总胆固醇/高密度脂蛋白比值在心血管疾病中的研究进展

目前心血管疾病在全世界仍有着较高的发病率和死亡率,既往研究已证实血脂是心血管疾病的独立危险因素,与动脉粥样化性心血管疾病(ASCVD)密切相关。总胆固醇/高密度脂蛋(TC/HDL-C)比值属于血脂指标的衍生指标,临床研究已表明其与心血管疾病的诊断及预后相关。近些年研究发现,部分人群TC/HDL-C比值与低密度脂蛋白(LDL-C)和非高密度脂蛋白(non-HDL-C)水平存在不一致的现象,这提示TC/HDL-C比值可能为LDL-C和non-HDL-C提供额外血脂信息,为降脂治疗提供新的思路。本文就TC/HDL-C比值在心血管疾病中的应用及最新进展做一系统综述。

4218例体检人群血脂、血糖检测结果分析

目的:分析4218例体检人群血脂、血糖检测结果方法2008年来我社区卫生服务中心进行健康体检的人群,年龄18～82岁,共4218例,检测血脂和空腹血糖。结果4218例体检人群血清测定中,TC≥6.22mmol者596例,占14.13%;TG≥1.70mmol者737例,占17.47%;LDL-C≥4.14mmol/L者797例,占18.90%;HDL-C≤1.04mmol/L者614例,占14.56%;GLU≥6.1mmol/L者213例,占5.05%。各年龄组中,血脂随增龄而偏高,特别在31～60岁组为明显。血糖偏高多在40岁以后,60岁以上老年人血糖偏高者增多。结论4218例体检人群血脂异常、血脂边缘异常和空腹血糖偏高的患病率高,随增龄而增高,

洛伐他汀调脂治疗56例临床观察

目的:调脂治疗可以很好地防止心血管事件的发生。本文观察小剂量洛伐他汀调脂治疗的疗效。方法:按照中国《血脂防治建议》标准。血清总胆固醇(TC)>5.72mmol/L,甘油三酯(TG)>1.7mmol/L,低密度脂蛋白胆固醇(LDL-C)>3.64mmol/L。入选患者56例,每日口服洛伐他汀20mg,共4周。观察用药前后血脂指标的变化。结果:有效64.28%、显效25%,总有效89.28%。用药前后比较TC、TG、LDL-C均有显著变化(P<0.05),其中对LDL-C作用明显。结论:小剂量洛伐他汀使用方便安全有效且价格合理。

The Effects of Apolipoprotein E Polymorphism on Serum Lipids, Lipoproteins and Apolipoproteins Variation

Objective: To study the effects of Apolipoprotein E (ApoE) polymorphism onserum levels of lipids, lipoproteins and apolipoproteins. Methods: Fragments of ApoE gene forthex-on containing codon 112 and 158 polymorphic locus were amplified by PCR, and then digested untilCfo I endonuclease. Genotypes and alleles frequencies of 168 healthy persons in Jiangsu area werecalculated. The effects of ApoE genotypes and alleles on serum lipids, lipoproteins andapolipoproteins variation were analyzed. Results: The effects of ApoE alleles on total cholesterol(TC), law density lipoprotein-cholesterol (LDL-C), ApoB was: along a decreasing gradientε_4>ε_3>ε_2. The effect of ε_4 allele was to increase serum levels of TC, LDL-C and ApoB, andthe ε_2 allele had an effect opposite to that of ε_4 allele. Conclusion: ApoE polymorphism is anindependent genetic factor on individual serum levels of lipids and apolipoproteins.

