Postprandial Hypertriglyceridaemia Revisited in the Era of Non-Fasting Lipid Profile Testing: A 2019 Expert Panel Statement, Main Text

2019 ◽  
Vol 17 (5) ◽  
pp. 498-514 ◽  
Author(s):  
Genovefa D. Kolovou ◽  
Gerald F. Watts ◽  
Dimitri P. Mikhailidis ◽  
Pablo Pérez-Martínez ◽  
Samia Mora ◽  
...  

: Residual vascular risk exists despite the aggressive lowering of Low-Density Lipoprotein Cholesterol (LDL-C). A contributor to this residual risk may be elevated fasting, or non-fasting, levels of Triglyceride (TG)-rich lipoproteins. Therefore, there is a need to establish whethe a standardised Oral Fat Tolerance Test (OFTT) can improve atherosclerotic Cardiovascular (CV) Disease (ASCVD) risk prediction in addition to a fasting or non-fasting lipid profile. : An expert panel considered the role of postprandial hypertriglyceridaemia (as represented by an OFTT) in predicting ASCVD. The panel updated its 2011 statement by considering new studies and various patient categories. The recommendations are based on expert opinion since no strict endpoint trials have been performed. : Individuals with fasting TG concentration <1 mmol/L (89 mg/dL) commonly do not have an abnormal response to an OFTT. In contrast, those with fasting TG concentration ≥2 mmol/L (175 mg/dL) or nonfasting ≥2.3 mmol/L (200 mg/dL) will usually have an abnormal response. We recommend considering postprandial hypertriglyceridaemia testing when fasting TG concentrations and non-fasting TG concentrations are 1-2 mmol/L (89-175 mg/dL) and 1.3-2.3 mmol/L (115-200 mg/dL), respectively as an additional investigation for metabolic risk prediction along with other risk factors (obesity, current tobacco abuse, metabolic syndrome, hypertension, and diabetes mellitus). The panel proposes that an abnormal TG response to an OFTT (consisting of 75 g fat, 25 g carbohydrate and 10 g proteins) is >2.5 mmol/L (220 mg/dL). : Postprandial hypertriglyceridaemia is an emerging factor that may contribute to residual CV risk. This possibility requires further research. A standardised OFTT will allow comparisons between investigational studies. We acknowledge that the OFTT will be mainly used for research to further clarify the role of TG in relation to CV risk. For routine practice, there is a considerable support for the use of a single non-fasting sample.

Author(s):  
Gabriel Olukayode Ajayi ◽  
Elvis Uchechukwu Obi ◽  
Elizabeth Namesegua Elegbeleye ◽  
Precious Titilayo Obayemi ◽  
Oyindamola Mary Edamisan

Diabetes mellitus is a non-communicable disease which has been associated with liver and kidney injuries, and at the same time affects lipid profiles. The aim of this study was to investigate the role of Vernonia amygdalina (VAM) on plasma lipid profile, liver and kidney enzymes in rats with streptozotocin -induced diabetes. Twenty-five male albino wistar rats weighing between 137 and 223 g were randomly grouped into five of five rats per group as follows: control, diabetic, diabetic + metformin (MET), diabetic + VAM at 150, 300 mg/kg. Diabetes was induced by administration of 45 mg/kg body weight streptozotocin (STZ) dissolved in citrate buffer (0.01 M, pH 4.5) by single intraperitoneal injection. Three days after, when diabetes was confirmed, MET and VAM were administered daily by oral gavage for 7 days. Animals were fasted overnight after the last administration of MET and VAM, sacrificed, blood was collected and plasma prepared for lipid profile estimation. Liver and kidney were collected, weighed, homogenized and supernatants obtained for enzymes and biochemical assays. There were no significant (p>0.05) change in the weights of animal, liver and kidney, liver/rat and kidney/rat ratios, plasma cholesterol (CHOL) concentration, activities of liver and kidney aspartate aminotransferase (AST), alanine aminotransferase (ALT), liver gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), and liver and kidney total protein (TPRO) concentrations; significant (p<0.05) decrease in triglyceride (TRIG), high density lipoprotein-cholesterol (HDL), low density lipoprotein-cholesterol (LDL), very low density lipoprotein-cholesterol (VLDL); and significant (p<0.05) increase in fasting blood glucose (FBG) level, kidney GGT, LDH activities, liver and kidney creatinine (CREA) and total bilirubin (TBIL) concentrations of diabetic (STZ) rats compared with normal control. The treatment of the diabetic rats with MET and VAM significantly modulated positively these parameters compared with the diabetic rats. This study further explains the protective role played by VAM in dyslipidaemia, liver and kidney injuries resulting from diabetes.


