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Recurrent benign gingival lesions occurring in the anterior dentition are clinical dilemmas. While complete removal of such lesions is required to prevent recurrence, this can result in a poor esthetic outcome. Relative to this conundrum, this report discusses the diagnosis, psychologic management, and clinical treatment of two patients with recurring lesions on the facial gingiva of the mandibular and maxillary incisors, respectively. Patient A, a 55-year-old woman, presented with a recurrent peripheral ossifying fibroma (POF); Patient B, a 76-year-old man, presented with a recurrent pyogenic granuloma (PG). Both patients underwent multiple procedures and were ultimately treated without lesion recurrence. The efficacious surgical treatment of recurrent gingival lesions like POF and PG requires an aggressive approach involving lesion removal of the lesion as well as a 1.0- to 2.0-mm margin of normal tissue, underlying alveolar bone, and associated periodontal ligament (PDL). The rationale for this approach stresses the potential periodontal and esthetic ramifications that were considered. In summary, when recurrent benign gingival lesions are localized to the anterior part of the mouth, the approach to their surgical removal should be modified to minimize the extent of gingival recession and other potential esthetic issues. [ABSTRACT FROM AUTHOR]

Background: To date, it is not well known which systemic pathologies most frequently afflict patients with rotator cuff tear (RCT) and whether the coexistence of two or more pathologies can affect the lesion size. Therefore, we analyzed our database relative to a large group of patients who recently underwent rotator cuff repair. Methods: A total of 527 patients with full-thickness RCT were enrolled. For each patient, we checked the presence of at least one of diabetes, venous system diseases, cardiovascular diseases, hypercholesterolemia, blood hypertension, thyroid diseases, and a smoking habit. Patients were subdivided according to risk factors into five groups, representing those who had zero, one, two, three, and four or more risk factors, respectively. Statistical analysis was performed. Results: In total, 37% of our patients had no risk factors; 28% had one risk factor (arterial hypertension, smoking habit, and hypercholesterolemia were the most frequent); 23% had two risk factors (the hypertension/hypercholesterolemia association was the most frequent); and 8% suffered from three pathologies (the diabetes/arterial hypertension/hypercholesterolemia association was the most frequent). Comparing the cuff tear severity in patients without and with at least one risk factor, we observed that tear size increased in those with at least one risk factor. Conclusions: A total of 63% of patients with rotator cuff tears were either smokers and/or had at least one pathology capable of altering the peripheral microcirculation. Hypertension and hypercholesterolemia were the most frequent. Tear severity significantly increased with the presence of at least one risk factor. [ABSTRACT FROM AUTHOR]

• Dietary Inflammatory Index (DII) scores are positively associated with the risk of dyslipidemia. • Association between DII levels and dyslipidemia appears only in women. • Inflammation feature of diets is important for preventing dyslipidemia in middle-aged women. The dietary inflammatory index (DII) is a tool to evaluate the inflammatory potential of diets. Our research hypothesized that a higher DII score would be associated with an increased risk of dyslipidemia and that this outcome may differ by sex. Data from the Korean Genome and Epidemiology Study were used. The analysis included participants aged 40 to 69 years from the HEXA study (n = 40,500) and the Ansan-Ansung study (n = 4701). The mean follow-up was 5.03 years for the HEXA study and 8.14 years for the Ansan–Ansung study. The DII scores were calculated based on dietary data. Cox proportional hazards regression analysis was used to calculate hazard ratio (HR) and 95% confidence interval (CI). In pooled analyses, a high DII score was associated with a higher risk of dyslipidemia and its components. Sex-specific analyses revealed associations only in women. A pro-inflammatory diet, as indicated by a higher DII score, was associated with an increased risk of hypercholesterolemia, hyper-low-density lipoprotein cholesterolemia, hypertriglyceridemia, and dyslipidemia, with HR of 1.17 (95% CI: 1.06, 1.29), 1.16 (95% CI: 1.03, 1.29), 1.32 (95% CI: 1.12, 1.52), and 1.17 (95% CI: 1.08, 1.26), respectively. However, among men, there was no association between DII and dyslipidemia. These findings emphasize the inflammation feature of existing dietary patterns in influencing the development of dyslipidemia and related health issues. Further research will be needed to identify the mechanisms of how DII scores affect the risk of dyslipidemia. [Display omitted] This study aimed to investigate the association between DII and dyslipidemia among Korean adults, considering sex differences. Based on dietary data, the 38 food parameters were adopted to calculate DII. Sex-specific analyses revealed associations only in women. A pro-inflammatory diet, as indicated by a higher DII score, is associated with an increased risk of dyslipidemia, with HR of 1.17 [95% CI: 1.08, 1.26]. This result emphasizes the inflammation feature of diets is important for preventing dyslipidemia in middle-aged women. Abbreviations: DII, dietary inflammatory index; HR, hazard ratio; CI, confidence interval. [ABSTRACT FROM AUTHOR]

Background: Current guidelines highlight a paucity of evidence guiding optimal timing for non‐ST‐elevation myocardial infarction (NSTEMI) in high‐risk and non‐high‐risk cases. Aim: We assessed long‐term major adverse cardiovascular events (MACEs) in NSTEMI patients undergoing early (<24 h) versus delayed (>24 h) coronary angiography at 6 years. Secondary end‐points included all‐cause mortality and cumulative MACE outcomes. Methods: Baseline characteristics and clinical outcomes were assessed among 355 patients presenting to a tertiary regional hospital between 2017 and 2018. Cox proportional hazard models were generated for MACE and all‐cause mortality outcomes, adjusting for the Global Registry of Acute Coronary Events (GRACE) score, patient demographics, biomarkers and comorbidities. Results: Two hundred and seventy patients were included; 147 (54.4%) and 123 (45.6%) underwent early and delayed coronary angiography respectively. Median time to coronary angiography was 13.3 and 45.4 h respectively. At 6 years, 103 patients (38.1%) experienced MACE; 41 in the early group and 62 in the delayed group (hazard ratio (HR) = 2.23; 95% confidence interval (CI) = 1.50–3.31). After multivariable adjustment, the delayed group had higher rates of MACE (HR = 1.79; 95% CI = 1.19–2.70), all‐cause mortality (HR = 2.76; 95% CI = 1.36–5.63) and cumulative MACE (incidence rate ratio = 1.54; 95% CI = 1.12–2.11). Subgroup analysis of MACE outcomes in rural and weekend NSTEMI presentations was not significant between early and delayed coronary angiography (HR = 1.49; 95% CI = 0.83–2.62). Conclusion: Higher MACE rates in the delayed intervention group suggest further investigation is needed. Randomised control trials would be well suited to assess the role of early invasive intervention across all NSTEMI risk groups. [ABSTRACT FROM AUTHOR]

The article examines a large cross-sectional study using aortic computed tomography angiography to evaluate the prevalence and risk factors of aortic aneurysms (AAs) in adults, revealing a higher occurrence in men than women. Topics discussed include the association of hypertension with thoracic aortic aneurysms (TAAs), the impact of hypercholesterolemia and smoking on abdominal aortic aneurysms (AAAs), and the implications for screening based on demographic risk factors.

