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Background: The impact of baseline triglyceride-glucose (TyG) index and abnormal low or high-density lipoprotein cholesterol (LDL-C or HDL-C) levels on all-cause and cardiovascular disease (CVD) mortality remains unclear. This study aimed to investigate the relationship between TyG index and LDL-C or HDL-C and all-cause and CVD mortality. Methods: This retrospective cohort study analyzed data from health examinations of 69,068 older adults aged ≥60 in Xinzheng City, Henan Province, China, between January 2013 and January 2023. Cox proportional risk regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the TyG index and LDL-C or HDL-C about all-cause and CVD mortality. Restricted cubic spline was used to assess the dose-response relationship. Results: During 400,094 person-years of follow-up (median follow-up 5.8 years [interquartile range 3.0-9.12]), 13,664 deaths were recorded, of which 7,045 were due to CVD. Compared with participants in the second quartile of the TyG index, participants in the fourth quartile had a 16% increased risk of all-cause mortality (HR: 1.16, 95% CI: 1.12,1.22), and an 8% increased risk of CVD mortality (HR: 1.08, 95% CI: 1.01,1.16). Similar results were observed in LDL-C and HDL-C, with all-cause and CVD mortality risks for participants in the fourth quartile compared with participants in the third quartile for LDL-C of (HR: 1.07, 95% CI: 1.02,1.12) and (HR: 1.09, 95% CI: 1.01,1.17), respectively. The risk of all-cause and CVD mortality in participants in the fourth quartile group compared with those in the second HDL-C quartile group was (HR: 1.10, 95% CI: 1.05,1.16) and (HR: 1.11, 95% CI: 1.04,1.18), respectively. We found that the TyG index was nonlinearly associated with all-cause and CVD mortality (P non-linear <0.05), and LDL-C was nonlinearly associated with all-cause mortality (P non-linear <0.05) but linearly associated with CVD mortality (P non-linear >0.05). HDL-C, on the other hand, was in contrast to LDL-C, which showed a non-linear association with CVD mortality. We did not observe a significant interaction between TyG index and LDL-C or HDL-C (P >0.05). Conclusion: TyG index and LDL-C or HDL-C increased the risk of all-cause and CVD mortality, especially a high TyG index combined with abnormal LDL-C. [ABSTRACT FROM AUTHOR]

Over the last half-century, discussions on the exact targets for low-density lipoprotein cholesterol (LDL-C) reduction have evolved towards a more aggressive approach with lower LDL-C targets, particularly for high-risk patients with pre-existing atherosclerotic cardiovascular disease (ASCVD). A wealth of cardiovascular outcome trials have shown the efficacy of statin therapy in general, as well as the incremental impact of high-intensity statin therapy in particular. More recent trials have further demonstrated the impact of non-statin therapies, including ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, and, most recently, bempedoic acid, on reducing ASCVD outcomes. The availability of these and other newer therapies has prompted clinicians to strive for lower LDL-C targets to address residual ASCVD risk after statin therapy. This paper will provide an overview of the historical trends in lipid management and therapeutics and review the current state of evidence for lower LDL-C targets in clinical guidelines and recommendations.

BackgroundThe impact of baseline triglyceride-glucose (TyG) index and abnormal low or high-density lipoprotein cholesterol (LDL-C or HDL-C) levels on all-cause and cardiovascular disease (CVD) mortality remains unclear. This study aimed to investigate the relationship between TyG index and LDL-C or HDL-C and all-cause and CVD mortality.MethodsThis retrospective cohort study analyzed data from health examinations of 69,068 older adults aged ≥60 in Xinzheng City, Henan Province, China, between January 2013 and January 2023. Cox proportional risk regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the TyG index and LDL-C or HDL-C about all-cause and CVD mortality. Restricted cubic spline was used to assess the dose-response relationship.ResultsDuring 400,094 person-years of follow-up (median follow-up 5.8 years [interquartile range 3.0-9.12]), 13,664 deaths were recorded, of which 7,045 were due to CVD. Compared with participants in the second quartile of the TyG index, participants in the fourth quartile had a 16% increased risk of all-cause mortality (HR: 1.16, 95% CI: 1.12,1.22), and an 8% increased risk of CVD mortality (HR: 1.08, 95% CI: 1.01,1.16). Similar results were observed in LDL-C and HDL-C, with all-cause and CVD mortality risks for participants in the fourth quartile compared with participants in the third quartile for LDL-C of (HR: 1.07, 95% CI: 1.02,1.12) and (HR: 1.09, 95% CI: 1.01,1.17), respectively. The risk of all-cause and CVD mortality in participants in the fourth quartile group compared with those in the second HDL-C quartile group was (HR: 1.10, 95% CI: 1.05,1.16) and (HR: 1.11, 95% CI: 1.04,1.18), respectively. We found that the TyG index was nonlinearly associated with all-cause and CVD mortality (P non-linear 0.05). HDL-C, on the other hand, was in contrast to LDL-C, which showed a non-linear association with CVD mortality. We did not observe a significant interaction between TyG index and LDL-C or HDL-C (P >0.05).ConclusionTyG index and LDL-C or HDL-C increased the risk of all-cause and CVD mortality, especially a high TyG index combined with abnormal LDL-C.

中国缺血性卒中（ischemic stroke，IS）及TIA疾病负担沉重。LDL-C水平升高是卒中复发的独立危险因素，积极评估患者LDL-C不达标的原因，制订进一步治疗策略、监测频率以提高达标率具有重要临床意义。为加强医务工作者对IS及TIA疾病长期管理及监测的认识，规范长期血脂管理临床实践，中国卒中学会医疗质量管理与促进分会组织相关脑血管病临床医学专家，基于循证证据和临床实践、经多轮专家意见收集和研讨，拟定本科学声明。本科学声明对IS及TIA患者长期血脂管理、长期血脂监测及重点患者血脂管理等方面进行了阐述，以期为提升IS及TIA患者的长期血脂管理临床规范提供参考。 Abstract: The disease burden is substantial among Chinese patients with ischemic stroke (IS) and TIA. High LDL-C level is an independent risk factor for stroke recurrence. It is of clinical significance to assess the reasons resulting in unfavorable LDL-C control in patients, develop further treatment strategies, monitor frequencies to improve the LDL-C target attainment rate. To strengthen the understanding of medical workers on the long-term management and monitoring of IS and TIA, and standardize clinical practice of long-term lipid management, this scientific statement was formulated by clinical experts in cerebrovascular disease organized by the Chinese Stroke Association’s Subcommittee on Medical Quality Management and Promotion. The scientific statement, based on evidence-based research, clinical practice, multiple rounds of expert opinion collection, and thorough discussions, elaborated on long-term lipid management, monitoring, and lipid management in high-risk patients in IS and TIA. It aims to provide reference for improving clinical in long-term lipid management for IS and TIA patients.

The disease burden is substantial among Chinese patients with ischemic stroke (IS) and TIA. High LDL-C level is an independent risk factor for stroke recurrence. It is of clinical significance to assess the reasons resulting in unfavorable LDL-C control in patients, develop further treatment strategies, monitor frequencies to improve the LDL-C target attainment rate. To strengthen the understanding of medical workers on the long-term management and monitoring of IS and TIA, and standardize clinical practice of long-term lipid management, this scientific statement was formulated by clinical experts in cerebrovascular disease organized by the Chinese Stroke Association’s Subcommittee on Medical Quality Management and Promotion. The scientific statement, based on evidence-based research, clinical practice, multiple rounds of expert opinion collection, and thorough discussions, elaborated on long-term lipid management, monitoring, and lipid management in high-risk patients in IS and TIA. It aims to provide reference for improving clinical in long-term lipid management for IS and TIA patients. [ABSTRACT FROM AUTHOR]

Despite numerous advances in all areas of cardiovascular care, cardiovascular disease (CVD) is the leading cause of death in the United States (US). There is compelling evidence that interventions to improve diet are effective in cardiovascular disease prevention. This clinical practice statement emphasizes the importance of evidence-based dietary patterns in the prevention of atherosclerotic cardiovascular disease (ASCVD), and ASCVD risk factors, including hyperlipidemia, hypertension, diabetes, and obesity. A diet consisting predominantly of fruits, vegetables, legumes, nuts, seeds, plant protein and fatty fish is optimal for the prevention of ASCVD. Consuming more of these foods, while reducing consumption of foods with saturated fat, dietary cholesterol, salt, refined grain, and ultra-processed food intake are the common components of a healthful dietary pattern. Dietary recommendations for special populations including pediatrics, older persons, and nutrition and social determinants of health for ASCVD prevention are discussed.

