Possibilities of combined hypolipidemic therapy in different categories of high and very high cardiovascular risk patients (a pilot study)

Aim of the study was to evaluate the efficacy and safety of the combined use of statins with ezetimibe in patients of various nosological groups of high and very high cardiovascular risk. Material and methods. A prospective interventional non-randomized study included 40 people, mean age 60.7±9.5 years, high and very high cardiovascular risk, who did not receive statin therapy or took statins without reaching the target low density lipoprotein (LDL) cholesterol values. Patients were recommended to receive high-intensity statin therapy in combination with ezetimibe for 3 months. Biochemical parameters were determined by standard enzymatic methods and the beginning of combined lipid-correcting therapy and after 3 months. Results. In patients with high cardiovascular risk, the level of total cholesterol decreased by 39.7 % 3 months after treatment (6.8 ± 2.5 and 4.7 ± 2.5 mmol/L; p = 0.0001), the level of LDL cholesterol by 52.2 % (4.6 ± 2.4 and 2.8 ± 2.2 mmol/L; p = 0.0001), the TG level by 26 % (2.7 ± 1.1 and 2.0 ± 1.0 mmol/L; p = 0.008). In the group of patients with very high cardiovascular risk, we also noted a decrease in the total cholesterol level by 39.1 % (6.4 ± 1.4 and 4.4 ± 1.2 mmol/L; p = 0.0001), the level of LDL cholesterol by 45.5 % (4.4 ± 1.4 and 2.5 ± 0.9 mmol/L; p = 0.0001). We did not find statistically significant changes in the remaining lipid parameters. LDL cholesterol targets were achieved in 64 % of patients with high and 52 % of very high cardiovascular risk. There were no significant changes in activity of alanine and aspartate amino transferases, content creatine phosphokinase, glucose and glycated hemoglobin, glomerular filtration rate. Conclusions. Initial combination therapy with statin and ezetimibe is well tolerated and can reduce LDL cholesterol levels by 2 times within 3 months in various categories of patients with high and very high cardiovascular risk.

Low serum cholesterol level as a risk factor for out-of-hospital cardiac arrest: a case-control study

Objective We aimed to identify the association between low serum total cholesterol levels and the risk of out-of-hospital cardiac arrest (OHCA).Methods This case-control study was performed using datasets from the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES) project and the Korea National Health and Nutrition Examination Survey (KNHANES). Cases were defined as emergency medical service-treated adult patients who experienced OHCA with a presumed cardiac etiology from the CAPTURES project dataset. Four controls from the KNHANES dataset were matched to each case based on age, sex, and county. Multivariable conditional logistic regression analysis was conducted to evaluate the effect of total cholesterol levels on OHCA.Results A total of 607 matched case-control pairs were analyzed. We classified total cholesterol levels into six categories (<148, 148-166.9, 167-189.9, 190-215.9, 216.237.9, and ≥238 mg/dL) according to the distribution of total cholesterol levels in the KNHANES dataset. Subjects with a total cholesterol level of 167-189.9 mg/dL (25th.49th percentile of the KNHANES dataset) were used as the reference group. In both the adjusted models and sensitivity analysis, a total cholesterol level of <148 mg/dL was significantly associated with OHCA (adjusted odds ratio [95% confidence interval], 6.53 [4.47.9.56]).Conclusion We identified an association between very-low total cholesterol levels and an increased risk of OHCA in a large, community-based population. Future prospective studies are needed to better understand how a low lipid profile is associated with OHCA.

Assessing Cardiometabolic Health Risk in Children Living With Grandparent Primary Caregivers: Interim Analysis

Minimal research has been conducted on the effect that grandparents as primary caregivers have on the cardiometabolic health of children who live with them, even though a number of studies have examined the influence of parent caregivers. As a first step towards filling that gap, we examined physiological and behavioral indicators of cardiometabolic health risk among children (aged 7 to 12 years) living with grandparent primary caregivers in Oregon and Washington. We measured body mass index and total cholesterol/glycohemoglobin (HbA1c), as well as physical activity/sleep and diet. In this preliminary analysis of our findings with 10 dyads (mean age 64.2 ± 4.0 years for grandparents; 9.3 ± 1.9 years for grandchildren), we report that on most of the indicators - obesity, physical activity, sleep, and diet - these children’s levels were comparable to national averages across all household types (not differentiated by type of family structure). However, 25% of the grandchildren (n=2) participating in our study had a total cholesterol level ≥ 200, compared to 7.4% of children from a nationally representative dataset. Similarly, 14% of the grandchildren (n=1) participating in our study had HbA1c ≥ 6.5%, compared to &lt; 0.5% of children from a nationally representative dataset. Our findings suggest that these children may be at higher cardiometabolic health risk (e.g., hyperlipidemia). Further investigations with a larger sample and more examination of cardiometabolic risk profiles including lipids/blood glucose assessment are required to validate our preliminary findings.

