Association of Achilles tendon thickness with lipid profile and carotid IMT in patients with familial hypercholesterolemia

BACKGROUND AND AIMS

Familial hypercholesterolemia (FH) is characterized by high levels of low-density lipoprotein cholesterol (LDL-C) and Achilles tendon (AT) thickening. AT thickness (ATT) is useful for diagnosing FH and assessing the risk of coronary artery disease (CAD). Nevertheless, the relationship between AT thickening and lipid profile is not clear. We investigated the association of ATT with lipid Profile and carotid IMT.

METHODS

We included 450 patients with clinically diagnosed heterozygous FH. ATT was measured by ultrasonography.

RESULTS

The rate of thickening increased for both AT and carotid-IMT according to age (p < 0.001). In the teens, there was no carotid-IMT thickening, but 39 % of the subjects had a thickened AT. The thresholds of cumulative LDL-C values for AT and carotid-IMT thickening based on ROC curves were 9210 mg/dL∗years (AUC: 0.66, 95 % CI: 0.61-0.72) for ATT and 11,255 mg/dL∗years (AUC: 0.79, 95 % CI: 0.75-0.84) for carotid-IMT. For cumulative LDL-C levels ≥ median, untreated HDL-C level was lower in the AT thickened group than in the non-thickened group (AT thickened: 52 (43-63) mg/dL, non-thickened: 63 (52-72) mg/dL). There was a significant correlation between ATT and cumulative LDL-C (Male: R = 0.48 p < 0.001, Female: R = 0.33 p < 0.001).

CONCLUSIONS

We clarified that both cumulative exposure to LDL-C and untreated HDL-C levels were closely related to AT thickening. Our results show that in ultrasonographic assessment, ATT is more useful than carotid-IMT for predicting the degree of lipid deposition in tissues, especially in young adults.

Association of LDL-C/HDL-C Ratio With Hyperuricemia: A National Cohort Study

Hyperuricemia (HUA) is a metabolic abnormality syndrome caused by disorders of purine metabolism. This study aimed to investigate the predictive value of the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (LHR) for the risk of developing HUA. We extracted data from the China Health and Retirement Longitudinal Study (CHARLS) database from 2011 to 2016. Multivariable logistic regression, restricted cubic splines (RCSs) analysis, and linear correlation analysis were conducted to evaluate the association between LHR and risk of developing HUA. Subgroup analyses and interaction tests were also performed. A higher LHR was associated with an increased incidence of HUA (7.8% vs. 9.9% vs. 13.9, p < 0.001). The LHR was also higher in the HUA group compared to the non-HUA group (2.64 ± 1.07 vs. 2.40 ± 0.91, p < 0.001). When assessed as a continuous variable, LHR was independently associated with the risk of HUA (OR = 1.27, 95% CI = 1.16-1.39, p < 0.001). The risk of developing HUA was significantly higher among individuals with the highest LHR subgroup than those with the lowest LHR subgroup (OR = 1.81, 95% CI = 1.47-2.23, p < 0.001). RCS analysis revealed a significant nonlinear association between an increased LHR and a higher risk of developing HUA. The predictive abilities of LHR for HUA were 0.577. The composite variable comprising LHR and other traditional risk factors could significantly enhance the ability to predict HUA (C statistic = 0.677). In conclusion, a higher LHR was associated with an increased risk of developing HUA. Further studies on LHR could be beneficial for preventing and treating HUA.

Association of atherosclerosis indices, serum uric acid to high-density lipoprotein cholesterol ratio and triglycerides-glucose index with hypertension: A gender-disaggregated analysis

This study assessed the association between atherosclerosis indices, serum uric acid to high-density lipoprotein cholesterol ratio (UHR) and triglyceride-glucose (TyG) index and the prevalence of hypertension among MASHAD cohort participants. In this cross-sectional study, the participants were divided into hypertensive and non-hypertensive subjects. The atherosclerosis indices, UHR and TyG index of the two groups were compared. Logistic regression analyses were used to determine the associations of these indices with hypertension in both sex. Receiver operating characteristic (ROC) curve analysis was used to establish the cut-off values for differentiating hypertensive from non-hypertensive subjects. p-values < .05 were considered statistically significant. Data related to 9675 subjects (3035 hypertensive and 6640 non-hypertensive) were analyzed. The mean values of atherosclerosis indices, UHR and TyG index were significantly higher (p < .001) in the hypertensives compared to non-hypertensives. After adjustment for potential confounders, among men, the TyG index (OR = 1.360; 95% CI: 1.210-1.530; p < .001) remained an independent factor for hypertension. Among women, atherogenic index of plasma (OR = 1.005; 95% CI: 1.002-1.007; p < .001), UHR (OR = 1.043; 95% CI: 1.026-1.060; p < .001) and TyG index (OR = 1.519; 95% CI: 1.376-1.677; p < .001) remained independent factors for hypertension. ROC curve analysis revealed that compare to the other indices, TyG index had a better predictive value for hypertension in both sex, especially in women.

A non-linear connection between the total cholesterol to high-density lipoprotein cholesterol ratio and stroke risk: a retrospective cohort study from the China Health and Retirement Longitudinal Study

OBJECTIVE

The connection between total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio and stroke risk is controversial. This study aims to examine the connection between the TC/HDL-C ratio and stroke in middle-aged and older individuals who are part of the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

This study conducted a retrospective cohort analysis, enrolling a total of 10,184 participants who met the designated criteria from CHARLS between 2011 and 2012. We then used the Cox proportional-hazards regression model to analyze the relationship between the TC/HDL-C ratio and stroke risk. Using a Cox proportional hazards regression model with cubic spline functions and smooth curve fitting, we were able to identify the non-linear relationship between the TC/HDL-C ratio and stroke occurrence. The sensitivity and subgroup analyses were also performed to investigate the connection between TC/HDL-C ratio and stroke.

RESULTS

This study revealed a statistically significant association between the TC/HDL-C ratio and stroke risk in subjects aged 45 years or older after adjusting for risk factors (HR: 1.05, 95%CI 1.00-1.10, P = 0.0410). Furthermore, a non-linear connection between the TC/HDL-C ratio and stroke risk was detected, with a TC/HDL-C ratio inflection point of 3.71. We identified a significant positive connection between the TC/HDL-C ratio and stroke risk, when the TC/HDL-C ratio was less than 3.71 (HR: 1.25, 95%CI 1.07-1.45, P = 0.0039). However, their connection was not significant when the TC/HDL-C ratio exceeded 3.71 (HR: 1.00, 95%CI 0.94-1.06, P = 0.9232). The sensitivity analysis and subgroup analyses revealed that our findings were well-robust.

CONCLUSION

Our study demonstrated a positive, non-linear connection between the TC/HDL-C ratio and stroke risk in middle-aged and older individuals. There was a significant positive connection between the TC/HDL-C ratio and stroke risk, when the TC/HDL-C ratio was less than 3.71. The current research can be used as a guideline to support clinician consultation and optimize stroke prevention measures for middle-aged and older adults.

Achievement Rates for Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Atherosclerotic Cardiovascular Disease in a Real-World Setting in Japan

AIMS

The study aimed to investigate low-density lipoprotein cholesterol (LDL-C) goal achievement rates in patients receiving LDL-C-lowering therapy using recent real-world data, following the 2017 revision of the Japan Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases (JAS GL2017).

METHODS

Patients with documented LDL-C test results were extracted from the Medical Data Vision claims database between July 2018 and June 2021 and divided into three groups according to JAS GL2017: primary prevention high risk (Group I, LDL-C goal ＜120 mg/dL), secondary prevention (Group II, LDL-C goal ＜100 mg/dL), and secondary prevention high risk (Group III, LDL-C goal ＜70 mg/dL).

RESULTS

The mean LDL-C value was 108.7 mg/dL (n=125,235), 94.4 mg/dL (n=57,910), and 90.6 mg/dL (n=33,850) in Groups I, II, and III, respectively. Intensive statin monotherapy (pitavastatin, rosuvastatin, or atorvastatin) was the most frequently prescribed lipid-lowering treatment (21.6%, 30.8%, and 42.7% in Groups I, II, and III, respectively), followed by ezetimibe (2.5%, 7.1%, and 8.5% in Groups I, II, and III, respectively). LDL-C goals were achieved by 65.5%, 60.6%, and 25.4% of patients overall in Groups I, II, and III, respectively. Achievement rates were 83.9%, 75.3%, and 29.5% in patients prescribed intensive statin monotherapy and 82.3%, 86.4%, and 46.4% in those prescribed statin and ezetimibe combinations in Groups I, II, and III, respectively. In Group III, the proportion of patients with familial hypercholesterolemia prescribed statin and ezetimibe combinations achieving LDL-C goals was low (32.5%).

CONCLUSIONS

The proportion of patients achieving LDL-C goals for secondary prevention in the high-risk group remains low even with statin and ezetimibe combination therapy.

