present review article is to highlight the reliability and efficacy of non-HDL-Cholesterol and hence make recommendations to incorporate non-HDL-C in routine lipid panel for better assessment of CAD.

Efficacy of Majoon-e-Seer Alvi Khan in dyslipidemia: a single blind randomized standard controlled clinical trial

OBJECTIVES

Majoon-e-Seer Alvi Khan, a compound Unani formulation, has been indicated in disease conditions simulating dyslipidemia. The present study was done to substantiate the efficacy of Majoon-e-Seer Alvi Khan (MSAK) in dyslipidaemia on scientific parameters.

METHODS

A randomized, single-blind, Standard controlled, clinical trial was carried out on 40 patients of dyslipidemia who were randomly allocated into test (n=30) and control (n=10) groups. The test drug, MSAK, and control drug, tablet Atorvastatin was given to the respective group for 60 days along with lifestyle modification.

RESULTS

The test drug significantly alleviated the symptoms of subjective parameters (p<0.05). There was a statistically significant reduction in lipid profile of the patients in the test group (p<0.05) than control drug treatment.

CONCLUSIONS

The study evidenced that Majoon-e-Seer Alvi Khan is potentially effective and safe in the treatment of dyslipidemia. However, a multicentre study with a robust study design is required to generalize the results.

Efficacy of Majoon-e-Seer Alvi Khan in dyslipidemia: a single blind randomized standard controlled clinical trial

OBJECTIVES

Majoon-e-Seer Alvi Khan, a compound Unani formulation, has been indicated in disease conditions simulating dyslipidemia. The present study was done to substantiate the efficacy of Majoon-e-Seer Alvi Khan (MSAK) in dyslipidaemia on scientific parameters.

METHODS

A randomized, single-blind, Standard controlled, clinical trial was carried out on 40 patients of dyslipidemia who were randomly allocated into test (n=30) and control (n=10) groups. The test drug, MSAK, and control drug, tablet Atorvastatin was given to the respective group for 60 days along with lifestyle modification.

RESULTS

The test drug significantly alleviated the symptoms of subjective parameters (p<0.05). There was a statistically significant reduction in lipid profile of the patients in the test group (p<0.05) than control drug treatment.

CONCLUSIONS

The study evidenced that Majoon-e-Seer Alvi Khan is potentially effective and safe in the treatment of dyslipidemia. However, a multicentre study with a robust study design is required to generalize the results.

Familial Hypercholesterolemia in Asia Pacific: A Review of Epidemiology, Diagnosis, and Management in the Region

Familial hypercholesterolemia (FH) is a common genetic disease that is estimated to affect at least 15 million people in the Asia Pacific region. Affected individuals are at significantly increased risk of premature atherosclerotic cardiovascular disease. A literature review was undertaken to provide an overview of the epidemiology, diagnosis, and management of FH across the region.Currently, epidemiological data relating to FH are lacking across the Asia Pacific. Of the 15 countries and regions considered, locally conducted studies to determine FH prevalence were only identified for Australia, China, India, and Japan. Although practically all national clinical guidelines for dyslipidemia include some commentary on FH, specific guidelines on the management of FH are available for only one third of the countries and regions evaluated. Estimates of current FH diagnosis rates suggest that most affected individuals remain undiagnosed and untreated. Although innovative medications such as proprotein convertase subtilisin/kexin type 9 inhibitors have been approved and are available in most countries and regions considered, they are currently reimbursed in only one quarter.Despite these shortcomings, there is cause for optimism. Early experience with cascade screening in Hong Kong, India, and Vietnam has proven an effective means of identifying family members of probands, as has a reverse screening of family members of children with FH in China. FH registries are gaining momentum across the region, with registries now established in almost half of the countries and regions evaluated. This review concludes with a Call to Action on FH for Asia Pacific to engage healthcare professionals, improve public awareness, and form national FH alliances, comprising all relevant healthcare professional organizations, as a platform to expedite national quality improvement programs in the management of FH.