Association of Low Serum Cholesterol With Hemorrhagic Stroke

Background: Stroke is the second cause of death and third cause of disability in worldwide so control of risk factor is the best option for prevention of stroke and stroke related disability. Objectives: The study is to know the relation of low serum cholesterol with hemorrhagic stroke. Materials and Methods: This Study is a case control study carried out at Neurology and Medicine ward Mymensingh Medical college hospital (MMCH) from july2017 to December 2018 to see the association of low serum cholesterol with hemorrhagic stroke. A total number of 120 subjects more than 18 years were considered for the study. Among them 60 were study group and 60 were control group. The study population has been selected following some exclusion and inclusion criteria. Results: Result showed that hemorrhagic stroke was more in male than female, common after the age of 60 years. Lower middle classes are more sufferers. Hypertension was 76.7% of study group and serum cholesterol was significantly lower in study group than the control group. Conclusion: This study found that the serum total cholesterol level of study group is less than that of the healthy control group and the difference is statistically highly significant (p< 0.001). So it can be concluded that low serum cholesterol is associated with hemorrhagic stroke. KYAMC Journal. 2021;12(3): 147-152

Impact of the Main Cardiovascular Risk Factors on Plasma Extracellular Vesicles and Their Influence on the Heart’s Vulnerability to Ischemia-Reperfusion Injury

The majority of cardiovascular deaths are associated with acute coronary syndrome, especially ST-elevation myocardial infarction. Therapeutic reperfusion alone can contribute up to 40 percent of total infarct size following coronary artery occlusion, which is called ischemia-reperfusion injury (IRI). Its size depends on many factors, including the main risk factors of cardiovascular mortality, such as age, sex, systolic blood pressure, smoking, and total cholesterol level as well as obesity, diabetes, and physical effort. Extracellular vesicles (EVs) are membrane-coated particles released by every type of cell, which can carry content that affects the functioning of other tissues. Their role is essential in the communication between healthy and dysfunctional cells. In this article, data on the variability of the content of EVs in patients with the most prevalent cardiovascular risk factors is presented, and their influence on IRI is discussed.

Prevalence of Risk Factors for Stroke Patients at UKI General Hospital in 2015

Stroke is a disease caused by disturbance of brain blood circulation influenced by many risk factors such as age, blood pressure, blood sugar, and blood lipid level. This study aimed to determine the prevalence of risk factors that contribute to stroke incidence in stroke patients hospitalized at UKI General Hospital in 2015. The design of this study is retrospective with research methodology descriptive observational. The sample in this study is all cases of a stroke at UKI General Hospital in 2015. The result showed that the highest type of stroke is ischemic stroke (77%) with the largest age group of 40-60 years (51.3%), male sex (60 people). Prevalence risk factors are hypertension stage 2 (52,2%), blood glucose level <200 mg/dl (81,4%) low total cholesterol level (47,8%), LDL level borderline high (23%), low HDL level (44,2%). Keywords: stroke, risk factor, the prevalence

