scholarly journals High Triglyceride-Glucose Index is Associated with Poor Cardiovascular Outcomes in Non-Diabetic ACS Patients with LDL-C Below 1.8mmol/L

2020 ◽  
Author(s):  
Yue Zhang ◽  
Xiaosong Ding ◽  
Bing Hua ◽  
Qingbo Liu ◽  
Hui Gao ◽  
...  
Keyword(s):  
Infarct Size ◽  
Cox Regression ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Coronary Syndrome ◽  
Tyg Index ◽  
Triglyceride Glucose Index ◽  
Significant Difference ◽  
Cerebral Event ◽  
Index Level

Abstract Background: To evaluate the prognostic value of triglyceride glucose (TyG) index in non-diabetic acute coronary syndrome (ACS) patients with low-density lipoprotein cholesterol (LDL-C) below 1.8mmol/L.Methods: A total of 1655 non-diabetic ACS patients with LDL-C below 1.8mmol/L were included in the analysis. Patients were stratified into 2 groups. Incidence of acute myocardial infarction (AMI), infarct size in patients with AMI, and major adverse cardiac and cerebral event (MACCE) during a median of 35.6-month follow-up were determined and compared between the 2 groups. The TyG index was calculated using the following formula: ln [fasting triglycerides (mg/dL) ×fasting plasma glucose (mg/dL)/2].Results: Compared with the TyG index <8.33 group, the TyG index ≥8.33 group had significantly higher incidence of AMI (21.2% vs. 15.2%, p =0.014) and larger infarct size in patients with AMI (pTNI: 10.4 vs. 4.8 ng/ml, p =0.003; pCKMB: 52.8 vs. 22.0 ng/ml, p =0.006; pMyo: 73.7 vs. 46.0 ng/ml, p =0.038). Although there was no significant difference in mortality between the 2 groups, the incidence of revascularization of TyG index ≥8.33 group was significantly higher than that of TyG index <8.33 group (8.9% vs. 5.0%, p =0.035). Multivariable Cox regression revealed that the TyG index was positively associated with revascularization [HR (95% CI): 1.67 (1.02,2.75), p=0.043].Conclusion: In non-diabetic ACS patients with LDL-C below 1.8mmol/L, the high TyG index level was associated with higher incidence of AMI, larger infarct size, and higher incidence of revascularization. The high TyG index level might be a valid predictor of subsequent revascularization.Trial registration: retrospectively registered.

scholarly journals Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bo Wang ◽  
Jin Liu ◽  
Shiqun Chen ◽  
Ming Ying ◽  
Guanzhong Chen ◽  
...  
Keyword(s):  
Cox Regression ◽  
Cox Model ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Chinese Cohort ◽  
Artery Disease

Abstract Background Several studies have found that a low baseline low -density lipoprotein cholesterol (LDL-C) concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which is called the “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. The aim of this study was to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition. Method A total of 41,229 CAD patients admitted to Guangdong Provincial People’s Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (LDL-C < 1.8 mmol/L, n = 4863; LDL-C ≥ 1.8 mmol/L, n = 36,366). The Kaplan-Meier method and Cox regression analyses were used to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. Result In this real-world cohort (mean age 62.9 years; 74.9% male), there were 5257 cases of all-cause death during a median follow-up of 5.20 years [interquartile range (IQR): 3.05–7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with a worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that a low LDL-C level (< 1.8 mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96–1.24). After adjustment for nutritional status, the risk of all-cause mortality in patients with low LDL-C levels decreased (adjusted HR, 0.90; 95% CI, 0.83–0.98). In the final multivariate Cox model, a low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84–0.99). Conclusion This study demonstrated that the cholesterol paradox existed in CAD patients but disappeared after accounting for the effects of malnutrition.

