Friedewald's LDL-cholesterol estimation formula in a Japanese American population

Friedewald's formula is often used to estimate low density lipoprotein cholesterol (LDL-c) when direct measurement is not available. In this equation, the ratio of triglyceride (TG): cholesterol (C) in very low density lipoprotein (VLDL) is assumed to be 5:1. Recently it has been reported that in native Japanese the formula provided a better fit if this ratio is taken to be 4:1. The application of the formula was therefore examined in a sample of 229 second-generation Japanese American (Nisei) men. In this population, the 5:1 ratio of TG:C in VLDL was found to be appropriate. Thus the findings reported for native Japanese do not appear to be generally applicable to all Japanese populations.     

Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population

This report examines the wintertime vitamin D and PTH status of 308 participants in the Boston Low Income Elderly Osteoporosis Study of noninstitutionalized low income elderly men and women (age, 64-100 yr) living in subsidized housing in Boston, MA. Twenty-one percent of the 136 black subjects and 11% of the 110 whites had very low plasma 25-hydroxyvitamin D (25OHD) concentrations (<25 nmol/L), and 73% of the blacks and 35% of the whites had 25OHD concentrations less than 50 nmol/L. The mean 25OHD levels of the smaller Hispanic and Asian subsets were generally similar to those of the white subjects. In addition to race, significant predictors of 25OHD included vitamin D intake (positive association) and smoking (inverse association), but not sex or age. Low 25OHD concentrations were associated with increased PTH and reduced serum calcium. The PTH level in the black subjects was substantially higher than that in the white subjects, and this difference was only partially explained by the racial difference in 25OHD. Elderly individuals who live in northern areas, particularly African-Americans, should be strongly encouraged to increase their vitamin D intake, especially in winter.     

Short stature, obesity and arterial hypertension in a very low income population in North-eastern Brazil

BACKGROUND AND AIM: This cross-sectional study involved the adult population (age >18 and <60 years) of a 315-shack slum on the outskirts of the city of Maceió in North-eastern Brazil. The purpose was to investigate whether short stature in adults (an indicator of undernutrition in early life) is associated with arterial hypertension and obesity. METHODS AND RESULTS: We collected the subjects socio-economic data, and arterial hypertension (AH), weight, height, waist circumference and waist/hip (W/H) circumference ratio measurements. Hypertension was diagnosed as diastolic AH f 90 mmHg and/or systolic AH f 140 mmHg. The body mass index (BMI) was used to determine nutritional status, with overweight/obesity being defined on the basis of a cut-off point of 25 kg/m2. A W/H ratio of f 0.80 for women or f 0.95 for men was considered indicative of abdominal obesity. Short stature was defined as falling into the 1st quartile (Q) of height distribution. Hypertension was prevalent in 28.5% of the population (women=38.5%; men=18.4%). The systolic and diastolic AH readings were significantly higher in women in the 1st Q than in those in the 4th Q, and the same was true of W/H. The prevalence of hypertension was statistically significant for the first two Q's in comparison with the last two: 22.1% vs 14.6% (men), and 42.4% vs 34.6% (women). Hypertension was more prevalent in women who were obese and short (50%) than in those who were obese but not short (OR=1.98; CI=1.22-2.96). CONCLUSIONS: Living conditions were extremely precarious and the prevalence of hypertension was quite high. Stature negatively correlated with hypertension and overweight in women but not in men.     

Living conditions and gastroenteritis in the low income population of Tijuana, Mexico

A cross-sectional study was carried out in the low income population of certain areas of the city of Tijuana, Mexico. Data collected showed that these suburban areas are inhabited by people from rural areas of Mexico, with minimum education, that basically work at the "maquiladoras". General hygienic conditions were poor and the services insufficient. The prevalence of diarrheas among the population was extremely high in the two weeks previous to the study, being highest for children less than one year old, in which the proportion with at least one episode of diarrhea was 47 per cent.     

