Lipids – ABC CARDIOL

IJCS

Original Article

Analysis of the Lipid Profile and Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients from an Academic Health Institution in Belo Horizonte

Sarah Mattos Moraes et al. Matheus Evangelista da Costa Flávia Carvalho Leão Reis Kleisson Antônio Pontes Maia

Abstract

Background:

There is a lack of epidemiological data regarding the cardiovascular risk profile of patients with chronic kidney disease (CKD) undergoing hemodialysis in the Brazilian state of Minas Gerais.

Objective:

To analyze the lipid profile and assess the prevalence of traditional cardiovascular risk factors among patients with CKD on hemodialysis treated at an academic healthcare institution in Belo Horizonte, Minas Gerais, Brazil.

Methods:

This was a cross-sectional, observational, and non-interventional study. The researchers obtained clinical, laboratory, and demographic data from medical records and conducted structured individual interviews with all participants. The chi-square test of independence, Fisher’s exact test, and the Wilcoxon rank-sum test were applied. A significance level of 0.05 was adopted to establish the statistical validity of comparisons.

Results:

A total of 66 patients were included, representing 91.6% of all individuals undergoing hemodialysis at the study center. The mean age was 56 years. Among participants, 59% were male, and 89% self-identified as mixed race. A high prevalence of traditional cardiovascular risk factors was observed, including hypertension (95%), physical inactivity (69%), dyslipidemia (55%), diabetes mellitus (27%), current smoker (19%), and obesity (15%). The lipid profile analysis showed a median total cholesterol level of 170.9 mg/dL (interquartile range: 142.05 to 195.78 mg/dL) and Low-Density Lipoprotein (LDL-cholesterol) of 98.55 mg/dL (interquartile range: 77.80 to 121.98 mg/dL).

Conclusion:

This study demonstrated a high burden of cardiovascular risk factors among hemodialysis patients, with systemic arterial hypertension, dyslipidemia, physical inactivity, and diabetes mellitus being the most prevalent conditions. Furthermore, the lipid profile findings suggest suboptimal control of this lipid fraction in the studied population.

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IJCS

Original Article

Critical Analysis of the Clinical and Lipidic Profile of Patients with Acute Coronary Syndrome in a Public Hospital in São Paulo

Giovanna Ristori Costa et al. Luís Fernando Ferreira Cavalcante Renato Jorge Alves

Abstract

Background:

Myocardial infarction (MI) is highly influenced by risk factors such as dyslipidemia. Achieving low-density lipoprotein cholesterol (LDL-C) goals is key to reducing the residual cardiovascular risk. However, the proportion of patients with MI who accomplish this goal is unknown.

Objective:

Assess risk factors, lipid profile evolution from admission to the first outpatient consultation, and the therapy administered.

Methods:

This is a descriptive study of patient charts from a public hospital in São Paulo from June 2021 to March 2022. The statistical analyses employed were the Chi-square test and the paired t-test, with significance defined as p-values < 0.05.

Results:

ST-elevation MI (STEMI) occurred in 61% of the patients. Among the patients with previous MI, 50% did not use statins. There was a correlation between STEMI and no statin use (p < 0.05). At hospital discharge, 12%, 17%, and 13% lacked prescriptions for aspirin, clopidogrel, and statins, respectively. At the first outpatient consultation, only 8% of patients with available data reached the absolute LDL-C goal of <50 mg/dL. Only 9% of patients had their cholesterol levels assessed at admission and at the first outpatient consultation, while 26.7% of those achieved at least a 50% LDL-C reduction. The mean LDL-C reduction was 25% (p < 0.05).

Conclusion:

Considering the severity of the assessed patients, the cardiovascular risk stratification was ineffective, the pharmacologic therapy was not optimized, and the achievement of the LDL-C goals according to guidelines was unsatisfactory in this population.

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IJCS

Original Article

Agreement Between a Portable Cholesterol Device and Laboratory-Based Testing in Older Adults

Odilon Abrahin et al. Naicha Stefanie Félix Souza Rejane P. Abrahin Alex Harley Crisp

Abstract

Background:

It is crucial to monitor blood lipid levels accurately in older adults to assess cardiovascular risk. Although several portable strip-based devices are commercially available, their accuracy has not been well established.

Objective:

To evaluate the agreement of the Mission Cholesterol device and standard laboratory method results, using samples from older adults.

Methods:

Forty-nine patients (42 females) with an average age of 70 ± 8 years were included. The participants were instructed to fast for 12 hours before undergoing venous and capillary blood sampling for lipid analysis (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and triglyceride [TG] levels). The agreement between the Mission Cholesterol device and laboratory test results was assessed using the concordance correlation coefficient (CCC) and Bland–Altman plots. The accuracy levels were assessed based on the percentage bias recommended by the National Cholesterol Education Program (NCEP).

Results:

The TC measurement had a better accuracy level (bias = 10.91%; CCC = 0.89) than other lipid measurements. However, none of them met the NCEP’s acceptable standards for bias and concordance (CCC ≥ 0.90). Furthermore, the device demonstrated modest overall agreement in classifying lipid risk according to clinical reference values (agreement rates: TC, 67.3%; HDL-C, 65.3%; LDL-C, 49.0%; and TG, 61.2%).