Scientific relevance. Lowering low-density lipoprotein cholesterol (LDL-C) levels with statins is a generally accepted standard treatment for dyslipidaemia. However, adverse reactions and intolerance to statins have motivated the search for lipid-modifying agents with alternative mechanisms of action. Bempedoic acid is one of these alternative agents.Aim. The study aimed to review published data on the mechanism of action, pharmacokinetics, pharmacodynamics, safety and efficacy of bempedoic acid used as a lipid-lowering agent.Discussion. Similar to statins, bempedoic acid inhibits cholesterol synthesis from acetyl-CoA. Statins and bempedoic acid differ in their mechanisms of action mainly because the conversion of bempedoic acid into its active metabolite takes place only in the liver. As a result, bempedoic acid does not cause adverse drug reactions in muscles. The main safety and efficacy data on bempedoic acid were obtained in phase III CLEAR trials. Compared to placebo, bempedoic acid reduced LDL-C levels by an additional 18% in combination with maximum tolerated doses of statins and by 25% in monotherapy in patients with statin intolerance. In the CLEAR Outcomes trial, long-term treatment with bempedoic acid reduced the risk of major adverse cardiovascular events in patients with statin intolerance (n=13970) by 13%. A slight increase in gout attack frequency was observed, primarily in patients with pre-existing hyperuricaemia.Conclusions. Therefore, bempedoic acid is a safe and effective treatment option for patients with dyslipidaemia at high risk of atherosclerotic cardiovascular disease. It can be used either in combination with statins or, in the case of statin intolerance, as monotherapy and with ezetimibe.

Background With the growing incidence of metabolic diseases, there has been increasing attention given to the prevention and control of metabolic syndrome (MS) . As important screening markers of MS, the relationship between lipid ratios and MS has become a hot research topic. Objective To analyse the association and predictive value of triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio, total cholesterol/HDL-C (TC/HDL-C) ratio, low-density lipoprotein cholesterol/ HDL-C (LDL-C/HDL-C) ratio and non-HDL-C to the risk of MS in populations included in a multistage cross-sectional study in Guizhou Province. Methods This study retrospectively selected natural populations (totally 21 727 cases) from Guizhou who attended the National Survey of Chronic Diseases and Risk Factors in Surveillance Regions 2010, China Chronic Disease and Risk Factor Surveillance 2013, and two waves of China Adult Chronic Disease and Nutrition Surveillance (2015 and 2018) . Baseline data were collected, and according to MS prevalence included in which, subjects were divided into MS group (n=4 981) and non-MS group (n=16 746) . The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C for MS in males and females, respectively. The Delong test was used to compare the values of area under the ROC curve (AUC) of lipid ratios in predicting MS. Multivariate Logistic regression was used to analyze the association of lipid ratios with MS measured using odds ratio (OR) with 95% confidence interval (CI) , and to identify factors associated with MS among subjects stratified by survey time, age, sex, body mass index (BMI) , smoking and alcohol consumption. Results There were statistically significant differences in mean age, sex ratio, distribution of ethnicities, education level and marital status, prevalence of smoking and alcohol consumption, and mean BMI, TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C between MS group and non-MS group (P

Objective To analyze the effects of low -density lipoprotein cholesterol (LDL -C), high -density lipoprotein cholesterol (HDL-C), and the ratio (LDL-C/HDL-C) on the risk of hypertension, and to provide reference for the prevention and treatment of hypertension. Methods The data of this study came from the natural population cohort in Guizhou Province, which was established in 2010 and followed up from 2016 to 2020. The data were analyzed by/-test and Chi-square test with the use of SPSS20.0. The effects of LDL-C, HDL-C, and LDL-C/HDL-C on hypertension were analyzed by Cox proportional hazard regression model. The corrected risk ratio (adjusted hazard ratio, aHR) and its 95% confidence interval (95% CT) were calculated, and the dose -response relationship was described by restricted cubic spline method. Subgroup analyses by genders and ages were performed • Results A total of 5 388 participants were included and were followed up for 37 47537 person-years. During the follow-up period, there were 1 160 new cases of hypertension, and the incidence density was 30.96/1 000 person-years. The results of Cox proportional hazard regression model analysis showed that after adjusting the related factors, for every unit increase of LDL-C and LDL-C/HDL-C in the whole population, the risk of hypertension increased by 17% (aHR=lA7, 95%CI: 1.09-126) and 6% (aHR=1.06, 95%CI: L02_l.il), LDL-C and LDL-C/HDL-C were grouped according to quartile method and included in the model as classified variables. Compared with QI, the aHR of Q4 hypertension was 1.59 (95%CZ: 1.28-1.98) and 1.44 (95%CZ:1.20-1.71), respectively. Subgroup analysis showed that the risk of hypertension in Q4 was 146 (95%CZ: 1.08-1.99), L81 (95%CZ: 132-247), 1.53 (95%C?:1.21 -1.94)，and 240 (95C7:1.23-4.66) in men, women, < 65 years old, and 3 65 years old respectively compared with QI of LDL-C. Compared with QI of LDL-C/HDL-C, the risk of hypertension in Q4 was 1.41 (95%CZ: 1.10-1.82), 1.51 (95%CZ: 1.18--1.94), 1.41 (95%Cf: 1.16-1.70), and 2.09 (95%CI: 1.27-3.44)，respectively. The results of restricted cubic spline showed that the levels of LDL-C and LDL-C/HDL-C were positively correlated with the risk of hypertension. Conclusion The increase of LDL-C and LDL-C/HDL-C are the risk factors of hypertension, especially in women and people over 65 years old. [ABSTRACT FROM AUTHOR]

Background and aim: There are few prospective data on the prognostic value of normal admission low-density lipoprotein cholesterol (LDL-C) in statin-naïve patients with acute coronary syndromes (ACS) who are treated with a preemptive invasive strategy. We aimed to analyze the proportion of patients with normal LDL-C at admission for ACS in our practice, and their characteristics and clinical outcomes in comparison to patients with high admission LDL-C. Patients and methods: Two institutions’ prospective registries of patients with confirmed ACS from Jan 2017 to Jan 2023 were used to identify 1579 statin-naïve patients with no history of prior coronary artery disease (CAD), and with available LDL-C admission results, relevant clinical and procedural data, and short- and long-term follow-up data. Normal LDL-C at admission was defined as lower than 2.6 mmol/L. All demographic, clinical, procedural, and follow-up data were compared between patients with normal LDL-C and patients with a high LDL-C level (≥2.6 mmol/L) at admission. Results: There were 242 (15%) patients with normal LDL-C at admission. In comparison to patients with high LDL-cholesterol at admission, they were significantly older (median 67 vs. 62 years) with worse renal function, had significantly more cases of diabetes mellitus (DM) (26% vs. 17%), peripheral artery disease (PAD) (14% vs. 9%), chronic obstructive pulmonary disease (COPD) (8% vs. 2%), and psychological disorders requiring medical attention (19% vs. 10%). There were no significant differences in clinical type of ACS. Complexity of CAD estimated by coronary angiography was similar between the two groups (median Syntax score 12 for both groups). There were no significant differences in rates of complete revascularization (67% vs. 72%). Patients with normal LDL-C had significantly lower left ventricular ejection fraction (LVEF) at discharge (median LVEF 52% vs. 55%). Patients with normal LDL-C at admission had both significantly higher in-hospital mortality (5% vs. 2%, RR 2.07, 95% CI 1.08–3.96) and overall mortality during a median follow-up of 43 months (27% vs. 14%, RR 1.86, 95% CI 1.45–2.37). After adjusting for age, renal function, presence of diabetes mellitus, PAD, COPD, psychological disorders, BMI, and LVEF at discharge in a multivariate Cox regression analysis, normal LDL-C at admission remained significantly and independently associated with higher long-term mortality during follow-up (RR 1.48, 95% CI 1.05–2.09). Conclusions: A spontaneously normal LDL-C level at admission for ACS in statin-naïve patients was not rare and it was an independent risk factor for both substantially higher in-hospital mortality and mortality during long-term follow-up. Patients with normal LDL-C and otherwise high total cardiovascular risk scores should be detected early and treated with optimal medical therapy. However, additional research is needed to reveal all the missing pieces in their survival puzzle after ACS—beyond coronary anatomy, PCI optimization, numerical LDL-C levels, and statin therapy.

