The association of vitamin D with common diseases — an appraisal of recent evidence

It has been several years since the discovery of the pleiotropic effects of vitamin D, and there is still hot debate as to the role of vitamin D and attempts to standardise methods of determining 25(OH)D concentrations as well as supplementation with vitamin D. Many studies, both observational and randomised controlled trials, have revealed a whole range of opportunities of active vitamin D metabolite contribution to the treatment of common diseases. A relationship between high concentrations of vitamin D and a low risk of incidence of colorectal cancer, cardiovascular diseases, hypertension, ischaemic stroke, depression,metabolic syndrome and type 2 diabetes has been suggested for a long time, although recently published meta-analyses have created some doubts. There is no consensus regarding vitamin D supplementation and the optimum concentration of serum 25(OH)D. The Institute of Medicine’s 2011 report recommends achieving serum 25(OH)D concentration of 20 ng/mL as optimal, at a dosage of 600 IU of vitamin D per day. International recommendations suggest for individuals at risk a dosage of vitamin D of 2,000 IU per day. Polish experts advise that the optimal concentration of 25(OH)D should be greater than 30 ng/mL for adults

Angiopoietin-like proteins - their role in lipoprotein metabolism and association with atherogenic dyslipidemia

Scientists have been trying to find the best parameter for laboratory assessment of the risk of cardiovasculardiseases (CVD) for decades. Initially, the results of many studies indicated that the analysisof the lipid profile was sufficient to evaluate the risk of CVD. Further studies revealed that more preciselaboratory prediction of cardiovascular risk requires quantification of atherogenic lipoproteins. Recently,angiopoietin-like proteins 3, 4 and 8 (ANGPTLs) have been described as important regulators of plasmalipoprotein metabolism and triglyceride homeostasis. Mutations in ANGPTL3 leading to loss of its functionhave been linked to decreased risk of CVD in humans. Among potential new targets for the managementof dyslipidemia, ANGPTL3 may become a considerably promising one

Occurrence of hyperlipidemia in relation to body mass index in school children aged 9–11

Background. There is a link between lipid disorders and body mass and the occurrence of cardiovascular diseases. This study aimed at establishing the prevalence of lipid abnormalities in relation to body mass in children aged 9–11. Materials and methods. The study involved 232 presumably healthy school children aged 9-11. Fasting venous blood samples were taken from every child to assess the lipid profile: total cholesterol (TC), LDL cholesterol (LDL-C, direct measurement), HDL cholesterol (HDL-C) and triglycerides (TG). Anthropometric measurements were performed including height and weight, followed by calculating the body mass index (BMI) by using an online “OLAF” calculator. Results. The prevalence of hypercholesterolemia and an elevated concentration of LDL-C in the group of children was high and equaled 51.1% and 34.6%, respectively. Hypertriglyceridemia in the respective age groups of 9 and 10–11 years was found to be: 41.6% and 27.7%. Only in 9.5% of children the level of HDL-C was lower than optimal. The percentage of overweight was two-fold higher among boys than in girls (13.6 v. 6.9%), similarly the percentage of obesity was higher in boys compared with that in girls (15.5 v. 10.3%). Conclusions. In school children aged 9–11 the dominant and most frequent lipid abnormality, not associated with an increased body mass, was hypercholesterolemia followed by hypertriglyceridemia. Overweight and obesity were strongly related to gender and much more frequent among boys. There should be more attention paid to dyslipidemia and body weight already in childhood in the context of health policy and prevention

The cut-off values for non-fasting routine lipid parameters in presumably healthy 9–11-year-old children

Disorders of lipid metabolism cause accelerated atherosclerosis and increase cardiovascular risk, which is why lipid profile screening, especially at a young age, should be widely applied.Aim. The aim of the study was to determine the cut-off points for non-fasting lipid parameters in presumably healthy children aged 9-11 years.Material and methods. The study was performed with the use of blood samples taken in non-fasting state from 289 school children of both sexes (152 girls and 137 boys). Routine lipid profile was assessed: TC, LDL-C, HDL-C, and triglycerides. Laboratory measurements were performed in serum samples using abiochemical autoanalyser.Results. In this study we determined the 97.5 percentile values for TC, LDL-C, and triglycerides and the 2.5 percentile values for HDL-C. The upper cut-offs for TC, LDL-C, and triglycerides were found to be 239 mg/dL, 163 mg/dL, and 284 mg/dL, respectively, and the lower cut-off for HDL-C was 37 mg/dL.Conclusions. The upper range of non-fasting total cholesterol was higher by about 30 mg/dL compared to fasting state for a similar age range; the cut-off points in non-fasting children for LDL-C and TG were also higher. The lower cut-off for HDL-C was similar compared to fasting state for the respective age range. The determination of the non-fasting cut-off values for routine lipid profile in the paediatric population is essential for the proper evaluation of the cardiovascular risk because using the reference values for adults may cause an incorrect interpretation of the laboratory results

Comparison of two different methods for routine 25(OH)D measurement in paediatric serum samples