Conclusion:

The Mission Cholesterol device exhibited insufficient agreement levels for effective lipid profile monitoring and screening in older adults.

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IJCS

Original Article

Association Between Lipid Profile and Clinical Manifestations in Sickle Cell Anemia: A Systematic Review

Marina Tejo Dantas et al. Andressa Lopes Ana Marice Teixeira Ladeia

Abstract

Introduction

Sickle cell anemia (SCA) is a genetic disease associated with frequent episodes of acute illness. Changes in the lipid profile and a chronic inflammatory process make up the molecular aspects observed in this disease. Associations between these mechanisms and clinical manifestations could thus define severity profiles and therapeutic strategies.

Objectives

To verify whether there is an association between lipid profile and clinical manifestations in patients with SCA and if there is a correlation between lipid profile and laboratory markers in this disease.

Methodology

According to the PRISMA guidelines, a systematic review of the literature was conducted by searching the MEDLINE/PubMed, LILACS, SciELO, Scopus, and Cochrane databases. Articles were screened by reading the titles and abstracts, reaching those selected for full-text reading. The included studies were published between 2010 and 2020, were fully available in the databases, and addressed the proposed theme. The risk of individual bias was assessed by using the Joanna Briggs Institute checklist and the Newcastle-Ottawa scale.

Results

Out of the 144 identified articles, 15 were selected for analysis, resulting in a sample size of 2,230 individuals. HDL-C, LDL-C, total cholesterol , and triglycerides were the main variables analyzed in the lipid profiles. A correlation was observed between these variables and some of the most relevant clinical events in the disease, including vaso-occlusive seizures and acute thoracic syndrome.

Conclusion

Lipid metabolism disorders, especially hypocholesterolemia and hypertriglyceridemia, are linked to clinical events observed in SCA, suggesting they play a relevant role in the multifactorial pathogenesis of this disease.

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Original Article

Profile of IL-6 and TNF in Foam Cell Formation: An Improved Method Using Fluorescein Isothiocyanate (FITC) Probe

Cynthia Aparecida Castro et al. Tereza Cristina Buzinari Rafael Luis Bressani Lino Heloisa Sobreiro Selistre de Araújo … Fernanda de Freitas Aníbal Roberto Mario Machado Verzola Vanderlei Salvador Bagnato Natalia Mayumi Inada Gerson Jhonatan Rodrigues

Abstract

Background

The formation of foam cells occurs due to the increase in low-density plasma lipoprotein (LDL) and dysregulation of inflammation, which is important for the development of atherosclerosis.

Objective

To evaluate the profile of tumor necrosis factor-alpha (TNF-α) and Interleukin-6 (IL-6) in the existing foam cell formation method, optimizing this protocol.

Methods

The LDL was isolated, oxidized, and labeled with a Fluorescein isothiocyanate (FITC) probe. Foam cells were generated from THP-1 human monocyte-derived cells and incubated in the absence (control) or presence of FITC-ox-LDL (10, 50, 100, 150, or 200 μg/mL), for 12, 24, 48, or 72 hours. The accumulated FITC-ox-LDL in the cell was quantified by microscopy. The enzyme-linked immunosorbent assay was evaluated to quantify the IL-6 and TNF-α, with p < 0.05 considered significant.

Results

All the FITC-ox-LDL concentrations tested showed a higher fluorescence when compared to the control, showing a greater accumulation of lipoprotein in cells. The higher the concentration of FITC-ox-LDL, the greater the production of TNF-α and IL-6. The production of IL-6 by foam cells was detected up to the value of 150 µg/mL of the maximum stimulus for LDL. Concentrations above 50 μg/mL LDL stimulated greater release of TNF-α compared to control.

Conclusions

Our model contributes to the understanding of the release of IL-6 and TNF-α in response to different concentrations of ox-LDL, using an optimized method for the formation of foam cells.

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Original Article

Clinical Significance of Peptidase M20 Domain Containing 1 Ii Patients with Carotid Atherosclerosis

Xincheng Huang et al. Peiyuan He Linling Wu

Abstract

Background

Atherosclerosis is the main cause for most cardiovascular diseases, and new biomarkers for this condition are always needed. Peptidase M20 domain containing 1 (PM20D1) is associated with both lipid metabolism and obesity. However, no study focuses on the role of PM20D1 in carotid atherosclerosis.

Objective

The present study aimed to investigate the role of PM20D1 in carotid atherosclerosis patients.

Methods

The present prospective observational study contained a total of 231 carotid atherosclerosis patients, who went to our department between July 2018 and December 2019. Blood samples and medical characteristics were also obtained from 231 healthy individuals with the same body mass index distribution of carotid atherosclerosis patients. Serum PM20D1 was determined using enzyme-linked immunosorbent assay. Clinical and demographic characteristics of all patients were collected, including age, sex, body mass index and medical history. Levels of C-reactive protein, tumor necrosis factor, homocysteine, as well as total cholesterol, triglyceride, high-density leptin cholesterol and low-density leptin cholesterol were recorded. Statistical analysis was conducted using the SPSS software, with p<0.05 as statistically different.

