The association of blood lipid parameters variability with ischemic stroke in hypertensive patients

Background and aimsThe relationship between lipid variability and stroke among patients with hypertension were inconclusive. We aimed to investigate the association of lipid variability with ischemic stroke in hypertensive patients.Methods and resultsThis retrospective cohort study included 4995 individuals with hypertension between 2013 and 2015, and recorded their status of ischemic stroke until the end of 2018. The variability in total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured using the standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM) and average absolute difference between successive values (ASV). Multivariate Cox proportional hazards models with hazard ratios (HRs) and 95% confidence interval (CI) were performed. There were 110 cases of ischemic stroke during a median follow up of 4.2 years. The multivariable adjusted HRs and 95% CIs comparing the highest versus the lowest quartiles of SD of TC, LDL-C, HDL-C and TG were 4.429 (95% CI: 2.292, 8.560), 2.140 (95% CI: 1.264, 3.621), 1.368 (95% CI: 0.793, 2.359) and 1.421 (95% CI: 0.800, 2.525), respectively. High variability in TC and LDL-C were associated with a higher risk for ischemic stroke. Similarly, the results were consistent when calculating variability of TC and LDL-C using CV, ASV and VIM, and in various subgroup analyses.ConclusionHigher variability of TC and LDL-C associated with the risk of ischemic stroke among hypertensive patients. These findings suggest reducing variability of lipid parameters may decrease adverse outcomes.     

女性高血压人群血脂水平与缺血性卒中的相关性

目的 探讨女性高血压人群血脂水平与缺血性卒中的关系。方法对3607例女性原发性高血压病患者进行流行病学调查和实验室检查,通过Logistic回归获得各类血脂水平对缺血性卒中的风险率及95％可信区间（a）。结果调整各种混杂因素后,非高密度脂蛋白胆固醇（non-HDL-C）和总胆固醇与高密度脂蛋白胆固醇比率（TC／HDL—C）与缺血性卒中显著相关,OR分别为1．253（95％CI,1．039～1．512）和1．594（95％C1,1．267～2．006）。结论non-HDL和TC／HDL—C是女性高血压人群缺血性卒中独立的预测因子。     

Association of the ApoB/ApoA-I ratio with stroke risk: Findings from the China Health and Nutrition Survey (CHNS)

Background and aimsStudies on associations of apolipoprotein B (ApoB), apolipoprotein A-I (ApoA-I) and the ApoB/ApoA-I ratio with stroke risk are scarce. We aimed to prospectively examine the associations of the ApoB/ApoA-I ratio and other lipid profiles with the risk of stroke using data from the China Health and Nutrition Survey (CHNS).Methods and resultsA total of 7318 participants without stroke at baseline in 2009 were included in the final analysis and followed for a median of 6.1 years. The serum lipid profiles including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), ApoA-I, and ApoB were measured at baseline. Multivariable Cox proportional hazards models were used to evaluate the associations between these parameters and stroke risk. The ApoB/ApoA-I ratio was positively associated with incident stroke, yielding adjusted hazard ratio (HR) of 1.32 (95% CI: 1.09–1.59, P = 0.004). In comparison, ratio of ApoB and ApoA-I containing lipoproteins, the non-HDL-C/HDL-C ratio, possessed relatively weaker association with incident stroke (HR: 1.24, 95% CI: 1.01–1.52, P = 0.036). Furthermore, the risk associations for the ApoB/ApoA-I and non-HDL-C/HDL-C ratios were prominent among those participants aged >51, body mass index ≤23, or female. There were no significant associations of other lipids and their ratios with the stroke risk.ConclusionsHigher ApoB/ApoA-I ratio was associated with an increased risk of stroke. Our findings suggest that the ApoB/ApoA-I ratio may serve as a better risk indicator of stroke than other lipid profiles and their ratios.     

