The Relationship Between Cardiovascular Health and Rate of Cognitive Decline in Young-Old and Old-Old Adults: A Population-Based Study

Background: Modifiable vascular risk factors have been associated with late-life cognitive impairment. The Life Simple 7 (LS7) score comprises seven cardiovascular health metrics: smoking, diet, physical activity, body mass index, plasma glucose, total serum cholesterol, and blood pressure. Objective: To investigate the association between individual and composite LS7 metrics and rate of cognitive decline, and potential differences in these associations between young-old and old-old individuals. Methods: This cohort study included 1,950 participants aged≥60 years (M = 70.7 years) from the Swedish National Study on Aging and Care-Kungsholmen (SNAC-K), who underwent repeated neuropsychological testing (episodic and semantic memory, verbal fluency, processing speed, global cognition) across 12 years. The LS7 score was assessed at baseline and categorized as poor, intermediate, or optimal. Level and change in cognitive performance as a function LS7 categories were estimated using linear mixed-effects models. Results: Having an optimal LS7 total score was associated with better performance (expressed in standard deviation units) at baseline for perceptual speed (β= 0.21, 95%CI 0.12–0.29), verbal fluency (β= 0.08, 0.00–0.16), and global cognition (β= 0.06, 0.00–0.12) compared to the poor group. Age-stratified analyses revealed associations for cognitive level and change only in the young-old (< 78 years) group. For the specific metrics, diverging patterns were observed for young-old and old-old individuals. Conclusion: Meeting the LS7 criteria for ideal cardiovascular health in younger old age is associated with slower rate of cognitive decline. However, the LS7 criteria may have a different meaning for cognitive function in very old adults.

Indications for prescription and deprescription in multimorbid independently living elderly outpatients

Introduction Global trend to population ageing is associated with inevitable increase of polypharmacy in multimorbid elderly population. Purpose To estimate the level and structure of comorbidity and pharmacotherapy in independently living patients of different age groups with high and extreme cardiovascular risk, when observed in outpatient clinics Methods 282 consecutive patients of high cardiovascular risk have been enrolled. Inclusion criteria were: SCORE ≥5%, documented history of acute myocardial infarction (AMI), acute or transient cerebrovascular accident (CVD), coronary artery intervention, acute coronary syndrome (ACS), stable angina, intermittent claudication, type 2 diabetes mellitus (DM2) or type 1 DM with diabetic nephropathy, angiogram or ultrasound proved atherosclerotic plaques, total serum cholesterol level ≥8 mmol/L, blood pressure ≥180/110 mmHg and signed voluntary informed consent form. Current clinical conditions, pharmacologic treatment and indications for prescription and deprescription were studied. STOPP criteria for prescribing potentially non-recommended drugs in people over 65 years of age, START criteria for not prescribing necessary drugs in people over 65 years of age, non-recommended in elderly people over 65 drug list were used to assess polypharmacy. According to the WHO age classification, there were three groups: Group 1 (aged 45 to 59), Group 2 (aged 60 to 74) and Group 3 (aged 75 +). Results There were no differences in the frequency of statins administration (p=0.72) and antiplatelet agents (p=0.49) between 3 groups. Polypragmasia (administration of more than 5 drugs) was registered in 150 patients (53%) and was significantly more common in Group 3 (p=0.001). 48 cases of inadequate prescribing were registered in 46 (28%) elderly patients. 24 cases of prescribing potentially unacceptable medications for the elderly were reported. Conclusion Unavoidable polypragmasia was found in 53% multimorbid elderly patients. Irrational drug treatment was detected in 28% elderly patients STOPP criteria were met in 32.1% and START criteria were met in 30.4% cases. Polypragmasia being inevitable in elderly multimorbid patients, administration of any new medication should be performed after a thorough risk-benefits balance assessment. FUNDunding Acknowledgement Type of funding sources: None.

