Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome.

PURPOSE: Women with polycystic ovary syndrome are hyperandrogenemic and insulin resistant, which are associated with alterations in circulating lipid and lipoprotein levels. We sought to determine the prevalence of, and risk factors for, lipid abnormalities in these women. SUBJECTS AND METHODS: Non-Hispanic white women with polycystic ovary syndrome (n = 195) and ethnically matched control women (n = 62) had fasting blood obtained for hormone and lipid levels. Subjects were categorized by body mass index (nonobese <27 kg/m(2), obese > or =27 kg/m(2)), and analyses were adjusted for age. RESULTS: Total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels increased significantly in obese women with polycystic ovary syndrome (n = 153) compared with obese control women (n = 35; mean difference in total cholesterol level = 29 mg/dL; 95% confidence interval [CI]: 14 to 45 mg/dL; P <0.001; mean difference in LDL-C level = 16 mg/dL; 95% CI: 4 to 30 mg/dL; P = 0.006). Similarly, total cholesterol and LDL-C levels increased significantly in nonobese women with polycystic ovary syndrome (n = 42) compared with nonobese control women (n = 27; mean difference in total cholesterol = 32 mg/dL; 95% CI: 13 to 52 mg/dL; P <0.001; mean difference in LDL-C level = 32 mg/dL; 95% CI: 15 to 52 mg/dL; P <0.001). In obese women, high-density lipoprotein cholesterol (HDL-C) and triglyceride levels increased significantly in women with polycystic ovary syndrome compared with control women (mean difference in HDL-C level = 6 mg/dL; 95% CI: 2 to 12 mg/dL; P = 0.002; mean difference in triglyceride level = 34 mg/dL; 95% CI: 1 to 77 mg/dL; P = 0.04). Differences in LDL-C and HDL-C levels, but not triglyceride levels, remained significant after adjusting for alcohol intake, smoking, and exercise. Although age, body mass index, and polycystic ovary syndrome status were significant predictors of lipid levels, these factors accounted for no more than 25% of the variance. CONCLUSIONS: In this large study of non-Hispanic white women, elevations in LDL-C levels were the predominant lipid abnormality in women with polycystic ovary syndrome, independent of obesity. The characteristic dyslipidemia of insulin resistance was absent. Indeed, obese women with polycystic ovary syndrome had relatively elevated HDL-C levels, which may confer some protection against cardiovascular disease.     

Lipid changes on hormone therapy and coronary heart disease events in the Heart and Estrogen/progestin Replacement Study (HERS)

Background

Despite the effect of lowering low-density lipoprotein cholesterol (LDL-C) levels and raising high-density lipoprotein cholesterol (HDL-C) levels, combination hormone therapy did not reduce the incidence of coronary heart disease (CHD) events in the Heart and Estrogen/progestin Replacement Study (HERS). To explore possible mechanisms, we examined the association between lipid changes and CHD outcomes among women assigned to hormone therapy.

Methods

HERS participants were postmenopausal women with previously diagnosed CHD who were randomly assigned to receive conjugated estrogens and medroxyprogesterone or identical placebo and then followed-up for an average of 4.1 years. Among women assigned to hormone therapy, associations between baseline-to-year-1 lipid level changes and CHD events were compared with the associations observed for baseline lipids using multivariate proportional hazards models.

Results

Among women assigned to hormone therapy, CHD events were independently predicted by baseline LDL-C levels (relative hazard [RH] 0.94 per 15.6 mg/dL decrease, 95% CI 0.88-1.01) and HDL-C levels (RH 0.89 per 5.4 mg/dL increase, 95% CI 0.81-0.99), but not by triglyceride levels (RH 1.01 per 13.2mg/dL increase, 95% CI 0.97-1.06). CHD events were marginally associated with first-year reductions in LDL-C levels (RH 0.95 per 15.6mg/dL decrease, 95% CI 0.86-1.04), and were not associated with increases in HDL-C levels ( RH 1.03 per 5.4 mg/dL increase, 95% CI 0.91-1.16) or triglyceride levels (RH 1.01 per 13.2 mg/dL increase, 95% CI 0.98-1.05).

Conclusion

Changes in lipid levels with hormone therapy are not predictive of CHD outcomes in women with heart disease in the HERS trial.     

