Riesgo cardiovascular, dislipemias e indicación de estatinas en una población de obesos mórbidos

Introducción: La obesidad se relaciona con un riesgo cardiovascular (RCV) elevado. Esto nos obliga a tomar conductas terapéuticas y prevencionistas. El objetivo de este trabajo es evaluar el riesgo cardiovascular en una población de obesos mórbidos y valorar la correcta indicación de estatinas. Metodología: Estudio transversal, descriptivo, observacional, con la población obesos mórbidos del Programa de Obesidad y Cirugía Bariátrica (POCB) del Hospital Maciel, desde noviembre del 2014 a marzo del 2020. El RCV se valoró con la calculadora de la organización panamericana de la salud. La indicación de estatinas se consideró según RCV o diagnóstico de dislipemia. Resultados: Se analizaron 478 pacientes, el 84.3% fueron mujeres, la mediana para la edad fue de 44 años, y para el IMC 50 kg/m2. Se calculó un RCV bajo para el 57% de los pacientes; y alto o muy alto para un 37%. La prevalencia de las dislipemias fue 84,3%, a predominio de hipercolesterolemia (33,7%) y dislipemia aterogénica (19,5%). El 60.6% (290) de los pacientes presenta indicación de tratamiento con estatinas, solo el 38.9%. (113) las recibe. El 38.1% (43) alcanzan los objetivos terapéuticos. Conclusiones : La obesidad presenta múltiples comorbilidades que aumentan el RCV, aun así se encuentra subestimada por las calculadoras de riesgo. Queda en evidencia un infratratamiento farmacológico de estos pacientes, no logrando los objetivos terapéuticos propuestos.

Introduction: Obesity is related to a high cardiovascular risk (CVR). This forces us to take therapeutic and preventive behaviors. The objective of this work is to evaluate cardiovascular risk in a morbidly obese population and assess the correct indication of statins. Methodology: Cross-sectional, descriptive, observational study, with the morbidly obese population of the Obesity and Bariatric Surgery Program (POCB) of the Maciel Hospital, from November 2014 to March 2020. CVR was assessed with the calculator of the Pan-American health organization. The indication for statins was considered according to CVR or diagnosis of dyslipidemia. Results: 478 patients were analyzed, 84.3% were women, the median age was 44 years, and the BMI was 50 kg/m2. A low CVR was calculated for 57% of patients; and high or very high for 37%. The prevalence of dyslipidemia was 84.3%, with a predominance of hypercholesterolemia (33.7%) and atherogenic dyslipidemia (19.5%). 60.6% (290) of patients have an indication for treatment with statins, only 38.9%. (113) receives them. 38.1% (43) achieved therapeutic objectives. Conclusions: Obesity presents multiple comorbidities that increase CVR, yet it is underestimated by risk calculators. Pharmacological undertreatment of these patients is evident, not achieving the proposed therapeutic objectives.

Introdução : A obesidade está relacionada a um alto risco cardiovascular (RCV). Isso nos obriga a adotar comportamentos terapêuticos e preventivos. O objetivo deste trabalho é avaliar o risco cardiovascular em uma população com obesidade mórbida e avaliar a correta indicação de estatinas. Metodologia: Estudo transversal, descritivo, observacional, com a população com obesidade mórbida do Programa de Obesidade e Cirurgia Bariátrica (POCB) do Hospital Maciel, no período de novembro de 2014 a março de 2020. O RCV foi avaliado com a calculadora da organização pan-americana de saúde. A indicação de estatinas foi considerada de acordo com RCV ou diagnóstico de dislipidemia. Resultados: Foram analisados ​​478 pacientes, 84,3% eram mulheres, a mediana de idade foi de 44 anos e o IMC foi de 50 kg/m2. Um RCV baixo foi calculado para 57% dos pacientes; e alto ou muito alto para 37%. A prevalência de dislipidemia foi de 84,3%, com predomínio de hipercolesterolemia (33,7%) e dislipidemia aterogênica (19,5%). 60,6% (290) dos pacientes têm indicação de tratamento com estatinas, apenas 38,9%. (113) os recebe. 38,1% (43) alcançaram objetivos terapêuticos. Conclusões: A obesidade apresenta múltiplas comorbidades que aumentam o RCV, mas é subestimada pelas calculadoras de risco. É evidente o subtratamento farmacológico destes pacientes, não atingindo os objetivos terapêuticos propostos.

