Prevalence of Dyslipidemia and Management in the Thai Population, National Health Examination Survey IV, 2009

Helicobacter pylori exposure among the Awajún of the Peruvian Amazon: Prevalence and environmental, social, and biological associations

OBJECTIVES

Helicobacter pylori (H. pylori)-a gastric bacteria affecting almost 50% of the global population and leading to ulcers and cancer in severe cases-is a growing health concern among Indigenous populations who report a high burden of reported poor general health and gastrointestinal distress. We test hypothesized associations between H. pylori exposure patterns and environmental, social, and biological conditions among a sample of 212 Indigenous Awajún adults (112 males, 100 females, ages 18-65 years) living in the northern Peruvian Amazon.

MATERIALS AND METHODS

Dried blood spots were analyzed for H. pylori-specific IgG using a recently developed enzyme-linked immunosorbent assay. Resulting seropositivity rates and antibody concentrations, proxying past exposures to H. pylori were analyzed in relation to relevant environmental (toilet type, floor material, reported water quality), social (household size and education level), and biological (age, sex, BMI, blood pressure, immune and metabolic biomarkers) factors using multivariable regression analyses.

RESULTS

We found near ubiquitous seropositivity for H. pylori exposure in our sample (99.1% seropositive). In the regression analyses, elevations in H. pylori antibody concentrations were significantly higher among males compared to females (β = 0.36, p = 0.01). No associations were found with any other factors.

DISCUSSION

Anthropological research in the study communities suggests that the male bias in elevations of H. pylori antibody concentrations is related to cultural and biological factors. Future research is needed to further unravel these biocultural dynamics and determine whether elevations in H. pylori antibody concentrations have clinical relevance for gastrointestinal health outcomes in this population.

Metabolic and genetic risk factors associated with pre-diabetes and type 2 diabetes in Thai healthcare employees: A long-term study from the Siriraj Health (SIH) cohort study

BACKGROUND

The study of non-communicable diseases (NCDs) in a developing country like Thailand has rarely been conducted in long-term cohorts, especially among the working-age population. We aim to assess the prevalence and incidence of risk factors and their associations underlying NCDs, especially type-2 diabetes mellitus (T2DM) among healthcare workers enrolled in the Siriraj Health (SIH) study cohort.

METHODS

The SIH study was designed as a longitudinal cohort and conducted at Siriraj hospital, Thailand. A total of 5,011 participants (77% women) were recruited and follow-up. Physical examinations, blood biochemical analyses, family history assessments, behavior evaluations, and genetics factors were assessed.

RESULTS

The average age was 35.44±8.24 years and 51% of participants were overweight and obese. We observed that men were more likely to have a prevalence of T2DM and dyslipidemia (DLP) compared to women. Aging was significantly associated with pre-diabetes and T2DM (P<0.001). Additionally, aging, metabolic syndrome, and elevated triglycerides were associated with the development of pre-diabetes and T2DM. The minor T allele of the rs7903146(C/T) and rs4506565 (A/T) were associated with a high risk of developing pre-diabetes with odds ratios of 2.74 (95% confidence interval [CI]: 0.32-23.3) and 2.71 (95% CI: 0.32-23.07), respectively; however, these associations were statistically insignificant (P>0.05).

CONCLUSION

The findings of the SIH study provide a comprehensive understanding of the health status, risk factors, and genetic factors related to T2DM in a specific working population and highlight areas for further research and intervention to address the growing burden of T2DM and NCDs.

Hospital admission and mortality rates for ischemic heart disease in Thailand: 2012-2021

OBJECTIVE

To provide an update on the epidemiology of ischemic heart disease (IHD), including the age-standardized rates of hospital admission and mortality for IHD in Thailand from 2012 to 2021, using the Ministry of Public Health National database.

RESULTS

The overall age-standardized hospital admission rate for IHD decreased from 427.5 per 100,000 people in 2012 to 390.5 per 100,000 in 2021. In men, the age-standardized hospital admission rate was 462.7 per 100,000 people in 2012, reaching 485.8 per 100,000 in 2021, p for trend = 0.141. In women, the age-standardization hospital admission rate for IHD dropped by 24.1% over the decade (p for trend = 0.008). The overall age-standardized IHD mortality rate in 2012 was 23.4 per 100,000 people, peaked at 28.6 per 100,000 in 2016, and reached 26.9 per 100,000 in 2021, p for trend = 0.181. In men, the age-standardized IHD mortality rate rose by 26.6% over a decade, p for trend = 0.004. The age-standardized IHD mortality rate among women was consistent from 2012 to 2021, p for trend = 0.130. However, for people aged < 60, rising trends in IHD mortality rates over a decade were observed; it rose by 59.6% in men and 36.1% in women.

Investigation of the Therapeutic Potential of Organic Nitrates in Mortality Reduction Following Acute Myocardial Infarction in Hyperlipidemia Patients: A Population-Based Cohort Study

BACKGROUND

Dyslipidemia is a known risk factor for cardiac dysfunction, and lipid-lowering therapy with statins reduces symptoms and reduces hospitalization related to left ventricular heart failure. Acute myocardial infarction (AMI) is a cause of morbidity and mortality worldwide. In this study, we aimed to determine the real-world AMI treatment drug combination used in Taiwan by using the NHI database to understand the treatment outcomes of current clinical medications prescribed for hyperlipidemia patients with AMI.

METHODS

Using the NHI Research Database (NHIRD), we conducted a retrospective cohort study that compared different treatments for AMI in hyperlipidemia patients in the period from 2016 to 2018. We compared the survival outcomes between those treated with and without organic nitrates in this cohort.

RESULTS

We determined that most hyperlipidemia patients were aged 61-70 y (29.95-31.46% from 2016 to 2018), and the annual AMI risk in these patients was <1% (0.42-0.68% from 2016 to 2018). The majority of hyperlipidemia patients with AMI were women, and 25.64% were aged 61-70 y. Receiving organic nitrates was associated with lower all-cause mortality rates (HR, 95% CI, p-value = 0.714, 0.674-0.756, p < 0.0001). After multivariate analysis, the overall survival in four groups (beta-blockers, beta-blocker + diuretics, diuretics, and others) receiving an organic nitrate treatment was significantly higher than in the groups that were not treated with organic nitrates (beta-blockers HR = 0.536, beta-blocker + diuretics HR = 0.620, diuretics HR = 0.715, and others HR = 0.690).

CONCLUSIONS

The survival benefit was significantly greater in patients treated with organic nitrates than in those treated without organic nitrates, especially when combined with diuretics. A combination of organic nitrates could be a better treatment option for hyperlipidemia patients with AMI.

Trends in Prevalence of Hypertriglyceridemia and Related Factors in Korean Adults: A Serial Cross-Sectional Study

Objective

We aimed to investigate the longitudinal trends in prevalence of hypertriglyceridemia in Korean adults and hypertriglyceridemia-associated lifestyle habits, socioeconomic factors and comorbidities.

Methods

Data from the 2007-2020 Korea National Health and Nutrition Examination Survey (KNHANES) were used in this study. Two cutoff values (≥150 mg/dL and ≥200 mg/dL) for fasting serum triglyceride levels were used to estimate the age- and sex-specific prevalence of hypertriglyceridemia. Use of lipid-lowering medications, lifestyle factors such as smoking, alcohol consumption, and regular exercise, socioeconomic variables such as educational attainment and household income, and comorbidities such as obesity, abdominal obesity, hypertension, and diabetes mellitus were also investigated.

