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1.  Diabetes: managing dyslipidaemia 
Clinical Evidence  2008;2008:0610.
Introduction
Dyslipidaemia is a major contributor to the increased risk of heart disease found in people with diabetes. An increase of 1 mmol/L LDL-C is associated with a 1.57-fold increase in the risk of coronary heart disease (CHD) in people with type 2 diabetes. A diagnosis of diabetic dyslipidaemia requiring pharmacological treatment is determined by the person's lipid profile and level of cardiovascular risk.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions for dyslipidaemia in people with diabetes? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: anion exchange resins, combined treatments (for lipid modification), ezetimibe, fibrates, fish oil (for lipid modification), intensive multiple intervention treatment programmes (for lipid modification), nicotinic acid (for lipid modification), and statins.
Key Points
Dyslipidaemia is characterised by decreased circulating levels of high-density lipoprotein cholesterol (HDL-C) and increased circulating levels of triglycerides and low-density lipoprotein cholesterol (LDL-C). Dyslipidaemia is a major contributor to the increased risk of heart disease found in people with diabetes.An increase of 1 mmol/L LDL-C is associated with a 1.57-fold increase in the risk of CHD in people with type 2 diabetes.A diagnosis of diabetic dyslipidaemia requiring pharmacological treatment is determined by the person's lipid profile and level of cardiovascular risk. The classification of cardiovascular risk and lipid targets for drug treatment differ between the USA and the UK, and the rest of Europe. We used the United Kingdom Prospective Diabetes Study (UKPDS) risk calculator to estimate 10-year cardiovascular risk, and categorised a 15% or more risk as "higher risk", and 15% or less as "lower risk" according to the UK clinical guidelines. We found no RCTs of a solely lower-risk population, although some studies were excluded because of insufficient data to calculate risk. In clinical practice, most people with diabetes are increasingly considered at high cardiovascular risk, regardless of the presence or absence of other risk factors.
Statins are highly effective at improving cardiovascular outcomes in people with diabetes. Statins reduce cardiovascular mortality in people with type 2 diabetes with and without known CVD, and regardless of baseline total and LDL-C concentrations.Different statins seem to have similar efficacy at reducing LDL-C.
Combining statins with other treatments (such as ezetimibe or a fibrate) seems to reduce LDL-C more than statin treatments alone. Combinations could be useful in people with mixed dyslipidaemia where one drug fails to control all lipid parameters.
Fibrates seem to have a beneficial effect on cardiovascular mortality and morbidity by reducing triglyceride levels. In people with mixed dyslipidaemia, statins may also be required.
Intensive-treatment programmes involving multiple interventions (people seen by a nurse every 4-6 weeks) seem better at reducing cholesterol than usual-care programmes.
Fish oils may reduce triglyceride levels, but also seem to increase LDL-C levels, making them of limited benefit to most diabetic patients.
Nicotinic acid seems effective at increasing HDL-C and may reduce triglycerides. However, in clinical practice, nicotinic acid alone is not the preferred treatment for hypertriglyceridaemia, but may be used in combination with a statin in people with mixed dyslipidaemia, or in those unable to tolerate fibrates. Nicotinic acid seems to increase the incidence of flushing, particularly in female patients.
We don't know whether anion exchange resins or ezetimibe are useful in treating dyslipidaemia in people with diabetes, but they could be used in combination with a statin if the statin alone fails to achieve lipid targets.
PMCID: PMC2907966  PMID: 19450295
2.  Association of body mass index and abdominal adiposity with atherogenic lipid profile in Nigerians with type 2 diabetes and/or hypertension 
Background:
We explored the relationship between anthropometric indices (obesity and abdominal adiposity) and the presence of an atherogenic lipid profile in Nigerians with major cardiovascular risk factors (type 2 diabetes mellitus-T2DM, hypertension-HBP, and concomitant disease).
Materials and Methods:
Using a prospective design, 278 patients with T2DM, HBP, or concomitant disease, attending out-patient diabetes and hypertension clinics at a tertiary institution in Nigeria were evaluated. All patients were cholesterol-lowering oral medication naοve. Demographic and clinical data and anthropometric measurements were documented. Fasting lipid profiles were measured in all cases. The cut-off points for defining dyslipidaemia were: Elevated total cholesterol (TC) (mg/dL) ≥200, elevated low-density lipoprotein cholestrol (LDL-C) (mg/dL) ≥100, low high-density lipoprotein cholesterol (HDL-C) (mg/dL) <40 for men and <50 for women, and high triglycerides (TG) (mg/dL) ≥150 mg/dL.
Results:
We found a significantly higher mean BMI (kg/m2) in the HBP group (30.5 ± 6.0) compared to T2DM (28.1 ± 5.9) and concomitant HBP and T2DM groups (29.4 ± 5.2) (ANOVA; P = 0.02). The most frequent dyslipidaemia was elevated LDL-C in 92 (96.8%) HBP, 73 (85.9%) T2DM and 79 (80.6%) concomitant disease. The frequency of low HDL-C was highest in T2DM (68.2%) compared to the other 2 groups (P = 0.03).
Conclusions:
Only TG levels were found to relate with any anthropometric index (waist circumference (WC) in this case) in Nigerians with major cardiovascular risk factors in this study. Routine anthropometric indices do not appear to be reliable surrogates for atherogenicity measured by abnormalities in TC, LDL-C and HDL-C.
doi:10.4103/0300-1652.126296
PMCID: PMC3948963  PMID: 24665155
Atherogenic profile; blacks; diabetes; hypertension; metabolic syndrome; Nigerians
3.  A Comparative Study on the Fasting and the Postprandial Dyslipidaemia in Type 2 Diabetes Mellitus 
Background and Objectives: Type 2 Diabetes Mellitus (Type 2 DM), which is characterized by a relative insulin deficiency or insulin resistance is associated with a cluster of metabolic abnormalities, which includes glucose intolerance, hypertension, a unique dyslipidaemia, a procoagulant state, and an increase in macrovascular diseases. The present study was conducted to assess the significance of postprandial dyslipidaemia with respect to fasting dyslipidaemia, in the pathogenesis of atherosclerotic changes and possible cardiovascular diseases (CVD) and complications.
