scholarly journals New Perspectives on Atherogenic Dyslipidaemia and Cardiovascular Disease

2020 ◽  
Vol 15 ◽  
Author(s):  
Alberto J Lorenzatti ◽  
Peter P Toth
Keyword(s):  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Ldl Particles ◽  
Remnant Lipoproteins ◽  
Increased Risk ◽  
Atherogenic Dyslipidaemia ◽  
Low Hdl ◽  
Cv Disease ◽  
Lipid Abnormalities ◽  
Diabetes And Obesity

Over the past few decades, atherogenic dyslipidaemia has become one of the most common phenotypic presentations of lipid abnormalities, being strongly and unequivocally associated with an increased risk of cardiovascular (CV) disease. Despite the excellent results achieved from statin and non-statin management of LDL cholesterol and CV events prevention, there still remains a significant residual risk, associated with the prevalence of non-LDL cholesterol lipid patterns characterised by elevated triglyceride levels, low HDL cholesterol, a preponderance of small and dense LDL particles, accumulation of remnant lipoproteins and postprandial hyperlipidaemia. These qualitative and quantitative lipid modifications are largely associated with insulin resistance, type 2 diabetes and obesity, the prevalence of which has grown to epidemic proportions throughout the world. In this review, we analyse the pathophysiology of this particular dyslipidaemia, its relationship with the development of atherosclerotic CV disease and, finally, briefly describe the therapeutic approaches, including changes in lifestyle and current pharmacological interventions to manage these lipid alterations aimed at preventing CV events.

scholarly journals Serum Lipid Concentrations and Prevalence of Dyslipidemia in a Large Professional Population in Beijing

2005 ◽  
Vol 51 (1) ◽  
pp. 144-150 ◽  
Author(s):  
Zhiyan Li ◽  
Ruifeng Yang ◽  
Guobing Xu ◽  
Tiean Xia
Keyword(s):  
Serum Lipids ◽  
Ldl Cholesterol ◽  
Preventive Measures ◽  
Age Groups ◽  
Hdl Cholesterol ◽  
Coronary Artery Diseases ◽  
Lipid Concentration ◽  
The Past ◽  
Low Hdl ◽  
Lipid Abnormalities

Abstract Background: Lipid abnormalities are major risk factors for premature coronary artery diseases. We investigated serum lipids and the prevalence of dyslipidemia in a professional population in Beijing and compared these data with those obtained in a similar population during 1984–1986. Methods: We studied 14 963 individuals 20–90 years of age. Health status was determined by questionnaires and physical check-ups. Total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), and total triglycerides (TGs) were measured. TC >5.7 mmol/L, LDL-C >3.6 mmol/L, TGs >1.7 mmol/L, and HDL-C <0.9 mmol/L were defined as abnormal. Results: Mean serum TC, LDL-C, and TG concentrations were increased compared with the values obtained in 1984–1986, with 52.7% of males and 42.9% of females having at least one abnormal lipid concentration. Hypercholesterolemia occurred in 6% of males and 2.8% of females in the younger group (20–39 years) and in 20.2% of males and 38.7% of females in the older group (>60 years). HDL-C was abnormally low in ∼7% of males and in 1.6% of females. The prevalences of hypercholesterolemia, hypertriglyceridemia, and abnormally low HDL-C, especially the presence of slight hypertriglyceridemia, were higher than in 1984–1986 in all age groups. The increase was most prominent in the middle age group (40–59 years). Conclusions: Hypercholesterolemia, hypertriglyceridemia, and abnormally low HDL-C have increased considerably over the past 20 years in professional populations in Beijing. Dietary changes and less physical activity resulting from rapid improvements in living conditions may be the causes for the increases. Enhanced preventive measures should be undertaken to modify these situations.

