Efficacy of cholesterol levels and ratios in predicting future coronary heart disease in a Chinese population

Correlations of Serum Lipid Parameters and Atherogenic Indices With Left Ventricular Diastolic Dysfunction Among Apparently Healthy Patients With Type 2 Diabetes Mellitus: A Multicenter In-Hospital Cross-Sectional Study

Background: In adolescents with Type 1 diabetes, lipid ratios are predictors of left ventricular diastolic dysfunction (LVDD). However, whether this also applies to adults with Type 2 Diabetes Mellitus (T2DM) is unclear. This study is aimed at assessing the correlations of serum lipid parameters and atherogenic indices with LVDD in patients with T2DM. Methods: This cross-sectional study included 203 patients with T2DM aged 59.9 ± 13.6 years (111 males, sex ratio: 1 : 2 in favor of males) from eight randomly selected urban hospitals. Demographic information was collected, an anthropometric assessment was performed, and blood pressure was measured. Fasting blood samples were obtained to assess total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), glucose, and glycated hemoglobin. The atherogenic index of plasma (AIP), Castelli Risk Index I (CRI-I), Castelli Risk Index II (CRI-II), atherogenic coefficient, and non-HDL-C were determined using specific formulas. Diastolic function was assessed using echocardiography as per the 2016 updated guidelines of the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI). Results: Approximately 47.8% of the participants had LVDD. Compared with participants with normal diastolic function, those with LVDD were more likely to be older than 55 years (p < 0.001), tended to have obesity (p = 0.045), had a higher risk of developing dyslipidemia (p = 0.041), and higher AIP and CRI-II (p < 0.05) levels while having similar low HDL-C and hypertriglyceridemia frequencies. In the multivariate model adjusting for age, high AIP (adjusted odds ratio [aOR], 3.37; 95% confidence interval [CI], 1.22-5.34) and high CRI-II (aOR: 3.80; 95% CI: 2.25-6.35) were independent determinants of LVDD. Conclusions: These results highlight the importance of considering atherogenic indices, primarily AIP and CRI-II in the management of T2DM patients. High AIP and high CRI-II could serve as surrogate markers of LVDD, an early cardiovascular manifestation in patients with T2DM.

Clinical utility of lipid ratios as potential predictors of metabolic syndrome among the elderly population: Birjand Longitudinal Aging Study (BLAS)

BACKGROUND

Elderly adults are at higher risk of developing metabolic syndrome (MetS). The present study aims to investigate the relationship between lipid ratios and MetS in the elderly population.

METHODS

This study was conducted on elderly population of Birjand during 2018-2019. The data of this study was driven from Birjand Longitudinal Aging Study (BLAS). The participants were selected based on multistage stratified cluster sampling. Patients were categorized into quartiles according to the lipid ratios (TG/HDL-C, LDL-C/HDL-C, non-HDL/HDL-C), and the relationship between lipid ratio quartiles and MetS was determined by Logistic Regression using Odds Ratio. Finally, the optimal cut-off for each lipid ratio in MetS diagnosis was calculated according to the Area Under the Curve (AUC).

RESULTS

This study included 1356 individuals, of whom 655 were men and 701 were women. In our study, the crude prevalence of MetS was 792 (58%), including 543 (77.5%) women and 249 (38%) men. Increasing trends were observed in quartiles of all lipid ratios for TC, LDL-C, TG, and DBP. TG/HDL was also the best lipid ratio to diagnose the MetS, based on NCEP ATP III criteria. One unit increased in level of TG/HDL resulted in 3.94 (OR: 3.94; 95%CI: 2.48-6.6) and 11.56 (OR: 11.56; 95%CI: 6.93-19.29) increasing risk of having MetS in quartile 3 and 4 compared to quartile 1, respectively. In men and women, the cutoff for TG/HDL was 3.5 and 3.0, respectively.

CONCLUSIONS

Our results showed that the TG/HDL-C is superior to the LDL-C/HDL-C and the non-HDL /HDL-C to predict MetS among the elderly adults.

Glycative Stress, Glycated Hemoglobin, and Atherogenic Dyslipidemia in Patients with Hyperlipidemia

(1) Background: Diabetes mellitus (DM) is a significant health problem and is associated with dyslipidemia; however, the association between glycative stress, in terms of glycated hemoglobin (HbA1c), and atherogenic dyslipidemia in hyperlipidemic patients with and without DM has rarely been reported. (2) Methods: We prospectively recruited 949 hyperlipidemic patients from the Lipid Clinic of the National Taiwan University Hospital. HbA1c and fasting serum lipids, including total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDL-C and LDL-C), small dense LDL-C (sdLDL-C), very low-density lipoprotein cholesterol (VLDL-C), triglycerides, and advanced glycation end-products (AGEs), were measured. After fasting for 10-14 h, all subjects except those with DM underwent a standard oral glucose tolerance test (OGTT) with 75 g of glucose loading. All subjects were asked to discontinue the use of lipid-lowering agents for 8 weeks before recruitment. (3) Results: Patients with DM had a higher prevalence of hypertension and higher levels of triglyceride, TC/HDL-C ratio, AGEs, VLDL-C, and sdLDL-C. Among patients with higher HbA1c, the serum VLDL-C, AGEs, and TC/HDL-C ratio were significantly higher than those with lower HbA1c. After adjustment for covariates, multiple logistic regression analyses revealed different groups of dysglycemia with higher HbA1c had a higher odds ratio for TC/HDL-C ≥ 5, sdLDL-C ≥ 75th percentile, VLDL-C ≥ 75th percentile and AGEs ≥ 75th percentile. (4) Conclusions: A higher HbA1c was associated with a significant increase in the risk of atherogenic dyslipidemia and AGEs levels in patients with hyperlipidemia. The findings can be very promising in clinical application.

Clinical Aspects of Genetic and Non-Genetic Cardiovascular Risk Factors in Familial Hypercholesterolemia

Familial hypercholesterolemia (FH) is the most common monogenic metabolic disorder characterized by considerably elevated low-density lipoprotein cholesterol (LDL-C) levels leading to enhanced atherogenesis, early cardiovascular disease (CVD), and premature death. However, the wide phenotypic heterogeneity in FH makes the cardiovascular risk prediction challenging in clinical practice to determine optimal therapeutic strategy. Beyond the lifetime LDL-C vascular accumulation, other genetic and non-genetic risk factors might exacerbate CVD development. Besides the most frequent variants of three genes (LDL-R, APOB, and PCSK9) in some proband variants of other genes implicated in lipid metabolism and atherogenesis are responsible for FH phenotype. Furthermore, non-genetic factors, including traditional cardiovascular risk factors, metabolic and endocrine disorders might also worsen risk profile. Although some were extensively studied previously, others, such as common endocrine disorders including thyroid disorders or polycystic ovary syndrome are not widely evaluated in FH. In this review, we summarize the most important genetic and non-genetic factors that might affect the risk prediction and therapeutic strategy in FH through the eyes of clinicians focusing on disorders that might not be in the center of FH research. The review highlights the complexity of FH care and the need of an interdisciplinary attitude to find the best therapeutic approach in FH patients.

Synergistic Effects of Inflammation and Atherogenic Dyslipidemia on Subclinical Carotid Atherosclerosis Assessed by Ultrasound in Patients with Familial Hypercholesterolemia and Their Family Members

Low-density lipoprotein cholesterol (LDL-C) and total to high-density lipoprotein cholesterol (TC/HDL-C) ratio are both common risk factors for atherosclerotic cardiovascular diseases (ASCVDs). However, whether high-sensitivity C-reactive protein (hsCRP) has synergistic or attenuated effects on atherogenic dyslipidemia remains unclear. We investigated subclinical carotid atherosclerosis in patients with familial hypercholesterolemia (FH) and their family members. A total of 100 families with 761 participants were prospectively studied. Participants were categorized into four groups according to atherogenic dyslipidemia and inflammatory biomarkers. The group with LDL-C ≥ 160 mg/dL (or TC/HDL-C ratio ≥ 5) combined with hsCRP ≥ 2 mg/L have a thicker carotid intima-media thickness (CIMT) in different common carotid artery (CCA) areas and a higher percentage of high plaque scores compared with other subgroups. Multivariate logistic regression analysis revealed a significantly higher adjusted odds ratio (aOR) for thicker CIMT of 3.56 (95% CI: 1.56–8.16) was noted in those with concurrent LDL-C ≥ 160 mg/dL and hsCRP ≥ 2 mg/L compared with the group with concurrent LDL-C < 160 mg/dL and hsCRP < 2 mg/L. Our results demonstrated that systemic inflammation, in terms of higher hsCRP levels ≥ 2 mg/L, synergistically contributed to atherogenic dyslipidemia of higher LDL-C or a higher TC/HDL-C ratio on subclinical atherosclerosis.