Association Between Blood Heavy Metal Concentrations and Dyslipidemia in the Elderly

Our objective was to evaluate the relationship of blood metal levels including strontium, cadmium, lead, vanadium, aluminum, cobalt, and manganese with dyslipidemia in the elderly Chinese population. In this study, stratified cluster sampling was adopted in the elderly in two communities of Lu'an City from June to September 2016, and 1013 participants were finally included. The inductively coupled plasma mass spectrometry (ICP-MS) was used to measure the metals' concentrations in whole blood. After multivariable adjustment, the odds ratios (95% confidence interval [CI]) of dyslipidemia associated with the highest quartile of metal concentrations were 1.32 (0.89 ~ 1.96), 1.28 (0.83 ~ 1.97), 1.86 (1.23 ~ 2.80), 0.80 (0.55 ~ 1.16), 0.76 (0.51 ~ 1.13), 0.76 (0.53 ~ 1.11), and 1.14 (0.78 ~ 1.67) for strontium, cadmium, lead, vanadium, aluminum, cobalt, and manganese, respectively, compared with the lowest quartile. After reducing the dimensionality of metal elements by principal component analysis, we found that the combined exposure of aluminum, cobalt, and vanadium was the protective factor of non-dyslipidemia, while the combined exposure of cadmium, strontium, and lead was the risk factor of dyslipidemia.

Distribution of Lipids and Prevalence of Dyslipidemia among Indian Expatriates in Qatar

Background

Dyslipidemia is a significant risk factor for cardiovascular diseases (CVD). If detected and managed in the early stages of life, can reduce morbidity and mortality associated with CVD in a vulnerable population. Out of the 94 expatriate nationalities in Qatar, Indians constitute the most prominent single nationality, accounting for 21.8% of the total population (2,773,885 in 2019). This study aims to determine the status of the lipid profile among Indians in Qatar. Study Design. We conducted an observational retrospective study on lipid profile test data of Indian expatriates visiting a private healthcare facility in Qatar from Oct 17 to Oct 2018 to evaluate the gender and age-specific distribution of lipids and the prevalence of dyslipidemia.

Results

Among the total 4483 Indian expatriates (3891 men and 592 women), the mean (SD) mg/dL levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) were higher in men TC 196.9 (40.6), TG 168.9 (114.6), and LDL-C 122.9 (37.2) mg/dL compared to women TC 185 (38.1), TG 117.7 (78.2), and LDL-C 114.1 (31.1) mg/dL, p value < 0.0001. Utilizing predefined National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) limits to categorize dyslipidemias; the greater prevalence of elevated TC, TG, and LDL-C was noted in men 44.7%, 45.8%, and 40.9% than women 31.6%, 22%, and 28.7%, respectively. However, women had higher levels of mean high-density lipoprotein cholesterol (HDL-C) as 47.1 (9.8) mg/dL vs. 40.6 (8.3) mg/dL in men, p value < 0.05, the prevalence of dyslipidemia, low HDL-C was also more 65.7% vs. 48.9% in women than men. With age, men showed a declining trend while women showed a rising trend for mean lipid levels as well as for the prevalence of dyslipidemia, high TC, TG, and LDL-C (p value < 0.0001). The mean HDL-C cholesterol increased, and the prevalence of dyslipidemia, low HDL-C decreased with age in both the genders.

Conclusion

Our results demonstrate the higher mean lipid levels and prevalence of atherogenic dyslipidemia among Indian expatriate men than women counterparts at the younger age group. The screening programs and awareness campaigns must be initiated to prevent the early onset of dyslipidemia induced atherosclerosis leading to CVD. Future controlled studies are needed to estimate the prevalence of dyslipidemias among Indian migrants in Qatar.