Lipid-lowering drugs

ESC CardioMed ◽  
2018 ◽  
pp. 204-209
Author(s):  
Cesare R. Sirtori ◽  
Massimiliano Ruscica
Keyword(s):  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Omega 3 ◽  
Transfer Protein ◽  
Increased Risk ◽  
Low Hdl ◽  
Coronary Events ◽  
Systemic Agents

Hyperlipidaemias, multifactorial conditions partly genetically and partly life habit induced, are the most important underlying risk factors for cardiovascular disease. They can lead to arterial lipid deposition with a consequent increased risk of coronary events. The primary effort in hypolipidaemic drug therapy is focused on the lowering of the primary carriers of cholesterol, the low-density lipoproteins (LDLs), but more recent efforts have been placed on the lowering of triglycerides. Reduced levels of the protective high-density lipoproteins (HDLs) are generally considered a primary risk factor, ‘dysfunctional’ HDL may probably be a more important factor. Among drugs primarily reducing LDL cholesterol the most important systemic agents are statins. Non-systemic agents, such as resins, have a lesser use, whereas ezetimibe is frequently given in combination with statins. A new series of systemic compounds, the inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), recently available, have a higher activity on LDL cholesterol. Drugs indicated for the treatment of the homozygous forms of hypercholesterolaemia are lomitapide, an inhibitor of the microsomal transfer protein, and the antisense nucleotide mipomersen, designed to inhibit synthesis of apolipoprotein B. Treatment of hypertriglyceridaemias mainly relies on fibrates, activating the peroxisomal proliferator-activated receptor-α‎. They treat particularly the atherogenic dyslipidaemias (elevated triglycerides with low HDL cholesterol). Nicotinic acid is less frequently used and the omega-3 fatty acids have an as yet unclear cardiovascular protective activity.

Lipid-lowering drugs

ESC CardioMed ◽  
2018 ◽  
pp. 204-209
Author(s):  
Cesare R. Sirtori ◽  
Massimiliano Ruscica
Keyword(s):  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Omega 3 ◽  
Transfer Protein ◽  
Increased Risk ◽  
Low Hdl ◽  
Coronary Events ◽  
Systemic Agents

Hyperlipidaemias, multifactorial conditions partly genetically and partly life habit induced, are the most important underlying risk factors for cardiovascular disease. They can lead to arterial lipid deposition with a consequent increased risk of coronary events. The primary effort in hypolipidaemic drug therapy is focused on the lowering of the primary carriers of cholesterol, the low-density lipoproteins (LDLs), but more recent efforts have been placed on the lowering of triglycerides. Reduced levels of the protective high-density lipoproteins (HDLs) are generally considered a primary risk factor, ‘dysfunctional’ HDL may probably be a more important factor. Among drugs primarily reducing LDL cholesterol the most important systemic agents are statins. Non-systemic agents, such as resins, have a lesser use, whereas ezetimibe is frequently given in combination with statins. A new series of systemic compounds, the inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), recently available, have a higher activity on LDL cholesterol. Drugs indicated for the treatment of the homozygous forms of hypercholesterolaemia are lomitapide, an inhibitor of the microsomal transfer protein, and the antisense nucleotide mipomersen, designed to inhibit synthesis of apolipoprotein B. Treatment of hypertriglyceridaemias mainly relies on fibrates, activating the peroxisomal proliferator-activated receptor-α‎. They treat particularly the atherogenic dyslipidaemias (elevated triglycerides with low HDL cholesterol). Nicotinic acid is less frequently used and the omega-3 fatty acids have an as yet unclear cardiovascular protective activity.

scholarly journals Fasting and Nonfasting Triglycerides in Cardiovascular and Other Diseases

2015 ◽  
pp. S323-S330 ◽  
Author(s):  
J. PIŤHA ◽  
J. KOVÁŘ ◽  
T. BLAHOVÁ
Keyword(s):  
Cardiovascular Disease ◽  
Lipoprotein Metabolism ◽  
Hdl Cholesterol ◽  
Atherogenic Index ◽  
Serum Triglycerides ◽  
Ldl Particles ◽  
Remnant Lipoproteins ◽  
Increased Risk ◽  
Tight Association

