Diagnostic and prognostic implications of non-high-density lipoprotein cholesterol and homocysteine levels for cognitive impairment in thalamic infarction

BACKGROUND Patients with thalamic infarction experience abnormal blockages of multinuc-leated vessels,affecting the body and thereby the thalamus.Most patients with thalamic infarction have an adverse prognosis,which seriously affects their safety.Therefore,it is essential to analyze the independent risk factors that influence the prognosis of patients with thalamic infarction and develop corresponding preventive measures.AIM To explore the effect of non-high-density lipoprotein cholesterol(non-HDL-C)and Homocysteine(Hcy)levels in cognitive impairment in thalamic infarction.METHODS From March 2019 to March 2022,80 patients with thalamic infarction were divided into a group with cognitive impairment[Montreal Cognitive Assessment(MoCA)score<26;35 patients]and a group with normal cognitive function(MoCA score of 26-30;45 patients)according to the MoCA score.In addition,50 healthy people in the same period were selected as the control group.A correlation between the non-HDL-C and Hcy levels and the MoCA score and receiver operating characteristic curve was observed,and the serum non-HDL-C and Hcy levels were analyzed for the diagnosis of cognitive impairment in patients with thalamic infarction.According to the Modified Rankin Scale(MRS)score,80 patients with thalamic infarction were divided into a good prognosis group(MRS score≤2)and a poor prognosis group(MRS score>2).RESULTS The non-HDL-C and Hcy levels were significantly higher in the group with cognitive impairment than in the group with normal cognitive function(P<0.05).There was no significant difference in the non-HDL-C level between the control group and the group with normal cognitive function(P>0.05).The MoCA scores of the group with cognitive impairment were significantly lower than those of the group with normal cognitive function and the control group(P<0.05).There was a significant difference between the control group and the group with normal cognitive function(P<0.05).The non-HDL-C and Hcy levels were correlated with the MoCA score(P<0.05),cognitive impairment[areas under the curve(AUC)=0.709,95%confidence interval(95%CI):0.599-0.816],the non-HDL-C level,and could predict cognitive impairment in patients with thalamic infarction(AUC=0.738,95%CI:0.618-0.859).Hcy combined with non-HDL-C levels can predict cognitive impairment in patients with thalamic infarction(AUC=0.769,95%CI:0.721-0.895).RESULTS There were 50 patients in the good prognosis group and 30 patients in the poor prognosis group.Compared with the good prognosis group,in the poor prognosis group,the National Institutes of Health Stroke Scale(NIHSS)score,non-HDL-C level,Hcy level,large-area cerebral infarction,atrial fibrillation,and activated partial prothrombin time were statistically significant(P<0.05).The non-HDL-C level,the Hcy level,the NIHSS score,extensive cerebral serum,and atrial fibrillation may all be independent risk factors for poor prognosis in patients with thalamic infarction(P<0.05).CONCLUSION Non-HDL-C and Hcy levels are positively correlated with cognitive impairment in patients with thalamic infarction.Non-HDL-C and Hcy levels can be used in the diagnosis of cognitive impairment in patients with thalamic infarction,and the combined detection effect is better.The main factors affecting the prognosis of patients with thalamic infarction are the non-HDL-C level,the Hcy level,the NIHSS score,large-area cerebral infarction,and atrial fibrillation.Clinically,corresponding preventive measures can be formulated based on the above factors to prevent poor prognosis and reduce mortality.

Prevalence of High Non-high-density Lipoprotein Cholesterol and Associated Risk Factors in Patients with Diabetes Mellitus in Jilin Province,China:A Cross-sectional Study

Dyslipidemia is a risk factor for cardiovascular diseases（CVDs）in patients with diabetes,and non-high-density lipoprotein cholesterol（non-HDL-C）is a better predictor of CVDs than low-density lipoprotein cholesterol（LDL-C）in patients with diabetes.Therefore,we aimed to investigate the distribution of non-HDL-C and the prevalence of high non-HDL-C level in Chinese patients with diabetes mellitus and identify the

Associations of non-high-density lipoprotein cholesterol with metabolic syndrome and its components in Korean children and adolescents: the Korea National Health and Nutrition Examination Surveys 2008–2014