Metabolic syndrome and gallstone disease

AIM： To investigate the association between metabolic syndrome （NetS） and the development of gallstone disease （GSD）. METHODS： A cross-sectional study was conducted in 7570 subjects （4978 men aged 45.0：1：8.8 years, and 2592 women aged 45.3：1：9.5 years） enrolled from the physical check-up center of the hospital. The subjects included 918 patients with gallstones （653 men and 265 women） and 6652 healthy controls （4325 men and 2327 women） without gallstones. Body mass index （BII）, waist circumference, blood pressure, fasting plasma glucose （FPG） and serum lipids and lipoproteins levels were measured. Colorimetric method was used to measure cholesterol, high-density lipoprotein cho- lesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C）. Dextrose oxidizing enzyme method was used to measure FPG. Subjects were asked to complete a questionnaire that enquired about the information on demographic data, age, gender, histories of diabetes mellitus, hypertension, and chronic liver disease and so on. Metabolic syndrome was diagnosed according to the Adult Treatment Panel HI （ATP ]3） criteria. Gall- stones were defined by the presence of strong intralu- minal echoes that were gravity-dependent or attenu- ated ultrasound transmission. RESULTS： Among the 7570 subjects, the prevalence of the gallstone disease was 12.1% （13.1% in men and 10.2% in women）. BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose and serum triglyceride （TG） in cases group were higher than in controls, while serum high-density lipid was lower than in controls. There were significant differences in the waist circumference, blood pressure, FPG and TG between cases and controls. In an age- adjusted logistic regression model, metabolic syndrome was associated with gallstone disease. The age-adjust- ed odds ratio of MetS for GSD in men was 1.29 [95% confidence interval （CI）, 1.09-1.52; P = 0.0030], and 1.68 （95% CI, 1.26-2.25; P = 0.0004） in women; the overall age-adjusted odds ratio of NetS for GSD was 1.42 （95% CI, 1.23-1.64; P 〈 0.0001）. The men with more metabolic disorders had a higher prevalence of gallstone disease, the trend had statistical significance （P 〈 0.0001）. The presence of 5 components of the MetS increased the risk of gallstone disease by 3.4 times （P 〈 0.0001）. The prevalence of GSD in women who had 5 components of NetS was 5 times higher than in those without Nets component. The more the components of Mets, the higher the prevalence of GSD （P 〈 0.0001）. The presence of 5 components of the Mets increased the risk of gallstone disease by 4.0 times. CONCLUSION： GSD appears to be strongly associated with MetS, and the more the components of NetS, the higher the prevalence of GSD.

Yi-Qi-Zeng-Min-Tang,a Chinese medicine,ameliorates insulin resistance in type 2 diabetic rats

