The Importance of Being Aware of Intrinsic Methods' Limitation in Low-Density Lipoprotein Cholesterol Determination to Correctly Identify Cardiovascular Risk: Is Direct Determination Obtained with the Roche System Systematically Overestimating LDL in Very High-Risk Patients with Triglycerides Concentration of Less than 2.25 mmol/L?

BACKGROUND

low-density lipoprotein cholesterol (LDL-C) is a strong cardiovascular risk factor, but the methods used to correctly determine it are is still questioned. The aim of this study was to compare the direct determination of LDL-C levels, obtained with the Roche cobas c system, with LDL-C values calculated through Sampson's and Friedewald's equations in very high-risk patients with triglycerides concentrations of less than 2.25 mmol/L (<200 mg/dL).

METHODS

in 127 consecutive patients with a recent diagnosis of acute coronary syndrome and triglycerides of less than 2.25 mmol/L, plasma LDL-C was measured directly and calculated with Sampson's and Friedewald's equations before hospital discharge, and the data were compared.

RESULTS

median LDL values obtained with the Friedenwald and Sampson equations and with direct determination were 2.31 (IQR 1.59-3.21), 2.36 (IQR 1.66-3.26) and 2.64 (IQR 1.97-3.65) mmol/L, respectively. Direct measurements were higher by 0.35 and 0.40 mmol/L when compared to the levels calculated with Sampson's or Friedewald's equations, respectively (p < 0.01). The correlation between the two equations was almost perfect (rho 0.997) but decreased when the directly determined data were compared to those calculated with Sampson's equation (rho 0.954) or Friedewald's method (rho 0.939).

CONCLUSION

direct determination generated higher values of LDL-C concentration through a probable systematic overestimation.

Characterization of ultrasonically extracted flaxseed polysaccharide gum and assessing its lipid-lowering potential in a rat model

Flaxseed polysaccharide gum (FPG) was extracted through the ultrasound-assisted process using water as a solvent with a yield ranging from 8.05 ± 0.32% to 12.23 ± 0.45% by changing different extraction variables. The extracted FPG was analyzed for its functional groups and antioxidant potential. The maximum DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical scavenging activity (≈100%) of FPG was noted at concentrations beyond ≈10 mg·ml-1. The maximum inhibition percentage through ABTS (2,2'-azino-bis 3-ethylbenzothiazoline-6-sulfonic acid) (72.4% ± 1.9%) was noted at 40 mg·ml-1, which was observed to be less when compared to DPPH at the same concentration. The total antioxidant potential of the FPG solution at a concentration of 10 mg·ml-1 was equivalent to 461 mg ascorbic acid, which tends to increase with concentration at a much lower scope. The in vivo trial suggested that the least weight gain was noted in experimental groups G2 and Gh2. A significant reduction in total cholesterol was noticed in G1 (-14.14%) and G2 (-17.72%) and in Gh1 (-22.02%) and Gh2 (-34.68%) after 60 days of the trial compared to the baseline values. The maximum reduction in total triglyceride was observed in Gh2 (-25.06%) and Gh1 (-22.01%) after 60 days of the trial. It was an increasing trend in high-density lipoprotein cholesterol (HDL-c) in different experimental groups G2 (10.51%) than G1 (5.35%) and Gh2 (48.96%) and Gh1 (31.11%), respectively, after 60 days of study interval. Reduction of -5.05% and - 9.45% was observed in G1 and G2, while similar results were observed in Gh1 and Gh2. Conclusively, results suggested a possible protective role of FPG against hyperlipidemia.

Comparative Study of Calculated LDL-Cholesterol Levels with the Direct Assay in Patients with Hypothyroidism

Background Hypothyroidism is one among the many factors that predisposes one to coronary artery disease. As low-density lipoprotein-cholesterol (LDL-C) is associated with cardiovascular risk, calculated LDL-C should have good accuracy with minimal bias. Hypothyroidism alters the lipid composition of lipoproteins by the secretion of triglyceride-rich lipoproteins, which affects the calculation of LDL-C. The present study aimed to compare 13 different formulae for the calculation of LDL-C including the newly derived Martin's formula by direct assay in patients of hypothyroidism.

Method In this analytical cross-sectional study, a total of 105 patients with laboratory evidence of hypothyroidism, from January to June 2019, were studied, and blood samples were subjected for lipid profile analysis at central biochemistry laboratory. Calculated LDL-C was assessed by different formulae.

Result We observed that calculated LDL-C by Friedewald's, Cordova's, Anandaraja's, Hattori's, and Chen's formulae has bias less than ± 5 compared with direct LDL-C, with Anandaraja's formula having the lowest bias (2.744) and Cordova's formula having lowest bias percentage (−1.077) among them. According to the Bland–Altman plots, the bias in Friedewald's and Anandraja's were equally distributed below and above the reference line of direct LDL-C.

Conclusion This is the first study comparing different formulae for LDL-C calculation in patients with hypothyroidism. Anandaraja's formula was as equally effective as Friedewald's formula when used as an alternative cost-effective tool to evaluate LDL-C in hypothyroid patients. The recently proposed Martin's formula for calculated LDL-C had a higher bias when compared with Friedewald's and Anandaraja's formulae in patients with hypothyroidism.

Differential Effects of Exercise Programs on Neuregulin 4, Body Composition and Cardiometabolic Risk Factors in Men With Obesity

Background

Neuregulin 4 (Nrg4) is an adipokine that is sensitive to energy expenditure and with a potential role in metabolic homeostasis and obesity. This study examined the effects of 12 weeks of three different exercise training protocols on Nrg4 levels, cardiometabolic risk factors, and body composition parameters in men with obesity.

Methods

Sixty adult men with obesity (Mean ± SD; age: 27.60 ± 8.4 yrs.; height: 168.4 ± 2.6 cm; weight: 96.7 ± 7.2 kg) were randomly allocated into four equal (n = 15) groups: High- Intensity Interval Training (HIIT), Circuit Resistance Training (CRT), Moderate Intensity Continuous Training (MICT) or a control group. The HIIT protocol involved six bouts of 3-min high-intensity exercise (90% VO2peak) followed by 3-min low-intensity exercise (50% VO2peak). The CRT group performed three circuits of resistance training, where each circuit included 11 exercises at 20% of one-repetition maximum (1RM) and 70% of VO2peak, and with a work-to-rest ratio of 2:1 (40-s exercise and 20-s rest) and 60-s recovery between circuits. The MICT group performed 36 min of exercise at 70% of VO2peak. All measurements were taken 72 h before and after the first and last training sessions.

Results

There were significant differences between the groups in fat-free mass (FFM), (effect size (ES): 0.78), fat mass (ES: 0.86), VO2peak (ES: 0.59), high-density lipoprotein cholesterol (HDL-C) (ES: 0.83), low-density lipoprotein (LDL-C) (ES: 0.79), total cholesterol (TC) (ES: 0.90), triglyceride (TG) (ES: 0.52) glucose (ES: 0.39), insulin (ES: 0.61), HOM-IR (ES: 0.91) and Nrg4 (ES: 0.98) (p &lt; 0.05). There were no significant changes in very-low-density lipoprotein cholesterol (VLDL-C) (ES: 0.13) levels, or body weights (ES: 0.51) (p &gt; 0.05). Levels of Nrg4 were negatively correlated with LDL-C, TC, TG, VLDL-C, glucose, insulin, HOMA-IR (p &lt; 0.05) and positively with HDL-C (p &lt; 0.05).

Conclusion

Our results suggest that HIIT and CRT protocols have greater effects than MICT protocol on Nrg4 levels, metabolic and cardiovascular risk factors, and body composition variables in men with obesity.

Which LDL Value Should Clinicians Look at?

Objectives  LDL cholesterol is routinely estimated by the Friedewald formula to guide the treatment of dyslipidemia. However, Friedewald equation has certain limitations, especially with high triglyceride levels. Direct methods are available for LDL estimation but have received relatively little scrutiny in the Indian setting. This study was aimed at comparing the calculative and direct methods of LDL estimation in Indian hyperlipidemic patients. Materials and Methods  In this observational study, data from 380 consecutive lipid profiles of patients visiting a tertiary care hospital in Mumbai were analyzed retrospectively. CHOD PAP method was used to estimate total cholesterol. Enzymatic colorimetric method was used to estimate triglycerides. Enzyme selective protection method was used to estimate HDL. Direct LDL was estimated by homogenous enzymatic colorimetric assay and very low-density lipoprotein was calculated, whereas Friedewald's formula was used to derive calculated LDL. Results  Total cholesterol values correlated positively with the LDL values measured by both methods. However, a statistically significant difference was noted between the correlation coefficients of both the methods. Triglyceride values correlated weakly with the LDL levels measured by both the methods. A weak negative correlation was observed with LDL by the calculated method, whereas a weak positive correlation existed between TG and LDL by the direct method. The difference between the correlation coefficients was statistically significant. Conclusion  Both direct and calculated methods of LDL estimation have their limitations. A robust study with a larger sample size is needed to further investigate whether the differences in the different LDL estimation methods can translate to "clinical relevance" in the Indian setting.