Background and Aims: Hypercholesterolemia leads to cardiovascular diseases and atherosclerosis. Previous studies have highlighted the crucial role of gut microbiota in alleviating atherosclerosis progression and reducing plasma cholesterol. However, the protective effects of Houttuynia cordata Thunb (HCT), a well-known fishy Chinese herb, against hypercholesterolemia and vasculopathy remain largely unknown. This study aims to explore the effects of HCT extracts on vascular health and gut microbiota in golden Syrian hamsters with hypercholesterolemia. Methods: The hypercholesterolemia hamster model was established by feeding with a high-cholesterol diet. Aqueous or ethanolic HCT extracts were mixed with diet and concurrently given to hamsters for Six weeks. Plasma lipid profiles were evaluated. Aortas were collected to detect fatty streak areas. Feces were collected to analyze the abundance of microorganisms in the gut microbiota. Results: HCT ethanolic extract treatment remarkedly decreased plasma levels of total cholesterol and high-density lipoprotein cholesterol in hypercholesterolemic hamsters. Notably, both aqueous and ethanolic extracts of HCT reduced atherosclerotic plaques in hamsters fed with a high-cholesterol diet. Strikingly, the effects of HCT ethanolic extract in reducing atherosclerotic plaques are greater than aqueous extract. Furthermore, at the phylum level, the relative abundance of Firmicutes was decreased in hamsters treated with aqueous and ethanolic extracts of HCT. By contrast, the abundance of Bacteroidetes was increased by HCT treatment. At the family level, HCT extract favourably modulated the relative abundance of Porphyromonadaceae and Bacteroidales_S24-7_group. These findings indicate that HCT extracts may facilitate the growth of short-chain fatty acids-producing bacteria to alter gut microbiota composition, contributing to the reduction of plasma lipid levels. Conclusions: This study offers evidence demonstrating the effects of HCT extracts on alleviating atherosclerosis and lowering plasma cholesterol levels in the male hypercholesterolemic hamster model, offering novel insights into the pharmacological effects and promoting the application of HCT. This study highlights the potential of HCT as a dietary supplement to alleviate atherosclerosis, lower plasma cholesterol, and modulate the abundance of microorganisms in gut microbiota. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects 6–12% of United States women of reproductive age. Because women with PCOS are at an increased risk of developing type 2 diabetes, clinical practice guidelines from a number of organizations (e.g. American Diabetes Association, American College of Obstetricians and Gynecologists, US Preventive Services Task Force) recommend that individuals with PCOS are routinely screened for diabetes. Guidelines further indicate that an oral glucose tolerance test (OGTT) should be used for diabetes screening in women with PCOS as opposed to an A1C or fasting plasma glucose test. The purpose of this study is two-fold: 1) to estimate rates of diabetes screening among a nationwide sample of commercially insured women with PCOS and 2) to report the percentage of women screened using each test (OGTT, A1C, fasting plasma glucose) among those who were screened. Methods: We used the MarketScan Commercial Claims database (2011–2019) to identify a sample of women aged 18–64 years with PCOS who were free from diabetes at baseline and had ≥ 5 years of continuous enrollment in their insurance plan. PCOS was ascertained using International Classification of Disease diagnosis codes (ICD-9: 256.4; ICD-10: E28.2). Diabetes screening was ascertained using Current Procedural Terminology (CPT) codes (A1C: 8303683037; Fasting blood sugar: 82947; OGTT: 82950). Diabetes screening rates were calculated for the overall study sample as well as across subgroups defined by age, overweight/obesity, hypertension, hypercholesterolemia, and vascular disease. Results: In our sample of 191,110 commercially insured women with PCOS, 73.40% were screened at least once for diabetes during a five-year period. Among the women screened, 19.24% were screened using the Androgen Excess Society (AES)-recommended OGTT, 61.58% were screened using A1C, and 23.37% were screened using fasting blood sugar. Conclusions: In a sample of commercially insured individuals spanning the timeframe 2011–2019, nearly 75% of women with PCOS complied with the ACOG screening guidelines for diabetes. Although OGTT is recommended as the preferred screening tool for women with PCOS it was less commonly used than A1C and fasting blood sugar tests. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions The influence of hypercholesterolemia on the development of apical periodontitis (AP) is inconclusive. Recent studies revealed that cholesterol metabolite 27‐hydoxycholesterol (27HC) can affect cellular responses to bacterial infections and oestrogen status and raloxifene may influence its action. Herein, we aimed to examine the impact of 27HC on production of inflammatory mediators by macrophages and the regulatory function of raloxifene. The contribution of 27HC to AP development and the therapeutic effect of raloxifene were evaluated in a rat model.Murine macrophages J774 cells were used. The expression of inducible nitric oxide synthase (iNOS) was examined by Western blot. The concentrations of C‐C motif chemokine ligand (CCL) 2 and 27HC were assessed by enzyme‐linked immunosorbent assay. Colorimetric assay was used to evaluate cholesterol levels. Experimental AP was induced in ovariectomized (OVX) or un‐operated rats receiving high‐fat/high‐cholesterol diet (HFHCD) or normal diet (ND). Micro‐computed tomography and immunohistochemistry were employed to evaluate disease severity and the therapeutic effect of raloxifene.Cholesterol enhanced 27HC production in macrophages. 27HC induced iNOS and CCL2 synthesis by macrophages and estradiol suppressed the responses. In our animal model of AP, HFHCD plus OVX significantly augmented serum and lesion tissue levels of 27HC (p < .05 versus the ND group). Lesion size, infiltration of CD68+ cells, and iNOS+ monocytes were increased in parallel with 27HC accumulation. Raloxifene inhibited pro‐inflammatory effects of 27HC on macrophages and suppressed AP progression in HFHCD/OVX rats (p < .05 versus the vehicle control group).Our results suggested that 27HC contributes to AP aggravation associated with hypercholesterolemia. Oestrogen deficiency may both enhance 27HC production and exacerbate its downstream action. [ABSTRACT FROM AUTHOR]

Background: Atherogenic index of plasma (AIP) index is an important marker of insulin resistance and a significant risk factor for cardiovascular disease. Abdominal aortic calcification (AAC) is significantly associated with subclinical atherosclerotic disease. However, there are no studies that have examined the relationship between AIP index and AAC, so we investigated the potential association between them in the general population. Methods: This was a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES, 2013–2014). The association of AIP with AAC was estimated by multivariable regression analysis. Results: After adjusting for confounders, the odds of extensive AAC doubled per unit increase in the AIP index (OR = 2.00, 95% CI: 1.05, 3.83; P = 0.035). The multivariable OR and 95% CI of the highest AIP index tertile compared with the lowest tertile was significantly different. (OR = 1.73, 95% CI: 1.05, 2.83; P = 0.031). The subgroup analyses indicated that the association was consistent irrespective of age, sex, hypertension, diabetes, smoking status, eGFR and hypercholesteremia. Conclusions: The AIP index was independently associated with the presence of extensive AAC in the study population. Further studies are required to confirm this relationship. [ABSTRACT FROM AUTHOR]

Introduction: Hypercholesterolemia is a risk factor for premature arteriosclerosis. Inflammation and oxidative stress are thought to contribute to endothelial dysfunction preceding vasculopathy. We investigated the association between inflammation, glycocalyx biomarkers, endothelial function, and vascular parameters in children with hypercholesterolemia. Methods: In 22 patients (LDL-cholesterol >130 mg/dL; median age [IQR]: 13 [2.3] years) and 22 controls (13 [2.5] years), tumor necrosis factor-alpha (TNF-α), oxidized cholesterol (oxLDL), and glycocalyx biomarkers (Syndecan-1, Hyaluronan) were measured using immunoassays. Endothelial function was assessed by peripheral arterial tonometry, sublingual glycocalyx and microcirculation by videomicroscopy and carotid intima-media thickness by ultrasound. Results: OxLDL was significantly higher in patients (78.9 [38.2] vs. 50.3 [16.6] U/L, p = 0.002), whereas all other experimental parameters were comparable between groups. Multivariate analysis revealed a significant association of Syndecan-1 with TNF-α (β = 0.75, p < 0.001) and with hypercholesterolemia (β = 0.31, p = 0.030). The interaction term combining TNF-α and hypercholesterolemia showed a significant effect (p = 0.034). Sex was an independent predictor of endothelial function. Conclusion: The combined effect of hypercholesterolemia and inflammation on glycocalyx perturbation and the impact of sex in the premature development of arteriosclerosis deserve further evaluation. Therapeutic approaches tackling low-grade systemic inflammation may offer potential to prevent or delay progression of cardiovascular disease and cardiovascular complications. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence shows that peri‐conceptional and in‐utero exposures have lifetime health impacts for mothers and their offspring. Objectives: We conducted a Follow‐Up Study of the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial with two objectives. First, we determined if women who enrolled at the Utah site (N = 1001) of the EAGeR trial (2007–2011, N = 1228) could successfully be contacted and agree to complete an online questionnaire on their reproductive, cardio‐metabolic, and offspring respiratory health 9–14 years after original enrollment. Second, we evaluated if maternal exposure to low‐dose aspirin (LDA) during pregnancy was associated with maternal cardio‐metabolic health and offspring respiratory health. Methods: The original EAGeR study population included women, 18–40 years of age, who had 1–2 prior pregnancy losses, and who were trying to become pregnant. At follow‐up (2020–2021), participants from the Utah cohort completed a 13‐item online questionnaire on reproductive and cardio‐metabolic health, and those who had a live birth during EAGeR additionally completed a 7‐item questionnaire on the index child's respiratory health. Primary maternal outcomes included hypertension and hypercholesterolemia; primary offspring outcomes included wheezing and asthma. Results: Sixty‐eight percent (n = 678) of participants enrolled in the follow‐up study, with 10% and 15% reporting maternal hypertension and hypercholesterolemia, respectively; and 18% and 10% reporting offspring wheezing and asthma. We found no association between maternal LDA exposure and hypertension (risk difference [RD] −0.001, 95% confidence interval [CI] −0.05, 0.04) or hypercholesterolemia (RD −0.01, 95% CI −0.06, 0.05) at 9–14 years follow‐up. Maternal LDA exposure was not associated with offspring wheezing (RD −0.002, 95% CI −0.08, 0.08) or asthma (RD 0.13, 95% CI 0.11, 0.37) at follow‐up. Findings remained robust after considering potential confounding and selection bias. Conclusions: We observed no association between LDA exposure during pregnancy and maternal cardiometabolic or offspring respiratory health. [ABSTRACT FROM AUTHOR]