AIM:To investigate the effects of the Chinese herbal decoction,Yi-Qi-Zeng-Min-Tang(YQZMT),on insulin resistance in type 2 diabetic rats.METHODS:Sprague-Dawley rats were divided into two dietary regiments by feeding either normal pellet diet(NPD) or high fat diet(HFD).Four weeks later,the HFD-fed rats were injected intraperitoneally with lowdose streptozotocin(STZ).Rats with non-fasting blood glucose level ≥ 16.67 mmol/L were considered type 2 diabetic and further divided into five subgroups:the type 2 diabetes model group,low-dose,medium-doseand high-dose YQZMT groups,and rosiglitazone group.Age-matched NPD-fed rats served as controls.YQZMT or rosiglitazone were administered for 8 wk.Intraperitoneal glucose and insulin tolerance tests were performed before and after the treatment to measure the glucose tolerance and insulin sensitivity.Serum levels of biochemical parameters,adipocytokines,such as tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),as well as free fatty acids(FFAs),were also analyzed.RESULTS:There was significant elevation of insulin resistance and serum levels of fasting glucose(12.82 ± 1.08 mmol/L vs 3.60 ± 0.31 mmol/L,P < 0.01),insulin(7197.36 ± 253.89 pg/mL vs 4820.49 ± 326.89 pg/mL,P < 0.01),total cholesterol(TC)(8.40 ± 0.49 mmol/L vs 2.14 ± 0.06 mmol/L,P < 0.01),triglyceride(2.24 ± 0.12 mmol/L vs 0.78 ± 0.05 mmol/L,P < 0.01),low-density lipoprotein cholesterol(LDL-c)(7.84 ± 0.51 mmol/L vs 0.72 ± 0.04 mmol/L,P < 0.01) and decrease in high-density lipoprotein cholesterol(HDL-c)(0.57 ± 0.03 mmol/L vs 1.27 ± 0.03 mmol/L,P < 0.01) in the low-dose STZ and high-fat diet induced type 2 diabetic group when compared with the control group.Administration of YQZMT induced dose-and timedependent changes in insulin resistance,glucose and lipid profile,and reduced levels of FFA,TNF-α and IL-6 in the type 2 diabetic rats.After the treatment,compared with the diabetic group,the insulin resistance was ameliorated in the high-dose YQZMT(2.82 g/100 g per day) group,with a significant reduction in serum glucose(12.16 ± 1.00 mmol/L vs 17.65 ± 2.22 mmol/L,P < 0.01),homeostasis model assessment of basal insulin resistance(22.68 ± 2.37 vs 38.79 ± 9.02,P < 0.05),triglyceride(0.87 ± 0.15 mmol/L vs 1.99 ± 0.26 mmol/L,P < 0.01),TC(3.31 ± 0.52 mmol/L vs 6.50 ± 1.04 mmol/L,P < 0.01) and LDL-c(2.47 ± 0.50 mmol/L vs 6.00 ± 1.07 mmol/L,P < 0.01),and a signif icant increase in HDL-c(0.84 ± 0.08 mmol/L vs 0.50 ± 0.03 mmol/L,P < 0.01).But the body weight was not changed signif icantly.CONCLUSION:YQZMT,which ameliorates insulin resistance and does not cause increase in body weight,may be a suitable therapeutic adjunct for the treatment of type 2 diabetes.

Is the ratio of apoB/apoA-1 the best predictor for the severity of coronary artery lesions in Chinese diabetics with stable angina pectoris？ An assessment based on Gensini scores

Background There is a paucity of data about the best lipid ratio predicting the severity of coronary artery disease （CAD） in patients with diabetes mellitus. We determined the relationship between five conventional lipid ratios and the extent of coronary artery lesions in Chinese Type 2 diabetics with stable angina pectoris （SAP）. Methods A prospective cohort study within 373 type 2 diabetic patients diag- nosed with stable CAD by coronary angiography was performed. All patients were classified into three groups according to the tertiles of Gensini scores （GS, low group 〈 8 points n = 143; intermediate group 8-28 points, n = 109; high group 〉 28 points, n = 121）. Association between the ratios of apolipoprotein （apo） B and apoA-1, total cholesterol and high density lipoprotein cholesterol （TC/HDL-C）, triglycerides and HDL-C （TG/HDL-C）, low density lipoprotein cholesterol and HDL-C （LDL-C/HDL-C）, Non-HDL-C/HDL-C and GS were evaluated using the receivers operating characteristic （ROC） curves and multivariate logistic regression models. Results The ratio of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C, and Non-HDL-C/HDL-C were correlated with Gensini scores. Area under the ROC curves for predicting high Gensini scores in the ratios of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C and Non-HDL-C/HDL-C were 0.62, 0.60, 0.59 and 0.60, respec- tively （P 〈 0.005 for all）. According to multivariate logistic regression analysis after adjusted with demographic characteristic and other lipid parameters, the ratio of apoB/apoA-1 is qualified as an independent discriminator for the severity of CAD. However, after fiu-ther adjusting different baseline variables, such as left ventricular ejective fraction, hemoglobin Alc, leukocytes count and serum creatinine, none of the above lipid ratios remained. Conclusions Compared with other lipid parameters, the ratio of apoB/apoA-1 appears to be more significantly correlated with the extent of coronary artery lesions in Chinese diabetics, but it was not an independent predictor in these settings.