Results

The prevalence of hypertriglyceridemia among Koreans based on KNHANES 2007-2020 was 29.6% at ≥150 mg/dL and 16.1% at ≥200 mg/dL. While the rate of using lipid-lowering medications increased steadily from 2007 to 2020, changes in annual prevalence of hypertriglyceridemia were subtle. The prevalence of hypertriglyceridemia in men peaked in middle age (47.7% and 30.0% for ≥150 mg/dL and ≥200 mg/dL, respectively, in their 40s), but its prevalence in women increased throughout their lifetime (32.6% and 14.7% for ≥150 mg/dL and ≥200 mg/dL, respectively, in their 70s). Smoking and high-risk drinking exacerbated peak prevalence in both sexes. Young adults with any comorbidities had prominently increased prevalence of hypertriglyceridemia. The lowest levels of education and income were both associated with the higher prevalence of hypertriglyceridemia in both sexes.

Conclusion

It is important to understand the age- and sex-specific epidemiology of hypertriglyceridemia to establish its appropriate management plans.

Prevalence, awareness, and control of hypertension and associated factors among Royal Thai Army personnel in Thailand from 2017 to 2021

Hypertension (HTN) is a potential risk factor for cardiovascular diseases. We aimed to determine the prevalence, awareness, and control of HTN among RTA personnel in Thailand. We conducted a series of cross-sectional studies from 2017 to 2021. HTN was defined by systolic blood pressure (BP) ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg from a physical health examination, a history of HTN diagnosed by medical personnel, or taking antihypertensive medication. A total of 504,484 participants were included in the present study. The overall HTN prevalence was 29.4%. The prevalence of HTN among males was 30.5%, while it was 17.1% among females. Of the RTA personnel with HTN, 35.9% were aware of their condition. The overall control of HTN among RTA personnel with HTN was 15.8% in 2017 and 17.6% in 2021. Behavioral factors associated with HTN were current smoking, alcohol consumption, and sedentary behavior. A higher BMI was associated with higher HTN prevalence and HTN awareness but less likely to have controllable HTN. Male participants, younger individuals, current alcohol use, and sedentary behavior were associated with a lower prevalence of HTN awareness and controlled HTN. Current tobacco use was also associated with a lower prevalence of HTN awareness.

Rani ZZ, Sulaiman SA, Chow YP, Abdullah N, Ahmad N, Ismail N, Abdul Jalal N, Kamaruddin MA, Saperi AA, Jamal R. Hypercholesterolemia in the Malaysian Cohort Participants: Genetic and Non-Genetic Risk Factors

Hypercholesterolemia was prevalent in 44.9% of The Malaysian Cohort participants, of which 51% were Malay. This study aimed to identify the variants involved in hypercholesterolemia among Malays and to determine the association between genetic and non-genetic risk factors. This nested case–control study included 25 Malay participants with the highest low-density lipoprotein cholesterol (LDL-C, >4.9 mmol/L) and total cholesterol (TC, >7.5 mmol/L) and 25 participants with the lowest LDL-C/TC. Genomic DNA was extracted, and whole-exome sequencing was performed using the Ion ProtonTM system. All variants were annotated, filtered, and cross-referenced against publicly available databases. Forty-five selected variants were genotyped in 677 TMC Malay participants using the MassARRAY® System. The association between genetic and non-genetic risk factors was determined using logistic regression analysis. Age, fasting blood glucose, tobacco use, and family history of hyperlipidemia were significantly associated with hypercholesterolemia. Participants with the novel OSBPL7 (oxysterol-binding protein-like 7) c.651_652del variant had 17 times higher odds for hypercholesterolemia. Type 2 diabetes patients on medication and those with PCSK9 (proprotein convertase subtilisin/kexin type 9) rs151193009 had low odds for hypercholesterolemia. Genetic predisposition can interact with non-genetic factors to increase hypercholesterolemia risk in Malaysian Malays.

Undertreatment and Underachievement of LDL-C Target among Individuals with High and Very High Cardiovascular Risk in the Malaysian Community

Dyslipidaemia is a major cause of morbidity and mortality. The aims of this study are to determine the prevalence of dyslipidaemia subtypes, the proportions of lipid-lowering therapy (LLT) use, and the achievement of low-density lipoprotein cholesterol (LDL-C) treatment targets for high-risk (HR) and very high-risk (VHR) Malaysians. This cross-sectional study involves 5279 participants across 11 states in Malaysia. The data were obtained through a standardised questionnaire, anthropometric measurements, venous glucose and lipid profile. The participants with existing cardiovascular disease (CVD) or diabetes with at least one of the other major risk factors (smoking, hypertension or dyslipidaemia) were grouped into the VHR category. Other participants were risk-categorised using the Framingham General CVD Risk Score (FRS-CVD). The prevalence of elevated LDL-C, LLT use and LDL-C target were set according to respective risk categories. Pearson's chi-squared test was used to test the difference in the proportions. The mean ± standard deviation (SD) age was 41.1 ± 14.8 years, and 62.2% (3283/5279) of the group were females. Within the participant group, 51.5% were found to have elevated total cholesterol, 28.8% had low HDL-C, and 33.8% had high triglyceride. As for elevated LDL-C, 9.8% were in VHR, 8.6% in HR, 5.8% in MR and 34.9% in LR categories. Among the VHR group, 75.8% were not on LLT, and only 15.9% achieved the LDL-C target. As for the HR category, 87.7% were not on LLT, and only 16.1% achieved the LDL-C target. Dyslipidaemia is highly prevalent among Malaysians. The majority of VHR and HR participants were not on LLT and did not achieve LDL-C treatment targets. Proactive programs are warranted to combat dyslipidaemia-associated CVD events in these groups.

Supplementation with the Traditional Thai Polyherbal Medicine NawaTab Ameliorates Lipid Profiles in High-Fat Diet-Induced Hyperlipidemic Rats

A tablet formulation developed from Nawametho decoction (NawaTab), a traditional Thai herbal mixture described in the Worayokasan scripture, has been used clinically for several years in the management of borderline hyperlipidemic individuals. Nevertheless, scientific evidence supporting its claims has never been identified. This study aimed to describe the antihyperlipidemic properties of NawaTab in a well-described model of high-fat diet (HFD)-induced hyperlipidemic rats. Decoction of Nawametho containing equal quantities of Aegle marmelos (L.), Carthamus tinctorius L., Hibiscus sabdariffa Linn., Phyllanthus emblica L., Piper longum L., Piper nigrum L., Terminalia bellirica (Gaertn.) Roxb., Terminalia chebula Retz., and Zingiber officinale Roscoe were prepared. The HFD-fed rats were administered NawaTab for 4 consecutive weeks starting from the ninth week of HFD treatment at a dose of 125 mg/kg (p.o.). Anthropometric parameters, serum lipid profiles, lipase activity, and liver and renal functional markers were measured. Histopathological examination of the liver and any steatosis was carried out at the end of this study. Consecutive treatment with NawaTab (125 mg/kg/day) in HFD-induced hyperlipidemic rats caused a significant reduction in serum total cholesterol, triglyceride, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol levels. However, at the tested dose, NawaTab failed to prevent the onset of hepatic steatosis and adipose tissue accumulation. No adverse events due to the consumption of NawaTab on liver and kidney function markers were noted. These findings are the first suggestive evidence for the lipid-lowering capability of NawaTab. However, to promote the use of this formulation in the management of borderline hyperlipidemic patients, elucidation of the underlying mechanisms of action, quantification of biological markers, and clinical trials of NawaTab are urgently needed.

Gender Differences in Risk Factors for Dyslipidemia in the Khmer Ethnic People, Vietnam

Background

The majority of the Khmer ethnic people living in the Mekong Delta had a difficult socioeconomic life and limited access to information and health services. The study was conducted to determine the prevalence of dyslipidemia and risk factors in men and women of the Khmer ethnic people, in Vietnam.

Methods

A cross-sectional study was conducted on 1.800 Khmer people aged 25 - 64 yr living in Tra Vinh Province in the Mekong Delta region of Vietnam. Data were analyzed using descriptive statistics and multivariate logistic regression.

