Effect of Change in Total Cholesterol Levels on Cardiovascular Disease Among Young Adults

Role of Thymoquinone on sleep restriction and its mitigating effect on leptin-mediated signaling pathway in rat brain

BACKGROUND

Sleep and stress interact bidirectionally by acting on brain circuits that affect metabolism. Sleep and its alterations have impact on blood leptin levels, metabolic hormone that regulates appetite. Brain expresses the receptors for the peptide hormone leptin produced from adipocytes. The hypothalamic orexin neurons are low during sleep and active when awake, influenced by a complex interaction with leptin. Thymoquinone was found to be the major bioactive component of Nigella sativa. The aim of this study was to study the role of thymoquinone on sleep restriction and its mitigating effect on leptin-mediated signaling pathway in rat brain.

METHODS AND RESULTS

30 adult male Wistar rats were divided into 5 groups with 6 animals in each group: Control; Thymoquinone (TQ); Corn oil; Chronic Sleep restriction (CSR); and CSR + TQ. After 30 days, behavioral analysis, antioxidant, lipid profile, glucose level, liver and kidney function test, neurotransmitters, neuropeptides, and mRNA expression in in vivo studies were also assessed and pharmacokinetic and docking were done for thymoquinone. Thymoquinone has also shown good binding affinity to the target proteins. CSR has induced oxidative stress in the discrete brain regions and plasma. Current study has shown many evidences that sleep restriction has altered the neurobehavioral, antioxidant status, lipid profile, neurotransmitters, neuropeptide levels, and feeding behavior which damage the Orexin-leptin system which regulates the sleep and feeding that leads to metabolic dysfunction.

CONCLUSION

The potentiality of Thymoquinone was revealed in in silico studies, and its action in in vivo studies has proved its effectiveness. The study concludes that Thymoquinone has exhibited its effect by diminishing the metabolic dysfunction by its neuroprotective, antioxidant, and hypolipidemic properties.

Time-domain heart rate dynamics in the prognosis of progressive atherosclerosis

BACKGROUND AND AIM

The regular uptake of a high-fat diet (HFD) with changing lifestyle causes atherosclerosis leading to cardiovascular diseases and autonomic dysfunction. Therefore, the current study aimed to investigate the correlation of autonomic activity to lipid and atherosclerosis markers. Further, the study proposes a support vector machine (SVM) based model in the prediction of atherosclerosis severity.

METHODS AND RESULTS

The Lead-II electrocardiogram and blood markers were measured from both the control and the experiment subjects each week for nine consecutive weeks. The time-domain heart rate variability (HRV) parameters were derived, and the significance level was tested using a one-way Analysis of Variance. The correlation analysis was performed to determine the relation between autonomic parameters and lipid and atherosclerosis markers. The statistically significant time-domain values were used as features of the SVM. The observed results demonstrated the reduced time domain HRV parameters with the increase in lipid and atherosclerosis index markers with the progressive atherosclerosis severity. The correlation analysis revealed a negative association between time-domain HRV parameters with lipid and atherosclerosis parameters. The percentage accuracy increases from 86.58% to 98.71% with the increase in atherosclerosis severity with regular consumption of HFD.

CONCLUSIONS

Atherosclerosis causes autonomic dysfunction with reduced HRV. The negative correlation between autonomic parameters and lipid profile and atherosclerosis indexes marker revealed the potential role of vagal activity in the prognosis of atherosclerosis progression. The support vector machine presented a respectable accuracy in the prediction of atherosclerosis severity from the control group.

Nutrient utilization, growth performance, and antioxidative status of Barki lambs fed diets supplemented with black (Nigella sativa) and rocket (Eruca sativa) seeds

The current study aimed to determine the polyphenol compounds in Nigella sativa (NS) and Eruca sativa (ES) seeds, and evaluate the impact of their addition either as a sole additive or in combination on the growth performance, digestibility, some rumen and blood parameters and antioxidative status of Barki lambs. Forty-eight male lambs (27.18 ± 0.22 kg, 5-6 months), were divided into 4 balanced groups. The experimental diets were randomly distributed to the control group (CON); fed alfalfa hay plus concentrate feed mixture at a ratio of 30:70% without additives, while, NSD, ESD, and NESD groups: fed CON diet plus 2% NS, 2% ES or 1% NS + 1% ES, respectively as a ratio from total mixed ration (TMR). Results indicated that rutin and catechin were the most phenolic compounds observed either in NS or ES seeds. The NS and ES-supplemented groups recorded the highest (P < 0.05) values for dry matter digestibility, nutritive values, average daily gain, and the best feed conversion ratio. However, growth performance, nutritive value, and all nutrient digestibility except for dry matter were not significantly altered with the NESD group. Concentrations of ruminal NH3-N and TVFA were significantly (P < 0.05) reduced with the NESD group, with no significant differences in pH values among different groups. Values of blood parameters showed significant increases in WBCs, PCV, and T-AOC, and decreases in cholesterol, triglycerides, and MDA with the addition of NS and ES seeds or both. Therefore, the addition of NS and ES seeds is recommended to improve lambs' health and antioxidant status.

Mendelian randomization study of whole blood viscosity and cardiovascular diseases

AIMS

Association between whole blood viscosity (WBV) and an increased risk of cardiovascular disease (CVD) has been reported. However, the causal relationship between WBV and CVD remains not thoroughly investigated. The aim of this study was to investigate the causal relation between WBV and CVD.

METHODS

Two-sample Mendelian randomization (MR) was employed, with inverse variance weighting (IVW) as the primary method, to investigate the casual relationship between WBV and CVD. The calculated WBV and medical records of 378,210 individuals participating in the UK Biobank study were divided into halves and analyzed.

RESULTS

The means of calculated WBVs were 16.9 (standard deviation: 0.8) and 55.1 (standard deviation: 17.2) for high shear rate (HSR) and low shear rate (LSR), respectively. 37,859 (10.0%) major cardiovascular events (MACE) consisted of 23,894 (6.3%) cases of myocardial infarction (MI), 9,245 (2.4%) cases of ischemic stroke, 10,377 (2.7%) cases of revascularization, and 5,703 (1.5%) cases of coronary heart disease-related death. In the MR analysis, no evidence was found indicating a causal effect of WBV on MACE (IVW p-value for HSR = 0.81, IVW p-value for LSR = 0.47), MI (0.92, 0.83), ischemic stroke (0.52, 0.74), revascularization (0.71, 0.54), and coronary heart disease-related death (0.83, 0.70). The lack of sufficient evidence for causality persisted in other MR methods, including weighted median and MR-egger.

CONCLUSIONS

The Mendelian randomization analysis conducted in this study does not support a causal relationship between calculated WBV and CVD.

Eight weeks of daily cottonseed oil intake attenuates postprandial angiopoietin-like proteins 3 and 4 responses compared to olive oil in adults with hypercholesterolemia: A secondary analysis of a randomized clinical trial

Angiopoietin-like proteins (ANGPTLs) -3, -4, and -8 are regulators of lipid metabolism and have been shown to respond to changes in dietary fats. It is unknown how ANGPTLs respond to cottonseed oil (CSO) and olive oil (OO) consumption in a population with hypercholesterolemia. The purpose of this study was to determine the impact of CSO vs. OO consumption on fasting and postprandial ANGPTL responses in adults with hypercholesterolemia. We hypothesized that CSO would have lower fasting and postprandial ANGPTL responses compared with OO. Forty-two adults with high cholesterol completed a single-blind, randomized trial comparing CSO (n = 21) vs. OO (n = 21) diet enrichment. An 8-week partial outpatient feeding intervention provided ∼60% of the volunteers' total energy expenditure (∼30% of total energy expenditure as CSO or OO). The remaining 40% was not controlled. Fasting blood draws were taken at pre-, mid-, and postintervention visits. Volunteers consumed a high saturated fat meal followed by 5 hours of blood draws pre- and postvisits. Fasting ANGPTL3 had a marginally significant treatment by visit interaction (P = .06) showing an increase from pre- to postintervention in CSO vs. OO (CSO: 385.1 ± 27.7 to 440.3 ± 33.9 ng/mL; OO: 468.2 ± 38.3 to 449.2 ± 49.5 ng/mL). Both postprandial ANGPTL3 (P = .02) and ANGPTL4 (P < .01) had treatment by visit interactions suggesting increases from pre- to postintervention in OO vs. CSO with no differences between groups in ANGPTL8. These data show a worsening (increase) of postprandial ANGPTLs after the OO, but not CSO, intervention. This aligns with previously reported data in which postprandial triglycerides were protected from increases compared with OO. ANGPTLs may mediate protective effects of CSO consumption on lipid control. This trial was registered at clinicaltrials.gov (NCT04397055).

Effects of diets containing fish oils or fish oil concentrates with high cetoleic acid content on the circulating cholesterol concentration in rodents. A systematic review and meta-analysis

Hypercholesterolaemia is a major risk factor for CVD. Fish intake is associated with lower risk of CVD, whereas supplementation with n-3 long-chain PUFA (LC-PUFA) has little effect on the cholesterol concentration. We therefore investigated if cetoleic acid (CA), a long-chain MUFA (LC-MUFA) found especially in pelagic fish species, could lower the circulating total cholesterol (TC) concentration in rodents. A systematic literature search was performed using the databases PubMed, Web of Science and Embase, structured around the population (rodents), intervention (CA-rich fish oils or concentrates), comparator (diets not containing CA) and the primary outcome (circulating TC). Articles were assessed for risk of bias using the SYRCLE's tool. A meta-analysis was conducted in Review Manager v. 5.4.1 (the Cochrane Collaboration) to determine the effectiveness of consuming diets containing CA-rich fish oils or concentrates on the circulating TC concentration. Twelve articles were included in the systematic review and meta-analysis, with data from 288 rodents. Consumption of CA-rich fish oils and concentrates resulted in a significantly lower circulating TC concentration relative to comparator groups (mean difference -0·65 mmol/l, 95 % CI (-0·93, -0·37), P < 0·00001), with high statistical heterogeneity (I2 = 87 %). The risk of bias is unclear since few of the entries in the SYRCLE's tool were addressed. To conclude, intake of CA-rich fish oils and concentrates prevents high cholesterol concentration in rodents and should be further investigated as functional dietary ingredients or supplements to reduce the risk for developing CVD in humans.

