Diabetes is associated with an increased risk of cardiovascular disease in patients with familial hypercholesterolemia.

BACKGROUND: Familial hypercholesterolemia (FH) is the most common genetic disorder of lipoprotein metabolism, affecting 1:250 individuals worldwide. This monogenic disease is associated with lifelong elevation in circulating low-density lipoprotein cholesterol and premature cardiovascular disease (CVD). In 2016, the estimated prevalence of diabetes in Canada was 9%. In the FH population, little is known about the prevalence of diabetes and its impact on CVD risk. OBJECTIVE: The objectives of this study were to investigate the prevalence of diabetes among a large cohort of FH patients and to investigate the association between diabetes and CVD risk. METHODS: The FH Canada registry contains data on 3740 subjects. We selected adult patients with FH according to the Dutch Lipid Clinic Network criteria. After excluding subjects with missing data, there remained 1412 patients who were included in the final analysis. RESULTS: The present cohort from the FH Canada database comprises a total of 73 diabetic patients (5%). The prevalence of CVD was higher in diabetic FH patients (45%) than in nondiabetics (22%) (odds ratio 2.9, 95% confidence interval 1.8-4.7, P < .0001). However, the average Montreal-FH-SCORE was also higher in the diabetic group than in the nondiabetic group (29.7 vs 21.2, respectively, P < .0001). Diabetes was no longer a significant predictor of CVD when the analysis was adjusted for the Montreal-FH-SCORE. CONCLUSION: In conclusion, diabetic FH patients represent a high-risk group for CVD risk, most likely due to the fact that diabetic subjects have many concomitant cardiometabolic risk factors.

Analytical interferences resulting from intravenous lipid emulsion.

CONTEXT: Lipid resuscitation therapy using intravenous lipid emulsion (IVLE) for drug overdoses has gained widespread use. However, there is little information regarding its adverse effects. OBJECTIVES: We performed lipemic interference studies on typical automated platforms to investigate the potential of lipid resuscitation therapy to interfere with the reliability and turnaround time of analytes that would be of interest in acute intoxications. We also tested methods to minimize interferences. MATERIALS AND METHODS: Serum pools were supplemented with increasing concentrations of Intralipid-20%(®) (0-30%). Analyses were performed on Beckman-Coulter DXC800 and DXI and Roche Modular-P. Analytes demonstrating significant interference were re-measured after centrifugation (14 000 × g for 10 minutes). RESULTS: Triglyceride and glycerol-blanked triglyceride concentrations were similar in IVLE-free samples. However, with addition of IVLE, concentrations were markedly different (139 vs. 76 mmol/L). There was no appreciable interference on the troponin-I, sodium, potassium, chloride, calcium, bicarbonate or urea assays. Albumin and magnesium assays demonstrated significant interference. Amylase, lipase, phosphate, creatinine, total protein, ALT, CK and bilirubin became unmeasurable in IVLE-supplemented samples. Whereas glucose measurement by potentiometry was free of interference, colorimetric methodology was error prone. Centrifugation removed > 90% of glycerol-blanked triglyceride (max = 5.8 mmol/L), dramatically reducing lipid interferences. DISCUSSION: IVLE results in appreciable analytical interferences at concentrations demonstrated in lipid resuscitation therapy. Of particular concern is the marked interference on glucose and magnesium, which may result in unsuccessful and potentially harmful interventions. Major implications for patient care include reporting of incorrect results and delays in the reporting of time-sensitive results. Whenever possible, blood samples should be collected prior to initiating lipid therapy. Interferences can be minimized by brief centrifugation at relatively low speeds on equipment readily available in most core labs.