A study among the Gestational Diabetes Mellitus and Non-Gestational Diabetes Mellitus pregnant women highlighting the variations in lipid parameters attending ante natal clinics at Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India

Background: Wide variation in the lipid profile in pregnancy is quite common. Exaggerated changes in insulin and lipid levels in women with GDM during pregnancy, lead to significant alterations in lipid levels in comparison to normal pregnancy. Lipid metabolism during pregnancy has a significant role to play in the aetiology and pathogenesis of GDM as is indicated by various studies previously.Methods: A hospital-based case control study was conducted at Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha in the Department of Endocrinology. The sample size was 100 pregnant women. Study period was of one year from June 2018 to June 2019. In women of both the groups, i.e., with GDM and without GDM the mean age of presentation were 20-25 yrs. Out of the 100 cases, we took 50 patients of GDM in the cases group and 50 patients of non GDM pregnant women as control group. Fasting lipid profile was sent to the hospital laboratory analyzed by Tinder’s methods. The results thus obtained were analyzed using student ‘t’ test for statistical significance using SPSS version 20.Results: There was no statistical difference in age and parity between control and case group. Triglyceride (cases- 286.4±77.60 mg/dl) (controls-166±26mg/dl), total cholesterol (cases-256.5±41.7 mg/dl) (controls - 202.5±20.18mg/dl), VLDL (cases-53.4±13.2 mg/dl) (controls-46.6±13.1mg/dl) showed statistically significant values (p value<0.001). HDL and LDL values did not show any statistical significance (p value >0.5) among GDM and non GDM group. Lipid profile was performed predominately in women in II trimester.Conclusions: In comparison to non GDM women, it was observed that serum triglyceride, total cholesterol and VLDL level are significantly higher in woman with GDM. Whether lipid profile can be used as a predictor for gestational diabetes mellitus in future needs further research.

Correlation of blood sugar and lipid parameters with carotid intima media thickness among patients with type II diabetes mellitu

Background: Of the various non invasive imaging methods available, arterial intima media thickness measurement obtained by B mode ultrasound is currently recommended by the American Heart Association as being relatively safe, non invasive and inexpensive method of assessing sub clinical atherosclerosis, and being an independent predictor of atherosclerotic events. Aim: To study the correlation between glycemic and lipid levels with carotid intima media thickness among patients with type II diabetes mellitus. Methodology: A prospective longitudinal study was conducted for a period of one year. Patients in the age group of 30 to 70 years with type II diabetes for more than 2 years were included as our study subjects. A total of 100 patients were included as our study subjects. Anthropometric measurements, blood sugar parameters and lipid parameters were measured as per the guidelines. Carotid artery intima media thickness was measured by B mode ultrasound having an electric transducer with a mid frequency of 7.5 MHz. Scans were performed on both the right and left extracranial carotid arteries by trained personnel. The IMT values were measured in six well defined arterial segments- near wall and far wall of distal 6mm of common carotid, the carotid bulb and proximal 6mm of internal carotid artery of both sides. The final IMT considered was the average of the IMT values at the 12 sites examined. Results: A multivariate analysis was performed to assess the various factors influencing the increase in the thickness of CIMT and among that we found a significant correlation had occurred with the factors like BMI, waist hip ratio, fasting and post-prandial blood sugar, HbA1C and among the lipid parameters LDL, total cholesterol and triglycerides had shown a statistical significant correlation (p<.05), whereas factors like age, gender, hypertension status, duration of diabetes and HDL cholesterol among the lipid parameter did not show a statistical significant correlation with CIMT (p>.05). Conclusion: CIMT measurement can be used as a regular screening tool in diabetic patients for the early detection of atherosclerosis among them.

Serum Inflammatory Markers Of Diabetic Kidney Disease And Their Correlation To Lipid Parameters Among Diabetic Individuals Of Eastern India

Background : Diabetes mellitus is the leading cause of chronic renal failure . As the period of diabetes progresses there is simultaneous increase of inflammatory markers like high sensitive C reactive protein (hsCRP) with degree of renal involvement, suggested by albumin creatinine ratio and also dyslipidemia in diabetic patients. Materials & Methods: 120 diabetic individuals aged (30-60) yrs, divided in 3 groups of 40 subjects in each, namely: a) newly diagnosed˂5 years b) 5-10 years after diagnosis and c) ≥10 years after diagnosis were recruited as study subjects from a tertiary care hospital in sub Himalayan region. Results : Descriptive studies showing mean values of hsCRP ,ACR & lipid parameters were done in all 3 groups. One-way ANOVAwith post hoc analysis after Bonferroni correction in 3 different groups enunciated a significant and statistical increase (p <.001) of both hsCRP &ACR with duration of diabetes unlike the lipid parameters. hsCRP, ACR, cholesterol & LDLeven illustrated a very significant correlation between each other (p<0.001) , TG to hsCRPwhile HDLshowed no correlation to any parameters. Conclusion: Early detection, monitoring of inflammatory markers hsCRP, ACR & deranged lipid parameters are predictors of diabetic nephropathy that can help in modulating diabetes and its complications.

