BACKGROUND AND AIM: China faces dual challenges of ageing and obesity, yet long-term cohort evidence on obesity trajectories in midlife and older adulthood remains limited. METHODS AND RESULTS: Utilizing the Kunshan Agei...BACKGROUND AND AIM: China faces dual challenges of ageing and obesity, yet long-term cohort evidence on obesity trajectories in midlife and older adulthood remains limited. METHODS AND RESULTS: Utilizing the Kunshan Ageing Research with E-health cohort, we analyzed 2014-2024 obesity trends using professionally measured anthropometrics (repeated cross-sections, n = 69,880-118,639) and individual transition patterns (longitudinal analysis, n = 40,335-42,601). Over ten years, overall obesity prevalence among middle-aged/older adults rose significantly from 38.43% to 44.01%. Abdominal obesity surged from 42.91% to 54.64%. Metabolically unhealthy overweight/obesity (MUO) consistently predominated (>50%), yet metabolically healthy overweight/obesity (MHO) prevalence also increased markedly (13.18% to 19.10%). Longitudinally, 52.34% changed BMI category. Individuals with overweight progressed to obesity at 38.32%, while only 4.80% of those with obesity achieved normal weight. Abdominal obesity proved persistent, especially in women (59.46% maintained). Metabolically, 48.00% of MHO transitioned to MUO; 20.00% of metabolically unhealthy normal weight (MONW) individuals regained metabolic health. CONCLUSIONS: Obesity burden has risen markedly, with faster increases in men and high rates in older women. Because overweight appeared more modifiable than established obesity, midlife may be a key period for prevention, while combined monitoring of BMI, waist circumference, and metabolic markers in older adults may help identify high-risk individuals.
BACKGROUND AND AIM: There is a rising prevalence of cardiovascular disease (CVD) and CVD-related deaths in Nigeria, and a pressing need for targeted prevention strategies. However, robust evidence on cholesterol distribu...BACKGROUND AND AIM: There is a rising prevalence of cardiovascular disease (CVD) and CVD-related deaths in Nigeria, and a pressing need for targeted prevention strategies. However, robust evidence on cholesterol distribution, and population-specific lipid thresholds to guide risk assessment in Nigerian populations is lacking. This study aimed to describe sex- and age-specific distributions of total cholesterol, LDL-cholesterol (LDL-C), non-HDL cholesterol, and triglycerides in rural Nigerian adults, and to determine percentile-based lipid thresholds for this population. METHODS AND RESULTS: A cross-sectional study of 1309 adults (577 men, 732 women) was conducted in a tertiary hospital in Southern Nigeria. Blood test results collected over an 8-month period (April-November 2022) were analysed. Cholesterol distributions by sex and age-group were described, and 95th percentile lipid-thresholds were determined. Overall, 46.8% of participants had raised total cholesterol (mean 198.93 mg/dl (SD 57.81)), 14.6% had raised LDL-C (mean 120.83 mg/dl (SD 51.62)), and 27.9% had raised triglycerides (triglycerides 128.83 mg/dl (SD 75.26). Women had higher mean values than men for total cholesterol (203.3 mg/dl vs 193.4 mg/dl), LDL-C (125.1 mg/dl vs 115.5 mg/dl), and non-HDL cholesterol (148.4 mg/dl vs 141.1 mg/dl). The 95th percentile values for total cholesterol and LDL-C in the population were 294 mg/dl (7.6 mmol/L) and 205.7 mg/dl (5.3 mmol/L) respectively. CONCLUSIONS: Nearly half of rural Nigerian adults have dyslipidaemia, with women at disproportionately higher risk. The derived 95th percentile lipid thresholds may represent population-specific cut-offs for increased risk of atherosclerotic CVD within this population and similar settings in Nigeria. Evidence from this study will aid targeted interventions to reduce the hypercholesterolaemia burden and consequent atherosclerotic CVD risk.
