Plasma lipid levels in relation to disease severity in sickle cell anaemia in Abakaliki, Southeast Nigeria

Dyslipidaemia has been implicated in the pathophysiology of sickle cell disease (SCD) complications; hence its role requires further elucidation. Objectives: To investigate the relationship between disease severity and plasma lipid levels of patients with sickle cell anaemia. Methods: A cross-sectional study design was used for the survey. A total of 50 patients with sickle cell anaemia and 50 controls without SCD were recruited for the study. The clinical data and plasma lipid levels of lipids and haemoglobin parameters were analysed. Results: The majority of the participants were aged 18-25 years. Total plasma cholesterol and HDL-C were significantly lower in individuals with SCA compared with the controls (3.3±1.2 vs 4.2±1.2; p<0.001) and (1.3±0.5 vs 1.5±0.4; p = 0.038) respectively. Most patients with SCA had moderate disease severity (24; 48%). There was no statistically significant difference in the plasma levels of total cholesterol and HDL-C across the disease severity groups of SCA (p = 0.694 and 0.262). There was also no significant correlation between total cholesterol, HDL-C, and markers ofhaemolysis, haemoglobin F, and haemoglobin S levels. Conclusion: SCA is characterised by lower mean plasma TC and HDL than controls. However, no relationship was found between TC, HDL levels and SCD disease severity, markers of haemolysis, HbF and HbS levels. Further studies are required to ascertain the implications of plasma lipid levels in SCD

Cholesterolemia and triglyceridemia changes in adult with malaria in a hypo-endemic malaria region, Butembo-DR Congo

changes occur commonly among patients affected with malaria. This study aimed to assess lipid changes in blood among patients with malaria in Butembo, a hypoendemic region. Methods: This cross-sectional study, conducted in the Departments of Internal and Parasitology of Matanda Hospital, located in Butembo, from July 1st, 2020, to November 2, 2020; involved 100 patients diagnosed with malaria. Biochemical analyses carried out by three lab technicians were performed among patients who had positive malaria using positive thick film. Plasmodial species, the parasite density, the triglycerides, the total cholesterol, the HDL-cholesterol, the LDL-cholesterol were assessed. Results: Cholesteroleamia and HDLemia demonstrated a low level in 93% and in 61% of participants respectively; whereas 73% of cases showed an increased level of triglycerides in the blood. Lipidemia profile was independently associated with parasite density among patients with malaria. Conclusion: Although the lipid changes in the blood are not specific in the diagnosis of malaria, this study highlighted their status among patients with malaria. Further researches should be conducted to determine their impact on malaria outcomes. Therefore, dyslipidemia could be used in malaria screening.

Relationship between magnesium and lipids in patients with diabetes mellitus

Introduction: Non-communicable diseases, especially cardiovascular diseases (CVD), have become more prevalent across the world, more so in developing countries. Novel methods in the management of CVD risks in patients with diabetes mellitus, type 2 (DM2) requires constant attention and an ever-evolving approach. The role of magnesium supplementation in the management of CVD has been described, but the relationship between serum magnesium (Mg) and the lipid subsets have had conflicting results in different population groups. Methods: A cross-sectional study was performed by collecting data on patients with DM2 from a specialised diabetes clinic at Edendale Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa, between July 1, 2015 and June 30, 2016. Lipid subsets (total cholesterol [TC], high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL] and triglycerides [TG]), age, sex and Mg were recorded for analysis. Results: A total of 495 clinical data sheets were analysed. The majority of participants were female (73.45%) with a mean age of 56.97 years. A statistically significant, positive, linear relationship was found between Mg and TC (R= 0.11;p= 0.01) as well as Mg and LDL R= 0.14;p= 0.001), but not between Mg and HDL (R= 0.02;p= 0.66) and Mg and TG (R= 0.01;p= 0.82). Discussion: The results of this study are similar to findings by a group of researchers in China and differ when compared with studies observing Caucasian patients. It is plausible that intrinsic ethnic differences in lipid metabolism and the various ways in which magnesium requiring enzymatic processes are utilised may be responsible for the results found in the present study population versus those found in Caucasian study participants in other countries. More research is required to determine the effect of magnesium supplementation and CVD outcomes in the present study population

An update on the measurement and management of cholesterol with specific reference to secondary prevention of cardiovascular disease (CVD)