Lipoproteins, Cholesterol, and Atherosclerotic Cardiovascular Disease in East Asians and Europeans

One fifth of the world population live in East Asia comprising Japan, Korea, and China where ischemic heart disease, a major component of atherosclerotic cardiovascular disease (ASCVD), is the second most frequent cause of death. Each of low-density lipoproteins (LDL), remnant lipoproteins, and lipoprotein(a), summarized as non-high-density lipoproteins (non-HDL) or apolipoprotein B (apoB) containing lipoproteins, causes ASCVD. However, a significant proportion of the evidence on lipoproteins and lipoprotein cholesterol with risk of ASCVD came from White people mainly living in Europe and North America and not from people living in East Asia or of East Asian descent. With a unique biological, geohistorical, and social background in this world region, East Asians have distinctive characteristics that might have potential impact on the association of lipoproteins and lipoprotein cholesterol with risk of ASCVD. Considering the movement across national borders in the World, understanding of lipoprotein and lipoprotein cholesterol evidence on ASCVD in East Asia is important for both East Asian and non-East Asian populations wherever they live in the World.In this review, we introduce the biological features of lipoproteins and lipoprotein cholesterol and the evidence for their association with risk of ASCVD in East Asian and European populations. We also provide an overview of guideline recommendations for prevention of ASCVD in these two different world regions. Finally, specific preventive strategies and future perspectives are touched upon.

Time-varying effect of postoperative cholesterol profile on long-term outcomes of isolated coronary artery bypass graft surgery

BACKGROUND

Controlling cholesterol levels is one of the primary goals of preventing atherosclerotic plaque progression in patients undergoing coronary artery bypass graft (CABG) surgery. This study aimed to investigate the impact of serum cholesterol profile at multiple time points following isolated CABG surgery on long-term patient outcomes.

METHOD

This retrospective cohort study was conducted on the admission and follow-up data of isolated CABG patients from the Tehran Heart Center registry between 2009 and 2016. The association of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and their ratio as an atherogenic index with major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality were evaluated using time-varying survival analysis methods.

RESULT

A total of 18657 patients were included in this analysis. After adjusting for known confounding factors, no significant difference in all-cause mortality and MACCE was observed at different LDL levels. The incidence of acute coronary syndrome (ACS) in patients with LDL > 100 mg/dl and LDL < 50 mg/dl was significantly higher than in the control group (P-value = 0.004 and 0.04, respectively). The incidence of cerebrovascular accidents (CVA) at LDL > 100 mg/dl was also significantly higher compared to the control group (P -value = 0.033). Lower HDL levels were significantly associated with a higher MACCE (P -value < 0.001), all-cause mortality (P -value < 0.001), ACS (P -value = 0.00), and CVA (P -value = 0.014). The atherogenic index was also directly related to MACCE and all its components (all P-values < 0.001).

CONCLUSION

LDL/HDL ratio is suggested as a better marker for secondary prevention goals compared to LDL alone in patients undergoing CABG surgery.

Association of the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and major adverse cardiac and cerebrovascular events in patients with coronary heart disease undergoing percutaneous coronary intervention: a cohort study

BACKGROUND

Although dyslipidemia increases the risk of coronary heart disease (CHD) and its adverse prognosis, the association between the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) and major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in patients with CHD has not been adequately demonstrated. Therefore, the aim of this study was to assess the role of LDL-C/HDL-C in the risk of MACCE after PCI in patients with CHD.

METHODS

In this large cohort observational study, we enrolled 2226 patients with CHD treated with PCI. LDL-C/HDL-C was considered as an exposure variable and MACCE was considered as an outcome variable. Univariate and multivariate Logistic regression models and subgroup analyses were used to assess the relationship between LDL-C/HDL-C and the risk of MACCE.

RESULTS

A total of 2226 patients (mean age: 60.02 years; 68.00% male) were included in the analysis, and 373 patients suffered MACC. Patients who developed MACCE had higher levels of LDL-C/HDL-C compared to patients who did not develop MACCE [(2.79 ± 1.15) vs (2.64 ± 1.09), p = 0.023]. Univariate Logistic regression analysis showed a correlation between LDL-C/HDL-C and the risk of MACCE (OR: 1.121, 95% CI: 1.019-1.233, p = 0.019). Multivariate Logistic regression analysis showed that higher levels of LDL-C/HDL-C remained strongly associated with a higher risk of MACCE after stepwise adjustment for confounding variables [Model 4: T3 vs T1, OR: 1.455, 95% CI: 1.095-1.933, p = 0.010; per unit increase, OR: 1.158, 95% CI: 1.047-1.281, p = 0.004]. Further subgroup analysis showed that the association between LDL-C/HDL-C and MACCE risk remained in the subgroup ≤60 years, male, without diabetes, and with hypertension (p < 0.05).

CONCLUSION

Higher LDL-C/HDL-C was closely associated with a higher risk of MACCE after PCI in patients with CHD.

Association of Low-Density Lipoprotein Cholesterol with Risk of Coronary Heart Disease and Stroke among Middle-Aged Japanese Workers: An Analysis using Inverse Probability Weighting

AIMS

The associations between low-density lipoprotein cholesterol (LDL-C) and the risk of cardiovascular disease (CVD) subtypes are not well established among the Japanese population. This study used longitudinal data from the Aichi Workers' Cohort Study to explore the association between LDL-C levels and the risk of coronary heart disease (CHD) and stroke subtypes.

METHODS

Pooled data of 8966 adults (7093men and 1903 women) who were recruited between (2002) and (2008) were used for the current analysis. Propensity scores for the LDL-C categories were generated using multinomial logistic regression. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from the inverse probability weighted Cox proportional hazards model for LDL-C category associations with risks of CHD, stroke subtypes, and CVD.

RESULTS

During a median follow-up of 12 years, 122 strokes (57 ischemic strokes, 25 intracerebral hemorrhage, and 40 unknown subtypes) and 82 cases of CHD were observed. LDL-C 160- mg/dL compared to LDL-C 100-119 mg/dL was positively and significantly associated with the risk of CHD (HR: 4.56; 95% CI: 1.91-10.9) but not with ischemic stroke (HR: 0.99; 95% CI: 0.44-2.22). LDL-C was inversely associated with the risk of intracerebral hemorrhage (P for trend=0.009).

CONCLUSION

In middle-aged Japanese workers, LDL-C was significantly and positively associated with CHD, but not with ischemic stroke. LDL-C was inversely significantly associated with intracerebral hemorrhage.

Non-traditional lipid profiles and the risk of stroke: A systematic review and meta-analysis

AIMS

An increasing number of studies on non-traditional lipid profiles have been investigated in recent years. However, the associations between non-traditional lipid profiles and the risk of stroke remained inconsistent. Therefore, this meta-analysis aimed to evaluate the associations between non-traditional lipid profiles and the risk of stroke and clarify the dose-response relations.

DATA SYNTHESIS

We performed a systematic literature search in PubMed, Embase, and Web of Science databases until 1 November 2022 for relevant studies. Relative risks and 95% confidence intervals were pooled by random-effects or fixed-effects models. A total of 26 full-text studies with 676678 participants and 18057 stroke cases were eligible for the final study. We found a positive association between the risk of stroke and total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio (RR = 1.19,95%CI = 1.00-1.40, I² = 74.6%), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio (RR = 1.24,95%CI = 1.10-1.41, I² = 62.8%) or low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio (RR = 1.24, 95%CI = 1.11-1.39, I² = 49.4%). When focusing on the stroke subtype, a more significant association was observed between the risk of ischemic stroke and four non-traditional lipid profiles. In dose-response analysis, we found a linear association between TC/HDL-C ratio and the risk of stroke (RR = 1.16,95%CI = 1.07-1.26).

CONCLUSIONS

Elevated non-traditional lipid profiles were associated with an increased risk of ischemic stroke. The linear association showed the risk of stroke increased by 16% when the pooled RR of TC/HDL-C ratio per 1-unit increased.

REGISTRATION NUMBER IN PROSPERO

CRD42022321251.

Mortality risk in older Japanese people based on self-reported dyslipidemia treatment and socioeconomic status: The JAGES cohort study

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Older people under self-reported dyslipidemia treatment had some distinction.

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They had higher income and education levels than those without treatment.

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Their self-reported treatment status was negatively associated with mortality risk.

Few studies consider socioeconomic status when assessing mortality risk in dyslipidemia cases. This study used cohort data from the 2010 Japan Gerontological Evaluation Study (JAGES), which contains data on older Japanese people, to associate socioeconomic status with mortality risk in patients treated for dyslipidemia. In this 6-year longitudinal study, we examined 47,275 older Japanese people aged ≥ 65 years who could independently perform activities of daily living. Patients’ background characteristics were classified based on their dyslipidemia treatment status and were assessed using the chi-squared test. The mortality risk was assessed using the Cox proportional hazards model, wherein the objective and explanatory variables were total mortality and self-report of dyslipidemia treatment, respectively. The participants were stratified by sex and age into younger (aged 65–74 years) and older (aged ≥ 75 years) groups of men and women. The results were adjusted, with health condition, health behavior, and socioeconomic status as confounding factors. The adjusted hazard ratios of 5514 people who died during the follow-up who had self-reported dyslipidemia treatment were 0.49 [95% confidence interval (CI) 0.35–0.69] for younger men; 0.57 (95% CI 0.42–0.76) for older men; 0.52 (95% CI 0.34–0.80) for younger women; and 0.47 (95% CI 0.33–0.67) for older women. Older people undergoing treatment for dyslipidemia had factors beneficial for health, such as good socioeconomic status. Despite considering these factors, individuals undergoing dyslipidemia treatment had a negative association with mortality risk.

Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE)

Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes.Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH).Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (<i>P</i><0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.

A Consistency Model for Identifying the Effects of n-3 and n-6 Fatty Acids on Lipoproteins in Dialysis Patients

Numerous randomized controlled trials (RCTs) and meta-analyses have assessed the effects of supplemental dietary polyunsaturated fatty acids (PUFAs) on levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) and the LDL/HDL ratio in patients receiving renal replacement therapy (RRT). However, results are ambiguous due to mixed reports of various nutrients used in the intervention group. We performed a network meta-analysis of RCTs to assess the effects of PUFAs on lipid profiles in patients undergoing RRT. RCTs performed before November 2021 were gathered from three databases. The means, standard deviations and the number of cases for each arm were independently extracted by two authors to form a network meta-analysis of LDL and HDL levels and the LDL/HDL ratio in a random effects model. Twenty-eight RCTs (n = 2017 subjects) were included in this study. The pooled results revealed that the combination of omega-3 fatty acids (n-3) and omega-6 fatty acids (n-6) produced significantly lower LDL (standardized mean difference (SMD) = −1.43, 95% confidence interval: −2.28 to −0.57) than the placebo. Both n-3 fatty acids (SMD = 0.78) and the combination of n-3 + n-6 (SMD = 1.09) benefited HDL significantly compared with placebo. Moreover, n-3 alone also exhibited a significantly lower LDL/HDL ratio than placebo. Collectively, PUFAs seem to be adequate nutrients for controlling lipoproteins in patients undergoing RRT. Specifically, n-3 + n-6 supplementation improved LDL levels, while n-3 improved HDL levels and the LDL/HDL ratio. However, our data provide limited information on specific dosages of PUFAs to form a concrete recommendation.

Interaction Analysis of Abnormal Lipid Indices and Hypertension for Ischemic Stroke: A 10-Year Prospective Cohort Study

Background

Dyslipidemia and hypertension are two important independent risk factors for ischemic stroke (IS); however, their combined effect on IS remains uncertain.

Objectives

This present study aimed to evaluate the interaction effect of hypertension and abnormal lipid indices on IS in a 10-year prospective cohort in Chinese adults.

Methods

The cohort study of 4,128 participants was conducted in May 2009 and was followed up to July 2020. All qualified participants received a questionnaire survey, physical examination, and blood sample detection. Cox regression was used to evaluate the association of dyslipidemia and hypertension with IS, and calculate the hazard ratio (HR) and 95% confidence interval (CI). The relative excess risk of interaction (RERI) and the HR (95%CI) of interaction terms were used to examine additive and multiplicative interactions.

Results

In the hypertensive population, Non-HDL-C ≥190 mg/dl, LDL-C/HDL-C ≥2 and HDL-C ≥60 mg/dl were statistically associated with IS, and after adjusting for covariates, HRs (95%CIs) were 1.565 (1.007–2.429), 1.414 (1.034–1.933) and 0.665 (0.450–0.983), respectively. While in the non-hypertension population, no significant association of Non-HDL-C ≥190 mg/dl, LDL-C/HDL-C ≥2, and HDL-C ≥60 was detected with IS (P &gt; 0.05). There was a significant association between TC/HDL-C ≥ 3.6 and the decreased risk of IS in the non-hypertension population, and the HR (95%CI) was 0.479 (0.307–0.750). Whereas, a similar association was not observed in the hypertensive population. HDL-C ≥ 60 mg/dl, Non-HDL-C ≥ 190 mg/dl, TC/HDL-C ≥ 3.6, and TG/HDL-C ≥ 1 have additive and multiplicative interactions with hypertension (P &lt; 0.05). The RERIs (95% CIs) of the additive interaction are −0.93 (−1.882–0.044), 1.394 (0.38–2.407), 0.752 (0.354–1.151) and 0.575 (0.086–1.065), respectively. The HRs (95% CIs) of the multiplicative interaction terms were 0.498 (0.272–0.911), 4.218 (1.230–14.464), 2.423 (1.437–4.086) and 1.701 (1.016–2.848), respectively.

Conclusion

High concentration of HDL-C reduces the impact of hypertension on IS, while the high concentration of Non-HDL-C, TC/HDL-C, and TG/HDL-C positively interact with hypertension affecting the incidence of IS. This study provides useful evidence for the combined effects of dyslipidemia and hypertension in predicting IS.

The Associations of Lipid Profiles With Cardiovascular Diseases and Death in a 10-Year Prospective Cohort Study

Background: Dyslipidemia is one of the modifiable risk factors for cardiovascular diseases (CVD). Identifying subjects with lipid abnormality facilitates preventative interventions.

Objectives: To evaluate the effects of lipid indices on the risks of ischemic stroke (IS), coronary heart disease (CHD), CVD, all-cause death, and CVD death.

Methods: The cohort study of 4,128 subjects started in May 2009 and followed up to July 2020. Restricted cubic spline (RCS) regression analysis was used to explore the dose-response relationship between lipid indices with outcomes. Cox proportional hazard regression analysis was used to estimate the association with a hazard ratio (HR) and 95% CI.

Results: RCS analysis showed that there were significant linear associations of TG with IS, non-high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (ApoB), and total cholesterol (TC)/HDL-C ratio with all-cause death, non-HDL-C and RC with CVD death, and significant non-linear associations of ApoB with IS and CVD, TC, LDL-C, ApoAI, and TC/HDL-C ratio with CHD, and TC with all-cause death (all P <0.1). Cox regression analysis revealed that subjects with TC <155 mg/dl (vs. 155–184 mg/dl), > 185 mg/dl (vs. 155–184 mg/dl), and ApoB <0.7 g/l (vs. ≥0.7 g/l) had higher risks of CHD (P < 0.05), the adjusted HRs (95% CIs) were 1.933 (1.248–2.993), 1.561 (1.077–2.261), and 1.502 (1.01–2.234), respectively. Subjects with ApoAI > 2.1 g/l (vs. 1.6–2.1 g/l) and TG <80 mg/dl (vs. 80–177 mg/dl) had higher risks of CVD and all-cause death (P < 0.05), the adjusted HRs (95% CIs) were 1.476 (1.031–2.115) and 1.234 (1.002–1.519), respectively.

Conclusions: Lower or higher levels of TC, higher level of ApoAI, and lower level of ApoB were associated with increased risks of CVD, and lower level of TG was associated with increased all-cause death. Maintaining optimal lipid levels would help to prevent CVD and reduce mortality.

Association between remnant cholesterol and arterial stiffness: A secondary analysis based on a cross-sectional study

The relationship between conventional lipid parameters and arterial stiffness (AS) has been verified by previous studies. However, it remains unknown whether non‐conventional lipid parameters have certain predictive effect on AS represented by brachial‐ankle pulse wave velocity (baPWV). Therefore, the study was to explore the relationship between remnant cholesterol (RC) and other non‐conventional lipid parameters and AS in the general population free from cardiovascular disease. The study included 912 participants aged 24–84 years from a medical health checkup center of Murakami Memorial Hospital. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to examine the association between non‐conventional lipid parameters and AS. The results showed that compared with non‐AS group, the AS group had higher RC, non‐high‐density lipoprotein cholesterol (Non‐HDL‐C), atherogenic index of plasma (AIP), lipoprotein combine index (LCI), atherosclerosis index (AI), triglycerides/HDL‐C (TG/HDL‐C), Castelli's risk index I (CRI‐I) and Castelli's risk index II (CRI‐II). Then, the authors divided participants into two groups by the optimal cutoff point of 23.6 of RC determined by Youden index. The baPWV was significantly higher in higher RC group compared with lower RC group, and RC was positively correlated with baPWV. Multivariate Logistic regression analysis showed that, regarding lower RC as reference, higher RC was independently associated with higher risk of AS, independent of other risk factors (OR = 1.794, 95% CI: 1.267‐2.539, p = .001). The area under the curve of AS predicted by RC was higher than that of other non‐conventional lipid parameters (almost all p < .05). The findings indicated that increased RC was a significant predictor of AS.

Effects of Combined High-Protein Diet and Exercise Intervention on Cardiometabolic Health in Middle-Aged Obese Adults: A Randomized Controlled Trial

Background: Obesity is the main risk factor of cardiovascular diseases (CVD) and metabolic diseases. The middle-aged population is the age group with the highest prevalence of obesity. Thus, improving cardiometabolic health is important to prevent CVD and metabolic diseases in middle-aged obese adults. The aim of this study was to examine the effects of exercise alone or in combination with a high-protein diet on markers of cardiometabolic health in middle-aged adults with obesity.