Iron supplementation is a common method for alleviating symptoms of iron deficiency, but excessive iron intake may lead to systemic copper deficiencies and hypercholesterolemia. In our study, we explored the intricate relationship between dietary iron and copper levels and their impact on cholesterol metabolism. Using a rat model, we conducted dietary interventions with varying iron and copper concentrations and analyzed hepatic transcriptomes. High iron intake coupled with low copper intake induced hypercholesterolemia and altered the expression of genes associated with cholesterol and lipid metabolism, thereby, exacerbating cardiovascular disease risks. Conversely, copper supplementation mitigated these hepatic gene expression alterations, suggesting that dietary copper plays a role in cholesterol regulation. Transcriptomic analysis revealed significant upregulation of genes involved in cholesterol synthesis and antioxidative pathways in response to high iron intake, while genes involved in cholesterol elimination were downregulated. Furthermore, high iron consumption was associated with cellular apoptosis and the activation of cholesterol synthesis. Our findings underscore the importance of balanced iron and copper intake in cholesterol homeostasis and highlight the potential of copper supplementation for mitigating iron-induced hypercholesterolemia. [ABSTRACT FROM AUTHOR]

Hypercholesterolemia raises the risk for cardiovascular complications and overall health. Hypercholesterolemia is common, affecting 10% of the general population of the US, and heritable. Most individuals with hypercholesterolemia have a polygenic predisposition to the condition. Previously we identified a quantitative trait locus, Tachol1, linked to hypercholesterolemia on mouse chromosome 1 (Chr1) in a cross between C57BL/6J (B6) and TALLYHO/JngJ (TH) mice, a polygenic model for human obesity, type 2 diabetes and hyperlipidemia. Subsequently, using congenic mice that carry a TH-derived genomic segment of Chr1 on a B6 background, we demonstrated that the distal segment of Chr1, where Tachol1 maps, is necessary to cause hypercholesterolemia, as well as diet-induced obesity. In this study, we generated overlapping subcongenic lines to the distal segment of congenic region and characterized subcongenic mice carrying the smallest TH region of Tachol1, ~ 16.2 Mb in size (B6.TH-Chr1-16.2 Mb). Both male and female B6.TH-Chr1-16.2 Mb mice showed a significantly increased plasma total cholesterol levels compared to B6 on both chow and high fat (HF) diet. B6.TH-Chr1-16.2 Mb mice also had greater fat mass than B6 on HF diet, without increasing food intake. The gene and protein expression levels of absent in melanoma 2 (Aim2) gene were significantly upregulated in B6.TH-Chr1-16.2 Mb mice compared to B6. In summary, we confirmed the effect of Tachol1 on hypercholesterolemia and diet-induced obesity using subcongenic analysis. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease was the leading cause of death worldwide in 2021, with atherosclerotic cardiovascular disease, encompassing hypercholesterolemia, being a major contributing factor. A range of lipid-lowering medications is used for the management of hyperlipidemia, but the use of statins is considered as standard therapy. Unfortunately, some patients do not respond to this therapy, necessitating novel therapeutic approaches. Tafolecimab is a novel proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibody that inhibits the binding of PCSK9 with low-density lipoprotein receptors (LDLRs) and increases LDLR recycling, and thus it indirectly lowers circulating low-density lipoprotein cholesterol (LDL-C) levels by increasing LDL-C uptake. The primary objective of this study is to assess the efficacy of tafolecimab in reducing LDL-C levels. Methods: A thorough search was conducted on Medline (PubMed), Cochrane CENTRAL, Scopus, and Google Scholar from inception until December 2023. Review Manager was used for statistical analysis. The random effects model was used to calculate risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs). Heterogeneity was assessed using the Higgins I2 index. The risk of bias was assessed using Cochrane's RoB 2 tool. This review has been registered with PROSPERO (CRD42023471020). Results: A total of four Chinese studies matched the inclusion criteria and were included in this review. A total of 726 patients were included in this review, out of which 476 patients were males. Out of four, three studies that studied the efficacy of 450 mg tafolecimab every 4 weeks in patients (n = 462) as compared to placebo (n = 224) were included in the meta-analysis. According to the pooled results, tafolecimab caused a significant decrease in LDL-C levels from baseline to week 12 as compared to placebo (MD = − 63.78, 95% CI − 65.88 to − 61.68, p value < 0.00001, I2 = 97%). The pooled results showed that more patients achieved ≥ 50% reductions in LDL-C levels (RR = 52.33, 95% CI 18.51–147.95, p value < 0.00001, I2 = 0%) and LDL-C < 1.8 mmol/L (RR = 17.27, 95% CI 9.59–31.11, p value < 0.00001, I2 = 0%) at week 12 in the tafolecimab group than the placebo group. Additionally, tafolecimab also caused a robust decrease in non-HDL-C, apolipoprotein B, and lipoprotein(a) levels from baseline to week 12 compared to placebo. The overall risk of bias was low, as determined by the RoB 2 tool. Conclusions: Tafolecimab showed promising lipid-lowering efficacy and a well-tolerated safety profile. Our findings suggest its potential as an innovative therapeutic option for individuals with hypercholesterolemia; however, significant heterogeneity was observed in some results, making it difficult to come to a firm conclusion. Therefore, large-scale randomized trials are required to confirm our findings, particularly exploring the most effective dosage regimens across varied populations. Registration: PROSPERO identifier number CRD42023471020. [ABSTRACT FROM AUTHOR]

Amelioration of hypercholesterolemia is essential for the treatment of atherosclerotic cardiovascular disease. Sodium sulphate is the effective component of mirabilite, which has been used in traditional Chinese medicine for the treatment of various diseases. In the present study, C57BL/6 mice were fed with a high-cholesterol diet (HCD) for 7 weeks and were treated with sodium sulphate in the last three of those weeks. Sodium sulphate significantly reduced the total cholesterol level and the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio in the serum of mice fed the HCD. In addition, cytochrome P450 7a1 and 39a1 were significantly upregulated in the livers of mice treated with sodium sulphate. Furthermore, tribbles pseudokinase 3 expression was significantly increased in the livers of mice fed the HCD, but was significantly reduced by sodium sulphate treatment. In terms of the insulin signaling pathway, the ratio of phosphorylated AKT to total AKT in the livers of mice fed the HCD was significantly lower compared with that of control mice fed a normal diet, but was significantly increased by sodium sulphate treatment. Sodium sulphate treatment also reduced the levels of fibroblast growth factor (FGF)15 in the ileum and inhibited the FGF15/FGF receptor 4-Klotho β/c-Jun N-terminal kinase/c-Jun signaling pathway in the livers of mice fed the HCD. In addition, sodium sulphate changed the compo- sition of the gut microbiota of mice fed the HCD. In conclusion, sodium sulphate may mitigate hypercholesterolemia and hepatic insulin resistance in mice fed an HCD. [ABSTRACT FROM AUTHOR]

Purpose This report describes the step-by-step process that led to expansion of ambulatory care pharmacy services at a newly established internal medicine clinic within a patient-centered medical home in North Carolina. Summary Implementation of clinical pharmacist services at the clinic was led by a postgraduate year 2 (PGY2) pharmacy resident and guided by the 9 steps described in the book Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists. After a needs assessment and review of the demographics and insurance status of the clinic's target population, it was determined that pharmacist services would focus on quality measures including diabetes nephropathy screening, diabetes eye examination, blood glucose control in diabetes, discharge medication reconciliation, annual wellness visits, and medication adherence in diabetes, hypercholesterolemia, and hypertension. Clinic appointments were conducted under 3 models: a pharmacist-physician covisit model, a "floor model" of pharmacist consultation on drug information or medication management issues during medical resident sign-out sessions with supervising physicians (medical residents could also see patients along with the pharmacist at a covisit appointment), and a covisit model of stacked physician and pharmacist appointments. The pharmacist's services were expanded from 2 half-day clinic sessions per week initially to 5 or 6 half-day clinic sessions by the end of the residency year. Conclusion By the fourth quarter of the first PGY2 residency year in which ambulatory care pharmacy services were provided in the clinic, the clinical and financial impact of those services justified the addition of a second full-time pharmacist to the clinic team. [ABSTRACT FROM AUTHOR]