Results

The prevalence of dyslipidemia was high in men (47.3%) and in women (51.4%). Men had a higher prevalence of high TG (28.9% vs. 23.9%), whereas the prevalence of high TC (34.1% vs. 42.4%), and high LDL-C (28.2% vs. 37.9%) were lower in women, (all P<0.05). In men, dyslipidemia was significantly associated with central obesity (OR=2.58, 95% CI=1.32-5.06), overweight/obesity (OR=2.50, 95% CI=1.75-3.56), and diabetes (OR=2.15, 95% CI=1.22-3.78). In women, dyslipidemia was significantly associated with diabetes (OR=2.14, 95% CI=1.08-4.24), central obesity (OR=1.69, 95% CI=1.18-2.42), overweight/obesity (OR=1.50, 95% CI=1.06-2.10), and hypertension (OR=1.43, 95% CI=1.03-1.99). Age was significantly associated with increased risk of dyslipidemia in both genders.

Conclusion

Overall, the prevalence of dyslipidemia among Khmer men and women adults aged 25 - 64 years in Vietnam was high. Our findings indicated an urgent need to have dyslipidemia prevention intervention programs for the Khmer ethnic people in the Mekong Delta, especially training about obesity and increasing healthy lifestyles.

Determinants of Health-Related Quality of Life Among Community-Dwelling Thai Older Adults in Chiang Mai, Northern Thailand

Background

Population aging has been growing worldwide and Thailand has become an aged society with 20% of its population aged 60 and over. Age-related decline in physical and mental health impacts the health-related quality of life (HRQOL) of older adults.

Purpose

We aimed to describe the HRQOL of Thai older adults, residing in the community.

Methods

This cross-sectional survey was part of a Community-Integrated Intermediary Care project (CIIC), TCTR20190412004. A total of 1509 participants from an intervention arm of a cluster randomized controlled trial were included. A Thai version of the Euro-Qol questionnaire (EQ-5D-5L) was used to determine the HRQOL and associated sociodemographic background, health behaviors and underlying diseases of a representative sample from Maehia, Chiang Mai, Thailand. SPSS version 24 was used to analyze data via descriptive analysis and binary logistic regression.

Results

The mean age of the participants was 69.31±7.10 years, and nearly a quarter (23.8%) was older than 75 years. The mean EQ index score was 0.81±0.23 and older age, lower educational attainment, unemployment, lack of exercise habits, current smokers, having history of a fall in the last 6 months, diabetes, hyperlipidemia, dependency assessed using Barthel's Activity of Daily Living (ADL) Index, and depression using the Geriatric Depression Scale (GDS) were more likely to represent HRQOL-related problems.

Conclusion

Our findings have highlighted the factors affecting the HRQOL of community-dwelling older adults which could be of importance in preparing for active and healthy aging communities. The routine dependency assessment using the ADL index will be useful in estimating the HRQOL of the aging population. Fall prevention programs are also recommended to reduce dependency. Moreover, the association of having diabetes and hyperlipidemia with problems in HRQOL dimensions highlight the need for public health intervention not only to prevent the increasing burden of non-communicable diseases but also to improve the HRQOL of older adults.

Rising trends in obesity prevalence among Royal Thai Army personnel from 2017 to 2021

Obesity is an essential health issue leading to noncommunicable diseases (NCDs) as well as atherosclerotic cardiovascular diseases. We aimed to determine the trends in obesity prevalence among Royal Thai Army (RTA) personnel and their associated factors using the health examination of RTA personnel database. A series of cross-sectional studies were conducted from 2017 to 2021. A self-report guide was created using a standardized case report form to obtain demographic characteristics and determine behavioral risk factors. Obesity was defined as BMI [Formula: see text] 25 kg/m², and a total of 512,476 RTA personnel nationwide were included. Obesity prevalence rose from 42.1% (95% CI 41.7-42.4) in 2017 to 44.2% (95% CI 43.9-44.5) in 2021 (p for trend < 0.001). A significant surge was observed in obesity prevalence among young RTA personnel aged 18-24 years from 23.7% in 2017 to 28.4% in 2021 (p for trend < 0.001). Higher age individuals, male participants and RTA personnel residing in Bangkok tended to have a significantly higher risk for obesity. Further, regular exercise was a protective factor for obesity. Our data emphasized that obesity among the RTA personnel has been continuously rising over one half-decade, especially among young adults.

Global epidemiology of dyslipidaemias

Dyslipidaemias are alterations to the plasma lipid profile that are often associated with clinical conditions. Dyslipidaemias, particularly elevated plasma LDL-cholesterol levels, are major risk factors for cardiovascular disease, but some forms, such as hypertriglyceridaemia, are associated with severe diseases in other organ systems, including non-alcoholic fatty liver disease and acute pancreatitis. Dyslipidaemias can be genetically determined (primary or familial dyslipidaemias) or secondary to other conditions (such as diabetes mellitus, obesity or an unhealthy lifestyle), the latter being more common. Hypercholesterolaemia is the most common form of dyslipidaemia and is associated with an increased risk of cardiovascular disease, with elevated plasma LDL-cholesterol levels being the 15th leading risk factor for death in 1990, rising to 11th in 2007 and 8th in 2019. The global burden of dyslipidaemias has increased over the past 30 years. Furthermore, the combination of high triglyceride levels and low HDL-cholesterol levels (together with the presence of small, dense LDL particles), referred to as atherogenic dyslipidaemia, is highly prevalent in patients with diabetes or metabolic syndrome and increases their risk of cardiovascular disease. Given the increasing prevalence of diabetes worldwide, treating lipid abnormalities in these patients might reduce their risk of cardiovascular disease.

Awareness, treatment, control, and determinants of dyslipidemia among adults in China

Effective management of dyslipidemia is important. This study aimed to determine the awareness, treatment, control, and determinants of dyslipidemia in middle-aged and older Chinese adults in China. Using data from the 2015 China National Stroke Screening and Prevention Project (CNSSPP), a nationally representative sample of 135,403 Chinese adults aged 40 years or more were included in this analysis. Dyslipidemia was defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults final report (NCEP-ATP III) and the 2016 Chinese guidelines for the management of dyslipidemia in adults. Models were constructed to adjust for subjects’ characteristics with bivariate and multivariable logistic regression analyses. Overall, 51.1% of the subjects were women. Sixty-four percent were aware of their condition, of whom 18.9% received treatment, and of whom 7.2% had adequately controlled dyslipidemia. Dyslipidemia treatment was higher in men from rural areas than their urban counterparts. The multivariable logistic regression models revealed that women, urban residents, and general obesity were positively related to awareness. Women, married respondents, and current drinkers had higher odds of treatment. Age group, overweight, general obesity, urban residence, and women were independent determinants of control. Dyslipidemia awareness rate was moderately high, but treatment and control rates were low. Results can be used to develop policies and health promotion strategies with special focus on middle-aged and older adults.