Coalition of DNA polymorphisms of ApoB and ApoAI genes is related with coronary artery disease in Kazaks

Objective To explore the relationship between polymorphisms of XbaI and MspI loci of apolipoprotein B （ApoB） gene and -75 bp,＋83 bp loci of apolipoprotein AI （ApoAI） gene and coronary heart disease （CHD） in Kazaks of Xinjiang Uyghur Autonomous Region,China.Methods These loci were analyzed by PCR-restriction fragment length polymorphism （PCR-PFLP）.Two hundred and five patients with CHD and two hundred and thirty six controls were involved.Results There were significant distinctions among low-density lipoprotein cholesterol （LDL-C）,triglyceride （TG） and the ApoAI/ApoB ratio between the two groups,but no significant distinction among the polymorphism frequencies of the four sites between the two groups.The polymorphism coalition frequency of X-/Ms＋＋/M1＋-/M2＋＋ （named Coalition 11） was significantly higher in CHD compared to the control group （14.6％ vs.7.2％,P ＜ 0.05）.The level of total cholesterol （TC） in Coalition 1 1 was significantly higher and the level of the ApoAI/ApoB ratio in Coalition 11 was significantly lower than Coalition 1～10 in CHD patients.The level of the ApoAI/ApoB ratio of Coalition 11 was significantly lower than the Coalition 1～10 in control group.The levels of ApoAI/ApoB ratio of Coalition 3 were significantly higher compared to Coalition 11 in the two groups,respectively.The level of LDL-C of Coalition 3 was significantly lower than in the Coalition 11 in control group.The level of TC of Coalition 5 was significantly higher than Coalition 3 in the CHD group.The level of the ApoAI/ApoB ratio of Coalition 5 was significantly lower than in Coalition 3 or Coalition 1～10 of the two groups,respectively.The level of LDL-C of Coalition 5 was significantly higher than in Coalition 3 in control group.The ratio of ApoAI/ApoB was negatively related to TC,LDL-C and was positively related to HDL-C,both in CHD and control groups.Conclusion Coalition 11 of the 4 loci polymorphisms of the ApoB and ApoAI genes was correlated with CHD in Kazaks,and perhaps the ratio of ApoAI/ApoB was the most diagnostic parameter related with CHD among all lipid parameters.CHD may also be associated with Coalition 5,and,perhaps,Coalition 3 may have been confirmed as a protection factor against CHD,if more samples were enrolled.

Prevalence of Abnormity of Blood Lipid and Associated Factors in Health Examination Population in Beijing

Objective To investigate the prevalence of abnormity of blood lipid and associated factors in healthy population in Beijing. Methods Totally, 38 462 individuals who received health examination were enrolled in our study. We divided them into eight groups according to their ages. The levels of serum total cholesterol, triglyceride, high density lipoprotein cholesterol, and low density lipoprotein cholesterol were tested, and the relationship of blood lipid abnormity with body mass index (BMI) and fasting blood glucose was analyzed. Results The incidences of hypercholesterolemia, hyperglyceridemia, low high-density lipoprotein cholesterolemia, and hyper low-density lipoprotein cholesterolemia presented increasing trend in this population. The incidence rate of abnormity of blood lipid in health examination population increased with BMI increase. The incidence of abnormity of blood lipid in overweight and obesity population was significantly higher than that in low weight and normal weight populations (P<0.05). Meanwhile, the trend of abnormal blood lipid incidence coincided with that of abnormal fasting blood glucose. Conclusions The prevalence of overweight, obesity, and abnormity of blood lipid in Beijing presents increasing trend. The incidence of abnormity of blood lipid increases with BMI increase, in coincidence with that of fasting blood glucose.