BACKGROUND AND AIM: It has been suggested that foods abundant in anthocyanins may offer a range of health benefits. This study aimed to assess the effects of anthocyanin-rich dried fruits on cardiometabolic biomarkers an...BACKGROUND AND AIM: It has been suggested that foods abundant in anthocyanins may offer a range of health benefits. This study aimed to assess the effects of anthocyanin-rich dried fruits on cardiometabolic biomarkers and urinary polyphenols in coronary artery disease (CAD) patients. METHODS AND RESULTS: A randomized, parallel design was employed with CAD patients post-angioplasty (ages 30-75). Participants were assigned to either a control group or a group consuming 30g black raisins, 20g dried sour cherries, and 2g cranberry powder (∼66 mg anthocyanins) for 8 weeks. Urinary total polyphenols, plasma inflammatory factors, uric acid, lipids, insulin, the capacity of apo B-depleted plasma to efflux cholesterol were measured at baseline and following 8 weeks of intervention. Sixty-three patients completed the study (control, n = 32; anthocyanin-rich fruits group, n = 31). Compared to the control, the anthocyanin-rich fruits group exhibited a substantial increase in urinary total polyphenol excretion and a significant reduction in plasma uric acid (mean change and confidence interval: control, 0.2 mg/dL [-0.3, 0.6]; anthocyanin-rich fruits, 1.2 mg/dL [0.7, 1.8]; p < 0.01). This reduction correlated negatively with the change in urinary total flavanols (r = -0.351; p < 0.01). A non-significant tendency toward lower low-density lipoprotein cholesterol in anthocyanin-rich fruits was observed (p = 0.06). No significant between-group differences were found in plasma cholesterol efflux capacity or inflammatory biomarkers. CONCLUSIONS: This study demonstrates that modest anthocyanin intake from selected dried fruits increased urinary polyphenol excretion and reduced plasma uric acid in CAD patients, but did not affect lipid profiles, inflammation, or glycemic indices. Further research is needed to explore the precise mechanisms of action. TRIAL REGISTRATION: NCT05995002, dated 08 August 2023.
BACKGROUND AND AIMS: Hyperlipidemia and diabetes mellitus (DM) often occur together, increasing the risk of cardiovascular disease and premature death. While both conditions have been studied separately, national trends...BACKGROUND AND AIMS: Hyperlipidemia and diabetes mellitus (DM) often occur together, increasing the risk of cardiovascular disease and premature death. While both conditions have been studied separately, national trends in deaths related to their combination are not well understood. This study examines 25-year mortality trends associated with hyperlipidemia and DM among U.S. adults aged ≥25 years. METHODS AND RESULTS: We analyzed the CDC WONDER Multiple Cause-of-Death database (1999-2024) to identify adult deaths with ICD-10 codes E78 (hyperlipidemia) and E10-E14 (DM) listed as underlying or contributing causes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the direct method, standardized to the 2000 U S. POPULATION: Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Between 1999 and 2024, 595,203 deaths were attributed to hyperlipidemia with DM. AAMRs increased from 2.79 to 17.24, with an AAPC of 7.57 (95% CI: 6.28-9.19; p < 0.001). The fastest increase occurred from 1999 to 2004 (APC: 16.14), followed by a slower rise (APC: 5.52; p = 0.008). Mortality rates were consistently higher in men (12.22) than women (7.28) and in older adults (≥65 years: 37.88). Non-Hispanic American Indian/Alaskan Natives (13.16) and non-Hispanic Blacks (12.36) had the highest mean AAMRs. Regionally, the West (10.30) and Midwest (10.05) had the highest mean AAMRs, with the South demonstrating the fastest increase over time. Rural areas showed sharper increases than urban areas (AAPC: 8.96 vs. 8.00), though this urban-rural analysis was limited to 1999-2020 due to data availability. CONCLUSION: Mortality due to hyperlipidemia and DM has increased substantially, especially among vulnerable subgroups, highlighting the need for targeted metabolic and equity-focused interventions.
