Totum-070, a Polyphenol-Rich Plant Extract, Prevents Hypercholesterolemia in High-Fat Diet-Fed Hamsters by Inhibiting Intestinal Cholesterol Absorption.

Atherosclerotic cardiovascular disease is the leading cause of mortality worldwide, and hypercholesterolemia is a central risk factor for atherosclerosis. This study evaluated the effects of Totum-070, a plant-based polyphenol-rich supplement, in hamsters with high-fat diet (HFD)-induced dyslipidemia. The molecular mechanisms of action were explored using human Caco2 enterocytes. Totum-070 supplementation reduced the total cholesterol (-41%), non-HDL cholesterol (-47%), and triglycerides (-46%) in a dose-dependent manner, compared with HFD. HFD-induced hepatic steatosis was also significantly decreased by Totum-070, an effect associated with the reduction in various lipid and inflammatory gene expression. Upon challenging with olive oil gavage, the post-prandial triglyceride levels were strongly reduced. The sterol excretion in the feces was increased in the HFD-Totum-070 groups compared with the HFD group and associated with reduction of intestinal cholesterol absorption. These effects were confirmed in the Caco2 cells, where incubation with Totum-070 inhibited cholesterol uptake and apolipoprotein B secretion. Furthermore, a microbiota composition analysis revealed a strong effect of Totum-070 on the alpha and beta diversity of bacterial species and a significant decrease in the Firmicutes to Bacteroidetes ratio. Altogether, our findings indicate that Totum-070 lowers hypercholesterolemia by reducing intestinal cholesterol absorption, suggesting that its use as dietary supplement may be explored as a new preventive strategy for cardiovascular diseases.

Plants of the Rubiaceae Family with Effect on Metabolic Syndrome: Constituents, Pharmacology, and Molecular Targets.

Metabolic syndrome (MetS) predisposes individuals to chronic non-communicable diseases (NCDs) like type 2 diabetes (T2D), non-alcoholic fatty liver disease, atherosclerosis, and cardiovascular disorders caused by systemic inflammation, intestinal dysbiosis, and diminished antioxidant ability, leading to oxidative stress and compromised insulin sensitivity across vital organs. NCDs present a global health challenge characterized by lengthy and costly pharmacological treatments. Complementary and alternative medicine using herbal therapies has gained popularity. Approximately 350,000 plant species are considered medicinal, with 80% of the world's population opting for traditional remedies; however, only 21,000 plants are scientifically confirmed by the WHO. The Rubiaceae family is promissory for preventing and treating MetS and associated NCDs due to its rich content of metabolites renowned for their antioxidative, anti-inflammatory, and metabolic regulatory properties. These compounds influence transcription factors and mitigate chronic low-grade inflammation, liver lipotoxicity, oxidative stress, and insulin resistance, making them a cost-effective non-pharmacological approach for MetS prevention and treatment. This review aims to collect and update data that validate the traditional uses of the Rubiaceae family for treating MetS and associated NCDs from experimental models and human subjects, highlighting the mechanisms through which their extracts and metabolites modulate glucose and lipid metabolism at the molecular, biochemical, and physiological levels.

Effects of fenugreek supplementation on the components of metabolic syndrome: A systematic review and dose-response meta-analysis of randomized clinical trials.

Metabolic syndrome (MetS) is a cluster of metabolic disorders with a heavy disease burden. Fenugreek was reported to be effective in some components of MetS. Therefore, a comprehensive review and meta-analysis of randomized controlled trials was conducted to study the effects of fenugreek on MetS indices. From the beginning until August 2022, PubMed, Embase, Scopus, and Web of science were searched. Data were analyzed using the random-effect model, and presented as weighted mean difference (WMD) and associated 95 % confidence interval (CI). This meta-analysis comprised from a total of 29 eligible RCTs with 31 arms measuring fasting plasma glucose (FPG), Triglyceride (TG), high-density lipoprotein (HDL), waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The results indicated significant improving effects of fenugreek on FPG (WMD: -16.75 mg/dL; 95 % CI: -23.36, -10.15; P < 0.001), TG (-20.12 mg/dL; 95 % CI: -34.238, -5.994; P < 0.001), HDL (WMD: 3.55 mg/dL; 95 % CI: 1.98, 5.12; P < 0.001), WC (WMD: -2.51; 95 % CI: -3.78, -1.24; P < 0.001) and SBP (WMD: -3.45 mmHg; 95 % CI: -6.38, -0.52; P = 0.021); However the effect on DBP (WMD: 3.17; 95 % CI: -5.40, 11.73; P = 0.469) and BMI (WMD: -0.40 kg/m2; 95 % CI: -1.114, 0.324; P = 0.281) was not significant. Administration of fenugreek can meaningfully reduce FPG, TG, WC, and SBP and increase HDL. The overall results support possible protective and therapeutic effects of fenugreek on MetS parameters.