Methods and Statistical Analysis: Fifty diagnosed cases of type 2 DM which were in the age group of 35-65 years, which had a duration of diabetes of more than five years, were included in the study and 50 age and sex matched healthy subjects were taken as the controls. In both the study groups, we measured the serum levels of fasting as well as the postprandial lipid profile, which was comprised of the total Cholesterol (TC), triglycerides (TGs), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and the waist-hip ratio (WHI) as the cardiovascular risk factors. The statistical analysis was done by using the Students unpaired ‘t’-test.
Results: The results of this study showed significantly increased levels of serum total cholesterol, TGs, LDL-C and VLDL-C in the postprandial state as compared to those in the fasting state (p<0.001) and as compared to those in the fasting and the postprandial states of the controls (p<0.001). The serum HDL-C level was significantly lower in the postprandial state as compared to that in the fasting state (p<0.001). Also, the postprandial and the fasting HDL-C levels were significantly lower as compared to the levels in their respective control groups (p<0.001).
Conclusion: The findings of the present study indicated that the lipid profile, as a cardiovascular risk factor, was significantly elevated in the postprandial state as compared to that in the fasting state and that it was significantly elevated in the postprandial and the fasting states in the Type 2 DM patients as compared to the levels in their respective control groups. This signified a routine estimation of the postprandial lipid profile, rather than the fasting lipid parameters, in the cardiovascular risk assessment in Type 2 DM.
doi:10.7860/JCDR/2013/4845.2868
PMCID: PMC3644431  PMID: 23730633
Postprandial blood glucose (PBG); Cardiovascular disease (CVD); Waist-hip ratio (WHR)
4.  Reducing Vascular Events Risk in Patients with Dyslipidaemia: An Update for Clinicians 
Reducing the risk of vascular events in patients with dyslipidaemia requires cardiovascular disease risk stratification and lifestyle/pharmacological intervention on modifiable risk factors. Reduction of low-density lipoprotein cholesterol (LDL-C) with statins is highly effective in reducing cardiovascular disease in patients with and without diabetes, but leaves unaddressed a sizeable residual vascular risk (RvR), which is rarely quantified in routine clinical practice. Such RvR may relate to lack of strict target attainment for all atherogenic variables [LDL-C, non-high-density lipoprotein cholesterol (HDL-C) and/or apolipoprotein B100]. Another substantial lipid-related and modifiable RvR component is related to atherogenic dyslipidaemia, especially as global rates of obesity, type 2 diabetes and metabolic syndrome are increasing. Atherogenic dyslipidaemia is associated with insulin-stimulated very-low-density lipoprotein overproduction and reduced reverse cholesterol transport. The hallmark of atherogenic dyslipidaemia is the coexistence of low HDL-C and elevated triglycerides. Therapeutic lifestyle changes and combination lipid-lowering therapy with drugs targeting atherogenic dyslipidaemia (such as fibrates or innovative drugs targeting atherogenic dyslipidaemia and/or apolipoprotein B100 metabolism) on top of background statins, have a potential to reduce RvR in high-risk groups, as shown in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, in which combination therapy with simvastatin plus fenofibrate decreased macrovascular risk in patients with diabetes and atherogenic dyslipidaemia, and retinopathy risk irrespective of baseline lipids.
doi:10.1177/2040622311413952
PMCID: PMC3513890  PMID: 23251757
cardiovascular risk; low-density lipoprotein cholesterol; apolipoprotein B; atherogenic dyslipidaemia; metabolic syndrome; diabetes
5.  Prevalence of dyslipidaemia in statin-treated patients in South Africa: results of the DYSlipidaemia International Study (DYSIS) 
Cardiovascular Journal of Africa  2013;24(8):330-338.
Introduction and objectives
Cardiovascular disease (CVD) is the leading cause of mortality worldwide and increased levels of low-density lipoprotein cholesterol (LDL-C) are an important modifiable risk factor. Statins lower LDL-C levels and have been shown to reduce CVD risk. Despite the widespread availability of statins, many patients do not reach the lipid targets recommended by guidelines. We evaluated lipid goal attainment in statin-treated patients in South Africa and analysed variables contributing to poor goal attainment as part of the DYSlipidaemia International Study (DYSIS).
Methods
This cross-sectional, observational study enrolled 1 029 consecutive South African patients consulting officebased physicians. Patients were at least 45 years old, had to be treated with a stable dose of statins for at least three months and had been fasting for 12 hours. We evaluated lipid goal attainment and examined variables associated with residual dyslipidaemia [abnormal levels of LDL-C, highdensity lipoprotein cholesterol (HDL-C) and/or triglycerides (TG)].
Results
We found that 50.3% of the patients overall did not achieve target LDL-C levels and 73.5% of patients were at very high cardiovascular risk. In addition, 33.7% had low levels of HDL-C, while 45.3% had elevated TG levels despite statin therapy. Asian and mixed-ancestry patients but not black (vs Caucasian ethnicity), as well as obese individuals in South Africa were more likely to still have dyslipidaemia involving all three lipid fractions.
Conclusions
We observed that many patients in South Africa experienced persistent dyslipidaemia despite statin treatment, supporting the concept that there is a need for more intensive statin therapy or the development of novel treatment strategies. Measures aimed at combating obesity and other lifestyle-related risk factors are also vital for effectively controlling dyslipidaemia and reducing the burden of CVD.
doi:10.5830/CVJA-2013-071
PMCID: PMC3821092  PMID: 24240385
cardiovascular disease (CVD); dyslipidaemia; lipid abnormalities; statins; low-density lipoprotein cholesterol (LDL-C)
6.  Lipoprotein (a), C-reactive protein and some metabolic cardiovascular risk factors in type 2 DM 
Background
Lipoprotein (a) (LP (a) is an independent cardiovascular risk factor that is not widely studied in people of sub-Saharan African origin. The aim of this report is to determine the frequency of occurrence of elevated Lp (a) and possible relationship with total cholesterol (TCHOL), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), C reactive protein (CRP) and serum uric acid (SUA).
