Dyslipidemia and coronary artery calcium: From association to development of a risk-prediction nomogram

Background and aimsThe associations between dyslipidemia and coronary artery calcium (CAC) are controversial. We investigated their cross-sectional relationships and developed a predictive scoring system for prognostically significant coronary calcification (PSCC).Methods and resultsThis study evaluated the lipid profiles and the CAC score (CACS) measured through multidetector computed tomography (MDCT) among Taiwanese adult patients in a tertiary hospital between 2011 and 2016. Patients with CACS higher than 100 were classified as having PSCC. Dyslipidemia for each lipid component was defined based on the clinical cutoffs or the use of the lipid-lowering agents. Multivariable logistic regression was used to assess the association between dyslipidemia and PSCC and the model performance was assessed using calibration plot, discrimination, and a decision curve analysis.Of the 3586 eligible patients, 364 (10.2%) had PSCC. Increased age, male sex, higher body mass index (BMI), and higher level of triglyceride (TG) were associated with PSCC. The adjusted odds ratios (95% confidence intervals) of PSCC was 1.15 (0.90–1.47) for dyslipidemia defined by total cholesterol (TC) ≥200 mg/dL, 1.06 (0.83–1.35) for low-density-lipoprotein-cholesterol (LDL-C) ≥130 mg/dL, and 1.36 (1.06–1.75) for TG ≥ 200 mg/dL. The positive association between TG ≥ 200 mg/dL and PSCC was not modified by sex. Incorporating hypertriglyceridemia did not significantly improve the predictive performance of the base model comprising of age, sex, BMI, smoking, hypertension, diabetes, estimated glomerular filtration rate, and fasting glucose.ConclusionsHypertriglyceridemia was significantly associated with the prevalent odds of PSCC. Our proposed predictive model may be a useful screening tool for PSCC.     

Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure?

Sleeve gastrectomy(SG) is a restrictive bariatric surgery technique that was first used as part of restrictive horizontal gastrectomy in the original Scopinaro type biliopancreatic diversion. Its good results as a single technique have led to a rise in its use, and it is currently the second most performed technique worldwide. SG achieves clearly better results than other restrictive techniques and is comparable in some aspects to the Roux-en-Y gastric bypass, the current gold standard in bariatric surgery. These benefits have been associated with different pathophysiologic mechanisms unrelated to weight loss such as increased gastric emptying and intestinal transit, and activation of hormonal mechanisms such as increased GLP-1 hormone and decreased ghrelin. The aim of this review was to highlight the salient aspects of SG regarding its historical evolution, pathophysiologic mechanisms, main results, clinical applications and perioperative complications.     

Nonalcoholic Fatty Liver Disease: Dyslipidemia,Risk for Cardiovascular Complications,and Treatment Strategy

Studies have shown that nonalcoholic fatty liver disease (NAFLD) is strongly associated with several metabolic disorders and diseases, such as obesity, type 2 diabetes mellitus, and dyslipidemia. In NAFLD, dyslipidemia is manifested as increased serum triglyceride and low-density lipoprotein cholesterol levels and decreased high-density lipoprotein cholesterol levels, all of which are key risk factors for cardiovascular disease (CVD). CVD is a leading cause of mortality in NAFLD patients. Thus, implementation of an aggressive therapeutic strategy for dyslipidemia with hypolipidemic agents may mitigate the risk for CVD among NAFLD patients. Here, we provide a current review of literature regarding NAFLD, with particular emphasis on dyslipidemia and available treatment options.     

Recommendations for management of dyslipidemia in high cardiovascular risk patients

Overwhelming evidence supports a causal relationship between elevated levels of plasma cholesterol, particularly low-density lipoprotein cholesterol, and increased risk of coronary artery disease, which remains the leading cause of death and morbidity worldwide. Low-density lipoprotein cholesterol lowering has been the main goal of therapy, and clinical trial results from recently published studies of intensive statin therapy confirm the benefits of more aggressive lipid-lowering targets, particularly in subjects at high risk for cardiovascular events. This management update will focus on the implications of risk reduction in patients at high cardiovascular risk, and will provide practical steps to help further risk stratify these patients and help them reach their target goals.     