BACKGROUND AND AIM: Elevated Lp(a) is identified an independent risk factor for atherosclerosis. Coronary artery calcium scoring has become a routine clinical test in preventive cardiology to predict subclinical atherosc...BACKGROUND AND AIM: Elevated Lp(a) is identified an independent risk factor for atherosclerosis. Coronary artery calcium scoring has become a routine clinical test in preventive cardiology to predict subclinical atherosclerotic cardiovascular disease. The link between these two entities is not fully understood. The present study evaluates the association between exposure to a high circulating level of Lp(a) (≥50 mg/dl or ≥125 nmol/L) and advanced coronary artery calcification defined by a coronary artery calcium score ≥400 Agatston Unit in asymptomatic patients. METHODS AND RESULTS: A retrospective analysis was performed on 3697 subjects admitted for primary prevention and who underwent coronary artery calcium scoring, carotid arteries doppler ultrasound and at least one Lp (a) measurement between November 2015 and November 2024. The study population was divided into two groups: the non-pooled group including participants with CACS≥ 400AU versus the pooled group including participants with (100AU ≤ CACS<400AU) and (0≤CACS<100AU). Lp(a) was analysed as dichotomous and continuous variable. The mean of Lp(a) (42 ± 21<47 ± 26<58 ± 31 mg/dl, p = 0.351), the proportion of patients with high Lp(a) (25.1% < 26.5%<31.6%, p = 0.004) and the prevalence of carotid atherosclerosis (15.6% < 31%<45.7%, p = 0.001) increase while passing from low (0-99AU) to moderate (100-399AU) to high (≥400AU) CACS, respectively. Only the difference in means of Lp(a) among subgroups failed to achieve the statistical significance. The adjusted logistic regression model revealed a significant association between CACS≥400AU and Lp(a) when analysed either as dichotomous variable [adjusted OR = 1.666, 95%CI(1.342-2.070), p = 0.001] or continuous variable [adjusted OR = 1.041, 95%CI(1.011-1.071), p = 0.007] and carotid atherosclerosis [adjusted OR = 2.212, 95%CI(1.804-2.713), p = 0.001], respectively. The Spearman's Correlation Coefficient showed a weak positively significant correlation between CACS and Lp(a) (ρ = 0.052, p = 0.001). CONCLUSION: High circulating level of Lp(a) is a marker of advanced coronary artery calcification in patients who are not recognized for cardiovascular disease.
AIMS: This review aimed to examine the dose-response relationship between remnant cholesterol (RC) levels and CVD events in individuals with diabetes as well as high-to-low status of RC levels, highlighting its potential...AIMS: This review aimed to examine the dose-response relationship between remnant cholesterol (RC) levels and CVD events in individuals with diabetes as well as high-to-low status of RC levels, highlighting its potential clinical significance. DATA SYNTHESIS: This systematic review and meta-analysis followed the PRISMA guidelines and the PICO framework. The protocol was registered in PROSPERO (CRD420251031888). A comprehensive search was conducted up to April 10, 2025. Outcomes were pooled using random-effects models, and dose-response relationships were assessed with restricted cubic splines (RCS). Our meta-analysis pooled data from 2,276,576 participants included in fifteen studies. Higher remnant cholesterol compared with referenced level was associated with higher cardiovascular events, including: MACE, as defined including non-fatal myocardial infarction (MI), stroke, CVD death, and revascularization (Pooled HR = 1.64 (95% CI: 1.16-2.30, I = 91.7%)), revascularization (Pooled HR = 1.44 (95% CI: 1.22-1.70)), and ischemic stroke (Pooled HR = 1.12 (95% CI: 1.01-1.24)). Relationship with all-cause mortality, non-fatal MI, and atherosclerotic cardiovascular disease (ASCVD) was not significant. Dose-response analysis with RCS model revealed a statistically significant relationship between remnant cholesterol and the risk of MACE (p < 0.0001), myocardial infarction (p = 0.0008) ischemic stroke (p < 0.05). CONCLUSIONS: Higher remnant cholesterol levels are associated with increased cardiovascular risk in diabetes. The dose-response analysis supports its role as an important biomarker for cardiovascular risk, suggesting a potential for clinical use alongside traditional lipid markers.