中老年人群血脂水平对新发颈动脉斑块的预测作用

目的 了解2002年至2007年中老年人群颈动脉斑块的变化情况,评价基线血脂水平对新发颈动脉斑块的预测作用.方法 研究样本来自中美队列中的石景山人群和多省市队列中的北京大学社区人群.2002年9月对这两个人群进行基线颈动脉超声检查和心血管病危险因素调查,2007年9至10月复查颈动脉超声.以两次颈动脉检查数据完整的2000名中老年人为研究对象,对基线血脂水平与颈动脉斑块的关系进行分析.结果 (1)2002年至2007年,颈动脉斑块患病率男性从30.3%增加到62.2%,女性从21.5%增加到51.5%;新发斑块率男性为41.8%,女性为34.1%.(2)男女两性颈动脉新发斑块率随着基线总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)及总胆固醇与HDL-C比值(TC/HDL-C)水平的增高而增加,其变化趋势差异均有统计学意义(P＜0.05或P＜0.01).(3)交叉分析显示,LDL-C,HDL-C,甘油三酯对斑块发生率有协同作用.(4)多因素分析显示,高LDL-C、高non-HDL-C和高TC/HDL-C是男女两性新发颈动脉斑块的独立影响因素(男性OR值分别为1.44、1.45、1.59,女性OR值分别为1.47、1.35、1.64,均P＜0.05).结论 2002年至2007年,中老年人群颈动脉斑块患病率在快速增长.高LDL-C、nonHDL-C和TC/HDL-C水平是中老年人群新发颈动脉斑块的独立预测指标.     

血脂指标动态变化与冠心病患者择期经皮冠状动脉介入术后非靶血管病变进展的关系研究

背景冠心病(CHD)患者采用经皮冠状动脉介入治疗(PCI)具有确切效果,但存在靶血管支架再狭窄和非靶血管病变进展问题。目的探讨血脂指标动态变化与CHD患者择期PCI后非靶血管病变进展的关系。方法选取2017年1月-2019年5月空军军医大学第一附属医院心内科择期PCI后二次入院的CHD患者150例,根据非靶血管病变进展情况分为进展组45例和无进展组105例。比较两组患者性别、年龄、民族(包括回族、汉族)、吸烟情况、既往史(高血压、糖尿病)、CHD家族史、体质指数(BMI)、随访时间及syntax积分及第1次入院、第2次入院血脂指标〔包括总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、TG/HDL-C及non-HDL-C/HDL-C〕;CHD患者择期PCI后非靶血管病变进展的影响因素分析采用多因素Logistic回归分析;绘制受试者工作特征(ROC)曲线以评价non-HDL-C对CHD患者择期PCI后非靶血管病变进展的预测价值。结果进展组患者女性比例、糖尿病发生率、syntax积分高于无进展组,第1次入院TC、TG、non-HDL-C低于无进展组,两次入院TC、TG、LDL-C、non-HDL-C、TG/HDL-C、non-HDL-C/HDL-C差值高于无进展组(P<0.05)。多因素Logistic回归分析结果显示,性别〔OR=0.302,95%CI(0.122,0.751)〕、糖尿病〔OR=2.946,95%CI(1.222,7.102)〕、non-HDL-C动态变化〔OR=1.900,95%CI(1.131,3.192)〕、TG/HDL-C动态变化〔OR=1.506,95%CI(1.024,2.215)〕是CHD患者择期PCI后非靶血管病变进展的独立影响因素(P<0.05)。ROC曲线分析结果显示,non-HDL-C动态变化与TG/HDL-C动态变化预测CHD患者择期PCI后非靶血管病变进展的曲线下面积(AUC)比较,差异无统计学意义(P>0.05)。结论 non-HDL-C动态变化、TG/HDL-C动态变化是CHD患者择期PCI后非靶血管病变进展的独立影响因素,且其对CHD患者择期PCI后非靶血管病变进展有一定的预测价值。     

Association of non-HDL-C/HDL-C ratio and its dynamic changes with incident type 2 diabetes mellitus: The Rural Chinese Cohort Study