Advances in Mass Spectrometry-Based Blood Metabolomics Profiling for Non-Cancer Diseases: A Comprehensive Review

Blood metabolomics profiling using mass spectrometry has emerged as a powerful approach for investigating non-cancer diseases and understanding their underlying metabolic alterations. Blood, as a readily accessible physiological fluid, contains a diverse repertoire of metabolites derived from various physiological systems. Mass spectrometry offers a universal and precise analytical platform for the comprehensive analysis of blood metabolites, encompassing proteins, lipids, peptides, glycans, and immunoglobulins. In this comprehensive review, we present an overview of the research landscape in mass spectrometry-based blood metabolomics profiling. While the field of metabolomics research is primarily focused on cancer, this review specifically highlights studies related to non-cancer diseases, aiming to bring attention to valuable research that often remains overshadowed. Employing natural language processing methods, we processed 507 articles to provide insights into the application of metabolomic studies for specific diseases and physiological systems. The review encompasses a wide range of non-cancer diseases, with emphasis on cardiovascular disease, reproductive disease, diabetes, inflammation, and immunodeficiency states. By analyzing blood samples, researchers gain valuable insights into the metabolic perturbations associated with these diseases, potentially leading to the identification of novel biomarkers and the development of personalized therapeutic approaches. Furthermore, we provide a comprehensive overview of various mass spectrometry approaches utilized in blood metabolomics research, including GC-MS, LC-MS, and others discussing their advantages and limitations. To enhance the scope, we propose including recent review articles supporting the applicability of GC×GC-MS for metabolomics-based studies. This addition will contribute to a more exhaustive understanding of the available analytical techniques. The Integration of mass spectrometry-based blood profiling into clinical practice holds promise for improving disease diagnosis, treatment monitoring, and patient outcomes. By unraveling the complex metabolic alterations associated with non-cancer diseases, researchers and healthcare professionals can pave the way for precision medicine and personalized therapeutic interventions. Continuous advancements in mass spectrometry technology and data analysis methods will further enhance the potential of blood metabolomics profiling in non-cancer diseases, facilitating its translation from the laboratory to routine clinical application.

Association of balance impairment with risk of incident cardiovascular diseases among older adults

BACKGROUND

Rapid decline in balance is a hallmark of aging, elevating the risk of falls and other age-related geriatric illnesses among older adults.

OBJECTIVE

Our aim was to assess whether impairment in balance function is associated with the risk of incident CVD in older adults.

DESIGN

Retrospective cohort analysis.

PARTICIPANTS

A total of 129,024 participants who had undergone health screening between 2002 and 2009 were derived from the National Health Insurance Service-Senior cohort.

MAIN MEASURES

Balance impairment was evaluated using the open-eyes one-leg standing (OLS) test. The association between balance impairment and incident CVD was analyzed using the Cox proportional hazards regression model. All participants were followed up with until either the date of the first incident of CVD, death, or 31 December 2019.

KEY RESULTS

Those with abnormal balance function (< 10 s in OLS test) had a higher risk of CVD (adjusted hazard ratio [aHR] 1.23, CI 1.16-1.31). The association was significant in both the obese and the non-obese, but it seemed to be more pronounced in the latter. Results were supported by sensitivity analyses that did not include cases of CVD development in the first 1, 2, or 3 years and that used a different criterion to define balance dysfunction (< 9 s in OLS test).

CONCLUSIONS

Older adults with balance impairment were found to have an increased risk of incident CVD. Patients with impaired balance function may be a high-risk population who require preventive managements against CVD.

Ambient particulate matter exposure and urologic cancer: a longitudinal nationwide cohort study

Increased particulate matter (PM) exposure is positively associated with increased incidence and mortality of many human malignancies. However, evidence of urologic cancer is limited. We aimed to evaluate the association between PM10 exposure and the relative risk of urologic cancer. This nationwide longitudinal cohort study included 231,997 participants who underwent a baseline health examination in 2008 from the National Health Information Database of Korea. The primary endpoint was newly diagnosed urologic cancer according to PM10 exposure. Of the total 231,99 participants, 50,677 developed urologic cancer during a median follow-up of 6.7 years. After controlling for confounding factors, participants in the high PM10 exposure group had a higher risk of kidney cancer (hazard ratio [HR] 1.111, 95% confidence interval [CI] 1.068-1.157) and prostate cancer (HR 1.083, 95% CI 1.058-1.109) than those in the low PM10 exposure group. However, in urothelial cell carcinoma, there was no significant increase in the HRs in the high PM10 exposure group. For kidney cancer, participants with the following characteristics were more susceptible: age < 65 years, female sex, decreased regular physical activity, current smoking, no diabetes, no hypertension, normal body mass index, and desirable total cholesterol level. For prostate cancer, participants with the following characteristics were more susceptible: decreased regular physical activity, current smoking, and no hypertension. High PM10 exposure is associated with an increased risk of overall urologic cancers, especially kidney and prostate cancer.

Dietary supplementation with honeycomb extracts positively improved egg nutritional and flavor quality, serum antioxidant and immune functions of laying ducks

Introduction

Honeycomb is a traditional natural health medicine and has antioxidant, antibacterial, anti-inflammatory, antiviral and antitumor activities. It is currently unclear whether honeycomb extract supplementation has positive effects on the intensive farming laying duck production. This study aims to evaluate the effects of honeycomb extracts on the laying performance, egg nutritional and flavor quality, serum biochemical indexes, and antioxidant and immune status in laying ducks.

Methods

A total of 672 healthy 28-week-old Shanma laying ducks with similar laying performance and body weight were randomly distributed into four dietary treatments with 6 replicates of 28 birds. The birds in each treatment were fed the basal diet supplemented with 0 (control group), 0.5, 1.0 or 1.5 g/kg honeycomb extracts, respectively. Feed and water were provided ad libitum for 45 days. Laying performance, egg quality, egg nutrition and flavor quality, serum parameters were assessed.

Results

The results showed that compared with the control group, honeycomb extracts addition significantly increased the average daily feed intake but did not affect the other laying performance indexes, egg quality or serum biochemical indexes of laying ducks. Dietary supplementation with honeycomb extracts significantly increased crude protein content and decreased the contents of cholesterol and trimethylamine in eggs. Diets supplemented with 1.5 g/kg honeycomb extracts significantly improved egg total amino acids and flavor amino acids contents, monounsaturated fatty acids and polyunsaturated fatty acids composition and enhanced the serum antioxidant activity and immune functions of ducks.

Discussion

Duck eggs are rich in nutrients and a valuable source of high-quality food for human, while they are rarely consumed directly by consumers because of their stronger fishy odor and lower sensory quality. Many studies have showed that the influence of dietary supplementation on egg components. This study indicated that dietary supplementation with honeycomb extracts positively reduced the contents of egg cholesterol and trimethylamine, improve egg amino acids contents and fatty acid profiles, enhanced serum antioxidant and immune status of laying ducks. The recommended supplemental level of honeycomb extracts was 1.5 g/kg in the diet of laying ducks.

Remnant cholesterol, low-density lipoprotein cholesterol, and incident cardiovascular disease among Koreans: a national population-based study

AIMS

The synergistic association of remnant cholesterol (remnant-C) and low-density lipoprotein cholesterol (LDL-C) levels with incident cardiovascular disease (CVD) in various subgroups of Koreans was investigated.

METHODS AND RESULTS

Using the national health insurance data, we included subjects aged between 40 and 70 years without a history of CVD and at least two health screenings between 2009 and 2011. The subjects were divided into four groups by LDL-C and remnant-C levels. The primary outcome was CVD, which occurred between 2014 and 2017. Among 3 686 034 (45.6% women) subjects, 144 004 cardiovascular events occurred. Individuals in both high LDL-C and high remnant-C [hazard ratio (HR) 1.266, 95% confidence interval (CI) 1.243-1.289; 7.9%], high LDL-C only (HR 1.098, 95% CI 1.083-1.113; 21.2%), and high remnant-C only groups (HR 1.102, 95% CI 1.087-1.118; 19.1%) had higher risks of CVD than those in the reference group (LDL-C < 3.4 mmol/L and remnant-C < 0.8 mmol/L; 51.8%). A continuous and linear increase in CVD risk was found in those with higher remnant-C levels after adjustment for several confounders, including LDL-C levels. The association of remnant-C ≥ 0.8 mmol/L with an increased CVD risk was consistent across various strata.

CONCLUSIONS

Combined high remnant-C and LDL-C levels confer a higher CVD risk than that individually. Elevated remnant-C values independent of LDL-C levels were associated with a risk of incident CVD. Remnant cholesterol levels in addition to LDL-C levels are important considerations in risk stratification for the primary prevention of CVD.

How Do Minerals, Vitamins, and Intestinal Microbiota Affect the Development and Progression of Heart Disease in Adult and Pediatric Patients?

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, far ahead of cancer. Epidemiological data emphasize the participation of many risk factors that increase the incidence of CVDs, including genetic factors, age, and sex, but also lifestyle, mainly nutritional irregularities and, connected with them, overweight and obesity, as well as metabolic diseases. Despite the importance of cardiovascular problems in the whole society, the principles of prevention of CVDs are not widely disseminated, especially among the youngest. As a result, nutritional neglect, growing from childhood and adolescence, translates into the occurrence of numerous disease entities, including CVDs, in adult life. This review aimed to draw attention to the role of selected minerals and vitamins in health and the development and progression of CVDs in adults and children. Particular attention was paid to the effects of deficiency and toxicity of the analyzed compounds in the context of the cardiovascular system and to the role of intestinal microorganisms, which by interacting with nutrients, may contribute to the development of cardiovascular disorders. We hope this article will draw the attention of society and the medical community to emphasize promoting healthy eating and proper eating habits in children and adults, translating into increased awareness and a reduced risk of CVD.

Amino acid intake with protein food source and incident dyslipidemia in Korean adults from the Ansan and Ansung Study and the Health Examinee Study

Background

Dyslipidemia is a major risk factor for cardiovascular diseases and appropriate intake of amino acids may be helpful for the management of dyslipidemia. However, evidence of an association between amino acid intake and dyslipidemia in Korean adults is limited.