Efficacy and Safety of Evolocumab in Reducing Low Density Lipoprotein Cholesterol Levels in Chinese Patients with Non-ST-segment Elevation Acute Coronary Syndrome

2020 ◽  
Vol 18 ◽  
Author(s):  
Xiaohan Xu ◽  
Meng Chai ◽  
Yujing Cheng ◽  
Pingan Peng ◽  
Xiaoli Liu ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Chinese Patients ◽  
Lipid Lowering ◽  
Control Group ◽  
Lipid Lowering Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aims: To explore early intensive lipid-lowering therapy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Background: Lowering low-density lipoprotein cholesterol (LDL-C) levels can reduce cardiovascular morbidity and mortality in patients with atherosclerotic cardiovascular disease. Due to many reasons, the need for early intensive lipid-lowering therapy is far from being met in Chinese NSTE-ACS patients at high-risk of recurrent ischaemic events. Objective: To evaluate the feasibility, safety and efficacy of starting evolocumab in hospital to lower LDL-C levels in Chinese patients with NSTE-ACS. Methods: In this prospective cohort study initiated by researchers, 334 consecutive patients with NSTE-ACS who had sub-standard LDL-C levels (LDL-C ≥2.3 mmol/L after regular oral statin treatment for at least 4 weeks; or LDL-C ≥3.2 mmol/L without regular oral statin treatment) were included. Patients who agreed to treatment with evolocumab (140 mg subcutaneously every 2 weeks, initiated in hospital and used for 12 weeks after discharge) were enrolled in the evolocumab group (n=96) and others in the control group (n=238). All enrolled patients received regular statin treatment (atorvastatin 20 mg/day or rosuvastatin 10 mg/day; doses unchanged throughout the study).The primary endpoint was the change in LDL-C levels from baseline to week 12. Results: Most patients (67.1%) had not received regular statin treatment before. In the evolocumab group, LDL-C levels decreased significantly at week 4 and remained stable at week 8 and 12 (all p<0.001). At week 12, the LDL-C percentage change from baseline in the evolocumab group was -79.2±12.7% (from an average of 3.7 to 0.7 mmol/L), while in the control group it was -37.4±15.4% (from an average of 3.3 to 2.0 mmol/L). The mean difference between these 2 groups was -41.8% (95% CI -45.0 to -38.5%; p<0.001). At week 12, the proportions of patients with LDL-C levels <1.8 mmol/L and 1.4 mmol/L in the evolocumab group were significantly higher than in the control group (96.8 vs 36.1%; 90.6 vs 7.1%; both p<0.001). The incidence of adverse events and cardiovascular events was similar in both groups. Conclusions: In this prospective cohort study we evaluated the early initiation of evolocumab in NSTE-ACS patients in China. Evolocumab combined with statins significantly lowered LDL-C levels and increased the probability of achieving recommended LDL-C levels, with satisfactory safety and well tolerance.

The effect of table olive wastewater extract administration on the adult ovariectomized rat model of osteoporosis

2021 ◽  
pp. 1-26
Author(s):  
Alexandros S. Zervas ◽  
Pavlos P. Lelovas ◽  
Antonios Galanos ◽  
Dimitris Galanis ◽  
Maria Makropoulou ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Biomechanical Testing ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Abdominal Fat ◽  
Ovariectomized Rats ◽  
Mineral Density ◽  
Final Body Weight ◽  
Significant Difference ◽  
Table Olive

Abstract Recent efforts for alternative non-pharmaceutical treatments for postmenopausal osteoporosis are focused on nutritional measures. The aim of this study was to investigate the effect of table olive wastewater extract (OE) administration on bone mineral density (BMD) and biomechanical strength in ovariectomized rats. Thirty mature 9-month-old female Wistar rats were separated into 3 groups of ten; Control, Ovariectomized (OVX) and OVX+OE. BMD was measured before ovariectomy, 3 and 6 months afterwards. At the end of the study, blood, both femurs and tibias, internal organs and abdominal fat were collected. After three months, the percentage changes from baseline of the total and proximal tibial BMD of the OVX+OE group were both higher compared to the OVX group (p<0.005). Similar results were found after six months, when the percentage changes from baseline of the total and proximal tibial BMD of the OVX+OE group were both higher compared to the OVX group (p<0.005). Biomechanical testing of the femurs did not reveal any statistically significant difference between the groups. Body weights throughout the study, organs’ and abdominal fat ratios to final body weight, blood results (alanine aminotransferase; ALT, Gamma-glutamyltransferase; γ-GT, total cholesterol, high-density lipoprotein; HDL-cholesterol, low-density lipoprotein; LDL-cholesterol, calcium, phosphorus) were within normal limits and did not show any significant difference between the treated and untreated groups. As a conclusion, the administration of table olive wastewater extract for 6 months protected tibial BMD loss in comparison to the untreated OVX group without causing adverse effects.