Hypertriglyceridemia during infectious mononucleosis

Background Hypertriglyceridemia can be observed in lymphoproliferative disorders. Epstein-Barr virus-induced infectious mononucleosis can be considered a self-limiting lymphoproliferative disorder. The aim of this study is to investigate serum triglyceride concentrations, associated factors, and time-course changes in patients with infectious mononucleosis. Methods We report on an adult patient with extreme hypertriglyceridemia (triglycerides > 1000 mg/dL) during infectious mononucleosis. We then reviewed the clinical records of 360 patients admitted to the hospital due to infectious mononucleosis (median age 19 years, range 15–87 years; 51.4% male). Serum triglyceride concentrations were compared with those of a control sample from the general population, aged 18–30 years (n = 75). A second measurement of serum triglyceride concentrations, obtained during convalescence (median of 30 days after the initial determination), was available for 160 patients. Results Triglyceride concentrations in the acute phase (median 156 mg/dL; range, 27–452 mg/dL) were significantly higher than those of controls (P < 0.001). A total of 194 patients (53.9%) showed hypertriglyceridemia (triglycerides > 150 mg/dL), which was more common in the older patients. A significant correlation was observed between serum triglycerides and white blood cell counts, total cholesterol levels, and markers of liver damage. Serum triglyceride concentrations tended to decrease during convalescence (P < 0.001) and were lower than the initial measurement in 83.7% of the cases. Conversely, total serum cholesterol concentrations during the acute phase were lower than those of the controls and increased during convalescence (P < 0.001). Conclusions Patients with severe (in-hospital) infectious mononucleosis frequently show mild, transient hypertriglyceridemia. Further studies are needed to elucidate the mechanisms underlying these findings.

Investigation of nootropic potential of ethanol extract of Elettaria cardamomum Maton fruit (Cardamom): a spice of India

Background Cognitive impairment mainly affects learning and problem solving abilities of the person. Traditional medicines, due to fewer side effects, more efficacy and lesser cost are still the choice of treatment in India. The main objective of the present study is to explore the nootropic potential of ethanol extract of Elettaria cardamomum Maton fruits. The present study was conducted by using exteroceptive behavioral models like elevated plus maze, passive avoidance apparatus and object recognition task at doses 100, 300 and 500 mg/kg. Results Ethanol extract of E. cardamomum fruits significantly decreased transfer latency and increased step down latency and discrimination index respectively when compared to normal control groups. Piracetam and diazepam exhibited respective rise and fall in memory of the animals. The effect of plant extract on total serum cholesterol, acetylcholinesterase and malondialdehyde were more effective at two higher doses. However, it decreased serum glucose levels insignificantly whereas a significant rise in brain GSH levels was observed with increasing dose of the extract. Conclusions The study concludes that the nootropic effect of ethanol extract may be attributable to its anti-oxidant, anti-cholinesterase and cholesterol as well as glucose lowering potential.

Study to find out the significance of postprandial dyslipidemia in diabetic patients

: Diabetes Mellitus (DM) is a group of metabolic diseases, which is characterized by chronic hyperglycaemia, which results from the defects in the insulin action, insulin secretion or both. The most prevalent form of the disease, type 2 Diabetes Mellitus is often asymptomatic in the early stages and it may remain undiagnosed for many years.The insulin resistance in the liver leads to failure of the hyperinsulinaemia to suppress the gluconeogenesis, which increases fasting glucose levels and decreases. glycogen storage by the liver in the postprandial phase. Increased glucose production in the liver occurs early in the course of diabetes, and it is likely in skeletal muscles after the onset of the insulin secretory abnormalities and the insulin resistance. Due to the insulin resistance in the adipose tissue and obesity, the free fatty acid (FFA) flux from the adipocytes is increased, which in turn leads to an increase in lipid [very low-density lipoprotein (VLDL) and triglycerides] synthesis in the hepatocytes. This is responsible for the dyslipidaemia which is found in type2 diabetes mellitus [elevated triglycerides, reduced HDL, and increased low-density lipoprotein (LDL) particlesIndividuals with type 2 diabetes mellitus are at increased risk of developing microvascular and macrovascular complications.: To find out the significance of postprandial dyslipidemia in diabetic patients.: This is a cross-sectional study, wherein written informed consent was taken after giving detailed information to the participants regarding the study. Patients who were in the age group of 35-65 years, admitted in the Department of Medicine, RRMCH from November 2017 for next 18 months with Diabetes Mellitus who met a predefined inclusion and exclusion criteria were studied. The study was initiated after obtaining clearance from the institution's ethical committee.: There was a significant elevation of mean values of total serum cholesterol, LDL and TG of cases and controls in the postprandial state compared to their fasting state, statistical significance was found (P&#60;0.05).Mean values of total serum cholesterol, LDL and TG of cases in fasting state were significantly more compared to controls in fasting state, statistical significance was found (P&#60;0.05).Mean values of total serum cholesterol, LDL and TG of cases in the postprandial state were significantly more compared to controls in the postprandial state, statistical significance was found (P&#60;0.05).Mean values of both FBS and PPBS in cases were higher compared to controls (P&#60;0.05). Mean values of PPBS in cases and controls were significantly more compared to their respective FBS values (P&#60;0.05).The mean HbA1c values in cases were higher(7.142) compared to controls (5.554).: Prevalence of diabetes was highest in the age group 56-65 years in our hospital.As the duration of diabetes increases, there is an increased prevalence of dyslipidemia in the cases.Past history of HTN, IHD, PVD and CVA were found significantly more in subjects with fasting and postprandial dyslipidemia (cases) compared to those without(controls).Patients on irregular treatment (63%) were more in the study group(cases) compared to controls. So it could be said that patient not on regular treatment are more prone to have dyslipidemia. (fasting as well as postprandial). There was a significant increase in total serum cholesterol, LDL and TG in postprandial states of cases compared to that in controls, so it could be said that diabetic patients with fasting dyslipidemia are more prone to have dyslipidemia in the postprandial state.