Methods: Sixty-nine middle-aged adults with obesity were assigned randomly to the control group (C; n = 23), exercise group (E; n = 23), or exercise combined with high-protein diet group (EP; n = 23). Individuals in the E and EP groups received supervised exercise training and individuals in the EP group received high-protein diet intervention. Body composition (assessed by dual-energy X-ray absorptiometry), oral glucose tolerance test (OGTT), lipid profiles, and inflammatory markers were determined before and after 12 weeks of intervention. Insulin sensitivity index (ISI_0,120) was calculated from values of fasting and 2-h insulin and glucose concentration of OGTT. Insulin-peak-time during the OGTT was recorded to reflect β-cell function. Analysis of covariance with baseline values as covariates was used to examine the effects of the intervention. The significant level was set at 0.05.

Results: After 12 weeks of intervention, the E group had a greater percentage of individuals with early insulin-peak-time during the OGTT than that in the C and EP groups (p = 0.031). EP group had lower total cholesterol and triglycerides than that in the C group (p = 0.046 and 0.014, respectively). Within-group comparisons showed that the 2-h glucose of OGTT and C-reactive protein decreased in the EP group (p = 0.013 and 0.008, respectively) but not in the E and C groups; insulin sensitivity improved in the EP group (p = 0.016) and had a trend to improve in the E group (p = 0.052); and abdominal fat mass and total body fat mass decreased in both intervention groups (p < 0.05).

Conclusion: Combined high-protein diet and exercise intervention significantly decreased fat mass and improved lipid profiles, insulin sensitivity, glucose tolerance, and inflammation in middle-aged adults with obesity.

Clinical Trial Registration: Thai Clinical Trials Registry, TCTR20180913003, 13-09-2018.

SYTL3-SLC22A3 Single-Nucleotide Polymorphisms and Gene-Gene/Environment Interactions on the Risk of Hyperlipidemia

The current study aims to further delineate the associations between the synaptotagmin-like 3 (SYTL3) and solute carrier family 22 member 3 (SLC22A3) single-nucleotide polymorphisms (SNPs) and their haplotypes and gene–gene (G × G)/environment (G × E) interactions on the risk of hyperlipidemia (HLP) in the Maonan and Han ethnic groups. Genotype distribution among the SYTL3–SLC22A3 SNPs in 2,829 individual patients bearing no relationship to each other (Han, 1,436; Maonan, 1,393) was analyzed utilizing next-generation sequencing techniques. The genotype frequencies of the rs6455600, rs2129209, and rs446809 SNPs were varied between the two ethnic groups (P < 0.05–0.001). Various SNPs were correlated with serum levels of triglyceride (TG; rs446809), total cholesterol (TC; rs6455600, rs2129209, and rs539298), and low-density lipoprotein cholesterol (LDL-C; rs446809) among the Han population, whereas various SNPs were also correlated with TC (rs6455600 and rs539298), TG (rs446809), and LDL-C (rs446809) levels in the Maonan ethnic group (P < 0.008–0.001). One part of haplotypes resulted in worsened HLP-related morbidity in the Han (SYTL3 A-C-A-A; SLC22A3 A-A and A-G; and SYTL3–SLC22A3 A-C-A-A-A-A and A-C-A-A-A-G) and Maonan (SYTL3 A-C-A-A; SLC22A3 A-A and A-G; and SYTL3–SLC22A3 A-C-A-A-A-A, G-T-C-A-A-A, and G-T-C-A-C-A) ethnic groups, whereas another part of haplotypes lowered HLP-related health risks in the Han (SLC22A3 C-A and C-G and SYTL3–SLC22A3 A-C-A-A-C-A, A-C-A-A-C-G, and G-T-C-A-C-A) and Maonan (SLC22A3 C-G and SYTL3–SLC22A3 A-C-A-A-C-G) ethnic groups. We discovered that the SYTL3–SLC22A3 SNPs and their haplotypes were associated with serum lipid levels and the risk of HLP in our studied populations.

Weighted gene co-expression network analysis to identify key modules and hub genes related to hyperlipidaemia

BACKGROUND

The purpose of this study was to explore the potential molecular targets of hyperlipidaemia and the related molecular mechanisms.

METHODS

The microarray dataset of GSE66676 obtained from patients with hyperlipidaemia was downloaded. Weighted gene co-expression network (WGCNA) analysis was used to analyse the gene expression profile, and the royal blue module was considered to have the highest correlation. Gene Ontology (GO) functional and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were implemented for the identification of genes in the royal blue module using the Database for Annotation, Visualization and Integrated Discovery (DAVID) online tool (version 6.8; http://david.abcc.ncifcrf.gov ). A protein-protein interaction (PPI) network was established by using the online STRING tool. Then, several hub genes were identified by the MCODE and cytoHubba plug-ins in Cytoscape software.

RESULTS

The significant module (royal blue) identified was associated with TC, TG and non-HDL-C. GO and KEGG enrichment analyses revealed that the genes in the royal blue module were associated with carbon metabolism, steroid biosynthesis, fatty acid metabolism and biosynthesis pathways of unsaturated fatty acids. SQLE (degree = 17) was revealed as a key molecule associated with hypercholesterolaemia (HCH), and SCD was revealed as a key molecule associated with hypertriglyceridaemia (HTG). RT-qPCR analysis also confirmed the above results based on our HCH/HTG samples.

CONCLUSIONS

SQLE and SCD are related to hyperlipidaemia, and SQLE/SCD may be new targets for cholesterol-lowering or triglyceride-lowering therapy, respectively.

Association between SLC44A4-NOTCH4 SNPs and serum lipid levels in the Chinese Han and Maonan ethnic groups

BACKGROUND

The current research was to assess the relationship of the solute carrier family 44 member 4 (SLC44A4) rs577272, notch receptor 4 (NOTCH4) rs3134931 SNPs and serum lipid levels in the Han and Maonan ethnic groups.

METHODS

The genetic makeup of the SLC44A4 rs577272 and NOTCH4 rs3134931 SNPs in 2467 unrelated subjects (Han, 1254; Maonan,1213) was obtained by using polymerase chain reaction and restriction fragment length polymorphism technique, combined with gel electrophoresis, and confirmed by direct sequencing.

RESULTS

The genotype frequencies of SLC44A4 rs577272 and NOTCH4 rs3134931 SNPs were different between Han and Maonan populations (P < 0.05); respectively. The SLC44A4 rs577272 SNP was associated with total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels in Maonan group. The NOTCH4 rs3134931 SNP was associated with triglyceride (TG) in Han; and TG and low-density lipoprotein cholesterol (LDL-C) levels in Maonan groups (P < 0.025-0.001). Stratified analysis according to gender showed that the SLC44A4 rs577272 SNP was associated with TC and HDL-C in Han and Maonan females; TC in Maonan males, meanwhile, the NOTCH4 rs3134931 SNP was associated with TG and HDL-C in Han males; TG in Han females; TG and LDL-C in Maonan males; and TG, HDL-C and LDL-C in Maonan females. Linkage disequilibrium analysis showed that the most common haplotype was rs577272G-rs3134931A (> 50%) in both Han and Maonan groups. The haplotype of rs577272G-rs3134931A was associated with TG and HDL-C in Han; and TC, TG and HDL-C in Maonan ethnic groups.

CONCLUSIONS

These results suggest that the relationship among SLC44A4 rs577272, NOTCH4 rs3134931 SNPs and serum lipid parameters may vary depending on the gender and/or ethnicity/race in some populations. Haplotypes could explain more changes in serum lipid parameters than any single SNP alone particularly for TC, TG and HDL-C.

A U-shaped association between the LDL-cholesterol to HDL-cholesterol ratio and all-cause mortality in elderly hypertensive patients: a prospective cohort study

Background

The low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease (CVD). However, previous studies linking the LDL-C/HDL-C ratio to mortality have yielded inconsistent results and been limited by short follow-up periods. Therefore, the aim of the present study was to determine whether the LDL-C/HDL-C ratio could be an effective predictor of all-cause mortality in elderly hypertensive patients.

Methods

A total of 6941 hypertensive patients aged 65 years or older who were not treated with lipid-lowering drugs were selected from the Chinese Hypertension Registry for analysis. The endpoint of the study was all-cause mortality. The relationship between the LDL-C/HDL-C ratio and all-cause mortality was determined using multivariate Cox proportional hazards regression, smoothing curve fitting (penalized spline method), subgroup analysis and Kaplan–Meier survival curve analysis.

Results

During a median follow-up of 1.72 years, 157 all-cause deaths occurred. A U-shaped association was found between the LDL-C/HDL-C ratio and all-cause mortality. Patients were divided according to the quintiles of the LDL-C/HDL-C ratio. Compared to the reference group (Q3: 1.67–2.10), patients with both lower (Q1 and Q2) and higher (Q4 and Q5) LDL-C/HDL-C ratios had higher all-cause mortality (< 1.67: HR 1.81, 95% CI: 1.08–3.03; ≥2.10: HR 2.00, 95% CI: 1.18–3.39). Compared with the lower and higher LDL-C/HDL-C ratio groups, patients with LDL-C/HDL-C ratios of 1.67–2.10 had a significantly higher survival probability (log-rank P = 0.038).