The phenolic content of olive oil has a role in cardiovascular protection. Some clinical trial studies demonstrated that phenolic compounds of olive oil have antioxidant activity which can protect macronutrients from oxidative damages. The aim of this study was to summarize the results of clinical trials which assessed the effects of high‐ versus low‐phenol olive oil on oxidative stress biomarkers levels. We searched Scopus, PubMed, Web of Science, Google Scholar, ProQuest, and Embase up to July 2021. Eight clinical trials which evaluated the effect of the phenolic content of olive oil on oxidized‐LDL (ox‐LDL), malondialdehyde (MDA), or ferric‐reducing ability of plasma (FRAP) were included the meta analysis. A significant decrease was observed in ox‐LDL level (WMD: −0.29 U/L; 95% CI: −0.51, −0.07) and MDA (WMD: −1.82 μmoL/L; 95% CI: −3.13, −0.50). However, after subgroup analysis for MDA, the result was not significant for not serious limitation (SMD: −0.05, 95% CI: −0.35 to 0.24), but significant for serious limitation (SMD: −3.64, 95% CI: −4.29 to −2.99). Also, no significant change was found in FRAP (WMD: 0.0 mmoL/L; 95% CI: −0.03, 0.04) level. Dose–response analysis indicated a significant linear relationship between the phenolic content of olive oil and ox‐LDL. The present study showed some beneficial effects of high‐phenol compared with low‐phenol olive oil on ox‐LDL and MDA levels. According to the meta‐regression analysis along with the increasing phenolic content of olive oil, a reduction in oxidative stress biomarkers was observed. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia, a major risk factor for atherosclerotic cardiovascular disease, can be prevented by lowering low-density lipoprotein cholesterol (LDL-C) levels. The lipid improvement effects of Daeshiho-tang (DSHT), a herbal formula, have been proven through various preclinical studies based on anti-obesity and anti-inflammatory properties, however, clinical trials were few. This preliminary study aimed to assess the lipid-lowering effect of DSHT in patients with dyslipidemia and examine its safety profile. The study was a randomized, double-blind, placebo-controlled trial. The trial included 60 patients with untreated dyslipidemia: total cholesterol (TC) > 200 mg/dL, triglyceride (TG) > 150 mg/dL, LDL-C >130 mg/dL, or high-density lipoprotein cholesterol (HDL-C)

Background: Many of the patients with coronary heart disease require lifelong statin administration. Patients usually discontinue the medicine either due to side effects like myalgia, hepatotoxicity or due to the cost of the medicine. The aim of this study is to see the scope of adjustment of the regimen to alternate-day dosing as an option to be considered in patients for whom adverse effects or cost are issues. Materials and Methods: A comparative, prospective, parallel group and open study was performed on forty- two patients of both genders with dyslipidaemia within the age group of 30 to 60 years attending the out – patients department of Medicine of Nobel Medical College and Teaching Hospital from February 2020 to March 2020. Mean reductions in different lipid fractions in the two treatment groups over the eight-week study period was calculated and then compared. Frequencies of patients developing different side effects was also calculated and compared between the two groups. Results: Baseline characters of both the groups were well balanced. Low density lipoprorein-C was reduced by 33.8 % in once-daily group and 31.3 % in alternate-day group, respectively. Changes were also recorded for the other lipid parameters. Such changes were found to be of no significant difference when compared between the two groups (p>0.05). Conclusion: An alternate-day regimen of statin in patients of hyperlipidaemia showed similar effect on the lipid panel compared to daily regimen.

Objective: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the world. The proprotein convertase subtilisin/kexin type 9 ( PCSK9 ) E670G polymorphism has been reported to be associated with variability in levels of low density lipoprotein cholesterol, a risk factor for CAD. However, the relationship between PCSK9 E670G and CAD is still not fully elucidated., Methods: A total of 225 patients and 189 control subjects were recruited in this study. DNA was extracted from peripheral blood samples and was genotyped by mass array method. In addition, we also conducted a meta-analysis of case-control studies to elucidate the relationship of CAD and polymorphism., Results: The GG genotype of PCSK9 E670G was associated with a higher risk of CAD [odds ratio (OR) 2.994, 95% confidence interval (CI): 1.174-7.631], even adjusting for risk factors (OR 2.794, 95% CI: 1.215-7.460). Logistic regression analysis showed that the dominant genetic model increased the CAD risk (OR 2.313, 95% CI: 1.070-6.983) after adjusting the confounding factors. Meta-analysis results of 13 studies revealed that PCSK9 E670G polymorphism was correlated with CAD risk under different genetic models., Conclusion: Our results demonstrated that PCSK9 E670G genotype was associated with a high risk of CAD.

Objective: Several equations have been proposed as alternatives for the reference method of measuring low-density lipoprotein cholesterol (LDL-C). This study aimed to evaluate these alternatives in comparison to the homogeneous method and validate their clinical utility., Methods: Data on the lipid profiles of 1,006 Sudanese individuals were analyzed. The paired t-test was used to compare the results of direct and calculated LDL-C. Bland-Altman plots were used to demonstrate the differences between the measured and calculated LDL-C against the mean values. Linear regression was conducted, using the correlation coefficient ( r ) to quantify the relationship between methods. The bias between measured and calculated LDL-C was compared to the National Cholesterol Education Program Laboratory Standardization Panel criteria (i.e., accuracy within ±4% of expected values)., Results: The Martin and Anandaraja equations showed no significant difference compared to directly measured LDL-C ( p >0.05). The DeLong equation indicated an insignificant difference only with a 99% confidence interval ( p >0.01). The Martin, DeLong, and Teerakanchana equations exhibited the smallest limits of agreement, with data points concentrated closely around the mean difference line. Linear regression analysis revealed strong positive correlations ( r >0.8) for most equations, except for the Ahmadi equation. The DeLong, Rao, and Martin equations demonstrated superior performance for LDL cutoff points (bias within ± 4%). The DeLong formula also showed superior performance at different lipid levels, closely followed by the Martin equation (bias within ±4%)., Conclusion: The DeLong and Martin equations outperformed others, such as the widely used Friedewald equation, in calculating LDL-C. Further validation studies are needed., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (© 2024 The Korean Society of Lipid and Atherosclerosis.)

Yingbei Weng, Ripeng Yin, Lala Qian, Zhi Chen, Jie Wang, Huaqiang Xiang, Yangjing Xue, Kangting Ji, Xueqiang Guan Department of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People’s Republic of ChinaCorrespondence: Kangting Ji; Xueqiang GuanDepartment of Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Xueyuanxi Road, No. 109, Wenzhou, 325000, Zhejiang, People’s Republic of ChinaEmail jikt@wzmc.edu.cn; wzsgxq@163.comObjective: The aims of this study were to investigate the relationship between low-density lipoprotein cholesterol (LDL-C) levels and all-cause mortality in coronary care unit (CCU) patients, adjusting for a wide range of potential confounding factors, to examine the potential of LDL-C in predicting the prognostic value of CCU patients.Methods: Clinical data were extracted from Medical Information Mart for Intensive Care-III database (MIMIC-III database version v.1.4). Baseline data were collected within 24 hours after the patient was first admitted to the hospital. The primary endpoint of our study is 30-day all-cause mortality. The secondary endpoints are 90-day and one-year all-cause mortality and infections. Cox proportional hazard regression and propensity score-matched (PSM) analysis were used to analyze the association between LDL-C levels and prognostic value of CCU patients.Results: We included a total of 1476 patients with an average age of 66.7 ± 14.1 years (66% male). For 30-day all-cause mortality, the hazard ratio (95% confidence interval) of high LDL-C level group (≥ 55 mg/dl) was 0.42 (0.29, 0.62), which was compared with low LDL-C level group (< 55 mg/dl) in unadjusted model. After adjusting for age, gender and race, the association still existed (P < 0.05), and the HR (95% CI) was 0.49 (0.33, 0.72). Further adjustment of possible covariates showed similar correlation (P < 0.05), and HR (95% CI) was 0.65 (0.43, 0.97). Similar correlations were observed for 90-day and one-year all-cause mortality. The relationship between all-cause mortality and LDL-C levels in CCU patients was further verified by propensity score-matched (PSM) analysis. In addition, the higher the LDL-C level, the lower the risk of infection, odds ratio (OR) values in the three models were less than 1 (P < 0.05).Conclusion: Our data suggest that high LDL-C level is associated with a reduced risk of 30-day, 90-day, and one-year mortality of patients in the CCU. And this result is still stable in the PSM model. The results need to be verified in prospective trials.Keywords: low-density lipoprotein cholesterol, coronary care unit, all-cause mortality, cardiovascular disease

Abstract Background Life expectancy has greatly increased, generating an improvement in screening programs for disease prevention, lifesaving drugs and medical devices. The impact of lowering low-density lipoprotein cholesterol (LDL-C) in the very elderly is not well-established. Our aim was to explore the association of LDL-C, high density lipoprotein cholesterol (HDL-C) and lipid lowering drugs (LLDs) on cognitive decline, malignancies and overall survival. Methods This was a retrospective cohort study. Our study comprised 1498 (72.7%) males and 561 (27.3%) females, aged ≥70 who had attended the Institute for Medical Screening (IMS), Sheba Medical Center, Israel at least twice during 2013–2019. Data were obtained from the computerized database of the IMS. A manual quality control to identify potential discrepancies was performed. Results Overall, 6.3% of the subjects treated with LLDs (95/1421) versus 4.2% not treated (28/638), cognitively declined during the study years. No statistically significant effects of LDL-C, HDL-C and LLDs on cognitive decline were observed after correcting for age, prior stroke and other vascular risk factors. With regard to cancer, after adjusting for confounders and multiple inferences, no definite relationships were found. Conclusions This analysis of an elderly, high socioeconomic status cohort suggests several relationships between the use of LLDs and health outcomes, some beneficial, especially, with regard to certain types of cancer, but with a higher risk of cognitive decline. Further studies are warranted to clarify the health effects of these medications in the elderly.