Dietary Interventions Reduce Traditional and Novel Cardiovascular Risk Markers by Altering the Gut Microbiome and Their Metabolites

Aims: The current study investigates the role of diet in mediating the gut microbiome-cardiovascular association which has not yet been explored in humans.Methods and Results: Using a two-arm dietary intervention study in healthy participants (N = 70), we assessed the effects of omega-3 and fibre supplementation on gut microbiome composition and short-chain fatty acid (SCFA) production. We then investigated how changes in gut microbiome composition correlated with changes in traditional cardiovascular risk factors (cholesterol, triglycerides, blood pressure), cytokines, and novel validated markers such as GlycA and ceramides, previously linked to CVD incidence and mortality. Both interventions resulted in significant drops in blood pressure, cholesterol, proinflammatory cytokines, GlycA and ceramides (all P &lt; 0.05). Decreases in the atherogenic low-density lipoprotein triglyceride fraction, in total serum cholesterol were correlated with increases in butyric acid-production [β(SE) = −0.58 (0.06), P &lt; 0.001; −0.53 (0.04), P &lt; 0.001] and nominally associated with increases in some butyrogenic bacteria. Drops in GlycA were linked to increases in Bifidobacterium [β(SE) = −0.32 (0.04), P = 0.02] and other SCFAs including acetic acid [β(SE) = −0.28 (0.04), P = 0.02] and propionic acid [β(SE) = −0.3 (0.04), P = 0.02]. Additionally, we report for the first-time reductions in specific ceramide ratios that have been shown to predict CVD mortality and major adverse cardiovascular events such as d18:1/16:0, d18:0/24:0, and d18:1/24:1 which were associated with the reduction in the abundance in Colinsella and increases in Bifidobacteriuim and Coprococcus 3 and SCFAs (all P &lt; 0.05).Conclusion: Overall, these findings support the potential of using simple dietary interventions to alter validated biomarkers linked to cardiovascular risk via the gut microbiome composition and its metabolic functions.