Methods
This is a cross sectional study carried out in 200 Nigerian patients with type 2 DM and 100 sex and age matched healthy Controls aged between 32-86 years. We determined the frequency of occurrence of elevated Lp (a) levels in the study subjects and compared clinical and biochemical variables between type 2 diabetic patients and non-diabetic patients. Clinical and biochemical parameters were also compared between subjects with type 2 DM who had elevated LP (a) and normal LP (a) levels. Long term glycaemic control using glycosylated haemoglobin was determined and compared in the study subjects. Test statistics used include chi square, correlation coefficient analysis and Student's t test.
Results
The mean Lp(a) concentration differed significantly between type 2 diabetic patients and the Control subjects (18.7 (5.8) mg/dl vs 23 (6.8) mg/dl, 0.00001). Similarly, the prevalence of high LP (a) levels in type 2 DM patients was significantly higher than that of the Control subjects (12.5% vs 4%, p-0.019). The mean levels of the lipid profile parameters (TCHOL, LDL-C, TG, LDL/HDL) and CRP were significantly higher in DM patients than in the Control subjects. The mean LP (a) levels were comparable in both sexes and in DM subjects with and without hypertension. TG was the only parameter that differed significantly between subjects with elevated Lp (a) levels and those with normal Lp (a) levels. There was a significant positive correlation (r) between Lp(a) levels and TG, LDL-C. TCHOL, LDL/HDL and uric acid. No association was found between Lp(a) and clinical parameters such as age and anthropometric indices.
Conclusion
We have showed that Lp (a), CRP and other CVS risk factors cluster more in patients with DM than non DM patients. Serum Lp (a) levels are not associated with anthropometric and glycaemic indices.
doi:10.1186/1758-5996-2-51
PMCID: PMC2919447  PMID: 20663222
7.  The efficacy and safety of Simvastatin in the treatment of lipid abnormalities in diabetes mellitus 
Introduction:
Notable lipid abnormalities in DM include elevated LDL-C which have been reported to be the prevalent lipid abnormality in DM and elevated total cholesterol levels. Although the Statins are widely used in the management of lipid abnormalities, their effects on the lipid abnormalities in Nigerians with DM has not been extensively evaluated.
Objective:
This report sets out to determine the effect of Simvor, a brand of Simvastatin in Nigerians with DM and abnormal lipid profiles.
Materials and Methods:
A total of 300 diabetic patients with abnormal lipid profile who were treatment naοve for lipid disorders were longitudinally recruited for the study. They were managed with Simvastatin (Simvor) in doses ranging from 20-40 mg alongside dietary counseling and exercise recommendation.
Results:
The mean age (SD) of the study subjects was 58.4 (10 years). The male; female ratio was 99:211. The proportions of lipid abnormalities for LDL-C, TCHOL, HDL-C and TG were 87%, 45%, 53% and 7% respectively. Following Simvastatin (Simvor) treatment, the mean LDL-C value was reduced by 16%, TCHOL by 23%, TG by 6% and HDL-C increased by 10%. Simvastatin (Simvor) was generally well tolerated and no cardiovascular events were noted in the study subjects during the period of the study.
Conclusion:
Simvastatin (Simvor) was effective and well tolerated in the management of lipid disorders in Nigerians with DM.
doi:10.4103/2230-8210.107817
PMCID: PMC3659875  PMID: 23776861
Diabetes mellitus; lipid abnormalities; simvastatin
8.  Trends in Prevalence of Dyslipidaemias and the Risk of Mortality in Lithuanian Urban Population Aged 45–64 in Relation to the Presence of the Dyslipidaemias and the Other Cardiovascular Risk Factors 
PLoS ONE  2014;9(6):e100158.
The aim of this study was to provide reliable information on dyslipidaemias, to estimate the trend of the prevalence of dyslipidaemias and other selected cardiovascular disease (CVD) risk factors at population level, and to evaluate the risk of all-cause and CVD mortality in relation to presence of mixed dyslipidaemias and other CVD risk factors.
Methods
Data from the five surveys (1983–2008) are presented. A random sample of 9,209 subjects aged 45–64 was selected for statistical analysis. During follow-up there were 1653 death cases from any cause, 864 deaths from CVD. Estimates of hazard ratios (HR) and 95% confidence intervals (CI) were based on the multivariate Cox proportional hazards regression for all-cause mortality and CVD mortality.
Results
During 25 year period the prevalence of normal total cholesterol level (<5.2 mmol/L) significantly increased only in women; triglycerides and high density lipoprotein (HDL) cholesterol did not change in men and women. Findings in our longitudinal study showed that in men and women mixed dyslipidaemias (HDL cholesterol <1.03 mmol/L plus triglycerides ≥1.70 mmol/L) significantly increased the risk for all-cause and CVD mortality (respectively in men HR = 1.30; HR = 1.15, in women HR = 1.83; HR = 2.13). These mixed dyslipidaemia combinations combination with the other risk factors such as arterial hypertension, high fasting glucose level increased all-cause and CVD mortality risk in men and women; while, these mixed dyslipidaemias plus smoking increased all-cause and CVD mortality risk only in men compared to never smokers without these dyslipidaemias (respectively HR = 1.89; HR = 1.92); and these dyslipidaemias plus obesity increased all-cause and CVD mortality risk in women (respectively HR = 2.25; HR = 2.39) and CVD mortality risk in men (HR = 1.72), as compared to responders without obesity and these dyslipidaemias.
Conclusion
Mixed dyslipidaemias (reduced HDL cholesterol plus elevated triglycerides) significantly increased the risk for all-cause and CVD mortality in this Lithuanian population aged 45–64 years.
doi:10.1371/journal.pone.0100158
PMCID: PMC4067295  PMID: 24955583
9.  Impact of lipid-lowering therapy on the prevalence of dyslipidaemia in patients at high-risk of cardiovascular events in UK primary care – a retrospective database study 
Summary
Aims
To estimate the prevalence of dyslipidaemias in high-risk patients new to lipid-modifying therapy (LMT), and establish the extent to which these lipid abnormalities are addressed by treatment in UK clinical practice.
Methods
The PRIMULA study was a retrospective analysis, conducted using the UK General Practice Research Database. Two periods were studied as follows: a pretreatment period, defined as the 12 months before initiation of LMT (the index date), and a follow-up period of at least 12 months. Patients included in the study (n = 25,011) had dyslipidaemia with at least one abnormal lipid measurement [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) or triglycerides (TG)] in the pretreatment period. All patients were at high risk of cardiovascular events, which was defined as having a history of cardiovascular disease, a 10-year Framingham risk score higher than 20%, diabetes or hypertension, as defined by the Joint British Societies 2 guidelines.