Background Limited information is available on detailed sex/age-specific associations between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD) mortality and 'the optimal range' associated with the lowest CVD mortality in the general population. Methods Korean adults (N  = 14 884 975) who received routine health screenings during 2009–2010 were followed until 2018 for CVD mortality. Results During 8.8 years (mean) of follow-up, 94 344 individuals died from CVD. LDL-C had U-curve associations with mortality from CVD and its subtypes, except haemorrhagic stroke. Optimal range was 90–149 mg/dL for CVD; 70–114 for ischaemic heart disease; 85–129 for ischaemic stroke; ≥85 for subarachnoid haemorrhage; ≥130 for intracerebral haemorrhage; 115–159 for hypertension and heart failure; and 100–144 for sudden cardiac death. Assuming linear associations between 100 and 300 mg/dL, LDL-C was positively associated with CVD mortality [hazard ratio (HR) per 39-mg/dL (1-mmol/L) higher LDL-C = 1.10], largely due to ischaemic heart disease (HR = 1.26), followed by sudden cardiac death (HR = 1.13), ischaemic stroke (HR = 1.11) and heart failure (HR = 1.05). Intracerebral haemorrhage (HR = 0.90), but not subarachnoid haemorrhage, had inverse associations. Women and older adults had weaker positive associations than men and younger adults (P interaction < 0.001 for both sex and age). Individuals aged 75–84 years had modest positive associations with CVD mortality, especially ischaemic heart disease and ischaemic stroke. Conclusion LDL-C had U-curve associations for CVD mortality. The associations and optimal ranges differed across CVD subtypes. Women and older adults had weaker positive associations than men and younger adults. Positive associations with ischaemic heart disease and ischaemic stroke were maintained in adults aged 75–84 years. [ABSTRACT FROM AUTHOR]

Xiao Tang,1 Hongya Zhang,1 Yanxiang Zhao,2 Fang Lei,1 Qigui Liu,1 Dongmei Hu,1 Guorong Li,1 Guirong Song1 1Department of Health Statistics, School of Public Health, Dalian Medical University, Dalian City, Liaoning Province, 116044, People’s Republic of China; 2Department of Mathematics, George Washington University, Washington, DC, USACorrespondence: Guirong SongDepartment of Health Statistics, School of Public Health, Dalian Medical University, No. 9 South Road, Lvshun District, Dalian City, Liaoning Province, 116044, People’s Republic of ChinaTel +86-411-86110328Email songsara110@163.comBackground: Obesity is well recognized as a risk factor for cardiometabolic diseases. The development of obesity is a dynamic process that can be described as a multistate process with an emphasis on transitions between weight states. However, it is still unclear what convenient biomarkers predict transitions between weight states. The aim of this study was to show the dynamic nature of weight status in adults stratified by age and sex and to explore blood markers of metabolic syndrome (MetS) that predict transitions between weight states.Methods: This study involved 9795 individuals aged 18 to 56 at study entry who underwent at least two health check-ups in the eight-year period of study in the health check-up centre of our institution. Weight, height and biochemical indices were measured at each check-up. The participants were divided into four groups based on age and sex (young male, middle-aged male, young female and middle-aged female groups). A multistate Markov model containing 3 states (healthy weight, overweight and obesity) was adopted to study the longitudinal weight data.Results: Young people were more likely to transit between weight states than middle-aged people, and middle-aged people were more resistant to recover from worse states. The mean sojourn time in obesity was greatest in the middle-aged male group (6.23 years), and the predicted rate of obesity beginning with healthy weight was greatest in the young male group (13.7%). In multivariate models, age group and triglyceride (TG) and high-density lipoprotein cholesterol (HDL) levels were significant for specific transitions in females, whereas age group and HDL levels were significant in males. In females, if HDL levels increased 1 mmol/L, the probability of progression from healthy weight to overweight decreased by 37.0% (HR= 0.63), and the probabilities of recovery (overweight to healthy weight and obesity to overweight) increased by 62.0% (HR= 1.62) and 1.23-fold (HR= 2.23), respectively. In males, if TG levels increased 1 mmol/L, the risk of progression from healthy weight to overweight increased by 24.0% (HR= 1.24). Each unit increase in HDL levels was associated with a 0.99-fold (HR= 1.99) increase in the chance of recovery from overweight to healthy weight and with a 0.37-fold (HR= 0.63) decrease in the risk of progression from healthy weight to overweight.Conclusion: The weight status of young people was less stable than that of middle-aged people. Males were more likely to become overweight and more resistant to recover from worse states than females. Young males with healthy weight were more likely to develop obesity than other healthy weight groups. Blood lipid levels, especially HDL, were predictors of weight transitions in adults. Prevention and intervention measures should be applied early.Keywords: obesity, multistate Markov model, triglyceride, high-density lipoprotein cholesterol, low density lipoprotein cholesterol

Anandita Agarwala,1 Renato Quispe,2 Anne C Goldberg,3 Erin D Michos2 1Division of Cardiology, Baylor Scott and White Health, Heart Hospital Baylor Plano, Plano, TX, USA; 2Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 3Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, USACorrespondence: Erin D MichosCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USATel +410-502-6813Email edonnell@jhmi.eduAbstract: Bempedoic acid is a first-in-class, oral, inhibitor of cholesterol biosynthesis that is approved for use in patients with atherosclerotic cardiovascular disease (ASCVD) and for primary prevention in individuals with heterozygous familial hypercholesterolemia (HeFH) by the United States Food and Drug Administration. Pooled data from the phase III clinical trials, CLEAR Harmony and CLEAR Wisdom, have demonstrated the safety and efficacy of bempedoic acid with regard to lowering of low-density lipoprotein cholesterol (LDL-C) in patients with HeFH as an adjunct or alternative to currently existing lipid-lowering therapies. CLEAR Outcomes is a cardiovascular outcomes trial that is currently underway that will provide additional insight as to where bempedoic acid will fit into treatment regimens among the non-statin lipid-lowering therapy options. Patients who might particularly benefit from bempedoic acid are those with HeFH and those unable to take adequate doses of statins or take any statin therapy altogether who need additional LDL-C lowering. In this review, we will discuss the profile of bempedoic acid from its design, development, and its place in therapy for the management of LDL-C for the purposes of ASCVD prevention.Keywords: bempedoic acid, familial heterozygous hypercholesterolemia, lipids, atherosclerotic cardiovascular disease, prevention, low-density lipoprotein cholesterol

Panisa Manasirisuk,1 Nanthaphan Chainirun,1,2 Somsak Tiamkao,2,3 Sunee Lertsinudom,4 Kutcharin Phunikhom,5 Bundit Sawunyavisuth,6 Kittisak Sawanyawisuth3 1Department of Pharmacy Service, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand; 3Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 4Division of Pharmaceutical Care, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand; 5Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 6Department of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Nanthaphan ChainirunDepartment of Pharmacy Service, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, ThailandEmail kanokwanchainirun@yahoo.comKittisak SawanyawisuthDepartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, ThailandTel +66-43-363664Fax +66-43-348399Email kittisak@kku.ac.thBackground: The ability of statins to reduce LDL-c plays an important role in both primary and secondary prevention of atherosclerotic cardiovascular diseases. Such treatment can often be costly, but using generic atorvastatin may reduce cost by up to US$2635. In addition, a previous 8-week study found that it exhibited comparable efficacy to the brand-name medication. This study aimed to evaluate the efficacy of generic atorvastatin over a longer period of six months in a real-world setting.Methods: This was a retrospective cohort study in adult patients who had received brand-name atorvastatin for at least three months and then had switched to generic atorvastatin for at least six months. Lipid and safety profiles were evaluated at six months after switching. Adjusted analyses for age, sex, co-morbid disease, dosage, and indications for statin therapy were also performed.Results: During the study period, there were 488 patients who met the study criteria. The mean (SD) age of the patients was 60.97 (12.26) years, and 48.36% were male (236 patients). At six months, average total cholesterol, HDL-c, and LDL-c were all lower, from 174.43 to 166.15 mg/dL, from 51.64 to 49.51 mg/dL, and from 110.08 to 100.78 mg/dL (p < 0.001), respectively. There were no significant differences in terms of any other laboratory test results. LDL-c exhibited the highest significant reduction at 9.30 mg/dL. Stratified analyses by age, sex, co-morbid disease, dose, and indications for statin therapy revealed similar decreases in HDL-c and LDL-c as in the study population as a whole.Conclusion: Generic atorvastatin resulted in significantly lower LDL-c than name-brand atorvastatin but less of an increase in HDL-c.Keywords: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, HMG CoA reductase inhibitors