Higher Serum Total Cholesterol to High-Density Lipoprotein Cholesterol Ratio Is Associated with Increased Mortality among Incident Peritoneal Dialysis Patients

This study evaluated the association of the serum total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C) with mortality in incident peritoneal dialysis (PD) patients. We performed a multi-center, prospective cohort study of 630 incident PD patients from 2008 to 2015 in Korea. Participants were stratified into quintiles according to baseline TC, HDL-C, LDL-C and TC/HDL-C. The association between mortality and each lipid profile was evaluated using multivariate Cox regression analysis. During a median follow-up period of 70.3 ± 25.2 months, 185 deaths were recorded. The highest TC/HDL-C group had the highest body mass index, percentage of diabetes and serum albumin level. Multivariate analysis demonstrated that the highest quintile of TC/HDL-C was associated with increased risk of all-cause mortality (hazard ratio 1.69, 95% confidence interval 1.04-2.76; p = 0.036), whereas TC, HDL-C and LDL-C were not associated with mortality. Linear regression analysis showed a positive correlation between TC/HDL-C and body mass index. Increased serum TC/HDL-C was an independent risk factor for mortality in the subgroup of old age, female, cardiovascular disease and low HDL-C. The single lipid marker of TC or HDL-C was not able to predict mortality in PD patients. However, increased serum TC/HDL-C was independently associated with all-cause mortality in PD patients.

Effects of ambient PM2.5 and particle-bound metals on the healthy residents living near an electric arc furnace: A community- based study

Fine particulate matter (PM_2.5) emitted from electric arc furnaces (EAFs) poses health concerns. However, little research has been done on the impact of EAF on the health of community residents. This cross-sectional study conducted a PM_2.5 exposure assessment and health examination of community residents living near an EAF. A total of 965 residents aged 40-90 years were recruited. The residents' exposure to PM_2.5 was categorized according to the distance of their residence from the EAFs (<500, 500-1000, 1000-1500, 1500-2000, and > 2000 m). Average ambient PM_2.5 concentrations were estimated using a hybrid kriging/land-use regression (LUR) model. In addition, we selected two air-sampling sites to monitor the 2-year levels of PM_2.5 and particle-bound metals. A spot urine sample and blood samples were collected and ten heavy metal concentrations in the blood were analyzed. Inflammation- and oxidative stress-related biomarkers were measured. The associations between environmental factors and a biochemical examination were estimated using a generalized linear model. Active air sampling and hybrid kriging/LUR model simulation indicated increased levels of PM_2.5 near the EAF. The metal concentrations in PM_2.5 included Fe, Pb, Mn, Ni, As, Cu, Ni, Zn, and Al, which also significantly increased near the EAF. PM_2.5 levels were significantly associated with an increased total cholesterol-high-density lipoprotein (TC/HDL) ratio. High levels of PM_2.5 and malondialdehyde were associated with a 1.72-fold increased risk of TC/HDL ratio ≥ 4 (95% CI: 1.12-2.65) after adjusting for potential confounding factors. Blood Pb levels were significantly associated with increased systolic and diastolic blood pressure and decreased estimated glomerular filtration rate but negatively associated with distance from the EAF. The results show that people living near EAFs should pay more attention to adverse health problems, including atherogenic dyslipidemia, hypertension, and chronic kidney disease associated with exposure to PM_2.5 and particle-bound metals.

Six-Year Incidence of Cardiometabolic Risk Factors in a Population-Based Cohort of Chinese Adults Followed From 2009 to 2015

Background China faces a substantial burden from cardiometabolic diseases, but longitudinal studies on a wide range of cardiometabolic risk factors are limited. We examined the 6-year incidence of 8 cardiometabolic risk factors in a diverse, population-based cohort. Methods and Results In the China Health and Nutrition Survey, anthropometry, blood pressure, and fasting blood samples were collected from 9621 adults (47.6% men) aged 18 to 99 years in 2009 who were followed into 2015. Using inverse probability weights to account for loss to follow-up, we estimated the 6-year incidence of 8 cardiometabolic risk factors and compared the incidence of each risk factor across age groups using inverse probability-weighted sex-stratified logistic regression models. Incidence was noted for the following cardiometabolic risk factors during 2009-2015: hypertension (systolic/diastolic blood pressure ≥140/90 mm Hg; men: 29.2%; women: 24.9%), high waist circumference/height ratio (≥0.5; men: 42.4%; women: 43.8%), and high total to HDL (high-density lipoprotein) cholesterol ratio (≥5; men: 17.0%; women: 14.5%). Older men and women (aged ≥65 years) had the highest incidence of hypertension. Incidence of high waist circumference/height ratio and high LDL (low-density lipoprotein) cholesterol (≥130 mg/ dL ) was highest among older (aged ≥65 years) women, whereas incidence of overweight (body mass index ≥25) and high triglycerides (≥150 mg/ dL ) was highest among younger (aged 18-35 and 35-50 years) men. Conclusions We found increases in cardiometabolic risk among Chinese adults during this recent, short, 6-year period that are higher than previous studies in China. The higher incidence of overweight and elevated dyslipidemia markers in younger versus older men portends an increasing burden of cardiometabolic diseases in China as the younger population ages.

Simple renal cysts are associated with increased arterial stiffness in a Taiwanese population

Arterial stiffness has been found to be a predictive risk factor for cardiovascular disease. Simple renal cysts are associated with prehypertension, hypertension, diabetes, and increased serum creatinine, which are risk factors of cardiovascular events. The aim of this work was to clarify the association between simple renal cysts and arterial stiffness defined by the brachial and ankle pulse wave velocity (baPWV). Subjects with and without simple renal cysts had right baPWV values of 1522.8 ± 357.5 cm/s and 1344.2 ± 268.8 cm/s, respectively (p < 0.001). Based on multiple linear regression analysis, the presence of simple renal cysts was associated with increased baPWV values (p < 0.001). Both the size and the number of simple renal cysts were positively associated with an increased baPWV value. Subjects with a cyst size ≥2 cm (p < 0.001) and a cyst number ≥2 (p < 0.01) had higher baPWV values than those without SRCs. Simple renal cysts are associated with increased arterial stiffness.

Association between metabolic syndrome and bone mineral density in a Taiwanese elderly population

Previous studies have demonstrated uncertainty regarding the effect of metabolic syndrome (MetS) on bone. In the present work, we investigated the association between MetS, its components, and decreased bone mineral density (BMD) in a cross-sectional study of patients who underwent BMD measurement by dual-energy X-ray absorptiometry during a health examination. Decreased BMD was defined as either osteopenia or osteoporosis. MetS components and body mass index (BMI) were compared between individuals with normal and decreased BMD, and simple and multivariate logistic regression analyses were used to evaluate the association between the variables and decreased BMD in women and men. Among 1162 subjects in the study, the mean age was 59.9 ± 7.3 years, and 59.5% were men. The prevalence of MetS and osteoporosis was 34.2 and 19.6%, respectively. MetS was positively associated with BMD in men, while in women it was negatively associated with BMD. Regarding the relationship between MetS components and BMD, we found that in women, waist circumference (WC) and systolic and diastolic blood pressure were negatively associated with BMD, while high-density lipoprotein cholesterol (HDL-C) was positively associated. In men, WC and fasting glucose were positively associated with BMD, while HDL-C was negatively associated. We also found that an increase in the number of MetS components resulted in a significantly increased positive association with BMD, both before and after adjusting for age, in men but not in women, revealing a gender difference in the correlation between MetS components and BMD.