Results
At the index date, 98% of patients were initiated on statin monotherapy. After 12 months of treatment, 15.2% (sub-group range: 11.0–22.9%) of all high-risk patients had no lipid abnormalities. The proportions of patients with high TC or LDL-C levels decreased from 98.8% to 68.9%, and from 99.2% to 68.7%, respectively, over 12 months. The prevalence of high TG levels decreased from 45.0% to 26.9%, whereas that of low HDL-C levels increased, from 16.6% to 18.0%. Risk factors for cardiovascular events were not consistently associated with the likelihood of attaining optimal lipid levels.
Conclusions
Despite widespread use of statins, many individuals at high risk of cardiovascular events have persistently abnormal lipid levels, with over two-thirds of patients not achieving target levels of LDL-C or TC. Management of dyslipidaemia is therefore suboptimal in this important high-risk group in UK standard practice.
doi:10.1111/ijcp.12238
PMCID: PMC4232237  PMID: 23944233
10.  Prevalence and trend of dyslipidaemia from 1996 to 2006 among normal and overweight adolescents in Taiwan 
BMJ Open  2014;4(2):e003800.
Objectives
To evaluate the trend of dyslipidaemia from 1996 to 2006 and examine its relationship with weight status among adolescents in Taiwan.
Design
2 cross-sectional surveys were conducted in 1996 and 2006.
Setting
The junior high schools in Taipei.
Participants
After multistage sampling, total of 1500 and 1283 junior high school students were chosen in 1996 and 2006. After excluding missing data, a total of 1353 (676 boys and 677 girls) and 1203 (585 boys and 618 girls) children were included in the final analyses in 1996 and 2006.
Outcome measures
Anthropometric measures as body height and weight were measured, and body mass index (BMI) was calculated. Blood lipid profiles as total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol were measured.
Results
From 1996 to 2006, the prevalence of dyslipidaemia and hypercholesterolaemia significantly increased from 13% (95% CI 11.3% to 15.0%) to 22.3% (95% CI 20.0% to 24.7%) and 6.2% (95% CI 5.0% to 7.6%) to 13.8% (95% CI 11.9% to 15.9%), respectively. The prevalence of hypertriglyceridaemia and low HDL-C dyslipidaemia increased from 3% (95% CI 1.8% to 4.5%) to 4.3% (95% CI 2.8% to 6.2%) and 6.5% (95% CI 4.8% to 8.6%) to 11.6% (95% CI 9.1% to 14.5%), with significance seen only in boys. When compared with normal weight participants, overweight boys and girls faced a 2-fold and 1.6-fold increased risk of dyslipidaemia, respectively, in the 2006 study. The increased risk of low HDL-C dyslipidaemia for overweight participants was 2.6-fold and 7.2-fold in boys and girls, respectively. In 2006, each unit increment of BMI was associated with 28%, 13% and 13% risk of hypertriglyceridaemia, low HDL-C and dyslipidaemia for boys, and 25% risk of low HDL-C dyslipidaemia in girls.
Conclusions
The prevalence of dyslipidaemia had increased significantly for boys and girls in normal weight and overweight adolescents. Early screening of dyslipidaemia and weight intervention programmes in adolescents will be the key to prevent dyslipidaemia and cardiovascular-related comorbidities.
doi:10.1136/bmjopen-2013-003800
PMCID: PMC3939666  PMID: 24578534
Public Health; Basic Sciences
11.  Lipoprotein Subfractions in Metabolic Syndrome and Obesity: Clinical Significance and Therapeutic Approaches 
Nutrients  2013;5(3):928-948.
Small, dense low density lipoprotein (sdLDL) represents an emerging cardiovascular risk factor, since these particles can be associated with cardiovascular disease (CVD) independently of established risk factors, including plasma lipids. Obese subjects frequently have atherogenic dyslipidaemia, including elevated sdLDL levels, in addition to elevated triglycerides (TG), very low density lipoprotein (VLDL) and apolipoprotein-B, as well as decreased high density lipoprotein cholesterol (HDL-C) levels. Obesity-related co-morbidities, such as metabolic syndrome (MetS) are also characterized by dyslipidaemia. Therefore, agents that favourably modulate LDL subclasses may be of clinical value in these subjects. Statins are the lipid-lowering drug of choice. Also, anti-obesity and lipid lowering drugs other than statins could be useful in these patients. However, the effects of anti-obesity drugs on CVD risk factors remain unclear. We review the clinical significance of sdLDL in being overweight and obesity, as well as the efficacy of anti-obesity drugs on LDL subfractions in these individuals; a short comment on HDL subclasses is also included. Our literature search was based on PubMed and Scopus listings. Further research is required to fully explore both the significance of sdLDL and the efficacy of anti-obesity drugs on LDL subfractions in being overweight, obesity and MetS. Improving the lipoprotein profile in these patients may represent an efficient approach for reducing cardiovascular risk.
doi:10.3390/nu5030928
PMCID: PMC3705327  PMID: 23507795
lipoproteins; small dense low density lipoprotein; obesity; metabolic syndrome; obesity treatment; anti-obesity drugs; lipid-lowering drugs
12.  Overweight and Obesity, Lipid Profile and Atherogenic Indices among Civil Servants in Abakaliki, South Eastern Nigeria 
Background:
The association between dyslipidaemia, obesity and hypertension is well established, and all have been found to be risk factors for cardiovascular disease (CVD).
Aim:
To determine the prevalence of overweight and obesity, plasma lipid profile and atherogenic indices as markers for CVD among civil servants.
Subjects and Methods:
Two hundred and five (205) apparently healthy civil servants (106, 51.7% males) aged 21-60 years, mean and standard deviation (SD) 40.9 (11.3) years, enrolled between February and April 2008 were assessed for their plasma lipid profile and anthropometrics (body weight and height) using standard methods and techniques.