Moderately elevated plasma/serum triglycerides (2-10 mmol/l) signalize increased risk for cardiovascular disease or presence of non-alcoholic steatohepatitis. Extremely elevated triglycerides (more than 10 mmol/l) signalize increased risk for pancreatitis and lipemia retinalis. The concentration of triglycerides is regulated by many genetic and nongenetic factors. Extremely elevated triglycerides not provoked by nutritional factors, especially inappropriate alcohol intake are more likely to have a monogenic cause. On the contrary, mildly to moderately elevated triglycerides are often caused by polygenic disorders; these could be also associated with central obesity, insulin resistance, and diabetes mellitus. Concentration of triglycerides is also closely interconnected with presence of atherogenic remnant lipoproteins, impaired reverse cholesterol transport and more atherogenic small LDL particles. In general, there is tight association between triglycerides and many other metabolic factors including intermediate products of lipoprotein metabolism which are frequently atherogenic. Therefore, reliable evaluation of the independent role of triglycerides especially in atherosclerosis and cardiovascular disease is difficult. In individual cases values of HDL cholesterol, non-HDL cholesterol (total minus HDL cholesterol), non-HDL/nonLDL cholesterol (total minus HDL minus LDL cholesterol, especially in nonfasting status), atherogenic index of plasma and/or apolipoprotein B could help in decisions regarding aggressiveness of treatment.

scholarly journals Increased Remnant Cholesterol Explains Part of Residual Risk of All-Cause Mortality in 5414 Patients with Ischemic Heart Disease

2016 ◽  
Vol 62 (4) ◽  
pp. 593-604 ◽  
Author(s):  
Anne-Marie K Jepsen ◽  
Anne Langsted ◽  
Anette Varbo ◽  
Lia E Bang ◽  
Pia R Kamstrup ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Hazard Ratio ◽  
Residual Risk ◽  
Ischemic Heart ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Remnant Cholesterol

Abstract BACKGROUND Increased concentrations of remnant cholesterol are causally associated with increased risk of ischemic heart disease. We tested the hypothesis that increased remnant cholesterol is a risk factor for all-cause mortality in patients with ischemic heart disease. METHODS We included 5414 Danish patients diagnosed with ischemic heart disease. Patients on statins were not excluded. Calculated remnant cholesterol was nonfasting total cholesterol minus LDL and HDL cholesterol. During 35836 person-years of follow-up, 1319 patients died. RESULTS We examined both calculated and directly measured remnant cholesterol; importantly, however, measured remnant cholesterol made up only 9% of calculated remnant cholesterol at nonfasting triglyceride concentrations <1 mmol/L (89 mg/dL) and only 43% at triglycerides >5 mmol/L (443 mg/dL). Multivariable-adjusted hazard ratios for all-cause mortality compared with patients with calculated remnant cholesterol concentrations in the 0 to 60th percentiles were 1.2 (95% CI, 1.1–1.4) for patients in the 61st to 80th percentiles, 1.3 (1.1–1.5) for the 81st to 90th percentiles, 1.5 (1.1–1.8) for the 91st to 95th percentiles, and 1.6 (1.2–2.0) for patients in the 96th to 100th percentiles (trend, P < 0.001). Corresponding values for measured remnant cholesterol were 1.0 (0.8–1.1), 1.2 (1.0–1.4), 1.1 (0.9–1.5), and 1.3 (1.1–1.7) (trend, P = 0.006), and for measured LDL cholesterol 1.0 (0.9–1.1), 1.0 (0.8–1.2), 1.0 (0.8–1.3), and 1.1 (0.8–1.4) (trend, P = 0.88). Cumulative survival was reduced in patients with calculated remnant cholesterol ≥1 mmol/L (39 mg/dL) vs <1 mmol/L [log-rank, P = 9 × 10−6; hazard ratio 1.3 (1.2–1.5)], but not in patients with measured LDL cholesterol ≥3 mmol/L (116 mg/dL) vs <3 mmol/L [P = 0.76; hazard ratio 1.0 (0.9–1.1)]. CONCLUSIONS Increased concentrations of both calculated and measured remnant cholesterol were associated with increased all-cause mortality in patients with ischemic heart disease, which was not the case for increased concentrations of measured LDL cholesterol. This suggests that increased concentrations of remnant cholesterol explain part of the residual risk of all-cause mortality in patients with ischemic heart disease.