Exome sequence association study of levels and longitudinal change of cardiovascular risk factor phenotypes in European Americans and African Americans from the Atherosclerosis Risk in Communities Study

Cardiovascular disease (CVD) is responsible for 31% of all deaths worldwide. Among CVD risk factors are age, race, increased systolic blood pressure (BP), and dyslipidemia. Both BP and blood lipids levels change with age, with a dose-dependent relationship between the cumulative exposure to hyperlipidemia and the risk of CVD. We performed an exome sequence association study using longitudinal data with up to 7805 European Americans (EAs) and 3171 African Americans (AAs) from the Atherosclerosis Risk in Communities (ARIC) study. We assessed associations of common (minor allele frequency > 5%) nonsynonymous and splice-site variants and gene-based sets of rare variants with levels and with longitudinal change of seven CVD risk factor phenotypes (BP traits: systolic BP, diastolic BP, pulse pressure; lipids traits: triglycerides, total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C]). Furthermore, we investigated the relationship of the identified variants and genes with select CVD endpoints. We identified two novel genes: DCLK3 associated with the change of HDL-C levels in AAs and RAB7L1 associated with the change of LDL-C levels in EAs. RAB7L1 is further associated with an increased risk of heart failure in ARIC EAs. Investigation of the contribution of genetic factors to the longitudinal change of CVD risk factor phenotypes promotes our understanding of the etiology of CVD outcomes, stressing the importance of incorporating the longitudinal structure of the cohort data in future analyses.

Exploring the prophylactic role of soy isoflavones against polycystic ovarian syndrome

Soy isoflavones (SI) have strong estrogenic effect in tissues by binding to estrogen receptors and might be beneficial for women with polycystic ovarian syndrome (PCOS) by reduction in testosterone, cholesterol, insulin, weight gain, inflammatory markers, and oxidative stress. The study was planned to examine the effect of various levels of SI on nutrient intake, digestibility, lipid profile, insulin, and reproductive hormones of estradiol valerate (4 mg/rat/IM) PCOS induced rat models. Thirty-six Wistar 45 days old rats weighing 95 ± 5 g were divided into 4 groups, each having 9 rats: C (control: without SF), SF10 (SF 0.10 g/kg BW), SF15 (SF 0.15 g/kg BW), and SF20 (SF 0.20 g/kg BW). SF was given through the oral gavage. Food and water were offered ad libitum, and intake was recorded daily. During last week of trial, collected feces by total collection method and blood samples were used to calculate nutrient digestibility and biochemical analysis, respectively. Estrogen, progesterone, and prolactin were (p < .05) high in rats fed SF diet that was 4% and 30% increase from C, respectively. Insulin, testosterone, FSH, and LH were lowest in rats fed diet SF20. Significant (p < .05) reduction in cholesterol was observed in rats fed SF15 and SF20 as compared to C. Serum HDL was improved (p < .05) in all SIF0.10, SIF0.15, and SIF0.20 in comparison with PC. Serum LDL was significantly reduced to 68.89 ± 4.36 (mg/dl) in SIF0.20 and to 108.20 ± 4.14 (mg/dl) in SIF0.15, whereas insignificant reduction was observed in SIF0.10 as compared to PC. Highly significant reduction was noted in triglycerides level in SIF0.20; however, significant reduction was observed in both SIF0.10 and SIF0.15 as compared to PC after 3 months of treatment with soy isoflavones.

A Comparison Between the Therapeutic Effect of Metformin Alone versus a Combination Therapy with Insulin in Uncontrolled, Non-Adherence Patients with Type 2 Diabetes: Six Months Follow-Up

PURPOSE

The study aimed to compare the metabolic effects of an intensive dose of metformin alone among non-adherence patients with type 2 diabetes versus in combination with insulin among adherence patients.

METHODS

The prospective cohort study was carried out on a sample of 140 patients above 18 years old, divided into two groups. The first group (n=70) was recommended metformin monotherapy in an intensive dose of 2-3 g/day, whereas the second group (n=70) was prescribed metformin (1-2g/day) in combination with insulin. FPG, HbA1c, BMI, blood pressure, TC, TG, HDL-C, LDL-C, creatinine, and eGFR were measured for each patient at baseline and after a follow-up of 6 months of active treatment.

RESULTS

After six months of active treatment using monotherapy with an intensive dose of metformin, only 11.43% of patients achieved the target levels of HBA1c below 7%. In the group of patients treated using a combination of metformin with insulin, after six months of active treatment, 45.72% achieved HBA1c levels below 7% (p<0.0001). Compared with an intensive dose of metformin alone, the combination of insulin and metformin was associated with improved glycemic control (change of fasting blood glucose: 2.49 mmol/l vs 1.30 mmol/l, p=0.0016). Metformin use alone, as compared with insulin, was associated with a significant increase in HDL-C (+0.03 mmol/l vs -0.14 mmol/l, p=0.0485). Increased baseline obesity and increased baseline glycemia were the factors related to the likelihood of failing to achieve the target levels for HbA1c.

CONCLUSION

Metformin proved to be more effective in controlling hyperglycemia when combined with insulin therapy. Our study shows how many health benefits loss patients who, despite systematic diabetes education, do not agree to change their treatment in the form of adding a second drug, including insulin.

Small Dense Low-Density Lipoprotein Cholesterol and Carotid Intimal Medial Thickness Progression

AIM

The association between small dense low-density lipoprotein cholesterol (sdLDL-C) levels and carotid intimal medial thickness (cIMT) progression has not been evaluated fully. We assessed specialized lipoproteins, including sdLDL-C, with regard to cIMT progression in a prospective observational study in Japan.

METHODS

Plasma total cholesterol, direct LDL-C, sdLDL-C, LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL2-C, HDL3-C, triglycerides, Lp(a), and adiponectin were measured in 2,030 men and women (median age 59 years, free of cardiovascular disease (CVD) and off cholesterol lowering medication). At both baseline and after a five-year follow-up, cIMT was assessed. Univariate, multivariate regression, and least square analyses were performed to examine the relationships between direct LDL-C, sdLDL-C, and other lipoproteins with cIMT progression.

RESULTS

The median cIMT at baseline was 0.63 mm and five-year progression was 0.18 mm. After adjustment for standard CVD risk factors, including age, gender, systolic blood pressure, total cholesterol, HDL-C, smoking, diabetes, and hypertension treatment, only direct LDL-C, sdLDL-C, and the sdLDL-C/LDL-C ratio were associated with cIMT progression. Even in subjects with direct LDL-C ＜100 mg/dL, who were considered at low CVD risk, elevated sdLDL-C were associated with cIMT progression (P for trend=0.009) in a model with established CVD risk factors, although the sdLDL-C/LDL-C ratio did not. Those correlations did not change by including triglycerides as a controlling factor or excluding premenopausal women from the analyzed population.

CONCLUSIONS

Small dense LDL-C has a stronger relationship with cIMT progression than LDL-C does; therefore, measuring sdLDL-C may allow for the formulation of optimal therapy for CVD prevention.

Effect of thermally treated barley dietary fiber against hypercholesterolemia

Dietary fiber is a nondigestible constituent of vegetal foods, formed by insoluble and soluble dietary fiber. The intake of dietary fiber, especially soluble dietary fiber, is limited and demands researcher's attention. The modification of cereal's dietary fiber, predominantly insoluble fiber, could be one possible solution. The current study evaluated the comparative effects of several thermal treatments on the modification of insoluble dietary fiber in barley and explored their therapeutic potential in vivo against hypercholesterolemia. The two cultivars of barley, Haider-93 and Jau-87, were thermally treated using different techniques, and dietary fiber was extracted. Successively, the intake of these dietary fibers was evaluated for its antilipidemic activity in normal and hypercholesterolemic rats. In the first phase, thermal treatments especially cooking without soaking increased the soluble fiber (68.08%). The roasting all increased the soluble fiber contents, however, at relatively lower rate (53.91%). The results of efficacy study revealed that biochemical parameters in control animals were within the normal clinical ranges, thus appraising the safe status of the experimental diets. The thermally treated barley fiber decreased total cholesterol (12.14%-12.63%), low-density lipoprotein (14.12%-14.85%), and triglycerides (2.25%-4.32%). The study recorded increasing trends for high-density lipoprotein in both normal and hypercholesterolemic rats. In the nutshell, thermal modification of dietary fiber increased the ratio of soluble to insoluble dietary fiber that improved its hypocholesterolemic potential. The thermally treated barley dietary fiber is effective in reducing the lipid profile in Sprague-dawley rats than untreated dietary fiber and, therefore, can be considered as a functional food and ingredient to cope different lifestyle diseases.

Non-HDL or LDL cholesterol in heterozygous familial hypercholesterolaemia: findings of the Simon Broome Register

PURPOSE OF REVIEW

The role of non-HDL-C in the identification and management of lipid disorders is not clearly defined, although UK guidelines recommend its wider use in assessing the need for lipid-lowering therapy and as a treatment target.