Prevalence of plasma lipid disorders with an emphasis on LDL cholesterol in selected countries in the Asia-Pacific region

Cardiovascular disease (CVD) is a major cause of mortality and morbidity within the Asia-Pacific region, with the prevalence of CVD risk factors such as plasma lipid disorders increasing in many Asian countries. As members of the Cardiovascular RISk Prevention (CRISP) in Asia network, the authors have focused on plasma lipid disorders in the six countries within which they have clinical experience: Indonesia, Malaysia, Philippines, Thailand, Vietnam, and Australia. Based on country-specific national surveys, the prevalence of abnormal levels of total cholesterol, low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), and triglycerides (TG) are reported. An important caveat is that countries have used different thresholds to define plasma lipid disorders, making direct comparisons difficult. The prevalence of abnormal lipid levels was as follows: high total cholesterol (30.2-47.7%, thresholds: 190-213 mg/dL); high LDL-C (33.2-47.5%; thresholds: 130-135 mg/dL); low/abnormal HDL-C (22.9-72.0%; thresholds: 39-50 mg/dL); and high/abnormal TG (13.9-38.7%; thresholds: 150-177 mg/dL). Similarities and differences between country-specific guidelines for the management of plasma lipid disorders are highlighted. Based on the authors' clinical experience, some of the possible reasons for suboptimal management of plasma lipid disorders in each country are described. Issues common to several countries include physician reluctance to prescribe high-dose and/or high-intensity statins and poor understanding of disease, treatments, and side effects among patients. Treatment costs and geographical constraints have also hampered disease management in Indonesia and the Philippines. Understanding the factors governing the prevalence of plasma lipid disorders helps enhance strategies to reduce the burden of CVD in the Asia-Pacific region.

Factors associated with hypertriglyceridemia among the hill tribe people aged 30 years and over, Thailand: a cross-sectional study

BACKGROUND

Triglycerides are lipids in the human body that are produced from the consumption of daily food and drink. However, elevated serum triglycerides, also known as hypertriglyceridemia (HTG), are key biomarkers indicating an unhealthy status and increased risks of cardiovascular diseases (CVDs) and pancreatitis. Different groups of people have different patterns and styles of cooking and different patterns of consumption, such as hill tribe people, who have their own unique culture and cooking practices. This study aimed to estimate the prevalence of and determine the factors associated with HTG among the hill tribe population in Thailand.

METHOD

A cross-sectional study was performed. Data and a-5 mL blood sample were collected from participants who were members of one of the six main hill tribes in Thailand: Akah, Lahu, Hmong, Yao, Karen, and Lisu. People who lived in 30 selected hill tribe villages and aged 30 years over were asked to participate the study. Pearson correlation and logistic regression were used to detect the correlations and determine the associations between variables, respectively, at a significant level of α = 0.05.

RESULTS

A total of 2552 participants participated this study; 65.9% were females, 72.35% were aged 40-69 years, 76.7% had no education, 48.7% worked in the agricultural section, and 71.2% had an annual income of less than 50,000 baht/family. Regarding the triglyceride level, 41.7% of participants had elevated levels of serum triglyceride or HTG; 16.4% had a borderline high level, and 25.3% had a high level. After controlling for all potential confounder factors, three variables were found to be associated with elevated serum triglycerides. Those who were members of the Lahu and Hmong tribes were 1.62 times (95%CI = 1.25-2.01) and 1.63 times (95%CI = 1.23-2.16) more likely to have elevated serum triglycerides than those who were members of the Akha tribe, respectively. Those who used a high quantity of cooking oil for daily cooking were 0.73 times less likely to have an abnormal level of triglycerides than those who used a low quantity of cooking oil for daily cooking (95%CI = 0.58-0.91), and those who had a waist circumference indicating obesity were 1.28 times more likely to have an abnormal level of triglycerides than those who had a normal waist circumference (95%CI = 1.08-1.52).

CONCLUSION

Public health programs that focus on encouraging people to have regular exercise to reduce their body weight, particularly in some tribes, such as Lahu and Hmong, should be implemented.

High prevalence of dyslipidaemia subtypes and their associated personal and clinical attributes in Malaysian adults: the REDISCOVER study

BACKGROUND

Dyslipidaemia refers to lipid abnormalities consisting of either one or any combination of the following: elevated total cholesterol (TC), elevated low-density lipoprotein cholesterol (LDL-c), elevated triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-c). The prevalence of hypercholesterolaemia is steadily increasing in Malaysia. However, data on the prevalence of dyslipidaemia subtypes among Malaysians are lacking. This is important as it may have implications for preventive and management strategies for this increasing public health challenge. This study is aimed at determining the prevalence of dyslipidaemia subtypes and their associated personal and clinical attributes in Malaysians.

METHODS

REDISCOVER, a prospective study, enrolled 11,288 adults where sociodemographic data, anthropometric and blood pressure measurements, fasting lipid profile and glucose, and history of diabetes, hypertension, and smoking were obtained. The cross-sectional analytic sample presented in this article comprised 10,482 participants from baseline recruitment. The data was analysed by descriptive statistics and multivariable logistic regression.

RESULTS

The overall prevalence of elevated TC, elevated LDL-c, elevated TG, low HDL-c, and elevated non-HDL-c were 64.0% (95% CI 63.0-65.0), 56.7% (CI 55.7-57.7), 37.4% (CI 36.5-38.4), 36.2% (CI 35.2-37.1), and 56.2% (CI 55.3-57.2), respectively. Overweight, obesity, and central obesity were highly prevalent and significantly associated with elevated TC and all dyslipidaemia subtypes. Older age was associated with elevated TC, elevated LDL-c and elevated non-HDL-c. Hypertension was associated with elevated TC, elevated TG, and elevated non-HDL-c, while diabetes was associated with elevated TG and low HDL-c.

CONCLUSIONS

Elevated TC and all dyslipidaemia subtypes are highly prevalent in Malaysia where increased body mass seems the main driver. Differences in the prevalence and associated personal and clinical attributes may facilitate specific preventive and management strategies.

Factors associated with elevated low-density lipoprotein cholesterol levels among hill tribe people aged 30 years and over in Thailand: a cross-sectional study

Background

Low-density lipoprotein cholesterol (LDL-C) is one of the most important types of cholesterol and has an impact on health. Certain lifestyle and dietary habits in different populations may leads to increased levels of LDL-C, particularly among those with poor education and economic statuses, such as hill tribe people in Thailand. This study aimed to estimate the prevalence of and determine the factors associated with high LDL-C levels among hill tribe people in northern Thailand.

Methods

A cross-sectional study was performed to gather information from six main hill tribe populations: Akha, Lahu, Hmong, Yao, Karen, and Lisu. Individuals who were aged over 30 years and living in 30 selected hill tribe villages were invited to participate in the study. A validated questionnaire and 5-mL blood specimens were used to obtain data. Correlation analyses, chi-square tests, t-tests, and logistic regression were used to detect correlations and associations.

Results

A total of 2552 participants were recruited into the study; 65.9% were females, and 64.1% were aged younger than 60 years old. Approximately 69.6% of participants had abnormal LDL-C levels; 33.6% had above-optimal levels, 24.3% had borderline high levels, 8.0% had high levels, and 3.7% had very high levels. A total of 17.4% of participants had low high-density lipoprotein cholesterol (HDL-C) and high LDL-C levels, while 14.9% had high triglyceride and LDL-C levels. After controlling for sex, age, religion, education, annual family income, and marital status in the multivariate model, three variables were found to be associated with high LDL-C levels: occupation, the amount of lard used in daily cooking, and glycated hemoglobin (HbA1c). Those who were working as agriculturalists had a 1.34-fold greater chance of having abnormal LDL-C than traders and others (95% CI = 1.09–1.34). Those who used moderate and high quantities of lard in their daily cooking had a 1.45-fold (95% CI = 1.15–1.82) and 1.31-fold (95% CI = 1.04–1.68) greater likelihood of having abnormal LDL-C levels than those who used low quantities, respectively. Those who had abnormal HbA1c levels were less likely to develop abnormal LDL-C levels than those who had normal HbA1c levels (AOR = 0.69, 95% CI = 0.51–92).

Conclusions

Effective public health programs that do not conflict with the cultures of hill tribes are urgently needed, particularly programs encouraging the use of small quantities of lard for daily cooking practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10577-3.