Relationship of triglyceride–glucose index with chronic limb-threatening ischemia in lower extremity peripheral artery disease

Vascular ◽  
2021 ◽  
pp. 170853812110183
Author(s):  
Arda Aybars Pala ◽  
Yusuf Salim Urcun
Keyword(s):  
Lower Extremity ◽  
High Density Lipoprotein ◽  
Peripheral Artery Disease ◽  
Density Lipoprotein ◽  
Peripheral Artery ◽  
Tyg Index ◽  
Triglyceride Glucose Index ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Objectives Triglyceride-glucose index (TyG index), which is defined as the simple and novel marker of insulin resistance, is becoming increasingly important as a promising predictive marker for atherosclerotic diseases. Chronic limb-threatening ischemia is defined as the most advanced stage of the lower extremity peripheral artery disease, whose main cause is atherosclerosis and is associated in this respect with amputation, impaired quality of life, and mortality. The main purpose of the present study was to investigate the relation between the calculated TyG index values and chronic limb-threatening ischemia development. Methods A total of 296 patients who were diagnosed with lower extremity peripheral artery disease in our outpatient clinic between October 2018 and October 2020 were included in this study retrospectively. Two groups were formed by clinically staging the patients according to Rutherford Classification. Patients who did not develop chronic limb-threatening ischemia were classified as “Group 1” ( n = 224) and those who developed were classified as “Group 2” ( n = 72). Results The mean TyG index values that were calculated in Group 2 were significantly higher than in Group 1 (9.27 ± 0.31 vs. 9.00 ± 0.34, p < 0.001). In the multivariate logistic regression analysis conducted to determine the predictors of chronic limb-threatening ischemia development, C-reactive protein (OR [Odds Ratio]: 1.220, 95% CI [confidence interval]: 1.092–1.363, p < 0.001), high-density lipoprotein cholesterol (OR: 0.775, 95% CI: 0.715–0.839, p < 0.001) and TyG index (OR: 5.796, 95% CI: 2.050–16.382, p = 0.001) were identified as independent predictors. Receiver operating characteristic analysis revealed that the cut-off value of TyG index was 9.13 (area under the curve: 0.721, p < 0.001) with 70.8% sensitivity and 65.2% specificity. The TyG index was significantly correlated with Rutherford category, high-density lipoprotein cholesterol and mean platelet volume. Conclusions Chronic limb-threatening ischemia development may be predicted with the TyG index value, which is calculated easily from routine biochemical parameters, in patients diagnosed with lower extremity peripheral artery disease.

scholarly journals Predictive value of small dense low-density lipoprotein cholesterol for cardiovascular events in Chinese elder diabetes mellitus patients

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Li Xu ◽  
Xu Chen ◽  
Jingfen Lu ◽  
Yan Xu ◽  
Honglin Yang ◽  
...  
Keyword(s):  
Predictive Value ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Type 2 Dm