Cardiovascular disease remains the largest contributor to non-communicable adverse disease outcomes. Treatment and prevention of cardiovascular disease have evolved at a dramatic pace in the last 40 years. Serum-cholesterol has emerged as the dominant risk factor for coronary artery disease and events. The link between serum-cholesterol and arterial atherosclerosis is well documented. The attainment of cholesterol goals has historically concentrated on low-density lipoprotein cholesterol (LDL-C) levels. Current evidence and guidelines have shifted to the attainment of non-HDL-C target levels which represent a more thorough inclusion of small dense atherogenic particles. Methods to reduce serum-cholesterol mainly centre around the use of the HMG CoA-reductase inhibitors also known as the statins. High intensity statins like atorvastatin (80 mg) and rosuvastatin (40 mg) are now the preferred starting therapies to lower cholesterol by at least 40­50% in patients with established cardiovascular disease as secondary prevention. In the event of failure of these medications, evidence suggests that the addition of ezetimibe may enhance the total serum-lowering levels to 50­60%. New therapies aimed at inhibiting PCSK9 revealed exciting new targets for LDL-C lowering, but the high cost of these antibodies could preclude access to this therapeutic intervention. Aggressive pursuit of lower LDL-C or non-high-density lipoprotein cholesterol (non-HDL-C) levels may reduce the incidence of secondary myocardial infarctions, strokes and death from cardiovascular disease

Lipid profile and disease severity in sickle cell disease patients in Lagos State, Nigeria

Background: Sickle cell anaemia is an autosomal recessive disorder that arises due to the substitution of glutamic acid with valine. This occurs at position 6 of the haemoglobin b chain, resulting in the synthesis of abnormal haemoglobin and the consequent production of the characteristic sickled red blood cells. Studies have documented several alterations in lipid homeostasis in this population. Both hyper and hypolipidaemias are known to be associated with increased morbidity and mortality and it is therefore imperative to evaluate their relationships with sickle cell anaemia. Aim: The aim of this study was to establish baseline serum lipid levels in sickle cell anaemia patients in LASUTH and correlate this with severity scores in the patients. Subjects and Methods: Serum Total cholesterol (TC), Triglycerides (TG), Low density lipoproteins (LDL), High density lipoproteins (HDL) and Very low density lipoproteins (VLDL) were measured in 57 Haemoglobin SS (HbSS) patients in steady state. All patients used had been fasting for at least 10 hours prior to sample collection. The LDL/HDL was also calculated. Their disease severity was calculated using an objective scoring method. Results: Our results showed that there was no significant correlation between serum lipid levels and disease severity score

Prevalence and pattern of dyslipidaemia in type 2 diabetes mellitus patients at a tertiary care hospital

Background: Diabetes mellitus (DM) is a common secondary cause of dyslipidaemia, particularly if glycaemic control is poor, which in turn is an important risk factor for atherosclerosis and coronary artery disease.Objectives: (1) To study the prevalence and pattern of dyslipidaemia in patients with type 2 DM. (2) To determine the relationship (if any) between HbA1C and the lipid profile in type 2 diabetic patients.Methods: This was a cross-sectional study done in 200 type 2 diabetic patients attending the Diabetic Clinic at the Helen Joseph Hospital. Patients suffering from other known causes of secondary dyslipidaemia were excluded. Each patient's HbA1C and lipid profile results were recorded from their clinic files. The lipid profile included total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and calculated low-density lipoprotein cholesterol (LDL-C). Patients with one or more of the above parameters outside the targets recommended by the 2012 South African Dyslipidaemia Guidelines were considered to have uncontrolled dyslipidaemia.Results: Of the 200 type 2 DM patients studied, 86 (43%) were male and 114 (57%) female. Despite all patients being treated with lipid-lowering therapy (simvastatin at a mean daily dose of 20 mg), 187 patients (93.5%) did not achieve all their lipid targets. The most prevalent lipid parameter not at target was an LDL-C of ≥ 1.8 mmol/l in nearly 80% of patients. The most common pattern of dyslipidaemia was a combined dyslipidaemia(any two abnormal lipid parameters) affecting a total of 82 out of the 187 patients (43.8%) not reaching recommended targets. No significant relationship was found between HbA1C and any of the lipid parameters. Conclusion: The vast majority of the type 2 diabetic patients studied had dyslipidaemia not meeting recommended targets, despite the use of lipid-lowering therapy in all patients. There is a need for more intensive lipid-lowering therapy, particularly statin therapy in patients with dyslipidaemia. Measures aimed at combating obesity and other lifestyle-related risk factors are also vital and need to be implemented for effectively controlling dyslipidaemia and reducing the burden of CVD