Results

Serum PM20D1 levels were markedly lower in carotid atherosclerosis patients when compared to the healthy control, which were significantly lower in severe carotid atherosclerosis patients and carotid atherosclerosis/stroke patients. Patients with unstable plaques showed markedly lower PM20D1 when compared to patients with stable plaques. No significant difference was found among carotid atherosclerosis patients with different body mass index. Patients with higher PM20D1 levels showed significantly lower expression of C-reactive protein, tumor necrosis factor, homocysteine, triglyceride, total cholesterol and low-density leptin cholesterol. PM20D1 was negatively correlated with C-reactive protein, tumor necrosis factor, homocysteine, total cholesterol and low-density leptin cholesterol in carotid atherosclerosis patients, and could be used as a biomarker for severe carotid atherosclerosis patients or carotid atherosclerosis patients with stroke. Sex, tumor necrosis factor, homocysteine and PM20D1 were risk factors for carotid atherosclerosis.

Conclusion

PM20D1 was decreased in carotid atherosclerosis patients and was associated with severity, plaque stability, and levels of C-reactive protein, tumor necrosis factor, homocysteine, triglyceride, total cholesterol and low-density leptin cholesterol in carotid atherosclerosis patients.

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IJCS

Original Article

Effects of Physical Exercise on Lipid and Inflammatory Profile of Women Using Combined Oral Contraceptive: A Cross-Over Study

Vinícius Afonso Gomes et al. Marvyn de Santana do Sacramento Lucas Mendes Santa Cecilia Daniela Santos de Jesus … Juliane Santos Barbosa Fernanda Oliveira Baptista de Almeida Elaine Carvalho de Oliveira Jefferson Petto

Abstract

Background:

The use of combined oral contraceptives (COC) is a risk factor for atherosclerotic disease, and physical exercise can minimize this condition.

Objective:

To verify if high intensity interval training (HIIT) promotes changes in the lipid and inflammatory profile of women using COC.

Methods:

Sequential crossover study with women aged 20-30 years, classified as irregularly active by the international physical activity questionnaire (IPAQ), when using COC. A physical-clinical assessment was performed with anthropometric measurements, VO_2max, and analysis of lipid and inflammatory profile. Participants were divided into 2 groups: the initial intervention group (GII), which began practicing HIIT for 2 months, and the posterior intervention group (GIP), which remained inactive for the same period. The GII and GIP would then alternate their conditions. The collected data was divided into: Initial moment (IM), post-exercise moment (PEM) and post-inactivity (PIM). The statistical analyses were performed using the Statistical Package for the Social Sciences, adopting a significance level of p <0.05 .

Results:

Twelve women were evaluated. After crossing the GII and GIP data, there was a difference in the C-reactive protein values between the IM of 4 (1.6-6.3 mg/dL) vs. PEM 2 (1.5-5 mg/dL); as well as between the PEM vs. the PIM= 4 (1.5-5.8 mg/dL), with a p -value = 0.04 in the comparisons. There was no change between the “moments” of the lipid profile, although it was possible to notice a reduction in resting HR and an increase in indirect VO_2max.

Conclusion:

The HIIT program was able to reduce the inflammatory profile, but it did not alter the lipid profile of irregularly active women using COC.

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Original Article

Hypertension and Associated Lipid, Glucose, and Adiposity Parameters in School-Aged Adolescents in the Federal District, Brazil

Letícia Rocha Lima et al. Aline Bassetto Okamura Kênia Mara Baiocchi de Carvalho Eliane Said Dutra Vivian Siqueira Santos Gonçalves

Abstract

Background

The prevalence of hypertension and other metabolic disorders has increased in young individuals. However, no representative studies have been conducted in the population of the Federal District, Brazil.

Objective

To estimate the prevalence of hypertension and its association with lipid, glucose, and adiposity markers in school-aged adolescents living in the Federal District.

Methods

This cross-sectional study included participants of the Study of Cardiovascular Risks in Adolescents (Portuguese acronym, ERICA). Blood pressure, blood glucose, glycated hemoglobin, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, body mass index (BMI), waist circumference, and economic, demographic, and sexual maturity variables were assessed. The data were analyzed in Stata, and the analysis was divided into different stages: descriptive, crude, and adjusted. Significant results were set at p < 0.05.

Results

In total, 1,200 adolescents were included, and their mean age was 14.8 years. The prevalence of hypertension was 8% (95% confidence interval: 6.3; 9.9). Most parameters were associated with blood pressure in crude analysis. In adjusted analysis, glucose, lipid, and adiposity markers maintained the associations, and the highest magnitudes were those of BMI and HOMA-IR.

Conclusion

The study revealed a high prevalence of hypertension in adolescents living in the Federal District, and blood pressure levels were associated with other markers of lipid, glucose, and adiposity profile. The findings indicate the relevance of health surveillance for planning effective actions aimed at reversing this situation and preventing new cases.

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IJCS

Original Article

Better Adequacy of Food Intake According to Dietary Recommendations of National Cholesterol Education Program in Vegetarian Compared to Omnivorous Men

Luiza Antoniazzi et al. Julio Acosta-Navarro Adriana Midori Oki Maria Carlos Bonfim Maria Cristina Almeida Gaspar

Abstract

Background

The lower frequency of cardiovascular (CV) risk factors observed in vegetarians compared to omnivores may be due to more appropriate nutrient intake according to recommendations for the prevention of cardiovascular diseases.