Differential risk factors and morbidity/mortality pattern in type 2 diabetes: A study among two Mendelian populations with different ancestry (India)

BACKGROUND AND AIMS

Association studies of type 2 diabetes mellitus (T2DM) with risk factors have shown variable results. Moreover, population-specific comparative investigations are negligible. Therefore, the present study aimed to evaluate the association of dyslipidemia and obesity with impaired fasting glucose (IFG) and T2DM among two ethnically, geographically and culturally different populations in India.

METHODS

This was a cross-sectional study among Jats and Meiteis, each inhabiting a separate geographical region. A total of 2371 individuals, age ≥30 years were recruited through household survey. Obesity variables were captured using anthropometric measurements while fasting blood (2.5 mL) was drawn to measure lipid and glucose levels using enzymatic assay by spectrophotometer. Participants were categorized under normal, IFG and T2DM groups, indicative of diabetes progression stages. Statistical analysis was performed using SPSS 16.0 version.

RESULTS

Significant differential distribution of lipid and obesity variables among IFG and T2DM in both populations were observed. Odds ratio revealed high TC and all obesity variables except BMI posed significant increased risk for T2DM among Jats. Abnormal TG, VLDL, WC, and WHtR posed significant increased risk for T2DM among Meiteis. Age-cohort wise prevalence of T2DM showed increasing trend at ≥60 years among Jats and decreasing trend at ≥60 years among Meiteis, suggesting a potential higher morbidity in the former and mortality in latter because of T2DM.

CONCLUSIONS

The present study observed a differential association of risk factors for T2DM among Jats and Meiteis. This study emphasize the need to implement community-specific intervention programs for prevention, treatment and management of T2DM.

Statins and SARS-CoV-2 disease: Current concepts and possible benefits

BACKGROUND AND AIMS

Inflammation-mediated tissue injury is the major mechanism involved in the pathogenesis of coronavirus disease 2019 (COVID-2019), caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2). Statins have well-established anti-inflammatory, anti-thrombotic and immuno-modulatory effects. They may also influence viral entry into human cells.

METHODS

A literature search was done using PubMed and Google search engines to prepare a narrative review on this topic.

RESULTS

Statins interact with several different signaling pathways to exert their anti-inflammatory and vasculoprotective effects. They also variably affect cholesterol content of cell membranes and interfere with certain coronavirus enzymes involved in receptor-binding. Both these actions may influence SARS-CoV-2 entry into human cells. Statins also upregulate expression of angiotensin-converting enzyme 2 receptors on cell surfaces which may promote viral entry into the cells but at the same time, may minimize tissue injury through production of angiotensin [1-7]. The net impact of these different effects on COVID-19 pathogenesis is not clear. However, the retrospective clinical studies have shown that statin use is potentially associated with lower risk of developing severe illness and mortality and a faster time to recovery in patients with COVID-19.

CONCLUSIONS

Early observations suggest beneficial effect of statin use on the clinical outcomes in COVID-19. Prospective randomized studies as well as well-designed laboratory studies are required to confirm these observations and to elucidate the mechanisms of such benefits, if proven.

Risk factors, comorbiditiEs and Atherogenic dysLipidaemia in Indian YOUNG patients with dyslipidaemia attending hospital/clinic: REAL YOUNG (dyslipidaemia) study

Objective:

To evaluate the pattern of dyslipidaemia, risk factors, and comorbidities in young Indian adults with dyslipidaemia.

Methods:

A retrospective, multi-centric real-world study included individuals with dyslipidaemia, aged 18 - 45 years, attending to 623 hospitals/clinics across India. Data were collected retrospectively from medical records to note demographics, risk factors (smoking, alcohol consumption, sedentary lifestyle, family history of dyslipidaemia, diabetes mellitus, and hypertension), and clinical details (height, weight, waist circumference, body mass index (BMI), blood pressure, blood sugar, glycated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), low-density lipoproteins (LDL-C), and high-density lipoprotein (HDL-C)).A descriptive analysis and comparative analysis (Mann-Whitney U test and Chi-square test) were done.

