Atherogenic dyslipidemia in patients with established coronary artery disease

Related cardiometabolic factors and prevalence of low HDL-cholesterol levels and atherogenic dyslipidemia. SIMETAP-AD study

AIM

To determine the crude and sex- and age-adjusted prevalence rates of atherogenic dyslipidemia (AD) and low HDL-cholesterol levels (low-HDLc), and to assess their associations with cardiovascular risk factors, chronic kidney disease, cardiovascular and cardiometabolic diseases.

METHODS

Population-based cross-sectional study conducted in Primary Care, with randomly selected adult subjects. The AD was considered if the patients had hypertriglyceridemia (triglycerides≥150mg/dL) and low-HDLc (<40mg/dL [men];<50mg/dL [women]). Crude and sex- and age-adjusted prevalence rates were determined, and univariate and multivariate analysis were performed to assess related cardiometabolic factors.

RESULTS

Study population with 6,588 adults (55.9% women) with mean age 55.1 (±17.5) years. The mean HDLc levels were 49.2 (±12.6) mg/dL in men and 59.2 (±14.7) mg/dL in women. The crude prevalence rates of low-HDLc and AD were 30.8% (95%CI: 29.7-31.9), and 14.3% (95%CI: 13.5-15.2), respectively. The adjusted prevalence rates of low-HDLc were 28.0% in men and 31.0% in women, and AD were 16.4% in men and 10.6% in women. Seventy-three percent of the population with AD had high or very high cardiovascular risk. The independent factors associated with low HDLc or with AD were diabetes, smoking, abdominal obesity, and obesity. The major factors associated with low HDLc and AD were hypertriglyceridemia and diabetes, respectively.

CONCLUSIONS

Almost a third of the adult population had low HDL-C and half of them met AD criteria. Cardiometabolic factors were associated with low HDL-C and AD, highlighting hypertriglyceridemia with low HDLc, and DM with AD.

Prevalence of poor lipid control in patients with premature coronary artery disease

BACKGROUND AND AIMS

Lipid goals have become more stringent in high risk patients. However, no studies have analyzed lipid control defined as the composite achievement of goals in low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (Non-HDL-C) and apolipoproteinB-100 (ApoB-100), in patients with premature coronary artery disease (CAD). We aimed to analyze lipid control rates, and the associated factors with its poor achievement in patients with premature CAD.

METHODS AND RESULTS

The study included 1196 patients with CAD diagnosed before 55 and 65 years old in men and women, respectively. The American Heart Association/American College of Cardiology (non-strict) and the American Association of Clinical Endocrinologists (strict) criteria were used to analyze lipid control rates. Sociodemographic, dietary-healthy and clinical characteristics of the patients were collected. Participants were 54 ± 8 years old, 19.7% were women, and median CAD evolution was 2.4 years. Non-strict and strict lipid control was achieved in 23.0% and 8.9% of the patients, respectively. Moreover, 46.5% and 62.8% of the patients did not achieve any lipid goal using both criteria. Sociodemographic data were not different among patients who achieved or not lipid control. Treatment adherence<85%, prescription of low- and moderate-intensity statins, and obesity were consistently associated with poor lipid control.

CONCLUSIONS

Lipid control is suboptimal in patients with premature CAD. Low lipid-lowering treatment adherence, low prescription of high-intensity statins, and obesity were independently associated with poor lipid control. Novel preventive programs and more aggressive pharmacological intervention should be implemented in order to reduce the burden of premature CAD.