THE LIPID METABOLISM IN YOUNG AND MEDIUM MEN AGE WITH MYOCARDIAL INFARCTION AND RECURRENT EPISODES OF ISCHEMIA

Relevance. Dyslipidemia is considered one of the main risk factors for the development of recurrent myocardial infarction and early postinfarction angina. Aim. To evaluate the features of lipid metabolism in acute and subacute myocardial infarction in men under 60 years old with recurrent episodes of ischemia (recurrent myocardial infarction and/or early postinfarction angina) to search for new approaches to improve prevention measures. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 68 patients; II - control, without it - 427 patients. A comparative assessment of lipid metabolism parameters and their dynamics in selected groups were performed. Results. The study group differed in higher levels of total serum cholesterol (6.17±1.78 mmol/l) from the control group (5.56±1.28 mmol/l; p=0.02) at the end of the third week of disease, its dynamics during the observation period (I: 9.1%; p<0.0001; II: -1.8%; p<0.0001) and the dynamics of the atherogenic coefficient (I: -4.7.1; p=0.02; II: 6.3%; p<0.0001). In both groups, the group showed an increase in lipoproteins of low (I: 33.1; p=0.02; II: 45.5%; p<0.0001) and very low density (I: 275.8; p=0,0004; II: 233.4%; p<0.0001), atherogenic indices, decrease: triglycerides (I: -31.8%; p=0.02; II: -1.7%; p<0.0001) and high-density lipoproteins (I: -0.6%; p=0.02; II: -6.1%; p<0.0001). Conclusions. The group with recurrent ischemia is characterized by more pronounced hypercholesterolemia at the end of the subacute period of myocardial infarction in comparison with the control group due to an increase in the concentrations of atherogenic lipid metabolism fractions. The dynamics of indices and the coefficient of atherogenicity during this period is multidirectional, which requires additional study.

The Impact of Aqueous Leaf Extract of Soursop on Glucose and Lipid Profile in Alloxan Induced Diabetic Albino Rats

The blood glucose, total serum cholesterol, High Density Lipoprotein (HDL) and Triglyceride (TRIG) levels of all rats in each group were determined before induction, post-induction with alloxan and post treatment with various concentrations of extract and standard drug. The alloxan diabetic rats treated with gliberclamide and aqueous leaf extract of Annona muricata showed average means of body weights as; (235.73±3.14a, 263.94±2.25a and 236.5±1.74a) respectively after 4 weeks of treatment. The Glucose level revealed; 168.43±5.06e, 65.29±4.57f and 57.86±3.93e respectively. Lipid profile raised significantly post exposure of diabetic rats to both standard drug and extract after 4 weeks of treatment. Therefore, A. muricata compared favorably with the standard drug in the context of diabetes management.

The Role of Lipid Profile as an Independent Predictor of Non-alcoholic Steatosis and Steatohepatitis in Morbidly Obese Patients

Background and Aims: Obesity is one of the major health problems worldwide. Morbid obesity (body mass index &gt;40 kg/m2 or over 35 with a comorbidity) is associated, apart from other diseases, with an increased risk of non-alcoholic fatty liver disease (NAFLD). Moreover, dyslipidemia is an important comorbidity that is frequently found in NAFLD patients. The aim of this study was to analyze whether serum lipids in morbidly obese patients are associated with the spectrum of NAFLD.Methods: Total serum cholesterol, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, VLDL, and triglycerides were analyzed in 90 morbidly obese patients. The association of lipid profile parameters with histopathological, elastographic, and sonographic indices of NAFLD, non-alcoholic steatohepatitis (NASH), and liver fibrosis were explored.Results: The mean levels of serum total cholesterol, LDL-C, and non-HDL cholesterol in patients with positive histology for liver steatosis and NASH were significantly higher than those in patients with negative histology. None of the indices showed a strong association with NAFLD, NASH, or liver fibrosis after adjustment for potential confounders.Conclusion: A slight predictive value of lipid profile is not sufficiently enough to use solely as a non-invasive test in predicting NASH or liver fibrosis.

Management of Hyperlipidaemia through Ayurvedic Intervention

The potential of hyperlipidemia to engage in the pathology of atherosclerotic diseases such as coronary heart disease, which dominates the scenario of diseases causing morbidity and mortality in the world. Hyperlipidemia is defined as elevated serum levels of cholesterol, triglycerides, or both. It is characterized by abnormally elevated lipid concentrations in blood caused by impaired lipid and lipoprotein metabolism and has the potential to cause a variety of complications such as cardiovascular disease, diabetes, obesity, hypertension, atherosclerosis, and so on. Hyperlipidemia is classified as Medoroga in Ayurveda. The results obtained for the lipid profile parameter demonstrated a significant change. The difference in total serum cholesterol is 36 mg/dl, serum triglycerides is 32 mg/dl, serum LDL is 40 mg/dl, serum VLDL is 15 mg/dl and serum HDL is -3 mg/dl.