Trials suggest patients with ST-elevation myocardial infarction (STEMI) without 'standard modifiable cardiovascular risk factors' (SMuRFs) have poorer outcomes, but the role of ethnicity has not been investigated. We analyzed 118,177 STEMI patients using the Myocardial Ischaemia National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analyzed using hierarchical logistic regression models; patients with ≥1 SMuRF (n = 88,055) were compared with 'SMuRFless' patients (n = 30,122), with subgroup analysis comparing outcomes of White and Ethnic minority patients. SMuRFless patients had higher incidence of major adverse cardiovascular events (MACE) (odds ratio, OR: 1.09, 95% CI 1.02–1.16) and in-hospital mortality (OR: 1.09, 95% CI 1.01–1.18) after adjusting for demographics, Killip classification, cardiac arrest, and comorbidities. When additionally adjusting for invasive coronary angiography (ICA) and revascularisation (percutaneous coronary intervention (PCI) or coronary artery bypass grafts surgery (CABG)), results for in-hospital mortality were no longer significant (OR 1.05, 95% CI.97–1.13). There were no significant differences in outcomes according to ethnicity. Ethnic minority patients were more likely to undergo revascularisation with ≥1 SMuRF (88 vs 80%, P <.001) or SMuRFless (87 vs 77%, P <.001. Ethnic minority patients were more likely undergo ICA and revascularisation regardless of SMuRF status. [ABSTRACT FROM AUTHOR]

Introduction: The Package of Essential Non-Communicable (PEN) Disease Control was implemented in the primary healthcare system to manage cardiovascular disease (CVD) risk factors in Iran. This study aimed to evaluate the status of CVD risk factor control following the implementation of the PEN. Methods: This historical cohort study was conducted among 60-65-year-old residents to compare hypertension (HTN) control via mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), diabetes mellitus (DM) control via fasting blood sugar (FBS) and HbA1C tests, hyperlipidemia control via serum cholesterol and triglyceride levels, and overweight and obesity via body mass index (BMI) measurement in 2016 (before the implementation of the PEN project) and 2021 (after 5 years). Results: A total of 1,583 residents with a mean age of 62.32±1.70 years were included in the study. In 2021, compared to 2016, there was a significant decrease in the relative frequency of residents with high SBP from 13.7% to 9.3%, high DBP from 11.3% to 3.4%, FBS≥126 mg/dL from 25.6% to 19.7%, and BMI≥30 from 25.7% to 23.4%. Additionally, the mean DBP and the mean serum levels of FBS among all participants decreased significantly. However, the relative frequency of residents with total cholesterol≥200 mg/dL increased significantly from 11.5% to 14.2%. Conclusion: Following the implementation of the PEN, the control of HTN, DM, and obesity improved among 60-65-year-old residents. However, the control of hypercholesterolemia did not improve. [ABSTRACT FROM AUTHOR]

Hypercholesterolemia is characterized by elevated low‐density lipoprotein (LDL)‐cholesterol levels and an increased risk of cardiovascular disease. The adipokine chemerin is an additional risk factor. Here we investigated whether cholesterol‐lowering with statins or proprotein convertase subtilisin‐kexin type 9 inhibitors (PCSK9i) affects chemerin. Both statins and PCKS9i lowered plasma LDL‐cholesterol, triglycerides and total cholesterol in hypercholesterolemic patients, and increased high‐density lipoprotein (HDL)‐cholesterol. Yet, only statins additionally reduced chemerin and high‐sensitivity C‐reactive protein (hsCRP). Applying PCSK9i on top of statins did not further reduce chemerin. Around 20% of chemerin occurred in the HDL2/HDL3 fractions, while >75% was free. Statins lowered both HDL‐bound and free chemerin. Pull‐down assays revealed that chemerin binds to the HDL‐component Apolipoprotein A‐I (ApoA‐I). The statins, but not PCSK9i, diminished chemerin secretion from HepG2 cells by upregulating LDL receptor mRNA. Furthermore, chemerin inhibited HDL‐mediated cholesterol efflux via its chemerin chemokine‐like receptor 1 in differentiated macrophages. In conclusion, statins, but not PCSK9i, lower circulating chemerin by directly affecting its release from hepatocytes. Chemerin binds to ApoA‐I and inhibits HDL‐mediated cholesterol efflux. Statins prevent this by lowering HDL‐bound chemerin. Combined with their anti‐inflammatory effect evidenced by hsCRP suppression, this represents a novel cardiovascular protective function of statins that distinguishes them from PCSK9i. [ABSTRACT FROM AUTHOR]

Aims The prevalence and difference in risk factors for having thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) in men compared with women in the general population is not well described. This study aimed to test the hypotheses that (i) cardiovascular risk factors for TAA and AAA differ and (ii) the prevalence of TAA and AAA is sex specific. Methods and results Aortic examination using computed tomography angiography was performed in 11 294 individuals (56% women), with a mean age of 62 (range 40–95) years participating in the Copenhagen General Population Study. TAAs were defined as an ascending aortic diameter ≥45 mm and a descending aortic diameter ≥35 mm, while AAAs were defined as an abdominal aortic diameter ≥30 mm. Demographic data were obtained from questionnaires. Overall prevalence of aortic aneurysms (AAs) in the study population included: total population 2.1%, men 4.0% and women 0.7% (P -value men vs. women P < 0.001). AAs were independently associated with male sex, increasing age, and body surface area (BSA). While TAAs were associated with hypertension, odds ratio (OR) = 2.0 [95% confidence interval (CI): 1.5–2.8], AAAs were associated with hypercholesterolaemia and smoking, OR = 2.4 (95% CI: 1.6–3.6) and 3.2 (95% CI: 1.9–5.4). Conclusion Subclinical AAs are four times more prevalent in men than in women. In both sexes, increasing age and BSA are risk factors for AAs of any anatomical location. Whereas arterial hypertension is a risk factor for TAAs, hypercholesterolaemia and smoking are risk factors for AAAs. [ABSTRACT FROM AUTHOR]

Pineapple (Ananas comosus) fruit is a functional food that has become a part of healthy diets worldwide due to its nutrition and health benefits. Given this concept, the potential anti-hypercholesterolemic activity of pineapple fruit was assessed using in vitro HMG-CoA reductase (HMGCR) inhibition assay. Our findings show that pineapple fruit (PAF) extract showed HMGCR inhibition activity. These findings led to partial purification of PAF extract by gel filtration chromatography (GFC) whereby fraction PAF 06 exhibited 100.00% HMGCR inhibition at 10 mg/mL. Matrix assisted laser desorption ionization (MALDI) mass spectrometry profiling, HRMS, MS/MS, and dereplication identified N1, N10-diferuloylspermidine as potential HMGCR inhibitor in pineapple fruit. The MALDI mass spectrometry imaging (MSI) enabled the in situ spatiotemporal mapping of the HMGCR inhibitor, N1, N10-diferuloylspermidine, in the pineapple fruit tissue, with localization concentrated mainly in the tissue near the peel/shell and a gradual decrease towards the flesh and ovary. The MALDI MSI provided the first evidence of in situ spatial localization of N1, N10-diferuloylspermidine, a potential HMGCR inhibitor in pineapple while maintaining the cellular and structural features of the fruit tissues. [ABSTRACT FROM AUTHOR]

Background: This study was an introduction to the Swedish ALSrisc Study and explored the association of lifestyle and medical conditions, with risk and progression of amyotrophic lateral sclerosis (ALS). Methods: We included 265 newly diagnosed ALS patients during 2016–2022 in Stockholm and 207 ALS-free siblings and partners of the patients as controls. Information on body mass index (BMI), smoking, and history of head injuries, diabetes mellitus, hypercholesterolemia, and hypertension was obtained through the Euro-MOTOR questionnaire at recruitment. Patients were followed from diagnosis until death, invasive ventilation, or November 30, 2022. Results: Higher BMI at recruitment was associated with lower risk for ALS (OR 0.89, 95%CI 0.83–0.95), especially among those diagnosed after 65 years. One unit increase in the average BMI during the 3 decades before diagnosis was associated with a lower risk for ALS (OR 0.94, 95%CI 0.89–0.99). Diabetes was associated with lower risk of ALS (OR 0.38, 95%CI 0.16–0.90), while hypercholesterolemia was associated with higher risk of ALS (OR 2.10, 95%CI 1.13–3.90). Higher BMI at diagnosis was associated with lower risk of death (HR 0.91, 95%CI 0.84–0.98), while the highest level of smoking exposure (in pack-years) (HR 1.90, 95%CI 1.20–3.00), hypercholesterolemia (HR 1.84, 95%CI 1.06–3.19), and hypertension (HR 1.76, 95%CI 1.03–3.01) were associated with higher risk of death, following ALS diagnosis. Conclusions: Higher BMI and diabetes were associated with lower risk of ALS. Higher BMI was associated with lower risk of death, whereas smoking (especially in high pack-years), hypercholesterolemia, and hypertension were associated with higher risk of death after ALS diagnosis. [ABSTRACT FROM AUTHOR]

