Dyslipidemia and Associated Risk Factors in the Elderly Population in Asmara, Eritrea: Results from a Community-Based Cross-Sectional Study

Background. The ultimate goal of the study was to approximate the burden and patterns of dyslipidemia in a subset of the elderly population (≥60–85 years) living in Asmara, Eritrea, and to identify modifiable risk drivers. Methods. A total of 319 (145 (45.5%) male vs. 174 (54.5%) female, mean age ± SD (68.06 ± 6.16 years), participants from randomly selected estates within Asmara were enrolled. Demographic and medical information was collected using a standardized questionnaire. Anthropometric, lipid panel, fasting plasma glucose (FPG), and blood pressure (BP) measurements were subsequently taken. Results. The prevalence of dyslipidemia was 70.5%. The proportions of dyslipidemias were (in order of decreasing frequency) high TC (51.2%), LDL-C (43.7%), low HDL-C (28.2%), and TG (27.6%). The average (±SD) concentrations in mg/dL of TC, LDL-C, non-HDL-C, TG, HDL-C, TC/HDL-C, and TG/HDL-C were 202.2 ± 40.63 , 125.95 ± 33.16 , 151.72 ± 37.19 , 129 ± 57.16 , 50.48 ± 10.91 , 4.11 ± 0.91 , and 2.72 ± 1.49 , respectively. Furthermore, 17.5%, 21.6%, 11.0%, and 5.0% had abnormalities in 1, 2, 3, and 4 lipid disorders with the copresence of TC+LDL-C abnormalities dominating. Regarding National Cholesterol Education Program Third Adult Treatment Panel risk strata, 18.5%, 14.5%, 28.2%, and 12.9% were in high or very high-risk categories for TC, LDL-C, TG, and HDL-C, respectively. The high burden of dyslipidemia coexisted with an equally high burden of abdominal obesity (43.1%), FPG ≥ 100 mg / dL (16%), hypertension (28.5%), and physical inactivity. Overall, dyslipidemia was associated with sex (females: aOR = 2.6 , 95 % CI = 1.1 – 6.1 , p = 0.017 ) and daily physical activity—higher in individuals undertaking physical activity for <1 hour ( aOR = 2.6 , 95 % CI = 1.1 – 6.1 , p = 0.029 ), 1-2 hours ( aOR = 3.2 , 95 % CI = 1.24 – 8.5 , p = 0.016 ), and 2-3 hours ( aOR = 2.0 , 95 % CI = 0.7 – 5.8 , p = 0.192 ) (Ref: >3 hours). Additional associations included increasing FPG ( aOR = 1.02 , 95 % CI = 1.0 – 1.04 , p = 0.039 ), and BMI ( aOR = 1.19 , 95 % CI = 1.09 – 1.3 , p < 0.001 ). These factors, along with waist circumference (WC), consumption of traditional foods, systolic BP, and diastolic BP, were, with some variations, associated with disparate dyslipidemias. Conclusions. The burden of dyslipidemia in the elderly population in Asmara is high. Modifiable risk drivers included FPG, WC, physical inactivity, and low consumption of traditional food. Overall, efforts directed at scaling up early recognition and treatment, including optimal pharmacological and nonpharmacological therapy, at all levels of care, should be instituted.

Lipoproteins as Markers for Monitoring Cancer Progression

Lipoproteins are among the contributors of energy for the survival of cancer cells. Studies indicate there are complex functions and metabolism of lipoproteins in cancer. The current review is aimed at providing updates from studies related to the monitoring of lipoproteins in different types of cancer. This had led to numerous clinical and experimental studies. The review covers the major lipoproteins such as LDL cholesterol (LDL-C), oxidized low-density lipoprotein cholesterol (oxLDL-C), very low-density lipoprotein cholesterol (VLDL-C), and high-density lipoprotein cholesterol (HDL-C). This is mainly due to increasing evidence from clinical and experimental studies that relate association of lipoproteins with cancer. Generally, a significant association exists between LDL-C with carcinogenesis and high oxLDL with metastasis. This warrants further investigations to include Mendelian randomization design and to be conducted in a larger population to confirm the significance of LDL-C and its oxidized form as prognostic markers of cancer.