成人血脂异常的流行特征与影响因素

血脂异常是心脑血管疾病的重要危险因素,其流行状况和影响因素是倍受关注的热点。作者综述了近10年来我国成人血脂异常的流行特征、防控现况及其影响因素。我国成人血脂异常的水平和患病率与西方发达国家相比还处于较低水平,但比10年前有了较大升高。我国血脂异常以高甘油三酯血脂和低高密度脂蛋白血症为主,高胆固醇血症和高低密度脂蛋白相对较少。整体上男性高于女性,城市高于农村,有随着年龄增加而上升的趋势,但是各地血脂异常的水平和患病率差异巨大。血脂异常的知晓率、治疗率、控制率均处在很低的水平。血脂异常的主要影响因素有年龄、性别、体重超重或肥胖、锻炼、高血压、高血糖、高血尿酸、吸烟饮酒、纤维摄入不足、向心性肥胖等。     

血脂紊乱类型与胰岛素抵抗的关系

根据血脂变化 ,将 90 2名机关职员分为混合型高脂血症组、高甘油三酯血症组、高胆固醇血症组 ,单纯性低高密度脂蛋白血症组和正常血脂组 ,分析结果提示 ,混合型高脂血症、高甘油三酯血症患者存在胰岛素抵抗     

成都地区高脂血症调查分析(附7288例报告)

目的 了解成都地区人群当前血脂水平,高脂血症患病率及其影响因素。方法 整群抽样7288人,均居住3年以上,年龄18-80岁,调查一般人口统计学指标,烟酒嗜好,人均收入,个人及家族史,查血压,心率,体重指数及血液有关生化参数。结果 本组人群甘油三酯平均1.50mmol/L,随年龄增加,总胆固醇平均4.89mmol/L,高密度脂蛋白平均1.35mmol/L.甘油三酯≥1.70mmol/L者24.99％,≥2.3mmol/L者为13.4％,高密度脂蛋白<0.91mmol/L者为8.29％,混合性高脂血症(胆固醇≥5.2,甘油三酯≥2.3mmol/L者)有9.5％,双变量相关分析,胆固醇与甘油三酯与年龄,BMI,血糖,尿酸,舒张压,饮白酒,显著相关。与吸烟指数,心率,收缩压相关较弱。多变量逐步回归,甘油三酯与BMI,尿酸,饮酒及胆固醇,胆固醇与年龄,甘油三酯,高密度脂蛋白,血糖,BMI仍相关。结论 近年来成都地区血脂水平及高脂血症患病率均有明显增高,改善生活方式与一期预防是当务之急。     

Low-grade inflammation independently associates with cardiometabolic risk in children with overweight/obesity

Background and aimsPediatric obesity associates with both low-grade inflammation and cardiometabolic risk on the population level. Yet on an individual patient level, overweight/obesity does not always equal increased cardiometabolic risk. In this study, we examine whether low-grade inflammation associates with cardiometabolic risk in Danish children, independent of degree of adiposity. We further assess the value of integrating multiple inflammation markers to identify children with very-high cardiometabolic risk profiles.Method and resultsWe studied 2192 children and adolescents aged 6–18 years from an obesity clinic cohort and a population-based cohort, in a cross-sectional study design. Anthropometry, blood pressure, pubertal stage and body composition by dual-energy X-ray absorptiometry were assessed, and biomarkers including fasting serum high sensitivity C-reactive protein (hsCRP), white blood cells (WBC), resistin, lipid profile and glucose metabolism were measured. Adjusted correlation analysis and odds ratios were calculated. We found that, independent of degree of adiposity, having high-normal inflammation marker concentrations associated with increased cardiometabolic risk: for girls, hsCRP >0.57–9.98 mg/L (mid/upper tertile) associated with ~2-fold higher odds of dyslipidemia and hepatic steatosis (vs. lower tertile). For both sexes, WBC >7.0–12.4 10⁹/L (upper tertile) associated with 2.5-fold higher odds of insulin resistance. Lastly, children with multiple inflammation markers in the high-normal range exhibited the most severe cardiometabolic risk profile.ConclusionLow-grade inflammation associates with cardiometabolic risk in children independent of degree of adiposity. The associations vary with sex and inflammation marker measured. Finally, integrating multiple low-grade inflammation markers identifies a very-high-risk subgroup of children with overweight/obesity and may have clinical value.     