Objective

The purpose of this study was to investigate how the incidence of dyslipidemia in Korean adults is associated with the consumption of amino acids, essential and nonessential types, as well as the sources of these amino acids from food.

Methods

Data from 35,478 study participants without dyslipidemia at baseline from the Ansan and Ansung Study and the Health Examinee Study were used for the analysis. Dyslipidemia and its components such as hypertriglyceridemia, hypercholesterolemia, hyper-low-density lipoprotein (LDL) cholesterolemia and hypo-high-density lipoprotein (HDL) cholesterolemia were the main outcome in this study. The participants were categorized into quartiles, based on the intake of amino acids and plant-/animal-based proteins.

Results

On average, the follow-up period lasted for 5.7 years. The two major food groups that contributed to one-half of the intake for each type of amino acid were whole grain mixed rice and white rice. Compared to the lowest quartile group, the highest quartile groups of essential amino acid intake [men: hazard ratio (HR) = 0.78; 95% confidence interval (CI), 0.63-0.97; P for trend = 0.0088; women: HR = 0.86; 95% CI, 0.76-0.99; P for trend = 0.0201] and nonessential amino acid intake (men: HR = 0.75; 95% CI, 0.60-0.94; P for trend = 0.0069; women: HR = 0.81; 95% CI, 0.71-0.93; P for trend = 0.0024) had a decreased risk of dyslipidemia. Plant-based protein intake had a negative association and animal-based protein intake had a nonsignificant association with dyslipidemia after adjustment for energy-adjusted fat intake. Furthermore, the essential and nonessential amino acid intake showed stronger negative associations with dyslipidemia after further adjustment for energy-adjusted fat intake.

Conclusion

To conclude, the intake of amino acids may have a protective effect against dyslipidemia in Korean adults who are aged 40 years or older, regardless of their protein food sources.

Interactive effect of increased high sensitive C-reactive protein and dyslipidemia on cardiovascular diseases: a 12-year prospective cohort study

BACKGROUND

Dyslipidemia and inflammation are significant factors for the onset of cardiovascular diseases (CVD); however, studies regarding their interactions on the risk of CVD are scarce. This study aimed to assess the interaction of dyslipidemia and high-sensitivity C-reactive protein (hs-CRP) on CVD.

METHODS

This prospective cohort enrolled 4,128 adults at baseline in 2009 and followed them up until May 2022 for collecting CVD events. Cox-proportional hazard regression analysis estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) of the associations of increased hs-CRP (≥ 1 mg/L) and dyslipidemia with CVD. The additive interactions were explored using the relative excess risk of interaction (RERI) and the multiplicative interactions were assessed with HRs (95% CI) while the multiplicative interactions were assessed by the HRs (95% CI) of interaction terms.

RESULTS

The HRs of the association between increased hs-CRP and CVD were 1.42 (95% CI: 1.14-1.79) and 1.17 (95% CI: 0.89-1.53) among subjects with normal lipid levels and subjects with dyslipidemia, respectively. Stratified analyses by hs-CRP levels showed that among participants with normal hs-CRP (< 1 mg/L), TC ≥ 240 mg/dL, LDL-C ≥ 160 mg/dL, non-HDL-C ≥ 190 mg/dL, ApoB < 0.7 g/L, and LDL/HDL-C ≥ 2.02 were associated with CVD [HRs (95%CIs): 1.75 (1.21-2.54), 2.16 (1.37-3.41), 1.95 (1.29-2.97), 1.37 (1.01-1.67), and 1.30 (1.00-1.69), all P < 0.05, respectively]. While in the population with increased hs-CRP, only ApoAI > 2.10 g/L had a significant association with CVD [HR (95% CI): 1.69 (1.14-2.51)]. Interaction analyses showed that increased hs-CRP had multiplicative and additive interactions with LDL-C ≥ 160 mg/dL and non-HDL-C ≥ 190 mg/dL on the risk of CVD [HRs (95%CIs): 0.309 (0.153-0.621), and 0.505 (0.295-0.866); RERIs (95%CIs): -1.704 (-3.430-0.021 and - 0.694 (-1.476-0.089), respectively, all P < 0.05].

CONCLUSION

Overall our findings indicate negative interactions between abnormal blood lipid levels and hs-CRP on the risk of CVD. Further large-scale cohort studies with trajectories measurement of lipids and hs-CRP might verify our results as well explore the biological mechanism behind that interaction.

Marine Chitosan-Oligosaccharide Ameliorated Plasma Cholesterol in Hypercholesterolemic Hamsters by Modifying the Gut Microflora, Bile Acids, and Short-Chain Fatty Acids

This study evaluated the cholesterol-alleviating effect and underlying mechanisms of chitosan-oligosaccharide (COS) in hypercholesterolemic hamsters. Male hamsters (n = 24) were divided into three groups in a random fashion, and each group was fed one particular diet, namely a non-cholesterol diet (NCD), a high-cholesterol diet (HCD), and an HCD diet substituting 5% of the COS diet for six weeks. Subsequently, alterations in fecal bile acids (BAs), short-chain fatty acids (SCFAs), and gut microflora (GM) were investigated. COS intervention significantly reduced and increased the plasma total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) levels in hypercholesteremic hamsters. Furthermore, Non-HDL-C and total triacylglycerols (TG) levels were also reduced by COS supplementation. Additionally, COS could reduce and increase food intake and fecal SCFAs (acetate), respectively. Moreover, COS had beneficial effects on levels of BAs and GM related to cholesterol metabolism. This study provides novel evidence for the cholesterol-lowering activity of COS.

Association between Low-Density Lipoprotein Cholesterol and Vascular Biomarkers in Primary Prevention

Several noninvasive vascular biomarkers have been proposed to improve risk stratification for atherothrombotic events. To identify biomarkers suitable for detecting intermediate-risk individuals who might benefit from lipid-lowering treatment in primary prevention, the present study tested the association of plasma LDL-cholesterol with coronary artery calcification (CAC) Agatston score, high carotid and femoral intima-media thickness (IMT), low carotid distensibility and high carotid-femoral pulse-wave velocity in 260 asymptomatic individuals at intermediate cardiovascular risk and without diabetes and lipid-lowering treatment. High or low vascular biomarkers were considered when their value was above the 95th or below the 5th percentile, respectively, of the distribution in the healthy or in the study population. LDL-cholesterol was independently associated with the CAC score = 0 (OR 0.67; 95%CI 0.48-0.92, p = 0.01), CAC score > 100 (1.59; 1.08-2.39, p = 0.01) and high common femoral artery (CFA) IMT (1.89; 1.19-3.06, p < 0.01), but not with other biomarkers. Our data confirm that in individuals at intermediate risk, lipid-lowering treatment can be avoided in the presence of a CAC score = 0, while it should be used with a CAC score > 100. CFA IMT could represent a useful biomarker for decisions regarding lipid-lowering treatment. However, sex- and age-specific reference values should be established in a large healthy population.

Interaction of metabolism-related pathway gene variants with bisphenol A exposure on serum lipid profiles

Bisphenol A (BPA) can be metabolized by metabolic enzymes and may induce abnormal lipid metabolism. We hypothesized that BPA exposure and its interaction with metabolism-related genes might be associated with serum lipid profiles. We performed a two-stage study among 955 middle-aged and elderly participants in Wuhan, China. Urinary BPA level was estimated without (BPA, μg/L) or with (BPA/Cr, μg/g) adjustments for urinary creatinine and ln-transformed values (ln-BPA or ln-BPA/Cr) were used to normalize the asymmetrical distributions. A total of 412 metabolism-related gene variants were selected and used for gene-BPA interaction analysis. Multiple linear regression was used to analyze the interactions between BPA exposure and metabolism-related genes on serum lipid profiles. In the discovery stage, both ln-BPA and ln-BPA/Cr was associated with decreased high-density lipoprotein cholesterol (HDL-C). Gene-urinary BPA interaction for IGFBP7 rs9992658 was observed to associate with HDL-C levels in both discovery and validation stages, with P_interaction equal to 9.87×10^-4 (ln-BPA) and 1.22×10^-3 (ln-BPA/Cr) in combined analyses. In addition, the inverse association of urinary BPA with HDL-C levels was only observed among individuals carrying rs9992658 AA genotype, but not in individuals carrying rs9992658 AC or CC genotypes. The interaction between BPA exposure and metabolism-related gene IGFBP7 (rs9992658) was associated with HDL-C levels. AVAILABILITY OF DATA AND MATERIAL: Not applicable.

The Effects of HIIT vs. MICT and Sedentary Controls on Blood Lipid Concentrations in Nondiabetic Overweight and Obese Young Adults: A Meta-analysis

With rates of obesity and dyslipidemia rising among young adults, this meta-analysis aimed to compare the effects of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) and sedentary controls (CON) on low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and total cholesterol (TC) in nondiabetic overweight and obese young adults to determine if HIIT or MICT is more efficacious in improving dyslipidemia. Studies included in the analysis had to be randomized controlled trials or quasi-experimental studies, comparing the effects of HIIT versus MICT or CON on at least three variables of interest: LDL, HDL, TG, and TC, in nondiabetic adults, with body mass indexes (BMIs) above 25, and average ages between 18-30. The quality of the studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Eight studies fulfilled the selection criteria, with a mean PEDro quality score of 5.8. Compared to CON, HIIT significantly decreased the concentrations of LDL (-12.14 mg/dL, p = < 0.00001) and TC (-9.27 mg/dL, p = 0.003), without significantly affecting HDL or TG. Compared to MICT, HIIT significantly decreased the concentrations of LDL (-6.23 mg/dL, p = 0.05) and TC (-7.85 mg/dL, p = 0.02), without significantly affecting HDL or TG concentrations. HIIT is superior to MICT and CON in improving the concentrations of LDL and TC in our target population. As early management of dyslipidemia improves long-term health, we recommend clinicians consider HIIT training protocols for their nondiabetic overweight and obese young adult patients.

Secondary prevention and follow-up of patients with ACS and not-at-target LDL: An Italian real-world retro-prospective analysis by the inertia group

Background

In patients with recent ACS, the latest ESC/EAS guidelines for management of dyslipidaemia recommend intensification of LDL-C-lowering therapy.