A novel scoring system to analyze combined effect of lifestyle factors on pancreatic cancer risk: a retrospective case-control study

Although several risk factors for the onset of pancreatic ductal adenocarcinoma (PDAC) have been identified, currently, no scoring system to systemically evaluate the risk of PDAC has been established. In this study, we aimed to use a population of over 1200 patients to build a novel scoring system, and evaluated combined effects of risk factors for PDAC patients.A set of 4904 participants including 1274 PDAC patients and 3630 non-cancer individuals were recruited for the single-center study over 17-year period (1997~2013). Systematic logical analysis were presented for case and control groups, and a risk rating system was constructed to assess combined risk factors. Seven independent risk factors were identified with the increased risk of PDAC, were selected into the risk score. A merged risk assessment model was established, demonstrating significantly increased PDAC risk in following a number of rising scores. Individuals with scores from 1 to more than 4, the responding OR (95% CI) were 3.06 (2.57~3.65), 7.08 (5.63~8.91), 22.4 (14.2~35.4), and 31.4 (12.7~77.5), respectively. The integer-based risk score in the study can be used for risk stratification to accurately evaluate PDAC occurrence at an early stage. This scoring system provides an accurate risk assessment of PDAC risk.

Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients

BACKGROUND

Several lipid ratios may be predictors of coronary artery disease risk. We assessed the efficacy of Monascus purpureus Went rice (red yeast rice) on lowering lipid ratios.

METHOD AND RESULTS

We evaluated 79 hypercholesterolemic patients (aged 23-65 years) who received a twice-daily dose of either red yeast rice or a placebo at 600 mg for 8 weeks. The 8-week treatment with red yeast rice showed significantly greater reduction than the placebo treatment in low-density lipoprotein cholesterol levels, total cholesterol/high-density lipoprotein cholesterol, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and apolipoprotein B/apolipoprotein A-I ratios.

CONCLUSIONS

Red yeast rice can reduce lipid ratios in hypercholesterolemic patients.

Association of total cholesterol versus other serum lipid parameters with the short-term prediction of cardiovascular outcomes: Tehran Lipid and Glucose Study

OBJECTIVE

The aim of this study was to evaluate and compare the role of lipid markers including total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol with lipid indices (total/HDL cholesterol, LDL-cholesterol/HDL-cholesterol and non-HDL-cholesterol) as predictors of cardiovascular outcomes in adults over 30 years.

RESEARCH DESIGN AND METHOD

In a nested case-control study, 207 cardiovascular events among participants of the Tehran Lipid and Glucose Study (TLGS) were documented during 3 years of follow-up. Those cases that were free of cardiovascular disease at baseline (132 subjects) were matched to 264 controls for age and sex. In all subjects, demographic and clinical data including blood pressure and anthropometric measurements as well as serum lipids, fasting and 2-h plasma glucose were obtained from the database of the TLGS. We estimated the relative risk for each lipid parameter in a multiple stepwise regression model after adjustment for family history of premature coronary heart disease, smoking, systolic and diastolic blood pressure, fasting and 2-h plasma glucose and waist-to-hip ratio.

RESULTS

The relative risks associated with an increase of approximately 1 SD of independent lipid predictors in the multivariate model were as follows: total cholesterol, 1.6 (1.2-2.1), SD=1.3 mmol/l; LDL-cholesterol 1.5 (1.1-2.0), SD=1 mmol/l; non-HDL-cholesterol 1.6 (1.2-2.1), SD=1.2 mmol/l and cholesterol/HDL-cholesterol 1.5 (1.1-2.0), SD=1.8. Comparison of these four independent variables with receiver-operating characteristic curve analysis showed no significant difference in their predictive power for cardiovascular outcome. There was no association between HDL-cholesterol, triglyceride and LDL/HDL cholesterol and cardiovascular disease outcomes in multivariate analysis.

CONCLUSION

It seems that for short-term prediction of cardiovascular disease outcome, serum total cholesterol is the preferred lipid parameter to measure in the Iranian population.

Longitudinal trajectories of cholesterol from midlife through late life according to apolipoprotein E allele status

BACKGROUND

Previous research indicates that total cholesterol levels increase with age during young adulthood and middle age and decline with age later in life. This is attributed to changes in diet, body composition, medication use, physical activity, and hormone levels. In the current study we utilized data from the Framingham Heart Study Original Cohort to determine if variations in apolipoprotein E (APOE), a gene involved in regulating cholesterol homeostasis, influence trajectories of total cholesterol, HDL cholesterol, and total: HDL cholesterol ratio from midlife through late life.

METHODS

Cholesterol trajectories from midlife through late life were modeled using generalized additive mixed models and mixed-effects regression models.

RESULTS

APOE e2+ subjects had lower total cholesterol levels, higher HDL cholesterol levels, and lower total: HDL cholesterol ratios from midlife to late life compared to APOE e3 and APOE e4+ subjects. Statistically significant differences in life span cholesterol trajectories according to gender and use of cholesterol-lowering medications were also detected.

CONCLUSION

The findings from this research provide evidence that variations in APOE modify trajectories of serum cholesterol from midlife to late life. In order to efficiently modify cholesterol through the life span, it is important to take into account APOE allele status.

Clinical usefulness of lipid ratios to identify men and women with metabolic syndrome: a cross-sectional study

Background

Waist circumference, a metabolic syndrome (MetSy) criterion, is not routinely measured in clinical practice making early identification of individuals with MetSy challenging. It has been argued that ratios of commonly measured parameters such as lipids and lipoproteins may be an acceptable alternative for identifying individuals with MetSy. The objective of our study was to explore clinical utility of lipid ratios to identify men and women with MetSy; and to explore the association between lipid ratios and the number of MetSy components.

Methods

Men and women (N = 797) of Aboriginal, Chinese, European, and South Asian origin (35–60 years), recruited across ranges of body mass index (BMI), with no diagnosed cardiovascular disease (CVD) or on medications to treat CVD risk factors were assessed for anthropometrics, family history of CVD, MetSy components (waist circumference, blood pressure, glucose, triglycerides (TG), high-density-lipoprotein-cholesterol (HDL-C)), low-density-lipoprotein-cholesterol (LDL-C), nonHDL-C, and health-related behaviours.

Results

Mean levels of lipid ratios significantly increased with increasing number of MetSy components in men and women (p < 0.05). After adjustment for age, ethnicity, smoking, alcohol consumption, physical activity, family history of CVD and BMI, (and menopausal status in women), all lipid ratios were associated with the number of MetSy components in men and women (Poisson regression, p < 0.001). Compared to the rest of the lipid ratios (ROC curve analysis), TG/HDL-C was best able to discriminate between individuals with and without MetSy (AUC = 0.869 (95% CI: 0.830, 0.908) men; AUC = 0.872 (95% CI: 0.832, 0.912) women). The discriminatory power of TC/HDL-C and nonHDL-C/HDL-C to identify individuals with MetSY was the same (for both ratios, AUC = 0.793 (95% CI: 0.744, 0.842) men; 0.818 (95% CI: 0.772, 0.864) women). Additionally, LDL-C/HDL-C was a good marker for women (AUC = 0.759 (95% CI: 0.706, 0.812)), but not for men (AUC = 0.689 (95% CI: 0.631, 0.748)). Based on a multiethnic sample, we identified TG/HDL-C cut-off values of 1.62 in men and 1.18 in women that were best able to discriminate between men and women with and without MetSY.

Conclusions

Our results indicate that TG/HDL-C is a superior marker to identify men and women with MetSy compared to TC/HDL-C, LDL-C/HDL-C, and nonHDL-C/HDL-C.

Electronic supplementary material

The online version of this article (doi:10.1186/1476-511X-13-159) contains supplementary material, which is available to authorized users.

Effects of coenzyme q10 supplementation on serum lipoproteins, plasma fibrinogen, and blood pressure in patients with hyperlipidemia and myocardial infarction

BACKGROUND

Low plasma concentrations of coenzyme Q10 (CoQ10) have been associated with concentration of lipoproteins and other factors contributing to coronary heart diseases.

OBJECTIVES

The present investigation aimed to improve the blood pressure and serum lipoproteins concentration in patients with myocardial infarction (MI) by CoQ10 supplementation.

PATIENTS AND METHODS

In this randomized double-blinded controlled clinical trial, 52 Iranian patients with hyperlipidemia and MI were recruited to examine the effect of CoQ10 on serum total cholesterol (TC), LDL-C, HDL-C, triglyceride (TG), LDL-C/HDL-C ratio, TC/HDL-C ratio, fibrinogen, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Individuals were randomly allocated to two groups for receiving either 200 mg/d of CoQ10 or placebo for 12 weeks.