Effects of Calendula officinalis extract on liver histopathology, lipid profile, and oxidative stress in rats submitted to a diet rich in cholesterol and carbohydrates

Purpose: To evaluate the modulatory properties of Calendula officinalis L. (Asteraceae) (C. officinalis) extract on cafeteria diet-fed rats. Methods: A cafeteria diet was administered ad libitum for 45 days to induce dyslipidemia. Then, the rats were treated with the formulations containing C. officinalis in the doses of 50, 100, and 150 mg/kg or only with the vehicle formulation; the control group received a commercial ration. Results: The cafeteria diet decreased glutathione S-transferase activity and high-density lipoprotein plasmatic levels and damaged the hepatic architecture. The C. officinalis extract was able to reduce lipid infiltration in liver tissue and to modulate oxidative stress and lipid profile markers. Conclusions: The correlations between the variables suggest a pathological connection between oxidative stress markers and serum lipid profile.

American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.

OBJECTIVE: The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS: The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS: This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS: This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.

Efficacy of short duration versus conventional electroacupuncture in the treatment of obesity: a randomized crossover study.

OBJECTIVE: To compare the efficacy of short duration electroacupuncture (EA) with conventional EA to reduce weight and other parameters in obese Thai women. METHODS: A randomized crossover study was conducted in 76 simple obese women. Participants were randomized to undergo either eight weeks of 30-minute EA (EA30) followed by an eight-week washout period, then eight weeks of five-minute EA (EA5), or EA5 followed by a washout period, then EA30. Electro-acupuncture was performed at 14 acupoints for two sessions per week. Participants were randomized to undergo either eight weeks of EA30 followed by an eight-week washout period, then eight weeks of EA5, or EA5 followed by a washout period, then EA30. Electro-acupuncture was performed using a stainless silver needle at 14 acupoints for two sessions per week. The needle was connected to an electric stimulator that delivered a constant current, 40 Hz and 3 mA, for 30 or five minutes according to the assigned treatment period. The primary outcome was the difference in weight reduction between the short-duration and the conventional EA while differences in other anth-ropometric parameters and biochemical parameters were considered as secondary outcomes. RESULTS: After each treatment period, all anthro-pometric characteristics of both groups decreased from the baseline regardless of the treatment sequence, including body weight (1.4-1.8 kg; 0.01), body mass index (0.56-0.70 kg/m ; 0.01), waist and hip circumference, skinfold thickness and body fat percentage as well as the improvement in fasting blood glucose and lipid profiles. There were no significant differences of the treatment effects on anthropometric parameters and biomedical chemistries between conventional and short-duration EA. No adverse effects were reported. CONCLUSION: Short duration EA at 14 acupuncture points had comparable efficacy to conventional EA in reduction of weight and other anthropometric parameters as well as to improve biochemistry parameters in obese women.

Effects of Fish Oil Supplementation on Oxidative Stress Biomarkers and Liver Damage in Hypercholesterolemic Rats.

Metabolic syndrome, especially its component related to dyslipidemia, is related to the development of nonalcoholic fatty liver disease (NAFLD), which is a disease with a significant global prevalence. Supplementation with omega-3 polyunsaturated fatty acids emerged as a complementary therapeutic possibility for dyslipidemia, but its benefits are questioned. This paper aims at evaluating the effects of fish oil supplementation in rats with hypercholesterolemia induced by hypercholesterolemic diet (HD). The study design is based on an experimental model in which the animals were randomly divided into 3 groups: G1 (standard commercial feed + saline solution); G2 (hypercholesterolemic diet + saline solution) and G3 (hypercholesterolemic diet + fish oil) over a period of 16 weeks. Metabolic control parameters and oxidative stress biomarkers were evaluated according to standardized methodologies. The G3 group showed significantly lower values of plasma concentrations of TG, and hepatic myeloperoxidase as well as higher erythrocyte superoxide dismutase activity (p < 0.05). Regarding histopathological analysis, there was lipid accumulation in the liver of animals from group G2; meanwhile, hepatocytes reorganization and expressive reduction of lipid vacuoles and hepatic TG content was observed in group G3. This study demonstrated how fish oil supplementation reduced the plasma concentration and hepatic content of triglycerides, as well as liver tissue damage in histopathological analysis.