Corica D, Di Bonito P, Marzuillo P
… +10 more, Licenziati MR, Di Sessa A, Miraglia Del Giudice E, Faienza MF, Calcaterra V, Franco F, Maltoni G, Wasniewska M, Valerio G, Obesity Study Group of Italian Society of Pediatric Endocrinology and Diabetology, ISPED
BACKGROUND AND AIM: Glomerular hyperfiltration (GHF) is considered an early manifestation of obesity-related glomerulopathy. While reduced estimated glomerular filtration rate (eGFR) correlates with thyroid hormone (THs)...BACKGROUND AND AIM: Glomerular hyperfiltration (GHF) is considered an early manifestation of obesity-related glomerulopathy. While reduced estimated glomerular filtration rate (eGFR) correlates with thyroid hormone (THs) sensitivity, its relationship with hyperfiltration remains unexplored. To evaluate the association between sensitivity to THs and GHF in youths with overweight (OW) or obesity (OB). METHODS AND RESULTS: In this cross-sectional study, 654 youths with OW/OB (aged 6-18years), with eGFR >90 mL/min/1.73 m, and with normal THs were included. eGFR was calculated using full age spectrum equation. GHF was defined both as eGFR >120 mL/min/1.73 m and by considering a reference based on the age range of our population, specifically eGFR >135 mL/min/1.73 m. The fT3/fT4 ratio was evaluated to assess peripheral sensitivity, while TSH index (TSHI), Thyrotroph T4 Resistance Index (TT4RI), Thyroid Feedback Quantile-based Index (TFQI) and Parametric TFQI were calculated to assess central sensitivity. Pulse pressure (PP) was also calculated. Youth with GHF defined by eGFR>120 mL/min/1.73m2 (n = 203, 31%) had significantly higher values of fT3/fT4 ratio (p = 0.004), fasting glucose (p < 0.0001) and PP (p = 0.047) compared to those with normal eGFR. Odds ratio of GHF increase of 11.6-fold for each 1-unit increase in fT3/fT4 ratio (p = 0.004), 1.04-fold for each 1-unit increase in glucose (p < 0.0001) and 1 mmHg of PP (p = 0.043). These findings were confirmed for both the fT3/fT4 ratio and fasting glucose when applying the GHF cutoff of 135 mL/min/1.73 m. CONCLUSIONS: In youths with OW/OB, GHF is associated with increased peripheral TH sensitivity, higher glucose, and PP, suggesting a potential adaptive (allostatic) mechanism.
BACKGROUND AND AIM: Residual dyslipidemia persists in ischemic heart disease (IHD) patients despite statins. Omega-3 fatty acids may help, but their precise lipid effects and clinical integration need clarification. This...BACKGROUND AND AIM: Residual dyslipidemia persists in ischemic heart disease (IHD) patients despite statins. Omega-3 fatty acids may help, but their precise lipid effects and clinical integration need clarification. This meta-analysis aims to evaluate omega-3's impact on lipid profiles in IHD and contextualize findings within modern prevention strategies. METHODS AND RESULTS: We systematically searched PubMed, Cochrane, Web of Science, and Scopus (1988-2024) for RCTs of omega-3 (1-4 g/day EPA + DHA) versus placebo in IHD adults. Ten RCTs (n = 633) were included. Risk of bias (RoB 2) and evidence certainty (GRADE) were assessed. Random-effects meta-analysis was performed. Omega-3 significantly reduced triglycerides (MD: -17.53 mg/dL, 95% CI: -30.64 to -4.41; p = 0.009) and LDL-C (MD: -9.43 mg/dL, 95% CI: -14.20 to -4.65; p = 0.0001). A trend favored total cholesterol reduction (MD: -6.03 mg/dL, p = 0.05). HDL-C increased post-sensitivity analysis (MD: 1.66 mg/dL, p = 0.03). Heterogeneity was low (I = 0-31%). Evidence certainty was moderate for TG and LDL-C outcomes. CONCLUSIONS: Omega-3 supplementation significantly improves atherogenic lipids in IHD patients, supporting its adjunctive use. Implementation should prioritize high-dose EPA formulations and integrate with statin therapy within digitally-enhanced secondary prevention programs. PROSPERO REGISTRATION NUMBER: CRD42025643552.
