Lipids in Health and Disease最新文献

Background: Cardiogenic shock (CS) is a severe cardiac disorder with a high mortality rate. The triglyceride-glucose (TyG) index, a biomarker of insulin resistance, is associated with cardiovascular disease-related mortality. This study aimed to investigate the association between the TyG index and mortality in patients with CS.

Methods: This retrospective cohort study analyzed 727 patients with CS from the Medical Information Mart for Intensive Care IV database. The TyG index was calculated as follows: ln[triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Outcomes included 28-day intensive care unit (ICU) mortality and 28-day in-hospital mortality. Kaplan-Meier survival curve models and Cox proportional hazards regression models were used to evaluate the prognostic significance of the TyG index. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive efficacy of the TyG index for mortality. Subgroup analyses were conducted to determine the association between the TyG index and mortality across different groups.

Results: Non-survivors had a significantly higher TyG index (ICU: 9.30 vs. 9.13, p = 0.008; in-hospital: 9.29 vs. 9.13, p = 0.004). Adjusted Cox models showed that each 1-unit increase in the TyG index increased ICU mortality risk by 24% (hazard ratio [HR] = 1.24, 95% confidence interval [CI]:1.04-1.48; p = 0.015) and in-hospital mortality by 44% (HR = 1.44, 95% CI:1.11-1.88; p = 0.007). The Quartile 4 TyG index ICU mortality was increased by 77% (HR = 1.77, 95% CI:1.09-2.89) compared to that for Quartile 1 and in-hospital mortality was increased by 61% (HR = 1.61, 95% CI:1.08-2.38). The area under the ROC curve (AUROC) showed a modest standalone predictive ability of 0.56, but when combined with clinical variables, the AUROC improved to 0.80 (ICU) and 0.78 (in-hospital). Subgroup analyses identified stronger associations in patients ≥ 60 years, females, non-septic, and those with acute myocardial infarction or heart failure.

Conclusions: The TyG index is significantly associated with short-term mortality in patients with CS and may serve as a useful biomarker for risk stratification.

Trial registration: Not applicable.

Background: Lipid Accumulation Product (LAP) is a biomarker associated with excessive lipid accumulation and various metabolic diseases. Despite the well-established link between oral and systemic health, the association between LAP and oral health remains largely unexplored.

Methods: Data from 7,124 participants aged over 18 years from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2014 were analyzed. Multivariate logistic regression models were applied to evaluate the independent association between LAP and self-reported oral health outcomes, adjusting for potential confounders.

Results: There was a significant correlation between increasing LAP levels and deteriorating oral health status (β = 0.26, 95% CI: 0.20 to 0.32, P < 0.0001). Subgroup analyses revealed that the negative correlation between LAP and self-reported oral health outcomes was more pronounced in younger individuals and those with higher education levels. A non-linear relationship was identified, with oral health deteriorating significantly as LAP increased up to a threshold of 83, after which the relationship became non-significant.

Conclusions: This study demonstrates a robust association between LAP and self-reported oral health outcomes, suggesting that LAP could be a reliable indicator for assessing oral health status. The findings highlight the importance of targeted health interventions for populations with higher LAP indices to prevent oral health deterioration and potential systemic health issues.

Background: Elevated lipoprotein (a) (Lp(a)) is an independent risk factor for lower extremity artery disease (LEAD) with equivocal effect on amputation and mortality. Results regarding aggressive lipid-lowering therapies (LLT) are missing. We examined LEAD patients with Lp(a) measurement and the impact of intensive LLT on amputation and survival.

Methods: Baseline characteristics of 263 LEAD patients with Lp(a) measurement treated in a tertiary hospital from 01/2017 until 01/2022 were recorded. Patients were categorized into three groups according to their Lp(a) values (< 30 mg/dL, 30-90 mg/dL and > 90 mg/dL). Lipid values and LLT were recorded at baseline and during follow-up (median 750 days). Peripheral endovascular revascularizations (EVR), amputations and death during follow-up were analysed.

Results: Of 263 patients, 75% were male, mean age was 67 ± 10 years. Elevated Lp(a) values ≥ 30 mg/dL were found in 32%, 16% had values > 90 mg/dL. Baseline low-density lipoprotein cholesterol (LDL-C) was 89 ± 38 mg/dL, decreasing to 61 ± 30 mg/dL at follow-up, with no difference between Lp(a) groups (63 ± 32 mg/dL vs. 52 ± 23 mg/dL vs. 60 ± 25 mg/dL, p = 0.273). Statin dose was intensified more frequently in those with elevated Lp(a) (16% vs. 35% vs. 33%, p = 0.005), who also received significantly more often ezetimibe (50% vs. 58% vs. 73%, p = 0.028) and proprotein convertase subtilisin/kexin type 9 inhibitors (2% vs. 3% vs. 8%, p = 0.043). No difference was seen regarding EVR (91% vs. 95% vs. 90%, p = 0.729), amputations (4% vs. 7% vs. 0%, p = 0.245) and death (8% vs. 5% vs. 3%, p = 0.436).