RESULTS

There were not significant differences in serum LDL-C (2.70 ± 0.31 vs. 2.70 ± 0.35 mmol/L), TC (4.47 ± 0.33 vs. 4.93 ± 0.57 mmol/L), TG (2.48 ± 0.12 vs. 2.25 ± 0.69 mmol/L), and fibrinogen (2.08 ± 0.99 vs. 38.7 ± 0.64 mg/dL) between CoQ10 and placebo groups. After 12 weeks, a significant enhancement in serum HDL-C (1.44 ± 0.18 vs. 1.14 ± 0.18 mmol/L) level was observed between groups after the supplementation (P < 0.001). A significant reduction of TC, LDL-C, and fibrinogen and a significant increase in HDL-C concentration was observed in CoQ10 group after intervention (P < 0.001). Our assessment demonstrated statistically significant differences between the two groups in SBP and DBP after intervention (P < 0.001). ANCOVA also revealed significant differences in the ratio of LDL-C/HDL-C and TC/HDL-C between the two groups (1.89 ± 0.42 vs. 2.39 ± 0.38, P = 0.002; and 3.2 ± 0.5 vs. 4.24 ± 0.66, P = 0.01, respectively). A significant reduction of LDL-C/HDL-C and TC/HDL-C was observed in CoQ10 group (P < 0.001).

CONCLUSIONS

Twelve-week supplementation with CoQ10 in patients with hyperlipidemia and MI can improve blood pressure, serum HDL-C as well as LDL-C/HDL-C and TC/HDL-C ratios; therefore, it might decrease the risk of frequent MI.

Long sleep duration associated with a higher risk of increased arterial stiffness in males

STUDY OBJECTIVES

We aimed to examine the association between sleep duration and arterial stiffness among adults of different ages, because to date there has been only one study on this relationship, which was confined to middle-aged civil servants.

DESIGN

Cross-sectional study.

SETTING

A health examination center in National Cheng Kung University Hospital, Taiwan.

PARTICIPANTS

A total of 3,508 subjects, age 20-87 y, were enrolled after excluding those with a history of cerebrovascular events, coronary artery disease, peripheral artery disease, and taking lipid-lowering drugs, antihypertensives, hypoglycemic agents, and anti-inflammatory drugs, from October 2006 to August 2009.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

SLEEP DURATION WAS CLASSIFIED INTO THREE GROUPS: short (< 6 h), normal (6-8 h) and long (> 8 h). Arterial stiffness was measured by brachial-ankle pulse-wave velocity (baPWV), and increased arterial stiffness was defined as baPWV ≥ 1400 cm/sec. The sleep duration was different for subjects with and without increased arterial stiffness in males, but not in females. In the multivariate analysis for males, long sleepers (odds ratio [OR] 1.75, P = 0.034) but not short sleepers (OR 0.98, P = 0.92) had a higher risk of increased arterial stiffness. In addition, age, estimated glomerular filtration rate, hypertension, diabetes, total cholesterol/high-density lipoprotein cholesterol ratio, cigarette smoking, and exercise were also independently associated factors. However, in females, neither short nor long sleep duration was associated with increased arterial stiffness.

CONCLUSIONS

Long sleep duration was associated with a higher risk of increased arterial stiffness in males. Short sleepers did not exhibit a significant risk of increased arterial stiffness in either sex.

CITATION

Tsai TC, Wu JS, Yang YC, Huang YH, Lu FH, Chang CJ. Long sleep duration associated with a higher risk of increased arterial stiffness in males. SLEEP 2014;37(8):1315-1320.

Erosive esophagitis associated with metabolic syndrome, impaired liver function, and dyslipidemia

AIM: To investigate whether erosive esophagitis is correlated with metabolic syndrome and its components, abnormal liver function, and lipoprotein profiles.

METHODS: We conducted a cross-sectional, case control study of subjects who underwent upper endoscopy during a health examination at the Health Management and Evaluation Center of a tertiary medical care facility located in Southern Taiwan. Metabolic syndrome components, body mass index (BMI), liver function, dyslipidemia, and cardiovascular risk factors, as defined by the ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C), and the ratio of low-density lipoprotein cholesterol to HDL-C were compared between individuals with and without erosive esophagitis. Risk factors for erosive esophagitis were evaluated by multivariate logistic regression.

RESULTS: Erosive esophagitis was diagnosed in 507 of 5015 subjects who were individually age and sex matched to 507 esophagitis-free control subjects. In patients with erosive esophagitis, BMI, waist circumference, blood pressure, fasting plasma glucose, triglyceride levels, aspartate aminotransferase, alanine aminotransferase, the ratio of total cholesterol to HDL-C, and the ratio of low-density lipoprotein cholesterol to HDL-C were significantly higher and HDL-C was significantly lower compared to patients without erosive esophagitis (all P < 0.05). In a multivariate analysis, central obesity (OR = 1.38; 95%CI: 1.0-1.86), hypertension (OR = 1.35; 95%CI: 1.04-1.76), hypertriglyceridemia (OR = 1.34; 95%CI: 1.02-1.76), cardiovascular risk factors as defined by a ratio of total cholesterol to HDL-C > 5 (OR = 1.45; 95%CI: 1.06-1.97), and aspartate aminotransferase (OR = 1.59; 95%CI: 1.08-2.34) were significantly associated with erosive esophagitis.

CONCLUSION: Metabolic syndrome, impaired liver function, and a higher ratio of total cholesterol to HDL-C were associated with erosive esophagitis.

Very old adults with better memory function have higher low-density lipoprotein cholesterol levels and lower triglyceride to high-density lipoprotein cholesterol ratios: KOCOA Project

We cross-sectionally examined which lipid profiles are associated with better cognitive function among those aged 80 and older, free of dementia (Clinical Dementia Rating ≤0.5), functionally independent, and community-dwelling. Our cohort consisted of 193 participants from the "Keys to Optimal Cognitive Aging (KOCOA) Project", a prospective cohort study in Okinawa, Japan. Higher low-density lipoprotein cholesterol levels and lower triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratios were associated with higher scores in memory performance after controlling for confounders. Further research is required to clarify the associations among LDL-C levels, TG/HDL-C ratios, and healthy cognitive aging.

Wx/ae double-mutant brown rice prevents the rise in plasma lipid and glucose levels in mice

A wx/ae double-mutant rice is generated by crossing waxy mutant and amylose-extender mutant in rice. Wx/ae brown rice contains highly beneficial nutrients for lipid and glucose metabolism, including resistant starch, dietary fiber, and γ-oryzanol, when compared to Koshihikari brown rice, the non-waxy japonica cultivar. To examine the effects of wx/ae brown rice on glucose and lipid metabolism, type 2 diabetic NSY/Hos mice were fed a high-fat diet containing 25% of wx/ae brown rice or Koshihikari brown rice for 10 weeks. The plasma total cholesterol, non-high-density lipoprotein cholesterol, triglyceride, and non-esterified fatty acid levels of the wx/ae group were significantly lower than those of the Koshihikari group. Moreover, the fasting blood glucose level and pathological score of glycosuria of the wx/ae group were also significantly lower than those of the Koshihikari group. These results indicate that wx/ae brown rice has the potential to prevent the rise in plasma lipid and glucose levels.

[Impact of androgen deprivation on the lipid profile and atherogenic risk in prostate cancer patients]

OBJECTIVE

This study has aimed to analyze the changes observed in the lipid profile and atherogenic risk in prostate cancer patients subjected to androgen deprivation.

MATERIAL AND METHODS

Between 2001 and 2008, serum lipoproteins (total cholesterol, HDL, LDL and triglycerides) were determined in 636 patients. Of these, 129 were treated with maximum androgen blockade and 177 patients were only treated with LHRH analogue. The control group was formed by 339 subjected to prostate biopsy (212 with prostate cancer and 127 without prostate cancer). The atherogenic risk was calculated using the Castelli formula (total cholesterol/HDL).

RESULTS

Mean atherogenic risk was 4.2 in the control group and 4 in the group of patients subjected to androgenic deprivation, p>0.05. The mean atherogenic risk in those subjected to monotherapy with LHRH analogues was 4.1 while it was 3.9 in patients subjected to maximal androgen blockade, p=0.02. We did not found significant differences for atherogenic risk according to length of treatment, p>0.05. The multivariate analysis confirmed that the treatment modality was the only significant variable influencing atherogenic risk.

