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Hyperlipidemia and Cardiovascular Risk in Children and Adolescents. Biomedicines 2023; 11:biomedicines11030809. [PMID: 36979789 PMCID: PMC10045454 DOI: 10.3390/biomedicines11030809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) represents the major cause of morbidity and mortality worldwide. The onset of the atherosclerosis process occurs during childhood and adolescence, subsequently leading to the onset of cardiovascular disease as young adults. Several cardiovascular risk factors can be identified in children and adolescents; however, hyperlipidemia, in conjunction with the global obesity epidemic, has emerged as the most prevalent, playing a key role in the development of ASCVD. Therefore, screening for hyperlipidemia is strongly recommended to detect high-risk children presenting with these disorders, as these patients deserve more intensive investigation and intervention. Treatment should be initiated as early as possible in order to reduce the risk of future ASCVD. In this review, we will discuss lipid metabolism and hyperlipidemia, focusing on correlations with cardiovascular risk and screening and therapeutic management to reduce or almost completely avoid the development of ASCVD.
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Ohtaki S, Ashida K, Matsuo Y, Moritaka K, Iwata S, Nagayama A, Kawaguchi A, Koga H, Yoshinobu S, Hasuzawa N, Motomura S, Akiba J, Nakama T, Nomura M. Eruptive xanthomas as a marker for metabolic disorders: A specific form of xanthoma that reflects hypertriglyceridemia. Clin Case Rep 2022; 10:e05671. [PMID: 35474985 PMCID: PMC9021930 DOI: 10.1002/ccr3.5671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Eruptive xanthomas are skin manifestations associated with hypertriglyceridemia. Accordingly, the improvement of hypertriglyceridemia can ameliorate this condition. We report a case of a patient with type 2 diabetes mellitus who was diagnosed with this skin lesion. Clinicians should be aware that eruptive xanthomas could indicate metabolic disorders associated with atherosclerosis.
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Affiliation(s)
- Sohichiroh Ohtaki
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Yuko Matsuo
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Kanoko Moritaka
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Shimpei Iwata
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Ayako Nagayama
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Aya Kawaguchi
- Department of Diagnostic Pathology Kurume University Hospital Fukuoka Japan
- Department of Dermatology Kurume University School of Medicine Fukuoka Japan
| | - Hiroshi Koga
- Department of Dermatology Kurume University School of Medicine Fukuoka Japan
| | - Satoko Yoshinobu
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Nao Hasuzawa
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Seiichi Motomura
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
| | - Jun Akiba
- Department of Diagnostic Pathology Kurume University Hospital Fukuoka Japan
| | - Takekuni Nakama
- Department of Dermatology Kurume University School of Medicine Fukuoka Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism Department of Internal Medicine Kurume University School of Medicine Fukuoka Japan
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Connelly MA, Velez Rivera J, Guyton JR, Siddiqui MS, Sanyal AJ. Review article: the impact of liver-directed therapies on the atherogenic risk profile in non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2020; 52:619-636. [PMID: 32638417 PMCID: PMC7497003 DOI: 10.1111/apt.15935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/23/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with non-alcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease, are at higher risk of cardiovascular disease (CVD) and associated mortality. Therefore, it is important to understand how new therapies for non-alcoholic steatohepatitis (NASH) may impact CVD risk factors in these patients. AIMS To summarise the effects of drug therapies on lipid and lipoprotein levels in patients with NASH and provide insight into the potential mechanisms for the observed changes. METHODS PubMed searches of the literature were performed and results were compiled. RESULTS Recent clinical trials have highlighted the safety and efficacy of drug candidates for the treatment of NASH. Several agents have shown improvements in the histological features of NASH and liver function. Pioglitazone, a drug that is currently available for type 2 diabetes and may be useful for NASH, exhibits beneficial effects on lipids. However, agents such as farnesoid X receptor agonists, which are in development for NASH, may adversely affect circulating lipids and lipoproteins. CONCLUSIONS NASH is a multi-system disease with a disproportionate CVD burden. Current and future drugs for NASH have had variable impact on the atherogenic risk profile. Potential co-administration of a statin may help mitigate the negative impact of some of these therapies on lipid and lipoprotein levels.
