STUDY OF OUTCOME OF STATIN THERAPY IN PATIENTS BY CHECKING LIPID PROFILE AFTER 3 MONTHS OF STARTING TREATMENT IN STATIN NAIVE PATIENTS

Background: To describe the outcome of statin therapy in patients by checking lipid profile after 3 months of starting treatment in statin naive patients Methods: Study was conducted on Patients with indications for statins presenting to cardiology OPD, Medicine OPD and Endocrinology OPD and started on statins at PGIMER, Chandigarh, within a period of 9 months. Results: The mean decrease in total cholesterol, triglycerides, VLDL and LDL levels in primary prevention group mean decrease in after 3 months of statin treatment in comparison to baseline were 17.24%,21.24%, 22.83 % and 33.19% respectively and increase in mean HDL level was 9.55%. The mean decrease in total cholesterol, triglyceride, VLDL and LDL levels in secondary prevention group after 3 months of statin treatment in comparison to baseline were 14.35% 15.80%, 16.17% and 36.92% respectively and increase in mean HDL level was 8.77%. Concluded: So there was statistically significant change in lipid profile from baseline in both primary and secondary prevention groups after 3 months of statin treatment. Keywords: Statin, LDL,VLDL, HDL

Genetic Risk Score Enhances Coronary Artery Disease Risk Prediction in Individuals With Type 1 Diabetes

OBJECTIVE Individuals with type 1 diabetes are at a high lifetime risk of coronary artery disease (CAD) calling for early interventions. This study explores the use of a genetic risk score (GRS) for CAD risk prediction, compares it to established clinical markers and investigates its performance according to the age and pharmacological treatment. <p>RESEARCH DESIGN AND METHODS This study in 3,295 individuals with type 1 diabetes from the Finnish Diabetic Nephropathy Study (467 incident CAD, 14.8 years follow-up) employed three risk scores: a GRS, a validated clinical score and their combined score. Hazard ratios (HR) were calculated with Cox regression and model performances compared with Harrel’s C-index. </p> <p>RESULTS A HR of 6.7 for CAD was observed between the highest and the lowest 5^th percentile of the GRS (<i>P</i>=1.8×10^-6). The performance of GRS (C-index [C] 0.562) was similar to HbA_1c (C=0.563, <i>p</i>-value for difference 0.96), HDL (C=0.571, <i>P</i>=0.6) and total cholesterol (C=0.594, <i>P</i>=0.1). The GRS was not correlated with the clinical score (<i>r</i>=-0.013, <i>P</i>=0.5). The combined score outperformed the clinical score (C=0.813 vs C=0.820, <i>P</i>=0.003). The GRS performed better in individuals below the median age (38.6 years) compared to those above (C=0.637 vs C=0.546). </p> <p>CONCLUSIONS A GRS identified individuals at high risk of CAD and worked better in younger individuals. GRS was also an independent risk factor for CAD with a predictive power comparable to that of HbA_1c, HDL and total cholesterol and, when incorporated into a clinical model, modestly improved the predictions. The GRS promises early risk stratification in clinical practice by enhancing the prediction of CAD. </p>

Phytonutrients of Bitter Apricot Seeds Modulate Human Lipid Profile and LDL Subfractions in Adults with Elevated Cholesterol Levels

The objective of the present study was to evaluate the effect of short-term consumption of bitter apricot seeds phytonutrients on cardiovascular risk factors with a special focus on LDL cholesterol subfractions using the Lipoprint system. A group of 34 adult volunteers (21 female/13 male) consumed 60 mg kg−1 of body weight of bitter apricot seeds daily for 42 days. Subjects were divided into two groups: one with normal cholesterol levels (NTC) and one with elevated total cholesterol levels (ETC). Blood serum levels of total cholesterol (T-C), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C), and triglycerides (TG) did not change significantly (p > 0.05) in NTC group. However, there were significant decreasing of T-C (p ˂ 0.05) and LDL-C (p < 0.01) in ETC group. The LDL1, LDL2, and atherogenic LDL3−7 subfractions progressively decreased after 42 days of apricot seeds consumption in ETC group (p < 0.05). Apricot seeds consumption was associated with a significant increase in the mean LDL particle size especially in ETC group (p ˂ 0.01). The results of the present study support the hypothesis that daily consumption of bitter apricot seeds for 42 days positively modified the lipoprotein profile in the group with elevated total cholesterol.