Low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a useful marker for early-stage carotid atherosclerosis

A higher ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) is associated with a greater risk of cardiovascular events in patients with coronary heart disease. However, the role of this lipid index during early-stage atherosclerosis has not yet been established. This study investigated relationships between LDL-C/HDL-C ratio and carotid plaque score as assessed by ultrasonography in 825 subjects from the general population (527 men, 298 women; mean age, 60.5 years). To identify factors strongly associated with plaque score, stepwise multiple regression analysis was performed using various clinical variables including conventional lipid indices. In both sexes, increased LDL-C/HDL-C ratio was associated with increased plaque score (men: β = 0.132, P = .001; women: β = 0.150, P = .012). This association was maintained in men with normal LDL-C level (<140 mg/dL). The highest quartile of LDL-C/HDL-C ratio (>2.9 in men, >2.6 in women) showed significantly increased plaque score even when adjusted by factors included in the final model of stepwise analysis (P = .007 in men, P = .033 in women). No association was seen between LDL-C and plaque score in the multivariate-adjusted model. These findings indicate that increased LDL-C/HDL-C ratio may also be associated with initiation of atherosclerosis. Assessment of this lipid ratio may thus facilitate early management of atherosclerotic risks better rather than assessment of LDL-C alone.     

Lipids seasonal variability in type 2 diabetes

ObjectiveThe objective was to evaluate the seasonal lipid variations in type 2 diabetic (DM2) outpatients.Materials/Methods302 (183 women and 119 men) DM2 subjects with or without statins therapy were screened. Body weight, HbA1c, total cholesterol (TC), high density lipoprotein (HDL-C), triglycerides (Trg) and low density lipoprotein cholesterol (LDL-C) were measured and patients’ data of diet and physical activity were recorded during fall/winter (F/W) and spring/summer (S/S) seasons.ResultsHbA1c levels showed seasonal variability without statistical significance. During the colder seasons we observed an increase (P<.05) of weight associated with higher calorie intake and reduced physical activity. We showed a peak of TC, LDL-C and Trg levels during F/W while HDL-C levels were reduced. Median TC levels in F/W with respect to S/S were 197 vs 185 mg/dL (P<.001) without statins therapy and 172 vs 161 mg/dL (P<.001) in patients under statins therapy. Median LDL-C levels, without or with statin therapy, were 122 vs 114 mg/dL (P<.001) and 97.5 vs 88.5 mg/dL (P<.001), respectively. This seasonal lipids changes from F/W to S/S, modulated the percent of patients at LDL-C target < 100 mg/dL, both without or under statins treatment: from 22% to 29.5% (P<.05) with odds ratio 0.73 (95% CI 0.62–0.87) and from 47% to 55% (P<.001) with odds ratio 0.68 (95% CI 0.58–0.76), respectively.ConclusionsDM2 patients showed a peak of TC and LDL-C during colder months associated with changes of diet and lifestyle habits. This seasonal lipid trend modified the percentage of patients at LDL-C therapeutical target.     

Risk determination of dyslipidemia in populations characterized by low levels of high-density lipoprotein cholesterol

Background

Current guidelines for managing dyslipidemia qualify patients for treatment based on low-density lipoprotein cholesterol (LDL-C) levels and other risk factors for coronary heart disease (CHD). However, when LDL-C is the sole lipid criterion for initiating therapy, patients with levels below the treatment initiation threshold who are at high risk because of low levels (<40 mg/dL) of high-density lipoprotein cholesterol (HDL-C) might not be identified. Twenty percent of male patients with CHD in the United States fall into this category. The total cholesterol/HDL-C (TC/HDL-C) ratio predicts CHD risk regardless of the absolute LDL-C and HDL-C.

Methods

We compared guidelines based on TC/HDL-C and LDL-C with those recommended by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Both sets of guidelines were applied to 9837 adults (>20 years of age) in the Turkish Heart Study, which has shown that 75% of men and 50% of women in Turkey have HDL-C <40 mg/dL.

Results

ATP III guidelines identified 14% of Turkish adults, 20 years or older, as candidates for lifestyle treatment only and an additional 18% for drug treatment. In conjunction with ATP III LDL-C thresholds, the TC/HDL-C ratio (>3.5, patients with CHD; ≥6.0, 2+ risk factors, ≥7.0, 0 to 1 risk factor) assigned lifestyle therapy alone to 18% and drug treatment to an additional 36%. Among primary prevention subjects at high risk because of age (men ≥45 years; women ≥55 years), both sets of guidelines prescribed lifestyle therapy for only 5%; however, drug treatment was recommended for an additional 13% by ATP III guidelines and an additional 18% by TC/HDL-C and LDL-C.

Conclusions

In populations at risk for CHD caused by low HDL-C, qualification of subjects for treatment based on either the TC/HDL-C ratio or LDL-C thresholds identifies more high-risk subjects for treatment than LDL-C threshold values alone, and use of the ratio, instead of risk tables, simplifies the approach for physicians.     