Objective

To compare the dietary adequacy according to the recommendations of the National Cholesterol Education Program (NCEP) in apparently healthy vegetarian (VEG) and omnivorous (OMN) men.

Methods

This was a cross-sectional study, conducted with apparently healthy men (44 omnivorous and 44 vegetarians, ≥ 35 years), who were assessed for daily food consumption, anthropometric data, physical exercise status, and clinical data. Multiple logistic regression was used to test the association between the type of diet and the dietary adequacy. Significant values were considered for p<0.05.

Results

Several clinical CV risk markers were significantly lower in VEG when compared to OMN: body mass index (BMI) (23.1 vs. 27.3 kg/m2), systolic blood pressure (119.5 vs. 129.2 mmHg), and diastolic blood pressure (75.7 vs. 83.9 mmHg). VEG presented significant lower values of blood lipids and glucose. No significant difference was observed in caloric intake; however, VEG consumed significantly more carbohydrates, dietary fibers, and polyunsaturated fats. VEG presented an adequate consumption of dietary cholesterol and saturated and polyunsaturated fatty acids, regardless of caloric intake and age.

Conclusion

VEG were more likely to consume saturated fatty acids, dietary cholesterol, and fibers according to the recommendations of NCEP, factors that may contribute to lower levels of CV risk markers than OMN.

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Counterpoint

Counterpoint: Flexibilization of Fasting for Laboratory Determination of the Lipid Profile in Brazil: Science or Convenience?

Maria Cristina de Oliveira Izar

National and international guidelines for the management of dyslipidemias classically recommend measuring lipid profiles after fasting for at least 8 h.^– Lipid targets for assessing cardiovascular risk traditionally rely on plasma total-cholesterol and low-density lipoprotein-cholesterol (LDL-c) levels, with the latter being calculated by the Friedewald equation.

Some imprecision due to low or high triglycerides in calculating LDL-cholesterol may affect cardiovascular risk assessment, the definition of a therapeutic target, and the need to intensify the treatment.^, Accurate results require triglyceride levels below 400 mg/dL, but above 100 mg/dL the calculated LDL-c starts to be underestimated, when compared to ultracentrifugation measurements. Another limitation to the use of the formula is that samples must not contain beta-VLDL, as in the case of type III hyperlipoproteinemia. When one of these conditions are not satisfied, the equation cannot be used due to imprecision.^–

[…]

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Viewpoint

Flexibilization of Fasting for Laboratory Determination of the Lipid Profile in Brazil: Science or Convenience?

Caio Maurício Mendes de Cordova et al. Caroline Galgowski

A statement endorsed by medical specialty associations has been published in our country recommending the flexibilization of fasting before blood drawing for the laboratory determination of the lipid profile encompassing total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG) content and the corresponding calculation of non-HDL-cholesterol (TC – HDL-c). It was considered that non-fasting results do not clinically differ from fasting ones, and prospective studies and meta-analyses have consistently demonstrated that non-HDL-C at a non-fasting state would be at least as good as LDL-c in the prediction of CVD. It was also recommended that when TG > 4.52 mmol/L the formula proposed by Martin et al. should be used for LDL-c estimation.

The statement was based on the European Consensus on the matter published by Nordestgaard et al. However, the automatic application of this approach in Brazil deserves deeper consideration, considering the impact that it may cause on patient care. Furthermore, it is far from a consensus among clinical laboratory scientists and professionals in the country, as it became evident during the 44^th Brazilian Congress of Clinical Analysis held last June 11-14^th, 2017, and the 51^st Brazilian Congress of Clinical Pathology and Laboratory Medicine, held last September 26-29^th, 2017.

[…]

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Original Article

Impact of the Use of Different Diagnostic Criteria in the Prevalence of Dyslipidemia in Pregnant Women

Alina Coutinho Rodrigues Feitosa et al. Luciana Tedgue Barreto Isabela Matos da Silva Felipe Freire da Silva Gilson Soares Feitosa Filho

Abstract

Background:

There is a physiologic elevation of total cholesterol (TC) and triglycerides (TG) during pregnancy. Some authors define dyslipidemia (DLP) in pregnant women when TC, LDL and TG concentrations are above the 95th percentile (p95%) and HDL concentration is below the 5th percentile (P5%) for gestational age (GA).

Objective:

To compare the prevalence of DLP in pregnant women using percentiles criteria with the V Brazilian Guidelines on Dyslipidemia and the association with maternal and fetal outcomes.

Results:

Pregnant women with high-risk conditions, aged 18-50 years, and at least one lipid profile during pregnancy was classified as the presence of DLP by two diagnostic criteria. Clinical and laboratorial data of mothers and newborns were evaluated.

