Lipids in Health and Disease最新文献

Background: Insulin resistance (IR)-related indices and moderate-to-vigorous physical activity (MVPA) were independent predictors for cardiometabolic disease (CMD) and multimorbidity (CMM), but their combined effect is unclear. We aimed to investigate their joint effect on incident CMD and CMM.

Methods: This study was conducted from the UK Biobank accelerometer sub-study. The IR-related indices included triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), and metabolic score for IR (Mets-IR). Participants were divided according to the median values of IR-related indices and MVPA time. Cox regression was used to assess the associations between different groups and outcomes, with interaction effects estimated.

Results: 74,367 participants were included. Compared to participants with low TyG index and high MVPA, the adjusted HR (aHR) for CMD was 1.71 (95% CI: 1.55-1.88) for high TyG and low MVPA. The corresponding aHR were 1.82 (95%CI: 1.66-1.99) for TyG-BMI, 1.96 (95%CI: 1.77-2.17) for TyG-WC, 1.88 (95%CI: 1.71-2.07) for TyG-WHtR, and 1.90 (95%CI: 1.73-2.09) for Mets-IR, with significant additive interactions. Similar associations were observed in incident CMM.

Conclusions: IR-related indices and MVPA had synergistic effects in incident CMD and CMM, highlighting the importance of identification and prevention for CMD and CMM.

Background: National utilization trends of lipid-lowering therapy (LLT) have been studied for a subgroup of patients insured in Switzerland between 2013 and 2019. In 2019, the European Society of Cardiology (ESC) released new guidelines on the management of dyslipidaemia providing novel cholesterol targets. Additionally, new lipid-lowering compounds and combination drugs have been introduced. We aimed to evaluate trends in utilization and costs of LLT in Switzerland from 2015 to 2023, given the new ESC guidelines and drugs introduced.

Methods: We did a nationwide analysis of the Swiss tariff pool, a collection of administrative claims data covering all outpatient services for which an invoice has been submitted to compulsory health insurance across the country. We extrapolated defined daily doses (DDD) utilized, standardized DDD per 1,000 inhabitants, and cost of LLT.

Results: The rate of LLT utilization increased from 95.7 (95% CI: 95.6; 95.8) DDD per 1,000 population in 2015 to 113.1 (95% CI: 113.0; 113.2) in 2023. The overall cost increased from 217.96 million Swiss francs (2023 Euro: 250.1 million) to 274.91 million Swiss francs (2023 Euro: 297.7 million), respectively. The use of statins shifted from single compound drugs towards combination drugs with ezetimibe. PCSK9 inhibitors were increasingly used. Although their utilization was low, they were the main driver of the increasing costs. Their revenue market share increased from 0.4% in 2016 to 22.1% in 2023.

Conclusion: We showed increasing LLT utilization, primarily driven by new combinations of established drugs. PCSK9 inhibitors are still rarely utilized, however, they have substantially influenced the observed increase in cost.

Objective: To evaluate the predictive value of the atherogenic index of plasma (AIP) for coronary artery calcification (CAC), carotid atherosclerosis (CA), and their coexistence, and to develop a multidimensional risk prediction model to optimize early cardiovascular disease (CVD) screening.

Methods: A total of 32,992 individuals who underwent carotid intima-media thickness (CIMT) measurement and coronary CT calcium scoring at Sichuan Provincial People's Hospital between January and December 2023 were enrolled. Participants were classified into healthy, CAC, CA, and combined groups. AIP quartiles were derived from the cohort distribution. Nonparametric tests, Spearman correlation, and multivariable logistic regression with sequential covariate adjustments (Models 1-4) were applied. Predictive performance was assessed by sROC curves, AUC, and validated using bootstrap resampling and ten-fold cross-validation.

