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1.
Praxis (Bern 1994) ; 109(10): 755-762, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32752965

RESUMO

CME: Primary and Secondary Hypercholesterolemia Abstract. In patients with hypercholesterolemia and an LDL-cholesterol level >5 mmol/l, familial hypercholesterolemia (primary hypercholesterolemia) should be considered. This genetically determined illness should lead to medical therapy and screening for hypercholesterinemia in close relatives. Beside the superelevated LDL-cholesterol levels, additional clinically diagnostic findings and family anamnesis can support the diagnosis of familial hypercholesterolemia. The likelihood of familial hypercholesterolemia can be estimated using the Lipid Clinic Network Score. Additionally, a variety of exogenous factors may have an impact on lipoprotein metabolism and may lead to secondary hypercholesterolemia. Hypothyroidism, cholestasis, nephrotic syndrome or specific medications, among others, should be considered as potential factors leading to high cholesterol levels before familial hypercholesterolemia is suspected or lipid-lowering treatment is started.


Assuntos
Hipercolesterolemia , Hiperlipoproteinemia Tipo II , LDL-Colesterol , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/terapia , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/terapia , Lipídeos , Programas de Rastreamento
2.
PLoS One ; 15(8): e0238079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845916

RESUMO

BACKGROUND: Sitosterolemia is an inherited lipid disorder which presents with elevated serum sitosterol and can result in an increased risk of premature cardiovascular disease. However, sitosterol cannot be accurately measured by routine diagnostic assays, meaning that sitosterolemia diagnosis can often be difficult, especially with many clinical features overlapping with familial hypercholesterolemia. With such complications resulting in increasing reports of misdiagnosis, the prevalence of sitosterolemia is predicted to be much higher than previously reported. METHODS: Gas chromatography-mass spectrometry was utilized to measure sitosterol levels of normocholesterolemic and hypercholesterolemic children. Subsequently, an epidemiologically determined cutoff level of sitosterol was calculated and applied to estimate the prevalence of children with increased sitosterol and identify potential sitosterolemia patients. Massively parallel sequencing was used to confirm the diagnosis in suspected patients. RESULTS: Samples from 109 normocholesterolemic and 220 hypercholesterolemic were tested for phytosterols. Sitosterol and campesterol levels were significantly increased in hypercholesterolemic children (mean 22.0±45.9 µmol/L for sitosterol and 26.0±32.8 µmol/L for campesterol) compared to normocholesterolemic children (mean 12.1±4.9 µmol/L for sistosterol and 14.8±6.7 µmol/L for campesterol). Via application of a cutoff of 35.9 µmol/L, the prevalence rates for increased and overtly increased sitosterol in hypercholesterolemic children were 6.4% and 1.4% respectively. Furthermore, 3 suspected sitosterolemia patients were identified, with 2 patients receiving molecular confirmation for sitosterolemia diagnosis. CONCLUSIONS: Our findings reaffirm that the prevalence of sitosterolemia is probably much higher than previously reported, which also indicates the significant risk of misdiagnosis of sitosterolemia with familial hypercholesterolemia. Special lipid testing including sitosterol, especially in children with uncontrolled hypercholesterolemia, is recommended in children in order to identify potential sitosterolemia patients that would otherwise be neglected.


Assuntos
Hipercolesterolemia/diagnóstico , Sitosteroides/análise , Membro 5 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Membro 8 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Adolescente , Criança , Pré-Escolar , Colesterol/análogos & derivados , Colesterol/análise , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/genética , Lactente , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Enteropatias/genética , Erros Inatos do Metabolismo Lipídico/diagnóstico , Erros Inatos do Metabolismo Lipídico/epidemiologia , Erros Inatos do Metabolismo Lipídico/genética , Lipoproteínas/genética , Masculino , Linhagem , Fitosteróis/efeitos adversos , Fitosteróis/análise , Fitosteróis/genética , Prevalência
3.
Arterioscler Thromb Vasc Biol ; 40(9): 2310-2321, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32611242