Transitioning Adolescents and Young Adults with Lipid Disorders to Adult Health Care.

PURPOSE OF REVIEW: Pediatric healthcare providers have increasingly become aware of the need for timely and informative transition of adolescents and young adults with chronic medical conditions such as diabetes and cystic fibrosis. However, there is paucity of published data on the importance of and most effective way to transition youth with lipid disorders who are at increased risk of premature cardiovascular disease. RECENT FINDINGS: Evidence shows that atherosclerosis begins at a young age. However, there are no guidelines on the transition of adolescents and young adults with dyslipidemia. In addition, there are conflicting guidelines for lipid management in children versus adults, despite advances in medical pharmacotherapies for dyslipidemia. The lack of guidelines for transition and discordant recommendations for management of this vulnerable population places young adults at-risk for worsening of their underlying disease, and premature cardiovascular events.

[Adult and pediatric thesaurismosis: Lysosomal, lipid and glycogen storage diseases]. / Thésaurismoses adultes et pédiatriques : maladies de surcharge lysosomale, surcharges lipidiques et glycogénoses.

Thesaurismosis or storage diseases are rare genetic disorders due to an abnormal accumulation of an organic compound or its metabolite within cells. These conditions are either secondary to a defect in catabolism caused by enzymatic dysfunction or to a deficiency in transport proteins. They encompass lysosomal storage diseases, lipid storage diseases or dyslipidemias, and glycogen storage disorders or glycogenoses. Diagnosis is typically based on clinical and biological anomalies but may be made or suggested by the pathologist when symptoms are atypical or when biochemical or genetic tests are challenging to interpret. For accurate diagnosis, it is crucial to freeze a portion of the samples. Special staining and electronic microscopy can also aid in the diagnostic process. As the diagnosis is multidisciplinary, collaboration with clinicians, biochemists and geneticists is essential.

The association between perceived neighborhood safety and cardiovascular disease risk factors.

Cardiovascular disease (CVD) remains the leading cause of mortality in the U.S. accounting for 1 in 4 deaths each year. Environmental factors, such as neighborhood safety, may increase the risk of CVD. Therefore, the current study assessed perceived neighborhood safety and its association with CVD risk factors (i.e. dyslipidemia, hypertension, type II diabetes) among 663 adults (mean age: 49.97 years, 61.24% female, 78.28% White). Participants completed self-report measures as part of a larger study of environmental influences on cardiac health. Results indicated that individuals reporting low perceived neighborhood safety had greater odds of having at least one CVD risk factor (OR = 2.76, 95% CI: 1.46, 5.22) compared to those with high perceived safety. There was a significant interaction between gender and the presence of at least one CVD risk factor in relation to perceived neighborhood safety. Low perceived neighborhood safety was associated with greater odds of having at least one CVD risk factor among males (OR = 5.48, 95% C.I: 1.82, 16.52) but not females. These findings suggest that low perceived safety is associated with CVD risk factors, especially among males. Future work should seek to better understand the interaction by gender in the relationship between perceived safety and CVD risk factors.

Cognitive function in dyslipidemia patients: exploring the impact of statins.

Background: Evidence regarding the relationship between the use of statins and cognitive outcomes presents varying findings. This study aims to analyze the relationship between sustained statin use and cognitive performance in dyslipidemia patients. Methods: This study presents findings from the Beijing Ageing Brain Rejuvenation Initiative (BABRI) study, in which a cohort of community-dwelling dyslipidemia patients (Entire sample, N = 1,062, aged 50-86) was recruited. Participants were divided into two groups based on their sustained use statins (Statins group, N = 677) or not use any lipid-lowering agents (Untreated group, N = 385). Furthermore, the entire sample was stratified by age into the middle-aged sample (N = 451) and the older people sample (N = 611), following a similar categorization based on statin application. ANCOVA was used to evaluate the relationship between sustained statin use and cognitive function. Results: Overall, in the total sample, the statins group demonstrated better cognition in overall cognition, memory, visuospatial ability, attention, executive function, and language domains compared to the untreated group. Moreover, the statins group only showed better performance in attention among the middle-aged sample. In the older people sample, statins group exhibited superior cognitive performance across various cognitive domains compared to untreated group. Conclusion: Among dyslipidemia patients in Beijing community, sustained statin users exhibited superior cognitive function across all domains compared to untreated individuals, with particularly noticeable improvements among those aged 65 and above. These findings underscore the protective effect of statins on cognitive function in dyslipidemia patients, highlighting significant benefits for the older people population.

