Coronary heart disease risks associated with high levels of HDL cholesterol.

BackgroundThe association between high-density lipoprotein cholesterol (HDL-C) and coronary heart disease (CHD) events is not well described in individuals with very high levels of HDL-C (>80 mg/dL).Methods and resultsUsing pooled data from 6 community-based cohorts we examined CHD and total mortality risks across a broad range of HDL-C, including values in excess of 80 mg/dL. We used Cox proportional hazards models with penalized splines to assess multivariable, adjusted, sex-stratified associations of HDL-C with the hazard for CHD events and total mortality, using HDL-C 45 mg/dL and 55 mg/dL as the referent in men and women, respectively. Analyses included 11 515 men and 12 925 women yielding 307 245 person-years of follow-up. In men, the association between HDL-C and CHD events was inverse and linear across most HDL-C values; however at HDL-C values >90 mg/dL there was a plateau effect in the pattern of association. In women, the association between HDL-C and CHD events was inverse and linear across lower values of HDL-C, however at HDL-C values >75 mg/dL there were no further reductions in the hazard ratio point estimates for CHD. In unadjusted models there were increased total mortality risks in men with very high HDL-C, however mortality risks observed in participants with very high HDL-C were attenuated after adjustment for traditional risk factors.ConclusionsWe did not observe further reductions in CHD risk with HDL-C values higher than 90 mg/dL in men and 75 mg/dL in women

Causal relevance of blood lipid fractions in the development of carotid atherosclerosis: Mendelian randomization analysis.

BACKGROUND: Carotid intima-media thickness (CIMT), a subclinical measure of atherosclerosis, is associated with risk of coronary heart disease events. Statins reduce progression of CIMT and coronary heart disease risk in proportion to the reduction in low-density lipoprotein cholesterol. However, interventions targeting triglycerides (TGs) or high-density lipoprotein cholesterol (HDL-C) have produced inconsistent effects on CIMT and coronary heart disease risk, making it uncertain whether such agents are ineffective for coronary heart disease prevention or whether CIMT is an inadequate marker of HDL-C or TG-mediated effects. We aimed to determine the causal association among the 3 major blood lipid fractions and common CIMT using mendelian randomization analysis. METHODS AND RESULTS: Genetic scores specific for low-density lipoprotein cholesterol, HDL-C, and TGs were derived based on single nucleotide polymorphisms from a gene-centric array in ≈5000 individuals (Cardiochip scores) and from a genome-wide association meta-analysis in >100 000 individuals (Global Lipids Genetic Consortium scores). These were used as instruments in a mendelian randomization analysis in 2 prospective cohort studies. A genetically predicted 1 mmol/L higher low-density lipoprotein cholesterol concentration was associated with a higher common CIMT by 0.03 mm (95% confidence interval, 0.01-0.04) and 0.04 mm (95% confidence interval, 0.02-0.06) based on the Cardiochip and Global Lipids Genetic Consortium scores, respectively. HDL-C and TGs were not causally associated with CIMT. CONCLUSIONS: Our findings confirm a causal relationship between low-density lipoprotein cholesterol and CIMT but not with HDL-C and TGs. At present, the suitability of CIMT as a surrogate marker in trials of cardiovascular therapies targeting HDL-C and TGs is questionable and requires further study

The role of metformin response in lipid metabolism in patients with recent-onset type 2 diabetes: HbA1c level as a criterion for designating patients as responders or nonresponders to metformin