Conclusions: Aggressive LLT in high-risk LEAD patients with elevated Lp(a) levels enabled LDL-C target achievement in a majority by combination of established lipid-lowering agents. An increase in EVR, amputation or death could not be observed in patients with high Lp(a) levels.

Background and aims: Recent studies have suggested an interplay between conicity index (C-index)-related diabetes risk and lipid burden. It is plausible that the atherogenic index of plasma (AIP), fatty liver, and HbA1c mediate the association between C-index and diabetes risk, though this has not been fully explored. This study explored whether AIP, fatty liver, and HbA1c mediate the relationship between C-index and diabetes risk, as well as their combined effect.

Methods: Data from 15,453 participants in the NAGALA Cohort were analyzed (median follow-up 5.39 years). Restricted Cubic Spline (RCS) and univariate Cox regression models adjusted for risk factors were used to assess the role of AIP in modifying the C-index-diabetes relationship. Mediation analysis assessed the contributing factors, and predictive models for diabetes were established.

Results: Among normoglycemic individuals, the AIP and C-index remained significantly and positively associated with diabetes risk. Higher AIP levels strengthened the C-index-diabetes association, particularly in the AIP range of 0.11-≤1.21. In the initial model, hazard ratios (HRs) for those in the fourth quartile of the C-index distribution in this group showed a significant HR of 2.22 (1.37-3.59). As fatty liver and HbA1c levels were progressively adjusted, the HRs gradually decreased, but a significant HR of 1.70 (1.05-2.76) was retained in the fully adjusted model. No significant association was observed in the other AIP strata. Furthermore, AIP, fatty liver, and HbA1c mediated the relationship between C-index and diabetes risk, with mediation effects of 9.8%, 25.0%, and 13.4%, respectively. Notably, the combined model incorporating AIP, fatty liver, HbA1c, and the C-index achieved the highest predictive performance (AUC = 0.86), outperforming the C-index alone (AUC = 0.68).

Conclusions: C-index was significantly associated with diabetes risk, modified by AIP, fatty liver, and HbA1c. These findings emphas ize the importance of AIP along with the C-index, particularly in the context of fatty liver and HbA1c, for diabetes risk screening and management.

Introduction: Body composition has been associated with various health outcomes, but its specific relationship with arthritis risk remains unclear. The study aimed to examine the associations between lean body mass (LBM) and fat mass (FM) with arthritis risk in men and women and to identify their threshold values.

Methods: The data were obtained from the CHARLS, a prospective cohort study from 2011 to 2018. Multivariate Cox regression models evaluated the associations between LBM and FM and arthritis risk. Smoothing curves and two-piece linear regression models were applied to identify the inflection points of LBM and FM associated with arthritis risk.

Results: A total of 6,761 participants were included in this study. During a mean follow-up period of 6.66 years, 944 participants (13.96%) developed new-onset arthritis, with an incidence rate of 20.72 per 1,000 person-years. Multivariate Cox regression analysis demonstrated a significant linear association between FM and the risk of new-onset arthritis in men. Individuals in the highest FM quartile (Q4) had the highest risk of developing arthritis (HR = 1.25, 95% CI: 1.03-1.51). Two-piece linear regression models revealed nonlinear relationships between LBM, FM, and arthritis risk. Specifically, in men, LBM was negatively associated with arthritis risk when it was below 43.79 kg (HR = 0.97, 95% CI: 0.95-0.99), but this association was no longer significant above this threshold (HR = 1.01, 95% CI: 0.98-1.03). In women, arthritis risk significantly decreased when LBM exceeded 39.04 kg (HR = 0.92, 95% CI: 0.87-0.96). Additionally, in women, FM exhibited a U-shaped relationship with arthritis risk, with the lowest risk observed at an FM level of 17.16 kg.

Conclusions: Among Chinese adults aged 45 and older, maintaining appropriate levels of LBM and FM may help reduce arthritis risk. Based on the nonlinear findings, it is recommended to maintain LBM below 43.79 kg for men, above 39.04 kg for women, and to keep FM at approximately 17.16 kg for women, which may be appropriate.

Background: This study investigates the associations between modified triglyceride-glucose (TyG) indices and the triglyceride-to-high-density lipoprotein (TG/HDL) ratio, which are recognized as simple surrogate indicators of insulin resistance, with all-cause and cause-specific mortality.