Homozygous familial hypercholesterolemia (HoFH) is a rare autosomal recessive genetic disorder. It is difficult to diagnose and treat it at early stage. We present a nine-year-old boy with HoFH from China. At the beginning, he was misdiagnosed as xanthomatosis in the dermatology department of the local hospital, but the disease did not alleviate after three laser ablation operations. Later, blood lipid monitoring, ultrasound of heart and carotid artery were further added in our hospital, and finally the boy was diagnosed with HoFH by genetic testing. A biallelic mutations was observed in the fourth exon of low density lipoprotein receptor (LDLR): c.418G>A (p.E140K). Our patient achieved a relatively satisfactory therapeutic results after a series of lipid-lowering therapies including atorvastatin monotherapy, lipoprotein apheresis and double-filtration plasma pheresis. We found that LDL-C levels obtained 57% reduction from baseline after atorvastatin combined with double-filtration plasma pheresis (DFPP). It was observed that regression of carotid intima-media thickness (cIMT), valve regurgitation and xanthoma occurred after a series of Intensive lipid-lowering therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Pemafibrate, a selective PPARα modulator, has the beneficial effects on serum triglycerides (TGs) and very low density lipoprotein (VLDL), especially in patients with diabetes mellitus or metabolic syndrome. However, its effect on the low density lipoprotein cholesterol (LDL-C) levels is still undefined. LDL-C increased in some cases together with a decrease in TGs, and the profile of lipids, especially LDL-C, during pemafibrate administration was evaluated. Methods Pemafibrate was administered to type 2 diabetes patients with hypertriglyceridemia. Fifty-one type 2 diabetes patients (mean age 62 ± 13 years) with a high rate of hypertension and no renal insufficiency were analyzed. Pemafibrate 0.2 mg (0.1 mg twice daily) was administered, and serum lipids were monitored every 4–8 weeks from 8 weeks before administration to 24 weeks after administration. LDL-C was measured by the direct method. Lipoprotein fractions were measured by electrophoresis (polyacrylamide gel, PAG), and LDL-migration index (LDL-MI) was calculated to estimate small, dense LDL. Results Pemafibrate reduced serum TGs, midband and VLDL fractions by PAG. Pemafibrate increased LDL-C levels from baseline by 5.3% (− 3.8–19.1, IQR). Patients were divided into 2 groups: LDL-C increase of > 5.3% (group I, n = 25) and

Abstract Background Enzyme replacement therapy (ERT) with olipudase alfa, a recombinant human acid sphingomyelinase (rhASM), is being developed to treat patients with ASM deficiency (ASMD), commonly known as Niemann–Pick disease (NPD) types A or B. This study assessed the effect of ERT on lipid parameters and inflammatory markers. Methods Serum and plasma samples from five adults with NPD type B (NPD-B) who received olipudase alfa ERT for 26 weeks were analysed. We also collected fasting blood samples from fifteen age- and sex-matched participants as reference and comparison group. We measured fasting lipid profile, apolipoproteins B48 and B100 (apoB48 and apoB100), apolipoprotein A1 (apoA1), proprotein convertase subtilisin/klexin type 9 (PCSK9) mass, oxidised low-density lipoprotein (oxLDL), small dense low-density lipoprotein cholesterol (sdLDL-C) and tumour necrosis factor α (TNF-α). Results Patients with NPD-B, compared with age and sex matched reference group, had higher triglycerides, PCSK9, apoB48, oxLDL and TNF-α and lower high density lipoprotein cholesterol (HDL-C) and apoA1. Treatment with ERT was associated with improved lipid parameters including total cholesterol, triglycerides, low density lipoprotein cholesterol (LDL-C), sdLDL-C, oxLDL and apoB100. Though there was an increase in apoA1, HDL-C was slightly reduced. TNF-α showed a reduction. ApoB100 decreased in parallel with a decrease in total serum PCSK9 mass after ERT. Conclusion This study demonstrated that patients with NPD-B had a proatherogenic lipid profile and higher circulating TNF-α compared to reference group. There was an improvement in dyslipidaemia after olipudase alfa. It was possible that reductions in LDL-C and apoB100 were driven by reductions in TNF-α and PCSK9 following ERT.

Abstract Background Familial hypercholesterolemia(FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and non-traditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease(ASCVD) in this population. The aims of the study were: (a) to identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b) to evaluate the risk of new cardiovascular events at follow-up in FH patients stratified by lipid-lowering agents. Methods This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network(DLCN) and Simon Broome(SM) scores, 61 patients with DLCN score above 3 and possible/probable FH(SM score) were included. Results Nine hundred-eighty patients were examined and 61 (6.2%) were received the clinical diagnosis of FH. The mean age was 48.5±12.5 years, with more female patients than male patients (63.9% versus 36%). Hypertension was the main cardiovascular risk factor for both genders, followed by physical inactivity and obesity for the female group and active smoking for the male group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. The effective lipid-lowering drugs used were statin alone and statin in association with fenofibrate, which improved both the lipid profile values and the subclinical atherosclerosis markers (ankle-brachial index, carotid intima-media thickness and high-sensitivity C-reactive protein). New ASCVDs that emerged during the study were most commonly represented by coronary heart disease and stroke. At the same time, the new cardiovascular events were delayed in patients receiving the lipid-lowering drugs, without significant differences between them. Conclusions In patients with suspected FH, the lipid-lowering agents during the follow-up period delayed the new cardiovascular events, yet failed to reach the goals proposed by the guidelines.

Introduction: Conventionally, Friedewald's formula has been used to calculate Low Density Lipoprotein-Cholesterol (LDL-C) due to its simplicity and convenience although it has limitations. Many researchers have proposed different formulae to increase the accuracy of calculated LDL-C, but none of those have concluded about a single best formula owing to differences in selected study populations. As LDL-C measurement is of utmost importance for assessing the cardiovascular risk according to National Cholesterol Education Programme's (NCEP) Adult Treatment Panel III (ATP III), a search for a better formula to improve accuracy of cardiovascular disease (CVD) risk prediction is essential. Aim: To assess the validity of calculated LDL-C by nine formulae and compare them to values obtained by the direct method. Materials and Methods: A total of 324 participants were assessed retrospectively for serum lipid profile by standard methods from December 2020 to February 2021 at Employee State Insurance Corporation Medical College and Hospital, Sanathnagar, Hyderabad, Telangana, India. LDL-C was calculated using nine different formulae (Ahmadi, Anand, Chen, de Cordova, Friedewald, Hattori, Martin-Hopkins, Puavillai and Vujovic) and correlated with direct LDL-C. For further analysis, subjects were divided into five groups based on the Triglyceride levels (TG) viz; group 1 (TG <100 mg/dL), group 2 (TG: 100-150 mg/dL), group 3 (TG: 151-200 mg/dL), group 4 (TG: 201-400 mg/dL), group 5 (TG >400 mg/dL). Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 23.0. Results: Total of 324 lipid profile reports were analysed and calculated LDL-C by nine formulas were compared. At TG levels <100 mg/dL, Puavillai was the most accurate. Between TG levels 100-200 mg/dL, Martin-Hopkins showed better accuracy and correlation with direct LDL-C. At TG levels 201-400 and >400 mg/dL, Puavillai had better accuracy. But, none of the formulae showed strong correlation with Direct LDL-C at TG >400 mg/dL. ROC curves also showed that Puavillai performed better among all formulae, at all TG levels. Conclusion: Among the nine equations, Puavillai and Martin-Hopkins showed highest accuracy and better performance than others in the present study population. Martin-Hopkins can be used at TG levels of 100-200 mg/dl while Puavillai can be used at lower and higher TG levels in this demographic population for estimating LDL-C. [ABSTRACT FROM AUTHOR]

Mortality from cardiovascular diseases (CVD) in Russian Federation (RF) remains one of the highest in the world. Compared to 2003, the mortality from CVD decreased by 37%, but when compared with most European countries, it is 3 times higher. Most deaths (53%) occur due to coronary heart disease. While analyzing reasons of mortality, total economic impact due to hypercholesterolemia in RF is estimated as 1,3 trillion RUR annually. The prevalence of hypercholesterolemia is in more than 50% of working-age population in RF. Due to AISBERG study, the prevalence of HCE in ambulatory practice in RF is 84%. When using lipid-lowering medications, the frequency of reaching of target total cholesterol level does not exceed 12%. Active actions on primary and secondary prevention are needed to low mortality rate from CVD, including active promoting of healthy lifestyle, and prescribing if necessary of lipid-lowering therapy (LLT) regimens. The paper deals with significance of target low density lipoprotein cholesterol level in accordance with the latest recommendations as the main aim for LLT. Combined LLT with one of the most potent statins rosuvastatin and ezetimibe seems to be effective and safe strategy for achieving target lipid level in different populations of patients. At present, Rosulip Plus is available in Russia - an quantitative and proven combination of rosuvastatin and ezetimibe.