Hypercholesterolemia is one of the most important risk factors for cardiovascular diseases. However, it is mostly associated with vascular dysfunction and atherosclerotic lesions, while evidence of direct effects of hypercholesterolemia on cardiomyocytes and heart function is still incomplete and controversial. In this study, we assessed the direct effects of hypercholesterolemia on heart function and the electro-contractile properties of isolated cardiomyocytes. After 5 weeks, male Swiss mice fed with AIN-93 diet added with 1.25% cholesterol (CHO), developed an increase in total serum cholesterol levels and cardiomyocytes cholesterol content. These changes led to altered electrocardiographic records, with a shortening of the QT interval. Isolated cardiomyocytes displayed a shortening of the action potential duration with increased rate of depolarization, which was explained by increased IK, reduced ICa.L and altered INa voltage-dependent inactivation. Also, reduced diastolic [Ca2+]i was found with preserved adrenergic response and cellular contraction function. However, contraction of isolated hearts is impaired in isolated CHO hearts, before and after ischemia/reperfusion, although CHO heart was less susceptible to arrhythmic contractions. Overall, our results demonstrate that early hypercholesterolemia-driven increase in cellular cholesterol content is associated with direct modulation of the heart and cardiomyocytes' excitability, Ca2+ handling, and contraction. [ABSTRACT FROM AUTHOR]

In this study, a new component of Cyclocarya paliurus polysaccharides (CPP20) was precipitated by the gradient ethanol method, and the protective effect of CPP20 on hypercholesterolemia mice was investigated. In vitro, CPP20 had the ability to bind bile salts and inhibit cholesterol micelle solubility, and it could effectively clear free radicals (DPPH•, •OH, and ABTS+). In vivo, CPP20 effectively alleviated hypercholesterolemia and liver damage in mice. After CPP20 intervention, the activity of antioxidant enzymes (SOD, CAT, and GSH-Px) and the level of HDL-C in liver and serum were increased, and the activity of aminotransferase (ALT and AST) and the level of MDA, TC, TG, LDL-C, and TBA were decreased. Molecular experiments showed that CPP20 reduced cholesterol by regulating the mRNA expression of antioxidation-related genes (SOD, GSH-Px, and CAT) and genes related to the cholesterol metabolism (CYP7A1, CYP27A1, SREBP-2, HMGCR, and FXR) in liver. In addition, CPP20 alleviated intestinal microbiota disturbances in mice with hypercholesterolemia and increased levels of SCFAs. Therefore, CPP20 alleviates hypercholesterolemia by alleviating oxidative damage, maintaining cholesterol homeostasis, and regulating gut microbiota. [ABSTRACT FROM AUTHOR]

We examined the association between comorbid conditions and mild cognitive impairment (MCI) in Native Hawaiians and Pacific Islanders (NHPI) (n = 54). Cross-sectional, self-reported questionnaires were utilized to collect demographic, comorbid conditions, and MCI (via the AD8 index) data. Separate logistic regression models were conducted to investigate the relationship between comorbid conditions and MCI, adjusting for other covariates. We found significantly increased odds of MCI in those reporting high blood pressure (OR = 5.27; 95% CI: [1.36, 20.46]; p = 0.016), high cholesterol (OR = 7.30; 95% CI: [1.90, 28.14], p = 0.004), and prediabetes or borderline diabetes (OR = 4.53; 95% CI: [1.27, 16.16], p = 0.02) compared with those not reporting these respective conditions. These data show that hypertension, hypercholesterolemia, and prediabetes are associated with MCI in the NHPI community, suggesting that preventive strategies to reduce chronic conditions may also potentially slow cognitive decline in underrepresented/understudied NHPI. [ABSTRACT FROM AUTHOR]

The goal of this study was to investigate if there is an independent linear relationship between body mass index and gallbladder stone disease in obese people. In the years 2013-2019, 870 patients were recruited with new-onset asymptomatic gallbladder stone disease, and 870 healthy individuals at our university's affiliated hospital for annual medical examinations were also included. We examined weight, height, blood pressure, fasting blood glucose, and serum lipid indices, and used logistic multivariate regression analysis to assess their relationships. Multivariate analysis revealed that body mass index, waist-to-height ratio, and hypercholesterolemia were all significant risk variables for gallbladder stone disease (P < 0.01, all) in pre-initial overweight subjects. In both overweight and obese subjects, waist-to-height ratio had a significantly positive relationship with gallbladder stone disease (P < 0.01, both); hypercholesterolemia had a similar effect on overweight participants (P < 0.01). After stratification by gender, serum total cholesterol and low-density lipoprotein cholesterol were significant risk factors in male overweight-obese participants (P < 0.05, both), but waist-to-height ratio and low-density lipoprotein cholesterol were equivalent in female overweight-obese subjects (P < 0.05, both). In conclusion, body mass index may be the best predictor for new-diagnosed asymptomatic gallbladder stone disease risk in the pre-initial overweight population without diagnosed diabetes, whereas abdominal adiposity may be during each phase. [ABSTRACT FROM AUTHOR]

Coenzyme Q10 (Q10) and cholesterol are end-products of the mevalonate pathway, which is an essential metabolic network in the cell. Q10 has an established role as an electron transporter in the mitochondrial electron transport system and antioxidant protection. Here we investigated the hypothesis that chronic supplementation of Q10 could lower the cholesterol blood level in patients suffering from lipid disorders and ischemic heart disease (IHD). We also determined whether Q10 could influence the course of IHD assessed with the Rose questionnaire for the intensity of stenocardia symptoms. The study was conducted on 13 patients with mixed hyperlipidemia consisting of total cholesterol (TC) >300 mg/dL and triglycerides >200 mg/dL who were divided into those receiving orally either 50 mg Q10 t.i.d. (7 patients) or matching placebo pills (6 patients) over three months. We assessed TC and its fractions at monthly intervals. The findings were that Q10 significantly decreased the level of TC and low-density lipoprotein cholesterol by about 20% either, with inappreciable changes in other lipid fractions. Q10 also had a beneficial effect on stenocardia symptoms, lowering the incidence of chest pain attacks and the number of nitrate pills ingested. We conclude that Q10 exerts anticholesterolemic effects and is a viable candidate for adjunct hypercholesterolemia prophylaxis. [ABSTRACT FROM AUTHOR]

Hypercholesteremia is the main contributor to metabolic diseases, including obesity, hypertension, and diabetes, which are the primary global sources of morbidity and death rates. Garlic scapes, a member of the Allium sativum family and a rich source of antioxidants, are utilized in various cuisine preparations due to their unique flavors and tastes. The current study examined garlic scape powder's effect on apoprotein E and its ability to decrease cholesterol. In an in vivo experiment, normal, healthy Wistar albino rats (weeks) were divided into a negative control group (NC, n = 10) and a high‐fat diet‐raised group (n = 50) until they achieved cholesterol ≥250 mg/dL. Hypercholesteremic rats were further divided randomly into five groups: positive control (PC), standard group (fenofibrate 20 mg/kg bwt), and treatment groups G1, G2, and G3 that were administered with garlic scape powder 400 mg, 800 mg, and 1200 mg/kg bwt orally, respectively, for 3 months. The blood samples were examined for cholesterol, triglycerides, high‐density lipoproteins (HDLs), low‐density lipoproteins, apoprotein E, albumin levels, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). The liver tissues of the rats were subjected to histopathology. The lipid profile was assessed using serum kit techniques, whereas an ELISA kit was used to evaluate apoprotein E, and a serum kit was used to estimate ALT and AST. In comparison to all other groups except NC, the highest dose of 1200 mg/kg bwt of garlic scapes significantly (p ≤ .05) increased serum insulin (13.66 ± 0.72 μU/mL), apoprotein E levels (6.08 ± 0.10 mg/dL), HDL (42.1 ± 1.81 mg/dL), and reduce TG (88.7 ± 1.64 mg/dL) and decreased overall cholesterol levels (67.9 ± 1.17 mg/dL). Except for NC, all treatment groups had significantly (p ≤ .05) lower ALT and AST values than PC. To sum up, powdered garlic scapes may be a great way to avoid hyperlipidemia, which raises the risk of cardiovascular illnesses. ALT and AST levels were significantly (p ≤ .05) reduced in all treatment groups compared to PC, except for NC. In conclusion, garlic scape powder may be an excellent source to prevent hyperlipidemia, a risk factor for cardiovascular diseases. In addition, powdered garlic scapes supplementation at high doses may be used as an alternative natural source in functional foods to halt hyperlipidemia without liver toxicity in the long term. [ABSTRACT FROM AUTHOR]