Biochemical Effects of Statins on Lipid Parameters among Newly Diagnosed Dyslipidaemia Subjects in Primary Care

@#Introduction: Statins have several pleiotropic effects including its primary effect of lipid lowering that is important to prevent cardiovascular disease (CVD). Subjects often have heterogeneous responses to statin. This study aims to determine the biochemical effects of statins on lipid parameters among newly diagnosed dyslipidaemia subjects. Methods: This was a prospective observational study involving 118 newly diagnosed adults with dyslipidaemia from three government health clinics in Selangor, Malaysia. Biochemical analyses including fasting lipid profile [triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and apolipoproteins (apoA1, apoB) were taken at baseline and follow-up after a month on statin. Results: Majority of subjects (61.9%) were prescribed with lovastatin, with the rest on simvastatin. At baseline, the median values for all lipid profile parameters (TC, LDL-C, HDL-C) and non-conventional lipid parameters (LDL-C:HDL-C ratio, non-HDL-C, TC:HDL-C ratio, apoB:apoA1 ratio) were deranged except for TG and apoA1. On follow up, all parameters showed median values within the reference range except for HDL-C, non-HDL-C and TC:HDL-C ratio. There was significant difference in the effect of statins on lipid parameters including predictors of cardiovascular risk, simvastatin having better effects. Conclusions: Different statinshave varying effects on lipid parameters. Simvastatin showed significantly better effects compared to lovastatin. Non-HDL value should be included in the standard lipid profile report given its ease of use and implementation as it’s both a marker of coronary artery disease (CAD) risk stratification as well as an established determinant of goal attainment during therapy.

Relationship Between Dyslipidaemia And Glycaemic Status In Patients With Type 2 Diabetes Mellitus

The risk of coronary heart disease (CHD) is dramatically increased in diabetic patients due to their atherogenic lipid profile. The severity of CHD in diabetic patients has been found to be directly associated with glycated haemoglobin (HbA1c). According to the Malaysian Clinical Practice Guidelines on diabetes mellitus (DM), HbA1c level less than 6.5% reduces the risk of microvascular and macrovascular complications. Hence, this study aimed to determine the relationship between dyslipidaemia and glycaemic status in patients with type 2 DM (T2DM) patients in Hospital Putrajaya, a tertiary endocrine centre in Malaysia. This was a cross sectional, retrospective study of 214 T2DM patients with dyslipidaemia who had visited the endocrine clinic between January 2009 and December 2012. Significant correlations were found between fasting blood glucose (FBG) and HbA1c with total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL), non-high density lipoprotein cholesterol (non-HDL), LDL/HDL ratio and TC/HDL ratio; greater correlation being with HbA1c than FBG. In patients with HbA1c ≥ 6.5%, TC, TG, non-HDL and TC/HDL ratio were significantly higher than in patients with HbA1c < 6.5%. Non-HDL, LDL/HDL ratio, TC/HDL ratio and HbA1c were significantly lower in patients on statin treatment than nontreated patients (p<0.05). This significant association between glycaemic status and dyslipidaemia emphasises the additional possible use of HbA1c as a biomarker for dyslipidaemia as well as a potential indirect predictor of cardiovascular disease (CVD) risk in T2DM patients.

To study the hypotensive and hypolipidemic effects of garlic in smokers in the North Indian population.

Background: Garlic, latin name Allium Sativum, belongs to the onion family Alliaceae, have been widely recognized as agents for prevention and treatment of cardiovascular and other metabolic diseases like atherosclerosis, hyperlipidemia, thrombosis, hypertension and diabetes. Methods: This prospective study conducted on male smokers (n=40) in the department of physiology of Teerthanker Mahaveer Medical College & Research Centre. Selected smokers were further evaluated before and after giving raw fresh garlic weighing about 5-6gm daily for a month. Sample 1:- Before taking garlic parameters. Sample 2:- After taking garlic parameters. After one month all the parameters were analyzed and compared with the baseline parameters. Results: Garlic has a significant hypotensive effect by lowering DBP, SBP also lowered but it was not statistically significant. Also hypolipidemic effects of garlic were found to be statically significant in cases of triglyceride, HDL & LDL, but changes in cases of cholesterol and VLDL are not statically significant. Conclusions: Garlic being hypotensive and hypolipidemic in nature as shown in our study, therefore it can be concluded that garlic is beneficial for human beings. Its main beneficial effect for decreasing the lipid levels as well as the blood pressure in smokers.