BACKGROUND AND AIM: Cardiovascular-kidney-metabolic (CKM) syndrome is a disorder of growing global burden. This study aims to investigate the association between the hemoglobin-to-red cell distribution width ratio (HRR)...BACKGROUND AND AIM: Cardiovascular-kidney-metabolic (CKM) syndrome is a disorder of growing global burden. This study aims to investigate the association between the hemoglobin-to-red cell distribution width ratio (HRR) and mortality in individuals with CKM, and to evaluate the mediating role of estimate glomerular filtration rate (eGFR). METHODS AND RESULTS: We analyzed 7189 CKM patients from NHANES 2011-2018. The association between HRR and mortality was assessed using Cox regression, with nonlinearity examined by restricted cubic splines (RCS). Survival differences were plotted with Kaplan-Meier curves. Model robustness was tested via stratified and sensitivity analyses, and a mediation analysis evaluated the role of eGFR. The cohort comprised 7189 participants with 632 documented deaths during follow-up, including 120 cardiovascular-specific events. Across full adjusted models, higher HRR levels showed inverse correlations with mortality (P < 0.05). Per 1-unit increase in HRR, multivariable-adjusted risks decreased by 93% for both all-cause (HR: 0.07, 95% CI: 0.04-0.14) and cardiovascular mortality (HR: 0.07, 95% CI: 0.02-0.28). The highest HRR tertile demonstrating markedly lower mortality risks versus reference groups (all-cause: HR: 0.51; cardiovascular: HR: 0.51). Stratified analysis and sensitivity analysis demonstrated the stability of the model. RCS analysis confirmed a U-shaped relationship between HRR and all-cause mortality, while a linear relationship was observed between HRR and cardiovascular mortality. Mediation analysis showed eGFR accounted for 2.6% and 4.5% of the associations of HRR with all-cause and cardiovascular mortality, respectively. CONCLUSIONS: A higher HRR may be associated with reduced mortality in patients with CKM syndrome, and this association is partially mediated by eGFR.
BACKGROUND AND AIM: Remnant cholesterol (RC), lipoprotein(a) [Lp(a)], and inflammation are considered key residual cardiovascular risk (RCVR) factors. This study aimed to prospectively evaluate the independent and combin...BACKGROUND AND AIM: Remnant cholesterol (RC), lipoprotein(a) [Lp(a)], and inflammation are considered key residual cardiovascular risk (RCVR) factors. This study aimed to prospectively evaluate the independent and combined associations of RC, Lp(a), and C-reactive protein (CRP) with myocardial infarction (MI) risk in a general population with baseline low-density lipoprotein cholesterol (LDL-C) <2.6 mmol/L. METHODS AND RESULTS: Baseline RC, Lp(a), and CRP levels were categorized as high or low according to reference thresholds derived from a restricted cubic spline model. Participants were further classified by the number of elevated RCVR factors (0-3). Independent and combined associations of these biomarkers with MI risk were assessed, and their predictive performance was compared. Over a median follow-up of 13.6 years, 1,665 MI events were documented. Multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were 1.042 (0.924-1.175) for elevated RC, 1.255 (1.137-1.385) for high Lp(a), and 1.246 (1.123-1.384) for high CRP. Compared with participants with no elevated RCVR factors, adjusted HRs (95% CIs) for those with 1, 2, and 3 elevated factors were 1.413 (1.147-1.740), 1.566 (1.271-1.931), and 1.870 (1.493-2.343), respectively. The combined model including all three biomarkers demonstrated superior predictive performance compared with individual markers (DeLong test p < 0.01). CONCLUSIONS: Elevated Lp(a) and CRP were independently associated with increased MI risk, whereas RC was not. A combined assessment of RCVR factors provided greater predictive value than any single biomarker.