Conclusions

The results suggest that there is a U-shaped association between the LDL-C/HDL-C ratio and all-cause mortality. Both lower and higher LDL-C/HDL-C ratios were associated with increased all-cause mortality in elderly hypertensive patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-020-01413-5.

Sex-related associations of high-density lipoprotein cholesterol with aortic stiffness and endothelial glycocalyx integrity in treated hypertensive patients

Smoking, a well-recognized major cardiovascular (CV) risk factor, impairs endothelial function and increases aortic stiffness which indicates subclinical organ damage in hypertensive patients. Loss of endothelial glycocalyx (EG) integrity, as part of the endothelium, represents endothelial dysfunction. The authors aimed to investigate the role of increased HDL cholesterol levels (HDL-C), which usually are considered protective against CV disease, in aortic stiffness and endothelial integrity in middle-aged treated hypertensive patients regarding smoking habit. The authors studied 193 treated hypertensive patients ≥40 years (mean age = 61±11 years, 58% females), divided in four groups regarding sex and smoking. Increased perfusion boundary region of the 5-9 μm diameter sublingual arterial microvessels (PBR_5-9 ) was measured as a noninvasive accurate index of reduced EG thickness. Aortic stiffness was estimated by carotid-femoral pulse wave velocity (PWV). In the whole population, an inverse weak relationship was found between HDL-C and PWV (r = -.15, P = .03) and PBR_5-9 (ρ = -.15, P = .03). Moreover, HDL-C was negatively related to PBR_5-9 in males (r = -.29, P = .008) either smokers (r = -.35, P < .05) or non-smokers (r = -.27, P < .05) and PWV in female non-smokers (r = -.28, P = .009). In a multiple linear regression analysis, using age, weight, smoking, HDL-C, and LDL-C as independent variables, we found that HDL-C independently predicts PWV in the whole population (β = -.14, P = .02) and PBR_5-9 in male hypertensive patients (β = -.28, P = .01). Higher HDL-C levels are associated with reduced aortic stiffness in hypertensive patients, while they protect EG and subsequently endothelial function in middle-aged, treated hypertensive male patients (either smokers or not).

Associations of PRKN-PACRG SNPs and G × G and G × E interactions with the risk of hyperlipidaemia

This research aimed to assess the associations of 7 parkin RBR E3 ubiquitin protein ligase (PRKN) and 4 parkin coregulated gene (PACRG) single-nucleotide polymorphisms (SNPs), their haplotypes, gene-gene (G × G) and gene-environment (G × E) interactions with hyperlipidaemia in the Chinese Maonan minority. The genotypes of the 11 SNPs in 912 normal and 736 hyperlipidaemic subjects were detected with next-generation sequencing technology. The genotypic and allelic frequencies of the rs1105056, rs10755582, rs2155510, rs9365344, rs11966842, rs6904305 and rs11966948 SNPs were different between the normal and hyperlipidaemic groups (P < 0.05-0.001). Correlations between the above 7 SNPs and blood lipid levels were also observed (P < 0.0045-0.001, P < 0.0045 was considered statistically significant after Bonferroni correction). Strong linkage disequilibrium was found among the 11 SNPs (r2 = 0.01-0.64). The most common haplotypes were PRKN C-G-T-G-T-T-C (> 15%) and PACRG A-T-A-T (> 40%). The PRKN C-G-C-A-T-T-C and PRKN-PACRG C-G-T-G-T-T-C-A-T-A-T haplotypes were associated with an increased risk of hyperlipidaemia, whereas the PRKN-PACRG C-G-T-G-C-T-C-A-T-C-T and C-G-T-G-T-T-C-A-T-C-T haplotypes provided a protective effect. Association analysis based on the haplotypes and G × G interaction could improve the power to detect the risk of hyperlipidaemia over the analysis of any one SNP alone. The differences in serum lipid parameters between the hyperlipidaemic and normal groups might partly be due to the effects of the PRKN-PACRG SNPs and their haplotypes.

Association of LDL-C/HDL-C Ratio With Stroke Outcomes Within 1 Year After Onset: A Hospital-Based Follow-Up Study

Stroke remains a leading cause of death and disability. The low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C ratio) ratio has been confirmed to be a predictor of stroke. However, few studies have assessed the prognostic impact of the LDL-C/HDL-C ratio for stroke patients. We aimed to investigate the relationship between the LDL-C/HDL-C ratio and the prognosis following stroke in Chinese patients. A total of 3,410 patients who had experienced their first ischemic stroke was recruited to this study within 72 h of stroke onset. The patients were followed for at least 12 months. A multivariate regression analysis was used to assess the association between the LDL-C/HDL-C ratio and prognosis following stroke. We considered the LDL-C/HDL-C ratio as a continuous variable and stratified patients according to the LDL-C/HDL-C ratio quartile. A higher LDL-C/HDL-C ratio was associated with lower rates of death, recurrence, and moderate disability (defined as a modified Rankin scale score >2) at 3 months. Using group 1 as the reference group, the relative risk (RRs) at 3 months for death were 0.45 (95% confidence interval [CI]: 0.27, 0.77) for group 2, 0.58 (95% CI: 0.34, 0.98) for group 3, and 0.97 (95% CI: 0.60, 1.56) for group 4; for recurrence, the RRs were 0.75 (95% CI: 0.56, 0.99) for group 2, 0.65 (95% CI: 0.48, 0.89) for group 3, and 0.55 (95% CI: 0.39, 0.78) for group 4; and for moderate disability, the RRs were 0.74 (95% CI: 0.55, 0.99) for group 2, 0.65 (95% CI: 0.47, 0.89) for group 3, and 0.55 (95% CI: 0.39, 0.77) for group 4. At 12 months, patients in group 2 were the most protected against ischemic stroke death (RR: 0.57; 95% CI: 0.34, 0.95). However, there were no associations between the LDL-C/HDL-C ratio and stroke recurrence or moderate disability. A higher LDL-C/HDL-C ratio was found to protect against death, recurrence, and moderate disability at 3 months. However, there was no significant association between the LDL-C/HDL-C ratio and stroke recurrence or moderate disability at 12 months. These results nonetheless suggest that a higher LDL-C/HDL-C ratio was associated with short-term stroke prognosis.

SYNE1-QK1 SNPs, G × G and G × E interactions on the risk of hyperlipidaemia

This study aimed to assess the relationship of 3 spectrin repeat containing nuclear envelope protein 1 (SYNE1) and 4 KH domain containing RNA binding (QK1) single nucleotide polymorphisms (SNPs), their haplotypes, gene‐gene (G × G), gene‐environment (G × E) interactions and hypercholesterolaemia (HCH) and hypertriglyceridaemia (HTG) in the Chinese Maonan minority. The genetic make‐up of the SYNE1‐QK1 SNPs in 1932 unrelated subjects (normal, 641; HCH, 649; and HTG, 642) was obtained by next‐generation sequencing technologies. The genotypic frequencies of following SNPs were suggestively distinctive between the control and HCH groups (rs2623963, rs7745725, rs9459317, rs16897566), or between the control and HTG groups (rs2623963, rs1358317, rs7745725, rs1923608, rs16897566 SNPs; P < .05, respectively). Multiple‐locus linkage disequilibrium analysis indicated that the identified SNPs were not inherited independently. Several haplotypes and gene‐gene interaction haplotypes among the detected SNPs may be related with an increased morbidity of HCH (C‐G‐A, C‐G‐G and C‐G‐G‐T‐C‐A‐T) and HTG (C‐G‐G, G‐T‐G‐C, C‐G‐G‐G‐T‐G‐C and C‐G‐G‐T‐C‐A‐T), whereas others may be related with an decreased risk of HCH (G‐A‐A, G‐C‐A‐T, C‐A‐A‐T‐C‐A‐T and G‐A‐A‐G‐C‐A‐T) and HTG (G‐A‐A, G‐C‐A‐T, C‐A‐A‐T‐C‐A‐T and G‐A‐A‐G‐C‐A‐T). The association evaluation based on haplotypes and gene‐gene interactions could improve the power of detecting the risk of dyslipidaemia than anyone of SNP alone. There was significant three‐locus model involving SNP‐SNP, haplotype‐haplotype/environment and G × G interactions (P < .05‐0.001) that were detected by GMDR in HCH and HTG groups. Different interactions between genetic and environmental factors would produce different redundancy or synergy effects on the morbidity of HCH and/or HTG.