The effect of L-thyroxine replacement therapy on lipid based cardiovascular risk in subclinical hypothyroidism

The aim of our study was to assess the changes in serum lipid profiles after replacement therapy with L-T4 in patients with subclinical hypothyroidism (SCH), and to see whether there is an improvement in dyslipidemia based cardiovascular risk. Thirty non-smoker pre-menopausal women with newly diagnosed SCH (TSH between 4 and 10 microIU/ml) were involved in our study; twenty-six euthyroid healthy subjects were used as control group. TSH, free T3 (FT3), free T4 (FT4), total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) levels were measured before and after 6 months of L-T4 (50-100 microg/ day) therapy. TSH levels were targeted as < 2.0 microIU/ml. LDL-C was calculated using the Friedewald formula, while the cardiovascular risk was assessed with the TC/HDL-C ratio. Pre-treatment serum TC and LDL-C concentrations in SCH patients were significantly higher than those of euthyroid subjects (199.8 +/- 22.2 vs 181.5 +/- 24.6 mg/dl, p < 0.01; 146.3 +/- 26.1 vs 124.8 +/- 12 mg/dl, p < 0.001, respectively). TC, LDL-C levels and the TC/HDL-C ratio were reduced significantly after 6-month replacement therapy (-21.1 +/- 34.4 mg/dl or -10.5%, p < 0.01; -21.5 +/- 30.3 mg/dl or -14.7%, p < 0.001, respectively; and TC/HDL-C from 4.8 +/- 0.6 to 4.1 +/- 0.5 mg/dl, p < 0.01), while body mass index (BMI) values did not change. In conclusion, even mild elevations of TSH are associated with changes in lipid profile significant enough to raise the cardiovascular risk ratio, and these changes are corrected once the patients have been rendered euthyroid.     

Comparative effects on lipid levels of combination therapy with a statin and extended-release niacin or ezetimibe versus a statin alone (the COMPELL study)

International guidelines recommend lower target cholesterol levels and treatment of low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides for patients at moderately high to high coronary heart disease (CHD) risk. Combination therapy is often required to achieve multiple lipid treatment goals, and > or =50% reduction in low-density lipoprotein cholesterol (LDL-C) is needed in some patients to achieve aggressive LDL-C targets. In this context, we evaluated comparative effects on lipid levels of combination therapy at low to moderate doses with a statin plus extended-release niacin (niacin ER), a statin plus ezetimibe, and a highly potent statin alone. This was an open-label, multicenter, 12-week study in 292 patients (50% women) who qualified for drug therapy based on number of CHD risk factors. Patients were randomized to four parallel arms, titrated from low to moderate or high doses: atorvastatin/niacin ER, rosuvastatin/niacin ER, simvastatin/ezetimibe, or rosuvastatin alone. Baseline mean values were, for LDL-C 197 mg/dL (5.1 mmol/L), HDL-C 49 mg/dL (1.3 mmol/L), triglycerides 168 mg/dL (1.9 mmol/L). There were no significant differences among treatment groups in the change from baseline in LDL-C at pre-specified timepoints during treatment. All groups lowered LDL-C by approximately 50% or more (range -49 to -57%), achieving mean levels of 82-98 mg/dL (2.1-2.5 mmol/L). Changes in non-HDL-C (range -46 to -55%) mirrored those for LDL-C and did not differ among treatment groups. Statin/niacin ER combination regimens also increased HDL-C and large HDL (HDL2) and lowered triglycerides and lipoprotein (a) significantly more than other regimens. No drug-related myopathy or hepatotoxicity was observed. In this study, low to moderate dose combination therapy with a statin and niacin ER provided broad control of lipids and lipoproteins independently associated with CHD.     

Do Turkish adults really have lower serum levels of high-density lipoprotein cholesterol?