BACKGROUND AND AIM: High-intensity interval training (HIIT) is known to improve cardiorespiratory fitness (i.e., VO), a key marker of cardiometabolic health in individuals with metabolic syndrome (MetS). Nonetheless, bod...BACKGROUND AND AIM: High-intensity interval training (HIIT) is known to improve cardiorespiratory fitness (i.e., VO), a key marker of cardiometabolic health in individuals with metabolic syndrome (MetS). Nonetheless, body weight loss is widely recognized as a crucial factor in reducing insulin resistance and improving metabolic risk factors. Thus, we aimed to determine the importance of body weight loss following exercise training on improving MetS. METHODS AND RESULTS: Two hundred and twenty-eight adults (55.3 ± 7.9 yr) with overweight/obesity (32.5 ± 4.6 kg·m) and MetS were randomized to: a) standard health care non-exercise group (CONTROL group, N=58) or b) standard health care plus 16 weeks of HIIT (EXER group, N=170). MetS (MetS z-score), insulin resistance (HOMA-IR), cardiorespiratory fitness (VO), maximal cycling power (W), and body weight/composition were assessed. After intervention, EXER group participants were divided according to their weight loss response to training: i) those achieving the weight loss predicted from estimated exercise energy expenditure (-BW group, n=78; -3.3 ± 2.2 kg); ii) those not reaching the expected weight loss (=BW group, n=38; -0.7 ± 0.5 kg); iii) and those who gained weight (+BW group, n=54; 1.1 ± 1.0 kg). VO significantly improved regardless of body weight loss response (-BW, 0.3 ± 0.3; =BW, 0.2 ± 0.3; +BW, 0.3 ± 0.2 L·min; all p < 0.001) compared to CONTROL group (0.0 ± 0.3 L·min). However, significant improvements in MetS z-score (-0.31 ± 0.41) and HOMA-IR (-0.7 ± 1.6) were observed only in the -BW group (both p < 0.001). CONCLUSIONS: Exercise recommendations should consider that greater improvements in MetS are observed when interventions are accompanied by successful body weight loss. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05120778.
BACKGROUND AND AIM: The rising global burden of metabolic diseases-including hypertension, type 2 diabetes, hyperlipidemia, obesity, and non-alcoholic fatty liver disease-underscores the urgency of understanding their mo...BACKGROUND AND AIM: The rising global burden of metabolic diseases-including hypertension, type 2 diabetes, hyperlipidemia, obesity, and non-alcoholic fatty liver disease-underscores the urgency of understanding their modifiable risk factors, including cannabis use. We aimed to investigate the association between cannabis use and risk of metabolic diseases across different body mass index levels. METHODS AND RESULTS: We analyzed 91,002 UK Biobank participants without prevalent metabolic diseases at baseline. Multivariable Cox models evaluated associations between cannabis use and incident metabolic diseases. After adjustment, cannabis use was associated with modestly lower observed risks of overall metabolic disease (aHR = 0.94; 95% CI: 0.89-0.99), hypertension (aHR = 0.93; 95% CI: 0.87-1.00), type 2 diabetes (aHR = 0.82; 95% CI: 0.69-0.99), and obesity (heavy users: aHR = 0.57; 95% CI: 0.41-0.78). Significant BMI interactions were observed (P < 0.01), with inverse associations more evident among individuals with BMI<25. In participants with BMI>30, moderate use was associated with increased risk of metabolic disease (aHR = 1.26) and hypertension (aHR = 1.40). No significant associations were observed for hyperlipidemia or NAFLD. CONCLUSION: Cannabis use was associated with modestly lower observed risks of several metabolic outcomes, particularly among individuals with BMI<25. Associations varied by BMI and attenuated in higher BMI groups. Findings should be interpreted cautiously given the observational design.
