Could non-HDL-cholesterol be a better marker of atherogenic dyslipidemia in obstructive sleep apnea?

Background/objectiveObstructive sleep apnea (OSA) is independently associated with dyslipidemia, a surrogate marker of atherosclerosis. Low-density lipoprotein (LDL)-cholesterol is accepted as a major independent risk factor for cardiovascular disease. However, non-high-density lipoprotein (HDL)-cholesterol is a better marker of atherogenic dyslipidemia and recommended as a target of lipid lowering therapy. We aimed to assess the prevalence of atherogenic dyslipidemia, and relationship between OSA severity and serum LDL-cholesterol and non-HDL cholesterol levels in OSA patients.MethodsWe retrospectively evaluated treatment naïve 2361 subjects admitted to the sleep laboratory of a university hospital for polysomnography. All subjects’ lipid profile including total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, and non-HDL-cholesterol were measured.ResultsOut of 2361 patients (mean age 49.6 ± 11.9 years; 68.9% male, apnea-hypopnea index 36.6 ± 28.4/h), 185 (7.8%) had no OSA and 2176 (92.2%) had OSA. Atherogenic dyslipidemia prevalence was high (57–66%) in OSA patients, and especially increased in severe OSA compared to other groups (p < 0.05). Though total and LDL-cholesterol did not differ between those with and without OSA, non-HDL-cholesterol (p = 0.020), and triglycerides (p = 0.001) were higher and HDL-cholesterol levels (p = 0.018) were lower in OSA patients than non-OSA. Non-HDL-cholesterol was significantly correlated with OSA severity (p < 0.001) and hypoxia parameters (p < 0.01), whereas LDL-cholesterol showed no correlation.ConclusionsAtherogenic dyslipidemia is highly prevalent and non-HDL-cholesterol levels are significantly increased, predominantly in severe OSA patients. Non-HDL-cholesterol but not LDL-cholesterol, is significantly correlated with OSA severity and hypoxia parameters. Therefore, it could be better to use non-HDL-cholesterol, which is a guideline recommended target of lipid therapy, as a marker of atherosclerotic cardiovascular risk in OSA patients.     

2型糖尿病患者高危因素分析

目的 分析2型糖尿病患者各种高危险因素控制状况及其与慢性并发症的关系。方法 记录464例50岁以上的2型糖尿病患者收缩压、舒张压、血脂、糖化血红蛋白和体质指数，按有无并发症分为两组进行分析。结果 有并发症组糖尿病病程、血压、总胆固醇、低密度脂蛋白胆固醇和血纤维蛋白原明显增高。Wald卡方分析显示糖尿病病程和收缩压有统计学意义。多数患者这些危险因素未得到很好的控制。结论 糖尿病患者存在着多种高危因素，有慢性并发症者更为严重，应注意综合治疗。     

高血压患者多病共存现状研究

目的 分析高血压患者多病共存现状,为高血压防治工作提供借鉴资料。方法 以2019年3月至2020年12月在郑州市某医院高血压科就诊并签约管理的高血压患者作为研究对象,采用自制调查问卷收集高血压合并其他慢性疾病情况,对调查结果进行描述性分析。结果 本研究共纳入3 942例高血压患者,其中男性2 048例,女性1 894例;年龄37~78岁,平均（53.9±6.8）岁;高血压病程1~18年,平均（6.2±1.9）年;高血压分级：血压高值1 172例,1级高血压1 843例,2级高血压832例,3级高血压95例。共有多病共存者1 847例,发生率为46.85%。其中共存1种疾病1 316例,占71.25%,共存2种疾病464例,占25.12%,共存3种及以上疾病67例占3.63%。不同性别、年龄、吸烟、饮酒、体育锻炼、高血压病程、高血压分级的高血压患者多病共存患病率差异均有统计学意义（P<0.05或P<0.01）,其中男性、70~78岁、吸烟、饮酒、体育锻炼未达标、高血压病程16~18年、3级高血压患者多病共存患病率更高。高血压患者共存疾病中排在前3位的是血脂异常（587例、31.78%）、2型糖尿病（510例、27.61%）、冠心病（432例、23.39%）,其次为骨质疏松（384例、20.79%）、慢性阻塞性肺疾病（272例、14.73%）、脑梗死（156例、8.45%）、慢性肾病（113例、6.12%）。结论 高血压多病共存患者比例较高且共存疾病种类较多,常见的共存疾病是血脂异常、2型糖尿病、冠心病等,应针对高血压患者多病共存特点加强防治干预,积极控制血压的同时减少共存疾病的发生,提升高血压患者生活质量。     