BackgroundWe aimed to evaluate the association of the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (non-HDL-C/HDL-C) and its dynamic changes with incident type 2 diabetes mellitus (T2DM).MethodsA total of 11,487 nondiabetic participants ≥18 years old in rural China were recruited in 2007–2008 and followed up in 2013–2014. A Cox proportional-hazards model was used to assess the risk of incident T2DM by quartiles of baseline non-HDL-C/HDL-C ratio and dynamic absolute and relative changes in non-HDL-C/HDL-C ratio, estimating hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsRisk of incident T2DM was increased with quartiles 2, 3, and 4 versus quartile 1 of baseline non-HDL-C/HDL-C ratio (HR 1.46 [95% CI 1.08–1.98], 1.51 [1.12–2.03], and 2.16 [1.62–2.88], P_trend < 0.001). As compared with stable non-HDL-C/HDL-C ratio during follow-up, an absolute gain in non-HDL-C/HDL-C ratio was associated with increased risk of T2DM (HR 1.67 [95% CI 1.25–2.24] for quartile 3 and 2.00 [1.52–2.61] for quartile 4). A relative increase in non-HDL-C/HDL-C ratio was also associated with increased risk of T2DM (HR 1.56 [95% CI 1.19–2.04] for quartile 3 and 1.97 [1.49–2.60] for quartile 4). Subgroup analyses showed that the association of non-HDL-C/HDL-C ratio with T2DM risk remained consistent.ConclusionsIncreased non-HDL-C/HDL-C ratio is associated with increased risk of incident T2DM among rural Chinese adults, so the index may be an important indicator for identifying individuals at T2DM risk.     

Large scale cohort study of the relationship between serum cholesterol concentration and coronary events with low-dose simvastatin therapy in Japanese patients with hypercholesterolemia and coronary heart disease: secondary prevention cohort study of the Japan Lipid Intervention Trial (J-LIT).

Hyperlipidemia is primarily implicated in the progression of coronary heart disease (CHD) and its treatment is essential for patients with a history of CHD. Statins such as simvastatin, the lipid-lowering agents, are well-known for their ability to normalize patient's serum lipid levels. The Japan Lipid Intervention Trial study of simvastatin is the first nationwide investigation of the relationship between serum lipid levels and the development of CHD in Japanese patients with hypercholesterolemia. Of 5,127 patients, exclusively with a history of documented CHD at enrollment, 4,673 were treated with open-labeled simvastatin at an initial dose of 5-10 mg/day and were monitored for 6 years. The risk of coronary events tended to be higher in patients with a serum total cholesterol (TC) > or =240 mg/dl compared with total cholesterol <240 mg/dl. The concentration of low-density lipoprotein cholesterol (LDL-C) positively correlated and that of high-density lipoprotein cholesterol (HDL-C) inversely correlated with the risk of CHD. Each 10 mg/dl decrease in LDL-C and each 10 mg/dl increase in HDL-C concentration reduced the risk of CHD by 8.0% (95% confidence interval 3.8-12.0) and 28.3% (95% CI 13.9-40.3), respectively. A reasonable therapeutic strategy to reduce CHD progression in patients with prior CHD under low-dose statin treatment might be regulating the serum LDL-C concentration to at least <120 mg/dl and HDL-C >40 mg/dl, respectively.     

Low- and high-density lipoprotein cholesterol and ischemic cerebrovascular disease: the bezafibrate infarction prevention registry

BACKGROUND: Despite increasing evidence that beta-hydroxy-beta-methyglutaryl coenzyme A reductase inhibitors reduce the incidence of stroke in patients with coronary heart disease (CHD), the associations between blood lipid levels and cerebrovascular disease (CVD) are not clear. OBJECTIVE: To evaluate whether blood cholesterol level and its fractions are risk factors for stroke in a large group of patients with CHD. METHODS: We followed up 11 177 patients with documented CHD who were screened for but not included in the Bezafibrate Infarction Prevention study, a secondary prevention randomized clinical trial of lipid modification, and had no history of stroke for subsequent CVD. During a 6- to 8-year follow-up period, 941 patients were identified as having nonhemorrhagic CVD, of whom 487 had verified ischemic stroke or transient ischemic attack (TIA). RESULTS: Increases in age-adjusted rates of both nonhemorrhagic CVD and verified ischemic stroke or TIA were identified with increasing cholesterol and low-density lipoprotein cholesterol levels, decreasing high-density lipoprotein cholesterol levels, and decreasing percentage of total serum cholesterol contained in the HDL moiety. In logistic regression models, adjusting for clinical covariates, the following odds ratios (95% confidence intervals) were identified for lipid values in the upper vs lower tertile for the end point of nonhemorrhagic CVD: total cholesterol, 1.43 (1.20-1.70); low-density lipoprotein cholesterol, 1.52 (1.27-1.81), high-density lipoprotein cholesterol, 0.84 (0.70-1.00); and percentage of serum cholesterol contained in HDL, 0.69 (0.58-0.83). Similar trends appeared for the end point of verified ischemic stroke or TIA. CONCLUSION: These findings clearly support the role of total cholesterol and its fractions in prediction of ischemic CVD among patients with established CHD.     