Eligibility for marine omega-3 fatty acid supplementation after acute coronary syndromes.

Background and aims: The 2019 European Society of Cardiology guidelines for the management of dyslipidemia consider the use of high-dose marine omega-3 fatty acid (FA) eicosapentaenoic acid (EPA) supplementation (icosapent ethyl 2 × 2g/day) to lower residual cardiovascular risk in high-risk patients with hypertriglyceridemia. This study aimed to assess the eligibility for omega-3 FA-EPA supplementation in patients with acute coronary syndromes (ACS). Methods: In a prospective Swiss cohort of patients hospitalized for ACS, eligibility for marine omega-3 FA-EPA, defined as plasma triglyceride levels ranging from 1.5 to 5.6 mmol/l, was assessed at baseline and one-year follow-up and compared across subgroups. Lipid-lowering therapy intensification with statin and ezetimibe was modelled to simulate a hypothetical systematic treatment and its effect on omega-3 FA-EPA supplementation eligibility. Results: Of 2643 patients, 98 % were prescribed statin therapy at discharge, including 62 % at a high-intensity regimen; 93 % maintained it after one year, including 53 % at a high-intensity regimen. The use of ezetimibe was 3 % at discharge and 7 % at one year. Eligibility was observed in 32 % (32 % men, 29 % women) one year post-ACS. After modelling systematic treatment with statins, ezetimibe, and both, eligibility decreased to 31 %, 25 % and 24 %, respectively. Eligibility was higher in individuals aged <70 (34 vs 25 %), smokers (38 vs 28 %), diabetics (46 vs 29 %), hypertensive (35 vs 29 %), and obese patients (46 vs 22 % for normal weight), all with p-values <0.001. Conclusion: In a contemporary Swiss cohort of patients with ACS, up to 32 % would be eligible for omega-3 FA-EPA supplementation one year after ACS, highlighting an opportunity to mitigate residual cardiovascular risk in patients with ACS and hypertriglyceridemia.

Assessment of correlation between lipid ratios and body mass index in patients with type 2 diabetes mellitus in Sarajevo, Bosnia and Herzegovina.

Objective. Studies that have evaluated correlation between body mass index (BMI) and novel lipid indices such as triglycerides (TG)/high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC)/HDL-C, and low-density lipoprotein cholesterol (LDL-C)/HDL-C in type 2 diabetes mellitus (T2DM) are scarce. Hence, the aim of the present study was to explore the correlation between BMI and novel lipid indices in Bosnian patients with T2DM. Methods. Present study included 117 patients with T2DM (mean age: 66.51 years) and 68 controls (mean age: 68.37 years). BMI was calculated as weight/height². Lipids were measured by standard methods. TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were separately calculated. The differences between the groups were assessed by Student's t-test or Man Whitney U test. Correlations were determined by Spearman's test. Results. In a total sample of T2DM patients, 41.0% were overweight and 44.4% were obese. In the control group, 51.5% of subjects were overweight and 25.0% were obese. In T2DM group, a significant correlation was observed between BMI and HDL-C, LDL-C, TG/HDL, TC/HDL-C, and LDL-C/HDL-C ratios. In the control group, there was a significant correlation found between BMI and HDL-C, TG, TG/HDL, TC/HDL-C, and LDL-C/HDL-C-ratios. Correlation between BMI and other lipid parameters in T2DM and the control group was not determined. Conclusion. The present study showed significant correlation between BMI and novel lipid indices in both T2DM patients and the control group of subjects. Possible explanation for the observed results might be prevalence of overweight and obese participants in this study sample. Since novel lipid indices are used in the prediction of cardiometabolic risk, results obtained in the present study have valuable clinical implications.

Chinese expert consensus on blood lipid management in patients with diabetes (2024 edition).

