Hypertriglyceridemic-Waist Phenotype is Strongly Associated With Cardiovascular Risk Factor Clustering In Chinese adolescents

There is limited research on the relationship between the Hypertriglyceridemic-waist (HTW) phenotype and cardiovascular risk factors (CVRFs) in adolescents, and its association with cardiovascular risk factor clustering (CVRFC) is unclear. The aim of this study was to examine the association between HTW phenotype and CVRFs and CVRFC in adolescents. A total of 1478 adolescents aged 12-18 years were classified into normal triglyceride normal waist (NTNW, 66.4%), hypertriglyceridemia (HTG, 5.5%), enlarged waist (EW, 22.2%) and hypertriglyceridemia-waist (HTW, 5.8%) according to whether triglycerides (TG)≥1.47 mmol/L and waist circumference (WC) ≥90th percentile by gender and age. CVRFs in this study included elevated blood pressure(BP), impaired fasting glucose(IFG), high total cholesterol(TC), low high-density lipoprotein cholesterol (HDL-C), and high low-density lipoprotein cholesterol(LDL-C). After adjusting for gender and age, the HTW phenotype had a higher risk of Elevated BP, High TC, Low HDL-C and High LDL-C compared to the NTNW phenotype(the OR and 95% CI were 6.00 (3.79-9.52), 4.58 (2.68-7.83), 4.21 (2.44-7.26) and 6.15 (3.39-11.14), respectively). And the HTW phenotype increased the risk of CVRFC ≥ 2 and CVRFC ≥ 3 compared to the NTNW phenotype, the OR and 95% CI were 6.64 (4.08-10.80) and 11.74 (5.95-23.13), respectively. And similar results were obtained for both sexes when stratified by gender. The area under the ROC curve (AUC) for TG combining WC in the prediction of the CVRFC ≥ 2 and CVRFC ≥ 3 were 0.690 (0.651-0.728) and 0.697 (0.659-0.734) in boys, and the AUC were 0.684 (0.647-0.722) and 0.695 (0.657-0.732) for girls(all P<0.01), which were higher than TG or WC alone. These results revealed that the HTW phenotype is closely associated with cardiovascular risk factors clustering, and TG combining WC performed better than TG or WC alone in detecting cardiovascular risk factor clustering in both genders.

Change to a healthy diet in people over 70 years old: the PREDIMED experience

Purpose It is difficult to change dietary habits and maintain them in the long run, particularly in elderly people. We aimed to assess whether adherence to the Mediterranean diet (MedDiet) and cardiovascular risk factor were similar in the middle-aged and oldest participants in the PREDIMED study. Methods We analyzed participants belonging to the first and fourth quartiles of age (Q1 and Q4, respectively) to compare between-group differences in adherence to the nutritional intervention and cardiovascular risk factor (CRF) control during a 3-year follow-up. All participants underwent yearly clinical, nutritional, and laboratory assessments during the following. Results A total of 2278 patients were included (1091 and 1187 in Q1 and Q4, respectively). At baseline, mean ages were 59.6 ± 2.1 years in Q1 and 74.2 ± 2.6 years in Q4. In Q4, there were more women, greater prevalence of hypertension and diabetes, and lower obesity and smoking rates than the younger cohort (P ≤ 0.001, all). Adherence to the MedDiet was similar in Q1 and Q4 at baseline (mean 8.7 of 14 points for both) and improved significantly (P < 0.01) and to a similar extent (mean 10.2 and 10.0 points, respectively) during follow-up. Systolic blood pressure, low density–lipoprotein cholesterol, and body weight were similarly reduced at 3 years in Q1 and Q4 participants. Conclusion The youngest and oldest participants showed improved dietary habits and CRFs to a similar extent after 3 years’ intervention. Therefore, it is never too late to improve dietary habits and ameliorate CRF in high-risk individuals, even those of advanced age. Registration The trial is registered in the London-based Current Controlled Trials Registry (ISRCTN number 35739639).

Hypertriglyceridaemia: Contemporary management of a neglected cardiovascular risk factor

Hypertriglyceridaemia represents one of the most prevalent lipid abnormalities, however it is often eclipsed by focus on LDL cholesterol and is frequently overlooked by clinicians, despite it being an important cardiovascular risk factor. For most patients, hypertriglyceridaemia arises from a combination of environmental factors and multiple genetic variations with small effects. Even in cases with apparent familial clustering of hypertriglyceridaemia, a monogenetic cause is rarely identified. Common secondary causes include obesity, uncontrolled diabetes, alcohol, and various commonly used drugs. Correction of these factors, along with lifestyle optimisation, should be prioritised prior to commencing medication.The goal of drug treatment is to reduce the risk of cardiovascular disease in those with moderate hypertriglyceridaemia and the risk of pancreatitis in those with severe hypertriglyceridaemia.Recent and ongoing trials demonstrate the important role of triglycerides (TG) in determining residual risk in patients with cardiovascular disease (CVD) already established on statin therapy. Novel and emerging data on omega-3 fatty acids (high-dose icosapent ethyl) and the selective PPAR modulator pemafibrate are eagerly awaited and may provide further clarity for clinicians in determining which patients will benefit from TG lowering and help inform clinical guidelines. There are numerous novel therapies on the horizon that reduce TG by decreasing the activity of proteins that inhibit lipoprotein lipase such as apolipoprotein C-III (including Volanesorsen which was recently approved in Germany) and ANGPTL 3/4 which may offer promise for the future.