Dose-dependent Modulation of Lipid Parameters, Cytokines and RNA by -tocotrienol in Hypercholesterolemic Subjects Restricted to AHA Step-1 Diet.

Aims: Evaluate the consumption of -tocotrienol (free from tocopherols) on serum lipid parameters, and several cytokines (TNF-, IL-4, IL-6, IL-8, IL-10), including gene expression and circulating microRNAs (miRNAs) in hypercholesterolemic subjects. Study Design: The present preliminary dose-response study consisted of six phases. All hypercholesterolemic subjects took increasing doses of -tocotrienol (125, 250, 500,750 mg/d) plus AHA Step-1 diet for 4 weeks during the 30 weeks study period. Methodology: Hypercholesterolemic (n = 31; serum cholesterol > 5.2 mmol/L) subjects (males- 26/females 5; age range 50-71 years) were enrolled in the study from Wah Cantonment, Pakistan. Serum lipid parameters were measured by auto analyzers. Various plasma cytokines, cDNA, and miRNAs were estimated by Signosis kits. Results: All participants (n = 31) completed all phases of study. The -tocotrienol plus AHA Step-1 diet caused reductions in lipid parameters in a dose-dependent manner with maximum effects on serum total cholesterol (15%), LDL-cholesterol (18%), triglycerides (14%) with 250 mg/d dose (P< 0.001). Doses above 500 mg/d resulted ininduction in levels of all lipid parameters, except HDLcholesterol. The cytokines associated with cardiovascular disease (plasma TNF-, IL-2, IL-4, IL-6, IL-8, IL-10) were all down-regulated 39%-64% by -tocotrienol treatment (P< 0.01). Similar results were obtained with gene expression of these cytokines using whole blood messenger-RNA. In contrast, circulating miRNA-7a, miRNA-15a, miRNA-20a (anti-angiogenic), miRNA-21, miRNA- 29a, miRNA-92a, miRNA-200, miRNA-206 (skeletal muscle regeneration) down-regulated in hypercholesterolemic subjects, were up-regulated by -tocotrienol treatment as compared to baseline (P< 0.01). Conclusion: The present results confirm that consumption of -tocotrienol plus AHA Step-1 diet causes significant reduction in serum lipid parameters and several cytokines (TNF-, IL-2, IL-4, IL- 6, IL-8, IL-10) at a low optimal dose (250 mg/d). The capacity of -tocotrienol to modulate inflammation is partly attributable to dose-dependent properties of inhibition/activation, which may play a major role in future treatment of cardiovascular diseases.

Comparative evaluation of effects of combined oral anti-diabetic drugs (sulfonylurea plus pioglitazone and sulfonylurea plus metformin) over lipid parameters in type 2 diabetic patients.

Background: Type 2 diabetes is associated with significant cardiovascular morbidity and mortality. Dyslipidemia, which affects almost 50% of patients with type 2 diabetes, is a cardiovascular risk factor characterized by elevated triglyceride levels, low high-density lipoprotein (HDL) cholesterol levels, and a preponderance of small, dense, low-density lipoprotein (LDL) particles. In addition to their glucose-lowering properties, oral anti-diabetic agents may have effects on lipid levels, especially triglycerides (TGs), HDL-C, LDL-C and total cholesterol levels. Methods: A prospective, open-labeled, randomized, parallel-group study was carried out in sizable number of patients (n=40) of established type 2 diabetes on combined oral anti-diabetic drugs, to investigate the effects of combined oral anti-diabetic on lipid parameters who was not receiving any hypolipidemic agent in addition. Results: Statistically significant mean reduction of triglycerides (TGs) of 25.1mg/dl (a 15.30% reduction from baseline value) and by 13.5 mg/dl (a 8.94% reduction from baseline value) in the SU (sulfonylurea) plus PIO (pioglitazone) and SU plus MET (metformin) group respectively. Present study also shows improvement in HDL cholesterol with SU plus PIO group by 13.18% which is almost twice that observed in SU plus MET group (8.06%). Present study also shows increase in LDL cholesterol with SU plus PIO group by 2.10%, is just opposite to SU plus MET group (4.92 % decrease). With SU plus PIO group, a statistically significant mean reduction of total cholesterol (TC) of 8.33mg/dl (5.14 % decrease) and by 7.62 mg/dl (4.28% decrease) in the SU plus MET group. Conclusions: Pioglitazone, a thiazolidinedione, has been shown to improve the lipid profile in patients with type 2 diabetes by increasing HDL-C levels and by decreasing triglyceride and total cholesterol levels in monotherapy or combination regimens with sulfonylurea. Metformin also has been shown to reduce LDL-C, TC, and TG levels and increase HDL-C levels in monotherapy and in combination regimens with sulfonylurea. In contrast, LDL cholesterol levels mild increase with pioglitazone monotherapy or with SU combination therapy. Thus the results of this study have demonstrated that SU plus pioglitazone is an effective combination regimen for patients insufficiently treated with SU monotherapy and may provide possible positive effects on other coronary risk factors/ dyslipidemias associated with the type 2 diabetes.