Safety profile of atorvastatin-treated patients with low LDL-cholesterol levels

Data pooled from 21 atorvastatin clinical trials have been analyzed to establish the safety of reducing low density lipoprotein cholesterol (LDL-C) levels below currently recommended minimum targets in hypercholesterolemic patients. Safety data for atorvastatin-treated patients with at least one LDL-C value < or =80 mg/dl (2.1 mmol/l) (n = 319) during treatment (mean LDL-C level throughout treatment was 91 mg/dl [2.4 mmol/l]) were compared to those from all atorvastatin-treated patients (n = 2502) and patients treated with lovastatin, simvastatin or pravastatin (n = 742). The frequency of treatment-associated adverse events (AEs) in the atorvastatin LDL-C < or =80 mg/dl (2.1 mmol/l) subgroup (24%) was comparable to the frequencies observed for all atorvastatin-treated patients (20%) and for patients receiving the other statins (24%). Patient withdrawals due to treatment-associated AEs (constipation, dyspepsia and flatulence being the most common) were consistent and low across treatment groups. No treatment-associated deaths occurred in any group. Safety data for 21 atorvastatin-treated patients with LDL-C < or =50 mg/dl (1.3 mmol/l) were also analyzed and found to be similar to all atorvastatin-treated patients and patients treated with the other statins. While recognizing the short-term nature of the data (all patients who received atorvastatin were treated for < or =1 year and approximately 30% were treated for < or =6 months), this analysis suggests that reducing LDL-C levels below 80 (2.1 mmol/l) or 50 mg/dl (1.3 mmol/l) with atorvastatin does not alter its safety profile, as measured by frequency of AEs, which remains similar to those of other statins.     

Application of Friedewald's LDL-cholesterol estimation formula to serum lipids in the Japanese population

When direct measurement of serum low density lipoprotein cholesterol (LDL-c) is not available, it can be estimated from total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-c) by using the formula proposed by Friedewald: LDL-c = TC-[HDL-c + TG/k], k = 5 This formula assumes the triglyceride/cholesterol ratio in VLDL to be 5:1. However, it is changeable with serum triglyceride levels, and averaged as 4 among Japanese with triglycerides less than 400 mg/dl. The formula provides a better fit for Japanese people, when k = 4, rather than original k = 5. In addition, a better estimation is gained, if k is rotated according to the triglyceride levels of individual subjects; i.e. 3 for those with triglycerides less than 150 mg/dl, 4 for those with triglycerides from 150 to 299 mg/dl, 5 for those with triglycerides from 300 to 400 mg/dl. The percent error of estimation is less than 5% when k = 4, and about 1% when variable k is employed for populations of about 1,000 subjects in number.     

Small dense LDL-cholesterol relative to LDL-cholesterol is a strong independent determinant of hypoadiponectinemia in metabolic syndrome.

BACKGROUND: Small dense low-density lipoprotein (sd-LDL) is an atherogenic lipoprotein closely associated with an increased risk of cardiovascular diseases. However, a precise analysis of the actual amount of sd-LDL-cholesterol (sd-LDL-C) in patients with metabolic syndrome (MS) has not been performed. Methods and RESULTS: Among 214 patients enrolled in the present study, 101 patients (47%) met the Japanese MS criteria. The serum levels of sd-LDL-C determined with a dual detection HPLC system were higher in MS than non-MS patients, while total cholesterol and low-density lipoprotein-cholesterol (LDL-C) were similar between MS and non-MS patients. Compared with the sd-LDL-C and LDL-C level, the ratio sd-LDL-C/LDL-C was more closely correlated with various parameters associated with MS. A multivariate regression analysis revealed that the ratio sd-LDL-C/LDL-C is the strongest independent determinant of hypoadiponectinemia. Furthermore, weight reduction therapy through diet and exercise rapidly decreased LDL-C but slowly decreased sd-LDL-C. At 12 months after the therapy, weight reduction led to a significant decrease in the ratio sd-LDL-C/LDL-C in tandem with increasing adiponectin levels. CONCLUSIONS: These findings demonstrate that the ratio sd-LDL-C/LDL-C is tightly connected with hypoadiponectinemia and provides a useful clinical indicator for MS. The results also suggest that the elevation of this ratio can be modulated by long-term lifestyle changes.     

Correlation between income and non-alcoholic fatty liver disease in a Chinese population