Attainment of multifactorial treatment targets among the elderly in a lipid clinic

Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects 〉 65 years old （n = 465） with a follow-up 〉 3 years. Low-density lipoprotein cholesterol （LDL-C）, blood pressure （BP） and glycated hemoglobin （HbAlc） goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society （ESC/EAS）, European Society of Hypertension （ESH）/ESC and European Association for the Study of Diabetes （EASD） guidelines. Results The LDL-C targets were attained by 27~,4, 48% and 62% of very high, high and moderate risk patients, respectively. Those receiving statin ＋ ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy （48% vs. 33%, P 〈 0.05）. Of the diabetic sub- jects, 71% had BP 〈 140/85 mmHg, while 78% of those without diabetes had BP 〈 140/90 mmHg. A higher proportion of the non-diabetic individuals （86%） had BP 〈 150/90 mmHg. Also, a higher proportion of those with diabetes had HbAlc 〈 8% rather than 〈 7% （88% and 47%, respectively）. Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbAlc levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar- gets could be more easily achieved in this population.

Prevalence of Metabolic Syndrome and Its Associations with Other Metabolic Disorders and Cardiovascular Changes in Health Examination Population in Beijing

Objective To investigate the prevalence of metabolic syndrome(MS) and its associations with other metabolic disorders and cardiovascular changes in health examination population in Beijing.Methods Totally,10 916 individuals who received health examination in Health Examination Center of Peking Union Medical College Hospital were enrolled.The height,weight,blood pressure,serum levels of triglyceride,high-density lipoprotein cholesterol(HDL-C),and fasting blood glucose were recorded.MS was diagnosed based on the working criteria of Chinese Diabetes Society 2004(CDS2004).Meanwhile,other metabolic disorders,including fatty liver and hyperuricemia,were recorded.The cardiovascular changes were reflected by the reports of electrocardiogram(ECG) ST-T changes and atherosclerosis of retinal arteries.Results The overall prevalence rate of MS was 6.1%(666/10 916) in the population.The prevalence rate of MS in male was much higher than that in female(9.0% vs.2.7%,P=0.000).For individuals with MS,the prevalence rates of fatty liver and hyperuricemia were significantly higher than those without MS,respectively(70.4% vs.35.4%,P=0.000;29.9% vs.17.7%,P=0.000).As for cardiovascular changes,the prevalence rates of ECG ST-T changes and atherosclerosis of retinal arteries were significantly higher in individuals with MS than those without MS,respectively(13.8% vs.11.7%,P=0.012;12.0% vs.6.8%,P=0.000).Conclusions The prevalence of MS in Beijing population is high.The individuals with MS have a higher risk for other metabolic disorders and cardiovascular changes.

Atherosclerosis： from biology to pharmacological treatment

A recent explosion in the amount of cardiovascular risk has swept across the globe. Primary prevention is the preferred method to lower cardiovascular risk. Lowering the prevalence of obesity is the most urgent matter, and is pleiotropic since it affects blood pressure, lipid profiles, glucose metabolism, inflammation, and atherothrombotic disease progression. Given the current obstacles, success of primary prevention remains uncertain. At the same time, the consequences of delay and inaction will inevitably be disastrous, and the sense of urgency mounts. Pathological and epidemiological data confirm that atherosclerosis begins in early childhood, and advances seamlessly and inexorably throughout life. Risk factors in childhood are similar to those in adults, and track between stages of life. When indicated, aggressive treatment should begin at the earliest indication, and be continued for many years. For those patients at intermediate risk according to global risk scores, C-reactive protein, coronary artery calcium, and carotid intima-media thickness are available for further stratification. Using statins for primary prevention is recommended by guidelines, is prevalent, but remains under prescribed. Statin drugs are unrivaled, evidence-based, major weapons to lower cardiovascular risk. Even when low density lipoprotein cholesterol targets are attained, over half of patients continue to have disease progression and clinical events. Though clinical evidence is incomplete, altering or raising the blood high density lipoprotein cholesterol level continues to be pursued. The aim of this review is to point out the attention of key aspects of vulnerable plaques regarding their pathogenesis and treatment.