Objective

Report a real-world picture of lipid-lowering therapy prescribed and cholesterol targets achieved in post-ACS patients before and after a specific educational program.

Methods

Retrospective data collection prior to the educational course and prospective data collection after the course of consecutive very high-risk patients with ACS admitted in 2020 in 13 Italian cardiology departments, and with a non-target LDL-C level at discharge.

Results

Data from 336 patients were included, 229 in the retrospective phase and 107 in the post-course prospective phase. At discharge, statins were prescribed in 98.1% of patients, alone in 62.3% of patients (65% of which at high doses) and in combination with ezetimibe in 35.8% of cases (52% at high doses). A significant reduction was obtained in total and LDL cholesterol (LDL-C) from discharge to the first control visit. Thirty-five percent of patients achieved a target LDL-C <55 mg/dL according to ESC 2019 guidelines. Fifty percent of patients achieved the <55 mg/dL target for LDL-C after a mean of 120 days from the ACS event.

Conclusions

Our analysis, though numerically and methodologically limited, suggests that management of cholesterolaemia and achievement of LDL-C targets are largely suboptimal and need significant improvement to comply with the lipid-lowering guidelines for very high CV risk patients. Earlier high intensity statin combination therapy should be encouraged in patients with high residual risk.

Changes in total cholesterol level and cardiovascular disease risk among type 2 diabetes patients

Despite many diabetic patients having hypercholesterolemia, the association of total cholesterol (TC) levels with CVD risk in type 2 diabetes (T2D) patients is unclear. Diagnosis of type 2 diabetes often leads to changes in total cholesterol (TC) levels. Thus, we examined whether changes in TC levels from pre- to post-diagnosis of T2D were associated with CVD risk. From the National Health Insurance Service Cohort, 23,821 individuals diagnosed with T2D from 2003 to 2012 were followed-up for non-fatal CVD incidence through 2015. Two measurements of TC, 2 years before and after T2D diagnosis, were classified into 3 levels (low, middle, high) to define changes in cholesterol levels. Cox proportional hazards regression was performed to estimate adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs) for the associations between changes in cholesterol levels and CVD risk. Subgroup analyses were performed by use of lipid-lowering drugs. Compared with low-low, aHR of CVD was 1.31 [1.10-1.56] for low-middle and 1.80 [1.15-2.83] for low-high. Compared with middle-middle, aHR of CVD was 1.10 [0.92-1.31] for middle-high but 0.83 [0.73-0.94] for middle-low. Compared with high-high, aHR of CVD was 0.68 [0.56-0.83] for high-middle and 0.65 [0.49-0.86] for high-low. The associations were observed regardless of use of lipid-lowering drugs. For diabetic patients, management of TC levels may be important to lower CVD risk.

Dyslipidemia in Muscular Dystrophy: A Systematic Review and Meta-Analysis

BACKGROUND

Muscular dystrophies (MDs) are characterized by chronic muscle wasting but also poorly understood metabolic co-morbidities. We have recently shown that Duchenne MD (DMD) patients, dogs and asymptomatic carriers are affected by a new form of dyslipidemia that may exacerbate muscle damage.

OBJECTIVE

We aimed to perform a systematic review and meta-analysis for evidence that other types of MDs are associated with dyslipidemia compared to healthy controls.

METHODS

Search was conducted using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials for reports that compare plasma/serum lipids from MD patients and controls, and meta-analysis of cross-sectional studies quantifying total cholesterol, high-density lipoprotein, low density lipoprotein and triglycerides was performed.

RESULTS

Out of 749 studies, 17 met our inclusion criteria for meta-analysis. 14 of the 17 studies (82% ) included investigated myotonic dystrophy (DM); other studies were on pseudohypertrophic MD (PMD) or DMD. As a whole, MD individuals had significantly higher levels of circulating total cholesterol (Hedges' g with 95% confidence interval [CI], 0.80 [0.03 - 1.56]; p = 0.04) and triglycerides (Hedges' g with 95% confidence interval [CI], 2.28[0.63 - 3.92]; p = 0.01) compared to controls. Meta-regression analysis showed the percentage of male gender was significantly associated with the difference in total cholesterol (beta = 0.05; 95% CI, - 0.02 to 0.11; p = 0.043) and high-density lipoprotein (beta = - 9.38; 95% CI, - 16.26 to - 2.50; p = 0.028).

CONCLUSIONS

MD is associated with significantly higher circulating levels of total cholesterol and triglycerides. However, caution on the interpretation of these findings is warranted and future longitudinal research is required to better understand this relationship.

Association of Multitrajectories of Lipid Indices With Premature Cardiovascular Disease: A Cohort Study

Background The multitrajectory model can identify joint longitudinal patterns of different lipids simultaneously, which might help better understand the heterogeneous risk of premature cardiovascular disease (CVD) and facilitate targeted prevention programs. This study aimed to investigate the associations between multitrajectories of lipids with premature CVD. Methods and Results The study enrolled 78 526 participants from the Kailuan study, a prospective cohort study in Tangshan, China. Five distinct multitrajectories of triglyceride, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol over 6-year exposure were identified on the basis of Nagin's criteria, using group-based multitrajectory modeling. During a median follow-up of 6.75 years (507 645.94 person-years), 665 (0.85%) premature CVDs occurred. After adjustment for confounders, the highest risk of premature CVD was observed in group 4 (the highest and increasing triglyceride, optimal and decreasing LDL-C, low and decreasing high-density lipoprotein cholesterol) (hazard ratio [HR], 2.13 [95% CI, 1.36-3.32]), followed by group 5 (high and decreasing triglyceride, optimal and increasing LDL-C, low and decreasing high-density lipoprotein cholesterol) (HR, 2.07 [95% CI, 1.45-2.98]), and group 3 (optimal and increasing triglyceride, borderline high and increasing LDL-C, optimal and decreasing high-density lipoprotein cholesterol) (HR, 1.90 [95% CI, 1.32-2.73]). Conclusions Our results showed that the residual risk of premature CVD caused by increasing triglyceride levels remained high despite the fact that LDL-C levels were optimal or declining over time. These findings emphasized the importance of assessing the joint longitudinal patterns of lipids and undertaking potential interventions on triglyceride lowering to reduce the residual risk of premature CVD, even among individuals with optimal LDL-C levels.

Identification of predictors for the comprehensive clinical risk and severity of coronary lesions of acute coronary syndrome

Background

Acute coronary syndrome (ACS) is the most common cause of death in patients with coronary artery disease. The aim of the study was to identify the predictors of both comprehensive clinical risk and severity of coronary lesions by comprehensive use of GRACE and SYNTAX scores in patients with ACS.

Methods

Clinical data of 225 ACS patients who underwent coronary angiography between 2015 and 2016 were collected. Multiple logistic regression analysis (stepwise) was used to identify the predictors. The predictive ability of predictors and the model were determined using receiver operating characteristics analyses.

Results

Multivariable logistic regression analyses showed that high aspartate aminotransferase (AST) predicted the comprehensive clinical risk with odds ratios (ORs) and 95% confidence intervals (CIs) of 1.011 (1.002–1.021). High total cholesterol (TC) and red blood cell distribution width (RDW) predicted the severity of coronary lesions with ORs and 95% CIs of 1.517 (1.148–2.004) and 1.556 (1.195–2.028), respectively. Low prealbumin predicted both severity of coronary lesions and comprehensive clinical risk of ACS patients with ORs and 95% CIs of 0.743 (0.672–0.821) and 0.836 (0.769–0.909), respectively. The model with a combination of prealbumin and AST had the highest predictive efficacy for comprehensive clinical risk, and the combination of prealbumin, TC, and RDW had the highest predictive efficacy for the severity of coronary lesions. The sensitivity and specificity, and the optimal cut-off values of these four indexes were determined.

Conclusions

Four predictors for the comprehensive clinical risk and severity of coronary lesions of ACS were identified, which provided important information for the early diagnosis and appropriate treatment of ACS.

Risk factors and inflammatory markers in acute coronary syndrome-ST elevation myocardial infarction (STEMI)

OBJECTIVES

The increasing prevalence of coronary artery disease [CAD] poses worrying statistics. Atherosclerosis of coronary vessels is the main culprit for the spectrum of CAD especially acute coronary syndrome. Atherosclerosis is regarded as a consequence of inflammatory changes in the coronaries. Our study aimed to assess the role of risk factors and inflammatory markers with acute ST-elevation myocardial infarction [STEMI].

METHODS

100 patients with ST-elevation Myocardial infarction [STEMI] and 100 age and sex matched controls were included in the study. A history of risk factors like smoking, hypertension, diabetes and hypertension was noted. A venous blood sample was obtained for analysis of inflammatory markers. The data thus obtained was statistically analyzed.

RESULTS

The cases had a significant number of risk factors such as smoking, hypertension, and diabetes mellitus, previous history of CAD, increased body mass index [BMI], and raised high sensitive C-reactive protein [hs-CRP]. Patients with anterior myocardial infarction were older and had hypertension and diabetes mellitus. Patients with inferior myocardial infarction had high BMI, raised erythrocyte sedimentation rate [ESR] and alcoholism. Smokers, patients with diabetes mellitus, high total cholesterol, Low-density lipoprotein [LDL] cholesterol, and hs-CRP were more prone to complications.

CONCLUSIONS

Patients with a greater number of risk factors and raised inflammatory markers were at high risk of STEMI and its complications. An approach to control the modifiable risk factors like obesity and lifestyle changes can reduce the disease burden.

Association between total cholesterol and total bone mineral density in US adults: National Health and Nutrition Examination Survey (NHANES), 2011-2018

BACKGROUND

Accumulated evidence indicates that cholesterol is offensive to bone metabolism. Therefore, we examined the real-world study among total cholesterol and total bone mineral density (BMD). We investigated the relationship between total cholesterol and total BMD among 10,039 US participants aged 20-59 years old over the period 2011-2018 from the NHANES.

METHODS

To analyze the relationship among total cholesterol and total BMD, multivariate linear regression models were used. Fitted smoothing curves, generalized additive models, and threshold effect analysis were also conducted.