BACKGROUND: Coronary heart disease is the leading cause of death in Turkey. The Turkish Heart Study and TEKHARF study have been carried out at various times and in different parts of Turkey and have suggested that the Turkish population has a low high-density lipoprotein-cholesterol (HDL-C) level. However, in our daily practice, mean HDL-C levels were not as low as previously reported. Here, we investigated the lipid profile, especially the HDL-C level, in the population of the Duzce region of northwest Turkey. METHODS: Serum triglyceride, total cholesterol, and HDL-C levels were measured in 674 healthy volunteers (398 women and 276 men); low-density lipoprotein cholesterol (LDL-C) levels were calculated using the Friedewald equation. RESULTS: The mean serum HDL-C level was 46.1 +/- 9.8 mg/dl in men and 53.2 +/- 10.7 mg/dl in women; these values are higher than expected based on the Turkish Heart Study. The mean serum total cholesterol level was 196.7 +/- 43.2 mg/dL in men and 198.4 +/- 43.9 mg/dL in women; the mean LDL-C level was 119.6 +/- 34.9 mg/dL in men and 118.7 +/- 34.1 mg/dL in women; and the mean serum triglyceride level was 151.4 +/- 80.9 mg/dL in men and 132.1 +/- 68.9 mg/dL in women. CONCLUSIONS: Our finding that the HDL-C level in this population was higher than the previously reported levels in Turkey indicates that HDL-C levels may not be as low as previously thought. We believe that lower HDL-C levels that were previously reported might be due to the difference between techniques of analysis, nutritional status, and percent of subjects who were fasting in the day of analysis or improper subject inclusion which did not reflect the Turkish population causing selection bias.     

The effects of green coffee bean extract supplementation on lipid profile in humans: A systematic review and meta-analysis of randomized controlled trials

Background and aimThis systematic review and meta-analysis aimed to assess the effects of green coffee bean extract (GCBE) supplementation on lipid profile in adults.Methods and resultsThe PubMed/Medline, Scopus, Web of sciences, and Google Scholar were systematically searched for randomized controlled trials available in English and published before February 2019. The meta-analysis was conducted using fixed effects models, and between-study heterogeneity was assessed by Cochran's Q test and I². A total of 17 effect sizes were included in the meta-analysis. Combined effect sizes on serum total cholesterol concentrations revealed significant effects of GCBE supplementation on serum total cholesterol [weighted mean difference (WMD): −4.51 mg/dL, 95% confidence interval (CI): −6.89, −2.12, p < 0.001], low density lipoprotein-cholesterol (LDL-C) (WMD: −4.38 mg/dL, 95% CI: −6.44, −2.31, p < 0.001), and high density lipoprotein-cholesterol (HDL-C) (WMD: 2.63 mg/dL, 95% CI: 2.20, 3.07, p < 0.001) compared to controls. Nevertheless, no significant changes were observed in serum triglycerides levels (WMD: −4.34 mg/dL, 95% CI: −9.00, 0.32, p = 0.068).ConclusionThe evidence from available studies suggests that the GCBE supplementation leads to significant reductions in total cholesterol, HDL-C, and LDL-C levels, and has modest, but, non-significant effects on triglycerides levels.     

The effect of probiotic fermented milk products on blood lipid concentrations: A systematic review and meta-analysis of randomized controlled trials

AimFermented milk products are suggested as a supplementary therapy to help reduce blood lipid levels. However, the results of clinical studies are conflicting.Data synthesisThis study systematically reviewed 39 randomized controlled trials (n = 2237 participants) to investigate the effect of probiotic fermented milk products on blood lipids. A meta-analysis was performed using random effects models, with weighted mean differences (WMDs) and 95% confidence interval (CI). Statistically significant reductions in blood low-density lipoprotein cholesterol (LDL-C) (WMD: ?7.34 mg/dL, 95% CI: from ?10.04 to ?4.65, and P < 0.001) and total cholesterol (TC) concentrations (WMD: ?8.30 mg/dL, 95% CI: from ?11.42 to ?5.18, and P < 0.001) were observed. No statistically significant effect of probiotic fermented milk was observed on blood high-density lipoprotein cholesterol (HDL-C) and triacylglycerol (TAG) levels. The effect on TC and LDL-C level was more pronounced in men, and a greater reduction in TAG was observed in trials with longer interventions (≥8 weeks) as compared to their counterparts.ConclusionsAvailable evidence suggests that probiotic fermented milk products may help to reduce serum TC and LDL-C cholesterol levels, particularly in men and when they are consumed for ≥8 weeks.     