Effects of purified herbal extract of Salvia miltiorrhiza on lipid profile in hyperlipidemic patients

Background and Objective Hyperlipidemia is one of the most potent and best substantiated risk factors for coronary heart disease （CHD）. Purified Salvia miltiorrhiza extract （PSME） had been shown to have hypolipidemic effect in animal experiments. This study aimed to evaluate its lipids modulating effects in hyperlipidemic patients. Methods In this single-blind, placebo cantrolled study, lipid profiles of 80 hyperlipidemic patients were checked at same conditions. They were divided into two equal groups randomly （each composing of 40 patients）. They were given PSME tablet （800 mg） three times per day, or placebo tablet. All patients were put on NCEP type II diet and six weeks later, lipid profiles were checked. Results In PSME group, total cholesterol decreased by 27.32 mg/dl （12.3% reduction）, LDL-cholesterol decreased by 23.13 mg/dl （16.8% reduction） and HDL-cholesterol increased by 9.06 mg/dl （11.1%）, all were statistically significant. Although triglyceride dropped by 12.12 mg/dl （5.1%） but this was not significant statistically （P=0.34）. There were no significant changes oflipids levels in the placebo group. Conclusions PSME has significant favorable effect on total cholesterol, LDL-cholesterol, and HDL-cholesterol and may be a potential agent for the treatment ofatherogenic dyslipidemia.

Dyslipidemia： evidence of efficacy of the pharmacological and non-pharmacological treatment in the elderly

The clinical decision to control risk factors for cardiovascular disease （CVD） in the elderly takes the followings into consideration： （1） the elderly life expectancy; （2） the elderly biological age and functional capacity; （3） the role of cardiovascular disease in the elderly group; （4） the prevalence of risk factors in the elderly; and （5） The effectiveness of treatment of risk factors in the elderly. A large number of studies showed the efficacy of secondary and primary prevention of dyslipidemia in the elderly. However, the only trial that included patients over 80 years was the Heart Protection Study （HPS）. Statins are considered the first line therapy for lowering low-density lipoprotein cholesterol （LDL-C）. Because lifestyle changes are very difficult to achieve, doctors in general tend to prescribe many drugs to control cardiovascular risk factors. However, healthy food consumption remains a cornerstone in primary and secondary cardiovascular prevention and should be implemented by everyone.

Women and exercise in aging

Aging is associated with physiological declines, notably a decrease in bone mineral density （BMD） and lean body mass, with a concurrent increase in body fat and central adiposity. Interest in women and aging is of particular interest partly as a result of gender specific responses to aging, particularly as a result of menopause. It is possible that the onset of menopause may augment the physiological decline associated with aging and inactivity. More so, a higher incidence of metabolic syndrome （an accumulation of cardiovascular disease risk factors including obesity, low-density lipoprotein cholesterol, high blood pressure, and high fasting glucose） has been shown in middle-aged women during the postmenopausal period. This is due in part to the drastic changes in body composition, as previously discussed, but also a change in physical activity （PA） levels. Sarcopenia is an age related decrease in the cross-sectional area of skeletal muscle fibers that consequently leads to a decline in physical function, gait speed, balance, coordination, decreased BMD, and quality of life. PA plays an essential role in combating physiological decline associated with aging. Maintenance of adequate levels of PA can result in increased longevity and a reduced risk for metabolic disease along with other chronic diseases. The aim of this paper is to review relevant literature, examine current PA guidelines, and provide recom- mendations specific to women based on current research.

MODIFIED CLASSIC RISK FACTORS FOR CORONARY ARTERY DISEASE IN CHINESE HAN POPULATION

Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independent cardiovascular centers.Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis <10% in every lesion.The classic risk factors including family history,body mass index,smoking habits,hypertension,diabetes mellitus,and serum lipid levels were surveyed according to established criteria.Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected,including 481 men and 281 women,aged from 17 to 81(mean 60±10) years.The patients with CAD accounted for 55.5% of all participants,and controls 44.5%,respectively.Compared with the pattern in published data,our study showed that mean serum high density lipoprotein cholesterol(HDL-C) level was significantly lower(P<0.001) and triglycerides was significantly higher(P<0.001),while total cholesterol(TC) and low density lipoprotein cholesterol levels were comparative(both P>0.05).The prevalence of low HDL-C(<40 g/L) and hypertriglyceridemia(>150 g/L) were 27.2% and 41.4%,respectively.Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male(P<0.001).Lower HDL-C functioned as an independent risk factor for CAD only in men(RR=2.8,95%CI:1.5-4.2,P<0.001),yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development ofCAD in women.Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects,while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.