RESULTS

After adjusting for additional covariates, weighted multivariable linear regression models indicated total cholesterol concentration levels exhibited a negative relationship with total BMD, particularly among participants aged 20-29 years. Concerning subgroup analysis, stratified by gender, race/ethnicity and age group, the negative correlation of total cholesterol with total BMD dwelled in both female and male as well as in whites and other races (including Hispanic and Multi-Racial), but not in non-Hispanic blacks and Mexican American. In other races, this relationship presented a nonlinear association (inflection point: 6.7 mmol/L) with a U-shaped curve. Among participants aged 40 to 49 years, this relationship also followed a nonlinear association (inflection point: 5.84 mmol/L), indicating a saturation effect. Moreover, the three types of diabetes status were found to have negative, U-shaped, and positive relationships. In participants with borderline diabetes status, the relationship of total cholesterol with total BMD was a U-shaped curve (inflection point: 4.65 mmol/L).

CONCLUSIONS

For US young adults (20-29 years old), our study revealed a negative relationship between total cholesterol and total BMD. This association followed a U-shaped curve (inflection point: 4.65 mmol/L) in borderline diabetes status participants, a saturation curve (inflection point: 5.84 mmol/L) in participants aged 40-49 years and a nonlinear curve (inflection point: 6.7 mmol/L) in other races (including Hispanic and Multi-Racial). Therefore, keeping total cholesterol concentration at a reasonable level for young adults and diabetic population might be an approach to prevent osteoporosis or osteopenia.

Effects of diets containing proteins from fish muscles or fish by-products on the circulating cholesterol concentration in rodents: a systematic review and meta-analysis

A high circulating cholesterol concentration is considered an important risk factor for the development of CVD. Since lean fish intake and fish protein supplementation have been associated with lower cholesterol concentration in some but not all clinical studies, the main aim of this study was to investigate the effect of diets containing proteins from fish muscles and fish by-products on the serum/plasma total cholesterol (TC) concentration in rodents. A systematic literature search was performed using the databases PubMed, Web of Science and Embase, structured around the population (rodents), intervention (type of fish and fraction, protein dose and duration), comparator (casein) and the primary outcome (circulating TC). Articles were assessed for risk of bias using the SYRCLE's tool. A meta-analysis was conducted in Review Manager v. 5·4·1 (the Cochrane Collaboration) to determine the effectiveness of proteins from fish on the circulating TC concentration. Thirty-nine articles were included in the systematic review and meta-analysis, with data from 935 rodents. The risk of bias is unclear since few of the entries in the SYRCLE's tool were addressed. Consumption of proteins from fish resulted in a significantly lower circulating TC concentration when compared with control groups (mean difference -0·24 mmol/l, 95 % CI - 0·34, -0·15, P < 0·00001), with high statistical heterogeneity (I² = 71 %). To conclude, proteins from fish muscles and by-products show promise as a functional dietary ingredient or supplement by preventing high cholesterol concentration in rodents, thus reducing one of the most important risk factors for developing CVD.

Higher Total Cholesterol Concentration May Be Associated with Better Cognitive Performance among Elderly Females

BACKGROUND

The brain contains the highest level of cholesterol in the body, and the total amount of serum cholesterol in the blood has a huge impact on brain aging and cognitive performance. However, the association of total serum cholesterol with cognitive function remains uncertain. This study determines whether there is an association between the total amount of cholesterol in the blood and cognitive performance in elderly females without a history of stroke.

METHODS

This population-based cross-sectional study was conducted on elderly (over 60 years old) females and males without a history of stroke from 2011 to 2014 in the US National Health and Nutrition Examination Survey (NHANES). The primary exposure was total blood cholesterol, and the main outcome was cognitive performance; this association was assessed with logistic regression analysis and restricted cubic splines.

RESULTS

1309 female and 1272 male participants were included. In females, higher total cholesterol was significantly associated with higher cognitive scores, particularly in the digit symbol substitution test (OR 0.51, 95% CI (0.36-0.72)) and the animal fluency test (OR 0.64, 95% CI (0.45-0.91)). This association remained significant in models adjusted for age, race, smoking status, education level, and chronic conditions (OR 0.40, 95% CI (0.25-0.63)). This association was not significant in males, however.

CONCLUSIONS

A higher concentration of total cholesterol measured in later life may be a protective factor for cognitive performance among females over 60 years old without a history of stroke. Further, this association was more pronounced among women with higher levels of education than women with lower or no education.

Metabolic Responses to Eight Weeks of Consuming Cottonseed Oil v. Olive Oil in Adults with Dyslipidemia, a Randomized Trial

BACKGROUND

Differences in metabolic responses between diets rich in monounsaturated (MUFA) and polyunsaturated fats (PUFA) could affect energy balance and weight maintenance. The present study was a secondary analysis to investigate 8-week diet interventions rich in either PUFA (cottonseed oil (CSO)) or MUFA (olive oil (OO)) on metabolic responses in adults with dyslipidemia.

METHODS

Forty-one adults with dyslipidemia completed this randomized trial consisting of an 8-week partial-outpatient feeding trial. Provided foods accounted for ~60% of their daily energy needs, with ~30% of energy needs provided by CSO (n=20) or OO (n=21). At pre- and post-diet intervention visits, participants consumed a high saturated fat (SFA) meal (35% daily energy needs, 47.9% from SFA), and fasting and 3.5h postprandial indirect calorimetry was used to measure energy expenditure (EE) and substrate oxidation.

RESULTS

No changes were observed in fasting measures. The OO group had greater increases in postprandial EE (p=0.002); however, there were no differences in substrate oxidation between groups. A lack of metabolic flexibility was found in both groups, which was partially explained by changes in insulin sensitivity (homeostasis model assessment of insulin resistance (HOMA-IR)).

CONCLUSIONS

The results of the present study show OO, but not CSO, diet enrichment improves EE following the occasional high SFA meal, which may improve weight maintenance over time. Registered at clinicaltrials.gov (NCT04397055). This article is protected by copyright. All rights reserved.

Effects of sleep deprivation on coronary heart disease

The presence of artificial light enables humans to be active 24 h a day. Many people across the globe live in a social culture that encourages staying up late to meet the demands of various activities, such as work and school. Sleep deprivation (SD) is a severe health problem in modern society. Meanwhile, as with cardiometabolic disease, there was an obvious tendency that coronary heart disease (CHD) to become a global epidemic chronic disease. Specifically, SD can significantly increase the morbidity and mortality of CHD. However, the underlying mechanisms responsible for the effects of SD on CHD are multilayered and complex. Inflammatory response, lipid metabolism, oxidative stress, and endothelial function all contribute to cardiovascular lesions. In this review, the effects of SD on CHD development are summarized, and SD-related pathogenesis of coronary artery lesions is discussed. In general, early assessment of SD played a vital role in preventing the harmful consequences of CHD.

Towards Multiplexed and Multimodal Biosensor Platforms in Real-Time Monitoring of Metabolic Disorders

Metabolic syndrome (MS) is a cluster of conditions that increases the probability of heart disease, stroke, and diabetes, and is very common worldwide. While the exact cause of MS has yet to be understood, there is evidence indicating the relationship between MS and the dysregulation of the immune system. The resultant biomarkers that are expressed in the process are gaining relevance in the early detection of related MS. However, sensing only a single analyte has its limitations because one analyte can be involved with various conditions. Thus, for MS, which generally results from the co-existence of multiple complications, a multi-analyte sensing platform is necessary for precise diagnosis. In this review, we summarize various types of biomarkers related to MS and the non-invasively accessible biofluids that are available for sensing. Then two types of widely used sensing platform, the electrochemical and optical, are discussed in terms of multimodal biosensing, figure-of-merit (FOM), sensitivity, and specificity for early diagnosis of MS. This provides a thorough insight into the current status of the available platforms and how the electrochemical and optical modalities can complement each other for a more reliable sensing platform for MS.

Cholesterol-Lowering Therapy in Patients at Low-to-Moderate Cardiovascular Risk

Elevated low-density lipoprotein cholesterol (LDL-C) is unanimously recognized as a major modifiable risk factor related to the development of atherosclerotic cardiovascular disease (ASCVD). Consistent evidence confirms that reducing LDL-C is associated with reduction of major adverse cardiovascular events (MACEs), with benefits proportionally related to initial individual CV risk and absolute reduction of LDL-C levels. The recent European guidelines on cardiovascular prevention have proposed a revised approach in cardiovascular risk evaluation, taking into account a renewed consideration of the interaction between risk factors and possible confounding factors (e.g., age). Although for patients considered to be at high and very high cardiovascular risk the need for stringent risk factors treatment is clearly stated, for those who are at low-to-moderate cardiovascular risk the issue is more debated. For those latter subjects, current guidelines indicate that risk factor treatment is generally not necessary, unless the impact of CV risk modifiers, lifetime CV risk and treatment benefit may be substantial. In addition, despite the estimated low-to-moderate short-term CV risk, the early appearance of even mild LDL-C level elevations may contribute to impair long-term CV prognosis. Therefore, encouraging the achievement of desired LDL-C goals through tailored conservative lifestyle changes and, if necessary, pharmacologic strategies should not be excluded categorically in all low-to-moderate risk individuals. In this review, we summarize the most recent evidence that may influence the choice to treat or not to treat LDL-C elevations in subjects at low-to-moderate risk and the suggested therapeutic tools aimed at achieving the recommended LDL-C goals.

Blood Lipid Responses to Diets Enriched with Cottonseed Oil Compared With Olive Oil in Adults with High Cholesterol in a Randomized Trial

BACKGROUND

Increasing unsaturated fat intake is beneficial for cardiovascular health, but the type of unsaturated fat to recommend remains equivocal.

OBJECTIVES

We investigated the effects of an 8-week diet intervention that was rich in either cottonseed oil (CSO; PUFA rich) or olive oil (OO; MUFA rich) on blood lipids in hypercholesterolemic adults.

METHODS

Forty-three men and women with hypercholesterolemia (53 ± 10 years; BMI, 27.6 ± 4.8 kg/m2) completed this randomized parallel clinical trial consisting of an 8-week partial outpatient feeding intervention. Participants were given meals and snacks accounting for ∼60% of their daily energy needs, with 30% of energy needs from either CSO (n = 21) or OO (n = 22). At pre- and postdiet intervention visits, participants consumed a high-SFA meal (35% of total energy needs; 70% of energy from fat). The primary outcomes of fasting cholesterol profiles and secondary outcomes of postprandial blood lipids and glycemic markers were assessed over a 5-hour period.