Effects of Selenium Supplementation on Metabolic Status in Patients Undergoing for Coronary Artery Bypass Grafting (CABG) Surgery: a Randomized, Double-Blind, Placebo-Controlled Trial

This study was carried out to evaluate the effects of selenium supplementation on glycemic control, lipid profiles, and biomarkers of inflammation and oxidative stress in patients undergoing for coronary artery bypass grafting (CABG) surgery. This randomized, double-blind, placebo-controlled trial was performed among 33 patients undergoing for CABG surgery, aged 40-85 years old. Subjects were randomly allocated into two groups to intake either 200 μg/day selenium supplements as selenium yeast (n = 17) or placebo (n = 16) for 4 weeks. Glycemic control, lipid profiles, and biomarkers of inflammation and oxidative stress were assessed at baseline and at the end of trial. After the 4-week intervention, selenium supplementation significantly decreased fasting plasma glucose (FPG) (β, 6.76 mg/dL; 95% CI, - 13.13, - 0.40; P = 0.03), insulin (β, - 1.14 μIU/mL; 95% CI, - 2.01, - 0.28; P = 0.01); homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (β - 0.35; 95% CI, - 0.62, - 0.08; P = 0.01); and total-/HDL-cholesterol ratio (β - 0.31; 95% CI, - 0.51, - 0.09; P = 0.008); and significantly increased HDL-cholesterol levels (β, 2.72 mg/dL; 95% CI, 0.89, 4.55; P = 0.005) compared with the placebo. Moreover, selenium supplementation led to a significant reduction in high-sensitivity C-reactive protein (hs-CRP) (β, - 0.68 mg/L; 95% CI, - 1.18, - 0.17; P = 0.01) and malondialdehyde (MDA) (β, - 0.27 μmol/L; 95% CI, - 0.47, - 0.07; P = 0.009), and a significant elevation in total glutathione (GSH) levels (β, 77.33 μmol/L; 95% CI, 56.11, 98.55; P < 0.001) compared with the placebo. Selenium supplementation did not affect other metabolic profiles. Overall, our study demonstrated that selenium supplementation for 4 weeks to patients undergoing for CABG surgery had beneficial effects on FPG, insulin, HOMA-IR, total-/HDL-cholesterol ratio, HDL-cholesterol, hs-CRP, GSH, and MDA levels, but did not affect other metabolic profiles. Clinical trial registration number: http://www.irct.ir : IRCT2017090533941N22.

Low-intensity laser (660 NM) has analgesic effects on sternotomy of patients who underwent coronary artery bypass grafts

Background:

The aim of this study was to evaluate the efficacy of low-level laser therapy for reducing the acute pain of sternotomy in patients who underwent a coronary artery bypass graft (CABG).

Methods:

This study was conducted with ninety volunteers who electively submitted to CABG. The volunteers were randomly allocated into three groups of equal size (n = 30): control, placebo, and laser (λ of 660 nm and spatial average energy fluency of 1.06 J/cm²). Pain when coughing was assessed by a visual analog scale (VAS) and McGill Pain Questionnaire, according to sensory, affective, evaluative, and miscellaneous domains. The patients were followed for 1 month after the surgery.

Results:

The laser group had a greater decrease in pain with analogous results, as indicated by both the VAS and the McGill questionnaire (P ≤ 0.05) on sensory and affective scores, on days 6 and 8 postsurgery compared to the placebo and control groups.

Conclusion:

Laser seems to be effective promoting pain reduction after coronary-arterial bypass grafting.

[Lipid control in patients with coronary artery disease in a healthcare area in Cáceres (Spain): LIPICERES study]

INTRODUCTION AND OBJECTIVES

Current guidelines recommend a low-density lipoprotein cholesterol (LDLc) target of <70mg/dl for patients with coronary artery disease. Despite the well-established benefits of strict lipid control, the most recent studies show that control rate of lipid targets are alarmingly low. An analysis was performed on the lipid targets attained according to current guidelines for the prevention of cardiovascular disease in coronary patients in a Caceres healthcare area.

METHODS

An observational and cross-sectional study was carried out in a healthcare area in Caceres (Spain). The study included a total of 741 patients admitted for coronary disease between 2009 and 2015 with available lipid profile in the last 3 years Total cholesterol, high-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and non-HDLc were analysed.