Glycation of high-density lipoprotein triggers oxidative stress and promotes the proliferation and migration of vascular smooth muscle cells

Background In type 2 diabetes mellitus （T2DM）, high-density lipoprotein （HDL） impairs its anti-atherogenic properties and even develops to a pro-inflammatory and pro-atherogenic phenotype because of abnormal compositions and modifications. In this study, we ex- amined the effects and the related mechanisms of glycation of HDL on the proliferation and migration of vascular smooth muscle cells （VSMCs）. Methods ＆ Results Glycated HDL （G-HDL） was modified with D-glucose （25 mmol/L） in vitro. Diabetic HDL （D-HDL） was isolated from T2DM patients. Rat VSMCs were isolated from the thoracic aortas. Human VSMCs were obtained from ScienCell Research Laboratories. Alpha-actin was detected through immunofiuorescence. VSMC proliferation was assayed by Cell Count. VSMC migration was determined by transwell chamber and scratch-wound assay. Intracellular reactive oxygen species （ROS） was detected based on ROS-medi- ated 2＇,7＇-dichlorofluorescein （DCFH-DA） fluorescence. Compared to native HDL （N-HDL）, G-HDL remarkably promoted VSMC prolif- eration and migration in the dose and time-dependent manners. In addition, G-HDL enhanced ROS generation in VSMCs. However, the ROS scavenger, N-acetylcysteine, efficiently decreased ROS production and subsequently inhibited the proliferation of VSMCs induced by G-HDL. Similarly, D-HDL from T2DM patients also promoted ROS release and VSMC proliferation and migration. Conclusions HDL either glycated in vitro or isolated from T2DM patients triggered VSMC proliferation, migration, and oxidative stress. These results might partly interpret the higher morbidity of cardiovascular disease in T2DM patients.

Factors Associated with Coronary Artery Disease in Young Population(Age≤40):Analysis with 217 Cases

Objective To investigate the relevant factors of coronary artery disease （CAD） in young people under 40 years of age. Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006, including 272 men and 20 women, with the mean age being 36.7±3.7 years. The diagnosis of CAD was made in the cases presenting ~ 50% stenosis in coronary lumen in coronary angiography. Based on the diagnosis, 217 patients （204 men, 13 women） were assigned to CAD group, and 75 （68 men, 7 women） to non-CAD group. Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test, Z2 test, and multinomial logistic regression with SPSS 8.0 software. Results Most study subjects were current smokers （209/292, 71.6%）, and more than half had body mass index （BMI）〉24 kg/m2 （230/292, 78.8%） and usually took high-fat diet （162/292, 55.5%）. The proportion of heavy smokers （smoking history ≥10 years and t〉20 cigarettes per clay） were significantly higher in the CAD group than in the non-CAD group [20.7% （45/217） vs. 9.3% （7/75）, P=0.015）]. Heavy smoking [odds ratio （OR）, 1.89; 95% confidence interval （CI）, 1.74-2.05], hypertension （OR, 1.56; 95% CI, 1.48-1.65）, alcohol （OR, 1.37; 95% CI, 1.30-1.46）, type 2 diabetes mellitus （OR, 1.37; 95% CI, 1.25-1.50）, high-fat diet （OR, 1.35; 95% CI, 1.28-1.43）, and BMI〉24 kg/m2 （OR, 1.09; 95% CI, 1.03-1.17） were factors related to CAD in the young patients （all P〈0.05）. Total cholesterol （4.56_±1.46 mmol/L vs. 4.09_±1.00 mmol/L）, low-density lipoprotein cholesterol （2.38±1.11 mmol/L vs. 2.14±0.63 rnmol/L）, lipoprotein a （134.97±109.70 mg/L vs. 101.58±58.39 mg/L）, uric acid （359.89_±100.09 μmol/L vs. 336.75±94.36 μmol/L）, erythrocyte sedimentation rate （9.98± 12.19 ram/hour vs. 4.89_±4.92 mm/hour）, high-sensitivity C-reactive protein （3.42±4.39 mg/L vs. 2.80±_3.77 mg/L） and Big endothelin-1 （1.41±1.50 fmol/mL vs. 0.77_±1.13 fmol/mL） in plasma were significantly increased in the CAD group compared with the non-CAD group （all P〈0.05）. Conclusions Heavy smoking, hypertension, alcohol consumption, type 2 diabetes mellitus, high-fat diet and BMI〉24 kg/m2 were significantly related to CAD in patients aged ≤40, with heavy smoking presenting the highest OR. Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.

