Correlation of Friedewald's calculated low-density lipoprotein cholesterol levels with direct low-density lipoprotein cholesterol levels in a tertiary care hospital

Postprandial Hyperlipidemia: Association with Inflammation and Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis

OBJECTIVE

To describe postprandial lipidemia in patients with rheumatoid arthritis (RA) and to analyze its association with subclinical atherosclerosis and inflammatory activity.

METHODS

Observational study of 80 cases of RA and 80 sex- and age-matched controls. We excluded individuals with dyslipidemia. Postprandial hyperlipidemia (PPHL) was defined as postprandial triglycerides >220 mg/dL and/or postprandial ApoB48 levels >75th percentile (>p75). Plasma lipids, cholesterol, triglycerides, ApoB48, and total ApoB were evaluated at baseline and after a meal. Other variables analyzed included subclinical atherosclerosis (defined as presence of carotid atheromatous plaque), inflammatory activity (disease activity score (DAS28-ESR)), cytokines, apolipoproteins, and physical activity. A multivariate analysis was performed to identify factors associated with PPHL in patients with RA.

RESULTS

A total of 75 patients with RA and 67 healthy controls fulfilled the inclusion criteria. PPHL was more frequent in patients with RA than controls (No. (%), 29 (38.70) vs. 15 (22.40); p = 0.036), as was subclinical atherosclerosis (No. (%), 22 (30.10) vs. 10 (14.90); p = 0.032). PPHL in patients with RA was associated with subclinical atherosclerosis (OR (95% CI) 4.69 (1.09-12.11); p = 0.037), TNF-α (OR (95% CI) 2.00 (1.00-3.98); p = 0.048), high-sensitivity C-reactive protein (OR (95% CI) 1.10 (1.01-1.19); p = 0.027), and baseline triglycerides (OR (95% CI) 1.02 (1.00-1.04); p = 0.049).

CONCLUSION

PPHL was more frequent in patients with RA than in controls. PPHL in patients with RA was associated with inflammation and subclinical atherosclerosis.

Is data mining approach a best fit formula for estimation of low-density lipoprotein cholesterol?

Background:

With the change in the National Cholesterol Education Program ATP III guidelines, the risk of developing atherosclerosis has been now focused on total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Different treatment modalities are now targeted at lowering LDL cholesterol values. Hence greater emphasis is now led on the accurate and precise measurement of LDL cholesterol. Beta-quantification, though, is the best reference method for LDL cholesterol estimation, it has the disadvantage of being inconvenient in our routine practice. The new generation direct homogenous assay is now the method of choice. But being more expensive, various calculated methods have now been developed. This study is an attempt to compare different calculated formula with direct cholesterol assessment and to find out the best one.

Materials and Methods:

We compared LDL cholesterol measured by direct homogenous assay with the data mining approach (DM) and another calculated formula [Friedewald's Formula (FF) and Anandaraja Formula (AF)] in 266 samples with age greater than 18 years. Enrolled participants were divided into seven groups based upon their TG levels. Mean, percentage difference, and the correlation coefficient was assessed between calculated and direct LDL. Bland–Altman analysis was done to see the agreement between calculated vs direct LDL. All formulas were assessed among various TG levels with direct LDL by the Wilcoxon sign rank test.

Result:

1% level of significance was found between calculated and direct LDL with TG < 600 mg/dl. Mean and the percentage difference between direct and calculated LDL was lowest with the DM approach. Bland–Altman plot shows the best agreement of the DM approach with direct LDL.

Conclusion:

This study indicates that the DM approach is closer to direct LDL compared to FF & AF.

Novel markers of endothelial dysfunction in hepatitis C virus-related cirrhosis: More than a mere prediction of esophageal varices

BACKGROUND

Hepatitis C virus (HCV) infection may affect lipid metabolism by enhancing the circulating levels of inflammatory cytokines, together with its impact on endothelial function.

AIM

To evaluate the potential correlation of changes in lipid profile, carotid intima-media thickness (CIMT), and ankle-brachial index with the severity of fibrosis, grades of esophageal varices (EVs), and fibrosis indices.