Results: AIP levels differed significantly across groups, being lowest in healthy individuals (0.01) and highest in the CAC and combined groups (0.09 and 0.06, respectively). Spearman correlations between AIP and atherosclerotic burden were strongest in healthy participants (ρ = 0.89) and progressively attenuated in CAC (ρ = 0.64) and combined groups (ρ = 0.43). Higher AIP quartiles were associated with increased risk of CA, CAC, and combined lesions, with Model 4 showing the highest predictive performance (AUC = 0.91 for combined lesions). Bootstrap and cross-validation confirmed model stability.

Conclusion: AIP may help identify early subclinical coronary and carotid atherosclerosis, and sequential adjustment with metabolic indicators improves predictive performance. External validation is warranted.

Background: Dysbetalipoproteinaemia (dysβ) is a genetic lipid disorder characterised by accumulated remnant lipoproteins, leading to mixed hyperlipidaemia and increased cardiovascular risk. It is primarily associated with apolipoprotein E (apoE) ε2/ε2 homozygosity, although variants, such as arginine 145 cysteine (R145C), may also contribute. In sub-Saharan Africa, including Ghana, dysβ remains underdiagnosed due to limited awareness and access to diagnostic testing. This study assessed the prevalence of the dysβ phenotype in adult Ghanaians and its association with the apo ε2/ε2 genotype and R145C variant.

Methods: A cross-sectional study was conducted among 1,032 Ghanaian adults, comprising healthy controls (n = 702), diabetic patients (n = 268), and patients with ischaemic heart disease (IHD) (n = 62). Anthropometry, blood pressure, and lipid profiles were assessed. LDL particle size and remnant lipoproteins were visualised using polyacrylamide gradient gel electrophoresis (PGGE), while polymerase chain reaction and restriction fragment length polymorphism were used for apoE genotyping. Group comparisons were conducted using chi-square, Kruskal-Wallis and Mann-Whitney U tests.

Results: The prevalence of dysβ was 1.6%; 4.8% in IHD patients, 1.5% in diabetics and 1.3% in healthy controls (p = 0.80). The ε2/ε2 genotype was identified in 2.6% of participants, with 52% exhibiting the dysβ phenotype. The R145C variant was found in 4.0% of the participants: 6.0% in IHD patients, 5.9% in diabetics, and 2.5% in healthy controls, but none of these carriers developed dysβ. Among healthy controls with ε2/ε2 who had the dysβ phenotype, BMI, WHR, total cholesterol [4.10, IQR (3.27-4.75), and triglycerides [1.08, IQR (0.98-1.54), and lower HDL-C, were statistically comparable to those who did not have the dysβ phenotype.

Conclusion: This is the first report of dysβ prevalence in Ghana. Although the phenotype was generally mild, the findings highlight the need for further research into lipid disorders and the role of genetic screening in cardiovascular risk assessment in African nations.

Background: Stroke continues to be a predominant contributor to morbidity and mortality, with insulin resistance (IR) recognized as a significant risk factor. The predictive utility of cumulative IR-related indices for assessing stroke risk across varying glucose regulation statuses remains ambiguous. The present study investigated the associations between six cumulative IR-related indices-triglyceride-glucose (TyG) index, triglyceride-glucose-body mass index (TyG-BMI), Chinese visceral adiposity index (CVAI), metabolic score for insulin resistance (METS-IR), atherogenic index of plasma (AIP), and estimated glucose disposal rate (eGDR)-and stroke risk in individuals with abnormal glucose regulation (AGR) compared to those with normal glucose regulation (NGR).

Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS), comprising 5,129 individuals aged over 45 years, were analyzed. Six insulin resistance (IR) surrogate indices and their cumulative values were calculated, and their associations with incident stroke risk were examined via Cox proportional hazards models and RCS modeling. The predictive accuracy of these indices was evaluated with receiver-operating characteristic (ROC) curves, NRI, IDI, and relative importance.