Current Management Guidelines on Hyperlipidemia: The Silent Killer

Given the high incidence of cardiovascular events in the United States, strict control of modifiable risk factors is important. Pharmacotherapy is helpful in maintaining control of modifiable risk factors such as elevated lipids or hypercholesterolemia. Hypercholesterolemia can lead to atherosclerotic disease which may increase the risk of acute coronary events. Statin therapy has long been a mainstay in the treatment of hypercholesterolemia, but while highly regarded, statin therapy also has side effects that may lead to patient noncompliance. Therefore, various medicines are being developed to manage hypercholesterolemia. This paper will discuss the role that lipids play in the pathophysiology of atherosclerotic disease, review the current lipid management guidelines, and discuss new treatment options that are alternatives to statin therapy.

Familial Hypercholesterolemia (FH) in Iran: Findings from the Four-Year FH Registry

Background. Familial hypercholesterolemia (FH) is a common autosomal dominant disease. Its diagnosis in Iran was uncommon. Iran registry of FH (IRFH) has been started from 2017 from Isfahan. In this study, we report the four-year FH registry. Methods. The Iran FH registry is an ongoing study which is followed by a dynamic cohort. It has been started from 2017. The patients are selected from laboratories due to high cholesterol level and who have history of premature cardiovascular disease. The Dutch Lipid Clinic Network (DLCN) criteria are used for the detection of FH. Cascade screening is performed for detection of first-degree relative of patients. Results. Among the 997 individuals included in this registry, they were 522 (mean age 51.41 ± 12.91 year), 141 (mean age 51.66 ± 8.3 year), and 129 (mean age 41 ± 16.5 year) patients from laboratories, premature cardiovascular disease, and relatives, respectively. In total, 263 patients were diagnosed with probable or definite FH, and others were in the possible group. Low-density lipoprotein cholesterol (LDL) level was 141.42 ± 45.27 mg / dl in the laboratory group and 54.9% of patients were on LLT treatment. In patients with premature cardiovascular disease and FH, the LDL level was 91.93 ± 32.58 and was on LLT treatment. The LDL concentration in the first relative of FH patients was 152.88 ± 70.77 and 45.7% of them are on LLT therapy. Conclusions. Most of FH patients were underdiagnosed and undertreated before their inclusion in the IRFH. Cascade screening helps in the improvement of diagnosis.

Ipomea batatas Leaf Powder from Cameroon: Antioxidant Activity and Antihyperlipidemic Effect in Rats Fed with a High-Fat Diet

The present study consists of analyzing the phytochemical composition of Ipomoea batatas leaf powders and evaluating their antihyperlipidemic effect on rats receiving a high-fat diet. Ipomoea batatas leaves were collected from four agroecological areas of Cameroon, and powders were obtained after washing, drying, grinding, and sieving. Standard analytical methods were used to determine the phytochemical composition of two varieties (IRAD-tib1yellow-V1 and IRAD-1112white-V2) from North Z1, Adamawa Z2, West Z3, Center Z4. The effect of I. batatas leaf powder on lipid metabolism was assessed in vivo by feeding different groups of rats with a high-fat diet supplemented with 5 and 10% of I. batatas leaf powder during 30 days. At the end of the experimentation, total cholesterols, triglycerides, LDL- (low-density lipoprotein-) cholesterol, HDL- (High-density lipoprotein-) cholesterol, ASAT (aspartate aminotransferase), ALAT (alanine aminotransferase), and creatinine were measured using commercial enzymatic kits (Spinreact, Spain). The results of phytochemical analysis of I. batatas leaf powders revealed that the total phenol content ranged from 660.173 mg GAE/100 gDW (Z1V2) to 657.76 mg GAE/100 gDW (Z3V2), the flavonoids content ranged from 282.25 mgEC/100 gDW (Z3V1) to 325.05 mgEC/100 gDW (Z4V2), and the anthraquinone content ranged from 324.05 mg/100 gDW (Z3V2) to 326.72 mg/100 gDW (Z4V2). The total antioxidant capacity ranged from 19.00 (Z1V1) to 23.48 mg AAE/gDW (Z3V2), while the IC50 ranged from 1.58 mg/mL (Z1V1) to 3.08 mg/mL (Z3V2). Rats fed a high-fat diet and supplemented with 5 and 10% of I. batatas leaf powder showed a significant ( p < 0.05 ) reduction in body weight compared to the control with a reduction rate ranging from 6 to 10%. The consumption of I. batatas leaf powder for 30 days significantly ( p < 0.05 ) reduced serum total cholesterol, LDL-cholesterol, triglycerides, ALAT, and creatinine level. These results suggest the use of I. batatas leaves as a phytomedicine in the treatment of cardiovascular diseases.