RESULTS

The majority (74.4%) of patients were male, with a mean age of 68.5±13.1 years; 76.3±11.8 for women and 65.8±12.6 for men (P<.001). A total of 52.3% patients achieved the LDLc target of <70mg/dl, with no gender differences. Only 44.8% of the patients <55 years achieved their lipid targets, compared to 59.3% of the patients >75 years. About 68.2% of men had an HDLc>40mg/dl, and 54.8% of women had an HDLc>50mg/dl. Overall, 79.4% of patients had a TG<150mg/dl, with no gender differences, and 59.8% had a non-HDLc<100mg/dl.

CONCLUSIONS

Approximately one half of patients with coronary disease do not achieve their target lipid levels as defined in the European guidelines, and this rate is less than reported in previous studies. There are no gender differences in achieving lipid goals, and age is a predictor of adherence.

Prevalence, Treatment, and Control of Hypercholesterolemia in High Cardiovascular Risk Patients: Evidences from a Systematic Literature Review in Spain

Introduction

Cardiovascular diseases (CVDs) represent a major Public Health burden. High serum cholesterol levels have been linked to major CV risk. The objectives of this study were to review the epidemiology of hypercholesterolemia in high risk CV patients from Spain, by assessing its prevalence, the proportion of diagnosed patients undergoing pharmacological treatment and the degree of attained lipid control.

Methods

A systematic literature review was carried out using Medline and two Spanish databases. Manuscripts containing information on hypercholesterolemia in several high CV risk groups [diabetes mellitus (DM), Systematic COronary Risk Evaluation (SCORE) risk >5, or documented CVD], published between January 2010 and October 2014, were included.

Results

Of the 1947 published references initially retrieved, a full-text review was done on 264 manuscripts and 120 were finally included. Prevalence of hypercholesterolemia ranged from 50 to 84% in diabetics, 30–60% in patients with DM or elevated SCORE risk, 64–74% with coronary heart disease, 40–70% in stroke patients, and 60–80% in those with peripheral artery disease. Despite the finding that most of them were on pharmacological treatment, acceptable control of serum lipids was very variable, ranging from 15% to 65%. Among those with heterozygous familial hypercholesterolemia, 95–100% received treatment but less than 50% achieved their therapeutic goals.

Conclusions

An elevated prevalence of hypercholesterolemia can be found in targeted groups at high CV risk. Although most patients are receiving pharmacological treatment, rates of lipid control continue to be low, both in primary and secondary prevention.

Electronic supplementary material

The online version of this article (doi:10.1007/s12325-015-0252-y) contains supplementary material, which is available to authorized users.

Effect of liraglutide administration and a calorie-restricted diet on lipoprotein profile in overweight/obese persons with prediabetes

BACKGROUND AND AIMS

To evaluate the effects of 14 weeks of liraglutide plus modest caloric restriction on lipid/lipoprotein metabolism in overweight/obese persons with prediabetes.

METHODS AND RESULTS

Volunteers with prediabetes followed a calorie-restricted diet (-500 Kcal/day) plus liraglutide (n = 23) or placebo (n = 27) for 14 weeks. The groups were similar in age (58 ± 7 vs. 58 ± 8 years) and body mass index (31.9 ± 2.8 vs. 31.9 ± 3.5 kg/m(2)). A comprehensive lipid/lipoprotein profile was obtained before and after intervention using vertical auto profile (VAP). Weight loss was greater in the liraglutide group than in the placebo group (6.9 vs. 3.3 kg, p < 0.001), as was the fall in fasting plasma glucose concentration (9.9 mg/dL vs. 0.3 mg/dL, p < 0.001). VAP analysis revealed multiple improvements in lipid/lipoprotein metabolism in liraglutide-treated compared with placebo-treated volunteers, including decreases in concentrations of total cholesterol, low-density lipoprotein cholesterol and several of its subclasses, triglyceride, and non-high-density cholesterol. The liraglutide-treated group also had a significant shift away from small, dense low-density lipoprotein-particles, as well as decreases in apolipoprotein B concentration and ratio of apolipoprotein B/apolipoprotein A-1. There were no significant changes in the lipoprotein profile in the placebo-treated group.

