Screening and socioeconomic associations of dyslipidemia in young adults

Association of co-exposure to organophosphate esters and per- and polyfluoroalkyl substances and mixture with cardiovascular-kidney-liver-metabolic biomarkers among Chinese adults

BACKGROUND

Organophosphate esters (OPEs) and Per- and polyfluoroalkyl substances (PFAS) are ubiquitous environmental contaminants with common exposure sources, leading to their widespread presence in human body. However, evidence on co-exposure to OPEs and PFAS and its impact on cardiovascular-kidney-liver-metabolic biomarkers remains limited.

METHODS

In this cross-sectional study, 467 adults were enrolled from January to May 2022 during physical visits in Shijiazhuang, Hebei province. Eleven types of OPEs and twelves types of PFAS were detected, among which eight OPEs and six PFAS contaminants were detected in more than 60% of plasma samples. Seventeen biomarkers were assessed to comprehensively evaluate the cardiovascular-kidney-liver-metabolic function. Multiple linear regression, multipollutant models with sparse partial least squares, and Bayesian kernel machine regression (BKMR) models were applied to examine the associations of individual OPEs and PFAS and their mixtures with organ function and metabolism, respectively.

RESULTS

Of the over 400 exposure-outcome associations tested when modelling, we observed robust results across three models that perfluorohexanoic acid (PFHxS) was significantly positively associated with alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and indirect bilirubin (IBIL). Perfluorononanoic acid was significantly associated with decreased AST/ALT and increased very-low-density lipoprotein cholesterol levels. Besides, perfluorodecanoic acid was correlated with increased high lipoprotein cholesterol and perfluoroundecanoic acid was consistently associated with lower glucose level. BKMR analysis showed that OPEs and PFAS mixtures were positively associated with IBIL and TBIL, among which PFHxS was the main toxic chemicals.

CONCLUSIONS

Our findings suggest that exposure to OPEs and PFAS, especially PFHxS and PFNA, may disrupt organ function and metabolism in the general population, providing insight into the potential pathophysiological mechanisms of OPEs and PFAS co-exposure and chronic diseases.

Association between oral contraceptives with lipid profile: results from Hoveyzeh cohort study (HCS)

BACKGROUND

Oral contraceptives (OCs) affect lipid metabolism, which can cause hyperlipidemia, a risk factor for cardiovascular diseases. The study was designed to evaluate the possible changes in lipid profile due to using OCs.

METHODS

A cross-sectional study was conducted from April 2016 to August 2018 among women from the baseline phase Hoveyzeh cohort study (HCS). Sociodemographic data, anthropometric measurements, physical activity, and biochemical blood tests were measured for every participant. Multiple logistic regression was used to adjust the potential confounders.

RESULTS

Among 2272 participants, 1549 women were OC users, and 723 women were non-user OCs. The mean lipid profile levels were higher in OC users than in non-user OCs. Odds of abnormal Total cholesterol (TC) in OC users were significantly higher than those of non-users OCs [OR = 1.29 (95% CI;1.05 to 1.58)]. Also, the Odds of abnormal low-density lipoprotein (LDL) in OC users was 12% higher than in non-user OCs. However, no significant relationship between abnormal LDL with Oral Contraceptive Pills (OCPs) was observed.

CONCLUSIONS

The mean lipid profile was higher in OC users compared to non-user OCs. This finding highlights the need for public health strategies to prevent and detect hyperlipidemia in user OCs.

Obesity-Status-Linked Affecting Factors of Dyslipidemia in Korean Young-Adult Men: Based on the Korea National Health and Nutrition Examination Survey (2019-2021)

In recent years, there has been a growing trend of obesity and dyslipidemia among young adult men in South Korea. Therefore, we aimed to identify the obesity-related factors of dyslipidemia among young adult men in Korea using 3-year data (2019-2021) from the 8th Korea National Health and Nutrition Examination Survey. We included 1559 eligible men aged 19-39 years and examined the association between dyslipidemia and participants' general characteristics, health-related characteristics, and food intake according to obesity status. Statistical analysis was performed using complex sample analysis with weighted household and individual data. The affecting factors of dyslipidemia included age, body image perception, stress, and waist circumference (WC) in the body mass index (BMI) < 25 kg/m² group and age and WC in the BMI ≥ 25 kg/m² group. To prevent and manage dyslipidemia in young adult men, interventions should be developed separately for the normal, underweight, and obese groups. Effective intervention requires measuring WC and focusing on body fat control. Moreover, regular screening of this population should be performed to ensure early diagnosis and management of dyslipidemia.