Results:
Prevalent rates of overweight and obesity were 34.2% (70/205) and 6.8% (14/205), respectively, with more men affected than women. Abnormal lipids observed were: Elevated total cholesterol 37.1% (76/205), low-density lipoprotein-cholesterol (LDL-C) 37.1% (76/205), triglyceride 6.8% (14/205), reduced high-density lipoprotein-cholesterol (HDL-C) 8.8% (18/205) and elevated Atherogenic Index 10.7% (22/205) and Coronary Risk Index 9.8% (20/205), with the older age groups and higher Body Mass Index (BMI) groups being the most affected. Male subjects were found to have more favorable plasma lipid profile (lower LDL-C and higher HDL-C) than the females. Plasma lipids were positively correlated with BMI and artherogenic indices, except for HDL-C, which was negatively correlated with artherogenic indices and LDL-C but positively correlated with BMI.
Conclusion:
The findings show that civil servants in Abakaliki, particularly the females, those with higher BMI and advanced in age, exhibited unfavorable plasma lipids and social habits with a low level of physical activity, which may predispose them to CVD. In addition to epidemiological study of the general population, there is a need for education on healthier lifestyles such as good nutrition, weight reduction, smoking and alcohol cessation, greater physical activity and regular medical check-up.
doi:10.4103/2141-9248.109462
PMCID: PMC3634213  PMID: 23634323
Cardiovascular disease; Dyslipidaemia; Obesity; Overweight
13.  Comparative analysis of lipid profiles among patients with type 2 diabetes mellitus, hypertension and concurrent type 2 diabetes, and hypertension: a view of metabolic syndrome. 
Type 2 diabetes mellitus and hypertension are independent risk factors for atherosclerotic lesions that are partly linked with dyslipidaemia. This risk is additive when diabetes and hypertension occur concurrently. In order to determine if concurrent type 2 diabetes and hypertension results in putative increases in dyslipidaemia in a Nigerian population, we compared the plasma lipid levels, atherogenic index and prevalence of dyslipidaemia among age and sex-matched indigenous Nigerians with type 2 diabetes, hypertension and concurrent diabetes and hypertension. Age and sex-matched healthy Nigerians that are free of diabetes and hypertension served as controls. The patients as a whole were more likely to have dyslipidaemia than controls (p < 0.05). High-density lipoprotein cholesterol was similar among patients and controls. Mean total cholesterol, high-density lipoprotein cholesterol; low-density lipoprotein cholesterol and triglyceride levels, atherogenic index and prevalence of dyslipidaemia did not differ significantly among patients with hypertension, diabetes, and concurrent hypertension and diabetes (p = 0.99 for each parameter). It is concluded that concurrent hypertension and type 2 diabetes does not result in a more severe dyslipidaemia than when either of the two conditions occurs in isolation. We attribute this to the common pathogenic link between hypertension, diabetes and dyslipidaemia in metabolic syndrome. Evidence, albeit indirect, of this syndrome among native Africans is, therefore, provided.
PMCID: PMC2594520  PMID: 12793789
14.  Dyslipidaemia as a predictor of hypertension in middle-aged men 
European Heart Journal  2008;29(20):2561-2568.
Aims
Dyslipidaemia and hypertension are features of the metabolic syndrome, but the role of dyslipidaemia in the development of hypertension is less clear. We assessed the association of dyslipidaemia with incident hypertension during a 7-year follow-up in a population-based cohort of middle-aged men without hypertension at baseline.
Methods and results
In all, 88 of 311 men developed hypertension during the follow-up. A 1-SD increment in triglyceride concentrations was associated with a 1.6-fold [95% CI(confidence interval) 1.2–2.3] increased risk of developing hypertension, independently of features related to the metabolic syndrome. In separate multivariable models, the triglyceride content of high-density lipoprotein (HDL) cholesterol and apolipoprotein B concentrations were also associated with new-onset hypertension. In a stepwise backwards logistic regression model, concentrations of low-density lipoprotein (LDL) cholesterol [odds ratio (OR) 1.3, 95% CI 1.0–1.7 for a 1-SD change] and triglyceride content of HDL cholesterol (OR) 1.5, 95% CI 1.1–1.9) were positively associated with incident hypertension, whereas HDL concentrations (OR 0.7, 95% CI 0.5–0.9) seemed protective. In factor analyses, elevated triglyceride levels and related disturbances in lipid and cholesterol metabolism were associated with new-onset hypertension.
Conclusion
Dyslipidaemia characteristic of the metabolic syndrome predicts the development of hypertension during a 7-year follow-up of eastern Finnish men, independently of features related to insulin resistance. The recognition of dyslipidaemia and initiation of lifestyle treatment even in the absence of hypertension is likely to reduce the long-term burden of cardiovascular disease.
doi:10.1093/eurheartj/ehn061
PMCID: PMC2721716  PMID: 18308688
Hypertension; Lipoproteins; Apolipoproteins; Triglycerides; Lipoprotein triglycerides; Cohort studies
15.  Dyslipidaemic Pattern of Patients with Type 2 Diabetes Mellitus 
The aim of the study was to define dyslipidaemic pattern among type 2 diabetic patients using American Diabetes Association guidelines for the classification of lipoprotein concentrations into CVD risk categories. The total number screened was 211 type 2 diabetic patients who were on treatment between 2001 – 2002 for diabetes at the Outpatient Diabetes Clinic in HUSM Kubang Kerian. Fasting venous blood samples were analysed for plasma glucose, glycated hemoglobin and serum lipids. Type 2 diabetic patients with high, borderline, and low risk LDL cholesterol level were 62 %, 25 %, and 10 %, respectively. There were 26 % patients in the high risk HDL cholesterol group, 31 % were in the borderline risk group, and 43 % were in the low risk group. Only 3 % and 25 % of patients had triglycerides concentration in the high and borderline risk categories, respectively, but 72 % had low risk triglycerides levels. More female and younger subjects than men and older subjects had HDL cholesterol in high and borderline risk categories. The percentages of patients with triglycerides values at high and borderline high risk category were higher in poor and acceptable glycaemic control groups than good glycaemic control group. The most prevalent dyslipidaemia pattern was an isolated LDL cholesterol increase, which was observed in 35 % of the patients. The second most common pattern of dyslipidaemia was a combination of LDL cholesterol above goal with HDL cholesterol below target, which was observed in 30 % patients. Patients with established dyslipidaemia will require advice regarding diet, exercise and improvement in glycaemic control. An active strategy of early detection and drug treatment for dyslipidaemia is needed for type 2 diabetic patients.