RECENT FINDINGS

We examined the implications of the use of non-HDL-C as opposed to LDL-C in 253 people with hypercholesterolaemia before treatment and 573 after treatment in whom fasting total serum cholesterol, HDL-C and LDL-C had been recorded and the diagnosis of heterozygous familial hypercholesterolemia (heFH) was investigated by genetic testing. The difference and the limits of agreement between non-HDL-C and LDL-C calculated using the Friedewald formula were assessed in those with and without heFH-causing mutations.

SUMMARY

There were 147 mutation-positive and 106 mutation-negative pretreatment participants and 395 mutation-positive and 178 mutation-negative patients receiving treatment. The difference between non-HDL-C and LDL-C pretreatment in mutation-positive people (mean LDL-C 7.73 mmol/l) was 0.67 mmol/l (95% CI 0.62-0.73) and posttreatment (mean LDL-C 4.71 mmol/l) was 0.62 mmol/l (95% CI 0.59-0.65) with wide limits of agreement of -0.02 to 1.37 and 0.07-1.18 mmol/l, respectively. Among patients with heterozygous familial hypercholesterolaemia, use of estimated LDL-C derived from non-HDL-C in place of calculated LDL-C may result in diagnostic misclassification and difficulty in assessing the true reduction in LDL-C with treatment, because of the wide inter-individual limits of agreement around the mean difference between non-HDL-C and LDL-C.

Increased Blood Lipid Level is Associated with Cancer-Specific Mortality and All-Cause Mortality in Patients with Colorectal Cancer (≥65 Years): A Population-Based Prospective Cohort Study

Background

Hyperlipidaemia is related to the development of many cancers. The aim of this study was to explore whether blood lipid levels were associated with increased rates of cancer-specific mortality and all-cause mortality in patients with colorectal cancer (CRC).

Methods

Data on 8504 participants from The Irish Longitudinal Study on Ageing (TILDA) were analysed. A total of 304 participants with CRC who had experienced curative surgery were included. Logistic regression analysis was performed to analyse the relationship between blood lipid levels and CRC severity. Cox regression analysis was performed to assess the association between blood lipid levels and cancer-specific mortality and all-cause mortality in patients with CRC.

Results

In 304 patients with CRC, the average age was 67.8±5.4 years. The logistic regression analysis indicated that elevated levels of total cholesterol (2.104 [1.358–3.650]; P-trend<0.001), triglycerides (1.665 [1.337–2.076]; P-trend=0.005) and LDL (2.127 [1.446–4.099]; P-trend<0.001) but not HDL (0.688 [0.409–1.252]; P-trend=0.124) were associated with an increased risk of higher CRC stage after adjustments were made for age, sex, marital status, BMI, drinking status, smoking status, education, physical activity, antilipidaemic medications and self-reported CVDs (≥2). Cox proportional hazard analysis showed that higher blood lipid levels of total cholesterol, triglycerides and LDL were independently associated with higher rates of cancer-specific mortality and all-cause mortality. Similar results persisted in the sensitivity analysis using antilipidaemic medications as an additional covariate and the stratification analysis using antilipidaemic medications as a stratified variable.

Conclusion

Increased blood lipid levels were associated with an increased risk of cancer-specific mortality and all-cause mortality in patients with CRC after adjusting for potential confounding factors. Clinicians should pay more attention to the prognostic value of increased blood lipids in patients with CRC for the risk of death.

Achieving low-density lipoprotein cholesterol targets as assessed by different methods in patients with familial hypercholesterolemia: an analysis from the HELLAS-FH registry

Background

Familial hypercholesterolemia (FH) is characterized by elevated low-density lipoprotein cholesterol (LDL-C) levels and increased cardiovascular disease (CVD) risk. FH patients often have increased lipoprotein(a) [Lp(a)] levels, which further increase CVD risk. Novel methods for accurately calculating LDL-C have been proposed.

Methods

Patients with FH were recruited by a network of Greek sites participating in the HELLAS-FH registry. LDL-C levels were calculated using the Friedewald (LDL-C_F) and the Martin/Hopkins (LDL-C_M/H) equations as well as after correcting LDL-C_M/H for Lp(a) levels [LDL-C_Lp(a)corM/H]. The objective was to compare LDL-C levels and target achievement as estimated by different methods in FH patients.

Results

This analysis included 1620 patients (1423 adults and 197 children). In adults at diagnosis, LDL-C_F and LDL-C_M/H levels were similar [235 ± 70 mg/dL (6.1 ± 1.8 mmol/L) vs 235 ± 69 mg/dL (6.1 ± 1.8 mmol/L), respectively; P = NS], while LDL-C_Lp(a)corM/H levels were non-significantly lower than LDL-C_F [211 ± 61 mg/dL (5.5 ± 1.6 mmol/L); P = 0.432]. In treated adults (n = 966) both LDL-C_F [150 ± 71 mg/dL (3.9 ± 1.8 mmol/L)] and LDL-C_M/H levels [151 ± 70 mg/dL (6.1 ± 1.8 mmol/L); P = 0.746] were similar, whereas LDL-C_Lp(a)corM/H levels were significantly lower than LDL-C_F [121 ± 62 mg/dL (3.1 ± 1.6 mmol/L); P < 0.001]. Target achievement as per latest guidelines in treated patients using the LDL-C_M/H (2.5%) and especially LDL-C_Lp(a)corM/H methods (10.7%) were significantly different than LDL-C_F (2.9%; P < 0.001).

In children, all 3 formulas resulted in similar LDL-C levels, both at diagnosis and in treated patients. However, target achievement by LDL-C_F was lower compared with LDL-C_M/H and LDL-C_Lp(a)corM/H methods (22.1 vs 24.8 vs 33.3%; P < 0.001 for both comparisons).

Conclusion

LDL-C_Lp(a)corM/H results in significantly lower values and higher target achievement rate in both treated adults and children. If validated in clinical trials, LDL-C_Lp(a)corM/H may become the method of choice to more accurately estimate ‘true’ LDL-C levels in FH patients.

Non-HDL cholesterol as a therapeutic goal

Although cholesterol linked to low-density lipoproteins (c-LDL) is well established as a risk factor for cardiovascular disease, there is often a more complex dyslipidaemia pattern that contributes to the formation of atherosclerotic plaque. Non-HDL cholesterol (c-NO-HDL) is used to estimate the total amount of atherogenic lipoproteins in plasma, some of which are not usually determined in daily clinical practice. c-NO-HDL is easily calculated from the subtraction of total plasma cholesterol from the cholesterol content carried by high density lipoproteins. The c-NO-HDL has a predictive value superior to that of C-LDL to estimate the risk of major cardiovascular events in epidemiological studies. Genetic studies by analysis of the complete genome, together with those based on Mendelian randomisation, point to the aetiological character of c-NO-HDL on ischaemic heart disease (IHD). Intervention studies, and the meta-analyses derived from them, close the causal circle between c-NO-HDL and IHD, by demonstrating that any intervention that decreases the concentrations of the former reduces the incidence of arteriosclerotic heart disease. The European ESC/EAS 2016 guide for the management of dyslipidaemia considers c-NO-HDL as a therapeutic target with a Class IIa recommendation (should be performed) Level B (data from a single randomised clinical trial [RCT]) or from several non-RCTs), and sets its target at less than 100 or 130mg/dL for those patients with very high risk or high risk, respectively. These achievable c-NO-HDL values are easily calculated by adding 30mg/dL to the c-LDL targets.

Impact of improved low-density lipoprotein cholesterol assessment on guideline classification in the modern treatment era-Results from a racially diverse Brazilian cross-sectional study

BACKGROUND

The Martin/Hopkins low-density lipoprotein cholesterol equation (LDL-C_N) was previously demonstrated as more accurate than Friedewald LDL-C estimation (LDL-C_F) in a North American database not able to take race into account.

OBJECTIVES

We hypothesized that LDL-C_N would be more accurate than LDL-C_F and correlate better with LDL particle number (LDL-P) in a racially diverse Brazilian cohort.

METHODS

We performed a cross-sectional analysis of 4897 participants in the Brazilian Longitudinal Study of Adult Health, assessing LDL-C_F and LDL-C_N accuracy via overlap with ultracentrifugation-based measurement among clinical guideline LDL-C categories as well as mg/dL and percent error differences. We analyzed by triglyceride categories and correlated LDL-C estimation with LDL-P.

RESULTS

LDL-C_N demonstrated improved accuracy at 70 to <100 and <70 mg/dL (P < .001), with large errors ≥20 mg/dL about 9 times more frequent in LDL-C_F at LDL-C <70 mg/dL, mainly due to underestimation. Among individuals with LDL-C <70 mg/dL and triglycerides ≥150 mg/dL, 65% vs 100% of ultracentrifugation-based low-density lipoprotein cholesterol calculation fell within appropriate categories of estimated LDL-C_F and LDL-C_N, respectively (P < .001). Similar results were observed when analyzed for age, sex, and race. Participants at LDL-C <70 and 70 to <100 mg/dL with discordantly elevated LDL-C_N vs LDL-C_F had a 58.5% and 41.5% higher LDL-P than those with concordance (P < .0001), respectively.