Dyslipidemia and fasting glucose impairment among HIV patients three years after the first antiretroviral regimen in a Brazilian AIDS outpatient clinic

ObjectiveTo evaluate the cumulative incidence of dyslipidemia and fasting glucose impairment three years after initiating the first antiretroviral (ART) regimen and the association with the type of ART regimen in an AIDS outpatient clinic in Brazil.MethodsRetrospective cohort of HIV-1 infected patients attending an outpatient HIV clinic in Vitoria, Brazil, between January/2010 and May/2011. Data, including blood pressure, dyslipidemia (high total cholesterol and low HDL-C), fasting glucose, and cardiovascular risk by Framingham Risk Score were abstracted from medical records from clinic visits six months prior and three years after starting ART. We assessed independent associated factors for dyslipidemia using multiple logistic regression.ResultsFour hundred and ninety-eight patients on ART were studied. Median age was 45 years (interquartile range (IQR): 37–52), and median time since HIV diagnosis was 7.7 years (IQR: 3.8–10.0). The proportion of patients with dyslipidemia was 22.3% (95% CI: 18.6–25.9%) 36 months after ART initiation. Triglycerides levels >150 mg/dL (55.2% vs. 25.4%, p = 0.021) and high fasting glucose (5.8% vs. 2.3%, p = 0.034) were diagnosed more frequently after ART use when compared to baseline values. Multiple logistic regression analysis has shown dyslipidemia to be associated with lopinavir/r use [OR = 1.74 (95% CI: 1.12–2.86)].ConclusionThese data show high chance of dyslipidemia after initiation of ART. Long-term follow-up will help identify the impact of ART on cardiovascular risk.     

2型糖尿病患者颈围与血脂关系及其对血脂异常的预测作用——北京社区糖尿病研究（BCDS-10）

目的了解2型糖尿病患者颈围与血脂谱问的关系。方法选择2008年8月至2009年7月北京三甲医院与15个城区社区联合开展糖尿病纵向管理项目基线数据库中2410例2型糖尿病患者。全体参与医师经过专门培训,按统一要求调查并填写调查表,同时对患者进行体格检查及相关的实验室检查,血脂异常的诊断根据2007年中国成人血脂异常防治指南。结果（1）2410例中男986例,女1424例。平均颈围为（36±4）cm。总胆固醇为（5．2±1．1）mmol／L;甘油三酯为（1．8±1．2）mmol／L;高密度脂蛋白胆固醇（HDL-C）为（1．3±0．4）mmol／L;低密度脂蛋白胆固醇（LDL-C）为（3．0±0．9）mmol／L;（2）男性、女性的颈围均与甘油三酯呈正相关（男性r=0．093,女性r=0．077,均P〈0．01）,与HDL-C呈负相关（男性r=一0．144,女性r=一0．062,均P〈0．05）;（3）预测高甘油三酯血症最佳的颈围切点：男性为37em,女性为35em;预测HDL-C降低的颈围切点男性为40em,女性为35em;（4）预测高胆固醇血症受试者操作特征（ROC）曲线下面积男性组为0．511,女性组为0．480（P〉0．05）;预测LDL-C升高ROC曲线下面积男性为0．527;女性为0．519（P〉0．05）。结论2型糖尿病患者的颈围与血脂密切相关,尤其是甘油三酯和HDL-C;颈围可能做为筛查／评价2型糖尿病患者血脂异常的指标之一。