Abstract Background As a subcomponent of low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C) has been suggested to be a better predictor of cardiovascular diseases (CVD). The aim of this research was to evaluate the predictive value of the sdLDL-C in cardiovascular events (CVs) in Chinese elderly patients with type 2 diabetes mellitus (DM). Methods A total of 386 consecutive type 2 DM patients were included into this study during December 2014 to December 2016. The serum sdLDL-C level of each subject was measured by homogeneous method. During a period of 48-month’s follow-up, the occurrence of CVs and associated clinical information were recorded. Receiver operating characteristic (ROC) curves were used to assess the predictive value of serum sdLDL-C to occurrence of major CVs. Results A total of 92 CVs occurred during the study period. The ROC curve analysis manifested that sdLDL-C in the study population had a matchable discriminatory power (AUC for sdLDL-C was 0.7366, P = 0.003). In addition, Kaplan-Meier event-free survival curves displayed an obvious increase of CVs risk for sdLDL‐C ≧ 26 mg/dL (log-rank = 9.10, P = 0.003). This phenomenon had analogous results in patients who received statins at baseline (log rank = 7.336, P = 0.007). Cox regression analysis revealed that the increase in HbA1c, glucose, LDL-C, sdLDL-C, non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B (ApoB) and the decrease in apolipoprotein AI (ApoAI) were obviously interrelated with heightened CVs risk. Multiple Cox regression demonstrated that the increase of sdLDL-C and hemoglobin A1c (HbA1c) was significantly correlated with CVs. The results of the study indicated that high sdLDL-C level (> 10 mg/dL) was a risk factor for CVs in the multivariate model (HR 1.281, 95% CI 1.225–16.032; P < 0.01). Conclusion sdLDL-C level could be an effective predictor in predicting the future CVs for Chinese elderly patients with type 2 DM and dyslipidemia.

scholarly journals Triglyceride-rich lipoprotein and LDL particle subfractions and their association with incident type 2 diabetes: the PREVEND study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sara Sokooti ◽  
Jose L. Flores-Guerrero ◽  
Hiddo J. L. Heerspink ◽  
Margery A. Connelly ◽  
Stephan J. L. Bakker ◽  
...  
Keyword(s):  
Cell Function ◽  
Cox Regression ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Β Cell ◽  
Incident Type ◽  
Particle Characteristics ◽  
Ldl Size ◽  
Triglyceride Rich Lipoprotein ◽  
Β Cell Function

Abstract Background Triglyceride-rich lipoproteins particles (TRLP) and low density lipoprotein particles (LDLP) vary in size. Their association with β-cell function is not well described. We determined associations of TRLP and LDLP subfractions with β-cell function, estimated as HOMA-β, and evaluated their associations with incident T2D in the general population. Methods We included 4818 subjects of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study without T2D at baseline. TRLP and LDLP subfraction concentrations and their average sizes were measured using the LP4 algorithm of the Vantera nuclear magnetic resonance platform. HOMA-IR was used as measure of insulin resistance. HOMA-β was used as a proxy of β-cell function. Results In subjects without T2D at baseline, very large TRLP, and LDL size were inversely associated with HOMA-β, whereas large TRLP were positively associated with HOMA-β when taking account of HOMA-IR. During a median follow-up of 7.3 years, 263 participants developed T2D. In multivariable-adjusted Cox regression models, higher concentrations of total, very large, large, and very small TRLP (reflecting remnants lipoproteins) and greater TRL size were associated with an increased T2D risk after adjustment for relevant covariates, including age, sex, BMI, HDL-C, HOMA-β, and HOMA-IR. On the contrary, higher concentrations of large LDLP and greater LDL size were associated with a lower risk of developing T2D. Conclusions Specific TRL and LDL particle characteristics are associated with β-cell function taking account of HOMA-IR. Moreover, TRL and LDL particle characteristics are differently associated with incident T2D, even when taking account of HOMA-β and HOMA-IR.

Eligibility for PCSK9 inhibitors based on the 2019 ESC/EAS and 2018 ACC/AHA guidelines