职业人群不健康行为生活方式与高尿酸血症的关系及高血压、血脂异常的效应修饰作用

目的 探索不健康行为生活方式与高尿酸血症的关系,以及高血压、血脂异常的效应修饰作用,为预防高尿酸血症提供理论依据。方法 采用横断面调查研究设计,基于2021年10-12月来自四川省、贵州省28个地级市和重庆市33个区（县）中国铁路成都局集团有限公司的西南职业人群队列基线数据,通过问卷调查、体格测量及实验室生化检测收集研究对象的人口学特征、行为生活方式、慢性非传染性疾病患病情况。不健康行为生活方式得分根据吸烟、饮酒、膳食模式、体力活动和低体重/超重状况进行评分,分值越高不健康行为生活方式越多。采用多因素logistic回归模型分析不健康行为生活方式评分、吸烟状况、饮酒状况等与高尿酸血症的关系,采用分层分析探索高血压等疾病对不健康行为生活方式与高尿酸血症之间关系的修饰效应。结果 共纳入11 748名研究对象,高尿酸血症患病率为34.4%。多因素logistic回归分析显示,现在吸/既往吸烟、现在饮/既往饮酒及BMI异常是高尿酸血症患病的危险因素,不健康行为生活方式对高尿酸血症患病风险呈现累积效应,随着得分的升高,高尿酸血症患病风险升高,OR值由1.64（95%CI：1.34~2.00）上升至2.89（95%CI：2.39~3.50）。分层分析结果显示,在高血压及血脂异常人群中,不健康行为生活方式对高尿酸血症患病风险影响更大。结论 多种不健康行为生活方式的共存会升高高尿酸血症患病风险,这一效应在高血压、血脂异常人群中更明显。及时纠正不健康行为生活方式,并控制高血压和血脂异常,降低患高尿酸血症的风险。     

小檗碱对糖皮质激素大鼠血脂异常的调节作用

目的 探讨小檗碱对糖皮质激素大鼠血脂异常的调节作用.方法 50只3月龄雄性SD大鼠,随机分成5组,每组10只,分别给予泼尼松与不同剂量小檗碱12周,观察大鼠体质量、血液中血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、钙、磷、丙二醛及超氧化物歧化酶的变化.结果 给予泼尼松后大鼠体质量增加减慢,小檗碱可减轻泼尼松所致大鼠体质量增长幅度下降.给予泼尼松12周后,大鼠血液中血糖、甘油三酯、总胆固醇和丙二醛显著升高,高密度脂蛋白胆固醇降低;小檗碱可降低糖皮质激素大鼠血液中血糖、甘油三酯、总胆固醇和丙二醛含量,升高高密度脂蛋白胆固醇,对钙、磷及超氧化物歧化酶无显著影响.结论 小檗碱可改善糖皮质激素所致大鼠血脂代谢异常.     

多囊卵巢综合征患者的血脂代谢异常及与胰岛素抵抗的关系分析

目的:探讨多囊卵巢综合征(PCOS)患者血脂代谢异常及与胰岛素抵抗(IR)的关系,以期为血脂代谢异常PCOS患者的临床管理提供参考。方法:回顾性分析507例PCOS患者的临床资料,分析血脂代谢异常及其与腰臀比、体重指数(BMI)、IR指数、性激素水平等指标的相关关系。结果:PCOS患者IR的发生率为38.1%;与非IR的患者相比,伴有IR的患者具有较高的甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)和较低的高密度脂蛋白(HDL)(1.83±1.19vs1.12±0.70mmol/L、5.23±1.06vs4.91±0.90mmol/L、3.25±0.98vs2.88±0.79mmol/L、1.41±0.40vs1.64±0.36mmol/L,P<0.001)。总体血脂异常的发生率为24.7%,IR组显著高于非IR组(39.9%vs15.3%,P<0.001);TG、TC、LDL水平与胰岛素稳态模型-IR指数(HOMA-IR)值呈正相关,HDL水平与HOMA-IR值呈负相关。在控制BMI的影响后,TG与HDL水平仍与HOMA-IR值呈显著相关性。总体上,随着HOMA-IR值的增大,血脂异常的发生率逐渐增加。结论:PCOS患者胰岛素抵抗和血脂异常的发生率均较高,血脂异常与胰岛素抵抗呈相关性,推测临床上使用胰岛素增敏剂可能通过改善IR进而改善PCOS患者的血脂代谢异常。     

