Effects of Time-Restricted Eating on Cardiometabolic and Cardiovascular Health: Study Protocol (TRES)

This study aims to assess the safety, feasibility, and effectiveness of 10-hr Time-Restricted Eating (TRE) compared to ad libitum eating on anthropometric measurements, cardiometabolic and cardiovascular health in patients with Acute Coronary Syndrome (ACS). The Time-Restricted Eating Study (TRES) is a single-centre, pragmatic, prospective, randomised controlled trial that will include 48 patients with ACS. Participants will be randomised in a 1:1 ratio to the intervention group where eating duration is restricted to 10 hours per day or control group with no limitation of eating duration imposed. Testing is scheduled at baseline and after four weeks of intervention. The primary outcome is change in body weight after four weeks of intervention. Secondary outcomes include changes in body composition, glycaemic and lipid profiles, inflammatory markers, oxidative stress, endothelial function, arterial stiffness, blood pressure, heart rate, safety, and feasibility of TRE on patients with ACS. The study was approved by the UiTM Research Ethics Committee. Findings will be disseminated through manuscripts, reports, and presentations. Findings on the feasibility and effectiveness of TRE in patients with ACS may broaden the body of evidence for implementing TRE as a dietary intervention to prevent secondary cardiovascular diseases

A case report of heterozygous familial hypercholesterolaemia with LDLR gene mutation complicated by premature coronary artery disease detected in primary care

BackgroundFamilial Hypercholesterolemia (FH) is an autosomal dominant genetic condition predominantly caused by the low-density lipoprotein receptor (LDLR) gene mutation.Case SummaryThis is the case of a 54-year-old Malay woman with genetically confirmed FH complicated by premature coronary artery disease (PCAD). She was clinically diagnosed in primary care at 52 years old, fulfilling the Simon Broome Criteria (possible FH), Dutch Lipid Clinic Criteria (score of 8: probable FH) and Familial Hypercholesterolemia Case Ascertainment Tool (FAMCAT relative risk score of 9.51). Subsequently, she was confirmed to have a heterozygous LDLR c.190+4A>T intron 2 pathogenic variant at the age of 53 years. She was known to have hypercholesterolemia and was treated with statin since the age of 25. However, the lipid-lowering agent was not intensified to achieve the recommended treatment target. The delayed FH diagnosis has caused this patient to have PCAD and percutaneous coronary intervention (PCI) at the age of 29 years and a second PCI at the age of 49 years. She also has a very strong family history of hypercholesterolemia and PCAD, where seven out of eight of her siblings were affected. Despite this, FH was not diagnosed early and cascade screening of family members was not conducted, resulting in a missed opportunity to prevent PCAD.DiscussionFH can be clinically diagnosed in primary care to identify those who may require genetic testing. Multidisciplinary care focuses on improving identification, cascade screening and management of FH is vital to improving prognosis and ultimately preventing PCAD