血清胆红素和血脂的综合指数与冠心病的关系研究

目的探讨血清胆红素与血脂的综合指数与冠心病(CHD)的关系.方法将80名行冠状动脉造影术的患者分为2组:CHD组与对照组(冠状动脉正常).测定血清总胆红素水平(TBIL),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),计算出其综合指数:LDL-C/(HDL-C TBIL)和TC/(HDL-C TBIL),分析其与CHD之间的关系.结果CHD患者血清TBIL水平明显低于非冠心病患者(P＜0.05).CHD患者总胆固醇(TC),低密度脂蛋白胆固醇(LDL-C),LDL-C/(HDL-C TBIL)比值,TC/(HDL-C TBIL)比值水平明显高于冠状动脉正常组(P＜0.05).进行Logistic回归分析,TC,LDL-C,LDL-C/(HDL-C TBIL),TC/(HDL-C TBIL)可引入Logistic回归模型,它们为CHD的危险因素.结论CHD的发生与TBIL的降低有一定的相关性,综合考虑血脂、血清胆红素与血脂的综合指数有助于CHD的诊断.     

动脉硬化指数和非高密度脂蛋白胆固醇水平与冠状动脉病变程度相关性的初步研究

目的:探讨动脉硬化指数(AI)与冠心病(CHD)患者冠状动脉病变程度的关系。方法:对148例疑诊冠心病患者行冠状动脉造影(CAG)检查,将冠状动脉造影结果阳性者86例作为冠心病组,冠状动脉造影结果阴性者62例作为对照组。检测其TC、TG、LDL-C及HDL-C,计算AI值和非高密度脂蛋白胆固醇(non-HDL-C),并采用Gensini积分法评定冠状动脉病变程度,分析各指标与冠状动脉病变程度的关系。结果:与对照组比较,冠心病组TC、LDL-C、non-HDL-C、AI值显著增高,HDL-C显著降低(P0.05)。Spearman等级相关分析显示,仅non-HDL-C和AI水平与冠状动脉病变程度呈正相关(r=0.247,r=0.314,P0.05)。结论:CHD患者有较高的non-HDL-C和AI水平,可预测并评价冠状动脉病变严重程度。     

低密度与高密度脂蛋白胆固醇比值对冠心病的诊断价值

目的 探讨低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)浓度的比值与冠心病(CHD)的相关性。方法 对68例胸痛患者行冠状动脉造影,并同时测定其血脂成分。结果CHD组总胆固醇(TC)、血清甘油三酯(TG)、LDL-C、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C高于对照组,HDL-C(低于对照组。LDL-C/HDL-C与CHD的相关性最强(OR=3.79,OR95％Cl=1.88-6.14)。结论 CHD患者存在多种血脂异常,LDL-C/HDL-C是一项有较好使用价值的CHD预测指标。     

Triglycerides and triglycerides to high-density lipoprotein cholesterol ratio are strong predictors of incident hypertension in Middle Eastern women

Dyslipidemia has been reported as a risk factor for incident hypertension in a few prospective studies, however, no study has specifically assessed different lipid measures including the lipid ratios, that is, total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs)/HDL-C as predictors of hypertension among Middle Eastern women with high prevalences of dyslipidemia and hypertension. The study population consisted of 2831 non-hypertensive women, aged ≥ 20 years. We measured lipoproteins, and calculated non-HDL-C and the lipid ratios. The risk-factor-adjusted odds ratios for incident hypertension were calculated for every 1 standard deviation (s.d.) change in TC, log-transformed TG, HDL-C, non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using multivariate logistic regression analysis. Over a mean follow-up of 6.4 years, 397 women developed hypertension. An increase of 1 s.d. in TG, TC/HDL-C and TG/HDL-C increased the risk of incident hypertension by 16, 19 and 18%, respectively, and 1 s.d. increase in HDL-C decreased the risk of hypertension by 14% in the multivariable model (all P ≤ 0.05). In models excluding women with diabetes and central or general obesity, TG, TG/HDL-C and TC/HDL-C remained as independent predictors of incident hypertension. In conclusion, dyslipidemia, using serum TG and TG/HDL-C, in particular, may be useful in identification of women at risk of hypertension, even in those without diabetes and central or general obesity.     