Changing Perspectives on HDL: From Simple Quantity Measurements to Functional Quality Assessment

High-density lipoprotein (HDL) comprises a heterogeneous group of particles differing in size, density, and composition. HDL cholesterol (HDL-C) levels have long been suggested to indicate cardiovascular risk, inferred from multiple epidemiological studies. The failure of HDL-C targeted interventions and genetic studies has raised doubts on the atheroprotective role of HDL-C. The current consensus is that HDL-C is neither a biomarker nor a causative agent of cardiovascular disorders. With better understanding of the complex nature of HDL which comprises a large number of proteins and lipids with unique functions, recent focus has shifted from HDL quantity to HDL quality in terms of atheroprotective functions. The current research is focused on developing laboratory assays to assess HDL functions for cardiovascular risk prediction. Also, HDL mimetics designed based on the key determinants of HDL functions are being investigated to modify cardiovascular risk. Improving HDL functions by altering its composition is the key area of future research in HDL biology to reduce cardiovascular risk.

Effects of Starvation on the Levels of Triglycerides, Diacylglycerol, and Activity of Lipase in Male and Female Drosophila Melanogaster

We studied the effects of starvation on changes in neutral lipids in male and female Drosophila melanogaster (fruit fly) at different ages. When flies were subjected to starvation, the mortality rate was observed to be age- and gender-dependent: male flies died earlier as compared to female flies, and older flies died earlier than younger flies. There was an increase in the number of dead flies and the levels of diacylglycerol (DG) with starvation time. This increase in DG was observed much earlier in male flies as compared to female flies, which correlated with earlier death in male flies during starvation in comparison to female flies. We also analyzed the levels of triglycerides (TG) and lipase activity during starvation of flies. The levels of TG decreased depending upon the duration of starvation in both male and female flies. Interestingly, we observed that like DG, there was also an increase in lipase activity due to starvation, which also correlated with earlier death in male flies as compared to female flies. Our results suggest that increase in DG levels and lipase activity due to starvation may be the main cause of death in the flies.

Risk Factors Associated with Statin-Associated Muscle Symptoms in Patients Attending a Specialized Regional Lipid Clinic

Background. Statin-associated muscle symptoms (SAMS) are the major side effects reported for statins. Data from previous studies suggest that 7–29% of patients on statin had associated muscle symptoms. In the UK, there is a lack of corresponding data on SAMS and factors associated with the development of SAMS. Objective. This analysis is aimed at establishing the prevalence of SAMS and identifying major contributory risk factors in patients attending a lipid clinic. Methods. Clinical records of 535 consecutive patients, who visited the lipid clinic in the University Hospitals of Leicester, were studied retrospectively between 2009 and 2012. SAMS were defined by the presence of muscle symptoms with two or more different statins. Patients who reported muscle symptoms to statin with one or no rechallenge were excluded. The association of SAMS with clinical characteristics such as age and BMI, sex, smoking, excess alcohol, comorbidities, and medications was tested for statistical significance. A binomial logistic regression model was applied to adjust for risk factors significantly associated with SAMS. Results. The prevalence of SAMS was found to be 11%. On unadjusted analysis, the mean age of patients who had SAMS was significantly higher than those without SAMS ( 59.4 ± 10.5 years vs. 50.3 ± 13.4 years, respectively, P < 0.001 ). Nonsmokers were more likely to develop SAMS in comparison to active smokers ( P = 0.037 ). Patients taking antihypertensive medications were more likely to develop SAMS ( P = 0.010 ). In binomial logistic regression analysis, only age was positively and significantly associated with SAMS after adjusting for other risk factors ( β = 0.054 , P = 0.001 ). Conclusion. To the best of our knowledge, this study is the largest cohort of patients with SAMS in the United Kingdom. Our data suggest that the prevalence of SAMS is 11% and increased age is a risk factor associated with the development of SAMS in our cohort of patients.

