Clinical Strategies for Managing Dyslipidemias
James M. Rippe in Lifestyle Medicine, 2019
Dyslipidemia in the form of abnormalities in total cholesterol, lipoprotein (LDL), triglycerides (TG), and/or a reduced level of high-density lipoprotein (HDL) is a significant risk factor for coronary heart disease (CHD). The newer pharmacologic agents to reduce cholesterol include ezetimibe and PCSK9 inhibitors. The role of ezetimibe influencing LDL-C and CHD risk was highlighted by the IMPROVE-IT trial. Low HDL-C also is associated with development and progression of atherosclerosis and is generally considered a secondary target for therapeutic intervention. Triglyceride (TG) levels in the blood are elevated for about an hour following a meal, primarily as part of TG-rich chylomicrons, and in the fasting state they are primarily carried by Very Low Density Lipoprotein. Health consequences associated with excess body weight include dyslipidemia, all components of the metabolic syndrome, and thereby an increased risk of type 2 diabetes and CHD.
Magnesium and dyslipidemia
Kupetsky A. Erine in Magnesium, 2019
A cross-sectional study reported that hypomagnesemia was associated with the presence of metabolic abnormalities, supporting the possible role of magnesium in the pathways leading to the development of dyslipidemia. According to the National Health and Nutrition Examination Survey 1999–2010, the prevalence of dyslipidemia was 49.7%, 44.2%, and 28.6% among US adults with obesity, overweight, and normal weight, respectively. This pattern of dyslipidemia is consistent worldwide. Magnesium, the most abundant intracellular divalent cation and the second-most abundant intracellular cation, is an essential co-factor in the enzymatic process of high-energy phosphate production, the synthesis of nucleic acids and proteins, cytoskeletal function, cell cycle progression, the maintenance of membrane integrity and stability, ion homeostasis, and glucose-related metabolic pathways. In female rat models with dyslipidemia associated with the use of oral contraceptives, rats who received a high magnesium intake had higher plasma high-density lipoprotein-c levels, suggesting that dyslipidemia associated with oral contraceptive use may be prevented by supplementary dietary magnesium intake.
Identification and Management of Children with Dyslipidemia
James M. Rippe in Lifestyle Medicine, 2019
This chapter reviews the definition of dyslipidemia in childhood, discusses how to screen for dyslipidemia, presents treatment recommendations regarding diet and lifestyle, and offers guidance for starting medication when necessary. It also presents clinical cases to highlight the management of different dyslipidemias. The arterial fatty streak is the first lesion in the progression of atherosclerosis visible to the naked eye. This can be seen in children and adolescents with dyslipidemia. Nearly half of all overweight and obese children have at least one abnormal lipid value. Children with dyslipidemia are at risk of developing atherosclerotic cardiovascular disease. In 2011, the integrated screening guidelines from the National Heart, Lung, and Blood Institute expert panel were released. In them, the panel recommended that all children be screened for dyslipidemia at least once between the ages of 9 and 11 years and again between 17 and 21 years of age.
Saroglitazar for the treatment of dyslipidemia in diabetic patients
Published in Expert Opinion on Pharmacotherapy, 2015
Introduction: Diabetes and dyslipidemia are commonly associated modifiable risk factors for cardiovascular diseases. Majority of patients with diabetes also suffer from dyslipidemia (diabetic dyslipidemia). Diabetic dyslipidemia is more atherogenic as it is commonly associated with high triglyceride (TG) levels, high proportion of small dense low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol (HDL-C) level (atherogenic dyslipidemia). Currently used pharmacotherapies for the management of diabetes and dyslipidemia like thiazolidinediones (PPAR-γ agonist; for insulin resistance) and fibrates (PPAR-α agonist; for hypertriglyceridemia) have many limitations and side effects. Saroglitazar, a dual PPAR-α/γ agonists, is an emerging therapeutic option with its dual benefit on glycemic and lipid parameters. Areas covered: This paper reviews the clinical development of saroglitazar for the management of diabetic dyslipidemia. The efficacy and safety profile of saroglitazar is reviewed in context to currently available therapy like pioglitazone for diabetes and fibrates for hypertriglyceridemia. In addition, this paper also reviews the association between diabetes and dyslipidemia and the role of TG in reducing cardiovascular events. Expert opinion: Saroglitazar, a dual PPAR-α/γ agonist, is a potential therapeutic option for the management of diabetic dyslipidemia. It has dual benefit of significant improvement in glycemic parameters (glycated hemoglobin and fasting blood glucose) and significant improvement in dyslipidemia (TGs, apolipoprotein B, non-HDL-C). The results of Phase III clinical trials indicate that saroglitazar is devoid of conventional side effects of fibrates and pioglitazone. Future clinical trials of saroglitazar will further establish its place in the management of diabetes, dyslipidemia and associated cardiovascular risk.
Nomogram construction to predict dyslipidemia based on a logistic regression analysis
Published in Journal of Applied Statistics, 2020
Ju-Hyun Seo, Hyun-Ji Kim, Jea-Young Lee
ABSTRACT Dyslipidemia is a chronic disease requiring continuous management and is a well-known risk factor for cardiovascular diseases as well as hypertension and diabetes. However, no studies have so far visualized and predicted the probability of dyslipidemia. Hence, this study proposes a nomogram based on a logistic regression model that can visualize its risk factors and predict the probability of developing dyslipidemia. Twelve risk factors for dyslipidemia are identified through a chi-squared test. We then conduct a logistic regression analysis with two interaction variables to obtain a model and build a nomogram for dyslipidemia. Finally, we verify the constructed nomogram using a receiver operation characteristic curve and calibration plot.
The combined effect of serum cystatin C and dyslipidemia on hypertension in a large health check-up population in China
Published in Clinical and Experimental Hypertension, 2019
Jun Ma, Zewei Wu, Xiaojuan Zha, Xinying Zhu, Wenbo Li, Mingfei Jiang, Shuyi Wang, Shouzhi Wu, Yufeng Wen
ABSTRACT OBJECTIVE: Some studies have reported that both serum cystatin C (Cys C) and dyslipidemia are independently associated with hypertension. However, the combined effect of the two factors is still unknown. The present study was aimed at investigating the effect of Cys C combined with dyslipidemia on hypertension in a large health check-up population in China. METHODS: A total of 203 233 health check-up subjects from January 2011 to July 2016 were recruited into this cross-sectional study. A multivariate logistic regression model was used to evaluate the combined effect of Cys C and dyslipidemia on hypertension. RESULTS: In univariate analysis, Cys C, high-density lipoprotein cholesterol, low-density lipoprotein, total cholesterol, and triglycerides were independently correlated with hypertension (p