Az alacsony szérumkoleszterin-szint mint lehetséges öngyilkossági rizikótényező

Összefoglaló. Bevezetés: A koleszterinszint a köztudatban elsősorban mint cardiovascularis rizikófaktor van jelen. Nem mellékes azonban, hogy akár a magas, akár az alacsony koleszterinszint direkt összefüggésbe hozható számos pszichiátriai kórképpel. Célkitűzés: A jelen tanulmány célja felhívni a figyelmet a holisztikus nézőpont kialakítására, hisz a hypercholesterinaemia korai cardiovascularis elhalálozáshoz vezethet, viszont alacsony koleszterinszint esetén megnövekedhet a hangulatzavarra és főleg az öngyilkosságra való hajlam. Módszer: Kutatásunkban 200 olyan pszichiátriai beteg összkoleszterinszintjét vizsgáltuk meg, akik öngyilkossági gondolatokkal küszködtek. Az öngyilkossági veszélyt a Modified Scale for Suicide Ideation (Miller és mtsai) segítségével mértük. Eredmények: Az elért pontszámok alapján 3 kategóriába soroltuk a betegeket: 52 minimális suicid késztetésű, 49 középsúlyos és 99 súlyos rizikójú beteg. A legsúlyosabb kategóriába tartozó betegek nagy többségének (83 páciens, 84%) összkoleszterinje 4,5 mmol/l alatti volt. A másik két kategóriában ezen arány jelentősen kisebbnek bizonyult: a minimális suicid késztetésű kategóriában ez az érték csak 3 betegre (6%) volt vonatkoztatható, és a középsúlyosak esetén is csak 13 betegre (29%). Megbeszélés: Ezen tanulmányunk hátrányát képezheti a relatíve kis betegszám és a longitudinális utánkövetés megvalósításának hiánya. Következtetés: Jelen eredményeink alapján jogosan vetődhet fel a koleszterinszint mérésének rutinszerű bevezetése mint hatásos, szűrésre alkalmas öngyilkossági rizikófaktor biomarker. Orv Hetil. 2021; 162(43): 1732–1739. Summary. Introduction: High cholesterol levels are widely recognized as cardiovascular risk factors. However, lower or higher cholesterol levels can be in a solid relationship with several mental disorders, too. Objective: Our study aims to raise awareness about the fact that hypocholesterolemia is involved in various mood disorders and even suicidal behavior looks to be much more frequent. Method: Our current study implicates 200 psychiatric patients. These subjects had suicidal ideation upon hospital referral. In the first 24 hours, their total cholesterol levels were measured and the severity of self-harm intentions was evaluated with the Modified Scale for Suicide Ideation by Miller et al. Results: By the obtained evaluation score we differentiated 3 groups: 52 patients with low suicide risk, 49 with moderate risk and 99 with high suicide risk. In this last group, 83 patients had their serum total cholesterol level under 4,5 mmol/L (84%). By comparison, in the low-risk category only 3 patients (6%) and in the moderate-risk 13 patients (29%) were with such levels. Discussion: Clear conclusion cannot be drawn due to the reduced number of our patients, due to the absence of long-term consequent monitorization, and due to the heterogeneity of the studied population. Conclusion: Considering these data, a possible usefulness of total cholesterol levels in psychiatric patients may be suggested as a screening tool for the severity of suicidal ideation. Orv Hetil. 2021; 162(43): 1732–1739.

Risk Factors Associated With Diabetic Retinopathy: A Cross-Sectional Study Within Palestinian Patients in Northern West Bank

Risk factors associated with diabetes mellitus (DM) have been widely researched worldwide, but the determinants of these factors among diabetic retinopathy (DR) in Palestine are currently unclear. We aimed to assess the prevalence of DR among DM in Northern West Bank and identify factors associated with DR natural history. Patients with Type 2 diabetes (T2D) (n = 300, age &gt; 18 years) from a main diabetic center covering all northern provinces of Palestine were enrolled to this cross-sectional research. Demographic information including age, sex, and duration of T2D was obtained. Moreover, HbA1C, BMI, hypertension (HTN), controlled T2D, current smoking, and total cholesterol level were assessed. Potential correlations between these factors and DR diagnosed by ophthalmologist were evaluated using different tests on SPSS version 22. Prevalence of DR among our population was 30%; 47.8% of these patients showed mild non-proliferative DR (NPDR), 23.3% moderate NPDR, 16.7% severe NPDR, and 12.2% proliferative DR (PDR). Univariate logistic regression analysis showed age (p = 0.007), HTN (p = 0.022), uncontrolled T2D (p = 0.025), and duration of T2D (&lt;0.001) were mostly associated with DR while multivariate logistic regression showed duration of T2D as the major and solely risk factor for prevalence of DR (p &lt; 0.0001) and were positively correlated with severities of NPDR and being a strong predictor in the PDR (p = 0.001). We identified several important risk factors that affect DR, which could assist to develop effective strategies for metabolic disease prevention among populations in Palestine. Furthermore, our data suggest a necessity to control sugar serum levels and HTN.