Conclusion:

433 pregnant women aged 32.9 ± 6.5 years were studied. Most (54.6%) had lipid profile collected during third trimester. The prevalence of any lipid abnormalities according to the criteria of the National Guidelines was 83.8%: TC ≥ 200 mg/dL was found in 49.9%; LDL ≥ 160 mg/dL, in 14.3%, HDL ≤ 50 mg/dL in 44.4% and TG ≥ 150 mg/dL in 65.3%. Any changes of lipid according to percentiles criteria was found in 19.6%: elevation above the P95% for TC was found in 0.7%; for LDL, 1.7%; for TG 6.4% and HDL lower than the P5% in 13%. The frequency of comorbidity: hypertension, diabetes, smoking, obesity and preeclampsia was similar among pregnant women when DLP was compared by both criteria.

Conclusion:

The prevalence of DLP during pregnancy varies significantly depending on the criteria used, however none demonstrated superiority in association with comorbidities.

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Original Article

Evaluation of Sexual Dimorphism in the Efficacy and Safety of Simvastatin/Atorvastatin Therapy in a Southern Brazilian Cohort

Lisiane Smiderle et al. Luciana O. Lima Mara Helena Hutz Cézar Roberto Van der Sand … Luiz Carlos Van der Sand Maria Elvira Wagner Ferreira Renan Canibal Pires Silvana Almeida Marilu Fiegenbaum

Background:

Dyslipidemia is the primary risk factor for cardiovascular disease, and statins have been effective in controlling lipid levels. Sex differences in the pharmacokinetics and pharmacodynamics of statins contribute to interindividual variations in drug efficacy and toxicity.

Objective:

To evaluate the presence of sexual dimorphism in the efficacy and safety of simvastatin/atorvastatin treatment.

Methods:

Lipid levels of 495 patients (331 women and 164 men) were measured at baseline and after 6 ± 3 months of simvastatin/atorvastatin treatment to assess the efficacy and safety profiles of both drugs.

Results:

Women had higher baseline levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) compared with men (p < 0.0001). After treatment, women exhibited a greater decrease in plasma TC and LDL-C levels compared with men. After adjustment for covariates, baseline levels of TC and LDL-C influenced more than 30% of the efficacy of lipid-lowering therapy (p < 0.001), regardless of sex. Myalgia [with or without changes in creatine phosphokinase (CPK) levels] occurred more frequently in women (25.9%; p = 0.002), whereas an increase in CPK and/or abnormal liver function was more frequent in in men (17.9%; p = 0.017).

Conclusions:

Our results show that baseline TC and LDL-C levels are the main predictors of simvastatin/atorvastatin therapy efficacy, regardless of sex. In addition, they suggest the presence of sexual dimorphism in the safety of simvastatin/atorvastatin. The effect of sex differences on receptors, transporter proteins, and gene expression pathways needs to be better evaluated and characterized to confirm these observations.

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Artigo Original

Lipid Tetrad Index (LTI) and Lipid Pentad Index (LPI) in healthy subjects

Charles Augusto dos Santos Morais et al. Samuel Henrique Vieira Oliveira Luciana Moreira Lima

BACKGROUND: The prevalence of cardiovascular disease (CVD) has increased steadily in recent years. Literature data show that about 35% of atherosclerotic events occur in the absence of classic risk factors, requiring a broader assessment of the individual to better characterize the risk. Lipid Tetrad Index (LTI) and Lipid Pentad Index (LPI) constitute a new and efficient evaluation of the lipid profile and CVD risk. OBJECTIVE: This study assessed LTI and LPI in undergraduate students, seeking to establish the parameters of these indices in healthy subjects and correlate them with the conventional lipid profile. METHODS: The study included 110 students, 48 (44%) males and 62 (56%) females, mean age 20.9 ± 1.7. Apolipoprotein-AI, apolipoprotein B, total cholesterol, lipoprotein(a), triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were assessed, using specific diagnostic methods. LTI and LPI indices were calculated using the equations LTI = [total cholesterol x triglycerides x lipoprotein(a) / HDL] and LPI = [total cholesterol x triglycerides x lipoprotein(a) x apolipoprotein B/apolipoprotein-AI], respectively. RESULTS: LTI and LPI values were significantly higher in females compared to males. As for the other parameters, there were significant differences between males and females only regarding total cholesterol, HDL and apolipoprotein-AI. There were significant and positive correlations between LDL and LTI and between LDL and LPI. CONCLUSIONS: Findings indicate that both LTI and LPI were associated with LDL, a parameter not used to calculate lipid indices and widely used in clinical practice for cardiovascular risk assessment.

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Review Article

Statins in acute coronary syndromes

Alexandre Russo Sposito et al. Gentil Barreira de Aguiar Filho Amanda Rezende Aarão Francisco Thiago Tomaz de Sousa Marcelo Chiara Bertolami

Statins are the main resource available to reduce LDL-cholesterol levels. Their continuous use decreases cardiovascular morbidity and mortality due to atherosclerosis. The administration of these medications demonstrated to be effective in primary and secondary prevention clinical trials in low and high risk patients. Specialists believe that a possible benefit of hypolipidemic therapy in preventing complications of atherosclerotic diseases is in the reduction of deposition of atherogenic lipoproteins in vulnerable areas of the vasculature. Experimental studies with statins have shown an enormous variety of other effects that could extend the clinical benefit beyond the lipid profile modification itself. Statinbased therapies benefit other important components of the atherothrombotic process: inflammation, oxidation, coagulation, fibrinolysis, endothelial function, vasoreactivity and platelet function. The demonstration of the effects that do not depend on cholesterol lowering or the pleiotropic effects of statins provides the theoretical basis for their potential role as adjunctive therapy in acute coronary syndromes. Retrospective analyses of a variety of studies indicate the potential benefit of statins during acute coronary events. Recent clinical studies have addressed this important issue in prospective controlled trials showing strong evidence for the administration of statins as adjunctive therapy in acute coronary syndromes.