The effect of ginger supplementation on metabolic profiles in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: There is some evidence regarding the positive effects of ginger supplementation on metabolic profile in patients with type 2 diabetes (T2DM). However, they are conflicting. The present systematic review and meta-analysis aimed to summarize earlier findings for the effect of ginger supplementation on metabolic profile in patients with T2DM. METHODS: Scopus, PubMed and Google Scholar databases were systematically searched up until September 2021 to collect all randomized clinical trials that evaluated the effect of ginger supplementation on FBS, HbA1c, TC, TG, LDL, HDL, SBP and DBP in patients with T2DM. We conducted our study according to the 2020 PRISMA guidelines. We included only English language publications. Pooled effect sizes were measured using a random-effects model and were reported as the weighted mean difference (WMD) and 95% CI. In addition, the Cochrane Collaboration's risk of bias tool was used to evaluate quality of the trials. RESULTS: In overall, 10 articles were included in this systematic review and meta-analysis. Our pooled meta-analysis indicated a significant reduction in FBS following ginger supplementation by polling 8 effect sizes [weighted mean difference (WMD): - 18.81; 95% CI: - 28.70, - 8.92), I2 = 77.4%] and in HbA1C through 7 effect sizes (WMD: -0.57; 95% CI: -0.93, -0.20, I2 =88.6%). Pooling 5 effect sizes, we found a significant reduction in SBP (WMD: -4.20; 95% CI: -7.64, -0.77, I2 =97%) and DBP [WMD: - 1.61; 95% CI: - 3.04, - 0.18), I2 = 93.2%] after supplementation with ginger. However, our pooled meta-analysis indicated that ginger supplementation had no significant influence on lipid profile involving TG, TC, LDL and HDL. CONCLUSIONS: We found significant reductions in FBS, HbA1C, SBP and DBP after supplementation with ginger in patients with T2DM compared to control group, with no significant changes in serum lipids. Further large RCTs are required to shed light on this issue.

Effect and safety of Guanxinning tablets combined with antiplatelet therapy on acute coronary syndrome / 中国基层医药

Objective:To investigate the effect and safety of Guanxinning tablets combined with antiplatelet therapy on acute coronary syndrome. Methods:A total of 120 patients with acute coronary syndrome who received treatment in Shulan (Hangzhou) Hospital from January 2021 to December 2021 were included in this study. They were randomly divided into a control group and a study group ( n = 60/group). The control group was treated with antiplatelet drugs clopidogrel and aspirin. The study group was treated with clopidogrel, aspirin and Guanxinning tablets in combination. All patients were treated for 3 months. The levels of blood lipids (high-density lipoprotein cholesterol, total cholesterol, triglyceride, low-density lipoprotein cholesterol), C-reactive protein, tumor necrosis factor-α, endothelin-1, and vascular endothelial growth factor measured before and after treatment as well as the incidence of adverse reactions were compared between the two groups. Results:After treatment, serum levels of low-density lipoprotein cholesterol, total cholesterol, and triglyceride in each group were significantly decreased compared with those measured before treatment (all P < 0.05). After treatment, serum level of high-density lipoprotein cholesterol in each group was significantly increased compared with that measured before treatment ( P < 0.05). After treatment, serum levels of total cholesterol, low-density lipoprotein cholesterol, and triglyceride in the control group were (4.36 ± 1.01) mmol/L, (3.02 ± 0.28) mmol/L, and (1.98 ± 0.12) mmol/L respectively which were significantly higher than (3.98 ± 1.05) mmol/L, (2.52 ± 0.42) mmol/L, (1.58 ± 0.23) mmol/L in the study group ( t = -2.02, -7.67, -11.94, all P <0.05). Serum level of high-density lipoprotein cholesterol in the control group was significantly lower than that in the study group [(1.26 ± 0.08) mmol/L vs. (2.36 ± 0.16) mmol/L, t = 47.63, P < 0.001). After treatment, serum levels of C-reactive protein and endothelin-1 in the control group were (5.62 ± 0.56) mg/L and (86.24 ± 12.68) pg/L, respectively, which were significantly higher than (4.32 ± 0.82) mg/L and (75.26 ± 12.46) pg/L in the study group, ( t = -10.14, -4.78, both P < 0.001). After treatment, serum levels of tumor necrosis factor-α and vascular endothelial growth factor in the control group were (5.62 ± 0.56) mg/L and (76.28 ± 13.52) pg/L, which were significantly lower than (8.76 ± 1.06) mg/L and (86.32 ± 13.46) pg/L in the study group ( t = 20.23, 4.08, both P < 0.05). The incidence of adverse reactions in the study group was significantly lower than that in the control group [5.00% (3/60) vs. 8.33% (5/60), χ2 = -0.54, P > 0.05). Conclusion:Guanxinning tablets combined with antiplatelet has a remarkable therapeutic effect on acute coronary syndrome. It is highly safe and has a clinical application value.