Methods: A cohort of 410,515 participants from the UK Biobank was analyzed. Cox proportional hazard models and restricted cubic spline regression analyses were employed to examine the relationships between the TyG index, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TG/HDL ratio, and all-cause and cause-specific mortality. Structural equation modeling was employed to elucidate the associations between the TyG index, TG/HDL ratio, inflammation, metabolism, and mortality.

Results: The TyG index, TyG-WC, and TG/HDL ratio were associated with an increased risk of all-cause mortality by 3.7% (HR 1.037 [1.016, 1.059]), 0.1% (HR 1.001 [1.024, 1.031]), and 1.5% (HR 1.015 [1.006, 1.025]), respectively. Restricted cubic spline regression models revealed nonlinear trends in the TyG index, TyG-BMI, TyG-WC, and TG/HDL ratio in relation to both all-cause and cause-specific mortality (P for nonlinearity < 0.05). TyG index and TG/HDL ratio exhibited a J-shaped relationship with all-cause mortality as well as mortality from cancer, cardiovascular diseases, and respiratory diseases. Similarly, TyG-BMI demonstrated an L-shaped association with all-cause mortality and mortality due to cancer, cardiovascular diseases, and respiratory diseases. Additionally, TyG-WC was associated with a progressively increasing mortality risk once it exceeded a certain threshold. Structural equation modeling demonstrated that the TyG index and TG/HDL ratio influenced mortality through inflammation and lifestyle factors.

Conclusions: In conclusion, TyG, TyG-BMI, TyG-WC, and TG/HDL ratio are significantly associated with all-cause and cause-specific mortality in the general population.These associations appear to be linked to inflammation and lifestyle.

Background: Identifying micro- and macrovascular damage through microalbuminuria and arterial stiffness is essential for preventing renal and cardiovascular complications in patients with type 2 diabetes mellitus (T2D). The primary goal of this research is to investigate the association of the phase angle (PA), triglyceride‒glucose (TyG) index, and homeostasis model assessment for insulin resistance (HOMA-IR) with microalbuminuria and arterial stiffness in patients with T2D.

Methods: In this retrospective cross-sectional study, 938 participants with T2D were enrolled. The PA was calculated from bioelectrical impedance analysis. Logistic regression was used to analyze the association of PA, the TyG index and HOMA-IR with microalbuminuria (urinary albumin-to-creatinine ratio [UACR] > 30 mg/g using overnight urine) and increased arterial stiffness (brachial-ankle pulse wave velocity [baPWV] > 1400 cm/s), respectively. Potential nonlinear relationships between PA, the TyG index, and the prevalence of microalbuminuria and increased arterial stiffness were assessed via restricted cubic splines (RCS). Subgroup analysis evaluated the robustness of the association.

Results: PA was inversely correlated with the UACR (r = -0.29, P < 0.001) and baPWV (r = -0.37, P < 0.001). Confounder-adjusted analyses revealed that the highest tertile of PA was significantly associated with lower prevalences of both microalbuminuria and increased arterial stiffness than the lowest tertile, with ORs of 0.305 and 0.467 and P trends < 0.001 and 0.017, respectively. Conversely, the highest TyG tertile was associated with increased prevalences of microalbuminuria and increased arterial stiffness, with ORs of 1.727 and 1.625, respectively, but the P trends were not statistically significant. There were no significant associations between HOMA-IR and microalbuminuria and increased arterial stiffness. RCS analysis further confirmed a significant linear relationship between PA and both vascular complications. Subgroup analyses consistently demonstrated the association between PA and microalbuminuria across all subgroups stratified by sex, age, BMI, HbA1c, and duration of diabetes (all P < 0.01).

Conclusions: Compared with the TyG index and HOMA-IR, PA is independently and more strongly associated with microalbuminuria and increased arterial stiffness in patients with T2D.

Background: Infertility is a multifaceted condition influenced by metabolic and biochemical factors. Uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) may individually affect reproductive health. The UA-to-HDL-C ratio (UHR), an emerging indicator of chronic inflammation and metabolic status, may be associated with infertility because of its connections to metabolic disorders, disrupted reproductive processes, and other related factors. Nevertheless, evidence of the relationship between the UHR and infertility remains limited and controversial. Therefore, potential associations were analyzed in this study.

Methods: In this cross-sectional study, data from the 2013-2020 National Health and Nutrition Examination Survey (NHANES) were utilized, a nationally representative survey assessing the health and nutritional status of the U.S.