Role of lipid and lipoprotein profiles in risk assessment and therapy

Although low-density lipoprotein cholesterol (LDL-C) remains the primary target for coronary heart disease (CHD) prevention in the latest guidelines of the National Cholesterol Education Program, many individuals who have CHD do not have substantially elevated LDL-C but have derangement of other lipid fractions, most commonly low levels of high-density lipoprotein cholesterol (HDL-C). In the guidelines, HDL-C is important in risk stratification in primary prevention, influencing the need for and intensity of treatment of LDL-C, and both HDL-C and triglyceride are defined as risk factors for the metabolic syndrome, a secondary target of therapy. Triglyceride level also determines in which individuals non-HDL-C should be a secondary target of therapy. Risk assessment that takes into account the entire lipid profile will identify more high-risk individuals than evaluating LDL-C alone. Some epidemiologic data suggest that instead of measuring the cholesterol in LDL or HDL, measuring their respective apolipoproteins, apolipoprotein (apo) B-100 and apo A-I, may improve CHD risk assessment, and in some observational and interventional studies, ratios of lipids and/or apolipoproteins have been better predictors of CHD risk than levels of any one lipid fraction. Trials of lipid-modifying therapy also suggest that apolipoproteins and ratios may provide improved targets for therapy beyond LDL-C, but optimal values have not been established. Because lipid-modifying therapy affects multiple components of the lipid profile, the effect on all lipid parameters should be considered when selecting the most appropriate agent. Therapies with beneficial effects across the lipid profile would be expected to improve CHD risk reduction.     

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

AimsAn 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 synthesisWe 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).ConclusionsElevated 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 prosperoCRD42022321251.     

Clinical significance of high-density lipoprotein cholesterol in patients with low low-density lipoprotein cholesterol.

OBJECTIVES: We sought to evaluate the significance of high-density lipoprotein cholesterol (HDL-C) in the context of low low-density lipoprotein cholesterol (LDL-C). BACKGROUND: Earlier studies support an inverse correlation between circulating HDL-C and coronary risk in patients with normal or elevated LDL-C. METHODS: This study involved 4,188 patients attending the Palo Alto Veterans Administration Medical Center or affiliated clinics with LDL-C levels below 60 mg/dl. Outcomes were examined 1 year after the index LDL-C date. The combined primary end point was myocardial injury or hospitalization from ischemic heart disease. The secondary end point was all-cause mortality. RESULTS: Mean HDL-C levels (mg/dl) by quartile (Q) were: Q1 28 mg/dl, Q2 36 mg/dl, Q3 43 mg/dl, and Q4 63 mg/dl. The rate of myocardial injury or hospitalization for ischemic heart disease showed an inverse relationship to HDL-C (adjusted odds ratios: Q1 1.59 [95% confidence interval (CI) 1.16 to 2.19], Q2 1.39 [95% CI 1.01 to 1.92], Q3 1.33 [95% CI 0.96 to 1.84], and Q4 reference) that persisted regardless of statin use or recent myocardial injury. Analyzing HDL-C as a continuous variable revealed a 10% [95% CI 3% to 17%] increase in the combined end point of myocardial injury or hospitalization for ischemic heart disease for every 10-mg/dl decrease in HDL-C. The unadjusted and adjusted incidence of all-cause mortality demonstrated a U-shaped relationship to HDL-C (adjusted odds ratios: Q1 1.13 [95% CI 0.79 to 1.62], Q2 0.97 [95% CI 0.67 to 1.40], Q3 0.74 [95% CI 0.50 to 1.09], and Q4 reference). CONCLUSIONS: The inverse relationship between HDL-C and coronary risk persists even among patients with LDL-C below 60 mg/dl, although a U-shaped relationship is observed between HDL-C and all-cause mortality.     