Research progress of clinical application of Zhibitai capsule / 中国基层医药

Dyslipidemia is the pathological basis of the occurrence and development of atherosclerosis. It is a major independent risk factor for hypertension, coronary heart disease and cerebrovascular disease. Regulating blood lipid level plays an important role in decreasing the incidence of cardio-cerebrovascular disease. Zhibitai capsule, a lipid-regulating Chinese medicine, has the similar effect to statins. We searched animal experiment studies, clinical trials and reviews in China National Knowledge Infrastructure to analyze the application value and advantages of Zhibitai capsule.

LECISAN® y sus potencialidades terapéuticas para el abordaje farmacológico de la obesidad / LECISAN® and its therapeutic potentialities for the pharmacological approach to obesity

Introducción: La obesidad se ha identificado como un estado crónico de inflamación sistémica conocido como lipoinflamación. En los últimos tiempos ha cobrado relevancia el descubrimiento de moléculas clave que actúan como blancos terapéuticos, así como sus conexiones y mecanismos existentes. Por otra parte, es sabido lo difícil que es la obtención de nuevos fármacos naturales como alternativas o terapias complementarias en enfermedades crónicas no transmisibles como la obesidad y las dislipemias. El LECISAN® destaca como candidato por sus potencialidades. Objetivos: Valorar los resultados de investigaciones preclínicas y clínicas que avalan el uso del LECISAN®. Métodos: Se realizó una revisión sistemática y crítica de las evidencias de impacto de los efectos de la lecitina de soya. Se consultaron artículos publicados preferentemente en los últimos diez años en las bases de datos EBSCO, Google Scholar, Latindex, Redalyc, DOAJ, Dialnet, WorldCat, LILACS, SciELO y OATD. Conclusiones: El LECISAN® es un producto natural que rebasa el contexto de su empleo como suplemento nutricional, pero requiere nuevas investigaciones en el campo de la farmacología. Resultan contradictorios y poco concluyentes los resultados referentes a sus posibles efectos y usos(AU)

Introduction: Obesity has been identified as a chronic state of systemic inflammation known as lipoinflammation. In recent times, the discovery of key molecules acting as therapeutic targets, as well as their connections and existing mechanisms, has gained relevance. On the other hand, it is known how difficult it is to obtain new natural drugs as alternatives or complementary therapies in chronic noncommunicable diseases such as obesity and dyslipidemias. LECISAN® stands out as a candidate, for its potentialities. Objective: To assess the results of preclinical and clinical investigations that support the use of LECISAN®. Methods: A systematic and critical review of evidence about the impact of the effects of soy lecithin was carried out. Articles published preferably in the last ten years were consulted, from the EBSCO, Google Scholar, Latindex, Redalyc, DOAJ, Dialnet, WorldCat, LILACS, SciELO and OATD databases. Conclusions: LECISAN® is a natural product that goes beyond the context of its use as a nutritional supplement, but requires new research in the field of pharmacology. The results regarding its possible effects and uses are contradictory and inconclusive, based on hypotheses that relate an emulsifying action with the phospholipids present in the mixture, the antioxidant effects with isoflavones, the anti-inflammatory effects with the polyunsaturated fatty acids that regulate lipid metabolism, as well as the activation of the phospholipase A2 system with the consequent production of inflammatory cytosines(AU)

Pilates training improves aerobic capacity, but not lipid or lipoprotein levels in elderly women with dyslipidemia: A controlled trial.

INTRODUCTION: The aim of the present study was to verify the effects of a Pilates training on total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), glucose and C-reactive protein (CRP) levels, as well as on functionality of postmenopausal women with dyslipidemia. METHOD: This randomized study involved 35 sedentary women with dyslipidemia, aged between 60 and 75 years. One group participated in a Pilates exercises training with two to four weekly sessions during 10 weeks (Pilates group, n = 20) and the other group did not perform any intervention (control group, n = 6). Biochemical analyses and functionality parameters were measured before and after the 10 weeks. RESULTS: No significant differences were observed in TC, TG, LDL and HDL for both groups. Regarding glucose and CRP levels, significant reductions were observed in both groups after the intervention period. In functional parameters, both groups significantly increased their 30-s chair stand test values. On the other hand, only the Pilates group presented significant increments in the 6-min walk test (p < 0.05). CONCLUSION: Pilates training did not change lipid or lipoprotein levels, but improved cardiorespiratory fitness of elderly women with dyslipidemia.