Results:

Of the total 8135 patients, the majority were men (65.0%). Overall, 87.1% of population had one or multiple comorbidities which included the presence of dyslipidaemia alone (12.9%), dyslipidaemia with diabetes and hypertension (39.1%), dyslipidaemia with diabetes (33.6%), and dyslipidaemia with hypertension (14.4%). Sedentary lifestyle was prevalent observation in >50% of the population. Youngest age (18 - 25) group had higher prevalence of hypertriglyceridemia (63.2%), high LDL-C levels (56.8%), and low HDL-C levels (64.6%), while patients from the age group >25 to ≤35 years had the highest incidence of hypercholesterolemia (66.6%). Atherogenic dyslipidaemia was observed in 41.9%, 25.5%, and 23.2% of patients from age groups of ≥18 to ≤25, >25 to ≤35, and >35 to ≤45 years, respectively. Patients with HbA1c ≥6.5% had significantly higher levels of TG, TC, LDL-C, and lower HDL-C compared to those with HbA1c <6.5%.

Conclusion:

Hypertriglyceridemia, high LDL-C, low HDL-C, and atherogenic dyslipidaemia were prevalent in the young Indian cohort and sedentary lifestyle, and HbA1c ≥ 6.5% were the predominant risk factors of dyslipidaemia.

A systematic approach of method development for analysis of multiple classes of emerging contaminants in wastewater: a case study of a biological nutrient removal based plant

Pharmaceuticals, personal care products, synthetic hormones, and industrial manufacturing additives are used worldwide, and their residues are frequently detected in wastewater. In this study, a sensitive and selective method was developed and validated for the detection and quantification of 14 Emerging Contaminants (ECs) with various physico-chemical properties frequently found in wastewater. Solid Phase Extraction (SPE) allowed for extraction and concentration of the compounds. Liquid chromatography-mass spectrometry in both positive and negative electrospray ionization mode was used for the analysis. Three different combinations of mobile phase, water + 0.1% formic acid : acetonitrile + 0.1% formic acid (3 compounds), water + 0.1% formic acid : methanol (5) and 10 mM ammonium acetate buffer : acetonitrile + 0.1% formic acid (6) gave the best chromatographic conditions to analyze the contaminants in real wastewater samples. Four different eluents at acidic and basic sample pH values were tested to optimize the SPE methodology, and three different dilution ratios (1 : 1, 2 : 1, and 5 : 1) were tested to reduce the matrix effect. Data validation was conducted using linearity, intra and inter-day repeatability, LOD/LOQ, percentage recovery, and percentage process efficiency studies. As a case study, a biological nutrient removal (BNR) based plant was tested for the presence of ECs using the developed method. Removal efficiency at different treatment stages was assessed. Most of the treatment occurred at the secondary treatment stage, whereas primary treatment and disinfection had little effect on removal. All the contaminants were found in the inlet wastewater. Estrone (E1), an endocrine disrupting compound, was reported for the first time in Indian wastewater at 376.2 ng L-1. Seven, four, and two ECs were removed at high, medium, and low efficiencies, respectively. Carbamazepine showed negative removal. This study enhanced our understanding of the occurrence and fate of several ECs in BNR based treatment systems.

Is evaluation of non-HDL-C better than calculated LDL-C in CAD patients? MMIMSR experiences

Objective

The present study aimed to establish a better marker for the assessment of coronary artery disease (CAD).

Methods

One hundred patients of CAD (aged 20–60 years) of both sex and patients of hypertension with symptoms of CAD were selected for the study.50 age and sex matched healthy controls were chosen for the present study. Serum total cholesterol, triglycerides and HDL-C were estimated in Simens Dimensions RxL. LDL-C, VLDL-C were calculated by Friedwald Formula while non-HDL-C was calculated by subtracting HDL-C level from total cholesterol level. The comparison of non-HDL-C and friedwald calculated LDL-C was made in terms of independent‘t’ test, serum TG levels (TG ≤ 200 mg/dl and TG > 200 mg/dl) and area under receiver operating characteristic (AUROC) curve.

