Determinants of blood uric acid levels in a dyslipidemic Arab population

The objective of this study was to explore the relationships between circulating uric acid and lipid levels and components of the metabolic syndrome [MetS] in Arab dyslipidemic patients, a group already at high coronary artery disease risk. The medical records of 1,229 subjects [632 men, 597 women] referred for treatment of dyslipidemia and followed up for at least 12 months were reviewed. Serum levels of uric acid and lipids [total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein] and other variables in the National Cholesterol Education Program ATP III criteria definition of MetS were assessed at initial presentation and every 4- 6 months, under specific lipid-lowering treatment [statins and/or fibrates], in each of the subjects. Their respective associations were explored by appropriate logistic regression techniques with control for confounding risk factors, including age, gender and body mass index. 306 subjects [24.9%] of the study population were hyperuricemic; they were more likely to be men, obese and diabetic. Also the serum uric acid level [mean +/- SD] was greater in men with MetS compared with men without [377.0 +/- 98.0 vs. 361.6 +/- 83.1 micro mol/l, p < 0.05], an observation not reproduced in women. Uric acid levels had significant associations with the presence of fasting hyperglycemia, hypertension and large waist circumference [WC] in men, but only with large WC in women. With statin treatment, uric acid levels decreased by 10% within 1 year of treatment; with fibrates, uric acid levels remained unchanged or slightly increased. The data showed that hyperuricemia is common in dyslipidemic patients in Kuwait, where its important determinants are male sex, obesity, diabetes and statin treatment

Reference intervals for important serum sex steroid hormones, prostate specific antigen, insulin like growth factor 1 and IGF binding protein 3 concentration in a normal Kuwaiti adult male population

The purpose of this study was to determine the age-specific reference ranges for some important male sex steroid hormones, prostate-specific antigen [PSA], insulin-like growth factor-1 [IGF-1], and IGF binding protein-3 [IGFBP-3], for the Kuwaiti population. Blood samples were taken from 398 consenting, fasting, healthy Kuwaiti males aged 15-80 years between 8.00 a.m. and 12.00 noon. The serum concentrations of total testosterone [TT], dehydro-epiandrosterone sulfate [DHEAS], androstenedione [ADT], sex hormone binding globulin, luteinizing hormone [LH], follicle-stimulating hormone [FSH], prolactin, PSA, IGF-1 and IGFBP-3 were determined. A distribution curve was plotted and age-specific reference levels were determined for each analyte. The reference interval for parameters with a normal distribution [Gaussian] was mean +/- 2 SD, while for the non-normal distribution [non-Gaussian], it was 2.5-97.5 percentile. The reference intervals for the analytes obtained from this study were compared with those suggested by the kit manufacturers and currently used by the Ministry of Health, Kuwait Laboratories [MOHKL]. Serum IGFBP-3 and ADT had normal distribution while other analytes had non-normal distribution. The reference intervals from this study, manufacturers kit and MOHKL were as follows: TT 3-31, 9-60, 8-35 nmol/l; DHEAS 0.9-11, 1.0-7.3, 2.2- 15.2 micro mol/l; ADT 0.5-4.3, 0.8-2.8, 2.0-9.2 nmol/l; LH 1-11, 0.8-7.6, 0.4-5.7 mIU/l; FSH 0.5-11, 0.7-11.1, 1.1-13.5 mIU/l; prolactin 42-397, 53-360, 80-230 nmol/l; IGF-1 41-542, 78-956, 71-261 ng/ml; IGFBP-3 88- 2,090, 900-4,000, 900-4,000 ng/ml, and PSA 0-3.1, 0-4, 0-4 ng/ml, respectively. These data indicate that for Kuwaitis lower reference ranges must be used for serum TT, DHEAS, ADT, IGFBP-3 and PSA. There is no need to change the currently used reference interval for FSH whereas higher values must be used for LH, prolactin, and IGF-1

Diabetic Dyslipidaemia in Kuwait.