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Affiliation(s)
| | - Jonathan Velez Rivera
- Division of Endocrinology, Metabolism, and NutritionDepartment of MedicineDuke University Medical CenterDurhamNCUSA
| | - John R. Guyton
- Division of Endocrinology, Metabolism, and NutritionDepartment of MedicineDuke University Medical CenterDurhamNCUSA
| | | | - Arun J. Sanyal
- Division of Gastroenterology and HepatologyVirginia Commonwealth UniversityRichmondVAUSA
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Yokote K, Niwa K, Hakoda T, Oh F, Kajimoto Y, Fukui T, Kim H, Noda Y, Lundström T, Yajima T. Short-Term Efficacy (at 12 Weeks) and Long-Term Safety (up to 52 Weeks) of Omega-3 Free Fatty Acids (AZD0585) for the Treatment of Japanese Patients With Dyslipidemia - A Randomized, Double-Blind, Placebo-Controlled, Phase III Study. Circ J 2020; 84:994-1003. [PMID: 32281579 DOI: 10.1253/circj.cj-19-0358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study is the first to evaluate the short-term efficacy and long-term safety of AZD0585, a mixture of omega-3 free fatty acids, in Japanese patients with dyslipidemia.Methods and Results:In this randomized double-blind placebo-controlled Phase III study, 383 patients were randomized to 2 g AZD0585, 4 g AZD0585, or placebo once daily for 52 weeks. Eligible patients had low-density lipoprotein cholesterol (LDL-C) levels controlled regardless of statin use, and triglyceride levels between 150 and 499 mg/dL. The least-squares (LS) mean percentage changes in triglyceride concentrations from baseline to the 12-week endpoint (mean of measurements at Weeks 10 and 12) in the 2 and 4 g AZD0585 and placebo groups were -15.57%, -21.75%, and 11.15% respectively (P<0.0001 for both AZD0585 doses vs. placebo). No clinically significant changes from baseline to the 12-week endpoint in total cholesterol, LDL-C, and LDL-C/apolipoprotein (Apo) B were found with AZD0585. High-density lipoprotein cholesterol (HDL-C) was slightly increased and very low-density lipoprotein cholesterol, non-HDL-C, ApoC-II, and ApoC-III were decreased with AZD0585 compared with placebo at the 12-week endpoint. Lipid profiles up to Week 52 were consistent with those up to the 12-week endpoint. No clinically important safety concerns were raised. CONCLUSIONS AZD0585 significantly decreased serum triglyceride levels compared with placebo at the 12-week endpoint and was generally safe and well tolerated in Japanese patients with dyslipidemia.
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Affiliation(s)
- Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital
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Chahal N, Manlhiot C, Wong H, McCrindle BW. Effectiveness of omega-3 polysaturated fatty acids (fish oil) supplementation for treating hypertriglyceridemia in children and adolescents. Clin Pediatr (Phila) 2014; 53:645-51. [PMID: 24647701 DOI: 10.1177/0009922814527503] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Limited pharmacological options are available for management pediatric hypertriglyceridemia. We examined the effectiveness of dietary fish oil supplementation as a means to reduce triglyceride levels in pediatric patients. We reviewed 111 children aged 8 to 18 years with hypertriglyceridemia (≥1.5 mmol/L) undergoing treatment in a specialized dyslipidemia clinic. At the treating cardiologist's discretion, 60 subjects received nonprescription fish oil supplementation (500-1000 mg/d), while the remaining patients did not. Initially there were no baseline differences between groups, including the use of concomitant lipid-lowering medication. Treatment with fish oil was associated with a potential clinically relevant but non-statistically significant decrease in triglycerides and triglyceride-to-high-density lipoprotein (HDL) ratio. Fish oil had no effect on HDL-cholesterol, non-HDL-cholesterol, or total cholesterol. All associations remained unchanged when adjusted for body mass index z score, nutrition, physical activity, and screen time. Fish oil supplementation was not significantly effective in treating hypertriglyceridemia in pediatric patients.