2020 ◽  
pp. 204748732094010
Author(s):  
Konstantinos C Koskinas ◽  
Baris Gencer ◽  
David Nanchen ◽  
Mattia Branca ◽  
David Carballo ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Aims The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) and 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) lipid guidelines recently updated their recommendations regarding proprotein convertase subtilisin/kexin-9 inhibitors (PCSK9i). We assessed the potential eligibility for PCSK9i according to the new guidelines in patients with acute coronary syndromes. Methods and results We analysed a contemporary, prospective Swiss cohort of patients hospitalised for acute coronary syndromes. We modelled a statin intensification effect and an incremental ezetimibe effect on low-density lipoprotein-cholesterol levels among patients who were not on high-intensity statins or ezetimibe. One year after the index acute coronary syndrome event, treatment eligibility for PCSK9i was defined as low-density lipoprotein-cholesterol of 1.4 mmol/l or greater according to ESC/EAS guidelines. For ACC/AHA guidelines, treatment eligibility was defined as low-density lipoprotein-cholesterol of 1.8 mmol/l or greater in the presence of very high-risk atherosclerotic cardiovascular disease, defined by multiple major atherosclerotic cardiovascular disease events and/or high-risk conditions. Of 2521 patients, 93.2% were treated with statins (53% high-intensity statins) and 7.3% with ezetimibe at 1 year, and 54.9% had very high-risk atherosclerotic cardiovascular disease. Low-density lipoprotein-cholesterol levels less than 1.8 mmol/l and less than 1.4 mmol/l at 1 year were observed in 37.5% and 15.7% of patients, respectively. After modelling the statin intensification and ezetimibe effects, these numbers increased to 76.1% and 49%, respectively. The proportion of patients eligible for PCSK9i was 51% according to ESC/EAS criteria versus 14% according to ACC/AHA criteria. Conclusions In this analysis, the 2019 ESC/EAS guidelines rendered half of all post-acute coronary syndrome patients potentially eligible for PCSK9i treatment, as compared to a three-fold lower eligibility rate based on the 2018 ACC/AHA guidelines.

Small dense low density lipoprotein as a new novel risk factor for acute coronary syndrome

2011 ◽  
Vol 44 (13) ◽  
pp. S61
Author(s):  
Alavi Maryam Sadat ◽  
Emadzadeh Mahdi Reza ◽  
Ghayour Mobarhan Majid ◽  
Soukhtanloo Mohammad ◽  
Parizadeh Mohammad Reza ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Coronary Syndrome ◽  
New Novel

scholarly journals ANTI-HYPERLIPIDEMIC ACTIVITY OF METHANOLIC EXTRACT OF BOESENBERGIA PANDURATA (FINGER ROOT) IN EXPERIMENTAL INDUCED HYPERCHOLESTROLEMIC SPRAGUE DAWLEY RATS

2018 ◽  
Vol 11 (15) ◽  
pp. 8
Author(s):  
Santosh Fattepur ◽  
Kiran Chanabasappa Nilugal ◽  
Ranya Rajendran ◽  
Fadli Asmani ◽  
Eddy Yusuf
Keyword(s):  
Heart Diseases ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Positive Control ◽  
Lipoprotein Cholesterol ◽  
Current Therapy ◽  
Histopathological Study ◽  
Sprague Dawley ◽  
Methanolic Extracts ◽  
Significant Difference

Objective: Hyperlipidemia is one of the risk factors that contribute to the prevalence of coronary heart diseases and antihyperlipidemic agents, such as statin, was used to treat hyperlipidemia as a current therapy. Boesenbergia pandurata has not been exploited for antihyperlipidemic effect. Hence, this study aims to screen for the antihyperlipidemic activity of methanolic extracts of B. pandurata rhizomes (BPR extracts) in hypercholesterolemia-induced Sprague-Dawley rats.Methods: BPR extracts were prepared using the maceration method with 1500 ml of 80% methanol at room temperature for about 7 days. A toxicity study was carried out based on OECD guidelines. Hypercholesterolemia was induced by 6% lard oil, 2% of cheese, and egg yolks. Two different doses of BPR extracts, 200 and 400 mg/kg, were used to screen for antihyperlipidemic effect. Histopathological study was carried out in the liver. The results were evaluated for the statistically significant difference by using the one-way ANOVA followed by post hoc Dunnett test.Results: No mortality was witnessed even till 2 g/kg. Only 400 mg/kg of BPR extracts statistically reduced in total cholesterol (p<0.05), low-density lipoprotein-cholesterol (p<0.05) and an increase in high-density lipoprotein-cholesterol (p<0.05) when compared to the positive control. BPR extracts (400 mg/kg) showed less enlargement of lipid droplets as compared to positive control.Conclusion: BPR extracts can be a promising medicinal plant for treating hyperlipidemia in underdeveloped countries.

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