Background: The management in primary care (PC) of the patients with Heart Failure (HF) is different from the management hospital, in a special way compared to cardiology departments. Objective: To define the characteristics in both phenotypes of HF in prevalent and incident cases of HF in patients recruited in a large PC sample. Methods: We proposed a and longitudinal analyses, in patients of the IBERICAN cohort, that recruited 8,066 patients in the Spanish primary care system, with 15,488 patients-years of follow-up. Of them, 252 patients (3.1%) had diagnoses of HF. HF was classified according to the 2014 guidelines in two groups: HF with a reduced eject fraction or HFrEF (LVEF < 50%) and HF with preserved eject fraction or HFpEF (LVEF ≥ 50%). Recommended treatment was defined as the patient receiving drug treatment with Renin-Angiotensin-System (RAS) blockers with beta-blockers and, optionally, spironolactone. The incidence of new cases of HF was calculated in the 7,814 patients without HF in the inclusion visit. Finally, we analysed which variables associated the onset new cases and get the hazard ratio (HR) with the confidence interval at 95% ([95%CI]). Clinical trials register: NCT02261441 (02/05/2017). Results: The HFpEF was the most frequent phenotype in prevalent cases (61.1%) and incident cases (73.9%). Patients with HFrEF had a higher prevalence of coronary heart disease (p = 0.008) and PAD (p = 0.028), and no statistically significant differences was observed in the therapeutic groups used between both groups. The incidence of HF was 12.8 cases/1000 inhabitants/year, 35.6% of them was diagnosed in PC. The renin-angiotensin system blockers were more used in PC (60%) and beta-blockers (100%) and spironolactone (60%) in hospital. The female sex showed a protective effect for incident cases (0.51 [0.28–0.92]); and AF (HR [95%CI]: 2.90 [1.51–5.54]), coronary heart disease (HR [95%CI]: 2.18 [1.19-4.00]) and hypertension (HR [95%CI]: 1.91 [1.00-3.64]) increased the risk of developing HF. Conclusions: HF phenotype more frequent and incident in PC was the HFpEF, but only one third of them are diagnosed in PC level. The female sex showed a protective effect and atrial fibrillation, ischaemic heart disease and hypertension increased the risk of develop HF. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study is to determine if law enforcement officers develop subclinical atherosclerotic cardiovascular disease (ASCVD) earlier than nonofficers and. if so, the extent to which conventional risk factors explain this difference. Methods: Estimated pulse wave velocity (ePWV) was the marker of subclinical ASCVD. EPWX ASCVD risk factors, metabolic syndrome (MetS), and 1 0-year risk for ASCVD were compared among 408 law en- forcement officers anda civilian cohort. Results: EPWM 10-year ASCVD risk, and MetS prevalence increased significantly with age. All but the officers age 55 and older had higher ePWV coliort than the civilian cohort (P < 0,001), Ten-year ASCVD risk explained the most variability of ePWV (82 = 0.49, P < 0.001 ). Conclusions: Officers develop subclinical ASCVD earlier than nonofficers. Conventional ASCV[) risk factors only explain about half of this increase. Occupational factors may play a role in contributing to this increased ASCVD risk. [ABSTRACT FROM AUTHOR]

The article examines the effectiveness of aggressive lifestyle interventions, informed by the LIBRA risk score, in mitigating Alzheimer's disease risk and managing early-stage mild cognitive impairment.

Background: Cardiovascular disease remains a significant global health concern, with high low-density lipoprotein cholesterol (LDL-C) levels contributing to an increased risk. Familial hypercholesterolemia (FH) further complicates its management, necessitating additional lipid-lowering therapies. Evinacumab, an angiopoietin-like protein 3 monoclonal antibody, has emerged as a potential treatment, particularly for patients with FH, by effectively reducing LDL-C and triglyceride levels. This meta-analysis aimed to evaluate the efficacy and safety of evinacumab across diverse patient populations. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, relevant randomized controlled trials (RCTs) were systematically retrieved from multiple databases until November 24, 2023. The inclusion criteria were studies comparing evinacumab (at doses of 5 and 15 mg) to placebo, with outcomes focusing on lipid levels and adverse events. Standardized protocols were employed for data extraction and quality assessment, and statistical analysis was conducted using RevMan software. Results: Four RCTs, involving 270 patients, were included in the analysis. The analysis revealed significant reductions in lipid markers, particularly with the 15-mg dose of evinacumab, including triacylglycerols (standard mean difference [SMD] = −6.09, 95% confidence interval [CI] − 14.53 to 2.36, P = 0.16), total cholesterol (SMD = − 6.20, 95% CI − 11.53 to − 0.88, P = 0.02), high-density lipoprotein cholesterol (SMD = − 0.79, 95% CI − 1.27 to − 0.31, P = 0.001), LDL-C (SMD = − 4.58, 95% CI − 9.13 to − 0.03, P = 0.05), apolipoprotein (Apo) B (SMD = − 4.01, 95% CI − 7.53 to − 0.46, P = 0.03), and Apo C3 (SMD = − 7.67, 95% CI − 12.94 to − 2.41, P = 0.004). Adverse event analysis revealed no significant association, indicating good tolerability. Conclusion: High-dose evinacumab (15 mg) consistently demonstrated efficacy in reducing cholesterol and other lipid markers, with favorable tolerability. Further research is warranted to comprehensively assess its safety and clinical effectiveness, emphasizing the need for additional data to support its use in managing cardiovascular disease. [ABSTRACT FROM AUTHOR]

Introduction: Several observational studies have been conducted to assess the prevalence of cardiovascular risk factors in hypertensive patients; however, none has yet investigated prevalence, clustering, and current management of cardiovascular risk factors upon first referral to hypertension specialists, which is the aim of the present study. Methods: Consecutive adult outpatients with essential/secondary hypertension were included at the time of their first referral to hypertension specialists at 13 Italian centers in the period April 2022–2023 if they had at least one additional major cardiovascular risk factor among LDL-hypercholesterolemia, type 2 diabetes, and cigarette smoking. Prevalence, degree of control, and current management strategies of cardiovascular risk factors were assessed. Results: A total of 255 individuals were included, 40.2% women and 98.4% Caucasian. Mean age was 60.3±13.3 years and mean blood pressure [BP] was 140.3±17.9/84.8±12.3 mmHg). Most participants were smokers (55.3%), had a sedentary lifestyle (75.7%), suffered from overweight/obesity (51%) or high LDL-cholesterol (41.6%), had never adopted strategies to lose weight (55.7%), and were not on a low-salt diet (57.4%). Only a minority of patients reported receiving specialist counseling, and 27.9% had never received recommendations to correct unhealthy lifestyle habits. Nearly 90% of individuals with an estimated high/very high cardiovascular risk profile did not achieve recommended LDL-cholesterol targets. Conclusions: In patients with hypertension, both pharmacological and lifestyle therapeutic advice are yet to improve before referral to hypertension specialists. This should be considered in the primary care setting in order to optimize cardiovascular risk management strategies. [ABSTRACT FROM AUTHOR]

Hypercholesterolemia (high cholesterol) is an important risk factor for the development of cardiovascular disease (CVD). Shift work is now considered as one of the possible factors that could have an effect on lipid profile. The aim of this study was to determine the association of shift work with hypercholesterolemia among nurses. This cross‐sectional and descriptive-analytical study was conducted on nurses who worked in three hospitals. The sample size was 120 participants and divided into 60 shift workers and 60 day workers (nonshift workers). Demographic data, medical and occupational history were collected through a checklist. Data were analyzed by Mann–Whitney U, chi-square, and logistic regression analysis using SPSS version 22. There was statistically significant difference between prevalence of hypercholesterolemia and shift work. Also, a small percentage (8.33%) had low levels of HDL (high-density lipoprotein) in shift workers and 5% in day workers. On the other hand, there was no significant difference between HDL and shift work. The findings of this study showed that shift work is a risk factor for Hypercholesterolemia and increased duration of shift work was associated with higher risk of hypercholesterolemia in shift working nurses. Due to the indispensable of shift work in the nursing profession, it is essential to teach courses to promote healthy work environments and conduct periodical checkup to help nurses decrease their occupational problems. [ABSTRACT FROM AUTHOR]