Results & conclusion

The non-HDL-C levels (mean ± S.D) were higher in both test and control groups to that of the levels of friedwald calculated LDL-C. The area under receiver operating characteristic (AUROC) curve was significantly higher for non-HDL-C than for friedwald calculated LDL-C. The predictive value of non-HDL-C and friedwald calculated LDL-C were also compared in group A (serum TG ≤ 200 mg/dl) and group B (serum TG > 200 mg/dl). Non-HDL-C levels showed a significant difference in both the groups while the results were non-significant to that of friedwald calculated LDL. Thus, non-HDL-C is much specific and sensitive parameter for assessment of CAD risk. Moreover, non-HDL-C levels can also be done in non-fasting state with accuracy, thereby, it is patient friendly parameter. Therefore, the authors strongly suggest the incorporation of non-HDL-C in routine lipid profile panel.

Systemic Effects of Cryolipolysis in Central Obese Women: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

To investigate the adding effect of Cryolipolysis to a low-calorie diet program on lipid profile, liver enzymes, body mass index, waist-to-hip ratio, and volume reduction of subcutaneous fat tissue in central obese women.

STUDY DESIGN/MATERIALS AND METHODS

Sixty central obese women were randomly divided into two equal groups. Women in the control group received prescribed low-calorie diet regimen only, while women in the study group received three Cryolipolysis sessions plus the same dietary regimen for 3 months. Assessment of women in each group for weight, height to obtain the body mass index, waist-to-hip ratio, and abdominal subcutaneous fat thickness as well as evaluation of lipid profile and liver enzymes was done just before starting the treatment procedures and immediately after ending the study duration.

RESULTS

There were statistically significant improvements of waist-to-hip ratio, body mass index, total cholesterol, triglycerides, low- and high-density lipoprotein, as well as liver enzymes in favor of the study group (P < 0.001).

CONCLUSION

Women who underwent Cryolipolysis and diet program had better improvement in components of lipid profile and liver enzymes than women who were maintained over diet program alone. Measures to decrease waist circumference, associated with abdominal subcutaneous fat reduction, enhanced the systemic effects of Cryolipolysis. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Among young Sri Lankan patients with diabetes, how do lipid profiles differ between those with and without metabolic syndrome?

AIMS

Metabolic syndrome (MetS) is a risk factor for cardiovascular disease (CVD). Apolipoproteins are emerging as powerful predictors of CVD. We aimed to study associations of metabolic syndrome and apoB, apoAI, apoB/AI ratio in young Sri Lankans with type 2 diabetes.

MATERIALS & METHODS

Blood samples were available from 690 patients with type 2 diabetes in Sri Lanka Young Diabetes Study, and were analysed for apoB, apoAI, total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG) and glycated haemoglobin (HbA_1c). Their associations with MetS as perNCEP/ATPIII criteria were studied.

RESULTS

MetS was present in 60.9% of subjects. Of those with MetS, 76.0% were women. Those with MetS had higher apoB (1.27 V s 1.19 mmol/L; p = 0.001), apoB/AI (0.80 V s 0.75; p = 0.001), non-HDL cholesterol (NHDLC) (4.15 V s 3.98 mmol/L; p = 0.002),and triglycerides (1.51 V s 1.31 mmol/L; p < 0.001) and lower apoAI (1.58 V s 1.60 mmol/L; p = 0.03) and HDLC (1.02 V s 1.16 mmol/L, p < 0.001). ApoB and apoB/AIlevels increased significantly as the number of MetS components increased. ApoB and apoB:AI ratio were independently associated with MetS and components.

CONCLUSION

MetS showed a high prevalence among young Sri Lankans with diabetes. Elevated apoB is commonly clustered with other risk indicators in MetS.