Diabetes is a significant independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with dyslipidemia playing a critical role in the initiation and progression of ASCVD in diabetic patients. In China, the current prevalence of dyslipidemia in diabetes is high, but the control rate remains low. Therefore, to enhance lipid management in patients with diabetes, the Endocrinology and Metabolism Physician Branch of the Chinese Medical Doctor Association, in collaboration with the Experts' Committee of the National Society of Cardiometabolic Medicine, has convened experts to develop a consensus on the management of dyslipidemia in patients with type 1 or type 2 diabetes. The development of this consensus is informed by existing practices in lipid management among Chinese diabetic patients, incorporating contemporary evidence-based findings and guidelines from national and international sources. The consensus encompasses lipid profile characteristics, the current epidemiological status of dyslipidemia, ASCVD risk stratification, and lipid management procedures in diabetic patients. For the first time, both low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol have been recommended as primary targets for lipid intervention in diabetic patients. The consensus also includes a summary and recommendations for lipid management strategies in special diabetic populations, including children and adolescents, individuals aged 75 years and older, patients with chronic kidney disease, metabolic-associated fatty liver disease, and those who are pregnant. This comprehensive consensus aims to improve cardiovascular outcomes in diabetic patients by contributing to the dissemination of key clinical advancements and guiding clinical practice.

Cardiometabolic risk in children and adolescents with obesity: a position paper of the Italian Society for Pediatric Endocrinology and Diabetology.

Despite the implementation of preventive measures to counteract the obesity epidemics, the prevalence of childhood obesity is still alarming all over the world. Childhood obesity is the most common risk factor for both cardiovascular and metabolic diseases. In fact, an earlier onset of obesity can cause a greater risk of adiposity tracking across the lifespan and consequently a longer exposure to cardiometabolic risk factors. Accumulating evidence provided by prospective and intervention studies demonstrated the link between pediatric obesity and selected subclinical signs of cardiovascular damage (atherosclerosis and left ventricular hypertrophy), or fatal and not fatal cardiovascular events as early as 40 years of age.The numerous guidelines and scientific documents published in the last years demonstrate the relevance of assessing cardiometabolic risk factors in children and adolescents with OB.This Position paper, released by experts of the "Childhood Obesity study group" within the Italian Society for Pediatric Endocrinology and Diabetology, aims to review the assessment of cardiometabolic risk factors and comorbidities in children and adolescents with OW/OB on the light of the most recent scientific evidence.The main recommendations are: (a) early detection of comorbidities, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, polycystic ovary syndrome, inactivity, obstructive sleep apnea and decline in kidney function; (b) weight loss treatment, which is associated with a reduction of all cardiometabolic risk factors; (c) specific treatment of comorbidities, through lifestyle modifications or pharmacological treatment added to lifestyle for suitable individuals; d). monitoring comorbidities for mitigating future morbidity and mortality.

Effects of ß-hydroxy-ß-methylbutyrate (HMB) supplementation on lipid profile in adults: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials.

Background and aim: The regulation of lipid metabolism is crucial for preventing cardiovascular diseases, which are among the leading causes of mortality worldwide. ß-hydroxy-ß-methylbutyrate (HMB) has garnered attention for its potential role in modulating lipid profiles. However, the magnitude of these effects are unclear due to the heterogeneity of the studies. This study aimed to provide a comprehensive overview of the randomized controlled trials (RCTs) that have examined the effects of HMB on lipid profiles in adults. Methods: Databases including PubMed, Web of Science, and Scopus, were searched for relevant studies through January 2024. The study protocol was also registered at Prospero (no. CRD42024528549). Based on a random-effects model, we calculated WMDs and 95% confidence intervals (CIs). The outcomes assessed included total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Sensitivity, subgroup and meta-regression analyses were also conducted. Results: Our analysis included a total of 10 RCTs comprising 421 participants. The pooled data revealed no significant effect of HMB supplementation on TC (WMD: -2.26 mg/dL; 95%CI: -6.11 to 1.58; p = 0.25), TG (WMD: -2.83 mg/dL 95% CI: -12.93 to 7.27; p = 0.58), LDL-C (WMD: 0.13 mg/dL; 95%CI: -3.02 to 3.28; mg; p = 0.94), and HDL-C (WMD: -0.78 mg/dL; 95%CI: -2.04 to 0.48; p = 0.22). The quality of evidence was rated as moderate to low for all outcomes. Conclusion: The current evidence from RCTs suggests that HMB supplementation does not significantly alter lipid profiles, including TC, TG, LDL-C, and HDL-C. Further research is warranted to confirm these results and explore the potential mechanisms of action of HMB. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=528549, CRD42024528549.

Insights into medication adherence among Jordanian patients with dyslipidemia: evaluating health literacy, well-being, and doctor-patient communication.