Benaiges D, Olano M, Masip N
… +9 more, Ballesta S, Casajoana A, Pérez KA, Flores-Le Roux JA, Climent E, Subirana I, Castañer O, Goday A, Pedro-Botet J
BACKGROUND AND AIMS: Bariatric surgery (BS) improves cardiovascular risk (CVR) profiles in the short to mid-term, but long-term data remain limited. This study evaluated the 10-year evolution of estimated CVR in Mediterr...BACKGROUND AND AIMS: Bariatric surgery (BS) improves cardiovascular risk (CVR) profiles in the short to mid-term, but long-term data remain limited. This study evaluated the 10-year evolution of estimated CVR in Mediterranean patients with obesity undergoing BS, using the Registre Gironí del Cor (REGICOR) and SCORE2 models. METHODS AND RESULTS: A retrospective cohort study included 128 patients who underwent BS (laparoscopic sleeve gastrectomy [LSG] or laparoscopic Roux-en-Y gastric bypass [LRYGB]) between 2004 and 2012, with 10-year follow-up. CVR was estimated at baseline, 1, 5, and 10 years using REGICOR and SCORE2. Simulation analyses aimed to isolate the effect of aging from changes in cardiometabolic parameters. The cohort (86.7% women; mean age 46.8 ± 8.0 years; baseline BMI 44.4 ± 4.8 kg/m) showed significant CVR reduction at 1 year: REGICOR decreased from 3.48 ± 0.58% to 1.86 ± 0.34% (p < 0.001), SCORE2 from 2.67 ± 0.28% to 2.33 ± 0.24% (p = 0.001). At 10 years, REGICOR returned to baseline (3.15 ± 0.60%, p = 0.999), while SCORE2 increased to 4.05 ± 0.48% (p < 0.001). Simulation analyses suggested that aging might be one of the main contributors to the long-term increase in CVR. LRYGB was associated with a more favourable SCORE2 trajectory than LSG. CONCLUSION: BS confers sustained long-term benefit on estimated CVR. Despite patients being 10 years older, CVR remained close to preoperative levels, suggesting a potential attenuation of the expected age-related increase in risk.
BACKGROUND AND AIM: Pregnancy is a period of both physical and hormonal changes that have the function of ensuring the correct development of the child and providing for its needs, as well as preparing the mother for chi...BACKGROUND AND AIM: Pregnancy is a period of both physical and hormonal changes that have the function of ensuring the correct development of the child and providing for its needs, as well as preparing the mother for childbirth and breastfeeding. However, the physiological changes that occur during pregnancy may favor a predisposition to metabolic disorders. METHODS AND RESULTS: In the case of a woman affected by familial hypercholesterolemia, a pregnancy must obviously be planned with particular attention. Pregnancy involves important maternal physiological changes that lead to an exacerbation of maternal hypercholesterolemia, aggravated by the current practice of interruption or reduction of the dosage of lipid-lowering therapy during pregnancy and breastfeeding, which can have an impact on short- and long-term cardiac morbidity and mortality. CONCLUSIONS: We present our experience based on clinical cases of three women, two with homozygous familial hypercholesterolemia (FH) and one with severe heterozygous FH. Their history is very different, underlining how personalized clinical management is essential in pregnancy.
BACKGROUND AND PURPOSE: To evaluate the impact of early achievement of the low-density lipoprotein cholesterol (LDL-C) targets during the acute phase on clinical outcomes and safety in patients with atherosclerotic cereb...BACKGROUND AND PURPOSE: To evaluate the impact of early achievement of the low-density lipoprotein cholesterol (LDL-C) targets during the acute phase on clinical outcomes and safety in patients with atherosclerotic cerebral infarction, thereby providing evidence for optimizing the management strategy in the acute stage of stroke. METHODS AND RESULTS: In this prospective cohort study, 187 patients were stratified into an Early Achievement (EA, n = 68) group or a Non-Achievement (NA, n = 119) group based on LDL-C target attainment at 7 days after treatment initiation. During the 90-day follow-up, the EA group showed a significantly lower incidence of major adverse cardio-cerebrovascular events (MACCE) (1.47% vs. 11.76%, RR = 0.103, P = 0.014) and a higher proportion of patients achieving favorable functional outcomes (modified Rankin Scale [mRS] score ≤2) (92.54% vs. 80.95%, RR = 1.178, P = 0.024) compared with the NA group. The average improvement in the mRS score at 90 days was greater in the EA group by 0.416 points (β = 0.416, P = 0.002). No significant between-group difference was found in early neurological deterioration (END), and no serious adverse events were reported (P > 0.05). Lipidomic analysis revealed more pronounced reductions in 26 lipid species/subclasses in the EA group after 7 days of treatment (all P < 0.05). CONCLUSION: These results suggest that early achievement of LDL-C targets significantly reduces the incidence of MACCE in patients with atherosclerotic cerebral infarction, enhances neurological functional recovery in patients with AIS within 90 days, and demonstrates a favorable safety profile.