Epidemiology of Dyslipidemia Among Adult Population of Bangladesh

Background and aims: evatedEl level serum of lipids stimulate atherosclerosis, which is the risk factor for stroke, peripheral vascular taeohrrratrrocvtra disease. The aim of this study was to explore the pattern and associated factors of dyslipidemia among Bangladeshi adult population.

Material and methods: A descriptive cross-sectional study was conducted at the outpatient department (OPD) of four Medical College Hospitals, Bangladesh. 200 adults aged 20 to 65 years diagnosed case of dyslipidemia were randomly selected. Fasting CHO, HDL, LDL and TG were measured. According to the criteria of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), dyslipidemia was classified into (a) Hyper-lipidemia: TC>200 mg/dl, TG>150 mg/dl, (b) Hyper cholesterolemia: TC>200 mg/dl, (c) Hyper-triglyceridemia: TG>150 mg/dl, and (d) Atherogenic-dyslipidemia: TG>150 mg/dl, LDLC>165 mg/dl.

Results: Study found 46% hyperlipidemia, 37% atherogenic dyslipidemia, 13.5% hypercholesterolemia and only 3.5% hypertriglyceridemia. BMI, FBS and HDL-C were significantly higher among female compare to male (p=<0.01, <0.01 and 0.04 respectively). TC and TG were significantly higher among higher calorie intake group in compare to normal intake group (p=0.04).

Conclusions: Results of this study concluded that hyperlipidemia and atherogenic dyslipidemia are common and female dyslipidemic patients are susceptible to develop higher BMI, FBS, and HDL-C.

A Special Report on Changing Trends in Preventive Stroke/Cardiovascular Risk Assessment Via B-Mode Ultrasonography

PURPOSE OF REVIEW

Cardiovascular disease (CVD) and stroke risk assessment have been largely based on the success of traditional statistically derived risk calculators such as Pooled Cohort Risk Score or Framingham Risk Score. However, over the last decade, automated computational paradigms such as machine learning (ML) and deep learning (DL) techniques have penetrated into a variety of medical domains including CVD/stroke risk assessment. This review is mainly focused on the changing trends in CVD/stroke risk assessment and its stratification from statistical-based models to ML-based paradigms using non-invasive carotid ultrasonography.

RECENT FINDINGS

In this review, ML-based strategies are categorized into two types: non-image (or conventional ML-based) and image-based (or integrated ML-based). The success of conventional (non-image-based) ML-based algorithms lies in the different data-driven patterns or features which are used to train the ML systems. Typically these features are the patients' demographics, serum biomarkers, and multiple clinical parameters. The integrated (image-based) ML-based algorithms integrate the features derived from the ultrasound scans of the arterial walls (such as morphological measurements) with conventional risk factors in ML frameworks. Even though the review covers ML-based system designs for carotid and coronary ultrasonography, the main focus of the review is on CVD/stroke risk scores based on carotid ultrasound. There are two key conclusions from this review: (i) fusion of image-based features with conventional cardiovascular risk factors can lead to more accurate CVD/stroke risk stratification; (ii) the ability to handle multiple sources of information in big data framework using artificial intelligence-based paradigms (such as ML and DL) is likely to be the future in preventive CVD/stroke risk assessment.

Analysis of glycemic status in diabetes-naïve patients on statins: A hospital-based cross-sectional study

INTRODUCTION:

Randomized controlled trials, observational studies, and meta-analysis suggest risk of hyperglycemia in patients on statins, and this association is being viewed with renewed interest globally. The present study has tried to explore the possible diabetogenic effect of statins, the mechanism of this effect, and various comorbidities associated with this causation.

MATERIALS AND METHODS:

This cross-sectional study was carried out at the Department of Cardiology from October 2015 to March 2017. Patients on statins for at least 1 year and normoglycemic at the time of statin initiation were recruited in the study. The outcome of the present study was development of new-onset diabetes mellitus (NODM). Blood glucose levels and insulin levels were estimated. Other adverse reactions of statins and associated comorbidities in the patients were recorded. Descriptive statistics were used to analyze adverse drug reactions.