Morphological, biochemical and histological effects of aqueous extracts of peanut (Arachis hypogaea) on swiss mice in different diets

ABSTRACT Purpose: To evaluate the morphological, biochemical, and histological effects of aqueous extracts of peanut (skinless and added to 1% skin) in Swiss mice submitted to a high-fat diet. Methods: Forty male Swiss mice were divided into four groups (n=10 per group): GI) normocaloric diet; GII) high-fat diet; GIII) high-fat diet + 0.5 mL of peanut extract; GIV) high-fat diet + 0.5 mL of peanut extract + 1% peanut skin. The animals were weighed weekly and euthanized after 12 weeks for histopathological and biochemical analyses. The study was approved by the Animal Use Ethics Committee. Results: The animals in the GIV group had higher body weight when compared to the other ones. Increase in total cholesterol in GIII, increase in blood glucose in groups GII, GIII and GIV, decrease in serum low-density lipoprotein (LDL) concentration in groups GI and GIV and increase in serum concentration of C-reactive protein in GII were seen. The presence of vacuolar fat deposits was found in animal livers from GII. Conclusions: The extracts improved the plasma concentrations of animals that received a high-fat diet, including preventing morphological damage to liver tissue. These benefits were enhanced by the association of peanut shells with the extract.

Phytosterol supplementation in the treatment of dyslipidemia in children and adolescents: a systematic review / Suplementação de fitoesteróis no tratamento da dislipidemia em crianças e adolescentes: uma revisão sistemática

ABSTRACT Objective: To carry out a systematic review on the effects of phytosterol supplementation on the treatment of dyslipidemia in children and adolescents. Data sources: Review in the SciELO, Lilacs, Bireme, PubMed and Web of Science databases, with no time limit. Descriptors: phytosterols or plant sterols and dyslipidemias, hypercholesterolemia, cholesterol, children, adolescent, in English and Portuguese. The articles included were published in Portuguese, English or Spanish and evaluated the effect of phytosterol supplementation in pediatric patients with dyslipidemia. Documents that involved adults or animals, review papers, case studies and abstracts were excluded. Two authors performed independent extraction of articles. Of 113 abstracts, 19 were read in full and 12 were used in this manuscript. Data synthesis: Phytosterol supplementation to reduce cholesterol levels has been shown to be effective in reducing LDL-cholesterol levels by approximately 10%, with reductions above 10% in LDL-cholesterol levels observed after 8 to 12 weeks of intervention. Studies have not shown significant changes in HDL-cholesterol and triglyceride levels. Based on the absence of adverse effects, its use seems to be safe and of good tolerance in children and adolescents. Conclusions: Phytosterol supplementation seems to be of great therapeutic aid for the treatment of hypercholesterolemia in children and adolescents. Further studies assessing the long-term effect of phytosterol supplementation are necessary.

RESUMO Objetivo: Realizar uma revisão sistemática sobre os efeitos da suplementação de fitoesteróis no tratamento da dislipidemia em crianças e adolescentes. Fontes de dados: Revisão nos bancos SciELO, Lilacs, Bireme, Pubmed e Web of Science, sem limite de tempo. Descritores: phytosterols or plant sterols, dyslipidemias, hypercholesterolemia, cholesterol, children, adolescent, nas línguas inglesa e portuguesa. Os artigos incluídos foram publicados nos idiomas português, inglês ou espanhol e avaliaram o efeito da suplementação de fitoesteróis em pacientes pediátricos com dislipidemia. Estudos que envolviam adultos ou animais, trabalhos de revisão, estudos de caso e resumos foram excluídos. A extração independente de artigos foi realizada por dois autores. Do total de 113 resumos, 19 foram lidos na íntegra, e 12 utilizados neste manuscrito. Síntese de dados: A suplementação de fitoesteróis para a redução dos níveis de colesterol mostrou-se eficiente, de forma a promover a redução de aproximadamente 10% dos níveis de LDL-colesterol, sendo observadas reduções acima de 10% em 8 a 12 semanas de intervenção. Os estudos não mostraram alterações significantes nos níveis de HDL-colesterol e triglicérides. Com base na ausência de efeitos adversos, seu uso parece ser seguro e de boa tolerância em crianças e adolescentes. Conclusões: A suplementação com fitoesteróis parece ser de grande auxílio terapêutico para o tratamento da hipercolesterolemia em crianças e adolescentes. São necessários mais estudos que avaliem o efeito em longo prazo da suplementação de fitoesteróis.

Hipertrigliceridemia severa refractaria a tratamiento médico y pancreatitis aguda recurrente: uso de plasmaféresis crónica ambulatoria en el Hospital San Pablo de Coquimbo. Reporte de un caso

Severe Hypertriglyceridemia (HTG) is associated with complications such as acute pancreatitis (AP) with high morbidity and mortality rates. We report a 42 years-old man with refractory HTG diagnosed at 19 years of age, and multiple episodes of AP, admitted with the suspicion of a new AP episode. Serum triglycerides were over 2000 mg/dl. His body mass index was 18 kg/m2, there was no evidence of xanthomas or xanthelasmas, but lipemia retinalis was found. Management included heparin and insulin, added to his usual treatment with fibrates, statins, omega-3 fatty acids, and orlistat. Due to lack of response, apheresis was started. After five sessions, triglycerides decreased to 588 mg/dl (82% reduction) and levels remained below 1000 mg/dl with daily apheresis. The patient continued with weekly sessions as outpatient with a sustained good response.