ObjectiveThe aim of the study was to analyze the correlation between income and non-alcoholic fatty liver disease (NAFLD) in a Chinese population.Methodsubjects were divided into three groups according to liver fat content (LFC). (1) normal: LFC < 9.15%, 197 cases; (2) low LFC: LFC 9.15–20%, 532 cases; and (3) high LFC: LFC > 20%, 201 cases. Participants’ clinical and social background were collected, including a routine fasting test to assess the relevant indices. Intergroup differences were compared on 1-way ANOVA, to analyze the relation between income and each index on Pearson correlation, and independent factors for LFC were identified on binary logistic regression.Results(1) In retired persons, prevalence of NAFLD was greater in females (81.2%) than males (75%), but fell with age: the highest prevalence was between 40 and 49 years of age (87.5%), and the lowest above 70 years (68%). (2) Income correlated positively with triglyceride and serum uric acid levels and LFC (P < 0.05) and negatively with alanine aminotransferase (P = 0.01). (3) As income increased from level I to V, prevalence of NAFLD increased progressively (P < 0.05). In the study, LFC was taken as the dependent variable, and the traditional NAFLD risk factors and income level (I–V) were taken as independent variables. Income emerged as an independent risk factor for NAFLD. Risk in group V was 1.964-fold higher than in group I.ConclusionPrevalence of NAFLD was closely related to socio-economic level. Demographic risk factors include female gender, age 40–49 years, and monthly income > 5,000 RMB. Thus, if income is increased without improving educational level and health awareness, NAFLD prevalence will rise.     

Development of a technique of immunoadsorption of LDL-cholesterol

An immunoadsorption system for lowering plasma cholesterol was optimized. Several polyclonal and monoclonal antibodies were compared and the best results were obtained with goat polyclonal antibodies. The optimum quantity of antibodies to be immobilized on the gel was 5 mg/ml. Taking into account two variables, i.e., 1) that the regeneration must be as complete as possible and, 2) that immunoadsorbents must be used several times without a loss of adsorption capacity, desorption was achieved with 0.3 M glycine adjusted to pH 2.8. Antibody release from the immunoadsorbent was determined and can be minimized by glutaraldehyde treatment of the immunoadsorbent. Each phase, adsorption and desorption, respectively, was well-defined and synchronized, so that two columns could be used in parallel in an automated procedure. The kinetics of plasma protein removal demonstrated the efficiency and the specificity of the procedure.     

Prevalence and clinical characteristics of urinary incontinence in elderly individuals of a low income

To estimate the prevalence of urinary incontinence (UI) in elderly individuals of low income assisted by the primary health care system in S?o Paulo, Brazil. In this community-based, observational, cross-sectional study, participants assisted by the health family program in S?o Paulo, Brazil, were sampled and interviewed face to face by questionnaire. Participants (n=388) were selected from the collaborative program developed by the 10/66 Dementia Research Group, an International Network of investigators. Demographics, health history and a detailed assessment of UI and urinary symptoms were obtained. Prevalence of UI was calculated. Other variables included age, body mass index (BMI), duration of incontinence and characteristics of the symptoms. The association between UI and the variables was estimated using the Kruskal-Wallis test, Chi-squared test and Fisher test (depending on normality of the distribution and expected frequencies). Prevalence of UI was 38.4%. UI was more common in women than in men (50% vs. 18.3%, p<0.001). Diabetes, obesity and hypertension were associated with UI. Almost 36.2% of the cases were of mixed incontinence, 26.8% of urge incontinence and 24.2% of stress incontinence. Men were more likely to have urge-incontinence, while women were more likely to have mixed incontinence (p=0.001). UI is prevalent in the elderly of low income living in S?o Paulo and rates are higher than most previous studies. Chronic conditions such as hypertension, diabetes and obesity were associated with UI.     

Low estimated glomerular filtration rate is a major determinant of low ankle-brachial index and toe-brachial index in type 2 diabetes

We enrolled 1461 Taiwanese type 2 diabetic outpatients with ankle-brachial index (ABI) and toe-brachial index (TBI) examinations, excluding participants with history of stroke, end-stage renal disease, malignancy, acute myocardial infarction, amputation, and overt calcification of the lower limbs (ABI > 1.3). Ankle-brachial index values <0.9 were found in 2.8% of the patients and 5.7% had TBI < 0.6. Estimated glomerular filtration rate (eGFR; 90 ± 33 mL/min per 1.73 m2) obtained from 473 patients correlated significantly with both ABI and TBI. Progressive eGFR decline was observed in 419 participants with normal ABI and TBI, 35 with normal ABI but low TBI, and 19 with low ABI and normal or low TBI (P for trend < .001). After adjusting for confounding factors, age and eGFR were significantly associated with TBI and ABI. Low eGFR is associated with peripheral arterial disease in type 2 diabetes with mild to moderate renal insufficiency.     