Decrease in Serum HDL-C Level Is Associated with Elevation of Blood Pressure: Correlation Analysis from the Korean National Health and Nutrition Examination Survey 2017

A low-serum, high-density lipoproteins-cholesterol (HDL-C) level and high blood pressure (BP) are independent risk factors for cardiovascular disease and dementia. In the present study, in order to find putative correlation between low HDL-C and hypertension, 4552 subjects (20-80 years old) were selected from the Korean National Health And Nutrition Examination Survey 2017 (KNHANES VII-2, n = 2017 men, n = 2535 women). They were classified into four levels of blood pressure, ranging from BP1 (normal, below 120/80 mmHg for systolic BP (SBP)/diastolic BP (DBP), BP2 (prehypertension, 120/80 to 139/89 mmHg), BP3 (hypertension stage 1, 140/90-159/99 mmHg), and BP4 (hypertension stage 2, higher than 160/100 mmHg). Generally, in the total population, a higher SBP level and age were associated with a lower HDL-C in both genders. However, DBP was not associated with age in men. In the total population, Pearson's correlation analysis revealed that SBP (r = -0.188, p < 0.001) and DBP (r = -0.198, p < 0.001) showed negative correlations with percentage of HDL-C in total cholesterol (TC), HDL-C/TC (%). In both genders, HDL-C gradually decreased with age and HDL-C/TC (%) was more accurate in expressing a correlation with BP. Women showed a more distinct decrease in HDL-C with an elevation of BP and age than men. Both elevation of DBP and SBP were associated with a decrease in HDL-C, around 2.3-2.4 mg/dL, between normal range and hypertension 2 stage. Additionally, DBP was significantly associated with HDL-C/TC (%) (men: r = -0.136, p < 0.001; women: r = -0.152, p < 0.001), while HDL-C did not show a significant association with a change in DBP. In conclusion, SBP was positively correlated with age, but DBP did not change significantly with age. The correlation of BP and HDL-C depending on age showed that SBP gradually increased and HDL-C decreased with an increase in age. The percentage of HDL-C in TC was more significantly associated with a change in SBP and DBP in both genders.

Effect of a balanced Korean diet on metabolic risk factors among overweight/obese Korean adults: a randomized controlled trial

PURPOSE

This study was to see the effects of a balanced Korean diet (BKD) on metabolic risk factors in overweight or obese Korean adults, comparing with those of a typical American diet (TAD) and a diet recommended by the 2010 Dietary Guidelines for Americans (2010DGA).

METHODS

The study was designed as a randomized crossover controlled trial, in which 61 overweight or obese volunteers were divided into six groups and each consumed the BKD, 2010DGA, and TAD in a random order for 4 weeks separated by 2-week washout intervals. Anthropometric indices, blood pressure, blood lipid content, fasting blood glucose, and blood insulin level were measured at the beginning and end of each diet period.

RESULTS

A total of 54 participants completed the trial. The BKD caused more significant reductions of body mass index (BMI) (p < 0.001), body fat percent (p < 0.001), blood total cholesterol (p < 0.001), and low-density lipoprotein (LDL) cholesterol (p = 0.007) compared with the 2010DGA or TAD (all p values for differences between diets < 0.05). All three diets significantly lowered blood triglyceride levels (p < 0.05). The BKD decreased high-density lipoprotein (HDL) cholesterol (p = 0.001) and increased fasting blood glucose (p = 0.018), whereas TAD and 2010DGA increased HDL cholesterol and did not affect blood glucose levels. Furthermore, the BKD significantly decreased the proportion of individuals with elevated total cholesterol (p < 0.001) and LDL cholesterol (p < 0.01), whereas the 2010DGA significantly reduced the number of obese individuals (p < 0.05), and the TAD decreased the number of participants with elevated triglyceride levels (p < 0.05), but increased that of those with elevated LDL cholesterol (p < 0.05).

CONCLUSIONS

The Korean diet based on dietary guidelines improved metabolic risk factors such as BMI, body fat percent, and blood lipid profiles in overweight or obese Korean adults. These results provide evidence to recommend the Korean diet for preventing various metabolic diseases.

CLINICAL TRIAL REGISTRATION

The trial was registered at the Clinical Research Information Service (CRIS) in Korea, the primary registry of the World Health Organization (WHO) international clinical trial registry platform, under number KCT0002437.

IL28B gene polymorphism is correlated with changes in low-density lipoprotein cholesterol levels after clearance of hepatitis C virus using direct-acting antiviral treatment

BACKGROUND

Direct-acting antivirals (DAAs) rapidly clear hepatitis C virus (HCV), but the lipid dynamics after DAA treatment remain unknown. Low-density lipoprotein (LDL) cholesterolemia is the predicting factor for the onset and death of atherosclerotic cardiovascular diseases. Thus, in this study, we examined the frequency and risk of hyper-LDL cholesterolemia in HCV patients who achieved sustained virologic response (SVR) with DAA treatment.

METHODS

A total of 121 patients with HCV genotype 1b, who achieved SVR with DAA treatment, were examined for serum levels of total cholesterol, LDL-cholesterol (LDL-C), high-density lipoprotein, and triglycerides from the start of treatment until 2 years after SVR (SVR-2y). ΔLDL-C was defined as the change in LDL-C levels from treatment initiation to SVR-2y. Hyper-LDL cholesterolemia was defined as ≥ 140 mg/dL LDL-C at SVR-2y. Stepwise multiple regression analysis was performed to determine whether ΔLDL-C and hyper-LDL cholesterolemia are associated with other factors, including viral kinetics.

RESULTS

A total of 63, 3, and 55 patients were administered daclatasvir + asunaprevir, ombitasvir + paritaprevir + ritonavir, and ledipasvir + sofosbuvir, respectively. ΔLDL-C in patients with the IL28B (rs8099917) TG/GG genotype was significantly higher than in those with IL28B TT (27.3 ± 27.0 and 9.6 ± 27.3 mg/dL; P < 0.001). In addition, IL28B TG/GG was an independent risk factor for hyper-LDL cholesterolemia (odds ratio: 8.47; P < 0.001).

CONCLUSIONS

An IL28B polymorphism is associated with ΔLDL-C and hyper-LDL cholesterolemia after achieving SVR. Thus, lipid markers should be carefully monitored in patients who achieve SVR with DAA.

Association between the XKR6 rs7819412 SNP and serum lipid levels and the risk of coronary artery disease and ischemic stroke

Background

The present study aimed to expound the association between the XK related 6 gene (XKR6) rs7819412 single nucleotide polymorphism (SNP) and serum lipid profiles and the risk of coronary artery disease (CAD) and ischemic stroke.

Methods

The genetic makeup of the XKR6 rs7819412 SNP in 1783 unrelated participants (controls, 643; CAD, 588 and ischemic stroke, 552) of Han Chinese was obtained by the Snapshot technology.

Results

The genotypic frequencies of the SNP were disparate between CAD (GG, 81.0%; GA/AA, 19.0%) or ischemic stroke (GG, 81.2%; GA/AA, 18.8%) patients and healthy controls (GG, 85.7%, GA/AA, 14.3%; P < 0.05 vs. CAD or ischemic stroke; respectively). The A allele frequency was also diverse between CAD (10.1%) or ischemic stroke (10.0%) and control groups (7.5%; P < 0.05 vs. CAD or ischemic stroke; respectively). The GA/AA genotypes and A allele were associated with high risk of CAD and ischemic stroke (CAD: P = 0.026 for GA/AA vs. GG, P = 0.024 for A vs. G; Ischemic stroke: P = 0.029 for GA/AA vs. GG, P = 0.036 for A vs. G). The GA/AA genotypes were also associated with increased serum triglyceride (TG) concentration in CAD and total cholesterol (TC) concentration in ischemic stroke patients.

Conclusions

These data revealed that the XKR6 rs7819412 A allele was related to increased serum TG levels in CAD, TC levels in ischemic stroke patients and high risk of CAD and ischemic stroke.

The associations of lipids and lipid ratios with stroke: A prospective cohort study

Lipids and lipid ratios have been proven to be associated with cardiovascular disease; however, their relationships with stroke and stroke subtypes had not been fully understood. This study aims to assess the associations of lipids and lipid ratios with type-specific stroke and compare their predictive capacities for stroke occurrence. In this prospective cohort study, a total of 42 005 Chinese participants aged 20 to 80 who were free of stroke at baseline were included and selected into subgroups of stroke subtypes (ischemic, hemorrhagic, and total). Total stroke outcome included a combination of ischemic and hemorrhagic stroke. Over an average follow-up of 3.6 years, 781 participants developed stroke (623 ischemic and 158 hemorrhagic). In men, the highest TC/HDL-C quartile was significantly associated with increased ischemic stroke risk (multivariable-adjusted hazard ratio [HR], 1.52, 95% confidence interval [CI], 1.14-2.03) and total stroke risk (HR, 1.45, 95% CI, 1.12-1.87), and TC/HDL-C had the highest area under the receiver operating characteristic curve (AUC) for predicting ischemic (AUC, 0.868) and total stroke (AUC, 0.874). In women, the highest TG quartile was significantly associated with increased risk of ischemic (HR, 1.99, 95% CI, 1.11-3.59) and total stroke (HR, 1.85, 95% CI, 1.07-3.20), with AUCs of 0.850 and 0.861, respectively. No lipid variables were significantly associated with hemorrhagic stroke in both sex. In conclusion, TC/HDL-C ratio may better predict stroke risk in men, whereas TG was more valuable in predicting stroke risk in women. TC/HDL-C and TG may help to discriminate high stroke risk individuals and serve as potential targets for stroke prevention.

HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients

Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity, and finally to cardiovascular disease. The authors aimed to investigate the role of increased HDL cholesterol (HDL-C) levels, which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. The authors studied 120 treated hypertensive patients older than 50 years were divided regarding HDL-C tertiles in group HDL_H (HDL-C ≥ 71 mg/dL, upper HDL-C tertile) and group HDL_L (HDL-C < 71 mg/dL, two lower HDL-C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranging from 5 to 9 µm) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. PBR 5-9 was significantly decreased in group HDL_H (P = 0.04). In the whole population, HDL-C was inversely but moderately related to PBR 5-9 (r = -0.22, P = 0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL-C, LDL-C, and office SBP, as independent variables, the authors found that BMI (β = 0.25, P = 0.006) independently predicted PBR 5-9 in the whole population. In older hypertensive patients, HDL-C ranging between 71 and 101 mg/dL might moderately protect EG and subsequently endothelial function. Future studies in several groups of low- or high-risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL-C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.

Effects of sarpogrelate, eicosapentaenoic acid and pitavastatin on arterioslcerosis obliterans-related biomarkers in patients with type 2 diabetes (SAREPITASO study)

BACKGROUND

The aim was to evaluate the significance of arteriosclerosis obliterans-related biomarkers in patients with type 2 diabetes mellitus (T2DM), and to compare the effects of sarpogrelate, eicosapentaenoic acid (EPA) and pitavastatin on these markers.

PATIENTS AND METHODS

Seventy-two arteriosclerosis obliterans patients with T2DM were classified into two groups, pitavastatin with either sarpogrelate (PS) or EPA (PE). We observed no differences in all biomarkers between the PS and PE groups before treatments.

RESULTS

The levels of body mass index, hemoglobin A1c, soluble E-selectin, soluble vascular cell adhesion molecule 1, plasminogen activator inhibitor-1 and platelet-derived microparticle in the PE group decreased significantly after treatment. The ankle branchial pressure index and adiponectin levels significantly increased in the PE group after treatment compared with the PS group.

CONCLUSION

These results suggest that combination therapy using pitavastatin and EPA possesses an antiatherosclerotic effect and may be beneficial for prevention of vascular complications in patients with T2DM.

Genome-Wide Association Study Reveals Four Loci for Lipid Ratios in the Korean Population and the Constitutional Subgroup

Circulating lipid ratios are considered predictors of cardiovascular risks and metabolic syndrome, which cause coronary heart diseases. One constitutional type of Korean medicine prone to weight accumulation, the Tae-Eum type, predisposes the consumers to metabolic syndrome, hypertension, diabetes mellitus, etc. Here, we aimed to identify genetic variants for lipid ratios using a genome-wide association study (GWAS) and followed replication analysis in Koreans and constitutional subgroups. GWASs in 5,292 individuals of the Korean Genome and Epidemiology Study and replication analyses in 2,567 subjects of the Korea medicine Data Center were performed to identify genetic variants associated with triglyceride (TG) to HDL cholesterol (HDLC), LDL cholesterol (LDLC) to HDLC, and non-HDLC to HDLC ratios. For subgroup analysis, a computer-based constitution analysis tool was used to categorize the constitutional types of the subjects. In the discovery stage, seven variants in four loci, three variants in three loci, and two variants in one locus were associated with the ratios of log-transformed TG:HDLC (log[TG]:HDLC), LDLC:HDLC, and non-HDLC:HDLC, respectively. The associations of the GWAS variants with lipid ratios were replicated in the validation stage: for the log[TG]:HDLC ratio, rs6589566 near APOA5 and rs4244457 and rs6586891 near LPL; for the LDLC:HDLC ratio, rs4420638 near APOC1 and rs17445774 near C2orf47; and for the non-HDLC:HDLC ratio, rs6589566 near APOA5. Five of these six variants are known to be associated with TG, LDLC, and/or HDLC, but rs17445774 was newly identified to be involved in lipid level changes in this study. Constitutional subgroup analysis revealed effects of variants associated with log[TG]:HDLC and non-HDLC:HDLC ratios in both the Tae-Eum and non-Tae-Eum types, whereas the effect of the LDLC:HDLC ratio-associated variants remained only in the Tae-Eum type. In conclusion, we identified three log[TG]:HDLC ratio-associated variants, two LDLC:HDLC ratio-associated variants, and one non-HDLC:HDLC-associated variant in Koreans and the constitutional subgroups.

Validity of a Novel Method for Estimation of Low-Density Lipoprotein Cholesterol Levels in Diabetic Patients

AIM

Low-density lipoprotein cholesterol (LDL-C) is routinely estimated using the Friedewald equation [LDL-C(F)]. A novel method for LDL-C [LDL-C(M)] estimation recently proposed by Martin et al. was reported to be more accurate than the Friedewald formula in subjects in the United States. The validity of LDL-C(M) in different races and patients with diabetes mellitus (DM) has not been elucidated. The purpose of this study was to validate the LDL-C(M) estimates in Japanese population with type 2 DM by comparing with LDL-C(F) and directly measured LDL-C [LDL-C(D)].

METHODS

Both LDL-C(M) and LDL-C(F) levels were compared against LDL-C(D) measured by selective solubilization method in 1,828 Japanese patients with type 2 DM.

RESULTS

On linear regression analysis, LDL-C(M) showed a stronger correlation than that shown by LDL-C(F) (R=0.979 vs. R=0.953, respectively) with LDL-C(D). We further analyzed the effect of serum triglyceride (TG) concentrations on the accuracy of LDL-C(F) and LDL-C(M). Although LDL-C levels showed a positive correlation with TG levels, the LDL-C(F) levels tended to show a greater divergence from LDL-C(D) levels than that shown by LDL-C(M) with changes in TG levels.

CONCLUSION

We for the first time demonstrated a more useful measurement of LDL-C levels estimated by Martin's method than that estimated by the Friedewald equation in Japanese patients with DM.

Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling

BACKGROUND

Various lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation.

OBJECTIVE

To determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD.

DATA SOURCES

We searched databases and clinical trials registers from 2007 (including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials register, and the Cumulative Index to Nursing and Allied Health Literature) to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink and St Luke's Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature.

METHODS

In two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year.

RESULTS

A total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 (95% confidence interval 1.15 to 1.35) for CVD in a primary prevention population but heterogeneity was high (I(2) = 98%); similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention.

LIMITATION

Heterogeneity in meta-analyses.

CONCLUSIONS

While acknowledging known and potential unknown harms of statins, we find that more frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42013003727.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Serial measurement of lipid profile and inflammatory markers in patients with acute myocardial infarction

Serum concentration of lipids and lipoproteins changes during the course of acute coronary syndrome as a consequence of the inflammatory response. The objective of this study was to evaluate the effect of acute myocardial infarction (AMI) on the levels of lipid profile and inflammatory markers. We investigated 400 patients with AMI who were admitted within 24 h of onset of symptoms. Serum levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) were determined by standard enzymatic methods along with high sensitive C-reactive protein (hs-CRP) (latex enhanced immunoturbidimetric assay) and cytokines, interleukin (IL)-6 and IL-10 (quantitative ''sandwich'' enzyme-linked immunosorbent assay). The results indicate a trend of reduced TC, LDL, and HDL, and elevated TG levels, along with pro- and anti-inflammatory markers (p < 0.001), between day 1 and the day 2 serum samples of AMI patients. However, corrections in the serum levels have been observed at day 7. Our results demonstrate significant variations in the mean lipid levels and inflammatory markers between days 1, 2 and 7 after AMI. Therefore, it is recommended that the serum lipids should be assessed within 24 hours after infarction. Early treatment of hyperlipidemia provides potential benefits. Exact knowledge regarding baseline serum lipids and lipoprotein levels as well as their varying characteristics can provide a rational basis for clinical decisions about lipid lowering therapy.

The Association of Elevated HDL Levels With Carotid Atherosclerosis in Middle-Aged Women With Untreated Essential Hypertension

High-density lipoprotein cholesterol (HDL-C), a negative risk factor, is positively associated with a decreased risk of coronary heart disease. We investigated the association between high HDL-C levels and target organ damage (TOD) in never treated women with hypertension. We measured HDL-C levels in 117 women followed by estimation of TODs, that is, pulse wave velocity, microalbuminuria, left ventricular mass index, coronary flow reserve, and carotid intima–media thickness (cIMT). Women were divided into 2 groups (HDLH and HDLL), regarding HDL-C quartiles (upper quartile vs the first 3 lower quartiles). In HDLH group (HDL ≥70 mg/dL), cIMT was nonindependently, negatively related to HDL-C (ρ = −.42, P < .05). Using receiver –operating characteristic curve (ROC) analysis in the HDLH group, we concluded that the cutoff value of HDL ≥76.5 mg/dL moderately predicted the absence of carotid atherosclerosis (area under the curve: 0.77, P = .02; confidence interval: 0.57-0.97; sensitivity 73% and specificity 67%). Increased HDL-C may predict the absence of carotid atherosclerosis in middle-age women with untreated essential hypertension and consequently contribute to total cardiovascular risk estimation and treatment planning.