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Artigo Original

Effect of diet and indoor cycling on body composition and serum lipid

Valéria Sales do Valle et al. Danielli Braga de Mello Marcos de Sá Rego Fortes Estélio Henrique Martin Dantas Marco Antonio de Mattos

BACKGROUND: Indoor cycling is an aerobic exercise that employs large muscle groups of the lower limbs, lacking osteoarticular impact and high energy expenditure, which makes it interesting to generate a non-pharmacological strategy. OBJECTIVE: To assess body composition and lipid profile in overweight women after twelve weeks of low-calorie diet and indoor cycling training. METHODS: We randomly assigned 40 women (23.90 ± 3.10 years), divided into four groups: control (C), indoor cycling (CI), indoor cycling combined with low-calorie diet (CD) and low-calorie diet (D). The variables were: height and body mass, BMI, fat percentage, lean body mass, triglycerides, cholesterol and lipoproteins (HDL, LDL, VLDL). The indoor cycling training consisted of three weekly sessions of 45 minutes each and an energy restriction of about 1,200 kcal. The study lasted 12 weeks. We used descriptive statistics (mean and standard deviation) and inferential statistics (Student’s t test). The level of significance was p < 0.05. RESULTS: The groups CI, CD and D significantly reduced the mean anthropometric variables after 12 weeks of intervention (body mass, fat percentage and body mass index), and serum levels of total cholesterol and triglycerides. HDL cholesterol increased significantly for groups CI and CD. CONCLUSION: According to the results, the indoor cycling and the low-calorie diet helped fight overweight and control serum lipids.

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Artigo Original

Transdermal estradiol and lipid profile: effects on a specific group of Brazilian postmenopausal women

Daniel R. Callejon et al. Danyelle Romana. A. Rios Sílvio A. Franceschini Maria Regina T. Toloi

BACKGROUND: In postmenopausal women, significant changes occur that can induce cardiovascular diseases, such as atherogenic lipid profile, due to an increase in total cholesterol and LDL levels, and a decrease in HDL cholesterol levels. The hormone replacement therapy (HRT) can prevent these changes in lipid profile. OBJECTIVE: Verify the effects of HRT consisting of transdermal estradiol gel associated with medroxyprogesterone acetate on the lipid profile and biochemical parameters in Brazilian postmenopausal women. METHODS: This study is an open prospective longitudinal study, in which thirty postmenopausal women received transdermal estradiol gel (1 mg/day) continuously combined with oral medroxyprogesterone acetate (MPA) (5 mg/day) for 12 days/month. The following parameters were determined: total cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gama glutamyl transferase (GGT) and follicle-stimulating hormone (FSH). RESULTS: The parameters of the lipid profile did not show a significant decrease, while the levels of GGT and FSH had a statistically significant decrease. CONCLUSIONS: the treatment with transdermal estradiol gel did not have a significant impact on the lipid profile, thus not resulting in a beneficial effect on cardiovascular disease markers, suggesting that the dose, administration route and the time of treatment were important for these results. Moreover, the treatment using small dose and the transdermal administration route also had a significant hepatic effect in this population. Therefore, this treatment might provide interesting effects on the lipid profile in Brazilian postmenopausal women.

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Artigo Original

Homocysteine, folate and vitamin B12 in colombian patients with coronary disease

Gilberto Garcia et al. Juanita Trejos Beatriz Restrepo Patricia Landázuri

OBJECTIVE: To determine the occurrence of association between homocysteine, folate, or vitamin B12 plasma levels and acute coronary syndrome in Colombian patients. METHODS: Case control study: cases were 50 patients with acute coronary syndrome and controls were 50 outpatients without coronary syndrome. Homocysteine, folate and vitamin B12 levels were determined by means of chemiluminescence immunoassay. Cholesterol and lipoproteins, triglycerides, BUN, creatinine, hemoglobin and hematocrit were also measured. RESULTS: Mean homocysteine plasma concentrations were significantly different between cases (12.4 µmol/l ± 6.0) and controls (9.7 µmol/l ± 2.4), p=0.01. The folic acid levels of the cases were lower than those of the control patients (10.5 ng/ml ± 3.5 vs 12.6 ng/ml ± 3.6, respectively, p=0.01). An inverse relationship was found between folate and homocysteine levels. No relationship was observed between vitamin B12 levels and homocysteine levels. There was a significant difference in triglyceride levels between case and control groups (136.91 ± 67.27 vs 174.3 ± 77.6, respectively, p=0.01). The odds ratio for hyperhomocysteinemia in acute coronary syndrome was 4.45 (95% confidence interval: 1.5 – 13.3). CONCLUSION: The present study found a significant association between homocysteine levels and acute coronary syndrome in Colombian patients, similarly to the European and North American populations. There was a negative correlation between homocysteine plasma levels and folate levels. No association between plasmatic levels of homocysteine and those of vitamin B12 was observed.