CONCLUSIONS

In a diverse Brazilian cohort, LDL-C_N was more accurate than LDL-C_F at low LDL-C and high triglycerides. LDL-C_N may avoid underestimation of LDL-C and better reflect atherogenic lipid burden in low particle size, high particle count states.

Trends in the prevalence and management of diabetes in Korea: 2007-2017

OBJECTIVES

This study analyzed Korea National Health and Nutrition Examination Survey data from 2007 to 2017 to assess trends in the prevalence, treatment, and control of diabetes in Korean adults ≥30 years of age.

METHODS

Prevalent diabetes was defined as a fasting plasma glucose level ≥126 mg/dL, self-reported use of anti-diabetic treatment (insulin or oral anti-diabetic drugs), or diabetes diagnosis by a physician. Target levels were defined as glycosylated hemoglobin <6.5% or <7.0%, blood pressure <130/80 mmHg, and total cholesterol <200 mg/dL. All survey waves were age-standardized to the 2005 Korean census population.

RESULTS

Diabetes prevalence increased from 9.6% in 2007-2009 to 10.8% in 2016-2017 (p<0.001). Impaired fasting glucose prevalence significantly increased in both genders and almost every age group. Diabetes awareness and glycemic control did not show an increasing trend; however, the treatment rate and proportion of people diagnosed with diabetes achieving target blood pressure and total cholesterol levels improved from 57.2% to 63.5% (p=0.008), from 41.1% to 53.2% (p<0.001), and from 65.0% to 78.0% (p<0.001), respectively.

CONCLUSIONS

From 2007 to 2017, the prevalence of diabetes increased moderately in Korea, whereas the diabetes treatment rate and the proportion of people diagnosed with diabetes achieving target blood pressure and total cholesterol levels improved. However, awareness of diabetes and glycemic control require significant improvements. A national-level action plan is required to raise awareness about diabetes and prediabetes, with the goal of improving glycemic control and minimizing the occurrence of adverse health outcomes.

Bio-evaluation of functional date bars using rats as model organism against hypercholesterolemia

Background

The present research project was designed to evaluate the cholesterol lowering potential of different date varieties including one exotic (Ajwa) and three Pakistani varieties (Aseel, Khudravi, Hallawi).

Methods

The albino rats were divided into six groups on the basis of different diets which includes, control having basal diet, high cholesterol high sucrose diet, high cholesterol high sucrose diet plus Khudravi dates, high cholesterol high sucrose diet plus Hallawi dates, high cholesterol high sucrose diet plus Aseel dates, high cholesterol high sucrose diet plus Ajwa dates to evaluate maximum cholesterol lowering potential of each date variety.

Results

The results showed that Hallawi and Ajwa have lower crude fiber content as 2.02 ± 0.03% and 2.43 ± 0.04% however, lowest crude fat content (0.26 ± 0.01%) was also observed in ajwa. Mineral profile depicted that sodium (9.50–18.00 mg/100 g) was found to be in lesser amount among all varieties whereas, higher amount of potassium (465.00 to 887.20 mg/100 g) depicted that it is suitable for people having hypertension. Higher amount of reducing sugar was also observed in ajwa (79.45 ± 1.22%) followed by Hallawi (77.68 ± 1.42%). Total phenolic contents were found higher in Aseel (291.36 mg/100 g) whereas, minimum was observed in Khudravi (232.64 mg/100 g). Furthermore, date varieties were also examined rat modeling to evaluate their maximum cholesterol lowering efficiency. Ajwa and Hallawi were observed to suppress the cholesterol efficiently as 110 mg/dL and 103 mg/dL respectively. On the basis of chemical profiling and other parameters, two date varieties Ajwa and Hallawi showed almost similar results and found to have maximum serum cholesterol, LDL and triglyceride reduction potential with good kidney and liver functions. Functional date bar was also developed by using Hallawi variety andsubjected to sensory evaluation.

Conclusion

In nutshell, Hallawi date variety was considered as better cholesterol lowering potential among other indigenous varieties and very close to Ajwa variety. So that Hallawi can be used to suppress the deadly effects of obesity and allied discrepancies particularly hypercholesterolemia.

Economic Evaluation of the 2016 Chinese Guideline and Alternative Risk Thresholds of Initiating Statin Therapy for the Management of Atherosclerotic Cardiovascular Disease

OBJECTIVE

The 2016 Chinese guidelines for the management of dyslipidemia recommended mixed rules that centered around a 10% 10-year risk threshold to initiate statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). The present study aimed to evaluate the cost-effectiveness of the guideline statin-initiation strategy and alternative strategies.

METHODS

A decision analytic model using discrete event simulation with event probabilities based on a validated ASCVD risk prediction tool for Chinese was constructed. Risk factor inputs were from the dataset of a nationally representative survey of middle-aged and elderly Chinese. Data of statin treatment effectiveness were from a published meta-analysis. Other key input data were identified from the literature or relevant databases. The strategies we evaluated were the guideline strategy, a 15% 10-year risk threshold strategy and a 20% 10-year risk threshold strategy. After excluding any extended dominance strategies, the incremental costs per quality-adjusted life year (QALY) gained of each strategy was calculated.

RESULTS

The 20% 10-year risk threshold strategy was an extended dominance option. The incremental costs per QALY gained from the 15% 10-year risk threshold strategy compared with no treatment and the guideline strategy compared with the 15% 10-year risk threshold strategy were CN¥69,309 and CN¥154,944, respectively. The results were robust in most sensitivity analyses.

CONCLUSIONS

The guideline strategy and the 15% 10-year risk threshold strategy are optimal when using the three times and the two times the gross domestic product per capita willingness-to-pay standards, respectively.

Direct Versus Calculated LDL Cholesterol and C-Reactive Protein in Cardiovascular Disease Risk Assessment in the Framingham Offspring Study

BACKGROUND

Increases in circulating LDL cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) concentrations are significant risk factors for cardiovascular disease (CVD). We assessed direct LDL-C and hsCRP concentrations compared to standard risk factors in the Framingham Offspring Study.

METHODS

We used stored frozen plasma samples (-80 °C) obtained after an overnight fast from 3147 male and female participants (mean age, 58 years) free of CVD at cycle 6 of the Framingham Offspring Study. Overall, 677 participants (21.5%) had a CVD end point over a median of 16.0 years of follow-up. Total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), direct LDL-C (Denka Seiken and Kyowa Medex methods), and hsCRP (Dade Behring method) concentrations were measured by automated analysis. LDL-C was also calculated by both the Friedewald and Martin methods.

RESULTS

Considering all CVD outcomes on univariate analysis, significant factors included standard risk factors (age, hypertension, HDL-C, hypertension treatment, sex, diabetes, smoking, and TC concentration) and nonstandard risk factors (non-HDL-C, direct LDL-C and calculated LDL-C, TG, and hsCRP concentrations). On multivariate analysis, only the Denka Seiken direct LDL-C and the Dade Behring hsCRP were still significant on Cox regression analysis and improved the net risk reclassification index, but with modest effects. Discordance analysis confirmed the benefit of the Denka Seiken direct LDL-C method for prospective hard CVD endpoints (new-onset myocardial infarction, stroke, and/or CVD death).

CONCLUSIONS

Our data indicate that the Denka Seiken direct LDL-C and Dade Behring hsCRP measurements add significant, but modest, information about CVD risk, compared to standard risk factors and/or calculated LDL-C.

ApoB, small-dense LDL-C, Lp(a), LpPLA2 activity, and cognitive change

OBJECTIVE

To examine the association of specific lipoproteins/inflammatory enzyme with cognitive change.

METHODS

We examined the association of apolipoprotein B (ApoB), small-dense low-density lipoprotein cholesterol (sdLDL-C), lipoprotein (a) (Lp[a]), and lipoprotein-associated phospholipase A2 (LpPLA2) activity with 15-year change in Delayed Word Recall Test, Digit Symbol Substitution Test (DSST), Word Fluency Test (WFT), and overall summary score in 9,350 participants in the Atherosclerosis Risk in Communities study. We assessed interaction by race, sex, education, APOE ε4 status, and statin use. We also addressed questions of informative missingness, the role of stroke, and the influence of fasting status.

RESULTS

The mean (SD) age was 63.4 (5.7) years; 56.4% were women and 17.4% were black. We observed faster cognitive decline on DSST and global z scores with every 10-mg/dL higher sdLDL-C level (Δ DSST z score, -0.010; 95% confidence interval [CI] -0.017, -0.002 and Δ global z score, -0.011; -0.021, -0.001) and the highest vs the lowest ApoB quintiles (Δ DSST z score, -0.092; -0.0164, -0.019 and Δ global z score, -0.101; -0.200, -0.002). Association for the ApoB quintiles with Δ global z score (-0.10) was comparable with that of having 1 APOE ε4 allele (-0.11). Higher Lp(a) was associated with slower decline in DSST, WFT, and global z scores. LpPLA2 activity was not associated with cognitive change. Results were similar in sensitivity analyses. The associations of sdLDL-C or Lp(a) on cognitive change were more pronounced in statin users.

CONCLUSIONS

Optimal control of atherogenic lipoproteins such as ApoB and sdLDL-C in midlife for cardiovascular health may also benefit late-life cognitive health.