Lipid levels and the risk of hemorrhagic stroke: A dose–response meta-analysis

Background and aimsHemorrhagic stroke (HS) could damage human health and impose heavy social and economic burden around the world. An accumulating number of studies revealed the effect of lipid levels on HS, whereas the results were inconsistent. Therefore, we conducted a dose–response meta-analysis to evaluate the relationship between lipid levels and HS.Methods and resultsWe searched the databases for relative cohort studies, which were published before April 2020. We pooled adjusted effect size and performed the dose–response analysis by random-effect model. 31 eligible studies with 2,291,643 participants and 12,147 hemorrhagic stroke cases were included. An inverse association was observed between the risk of hemorrhagic stroke and total cholesterol (TC) (RR: 0.72; 95% CI: 0.64–0.82) or low-density lipoprotein cholesterol (LDL-C) (RR: 0.69; 95% CI: 0.53–0.89). Additionally, in dose–response analysis, the non-linear trend was also found between TC, high-density lipoprotein cholesterol (HDL-C), and risk of HS. When the level of TC and HDL-C was about 6 and 1.3 mmol/L separately, the risk of HS was decreased to the lowest. And we found a linear trend that for every 1 mmol/L triglyceride (TG) increase, the risk of HS decreased by 7%.ConclusionTC and LDL-C were both inversely related to the risk of HS. In dose–response analysis of TG, we also found the inverse linear trend. Furthermore, the non-linear trend suggested the level of TC and HDL-C was about 6 and 1.3 mmol/L separately could lead to the lowest risk of HS.     

Novel application of the traditional lipid ratios as strong risk predictors of nonsmall-cell lung cancer risk in a Chinese population

Dyslipidemia has been associated with cancer risk, yet the relationship between lipid ratios and nonsmall-cell lung cancer (NSCLC) is still unclear. This study aimed to explore the value of lipid ratios, including total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and triglyceride/HDL-C (TG/HDL-C) as predictors of NSCLC in a Chinese population. Adult patients with histologically confirmed NSCLC, without a previous history of cancer, concomitant disease associated with lipid metabolism disorders, or usage of lipid-lowering drugs, were enrolled from a single center. Controls without NSCLC, matched for age and sex, were enrolled from the same Center. Lipid profile including TC, TG, HDL-C were measured in all participants. TC/HDL-C and TG/HDL-C were calculated based on the levels of TC, TG, HDL-C. Seven hundred eighty-two NSCLC cases and 599 controls were enrolled. NSCLC patients had significantly higher TG/HDL-C and TC/HDL-C levels than those in the control. After controlling for confounding factors, TG/HDL-C (OR = 4.489, 95% CI: 2.463–6.035, P < .001) and TC/HDL-C (OR = 2.396, 95% CI: 2.086–2.752, P = .001) were independently associated with NSCLC risk. The incidence of NSCLC was increased with rising tertiles of TG/HDL-C and TC/HDL-C. Moreover, patients with TNM II-IV stage NSCLC had higher TG/HDL-C and TC/HDL-C than those in TNM I and Tis stage. TG/HDL-C and TC/HDL-C are positively correlated with NSCLC risk and TG/HDL-C is more predictive than TC/HDL-C in predicting the risk of NSCLC. The highest AUC was that of TG/HDL (0.898), at a cutoff point of 0.62, with 83.6% sensitivity and 83.5% specificity.     

Relationship between plasma lipids and all-cause mortality in nondemented elderly

OBJECTIVES: To investigate the relationship between plasma lipids and risk of death from all causes in nondemented elderly. DESIGN: Prospective cohort study. SETTING: Community-based sample of Medicare recipients, aged 65 years and older, residing in northern Manhattan. PARTICIPANTS: Two thousand two hundred seventy-seven nondemented elderly, aged 65 to 98; 672 (29.5%) white/non-Hispanic, 699 (30.7%) black/non-Hispanic, 876 (38.5%) Hispanic, and 30 (1.3%) other. MEASUREMENTS: Anthropometric measures: fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-HDL-C, body mass index, and apolipoprotein E (APOE) genotype. clinical measures: neuropsychological, neurological, medical, and functional assessments; medical history of diabetes mellitus, heart disease, hypertension, stroke, and treatment with lipid-lowering drugs. Vital status measure: National Death Index date of death. Survival methods were used to examine the relationship between plasma lipids and subsequent mortality in younger and older nondemented elderly, adjusting for potential confounders. RESULTS: Nondemented elderly with levels of total cholesterol, non-HDL-C, and LDL-C in the lowest quartile were approximately twice as likely to die as those in the highest quartile (rate ratio (RR)=1.8, 95% confidence interval (CI)=1.3-2.4). These results did not vary when analyses were adjusted for body mass index, APOE genotype, diabetes mellitus, heart disease, hypertension, stroke, diagnosis of cancer, current smoking status, or demographic variables. The association between lipid levels and risk of death was attenuated when subjects with less than 1 year of follow-up were excluded (RR=1.4, 95% CI=1.0-2.1). The relationship between total cholesterol, non-HDL-C, HDL-C, and triglycerides and risk of death did not differ for older (>or=75) and younger participants (>75), whereas the relationship between LDL-C and risk of death was stronger in younger than older participants (RR=2.4, 95% CI=1.2-4.9 vs RR=1.6, 95% CI=1.02-2.6, respectively). Overall, women had higher mean lipid levels than men and lower mortality risk, but the risk of death was comparable for men and women with comparable low lipid levels. CONCLUSION: Low cholesterol level is a robust predictor of mortality in the nondemented elderly and may be a surrogate of frailty or subclinical disease. More research is needed to understand these associations.     