METHODS

The study included 240 subjects who were divided into 3 groups; group 1 (n = 90, HCV-related cirrhotic patients with EVs), group 2 (n = 90, HCV-related cirrhotic patients without EVs), and group 3 (n = 60, served as the healthy control group). All patients underwent routine laboratory tests, including a lipid profile assay. Low-density lipoproteins (LDL)/platelet count and platelet/splenic diameter ratios were calculated. Abdominal ultrasonography, CIMT by carotid Doppler, bedside ankle-brachial index (ABI), liver stiffness measurement, and upper gastrointestinal endoscopy were performed.

RESULTS

Multivariate logistic regression revealed that very-low-density lipoprotein (VLDL) (β = 0.988, odds ratio 2.5, P = 0.001), LDL/platelet count ratio (β = 1.178, odds ratio 3.24, P = 0.001), CIMT (β = 1.37, odds ratio 3.9, P = 0.001), and ABI (β = 2.3, odds ratio 5.9, P = 0.001) were the key variables associated with significant fibrosis, EVs and endothelial dysfunction. CIMT and LDL/platelet count ratio were predictive of advanced fibrosis and EVs at cutoff values of 1.1 mm and 1 mm, respectively, with an area under the curve (AUC) of 0.966 and 0.960 (P = 0.001), while VLDL and ABI at a cutoff of 16.5 mg/dL and 0.94 were predictive of advanced fibrosis and EVs with an AUC of 0.891 and 0.823, respectively (P = 0.001).

CONCLUSION

CIMT, ABI, VLDL, LDL/platelet count ratio are good non-invasive predictors of advanced fibrosis, presence of EVs, and endothelial dysfunction in liver cirrhosis.

Integration of Different Disciplines in Medicine: A Vertical Integrated Teaching Session for Undergraduate Medical Students

INTRODUCTION

The medical course is very vast and disciplines are covered in different phases. Most of the teaching methods are didactic and conducted by individual disciplines; that's why students fail to see the relevance of different disciplines and do not develop the required skills such as critical thinking, problem solving, and decision making. Solution to this is integrated teaching by various disciplines.

METHODS

A cross-sectional study was conducted among VI semester MBBS students and all the students who attended the class were included, using universal sampling. A descriptive analysis of the feedback was done for the students at the end of an integrated teaching session to assess the perceptions of students towards a new method of integrated teaching. A handout with all the relevant information was shared with the students as the study material. The results were presented in percentages.

RESULTS

Ninety seven percent of the students stated that the objective of the session was achieved. Most of the students (92.7%) believed that they had learned new skills which would be applicable in future practice. Most of the students (42.3%) appreciated the problem solving session followed by all the sessions equally (20.7%). Around 97.3% of the students shared that the handouts produced them with valuable information to support the session, and 92.8% of them gave feedback that they would use it in future as a reference material.

CONCLUSION

The current descriptive analysis shows that students appreciated and enjoyed this new method of teaching learning session with the problem solving section as the most appreciated part of the integrated teaching session. The handout was well appreciated and utilized as a reference material during the session and students were also interested in using the same in future as a reference material.

Eight biomarkers on a novel strip for early diagnosis of acute myocardial infarction

Accurate detection of markers in human serum is important in the early diagnosis of acute myocardial infarction (AMI). This work presents a novel eight biomarker strip, which combines dry chemistry with a fluorescence lateral flow assay. Eight AMI markers were employed simultaneously for sensitive detection, including cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), uric acid (UA), myoglobin (Myo), creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI). The strip offers the advantages of simple fabrication, convenience, time-saving detection and accurate assessment for AMI. Moreover, the strip possesses acceptable applicability for human serum. This proposed strategy establishes a remarkable platform for the construction of a multi-target detection strip that is feasible for accurate detection for real human serum samples.