RESUMO

OBJECTIVE: Plant stanol ester supplementation (2-3 g plant stanols/d) reduces plasma LDL (low-density lipoprotein) cholesterol concentration by 9% to 12% and is, therefore, recommended as part of prevention and treatment of atherosclerotic cardiovascular disease. In addition to plasma LDL-cholesterol concentration, also qualitative properties of LDL particles can influence atherogenesis. However, the effect of plant stanol ester consumption on the proatherogenic properties of LDL has not been studied. Approach and Results: Study subjects (n=90) were randomized to consume either a plant stanol ester-enriched spread (3.0 g plant stanols/d) or the same spread without added plant stanol esters for 6 months. Blood samples were taken at baseline and after the intervention. The aggregation susceptibility of LDL particles was analyzed by inducing aggregation of isolated LDL and following aggregate formation. LDL lipidome was determined by mass spectrometry. Binding of serum lipoproteins to proteoglycans was measured using a microtiter well-based assay. LDL aggregation susceptibility was decreased in the plant stanol ester group, and the median aggregate size after incubation for 2 hours decreased from 1490 to 620 nm, P=0.001. Plant stanol ester-induced decrease in LDL aggregation was more extensive in participants having body mass index<25 kg/m2. Decreased LDL aggregation susceptibility was associated with decreased proportion of LDL-sphingomyelins and increased proportion of LDL-triacylglycerols. LDL binding to proteoglycans was decreased in the plant stanol ester group, the decrease depending on decreased serum LDL-cholesterol concentration. CONCLUSIONS: Consumption of plant stanol esters decreases the aggregation susceptibility of LDL particles by modifying LDL lipidome. The resulting improvement of LDL quality may be beneficial for cardiovascular health. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01315964.


Assuntos
Dieta , Ésteres/administração & dosagem , Hipercolesterolemia/dietoterapia , Lipoproteínas LDL/sangue , Fitosteróis/administração & dosagem , Agregados Proteicos , Adulto , Idoso , Biomarcadores/sangue , LDL-Colesterol/sangue , Método Duplo-Cego , Feminino , Finlândia , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Lipidômica , Masculino , Pessoa de Meia-Idade , Proteoglicanas/sangue , Esfingomielinas/sangue , Fatores de Tempo , Resultado do Tratamento , Triglicerídeos/sangue , Adulto Jovem
4.
Nutr Metab Cardiovasc Dis ; 30(7): 1137-1146, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32456947

RESUMO

BACKGROUND AND AIMS: The increased risk of cardiovascular disease under hypercholesterolemia is due to associations between oxidized low-density lipoprotein (ox-LDL) and lipoprotein-associated phospholipase A2 (Lp-PLA2) and between ox-LDL and coagulant profiles. We investigated the impact of different ox-LDL levels on coagulation time and plasma metabolomes in subjects with borderline hypercholesterolemia. METHODS AND RESULTS: One hundred thirty-one subjects with borderline hypercholesterolemia (serum cholesterol ≥200 mg/dL) were divided into low ox-LDL (n = 66) and high ox-LDL (n = 65) groups. After adjusting for confounding factors, the high ox-LDL group exhibited a significantly decreased activated partial thromboplastin time (aPTT) and prothrombin time (PT) and increased Lp-PLA2 activity. Compared to the low ox-LDL group, the high ox-LDL group exhibited significantly increased intensities of 17 lysophosphatidylcholines (lysoPCs) and 7 lysophosphatidylethanolamines (lysoPEs). Ox-LDL was inversely correlated with aPTT and PT and positively correlated with Lp-PLA2 activity. Positive correlations were also found among ox-LDL, Lp-PLA2 activity, lysoPCs, and lysoPEs. LysoPCs and lysoPEs were inversely correlated with PT and aPTT. The identified plasma metabolites, including amino acids, fatty acid amides, acylcarnitines, and lysophospholipids, were significantly upregulated in the high ox-LDL group. CONCLUSION: High ox-LDL levels may be involved in the development of a procoagulant state in subjects with borderline hypercholesterolemia by increasing Lp-PLA2 activity and lysoPC and lysoPE levels.


Assuntos
1-Alquil-2-acetilglicerofosfocolina Esterase/sangue , Fatores de Coagulação Sanguínea/análise , Coagulação Sanguínea , Hipercolesterolemia/sangue , Lipoproteínas LDL/sangue , Lisofosfatidilcolinas/sangue , Lisofosfolipídeos/sangue , Biomarcadores/sangue , Feminino , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/enzimologia , Masculino , Metabolômica , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Regulação para Cima
5.
Nutr Metab Cardiovasc Dis ; 30(6): 907-914, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32249143

RESUMO

BACKGROUND AND AIM: General population awareness about cardiovascular risk factors is usually low. The aim of the present study was to evaluate the vascular aging of subjects aware and not aware to be hypertensive, hypercholesterolemic, hypertriglyceridemic or diabetics in a general population sample. METHODS AND RESULTS: We interviewed 1652 subjects without atherosclerotic cardiovascular diseases (M: 46.6%, F: 53.4%) about their awareness of hypertension, hypercholesterolemia, hypertriglyceridemia or type 2 diabetes. Then we compared the augmentation index and pulse wave velocity of subjects aware and not aware of the investigated cardiovascular risk factors. 1049 participants declared not to be hypertensive, while 32 were not sure. Among them, respectively, 23.5% and 50% were hypertensive. Subjects not aware of their hypertension had significantly higher aortic blood pressure than aware ones (p < 0.001). 841 participants declared not to be hypercholesterolemic, while 60 were not sure. Among them, respectively, 18.1% and 40% were hypercholesterolemic. Subjects not aware of their hypercholesterolemia had significantly higher augmentation index than the aware ones (p < 0.05). 1226 participants declared not to be hypertriglyceridemic, while 200 were not sure. Among them, respectively, 19.2% and 44% were hypertriglyceridemic. Subjects not aware of their hypertriglyceridemia had significantly higher TG levels aware ones (p < 0.05), although this seemed to not related to increased arterial stiffness. 1472 participants declared not to be diabetic, while 20 were not sure. Among them, respectively, 2.0% and 25.0% were diabetics. Subjects not aware of their diabetes had significantly higher augmentation index than the aware ones (p < 0.05). CONCLUSIONS: In conclusion, the lack of awareness of hypertension and hypercholesterolemia is relatively frequent in the general population and is associated to significantly higher arterial stiffness.