Perfluoroalkyl acids in serum of Korean children: Occurrences, related sources, and associated health outcomes

Perfluoroalkyl acids (PFAAs) have been widely used in human environment, and their exposure among general population has been frequently reported. However, extent of PFAAs exposure and their potential effects among children are not well characterized. In this study, children of between 3 and 18 years of age (n = 150) were recruited in Seoul and Gyeonggi, Korea, and the serum levels of 16 PFAAs along with lipids and thyroid hormones were measured. Questionnaire survey was conducted for dietary and behavioral characteristics of the children. Among the measured PFAAs, PFOA, PFNA, PFHxS, and PFOS were detected in all the samples, and PFUnDA and PFDA were detected in over 75% of the samples. PFOS was detected at the highest concentration with a median of 5.68 ng/mL. PFUnDA was detected at higher levels (median of 0.652 ng/mL) compared to those reported for children in USA. Serum PFAA levels were not different by sex among the children of <10 years of age, but in older children, those of boys are significantly higher than girls. Physiological characteristics like menstruation may explain lower PFAAs levels of the girls. In addition, breastmilk consumption, fish/shellfish consumption, non-stick frying pan use, and waterproof cloth use were identified as potential sources of PFAAs exposure. Serum PFUnDA level was positively associated with total cholesterol and low-density lipoprotein level of the children. PFNA was positively associated with free T4 level. High levels of PFUnDA among children and its association with serum lipids warrant replication and confirmation in other populations and/or supports by experimental studies.

Phytochemical composition, antilipidemic and antihypercholestrolemic perspectives of Bael leaf extracts

BACKGROUND

In recent times, focus on plant research has improved all over the world and essential parts of plants provide bioactive compounds in human diet. The bael (Aegle marmelos) has enormous traditional uses in the treatment of chronic diarrhea, dysentery, peptic ulcers and as a laxative. The main focus of this study was characterization of bael leaf extract for its bioactive constituents, antihypercholestrolemic and antilipidemic perspectives.

METHODS

After proximate composition of bael powder, the aqueous extract of bael leaf was used for phytochemical profiling (alkaloids, total phenolic content and total flavonoid content). Afterwards, normal rats group G0 was administrated basal diet while G1 and G2 normal rat groups were fed diets containing bael leaf extract 125 mg and 250 mg, respectively for consecutive 60 days. In a similar way, hyperlipidemic rats group Gh0 was administrated basal diet while Gh1 and Gh2 hyperlipidemic rat groups were fed diets containing bael leaf extract 125 mg and 250 mg, respectively for consecutive 60 days. The blood drawn on day 0, day 30 and day 60 was analyzed for serum parameters, such as total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides concentration and free and ester cholesterol.

RESULTS

Bael leaf powder is a rich source of crude fiber (14.50 ± 0.10 g/100 g). Aqueous extract of bael leaf contains alkaloids (15.58 ± 0.05 mg/g), flavonoids (64.00 ± 0.05 mg/g), phenolics (30.34 ± 0.01 GAEmg/g). From the In vivo studies, the lowest weight gain was observed in group G2 and in Gh2 as compared to control of both groups. The decrease in serum TC for G1-15.06%, G2-17.27% while in Gh1-22.46% and Gh2-34.82% after day 60, respectively. The maximum decrease was observed in group G2 (- 14.33%) and in Gh2 (- 24.79%) for triglycerides after 60 days. For HDL-cholesterol, significant increase (11.20%) in G2 and (49.83%) in Gh2 was observed of after 60 days. A trend in decrease of serum LDL-cholesterol in G2 (- 9.63%) and in Gh2 (- 44.65%) was also observed at day 60, and - 19.05% and - 30.06% decrease was noted in G2 and Gh2, respectively and decreasing trend was observed in free and total cholesterol - 22.30% and - 81.49% for groups G2 and Gh2 after day 60.

CONCLUSIONS

The results of the present study demonstrated that the extract contents of bael leaf provide protective role against hypercholesterolemic and hyperlipidemic conditions.

Evaluation of a new equation for LDL-c estimation and prediction of death by cardiovascular related events in a German population-based study cohort

A simple equation established by Cordova & Cordova (LDL-COR) was developed to provide an improved estimation of LDL-cholesterol in a large Brazilian laboratory database. We evaluated this new equation in a general population cohort in Pomerania, north-eastern Germany (SHIP Study) compared to other existing formulas (Anandaraja, Teerakanchana, Chen, Hattori, Martin, Friedewald and Ahmadi), and its power in the prediction of death by atherosclerosis related events as the primary outcome. Analysis was conducted on a cohort of 4075 individuals considering age, gender, use of lipid lowering therapy and associated co-morbidities such as diabetes, hepatic, kidney and thyroid disease. LDL-COR values had a lower standard deviation compared to the previously published equations: 0.92 versus 1.02, 1.02, 1.03, 1.04, 1.09, 1.10 and 1.74 mmol/L, respectively. All of the factors known to affect the results obtained by the Friedewald's equation (LDL-FW), except fibrate use, were associated with the difference between LDL-COR and LDL-FW (p < .01), with TSH being borderline (p = .06). LDL-COR determined a higher hazard ratio (1.23 versus 1.12, 1.19, 1.21, 1.19, 1.21 and 1.19) for cardiovascular disease related mortality, incident stroke or myocardial infarction compared to the other evaluated formulas, except for Ahmadi's (1.24), and the same adjusted predictive power considering all confounding factors. The proposed simple equation was demonstrated to be suitable for a more precise LDL-c estimation in the studied population. Since LDL-c is a parameter frequently requested by medical laboratories in clinical routine, and will probably remain so, precise methods for its estimation are needed when direct measurement is not available.

Midlife systemic inflammatory markers are associated with late-life brain volume: The ARIC study

OBJECTIVE

To clarify the temporal relationship between systemic inflammation and neurodegeneration, we examined whether a higher level of circulating inflammatory markers during midlife was associated with smaller brain volumes in late life using a large biracial prospective cohort study.

METHODS

Plasma levels of systemic inflammatory markers (fibrinogen, albumin, white blood cell count, von Willebrand factor, and Factor VIII) were assessed at baseline in 1,633 participants (mean age 53 [5] years, 60% female, 27% African American) enrolled in the Atherosclerosis Risk in Communities Study. Using all 5 inflammatory markers, an inflammation composite score was created for each participant. We assessed episodic memory and regional brain volumes, using 3T MRI, 24 years later.

RESULTS

Each SD increase in midlife inflammation composite score was associated with 1,788 mm3 greater ventricular (p = 0.013), 110 mm3 smaller hippocampal (p = 0.013), 519 mm3 smaller occipital (p = 0.009), and 532 mm3 smaller Alzheimer disease signature region (p = 0.008) volumes, and reduced episodic memory (p = 0.046) 24 years later. Compared to participants with no elevated (4th quartile) midlife inflammatory markers, participants with elevations in 3 or more markers had, on average, 5% smaller hippocampal and Alzheimer disease signature region volumes. The association between midlife inflammation and late-life brain volume was modified by age and race, whereby younger participants and white participants with higher levels of systemic inflammation during midlife were more likely to show reduced brain volumes subsequently.

CONCLUSIONS

Our prospective findings provide evidence for what may be an early contributory role of systemic inflammation in neurodegeneration and cognitive aging.

Association of midlife lipids with 20-year cognitive change: A cohort study

INTRODUCTION

Existing studies predominantly consider the association of late-life lipid levels and subsequent cognitive change. However, midlife rather than late-life risk factors are often most relevant to cognitive health.

METHODS

We quantified the association between measured serum lipids in midlife and subsequent 20-year change in performance on three cognitive tests in 13,997 participants of the Atherosclerosis Risk in Communities study.

RESULTS

Elevated total cholesterol, low-density lipoprotein cholesterol, and triglycerides were associated with greater 20-year decline on a test of executive function, sustained attention, and processing speed. Higher total cholesterol and triglycerides were also associated with greater 20-year decline in memory scores and a measure summarizing performance on all three tests. High-density lipoprotein cholesterol was not associated with cognitive change. Results were materially unchanged in sensitivity analyses addressing informative missingness.

DISCUSSION

Elevated total cholesterol, low-density lipoprotein cholesterol, and triglycerides in midlife were associated with greater 20-year cognitive decline.

Prediction of future cardiovascular disease with an equation to estimate apolipoprotein B in patients with high cardiovascular risk: an analysis from the TNT and IDEAL study

BACKGROUND

Apolipoprotein B (apoB) is known to be a more powerful predictor of cardiovascular disease than conventional lipids. We aimed to determine the clinical relevance of a newly developed equation to estimate serum apoB levels based on total cholesterol, HDL cholesterol, and triglycerides in patients with high cardiovascular risk.

METHODS

The occurrence of a major cardiovascular event (MCVE) was assessed using the data from the Treating to New Targets (TNT) and Incremental Decrease in End points through Aggressive Lipid lowering (IDEAL) trials.