Cell wall polysaccharides (dietary fiber) in cereal grains contribute to health benefits. The novelty of the current study was an effort to explore the in vivo therapeutic potential of different cereal bran cell walls against hypercholesterolemia. For this purpose, the cell walls were isolated from different cereal brans (wheat, maize, oats, and barley), and the intake of these cereal bran cell walls was evaluated for their anti‐lipidemic activity in normal and hypercholesterolemic rats. The serum taken from the rats was tested for cholesterol, lipid, and triglyceride profiles before and after treatment. The outcomes of the current study have shown that the cereal cell wall has a significant hypercholesterolemia effect. The biochemical parameters of the control animals were within the normal clinical ranges, indicating that the experimental diets were safe. Among cereal bran cell walls, barley bran significantly decreased cholesterol (56.35 ± 1.35 mg/dL), low‐density lipoprotein (56.35 ± 1.05 mg/dL), triglycerides (105.29 ± 1.95 mg/dL), and increased high‐density lipoprotein level (48.35 ± 1.35 mg/dL). These findings provide conclusive evidence that the cereal cell wall is beneficial in the treatment of hypercholesterolemia and may potentially provide protection against other acute, recurring, or chronic illnesses. [ABSTRACT FROM AUTHOR]

• We confirmed the predictive value of ESC/EAS 2019 risk stratification in a Portuguese cohort. • Total ASCVD events, fatal and non-fatal, were included in the analysis. • Poor LDL-C goal attainment was observed by the time patients entered risk categories. • Moderate intensity statins were the most frequently prescribed for all risk categories. • Individual risk criteria had a significant impact on cardiovascular outcomes. Cardiovascular (CV) risk scores identify individuals at higher long-term risk of CV events that may benefit from more aggressive preventive interventions. To assess the association of CV-risk categories and criteria with long-term CV events. Observational cohort study between 2000–2019 on patients aged 40–80 years, followed by 14 primary care centers assisted by 1 hospital in Portugal. Follow-up began when electronic health records data allowed for CV-risk classification and dynamic reassessment per 2019 ESC/EAS Guidelines. Inclusion criteria required at least one appointment with a primary care physician within three years before follow-up initiation. We assessed the 10-year adjusted hazard-ratio of combined CV death and non-fatal atherosclerotic cardiovascular disease (ASCVD) hospitalization, across SCORE risk categories and criteria, using Cox proportional hazards models adjusted for sex, age, competing comorbidities, and medication. The study included 161 681 observations from 87 035 unique patients. During the observation period, 71 787 patients were classified as low/moderate, 51 476 as high and 38 418 as very-high CV-risk categories. In the very-high group, prevalent comorbidities were hypertension (69%), hypercholesterolemia (69%) and type 2 diabetes (61%), and 13% were hospitalized for ASCVD. The adjusted 10-year hazard ratio of the composite of CV death or ASCVD hospitalization was 2.10 (95% CI: 1.91–2.32) for high-risk and 3.56 (95% CI: 3.21–3.96) for very-high-risk patients (low-risk as reference). Our study reinforces the prognostic relevance of CV-risk stratification for long-term prediction of CV death and ASCVD hospitalization in an unselected cohort, independently of sex, age, competing comorbidities and medication. [ABSTRACT FROM AUTHOR]

• We present a novel approach to the adaptation of implementation recommendations from clinical guidelines into implementation strategies, using care of familial hypercholesterolaemia as an example. • We provide guidance on how implementation strategies can be tailored to local-contexts by key partners. • We draw upon existing programs in the literature to highlight how the application of this process is feasible. The International Atherosclerosis Society (IAS) published an evidence-informed guidance for familial hypercholesterolemia (FH) that provides both clinical and implementation recommendations. We reference examples of strategies from the literature to explore how these implementation recommendations can be tailored into implementation strategies at the local-level for stakeholders guided by a framework proposed by Sarkies and Jones. Four authors of the IAS guidance selected two published exemplar implementation recommendations for detection, management, and general implementation. Each recommendation was described as an implementation strategy using Proctor's guidance for specifying and reporting implementation strategies. It recommends reporting the actor (who), action (what), action-target (who is impacted), temporality (how often), and dose (how much) for each implementation strategy. Detection: A centralized cascade testing model, mobilized nurses (actor) to relative's homes, after the diagnosis of the proband (temporality), once (dose) to consent, obtain a blood sample and health information (action) on relatives (action-target). Management: A primary care initiative to improve FH management included an educational session (action) with clinicians (action-target), computer-based reminder message and message to patients to have their cholesterol screened once (dose) at a visit or outreach (temporality) by researchers (actor). General: A partnership between a statewide public pathology provider, local public hospital network, primary health network, government health ministry, and an academic university (actors) was established to implement a primary-tertiary shared care model (action) to improve the detection of FH (action-target). We demonstrate that implementation recommendations can be specified and reported for different local contexts with examples on monitoring, evaluation, and sustainability in practice. [ABSTRACT FROM AUTHOR]

Background/objectives: Dietary habits are a significant predictor of hypertension (HTN). We aimed to evaluate the long-term association between adherence to the Mediterranean diet and HTN incidence. Subjects/methods: This was a prospective study among 1415 non-hypertensive adults (44% men, age: 41 ± 13 years) followed up for 20 years. Anthropometric, lifestyle, and clinical parameters were evaluated at baseline. Adherence to the Mediterranean diet was evaluated both at baseline and 10 years through the MedDietScore (range: 0–55, higher values indicate greater adherence). Results: At the 20-year follow-up, 314 new HTN cases were recorded. HTN incidence was 35.5%, 22.5%, and 8.7% in the lowest, middle, and upper tertile of baseline MedDietScore, respectively (p < 0.001). For each 1-point increase in baseline MedDietScore, the 20-year HTN risk decreased by 7% [relative risk (RR): 0.925, 95% confidence interval (CI): 0.906, 0.943], and this effect remained significant after adjustment for age, sex, and baseline lifestyle and clinical confounders, i.e., body mass index, physical activity, smoking, systolic and diastolic blood pressure, family history of HTN, and presence of hypercholesterolemia and diabetes mellitus (RR: 0.973, 95%CI: 0.949, 0.997). In a similar multiadjusted model, compared to subjects who were consistently away from the Mediterranean diet (in the lowest MedDietScore tertile both at baseline and 10 years), only those who were consistently close (in the middle and upper MedDietScore tertiles both at baseline and 10 years) exhibited a 47% lower 20-year HTN risk. Conclusion: A high adherence to the Mediterranean diet, particularly when longitudinally sustained, is associated with lower incidence of HTN. [ABSTRACT FROM AUTHOR]

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Background and Aims: The objective of this study was to assess current condition of three noncommunicable diseases (NCDs)‐diabetes, hypertension, and hypercholesterolemia and vulnerable cohorts among adults in Bangladesh. Methods: The STEPwise Approach to the NCD Risk Factor Surveillance survey of 2018 was analyzed to evaluate the association between NCDs and sociodemographic factors, levels of physical activity, and behavioral measurements. Complex survey weight‐adjusted logistic models were fitted. Results: From 6875 samples, prevalence of diabetes, hypertension and hypercholesterolemia were 27.3%, 9.8%, and 30.2%, respectively. The prevalence of the three NCDs were higher among older respondents. Low occupational activity with obese‐BMI status people was more prone to NCDs. Lower prevalence of hypercholesterolemia was observed in Rangpur, Rajshahi, and Mymensingh, whereas lesser diabetes in Khulna region. Likelihood of NCDs were higher among highly educated, urban residents with low physical activity. Lesser physical activity, and lack of weight maintenance were found to be key factors in higher rates of NCDs in Bangladesh. Conclusion: Greater education and less strenuous profession led to a higher chance of NCDs. Overall, physical activity and maintenance of weight seem to be factors driving higher rates of NCDs in Bangladesh. As a preventive measure against NCDs, an active lifestyle is to be encouraged, particularly to the most vulnerable cohort. [ABSTRACT FROM AUTHOR]