Assuntos
Envelhecimento , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Hipertrigliceridemia/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Colesterol/sangue , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertrigliceridemia/sangue , Hipertrigliceridemia/diagnóstico , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Triglicerídeos/sangue , Rigidez Vascular , Adulto Jovem
6.
Am J Cardiol ; 125(9): 1312-1316, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32143815

RESUMO

Sitosterolemia is a rare lipid metabolism disease with heterogeneous manifestations. Atherosclerosis can occur in children, and therefore, early detection, diagnosis, and treatment of this disease are important. We studied 18 pediatric patients with sitosterolemia who showed a significant increase in plasma lipid levels and analyzed their clinical, biochemical, and genetic characteristics. We recorded the initial serum lipid results and clinical manifestations of the patients. Lipid and plant sterol levels were measured after homozygous or compound heterozygous mutations of ABCG5 or ABCG8 were identified by genetic testing. Plasma plant sterol levels were analyzed by gas chromatography. Fourteen cases of sitosterolemia were examined by ultrasound and echocardiography. The initial total cholesterol and low-density lipoprotein levels of the children were significantly increased, but then markedly decreased after diet control or drug treatment, and even reached normal levels. Carotid atherosclerosis and aortic valve regurgitation were present in three of 14 patients. Serum lipid levels of children with sitosterolemia and xanthomas were notably higher than those without xanthomas. There were no significant differences in clinical manifestations between patients with different genotypes. In conclusion, sitosterolemia should be considered in children with hyperlipidemia who do not present with xanthomas, especially with a significant increase in total cholesterol and low-density lipoprotein levels. There does not appear to be a correlation between clinical phenotype and genotype.


Assuntos
Hipercolesterolemia/diagnóstico , Enteropatias/diagnóstico , Erros Inatos do Metabolismo Lipídico/diagnóstico , Fitosteróis/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Hipercolesterolemia/sangue , Lactente , Enteropatias/sangue , Erros Inatos do Metabolismo Lipídico/sangue , Masculino , Fitosteróis/sangue
7.
Lab Med ; 51(2): 217-220, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31414129

RESUMO

Hypercholesterolemia is characterized by serum cholesterol levels greater than 5 mmol per L. However, the distribution of cholesterol among lipoprotein classes has a significant bearing on diagnosis: high-low-density lipoprotein (LDL) cholesterol suggests familial hypercholesterolemia, whereas high-high-density lipoprotein (HDL) cholesterol is associated with hyperalphalipoproteinemia. On routine screening, a 23-year-old man presented with a total cholesterol level of 7.6 mmol per L but was subsequently found to have an HDL cholesterol level of 5.6 mmol per L. The clinical picture was confounded by his use of red yeast rice extract, a popular health supplement with hypolipidemic effects. In this case individual, the use of red yeast rice extract caused a hyperlipidemic state, ostensibly through downregulation of cholesteryl ester transfer protein. This case emphasizes the extended role of laboratory medicine in complex cases of hyperlipidemia.


Assuntos
HDL-Colesterol/sangue , Suplementos Nutricionais/efeitos adversos , Comportamento Alimentar , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/patologia , Oryza , Adulto , Proteínas de Transferência de Ésteres de Colesterol/antagonistas & inibidores , Humanos , Masculino , Adulto Jovem
8.
Clín. investig. arterioscler. (Ed. impr.) ; 31(6): 251-260, nov.-dic. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-185150