Subclinical hypothyroidism and lipid abnormalities in older women attending a vascular disease prevention clinic: effect of thyroid replacement therapy

The authors evaluated the frequency and type of lipid disorders associated with subclinical hypothyroidism (SH) in older women referred to their university vascular disease prevention clinic. They also assessed the results of thyroid replacement therapy. Fasting serum lipid profiles and thyroid function tests were measured in 333 apparently healthy women (mean age: 71.8 +/- 7 years). These women were divided into 3 groups: group I: 60-69 years old (n = 132); group II: 70-79 years old (n = 153); group III: 80-89 years old (n = 48). SH was defined as a serum thyrotropin concentration higher than 3.20 mlU/mL with a normal free thyroxine concentration. The prevalence of SH was 7.5%. Thyrotropin was higher than 3.20 mU/mL in 25 women; 7 (5.3%), 14 (9.2%), and 4 (8.3%) in groups I, II, and III, respectively. Low-density lipoprotein cholesterol (LDL-C) concentrations were higher in the women with SH (p = 0.037). The mean values of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C ratio, lipoprotein (a) (Lp[a]), apolipoprotein A-I (apo AI) apolipoprotein B100 (apo B) and apo B/apo A ratio were higher and triglycerides (TG) were lower, compared with those with normal levels of thyrotropin. However, none of these differences reached significance. Restoration of euthyroid status (thyroxine: 50-100 microg/day) in 17 SH women significantly improved TC (p = 0.017), LDL-C (p = 0.014), TC/HDL-C (p = 0.05), LDL-C/HDL-C (p = 0.03), apo B (p = 0.013), and Lp(a) (p = 0.0005) values. SH is relatively common in older women attending a vascular disease prevention clinic. Thyroid hormone replacement therapy significantly improved serum lipids. In particular, the reduction in LDL-C and Lp(a) concentrations may be of clinical benefit.     

Relationships between Smoking Status,Cardiovascular Risk Factors,and Lipoproteins in a Large Japanese Population

Aims: Smoking is a major risk factor for cardiovascular disease (CVD), a leading cause of death and disability. Other CVD risk factors include age, gender, hypertension, diabetes, increased low-density lipoprotein cholesterol (LDL-C) and decreased high-density lipoprotein cholesterol (HDL-C). Our goal was to assess relationships between smoking status and CVD risk factors, with a focus on direct LDL-C, HDL-C, triglycerides (TG) and small dense LDL-C (sdLDL-C). Methods: A total of 34,497 Japanese men and women, mean age 51 years, had their CVD risk factors including fasting serum total cholesterol, TG, HDL-C, sdLDL-C, and direct LDL-C assessed. One-way ANOVA and multiple linear regression analyses were carried to assess the interrelationships of these parameters with smoking. Results: In both men and women, current smokers had significantly ( p ＜0.001) higher median TG (+19.6%, +16.9%) and sdLDL-C levels (+12.7%, +4.2%) levels, and significantly ( p ＜0.001) lower HDL-C levels (-7.3%, -4.3%) than non-smokers. They were also significantly ( p ＜0.05) more likely to have TG values ＞150 mg/dL (+56.8%, +116.3%), sdLDL-C ＞40.1 mg/dL (+28.8%, +44.9%), and HDL-C ＜40 mg/dL (+89.8%, +114.3%). Ex-smokers generally had lipid values that were intermediate between non-smokers and current smokers. Multivariate analysis confirmed the significance of these relationships. Conclusion: Our data indicate that current cigarette smoking is associated with increased TG and sdLDL-C levels, as well as decreased HDL-C levels. Furthermore, smoking effect on lipid profiles remain after cessation. These data provide further justification for smoking cessation.     

The relationship between thyrotropin and low density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects

High levels of TSH are associated with an increased cardiovascular risk. Many cardiovascular risk factors cluster within the insulin resistance syndrome. It is not known whether levels of TSH cluster as well. We conducted this research to test the hypothesis that TSH, insulin sensitivity, and levels of low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) are interdependent in euthyroid subjects. Levels of TSH, free thyroid hormone, and serum lipids were measured in fasting serum samples taken before performance of a hyperinsulinemic euglycemic clamp to assess insulin sensitivity in 46 healthy euthyroid subjects with a mean TSH of 1.8 +/- 0.7 mU/L. Significant age- and sex-adjusted partial correlations of TSH with LDL-C (r = 0.48; P < 0.01) and HDL-C (r = -0.36; P < 0.05) were observed. TSH was not significantly correlated with insulin sensitivity or fasting triglyceride concentrations. In line with these results, we found the associations of TSH with LDL-C and HDL-C to be independent of insulin sensitivity. However, we observed significant effect-modification of the association of TSH with LDL-C by insulin sensitivity (P = 0.02). This effect-modification implies a range of associations of TSH with LDL-C that varies from absent in insulin-sensitive subjects to strongly positive in insulin-resistant subjects. We conclude that the increased cardiovascular risk associated with subclinical hypothyroidism seems to extend itself into the normal range of thyroid function. Importantly, the effect-modification of the association of TSH with LDL-C by insulin sensitivity suggests that insulin-resistant subjects are most susceptible to this increased risk.     