Effects of Dietary Fat Intake on HDL Metabolism

High-density lipoprotein (HDL) is a lipoprotein which has anti-atherogenic property by reversing cholesterol transport from the peripheral tissues to liver. Low HDL-cholesterol (HDL-C) as well as high low-density lipoprotein-cholesterol (LDL-C) is associated with the development of coronary heart diseases (CHD). Various epidemiological studies have suggested that the development of CHD increase in individuals with less than 40 mg/dL of HDL-C. In spite of accumulation of evidences suggesting a significant association between low HDL-C and CHD, effects of dietary factors on HDL metabolism remained largely unknown. We reviewed published articles about effects of dietary fat intake on HDL metabolism. The substitution of fatty acids (FA) for carbohydrates is beneficially associated with HDL metabolism. Monounsaturated FA intake may not affect HDL-C. Trans-FA is significantly associated with reduction of HDL-C, and is also adversely related with total cholesterol/HDL-C. Fish oils consumption, especially docosahexaenoic acid consumption, may be favorably associated with HDL metabolism. Although plant sterols and stanols may not affect HDL-C, policosanol intake is associated with a clinically significant decrease in the LDL/HDL ratio.

Effects of palm and sunflower oils on serum cholesterol and fatty liver in rats

Palm oil is a common cooking ingredient used in the commercial food industry as the second largest consumed vegetable oil in the world. Because of its lower cost and highly saturated nature, it usually maintains a solid form at room temperature and is used as a cheap substitute for butter. However, there has been a growing health concern about palm oil because of the link between dietary fats and coronary heart disease. Palm oil contains ∼49% saturated fat, a relatively high concentration compared with other vegetable oils. Consequently, high intakes of saturated fat from palm oil induce a larger increase in plasma concentrations of total cholesterol and low-density lipoproteins. In the present study, we examined the hyperlipidemia of palm oil and the risk of cardiovascular disease (CVD) using a rat model in comparison with sunflower oil with a relatively low level of saturated fat. On in vivo examination using Sprague-Dawley (SD) rats for 22 days, there were no significant differences in serum lipid levels, suggesting that palm oil may not cause hyperlipidemia and elevate CVD risk. However, liver samples obtained from SD rats fed with palm oil showed a lot of large lipid inclusions stained with the Oil Red O working solution, but not much lipid accumulation was observed in rats treated with sunflower oil. In addition, lipid accumulation in the mixed oil group fed the combination of palm and sunflower (1:1) oil was shown to be at an intermediary level between the palm oil group and sunflower oil group. Taken together, these results indicate that palm oil, a highly saturated form of vegetable oil, may induce dysfunction of the liver lipid metabolism before affecting serum lipid levels. On the other hand, sunflower oil, a highly unsaturated vegetable oil, was shown to be well metabolized in liver.

Effects of Carbohydrate and Dietary Fiber Intake, Glycemic Index and Glycemic Load on HDL Metabolism in Asian Populations

High-density lipoprotein (HDL) is a lipoprotein which has anti-atherogenic property by reverse cholesterol transport from the peripheral tissues to liver. Low HDL-cholesterol (HDL-C) levels are associated with the development of coronary artery diseases (CADs). Various epidemiological studies have suggested that the development of CAD increase in individuals with less than 40 mg/dL of HDL-C. In spite of accumulation of evidences which suggest a significant association between low HDL-C and cardiovascular diseases, effects of dietary factors on HDL metabolism remained largely unknown. There may be interracial differences in effects of dietary factors on HDL metabolism. Here we reviewed published articles about effects of carbohydrate and dietary fiber intake, glycemic index (GI) and glycemic load (GL), on HDL-C metabolism, regarding meta-analyses and clinical studies performed in Asian population as important articles. Low carbohydrate intake, GI and GL may be beneficially associated with HDL metabolism. Dietary fiber intake may be favorably associated with HDL metabolism in Asian populations.

Efficacy of low-dose rosuvastatin in patients with type 2 diabetes and hypo high-density lipoprotein cholesterolaemia

Objective

To analyse the efficacy of low-dose rosuvastatin for treating hypo high-density lipoprotein (HDL) cholesterolaemia in patients with type 2 diabetes and dyslipidaemia.

Methods

Patients with HDL-cholesterol (C) <40 mg/dl and triglycerides (TG) <400 mg/dl who were receiving treatment with lipid-lowering drugs other than rosuvastatin (or previously untreated with lipid-lowering drugs) and with low-density lipoprotein [LDL]-C ≥120 mg/dl were included. Patients were treated with 2.5 or 5 mg rosuvastatin orally, once daily, to achieve the target LDL-C level specified in Japanese guidelines. Changes in total cholesterol, HDL-C, TG, LDL-C, LDL-C/HDL-C and non-HDL-C at 3 and 6 months were prospectively analysed. Safety was evaluated by examining changes in hepatorenal function, glucose metabolism and creatine kinase.

Results

Out of 49 patients, all lipid parameters other than TG were significantly improved at 3 and 6 months. At 3 months, 83.3% of patients had achieved the target LDL-C level. Among nonlipid parameters, no changes were observed except for estimated glomerular filtration rate, which was improved by + 5.2% and + 9.6% at 3 and 6 months, respectively.

Conclusions

Low-dose rosuvastatin was effective in improving hypo-HDL cholesterolaemia and may have renoprotective effects.

An International Atherosclerosis Society Position Paper: global recommendations for the management of dyslipidemia--full report

An international panel of the International Atherosclerosis Society has developed a new set of recommendations for the management of dyslipidemia. The panel identifies non--high-density lipoprotein cholesterol as the major atherogenic lipoprotein. Primary and secondary prevention are considered separately. Optimal levels for atherogenic lipoproteins are derived for the two forms of prevention. For primary prevention, the recommendations emphasize lifestyle therapies to reduce atherogenic lipoproteins; drug therapy is reserved for subjects at greater risk. Risk assessment is based on estimation of lifetime risk according to differences in baseline population risk in different nations or regions. Secondary prevention emphasizes use of cholesterol-lowering drugs to attain optimal levels of atherogenic lipoproteins.

Predictive value of lipoprotein indices for residual risk of acute myocardial infarction and sudden death in men with low-density lipoprotein cholesterol levels <120 mg/dl

Several epidemiologic studies have demonstrated that plasma low-density lipoprotein cholesterol (LDL-C) profile is a key risk indicator for coronary heart disease (CHD). However, almost half of all patients with CHD have normal LDL-C levels. A total of 7,931 male subjects aged ≥40 years from the general population with no cardiovascular history and no use of lipid-lowering agents were followed for incidence of acute myocardial infarction (AMI) and sudden death. Of the 4,827 participants with LDL-C levels <120 mg/dl, 55 subjects had a first AMI/sudden death during an average of 5.5 years of follow-up. After adjustment for confounding factors, multiadjusted hazard ratios (HRs) were increased by 1 SD for non-high-density lipoprotein cholesterol (non-HDL-C; HR = 1.36, 95% confidence interval [CI], 1.02 to 1.81), total cholesterol (TC)/HDL-C ratio (HR = 1.40, 95% CI: 1.11 to 1.78) and LDL-C/HDL-C ratio (HR = 1.32, 95% CI: 1.02 to 1.73) but not for LDL-C (HR = 1.09, 95% CI: 0.82 to 1.44) and HDL-C (HR = 0.84, 95% CI: 0.68 to 1.04). When stratified as categorical variables on the basis of points with highest accuracy on receiver operating characteristic analysis, non-HDL-C levels >126 mg/dl (HR = 1.25, 95% CI: 1.03 to 1.51), TC/HDL-C ratio above 3.5 (HR = 1.22, 95% CI: 1.01 to 1.48) and LDL-C/HDL-C ratio >1.9 (HR = 1.25, 95% CI: 1.04 to 1.51) had increased multiadjusted HRs for AMI/sudden death. In conclusion, in men with LDL-C levels <120 mg/dl, non HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios have predictive value for residual risk of AMI/sudden death.

Lipid profile of patients with acute myocardial infarction and its correlation with systemic inflammation

The biomarker potential of using various lipids fractions for predicting risk of acute myocardial infarction (AMI) is controversial. We therefore compared the lipid profiles, including serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL) and triglycerides (TG), in 67 AMI patients. Patients included 28 STEMI (ST-elevated myocardial infarction) patients, 39 NSTEMI (non-ST-elevated myocardial infarction) patients and 25 patients with chest pain. Control group included 54 age- and gender-matched normal subjects. We also studied the correlation between lipid profile and systemic inflammation in these subjects. There were significant decreases in TC, LDL and HDL levels in both STEMI and NSTEMI patients as compared to normal subjects; however, patients with chest pain did not show any significant change in these lipids. Serum TG levels did not differ significantly among the study groups. There were significant increases in serum high-sensitive C-reactive protein (hs-CRP) levels in STEMI and NSTEMI patients, as compared to control group. Serum hs-CRP showed significant inverse correlation with HDL; however, hs-CRP was not correlated with TC, LDL, and TG. In conclusion, our findings suggest that reduction in serum TC does not prevent the risk of AMI, whereas a decrease in serum HDL and increase in hs-CRP strongly predisposes the risky individuals to an AMI event. We emphasize the importance of HDL and CRP measurements for the assessment of a combined lipid-inflammation risk factor that could be a useful predictor of high risk individuals, as well as a prognostic marker in AMI patients.