Author(s):  
Sheena Chopra ◽  
Sangeeta Pahwa

Background: Preeclampsia is associated with adverse pregnancy outcome and is a major cause of the fetomaternal morbidity and mortality. This study aimed at finding the role of lipid profile and uterine artery Doppler as a reliable predictor of risk of preeclampsia in early second trimester.Methods: This study is conducted in the obstetrics and gynecology department of a tertiary care teaching hospital, Amritsar. Lipid profile and Uterine artery doppler is estimated in 100 antenatal women from 14-20 weeks of period of gestation who met the inclusion criteria and are followed up till delivery or till preeclampsia sets in.Results: Out of 100 subjects 74 remained normotensive (Group A) and 26 developed preeclampsia (Group B). The mean serum level of total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL) and very low-density lipoprotein cholesterol (VLDL) was significantly higher in Group B as compared to group A women. The Preeclamptic women showed significant fall in high density lipoprotein cholesterol (HDL) level as compared to normal pregnant women. The mean S/D ratio, PI and RI values of uterine artery Doppler were higher for group B and were statistically significant.Conclusions: The combined predictive value of lipid profile and uterine artery Doppler for estimating risk of preeclampsia was more reliable than of any of the test individually.


Author(s):  
Д.П. Покусаева ◽  
И.А. Аниховская ◽  
Л.А. Коробкова ◽  
М.Ю. Яковлев

В последние годы большое внимание уделяется роли микробиоты в атерогенезе с позиций воспалительной теории. На основании экспериментальных и клинических данных была сформулирована эндотоксиновая теория атеросклероза. Подтверждением важной роли кишечного липополисахарида в атерогенезе является возрастная динамика показателей системной эндотоксинеми и липидного профиля. Цель исследования - выявление взаимосвязи между показателями системной эндотоксинемии и факторами риска атеросклероза, в аспекте возрастных и гендерных различий. Методика. Обследовано 113 пациентов среднего возраста. Все пациенты прошли оценку факторов риска развития атеросклероза по шкале SCORE. Пациенты были отнесены к средней группе риска (до 5%), оценивали себя как «здоровые», жалоб на момент обследования не предъявляли. Индекс массы тела был до 30 кг/м2. Определялись показатели липидного профиля (анализатор «StatFax 3300», США, реактивы «Analyticon», Германия): уровень общего холестерина, липопротеинов высокой плотности и уровень триглицеридов, рассчитывался индекс атерогенности и концентрация липопротеинов низкой плотности. Определялись параметры системной эндотоксинемии: концентрации липополисахарида (микро-ЛАЛ-тест), уровень антител к гидрофобной и гидрофильной частям молекулы ЛПС методом «СОИС-ИФА». Результаты. Выявлена прямая значимая корреляция концентрации общего холестерина, липопротеинов низкой плотности и липопротеинов высокой плотности в зависимости от возраста. При построении регрессионной модели зависимости показателей системной эндотоксинемии от пола и возраста пациентов не выявлено. При визуальной оценке графиков обращает внимание наличие у женщин тенденции к возрастному повышению уровня липополисахарида и снижению концентрации антител к гидрофильной части молекулы липополисахарида. Обнаружены гендерные различия показателей липидного профиля и уровня липополисахарида. Заключение. Статистически значимая возрастная динамика показателей липидного профиля при тенденции к нарастанию уровня липополисахарида, а также снижение концентрации антител к гидрофильной части молекула липополисахарида, имеющее определённые гендерные различия, свидетельствует о целесообразности продолжения исследований с увеличением числа обследованных в расширенном возрастном диапазоне. Atherosclerosis is a polyetiologic disease. In recent years, much attention has been paid to the role of the microbiota in atherogenesis from the perspective of inflammatory theory. Based on experimental and clinical data, the endotoxin theory of atherosclerosis was formulated. Confirmation of the important role of intestinal lipopolysaccharide in atherogenesis is the age dynamics of systemic endotoxemia parametrs and lipid profile. The goal of our study was to identify the relationship between the indicators of systemic endotoxemia and the generally accepted risk factors for atherosclerosis, especially the age dynamics and the influence of gender. Methods. We examined 113 patients middle age. All patients were assessed for risk factors for atherosclerosis according to the SCORE scale. Patients were assigned to the average risk group (up to 5%), rated themselves as “healthy”, did not present any complaints at the time of the survey. The body mass index was up to 30 kg/m2. Indicators of the lipid profile were determined («StatFax» 3300 analyzer, USA, «Analyticon» reagents, Germany): the level of total cholesterol, high-density lipoprotein and triglyceride levels, the atherogenic index and the concentration of low-density lipoprotein were calculated. The parameters of systemic endotoxemia were determined: the concentration of lipopolysaccharide using a micro-LAL test, the level of antibodies to the hydrophobic and hydrophilic parts of the lipopolysaccharide molecule using the “SOIS-ELISA” method. Results. A direct significant correlation was found between the concentration of total cholesterol, low-density lipoprotein and high-density lipoprotein, depending on age. When constructing a regression model of the age dynamics, the concentrations of lipopolysaccharides, antibodies to the hydrophobic and hydrophilic parts of the lipopolysaccharide molecule were not detected (p> 0.05). When adjusted for gender, the age dynamics of systemic endotoxemia was also not observed. When visually assessing the graphs, attention is drawn to the fact that women have an age-related tendency to increase the level of lipopolysaccharide and a decrease in the concentration of antibodies to the hydrophilic part of the lipopolysaccharide molecule. In addition, gender differences in lipid profile and lipopolysaccharide levels were found. Conclusion. The significant age-related dynamics of the lipid profile in the presence of a tendency to an increase in the level of lipopolysaccharide and a decrease in the concentration of antibodies to the hydrophilic part of the lipopolysaccharide molecule, which has certain gender differences, revealed the necessity and feasibility of continuing research with an increase in the number of subjects and in the extended age range.