Effect of coconut oil on cardio-metabolic risk: A systematic review and meta-analysis of interventional studies

Background and aimsHigh total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) could be major risk factors for cardiovascular disease burden among high risk populations especially in South Asians. This systematic review and meta-analysis aimed to quantify the effects of coconut oil compared with other oils and fats on cardio-metabolic parameters.MethodsPubMed, Scopus and Web of Science were systematically searched. The main outcomes included are lipid and glycemic parameters. Subgroup analyses were performed to evaluate individual comparisons of vegetable oils and animal fat with coconut oil. Data were pooled using random-effects meta-analysis.ResultsCoconut oil consumption significantly increased TC by 15.42 mg/dL (95% CI, 8.96–21.88, p < 0.001), LDL-C by 10.14 mg/dL (95% CI, 4.44–15.84, p < 0.001) and high density lipoprorein cholesterol (HDL-C) by 2.61 mg/dL (95% CI, 0.95–4.26, p = 0.002), and significantly decreased glycosylated hemoglobin (HbA1c) by 0.39 mg/dL (95% CI, −0.50 to −0.27, p < 0.001) but, it had no effects on triglycerides (TG), (4.25 mg/dL; 95% CI, −0.49-8.99, p = 0.08) when compared with the control group. Sub-group analysis demonstrated that coconut oil significantly increased TC and LDL-C over corn, palm, soybean and safflower oils and not over olive oil. Compared with butter, coconut oil showed a better pattern in cardio-metabolic markers by significantly increasing HDL-C (4.38 mg/dL, 95% CI, 0.40 to 8.36, p = 0.03) and decreasing LDL-C (−14.90 mg/dL, 95% CI, −23.02 to-6.77, p < 0.001).ConclusionsOur results suggest that coconut oil consumption results in significantly higher TC, LDL-C and HDL-C than other oils. Consumption of coconut oil can be one of the risk factors for CVDs in South Asians.     

Plasma fasting and nonfasting triglycerides and high-density lipoprotein cholesterol in atherosclerotic stroke: Different profiles according to low-density lipoprotein cholesterol

Although low-density lipoprotein cholesterol (LDL-C) is the main lipid target for cardiovascular risk reduction, recent studies suggest that other lipid indicies are also associated with vascular events. We hypothesized that the association of triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) with atherosclerotic stroke (AS) differs depending on LDL-C levels. Data prospectively collected on subjects admitted with acute ischemic stroke to a university medical center were analyzed. We divided the patients into AS and non-atherosclerotic stroke (NAS) groups and independent association of lipid parameters and genetic influences of apolipoprotein A5 (ApoA5) polymorphisms with AS were evaluated. Of 268 patients, 160 (59.7%) were classified with AS and 108 (40.3%) were classified with NAS. Vascular risk factors were more prevalent in AS patients than in those with NAS; additionally, AS patients' anthropometric indexes and laboratory findings showed that they were prone to atherosclerosis. AS was independently associated with fasting TG (OR per 10 mg/dL increase, 1.38; 95% CI, 1.16–1.64; OR for highest vs. lowest tertile, 12.85; 95% CI, 3.31–49.85), HDL-C (OR per 10 mg/dL increase, 0.61; 95% CI, 0.42–0.88; OR for lowest vs. highest tertile, 4.28; 95% CI, 1.16–15.86), and nonfasting TG (OR per 10 10 mg/dL increase, 1.25; 95% CI, 1.11–1.42; OR for highest vs. lowest tertile, 8.20; 95% CI, 1.98–33.88) only among patients with LDL <100 mg/dL. No interaction was observed between fasting and nonfasting TG and ApoA5 polymorphisms. In conclusion, fasting and nonfasting TG and HDL-C were associated with AS only when patients had low levels of LDL-C. Non-LDL-C may have an additional role in addition to the LDL-C levels in AS development.     

Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials

PURPOSE: Use the meta-analytic approach to examine the effects of aerobic exercise on lipids and lipoproteins in adults with cardiovascular disease (CVD). METHODS: Studies were retrieved via electronic databases, review of reference lists from retrieved articles, including reviews, and hand searching. Inclusion criteria were: (1) randomized controlled trials, (2) aerobic exercise >or=4 weeks as an intervention, (3) studies published in English language only between January 1, 1955 and January 1, 2005, (4) studies published in journals or as dissertations or master's theses, (5) human subjects >or=18 years, (6) all subjects diagnosed with some type of CVD, and (7) pre and post data available for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and/or triglycerides (TG). Random-effects models were used for data analysis. RESULTS: Of the more than 3,000 studies reviewed, a total of 10 representing 1,260 subjects (580 exercise, 680 control) were included in our analysis. There was a statistically significant increase of 9% in HDL-C (mean +/- SEM, 3.7 +/- 1.3 mg/dL; 95% CI, 1.2 to 6.1 mg/dL) and a statistically significant decrease of 11% in TG (-19.3 +/- 5.4 mg/dL; 95% CI, -30.1 to -8.5 mg/dL), but no statistically significant decreases in TC or LDL-C (TC, -8.8 +/- 6.8 mg/dL; 95% CI, -22.3 to 4.7 mg/dL; LDL-C, -7.7 +/- 6.0 mg/dL; 95% CI, -19.5 to 4.2 mg/dL). CONCLUSIONS: The present findings suggest that chronic aerobic exercise increases HDL-C and decreases TG in adults, especially men, with CVD.     

Prevalence and phenotypic distribution of dyslipidemia in type 1 diabetes mellitus: effect of glycemic control

BACKGROUND: Data on the prevalence of dyslipidemia in type 1 diabetes mellitus are scarce and are based on total triglyceride and total cholesterol concentrations alone. OBJECTIVE: To assess the effect of glycemic optimization on the prevalence of dyslipidemia and low-density lipoprotein cholesterol (LDL-C) concentrations requiring intervention in patients with type 1 diabetes. PATIENTS: A total of 334 adults with type 1 diabetes and 803 nondiabetic control subjects. METHODS: Levels of glycosylated hemoglobin, total cholesterol, total triglyceride, high-density lipoprotein cholesterol (HDL-C), and LDL-C were assessed at baseline and after 3 to 6 months of intensive therapy with multiple insulin doses. RESULTS: Levels of LDL-C greater than 4.13 mmol/L (>160 mg/dL) and total triglyceride greater than 2.25 mmol/L (>200 mg/dL) and low HDL-C levels (<0.9 mmol/L [<35 mg/dL] in men or <1.1 mmol/L [<45 mg/dL] in women) were found in 16%, 5%, and 20% of patients and 13%, 6%, and 9% of controls, respectively (P<.001 for HDL-C). Diabetic women showed more hypercholesterolemia than nondiabetic women (15.6% vs 8.5%; P =.04). After glycemic optimization (mean +/- SD glycosylated hemoglobin decrease, 2.2 +/- 1.96 percentage points), the prevalence of LDL-C levels greater than 4.13 mmol/L (>160 mg/dL) became lower in diabetic men than in nondiabetic men (9.7% vs 17.5%; P =.04), but women showed frequencies of dyslipidemia similar to their nondiabetic counterparts. The proportion of patients with LDL-C concentrations requiring lifestyle (>2.6 mmol/L [>100 mg/dL]) or drug (>3.4 mmol/L [>130 mg/dL]) intervention decreased from 78% and 42% to 66% and 26%, respectively. CONCLUSIONS: Low HDL-C is the most frequent dyslipidemic disorder in patients with poorly controlled insulin-treated type 1 diabetes, and a high proportion show LDL-C levels requiring intervention. Less favorable lipid profiles could explain the absence of sex protection in diabetic women. The improvement caused by glycemic optimization puts forward intensive therapy as the initial treatment of choice for dyslipidemia in poorly controlled type 1 diabetes.     

Lipid profile disturbances are highly prevalent in Japanese-Brazilians

High prevalence of diabetes has been previously reported in Japanese-Brazilians. In an attempt to better estimate the cardiometabolic risk, this study evaluated lipid disorders in 1,330 Japanese-Brazilians (46% men) aged>30 years. Hypercholesterolemia was defined as serum cholesterol>240 mg/dL, hypertriglyceridemia as values>150 mg/dL and low-HDL-C as values<40 mg/dL and <50 mg/dl for men and women respectively. The prevalence of dyslipidemias was compared by the chi-square test between gender and glycemic category. Mean and Standard Deviation of lipids and lipoproteins were compared by the Student t-Test between gender. Hypertriglyceridemia was detected in 66.0% [95% CI: 63.5-68.5] of the population, being more common in men and increasing with deterioration of glucose metabolism. Mean level of triglycerides was 235.7+/-196.3 mg/dL. The prevalence of hypercholesterolemia was 24.4% [95% CI: 22.1-26.7]. Low HDL-C was observed in 17.5% [95% CI: 14.5-20.5] of men and 43.0% [95% CI: 39.4- 46.6] of women but total/HDL-cholesterol ratio was lower in women (4.23+/-0.68 vs. 4.40+/-0.73, p<0.001). In Japanese-Brazilians, hypertriglyceridemia is the commonest dyslipidemia, in agreement with the high prevalence of diabetes. Men showed a worse lipid profile than women; it was suggested that the Western diet and living habits could be deteriorating their health.     