An Age-Period-Cohort Analysis of Prevalence and Consultation Rate for Dyslipidemia in Japan

This study involved an age-period-cohort analysis of the consultation rate and prevalence of dyslipidemia in Japan, based on Patient Survey data from 1999 to 2017 and open data of national database of health insurance claims and specific health checkups in Japan from 2013 to 2016. Our results showed that the consultation rates were lower than the prevalence, regardless of age, year, and sex, and particularly among middle-aged and male respondents. Additionally, both the consultation rate and prevalence increased with increasing age to a greater extent among women than men, and the degree of increase in the consultation rate was larger than that in prevalence among women. Furthermore, although the cohort effect on prevalence began to decrease among men in cohorts born in approximately 1960, the effect decreased among women in cohorts born between the 1930s and 1960s and exhibited an increasing trend thereafter.

Comparison of three equations for estimating low-density lipoprotein-cholesterol in the rural northeastern region of Thailand

BACKGROUND

Cardiovascular disease is the most common cause of death worldwide, and the detection of LDL-C contributes to reducing risks. However, the LDL-C is rarely evaluated according to the gold standard method because it is costly and time-consuming. This study aimed to determine the agreement of LDL-C among three equations, namely Friedewald's equation, Puavilai's equation, and Dansethakul's equation.

METHODS

A cross-sectional descriptive study.

RESULTS

Using the data of lipid measurement from a specific group of people in the remote rural area, we found that the Thai equations have more superior agreement with direct measurement than the Friedewald equation (ICC = 0.870, 95% CI = 0.857-0.882) when the agreement of continuous data was used for total analysis. Although the categorical analysis that gave better agreement was from Friedewald equation (K index = 0.730, 95% CI = 0.720-0.751), the findings from this study confirmed the population-specific use of Pauvilai's equation and Dansethakul's equation for determining the LDL-C.

CONCLUSION

Pauvilai's equation showed better agreement with direct measurement for LDL-C. Thus, it could be considered as an alternative for the direct method, particularly in laboratories in rural areas in Thailand.

High serum concentration of selenium, but not calcium, cobalt, copper, iron, and magnesium, increased the risk of both hyperglycemia and dyslipidemia in adults: A health examination center based cross-sectional study

BACKGROUND

Metabolic disorders of glucose and lipid were associated with some mineral elements, and data were warranted from various contexts to make the association more explicit.

OBJECTIVE

To investigate the relationships between the serum concentrations of six mineral elements (calcium, cobalt, copper, iron, magnesium, and selenium) and the risk of hyperglycemia and dyslipidemia in adults.

METHODS

The basic information and the over-night fasting serum samples of adults were randomly collected at a health examination center. The serum concentrations of glucose and lipids were measured with an automatic biochemical analyzer, and the mineral elements were measured with an inductively coupled plasma mass spectrometer. Data were analyzed between the hyperglycemia group (HGg) and the normal glucose group (NGg) as well as between the dyslipidemia group (DLg) and the normal lipid group (NLg).

RESULTS

A total of 1466 adults aged 22-81 years (male/female = 1.8) were included, 110 in the HGg and 1356 in the NGg, or 873 in the DLg and 593 in the NLg. The serum element concentration medians [P50 (P25-P75)] significantly different between the HGg and the NGg were 0.83 (0.75-0.94) vs. 0.76 (0.68-0.87) mg/L for copper and 100 (90-110) vs. 94 (87-103) μg/L for selenium (P < 0.001), while those between the DLg and the NLg were 99 (92-110) vs. 97 (90-106) mg/L for calcium, 0.78 (0.69-0.88) vs. 0.75 (0.66-0.85) mg/L for copper, 1.7 (1.4-2.0) vs. 1.6 (1.3-2.0) mg/L for iron, 24 (22-28) vs. 23 (22-27) mg/L for magnesium, and 97 (89-106) vs. 92 (84-100) μg/L for selenium (P < 0.05). When the copper and selenium between the HGg and the NGg were analyzed by logistic regression with age, gender, body mass index, and mineral elements adjusted, only the highest quartile of selenium concentration had association with the increased risk of hyperglycemia [quartile (Q) 4 against Q1: OR = 2.9, 95 % CI = 1.5-5.5, P < 0.001). When the five differed mineral elements between the DLg and the NLg were similarly analyzed, only iron and selenium had associations with the increased risk of dyslipidemia (e.g., Q4 against Q1: OR = 1.4, 95 % CI = 1.1-2.0 for iron and OR = 2.9, 95 % CI = 2.1-4.0 for selenium, P < 0.05).

CONCLUSION

In contrast to those of calcium, cobalt, copper, iron, and magnesium, the higher serum concentration of selenium increased the risk of both hyperglycemia and dyslipidemia in the study population of adult Chinese.

The potential of antioxidant-rich Maoberry (Antidesma bunius) extract on fat metabolism in liver tissues of rats fed a high-fat diet

Backgound

Obesity and dyslipidemia are major risk factors associated with non-alcoholic fatty liver disease (NAFLD). NAFLD refers to the accumulation of fat in more than 5% of the liver without alcohol consumption. NAFLD is the most common liver disease and is rapidly becoming a global public health problem. Maoberry (Antidesma bunius) is a fruit rich in antioxidants, especially phenolic compounds, which are reported to have benefits for patients with NAFLD.

Methods

We evaluated the effect of Maoberry extract on fat metabolism in liver tissues of high fat diet–induced rats. Five (5) groups (n = 12) of male Sprague-Dawley (SD) rats were divided into those given a high fat diet with no treatment (HF), different dosages of Maoberry extracts (0.38 [ML], 0.76 [MM) and 1.52 [MH] g/kg body weight) and 10 mg/kg statin (STAT). The rats were fed a high fat diet for 4 weeks to induce obesity and subsequently continued more for 12 weeks with treatments of Maoberry extracts or STAT. The levels of triglyceride, liver enzymes, oxidative stress and inflammation markers, triglyceride synthesis regulators, and pathology of the liver in high fat diet-induced rats were investigated.

Results

Feeding Maoberry extract in MH groups resulted in decreasing levels of serum alanine aminotransferase (ALT), liver triglyceride, liver thiobarbituric acid reactive substances (TBARS) and mRNA expression of tumour necrosis factor (TNF)-α, interleukin (IL)-6, glycerol-3-phosphate acyltransferase (GPAT)-1 and acetyl-coenzyme A carboxylase (ACC) compared with the HF group (P < 0.05). Moreover, histopathological study of the liver showed reduced fat droplets in the Maoberry extract treatment groups, especially in MH groups and STAT treatment groups.

Conclusions

The improvements of fat metabolism in liver tissues of rats fed a high-fat diet were observed in Maoberry extracts treatment groups. The underline mechanism that link to fat metabolism might be through the process accompanied with down-regulated the gene expression of key enzymes of lipid production, antioxidant activity, and anti-inflammation properties of Maoberry extracts which contains high levels of phenolic and flavonoid compounds.

Effects of Opisthorchis viverrini infection on glucose and lipid profiles in human hosts: A cross-sectional and prospective follow-up study from Thailand

Opisthorchis viverrini (OV) infection is endemic to the Northeast Thailand where the prevalence of Type 2 Diabetes mellitus (T2DM) is higher whilst the incidence of cardiovascular diseases (CVDs) is lower than the rest of Thailand. Helminth infection has both nutritional and immunological impact on their definitive hosts. Thus, a cross-sectional study was performed to see the effects of OV infection on glucose and lipid profiles. For this purpose, 200 each of OV infected and uninfected residents were recruited and their glycated hemoglobin (HbA1c), total cholesterol, triglycerides, low- and high-density lipoproteins (LDL and HDL) levels and anthropometric measurements, including BMI were examined. Then, as the prospective follow- up study, changes of those metabolic parameters of OV positive subjects (n = 120) before and after Praziquantel (PZQ) treatment were monitored for six months. The results showed that OV infection has a protective effect against hyperglycemia (OR 0.482 and p = .04) and metabolic disease risk group (OR 0.478 and p = .03). OV positive participants had lower HbA1c (5.5% Vs. 6.01%, p = .001) but higher HDL (54.07 Vs. 49.46 mg/dL, p = .001) than OV negative participants that are statistically significant. After PZQ treatment for OV-positive subjects, their serum levels of HbA1c (p < .05) and HDL (p < .05) significantly rose during the follow up. Apparently, OV infection lowers HbA1c but increases HDL in definitive human hosts.