CONCLUSIONS

This study demonstrates that continuous androgen deprivation does not increase atherogenic risk in patients with prostate cancer. This risk also did not increase during the treatment. The association of bicalutamide to the LHRH analogue seems to have a protective effect on atherogenic risk.

Indicators associated with coronary atherosclerosis in metabolic syndrome

BACKGROUND

Metabolic factors associated with coronary atherosclerosis (CA) in metabolic syndrome (MetS) remain unclear.

METHODS

A total of 550 consecutive subjects without documented coronary artery disease who received contrast-enhanced coronary computed tomography angiography were analyzed. CA was defined as coronary artery calcification (CAC) scores >0 or, zero CAC score combining noncalcified plaques within the proximal third segment of major coronary arteries. Metabolic factors and novel atherosclerotic biomarkers including high-sensitive C-reactive protein (hs-CRP) and adiponectin were measured. MetS was recognized according to the ethnicity-specific National Cholesterol Educational Program Adult Treatment Panel III, 2001.

RESULTS

After adjusted with novel atherosclerotic biomarkers, MetS was significantly associated with CA Odds ratio [OR], 2.88; 95% confidence interval [CI], 1.88 to 4.42; p<0.001). Subgroup analysis revealed that fasting blood glucose ≥ 110 mg/dl/diabetes mellitus in non-MetS subjects (OR, 1.40; 95%CI, 1.08 to 1.82; p<0.05) and total cholesterol (TC)/high density lipoprotein-cholesterol (HDL-C) ≥ 4.2 in MetS subjects (OR, 4.44; 95%CI, 1.93 to 10.20; p<0.001) were independently associated with CA. Both indicators were significantly associated with increased serum hs-CRP and reduced adiponectin levels in all subjects.

CONCLUSIONS

MetS is independently associated with CA after adjustment of atherosclerotic biomarkers. TC/HDL-C ≥ 4.2 in MetS and fasting blood glucose ≥ 110 mg/dl/diabetes mellitus in non-MetS subjects are independent indicators of CA, suggesting the potential difference in pathophysiology of CA.

High-density lipoprotein cholesterol as a predictor of clinical outcomes in patients achieving low-density lipoprotein cholesterol targets with statins after percutaneous coronary intervention

Background

A low level of high-density lipoprotein cholesterol (HDL-C) is strongly associated with cardiovascular events. However, the significance of HDL-C after statin therapy on the outcome of patients who have undergone percutaneous coronary intervention (PCI) with drug eluting stents (DES) is unclear.

Objectives

To investigate the significance of HDL-C after statin therapy on cardiovascular events in patients with coronary artery disease after DES implantation.

Methods

Patients who underwent PCI with DES from January 2004 to December 2009 were prospectively enrolled. The follow-up lipid panel of 2693 patients (median lab follow-up duration 225 days) who had continued using statins after PCI and who attained low-density lipoprotein cholesterol (LDL-C) <100 mg/dl was analysed. Major adverse cardiac events (MACE), including all-cause death, non-fatal myocardial infarction, and target vessel revascularisation according to follow-up HDL-C level (40 mg/dl for men or 50 mg/dl for women) were compared with the use of propensity scores matching.

Results

Median follow-up duration was 832 days. 1585 (58.9%) patients had low follow-up HDL-C and 1108 had high follow-up HDL-C. The low follow-up HDL-C group had significantly higher rates of MACE. Low follow-up HDL-C was a significant independent predictor of MACE (adjusted HR 1.404, 95% CI 1.111 to 1.774, p=0.004). In further analysis with propensity scores matching, overall findings were consistent.

Conclusions

Raising HDL-C levels may be a subsequent goal after achieving target LDL-C levels in patients with DES implantation.

The use of plasma lipid and lipoprotein ratios in interpreting the hyperlipidaemia of pregnancy

The aim of this study was to determine the lipid and lipoproteins ratio in pregnant mothers and to evaluate their role in the interpretation of hyperlipidaemias. A total of 222 pregnant women who registered for ANC and 222 non-pregnant healthy women of the sameage and parity as control were recruited for the study. A sample of venous blood after an overnight fast was collected for analysis and interpretation. The mean ± SD age (years) of pregnant women, 27.317 ± 7.283 years and that of the non-pregnant women, 26.234 ± 6.234 years are not significantly different, p = 0.429. Total cholesterol, HDL-c and TGs were significantly higher in pregnant women (5.29 ± 1.04 mmol/l, 1.64 ± 0.42 mmol/l and 1.74 ± 0.42 mmol/l) compared with that of non-pregnant women (4.64 ± 0.92 mmol/l, 1.25 ± 0.35 mmol/l and 1.37 ± 0.45 mmol/l, respectively) All showed p < 0.000. The frequencies of hypercholesterolaemia, 96(43.2%) and hypertriglyceridaemia, 82 (36.9%), are significantly higher in the pregnant women than in the non-pregnant women, 58 (26.1%) and 26 (11.7%), respectively. TC/HDL-C ratio, 3.33 ± 1.01 and LDL/HDL-C ratio, 1.91 ± 0.85 are significantly lower in pregnant women compared with non-pregnant women counterparts, 3.89 ± 0.97 and 2.35 ± 0.84, respectively. Similarly the frequencies of increased TC/HDL-C ratio, 22 (9.9%) and LDL/HDL-C ratio, 16 (7.2%) are significantly less in the pregnant compared with the non-pregnant women, 54 (24.3%) and 28 (12.6%), respectively.

DPP4 gene DNA methylation in the omentum is associated with its gene expression and plasma lipid profile in severe obesity

Severely obese subjects with the metabolic syndrome (MS) have higher dipeptidyl peptidase-4 (DPP4) expression in their visceral adipose tissue (VAT) compared to obese individuals without MS. We tested the hypothesis that methylation level of CpG sites in the DPP4 promoter CpG island in VAT was genotype-dependent and associated with DPP4 mRNA abundance and MS-related phenotypes. The VAT DNA was extracted in 92 severely obese premenopausal women undergoing biliopancreatic derivation for the treatment of obesity. Women were nondiabetic and none of them used medication to treat MS features. Cytosine methylation rates (%) of 102 CpG sites in the DPP4 CpG island were assessed by pyrosequencing of sodium bisulfite-treated DNA. Methylation rates were >10% for CpG sites 94-102. Their mean methylation rate (%Meth(94-102)) was different between genotypes for DPP4 polymorphisms rs13015258 (P = 0.001), rs17848915 (P = 0.0004), and c.1926 G>A (P = 0.001). The %Meth(94-102) correlated negatively with DPP4 mRNA abundance (r = -0.25, P < 0.05) and positively with plasma high-density lipoprotein (HDL) cholesterol concentrations (r = 0.22, P < 0.05), whereas DPP4 mRNA abundance correlated positively with plasma total-/HDL-cholesterol ratio (r = 0.25; P < 0.05). In the VAT of nondiabetic severely obese women, genotype-dependent methylation levels of specific CpG sites in the DPP4 promoter CpG island were associated with DPP4 gene expression and variability in the plasma lipid profile. Higher DPP4 gene expression in VAT and its relationship with the plasma lipid profile may be explained by actually unknown DPP4 biological effect or, to another extent, may also be a marker of VAT inflammation known to be associated with metabolic disturbances.

The estimated risk for coronary heart disease and prevalence of dyslipidemia among workers of information technology industries in Taiwan

BACKGROUND

Individuals working in information technology (IT) industries suffer from high work stress, possibly causing adverse impacts on their health. However, studies of cardiovascular risk factors among these workers are lacking. The aims of this study were to evaluate the estimated risk for coronary heart disease (CHD) and prevalence of dyslipidemia among IT workers.

METHODS

A total of 941 employees from 11 IT companies were enrolled and the anthropometrics and serum lipid profiles were measured. The 10-year risk for CHD was calculated based on the Framingham risk score.

RESULTS

Compared with lipid profiles in a representative sample (n=6589), IT workers had a significantly higher prevalence of obesity, hypercholesterolemia, low level of HDL-C, and high level of LDL-C in each age group. Their overall estimated 10-year risk for CHD was higher than the average risk of an age- and gender-matched population (2.91% vs. 2.79%, p=0.027). Working for more than 10h/day was associated with a higher estimated CHD risk (3.62% vs. 2.54%, p<0.01).