[Familial chylomicronemia]. / Quilomicronemia familiar.

Familial chylomicronemia is a disease in which a genetic mutation affects the ability of the organism to metabolize triglycerides bound to lipoproteins, causing extremely high plasma triglycerides and associated consequences. The most frequent complication is acute pancreatitis, which may lead to multiorganic failure or pancreatic insufficiency. Familial chylomicronemia also exerts a profound negative impact on quality of life, social relationships and professional development. The gene most frequently affected is lipoprotein lipase-1 gene (LPL), the enzyme in charge of hydrolyzing circulating triglycerides for tissue uptake. Mutations in other genes regulating maturation, transport or polymerization (eg. APOC2, APOAV, LMF-1, GPIHBP-1) of lipoprotein lipase-1, may also be involved. However, in about 30% of patients the causal variant is not identified. Familial chylomicronemia should be suspected in patients with severe hypertriglyceridemia with poor response to conventional treatment, or accompanied by eruptive xanthomas, lipemia retinalis or abdominal pain. The availability of risk scores and genetic tests should facilitate its opportune detection and management. Nutritional therapy is based on a very-low-fat diet with adequate supply of lipid-soluble vitamins and essential fatty acids, plus avoidance of alcohol consumption. Current pharmacological treatment may include fibrates and omega-3 fatty acids but prioritizes biotechnological agents targeting the molecular disturbances of the disease. These include an antisense oligonucleotide against apoC-III (volanesorsen), a monoclonal antibody against angiopoietin-like protein-3 (evinacumab), and other agents currently in development.

La quilomicronemia familiar es una condición en que una mutación genética altera la capacidad de metabolizar los triglicéridos que viajan en las lipoproteínas, causando elevación extrema de triglicéridos plasmáticos y complicaciones asociadas. La complicación más frecuente es la pancreatitis, que puede llevar a falla multiorgánica o insuficiencia pancreática. La quilomicronemia familiar también afecta la calidad de vida, las relaciones sociales y el desarrollo profesional. El gen más frecuentemente afectado en la quilomicronemia familiar es el de lipoproteína lipasa-1 (LPL), enzima que hidroliza triglicéridos circulantes para su captación tisular. Mutaciones en genes (como APOC2, APOAV, LMF-1, GPIHBP-1) que codifican para proteínas que regulan la maduración, transporte o polimerización de lipoproteína lipasa-1, también pueden estar involucradas. Sin embargo, en cerca del 30% de los pacientes no se encuentra la variante causal. La quilomicronemia familiar debe sospecharse en casos de hipertrigliceridemia extrema, resistente al tratamiento convencional, o que se acompaña de xantomas eruptivos, lipemia retinalis o dolor abdominal. La disponibilidad de escalas de riesgo y pruebas genéticas deben promover la detección oportuna. La nutrición se basa en una dieta muy baja en grasa con adecuada suplencia de vitaminas liposolubles y ácidos grasos esenciales, además de evitar el consumo de alcohol. Si bien el tratamiento farmacológico incluye fibratos y ácidos grasos omega 3, el enfoque actual privilegia agentes biotecnológicos dirigidos a los defectos moleculares propios de la enfermedad. Ello incluye un oligonucleótido antisentido dirigido contra apoC-III (volanesorsen), un anticuerpo monoclonal contra la proteína similar a angiopoietina tipo 3 (evinacumab), y otros compuestos en desarrollo.

Quilomicronemia familiar / Familial chylomicronemia

Resumen La quilomicronemia familiar es una condición en que una mutación genética altera la capacidad de metabolizar los triglicéridos que viajan en las lipoproteínas, causando elevación extrema de triglicéridos plasmáticos y complicaciones asociadas. La complicación más frecuente es la pancreatitis, que puede llevar a falla multiorgánica o insuficiencia pancreática. La quilomicronemia familiar también afecta la calidad de vida, las relaciones sociales y el desarrollo profesional. El gen más frecuentemente afectado en la quilomicronemia familiar es el de lipoproteína lipasa-1 (LPL), enzima que hidroliza triglicéridos circulantes para su captación tisular. Mutaciones en genes (como APOC2, APOAV, LMF-1, GPIHBP-1) que codifican para proteínas que regulan la maduración, transporte o polimerización de lipoproteína lipasa-1, también pueden estar involucradas. Sin embargo, en cerca del 30% de los pacientes no se encuentra la variante causal. La quilomicronemia familiar debe sospecharse en casos de hipertrigliceridemia extrema, resistente al tratamiento convencional, o que se acompaña de xantomas eruptivos, lipemia retinalis o dolor abdominal. La disponibilidad de escalas de riesgo y pruebas genéticas deben promover la detección oportuna. La nutrición se basa en una dieta muy baja en grasa con adecuada suplencia de vitaminas liposolubles y ácidos grasos esenciales, además de evitar el consumo de alcohol. Si bien el tratamiento farmacológico incluye fibratos y ácidos grasos omega 3, el enfoque actual privilegia agentes biotecnológicos dirigidos a los defectos moleculares propios de la enfermedad. Ello incluye un oligonucleótido antisentido dirigido contra apoC-III (volanesorsen), un anticuerpo monoclonal contra la proteína similar a angiopoietina tipo 3 (evinacumab), y otros compuestos en desarrollo.