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Artigo Original

Lipid profile analysis in school children

Carlos Scherr et al. Cyntia Karla Magalhães Waldir Malheiros

BACKGROUND: According to the World Health Organization, coronary atherosclerosis is the leading cause of death worldwide. The INTERHEART study demonstrated that dyslipidemia is one of the most important independent risk factors for AMI. OBJECTIVE: To evaluate the lipid profile and blood pressure of school children attending private (paid) and public/philanthropic (free) schools. METHODS: Blood samples from 343 children were tested and correlated with their lifestyle. Statistical analysis was carried out using the Student’s t-test for independent samples to compare the means, and the chi-square test (c2) to compare proportions. The significance level was set at 5%. RESULTS: Total cholesterol and its HDL and LDL fractions, as well as the Castelli Index I, were higher among private school students, with statistical significance for both genders, except for HDL in boys. Blood pressure was higher in the same group, but without reaching statistical significance. Twenty-three percent of private school students had total cholesterol > 190 mg/d, as compared to 4% of those attending public/philanthropic institutions. When the dietary and physical activity surveys were compared and correlated with the lipid profile, a clear association was found between daily physical activity and nutritional guidance among those of lower socioeconomic status. CONCLUSION: This study demonstrated the positive correlation of total cholesterol and its LDL fraction with eating habits and more intense and regular physical activity, benefiting the most needy children, compared to those enrolled in private schools.

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Artigo Original

Lipid profile and nutrition counseling effects in adolescents with family history of premature coronary artery disease

Gislaine A. Mendes et al. Tania L. Martinez Maria C. Izar Olga M. Amancio … Neil F. Novo Simone C. Matheus Marcelo C. Bertolami Francisco Antonio Helfenstein Fonseca

OBJECTIVE: To assess lipid profile and nutritional parameters from adolescents with family history of premature coronary artery disease (CAD) and assess the effects of nutritional counseling. METHODS: The study included 48 adolescents of both gender and with ages ranging from 10 and 19 years old (case group, n=18; control group, n=30). RESULTS: Offspring of young individuals with coronary artery disease showed higher values of total cholesterol (189 ± 30 vs. 167 ± 26 mg/dl, p < 0.01), LDL-C (144 ± 20 vs. 100 ± 27 mg/dl, p < 0.001) and apoB (80 ± 15 vs. 61 ± 18 mg/dl, p = 0.001) and lower values of HDL-C (45 ± 9 vs. 51 ± 13 mg/dl, p < 0.02) than control young individuals. Differences were not found for triglycerides and apoA-I. With a dietotherapeutic counseling, we obtained a reduction in alimentary consumption of saturated fatty acids (pre: 15.5 ± 4.7% vs. post: 6.6 ± 3.7%, p = 0.003) and an improvement in lipid profile: TC (-8%, p = 0.033), LDL-C (-18.2%, p = 0.001), TG (-53%, p = 0.002) rates in offspring of premature CAD patients who showed hyperlipidemia. CONCLUSION: The presence of dyslipidemia was more prevalent among offspring adolescents of premature CAD patients, but it was responsive to nutritional intervention.

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Serum lipids in school kids and adolescents from Florianópolis, SC, Brazil: Healthy Floripa 2040 study

Isabela de Carlos Back Giuliano et al. Mário Sérgio Soares de Azeredo Coutinho Sérgio Fernando Torres de Freitas Maria Marlene de Souza Pires … João Nilson Zunino Robespierre Queiroz da Costa Ribeiro

OBJECTIVE: To determine the distribution of serum lipids in children and adolescents of Florianopolis, Santa Catarina State, Brazil. To determine the association between undesirable levels for total cholesterol (>170 mg/dL) and others coronary heart disease risks factors. METHODS: A questionnaire, physical examination and blood analyses were collected from randomized sample from school kids aged range from 7 to 18 years old. RESULTS: 1,053 students participated, aged between 7 and 18 years old. They presented a total cholesterol mean of 162±28 mg/dl, triglyceride mean of 93±47 mg/dl, HDL-cholesterol mean of 53±10 mg/dl, LDL-cholesterol mean of 92±24 mg/dl and non-HDL cholesterol mean of 109±26 mg/dl. The TC/HDL and LDL/HDL mean rates were, respectively, 3.1±0.6 and 1.8±0.5. Findings showed that private school children, 10 years old or less, girls and black children had higher lipids values. Overall findings suggest that the best logistic regression model which explained abnormal total cholesterol levels included: obesity, stroke and heart attack familial history, feminine gender, age of 10 years old or less and overweight body image determined on inspection. CONCLUSION: In comparison to international literature, our results, showed intermediated total cholesterol, lower LDL-cholesterol and non-HDL-cholesterol and higher HDL-cholesterol. Therefore, primary prevention programs are needed to be carrying out, especially among overweight children and adolescents so to prevent ischemic heart disease as adulthood.