RESULTS

There were greater reductions from baseline to week 8 in fasting serum total cholesterol (TC; -17.0 ± 3.94 mg/dL compared with -2.18 ± 3.72 mg/dL, respectively; P = 0.008), LDL cholesterol (-19.7 ± 3.94 mg/dL compared with -5.72 ± 4.23 mg/dL, respectively; P = 0.018), non-HDL cholesterol (-20.8 mg/dL ± 4.00 compared with -6.61 ± 4.01 mg/dL, respectively; P = 0.014), and apoB (-11.8 mg/dL ± 2.37 compared with -3.10 ± 2.99 mg/dL, respectively; P = 0.05), in CSO compared with OO. There were also visit effects from baseline to week 8 for increases in HDL cholesterol (CSO, 56.5 ± 2.79 mg/dL to 60.2 ± 3.35 mg/dL, respectively; OO: 59.7 ± 2.63 mg/dL to 64.1 ± 2.24 mg/dL, respectively; P < 0.001), and decreases in the TC:HDL-cholesterol ratio (CSO, 4.30 ± 0.27 mg/dL to 3.78 ± 0.27 mg/dL, respectively; OO, 3.94 ± 0.16 mg/dL to 3.57 ± 0.11 mg/dL, respectively; P < 0.001), regardless of group assignment. In response to the high-SFA meal, there were differences in postprandial plasma glucose (P = 0.003) and triglyceride (P = 0.004) responses and a trend in nonesterified fatty acids (P = 0.11) between groups, showing protection in the postprandial state from an occasional high-SFA fat meal with CSO, but not OO, diet enrichment.

CONCLUSIONS

CSO, but not OO, diet enrichment caused substantial improvements in fasting and postprandial blood lipids and postprandial glycemia in hypercholesterolemic adults. This trial was registered at clinicaltrials.gov as NCT04397055.

Associations of total urinary arsenic with total cholesterol and high-density lipoprotein among 12-17-year-old participants from the 2009-2016 NHANES cycles: A cross-sectional study

INTRODUCTION

Hypertension and diabetes are highly prevalent among US adults. Arsenic exposure is associated with these cardiometabolic morbidities but the relationship between arsenic exposure and cholesterol markers of cardiometabolic disease has not been elucidated, especially at younger ages, when many chronic diseases may initiate. This study examined the association of total urinary arsenic with total cholesterol (TC) and high-density lipoprotein cholesterol (HDL) and explored effect modification by weight status.

METHODS

The study sample consisted of 12-17-year-old participants with complete data from the 2009-2016 National Health and Nutrition Examination Survey cycles. The cross-sectional associations of creatinine-adjusted total urinary arsenic with TC and HDL were assessed using multivariable linear regression models with survey weights. Three models were built, adjusting for varying combinations of age, gender, race/ethnicity, weight status, survey cycle, family income to poverty ratio, reference person education level, arsenobetaine, and dimethylarsinic acid (DMA). Model adjustments for arsenobetaine approximated inorganic arsenic exposure, and further adjustment for DMA approximated unmethylated inorganic arsenic exposure. We also explored weight status (underweight/healthy, overweight, and obese) as a potential effect modifier of these relationships using stratified analyses and interaction tests.

RESULTS

The final analytical sample consisted of 1,177 12-17-year-old participants. After adjusting for covariates and arsenobetaine, creatinine-adjusted arsenic was positively associated with HDL levels (β = 0.063; 95% CI: 0.007, 0.119). Upon further adjustment for DMA, creatinine-adjusted arsenic was positively associated with HDL levels (β = 0.079; 95% CI: 0.015, 0.143) and TC levels (β = 0.258; 95% CI: 0.002, 0.515). No effect modification by weight status was observed.

CONCLUSIONS

We found a positive association of approximated unmethylated inorganic arsenic exposure with TC, and contrary to our expectation, with HDL. There was no effect modification by weight status. Our findings should be confirmed by conducting longitudinal studies among adolescents exposed to low-level arsenic and focusing specifically on urinary inorganic arsenic concentrations.

Ideal Cardiovascular Health in Young Adults With Established Cardiovascular Diseases

There has been an increase in the prevalence of cardiovascular diseases among young adults in the United States that has been attributed, in part, to a rise in overweight and obesity, use of combustible tobacco and unhealthy diet and exercise patterns. These factors are influenced further by socioeconomic status and other social determinants of health. In the My Research Legacy study, we examined ideal cardiovascular health in young adults aged 18– <50 years with cardiovascular disease using the Life's Simple 7 survey and data from digital health devices. Young adults with cardiovascular disease (n = 349) were older, had a lower socioeconomic status, a higher prevalence of risk factors, and lower Life's Simple 7 Health Scores (6.4 ± 1.5 vs. 7.1 ± 1.5, p < 0.01) compared to young adults without cardiovascular disease (n = 696). Analysis of digital health device data revealed that young adults with cardiovascular disease performed a similar number of weekly minutes of moderate and vigorous exercise as those without disease leading to similar ideal activity scores. Young adults with cardiovascular disease also shared similarities in modifiable risk factors with adults aged ≥50 years with cardiovascular disease (n = 217), including weight, dietary habits, and weekly minutes of exercise. Latent class analysis identified two phenogroups of young adults with cardiovascular disease: phenogroup 1 was characterized by more advantageous cardiovascular health factors and behaviors resulting in higher Life's Simple 7 Health Scores than phenogroup 2 (7.4 ± 1.2 vs. 5.5 ± 1.1, p < 0.01). These findings in young adults with cardiovascular disease may inform the design of behavioral and therapeutic interventions in the future to decrease cardiovascular morbidity and mortality.

Changes in Impaired Fasting Glucose and Borderline High Low-Density Lipoprotein-Cholesterol Status Alter the Risk of Cardiovascular Disease: A 9-Year Prospective Cohort Study

BACKGROUND

We aimed to characterize the relationships of the changes in impaired fasting glucose (IFG) and borderline high low-density lipoprotein-cholesterol (LDL-C) status with cardiovascular disease (CVD).

METHODS

A total of 36,537 participants who did not have previous CVD, diabetes mellitus, or high LDL-C (≥ 4.1 mmol/L), nor were taking lipid-lowering drugs were recruited from the Kailuan study. The participants were allocated to six groups according to their baseline and follow-up fasting blood glucose (FBG) and LDL-C concentrations: (1) both were normal; (2) both normal at baseline, one abnormality subsequently; (3) both normal at baseline, both abnormal subsequently; (4) at least one abnormality that became normal; (5) at least one abnormality at baseline, a single abnormality subsequently; and (6) at least one abnormality, two abnormalities subsequently. The outcomes were CVD and subtypes of CVD (myocardial infarction and stroke). Multiple Cox regression models were used to calculate adjusted hazard ratio (HR) and confidence interval (95% CI).

RESULTS

During a median follow-up period of 9.00 years, 1,753 participants experienced a CVD event. After adjustment for covariates, participants with IFG in combination with a borderline high LDL-C status at baseline and follow-up had higher risks of CVD (HR: 1.52; 95% CI: 1.04-2.23 and HR: 1.38, 95% CI: 1.13-1.70, respectively) compared with those with normal fasting blood glucose and LDL-C. Compared with participants that remained normal, those who changed from normality to having two abnormalities were at a higher risk of CVD (HR: 1.26; 95% CI: 0.98-1.61), as were those who changed from at least one abnormality to two abnormalities (HR: 1.48, 95% CI: 1.02-2.15).

CONCLUSION

Changes in IFG and borderline high LDL-C status alter the risk of CVD and its subtype, implying that it is important to focus on such individuals for the prevention and control of CVD.

Effects of guar gum supplementation on the lipid profile: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Guar gum can be used as an adjuvant in the treatment of dyslipidemia. However, based on data from different studies, the effectiveness of this product is not uniform. Therefore, we conducted a dose-response meta-analysis between guar gum supplementation and lipid profile.

METHODS AND RESULTS

Five databases (Scopus, Web of Science, PubMed/Medline, Embase, and Google Scholar) were searched to identify relevant articles published up to July 2020. The weighted mean difference (WMD) was derived based on the random-effects model. Overall findings were generated from 25 eligible trials. Patients' conditions included hyperlipidemia, diabetes, metabolic syndrome, hypertension, overweight, carotid endarterectomy, and menopausal women. Prescribed gum dose varied between 100 mg/d and 30 g/d for 1-24 months. Compared with control groups, guar gum supplementation decreased total cholesterol (TC) by -20.41 mg/dL (95% CI: -26.76 to -14.07; P < 0.001) and low-density lipoprotein-cholesterol (LDL-C) by -17.37 mg/dL (95% CI: -23.60 to -11.13; P < 0.001), but did not change triglycerides (TG) (WMD: -6.53 mg/dL, 95% CI: -16.03 to 2.97; P = 0.178) and high-density lipoprotein-cholesterol (HDL-C) (WMD: -0.62 mg/dL, 95% CI: -1.68 to 0.44, P = 0.252).

CONCLUSIONS

Guar gum supplementation significantly reduced serum LDL-C and TC levels in patients with cardiometabolic problems, but had neutral effects on TG and HDL-C levels.

Two-Year Change in Serum Total Cholesterol Is Associated With Incident Ischemic Stroke: Results From the Kailuan Study

Background and Purpose: Compared with one single measurement, dynamic change of lipid parameter calculated by repeated measurements has been recognized as a potential biometric to make stroke risk assessments. Total cholesterol (TC) is an important risk factor for stroke, but the relationship between TC change and incident stroke has not been investigated thoroughly. We thus aimed to explore the association between 2-year TC change and the risk of incident stroke, both ischemic and hemorrhagic, in the general population. Methods: From June 2006 to October 2007, a total of 70,999 participants with complete TC value at baseline (2006-2007) and the second examination (2008-2009) were included in our study. The change of TC was calculated as the 2-year follow-up TC subtracting baseline TC. Cox proportional hazards regression analysis was used to evaluate the association between the tertile of TC change and risk of incident stroke and stroke subtypes. Results: A total of 2,815 cases of stroke events were identified with a median follow-up period of 9.0 years. After adjusting for baseline TC and confounding factors, 2-year TC change was independently associated with increased risk of total stroke (HR 1.07, 95% CI 1.02-1.12) and ischemic stroke (HR 1.08, 95% CI 1.03-1.13) per SD (1.04 mmol/L) increase, while no significant association was obtained between TC change and intracerebral hemorrhage (p = 0.659). Conclusions: Increased 2-year TC change is associated with an elevated risk of incident total stroke and ischemic stroke, irrespective of the baseline TC value. Maintaining a sustained ideal level of TC is important for stroke prevention.