PMCID: PMC3438150  PMID: 22977359
Dyslipidaemia; Type 2 Diabetes
16.  Urban-Rural Differences in Atherogenic Dyslipidaemia (URDAD Study): A Retrospective Report on Diabetic and Non-diabetic Subjects of Northern India 
ABSTRACT
Diabetes and urbanization are major contributors to increased risk factors of cardiovascular diseases. Studying whether atherogenic dyslipidaemia increases with urbanization in type 2 diabetes mellitus is, therefore, important. The sample of the present study consisted of 400 subjects. They were categorized according to residential area and diabetes into four groups: urban diabetic group, urban non-diabetic control group (from a metropolitan city Delhi), rural non-diabetic diabetic group, and rural control group (from villages of Khanpur Kalan, Sonepat, Haryana). Differences in lipid levels and risk factors of emerging cardiovascular diseases between groups were evaluated with analysis of variance. Diabetic patients of both urban and rural areas had significantly higher total cholesterol (TC), triglycerides (TG), very low-density lipoproteins (VLDL), TC to high-density lipoprotein cholesterol (TC/HDL) ratio, TG to high-density lipoprotein cholesterol (TG/HDL) ratio, and atherogenic index (AI) compared to respective controls (p<0.05). The HDL concentrations in urban diabetics were significantly lower (p<0.05) than in urban non-diabetic group and rural diabetic group. Comparison between urban and rural diabetic groups showed significantly higher atherogenic dyslipidaemia (AD) in the urban patient-group (p<0.05). We evaluated significant relationships of diabetes and urbanization with AD by multiple regression analysis. Receiver operating curve (ROC) analysis showed high area under curve (AUC) for TG/HDL in urban diabetic group (0.776, p<0.0001) and in rural diabetic group (0.692, p<0.0001). It is concluded that diabetes was associated with higher AD parameters. Urbanization in diabetes is also associated with elevated levels of AD, indicating higher risk in urban population. This study suggests that TG/HDL may be particularly useful as atherogenic risk predictor in newly-diagnosed type 2 diabetic patients.
PMCID: PMC4221455  PMID: 25395912
Atherogenic dyslipidaemia; Atherogenic index; Diabetes; Urbanization; India
17.  Primary prevention of CVD: treating dyslipidaemia 
Clinical Evidence  2008;2008:0215.
Introduction
The incidence of dyslipidaemia is high: in 2000, approximately 25% of adults in the USA had total cholesterol greater than 6.2 mmol/L or were taking lipid-lowering medication. Primary prevention in this context is defined as long-term management of people at increased risk but with no clinically overt evidence of CVD — such as acute MI, angina, stroke, and PVD — and who have not undergone revascularisation.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of pharmacological cholesterol-lowering interventions in people at low risk (less than 0.6% annual CHD risk); at medium risk (0.6-1.4% annual CHD risk); and at high risk (at least 1.5% annual CHD risk)? What are the effects of reduced or modified fat diet? We searched: Medline, Embase, The Cochrane Library and other important databases up to March 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: fibrates, niacin, reduced- or modified-fat diet, resins, and statins.
Key Points
Dyslipidaemia, defined as elevated total or low-density lipoprotein (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL) cholesterol, is an important risk factor for coronary heart disease (CHD) and stroke. The incidence of dyslipidaemia is high: in 2000, approximately 25% of adults in the US had total cholesterol greater than 6.2 mmol/L, or were taking lipid-lowering medication.There is a continuous, graded relationship between the total plasma cholesterol concentration and ischaemic heart disease (IHD) morbidity and mortality. IHD is the leading single cause of death in high-income countries and second in low- and middle-income countries.Primary prevention in this context is defined as long-term management of people at increased risk, but with no clinically overt evidence of CVD, such as MI, angina, stroke, and peripheral vascular disease, and who have not undergone revascularisation.
Statins have been shown to be highly effective, particularly in treating people at high risk of CHD (more than 1.5% annually). Although effective in people in all risk categories (low risk, medium risk) , it appears that the magnitude of benefit is related to the individual's baseline risk of CHD events.
In people at medium risk of CHD (0.6%-1.4% annually), fibrates have been shown to effectively reduce the rate of CHD, but not of overall mortality, compared with placebo. Resins may also be beneficial in reducing non-fatal MI and CHD death in this group, but we found no evidence relating to the effects of niacin.We found no evidence that examined the efficacy of niacin, fibrates, or resins in people either at low or high risk of CHD.
The effectiveness of reduced-fat diets to reduce cardiovascular events in primary prevention is unclear.
PMCID: PMC2907953  PMID: 19450334
18.  Primary prevention of CVD: treating dyslipidaemia 
Clinical Evidence  2010;2010:0215.
Introduction
The incidence of dyslipidaemia is high: in 2000, approximately 25% of adults in the USA had total cholesterol greater than 6.2 mmol/L or were taking lipid-lowering medication. Primary prevention in this context is defined as long-term management of people at increased risk but with no clinically overt evidence of CVD — such as acute MI, angina, stroke, and PVD — and who have not undergone revascularisation.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of pharmacological cholesterol-lowering interventions in people at low risk (less than 0.6% annual CHD risk); at medium risk (0.6–1.4% annual CHD risk); and at high risk (at least 1.5% annual CHD risk)? What are the effects of reduced or modified fat diet? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: ezetimibe, fibrates, niacin (nicotinic acid), reduced- or modified-fat diet, resins, and statins.
Key Points
Dyslipidaemia, defined as elevated total or low-density lipoprotein (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL) cholesterol, is an important risk factor for coronary heart disease (CHD) and stroke. The incidence of dyslipidaemia is high: in 2000, approximately 25% of adults in the US had total cholesterol greater than 6.2 mmol/L, or were taking lipid-lowering medication.There is a continuous, graded relationship between the total plasma cholesterol concentration and ischaemic heart disease (IHD) morbidity and mortality. IHD is the leading single cause of death in high-income countries and the second in low- and middle-income countries.Primary prevention in this context is defined as long-term management of people at increased risk, but with no clinically overt evidence of CVD, such as MI, angina, stroke, and peripheral vascular disease, and who have not undergone revascularisation.