2018 ◽  
Vol 7 (5) ◽  
pp. 637-644 ◽  
Author(s):  
Lang Qin ◽  
Xiaoming Zhu ◽  
Xiaoxia Liu ◽  
Meifang Zeng ◽  
Ran Tao ◽  
...  

Introduction The purpose of the study was to describe lipid profile and explore pathogenetic role of LDL-c on hypertension in patients with Cushing’s disease (CD). Hypertension is a common feature in patients with CD. Previous study found low-density lipoprotein cholesterol (LDL-c) uptake in vascular cells might be involved in vascular remodeling in patients with CD. Therefore, we evaluated the relationship between lipid profile and the blood pressure in patients with CD. Methods This retrospective study included 84 patients referred to Huashan Hospital for the evaluation and diagnosis of CD from January 2012 to December 2013. All subjects had detailed clinical evaluation by the same group of endocrinology specialists to avoid subjective influences. Results We found that high LDL-c patients had significant higher body mass index (BMI), systolic blood pressure (SBP), cholesterol (CHO), triglyceride (TG), and apolipoproteinB (apoB) (P < 0.05). An association was detected between SBP values and lipids profile including CHO, TG, LDL-c, apolipoproteinA (apoA), apoB and lipoprotein(a) (LP(a)). After adjustment for all covariates, the LDL-c remained positively associated with SBP. In patients with or without taking statins, patients with LDL-c ≥3.37 mmol/L had higher SBP than patients with LDL-c <3.37 mmol/L. Then, LDL-c was coded using restricted cubic splines (RCS) function with three knots located at the 5th, 50th and 95th percentiles of the distribution of LDL-c. Compared to individuals with 3.215 mmol/L of LDL-c, individuals with 4.0, 4.5 and 5.0 mmol/L of LDL-c had differences of 3.86, 8.53 and 14.11 mmHg in SBP, respectively. Conclusions An independent association between LDL-c and SBP was found in patients with CD. We speculate that LDL-c may be a pathogenic factor for hypertension in those patients.