RESULTS:

A total of 104 patients met the inclusion criteria, of which eight patients (7.7%) developed NODM and 4 (3.8%) developed prediabetes. Atorvastatin 40 mg was most commonly prescribed statin. About 25% of patients taking atorvastatin 80 mg developed diabetes

CONCLUSION:

Statins have a mild-to-moderate risk of developing NODM. The dose of statins is an important factor that increases the risk of diabetes in statin users

Regional differences in ischemic stroke in India (north vs. south)

BACKGROUND

India is a large country with geographically diverse populations and varying risk factors. Identification of regional differences can improve healthcare policy decisions.

AIM

To study regional differences in stroke between North and South India.

METHODS

We analyzed data from the Indo-US Collaborative Stroke Project, a National Institute of Health-funded multicentre prospective study conducted in five academic centers in India with a US-based coordinating center. Risk factors, severity, mechanisms, management, complications, and outcomes among ischemic stroke patients were compared between North and South Indian centers.

RESULTS

Of the 2066 patients enrolled from North (n = 1060) and South India (n = 1006), North Indian patients were significantly older with fewer men and had lower rates of diabetes (32.8% vs. 38.7%, p < 0.01), dyslipidemia (3.5% vs. 25.7%, p < 0.01), tobacco use (27% vs. 38%, p < 0.001), and alcohol use (30.1% vs. 38.6%, p < 0.01). North Indian patients had higher median National Institute of Health stroke scale scores (10 vs. 9, p < 0.01), more frequent large-artery atherosclerosis mechanism (34% vs. 25.6%, p < 0.001), intravenous thrombolysis (14.0% vs. 6.1%, p < 0.001), and lower rates of pneumonia (10.5% vs. 15.1%, p = 0.02). The three-month outcome (modified Rankin Scale score 0-2, 45.8% vs. 50.3%, p = 0.08) did not differ; however, North Indian patients had higher 90-day mortality (23.5% vs. 13.5%, p < 0.0001).

CONCLUSIONS

The substantial regional differences in stroke risk factors and mechanisms may be partly explained by factors such as differing dietary habits and lifestyle, which can be addressed at a national level. Differences in acute and inpatient stroke care suggest a need for better adoption of national stroke management guidelines.

Prevalence of dyslipidemia among the diabetic patients in southern Bangladesh: A cross-sectional study

AIM

Diabetic dyslipidemia is one of the major risk factors for cardiovascular disease which has a vast mortality rate throughout the world. Early detection and treatment of dyslipidemia can avoid risk for cardiovascular disorder in diabetic patients. This study was conducted to determine the prevalence of and pattern of dyslipidemia in diabetic patients.

MATERIALS AND METHODS

This cross sectional study was performed in several specialized diabetic hospital of Noakhali, a southern district of Bangladesh. All known cases of diabetes mellitus were evaluated for their lipid profile. A total number of 1008 patients were included in the study having 683 (67.8%) female and 325 (32.2%) male subjects.

RESULTS

The prevalence of dyslipidemia among the male subjects was 73% while among female subjects 71%. Among diabetic males the percentage of high serum Cholesterol, high serum TG (Triglyceride), low HDL (High density cholesterol) and high LDL (Low density cholesterol) was 35.69%, 44.31%, 50.15% and 72.92% respectively, whereas the female had the percentage at 35.29%, 40.85%, 49.49% and 70.57% respectively.

CONCLUSION

Majority portion of the study subjects were dyslipidemic. The most prevalent pattern among both male and female was high level of LDL and low level of HDL. The prevalence of dyslipidemia in Bangladesh is significantly high, which indicates the urgency of lifestyle intervention strategies to prevent and manage this important health problem and risk factor.