Statins have been shown to be highly effective, particularly in treating people at high risk of CHD (at least 1.5% annual risk of CHD). Although effective in people in all risk categories (low risk, medium risk), it seems that the magnitude of benefit is related to the individual's baseline risk of CHD events.
In people at medium risk of CHD (0.6–1.4% annual risk of CHD), fibrates have been shown to reduce the rate of CHD, but not of overall mortality, compared with placebo. We don't know whether resins are beneficial in reducing non-fatal MI and CHD death in people at medium risk of CHD. We found no evidence relating to the effects of niacin (nicotinic acid) in people at medium risk of CHD.We found no evidence that examined the efficacy of niacin, fibrates, or resins in people either at low or high risk of CHD. We found no evidence on the effects of ezetimibe in people at low, medium, or high risk of CHD events.
A reduced- or modified-fat diet may be beneficial in reducing cardiovascular events in people at risk of CHD events.
PMCID: PMC3217758  PMID: 21418693
19.  Lipid and lipoprotein levels and trends in rheumatoid arthritis compared to the general population 
Arthritis care & research  2013;65(12):2046-2050.
Objectives
Differences in lipid levels associated with cardiovascular (CV) risk between rheumatoid arthritis (RA) and the general population remain unclear. Determining these differences is important in understanding the role of lipids in CV risk in RA.
Methods
We studied 2,005 RA subjects from two large academic medical centers. We extracted electronic medical record (EMR) data on the first low density lipoprotein (LDL), total cholesterol (TChol) and high density lipoprotein (HDL) within 1 year of the LDL. Subjects with an electronic statin prescription prior to the first LDL were excluded.
We compared lipid levels in RA to levels from the general United States population (Carroll, et al., JAMA 2012), using the t-test and stratifying by published parameters, i.e. 2007–2010, women. We determined lipid trends using separate linear regression models for TChol, LDL and HDL, testing the association between year of measurement (1989–2010) and lipid level, adjusted by age and gender. Lipid trends were qualitatively compared to those reported in Carroll, et al.
Results
Women with RA had a significantly lower Tchol (186 vs 200mg/dL, p=0.002) and LDL (105 vs 118mg/dL, p=0.001) compared to the general population (2007–2010). HDL was not significantly different in the two groups. In the RA cohort, Tchol and LDL significantly decreased each year, while HDL increased (all with p<0.0001), consistent with overall trends observed in Carroll, et al.
Conclusion
RA patients appear to have an overall lower Tchol and LDL than the general population, despite the general overall risk of CVD in RA from observational studies.
doi:10.1002/acr.22091
PMCID: PMC4060244  PMID: 23925980
20.  Impact of Fenofibrate on Type 2 Diabetes Patients with Features of the Metabolic Syndrome: Subgroup Analysis From FIELD 
Current Cardiology Reviews  2010;6(2):112-118.
Given evidence of increasing prevalence in developed and developing countries, as a result of obesity trends and sedentary lifestyles, the metabolic syndrome represents an increasing burden on healthcare systems. Management guidelines for dyslipidaemia have primarily focused on LDL-C reduction; however, this approach fails to sufficiently address other lipid abnormalities associated with the metabolic syndrome. Atherogenic dyslipidaemia (characterized by elevated triglycerides and low HDL-C) is strongly associated with insulin-resistant states, such as type 2 diabetes and the metabolic syndrome, and is also a common finding among patients receiving treatment for dyslipidaemia. Intervening against atherogenic dyslipidaemia may address a substantial modifiable fraction of residual cardiovascular risk that remains after treatment with a statin. Recent findings from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study support this view. Fenofibrate treatment was shown to be especially effective in treating marked atherogenic dyslipidaemia, with a significant 27% relative risk reduction for cardiovascular events (P=0.0005, vs. 11%, P=0.035 for all patients) relative to placebo. These data, together with the earlier demonstration of significant microvascular benefits associated with this treatment, suggest a role for fenofibrate, in addition to statin therapy and lifestyle intervention, for reducing global vascular risk in type 2 diabetes patients and for impacting atherogenic dyslipidaemia associated with the metabolic syndrome.
doi:10.2174/157340310791162686
PMCID: PMC2892076  PMID: 21532777
Metabolic syndrome; cardiovascular risk; PPARα agonists; fenofibrate; type 2 diabetes.
21.  Residual macrovascular risk in 2013: what have we learned? 
Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.
doi:10.1186/1475-2840-13-26
PMCID: PMC3922777  PMID: 24460800
Residual cardiovascular risk; Atherogenic dyslipidaemia; Type 2 diabetes; Therapeutic options
22.  Pitavastatin: Finding its Place in Therapy 
Dyslipidaemia is a major risk factor for cardiovascular (CV) disease. Despite the widespread availability of effective lipid-lowering agents, an unacceptably large proportion of patients fail to attain their target low-density lipoprotein cholesterol (LDL-C) level in clinical practice. Reasons for this include undertreatment, poor adherence/persistence with therapy and failure to address non-LDL-C residual risk factors such as high levels of triglycerides, low high-density lipoprotein cholesterol (HDL-C) concentrations and raised apolipoprotein B: apolipoprotein A1 ratios. Pitavastatin is a novel, well-tolerated statin with a noninferior or superior lipid-lowering efficacy to comparable doses of atorvastatin, simvastatin, and prava-statin in a wide range of patients with hypercholesterolemia or combined dyslipidaemia. Compared with other statins, pitavastatin produces consistently greater increases in HDL-C levels that are sustained over the long term. In addition to pravastatin's potent effects on lipid profiles, a number of pleiotropic benefits have been identified that may contribute to a reduction in residual cardiovascular risk in people with dyslipidaemia and could partly account for pitavastatin's ability to regress coronary plaques in patients with acute coronary syndrome. Pitavastatin's unique metabolic profile results in a high efficacy at low (1-4 mg) doses and minimal drug interactions with cytochrome CYP3A4 substrates, making it an excellent choice for people requiring multiple medications. Although future trials are required to assess the impact of pitavastatin treatment on CV morbidity and mortality, studies to date suggest that pitavastatin will play an important role in the future management of dyslipidaemia and in the overall reduction of CV risk.
doi:10.1177/2040622310389227
PMCID: PMC3513875  PMID: 23251745
cardiovascular; dyslipidaemia; hypercholesterolemia; lipid; pitavastatin; statin
23.  A Study on Interleukin —1β and Lipid Profile as Markers of Cardiovascular Risk in Rheumatoid Arthritis 
Introduction: The dyslipidaemia in Rheumatoid Arthritis (RA) is associated with accelerated atherosclerosis. A prospective clinical evaluation study was undertaken to find out the proportion of the rheumatoid arthritis patients who were suffering from dyslipidaemia, the change in the lipid levels and the disease activity after an intervention with antirheumatic therapy.