Background: In this study, we investigated whether response to metformin, the most frequently drug for diabetes treatment, influences the therapeutic effects of antilipidemic medication in newly diagnosed patients with type 2 diabetes mellitus (T2DM). Methods: A total of 150 patients with T2DM were classified into two groups following 3 months of metformin therapy (1000mg twice daily): responders (patients showing >1% reduction in HbA1c from baseline) and nonresponders (patients showing <1% reduction in HbA1c from baseline). The patients received atorvastatin 20 mg, gemfibrozil 300 mg, or atorvastatin 20 mg and gemfibrozil 300 mg daily. Principal Findings: HbA1c and fasting glucose levels were significantly different between baseline and 3 months among responders receiving atorvastatin; however, these differences were not statistically significant in nonresponders. Atherogenic ratios of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C; p = 0.002), total cholesterol to HDL-C (TC/HDL-C; p<0.001) and AIP (the atherogenic index of plasma; p = 0.004) decreased significantly in responders receiving atorvastatin than in nonresponders. Moreover, responders receiving atorvastatin showed a significant increase in HDL-C levels but nonresponders receiving atorvastatin did not (p = 0.007). The multivariate model identified a significant association between metformin response (as the independent variable) and TG, TC, HDL-C and LDL-C (dependent variables; Wilk's λ = 0.927, p = 0.036). Conclusions: Metformin response affects therapeutic outcomes of atorvastatin on atherogenic lipid markers in patients newly diagnosed with T2DM. Metformin has a greater impact on BMI in responders of metformin compared to nonresponders. Adoption of better therapeutic strategies for reducing atherogenic lipid markers may be necessary for metformin nonresponders. © 2016 Kashi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Relationship Between Physical Conditioning and Plasma High Density Lipoprotein-Cholesterol Concentration

Five subjects (three females and two males) took part in an exercise regimen in order to determine if aerobic exercise results in an increase in high-density lipoprotein-cholesterol levels (HDL-C) in the plasma. The exercise regimen consisted of running three miles a day, five days per week for six months. Running speed was at such a pace that the subjects attained a minimum of 60% of their maximal heart rate reserve (MHRR). Before the training program began the following parameters were measured in all of the subjects: height, weight, percent body fat, maximal oxygen consumption (Vₒ₂ max), vital capacity, resting heart rate, resting blood pressure, HDL-C, plasma triglycerides (TG), and plasma cholesterol (TC). These same measurements were retaken every two months and at the conclusion of the study. The exercise protocol produced significant changes in Vₒ₂ max and resting heart rate. None of the other parameters were significantly changed. The results of this study have shown that aerobic exercise does not cause significant changes in HDL-C levels

HDL-C and Mortality

Non peer reviewe

The cardiovascular risk of young women with polycystic ovary syndrome: an observational, analytical, prospective case-control study

To evaluate the cardiovascular risk of polycystic ovary syndrome (PCOS), we investigated lipid profile, metabolic pattern, and echocardiography in 30 young women with PCOS and 30 healthy age- and body mass index (BMI)-matched women. PCOS women had higher fasting glucose and insulin levels, homeostasis model assessment score of insulin sensitivity, total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels, and TC/high density lipoprotein cholesterol (HDL-C) ratio and lower HDL-C levels than controls. Additionally, PCOS women had higher left atrium size (32.0 +/- 4.9 vs. 27.4 +/- 2.1 mm; P &lt; 0.0001) and left ventricular mass index (80.5 +/- 18.1 vs. 56.1 +/- 5.4 g/m(2); P &lt; 0.0001) and lower left ventricular ejection fraction (64.4 +/- 4.1 vs. 67.1 +/- 2.6%; P = 0.003) and early to late mitral flow velocity ratio (1.6 +/- 0.4 vs. 2.1 +/- 0.2; P &lt; 0.0001) than controls. When patients and controls were grouped according to BMI [normal weight (BMI, &gt;18 and &lt;25 kg/m(2)), overweight (BMI, 25.1-30 kg/m(2)), and obese (BMI, &gt;30 kg/m(2))], the differences between PCOS women and controls were maintained in overweight and obese women. In normal weight PCOS women, a significant increase in left ventricular mass index and a decrease in diastolic filling were observed, notwithstanding no change in TC, LDL-C, HDL-C, TC/HDL-C ratio, and TG compared with controls. In conclusion, our data show the detrimental effect of PCOS on the cardiovascular system even in young women asymptomatic for cardiac disease

The Correlation of Dyslipidemia with the Extent of Coronary Artery Disease in the Multiethnic Study of Atherosclerosis.