Prevalence of Non-AIDS Comorbidities and Factors Associated with Metabolic Complications among HIV-Infected Patients at a Thai Referral Hospital

Objectives:

The prevalence of non-AIDS-related comorbidities is increasing in HIV-infected patients receiving antiretroviral therapy. In Thailand, data regarding the prevalence of non-AIDS comorbidities and factors associated with metabolic complications in HIV-infected patients have not been well-documented.

Methods:

This cross-sectional study was conducted in 2011 and included 874 HIV-infected patients.

Results:

The age of patients was 45(8) years represented as mean (standard deviation [SD]). The current CD4 count was 502(247) cells/mm³. In all, 388 (44%) of the included patients had at least 1non-AIDS comorbidity. The most frequently documented comorbidities were hyperlipidemia in 271 (70%) patients. Using multivariate analysis, older age(odds ratio [OR] = 1.82, 95% confidence interval [CI] = 1.51-2.19), male sex (OR = 1.55, 95%CI = 1.14-2.11), high current CD4 count(OR = 1.00, 95%CI = 1.00-1.00), and taking abacavir (ABC)-containing(OR = 2.59, 95%CI = 1.16-5.78)and didanosine (ddI)-containing antiretroviral regimens (OR = 4.16, 95%CI = 1.09-15.84)were associated with the presence of metabolic complications (all Ps<.05).

Conclusion:

The prevalence of comorbidities is substantially high. Clinical monitoring and effective management of these comorbidities and metabolic complications are recommended, especially in HIV-infected patients who present with these associated factors.

A Relationship between Dietary Patterns and Dyslipidemia in Urban-dwelling Middle-Aged Korean Men: Using Korean Genome and Epidemiology Study (KoGES)

An increase in the prevalence of dyslipidemia has been strongly associated with the mortality rate of cardiovascular disease. We conducted a cross-sectional analysis to determine the relationship between dietary patterns and dyslipidemia in adult men aged 40–64 years. A total of 5,643 subjects from the Korean Genome and Epidemiology Study (KoGES) were selected for the final analysis. We analyzed 24-hour dietary recall data. Using principal component analysis, 3 dietary patterns were identified: rice based Korean food pattern, flour based western dietary pattern, and convenience food dietary pattern. The flour based western dietary pattern was significantly and positively associated with total cholesterol, and low density lipoprotein (LDL) cholesterol (p for trend < 0.05). With regard to the rice based Korean food pattern, the group with the highest factor score had a significantly lower risk of hyper LDL cholesterolemia (odds ratio [OR], 0.802; 95% confidence interval [CI], 0.698–0.922) and high total cholesterol levels (OR, 0.868; 95% CI, 0.761–0.990) than the group with the lowest factor score. For the flour based western dietary pattern the group with the highest factor score showed a significantly high risk of hyper LDL cholesterolemia (OR, 1.189; 95% CI, 1.033–1.367; p for trend < 0.05) than the group with the lowest factor score. Our results showed that the rice based Korean food pattern protected against dyslipidemia. In contrast, the western staple pattern, which is rich in flour and processed foods, was independently associated with dyslipidemia in urban male residents of Korea.

Prevalence of dyslipidemia associated with complications in diabetic patients: a nationwide study in Thailand

Background

Dyslipidemia is an important modifiable risk factor for cardiovascular disease. It is diagnosed by the presence of an abnormal lipid profile, primarily with elevated levels of plasma cholesterol, triglyceride, or both, or reduced levels of high-density lipoprotein cholesterol. However, some studies have reported increased risk of ischemic stroke with elevated low-density lipoprotein cholesterol (LDL-C) levels and increased risk of cardiovascular mortality independent of LDL-C levels in type 2 diabetes mellitus (T2DM) patients.

Methods

In this cross-sectional study, data were included for Thai adults with diabetes from the Diabetes Mellitus/ Hypertension (DM/HT) study, 2010–2014 (data was collected by the Medical Research Network of the Consortium of Thai Medical Schools). The target population comprised T2DM patients who were treated at a hospital for more than 12 months. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to determine factors associated with dyslipidemia.

Results

In total, 140,557 participants (average age, 60 years) were enrolled, with a dyslipidemia prevalence of 88.9% in the cohort. The factors associated with dyslipidemia included female sex (aOR: 1.47, 95% CI: 1.38–1.56); age < 50 years (aOR: 1.16, 95% CI: 1.10–1.22); waist circumference ≥ 90 cm in males and ≥ 80 cm in females (aOR: 1.23, 95% CI: 1.16–1.31); treatment at a primary care unit (aOR: 1.28, 95% CI: 1.23–1.33); and a history of unknown stroke (aOR: 1.10, 95% CI: 1.02–1.19), coronary revascularization (aOR: 0.85, 95% CI: 0.79–0.91), diabetic nephropathy (aOR: 1.06, 95% CI: 1.01–1.12), or renal insufficiency (aOR: 1.08, 95% CI: 1.02–1.13).

Conclusions

Dyslipidemia is prevalent among Thai T2DMpatients and is associated with gender; age; obesity; central obesity; treatment at a primary care unit; and a history of unknown stroke, coronary revascularization, diabetic nephropathy, and renal insufficiency. Our study results will help increase the awareness of healthcare providers regarding dyslipidemia in diabetic patients. To reduce cardiovascular risk, healthcare professionals should provide regular follow-up and proper advice and ensure primary prevention of vascular complications. Improved education and increased self-awareness regarding the need to change behaviors and regular intake of medication would help decrease dyslipidemia prevalence among diabetic patients.

Appropriate Total cholesterol cut-offs for detection of abnormal LDL cholesterol and non-HDL cholesterol among low cardiovascular risk population

BACKGROUND

Current guidelines suggest screening for dyslipidemia in early adulthood. In Thailand, a screening total cholesterol level is most commonly used potentially due to the costs of the test. However, the appropriate TC cut-off point that correlates with elevated low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (Non-HDL-C) levels for the low cardiovascular risk younger population have not been examined extensively in the literature.

METHODS

This study identified 1754 subjects with low cardiovascular risk. All participants had a physical examination and a venous blood sample sent for laboratory assessment of fasting blood glucose, TC, LDL-C, HDL-C levels. A non-HDL-C level for everyone was calculated by subtracting HDL-C levels from their total cholesterol levels. Sensitivity and specificity of different TC cutoff points in detection of abnormal LDL-C levels (≥ 130 mg/dL and ≥ 160 mg/dL) and abnormal non-HDL-C levels (≥ 160 mg/dL and ≥ 190 mg/dL) were calculated. Receiver operating characteristics (ROC) curve analysis was used to evaluate the predictive utility of TC for the abnormal LDL-C and abnormal non-HDL-C levels.

RESULTS

The conventional range TC cut off point, between 200 to 240, had varying diagnostic properties for detection of elevated LDL-C and Non-HDL-C within this low risk population. A TC cut off point 210 would have a sensitivity of 70% and specificity of 92.5% for detection of LDL-C ≥ 130 and a sensitivity of 96.7% and specificity of 85.6% for identifying those with Non-HDL-C ≥ 160. The TC cut off point of 230 had a sensitivity of 74.9% and specificity of 92.0% in identifying those with LDL-C ≥ 160 and a sensitivity of 98.6% and specificity of 89.8% in detection of non-HDL-C ≥ 190.