Abstract 3441: Paraoxonase-192 Polymorphism Interaction with Low HDL Cholesterol in Coronary Artery Risk

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Andreia M Pereira ◽  
Isabel M Mendonca ◽  
Ana I Freitas ◽  
Ana C Sousa ◽  
Susana Gomes ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Coronary Artery ◽  
Hdl Cholesterol ◽  
High Density Lipoproteins ◽  
Synergy Index ◽  
Attributable Proportion ◽  
Increased Risk ◽  
Low Hdl ◽  
Lower Ability ◽  
Male Sex

Background: Increased lipid peroxidation is associated with accelerated progression of atherosclerosis. Paraoxonase (PON1) is an antioxidative enzyme in high density lipoproteins (HDL), which protects against lipid per oxidation and Coronary Artery Disease (CAD). PON 1 activity is under genetic control and its molecular basis is a polymorphism in the PON 1 gene that shows two common isoforms: Q (192 Gln) with high ability to protect LDL from lipid peroxidation in vitro, and R (Arg) with lower ability. Aim: To explore the interaction of the R allele paraoxonase gene and low HDL cholesterol concentrations, in CAD risk emergence. Methods: 818 individuals participated in the study, 298 coronary patients, 55.0±10.3 years, 78.9% male sex, and 520 healthy controls, 47.3±12.6 years, 57.5% male sex, age and sex matched. Low HDL-C was defined as <0.90 mmol/L in men and < 1.11 mmol/L in the women. Comparisons of genotypes between cases and control subjects were performed by a chi-square test. Statistical significance was accepted at p<0.05. Odds ratio as well as their 95% confidence intervals for the RR genotypes and HDL deficient subjects were computed using univariate analysis (2x2 tables). To determine the interaction between the RR paraoxonase genotype and HDL-deficient subjects, we used the epidemiologic tables 4x2 and the synergy measures: the additive model (Rothman’s synergy index) and the multiplicative model (Khoury’s synergy index). We calculated the relative excess risk (RERI) and the attributable proportion (AP) due to interaction (Rothman). Results: The PON 1 RR192 is associated with coronary heart disease [OR=1.61; p=0.043] in whole population. The HDL-deficient subjects 192 RR homozygotes showed an increased risk of CAD (OR=17.38; p< 0.0001) compared to normal HDL 192 RR (OR=1.39; p=0.348) and HDL-deficient subjects not carrying RR genotype (OR=7.79; p<0.0001). The genotype PON 192 RR increases the risk of CAD in the HDL-deficient populations (SI=2.3, SIM=1.6). The attributable proportion due to this interaction (AP) was 0.53, meaning that 53% of CAD was explained by this interaction. Conclusion: These data suggest the existence of a synergistic effect of the RR 192 PON 1 genotype (with lower ability) and HDL-deficient subjects in CAD emergence.

scholarly journals Changes in socio-economic status and lipoproteins in Chilean adolescents: a 16-year longitudinal study

2018 ◽  
Vol 22 (2) ◽  
pp. 344-353
Author(s):  
Zachary J Madewell ◽  
Estela Blanco ◽  
Raquel Burrows ◽  
Betsy Lozoff ◽  
Sheila Gahagan
Keyword(s):  
Social Capital ◽  
Longitudinal Study ◽  
Linear Models ◽  
Ldl Cholesterol ◽  
Economic Status ◽  
Hdl Cholesterol ◽  
Varimax Rotation ◽  
Socio Economic Status ◽  
Low Hdl ◽  
Environmental Capital