RESUMO

Introduction: High Density Lipoproteins (HDL) are dysfunctional in hypercholesterolemia patients. The hypothesis was tested that nicotinamide (NAM) administration will influence HDL metabolism and reverse cholesterol transport from macrophages to the liver and feces in vivo (m-RCT) in a murine model of hypercholesterolemia. Methods: Apolipoprotein E-deficient (KOE) mice were challenged with a high-fat diet for 4 weeks. The effect of different doses of NAM on cholesterol metabolism, and the ability of HDL to promote m-RCT was assessed. Results: The administration of NAM to KOE mice produced an increase (∼1.5-fold; P < 0.05) in the plasma levels of cholesterol, which was mainly accounted for by the non-HDL fraction. NAM produced a [3H]-cholesterol plasma accumulation (∼1.5-fold) in the m-RCT setting. As revealed by kinetic analysis, the latter was mainly explained by an impaired clearance of circulating non-HDL (∼0.8-fold). The relative content of [3H]-tracer was lowered in the livers (∼0.6-fold) and feces (> 0.5-fold) of NAM-treated mice. This finding was accompanied by a significant (or trend close to significance) up-regulation of the relative gene expression of Abcg5 and Abcg8 in the liver (Abcg5: 2.9-fold; P < 0.05; Abcg8: 2.4-fold; P = 0.06) and small intestine (Abcg5: 2.1-fold; P = 0.15; Abcg8: 1.9-fold; P < 0.05) of high-dose, NAM-treated mice. Conclusion: The data from this study show that the administration of NAM to KOE mice impaired m-RCT in vivo. This finding was partly due to a defective hepatic clearance of plasma non-HDL


No dispnible


Assuntos
Animais , Camundongos , Apolipoproteínas E/deficiência , Niacinamida/administração & dosagem , Colesterol/análise , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/tratamento farmacológico , Apolipoproteínas E/administração & dosagem , Niacinamida/metabolismo , Colesterol/metabolismo , Gorduras na Dieta , Expressão Gênica , HDL-Colesterol
9.
Rev. lab. clín ; 12(4): e21-e33, oct.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187309

RESUMO

Las dislipidemias son alteraciones del metabolismo lipídico que cursan con concentraciones de lípidos alteradas, tanto por exceso como por defecto. Estas alteraciones están fuertemente asociadas con el proceso aterosclerótico, y se ha demostrado que el control de dichas alteraciones consigue disminuir la incidencia de episodios de origen isquémico. Diagnosticar las dislipidemias desde un punto de vista etiológico es muy importante, ya que el riesgo cardiovascular al que predispone cada una de ellas es diferente, dependiendo del tipo de lipoproteína que esté alterada y de su concentración. Por ello es de gran utilidad disponer de algoritmos diagnósticos sencillos que incluyan magnitudes del metabolismo lipídico disponibles en la mayoría de los laboratorios clínicos, con el fin de realizar el diagnóstico inicial del tipo de dislipidemia, en caso de poseer las herramientas diagnósticas adecuadas identificarla y, en caso contrario, disponer de la información apropiada para recomendar la ampliación del estudio en otro centro que disponga de los recursos necesarios para establecer el diagnóstico


Dyslipidaemias are alterations in lipid metabolism that involve an excess, as well as a deficit, in lipid concentrations. These alterations are strongly associated with atherosclerosis, and it has been shown that its control reduces the incidence of episodes of ischaemic origin. Diagnosing dyslipidaemias from an aetiological point of view is very important, since the cardiovascular risk to which each one predisposes is different, and depends on the type of lipoprotein that is altered and its concentration. For this reason, it is very useful to have simple diagnostic algorithms that include the measurements of lipid metabolism that are available in most clinical laboratories in order to make the initial diagnosis of the type of dyslipidaemia. In the case of having the right diagnostic tools, identify it; and if not, to have the appropriate information to recommend the extension of the study in another centre with resources to establish the diagnosis


Assuntos
Humanos , Dislipidemias/diagnóstico , Transtornos do Metabolismo dos Lipídeos/diagnóstico , Hiperlipidemias/diagnóstico , Lipidoses/diagnóstico , Hipercolesterolemia/diagnóstico , Colesterol/sangue , Lipídeos/sangue , Técnicas de Laboratório Clínico/métodos , Guias como Assunto , Metabolismo dos Lipídeos/fisiologia , Dislipidemias/classificação , Diagnóstico Diferencial
10.
Cardiovasc Drugs Ther ; 33(5): 625-639, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31773344

RESUMO

Statins are currently the primary treatment for hyperlipidemia, particularly for the treatment of high levels of low-density lipoprotein cholesterol (LDL-C), as many studies have proven benefit in a variety of populations. The benefits of statin treatment for high cholesterol have been proven in many trials. Forefront among different adverse events is statin-induced myopathy, which still eludes complete understanding, and may range anywhere from muscle soreness or fatigue to potentially extremely rare occurrence of rhabdomyolysis.As most adverse events are rare and not life-threatening, in high-risk patients, a high-dose statin should be started initially as data suggests that clinicians rarely up titrate statin therapy after initial prescription leading to under-treatment of many patients requiring high-dose statin therapy. As we will discuss in this paper, musculoskeletal side effects are the main concern and reason for discontinuing statin therapy. The occurrence and true association of other adverse events in patients on statin such as new onset of diabetes, hepatic toxicity, or cognitive impairment are rare, controversial, and not proven. In placebo-controlled studies, abnormal liver function occurs to a similar degree in statin- and placebo-treated patients. This led to FDA removal of the requirement to monitor liver function tests in patients on statin therapy.The combination of statins with other compounds such as ezetimibe or PCSK9 inhibitors has shown some additional benefits in the treatment of hypercholesterolemia. The goal of this manuscript is to conduct a comprehensive review about most commonly used statins and compare data on their history, structures, benefits, adverse effects, and clinical outcomes.