RESULTS

Pooled analysis of these two data sets showed that both directly-measured apoB (HR per 1-SD (95% CI): 1.16 (1.11-1.21), P < 0.001) and apoB estimated from the eq. (HR per 1-SD (95% CI): 1.14 (1.09-1.19), P < 0.001) were significantly associated with the development of a future MCVE. Prediction of MCVEs by the apoB eq. (C statistic 0.650) was nearly identical to that of directly-measured apoB (0.651). In addition, the net reclassification indices indicated no difference in the prediction of MCVEs between models including the apoB equation and directly-measured apoB (1% (-1.3-4.0), P = 0.31).

CONCLUSIONS

Our equation to predict apoB levels showed MCVE risk prediction comparable to directly-measured apoB in high risk patients with previous coronary heart disease.

Performance of Calculated and Directly Measured Low-Density Lipoprotein Cholesterol in a Pediatric Population

OBJECTIVES

An assessment of methods for the accurate measurement of low-density lipoprotein cholesterol (LDL-C) at decreased concentrations has not yet been carried out. We evaluated the performance of the Friedewald equation, a direct enzymatic assay, and a novel equation for determining LDL-C levels in a pediatric population with elevated triglycerides and reduced LDL-C levels.

METHODS

LDL-C concentrations of 127 pediatric patients were determined by the Friedewald equation, a direct enzymatic assay, and a novel equation. The bias of each approach was assessed at selected LDL-C cutoffs and after stratifying samples by triglyceride content. The concordance of each approach, relative to the reference method, was determined at LDL-C cut-points of less than 70, 70 to 99, and 100 to 129 mg/dL.

RESULTS

The Friedewald equation substantially underestimated pediatric LDL-C concentrations below 100 mg/dL in the presence of elevated triglycerides. The Ortho Clinical Diagnostics (Raritan, NJ) direct LDL assay was positively biased at low LDL-C levels. The novel equation most effectively reduced the bias of the Friedewald equation at all LDL-C concentrations and increased the concordance of sample classification to the reference method.

CONCLUSIONS

The novel equation should be used for accurate measurement of pediatric LDL-C when the concentration is below 100 mg/dL in the presence of elevated triglycerides (150-399 mg/dL).

Midlife and Late-Life Vascular Risk Factors and White Matter Microstructural Integrity: The Atherosclerosis Risk in Communities Neurocognitive Study

Background

Diffusion tensor imaging measures of white matter (WM) microstructural integrity appear to provide earlier indication of WM injury than WM hyperintensities; however, risk factors for poor WM microstructural integrity have not been established. Our study quantifies the association between vascular risk factors in midlife and late life with measures of late‐life WM microstructural integrity.

Methods and Results

We used data from 1851 participants in ARIC (Atherosclerosis Risk in Communities Study) who completed 3‐T magnetic resonance imaging, including diffusion tensor imaging, as part of the ARIC Neurocognitive Study (ARIC‐NCS). We quantified the association among lipids, glucose, and blood pressure from the baseline ARIC visit (1987–1989, ages 44–65, midlife) and visit 5 of ARIC (2011–2013, ages 67–90, late life, concurrent with ARIC‐NCS) with regional and overall WM mean diffusivity and fractional anisotropy obtained at ARIC visit 5 for ARIC participants. We also considered whether these associations were independent of or modified by WM hyperintensity volumes. We found that elevated blood pressure in midlife and late life and elevated glucose in midlife, but not late life, were associated with worse late‐life WM microstructural integrity. These associations were independent of the degree of WM hyperintensity, and the association between glucose and WM microstructural integrity appeared stronger for those with the least WM hyperintensity. There was little support for an adverse association between lipids and WM microstructural integrity.

Conclusions

Hypertension in both midlife and late life and elevated glucose in midlife are related to worse WM microstructural integrity in late life.

Usefulness of Non-High-Density Lipoprotein Cholesterol as a Predictor of Cardiovascular Disease Mortality in Men in 22-Year Follow-Up

Non-high-density lipoprotein cholesterol (non-HDL-C) may be equivalent or superior to low-density lipoprotein cholesterol (LDL-C) for prediction of cardiovascular disease (CVD) risk. However, studies comparing the predictive values of LDL-C and non-HDL-C for CVD and total mortality in a long-term follow-up yielded conflicting results. The Cardiovascular Occupational Risk Factor Determination in Israel Study (CORDIS) is a prospective cohort study of a young industrial population of workers with a long-term follow-up. The initial phase of the study was carried out in 1985-1999. Interviews and physical examinations were conducted, and fasting blood samples, including lipid panels, were undertaken. In 2007, after a 22-year follow-up period, the baseline data were merged with data on all-cause and CVD mortality obtained from the Israeli National Death Registry. A total of 4,832 men were included in the analysis with a mean age of 42.1 ± 12.1 years. Univariate analysis indicated a positive association between non-HDL-C and LDL-C levels and an increased risk for both all-cause and CVD mortality. Multiple regression analysis, following adjustment for potential confounders, resulted in attenuation of the association of both lipoproteins with total mortality. The adjusted association between non-HDL-C levels ≥190 mg/dl and CVD mortality remained significant (hazard ratio 1.80, 95% confidence interval 1.10 to 2.96), but the association of LDL-C with CVD mortality was attenuated (hazard ratio 1.53, 95% confidence interval 0.98 to 2.39). In conclusion, non-HDL-C may be a more potent predictor of CVD mortality than LDL-C levels.

The Rationale for Intervention to Reduce the Risk of Coronary Heart Disease

Cardiovascular diseases remain extremely common and the United States and are the single most common cause for death in both men and women. Many risk factors including cigarette smoking, elevated cholesterol, high blood pressure, obesity and in inactive lifestyle carry a significant lifestyle component. This fact is recognized in the National Guidelines for the Treatment of many risk factors for cardiovascular disease. Moreover, lifestyle intervention, in combination with proper medical and/or surgical therapy can play a significant role in the management of existing cardiovascular disease. In this review, we provide background and rationale for interventions to reduce the risk of coronary heart disease with a particular emphasis on intervening to improve lifestyle related issues. To achieve the best outcomes clinicians must be skilled not only in pharmacologic and surgical therapies but also in counseling patients on various lifestyle interventions to lower the risk of cardiovascular disease.

Evaluation of Methods for the Measurement of Low-Density Lipoprotein Cholesterol

A high concentration of low-density lipoprotein cholesterol (LDL-C) in plasma is one of the strongest risk factors for atherosclerotic cardiovascular disease and mortality. The most common approach to determining LDL-C in the clinical laboratory is the Friedewald calculation. There is an increased interest to improve the accuracy of LDL-C estimated by this equation. The expert panel convened by National Cholesterol Education Program has recommended the development of accurate direct methods to measure LDL-C. Several homogeneous and fully automated methods have been introduced in recent years that show improved precision and accuracy over earlier methods, especially the Friedewald calculation. Each of the atherogenic particles in plasma—very-low, intermediate-, and low-density lipoprotein—as well as lipoprotein (a), contain one molecule of apolipoprotein B (apoB) and thus, plasma total concentration of apoB reflects the number of atherogenic particles. Several studies suggested that the measurement of apoB could improve the prediction of risk of coronary artery disease. Thus, in addition to the newly developed direct assays, alternative calculation procedures have been proposed that also take into consideration total serum apoB concentration for the estimation of LDL-C and the presence of small, dense LDL particles. The new generation of homogenous methods for the measurement of LDL-C and the use of serum apoB concentration for the estimation of LDL-C can contribute to the accurate LDL-C determination.

Phytopreventive antihypercholesterolmic and antilipidemic perspectives of zedoary (Curcuma Zedoaria Roscoe.) herbal tea

BACKGROUND

Metabolic syndrome is an increasingly prevalent problem, not only in industrialized developed countries, but in developing countries as well. The modern healthcare to reduce the dysfunction of metabolic syndrome is burdened with great problems of unsafe medicines and certain degree of side effects. Medicinal plants and derived component products are becoming increasingly popular in modern society as natural alternatives to synthetic multiple drugs for the treatment of hypercholesterolemia and hypertriglyceridemia. The present research work was carried out to evaluate the zedoary (Curcuma zedoaria Roscoe.) herbal tea (ZHT) for antihypercholestrolemic and antilipidemic perspectives in discerning consumers.

METHODS

Zedoary rhizome dried powder (ZRDP) after proximate composition analysis was used to prepared ZHT samples as T1 (500 mg ZRDP), T2 (1 g ZRDP) and T3 (1.5 g ZRDP) in 200 mL boiling water for 5 minutes, respectively. ZHT samples were characterized for total phenolic compounds (TPC), DPPH inhibition, total flavonoids, color tonality (L*, a* and b* value), pH, acidity, total soluble solids (TSS) and sensory acceptance. Thirty mild-hypercholestrolemic male human volunteers were randomly allocated to three groups (G1, G2 and G3) and each group consisting of 1o mild-hypercholestrolemic male human subjects. The volunteers were assigned ZHT samples for consecutive two months. The blood drawn for day 0, day 30 and day 60 after an overnight 12 h fast was analyzed for serum parameters such as total cholesterol (TC), high-density lipoprotein cholesterol (HDL-cholesterol), low-density lipoprotein cholesterol (LDL-cholesterol) and triglycerides (TG) concentration.