Abstract Familial chylomicronemia is a disease in which a genetic mutation affects the ability of the organism to metabolize triglycerides bound to lipoproteins, causing extremely high plasma triglycerides and associated consequences. The most frequent complication is acute pancreatitis, which may lead to multiorganic failure or pancreatic insufficiency. Familial chylomicronemia also exerts a profound negative impact on quality of life, social relationships and professional development. The gene most frequently affected is lipoprotein lipase-1 gene (LPL), the enzyme in charge of hydrolyzing circulating triglycerides for tissue uptake. Mutations in other genes regulating maturation, transport or polymerization (eg. APOC2, APOAV, LMF-1, GPIHBP-1) of lipoprotein lipase-1, may also be involved. However, in about 30% of patients the causal variant is not identified. Familial chylomicronemia should be suspected in patients with severe hypertriglyceridemia with poor response to conventional treatment, or accompanied by eruptive xanthomas, lipemia retinalis or abdominal pain. The availability of risk scores and genetic tests should facilitate its opportune detection and management. Nutritional therapy is based on a very-low-fat diet with adequate supply of lipid-soluble vitamins and essential fatty acids, plus avoidance of alcohol consumption. Current pharmacological treatment may include fibrates and omega-3 fatty acids but prioritizes biotechnological agents targeting the molecular disturbances of the disease. These include an antisense oligonucleotide against apoC-III (volanesorsen), a monoclonal antibody against angiopoietin-like protein-3 (evinacumab), and other agents currently in development.

Diet and Nutraceutical Supplementation in Dyslipidemic Patients: First Results of an Italian Single Center Real-World Retrospective Analysis.

BACKGROUND: Dyslipidemias are a heterogeneous group of metabolic disorders mainly characterized by an increased risk of atherosclerotic cardiovascular disease (ASCVD) or other conditions, such as acute pancreatitis in hypertriglyceridemia. The aim of this study was to evaluate the effect of diet treatment and nutraceutical (NUTs) supplementation on the plasma lipid profile in outpatient dyslipidemic subjects, considering the influence of several factors (i.e., gender, age, body mass index, alcohol consumption, and smoking habits). METHODS: 487 dyslipidemic patients spanning from 2015 to 2019 were treated with a Mediterranean diet or NUTs in a real-word setting and were retrospectively analyzed. General characteristics and lipid profile at baseline and after the follow-up period were evaluated. RESULTS: Diet alone reduced total cholesterol (-19 mg/dL, -7.7%), LDL cholesterol (-18 mg/dL, -10.1%), and triglycerides (-20 mg/dL, -16.7%). Triglycerides (TG) decreased more in men, while women were associated with higher reduction of LDL cholesterol (LDL-C). Different types of NUTs further ameliorate lipid profiles when associated with diet. Nevertheless, most patients at low ASCVD risk (222 out of 262, 81.6%) did not achieve the 2019 ESC/EAS guidelines recommended LDL-C goals (i.e., LDL-C < 116 mg/dL). CONCLUSION: Lipid-lowering diet improves lipid profile, and NUTs can boost its efficacy, but taken together they are mainly unsatisfactory with respect to the targets imposed by 2019 EAS/ESC guidelines.

[Approach to Patients with Statin Intolerance: Evidence-Based Review]. / Abordagem aos Doentes com Intolerância às Estatinas: Revisão Baseada na Evidência.