BackgroundThe extent of coronary artery calcium (CAC) improves cardiovascular disease (CVD) risk prediction. The association between common dyslipidemias (combined hyperlipidemia, simple hypercholesterolemia, metabolic Syndrome (MetS), isolated low high-density lipoprotein cholesterol, and isolated hypertriglyceridemia) compared with normolipidemia and the risk of multivessel CAC is underinvestigated.ObjectivesTo determine whether there is an association between common dyslipidemias compared with normolipidemia, and the extent of coronary artery involvement among MESA participants who were free of clinical cardiovascular disease at baseline.MethodsIn a cross-sectional analysis, 4,917 MESA participants were classified into six groups defined by specific LDL-c, HDL-c, or triglyceride cutoff points. Multivessel CAC was defined as involvement of at least 2 coronary arteries. Multivariate Poisson regression analysis evaluated the association of each group with multivessel CAC after adjusting for CVD risk factors.ResultsUnadjusted analysis showed that all groups except hypertriglyceridemia had statistically significant prevalence ratios of having multivessel CAC as compared to the normolipidemia group. The same groups maintained statistical significance prevalence ratios with multivariate analysis adjusting for other risk factors including Agatston CAC score [combined hyperlipidemia 1.41 (1.06-1.87), hypercholesterolemia 1.55 (1.26-1.92), MetS 1.28 (1.09-1.51), and low HDL-c 1.20 (1.02-1.40)].ConclusionCombined hyperlipidemia, simple hypercholesterolemia, MetS, and low HDL-c were associated with multivessel coronary artery disease independent of CVD risk factors and CAC score. These findings may lay the groundwork for further analysis of the underlying mechanisms in the observed relationship, as well as for the development of clinical strategies for primary prevention

Rasio Trigliserida/High Density Lipoprotein-Cholesterol pada Remaja Stunted Obesity Usia 15-18 Tahun di Kota Semarang

Latar belakang: Stunted menjadi permasalahan gizi di Indonesia. Individu stunted memiliki risiko 3,4 kali untuk menjadi obesitas dibanding individu non-stunted. Remaja dengan stunted obesity memiliki risiko tinggi terhadap sindrom metabolik dan gangguan metabolik lainnya. Rasio trigliserida/High Density Lipoprotein-Cholesterol (TG/HDL-C) dapat mengidentifikasi individu dengan risiko sindrom metabolik dan gangguan kardiometabolik. Penelitian ini bertujuan untuk mengetahui perbedaan rasio TG/HDL-C pada remaja stunted obesity dan non-stunted obesity di Kota Semarang. Metode: Penelitian ini menggunakan rancangan cross sectional pada 2 kelompok: remaja stunted obesity dan non-stunted obesity. Total subjek yaitu 2299 remaja usia 15-18 tahun dengan skrining yang dilakukan secara random terhadap 4 sekolah dari area urban dan suburban di Kota Semarang. Penentuan status gizi berdasarkan tinggi badan menurut umur, Indeks Massa Tubuh (IMT) menurut umur, dan lingkar pinggang. Pengukuran kadar trigliserida dan HDL-C menggunakan metode enzimatik kolorimetri. Analisis data menggunakan uji t independen. Hasil: Angka kejadian obesitas pada remaja sebesar 8,52%, terdiri dari stunted obesity (1,96%) dan non-stunted obesity (6,57%). Sebanyak 26,93% remaja memiliki kadar trigliserida tinggi dan 75,00% remaja memiliki kadar HDL-C rendah. Ditemukan 80,80% remaja dengan rasio TG/HDL-C ≥1,70. Rerata kadar trigliserida, HDL-C, dan rasio TG/HDL-C pada remaja stunted obesity lebih tinggi dari kelompok remaja non-stunted obesity dimana tidak bermakna. Simpulan: Rerata rasio TG/HDL-C pada kelompok remaja stunted obesity lebih tinggi dibanding kelompok remaja non-stunted obesity (p=0,745