Acculturation and Cardiovascular Risk Screening among African Immigrants: The African Immigrant Health Study

Acculturation and immigration-related factors may impact preventive, routine cardiovascular risk (CV) screening among African immigrants. We examined the associations between length of stay, percent of life spent in the U.S. (proxy for acculturation), and CV screening. Outcomes were recent screening for hypertension, diabetes, and dyslipidemia. Multivariable logistic regression analyses were used to examine these relationships. Among 437 African immigrants, 60% were males, mean age was 47 years, 61% had lived in the U.S. for ≥10 years, mean length of stay was 15 years, and 81% were employed. Only 67% were insured. In the 12 months prior, 85% had screened for hypertension, 45% for diabetes, and 63% for dyslipidemia. African immigrants with a ≥10-year length of U.S. stay had 2.20 (95%Confidence Intervals: 1.31−3.67), and those with >25% years of life spent in the U.S. had 3.62 (95%CI: 1.96−6.68) higher odds of dyslipidemia screening compared to those with a <10-year length of stay and ≤25% years of life spent in the U.S., respectively. Overall, screening for CV risk higher in African immigrants who have lived longer (≥10 years) in the U.S. Recent African immigrants may experience challenges in accessing healthcare. Health policies targeting recent and uninsured African immigrants may improve access to CV screening services.

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

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

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

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

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

PREVALENCE OF TRADITIONAL CARDIOVASCULAR RISK FACTORS FOR CORONARY ARTERY DISEASE AND ELEVATED FIBRINOGEN AMONG ACTIVE MILITARY PERSONNEL IN REPUBLIC OF SERBIA: A CROSS-SECTIONAL STUDY

Background

It is well known that less than 1% of the population achieves ideal cardiovascular health, and 65% of patients do not have their conventional risk biomarkers under control. Military service has its own particularities that may contribute to cardiovascular risk.

Methods

To define the preventive strategy goals, we analysed the prevalence of traditional cardiovascular risk factors for coronary artery disease and elevated fibrinogen among active military personnel in the Republic of Serbia.

Results

The cross-sectional study included 738 individuals older than 20 years, mostly between 31 and 40 years old. The mean value of SBP for the whole group was 122.39± 9.42 mmHg, and for the DBP, it was 79.94±6.56 mmHg. Among active military personnel, 72.7% (533) had prehypertension, and 13.8% (101) was hypertensive. Both body mass and BMI index among the observed age subgroups were found to increase with the age of the patients and cholesterol values. HDL cholesterol values also differed statistically significantly between age subgroups, with the proportion of individuals with HDL less than 1.5 mmol/L in all subgroups being about 85%, the only in the 41-50 age group was lower, 76.4%. LDL cholesterol and the proportion of individuals who had LDL 3.5 increases with the age of patients, and an identical trend was recorded with triglycerides. With ageing, fibrinogen levels increased.

Conclusions

Those findings considering cardio and cerebrovascular risk factors would help create a new approach for primary prevention for these categories of individuals.

Changes in Cardiovascular Risk Factors in Residents of the Siberian Region (According to Epidemiological Studies)

Aim. To analyze prevalence of cardiovascular risk factors in the Kemerovo region based on the results of epidemiological studies (2013 and 2016).

Material and methods. The study was based on two large epidemiological studies of the Kemerovo region: on 2013, «The epidemiology of cardiovascular diseases and their risk factors in the Russian Federation» and on 2016, «The prospective study of urban and rural epidemiology: study of the influence of social factors on chronic non-infectious diseases in low, middle and high income countries». In the study we analyzed cardiovascular risk factors using identical questionnaires, functional, anthropometric, biochemical means and measured on identical scales. As a result, we analyzed the prevalence of smoking, diabetes mellitus, overweight and obesity, abdominal obesity, hypercholesterolemia and hypertriglyceridemia, high levels of low-density lipoprotein (LDL).