The effect of guar gum consumption on the lipid profile in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

Dyslipidemia is a common encounter in type 2 diabetes mellitus (T2DM) and the current strategies to manage it are still suboptimal. Subsequently, identifying newer molecules with lipid-lowering effects is necessary. A great deal of attention has been given in recent years to fiber supplements, e.g., guar gum. Thus, we screened and evaluated the quality of the evidence regarding the benefits of guar gum supplementation in T2DM and conducted a meta-analysis to assess the effects of this compound on serum lipids in T2DM. We conducted a comprehensive search in PubMed/Medline, Web of Science, Scopus, Google Scholar and Embase, from the inception of these databases until January 2021. In total, 11 papers were included based on the eligible criteria in our meta-analysis. The meta-analysis of the eligible trials demonstrated a significant reduction of total cholesterol (TC) (WMD: -20.32 mg/dL, 95% CI: -27.02, -13.62, P < 0.001) and low-density lipoprotein cholesterol (LDL-C) (WMD: -14.52 mg/dL, 95% CI: -20.69, -8.35, P < 0.001) following guar gum supplementation in T2DM patients. The subgroup analysis based on the dosage (g/day) of this compound revealed that ≥20 g/day of guar gum led to a notable decrease in triglyceride (TG) levels (WMD: -12.55 mg/dL, 95% CI: -23.72, -1.37, P = 0.02) versus < 20 g/day (WMD: -1.84 mg/dL, 95% CI: -32.18, 28.49, P = 0.90). Guar gum supplementation had no effects on high-density lipoprotein cholesterol (HDL-C) (WMD: 0.66 mg/dL, 95% CI: -0.95, 2.28, P = 0.42). Guar gum consumption has lipid-lowering effects when administered to patients with type 2 diabetes mellitus and it is particularly able to reduce TC, LDL-C and TG levels. Further research is however needed to confirm our findings.

Age dependent association between remnant cholesterol and cardiovascular disease

Background and aims

High remnant cholesterol is associated with cardiovascular disease (CVD), but whether CVD risk attributable to remnant cholesterol vary between young and later adults remains unknown. The study aimed to assess age differences in the association between remnant cholesterol and CVD.

Methods

This prospective study included 95 663 participants without CVD and lipid-lowering treatment at baseline, including 16 254 young adults (age 18-39 years) and 79 409 later adults (age ≥40 years). Individuals were grouped by clinically meaningful remnant cholesterol concentrations of <0.50, 0.50-0.99, 1.00-1.49, and ≥1.50 mmol/L. Multivariable Cox regressions were performed to calculate hazard ratio (HR).

Results

During a median follow-up of 11.01 years, 164 incident CVD were identified in young adults, and 6081 cases in later adults. After multivariate adjustment, the association between remnant cholesterol and CVD was more pronounced in young adults than later adults (P for interaction=0.0019), the HR was 2.24 (95% confidence interval [CI], 1.45-3.47) for young individuals with remnant cholesterol ≥1.50 mmol/L, compared to individuals with remnant cholesterol <0.50 mmol/L, while the corresponding HR was 1.21 (95% CI, 1.13-1.29) for later adults. Furthermore, the population attributable risk percentage for remnant cholesterol < 1.50 vs ≥ 1.50 mmol/L was also higher in young (14.8%) than later adults (4.2%).

Conclusions

Despite a lower incidence risk of CVD among young adults compared later adults, the stronger association and greater attributable risk of remnant cholesterol among young adults highlight the importance of preventive efforts across the adult life course.

Possible mechanisms of cholesterol elevation aggravating COVID-19

Importance: Despite the availability of a vaccine against the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), humans will have to live with this virus and the after-effects of the coronavirus disease 2019 (COVID-19) infection for a long time. Cholesterol plays an important role in the infection and prognosis of SARS-CoV-2, and the study of its mechanism is of great significance not only for the treatment of COVID-19 but also for research on generic antiviral drugs. Observations: Cholesterol promotes the development of atherosclerosis by activating NLR family pyrin domain containing 3 (NLRP3), and the resulting inflammatory environment indirectly contributes to COVID-19 infection and subsequent deterioration. In in vitro studies, membrane cholesterol increased the number of viral entry sites on the host cell membrane and the number of angiotensin-converting enzyme 2 (ACE2) receptors in the membrane fusion site. Previous studies have shown that the fusion protein of the virus interacts with cholesterol, and the spike protein of SARS-CoV-2 also requires cholesterol to enter the host cells. Cholesterol in blood interacts with the spike protein to promote the entry of spike cells, wherein the scavenger receptor class B type 1 (SR-B1) plays an important role. Because of the cardiovascular protective effects of lipid-lowering therapy and the additional anti-inflammatory effects of lipid-lowering drugs, it is currently recommended to continue lipid-lowering therapy for patients with COVID-19, but the safety of extremely low LDL-C is questionable. Conclusions and Relevance: Cholesterol can indirectly increase the susceptibility of patients to SARS-CoV-2 and increase the risk of death from COVID-19, which are mediated by NLRP3 and atherosclerotic plaques, respectively. Cholesterol present in the host cell membrane, virus, and blood may also directly participate in the virus cell entry process, but the specific mechanism still needs further study. Patients with COVID-19 are recommended to continue lipid-lowering therapy.

Prognostic Value of Cardiovascular Testing in Asymptomatic Patients With a History of Cardiovascular Disease: A Review of Contemporary Medical Literature

The cardiac stress testing, carotid duplex, coronary artery calcium (CAC) scoring, myocardial perfusion imaging, coronary angiography, C-reactive protein (CRP), glycated hemoglobin (HbA1C), total serum cholesterol, duplex ultrasonography, digital subtraction angiography, magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography, and ankle-brachial index (ABI) independently predict the risks and prognostic outcomes in asymptomatic cardiovascular disease (CVD) patients. The peripheral artery disease (PAD) screening guides the diagnosis, management, and prognosis of hemodynamically significant arterial stenosis, calcification, and malignant hypertension in patients with CVD without symptoms. The 79% sensitivity and 96% specificity of ABI screening, 90% sensitivity and 97% specificity of MRA, and 95% sensitivity and 50% specificity of CTA for tracking arterial occlusion indicate the high prognostic value of these tests in the setting of CVD. The 85% specificity and 60-70% sensitivity of cardiac stress testing substantiate its suitability to determine asymptomatic CVD prognosis related to myocardial ischemia, heart failure, multivessel disease, and unstable angina. The carotid duplex ultrasound potentially identifies long-term mortality, stroke, atherosclerosis, plaque instability, and angiographic stenosis among asymptomatic CVD patients with 94% specificity and 90% sensitivity. The CAC scoring has a positive predictive value (PPV) of 45.7% for identifying aortic valve calcium and PPV of 79.3% for tracking thoracic artery calcium. The medical literature provides substantial evidence concerning the validity, reliability, and prognostic value of cardiovascular testing for asymptomatic patients. Future studies are needed to undertake detailed assessments of benefits versus adverse outcomes associated with the prospective scaling (of cardiovascular testing) across asymptomatic CVD patients.

Determining the effect size of aerobic exercise training on the standard lipid profile in sedentary adults with three or more metabolic syndrome factors: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVES

To estimate the change in the standard lipid profile (SLP) of adults diagnosed with ≥3 metabolic syndrome (MetS) factors following aerobic exercise training (AET); and to investigate whether study/intervention covariates are associated with this change.

DESIGN

Systematic review with univariate meta-analysis and meta-regression.

DATA SOURCES

English language searches of online databases from inception until July 2020. ELIGIBILITY CRITERIA: (1) Published randomised controlled human trials with study population ≥10 per group; (2) sedentary adults with ≥3 MetS factors but otherwise free of chronic disease, not pregnant/lactating; (3) AET-only intervention with duration ≥12 weeks; and (4) reporting pre-post intervention SLP outcomes.

RESULTS

Various univariate meta-analyses pooled 48 data sets of 2990 participants. Aerobic exercise training significantly (P<.001) improved all lipids (mmol/L mean difference ranges, 95% CIs): total cholesterol, -0.19 (-0.26 to -0.12) to -0.29 (-0.36 to -0.21); triglycerides, -0.17 (-0.19 to -0.14) to -0.18 (-0.24 to -0.13); high-density lipoprotein-cholesterol (HDL-C), 0.05 (0.03 to 0.07) to 0.10 (0.05 to 0.15); and low-density lipoprotein-cholesterol (LDL-C), -0.12 (-0.16 to -0.9) to -0.20 (-0.25 to -0.14). Meta-regression showed that intensity may explain change in triglycerides and volume may explain change in HDL-C and LDL-C.

CONCLUSION

Aerobic exercise training positively changes the SLP of sedentary and otherwise healthy adults with ≥3 MetS factors. Adjusting AET intervention training variables may increase the effects of AET on triglycerides and HDL-C.

PROSPERO REGISTRATION NUMBER

CRD42020151925.

Antiplatelet Effects of PCSK9 Inhibitors in Primary Hypercholesterolemia

Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a novel group of hypolipidemic drugs that are recommended particularly for high-risk hypercholesterolemia patients, including those with primary hypercholesterolemia (PH), where lifelong exposure to high low-density lipoprotein (LDL) cholesterol levels results in an elevated risk of atherosclerosis at an early age. The onset and progression of atherosclerosis is significantly influenced by activated platelets. Oxidized LDL influences platelet activation by interacting with their surface receptors and remodeling the composition of their cell membrane. This results in platelet aggregation, endothelial cell activation, promotion of inflammation and oxidative stress, and acceleration of lipid accumulation in atherosclerotic plaques. PCSK9 inhibitors reduce platelet activation by both significantly lowering LDL levels and reducing the LDL receptor-mediated activation of platelets by PCSK9. They also work synergistically with other hypolipidemic and antithrombotic drugs, including statins, ezetimibe, acetylsalicylic acid, clopidogrel, and ticagrelor, which enhances their antiplatelet and LDL-lowering effects. In this review, we summarize the currently available evidence on platelet hyperreactivity in PH, the effects of PCSK9 inhibitors on platelets, and their synergism with other drugs used in PH therapy.