RESULTS

The ZRDP possessed abundantly the crude protein (13.5 ± 0.68 %), total dietary fiber (21.86 ± 0.71 %), acid detergent fiber (13.22 ± 0.44 %), neutral detergent fiber (18.68 ± 0.53 %) and mineral contents. Highest TPC, DPPH inhibition and total flavonoids values were observed 9.74 ± 0.64 (mg GAE/g DW), 47.28 ± 1.62 (%) and 17.12 ± 0.75 (QE mg/g), respectively in T3. L* value was significantly (p ≤ 0.05) low for T3 samples. In contrast, a* value and b* value was significantly (p ≤ 0.05) higher for T3 when compared with T1 and T2. T3 samples showed lower pH (5.13 ± 0.13) and higher acidity (0.25 ± 0.08) values than T1 (5.64 ± 0.25, 0.17 ± 0.05) and T2 (5.42 ± 0.21, 0.21 ± 0.06), respectively. Similarly, an increasing trend in TSS contents was observed. Sensory scores assigned to color, flavor, aroma and overall acceptability attributes varied in a quite narrow range for all ZHT samples. The lowest evaluation scores were recorded for T3 samples. The G3 showed the more reduction in body weight and BMI during efficacy study as compared to G1 and G2. The decrease in serum TC for G1, G2 and G3 on day 60 was observed 9 %, 14 % and 17 %, respectively when compared with reference value at day 0. The consumption of T3 resulted in significant increase (6.8 %) of HDL-cholesterol after two months. A trend in decrease of serum LDL-cholesterol (5.6 %) and TG (12.5 %) was also observed after consumption of T3 at day 60.

CONCLUSIONS

The results of the present study conclude that the strong phenolic contents and radical scavenging activity of zedoary rhizome have protective role against hypercholesterolemic and lipidemic conditions.

Measuring Low Density Lipoprotein Cholesterol: Comparison of Direct Measurement by HiSens Reagents and Friedewald Estimation

BACKGROUND

Directly measured low density lipoprotein cholesterol (DLDLC) has been reported to be more accurate than calculated low density lipoprotein cholesterol (CLDLC) using the Friedewald equation. However, some limitations of DLDLC have been reported. In this study, we evaluated differences between CLDLC and DLDLC measured using HiSens reagents.

METHODS

Data were collected from 582 persons undergoing routine physical examinations at a general hospital. LDLC measurements were made directly or estimated using the Friedewald formula, and were classified according to the National Cholesterol Education Program's Adult Treatment Panel III guidelines. The relationship between these differences and other clinically relevant factors, such as triglyceride (TG) levels, were examined using multiple logistic regression analysis.

RESULTS

The DLDLC and CLDLC were strongly correlated according to simple linear regression analysis (r=0.917, P<0.001) but the mean difference between measurements was -11.0±15.3 (-62 to 90.5) mg/dL (P<0.001). For more than 10 mg/dL of their absolute differences, the DLDLC was typically lower than the CLDLC. The highest discrepancies in LDLC measurements occurred when LDLC was more than 160 mg/dL and less than 190 mg/dL. Differences in LDLC measurements were prone to striking negative and positive biases dependent on CLDLC and TG concentrations, respectively (all r>0.5).

CONCLUSION

Unlike other studies, DLDLC was significantly lower than CLDLC and the large differences in LDLC concentrations were not dependent on TG concentration. Our work suggests that verification of DLDLC accuracy is needed and differences in LDLC measurements should be accounted for in making clinical decisions.

A new formula for estimation of low-density lipoprotein cholesterol in an ethnic Chinese population

BACKGROUND

Low-density lipoprotein cholesterol (LDL-C) is an established risk factor for cardiovascular disease and is usually estimated by the Friedewald formula (FF) calculated from three parameters, namely, total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C). We aimed to develop a new and simple formula (NF) for LDL-C estimation.

METHODS

This cross-sectional study enrolled two study populations (a testing group, n=16,749, and a validation group, n=4940). Linear regression analysis was used in the testing group to investigate the association between measured LDL-C (mLDL-C) and TC concentration, and was verified in the validation group.

RESULTS

The NF yielded an estimated LDL-C (eLDL-C) equal to 0.75 × total cholesterol-0.6465 (mmol/L). For the subjects with TC between 2.58 and 7.74 mmol/L, the difference between mLDL-C and eLDL-C using the NF was less than that from the FF (testing group: -0.04 to -0.20 vs. -0.28 to -0.38 mmol/L; validation group: 0.01 to -0.12 vs. -0.23 to -0.30 mmol/L; p<0.001, respectively). The predictability of the NF was not inferior to that of the FF in subjects with different triglyceride and HDL-C concentrations, and was not affected by diabetes diagnosis and statin use. However, the NF performed similar to or worse than the FF at TC concentrations <2.58 mmol/L and >7.74 mmol/L, respectively.

CONCLUSIONS

In the Chinese population, the accuracy of eLDL-C measurement with the NF was better than that with the FF, especially in subjects with TC levels between 2.58 and 7.74 mmol/L. The NF is simple and may be used for screening as well as for follow-up of patients on lipid lowering agents.

Preventive role of green tea catechins from obesity and related disorders especially hypercholesterolemia and hyperglycemia

Background

During the last few years, scientific investigations have proposed diet based regimens to prevent several health ailments including obesity, hypercholesterolemia and diabetes. In this regard, a promising tool is the use of functional foods/nutraceuticals. Present research project was an attempt to explore nutraceutical worth of locally grown green tea variety (Qi-Men) against lifestyle related disorders.

Methods

Functional drinks (T₂ and T₃) were prepared by adding catechins and epigallocatechin gallate (EGCG) @ 550 mg/500 mL and compared with control (T₁). These functional drinks were tested in experimental rats modeling (Sprague Dawley). Based on diets, four studies were conducted i.e. trial-I (normal diet), trial-II (high cholesterol diet), trial-III (high sucrose diet), trial-IV (high cholesterol + high sucrose diet). Rats were monitored daily for their feed and drink intake while body weight was measured on weekly basis. After period of 56 days rats were sacrificed and evaluated their serum lipid (cholesterol, LDL and HDL), glucose and insulin levels.

Results

Results for feed consumption by rats revealed that highest feed intake was recorded in group provided control drink than other groups. However, non significant differences were noted among all groups for drink consumption. Functional drinks resulted in significant reduction in body weight with maximum lowering noted in trial-II and III i.e. 10.73 to 8.49% and 10.12 to 10.49%, respectively. Likewise, cholesterol and LDL were substantially reduced with 14.42% decrease observed in trial-IV and 30.43% in trial-II, respectively. Furthermore, serum glucose and insulin levels were also lowered significantly in the trial-III and IV while in trial-I and II differences were non-significant. In contrast to lipid profile, experimental drink containing EGCG reduced the trait better than catechins based functional drink.

Conclusions

The drinks supplemented with catechins and EGCG are effective against obesity, hypercholesterolemia and hyperglycemia.

Low-density lipoprotein cholesterol levels in adults with type 2 diabetes: an alternative equation for accurate estimation and improved cardiovascular risk classification

Low-density lipoprotein cholesterol (LDL-C) is a major risk factor for atherosclerotic disease. Despite its limitations, Friedewald-calculated LDL-C (F-LDL-C) remains widely used for LDL-C determination. In this observational study of 1999 adults with type 2 diabetes mellitus (T2DM), we compare the accuracy of F-LDL-C to directly measured LDL-C (M-LDL-C) and derived and validated a new [SMART2D (Singapore Study of MAcro-angiopathy and Micro-Vascular Reactivity in Type 2 Diabetes)] formula to estimate LDL-C. From 1000 randomly selected patients, M-LDL-C was compared to F-LDL-C. Using multiple linear regression to identify independent predictors for M-LDL-C, the SMART2D equation was derived and subsequently validated in the next 981 patients. F-LDL-C was 0.367 (0.216) mmol/L lower than M-LDL-C. This difference was -0.009 (0.189) for SMART2D-LDL-C. Using F-LDL-C, 27% with M-LDL-C ≥2.6 mmol/L were classified as LDL-C <2.6 mmol/L, reduced to 2.1% when using SMART2D-LDL-C. With F-LDL-C, misclassification was greater when triglycerides were ≥2.2 mmol/L, especially for the lower LDL-C cut-offs (1.8 and 2.6 mmol/L), and this was markedly improved with SMART2D-LDL-C. In conclusion, in T2DM, F-LDL-C underestimates M-LDL-C, with misclassifications that may potentially have an impact on therapeutic decisions in T2DM. The SMART2D equation improves accuracy of estimate, reducing misclassifications. Trials will be needed to ascertain the clinical significance of these findings.

Comparison of various formulae for estimating low-density lipoprotein cholesterol by a combination of ages and genders in Taiwanese adults

Background

The accuracy and precision of the Friedewald formula for estimating low-density lipoprotein cholesterol (LDL-C) is questionable. Although other formulae have been developed, only a few studies compare them. Thus, we compared the efficiencies of various formulae, based on the age and gender of adults, to determine which ones yield more accurate estimations in terms of mean squared error, and which formulae underestimated and overestimated LDL-C performance.