Abstract Background Green tea drinking has been proven to lower lipid and exert cardiovascular protection, while the potential mechanism has not been fully determined. This study was to investigate whether the beneficial impact of epigallocatechingallate (EGCG), a type of catechin in green tea on lipids is associated with proprotein convertase subtilisin/kexin type 9 (PCSK9) pathways. Methods We studied the effects and underlying molecular mechanism of EGCG or green tea on regulating cholesterol from human, animal and in vitro. Results In the age- and gender-matched case control observation, we found that individuals with frequent tea consumption (n = 224) had the lower plasma PCSK9 and low density lipoprotein cholesterol (LDL-C) levels compared with ones without tea consumption (n = 224, p

Background: The aim of this study was to compare LDL-C estimations using various equations with directly measured LDL-C and to find the most accurate and reliable equation for measuring serum LDL-C at different triglycerides level. Materials and Methods: In this study, we performed a retrospective analysis on the database of our Laboratory Information System to retrieve results of lipid profile in patients visiting Dhulikhel Hospital during the period of 6 months. A total of 1420 participants were classified into three groups according to triglyceride (TG) concentrations as follows: 199 mg/dL. LDL-C was calculated using the Friedewald, Chen, Vujovic, Hattori, Anandaraja and modified Friedewald equations and compared with directly measured LDL-C concentration (enzymatic method on Biosystems, BA-400). Results: In most of the instances, calculated LDL-C value was higher than the directly measured LDL-C values with negative mean difference with the exception of Hattori equation. The intraclass correlation coefficient (ICC) between the estimated and directly-measured LDL-C was higher with the Friedewald equation (ICC=0.917; 95% CI: 0.904-0.927) for all serum TG ranges compared with other equations. The reliability of all the equations was good with ICC being above 0.75 while that of the Friedewald equation was excellent in all the TG groups with ICC being above 0.9. Hattori equation was better in estimating LDL-C at normal TG range (ICC=0.927; 95% CI: 0.917-0.937) and borderline high TG (ICC= 0.933; 95% CI: 0.908-0.951). Conclusion: Calculated LDL-C using appropriate equations can be an alternative cost-effective tool to measure LDL-C when the direct measurement cannot be afforded.

Abstract Objectives Numerous studies have reported that lipid metabolic abnormalities may play an important role in the development of Parkinson’s disease (PD), with mixed results. This meta-analysis aims to systematically assess the relationship between serum cholesterol or triglyceride and the PD risk and to further determine the role of dyslipidemia in potential predictive value. Methods This research systematically consulted and screened observational studies to evaluate the association of serum lipids with the risk of PD as of April 01, 2020 based on the inclusion and exclusion criteria. Two researchers screened and extracted the data independently. Then this article summarized the characteristics of all clinical studies and collected the corresponding data to perform pooled and sensitivity analyses. The meta-analysis was performed by using the RevMan 5.3 software after data extraction, quality assessment and analysis of publication bias. Results Twenty-one related studies (13 case-control and 8 cohort studies) were selected with a total of 980,180 subjects, including 11,188 PD patients. Meta-analysis showed that higher levels of serum triglyceride (S-TG) [standard mean different (SMD) = − 0.26 (95% confidence interval (CI): − 0.39 to − 0.13, p

Aim. To study the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, alirocumab, on lipid levels in patients who receive secondary prevention of cardiovascular diseases (CVD) and require enhanced lipid-lowering therapy.Material and methods. The study included 49 patients (aged of 61.53±1.14 years; 31 [63.3%] men) receiving alirocumab who did not reach the target low density lipoprotein cholesterol (LDL-C) concentrations despite the ongoing optimal lipid-lowering therapy. In all patients, the initial level of lipids was evaluated, as well as their parameters after subsequent alirocumab injections.Results. LDL-C serum level significantly decreased after the first injection compared to the initial level from 2.92±0.22 to 1.65±0.19 mmol/L (p

Abstract Background Real-world evidence of low-density lipoprotein cholesterol (LDL-C) goal attainment rates for Asian patients is deficient. The objective of this study was to assess the status of dyslipidemia management, especially in high-risk patients with cardiovascular disease (CVD) including stroke and acute coronary syndrome (ACS). Methods This was a retrospective cohort study of 514,866 subjects from the National Health Insurance Service-National Health Screening Cohort database in Korea. Participants were followed up from 2002 to 2015. Subjects with a high-risk of CVD prior to LDL-C measurement and subjects who were newly-diagnosed for high-risk of CVD following LDL-C measurement were defined as known high-risk patients (n = 224,837) and newly defined high-risk patients (n = 127,559), respectively. Data were analyzed by disease status: stroke, ACS, coronary heart disease (CHD), peripheral artery disease (PAD), diabetes mellitus (DM) and atherosclerotic artery disease (AAD). Results Overall, less than 50% of patients in each disease category achieved LDL-C goals (LDL-C

Introduction: Low-density lipoprotein cholesterol (LDL-C) is widely recognized as an established cardiovascular risk marker. Recent studies have shown that Friedewald underestimates LDL-C at lower levels, which could result in under treatment of high-risk patients of Atherosclerotic cardiovascular disease (ASCVD). A novel method Martin/Hopkins (LDL-CN) using a patient-specific conversion factor provides more accurate calculated LDL-C levels, LDL-C estimation is very important in high-risk patients to consider therapy. Aims: To compare LDL-C values by using two formulae and direct estimation. Materials and methods: A prospective study was undertaken in Department of Biochemistry in 1393 subjects from Dec 2018 to March 2019 with mean age of (53.23±13.36). LDL-C was calculated by using Friedewald formula LDL-C (LDL-CF) and Martin/Hopkins equation (LDL-CN) in 1000 subjects with Triglycerides (TG) 400 ldl was directly estimated (LDL-CD) with kit in Beckman coulter Dxc860i. Results: For this analysis, the mean age was (53.23±13.36). In 1000 patients, with TG400 mg/dl, the mean of LDL-CF (71.83±55.93mg/dl), was significantly lower compared to LDL-CD (104.17±41.6mg/dl) and LDL-CN (107.37±42.73mg/dl). p value was significant between Martin/Hopkins and Friedewald (400mg/dl to treat high risk cases of ASCVD.

Introduction: Conventionally, Friedewald’s formula has been used to calculate Low Density Lipoprotein- Cholesterol (LDL-C) due to its simplicity and convenience although it has limitations. Many researchers have proposed different formulae to increase the accuracy of calculated LDL-C, but none of those have concluded about a single best formula owing to differences in selected study populations. As LDL-C measurement is of utmost importance for assessing the cardiovascular risk according to National Cholesterol Education Programme’s (NCEP) Adult Treatment Panel III (ATP III), a search for a better formula to improve accuracy of cardiovascular disease (CVD) risk prediction is essential. Aim: To assess the validity of calculated LDL-C by nine formulae and compare them to values obtained by the direct method. Materials and Methods: A total of 324 participants were assessed retrospectively for serum lipid profile by standard methods from December 2020 to February 2021 at Employee State Insurance Corporation Medical College and Hospital, Sanathnagar, Hyderabad, Telangana, India. LDL-C was calculated using nine different formulae (Ahmadi, Anand, Chen, de Cordova, Friedewald, Hattori, Martin-Hopkins, Puavillai and Vujovic) and correlated with direct LDL-C. For further analysis, subjects were divided into five groups based on the Triglyceride levels (TG) viz; group 1 (TG 400 mg/dL). Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 23.0. Results: Total of 324 lipid profile reports were analysed and calculated LDL-C by nine formulas were compared. At TG levels 400 mg/dL, Puavillai had better accuracy. But, none of the formulae showed strong correlation with Direct LDL-C at TG >400 mg/dL. ROC curves also showed that Puavillai performed better among all formulae, at all TG levels. Conclusion: Among the nine equations, Puavillai and Martin-Hopkins showed highest accuracy and better performance than others in the present study population. Martin-Hopkins can be used at TG levels of 100-200 mg/dL while Puavillai can be used at lower and higher TG levels in this demographic population for estimating LDL-C.

Background: Life expectancy has greatly increased, generating an improvement in screening programs for disease prevention, lifesaving drugs and medical devices. The impact of lowering low-density lipoprotein cholesterol (LDL-C) in the very elderly is not well-established. Our aim was to explore the association of LDL-C, high density lipoprotein cholesterol (HDL-C) and lipid lowering drugs (LLDs) on cognitive decline, malignancies and overall survival. Methods: This was a retrospective cohort study. Our study comprised 1498 (72.7%) males and 561 (27.3%) females, aged ≥70 who had attended the Institute for Medical Screening (IMS), Sheba Medical Center, Israel at least twice during 2013–2019. Data were obtained from the computerized database of the IMS. A manual quality control to identify potential discrepancies was performed. Results: Overall, 6.3% of the subjects treated with LLDs (95/1421) versus 4.2% not treated (28/638), cognitively declined during the study years. No statistically significant effects of LDL-C, HDL-C and LLDs on cognitive decline were observed after correcting for age, prior stroke and other vascular risk factors. With regard to cancer, after adjusting for confounders and multiple inferences, no definite relationships were found. Conclusions: This analysis of an elderly, high socioeconomic status cohort suggests several relationships between the use of LLDs and health outcomes, some beneficial, especially, with regard to certain types of cancer, but with a higher risk of cognitive decline. Further studies are warranted to clarify the health effects of these medications in the elderly. [ABSTRACT FROM AUTHOR]