Background: This study aimed to assess medication adherence among Jordanian patients with dyslipidemia and evaluate the impact of health literacy, well-being, and doctor-patient communication on adherence in this population. Dyslipidemia is a prevalent condition that significantly increases the risk of cardiovascular diseases, and understanding the factors influencing medication adherence is crucial for improving patient outcomes. Methods: An observational cross-sectional study was conducted from March to July 2023. A convenience sample of adult Jordanians diagnosed with dyslipidemia was surveyed in a tertiary hospital using validated scales: the Lebanese Medication Adherence Scale-14 (LMAS-14), the Doctor-Patient Communication Scale (DPC), the WHO well-being index, and the health literacy scale. Bivariate analysis and linear regression models were employed to analyze associations. Results: Among 410 participants (mean age 58.62 ± 12.11 years), the mean scores were LMAS-14 (35.10), DPC (55.77), WHO well-being (47.53), and health literacy (38.96). Higher medication adherence was associated with older age (B = 0.093, p = 0.049), university education (B = 2.872, p = 0.017), prior surgery (B = 2.317, p = 0.021), medium income level (B = 3.605, p = 0.006), and better doctor-patient communication (B = 0.166, p = 0.003). Conversely, cigarette smoking (B = -3.854, p = 0.001) and health insurance (B = -2.146, p = 0.039) were linked to lower adherence. Conclusion: The findings underscore the substantial interplay of socio-demographic and clinical factors affecting medication adherence. Enhanced public health interventions focusing on improving health literacy, communication quality, and addressing socio-economic conditions are vital for better adherence and patient outcomes in Jordan.

The effect of glucomannan supplementation on lipid profile in adults: a GRADE-assessed systematic review and meta-analysis.

BACKGROUND: Glucomannan has been studied for various health benefits, but its effects on lipid profile in adults are not well understood. This meta-analysis aims to evaluate the impact of glucomannan supplementation on serum/plasma levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), Apo B1, Apo A1, APO-B/ A1 ratio, and LDL-C/ HDL-C in adults. METHODS: A comprehensive search was conducted across Scopus, PubMed, Embase, and Web of Science from inception to June 2024 to identify randomized controlled trials (RCTs) assessing glucomannan supplementation on lipid profile in adults. Data were extracted and analyzed using random effects model to determine the standardized mean differences (SMDs) and 95% confidence intervals (CIs) for each biomarker. RESULTS: Glucomannan supplementation significantly decreased TC (SMD: -3.299; 95% CI: -4.955, -1.664, P < 0.001; I 2 = 95.41%, P-heterogeneity < 0.001), LDL-C (SMD: -2.993; 95% CI: -4.958, -1.028; P = 0.006; I 2 = 95.49%, P-heterogeneity < 0.001), and Apo B1 (SMD: -2.2; 95% CI: -3.58, -0.82; P = 0.01). However, glucomannan did not alter the levels of TG (SMD: -0.119; 95% CI: -1.076, 0.837, P = 0.789; I 2 = 91.63%, P-heterogeneity < 0.001), Apo A1 (SMD: -0.48; 95% CI: -6.27, 5.32; P = 0.76), APO-B/ A1 ratio (SMD: -1.15; 95% CI: -2.91, 0.61; P = 0.11), and LDL-C/ HDL-C ratio (SMD: -2.2; 95% CI: -7.28, 2.87; P = 0.2). CONCLUSIONS: Glucomannan supplementation has a beneficial effect on the level of TC and LDL-C.

Cucurbita Pepo L. Seed Oil Modulates Dyslipidemia and Neuronal Dysfunction in Tramadol-Induced Toxicity in Wistar Albino Rats.

Objective: The modulating effects of Cucurbita pepo seed oil (CPSO) on dyslipidemia and neuronal dysfunction in tramadol toxicity were studied. Methods: Fifty-six albino rats were divided into seven groups of eight rats each after a 2-week acclimatization period. All animals had unrestricted access to water and feed, and treatments were administered orally once daily for 42 days. Glutamate dehydrogenase and glutaminase activities were assessed using brain homogenate, while lipid profiles were analyzed in serum samples. Results: Tramadol toxicity was evidenced by significant (P < 0.05) increases in brain glutamate dehydrogenase along with significant (P < 0.05) decreases in the activities of glutaminase in the group administered only tramadol. Also, serum levels of total cholesterol, LDL-C and triglycerides also increased significantly (P < 0.05) following administration of tramadol with decreased level of HDL-C (P < 0.05). However, treatment with CPSO significantly restored the activities and levels of the altered biochemical parameters in a dose-dependent manner. The results of the biochemical investigation using the lipid profile and the enzymes of glutamate metabolism were corroborated by the results obtained from the histopathological examination of the brain. Conclusion: The results of this study therefore suggest that tramadol-induced dyslipidemia and neuronal dysfunction be managed and prevented by the administration of Cucurbita pepo seed oil.