Reduction of Cholesterol and Fasting Blood Sugar Levels by One Month Supplementation of Fresh Garlic in Diabetic Libyan Patients: A Double Blind, Baseline Controlled Study

Background: The therapeutic effects of fresh garlic remain controversial. The aim of this study is to investigate whether supplementation of fresh garlic could improve blood glucose and cholesterol profile in Libyan diabetic patients with moderate blood cholesterol.Methods:Forty-six diabetic patients were randomly assigned to either fresh garlic alone (≈2 grams/day), or fresh garlic in combination with glibenclamide taken on an empty stomach every morning for a month. Serum blood glucose, cholesterol and blood pressure were measured before starting treatment and after the end of the treatment period.Results: Fresh garlic alone was able to decrease the mean serum cholesterol levels by 26 mg/dl (84% of the original base values), while the combination of fresh garlic and glibenclamide produced a 28 mg/dl decrease in the mean serum cholesterol (85% of the original base values). Fresh garlic alone was able as well to decrease the mean blood glucose levels by 20 mg/dl (85% of the original base values), while the combination of fresh garlic and glibenclamide produced a 60 mg/dl decrease in the serum glucose levels (72% of the original base values). Neither treatment had a significant effect on the mean systolic or diastolic blood pressures after 30 days of treatment.Conclusion: Administration of fresh garlic every morning for a month significantly reduced the blood cholesterol and fasting blood glucose levels in diabetic patients. Thus administering dietary fresh garlic daily to diabetic patients might have cardio-protective effects on diabetic patients

Prevalence of Risk Factors for Non-Communicable Diseases for New Patients Reporting to Korle-Bu Teaching Hospital

Background: The risk factors of Noncommunicable diseases (NCDs) are not routinely monitored; especially among populace reporting to hospitals to detect and also advise on preventive measures; a key strategy to reducing the impact of NCDs on the Health Care System and population. Methods: A cross-sectional survey was carried out between the months of May and June; 2010 among a sample representative of the medical and surgical out-patients population to determine the prevalence of certain risk factors of non-communicable diseases (NCDs). Participants (n = 230) were selected by systematic random sampling. Standardized international protocols were used to measure the prevalence of smoking; alcohol consumption; physical inactivity; obesity; raised blood pressure; raised blood glucose and total cholesterol. Results: The obesity level of the study population was 40.4 with 54 being overweight. Tobacco use among the respondents was 4.8. Alcohol consumption was 64.8; with 54.3 of the study population being physically inactive. Almost 48 and 70.9 of the participants consumed fruits and vegetables respectively; at least three days in a week. The prevalence of hypertension was 33.6 for men and 35.2 for women. The prevalence of raised glucose and total blood cholesterol level among the study population was 6.5. Almost 62 of the participants had a combination of three or more risk factors. Conclusion: The prevalence of the significant risk factors in this study were physical inactivity (54.3); alcohol consumption (64.8); overweight (54); obesity (40.4) and raised blood pressure (34.3). Hospitals should therefore include NCD risk factor monitoring as part of routine services

Treatment of Hypercholesterolaemia in Patients with Diabetes Mellitus

Numerous studies have shown that statins reduce cardiovascular events; including stroke and mortality in diabetics. The American Diabetes Association 2013 guidelines recommend that diabetics at high risk for cardiovascular events should have their serum low-density lipoprotein (LDL) cholesterol reduced to 70 mg/dl (1.8 mmol/l) with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to 100 mg/dl (2.6 mmol/l). The 2013 American College of Cardiology/American Heart Association lipid guidelines recommend giving high-dose statins to adult diabetics aged ? 75 years with atherosclerotic vascular disease (ASCVD) unless contraindicated with a class I indication and moderate-dose or high-dose statins to diabetics with ASCVD ? 75 years with a class IIa indication. Diabetics ? 21 years with a serum LDL cholesterol of ? 190 mg/dl (4.9 mmol/l) should be treated with high-dose statins with a class I indication. For primary prevention in diabetics aged 40 to 75 years and serum LDL cholesterol between 70 and 189 mg/dl (1.8 and 4.9 mmol/l); moderate-dose statins should be given with a class I indication. For primary prevention in diabetics aged 40 to 75 years; a serum LDL cholesterol between 70 and189 mg/dl (1.8 and 4.9 mmol/l); and a 10-year risk of ASCVD of ? 7.5 calculated from the Pooled Heart Equation; high-dose statins should be given with a class IIa indication. For primary prevention in diabetics aged 21 to 39 years or older than 75 years and a serum LDL cholesterol between 70 and 189 mg/dl (1.8 and 4.9 mmol/l); moderate-dose statins or high-dose statins should be given with a class IIa indication. There is no additional ASCVD reduction from adding non-statin therapy to further lower non-high-density lipoprotein (HDL) cholesterol once an LDL cholesterol goal has been reached. Clinical trials have found no lowering of cardiovascular events or mortality in diabetics treated with statins with the addition of nicotinic acid; fibric acid derivatives; ezetemibe; or drugs that raise serum HDL cholesterol