CONCLUSIONS

Early screening for dyslipidemia in young adults is suggested by many guidelines. This population is likely to be those with lower cardiovascular risk and may needed to have repeated screening over time. Screening using TC with appropriate a cut off points may be a more cost-effective screening test in settings with limited resources, coverage and accessibility.

Regulatory effect of Phikud Navakot extract on HMG-CoA reductase and LDL-R: potential and alternate agents for lowering blood cholesterol

Background

For decades, various cardiovascular symptoms have been relieved by the use of Ya-Hom Navakot, which is a formulation comprising 54 herbal medicines. The Thailand Ministry of Public Health listed Ya-Hom Navakot’s nine active principle and nomenclative herbal ingredients and termed them ‘Phikud Navakot’ (PN). Several reports have confirmed that PN has cardiovascular benefits similar to Ya-Hom Navakot. However, whether PN facilitates lipid-lowering activity remains unclear.

Methods

The present study investigated an in vitro model for examining the gene expression levels of 3-hydroxyl-3-methylglutaryl-CoA reductase (HMGCR) and low-density lipoprotein receptor (LDL-R) in HepG2 cells using qRT-PCR. The ethanol and water extractions of Ya-Hom Navakot, PN and Ya-Hom Navakot without PN were compared.

Results

One mg/ml of both NYEF and NYWF were found to significantly lower cholesterol by either the up-regulation of LDL-R or down-regulation of HMGCR compared with negative controls and 1 mg/ml simvastatin (p < 0.05). PNEF also up-regulated LDL-R gene expression, even more than NYEF (p < 0.05). In addition, the ethanol and water extracts of PN significantly down-regulated HMGCR gene expression compared with those of Ya-Hom Navakot without PN (p < 0.05).

Conclusion

The use of Ya-Hom Navakot or PN may provide an alternative treatment to lower cholesterol through HMGCR gene inhibition and LDL-R gene enhancement.

Expert opinion on the applicability of dyslipidemia guidelines in Asia and the Middle East

Cardiovascular disease (CVD) is a growing burden across the world. In Asia and the Middle East, in particular, CVD is among the most prevalent and debilitating diseases. Dyslipidemia is an important factor in the development of atherosclerosis and associated cardiovascular events, and so effective management strategies are critical to reducing overall cardiovascular risk. Multiple dyslipidemia guidelines have been developed by international bodies such as the European Society of Cardiology/European Atherosclerosis Society and the American College of Cardiology/American Heart Association, which all have similarities in practice recommendations for the optimal management of dyslipidemia. However, they differ in certain aspects including pharmacological treatment, lifestyle modification and the target levels used for low-density lipoprotein cholesterol. The evidence behind these guidelines is generally based on data from Western populations, and their applicability to people in Asia and the Middle East is largely untested. As a result, practitioners within Asia and the Middle East continue to rely on international evidence despite population differences in lipid phenotypes and CVD risk factors. An expert panel was convened to review the international guidelines commonly used in Asia and the Middle East and determine their applicability to clinical practice in the region, with specific recommendations, or considerations, provided where current guideline recommendations differ from local practice. Herein, we describe the heterogeneous approaches and application of current guidelines used to manage dyslipidemia in Asia and the Middle East. We provide consensus management recommendations to cover different patient scenarios, including primary prevention, elderly, chronic kidney disease, type 2 diabetes, documented CVD, acute coronary syndromes and family history of ischemic heart disease. Moreover, we advocate for countries within the Asian and Middle East regions to continue to develop guidelines that are appropriate for the local population.

Does Adjuvant Treatment With Ginkgo Biloba to Statins Have Additional Benefits in Patients With Dyslipidemia?

Objective: Ginkgo biloba are widely used alone or in combination with other lipid-lowering agents in the treatment of dyslipidemia in China. We conducted this meta-analysis to investigate whether adjuvant treatment with ginkgo biloba leaves to statins has incremental benefits in patients with dyslipidemia. Methods: Potential studies were searched from PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang database up to October 2017. Only randomized controlled trials (RCTs) comparing the efficacy and safety of ginkgo biloba leaves plus statins versus statins alone in patients with dyslipidemia were included. Results: Eight RCTs involving 664 patients were included. Compared with statins therapy alone, combination of statins and ginkgo biloba leaves therapy achieved greater reductions in triglycerides [mean difference (MD) -0.32 mmol/L; 95% confidence interval (CI) -0.43 to -0.20], total cholesterol (MD -0.61 mmol/L; 95% CI -0.90 to -0.33), or low-density lipoprotein cholesterol (LDL-C) (MD -0.32 mmol/L; 95% CI -0.48 to -0.16), and a greater increment in high-density lipoprotein cholesterol (MD 0.26 mmol/L; 95% CI 0.15 to 0.37). Subgroup analyses showed that ginkgo biloba leaves plus simvastatin appeared to achieve a greater reduction in serum levels of triglycerides, total cholesterol, and LDL-C than in combination with atorvastatin therapy. Conclusion: This meta-analysis suggests that adjuvant treatment with ginkgo biloba leaves appears to improve blood lipid parameters than statins therapy alone. More well-designed RCTs are needed to investigate the benefits of the combination of statins and ginkgo biloba leaves.

Burden of musculoskeletal disorders among registered nurses: evidence from the Thai nurse cohort study

Background

Musculoskeletal disorders (MSDs) are a major public health problem among registered nurses (RNs) in Thailand. Information on their burdens at a national level is limited. This study estimated the prevalence of MSDs among RNs using the 2009 Thai Nurse Cohort, a nationally representative sample of RNs in Thailand.

Methods

This study is part of the first wave survey of the Thai Nurse Cohort Study (TNCS) conducted in 2009. Members of the cohort consisted of 18,756 RNs across Thailand. A 13-page self-administered questionnaire was sent to participants where MSDs were measured by self-reported answers to questions related to experiencing MSDs during a previous year. However, 1070 RNs were excluded from this study since they were unemployed during a previous year, therefore the final sample size was 17,686 RNs. A 12-month prevalence of MSDs and its 95% confidence interval (95% CI) were estimated based on normal approximation to binomial distribution. Chi-square test for trend was used.

Results

Of the 17,686 RNs, 47.8% (95% CI: 47.0–48.5) reported having MSDs during the previous 12 months. The prevalence of MSDs significantly increased with age, body mass index, and working duration (all P < 0.001). Compared to the non-MSD group, RNs with MSDs had a higher proportion who perceived MSDs as a long-term, chronic medical condition (78.1% vs 20.7%; p < 0.001), being currently on medication (49.4% vs 14.7%; p < 0.001), using pain relief medication almost every day (9.0% vs 1.9%; p < 0.001), experiencing sickness absence (15.7% vs 1.1%; p < 0.001), seeking medical specialist consultations (odds ratio, OR 2.2; 95% CI: 2.0–2.3; p < 0.001), and seeking alternative medications (OR 2.5; 95% CI: 2.3–2.7; p < 0.001).

Conclusions

Musculoskeletal disorders affected almost half of the RNs in Thailand annually. They placed a major healthcare burden and were a major cause of working days lost due to sick leaves, diminished productivity and quality of patient care. More attention should be paid to the prevention and effective management of MSDs in RNs in Thailand. Further study on ergonomics related to MSDs and its prevention are needed.

Determinants of prevalence, awareness, treatment and control of high LDL-C in Turkey

Objective:

High blood cholesterol is one of the main modifiable risk factors for cardiovascular diseases (CVDs). The aim of the study is to determine the factors associated with the prevalence, awareness, treatment, and control of high “low-density lipoprotein-cholesterol” (LDL-C) among adults aged ≥20 years in Turkey.