Methods

This study compares various formulae in terms of mean squared error (MSE), as well as underestimation and overestimation of LDL-C concentrations, using subjects of various ages and both genders. Six groups were examined in this study based on age and gender: males 20–44 years old, 45–64, and 65 and above, and females in the same three age ranges.

Results

The results show that the Friedewald formula has relatively low accuracy, and while its performance among older (aged 45 and above) women with triglyceride concentrations ≤ 400 mg/dL is better than that with other groups, it is still more inaccurate than the other formulae. In terms of prediction errors and mean squared errors, Tsai’s formula (TF) and a calibrated TF provide the most accurate results with regard to the LDL-C concentration. Moreover, based on a cross-validation of age and gender, these two formulae provide highly accurate results for the LDL-C concentrations of all the studied groups, except for women aged 20–44 years.

Conclusions

Based on the experimental results, this study provides a set of benchmarks for the formulae used in LDL-C tests when considering the factors of age and gender. Therefore, it is a valuable method for providing formula benchmarking.

Ameliorative effects of Monascus pilosus-fermented black soybean (Glycine max L. Merrill) on high-fat diet-induced obesity

The purpose of this study was to examine the antiobesity effects of Monascus pilosus-fermented black soybean (F-BS) in C57BL/6 mice with high-fat diet (HFD)-induced obesity. F-BS (oral, 0.5 and 1.0 g/kg per body weight, twice per day) ameliorated obesity by reducing body and liver weight increases, and regulating blood glucose and cholesterol levels in C57BL/6 mice fed a control or HFD with oral administration of F-BS for 12 weeks. F-BS suppressed the growth of epididymal, retroperitoneal, and perirenal fat pads by preventing increases in the adipocyte size. Moreover, the levels of blood glucose, total cholesterol, and leptin were significantly lowered by F-BS administration in a dose-dependent manner. These results indicated that F-BS is a beneficial food supplement for preventing obesity, controlling blood glucose, and lowering cholesterol. Future research strategies should address the mechanisms that selectively regulate obesity, including hyperglycemia and hypercholesterolemia.

Nigella sativa Fixed and Essential Oil Supplementation Modulates Hyperglycemia and Allied Complications in Streptozotocin-Induced Diabetes Mellitus

In the recent era, diabetes mellitus has emerged as one of the significant threats to public health and this situation demands the attention of the researchers and allied stakeholders. Dietary regimens using functional and nutraceutical foods are gaining wide range of acceptance and some traditional medicinal plants are of considerable importance. The main objective of this instant study was to explore the antidiabetic potential of Nigella sativa fixed oil (NSFO) and essential oil (NSEO). Three experimental groups of rats received diets during the entire study duration, that is, D1 (control), D2 (NSFO: 4.0%), and D3 (NSEO: 0.30%). Experimental diets (NSFO & NSEO) modulated the lipid profile, while decreasing the antioxidant damage. However, production of free radicals, that is, MDA, and conjugated dienes increased by 59.00 and 33.63%, respectively, in control. On the contrary, NSFO and NSEO reduced the MDA levels by 11.54 and 26.86% and the conjugated dienes levels by 32.53 and 38.39%, respectively. N. sativa oils improved the health and showed some promising anti-diabetic results.

Wheat germ oil and α-lipoic acid predominantly improve the lipid profile of broiler meat

In response to recent assertions that synthetic antioxidants may have the potential to cause toxic effects and to consumers' increased attention to consuming natural products, the poultry industry has been seeking sources of natural antioxidants, alone or in combination with synthetic antioxidants that are currently being used by the industry. The present study was conducted to determine the effect of α-lipoic acid, α-tocopherol, and wheat germ oil on the status of antioxidant enzymes, fatty acid profile, and serum biochemical profile of broiler blood. One-day-old (180) broiler birds were fed six different feeds varying in their antioxidant content: no addition (T1), natural α-tocopherol (wheat germ oil, T2), synthetic α-tocopherol (T3), α-lipoic acid (T4), α-lipoic acid together with natural α-tocopherol (T5), and α-lipoic acid together with synthetic α-tocopherol (T6). The composition of saturated and unsaturated fatty acids in the breast and leg meat was positively influenced by the different dietary supplements. The content of fatty acid was significantly greater in broilers receiving T2 both in breast (23.92%) and in leg (25.82%) meat, whereas lower fatty acid levels was found in broilers receiving diets containing T6 in the breast (19.57%) and leg (21.30%) meat. Serum total cholesterol (113.42 mg/dL) and triglycerides (52.29 mg/dL) were lowest in the group given natural α-tocopherol and α-lipoic acid. Wheat germ oil containing natural α-tocopherol alone or with α-lipoic acid was more effective than synthetic α-tocopherol in raising levels of antioxidant enzymes superoxide dismutase, catalase, and glutathione reductase while lowering plasma total cholesterol, low-density lipoprotein, and triglycerides and raising high-density lipoprotein and plasma protein significantly. It was concluded that the combination of wheat germ oil and α-lipoic acid is helpful in improving the lipid profile of broilers.

Human plasma anti-α-galactoside antibody forms immune complex with autologous lipoprotein(a)

Anti-α-galactoside antibody (anti-Gal) from human plasma that bound to α-galactoside-bearing guar galactomannan gel and was eluted with specific sugar (affinity-purified anti-Gal ; APAG) invariably contained apo(a) and apo B subunits in a proportion close to that in plasma lipoprotein(a) [Lp(a)]. Since LDL does not contain apo(a), result suggested Lp(a) as a component of APAG. Lp(a) in APAG was complexed with anti-Gal since plate-coated anti-apo(a) captured Lp(a) along with the antibody. Association of Lp(a) with anti-Gal in APAG was considerably lower in presence of anti-Gal-specific sugar, suggesting that Lp(a) occupied the sugar-binding site of anti-Gal. Content of Lp(a)-bound anti-Gal in APAG, though a minor fraction of total antibody, increased steadily with total Lp(a) content of plasma. Further, Lp(a) released from immune complex-rich fraction of plasma by anti-Gal- specific sugar was proportional to total plasma Lp(a). Anti-Gal titre decreased with increasing Lp(a) concentration among 114 plasma samples. Results indicate the potential of anti-Gal molecules with its binding site partially occupied by Lp(a) molecule(s) to a) use the remaining binding site(s) to recognize other macromolecules or cells and b) transport Lp(a) across Fc receptor-bearing cells.

An equation to estimate the concentration of serum apolipoprotein B

Background

Several large prospective studies have demonstrated that apolipoprotein B (apoB) has greater value in predicting cardiovascular risk than any other lipid measurements. Currently, however, serum apoB levels are not routinely measured, because of the additional cost. The aim of this study was to develop an equation to estimate apoB from conventional lipid measurements including total cholesterol, HDL cholesterol, and triglycerides.

Methods

Data from a total of 78,127 subjects (47,057 men and 31,070 women), aged 15 to 88 years (mean age 41.8 years) were reviewed to develop an apoB equation. Additional datasets from the same institution and the NHANES obtained in 2007–2008 were used for internal (n = 73,445) and external validation (n = 3,097), respectively.

Results

We developed an apoB equation based on a linear regression model that contains total cholesterol, triglycerides, and HDL cholesterol as terms (model 1). To more precisely estimate the serum apoB level, we adjusted mode1 1 using a cutoff serum triglyceride value of 270 mg/dl (model 2). Model 2 showed more randomly distributed residuals in patients with diabetes, atherogenic dyslipidemia, and those taking lipid-lowering agents than model 1. The residuals in the development, internal validation, and external validation datasets were also randomly distributed around 0 with no clear trends.

Conclusion

The new equation we developed to estimate serum apoB concentrations is accurate and can be used in diverse subgroups of patients including those with diabetes, atherogenic dyslipidemia, and those taking lipid-lowering agents.

Optimal range of triglyceride values to estimate serum low density lipoprotein cholesterol concentration in Korean adults: the Korea National Health and Nutrition Examination Survey, 2009

The aims of this study were to investigate the validity of Friedewald's formula and to propose a range of triglyceride values over which the formula can be used without significant error. This was a cross-sectional analysis of 1,929 subjects (946 males and 983 females) aged 20 yr and older using data of the Korea National Health and Nutrition Examination Survey in 2009. Estimated total number was considered to be 10,633,655 (5,846,384 males and 4,787,271 females). Calculated and directly-measured low density lipoprotein cholesterol (LDL-C) values were highly correlated (r = 0.96); however, significant differences were observed between the directly-measured and calculated LDL-C concentrations. Subjects in the underestimated group (10.5%) had higher dysmetabolic profiles than those in the overestimated group (11.4%). Although serum triglyceride level showed the greatest independent association with differences between the calculated and directly-measured LDL-C concentrations, no statistically significant differences were noted when triglyceride concentration was between 36 and 298 mg/dL (93.2%). In conclusion, Friedewald's formula accurately estimates directly-measured serum LDL-C concentration in Korean adults. However, the formula can be applied to subjects with serum triglyceride concentrations from 36 to 298 mg/dL without significant error.