Effects of switching statins on lipid and apolipoprotein ratios in the MERCURY I study

BACKGROUND: Lipid ratios are clinically useful markers of coronary artery disease (CAD) risk. The effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin on lipid ratios were investigated in the Measuring Effective Reductions in Cholesterol Using Rosuvastatin TherapY (MERCURY) I trial. METHODS: This trial was conducted in 3140 hypercholesterolemic patients with CAD, atherosclerosis, type 2 diabetes mellitus, or a 20% 10-year risk for CAD. Patients were randomized to rosuvastatin 10 mg, atorvastatin 10 or 20 mg, simvastatin 20 mg, or pravastatin 40 mg for 8 weeks; all patients except those receiving rosuvastatin 10 mg either were switched to rosuvastatin 10 or 20 mg or remained on initial treatment for 8 more weeks. RESULTS: At 8 weeks, reductions in total cholesterol (TC):high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol:HDL-C, non-HDL-C:HDL-C, and apolipoprotein (apo) B:apo A-I ratios with rosuvastatin 10 mg were significantly greater than those with atorvastatin 10 mg, atorvastatin 20 mg, simvastatin 20 mg, and pravastatin 40 mg (P<0.0001 for all). At week 16, switching to rosuvastatin 10 mg from atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg and to rosuvastatin 20 mg from atorvastatin 20 mg produced significantly greater reductions in all lipid ratios (P< or =0.0001 for all). Switching to rosuvastatin 10 mg from atorvastatin 20 mg produced significantly greater reductions in TC:HDL-C (P<0.025) and apo B:apo A-I (P<0.01). CONCLUSIONS: Rosuvastatin 10 mg reduces lipid ratios more than equivalent and higher doses of other statins; switching to equal or lower doses of rosuvastatin produces significantly improved reductions in lipid ratios.     

Lipid profiles and the risk of new-onset hypertension in a Chinese community-based cohort

Background and aimsDyslipidemia and hypertension, key risk factors for cardiovascular disease, may share similar pathophysiological processes. A longitudinal association was reported between dyslipidemia and new-onset hypertension, but few data were published in Asian. We aimed to investigate the association of lipid profiles with new-onset hypertension in a Chinese community-based non-hypertensive cohort without lipid-lowering treatment (n = 1802).Methods and resultsNew-onset hypertension was defined as any self-reported history of hypertension, systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or receiving antihypertensive medications at follow-up. Logistic regression models were used to evaluate the associations. Participants were aged 53.97 ± 7.49 years, 31.19% were men, and 64.54% with dyslipidemia. During a median of 2.30 years follow-up, the incidence of new-onset hypertension was 12.99%. Multivariate adjusted risks of new-onset hypertension increased with triglyceride increases (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.03–1.27) and high-density lipoprotein cholesterol (HDL-C) decreases (OR = 0.47, 95% CI: 0.29–0.76) for one unit. However, threshold effects were observed for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and non-HDL-C. Compared with subjects with hyperlipidemia, in those with normal concentrations of TC, LDL-C, and non-HDL-C increased risks of new-onset hypertension were observed with OR (95% CI) of 1.65 (1.10–2.46), 1.58 (1.07–2.33), and 1.57 (1.15–2.15) for one unit increasement, respectively, after adjusting for all covariates.ConclusionHigher TG and lower HDL-C increased the risk of new-onset hypertension, but for TC, LDL-C and non-HDLC, the risk of new-onset hypertension was increased only at normal concentrations in a Chinese community-based cohort.