Update on smoking. Alternatives for the management of patients with cardiovascular risk

Smoking is the leading cause of morbidity and mortality worldwide and is clearly involved as a cardiovascular risk factor. Smoking has different effects on the cardiovascular system, such as a decrease in nitric oxide, increased inflammatory response, increased adhesion of pro-atherogenic molecules, lipid disturbances, generation of oxidative stress and endothelial dysfunction as can be shown in different biomarkers modifications. Despite the aids currently available for smoking cessation, many smokers are unwilling or unable to achieve this. So alternative tools with potential harm reduction, such as non-combustion tobacco products, could be an option due to the better results they had shown on cardiovascular risk factors. This has led these devices to be taken into account as a risk-modifying tobacco product according to the FDA.

Apo A1/Apo B ratio and acute coronary syndrome among peritoneal dialysis patients

BACKGROUND

Acute coronary syndrome (ACS) is prevalent in continuous ambulatory peritoneal dialysis (CAPD) patients. However, the association between the apoprotein profile and ACS is not well known. Therefore, we aimed to investigate the relationship between apoproteins and ACS in CAPD patients.

METHODS

Eighty-one CAPD patients were included in this retrospective study. The primary endpoint was ACS. Predictors were baseline apoprotein levels, particularly the ratio of apoprotein A1 (Apo A1)/apoprotein B (Apo B). Cox regression was used to determine the relationship between Apo A1/Apo B and ACS.

RESULTS

During follow-up, 34 (41.98%) CAPD patients experienced an ACS. ACS patients had higher levels of total cholesterol (p = 0.03), low-density lipoprotein cholesterol (LDL-C) (p = 0.04), C-reactive protein (p = 0.01), and Apo B (p < 0.01). However, hemoglobin (p = 0.01) and Apo A1/Apo B (p < 0.01) were lower in the ACS group than the non-ACS group. Patients with Apo A1/Apo B ≥ 1.105 experienced fewer ACS compared with those with Apo A1/Apo B < 1.105 (33.33% vs. 75.56%, p = 0.03). In Cox regression, Apo A1/Apo B (RR, 0.06; 95% CI, 0.00-0.77; p = 0.03) was independently associated with ACS.

CONCLUSIONS

Apo A1/Apo B was strongly associated with ACS and may be considered as a predictor of future ACS in CAPD patients.

Vitamin D supplementation reduces serum lipids of children with hypertriacylglycerolemia: A randomized, triple-masked, placebo-controlled crossover trial

OBJECTIVES

This study aimed to evaluate the effect of cholecalciferol supplementation on the body composition and metabolic profile of children with hypertriacylglycerolemia.

METHODS

This is a randomized, triple-masked, placebo-controlled, crossover trial of 44 Brazilian children with hypertriacylglycerolemia, age 4 to 11 y. The sample included eutrophic and overweight/obese children according to body mass index for age, with sufficient and insufficient vitamin D basal levels. The intervention lasted 34 wk, with two periods of 12 wk each separated by a 10-wk washout. The two groups, supplemented and placebo, received five drops of cholecalciferol (equivalent to 1000 international unit/d) and five drops of sunflower oil, respectively, daily for 12 wk. Sociodemographic, economic, sunscreen use, percentage of body surface area daily exposed to sun, physical activity, anthropometry (body mass and height), body composition (waist circumference, body fat percentage, fat-free mass, triceps, and subscapular skinfolds), biochemical profile (25-hydroxyvitamin D, fasting glucose, and lipid fractions), blood pressure, and food intake data were collected.

RESULTS

Of the 44 children who concluded the study, 56.80% were female, 54.50% were of brown race, 81.82% had sufficient serum 25-hydroxyvitamin D (≥75 nmol/L), and 50.00% were overweight/obese according to body mass index for age. There was a reduction in serum total cholesterol (P < 0.001), low-density lipoprotein cholesterol (P < 0.001), nonhigh-density lipoprotein cholesterol (P < 0.001), total cholesterol/high-density lipoprotein cholesterol (P = 0.001), and low/high-density lipoprotein cholesterol ratios (P < 0.001) in the supplemented group compared with the placebo group.

CONCLUSIONS

Cholecalciferol supplementation improved the lipid profile of children with hypertriacylglycerolemia without altering body composition.

Association of baseline as well as change in lipid levels with the risk of cardiovascular diseases and all-cause deaths

High baseline atherogenic lipid level has been an established risk factor for the risk of cardiovascular events. Evidence concerning the role of lipid changes in cardiovascular and death risks are inconclusive. A cohort study was conducted based on the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (n = 4072, mean 44.8 years, 53.5% women) assessing lipid levels of the participants repeatedly measured in 2002 and 2007. Combined baseline and changes in lipid levels were classified into four groups-stable or decreasing lipid changes and increasing lipid changes with low- and high-risk baseline lipid levels. Developing cardiovascular events (n = 225) and all-cause deaths (n = 345) were ascertained during a median follow-up of 13.3 years. Participants with increasing and higher total cholesterol level were more likely to develop cardiovascular risks. Similar patterns for cardiovascular events were observed across other lipid profile changes. However, participants with increasing total cholesterol, LDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C) levels were more likely to be at a lower risk for all-cause deaths. Baseline and changes in total cholesterol, triglycerides, and LDL-C levels were positively associated with the risk of cardiovascular diseases, whereas baseline and changes in total cholesterol and LDL-C and non-HDL-C levels were inversely associated with all-cause deaths.

Prevalence, awareness, treatment, and control of dyslipidemia among diabetes mellitus patients and predictors of optimal dyslipidemia control: results from the Korea National Health and Nutrition Examination Survey

Background

This study aimed to investigate the prevalence, awareness, treatment, and control rates of dyslipidemia and identify the predictors of optimal control (low-density lipoprotein cholesterol < 100 mg/dL) among patients with diabetes mellitus (DM).

Methods

A cross-sectional study was conducted using the representative Korea National Health and Nutrition Examination Survey (2014–2018). Overall, 4311 patients with DM, aged ≥19 years, and without cardiovascular diseases were selected, and the prevalence, awareness, treatment, and control rates of dyslipidemia were calculated. Univariate and multivariate logistic regression analyses were conducted to evaluate the factors influencing the optimal control of dyslipidemia.

Results

Dyslipidemia was prevalent in 83.3% of patients with DM, but the awareness and treatment rates were 36.5 and 26.9%, respectively. The control rate among all patients with dyslipidemia was 18.8%, whereas it was 61.1% among those being treated. Prevalence and awareness rates were also significantly higher in women than in men. Dyslipidemia was most prevalent in those aged 19–39 years, but the rates of awareness, treatment, and control among all patients with dyslipidemia in this age group were significantly lower than those in other age groups. The predictors of optimal control were age ≥ 40 years [range 40–49 years: adjusted odds ratio (aOR) 3.73, 95% confidence interval (CI) 1.43–9.72; 50–59 years: aOR 6.25, 95% CI 2.50–15.65; 60–69 years: aOR 6.96, 95% CI 2.77–17.44; 70–79 years: aOR 9.21, 95% CI 3.58–23.74; and ≥ 80 years: aOR 4.43, 95% CI 1.60–12.27]; urban living (aOR 1.44, 95% CI 1.15–1.80); higher body mass index (aOR 1.27, 95% CI 1.13–1.42); lower glycated hemoglobin levels (aOR 0.71, 95% CI 0.67–0.76); hypertension (aOR 1.53, 95% CI 1.22–1.92); poorer self-rated health status (aOR 0.72, 95% CI 0.62–0.84); and receiving regular health check-ups (aOR 1.58, 95% CI 1.25–2.00).

Conclusions

Most patients with DM were diagnosed with dyslipidemia, but many were unaware of or untreated for their condition. Therefore, their control rate was suboptimal. Thus, by understanding factors influencing optimal control of dyslipidemia, physicians should make more effort to encourage patients to undergo treatment and thus, adequately control their dyslipidemia.

Rest-activity rhythms in emerging adults: implications for cardiometabolic health

Emerging adulthood (18-25 years) represents a window of opportunity to modify the trajectory of cardiometabolic disease risk into older adulthood. Not known is the extent to which rest-activity rhythms (RAR) may be related to biomarkers of cardiometabolic health in this population. In this cross-sectional, observational study, 52 healthy emerging adults wore wrist accelerometers (14 consecutive days; 24 h/day) for assessment of nonparametric RAR metrics, including interdaily stability (IS; day-to-day RAR consistency), intradaily variability (IV; within-day RAR fragmentation), and relative amplitude (RA; robustness of RAR), as well as autocorrelation (correlation of rest/activity levels at 24-h lag-times). Cardiometabolic biomarkers, including body mass index (BMI), body fat percentage, blood pressure (BP), fasting lipids, glucose, and C-reactive protein (CRP) were assessed. Additional measures including physical activity, sleep duration, and habitual caffeine and alcohol consumption were also evaluated. A series of multivariable regression models of cardiometabolic biomarkers were used to quantify associations with RAR metrics. On average, participants were 20 ± 1 years of age (21 males, 31 females), non-obese, and non-hypertensive. All were nonsmokers and free of major diseases or conditions. In separate models, which adjusted for sex, BMI, moderate-vigorous physical activity, sleep duration, caffeine, and alcohol consumption, IS was inversely associated with total cholesterol (p ≤ 0.01) and non-HDL cholesterol (p < .05), IV was positively associated with CRP (p < .05), and autocorrelation was inversely associated with total cholesterol (p < .05) and CRP (p < .05). Conversely, associations between RA and cardiometabolic biomarkers were nonsignificant after adjustment for BMI, alcohol, and caffeine consumption. In conclusion, RAR metrics, namely, a higher IS, lower IV, and higher autocorrelation, emerged as novel biomarkers associated with more favorable indices of cardiometabolic health in this sample of apparently healthy emerging adults.