Results: In the overall cohort, elevated AIP, CVAI, METS-IR, TyG, and TyG-BMI were correlated with an increased risk of stroke, whereas higher eGDR values were associated with a decreased risk of stroke. The statistically significant associations of some indices with stroke risk were lost within both the AGR subgroup and the NGR subgroup. Compared with the other indices, the cumulative eGDR showed the strongest and most consistent association with stroke risk in all the subgroups, with the highest predictive power (overall AUC = 0.663; AGR subgroup AUC = 0.647; and NGR subgroup AUC = 0.673). Adding the cumulative eGDR to the conventional risk factor model enhanced the accuracy of stroke prediction.

Conclusions: Cumulative IR-related indices, particularly the eGDR, are strong predictors of stroke risk in individuals with both AGR and NGR. Owing to the superior predictive performance of the cumulative eGDR, its use may improve stroke risk assessment, enabling more targeted interventions for stroke prevention among middle-aged and elderly individuals.

Background: Lipoprotein(a) [Lp(a)] is a known independent risk factor for cardiovascular disease, yet awareness and management remain limited. The psychosocial implications of elevated Lp(a)-levels have been poorly characterized.

Objectives: To compare cardiovascular outcomes and cardiovascular risk factor (CVRF) modification in individuals with normal vs. elevated Lp(a) levels, and to assess the impact of individualized prevention recommendations. For the first time, the individual psychological stress caused by Lp(a) is being surveyed.

Methods: The ELITE study is a prospective, interventional cohort study conducted in north-western Germany. Participants were regularly assessed for CVRFs, including Lp(a), hypertension, dyslipidemia, diabetes mellitus, weight, nicotine - as well as lipoprotein (a), physical activity, dietary habits, depression and stress. They received written, personalized prevention recommendations. Follow-up averaged 4.4 years. Two groups were analyzed: Group 1 (Gr1, n=3,241) with normal Lp(a), and Group 2 (Gr2, n=841) with elevated Lp(a ≥75 nmol/l).

Results: Gr2 (mean Lp(a) 154.8 nmol/l) and Gr1 (mean Lp(a) 16.4 nmol/l) were comparable in age (~53 years) and sex distribution (~49% female). Most participants with elevated Lp(a) were previously unaware of their levels; 30% were referred to specialists, and ~40% reported concern or anxiety. Combined cardiovascular endpoints (CHD, stroke, heart failure, PAD, carotid stenosis, AF) occurred significantly more often in Gr2 (p<0.001), despite similar CVRF profiles, except for higher baseline LDL-C in Gr2 (p<0.001). Hypertension (61%) and physical inactivity (57%) were the most prevalent CVRFs. Personalized prevention measures led to significant improvements in blood pressure, LDL-C, smoking, physical activity, and weight in both groups. Lipid-lowering therapy improved markedly in Gr2 (12% to 23%).

Conclusions: Elevated Lp(a) is associated with a significantly higher rate of cardiovascular events, independent of traditional CVRFs. This confirms a causal role of Lp(a) in CV morbidity. Personalized written prevention recommendations improved CVRFs across both groups, though further optimization is needed. Notably, elevated Lp(a) also imposes a psychosocial burden, underlining the need for enhanced education, counseling, and clinical pathways.

Background: Self-harm is a significant public health concern, with increasing prevalence globally. Omega-3 fatty acids (FAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are known for their health benefits, including potential mental health improvements. This study explores the association between omega-3 FAs and self-harm behaviors using data from the UK Biobank (UKBB).

Objectives: To investigate the relationship between plasma levels of omega-3 FAs and various measures of self-harm, including passive suicidal ideation and deliberate self-harm, within a large cohort study.

Methods: This observational study analyzed data from a random subset of 258,012 participants with plasma omega-3 FA levels, covariate data, and self-harm records. Omega-3 levels were measured using Nuclear Magnetic Resonance (NMR) and are expressed as a percent of total FAs. Self-harm outcomes were assessed through self-reported questionnaires and medical records. Covariates included demographic, health, and lifestyle factors. Statistical analyses involved logistic regression and Cox proportional hazards models, adjusting for relevant covariates. Adjusted odds ratios (aORs) are presented and 95% confidence intervals.