2019 ◽  
Vol 6 (4) ◽  
pp. 1303
Author(s):  
Mahendrapal Singh ◽  
Mohd. Imran Khan ◽  
A. C. Gupta ◽  
Richa Giri ◽  
Ashfak Alam

Background: Cirrhosis is defined anatomically as a diffuse process with fibrosis and nodule formation. It is the result of the fibrogenesis that occurs with chronic liver injury. For reduced liver biosynthesis capacity, low level of serum cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) is usually observed in the chronic liver disease. Due to the high prevalence of chronic liver disease in our country we have conducted this study to determine role of lipid profile in a patient with cirrhosis and to assess its relationship to the severity of cirrhosis.Methods: In this cross-sectional study, patients classified in 3 groups as per CTP classification for severity of cirrhosis. Serum lipid profile was observed in these patients. The primary aim was to assess changes in various parameters of lipid profile and its relationship with severity of liver cirrhosis.Results: About 74 cirrhotic patients were enrolled, 20 in class A, 25 in class B and 29 in class C. serum lipid profile was observed in these patients. Serum cholesterol and HDL cholesterol were decreased with increasing severity of cirrhosis. Serum triglyceride level increases with progression of cirrhosis and very low density lipoprotein (VLDL) level has no correlation with severity of cirrhosis.Conclusions: Serum cholesterol and HDL level decreases with progression of cirrhosis. In future serum lipid profile can be used in classification criteria for assessing severity of liver cirrhosis.


1997 ◽  
Vol 77 (04) ◽  
pp. 710-717 ◽  
Author(s):  
Marieke E van der Kaaden ◽  
Dingeman C Rijken ◽  
J Kar Kruijt ◽  
Theo J C van Berkel ◽  
Johan Kuiper

SummaryUrokinase-type plasminogen activator (u-PA) is used as a thrombolytic agent in the treatment of acute myocardial infarction. In vitro, recombinant single-chain u-PA (rscu-PA) expressed in E.coli is recognized by the Low-Density Lipoprotein Receptor-related Protein (LRP) on rat parenchymal liver cells. In this study we investigated the role of LRP in the liver uptake and plasma clearance of rscu-PA in rats. A preinjection of the LRP inhibitor GST-RAP reduced the maximal liver uptake of 125I-rscu-PA at 5 min after injection from 50 to 30% of the injected dose and decreased the clearance of rscu-PA from 2.37 ml/min to 1.58 ml/min. Parenchymal, Kupffer and endothelial cells were responsible for 40, 50 and 10% of the liver uptake, respectively. The reduction in liver uptake of rscu-PA by the preinjection of GST-RAP was caused by a 91 % and 62% reduction in the uptake by parenchymal and Kupffer cells, respectively. In order to investigate the part of rscu-PA that accounted for the interaction with LRP, experiments were performed with a mutant of rscu-PA lacking residues 11-135 (= deltal25- rscu-PA). Deletion of residues 11-135 resulted in a 80% reduction in liver uptake and a 2.4 times slower clearance (0.97 ml/min). The parenchymal, Kupffer and endothelial cells were responsible for respectively 60, 33 and 7% of the liver uptake of 125I-deltal25-rscu-PA. Preinjection of GST-RAP completely reduced the liver uptake of delta 125-rscu-PA and reduced its clearance to 0.79 ml/min. Treatment of isolated Kupffer cells with PI-PLC reduced the binding of rscu-PA by 40%, suggesting the involvement of the urokinase-type Plasminogen Activator Receptor (u-PAR) in the recognition of rscu-PA. Our results demonstrate that in vivo LRP is responsible for more than 90% of the parenchymal liver cell mediated uptake of rscu-PA and for 60% of the Kupffer cell interaction. It is also suggested that u-PAR is involved in the Kupffer cell recognition of rscu-PA.