CONCLUSIONS

A higher prevalence of hyperlipidemia was noted among IT workers. Their estimated 10-year CHD risk was also higher than average. More aggressive interventions to reduce the risk of CHD in this population are needed.

Metabolic syndrome: prevalence and risk factors in southern China

This was a cross-sectional study to investigate the epidemiology of metabolic syndrome and the distribution of inter-related metabolic abnormalities in different population groups in Guangdong, southern China. Individuals were recruited according to the percentage of different occupational populations in southern China. The study cohort included 1206 subjects, and the prevalence and distribution of the components of metabolic syndrome were assessed using the National Cholesterol Education Program Adult Treatment Panel III 2005 criteria. The unadjusted rate of metabolic syndrome was 26.7%, and the prevalences of hypertension and diabetes were 38.0% and 4.3% respectively. Hypertension, diabetes, metabolic syndrome, abdominal obesity, elevated blood glucose and elevated blood pressure decreased significantly with increasing levels of life stress and anxiety. The prevalence of hypertension and metabolic syndrome in southern China is very high, and early identification and treatment of at-risk individuals may help target intervention to improve future cardiovascular health.

Prospective studies on the relationship between high-density lipoprotein cholesterol and cardiovascular risk: a systematic review

Epidemiological studies have extensively evaluated the association between high-density lipoprotein cholesterol (HDL-C) and cardiovascular disease (CVD) risk. The objective of this systematic review was to enumerate the number of original prospective studies that showed a significant association between HDL-C and CVD risk and provided evidence of the consistency of this association across other lipid risk factors. A systematic MEDLINE literature search identified 53 prospective cohort and five nested case-control studies that provided multivariate assessments of the association between HDL-C and CVD risk. Among these 58 prospective studies, 31 studies found a significant inverse association between HDL-C and CVD risk for all CVD outcomes and subpopulations studied, whereas 17 studies found a significant association for some CVD outcomes and/or subpopulations assessed. The ratio of studies that found a significant association out of the total studies identified was similar across all CVD outcomes, although there was less evidence for stroke and atherosclerotic outcomes. Only seven studies tested for the consistency of this association across other lipid risk factors, of which six studies suggested that the association was consistent across other lipid levels. In conclusion, the association between HDL-C and CVD risk is significant and strong, although further evidence may be needed to establish whether this association is consistent across other lipid risk factors. Furthermore, uncertainties remain regarding the mechanism in which HDL-C exerts its effects, suggesting a need for further research focused on new methods for reliable measurement.

Effect of cranberry extracts on lipid profiles in subjects with Type 2 diabetes

AIM

To examine the effect of cranberry ingestion on lipid profiles in Type 2 diabetic patients taking oral glucose-lowering drugs.

METHODS

Thirty Type 2 diabetic subjects (16 males and 14 females; mean age 65 +/- 1 years) who were taking oral glucose-lowering medication regularly were enrolled in this randomized, placebo-controlled, double-blind study. Changes in lipid profiles, oxidized low-density lipoprotein (ox-LDL), glycaemic control, components of the metabolic syndrome, C-reactive protein (CRP) and urinary albumin excretion (UAE) were assessed after cranberry or placebo treatment for 12 weeks.

RESULTS

Low-density lipoprotein (LDL) cholesterol decreased significantly in the cranberry group (from 3.3 +/- 0.2 to 2.9 +/- 0.2 mmol/l, P = 0.005) and the decrease was significantly greater than that in the placebo group (-0.4 +/- 0.1 vs. 0.2 +/- 0.1 mmol/l, P < 0.001). Total cholesterol and total : high-density lipoprotein (HDL) cholesterol ratio also decreased significantly (P = 0.020 and 0.044, respectively) in the cranberry group and the reductions were significantly different from those in the placebo group (P < 0.001 and P = 0.032, respectively). However, ox-LDL levels did not change significantly in response to cranberry consumption. Neither fasting glucose nor glycated haemoglobin improved in either group. Changes in components of the metabolic syndrome, UAE and CRP were not significantly different between groups.

CONCLUSIONS

Cranberry supplements are effective in reducing atherosclerotic cholesterol profiles, including LDL cholesterol and total cholesterol levels, as well as total : HDL cholesterol ratio, and have a neutral effect on glycaemic control in Type 2 diabetic subjects taking oral glucose-lowering agents.

Presence of metabolic syndrome in football linemen

CONTEXT

Metabolic syndrome is a clustering of symptoms associated with abdominal obesity that demonstrates a high risk for cardiovascular disease and type II diabetes mellitus.

OBJECTIVE

To evaluate football linemen in National Collegiate Athletic Association Divisions I, II, and III schools for the presence of metabolic syndrome according to the American Heart Association/National Heart, Lung, and Blood Institute criteria as well as to document other related biomarkers.

DESIGN

Cross-sectional descriptive study.

SETTING

Three university locations on the first full day of football camp in early morning.

PATIENTS OR OTHER PARTICIPANTS

Of 76 football linemen, 70 were able to provide blood samples.

MAIN OUTCOME MEASURE(S)

Height, mass, blood pressure, upper-body skinfolds, and waist circumference were measured at various stations. Two small venous samples of blood were collected and analyzed in a hospital laboratory for fasting insulin, glucose, high-density lipoprotein, total cholesterol, triglycerides, C-reactive protein, and glycosylated hemoglobin. The last station was a verbal family history for cardiovascular disease and diabetes; also, athletes filled out a nutrition attitudes questionnaire.

RESULTS

Of the 70 athletes, 34 were identified as having metabolic syndrome according to measures of blood pressure, waist circumference, fasting glucose, high-density lipoprotein, and triglycerides. The mean total cholesterol-to-high-density lipoprotein cholesterol ratio for the group was 4.95, with 32 participants displaying values higher than 5.0. Twelve volunteers had total cholesterol levels greater than 200 mmol/L, 15 had high levels of C-reactive protein, and 9 had slightly elevated levels of glycosylated hemoglobin.

CONCLUSIONS

Although athletes might be assumed to be protected from risks of cardiovascular disease, we found a high incidence of metabolic syndrome and other associated adverse biomarkers for heart disease in collegiate football linemen. Early screening, awareness, and intervention may have favorable effects on the overall health outcomes of football linemen.

Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomized, double blind placebo controlled trial

Cardiovascular diseases are the chief causes of death in the UK, and are associated with high circulating levels of total cholesterol in the plasma. Artichoke leaf extracts (ALEs) have been reported to reduce plasma lipids levels, including total cholesterol, although high quality data is lacking. The objective of this trial was to assess the effect of ALE on plasma lipid levels and general well-being in otherwise healthy adults with mild to moderate hypercholesterolemia. 131 adults were screened for total plasma cholesterol in the range 6.0-8.0 mmol/l, with 75 suitable volunteers randomised onto the trial. Volunteers consumed 1280 mg of a standardised ALE, or matched placebo, daily for 12 weeks. Plasma total cholesterol decreased in the treatment group by an average of 4.2% (from 7.16 (SD 0.62) mmol/l to 6.86 (SD 0.68) mmol/l) and increased in the control group by an average of 1.9% (6.90 (SD 0.49) mmol/l to 7.03 (0.61) mmol/l), the difference between groups being statistically significant (p=0.025). No significant differences between groups were observed for LDL cholesterol, HDL cholesterol or triglyceride levels. General well-being improved significantly in both the treatment (11%) and control groups (9%) with no significant differences between groups. In conclusion, ALE consumption resulted in a modest but favourable statistically significant difference in total cholesterol after 12 weeks. In comparison with a previous trial, it is suggested that the apparent positive health status of the study population may have contributed to the modesty of the observed response.

High total-to-HDL cholesterol ratio predicting deterioration of ankle brachial index in Asian type 2 diabetic subjects

AIMS

We conducted a prospective study to determine the risk factors for decrease in ABI in Chinese subjects with type 2 diabetes during a 3-year period.

METHODS

Type 2 diabetic subjects with normal ABI were enrolled in this study. The risk factors for PVD and ABI were examined before and after the follow-up period.