Assuntos
LDL-Colesterol/sangue , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Animais , Biomarcadores/sangue , Regulação para Baixo , Quimioterapia Combinada , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Rabdomiólise/induzido quimicamente , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
Methodist Debakey Cardiovasc J ; 15(3): 192-199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687098

RESUMO

The extract of red yeast rice (RYR) is the most effective cholesterol-lowering nutraceutical on the market. In particular, its effectiveness is directly related to the amount of monacolin K within the extract (up to 10 mg/day). Consuming monacolin K on a daily basis reduces low-density lipoprotein (LDL) cholesterol plasma levels between 15% and 25% within 6 to 8 weeks. Certainly, the decrease in LDL-cholesterol is accompanied by a similar reduction in total cholesterol, non-high-density lipoprotein cholesterol, plasma apolipoprotein B, matrix metalloproteinases 2 and 9, and high-sensitivity C-reactive protein. Furthermore, the RYR lipid-lowering effect is associated with significant improvements in pulse wave velocity and endothelial function, which are validated and reliable biomarker tools able to detect vascular aging. Although it has a mechanism of action similar to statins, a daily consumption of between 3 and 10 mg monacolin K has only minimal associated risks, and mild myalgias are seen only in the frailest patients (those who also cannot tolerate minimal dosages of statin). The monacolin K found in RYR is a safe and effective supplement for managing mild to moderate hypercholesterolemia in people with no additional cardiovascular risk factors.


Assuntos
Produtos Biológicos/uso terapêutico , Colesterol/sangue , Suplementos Nutricionais , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Lovastatina/uso terapêutico , Animais , Produtos Biológicos/efeitos adversos , Biomarcadores/sangue , Suplementos Nutricionais/efeitos adversos , Regulação para Baixo , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Lovastatina/efeitos adversos , Resultado do Tratamento
12.
Zhonghua Nei Ke Za Zhi ; 58(11): 823-825, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665858

RESUMO

This study was aimed to investigate the association between dyslipidemia and thyroid associated ophthalmopathy (TAO). We evaluated the relationship between dyslipidemia and TAO in 218 patients with Graves' disease (GD) and found that the serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) in the GD subjects with TAO (n=110) were significantly increased [(5.32±1.39) mmol/L vs. (3.18±2.12) mmol/L, (2.98±0.75) mmol/L vs. (1.25±0.98) mmol/L] than those in the GD subjects without TAO (n=108). TC and LDL-C were positively correlated with the Clinical disease activity score (CAS) [TC (r=0.7, P=0.03),LDL-C (r=0.82, P=0.03)], and the levels of TC (OR=2.56, P=0.02) and LDL-C(OR=2.01, P=0.015) were positively associated with TAO. These suggested that high serum cholesterol level is a novel risk factor for TAO, and management of blood lipids should be included in the treatment of TAO.


Assuntos
Colesterol/sangue , Oftalmopatia de Graves/diagnóstico , Hipercolesterolemia/diagnóstico , LDL-Colesterol , Oftalmopatia de Graves/sangue , Humanos , Hipercolesterolemia/sangue , Fatores de Risco
13.
Int J Occup Med Environ Health ; 32(6): 865-872, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31603437

RESUMO

Long-term exposure to hypercholesterolemia is the cause of atherosclerosis, which in turn causes cardiovascular and cerebrovascular events. In developed countries, including Poland, vascular diseases are the main cause of death. They affect an ever younger part of the population, including the working population. The authors address the problem of epidemiology of cardiovascular diseases, unsatisfactory detection and treatment, economic consequences for the health care system, and the possibilities of using occupational medicine services in the prevention of this health problem. Due to the fact that the early detection of diseases caused by high blood cholesterol levels is relatively low in Poland, obligatory occupational medicine examinations seem to be a key element of the second-line prevention. Therefore, it seems natural to consider the idea of extending the scope of obligatory examinations and introducing tests that allow lipid disorders to be detected at an early stage. This can contribute to a general improvement of the health of the population, and to economic benefits, such as a decrease in the costs of treatment of the disorders that have been detected too late. Broadening the scope of occupational examinations is also important from the perspective of public health and epidemiology of cardiovascular diseases, thus being an element of prevention of civilization diseases. It means improving health and building health awareness, and it should translate into regular health examinations. The performance of these examinations should result not only from the obligation, but also from the patient's conviction about the importance of early detection of disorders, including lipid disorders, for an effective therapy. Int J Occup Med Environ Health. 2019;32(6):865-72.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Hipercolesterolemia/prevenção & controle , Medicina do Trabalho/métodos , Colesterol/sangue , Humanos , Hipercolesterolemia/diagnóstico , Polônia/epidemiologia , Fatores de Risco
14.
High Blood Press Cardiovasc Prev ; 26(4): 345-350, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31352663