Dyslipidemia and oxidative modifications of lipid are frequently associated in patients with chronic kidney diseases (CKD) and considered the most important risk factors for cardiovascular events. Melatonin is a well-known potent antioxidant and has beneficial effect on lipid metabolism. the study was designed to evaluate if Melatonin could improve lipid profile and ameliorates lipid peroxidation. This single blind placebo controlled clinical study carried out on 41 patients with CKD who were randomized into two groups, control groups (n=20) those who received placebo cap and melatonin group those who received 5mg melatonin (n=21). Lipid profile [total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C)] and parameters of lipid peroxidation [oxidized LDL (oxLDL) and malondialdehyde (MDA) were measured before and after 12 weeks of the treatment. After 12 weeks of treatment, melatonin significantly increased HDL-C and decreased LDL-C compared to the initial value. The elevation in HDL-C and reduction in LDL-C were significantly different from that in placebo group. Also, both oxLDL and MDA levels significantly lowered by melatonin compared to the baseline and to the placebo group. Collectively, the results of our study showed that melatonin has advantageous effect on lipid profile and inhibit lipid peroxidation in patients with CKD.


Author(s):  
Eman A. Al-Rekabi ◽  
Dheyaa K. Alomer ◽  
Rana Talib Al-Muswie ◽  
Khalid G. Al-Fartosi

The present study aimed to investigate the effect of turmeric and ginger on lipid profile of male rats exposed to oxidative stress induced by hydrogen peroxide H2O2 at a concentration of 1% given with consumed drinking water to male rats. Methods: 200 mg/kg from turmeric and ginger were used, and the animals were treatment for 30 days. Results: the results showed a significant increase in cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), whereas it explained a significant decrease in high density lipoprotein (HDL) of male rats exposed to oxidative stress when compared with control group. the results showed a significant decrease in cholesterol, triglycerides, (LDL), (VLDL), whereas it explained a significant increase in (HDL) of rats treated with turmeric and ginger at dose 200 mg/kg when compared with male rats exposed to oxidative stress.


2020 ◽  
Vol 27 (7) ◽  
pp. 1041-1051 ◽  
Author(s):  
Michael Spartalis ◽  
Eleftherios Spartalis ◽  
Antonios Athanasiou ◽  
Stavroula A. Paschou ◽  
Christos Kontogiannis ◽  
...  

Atherosclerotic disease is still one of the leading causes of mortality. Atherosclerosis is a complex progressive and systematic artery disease that involves the intima of the large and middle artery vessels. The inflammation has a key role in the pathophysiological process of the disease and the infiltration of the intima from monocytes, macrophages and T-lymphocytes combined with endothelial dysfunction and accumulated oxidized low-density lipoprotein (LDL) are the main findings of atherogenesis. The development of atherosclerosis involves multiple genetic and environmental factors. Although a large number of genes, genetic polymorphisms, and susceptible loci have been identified in chromosomal regions associated with atherosclerosis, it is the epigenetic process that regulates the chromosomal organization and genetic expression that plays a critical role in the pathogenesis of atherosclerosis. Despite the positive progress made in understanding the pathogenesis of atherosclerosis, the knowledge about the disease remains scarce.


2019 ◽  
Vol 17 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Thomas F. Whayne

The non-traditional cardiovascular (CV) risk factors that appear to be of most clinical interest include: apolipoprotein A (ApoA), apolipoprotein B (ApoB), high-sensitivity C-Reactive protein (hsCRP), homocysteine, interleukin 1 (IL1), lipoprotein (a) [Lp(a)], the density of low-density lipoprotein (LDL) particles, the LDL particle number, tissue/tumor necrosis factor-α (TNF-α) and uric acid. These non-traditional risk factors may be of value in adding further confirmation and attention to suspected significant CV risk. They can also provide a better understanding of current concepts of atherogenesis (e.g. various potential mechanisms associated with inflammation) as an etiology and in guiding current plus future therapies. In the mid-20th century, atherosclerosis and CV disease were considered mechanistic occurrences with essentially no attention to possible metabolic and molecular etiologies. Therefore, the only treatments then centered around mainly surgical procedures to try to improve blood flow, first with peripheral arterial disease (PAD) and later coronary artery disease (CAD). Now, failure to treat CV risk factors, especially where there is good evidence-based medicine, as in the case of statins for high CV risk patients, is considered medical negligence. Nevertheless, many problems remain to be solved regarding atherosclerosis prevention and treatment.


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