Impact of interferon-free antivirus therapy on lipid profiles in patients with chronic hepatitis C genotype 1b

AIM To investigate the influence of interferon-free antivirus therapy on lipid profiles in chronic hepatitis C virus genotype 1b(HCV1b) infection.METHODS Interferon-free antiviral agents were used to treat 276 patients with chronic HCV1 b infection, and changes in serum lipids of those who achieved sustained virologic response(SVR) were examined. The treatment regimen included 24 wk of daclatasvir plus asunaprevir(DCV + ASV) or 12 wk of sofosbuvir plus ledipasvir(SOF + LDV). SVR was achieved in 121(85.8%) of 141 patients treated with DCV + ASV and 132(97.8%) of 135 patients treated with SOF + LDV. In the two patient groups(DCV + ASV-SVR and SOF + LDV-SVR), serum total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), and triglycerides were measured at baseline during treatment and at 4 and 12 wk after treatment. Then, longitudinal changes in lipid profiles were analyzed.RESULTS Serum levels of TC, LDL-C, and HDL-C were significantly increased throughout the observation period in both the DCV + ASV-SVR and SOF + LDV-SVR groups. During antivirus treatment, the increases in TC and LDL-C were significantly greater in the SOF + LDVSVR group than in the DCV + ASV-SVR group(P < 0.001). At 4 and 12 wk after the therapy, serum levels of TC and LDL-C were similar between the two groups and were significantly greater than those at baseline. Approximately 75%-80% of the increase in TC was derived from an increased LDL-C. In multiple regression analysis, the difference in therapy protocol(DCA + ASV or SOF + LDV) was an independent predictor that was significantly associated with the increase in TC and LDL-C at 4 wk of therapy.CONCLUSION Serum cholesterol significantly increased during SOF + LDV treatment. After treatment, HCV elimination was associated with a similar increase in cholesterol regardless of the therapy protocol.

Relationship between lipidslevelsand right ventricular volume overload in congestive heart failure

BackgroundThe relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechan-isms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels.MethodsWe collected data of clinical characteristics, echocardio-graph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels[including total cho-lesterol（TCL）, high-density lipoprotein cholesterol（HDL-C）, low-density lipoprotein cholesterol（LDL-C）, and triglycerides（TG）]and right ventricle end diastolic diameter （RVEDD）, left ventricle end diastolic diameter （LVEDD）, right atrium diameter （RA）, left atrium diameter （LA）, or left ventricle ejection fraction （LVEF） were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area.ResultsThere was a significantly inverse correlation between TCL le-vels and RVEDD （r=-0.34,P〈0.001） and RA （r=-0.36,P〈0.001）. Other lipids such as LDL-C, HDL-C, and TG had asimilar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use.ConclusionsLipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as wellas identify a causal relationship, if any.