Overconsumption of Omega-6 Polyunsaturated Fatty Acids (PUFAs) versus Deficiency of Omega-3 PUFAs in Modern-Day Diets: The Disturbing Factor for Their “Balanced Antagonistic Metabolic Functions” in the Human Body

Polyunsaturated fatty acids (PUFAs) contain ≥2 double-bond desaturations within the acyl chain. Omega-3 (n-3) and Omega-6 (n-6) PUFAs are the two known important families in human health and nutrition. In both Omega families, many forms of PUFAs exist: α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) from the n-3 family and linoleic acid (LA), dihomo-γ-linolenic acid (DGLA), and arachidonic acid (AA) from the n-6 family are the important PUFAs for human health. Omega-3 and Omega-6 PUFAs are competitively metabolized by the same set of desaturation, elongation, and oxygenase enzymes. The lipid mediators produced from their oxidative metabolism perform opposing (antagonistic) functions in the human body. Except for DGLA, n-6 PUFA-derived lipid mediators enhance inflammation, platelet aggregation, and vasoconstriction, while those of n-3 inhibit inflammation and platelet aggregation and enhance vasodilation. Overconsumption of n-6 PUFAs with low intake of n-3 PUFAs is highly associated with the pathogenesis of many modern diet-related chronic diseases. The volume of n-6 PUFAs is largely exceeding the volume of n-3PUFAs. The current n-6/n-3 ratio is 20-50/1. Due to higher ratios of n-6/n-3 in modern diets, larger quantities of LA- and AA-derived lipid mediators are produced, becoming the main causes of the formation of thrombus and atheroma, the allergic and inflammatory disorders, and the proliferation of cells, as well as the hyperactive endocannabinoid system. Therefore, in order to reduce all of these risks which are due to overconsumption of n-6 PUFAs, individuals are required to take both PUFAs in the highly recommended n-6/n-3 ratio which is 4-5/1.

Distribution of Lipids and Prevalence of Dyslipidemia among Indian Expatriates in Qatar

Background. Dyslipidemia is a significant risk factor for cardiovascular diseases (CVD). If detected and managed in the early stages of life, can reduce morbidity and mortality associated with CVD in a vulnerable population. Out of the 94 expatriate nationalities in Qatar, Indians constitute the most prominent single nationality, accounting for 21.8% of the total population (2,773,885 in 2019). This study aims to determine the status of the lipid profile among Indians in Qatar. Study Design. We conducted an observational retrospective study on lipid profile test data of Indian expatriates visiting a private healthcare facility in Qatar from Oct 17 to Oct 2018 to evaluate the gender and age-specific distribution of lipids and the prevalence of dyslipidemia. Results. Among the total 4483 Indian expatriates (3891 men and 592 women), the mean (SD) mg/dL levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) were higher in men TC 196.9 (40.6), TG 168.9 (114.6), and LDL-C 122.9 (37.2) mg/dL compared to women TC 185 (38.1), TG 117.7 (78.2), and LDL-C 114.1 (31.1) mg/dL, p value < 0.0001. Utilizing predefined National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) limits to categorize dyslipidemias; the greater prevalence of elevated TC, TG, and LDL-C was noted in men 44.7%, 45.8%, and 40.9% than women 31.6%, 22%, and 28.7%, respectively. However, women had higher levels of mean high-density lipoprotein cholesterol (HDL-C) as 47.1 (9.8) mg/dL vs. 40.6 (8.3) mg/dL in men, p value < 0.05, the prevalence of dyslipidemia, low HDL-C was also more 65.7% vs. 48.9% in women than men. With age, men showed a declining trend while women showed a rising trend for mean lipid levels as well as for the prevalence of dyslipidemia, high TC, TG, and LDL-C ( p value < 0.0001). The mean HDL-C cholesterol increased, and the prevalence of dyslipidemia, low HDL-C decreased with age in both the genders. Conclusion. Our results demonstrate the higher mean lipid levels and prevalence of atherogenic dyslipidemia among Indian expatriate men than women counterparts at the younger age group. The screening programs and awareness campaigns must be initiated to prevent the early onset of dyslipidemia induced atherosclerosis leading to CVD. Future controlled studies are needed to estimate the prevalence of dyslipidemias among Indian migrants in Qatar.