Results: Higher levels of DHA, non-DHA (ALA+EPA+DPA) and total omega-3 were generally inversely associated with passive suicidal ideation, history of self-harm, and future self-harm, with both DHA and non-DHA showing some of the strongest associations. Participants in the highest quintile of non-DHA had a 14% lower risk of passive suicidal ideation in the last year (aOR = 0.86; 95% CI 0.75, 0.99), and the highest DHA levels were associated with a 33% lower odds of history of self-harm (aOR = 0.67; 95% CI 0.55, 0.83). These associations were generally stronger for medical record-based outcomes than for self-reported data.

Conclusions: This study provides evidence that higher omega-3 FA levels, both DHA and non-DHA, are associated with reduced risks of self-harm and suicidal ideation. These findings suggest that omega-3 FAs may play a protective role in mental health, highlighting the potential of dietary interventions to mitigate self-harm behaviors.

Background: Currently total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are used in clinical practice to estimate future cardiovascular risk. We assessed whether other lipoprotein subclasses also contribute to cause-specific and all-cause mortality in the general population.

Methods: Two independent cohorts of the Study of Health in Pomerania (SHIP-START and SHIP-TREND) were used. Participants were selected from population registration offices. The primary outcomes were all-cause, cardiovascular and cancer mortality. TC, total triglycerides (TG), phospholipids as well as the fractional concentrations of cholesterol, TG, phospholipids, and apolipoproteins of all lipoprotein subclasses were measured using nuclear magnetic resonance spectroscopy. Cox proportional hazard regression models were applied to assess the association between lipoprotein subclasses and mortality. Additionally, cause-specific hazards for cardiovascular disease (CVD) and cancer mortality were modelled considering competing events.

Results: Data from 3,579 SHIP-START and 4,267 SHIP-TREND individuals were included. During follow-up, 946 (26.4%) SHIP-START and 387 (9.1%) SHIP-TREND participants died. In both cohorts, total LDL-TG and LDL1-TG to LDL6-TG but not total TG were positively or U-shaped related with all-cause mortality. In SHIP-START, total TG, VLDL-TG, IDL-TG and LDL-TG (including subclasses) were associated with CVD mortality. HDL4-C as well as small and dense LDL-C (e.g. LDL6-C) represented risk factors for mortality with mutually enhancing effects.

Conclusions: The findings suggest that lipoprotein subclasses, especially LDL-TGs or HDL4-C/LDL6-C, provide information beyond the established TC and LDL-C levels and therefore might be of use for an early identification of subjects at risk.

Background: Delirium is a common neuropsychiatric complication following major gastrointestinal surgery and is associated with poor postoperative outcomes. Patients undergoing gastric surgery often experience significant metabolic stress and insulin resistance, which may contribute to delirium. The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance, but its predictive value for postoperative delirium in gastric surgery patients remains unclear.

Methods: This retrospective study used data from the MIMIC-IV database and included 819 ICU patients after gastric surgery. Exposure was the triglyceride-glucose (TyG) index from first available labs; outcome was ICU delirium assessed by CAM-ICU. Associations were examined with multivariable logistic regression, with standard covariate adjustment.

Results: Increased ICU delirium was independently linked to a higher TyG index (OR = 1.25, 95% CI: 1.01-1.56). RCS revealed a U-shaped relationship. The association remained stable after PSM and across multiple subgroups. SHAP analysis confirmed TyG as a meaningful predictor.

Conclusion: A greater TyG index was linked in this retrospective analysis to a higher incidence of postoperative delirium in individuals after gastric surgery. These findings support preoperative risk stratification and targeted monitoring to enhance peri-operative safety and recovery in gastric surgery patients, and prospective studies are warranted to validate its clinical utility.