AbstractObjectiveThe present longitudinal study assessed whether changes in socio-economic status (SES) from infancy to adolescence were associated with plasma lipoprotein concentrations in adolescence, of which low HDL-cholesterol (HDL-C) and high LDL-cholesterol (LDL-C), TAG and total cholesterol (TC) concentrations are associated with higher cardiovascular risk.DesignSES, assessed using the modified Graffar Index, was calculated at 1, 5, 10 and 16 years. Principal components factor analysis with varimax rotation extracted two orthogonal SES factors, termed ‘environmental capital’ and ‘social capital’. Generalized linear models were used to analyse associations between environmental and social capital at 1 and 16 years and outcomes (HDL-C, LDL-C, TAG, TC) at 16 years, as well as changes in environmental and social capital from 1–5, 5–10, 10–16 and 1–16 years, and outcomes at 16 years.SettingSantiago, Chile.ParticipantsWe evaluated 665 participants from the Santiago Longitudinal Study enrolled at infancy in Fe-deficiency anaemia studies and examined every 5 years to age 16 years.ResultsSocial capital in infancy was associated with higher HDL-C in adolescence. Environmental capital in adolescence was associated with higher LDL-C and TC during adolescence. Changing environmental capital from 1–16 years was associated with higher LDL-C. Changing environmental capital from 1–5 and 1–16 years was associated with higher TC.ConclusionsImprovements in environmental capital throughout childhood were associated with less healthy LDL-C and TC concentrations in adolescence. We found no evidence of associations between changing environmental capital and HDL-C or TAG, or changing social capital and HDL-C, LDL-C, TAG or TC.

scholarly journals Lipid abnormalities in elderly patients with subclinical hyperthyroidism

2003 ◽  
Vol 56 (11-12) ◽  
pp. 564-567 ◽  
Author(s):  
Zorica Caparevic ◽  
Dragos Stojanovic ◽  
Vesna Ilic ◽  
Gradimir Bojkovic ◽  
Mirjana Stojanovic
Keyword(s):  
Atrial Fibrillation ◽  
Thyroid Hormone ◽  
Elderly Patients ◽  
Cardiac Hypertrophy ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Antithyroid Drugs ◽  
Subclinical Hyperthyroidism ◽  
Cholesterol Levels ◽  
Lipid Abnormalities

Introduction Sensitive thyroid-stimulating hormone (TSH) assays provide identification of many patients with subclinical hyperthyroidism resulting from excessive production or excessive replacement of thyroid hormone. Subclinical hyperthyroidism is defined by a TSH below normal (suppressed) with normal serum T3 and T4 levels. Subclinical hyperthyroidism is the goal of thyroid hormone therapy in patients with thyroid cancer, solitary thyroid nodules, multinodular or diffuse goiters, or a history of head and neck irradiation. Benefits of TSH suppression in these patients, were thought to exceed the risks of subclinical hyperthyroidism. Subclinical hyperthyroidism also occurs in patients with thyroiditis and those with autoimmune thyroid disease. Other causes of TSH suppression, such as use of glucocorticoids, severe illness and pituitary dysfunction should be excluded. Material and methods This investigation included 55 elderly patients with subclical hyperthyroidism in order to establish the type and degree of lipid abnormalities and effects of therapy with antithyroid drugs (methimazole 10 mg/day) during three months. These patients presented with no or minimal symptoms of thyroid hormone excess, but 56% of patients experienced atrial fibrillation and cardiac hypertrophy. Results Levels of serum cholesterol, LDL-cholesterol and HDL-cholesterol were decreased. We found a significant increase of serum cholesterol, LDL-cholesterol and HDL-cholesterol levels after treatment. Discussion and Conclusion Subclinical hyperthyroidism in elderly individuals is difficult to diagnose because it may present only with cardiac manifestations including atrial fibrillation and cardiac hypertrophy. There is general agreement that measurement of serum TSH is the most sensitive indicator of thyroid hormone activity in its target tissues. Patients with subclinical hyperthyroidism tend to have low serum total cholesterol, LDL-cholesterol anf HDL-cholesterol levels. These values increase after treatment. Most patients with subclinical hyperthyroidism should be treated with antithyroid drugs to prevent cardiovascular complications and bone loss, particulary among postmenopausal women.