Prevención en diabetes mellitus y riesgo cardiovascular: enfoque médico y nutricional

Introducción. La epidemia de diabetes mellitus tipo 2 (DM2) incrementa la enfermedad cardiovascular y la morbimortalidad; por tanto, es importante prevenir, tratar integralmente y valorar complicaciones y comorbilidades asociadas.Objetivo. Presentar una revisión sobre prevención de DM2 y riesgo cardiovascular con enfoque médico y nutricional.Materiales y métodos. Se hizo una revisión en las bases de datos Embase, PubMed, Bireme (LILACS, SciELO) y Cochrane Library con términos específicos. La búsqueda se hizo en inglés y español sobre publicaciones entre 2001 y 2016.Resultados. Se encontraron 811 publicaciones y, después de aplicar los criterios de inclusión y exclusión, se seleccionaron 71 documentos clasificados así: 24 artículos de investigación, 14 artículos de revisión, 18 guías clínicas, 8 consensos y 7 de otras categorías (informes, capítulos de libro, normatividad y un libro)Conclusión. La educación es una herramienta fundamental para prevenir y tratar factores de riesgo. Se debe incentivar el trabajo en equipo con el paciente y la familia para reducir el desarrollo de comorbilidades asociadas a DM2.

Impact of glucose and lipid markers on the correlation of calculated and enzymatic measured low-density lipoprotein cholesterol in diabetic patients with coronary artery disease

BACKGROUND AND AIMS

Low-density lipoprotein cholesterol (LDL-C) is widely estimated by Friedewald equation (FE) and Enzymatic test (ET), which are affected by several factors. The aim of this study was to observe the impact of diabetic lipid and glucose patterns on the correlation between FE LDL-C (F-LDL) and ET LDL-C (E-LDL) in patients with coronary artery disease (CAD).

METHODS AND RESULTS

A total of 8155 CAD patients were consecutively enrolled and their lipid profiles were measured. The impacts of triglyceride (TG), glycosylated hemoglobin A1c (HbA1c), and high-density lipoprotein cholesterol (HDL-C) on the correlation of F-LDL and E-LDL were examined. The difference value (DV) between F-LDL and E-LDL was compared using ANOVA test. The CAD patients with DM were elder and had higher body mass index, plasma TG compared with those without DM (P < .05 separately). In the whole population, F-LDL was lower than E-LDL but showed a high correlation with E-LDL (r = .970, P = .000). Moreover, as the TG concentrations increased, the DV increased accordingly but the correlation between F-LDL and E-LDL decreased (P < .01). The similar trend was also found in both DM and non-DM patients comparing with different TG groups. However, in patients with DM, there was no significant difference of DV in different HbA1c groups or HDL-C concentrations (P > .05).

CONCLUSION

Although F-LDL might underestimate the value of LDL-C, the correlation between F-LDL and E-LDL was clinically acceptable (r = .97), suggesting the LDL-C values measured by two methods were similarly reliable in CAD patients with or without DM.

Factors Causing Disagreement between Measured and Calculated Low Density Lipoprotein-Cholesterol (LDL-C) in Clinical Laboratory Services

Background

Since measured low density lipoprotein-cholesterol (LDL-C) has been available in clinical laboratories, there have been concern about the disagreement between measured and calculated LDL-C and the factors causing their disagreement.

Material/Methods

Serum lipid concentrations were collected from 1,339 medical records of patients admitted to hospital between 2013 and 2015. They were grouped by their total cholesterol (TC), triglycerides (TG), and high-density lipoprotein-cholesterol (HDL-C) concentrations and the agreement between measured and calculated LDL-C was statistically analyzed.

Results

A strong relationship was found between measured and calculated LDL-C. Significantly disagreements between measured and calculated LDL-C were found in all groups in 2013 and 2014 when lipids were analyzed by Cobas C501. Disagreements found in groups of low TG and low HDL-C concentrations in 2015 were when lipids were analyzed by Abbott Architect ci8200. In groups of calculated LDL-C <1.81 mmol/L, around 80% had the measured LDL-C >1.81 mmol/L. Among various atherogenic indices, non-HDL-C showed the strongest relationship with LDL-C, while TC to HDL-C ratio showed the strongest agreement with the LDL-C.

Conclusions

The disagreement between measured and calculated LDL-C in a clinical laboratory seemed to depend on the analytical system used, and was probably associated with individual laboratory variations.