颈动脉不稳定型斑块、血脂、血压与急性脑梗死关系的病例对照研究

目的 探讨颈动脉不稳定型斑块、血脂、血压与急性脑梗死之间的关系。方法 行彩色多普勒超声检查了解颈动脉斑块性质,同时对比血脂、血压水平,采用病例对照研究设计比较脑梗死组与对照组之间的差异。结果 与对照组比较,脑梗死组斑块检出率高于对照组（χ²=12.477,P<0.001）;且不稳定斑块占脑梗死组检出斑块的70.2% ,差异均有统计学意义（χ²=7.754,P=0.005）。脑梗死患者总胆固醇、甘油三酯、极低密度脂蛋白胆固醇及低密度脂蛋白胆固醇高于对照组,高密度脂蛋白胆固醇低于对照组,差异均有统计学意义（均有P<0.05）。两组检出有不稳定斑块者的高密度脂蛋白胆固醇低于无斑块者、低密度脂蛋白胆固醇高于无斑块者,差异均有统计学意义（均有P<0.05）。脑梗死组收缩压及舒张压均高于对照组,差异有统计学意义（均有P<0.05）。研究对象中既往有高血压病史者中,脑梗死组收缩压和舒张压均高于对照组（t₁=3.154,P₁=0.003;t₂=4.384,P₂<0.001）,差异有统计学意义。结论 急性脑梗死的发病与颈动脉不稳定型斑块、血脂、血压有相关关系,在危险因素出现早期进行积极的干预治疗,对于降低急性脑梗死发病率可能有重要意义。     

Role of dyslipidemia in ischemic stroke patients treated in the telestroke network

PurposeThe relationship between the telestroke technology and clinical risk factors in a dysplipidemic ischemic stroke population and neurologic outcomes is not fully understood. This issue was investigated in this study.Patients and methodsWe analyzed retrospective data collected from a regional stroke registry to identify demographic and clinical risk factors in patients with improving (NIHSS ​≤ ​7) or worsening (NIHSS ​> ​7) neurologic outcome in dyslipidemic ischemic stroke population. We used logistic multivariate models to identify independent predictors of improving or worsening outcome based on dyslipidemia disease status in ischemic stroke patients.ResultsIn the adjusted analysis for dyslipidemic ischemic stroke population, cholesterol reducer use (odd ratio; [OR] ​= ​0.393, 95% confidence interval [CI], 0.176–0.879, P ​= ​0.023) and direct admission (OR ​= ​0.435, 95% CI, 0.199–0.953, P ​= ​0.037) were more likely to be associated with neurologic improvement and no clinical or demographic factors were associated with poor neurologic outcome in dyslipidemic ischemic stroke patients treated in the telestroke network.For the ischemic stroke population without dyslipidemia, increasing age (OR ​= ​1.070, 95% CI, 1.031–1.109, P ​< ​0.001), coronary artery disease (OR ​= ​3.633, 95% CI, 1.307–10.099, P ​= ​0.013), history of drug or alcohol abuse (OR ​= ​6.548, 95% CI, 1.106–38.777, P ​= ​0.038), and improvement in ambulatory outcome (OR ​= ​2.880, 95% CI, 1.183–7.010, P ​= ​0.020) were associated with worsening neurological functions, while being Caucasian (OR ​= ​0.294, 95% CI, 0.098–0.882, P ​= ​0.029) was associated with improving neurologic functions.ConclusionDemographic and clinical risk factors among the dysplipidemic ischemic stroke population in the telestroke network were not associated with worsening neurologic functions.     

Curcuminoids modify lipid profile in type 2 diabetes mellitus: A randomized controlled trial

BackgroundType 2 diabetes (T2D) is an established risk factor for cardiovascular disease (CVD) and is associated with disturbed metabolism of lipids and lipoproteins. Curcuminoids are natural products with anti-diabetic and lipid-modifying actions but their efficacy in improving dyslipidemia in diabetic individuals has not been sufficiently studied.ObjectiveTo investigate the efficacy of supplementation with curcuminoids, plus piperine as an absorption enhancer, in improving serum lipids in patients with T2D.MethodsIn this 12-week randomized double-blind placebo-controlled trial, subjects with T2D (n = 118) were assigned to curcuminoids (1000 mg/day plus piperine 10 mg/day) or placebo plus standard of care for T2D. Serum concentrations of lipids including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), lipoprotein(a) [Lp(a)], and non-HDL-C were determined at baseline and at the end of trial.ResultsBetween-group comparison of change in the study parameters revealed significant reductions in serum levels of TC (−21.86 ± 25.78 versus −17.06 ± 41.51, respectively; p = 0.023), non-HDL-C (−23.42 ± 25.13 versus −16.84 ± 41.42, respectively; p = 0.014) and Lp(a) (−1.50 ± 1.61 versus −0.34 ± 1.73, respectively; p = 0.001) and elevations in serum HDL-C levels (1.56 ± 4.25 versus −0.22 ± 4.62, respectively; p = 0.048) in the curcuminoids group as compared with the placebo group (p < 0.05). Serum TG and LDL-C changes did not show any significant difference between the study groups (p > 0.05).ConclusionCurcuminoids supplementation can reduce serum levels of atherogenic lipid indices including non-HDL-C and Lp(a). Therefore, curcuminoids supplementation could contribute to a reduced risk of cardiovascular events in dyslipidemic patients with T2D.