Association of low total cholesterol level with clinical outcomes in patients with atrial fibrillation: the Fushimi AF registry

Background Hyperlipidemia is a well-established risk factor for cardiovascular disease. However, low cholesterol is also reported to be associated with poor outcome in patients with chronic disease, which is called “cholesterol paradox”, and the association of cholesterol level with the incidence of clinical outcomes in patients with atrial fibrillation (AF) remains unclear. Methods In the Fushimi AF Registry, a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan, follow-up data and baseline total cholesterol levels were available in 3,054 patients. We excluded 767 patients who were taking statins, and 2,267 patients were included in the analyses. We defined low cholesterol as total cholesterol &lt;150 mg/dl, and examined the incidence of all-cause death, stroke/systemic embolism (SE), heart failure (HF) hospitalization, and major bleeding. Results Patients with low cholesterol (N=464 (20.4%)) were older, more often male, and had higher prevalence of low body weight (&lt;50 kg), permanent/persistent AF, prior stroke/SE, HF, chronic kidney disease, and anemia (hemoglobin &lt;11 g/dl). CHA2DS2-VASc score was higher in patients with low cholesterol (low cholesterol vs others; 3.6±1.6 vs 3.2±1.7: P&lt;0.001). Prescription of oral anti-coagulants was comparable between the groups (50.0% vs 54.5%: P=0.09). During the median follow-up of 1,805 days, the incidence of all-cause death, stroke/SE, HF hospitalization, and major bleeding was significantly higher in patients with low cholesterol (all-cause death, 10.9 vs 3.8 /100 person-years; stroke/SE, 3.4 vs 1.9 /100 person-years; HF hospitalization, 4.7 vs 2.5 /100 person-years; major bleeding, 2.7 vs 1.4 /100 person-years) (Figure 1). After adjustment for the components of CHA2DS2-VASc score, low body weight, permanent/persistent AF, chronic kidney disease, anemia, and prescription of oral anti-coagulants, low cholesterol was significantly associated with the incidence of all-cause death and stroke/SE, but not with that of HF hospitalization or major bleeding (Figure 2, model 3). Total cholesterol levels were still significantly and inversely associated with the incidence of all-cause death (hazard ratio, 0.94; 95% confidence interval, 0.92–0.96 for 10 mg/dl increase) and stroke/SE (hazard ratio, 0.96; 95% confidence interval, 0.92–0.999 for 10 mg/dl increase), when analyzed as continuous variables. Subgroup analysis revealed that the risk of low cholesterol for all-cause death was more pronounced in female (interaction P, 0.049), patient without prior stroke/SE (interaction P, 0.01), those without HF (interaction P, 0.01), and those without vascular disease (interaction P, 0.001). The risk for stroke/SE was more pronounced in patients without vascular disease (interaction P, 0.01). Conclusion Low total cholesterol level was significantly associated with the incidence of all-cause and stroke/SE in AF patients not taking statins, suggesting the existence of cholesterol paradox in AF. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boehringer Ingelheim, Bayer Healthcare, Pfizer, Bristol-Myers Squibb, Astellas Pharma, AstraZeneca, Daiichi-Sankyo, Novartis Pharma, MSD, Sanofi-Avent

Blood Lead Levels and Cardiovascular Disease Risk: Results from the Korean National Health and Nutrition Examination Survey

(1) Objective: Lead, a heavy metal that exists commonly in air, soil and crops may cause chronic disease in the cardiovascular system. The purpose of this study is to investigate how blood lead levels affect cardiovascular disease in adults. (2) Study Design and Participants: It is a cross-sectional, descriptive study using data from the Korean National Health and Nutrition Examination Survey (KNHANES). Data from a total of 1929 participants, derived from the KNHANES, conducted by the Korea Centers for Disease Control and Prevention, in 2017, were analyzed using SPSS version 25.0. (3) Measurement: The cardiovascular disease risk was calculated using the Framingham risk score. There was a strong positive correlation between blood lead levels and the Framingham risk score. Furthermore, of the FRS sub-criteria, systolic blood pressure, HDL cholesterol level and total cholesterol level all also showed a significant correlation. (4) Results: We analyzed the correlation between PbB levels and the FRS sub-criteria, including systolic blood pressure, HDL cholesterol level, total cholesterol level and the FRS total. We found a significant positive correlation between PbB levels and systolic blood pressure, FRS total and total cholesterol level (p < 0.05), as well as a significant negative correlation with HDL cholesterol level (p < 0.05). (5) Conclusion: Based on the perception that there is no lower toxicological threshold for blood lead, it is necessary to restrict lead in product manufacturing for the purpose of public health. In addition, it is necessary to be aware of the dangers of exposure to even small amounts of lead in daily life.