The Influence of Physical Activity and Diet Mobile Apps on Cardiovascular Disease Risk Factors: Meta-Review.

BACKGROUND: The literature on whether physical activity (PA) and PA and diet (PA+Diet) mobile apps improve cardiovascular disease (CVD) risk factors is promising. OBJECTIVE: The aim of this meta-review is to provide an evidence synthesis of systematic reviews and meta-analyses examining the influence of PA and PA+Diet apps on the major CVD risk factors. METHODS: We systematically searched 5 databases until January 12, 2022. Included systematic reviews and meta-analyses (1) reported the CVD risk factor outcomes of BMI, waist circumference, body weight, blood pressure (BP), hemoglobin A1c (HbA1c), fasting blood glucose, blood lipids, or PA; (2) enrolled healthy participants ≥18 years who may or may not have the metabolic syndrome, diabetes mellitus, or preexisting CVD risk factors; (3) reviewed PA or PA+Diet app interventions integrating behavioral change techniques (BCT) to deliver their information; and (4) had a nonapp control. RESULTS: In total, 17 reviews (9 systematic reviews and 8 meta-analyses) published between 2012 and 2021 qualified. Participants were middle-aged, mostly women ranging in number from 10 to 62,219. Interventions lasted from 1 to 24 months, with the most common behavioral strategies being personalized feedback (n=8), self-monitoring (n=7), and goal setting (n=5). Of the PA app systematic reviews (N=4), the following CVD risk factors improved: body weight and BMI (n=2, 50%), BP (n=1, 25%), HbA1c (n=1, 25%), and blood lipids (n=1, 25%) decreased, while PA (n=4, 100%) increased. Of the PA+Diet app systematic reviews (N=5), the following CVD risk factors improved: body weight and BMI (n=3, 60%), BP (n=1, 20%), and HbA1c (n=3, 60%) decreased, while PA (n=3, 60%) increased. Of the PA app meta-analyses (N=1), the following CVD risk factors improved: body weight decreased (-0.73 kg, 95% CI -1.45 to -0.01; P=.05) and PA increased by 25 minutes/week (95% CI 0.58-1.68; P<.001), while BMI (-0.09 kg/m2, 95% CI -0.29 to 0.10; P=.35) and waist circumference (-1.92 cm, 95% CI -3.94 to 0.09; P=.06) tended to decrease. Of the PA+Diet app meta-analyses (n=4), the following CVD risk factors improved: body weight (n=4, 100%; from -1.79 kg 95% CI -3.17 to -0.41; P=.01 to -2.80 kg 95% CI -4.54 to -1.06, P=.002), BMI (n=1, 25%; -0.64 kg/m2, 95% CI -1.09 to -0.18; P=.01), waist circumference (n=1, 25%; -2.46 cm, 95% CI -4.56 to -0.36; P=.02), systolic/diastolic BP (n=1, 25%; -4.22/-2.87 mm Hg, 95% CI -6.54 to -1.91/ -4.44 to -1.29; P<.01), and HbA1c (n=1, 25%; -0.43%, 95% CI -0.68 to -0.19; P<.001) decreased. CONCLUSIONS: PA and PA+Diet apps appear to be most consistent in improving PA and anthropometric measures with favorable but less consistent effects on other CVD risk factors. Future studies are needed that directly compare and better quantify the effects of PA and PA+Diet apps on CVD risk factors. TRIAL REGISTRATION: PROSPERO CRD42023392359; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392359.

Relationship Between Smoking and Lipid Profile in Four Primary Health Care Units: A Research Study.