About 15% of the adult Kuwaiti population has type 2 diabetes and over 50% are hyperlipidaemic by current diagnostic criteria. Not surprisingly, coronary heart disease [CHD] is the leading cause of death in Kuwait. Reports from coronary care units in Kuwait suggest that 40-80% of the CHD patients were diabetic and 50-80% hyperlipidaemic. The pattern worldwide is similar. International guidelines have therefore consistently recognised diabetes as a major risk factor for CHD. In our Lipid Clinic population in Kuwait, about 30% are diabetic. The commonest lipid abnormalities seen in Kuwaiti diabetic patients, as elsewhere, are hypertriglyceridaemia with low HDL levels and variable LDL levels. About 75% of the subjects had either mixed hyperlipidaemia or predominant hypertriglyceridaemia. There are possibly some compositional changes in LDL in the diabetic subjects in that there were important differences in the statistical relationships between LDL and HDL and their respective apolipoproteins - apo B and apo A-1 in diabetic as compared to non-diabetic subjects. Other important observations made in diabetic subjects in Kuwait are: [i] similar serum Lp [a] levels and pattern of apo[a] polymorphism with non-diabetic subjects, with no demonstrable relationship between serum levels of Lp[a] and insulin/insulin sensitivity, although with CHD, Lp[a] levels were increased; [ii] diabetic hyperlipidaemic subjects had elevated PAI-1 levels with significant correlations between blood PAI-1 and insulin levels suggesting underlying insulin resistance [syndrome X]. Various landmark trials of cholesterol-lowering therapies in the prevention of CHD have consistently demonstrated near-normalization of the increased CHD risk in diabetes. Our experience in Kuwait suggests that diabetic patients and others with mixed hyperlipidaemia benefit from tight glycaemic control, appropriate advice on diet and exercise with regular reinforcement by continuing contact with professional dietitians and regular availability of drugs where prescribed. Often, it is the regular compliance with medication that is important, rather than the specific medication used particularly where HMG CoA reductase inhibitors [statin drugs] are not always available. A useful guideline for management of dyslipidaemia in diabetes is suggested

Comparative assssment of three commercially available methods for measurement of serum apolipoproteins A-1 and B

The aim of the study was to establish a reliable and cost-effective method of assessing apolipoprotein levels in a Kuwaiti teaching hospital Lipid Clinic population. Plasma levels of apo A-I and B were assayed in 88 subjects by each of the following 3 immunological methods: [1] Behring's nephelometry with dedicated reagents; [2] turbidimetry on a Hitachi 911 Autoanalyser using reagents from Boehringer; and [3] manual turbidimetry with Randox reagents. For both apo A-I and B, the levels obtained were consistently highest for method 1, lowest for method 3, and intermediate for method 2. With regards to apo A-I, the differences were statistically significant for 2 and 3 vs. I [p <0.001], but not between 2 and 3. For apo B, values obtained for methods I and 2 were similar statistically but significantly higher than those from method 3 [p < 0.01]. The correlation between values for apo A-I and apo B obtained by the three methods demonstrated a similar trend: for apo A-I, the correlation coefficients were greatest [r 0.75] for method 1/2, and less for 1/3 [r 0.64] and 2/3 [r 0.62]; for apo B, the correlation for 1/2 [r 0.74] was greater than for 1/3 [r 0.43] and 2/3 [r 0.69] [all p <0.001]. Altman and Bland plots indicated -20% bias for apo A-I and apo B between methods I and 2, much smaller than the -20%->100% range for 1/3 and 2/3 for both apoproteins. Similarly concordance for diagnostic values of apo A-I [<1.20 g/l] and apo B [>1.20 g/l] were best for methods 1 and 2. In economic terms, assays for either apo A-I or apo B cost about $3.00 for methods 1 and 2, with a similar technician time/sample of about 2 minutes; for 3, the cost is less [about $2.25], but technician time/sample was about doubled. The study suggests that measured apo A-I and B levels may differ depending on the type of commercial kits used, making it imperative for each laboratory to establish its own reference range. Caution should be exercised in inter-laboratory comparisons of data on apo A-I and B, particularly as applied to patient care

relationships between serum lipoproteins and apolipoproteins A-1 nad B levels in hyperlipidemic patients in Kuwait