Prevalence of hypercholesterolemia in young people under 45 years old with abdominal obesity in Novosibirsk

The study was devoted to the study of the prevalence of hypercholesterolemia (hyper-Chol) and hypercholesterolemia of low density lipoproteins (hyper-LDL-C) against the background of abdominal obesity (AO) in a population aged 25–44 years in Novosibirsk. Material and methods. A crosssectional survey of the population aged 25–44 years in Novosibirsk (Russia) was carried out. 1415 people were examined, including 670 men (47.3 %) and 745 women (52.7 %), pregnant women or being on maternity leave were not included in the study). All subjects were assessed for the presence of AO, hyper-Chol and hyper-LDL-C. Results. Individuals with AO had higher average values of total cholesterol and LDL cholesterol. The prevalence of hyper-Chol in individuals with AO was 1.3 times higher and hyper-LDL-C – 1.2 times higher than in individuals without AO. In women with AO, the prevalence of hyper-Chol was 1.2 times higher and hyper-LDL-C – 1.3 times higher than in women without AO. In men with AO, the prevalence of hyper-Chol was 1.4 times higher and hyper-LDL-C – 1.2 times higher than in men without AO. When conducting logistic regression analysis, it was found that in a young population under 45 years of age, abdominal obesity was significantly associated with the presence of atherogenic hypercholesterolemia in both sexes. In men, significant associations of AO with both hyper-Chol and hyper-LDL-C were noted, in women – only with hyper-LDL-C. Conclusions. A population study of young people (25–44 years old) revealed associations of atherogenic hypercholesterolemia with abdominal obesity.

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.

Genetic Risk Score Enhances Coronary Artery Disease Risk Prediction in Individuals With Type 1 Diabetes

OBJECTIVE Individuals with type 1 diabetes are at a high lifetime risk of coronary artery disease (CAD) calling for early interventions. This study explores the use of a genetic risk score (GRS) for CAD risk prediction, compares it to established clinical markers and investigates its performance according to the age and pharmacological treatment. <p>RESEARCH DESIGN AND METHODS This study in 3,295 individuals with type 1 diabetes from the Finnish Diabetic Nephropathy Study (467 incident CAD, 14.8 years follow-up) employed three risk scores: a GRS, a validated clinical score and their combined score. Hazard ratios (HR) were calculated with Cox regression and model performances compared with Harrel’s C-index. </p> <p>RESULTS A HR of 6.7 for CAD was observed between the highest and the lowest 5^th percentile of the GRS (<i>P</i>=1.8×10^-6). The performance of GRS (C-index [C] 0.562) was similar to HbA_1c (C=0.563, <i>p</i>-value for difference 0.96), HDL (C=0.571, <i>P</i>=0.6) and total cholesterol (C=0.594, <i>P</i>=0.1). The GRS was not correlated with the clinical score (<i>r</i>=-0.013, <i>P</i>=0.5). The combined score outperformed the clinical score (C=0.813 vs C=0.820, <i>P</i>=0.003). The GRS performed better in individuals below the median age (38.6 years) compared to those above (C=0.637 vs C=0.546). </p> <p>CONCLUSIONS A GRS identified individuals at high risk of CAD and worked better in younger individuals. GRS was also an independent risk factor for CAD with a predictive power comparable to that of HbA_1c, HDL and total cholesterol and, when incorporated into a clinical model, modestly improved the predictions. The GRS promises early risk stratification in clinical practice by enhancing the prediction of CAD. </p>

Genetic Risk Score Enhances Coronary Artery Disease Risk Prediction in Individuals With Type 1 Diabetes

OBJECTIVE Individuals with type 1 diabetes are at a high lifetime risk of coronary artery disease (CAD), calling for early interventions. This study explores the use of a genetic risk score (GRS) for CAD risk prediction, compares it to established clinical markers, and investigates its performance according to the age and pharmacological treatment. RESEARCH DESIGN AND METHODS This study in 3,295 individuals with type 1 diabetes from the Finnish Diabetic Nephropathy Study (467 incident CAD, 14.8 years follow-up) used three risk scores: a GRS, a validated clinical score, and their combined score. Hazard ratios (HR) were calculated with Cox regression, and model performances were compared with the Harrell C-index (C-index). RESULTS A HR of 6.7 for CAD was observed between the highest and the lowest 5th percentile of the GRS (P = 1.8 × 10−6). The performance of GRS (C-index = 0.562) was similar to HbA1c (C-index = 0.563, P = 0.96 for difference), HDL (C-index = 0.571, P = 0.6), and total cholesterol (C-index = 0.594, P = 0.1). The GRS was not correlated with the clinical score (r = −0.013, P = 0.5). The combined score outperformed the clinical score (C-index = 0.813 vs. C-index = 0.820, P = 0.003). The GRS performed better in individuals below the median age (38.6 years) compared with those above (C-index = 0.637 vs. C-index = 0.546). CONCLUSIONS A GRS identified individuals at high risk of CAD and worked better in younger individuals. GRS was also an independent risk factor for CAD, with a predictive power comparable to that of HbA1c and HDL and total cholesterol, and when incorporated into a clinical model, modestly improved the predictions. The GRS promises early risk stratification in clinical practice by enhancing the prediction of CAD.