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Affiliation(s)
- Nita Chahal
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Helen Wong
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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Ina K, Hayashi T, Araki A, Kawashima S, Sone H, Watanabe H, Ohrui T, Yokote K, Takemoto M, Kubota K, Noda M, Noto H, Ding QF, Zhang J, Yu ZY, Yoon BK, Nomura H, Kuzuya M. Importance of high-density lipoprotein cholesterol levels in elderly diabetic individuals with type IIb dyslipidemia: A 2-year survey of cardiovascular events. Geriatr Gerontol Int 2013; 14:806-10. [PMID: 24215618 DOI: 10.1111/ggi.12168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 11/26/2022]
Abstract
AIM The risk factors for ischemic heart disease (IHD) or cerebrovascular accident (CVA) in elderly diabetic individuals with type IIb dyslipidemia are not fully known. Therefore, we investigated the relationship between lipid levels and IHD and CVA in diabetic individuals with type IIb dyslipidemia. METHOD The Japan Cholesterol and Diabetes Mellitus Study is a prospective cohort study of 4014 type 2 diabetic patients (1936 women; age 67.4 ± 9.5 years). The primary end-points were the onset of IHD or CVA. Lipid and glucose levels, and other factors were investigated in relation to the occurrence of IHD or CVA. A total of 462 participants were included in the group of patients with type IIb dyslipidemia. RESULTS The 462 diabetic participants with type IIb dyslipidemia were divided into those who were aged <65 years, 65-74 years and >75 years (n=168, 190 and 104, respectively). High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol/HDL-C were significantly associated with the risk of cardiovascular events in diabetic individuals with type IIb dyslipidemia who were aged <65 years, and HDL-C and diastolic blood pressure was significantly associated with cardiovascular events in patients aged 65-74 years. Non-HDL-C was not significantly associated with the risk of cardiovascular events. Multiple regression analysis showed that lower HDL-C was significantly associated with the risk of cardiovascular events in diabetic individuals with type IIb dyslipidemia who were aged <65 years and 65-74 years. CONCLUSIONS Lower HDL-C was an important risk factor for cardiovascular events in diabetic individuals with type IIb dyslipidemia who were aged <75 years.
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Affiliation(s)
- Koichiro Ina
- Department of Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Funaki T, Shoji K, Yotani N, Katsuta T, Miyazaki O, Nosaka S, Masaki H, Saitoh A. The value of radiographic findings for the progression of pandemic 2009 influenza A/H1N1 virus infection. BMC Infect Dis 2013; 13:516. [PMID: 24180416 PMCID: PMC4228410 DOI: 10.1186/1471-2334-13-516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 10/28/2013] [Indexed: 11/29/2022] Open
Abstract
Background Most illnesses caused by pandemic influenza A (H1N1) pdm09 virus (A/H1N1) infection are acute and self-limiting among children. However, in some children, disease progression is rapid and may require hospitalization and transfer to a pediatric intensive care unit (PICU). We investigated factors associated with rapid disease progression among children admitted to hospital for A/H1N1 infection, particularly findings on initial chest radiographs. Methods In this retrospective study, we investigated the records of children who had received a laboratory or clinical diagnosis of A/H1N1 infection and were admitted to the largest children’s hospital in Japan between May 2009 and March 2010. The medical records were reviewed for age, underlying diseases, vital signs on admission, initial chest radiographic findings, and clinical outcomes. According to chest radiographic findings, patients were classified into 4 groups, as follows: [1] normal (n = 46), [2] hilar and/or peribronchial markings alone (n = 64), [3] consolidation (n = 64), and [4] other findings (n = 29). Factors associated with clinical outcomes were analyzed using logistic regression. Results Two hundreds and three patients (median 6.8 years) were enrolled in this study. Fifteen percent (31/203) of patients were admitted to PICU. Among 31 patients, 39% (12/31) of patients required mechanical ventilation (MV). When the initial chest radiographic findings were compared between patients with consolidation (n = 64) and those without consolidation (n = 139), a higher percentage of patients with consolidation were admitted to PICU (29.7% vs.8.6%, P < 0.001) and required MV (17.2% vs. 0.7%, P < 0.001). These findings remain significant when the data were analyzed with the logistic regression (P < 0.001, P < 0.001, respectively). Conclusions Consolidation on initial chest radiographs was the most significant factor to predict clinical course of hospitalized children with the 2009 A/H1N1 infection.
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Affiliation(s)
| | | | | | | | | | | | | | - Akihiko Saitoh
- Department of Medical Subspecialties, Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan.