RESULTS

A total of 107 type 2 diabetic subjects completed the assessment. Based on the change of ABI, the study subjects were divided into two groups. Forty subjects, in Group 1, had a decrease in ABI; 67 subjects, in Group 2, had no decrease in ABI after the 3-year follow-up. The baseline total-to-HDL cholesterol ratio (4.5+/-1.2 vs. 3.9+/-1.0, P=0.018) and serum creatinine (99.0+/-18.0micromol/L vs. 88.8+/-15.7micromol/L, P=0.004) were significantly higher, and the HDL cholesterol concentration was significantly lower (1.11+/-0.26mmol/L vs. 1.27+/-0.39mmol/L, P=0.011) in Group 1 than in Group 2. Furthermore, total-to-HDL cholesterol ratio was the variable showed an inverse correlation and independent predictor for the change in ABI after the 3-year follow-up.

CONCLUSIONS

Total-to-HDL cholesterol ratio is a major risk factor for PVD and showed an inverse trend to change in ABI in Asian type 2 diabetic subjects.

HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events

BACKGROUND

High-density lipoprotein (HDL) cholesterol levels are a strong inverse predictor of cardiovascular events. However, it is not clear whether this association is maintained at very low levels of low-density lipoprotein (LDL) cholesterol.

METHODS

A post hoc analysis of the recently completed Treating to New Targets (TNT) study assessed the predictive value of HDL cholesterol levels in 9770 patients. The primary outcome measure was the time to a first major cardiovascular event, defined as death from coronary heart disease, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. The predictive relationship between HDL cholesterol levels at the third month of treatment with statins and the time to the first major cardiovascular event was assessed in univariate and multivariate analyses and was also assessed for specific LDL cholesterol strata, including subjects with LDL cholesterol levels below 70 mg per deciliter (1.8 mmol per liter).

RESULTS

The HDL cholesterol level in patients receiving statins was predictive of major cardiovascular events across the TNT study cohort, both when HDL cholesterol was considered as a continuous variable and when subjects were stratified according to quintiles of HDL cholesterol level. When the analysis was stratified according to LDL cholesterol level in patients receiving statins, the relationship between HDL cholesterol level and major cardiovascular events was of borderline significance (P=0.05). Even among study subjects with LDL cholesterol levels below 70 mg per deciliter, those in the highest quintile of HDL cholesterol level were at less risk for major cardiovascular events than those in the lowest quintile (P=0.03).

CONCLUSIONS

In this post hoc analysis, HDL cholesterol levels were predictive of major cardiovascular events in patients treated with statins. This relationship was also observed among patients with LDL cholesterol levels below 70 mg per deciliter. (ClinicalTrials.gov number, NCT00327691 [ClinicalTrials.gov].).

Apolipoprotein B and non-high density lipoprotein cholesterol and the risk of coronary heart disease in Chinese

The aim of our study was to compare apolipoprotein B (apoB), non-high density lipoprotein cholesterol (nonHDL-C), low density lipoprotein cholesterol (LDL-C), and other lipid markers as predictors of coronary heart disease (CHD) in Chinese. Overall, 122 individuals developed CHD during a median 13.6 years of follow-up in 3,568 adult participants from a community-based cohort. The multivariate relative risk of CHD in the highest quintile compared with the lowest quintile was 2.74 [95% confidence interval (CI), 1.45-5.19] for apoB, 1.98 (95% CI, 1.00-3.92) for nonHDL-C, and 1.86 (95% CI, 1.00-3.49) for LDL-C (all tests for trend, P < 0.05). ApoB also had the highest receiver operator characteristic curve area (0.63; 95% CI, 0.58-0.68) in predicting CHD. When apoB and nonHDL-C were mutually adjusted, only apoB was predictive; the relative risk was 2.80 (95% CI, 1.31-5.96; P = 0.001) compared with 1.09 (95% CI, 0.49-2.40; P = 0.75) for nonHDL-C. Compared with the lowest risk, participants with the highest apoB and total cholesterol/HDL-C had a 3-fold increased risk of developing CHD (relative risk = 3.21; 95% CI, 1.45-7.14). These data provide strong evidence that apoB concentration was a better predictor of CHD than other lipid markers in Chinese.

Occupation is more important than rural or urban residence in explaining the prevalence of metabolic and cardiovascular disease risk in Guatemalan adults

Diet and activity pattern changes consequent to urbanization are contributing to the global epidemic of cardiovascular disease; less research has focused on activity within rural populations. We studied 527 women and 360 men (25-42 y), all rural-born and currently residing in rural or urban areas of Guatemala. We further classified rural male occupations as agricultural or nonagricultural. Overweight status (BMI > or = 25 kg/m(2)) differed by residence/occupation among men (agricultural-rural, 27%; nonagricultural-rural, 44%; and urban, 55%; P< 0.01) and women (rural, 58%; and urban, 68%; P= 0.04). A moderate-to-vigorous lifestyle was reported by 76, 37, and 20% of men (agricultural-rural, nonagricultural-rural, and urban, respectively; P< 0.01); most women were sedentary, with no difference by residence. Prevalence of the metabolic syndrome was 17, 24, and 28% in agricultural-rural, nonagricultural-rural, and urban men, respectively (P= 0.2), and 44 and 45% in rural and urban women (P= 0.4). Dietary variables were largely unassociated with adiposity or cardio-metabolic risk factors; physical activity was inversely associated with the percentage of body fat in men. Percent body fat was inversely associated with HDL-cholesterol, and positively associated with triglycerides, blood pressure, and the metabolic syndrome in both men and women, and with LDL-cholesterol and fasting glucose in women. Differences in physical activity level, mainly attributable to occupation, appear more important than residence, per se, in influencing the risk for cardiovascular disease among men; differences among these sedentary women are likely related to other factors associated with an urban environment.

Relationship between total cholesterol/high-density lipoprotein cholesterol ratio, triglyceride/high-density lipoprotein cholesterol ratio, and high-density lipoprotein subclasses

Alterations in plasma lipid levels can influence the composition, content, and distribution of plasma lipoprotein subclasses that affect atherosclerosis risk. This study evaluated the relationship between plasma total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, and HDL subclass distribution. The apolipoprotein A-I contents of plasma HDL subclasses were quantitated by 2-dimensional gel electrophoresis coupled with immunodetection in 442 Chinese subjects. The particle size of HDL shifted toward smaller size with the elevation of TC/HDL-C and TG/HDL-C ratios. The ratio of large-sized HDL(2b) to small-sized prebeta(1)-HDL (HDL(2b)/prebeta(1)-HDL) was about 4.7 in the subjects with TC/HDL-C of 3.3 or lower and TG/HDL-C of 2.5 or lower, whereas it was only approximately 1.1 in subjects with TC/HDL-C greater than 6 and TG/HDL-C greater than 5. Pearson correlation analysis revealed that the TC/HDL-C ratio was positively correlated with prebeta(1)-HDL and HDL(3a) but negatively correlated with HDL(2a) and HDL(2b), whereas the TC/HDL-C ratio was only inversely correlated with HDL(2b). The TC/HDL-C and TG/HDL-C ratios together may be a good indicator of HDL subclass distribution. When these 2 ratios increased simultaneously, the trend toward smaller HDL size was obvious, which, in turn, indicated that the maturation of HDL might be impeded and the reverse cholesterol transport might be weakened. In addition, the TG/HDL-C ratio might be a more powerful factor to influence the distribution of HDL subclasses.

Measurement of cumulative physiological dysregulation in an older population

The allostatic load framework postulates that an important pathway connecting the social environment with health involves biological responses to stressful stimuli and the subsequent dysregulation of interrelated physiological systems. We formulate a new measure for cumulative physiological dysregulation using a grade of membership model estimated with biodemographic data from a national sample of older Taiwanese persons. We investigate associations between the measure and physical, psychological, and cognitive function. The results provide insights into the relationships between a set of biological profiles and various health outcomes, identify limitations of earlier approaches, and underscore next steps in the development of improved for mulations of physiological dysregulation.