INTRODUCTION: Statins are among the most effective drugs in lowering cholesterol levels and, consequently, in reducing cardiovascular mortality and morbidity. Although generally well tolerated, they have adverse effects that may reduce patient adherence to therapy. The objective of this evidence-based review is to summarize the evidence on the effectiveness of alternative management strategies in patients with intolerance to statins. MATERIAL AND METHODS: A literature search including clinical practice guidelines, systematic reviews and meta-analyses was conducted, in January 2017, in major international databases, and considered articles published in the last 10 years. The search was complemented with research papers published over the past three years and found in the PubMed database. The level of evidence and strength of recommendation were determined using the scale Strength of Recommendation Taxonomy - SORT. RESULTS: We included eight guidelines, six systematic reviews and one research paper. DISCUSSION: The strategies proposed by the different studies vary according to the severity of symptoms of intolerance including maintenance of the statin therapy (dose reduction, addition of a statin of equal or lower intensity or alternate days' uptake) and lipid-lowering therapy with other drugs (ezetimibe monotherapy or association with statin tolerated dose). Supplementation with coenzyme Q10 or vitamin D, in order to improve adherence to treatment with statins, is not recommended. CONCLUSION: This review highlights some alternatives to address patients' intolerance to statins; however, these are mostly based on recommendations with low to moderate evidence. Therefore, further research with randomized studies involving greater number of patients is required, in order to obtain a more robust recommendation.

Introdução: As estatinas são dos fármacos mais eficazes na redução dos níveis de colesterol e, consequentemente, da morbimortalidade cardiovascular. Apesar de globalmente bem toleradas, têm efeitos secundários que podem condicionar a adesão dos doentes à terapêutica. O objetivo desta revisão é sintetizar a evidência existente acerca da eficácia das estratégias alternativas de abordagem da dislipidemia nos doentes intolerantes às estatinas.Material e Métodos: Realizámos uma pesquisa bibliográfica de normas de orientação clínica, revisões sistemáticas e meta-análises em janeiro de 2017, nas principais bases de dados internacionais, tendo sido considerados os artigos publicados nos últimos 10 anos, e ainda de artigos originais na base de dados PubMed publicados nos últimos três anos. O nível de evidência e força de recomendação foram determinados utilizando a escala de Strenght of Recommendation Taxonomy - SORT.Resultados: Incluímos oito normas de orientação clínica, seis revisões sistemáticas e um artigo original.Discussão: A abordagem ao doente intolerante às estatinas varia conforme a gravidade dos sintomas e inclui a manutenção da terapêutica com estatina (redução da dose, introdução de uma estatina de igual ou menor intensidade ou toma em dias alternados), a terapêutica com outros fármacos hipolipemiantes (ezetimiba em monoterapia ou associação com estatina em dose tolerada). A suplementação com coenzima Q10 ou com vitamina D, para melhorar a adesão ao tratamento com estatinas, está desaconselhada.Conclusão: Apesar de apontarmos algumas estratégias de abordagem à intolerância às estatinas, estas baseiam-se maioritariamente em recomendações com evidência fraca a moderada, sendo necessários estudos aleatorizados com maior número de doentes para uma recomendação mais robusta.

Avaliação da capacidade redutora de lipidograma do extrato aquoso de Abelmoschus esculentus: estudo in vivo / Lipidogram reducing capacity assessment of Abelmoschus esculentus water extract: in vivo study

Objetivo: Avaliar a relação do extrato aquoso de A. esculentus como agente redutor das taxas de lipídeos no sangue periférico de Rattus novergicus. Métodos: Foram usados Rattus novergicus (n=21), divididos em três grupos de sete, com alimentação ad libitum, sendo um grupo controle negativo, um controle positivo e um teste, onde os três foram submetidos a uma dieta hipercalórica, sendo que no segundo houve administração de Sinvastatina® e no terceiro, extrato aquoso de A. esculentus. Foi realizada a dosagem sérica de colesterol total, triglicerídeos e HDL, além das medidas de peso e tamanho. Resultados:O grupo T apresentou resultado significativo para o colesterol HDL, quando comparado ao controle negativo, mostrando-se com valor de 40,33 ± 1,25 mg/dl e 35,5 ± 0,92 mg/dl, respectivamente, p < 0,05. Porém, em relação aos demais parâmetros, o extrato aquoso não apresentou significância estatística, quando comparado aos controles positivo e negativo. Conclusão: O extrato aquoso de A. esculentus mostrou-se eficaz na elevação do HDL plasmático.

Objective: To evaluate the relationship of the aqueous extract of A. esculentusas a lipid lowering agent in Rattus novergicus peripheral blood. Methods:Rattus novergicus (n = 21) were used, divided into three groups of seven, with ad libitum feeding, being a negative control group, a positive control and a test, where the three were submitted to a hypercaloric diet, and in the second Sinvastatin® was administered, and in the third, aqueous extract of A. esculentus. Serum total cholesterol, triglycerides and HDL were measured, as well as weight and size measurements. Results: Group T showed a significant result for HDL cholesterol when compared to the negative control, with values of 40.33 ± 1.25 mg / dl and 35.5 ± 0.92 mg / dl (p < 0,05), respectively. However, in relation to the other parameters, the aqueous extract wasn't statistically significant when compared to the positive and negative controls. Conclusion: The aqueous extract of A. esculentus was effective in elevating plasma HDL.