Aims and Objectives: To study the disease activity in Rheumatoid arthritis patients by measuring the serum levels of interleukin-1β (IL-1 β), to find out the proportion of rheumatoid arthritis patients who were suffering from dyslipidaemia, to correlate the disease activity with the lipid profile and to look for the change in the lipid levels and the disease activity after an intervention with antirheumatic therapy.
Material and Methods: This study was done on 30 RA patients (fulfilling the American College of Rheumatology criteria). The lipid profile estimation was done by an enzymatic, colourimetric method and IL-1β was estimated by a chemiluminescence method. Dyslipidaemia was defined by taking the cut-off values of the NCEP-ATPIII guidelines. The patients with other comorbid illnesses and those who were on statins were excluded. The patients were followed up after 12 weeks of starting with the anti-rheumatic therapy.
Results: 36.7% of the patients had high total cholesterols, 53.3% of the patients had high triacylglycerol levels, 73.3% of the patients had decreased HDL-cholesterol and 33.3% of the patients had high LDL-cholesterols. 86.7% of the patients had IL-1β levels which were above the reference range. After the treatment, the number of patients with dyslipidaemia came down, with 23.3% patients having high total cholesterol levels, 43.3% of the patients having elevated triacylglycerol levels, 46.7% patients having low HDL-cholesterol levels and 20% patients having elevated LDL-cholesterol levels. 66.7% of the patients had IL-1β which was above the reference range.
Conclusion: The proportion of dyslipidaemic patients had decreased in the follow up visit, along with a decrease in the disease activity, as were indicated by the decreased levels of IL-1β. The management of dyslipidaemia in RA should be a part of the general cardiovascular risk management. Therefore, a good control of the disease activity should be given priority, so that both the quality of life and the long-term outcomes can be improved.
doi:10.7860/JCDR/2013/6110.3122
PMCID: PMC3749620  PMID: 23998050
Cardiovascular risk; Dylipidaemia; Interleukin-1β; Rheumatoid arthritis
24.  Plasma lipids, lipoproteins, and apolipoproteins in Nigerian diabetes mellitus, essential hypertension, and hypertensive-diabetic patients. 
Plasma lipids, lipoproteins, and apolipoproteins were assessed in three groups of Nigerians at increased risk for atherosclerotic heart disease. The three patient groups, diabetes mellitus (n = 15), essential hypertension (n = 12), and hypertensive-diabetes mellitus (n = 11), were compared with age-matched, apparently healthy controls (n = 14). In subjects with diabetes mellitus, triglyceride and its related apolipoproteins CIII and CIII:NonB were significantly higher than controls. High-density lipoprotein cholesterol (HDL-C) was significantly lower; its related ratios, total/HDL-C and low-density lipoprotein cholesterol (LDL-C)/HDL-C were significantly higher than those for controls. Subjects with hypertension and hypertensive-diabetes mellitus had significantly higher values than controls for those lipids and lipid fractions considered atherogenic (total cholesterol, LDL-C, triglyceride, and the total/HDL-C and LDL-C/HDL-C ratios) as well as apolipoproteins B, CIII, and lipoprotein particles Lp(a) and CIII:NonB. Only hypertensive-diabetes mellitus subjects had lower HDL-C levels, while hypertension patients had significantly higher apolipoprotein AI and LpAI concentrations than controls. Subjects with hypertensive-diabetes mellitus had significantly worse lipid, lipoprotein, and apolipoprotein profiles both in terms of increased atherogenic and reduced anti-atherogenic parameters compared with subjects with diabetes mellitus or hypertension only. These studies suggest that Nigerians with diabetes, hypertension, and especially both hypertension and diabetes need to be fully evaluated from a lipid and lipoprotein standpoint, and any abnormalities detected need to be taken into consideration during therapy of this group of high-risk patients.
PMCID: PMC2607772  PMID: 7897682
25.  Comparing the effects of insulin glargine and thiazolidinediones on plasma lipids in type 2 diabetes: a patient-level pooled analysis 
Background
The prevalence of dyslipidaemia and the risk of cardiovascular disease are elevated in patients with type 2 diabetes. This analysis compared the effects of insulin glargine versus thiazolidinediones (TZDs) on lipid profiles.
Methods
Patient-level data were pooled from two randomized clinical studies. The population included 552 men and women aged >18 years, diagnosed with type 2 diabetes for at least 6 months, on metformin and/or sulphonylurea, and with A1C ≥7.5% and <12.0% at screening. Lipid outcome measures included change from baseline in lipid levels [low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol, triglycerides, and free fatty acids] and attainment of lipid goals for LDL-C, non-HDL-C, and triglycerides.
Results
Both insulin glargine and TZDs improved lipid profiles from baseline values. Compared with TZDs, treatment with insulin glargine led to 7.9% greater reduction in LDL-C (p < 0.0003), 7.5% greater reduction in non-HDL-C (p < 0.0001), and 7.8% greater reduction in total cholesterol (p < 0.0001), whereas the HDL-C increase with TZD was 7.6% greater than that with insulin glargine (p < 0.0001). The percentage of patients attaining the lipid goals was comparable between insulin glargine and pioglitazone, but lower for rosiglitazone. Insulin glargine improved glycaemic control more than TZDs; however, insulin glargine caused more hypoglycaemia. Treatment with TZDs caused more weight gain and peripheral oedema.
Conclusion
These findings suggest that the favourable effects of insulin glargine on plasma lipid profiles should be considered among the advantages of treatment with insulin glargine as they are for TZDs. Copyright © 2011 John Wiley & Sons, Ltd.
doi:10.1002/dmrr.1305
PMCID: PMC3380564  PMID: 22081557
insulin glargine; lipids; thiazolidinediones; type 2 diabetes

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