Background: Different guidelines recommend different approaches to lipid management in patients with atherosclerotic cardiovascular disease. We aim to determine the best strategy for lipid management in Asian patients undergoing percutaneous coronary intervention (PCI).Method: This was a retrospective cohort study conducted in patients who underwent first-ever PCI from 14 hospitals in Hong Kong. All participants either achieved low-density lipoprotein cholesterol (LDL-C) target of

Objective: A significant proportion of persons with metabolic syndrome (MetS), prediabetes, or type 2 diabetes (T2D) do not develop atherosclerotic cardiovascular disease (ASCVD).We sought to determine whether discordantly normal apolipoprotein B (ApoB) relative to elevated LDL-C may help to explain heterogeneity in ASCVD risk among persons with metabolic disorders. Methods: There were 278 Bogalusa Heart Study participants with MetS (n=95), prediabetes (n=233), or T2D (n=31) and LDL-C ≥100 mg/dL who were free of carotid plaque at baseline (2001-02) and underwent carotid ultrasound at follow-up (2013-16). Multivariable modified Poisson regression estimated the long-term absence of carotid plaque for lower ApoB, continuously and categorically. Results: Participants were on average 36.1 years old at baseline, 61.5% were women, and 31.7% were black. A total of 50.7% had discordantly normal ApoB (

On the basis of large cardiovascular clinical trials of lipid-lowering agents that showed a considerable decrease in the incidence of primary melanomas in the active agent arm, we have carried out a randomized, double-blind clinical trial examining the impact of lovastatin on various biomarkers of melanoma pathogenesis. Subjects with at least two clinically atypical nevi were randomized to receive oral lovastatin or placebo for a 6-month period. Clinical, histopathologic, and molecular biomarkers were evaluated for change in the two groups. Eighty subjects were randomized, evaluable, and included in the analyses. Lovastatin showed no benefit in comparison with placebo in the primary endpoint of decreasing the level of histopathologic atypia, nor in any of the secondary endpoints of decreasing clinical atypia, impact on nevus number, nor in showing significant changes in any of the molecular biomarkers. There were no significant differences in adverse event profiles for lovastatin compared with placebo. The lovastatin arm did show a significant and considerable decrease in total serum cholesterol and serum low-density lipoprotein (LDL) levels compared with placebo, an expected result. This finding bolsters confidence in subject compliance. Given the results of this trial, it is concluded that if lovastatin were to lower the incidence of melanoma, it would appear not to be doing so by reversing atypia of precursor atypical nevi over the 6-month time frame studied. Further research into the pathogenesis of melanoma and in other potential chemopreventive agents is needed. ©2014 AACR.

Perfluoroalkyl acids (PFAAs) are persistent, synthetic compounds that are used in a number of consumer products. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) have been associated with cardiovascular risk factors, and changes in gene expression and DNA methylation in animals and cellular systems. However, whether PFAA exposure is associated with LINE-1 DNA methylation, a potential marker of cardiovascular risk, in humans remains unknown. We sought to evaluate the cross-sectional associations between serum PFAAs and LINE-1 DNA methylation in a population highly exposed to PFOA. We measured serum PFAAs twice four to five years apart in 685 adult participants (47% male, mean age±SD=42±11years). We measured percent LINE-1 DNA methylation in peripheral blood leukocytes at the second time point (follow-up), and estimated absolute differences in LINE-1 methylation associated with an interquartile (IQR) shift in mean PFAA serum levels. IQR increases in mean serum PFOA, PFOS, perfluorononanoic acid (PFNA), and perfluorohexane sulfonate (PFHxS) were associated with differences of -0.04 (p=0.16), 0.20 (p=0.001), 0.06 (p=0.19), and 0.02 (p=0.57), respectively, in % LINE-1 methylation at follow-up after adjustment for potential confounders. We observed a monotonic increase in LINE-1 DNA methylation across tertiles of PFOS and PFNA (ptrend=0.02 for both associations), but not across tertiles of PFOA or PFHxS (ptrend=0.71 and 0.44, respectively). In summary, serum PFOS was associated with LINE-1 methylation, while serum PFOA, PFHxS, and PFNA were not. Additional research is needed to more precisely determine whether these compounds are epigenetically active.

These guidelines represent all current aspects of etiology, diagnosis, and treatment of the clinical and statistical group of familial hypercholesterolemia in both adults and children in accordance with the requirements of the Ministry of Health of Russia.

10-Dehydrogingerdione is a novel cholesteryl ester transfer protein (CETP) inhibitor of natural origin. Some synthetic CETP inhibitors have recently been reported to suppress proprotein convertase subtilisin/kexin type 9 (PCSK9). Therefore, the present study aimed mainly to clarify the effect of 10-Dehydrogingerdione on cellular adhesion inflammatory molecules, platelet activation and endothelial dysfunction markers in addition to PCSK9 as compared to atorvastatin in dyslipidemic rabbits. Dyslipidemia was induced in 30 male rabbits, distributed in 3 equal groups through feeding dietary cholesterol (0.5% w/w) for 3 months. Two dyslipidemic groups were concurrently treated with either atorvastatin or 10-Dehydrogingerdione (10 mg/kg/ day, p.o) and dietary cholesterol. One additional group including 10 normal rabbits fed normal diet served as normal control (NC) group. Both 10-Dehydrogingerdione and atorvastatin significantly reduced serum CETP level and activity as well as PCSK9 and low density lipoprotein cholesterol (LDL-C) levels but increased high density lipoprotein cholesterol (HDL-C) levels as compared to dyslipidemic control (DC) rabbits (p

Background: Enzyme replacement therapy (ERT) with olipudase alfa, a recombinant human acid sphingomyelinase (rhASM), is being developed to treat patients with ASM deficiency (ASMD), commonly known as Niemann-Pick disease (NPD) types A or B. This study assessed the effect of ERT on lipid parameters and inflammatory markers.Methods: Serum and plasma samples from five adults with NPD type B (NPD-B) who received olipudase alfa ERT for 26 weeks were analysed. We also collected fasting blood samples from fifteen age- and sex-matched participants as reference and comparison group. We measured fasting lipid profile, apolipoproteins B48 and B100 (apoB48 and apoB100), apolipoprotein A1 (apoA1), proprotein convertase subtilisin/klexin type 9 (PCSK9) mass, oxidised low-density lipoprotein (oxLDL), small dense low-density lipoprotein cholesterol (sdLDL-C) and tumour necrosis factor α (TNF-α).Results: Patients with NPD-B, compared with age and sex matched reference group, had higher triglycerides, PCSK9, apoB48, oxLDL and TNF-α and lower high density lipoprotein cholesterol (HDL-C) and apoA1. Treatment with ERT was associated with improved lipid parameters including total cholesterol, triglycerides, low density lipoprotein cholesterol (LDL-C), sdLDL-C, oxLDL and apoB100. Though there was an increase in apoA1, HDL-C was slightly reduced. TNF-α showed a reduction. ApoB100 decreased in parallel with a decrease in total serum PCSK9 mass after ERT.Conclusion: This study demonstrated that patients with NPD-B had a proatherogenic lipid profile and higher circulating TNF-α compared to reference group. There was an improvement in dyslipidaemia after olipudase alfa. It was possible that reductions in LDL-C and apoB100 were driven by reductions in TNF-α and PCSK9 following ERT. [ABSTRACT FROM AUTHOR]