Results. Univariate analysis indicates that in the sample of 2016, compared to the sample of 2013, the prevalence of smoking is statistically significantly lower, as well as the proportion of participants with high cholesterol levels, but not taking lipid-lowering drugs. In contrast, the prevalence of diabetes, hypercholesterolemia and hypertriglyceridemia is higher. In women, the frequency of abdominal obesity on 2016 is lower than on 2013: at 35-44 age group odds ratio (OR) =0.67 with 95% confidence interval (CI) 0.44-1.03, at 45-54 age group OR =0.47 with 95% CI 0.31-0.72, 55-65 age group OR =0.49 with 95% CI 0.30-0.79. A high incidence of diabetes, hypercholesterolemia and hypertriglyceridemia is characteristic mainly of older women (55-65 age group): accordingly, OR =1.96 with 95% CI 1.19-3.22, OR =1.42 with 95% CI 1,02-1.97, OR =1.51 at 95% CI 1.08-2.12. In the 45-54 age group of men, they smoked statistically significantly less often on 2016 compared to 2013, OR =0.59 with 95% CI 0.36-0.96. The prevalence of overweight and obesity in both samples is the same: for women, the OR for overweight in different age groups is within 0.74-0.87, for men - within 0.95-1.78; for obesity OR in women is from 0.70 to 0.79, in men - from 1.03 to 1.34.

Conclusion. A significant advantage of the study is the analysis of changes in prevalence in age and gender groups, which showed significant differences in the dynamics of men and women in different age categories for a number of risk factors. Analysis of the dynamics of the prevalence of cardiovascular risk factors makes it possible to assess the effectiveness of state and regional policies in the field of health protection and, first of all, "risk groups” that require closer attention, development and implementation of targeted health-saving technologies.

Metabolic comorbidities and the association with risks of recurrent metastatic disease in breast cancer survivors

BACKGROUND

Obesity and other metabolic comorbidities affect over 10% of patients with breast cancer and are closely related with adverse outcomes. Although metabolic comorbidities among breast cancer patients in low- and middle-income countries are suggested to be lower, only a few studies are currently available. Effective management of metabolic comorbidities in cancer patients has been associated with better outcomes.

METHODS

Non-metastatic breast cancer patients (N = 1081) treated in our department (2014-2018) were monitored for the presence of high Body Mass Index (BMI), diabetes or glucose intolerance, dyslipidemia, and hypertension and the development of recurrent metastatic diseases during a median follow-up of 3.9 years.

RESULTS

Glucose intolerance, hypertension, dyslipidemia, and BMI ≥ 27.7 kg/m² considered at risk for metabolic comorbidities were found in 26.5, 42.6, 27.7, and 23.3% of breast cancer patients, respectively. Diabetes or glucose intolerance and having both glucose intolerance and dyslipidemia were associated with the risk of recurrent metastatic disease (OR = 1.442, 95%CI = 1.071-1.943, p = 0.016 and OR = 1.495, 95%CI = 1.090-2.049, p = 0.010; respectively). Having three or more metabolic comorbidities was significantly associated with the risk of recurrent metastatic disease (OR = 1.647, 95%CI = 1.139-2.382, p = 0.008) compared to patients without any comorbidity. The metabolic comorbidities were distributed unevenly among breast cancer subtypes. A significant association with recurrent metastatic disease was found in the Luminal B-like subtype. In post-menopausal patients, having more than three comorbidities was associated with a higher risk of recurrent metastatic disease compared to those without any comorbidity (OR = 2.000, 95%CI = 1.035-3.067, p = 0.001). The risks of having three or more metabolic comorbidities were significantly higher in breast cancer survivors who were obese, lived in an urban area, and received hormonal therapy of aromatase inhibitors.

CONCLUSION

Metabolic comorbidities were frequently found in breast cancer patients and were associated with higher risks to develop recurrent metastatic disease, particularly in post-menopausal women. Subsequent larger studies are needed to better understand the association of metabolic comorbidities with patients' quality of life and prognosis, and to explore the potential combination of clinical intervention and lifestyle modification in breast cancer survivors to treat as well as reduce their impact.