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Takahara M, Katakami N, Kaneto H, Noguchi M, Shimomura I. Prediction of the presence of insulin resistance using general health checkup data in Japanese employees with metabolic risk factors. J Atheroscler Thromb 2013; 21:38-48. [PMID: 24025703 DOI: 10.5551/jat.18622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of the current study was to develop a predictive model of insulin resistance using general health checkup data in Japanese employees with one or more metabolic risk factors. METHODS We used a database of 846 Japanese employees with one or more metabolic risk factors who underwent general health checkup and a 75-g oral glucose tolerance test (OGTT). Logistic regression models were developed to predict existing insulin resistance evaluated using the Matsuda index. The predictive performance of these models was assessed using the C statistic. RESULTS The C statistics of body mass index (BMI), waist circumference and their combined use were 0.743, 0.732 and 0.749, with no significant differences. The multivariate backward selection model, in which BMI, the levels of plasma glucose, high-density lipoprotein (HDL) cholesterol, log-transformed triglycerides and log-transformed alanine aminotransferase and hypertension under treatment remained, had a C statistic of 0.816, with a significant difference compared to the combined use of BMI and waist circumference (p<0.01). The C statistic was not significantly reduced when the levels of log-transformed triglycerides and log-transformed alanine aminotransferase and hypertension under treatment were simultaneously excluded from the multivariate model (p=0.14). On the other hand, further exclusion of any of the remaining three variables significantly reduced the C statistic (all p<0.01). CONCLUSIONS When predicting the presence of insulin resistance using general health checkup data in Japanese employees with metabolic risk factors, it is important to take into consideration the BMI and fasting plasma glucose and HDL cholesterol levels.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine
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Miyamoto M, Kotani K, Okada K, Ando A, Hasegawa H, Kanai H, Ishibashi S, Yamada T, Taniguchi N. Arterial wall elasticity measured using the phased tracking method and atherosclerotic risk factors in patients with type 2 diabetes. J Atheroscler Thromb 2013; 20:678-87. [PMID: 23648429 DOI: 10.5551/jat.16220] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of this study was to investigate the relationship between atherosclerotic manifestations and brachial and radial arterial wall elasticity (AWE) measured using the phased tracking method in patients with type 2 diabetes mellitus (T2DM). METHODS This study included T2DM patients (n= 220, mean age 59 years) without a history of stroke or coronary artery disease. The brachial AWE, radial AWE, carotid mean intima-media thickness (IMT), max-IMT and flow-mediated vasodilation (FMD) were measured. The patients were classified according to the number of atherosclerotic risk factors, including obesity, dyslipidemia and hypertension. Group 1 included T2DM patients only, group 2 included patients with two risk factors, group 3 included patients with three risk factors and group 4 included patients with four risk factors. The patients were also divided into two groups according to microangiopathic complications, including retinopathy and nephropathy. The between-group differences were analyzed. RESULTS The brachial AWE (548, 697, 755 and 771 kPa for groups 1, 2, 3 and 4, respectively) and radial AWE (532, 637, 717 and 782 kPa for groups 1, 2, 3 and 4, respectively) significantly increased in association with an increasing number of risk factors. The brachial AWE and radial AWE were significantly higher in the patients with microangiopathic complications than in those without microangiopathic complications (brachial AWE 797 and 694 kPa and radial AWE 780 and 660 kPa, respectively). Receiver operating characteristic curve analyses revealed that, for brachial AWE and radial AWE, the area under the curve was equal to the max-IMT and higher than the mean-IMT and FMD. CONCLUSIONS Upper limb AWE measurement can reflect the degree of atherosclerosis risk overload and may be useful for evaluating vascular complications in T2DM patients.
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Affiliation(s)
- Michiaki Miyamoto
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
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Takahara M, Katakami N, Kaneto H, Noguchi M, Shimomura I. Evaluation of hypertriglyceridemia using non-fasting health checkup data in a Japanese population. J Atheroscler Thromb 2013; 20:661-9. [PMID: 23604042 DOI: 10.5551/jat.17376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Some employees have difficulty undergoing health checkups in the workplace in a fasting state. However, hypertriglyceridemia is usually diagnosed based on fasting triglyceride (TG) measurements. The current study investigated the performance of non-fasting health checkup data for predicting hypertriglyceridemia in a Japanese population. METHODS We recruited a total of 1,959 Japanese employees who had their fasting TG levels reexamined after undergoing initial health checkups under either a fasting (the fasting population; n= 856) or non-fasting state (the non-fasting population; n= 1103). Hypertriglyceridemia was defined as a fasting TG level of ≥ 1.7 mmol/l. RESULTS The area under the receiver operating characteristic (ROC) curve of the initial TG measurements for reexamination-detected hypertriglyceridemia was 0.85 in the fasting population and 0.83 in the non-fasting population. The area under the ROC curve of the initial TG measurements in the non-fasting population was not inferior to that of the multivariate model where other non-fasting health checkup data were added. The optimal non-fasting TG cutoff point was 2.0 mmol/l. The cutoff point was further lowered when the population was limited to patients undergoing health checkups four or more hours after their last meal and when the prevalence of hypertriglyceridemia in the population was simulated to be reduced. CONCLUSIONS The non-fasting workplace TG measurements by themselves exhibited a tolerable performance for predicting hypertriglyceridemia. The optimal cutoff point in Japanese employees appears to be lower than 2.3 mmol/l, the recently proposed Western cutoff point.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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