Effect of a short-term diet and exercise intervention on metabolic syndrome in overweight children

Overweight and the metabolic syndrome are increasing radically in children. The present study was designed to examine the effects of lifestyle modification in 16 children who were placed on a high-fiber, low-fat diet in a 2-week residential program where food was provided ad libitum and daily aerobic exercise was performed. In each subject, pre- and postintervention fasting blood was drawn. Insulin (27.2 +/- 3.5 vs 18.3 +/- 1.7 microU/mL, P < .01), homeostasis model assessment for insulin resistance (5.79 +/- 0.81 vs 4.13 +/- 0.38, P < .05), and body weight (92.0 +/- 7.0 vs 88.0 +/- 6.8 kg, P < .01) were reduced significantly. Total cholesterol (165 +/- 7.8 vs 127 +/- 7.4 mg/dL, P < .01), low-density lipoprotein (94.1 +/- 8.2 vs 68.5 +/- 6.7 mg/dL, P < .01), triglycerides (146 +/- 16.2 vs 88.1 +/- 8.1 mg/dL, P < .01), and total cholesterol-high-density lipoprotein (4.16 +/- 0.30 vs 3.34 +/- 0.30, P < .01) and low-density lipoprotein-high-density lipoprotein ratios (2.41 +/- 0.3 vs 1.86 +/- 0.2, P < .01) were reduced, with no change in high-density lipoprotein observed (42.3 +/- 2.4 vs 40.8 +/- 3.0 mg/dL). Systolic blood pressure (130 +/- 3.1 vs 117 +/- 1.8 mm Hg, P < .001) and diastolic blood pressure (74.3 +/- 3.0 vs 67.2 +/- 2.3 mm Hg, P = .01) also decreased. Most notably, before the intervention, 7 of the 16 subjects were classified with metabolic syndrome. After the 2-week intervention, despite remaining overweight, reversal of metabolic syndrome was noted in all 7 subjects. All of these changes occurred despite only modest improvements in the percentage of body fat (37.5% +/- 1.1% vs 36.4% +/- 1.2%, P < .01) and body mass index (33.2 +/- 1.9 vs 31.8 +/- 1.9 kg/m(2), P < .01). These results indicate that a short-term rigorous diet and exercise regimen can reverse metabolic syndrome, even in youth without documented atherosclerosis.

Effects of rosiglitazone on endothelial function, C-reactive protein, and components of the metabolic syndrome in nondiabetic patients with the metabolic syndrome

Fifty nondiabetic patients who met a modified National Cholesterol Education Program definition for the metabolic syndrome were randomized to receive either rosiglitazone (4 mg/day; n = 25) or placebo (n = 25) for 8 weeks. Compared with those receiving placebo, patients in the rosiglitazone group achieved significant reductions in fasting plasma insulin levels (-40%), homeostasis model assessment indexes (-45%), systolic and diastolic blood pressures, and high-sensitivity C-reactive protein levels (-31%). There were no changes in fasting plasma glucose with either treatment. Although rosiglitazone treatment greatly increased plasma levels of low-density lipoprotein cholesterol (18%) and apolipoprotein B (16%), it significantly improved both endothelium-dependent flow-mediated vasodilation (p <0.001) and endothelium-independent nitroglycerin-induced vasodilation (p = 0.01) of the right brachial artery.

Efficacy of fenofibrate and simvastatin on endothelial function and inflammatory markers in patients with combined hyperlipidemia: relations with baseline lipid profiles

Given that combination therapy with statin plus fibrate confers a risk of myopathy, it is worthwhile to determine whether statin or fibrate monotherapy is associated with greater clinical benefit in individuals with combined hyperlipidemia. In this randomized double-blind study, we compared the efficacy of simvastatin and fenofibrate on indexes of endothelial function (flow-mediated dilation (FMD) of the brachial artery) and inflammatory markers (plasma high-sensitivity C-reactive protein (CRP), interleukin-1 beta (IL-1 beta), soluble CD40, and soluble CD40 ligand (sCD40L) levels), as surrogate indicators of future coronary heart disease (CHD), in patients with combined hyperlipidemia. A total of 70 patients with plasma triglyceride levels between 200 and 500 mg/dl and total cholesterol levels of >200 mg/dl were randomly assigned to receive either simvastatin (20 mg/day) (n=35) or micronized fenofibrate (200 mg/day) (n=35) for 8 weeks. Treatment with simvastatin was associated with significantly greater reduction of total cholesterol and low-density lipoprotein cholesterol (LDL-C), while the decrease in triglycerides was significantly greater in patients receiving fenofibrate. Both fenofibrate and simvastatin markedly reduced plasma levels of high-sensitivity CRP, IL-1 beta, and sCD40L, and improved endothelium-dependent FMD without mutual differences. The changes in plasma inflammatory markers did not correlate with baseline clinical characteristics in both groups. However, the improvement in FMD with fenofibrate treatment correlated inversely with baseline high-density lipoprotein cholesterol (HDL-C) levels, whereas the improvement in FMD with simvastatin treatment was positively related to HDL-C levels. Accordingly, in the subgroup with a baseline HDL-C of < or =40 mg/dl, only fenofibrate significantly improved the endothelium-dependent FMD. On the other hand, in the subgroup with HDL-C >40 mg/dl, only treatment with simvastatin achieved significant improvement in FMD. The data here indicate that in patients with combined hyperlipidemia, both fenofibrate and simvastatin have comparative beneficial effects on various inflammatory markers and differential beneficial effects on endothelial function according to baseline HDL-C levels. These findings should be validated by additional prospective studies, in which patients are stratified by baseline HDL-C prior to randomization.

Effects of Greek Orthodox Christian Church fasting on serum lipids and obesity

BACKGROUND

No study to date has focused on the impact of Greek Orthodox Christian fasting on serum lipoproteins and obesity yet.

METHODS

120 Greek adults were followed longitudinally for one year. Sixty fasted regularly in all fasting periods (fasters) and 60 did not fast at all (controls). The three major fasting periods under study were: Christmas (40 days), Lent (48 days) and Assumption (August, 15 days). A total of 6 measurements were made during one year including pre- and end-fasting blood collection, serum lipoprotein analyses and anthropometric measurements.

RESULTS

Statistically significant end-fasting total and LDL cholesterol differences were found in fasters. Fasters compared to controls presented 12.5% lower end-total cholesterol (p < 0.001), 15.9% lower end-LDL cholesterol (p < 0.001) and 1.5% lower end-BMI (p < 0.001). The end- LDL/HDL ratio was lower in fasters (6.5%, p < 0.05) while the change in end- HDL cholesterol in fasters (4.6% decline) was not significant. Similar results were found when the pre- and end-fasting values of fasters were compared. No change was found in control subjects.

CONCLUSIONS

Adherence to Greek Orthodox fasting periods contributes to a reduction in the blood lipid profile including a non-significant reduction in HDL cholesterol and possible impact on obesity.

Lipid and apolipoprotein ratios: association with coronary artery disease and effects of rosuvastatin compared with atorvastatin, pravastatin, and simvastatin

Plasma lipid and apolipoprotein ratios that include both an atherogenic and an antiatherogenic lipid component (eg, total cholesterol/high-density lipoprotein [HDL] cholesterol ratio, low-density lipoprotein [LDL] cholesterol/HDL cholesterol ratio, non-HDL cholesterol/HDL cholesterol ratio, and apolipoprotein [apo] B/apo A-I ratio) have been found to be strong predictors of coronary artery disease (CAD) risk. Three trials that compared the effects of rosuvastatin 10 mg versus atorvastatin 10 mg and 2 trials that compared the effects of rosuvastatin 10 mg versus simvastatin 20 mg and pravastatin 20 mg on lipid ratios in patients with hypercholesterolemia were prospectively designed for pooled analysis. At 12 weeks, in the 3-trial pooled analysis, rosuvastatin 10 mg (n = 389) showed significantly greater reductions in all 4 lipid ratios compared with atorvastatin 10 mg (n = 393) (p <0.001). The mean percent reduction from baseline in the LDL cholesterol/HDL cholesterol ratio was 51% in patients treated with rosuvastatin 10 mg versus 39% in patients treated with atorvastatin 10 mg. In the 2-trial pooled analysis, treatment with rosuvastatin 10 mg (n = 226) also resulted in significantly greater reductions in all 4 lipid ratios compared with both simvastatin 20 mg (n = 249) and pravastatin 20 mg (n = 252) (p <0.001). Mean percent reductions from baseline in the LDL cholesterol/HDL cholesterol ratio were 52%, 39%, and 30% for rosuvastatin 10 mg, simvastatin 20 mg, and pravastatin 20 mg, respectively, in these 2 trials.