Eggs: Clearing the Charges; Exploring the Potential

Of all the various kinds of foods; an egg is special for its combination of all essential food nutrients in one item. However for much of the past 40 years; the public has been warned away from eggs because of concerns that they increase the risk of coronary heart disease and stroke and a claim that they raise the blood pressure by causing vasoconstriction. In Tanzania; up to date there are some cultures that forbid women in general or pregnant women in particular from eating eggs due toa belief that they will get bald babies or have problems during delivery. Several studies over the years have examined egg intake and its relationship with coronary outcome. When dietary confounders were considered; no association was seen between egg consumption and the risk of coronary heart disease in non-diabetic men and women. Recent researches have not only linked eggs with biological functions beyond basic nutrition but to a huge potential in the medical field. Eggs are now linked to fetal brain development and boosting of the immune system thus consequently lowering the risk of getting breast cancer; colon and lung cancer. For already developed cancer; eggs show potential for the development of promising anticancer drugs through the production of Monoclonal antibodies. They are also proven to prevent cataract and macular degeneration and protect against heart attacks and strokes by preventing arteriosclerosis and facilitating fat metabolism. Moreover researchers now not only prove eggs do not increase your blood cholesterol; but also link eggs to lowering high blood pressure by acting like an antihypertensive through an ACEI like inhibiting mechanism. Components in eggs were also found to be active as anti-adhesives; microbiocidals and as chelators in metal poisoning

Looking for a More Useful Atherogenic Index for Nigerians

Researchers have divided opinion as to which lipid fraction or cholesterol ratio can effectively be used to predict the chances of an individual developing heart disease or can best describe the atherogenic index of an individual. In this study the atherogenic risk of Nigerian hypertensives and normotensives was examined by different parameters in an attempt to find out which one best separates the high risk individual from the one with low risk of atherogenicity. Lipid profile and lipid ratios were examined by standard methods in 330 untreated hypertensives and 110 age snd sex matched normotensives in Nigerian hypertensives and normotensives respectively in UBTH; Benin City; Nigeria. Statistical analysis was used to determine which lipid parameter(s) gave a better reflection of the atherogenic index. The mean of serum lipids and lipid ratios were significantly higher in the hypertensives than in the normotensives. The mean of the atherogenic index of plasma (AIP); log (Tg/HDL-C) was significantly positive for the hypertensives but significantly negative for the study population and for the normotensives; p

Metabolic syndrome using national cholesterol education program criteria in black patients with arterial hypertension

Objective: to assess the prevalence and correlates of the metabolic syndrome (MS) in black patients with essential hypertension. Methods: A total of 100 consecutive essential hypertensives (53 men and 47 women, mean age 49 ± 10 years, BMI 27 ± 5 Kg/m², SBP 155 ± 19 mmHg, DBP 101 ± 11 mmHg) attending the University of Kinshasa outpatient hypertension clinic and included in a case-control study of lipids and lipoproteins were considered for the present cross sectional analysis. All patients underwent clinical, laboratory and electrocardiographic investigations searching for lipid and lipid cardiovascular risk factors. NCEP-ATP III criteria were used to define the MS. Between group comparisons were made with the Student t test, Mann Whitney U test or Chi square as appropriate. Results: 31 hypertensive patients (33%), 23 men and 8 women, fulfilled the NCEP-ATP III criteria of the MS. In univariate analysis, aside the variables defining the MS, patients with the MS had a significantly higher TC/HDL-c ratio (4.44 ± 2.40 vs 3.79 ± 1.82; p ≤ 0.05) and proportion (13% vs 3%, p ≤ 0.05) of smokers; they paradoxically showed lower proportion (39% vs 52%, p ≤ 0.05) of left ventricular hypertrophy (LVH) in comparison to those without the MS. The two groups were similar for age, sex distribution, duration of hypertension, physical activity, treatment status, BP and other biological variables. Multivariate logistic regression analysis was used to determine the independent contribution of risk factors to the risk of MS. Conclusion: MS is common among Congolese patients with essential hypertension and seems to be paradoxically associated with less pronounced cardiac damage probably due to the phenomenon of reverse epidemiology of traditional cardiovascular risk factors