Elevated apolipoprotein A1 and HDL cholesterol associated with age-related macular degeneration: two population cohorts

2021 ◽  
Author(s):  
Liv Tybjærg Nordestgaard ◽  
Anne Tybjærg-Hansen ◽  
Ruth Frikke-Schmidt ◽  
Børge Grønne Nordestgaard
Keyword(s):  
Macular Degeneration ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Age Related Macular Degeneration ◽  
Apolipoprotein A1 ◽  
Age Related ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Plasma Apolipoprotein

Abstract Context To enable prevention and treatment of age-related macular degeneration(AMD), understanding risk factors for AMD is important. Objective We tested the hypotheses that elevated plasma apolipoprotein A1 and high-density lipoprotein(HDL) cholesterol, and low levels of low-density lipoprotein(LDL) cholesterol, are associated with increased risk of AMD. Design and Setting From the Danish general population, we studied 106,703 and 16,032 individuals in the Copenhagen General Population Study(CGPS) and the Copenhagen City Heart Study(CCHS) with median follow-up of respectively 9 and 32 years. Main Outcome Measures 1,787 AMD in CGPS and 206 in CCHS. Results Higher concentrations of plasma apolipoprotein A1 and HDL cholesterol, and lower concentrations of LDL cholesterol, were associated with higher risk of AMD in CGPS. After multifactorial adjustment, individuals in the highest versus lowest quartile of plasma apolipoprotein A1 and HDL cholesterol had hazard ratios for AMD of 1.40(95%CI:1.20-1.63) and 1.22(1.03-1.45). Corresponding hazard ratios for individuals in the lowest versus highest quartile of LDL cholesterol were 1.18(1.02-1.37). Per 100 mg/dL higher plasma apolipoprotein A1, 1 mmol/L(39 mg/dL) higher HDL, and 1 mmol/L(39mmol/L) lower LDL cholesterol, the hazard ratios for AMD were 1.53(1.31-1.80), 1.19(1.07-1.32), and 1.05(1.00-1.11), respectively, with similar results across strata of different risk factors. Higher concentrations of HDL cholesterol were also associated with higher risk of AMD in the CCHS. Conclusion Elevated plasma apolipoprotein A1 and HDL cholesterol, and lower LDL cholesterol, are associated with increased risk of age-related macular degeneration.

scholarly journals GLYCEMIC AND LIPIDEIC STATUS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

2014 ◽  
Vol 04 (01) ◽  
pp. 009-014
Author(s):  
A. Harish Rao
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Total Cholesterol ◽  
Ldl Cholesterol ◽  
Fasting Glucose ◽  
Hdl Cholesterol ◽  
Serum Levels ◽  
Glucose Levels ◽  
Low Hdl ◽  
One Year

Abstract: Objective: to know the glycemic and lipidaemic status in patients with acute myocardial infarction, and with the secondary objective to know the effect of age, gender, diabetes, smoking, hypertension on fasting glucose and lipid levels. Methods and materials: The 74 patients admitted for acute myocardial infarction during the study period of one year were analysed for fasting glucose values and serum levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Results: The mean serum concentrations of total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol were 233.28±45.34, 139.22±41.71, 171.43±36.53 and 27.07±36.53 respectively. Mean levels of total cholesterol, HDL cholesterol, triglycerides and fasting glucose values were not affected by age, gender, BMI, hypertension and smoking. BMI >30kg/m2 was associated with increased levels of total cholesterol(p=0.013) and LDL cholesterol(p=0.014). Also increase LDL cholesterol was seen in male gender(p=0.04). The prevalence of hypercholesterolemia, hypertriglyceridemia and low HDL cholesterol was 82.4%,77% and 78% respectively. Diabetes had no effect on lipid profile. Conclusion: our study highlighted the prevalence of dyslipidemias associated with myocardial infarction but not significant impact of fasting glucose levels.

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