CONCLUSION

Treatment with liraglutide plus modest calorie restriction led to enhanced weight loss, a decrease in fasting plasma glucose concentration, and improvement in multiple aspects of lipid/lipoprotein metabolism associated with increased cardiovascular disease (CVD) risk. The significant clinical benefit associated with liraglutide-assisted weight loss in a group at high risk for CVD - obese/overweight individuals with prediabetes - as seen in our pilot study, suggests that this approach deserves further study.

Prevalence of atherogenic dyslipidemia in primary care patients at moderate-very high risk of cardiovascular disease. Cardiovascular risk perception

INTRODUCTION

Atherogenic dyslipidemia is an important risk factor for cardiovascular disease. We aim to determine atherogenic dyslipidemia prevalence in primary care patients at moderate-very high cardiovascular risk and its associated cardiovascular risk perception in Spain.

METHODS

This cross-sectional study included 1137 primary care patients. Patients had previous cardiovascular disease, diabetes mellitus, SCORE risk ≥ 3, severe hypertension or dyslipidemia. Atherogenic dyslipidemia was defined as low HDL-C (<40 mg/dL [males], <50 mg/dL [females]) and elevated triglycerides (≥ 150 mg/dL). A visual analog scale was used to define a perceived cardiovascular disease risk score.

RESULTS

Mean age was 63.9 ± 9.7 years (64.6% males). The mean BMI was 29.1 ± 4.3 kg/m(2), and mean waist circumference 104.2 ± 12.7 cm (males), and 97.2 ± 14.0 cm (females). 29.4% were smokers, 76.4% had hypertension, 48.0% were diabetics, 24.7% had previous myocardial infarction, and 17.8% peripheral arterial disease. European guidelines classified 83.6% at very high cardiovascular risk. Recommended HDL-C levels were achieved by 50.1% of patients and 37.3% had triglycerides in the reference range. Target LDL-C was achieved by 8.8%. The overall atherogenic dyslipidemia prevalence was 27.1% (34.1% in diabetics). This prevalence in patients achieving target LDL-C was 21.4%. Cardiovascular risk perceived by patients was 4.3/10, while primary care physicians scored 5.7/10.

CONCLUSIONS

When LDL-C levels are controlled, atherogenic dyslipidemia is more prevalent in those patients at highest cardiovascular risk and with diabetes. This highlights the importance of intervention strategies to prevent the residual vascular risk in this population. Both patients and physicians underestimated cardiovascular risk.

Predictive factors of achieving therapeutic goals of hypertriglyceridemia

OBJECTIVES

The aim of this study was to ascertain the factors associated with non-achievement of triglyceride (TG) goals in a cohort of hypertriglyceridemic patients attending the lipid clinics of the Spanish Arteriosclerosis Society (LC-SAS).

METHODS

Patients with high TG levels (>2.2 mmol/L; 200 mg/dL) were included in this multicenter, prospective, observational study and followed up for 1 year. The TG goal was ≤2.2 mmol/L (200 mg/dL). Main limitations of this study are that etiologic diagnosis of hypertriglyceridemia was not done under unified criteria and drug compliance was not evaluated.

RESULTS

From 1394 patients initially included in the study, 929 (age range: 50 ± 12 years, 26% women) were followed up for 1 year; 523 patients (56%) failed to reach the TG target. These patients were younger, had a higher body mass index (BMI), were more frequently smokers, hypertensive and diabetic and had more severe dyslipidemia. They were also more sedentary, their diet was of poorer quality and they had higher alcohol consumption. The independent predictors of treatment failure were hypertriglyceridemia severity, low high density lipoprotein cholesterol (HDL-C), and high non-HDL-C, alcohol consumption and a raised BMI, while drug treatment had no predictive power.

CONCLUSION

Independent predictors of failure to achieve hypertriglyceridemia treatment goals are inappropriate lifestyle, evidenced by insufficient weight loss, alcohol consumption and dyslipidemia severity.