Over the last decade interest in automated assays for 25-hydroxy-vitamin D measurement have greatly increased. The presence of different metabolites of vitamin D in the blood influences measurement of its concentration. In paediatric subjects the basic interference is due to the presence of 3-epi-25(OH)D2/D3, which  despite their biological inactivity, influences the total concentration of 25(OH)D. Aim: We assessed the analytical performance and usefulness of two different assays for measurement of total 25(OH)D in children. Materials and Methods: The study was performed in blood samples taken from 100 school-children aged 9–11 years. In all serum samples 25(OH)D total concentration was measured with the use of chemilumi-nescent assay, which is known to show no cross-reactivity with 3-epi-25(OH)D, and with the use of a newly developed enzyme-immunosorbent method. Results: The mean 25(OH)D concentration in children measured with enzyme-immunosorbent assay (EIA) was significantly higher, at 28.06 ng/mL, than with the chemiluminescent assay (CLIA), at 21.13 ng/mL;   < 0.0001. In children with optimal weight the average 25(OH)D was 32.93 ng/ml (EIA) and 21.5 ng/mL (CLIA) (p < 0.0001), respectively, whereas in a subgroup with overweight/obesity the mean concentra-tion of 25(OH)D was similar, at 23.2 ng/ml (EIA) and 20.76 ng/ml (CLIA) (p = 0.15). The nonparametric Spearman’s rank correlation of two methods equalled 0.47; 95%CI (0.11 to 0.60) with a significance level  p < 0.0001. The calculated concordance correlation coefficient between two methods in the whole group was 0.26; 95%CI (0.17 to 0.35). In a subgroup of children with optimal body mass (N = 50) the concor-dance correlation coefficient was 0.18; 95%CI (0.06 to 0.29), whereas in children with overweight/obesity (N = 50) it was 0.44; 95%CI (0.29 to 057). Mean bias for the enzyme-immunosorbent method equalled 18.7%; +/- 1.96 SD (101.3% to -64%). Conclusions: With reference to 25(OH)D measurement in children, Spearman’s correlation coefficient indicated “moderate correlation” between the two compared methods, whereas the strength of agree-ment (concordance) between both methods was characterised as “poor”. The proper selection of assay for accurate assessment of vitamin D status in paediatric samples is necessary to avoid misdiagnosis

The impact of metabolic syndrome on the antiplatelet effect of clopidogrel and aspirin in patients with acute coronary syndrome

Aim. The aim of this study was to evaluate the impact of metabolic syndrome and features clustering in this syndrome on the antiplatelet effect of clopidogrel and aspirin in patients with myocardial infarction.Material and methods. The study population comprised 186 consecutive patients treated with primary percutaneous coronary intervention for acute myocardial infarction. Measurements of ADP induced platelet aggregation (ADP-PA) and arachidonic acid induced platelet aggregation (AA-PA) were performed using impedance aggregometry with a Multiplate Analyser. The following factors were analysed as potential determinants of responsiveness to clopidogrel and to aspirin: diagnosed metabolic syndrome, diabetes, hypertension, abdominal obesity, body mass index (BMI), and serum concentrations of triglycerides, HDL-cholesterol and high sensitivity C-reactive protein (hsCRP).Results. The ADP-PA was significantly higher in patients with metabolic syndrome and with diabetes.The AA-PA was significantly higher in subjects with increased levels of hsCRP and in subjects with BMI > 25 kg/m2. The hsCRP was found to be the only independent factor influencing APD-PA (p=0.034). Serum concentrations of hsCRP, HDL-cholesterol and abdominal obesity were independent factors influencing AA-PA (p=0.000004).Conclusion. Metabolic syndrome, diabetes mellitus, obesity and increased hsCRP are determinants of low responsiveness to aspirin and clopidogrel in patients with ACS treated with PCI

Assessment of endothelial function in relation to the presence of type 2 diabetes mellitus in patients with prior myocardial infarction: a pilot study using peripheral arterial tonometry

Background. Endothelial dysfunction represents an early stage of atherosclerosis, while hyperglycaemia remains an important cause of endothelial dysfunction. The aim of this study was to assess endothelial function in patients with prior ST-segment elevation myocardial infarction (STEMI) in relation to the presence of type 2 diabetes mellitus (DM).Materials and methods: Eighty three adults treated with primary percutaneous intervention for STEMI within the previous 12–18 months were enrolled in a case-control study. The control group consisted of 21 healthy volunteers. Endothelial function was assessed with peripheral arterial tonometry (PAT). The value of reactive hyperemia index (RHI) and the presence of endothelial dysfunction (defined as RHI ≤ 2.0) were respectively the primary and secondary study endpoints.Results. RHI was significantly lower in post-STEMI subjects with concomitant type 2 DM (n = 21) than in healthy volunteers [1.70 (1.44–1.96) vs 2.15 (1.82–2.50); p = 0.006]. On the other hand, there were no significant differences in RHI between post-STEMI patients with and without type 2 DM [n = 62; RHI: 1.87 (1.59–2.39)], nor between the latter group and the control group. In terms of the secondary study endpoint, we observed a decreasing prevalence of endothelial dysfunction across the compared groups [76.2% vs 54.8% vs 38.1% for post-STEMI diabetics, post-STEMI non-diabetics and controls, respectively; p for trend = 0.013].Conclusions. Our study indicates that endothelial function assessed with PAT is significantly worse inpost-STEMI subjects with concomitant type 2 DM compared to healthy controls, but it does not seem to be substantially different in diabetic vs. non-diabetic STEMI survivors. The clinical significance of ourfindings warrants further investigation in adequately powered, prospective studies