Background In this study, we aimed to investigate the relationship between single-gender Korean references for non-high-density lipoprotein cholesterol (non-HDL-C) and metabolic syndrome (MetS) in childhood. Methods A total of 5742 Korean children aged 10–18 years who participated in a national survey were included. The sub-jects were classified into three groups based on single-gender non-HDL-C levels as follows: <120 mg/dL (desirable), ≥120 and <150 mg/dL (borderline high), and ≥150 mg/dL (high). Results Males in the borderline high non-HDL-C group had odds ratios (ORs) of 2.86 (95% confidence interval, 2.30–3.56) for elevated triglycerides (TG), 1.73 (1.08–1.79) for reduced high-density lipoprotein cholesterol (HDL-C) and 1.73 (1.08–2.78) for MetS compared with males in the desirable non-HDL-C group after adjusting for covariates. Males in the high non-HDL-C group had ORs of 1.65 (1.14–2.41) for elevated blood pressure (BP), 6.21 (4.27–9.05) for elevated TG, and 3.29 (1.49–7.26) for MetS compared with males in the desirable non-HDL-C group. Females in the borderline high non-HDL-C group had ORs of 3.03 (2.43–3.76) for elevated TG, 1.63 (1.13–2.35) for reduced HDL-C, and 4.53 (2.47–8.31) for MetS compared with females in the desirable non-HDL-C group. Females in the high non-HDL-C group had ORs of 1.43 (1.00–2.04) for elevated BP, 6.36 (4.45–9.08) for elevated TG, and 7.64 (3.65–15.96) for MetS compared with females in the desirable non-HDL-C group. Conclusion Our results suggest that, in a Korean population, a non-HDL-C level of 120 mg/dL for males and 150 mg/dL for females is the threshold between borderline high and high risk for MetS.

Association between sensitivity to thyroid hormones and non-highdensity lipoprotein cholesterol levels in patients with type 2 diabetes mellitus

BACKGROUND Dyslipidemia and type 2 diabetes mellitus(T2DM)are chronic conditions with substantial public health implications.Effective management of lipid metabolism in patients with T2DM is critical.However,there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population,particularly concerning non-high-density lipoprotein cholesterol(non-HDL-C).AIM To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM.METHODS In this cross-sectional study,thyroid hormone sensitivity indices,the thyroid feedback quantile-based index(TFQI),the thyroid-stimulating hormone index(TSHI),the thyrotrophic T4 resistance index(TT4RI),and the free triiodothyronine(FT3)/free thyroxine(FT4)ratio were calculated.Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels.Random forest variable importance and Shapley Additive Explanations(SHAP)summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor.RESULTS Among the 994 participants,389(39.13%)had high non-HDL-C levels.Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI(OR:1.584;95%CI:1.088-2.304;P=0.016),TSHI(OR:1.238;95%CI:1.034-1.482;P=0.02),and TT4RI(OR:1.075;95%CI:1.006-1.149;P=0.032)but was not significantly correlated with the FT3/FT4 ratio.The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex.An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men(OR:1.331;95%CI:1.003-1.766;P=0.048)but elevated TFQI levels in women(OR:2.337;95%CI:1.4-3.901;P=0.001).Among the analyzed variables,the average SHAP values were highest for TSHI,followed by TT4RI.CONCLUSION Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.

Association of baseline serum cholesterol with benefits of intensive blood pressure control

Background:Intensive systolic blood pressure(SBP)control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial.Whether baseline serum lipid parameters influence the benefits of intensive SBP control is unclear.Methods:The STEP trial was a randomized controlled trial that compared the effects of intensive(SBP target of 110 to<130 mmHg)and standard(SBP target of 130 to<150 mmHg)SBP control in Chinese patients aged 60 to 80 years with hypertension.The primary outcome was a composite of cardiovascular disease events.A total of 8283 participants from the STEP study were included in this post hoc analysis to examine whether the effects of the SBP intervention differed by baseline low-density lipoprotein cholesterol(LDL-C)and non-high-density lipoprotein cholesterol(non-HDL-C)concentrations.Results:Regardless of the randomized SBP intervention,baseline LDL-C and non-HDL-C concentrations had a J-shaped association with the hazard of the primary outcome.However,the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline LDL-C level(P for interaction=0.80)and non-HDL-C level(P for interaction=0.95).Adjusted subgroup analysis using tertiles in LDL-C1(hazard ratio[HR],0.77;95%confidence interval[CI],0.52-1.13;P=0.18),LDL-C2(HR,0.81;95%CI,0.55-1.20;P=0.29),and LDL-C3(HR,0.68;95%CI,0.47-0.98;P=0.04)was provided,with an interaction P value of 0.49.Similar results were showed in non-HDL-C1(HR,0.87;95%CI,0.59-1.29;P=0.49),non-HDL-C2(HR,0.70;95%CI,0.48-1.04;P=0.08),and non-HDL-C3(HR,0.67;95%CI,0.47-0.95;P=0.03),with an interaction P-value of 0.47.Conclusion:High baseline serum LDL-C and non-HDL-C concentrations were associated with increased risk of primary cardiovascular disease outcome,but there was no evidence that the benefit of the intensive SBP control differed by baseline LDL-C and non-HDL-C concentrations.Clinical trial registration:ClinicalTrials.gov,NCT03015311.