Prevalence of low LDL-cholesterol levels and elevated high-sensitivity C-reactive protein levels in apparently healthy Korean adults

Background and aimsThe Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) reported reduced cardiovascular and all-cause mortality in patients with elevated C-reactive protein (CRP) and low LDL-cholesterol (LDL-C) levels treated with statins. The aims of this study were to determine the proportion of “JUPITER-eligible” Korean adults and to describe their characteristics.Methods and resultsAs many as 15,154 subjects with serum LDL-C levels <130 mg/dL were selected among 28,851 middle-aged participants (men ≥ 50 years, women ≥ 60 years) who participated in a routine health check-up program. Among the participants with LDL-C less than 130 mg/dL, only 15% had CRP levels ≥2.0 mg/L (7.9% of original participants). Subjects were divided into four groups according to CRP levels (<0.5, ≥0.5 ? <1.0, ≥1.0 ? <2.0, and ≥2.0 mg/L). Mean HDL-C and apolipoprotein A1 levels decreased significantly as the mean CRP values increased. The insulin and homeostasis model of insulin resistance was significantly different according to CRP quartile. The number of subjects with metabolic syndrome and its components increased significantly as the mean CRP values increased.ConclusionIn this Asian population, few individuals with low LDL-C levels had CRP levels ≥2.0 mg/L. Elevated CRP levels were associated with components of atherogenic dyslipidemia and insulin resistance. Additional clinical trials should be designed and performed in different ethnic groups, as different CRP cut-off levels may be required in different ethnic groups.     

Low rate of occult hepatitis B virus infection among anti-HBc positive blood donors living in a low prevalence region in Brazil

OBJECTIVE: The aim of this study was to determine the rate of occult hepatitis B virus (HBV) infection among blood donors living in a geographic region of low (5.6%) anti-HBc prevalence. SUBJECTS AND METHODS: Sera from 150 candidate blood donors whose blood was rejected due to total anti-HBc reactivity (despite absence of HBsAg) were tested for anti-HBs and IgM anti-HBc antibodies, as well as for HBeAg/anti-HBe. Serum HBV DNA was sought by using a PCR assay able to amplify part of the surface gene. Viral load was measured in the PCR positive samples. RESULTS: The pattern 'anti-HBc alone' (without HBsAg and anti-HBs antibodies) was found in 64 (42.7%) subjects. IgM anti-HBc and anti-HBe antibodies were detected in 2 (1.3%) and 80 (53.3%) samples, respectively. No sample was HBeAg-reactive. HBV DNA was repeatedly found in five (3.3%) samples, three of which were anti-HBs positive and two anti-HBs negative. All five HBV DNA positive samples showed a low viral load (<1000copies/ml). CONCLUSIONS: The data indicated a low rate of occult infection among anti-HBc positive, HBsAg negative blood donors living in a region of low prevalence of infection. Viral load was very low in all HBV infected subjects.     

Tuberculosis morbidity in regions with a low population density

Tuberculosis incidence was studied in the northern areas of Irkutsk Province with low population density. In the areas slower lowering of pulmonary tuberculosis incidence was noted. The main contingent of the new cases included persons with the disease detected during fluorographic examinations. In the areas with low population density, the percentage of the new cases with tubercle bacilli isolation and late diagnosis of tuberculosis was higher than in the areas with high population density. The influence of migration on the epidemiological status with respect to tuberculosis in the areas with low population density was less significant as compared to that in the areas with high population density.     

Change in amputation rate in a Turkish diabetic foot population

Diabetic foot, an important cause of morbidity and mortality, is an important economic problem in all countries. We examined the duration of diabetes, ratio of hospitalization, and the amputation rates of our diabetic foot patients between 1996 and 2002 and compared the results with those obtained between 1985 and 1995. Medical reports of 117 patients with diabetic foot referred to Gazi University Medical Faculty between 1996 and 2002 were retrospectively analyzed. The mean age was 61.09+/-10.87 years and mean duration of diabetes was 16.14+/-9.44 years. Sixty-one patients were hospitalized and 56 patients were followed in our outpatient clinic. The mean duration of hospitalization was 45.00+/-18.74 (20-74) days in amputees and 28.95+/-11.61 (10-47) days in the nonamputees (P=.023). The mean age and duration of diabetes were significantly higher in amputees in the present group than that in the previous group. The amputation rate was significantly lower in the group studied between 1996 and 2002 compared to the group followed between 1985 and 1995 (9.4% vs. 21%, respectively, P<.001). Appropriate diabetes education and systematic follow-up in an outpatient clinic may delay preventable diabetic foot lesions and reduce the amputation rate.