RESUMO

INTRODUCION: Treatment strategies for patients with pre-hypertension and low-moderate cardiovascular (CV) risk may include nutraceutical compounds (NCs). AIM: To investigate the efficacy and safety of a new-generation of NC in lowering BP values and improving metabolic profile, in a group of hyper-cholesterolemic subjects with pre-hypertension. METHODS: 131 subjects with pre-hypertension (systolic BP 130-139 mmHg and/or diastolic BP 85-89 mmHg) without organ damage and history of CV diseases were enrolled. 66 subjects were treated with a once-daily oral formulation of a NC (red yeast rice, Berberine, Coenzyme Q10, folic acid and chrome) added to diet for 3 months, while 65 patients followed a diet only. Differences in serum total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDLC and HDLC), triglycerides (TG), glycemia, creatine phosphokinase (CPK), aspartate aminotransferase (AST) alanine aminotransferase (ALT) and body mass index (BMI) were evaluated. RESULTS: At the end of treatment, significant reductions of TC, LDLC, TG glucose levels were observed in both treatment groups, while HDLC values increased in the active treatment group only. A greater reduction of TC, LDLC and glycemia was observed in the treatment group. TG levels were not different within the two groups. BP and BMI levels remained unchanged, as well AST, ALT; CPK slightly increased in both groups, but it remained in the normal range. CONCLUSIONS: In patients with pre-hypertension, NC supplementation was safe, well tolerated and effective in improving lipid pattern and glucose levels and in preventing the progression to overt hypertension.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glicemia/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Suplementos Nutricionais , Hipercolesterolemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Pré-Hipertensão/tratamento farmacológico , Idoso , Anti-Hipertensivos/efeitos adversos , Biomarcadores/sangue , Glicemia/metabolismo , Suplementos Nutricionais/efeitos adversos , Progressão da Doença , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipoglicemiantes/efeitos adversos , Hipolipemiantes/efeitos adversos , Itália , Masculino , Pessoa de Meia-Idade , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/fisiopatologia , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Nutrients ; 11(8)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31357534

RESUMO

The consumption of antioxidant-rich foods such as virgin olive oil (VOO) promotes high-density lipoprotein (HDL) anti-atherogenic capacities. Intake of functional VOOs (enriched with olive/thyme phenolic compounds (PCs)) also improves HDL functions, but the gene expression changes behind these benefits are not fully understood. Our aim was to determine whether these functional VOOs could enhance the expression of cholesterol efflux-related genes. In a randomized, double-blind, crossover, controlled trial, 22 hypercholesterolemic subjects ingested for three weeks 25 mL/day of: (1) a functional VOO enriched with olive oil PCs (500 mg/kg); (2) a functional VOO enriched with olive oil (250 mg/kg) and thyme PCs (250 mg/kg; FVOOT), and; (3) a natural VOO (olive oil PCs: 80 mg/kg, control intervention). We assessed whether these interventions improved the expression of cholesterol efflux-related genes in peripheral blood mononuclear cells by quantitative reverse-transcription polymerase chain reactions. The FVOOT intervention upregulated the expression of CYP27A1 (P = 0.041 and P = 0.053, versus baseline and the control intervention, respectively), CAV1 (P = 0.070, versus the control intervention), and LXRß, RXRα, and PPARß/δ (P = 0.005, P = 0.005, and P = 0.038, respectively, relative to the baseline). The consumption of a functional VOO enriched with olive oil and thyme PCs enhanced the expression of key cholesterol efflux regulators, such as CYP27A1 and nuclear receptor-related genes.


Assuntos
Colesterol/sangue , Alimentos Fortificados , Hipercolesterolemia/dietoterapia , Metabolismo dos Lipídeos/genética , Azeite de Oliva/administração & dosagem , Fenóis/administração & dosagem , Extratos Vegetais/administração & dosagem , Thymus (Planta) , Biomarcadores/sangue , Estudos Cross-Over , Método Duplo-Cego , Feminino , Regulação da Expressão Gênica , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/genética , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
16.
Int J Rheum Dis ; 22(8): 1445-1451, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31317680