Background: Pemafibrate, a selective PPARα modulator, has the beneficial effects on serum triglycerides (TGs) and very low density lipoprotein (VLDL), especially in patients with diabetes mellitus or metabolic syndrome. However, its effect on the low density lipoprotein cholesterol (LDL-C) levels is still undefined. LDL-C increased in some cases together with a decrease in TGs, and the profile of lipids, especially LDL-C, during pemafibrate administration was evaluated. Methods: Pemafibrate was administered to type 2 diabetes patients with hypertriglyceridemia. Fifty-one type 2 diabetes patients (mean age 62 ± 13 years) with a high rate of hypertension and no renal insufficiency were analyzed. Pemafibrate 0.2 mg (0.1 mg twice daily) was administered, and serum lipids were monitored every 4–8 weeks from 8 weeks before administration to 24 weeks after administration. LDL-C was measured by the direct method. Lipoprotein fractions were measured by electrophoresis (polyacrylamide gel, PAG), and LDL-migration index (LDL-MI) was calculated to estimate small, dense LDL. Results: Pemafibrate reduced serum TGs, midband and VLDL fractions by PAG. Pemafibrate increased LDL-C levels from baseline by 5.3% (− 3.8–19.1, IQR). Patients were divided into 2 groups: LDL-C increase of > 5.3% (group I, n = 25) and < 5.3% (group NI, n = 26) after pemafibrate. Compared to group NI, group I had lower LDL-C (2.53 [1.96–3.26] vs. 3.36 [3.05–3.72] mmol/L, P = 0.0009), higher TGs (3.71 [2.62–6.69] vs. 3.25 [2.64–3.80] mmol/L), lower LDL by PAG (34.2 [14.5, SD] vs. 46.4% [6.5], P = 0.0011), higher VLDL by PAG (28.2 [10.8] vs. 22.0% [5.2], P = 0.0234), and higher LDL-MI (0.421 [0.391–0.450] vs. 0.354 [0.341–0.396], P < 0.0001) at baseline. Pemafibrate decreased LDL-MI in group I, and the differences between the groups disappeared. These results showed contradictory effects of pemafibrate on LDL-C levels, and these effects were dependent on the baseline levels of LDL-C and TGs. Conclusions: Pemafibrate significantly reduced TGs, VLDL, midband, and small, dense LDL, but increased LDL-C in diabetes patients with higher baseline TGs and lower baseline LDL-C. Even if pre-dose LDL-C remains in the normal range, pemafibrate improves LDL composition and may reduce cardiovascular disease risk. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines published by the European Society of Cardiology and the American College of Cardiology/American Heart Association provide recommendations based on evidence, including randomized controlled trials and registry data, for clinicians to enable efficient clinical decision-making and improve prognosis for patients with acute myocardial infarction (AMI). However, there are several differences in practice, health systems, and races between Korea and Western countries; further, many studies on pharmacotherapy were conducted in the pre-percutaneous coronary intervention era. An expert consensus document on pharmacotherapy for AMI was recently published following demands for the establishment of Korean guideline reflecting data in the modern percutaneous coronary intervention era. In this review, we summarized AMI guidelines from Europe, America, Japan, and Korea, and analyzed studies on pharmacotherapy for AMI including well-organized randomized controlled trials by Korean researchers and large-sized registry datasets, such as the Korea Acute Myocardial Infarction Registry and the Korean National Health Insurance Service. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolemia(FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and non-traditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease(ASCVD) in this population. The aims of the study were: (a) to identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b) to evaluate the risk of new cardiovascular events at follow-up in FH patients stratified by lipid-lowering agents. Methods: This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network(DLCN) and Simon Broome(SM) scores, 61 patients with DLCN score above 3 and possible/probable FH(SM score) were included. Results: Nine hundred-eighty patients were examined and 61 (6.2%) were received the clinical diagnosis of FH. The mean age was 48.5±12.5 years, with more female patients than male patients (63.9% versus 36%). Hypertension was the main cardiovascular risk factor for both genders, followed by physical inactivity and obesity for the female group and active smoking for the male group. The measured DLCN score recorded: "possible" FH identified in 39.4%, "probable" FH in 45.9% and "definite" FH in 14.7%. The effective lipid-lowering drugs used were statin alone and statin in association with fenofibrate, which improved both the lipid profile values and the subclinical atherosclerosis markers (ankle-brachial index, carotid intima-media thickness and high-sensitivity C-reactive protein). New ASCVDs that emerged during the study were most commonly represented by coronary heart disease and stroke. At the same time, the new cardiovascular events were delayed in patients receiving the lipid-lowering drugs, without significant differences between them. Conclusions: In patients with suspected FH, the lipid-lowering agents during the follow-up period delayed the new cardiovascular events, yet failed to reach the goals proposed by the guidelines. [ABSTRACT FROM AUTHOR]

Background and Aim: There are few prospective data on the prognostic value of normal admission low-density lipoprotein cholesterol (LDL-C) in statin-naïve patients with acute coronary syndromes (ACS) who are treated with a preemptive invasive strategy. We aimed to analyze the proportion of patients with normal LDL-C at admission for ACS in our practice, and their characteristics and clinical outcomes in comparison to patients with high admission LDL-C., Patients and Methods: Two institutions' prospective registries of patients with confirmed ACS from Jan 2017 to Jan 2023 were used to identify 1579 statin-naïve patients with no history of prior coronary artery disease (CAD), and with available LDL-C admission results, relevant clinical and procedural data, and short- and long-term follow-up data. Normal LDL-C at admission was defined as lower than 2.6 mmol/L. All demographic, clinical, procedural, and follow-up data were compared between patients with normal LDL-C and patients with a high LDL-C level (≥2.6 mmol/L) at admission., Results: There were 242 (15%) patients with normal LDL-C at admission. In comparison to patients with high LDL-cholesterol at admission, they were significantly older (median 67 vs. 62 years) with worse renal function, had significantly more cases of diabetes mellitus (DM) (26% vs. 17%), peripheral artery disease (PAD) (14% vs. 9%), chronic obstructive pulmonary disease (COPD) (8% vs. 2%), and psychological disorders requiring medical attention (19% vs. 10%). There were no significant differences in clinical type of ACS. Complexity of CAD estimated by coronary angiography was similar between the two groups (median Syntax score 12 for both groups). There were no significant differences in rates of complete revascularization (67% vs. 72%). Patients with normal LDL-C had significantly lower left ventricular ejection fraction (LVEF) at discharge (median LVEF 52% vs. 55%). Patients with normal LDL-C at admission had both significantly higher in-hospital mortality (5% vs. 2%, RR 2.07, 95% CI 1.08-3.96) and overall mortality during a median follow-up of 43 months (27% vs. 14%, RR 1.86, 95% CI 1.45-2.37). After adjusting for age, renal function, presence of diabetes mellitus, PAD, COPD, psychological disorders, BMI, and LVEF at discharge in a multivariate Cox regression analysis, normal LDL-C at admission remained significantly and independently associated with higher long-term mortality during follow-up (RR 1.48, 95% CI 1.05-2.09)., Conclusions: A spontaneously normal LDL-C level at admission for ACS in statin-naïve patients was not rare and it was an independent risk factor for both substantially higher in-hospital mortality and mortality during long-term follow-up. Patients with normal LDL-C and otherwise high total cardiovascular risk scores should be detected early and treated with optimal medical therapy. However, additional research is needed to reveal all the missing pieces in their survival puzzle after ACS-beyond coronary anatomy, PCI optimization, numerical LDL-C levels, and statin therapy.

Familial hypercholesterolemia is the most common hereditary disease characterized by an increase in low density lipoprotein cholesterol levels and the premature development of atherosclerosis-related cardiovascular diseases. Diagnosis and treatment of such patients are associated with certain difficulties. This review presents data on the prevalence of familial hypercholesterolemia, identification of patients with such a diagnosis, prevention of adverse cardiovascular events, and also discusses the appointment of lipid-lowering therapy.

Background Inflammation is an independent causal risk factor for atherosclerotic cardiovascular diseases (ASCVDs). However, whether hsCRP (high‐sensitivity C‐reactive protein) is prognostic across various levels of atherogenic lipid measures such as low‐density lipoprotein cholesterol, non–high‐density lipoprotein cholesterol, apolipoprotein B and total cholesterol/high‐density lipoprotein cholesterol in primary prevention is unknown. Methods and Results We studied 9748 ARIC (Atherosclerosis Risk in Communities) study participants who were free of ASCVD at baseline (visit 4, 1996–1998) and had measurements of lipids, apolipoprotein B, and hsCRP. We used multivariable adjusted Cox models to estimate the risk of incident ASCVD events associated with hsCRP levels (less than/greater than or equal to median) in individuals where triple lipid measures combined (low‐density lipoprotein cholesterol + non–high‐density lipoprotein cholesterol + apolipoprotein B) or quadruple measures combined [triple + total cholesterol/high‐density lipoprotein cholesterol] were less than versus greater than or equal to median cut points. Mean age of participants was 62.6±5.6 years; 59% women, 22% black. There were 1574 ASCVD events over median (interquartile range) follow‐up of 18.4 (12.8–19.5) years, and discordance between hsCRP and lipid measures was prevalent in 50% of the population. hsCRP greater than or equal to median (2.4 mg/L), compared with less than median, was associated with an increased risk of ASCVD in individuals with less than median levels of the triple (adjusted hazard ratio, 1.33; 95% CI, 1.09–1.60) and quadruple (adjusted hazard ratio,1.47; 95% CI, 1.18–1.85) lipid measures. Such increased risk was consistent among individuals with low (

Studies have revealed mixed results on how antidepressant drugs affect lipid profiles of patients with major depression disorder (MDD). Even less is known about how patients respond to a switch of antidepressant medication with respect to their metabolic profile. For this, effects of a switch in antidepressants medication on lipid markers were studied in MDD patients. 15 participants (females = 86.67%; males = 13.33%; age: 49.45 ± 7.45 years) with MDD and a prescribed switch in their antidepressant medication were recruited at a psychosomatic rehabilitation clinic. Participants were characterized (with questionnaires and blood samples) at admission to the rehabilitation clinic (baseline, T0) and followed up with a blood sample two weeks (T1) later. HDL, LDL, total cholesterol, and triglycerides were determined (T0), and their change analyzed (Wilcoxon test) at follow up (T1). Decrements in HDL (p = 0.041), LDL (p < 0.001), and total cholesterol (p < 0.001) were observed two weeks after a switch in antidepressant medication. Triglycerides showed no difference (p = 0.699). Overall, LDL, HDL, and total cholesterol are affected by a change in antidepressant drugs in patients with MDD. These observations are of clinical relevance for medical practitioners in the planning and management of treatment strategies for MDD patients.