Methods:

We used data from Chronic Diseases and Risk Factors Survey conducted in 2011–2012. The presence of high LDL-C, lipid-lowering treatment eligibility, and achievement of target LDL-C were defined according to the third Adult Treatment Panel guidelines on treatment of high cholesterol. Multivariate logistic regression analyses were performed to determine the associations between participant characteristics and high LDL-C prevalence, awareness, treatment, and control.

Results:

Framingham risk score categorization was performed for 13121 individuals aged ≥20 years. Approximately, 28% of the participants presented with high LDL-C. Among those with high LDL-C, 55.8% were aware of their situation; among those aware of high LDL-C, 46.9% were receiving lipid-lowering medication, and 50.6% of individuals who were receiving treatment achieved target LDL-C levels on the basis of their coronary heart disease (CHD) risk. Control of high LDL-C was negatively associated with the presence of diabetes mellitus (odds ratio: 0.36, 95% CI: 0.27–0.49, p<0.001).

Conclusion:

Despite the high awareness rates, there was a high proportion of adults who did not receive treatment or achieve recommended levels of LDL-C during treatment. The low treatment and control levels among individuals based on their CHD risk levels call for a better application of recommendations regarding personal preventive measures and treatments in Turkey.

Prevalence of plasma small dense LDL is increased in obesity in a Thai population

BACKGROUND

Plasma low density lipoprotein (LDL) particles vary in size, density, electrical charge and chemical composition. An increased presence of small dense LDL (sdLDL), along with raised triglyceride concentrations and decreased high density lipoprotein (HDL) cholesterol concentrations is commonly known as the atherogenic triad and has been observed in some cases of obesity, principally in Europe and America. This study examines the prevalence of sdLDL in the plasma of an obese (BMI≥25 kg/m2) Thai population.

METHODS

Plasma from fasted obese (n=48) and non-obese (n=16) Thai participants was subjected to density gradient ultracentrifugation in iodixanol to separate lipoproteins. Gradients were unloaded top-to-bottom into 20 fractions which were assayed for cholesterol, triglyceride, apo B and apo A-1 to identify lipoprotein types and subtypes.

RESULTS

LDL cholesterol was subfractionated into LDL I+II (fractions 3-6, ρ=1.021-1.033 g/ml) which was considered to represent large buoyant LDL (lbLDL), LDL III (fractions 7-9, ρ=1.036-1.039 g/ml) which was considered to represent sdLDL, and, LDL IV (fractions 10-12, ρ=1.044-1.051 g/ml) which was considered to represent very sdLDL. Concentrations of LDL III and IV were increased by 15-20% in obese participants whilst that of LDL I+II was concomitantly decreased by 10%. This was accompanied by a 50% increase in plasma triglyceride concentrations and 15% decrease in HDL cholesterol concentrations. Only 3/16 (19%) non-obese participants had a pattern B LDL cholesterol profile (peak density of >1.033 g/ml), whilst 28/48 (58%) obese participants were pattern B. When expressed as a fraction of the LDL concentration, total sdLDL (i.e. LDL III+IV) showed highly significant correlations to plasma triglyceride concentrations and the triglyceride/HDL cholesterol ratio.

CONCLUSIONS

The prevalence of sdLDL is increased in obesity in a Thai population such that they demonstrate a similar atherogenic triad to that previously observed in European and American populations.

Serum cholesterol reduction efficacy of biscuits with added plant stanol ester

This study's aim was to test the low-density lipoprotein cholesterol- (LDL-c-) lowering efficacy of biscuits containing 2 g of plant stanols, which corresponded to 3.4 g of plant stanol esters. The biscuit is a new food format that can be consumed as a snack. In a double-blind, placebo-controlled parallel design study, 119 mildly to moderately hypercholesterolemic volunteers were randomized to plant stanol or control groups. Subjects were comparable in age, gender, lipid profiles, and body mass index. They consumed a control biscuit once a day for a two-week period, followed by a four-week intervention period that either had a plant stanol ester biscuit or a control. During the habitual diet, one biscuit per day was consumed at any time that subjects wished. Serum lipid profiles were measured at the first day of run-in, at baseline, and at the study's end. Compared to the control, the total cholesterol (TC), LDL-c, and the LDL-to-high-density lipoprotein (LDL/HDL) ratio had serum reductions of 4.9%, 6.1%, and 4.3%, respectively, and were observed after 4 weeks of biscuit consumption with added plant stanols (P < 0.05). A significantly higher reduction in LDL-c (8.9%) and LDL/HDL ratio (11.4%) was measured in those taking a plant stanol biscuit with a meal compared to those who consumed a plant stanol biscuit without other food. In conclusion, incorporating plant stanols into a biscuit is an attractive, convenient, and acceptable way to modestly lower elevated cholesterol concentrations. For optimal efficacy, biscuits should be consumed with a meal as part of a healthy diet.

Characterization of lipid parameters in diabetic and non-diabetic atherosclerotic patients

Background & Objective

The relationship between lipid profile perturbation and diabetes associated complications has long been an area of interest. Dyslipidemia is a potent predictor of cardiovascular morbidity and mortality in diabetic patients. The aim of present study was to investigate relationship between aging and lipid profiles in diabetic and non-diabetic atherosclerotic patients.

Methods

Five hundred and seventy six individuals (45–75 year age) participated in this study. Among these, 192 were having history of diabetes mellitus and atherosclerosis. Individuals are categorized on the base of health (normal, non-diabetic atherosclerosis, diabetic atherosclerosis) and age (45–55 years, 56–65 years, and 66–75 years). All the participants were subjected to the procedures like a detailed history, biochemical analysis for fasting blood sugar, hemoglobin A1c, total cholesterol (TC), triglycerides (TG), low-density lipoprotein-(LDL), very low-density lipoprotein (VLDL) and high-density lipoprotein (HDL). All these parameters were compared between diabetic and non-diabetic atherosclerotic patients of all three age groups. TC/HDL and LDL/HDL were also calculated.

Results

Diabetic atherosclerotic individuals (both males and females) had high level of TC, TG, LDL, VLDL and low level of HDL in comparison to non-diabetic atherosclerotic and normal control individuals. Among all three age groups, lipoprotein abnormality was observed to be more frequent in females than males. There was a significant increase in TC/HDL and LDL/HDL ratio in diabetic atherosclerotic subjects compared to age and sex matched non-diabetic atherosclerotic and normal control.

Conclusions

Degree of dyslipidemia increases with increase in age in both genders. Female are more prone to diabetic dyslipidemia and hence have more risk of developing atherosclerosis with increasing age.

The intake of energy and selected nutrients by thai urban sedentary workers: an evaluation of adherence to dietary recommendations

Rapid changes in Thailand's nutrition and lifestyles have led to increasing diet-related pathologies among people with sedentary occupations. This study examines the extent to which the dietary intake of nutrients and energy by a sample of Thai sedentary workers conforms to the Thai Dietary Reference Intakes (Thai DRIs). The nutrients and energy intake estimates were based on self-reported information collected with a single 24-hour dietary recall and nonweighed 2-day food record. The study participants were Thai adults aged 20-50 years employed in sedentary occupations. A convenience sample of 215 healthy individuals (75 males and 140 females) was based on four randomly selected worksites in the Bangkok metropolitan area. For male participants, the study found a median energy intake of 1,485 kcal/day, with 54.4% of energy coming from carbohydrate, 15.9% from protein, and 29.6% from fat. Females' median energy intake was 1,428 kcal/day, 56% of which came from carbohydrate, 16.2% from protein, and 28.6% from fat. Both genders showed insufficient intake of fiber and most micronutrients. This study provides the material for preventive public health interventions focusing on nutrition-related diseases affecting Thailand's rapidly growing sedentary workforce.