RESUMO

AIM: To investigate the effects on hypercholesterolemia and hypertriglyceridemia in gouty patients receiving uric acid-lowering therapy (UALT). METHODS: A retrospective study was performed from January 2015 to December 2017 in gouty patients receiving UALT. A total of 124 gouty patients with hypercholesterolemia or hypertriglyceridemia who were administered UALT were monitored. Of the 124 patients with gout, 52 were treated with febuxostat, 29 were treated with allopurinol, and 43 were treated with benzbromarone. Cholesterol and triglyceride levels were recorded and analyzed following treatment for 8-10 weeks. RESULTS: We compared the efficacy of febuxostat, allopurinol, and benzbromarone. All therapies mildly influenced serum cholesterol and triglyceride levels. Febuxostat significantly decreased cholesterol and triglyceride levels in patients who did not receive lipid-lowering therapy. Allopurinol and benzbromarone modestly decreased triglyceride levels, but cholesterol levels were unaffected. CONCLUSION: Uric acid-lowering therapy benefits hyperlipidemia in gouty patients. Febuxostat effectively improved serum cholesterol and triglyceride levels compared to allopurinol and benzbromarone in patients with gout.


Assuntos
Colesterol/sangue , Supressores da Gota/uso terapêutico , Gota/tratamento farmacológico , Hipercolesterolemia/sangue , Hipertrigliceridemia/sangue , Triglicerídeos/sangue , Ácido Úrico/sangue , Adulto , Alopurinol/uso terapêutico , Benzobromarona/uso terapêutico , Biomarcadores/sangue , Febuxostat/uso terapêutico , Feminino , Gota/sangue , Gota/diagnóstico , Humanos , Hipercolesterolemia/diagnóstico , Hipertrigliceridemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Uricosúricos/uso terapêutico
17.
J Am Coll Cardiol ; 73(23): 2932-2942, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31196449

RESUMO

BACKGROUND: The taxonomy of cardiovascular (CV) diseases is divided into a broad spectrum of clinical entities. Many such diseases coincide in specific patient groups and suggest shared predisposition. OBJECTIVES: This study focused on coronary artery disease (CAD) and investigated the genetic relationship to CV and non-CV diseases with reported CAD comorbidity. METHODS: This study examined 425,196 UK Biobank participants to determine a genetic risk score (GRS) based on 300 CAD associated variants (CAD-GRS). This score was associated with 22 traits, including risk factors, diseases secondary to CAD, as well as comorbid and non-CV conditions. Sensitivity analyses were performed in individuals free from CAD or stable angina diagnosis. RESULTS: Hypercholesterolemia (odds ratio [OR]: 1.27; 95% CI: 1.26 to 1.29) and hypertension (OR: 1.11; 95% CI: 1.10 to 1.12) were strongly associated with the CAD-GRS, which indicated that the score contained variants predisposing to these conditions. However, the CAD-GRS was also significant in patients with CAD who were free of CAD risk factors (OR: 1.37; 95% CI: 1.30 to 1.44). The study observed significant associations between the CAD-GRS and peripheral arterial disease (OR: 1.28; 95% CI: 1.23 to 1.32), abdominal aortic aneurysms (OR: 1.28; 95% CI: 1.20 to 1.37), and stroke (OR: 1.08; 95% CI: 1.05 to 1.10), which remained significant in sensitivity analyses that suggested shared genetic predisposition. The score was also associated with heart failure (OR: 1.25; 95% CI: 1.22 to 1.29), atrial fibrillation (OR: 1.08; 95% CI: 1.05 to 1.10), and premature death (OR: 1.04; 95% CI: 1.02 to 1.06). These associations were abolished in sensitivity analyses that indicated that they were secondary to prevalent CAD. Finally, an inverse association was observed between the score and migraine headaches (OR: 0.94; 95% CI: 0.93 to 0.96). CONCLUSIONS: A wide spectrum of CV conditions, including premature death, might develop consecutively or in parallel with CAD for the same genetic roots. In conditions like heart failure, the study found evidence that the CAD-GRS could be used to stratify patients with no or limited genetic overlap with CAD risk. Increased genetic predisposition to CAD was inversely associated with migraine headaches.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/genética , Predisposição Genética para Doença/epidemiologia , Predisposição Genética para Doença/genética , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/genética , Bancos de Espécimes Biológicos/tendências , Estudos de Coortes , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/genética , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/genética , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Nefropatias/genética , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Reino Unido/epidemiologia
18.
Int J Low Extrem Wounds ; 18(3): 301-308, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31140336

RESUMO

Introduction. Chronic illness and risk factors for chronic illness are rising public health concerns for individuals and health care systems. Individuals with venous leg ulceration (VLU) have at least one chronic illness. As there is a projected increase in VLU prevalence there is a need to determine concurrent prevalence of risk factors for chronic illness among this population. Methods. A cross-sectional design conducted in 8 community, nurse-led, leg ulcer clinics. Results. Fifty patients (58%, n = 29 females) were enrolled. Seventy percent were >65 years old; 90% had at least one chronic illness; 60% had hypertension; 30% had atrial fibrillation; 18% had diabetes; 18% heart failure; and 28.6% musculoskeletal conditions. All had at least one risk factors for chronic illness (mean = 2.26), the most frequent being overweight (30%), obesity (30%), high cholesterol (22.2%), and restricted physical activity (22%). Participants took a mean 5.2 medications daily and 26% were on current oral antibiotics. Conclusions. Comprehensive, holistic assessment and regular reassessment with a preventative focus needs to consider chronic illness and risk factors for chronic illness. Patients with VLU are in frequent contact with their multidisciplinary team. This is an opportunity to improve care and make every encounter count.