Introduction Smoking is the most preventable cause of cardiovascular disease (CVD). Dyslipidemia is also an important risk factor for CVD. Yet, research has provided contradicting findings regarding the association between smoking and blood lipids. This study aims to assess the relationship between smoking and dyslipidemia, as well as compliance with the previously established treatment target. Materials and methods This was a cross-sectional study. Apparently, healthy users aged 40 or over, were from four primary health care units (PHCU) in Portugal. The inclusion criteria were: age between 40 and 69 and active enrollment in one of the four PHCU. The exclusion criteria were: background of atherosclerotic disease, heart failure, chronic kidney disease, diabetes mellitus, and a history of acute myocardial infarction; no record of lipid profile or triglyceride value of more than 400 mg/dL. Cardiovascular risk levels were determined using the Systematic Coronary Risk Evaluation (SCORE) 2 risk. The low-density lipoprotein cholesterol (LDL-c) target was considered the recommendation by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2019. Results From an initial population of 16,939 patients, 12,076 apparently healthy patients were included. The difference between cholesterol values is statistically significant, with total cholesterol, LDL-c, and triglyceride values tending to be higher in the smoking group and the high-density lipoprotein cholesterol (HDL-c) value tending to be higher in the non-smoking group. Regarding the LDL target, there is also a statistically significant difference between smokers and non-smokers. Discussion Smoking and dyslipidemia are two isolated cardiovascular risk factors. Their association has been questioned. This study demonstrated that there is an association between smoking and the lipid profile, but also with the LDL target. However, there are some biases that must be considered, and which do not allow for generalization. Conclusions This study concludes that smoking negatively influences the lipid profile, with lipids being found less frequently on target. However, more studies are needed in this area, particularly studying other relevant factors such as body mass index.

Prognostic Value of Fibrosis-4 in Acute Ischemic Stroke Patients Undergoing Intravenous Thrombolysis.

Purpose: Although recombinant tissue plasminogen activator (rt-PA) treatment is efficient in patients with acute ischemic stroke (AIS), a significant percentage of patients who received rt-PA intravenous thrombolysis (IVT) do not achieve a good prognosis. Therefore, the factors that affect the poor prognosis of patients with IVT are needed. The Fibrosis-4 (FIB-4) index has been used as a liver fibrosis biomarker. We aimed to investigate the relationship between the FIB-4 index and functional outcomes in patients with AIS receiving IVT. Patients and Methods: This study prospectively included consecutive patients with AIS receiving IVT between April 2015 and May 2022. We collected clinical and laboratory data and calculated the FIB-4 index. Clinical outcome was poor functional outcome (mRS ≥3) at 3 months after IVT. Multivariate logistic regression analysis was used to analyze the association between FIB-4 and outcome. We explored the interactive effect of FIB-4 and dyslipidemia on poor outcomes, and subgroup analysis was performed. Furthermore, an individualized prediction model based on the FIB-4 for functional outcome was established in the dyslipidemia group. Results: A total of 1135 patients were included, and 41.50% had poor 3-month outcomes. After adjusted by other variants that P value <0.05 in univariable analysis, FIB-4 was independently associated with poor outcomes (OR=1.420; 95% CI: 1.113-1.812; P=0.004). There was a significant interaction between FIB-4 and dyslipidemia on poor outcome (P=0.036), and the independent association between FIB-4 and poor outcome was maintained in the dyslipidemia subgroup (OR=1.646; 95% CI: 1.228-2.206; P=0.001). Furthermore, in the dyslipidemia group, the FIB-4-based prediction model had good predictive value (the AUC of the training and validation sets were 0.767 and 0.708, respectively), good calibration (P-values for the Hosmer-Lemeshow test >0.05), and clinical usefulness. Conclusion: FIB-4 is an independent risk factor for poor outcomes in IVT patients with dyslipidemia, which can be used as a simple predictor of their prognosis.

Blood L-cystine levels positively related to increased risk of hypertension.