Population: Female participants aged 18-45 years (n = 6502) whose infertility status was determined through self-reported responses to reproductive health questions were included. The primary outcome was infertility, defined on the basis of responses indicating difficulty in conceiving over the past year. Between-group differences were analyzed via Student's t test or the Mann‒Whitney U test for continuous variables or the chi-square test for categorical data. The independent association between infertility status and the log UHR was assessed by log computes logarithms by default natural logarithms. Subgroup analyses were performed to assess the strength of the results.

Results: The mean log UHR of the women in the infertility group was significantly greater than that of the women in the noninfertility group (5.34 vs. 5.22, P < 0.001). Adjusted analyses revealed that an increase in the log UHR was associated with greater odds of infertility (odds ratio (OR) = 1.830, 95% confidence interval (CI) 1.396-2.401). Subgroup analysis revealed that women younger than 35 years with an elevated log UHR faced an even greater risk of infertility (OR = 2.716, 95% CI 1.784-4.162; P < 0.001).

Conclusions: An elevated UHR is associated with a higher risk of infertility, and this knowledge may be beneficial for developing a nonpharmacological intervention for improving fertility outcomes. Further research is needed to clarify the direct impact of the UHR on female infertility, which could inform future strategies for prevention and treatment.

Background: Evolocumab has shown significant reductions in low-density lipoprotein cholesterol (LDL-C) levels and incident cardiovascular events among acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Nonetheless, the potential modification of evolocumab's effectiveness by baseline inflammatory risk remains unclear. We aimed to assess evolocumab's effectiveness based on baseline neutrophil-to-lymphocyte ratio (NLR) and evaluate residual inflammatory and cholesterol-related risks across varying on-treatment NLR and LDL-C levels.

Methods: This multicentric, retrospective analysis enrolled consecutive patients with ACS undergoing PCI and exhibiting elevated LDL-C at the First Affiliated Hospital of Zhengzhou University and Zhongda Hospital Southeast University between March 2019 and August 2021. Patients were categorized into evolocumab and standard-of-care treatment groups based on evolocumab administration. Hazard ratios for the primary composite outcome-including myocardial infarction, ischemic stroke, cardiac death, unplanned coronary revascularization, and hospitalization due to unstable angina-comparing baseline NLR quartiles were computed using multivariable Cox regression. We assessed evolocumab's impact on the primary outcome across median-based NLR dichotomization and evaluated the outcome across 1-month NLR and LDL-C levels.

Results: The median baseline NLR was 2.99 (IQR: 2.14-4.69), remaining stable following evolocumab therapy. Each NLR quartile increase heightened the risk of primary outcome by 29% (95% CI, 17-42%; P < 0.01). The relative risk reductions with evolocumab were consistent across NLR categories (P-interaction > 0.05), but absolute risk reductions were higher in high-NLR patients (2.9% vs. 6.2%). Residual inflammatory and cholesterol risks, indicated by on-treatment NLR and LDL-C, independently correlated with the primary outcome (P < 0.001).

Conclusions: Higher baseline NLR is associated with increased cardiovascular risk in ACS/PCI patients. Relative risk reductions with evolocumab were consistent across NLR categories, while absolute risk reductions were more significant in high-NLR patients. Minimized risk is observed in patients with the lowest on-treatment NLR and LDL-C levels.

Background: Visceral adipose tissue (VAT) is strongly associated with metabolic diseases. Both high-intensity interval training (HIT) and moderate-intensity training (MIT) reduce VAT effectively; however, HIT might mediate greater VAT loss in females. The estrogen receptor α (ERα) pathway may play a key role. The aim of the present study was to confirm the role of adipose/hypothalamic ERα in HIT/MIT-mediated VAT loss, as well as the associated hypothalamic electrophysiology and body catabolism changes in pre- and post-menopausal animal models.

Methods: Ovariectomy (OVX) or sham surgeries were conducted to establish pre/postmenopausal female rat models. After distance-matched long-term HIT and MIT interventions, ERα expression in hypothalamic/VAT, as well as food intake, spontaneous physical activity (SPA), VAT mass and morphology, local field potential (LFPs) in paraventricular nuclei (PVN) and excessive post-exercise oxygen consumption (EPOC), were observed. A target chemical block during the post-exercise recovery period was executed to further verify the role of the hypothalamic ERα pathway.

Results: HIT enhanced the expression of ERα in the hypothalamus rather than VAT in the pre-, but not the postmenopausal group, which was accompanied by elevated LFP power density in α and β bands, enhanced EPOC and larger VAT loss than MIT. Chemical blockade of ERα suppressed EPOC and VAT catabolism mediated by HIT.

Conclusion: During the post-exercise recovery period, the hypothalamic ERα pathway involved in HIT induced EPOC elevation and VAT reduction in premenopausal female rats.