It has been suggested that assaying blood levels of apolipoproteins [apo] A-1 and B could constitute a better alternative to measuring HDL and LDL levels in the routine assessment of lipid disorders. We have therefore evaluated the relationships between the serum levels of apo A-1 and B and the lipoproteins HDL and LDL in 214 hyperlipidaemic subjects [46 diabetic, 168 nondiabetic] and 69 normolipidaemic healthy subjects resident in Kuwait. There were no significant differences in age between the groups. The levels of total cholesterol [TC], triglycerides [TG], HDL, LDL, and apo A-1 and B showed the expected differences between the normo- and hyper-lipidaemic groups [diabetic and nondiabetic]. In the hyperlipidaemic subjects as a whole, there were significant correlations between apo A 1 and HDL [r 0.52, p<0.001] and between apo B and TC [r 0.65] TG [r 0.38] and LDL [r 0.66] all p <0.001 These relationships were somewhat weaker than seen in the normnolipidaemic subjects [apo A-1/HDL r 0.76, apo B/LDL, r 0.81, all p<0.001]. The diabetic hyperlipidaemic subjects also had somewhat weaker correlations [apo A-1/HDL, r 0.56, apo B/LDL, r 0.60, p < 0.001] than the nondiabetic hyperlipidaemic subjects [apo A-1/HDL, r 0.60, apo B/LDL, r 0.68, p < 0.00]. Using decision limits proposed for apo B [>1 20g/L] LDL [3.4 mmol/L], apo A-1 [< 1 20gfL] and HDL [<0 9 mmol/L], the percentages of hyperlipidaemic subjects with atherogenic values did not satisfactorily correspond for apo A-1 vs. HDL, but corresponded better for apo B vs. LDL, both for the diabetic and nondiabetic subjects. These observations suggest that, while there are clearly significant relationships between plasma levels of apo A-1and B and the lipoproteins HDL and LDL, the strength of those relationships appear better in normo- as compared to hyper-lipidaemic patients. Care should therefore be taken in using measurements of apolipoproteins and lipoproteins interchangeably in the routine management of hyperlipidaemic patients. Rather, both measurements should be made simultaneously and used to complement each other in the overall assessment of need for therapy in these patients

Lipid clinic service in Kuwait: Preliminary observations

Despite a dramatic increase in the prevalence of coronary heart disease [CHD] within the Kuwaiti population, hyperlipidemia, which is an important risk factor for CHD, is inadequately characterized. Since over half of all patients seen at Kuwait's Mubrarak Teaching Hospital had elevated plasma cholesterol and/or triglyceride levels, the hospital opened a Lipid Clinic Service [LCS]. The LCS provides a specialized diagnostic and therapeutic service to patients with primary hyperlipidemia. This report presents our preliminary observations on the first 150 patients seen at this clinic during the first 6 months of operation [March-September 1995]. A nationality survey of the clinic attendess revealed that 46.7% were Kuwaitis, 4.0% other Gulf Arabs, 34.0% other Arabs [predominantly Egyptians] and 15.3% South Asians [predominantly Indians]. Patient referrals came to the clinic from neighboring polyclinics [38.7%], hospital outpatient clinics [25.3%], clinical biochemistry laboratory [16.7%], hospital dietetic service [5.3%] as well as other sources [14.0%]. Of the 117 patients with primary hyperlipidemia, 48.7% had predominant hypercholesterolemia, 23.9% were classified as mixed hyperlipidemia, and 27.4% had predominant hypertriglyceridemia. Over 75% of the men, and 22% of the women smoked regularly. About a third of women were postmenopausal. The pattern of observations in the 28 patients with diabetes, incidentally seen in the clinic, was similar to that in the nondiabetic subjects with primary hyperlipidemia. The constellation of biochemical risk factors for CHD [higher triglyceride and uric acid and lower high density lipoprotein levels, coupled with a tendency towards central obesity and cigarette smoking] was more common in the men than in the in the women. This may account for a higher risk of CHD in men. Lipid and metabolic profiles did not differ between Kuwaitis and other nationals, suggesting that similar factors underlie the disorder in all patients. These features, similarly, did not differ between the pre- and postmenopausal women. This preliminary report on the first 150 patients seen in the LCS in Kuwait demonstrates a need for this type of specialized service in the country