AIMS: Overweight and obesity are increasingly common amongst people with type 1 diabetes mellitus (T1DM). Low carbohydrate diets (LCDs) including intermittent fasting diets (IFDs) are popular in the general population, b...AIMS: Overweight and obesity are increasingly common amongst people with type 1 diabetes mellitus (T1DM). Low carbohydrate diets (LCDs) including intermittent fasting diets (IFDs) are popular in the general population, but the efficacy and safety of these diets for weight loss remains unclear in people with T1DM and overweight/obesity. It is also unclear whether eucaloric versus hypocaloric LCDs have a differential effect on metabolic and quality of life (QoL) outcomes. DATA SYNTHESIS: This systematic review synthesised data from randomised and non-randomised interventional studies assessing the efficacy and safety of LCDs including IFDs in adults with T1DM; we included studies involving at least some participants with overweight/obesity. Co-primary outcomes included change in body weight/body mass index (BMI), HbA1c, and QoL measures. Secondary/exploratory outcomes included change in body composition, continuous glucose monitoring metrics, total daily insulin requirements, lipid profile, blood pressure, as well as adherence to the prescribed dietary regimen. The search yielded 3694 results, with 13 eligible papers (8 main papers, 5 sub-analyses). Meta-analysis was not possible due to study heterogeneity. Amongst the studies involving hypocaloric LCDs (n = 3, 2 studies involved IFDs), the majority reported significant reductions in body weight, but no significant change in HbA1c. Amongst the studies involving eucaloric LCDs (n = 5, no IFDs), the majority reported significant reductions in body weight and HbA1c. QoL measures were only available for the studies involving eucaloric LCDs, with no major adverse effects noted. None of the studies reported major safety issues. CONCLUSIONS: The limited evidence available showed that the majority of studies involving eucaloric or hypocaloric LCDs reported beneficial effects on body weight. The majority of studies involving eucaloric (but not hypocaloric) LCDs reported a modest benefit on HbA1c and no adverse effects on QoL measures. To confirm and expand on the findings of this review, further high-quality, larger scale randomised controlled trials are required specifically in people with T1DM and overweight/obesity.
AIMS: Several observational and genetic studies have found an association between high urate serum levels and hypertension, heart failure, and cardiovascular mortality. Bempedoic acid is a recently approved hypocholester...AIMS: Several observational and genetic studies have found an association between high urate serum levels and hypertension, heart failure, and cardiovascular mortality. Bempedoic acid is a recently approved hypocholesterolemic agent acting by inhibiting the ATP citrate lyase and thus the hepatic cholesterol biosynthesis. Despite its optimal safety profile, a minor and reversible increase of serum uric acid levels has been observed. This effect is due to the inhibition by bempedoic acid of organic anion transporters 2 and 3 (OAT2 and OAT3) which mediate the renal excretion of urate. DATA SYNTHESIS: The increased levels of uric acid were associated with higher incidence of gout and could potentially have a negative effect on cardiovascular diseases. However, any adverse urate effect seems not to be clinically dominant for at least two reasons: 1) the extent of cardiovascular events reduction with bempedoic acid was similar to the one achieved with statins for a given magnitude of LDL-C lowering; 2) bempedoic acid was not associated with increased incidence of hypertension and heart failure, cardiovascular diseases strictly associated with hyperuricemia. Finally, uric acid lowering agents have not consistently demonstrated cardiovascular benefit in randomized clinical trials, and other drugs increasing, to the same extent, uric acid plasma levels, i.e. thiazide diuretic, do not increase cardiovascular risk. CONCLUSIONS: Thus, the iatrogenic increase of plasma uric acid levels by the inhibition of OAT does not appear to have a clinically relevant negative impact on cardiovascular diseases.