Background and Objectives: Lowering low-density lipoprotein (LDL-C) levels is critical for preventing atherosclerotic cardiovascular disease, yet some patients fail to reach the LDL-C targets despite available intensive lipid-lowering therapies. This study assessed the effectiveness and safety profile of alirocumab, evolocumab, and inclisiran in lipid reduction. Materials and Methods: A cohort of 51 patients (median (Q1–Q3) age: 49.0 (39.5–57.5) years) was analyzed. Eligibility included an LDL-C level > 2.5 mmol/L while on the maximum tolerated dose of statin and ezetimibe, a diagnosis of familial hypercholesterolemia, or a very high risk of cardiovascular diseases following myocardial infarction within 12 months prior to the study. Follow-ups and lab assessments were conducted at baseline (51 patients), 3 months (51 patients), and 15 months (26 patients) after the treatment initiation. Results: Median initial LDL-C levels 4.1 (2.9–5.0) mmol/L, decreasing significantly to 1.1 (0.9–1.6) mmol/L at 3 months and 1.0 (0.7–1.8) mmol/L at 15 months (p < 0.001). Total cholesterol also reduced significantly compared to baseline at both intervals (p < 0.001). No substantial differences in LDL-C or total cholesterol levels were observed between 3- and 15-month observations (p > 0.05). No statistically significant differences were noted in cholesterol reduction among the alirocumab, evolocumab, and inclisiran groups at 3 months. The safety profile was favorable, with no reported adverse cardiovascular events or significant changes in alanine transaminase, creatinine, or creatine kinase levels. Conclusions: Alirocumab, evolocumab, and inclisiran notably decreased LDL-C and total cholesterol levels without significant adverse effects, underscoring their potential as effective treatments in patients who do not achieve lipid targets with conventional therapies. [ABSTRACT FROM AUTHOR]

Background: Hypercoagulability emerges as a central pathological feature and clinical complication in nephrotic syndrome. Increased platelet activation and aggregability are closely related to hypercoagulability in nephrotic syndrome. Monocyte-platelet aggregates (MPAs) have been proposed to represent a robust biomarker of platelet activation. The aim of this study was to investigate levels of the circulating MPAs and MPAs with the different monocyte subsets to evaluate the association of MPAs with hypercoagulability in nephrotic syndrome. Methods: Thirty-two patients with nephrotic syndrome were enrolled. In addition, thirty-two healthy age and sex matched adult volunteers served as healthy controls. MPAs were identified by CD14 monocytes positive for CD41a platelets. The classical (CD14 + + CD16-, CM), the intermediate (CD14 + + CD16+, IM) and the non-classical (CD14 + CD16++, NCM) monocytes, as well as subset specific MPAs, were measured by flow cytometry. Results: Patients with nephrotic syndrome showed a higher percentage of circulating MPAs as compared with healthy controls (p < 0.001). The percentages of MPAs with CM, IM, and NCM were higher than those of healthy controls (p = 0.012, p < 0.001 and p < 0.001, respectively). Circulating MPAs showed correlations with hypoalbuminemia (r=-0.85; p < 0.001), hypercholesterolemia (r = 0.54; p < 0.001), fibrinogen (r = 0.70; p < 0.001) and D-dimer (r = 0.37; p = 0.003), but not with hypertriglyceridemia in nephrotic syndrome. The AUC for the prediction of hypercoagulability in nephrotic syndrome using MPAs was 0.79 (95% CI 0.68–0.90, p < 0.001). The sensitivity of MPAs in predicting hypercoagulability was 0.71, and the specificity was 0.78. Conclusion: Increased MPAs were correlated with hypercoagulability in nephrotic syndrome. MPAs may serve as a potential biomarker for thrombophilic or hypercoagulable state and provide novel insight into the mechanisms of anticoagulation in nephrotic syndrome. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolemia (FH) poses a substantial risk of cardiovascular diseases. The recent approval of evinacumab signifies a breakthrough in FH management. This review synthesizes evidence from diverse clinical trials, examining evinacumab's efficacy, safety, and broader impact on hypercholesterolemia. Body: As highlighted by multiple trials, Evinacumab demonstrates robust efficacy in reducing LDL-C levels, particularly in refractory cases. Its sustained impact, evidenced by enduring reductions in LDL-C levels throughout extended treatment periods, positions it as a potential long-term solution. While the safety profile appears favorable, instances of deaths underline the importance of holistic clinical management and ongoing surveillance. The clinical implications are profound, suggesting evinacumab's potential inclusion in guidelines for managing severe lipid disorders. Conclusion: Future research directions emphasize inclusivity, diversity, and real-world applications to establish sustained efficacy and safety across diverse populations. Integrating evinacumab into clinical guidelines requires evidence-based recommendations, necessitating collaboration between researchers, clinicians, and guideline developers. [ABSTRACT FROM AUTHOR]

Elevated plasma concentration of cholesterol bound to LDL (LDL-C) is the predominant risk factor for cardiovascular (CV) diseases. An important number of clinical trials demonstrated that the use of statins to reduce LDL-C is beneficial in terms of prevention of CV events in the entire population. Over time, specific LDL-C targets to be achieved have been established to guarantee the best outcome for the patient from the therapeutic intervention. The fundamental role of the clinical laboratory in diagnosis and treatment monitoring of dyslipidemias, requires that harmonization in the different phases of the laboratory process be pursued and achieved in order to allow the correct management of patients. The harmonization process has been the subject of national and international recommendations over time; however, a further recommendation is essential, considering that some recent evidences testify to a sub-optimal adoption of the indications by a non-negligible number of laboratories, confirming the need to repeat training and information activities. Aim of this joint document is to analyze the importance of the therapeutic targets to be achieved and the critical elements of laboratory diagnostic related to dyslipidemia, in order to provide indications for the harmonization of the reporting of the lipid profile. According to these recommendations, the lipid parameters should be reported accompanied by the therapeutic goals differentiated by the risk categories for LDL-C and non-HDL-C and by the threshold values for the other parameters. The use of comparison terms like Reference values or Normal values in the laboratory report must be definitely abandoned. [ABSTRACT FROM AUTHOR]

Due to increasing life expectancy, women spend a significant part of their lives in menopause. Women with a history of endometriosis are more likely to become menopausal at an early age due to bilateral oophorectomy or repeated ovarian surgery. In addition, some medical therapies used for endometriosis, such as gonadotropin releasing hormone agonists or progestins reduce bone mineral density. Furthermore, women with endometriosis have a higher background risk of cardiovascular disorders and hypercholesterolemia. Hence, it is important to recommend the use of hormone replacement therapy (HRT) to these women when they become menopausal, at least until the age of natural menopause. Although based on limited data, there is a possibility of reactivation of symptoms of endometriosis or its lesions, and a theoretical possibility of malignant transformation, although this remains unproven. Therefore, women should be advised in the light of this information before starting HRT after the age of natural menopause and are asked to seek help if they experience symptoms that may indicate these changes. Estrogen only HRT should be avoided and combined HRT preparations should be recommended, even after a hysterectomy. [ABSTRACT FROM AUTHOR]

A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model. Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention. Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols. Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively. Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on −0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured. In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%–61% (control 50%–52%), non-significant. However, the percentage of patients with LDL-C < 3.0 mmol/L increased from 34%–40% (control 36%–36%), p =.043, and digit preference decreased, 39%−27% (control 41%−35%), p = 0.000. The number of antihypertensive drugs was constant, 1.63 − 1.64 (control 1.62 − 1.62), non-significant, but drug choice changed in line with recommendations. Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment. Hypertension is common and often suboptimally treated in relation to existing guidelines. This register study evaluates the results of a staff training intervention promoting nurse-led care. The intervention had an impact on measurement techniques, drug choice and improved cholesterol control. [ABSTRACT FROM AUTHOR]

Obesity is a global health issue of great concern. It leads to hyperplasia, hypertrophy of adipocytes, and metabolic complications including coronary artery disease, and cerebrovascular disease. The effectiveness of cinnamon zeylanicum as a medicinal herb comes from its anti-inflammatory and antioxidant properties. The purpose of this study was to assess the potential beneficial effects of cinnamon on adrenal toxicity caused by a high-fat diet in male albino rats. Four equal groups of the experimental animals were used, the control group, the cinnamon group, the high-fat diet group, the high-fat diet, and the cinnamon group. Animals fed cinnamon showed similar results with the control group. The adrenal cortex sections of high-fat diet-fed animals showed different degenerative changes in all layers of the adrenal gland, cortex, medulla, and corrugation of the capsule. Ultra structurally, a lot of adrenal cortical cells appeared with irregular pyknotic nuclei, swollen mitochondria, dilated sER, and numerous lipid droplets with variable shapes and sizes. Moreover, a significant rise in the immunohistochemical expression of cytochrome c in a large number of cortical cells was observed. On the contrary, animals given cinnamon and a high-fat diet exhibited noticeable improvement in the structure of the adrenal gland, and the immunohistochemical expression of cytochrome c was observed in the third group. The histological structure of the adrenal gland appeared to be mostly the same as the control one. Cinnamon has a potential effect in improving adrenal toxicity against a high-fat diet because of the natural constituent capable of its pharmaceutical effects. [ABSTRACT FROM AUTHOR]