Potential therapeutic effects of green tea on obese lipid profile – a systematic review

Background: Green tea, obtained from the plant Camellis sinensis, is one of the oldest drinks in the world and contains numerous bioactive compounds. Studies have demonstrated the efficacy of green tea in preventing obesity and cardiovascular diseases that may be related to the reduction of lipid levels. Aim: This study aimed to evidence, through a systematic review, the therapeutic potential of green tea on the lipid profile in preclinical studies in obese animals and clinical studies in obese individuals. Methods: This systematic review follows the recommendations of the preferred report items for systematic reviews and meta-analyses. The electronic databases, PubMed (Medline), Science Direct, Scopus, and Web of Science were consulted. Articles from January 2009 to December 2019 were selected. Results: This search resulted in twenty-nine articles were included cirtically reviewed. In experimental studies, green tea administration has been shown to reduce total cholesterol, triglycerides and low-density lipoprotein cholesterol in animals exposed to obesity-inducing diet. In humans’ studies green tea was not shown to be effective for obese lipid control. Because supplementation with green tea extract reduced total cholesterol, triglycerides, low-density lipoprotein for three months at a specific dose. Conclusion: Therefore, green tea appears to act as a protective agent for dyslipidemia in obesity-induced animals. In human studies, green tea has not been shown to be effective in controlling obese lipids.

Variability of glucose, insulin, and lipid disturbances in first-episode psychosis: a meta-analysis

Background First-episode psychosis (FEP) is associated with metabolic alterations. However, it is not known if there is heterogeneity in these alterations beyond what might be expected due to normal individual differences, indicative of subgroups of patients at greater vulnerability to metabolic dysregulation. Methods We employed meta-analysis of variance, indexed using the coefficient of variation ratio (CVR), to compare variability of the following metabolic parameters in antipsychotic naïve FEP and controls: fasting glucose, glucose post-oral glucose tolerance test (OGTT), fasting insulin, insulin resistance, haemoglobin A1c (HbA1c), total-cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides. Standardised mean difference in metabolic parameters between groups was also calculated; meta-regression analyses examined physiological/demographic/psychopathological moderators of metabolic change. Results Twenty-eight studies were analysed (1716 patients, 1893 controls). Variability of fasting glucose [CVR = 1.32; 95% confidence interval (CI) 1.12–1.55; p = 0.001], glucose post-OGTT (CVR = 1.43; 95% CI 1.10–1.87; p = 0.008), fasting insulin (CVR = 1.31; 95% CI 1.09–1.58; p = 0.01), insulin resistance (CVR = 1.34; 95% CI 1.12–1.60; p = 0.001), HbA1c (CVR = 1.18; 95% CI 1.06–1.27; p < 0.0001), total-cholesterol (CVR = 1.15; 95% CI 1.01–1.31; p = 0.03), LDL-cholesterol (CVR = 1.28; 95% CI 1.09–1.50; p = 0.002), and HDL-cholesterol (CVR = 1.15; 95% CI 1.00–1.31; p < 0.05), but not triglycerides, was greater in patients than controls. Mean glucose, glucose post-OGTT, fasting insulin, insulin resistance, and triglycerides were greater in patients; mean total-cholesterol and HDL-cholesterol were reduced in patients. Increased symptom severity and female sex were associated with worse metabolic outcomes. Conclusions Patients with FEP present with greater variability in metabolic parameters relative to controls, consistent with a subgroup of patients with more severe metabolic changes compared to others. Understanding determinants of metabolic variability could help identify patients at-risk of developing metabolic syndrome. Female sex and severe psychopathology are associated with poorer metabolic outcomes, with implications for metabolic monitoring in clinical practice.

Prevention continuum: an assessment of cardiovascular disease prevention based on the data from a survey of doctors

Aim. To assess the awareness and engagement of health professionals in Russia in the main aspects of cardiovascular disease prevention.Material and methods. In order to assess engagement and awareness, an online survey of Russian primary health care providers was conducted in March 2021. The survey was conducted using original questionnaire, which includes the main questions aimed at early identification of patients with modifiable cardiovascular risk factors.Results. In case of newly diagnosed hypercholesterolemia and elevated blood pressure during screening, 91,8% (n=458) of the surveyed medical specialists record the results and immediately consult the patient on these issues. Similar responses was obtained by 93% (n=464) of doctors for patients with previously prescribed antihypertensive and/or lipid-lowering therapy. In addition, 46,5% (n=232) responded that during screening, 10-30% of patients had newly diagnosed hypertension and/or total cholesterol >5 mmol/L. A total of 28,9% (n=144) of respondents noted that 30-50% of patients with newly diagnosed hypertension and/or total cholesterol >5 mmol/L are detected at screening. It is noteworthy that 41,9% (n=209) of physicians devote 1 to 5 minutes to a patient, describing the changes in lifestyle, diet and physical activity. For 35,1% (n=175) of the respondents, this takes from 5 to 10 minutes, 22% (n=110) — >10 minutes, while ~5 respondents refer patients to another specialist for this purpose.Conclusion. The survey showed a high awareness of medical specialists in the need to monitor and modify risk factors. However, ~40% of surveyed doctors do not devote enough time to explaining issues of modifying lifestyle, diet and physical activity.