Assuntos
Doença Crônica/epidemiologia , Hipercolesterolemia , Sobrepeso , Úlcera Varicosa , Atividades Cotidianas , Idoso , Estudos Transversais , Feminino , Saúde Holística , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Irlanda/epidemiologia , Úlcera da Perna , Masculino , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/fisiopatologia
19.
Nutr Metab Cardiovasc Dis ; 29(7): 701-709, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31133496

RESUMO

BACKGROUND AND AIMS: We investigated the association between statin use and site-specific risk of colorectal cancer in individuals with hypercholesterolemia. METHODS AND RESULTS: This study is based on the National Health Insurance Service-National Health Screening Cohort, conducted during 2002-2015. Statin users were classified as high and low users according to medication possession ratio (MPR). Statin nonusers comprised participants who did not use statins during the entire follow-up period. In total, 17,737 statin users and 13,412 statin nonusers were included in the analysis, with a median follow-up period of 12.7 years. Cox proportional hazards regression models were adopted after stepwise adjustment for confounders to investigate prospective association between statin usage and colorectal cancer risk. In total, 378 (2.3%) of 16,588 male participants and 239 (1.6%) of 14,561 female participants had colorectal cancer during the follow-up period. Compared to nonusers, fully adjusted hazard ratios (HRs) (95% confidence intervals [95% CIs]) for colorectal cancer risk in high statin users were 0.56 (0.42-0.75) in men and 0.64 (0.46-0.90) in women. In men, the fully adjusted HRs for proximal and rectal cancer for high users were 0.29 (0.15-0.56) and 0.52 (0.35-0.78), respectively, compared to those for nonusers. In women, statistical significance was seen only in rectal cancer (HR 0.43 [0.25-0.72]) but not in proximal or distal colon cancer. CONCLUSIONS: High statin users with hypercholesterolemia were associated with lower risk of overall colorectal cancer, especially proximal colon cancer in men and rectal cancer in both sexes.


Assuntos
Colesterol/sangue , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Programas Nacionais de Saúde , Adulto , Idoso , Biomarcadores/sangue , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
20.
J Pediatr Endocrinol Metab ; 32(6): 561-568, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31129653

RESUMO

Background Severe obesity is associated with a number of cardiometabolic risk factors. Thyroid-stimulating hormone (TSH) levels are often slightly increased in children with obesity. The clinical significance of the mild elevation in TSH in children with obesity is unclear. Objective To examine the association between TSH and lipids in children with severe obesity. Methods We performed a retrospective analysis of records of children with severe obesity with simultaneous measurements of TSH and lipids. Children with TSH <0.3 mIU/L and ≥10 mIU/L were excluded. The relationship between TSH and lipids was evaluated using univariate/multiple variable linear and logistic regression. Results The study included 834 children (age 13.8 ± 4.1 years, males 46%, body mass index [BMI]: 36.9 ± 7.6 kg/m2; BMI z-score 2.6 ± 0.4). Seventy-four (8.9%) children had TSH between 5 and <10 mIU/L (high TSH [HTSH]). TSH was positively associated with non-high-density lipoprotein (HDL) cholesterol (ß: 1.74; 95% confidence interval [CI] 0.29-3.20, p = 0.02). Total cholesterol and non-HDL cholesterol were higher in males with HTSH compared to those with normal TSH (175.5 vs. 163.5 mg/dL, p = 0.02 and 133.7 vs. 121.4 mg/dL, p = 0.02, respectively). The odds of elevated non-HDL cholesterol (≥145 mg/dL) was higher in males with HTSH relative to those with normal TSH (odds ratio [OR]: 2.78; 95% CI 1.35-5.69, p = 0.005). Conclusions TSH levels were positively associated with non-HDL cholesterol in children with severe obesity. Males with mildly elevated TSH had higher total cholesterol and non-HDL cholesterol compared to males with normal TSH. Further studies are warranted to determine if levothyroxine therapy would result in improvement in total cholesterol or non-HDL cholesterol in children with severe obesity with mildly elevated TSH.


Assuntos
Biomarcadores/sangue , Hipercolesterolemia/etiologia , Hipertireoxinemia/etiologia , Lipídeos/sangue , Obesidade Mórbida/complicações , Tireotropina/sangue , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipertireoxinemia/sangue , Hipertireoxinemia/diagnóstico , Masculino , Prognóstico , Estudos Retrospectivos
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