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Lipidic profile of individuals without cardiopathy with overweight and obesity

Fernando Araújo et al. Alice T. Yamada Marinalva V. M. Araújo Maria do Rosário D. O. Latorre Alfredo J. Mansur

OBJECTIVE: To assess the lipidic profile of overweight and obese individuals submitted to cardiologic assessment and who did not show evidences of cardiopathy. METHODS: Sample with 684 individuals, 389 (56.9%) women and 295 (43.1%) men, with age ranging from 14 to 74 (average of 40.6) years old, without evidences of cardiopathy after clinical assessment and analysis of electrocardiogram, thorax radiography, ergometric test on treadmill and two-dimensional Doppler echocardiogram. The serum profile of lipids and glucose regarding sex and ranges of body mass index (BMI) – eutrophic up to 24.9 Kg/m², overweight 25-29.9 Kg/m² and obese > 30 Kg/m², was studied. RESULTS: The following means showed a significant statistic difference between the sexes: glucose (mg/dL) in women 90.21±23.13 and men 95.28±28.64 (p<0.001); triglycerides (mg/dL) in women 97.27±55.24 and men 141.47±57.06 (p<0.001) and HDL-C (mg/dL) in women 52.63±13.92 and men 43±10.88 (p<0.001). The average BMI in women was 26.15 and in men 26.33 (p=ns). In the analysis through BMI ranges there was a significant difference between the sexes (p=0.037). In the categories of overweight and obesity, only the means of triglycerides in women showed a significant statistic difference: overweight women with 102.25±60.68 mg/dL and obese 121.64±63.57 mg/dL (p=0.034). CONCLUSION: Women without cardiopathy showed serum levels of glucose, triglycerides and HDL-cholesterol lower than men's. In both sexes, the means are lower in the comparison with eutrophic and overweight, and only the triglycerides average of women with overweight and obesity showed significant statistic difference.

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Concordance of the scoring system for controlling the serum levels of cholesterol and fat

Marcia de Araujo Leite Nacif et al. Edeli Simioni de Abreu Elizabeth Aparecida Ferraz da Silva Torres

OBJECTIVE: To evaluate the comprehension of the scoring system for controlling the serum levels of cholesterol and fat as an instrument of dietary intervention for hypercholesterolemic patients. METHODS: The study comprised 153 individuals of both sexes, with ages ranging from 20 to 65 years, who sought medical care in a hospital or in a basic health unit. They were divided into the following 3 groups: hypercholesterolemic individuals, individuals with no diagnosis of hypercholesterolemia, and health care professionals. A 24-hour recall was used with each individual, who applied the cholesterol/saturated-fat index to their diets, consulting the scoring system. The researcher confirmed the calculation of each participant, considering her calculation as the a reference pattern. Understanding of the system was assessed through comparison between the reference pattern and the data obtained by the interviewees, using the intraclass correlation coefficient. RESULTS: The patients without a diagnosis of hypercholesterolemia obtained a high correlation in all meals. The morning and afternoon snacks and supper were the meals with the greatest correlation (r=1). In hypercholesterolemic individuals, supper was the meal with the greatest concordance with the reference score (r=1), and the health care professionals obtained a correlation coefficient of 1 in all meals, except lunch (r=0.99). CONCLUSION: The scoring system was fast, simple, and easy to be understood and accepted by the population studied.

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Comparison of the lipid profile, blood pressure, and dietary habits of adolescents and children descended from hypertensive and normotensive individuals

Maria Cristina Elias et al. Max Samuel Mattos Bolívar Francisco Antonio Helfenstein Fonseca Tania Leme da Rocha Martinez … Japy Angelini Celso Ferreira Nelson Kasinski Angelo Amato Vincenzo de Paola Antonio Carlos Camargo Carvalho

OBJECTIVE: To compare blood pressure, lipid profile, food intake, and anthropometric data of adolescents with or without a familial history of hypertension. METHODS: Forty-three adolescents from both sexes were assessed, with ages ranging from 11 to 18 years old. Twenty had hypertensive parents, and 23 had normotensive parents. The following variables were examined: blood pressure, food intake, anthropometric data, lipid profile, and the results of following dietary guidelines (American Heart Association). RESULTS: The offspring of hypertensive parents had greater baseline systolic blood pressure (109 ± 3 vs. 99 ± 2 mm Hg, P=0.01), diastolic blood pressure (68 ± 2 vs. 62 ± 2 mm Hg, p=0.04), greater TC/HDL-C ratio (4.1 ± 0.3 vs. 3.2 ± 0.2, P<0.01), and greater LDL/HDL-C (2.7 ± 0.2 vs. 1.9 ± 0.1, P<0.01), and smaller values of HDL-C (43 ± 2 vs.53 ± 2 mg/dL, P<0.005). Dietary intake and anthropometric measures assessed did not differ between the groups. Even though dietary intervention resulted in reductions in body mass index (21.0± 1.2 vs. 20.1 ± 1.1 kg/m², P<0.01), it did not change dyslipidemia present in the offspring of hypertensive individuals. CONCLUSION: Increased blood pressure levels and less favorable lipid profiles are found among offspring of hypertensive parents, where low levels of HDL-C were the most relevant finding regardless of anthropometric or nutritional variables.

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