Quantitative Analysis of Gallstones in Libyan Patients

Gallstone disease is one of the major surgical problems in the Libyan population; it is probably related to diet; especially excessive consumption of meat. The study was conducted to determine the composition of gallstones and their possible etiology in a Libyan population. The chemical composition of gallstones from 41 patients (six males and 35 females) was analyzed. The stones were classified into cholesterol; pigment; and mixed stones (MS). Cholesterol stones (CS) showed a significantly higher cholesterol content than pigment stones (PS) (p=0.0085) though not significantly higher than MS. Their phospholipid content and inorganic phosphates were higher than in the other types of stones and oxalate content was significantly elevated in comparison with MS (p=0.0471). In MS; the cholesterol; bile acids; and bilirubin were intermediate between cholesterol and PS; whereas triglycerides were significantly more than PS (p=0.0004). Bilirubin (0.0001) and bile acids (p=0.0009) were significantly higher than CS (p=0.0001). However; they contained the lowest amounts of sodium; potassium; magnesium; and oxalate. In PS; bilirubin (p=0.0001) was significantly higher than both groups. Bile acid content was significantly higher than CS (p=0.0001) but not significantly more than MS. They showed the highest values of calcium; sodium; potassium; magnesium; and chlorides compared to the other types of stones. High levels of cholesterol in stones and dyslipidemia associated with mixed as well as cholesterol gallstones suggest an etiological association and efforts to reduce dietary fat among the Libyan population may lead to decreased cholesterol and mixed gallstones

Effect of calcium lactate supplementation on cholesterol concentration in patients with hyperlipidaemia and previous viral hepatitis: a preliminary report

The aim of the study was to estimate the effect of calcium supplementation on cholesterol concentrations in patients with hyperlipidaemia and previous viral hepatitis. The study comprised 43 patients; aged 28 to 82 years (21 with type 2 hyperlipidaemia). The control group included 22 healthy subjects. After four weeks of a hypolipaemic diet (wash-out period); the patients with type 2 hyperlipidaemia were recruited to a group administered a complex preparation containing 170 mg of calcium lactate and 60 mg of vitamin C (Calcium C; Polfa-Lodz SA; Poland) at a dose of one tablet three times a day. After four weeks of active therapy; the concentration of total cholesterol (TC); low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) decreased by 4; 6 and 8; respectively. Statistical significance was obtained for only TC (p = 0.03) when comparing the group of patients with hypercholesterolaemia before and after the therapy with the calcium preparation. A statistically insignificant increase of high-density lipoprotein cholesterol (HDL-C) of 1was observed. Within the four-week period of calcium supplementation at a dose of 510 mg/24 h; the total concentration of calcium decreased by 3; whereas the concentration of ionised calcium increased by 7. None of the obtained values was of statistical significance. In patients with type 2 hyperlipidaemia and previous viral hepatitis; a four-week supplementation of calcium in a calcium lactate preparation beneficially modified the lipid profile. it statistically significantly decreased the total cholesterol concentration by 4(p = 0.03); did not cause any significant changes in serum calcium concentration; was well tolerated and did not induce any side effects

The Effect of Moderate Alcohol Intake on Gallblader Motility: a Milk Ultrasonographic Study

Objectives: To assess the effect of periodic and moderate alcohol intake on gallbladder motility. Methods: The ultrasonographic ellipsoid method was used in 21 healthy male subjects: 12 non-alcohol and 9 alcohol drinkers. The stimulus for gallbladder contraction was 165 ml of half cream milk. Gallbladder dynamics were studied for 20 minutes following the ingestion of the milk. The mean percentage change in gallbladder volume after 10 and 20 minutes gave indications of gallbladder motility. Results: Moderate and periodic alcohol intake did not stimulate rapid postprandial gallbladder emptying. Conclusion: The protective effect of alcohol against biliary cholesterol cholelithiasis could not be due to stimulation of gallbladder emptying