Hypertension is one component of metabolic syndrome (MetS). Here, the study evaluated hypertension-associated metabolites in relation to other MetS components. Fasting plasma samples were collected from 22 hypertensive and 63 normotensive subjects for non-targeted metabolomics. Compared with normotensive subjects, hypertensive patients were more diabetic (6.3% vs. 36.4%) and had dyslipidemia (27.0% vs. 63.6%) (both p < .05). By non-targeted metabolomics, 758 metabolites in 22 classes were identified and 56 were differentially regulated between hypertensive and normotensive groups. Amongst these 56 metabolites, receiver operating characteristic analysis showed that 14 had an area under the curve above 0.6. Multivariate-adjusted logistic regression analysis demonstrated that per one-fold increase of L-glutmatic acid, L-cystine, (9S,10E,12Z,15Z)-9-Hydroxy-10,12,15-octadecatrienoic acid, deoxyribose 5-phosphate, and falcarinolone, the odds ratios were 3.64, 4.61, 0.26, 0.26, and 0.37 for having the risk of hypertension, respectively. Of five metabolites, by Spearman's correlation analysis, only L-glutmatic acid and L-cystine levels were positively associated with systolic and diastolic blood pressure (all p < .05). Spearman's correlation analysis further revealed that L-glutmatic acid levels were positively correlated with to body mass index (BMI), fasting blood glucose, and serum triglyceride but negatively associated with HDL-c (all p < .05) whereas L-cystine levels were not related to any of these components (p ≥ .13). Multivariate-adjusted linear regression analysis confirmed the positive correlation between L-cystine levels and systolic or diastolic blood pressure (ß = 2.66 for SBP; ß = 2.50 for DBP; both p < .05). In conclusion, L-cystine could be a potent metabolite for increased risk of hypertension.

Gut microbiome shifts in adolescents after sleeve gastrectomy with increased oral-associated taxa and pro-inflammatory potential.

Background: Bariatric surgery is highly effective in achieving weight loss in children and adolescents with severe obesity, however the underlying mechanisms are incompletely understood, and gut microbiome changes are unknown. Objectives: 1) To comprehensively examine gut microbiome and metabolome changes after laparoscopic vertical sleeve gastrectomy (VSG) in adolescents and 2) to assess whether the microbiome/metabolome changes observed with VSG influence phenotype using germ-free murine models. Design: 1) A longitudinal observational study in adolescents undergoing VSG with serial stool samples undergoing shotgun metagenomic microbiome sequencing and metabolomics (polar metabolites, bile acids and short chain fatty acids) and 2) a human-to-mouse fecal transplant study. Results: We show adolescents exhibit significant gut microbiome and metabolome shifts several months after VSG, with increased alpha diversity and notably with enrichment of oral-associated taxa. To assess causality of the microbiome/metabolome changes in phenotype, pre-VSG and post-VSG stool was transplanted into germ-free mice. Post-VSG stool was not associated with any beneficial outcomes such as adiposity reduction compared pre-VSG stool. However, post-VSG stool exhibited an inflammatory phenotype with increased intestinal Th17 and decreased regulatory T cells. Concomitantly, we found elevated fecal calprotectin and an enrichment of proinflammatory pathways in a subset of adolescents post-VSG. Conclusion: We show that in some adolescents, microbiome changes post-VSG may have inflammatory potential, which may be of importance considering the increased incidence of inflammatory bowel disease post-VSG.

Metabolic, cardiac, and bone health testing in patients with prostate cancer on androgen-deprivation therapy: A population-based assessment of adherence to therapeutic monitoring guidelines.

BACKGROUND: Androgen-deprivation therapy (ADT) remains a cornerstone in treatment for patients with advanced prostate cancer. ADT is associated with several adverse effects, including osteoporosis, metabolic syndrome, and cardiovascular events, leading to guidelines recommending routine testing to monitor for these toxicities. There is a lack of data assessing adherence to these recommendations. METHODS: The authors conducted a retrospective cohort study using administrative data from Ontario, Canada between 2008 and 2021. They identified all older men (aged 65 years and older) who received ADT for prostate cancer using comprehensive provincial health databases. The primary outcomes were the use of testing for lipids, dysglycemia (glucose), bone health serum, and bone density between 6 weeks before and 1 year after the initiation of ADT. RESULTS: In total, 29,097 patients were examined, of whom 52.8% were prescribed ADT by urologists, 37.9% were prescribed ADT by radiation oncologists, 2.8% were prescribed ADT by medical oncologists, and 2.4% were prescribed ADT by other physicians. Adherence to guidelines was low: only 21.3% of patients received a bone density scan, 41.2% underwent bone health-related serum tests, 51.3% completed a lipid profile, and 65.9% underwent dysglycemia testing within 1 year of diagnosis. Overall, only 11.9% of patients received all of the recommended investigations. Adherence to testing did not appear to improve over time (2008-2021) or with guideline publication. Patient (age) and physician (specialty) factors had important associations with adherence to testing. CONCLUSIONS: Most patients receiving ADT for prostate cancer do not receive recommended testing to monitor for treatment-related toxicity. Further study is required to address barriers to therapeutic monitoring of men on ADT and to reduce treatment-associated adverse events.