血清TSH水平与血脂异常的相关性研究

目的 探讨亚临床甲状腺功能减退(甲减)以及甲状腺功能正常的人群中TSH水平与血脂谱之间的关系.方法 2007年在沈阳市大东区进行糖尿病及甲状腺疾病的整群抽样调查,其中包括亚临床甲减110例和1 240名甲状腺功能正常者进入研究,研究对象既往无甲状腺病史,未服用影响甲状腺功能和调节血脂的药物.检查项目包括甲状腺功能、血脂、空腹血糖、胰岛素等.结果 (1)亚临床甲减患者高密度脂蛋白胆固醇(HDL-C)水平低于甲状腺功能正常组.(2)按照<中国成人血脂异常诊治指南>将人群分组,在超重的人群中(体重指数≥24.0 kg/m2),高低密度脂蛋白胆固醇(LDL-C)组的TSH水平明显升高[(3.07±0.27对2.41±0.11)mU/L,P=0.027],这种差异在超重女性组中更加明显.甲状腺功能正常且超重的人群中,TSH与总胆固醇呈正相关,且这种相关性不受稳态模型评估的胰岛素抵抗指数(HOMA-IR)的影响.(3)在女性中,TSH与甘油三酯呈正相关,与HDL-C呈负相关.在超重的女性组中,TSH与总胆固醇、LDL-C呈正相关,且经过年龄、性别、体重指数等因素的校正后相关性仍然存在.结论在甲状腺功能正常及亚临床甲状腺功能减退症人群中,TSH升高为血脂异常的危险因素,且独立于胰岛素抵抗.

Abstract：

Objective To investigate the relationship between serum thyrotrophin(TSH)and dyslipidemia in subclinical hypothyroid and euthyroid subjects. Methods An epidemiological study on diabetes and thyroid diseases was performed in Dadong community, Shenyang city, in 2007. 110 subjects with subclinical hypothyroidism(SCH)and 1 240 euthyroid subjects were enrolled in the study. Neither history of thyroid diseases nor administration of thyroid-related and lipid-regulating medicines were reported in these subjects. The levels of serum thyroid hormones, lipids, fasting plasma glucose(FPG), and insulin were determined. Results (1)Patients with SCH had significantly lower HDL-C levels than those who were euthyroid.(2)According to the guideline of treatment of adult dyslipidemia in China, the lipid profiles were each categorized. Mean TSH levels were higher in subjects in the dyslipidemia subclass than subjects in the normal subclass. The differences were significant in high LDL-C subclass in overweight individuals. In euthyroid overweight women, mean TSH levels were significantly higher in high LDL-C subclass. In the euthyroid population, TSH was positively associated with total cholesterol in overweight population. The association was not modified by the homestasis model assessment for insulin resistance(HOMA-IR)values.(3)TSH was associated positively with serum triglycerides and negatively with serum HDL-C in women. TSH was positively associated with total cholesterol in overweight population and positively associated with total cholesterol and LDL-C in overweight women after adjustment for age, sex, and body mass index. Conclusion Raised serum TSH seems to be a risk factor of dyslipidemia in subclinical hypothyroid and euthyroid subjects, which is independent of insulin sensitivity.     

Serum lipids in north Indian children treated for kawasaki disease

A prospective cross sectional analysis of serum lipids was carried out in 20 children aged between 1.3 and 16 years with Kawasaki disease (KD). The controls were siblings of other patients. The mean interval between diagnosis of the disease and time of assay was 2.6 years (range 0.41 to 6 years). Standard biochemical methods were employed for determination of various components of the lipid profiles. There were significant differences in high-density lipoprotein cholesterol (HDL-C) (40.37 +/- 12.0 mg/dL versus 53.49 +/- 4.31 mg/dL, P < 0.001) and low-density lipoprotein cholesterol (LDL-C) concentrations (77.76 +/- 26.25 mg/dL versus 57.7 +/- 23.2 mg/dL, P < 0.05) between the cases and controls. Lower HDL-C levels persisted at 1-3 and more than 3 years of disease duration. No significant differences were seen in the values of other parameters in the lipidogram, such as total cholesterol (TC), triglycerides (TG), and very low-density lipoprotein cholesterol (VLDL-C). Premature atherosclerosis that occurs in KD may be secondary to these lipid metabolism abnormalities.