Association of High Density Lipoprotein Cholesterol with Renal Function in Type 2 Diabetic Subjects in a Bangladeshi Population.

Background: Abnormalities in lipid metabolism are associated with renal diseases. Association of serum lipid parameters with renal function is less studied in subjects with type 2 diabetes in Bangladeshi population. Objective: To assess the correlation of high density lipoprotein cholesterol with glomerular filtration rate (GFR) in type 2 diabetic subjects. Materials and Methods: One thousand three hundred thirty confirmed diabetic subjects advised for HbA1c, serum creatinine, serum total cholesterol, serum triglycerides, serum HDL cholesterol and LDL cholesterol were included in the study. Serum total cholesterol, HDL cholesterol, triglyceride, serum creatinine, HbA1c were measured by standard methods and serum LDL cholesterol was calculated by Friedewald’s formula. GFR was calculated by MDRD4 variables prediction equation. Total subjects were grouped according to sex; both males and females were subdivided into three subgroups depending on GFR values. Results of lipid parameters were compared by one-way ANOVA among different groups and correlation of lipid parameters with GFR were expressed by Pearson r. Results: HDL cholesterol was significantly different among different GFR groups (p<0.05) and positively correlated with GFR (r = 0.1386, p<0.001) in males. Total cholesterol and LDL cholesterol showed feeble positive correlation with GFR (r = 0.0789, p<0.05 for total cholesterol and r = 0.0768, p<0.05 for LDL cholesterol), but are not significantly different among GFR groups (p>0.05) in males. Total cholesterol, HDL cholesterol, LDL cholesterol, non-HDL cholesterol and LDLC/ HDL-C were significantly different among three different GFR groups (p<0.01) and only HDL cholesterol and LDL-C/HDL-C showed weak correlation with GFR (r = 0.0770, p<0.05 for HDL cholesterol and r = -0.0803, p<0.05 for LDL-C/HDL-C) in females. Conclusion: The study revealed that HDL cholesterol was significantly and positively correlated with glomerular filtration rate in both male and female diabetic subjects and assessment of lipid parameters might be a helpful tool to prevent or delay the progression of renal insufficiency.

Effect of altered levels of micronutrients on lipid parameters in thyroid dysfunction.

Trace elements are extremely important for normal metabolism. Copper is one of the trace metals which has important physiological function in maintaining thyroid activity. Copper is known to effect lipid metabolism. Increase in serum copper level is associated with decrease in concentration of total cholesterol (TC). Thyroid hormone binding transcription factors, which are essential for modulation of gene expression, contain zinc bound to cysteine residues and also thyroid hormones influence zinc metabolism by affecting zinc absorption and excretion. Zinc is required for enzymes involved in lipid synthesis and lipoprotein excretion. The purpose of this study was to determine the effect of various levels of serum copper and zinc on total cholesterol, plasma triglyceride and low density lipoprotein cholesterol in subjects with thyroid dysfunction. 61 subjects were divided into three groups of 13 hypothyroid, 23 hyperthyroid and 25 euthyroid based on thyroid stimulating hormone levels. The correlation between serum copper and low density lipoprotein (p <0.01) (r = -0.842), serum zinc correlated strongly negative and significantly with total cholesterol (r= -0.564) , low density lipoprotein cholesterol (r= -0.666) in hyperthyroid group. But the correlation in hypothyroid and euthyroid group differed and was not significant. Elevated levels of total cholesterol and low density lipoprotein cholesterol may be proatherogenic and increase the risk of cardio vascular diseases hence measures must be taken in correcting and maintaining levels of micronutrients in thyroid dysfunction.

Correlation between Androgenetic Alopecia and Lipid Parameters for Risk Factors of Coronary Artery Disease / 대한피부과학회지

BACKGROUND: The association of androgenetic alopecia and coronary artery disease has not been well documented although many studies have tried to reveal this association. This relationship is still a controversial issue. OBJECTIVES: The aim of this study is to investigate the association between the androgenetic alopecia and lipid parameters for risk factors of coronary artery disease. METHODS: The subjects of this study were 102 patients with androgenetic alopecia who had visited the Department of Dermatology, Pil-dong Hospital, College of medicine, Chung-Ang University during 2 years (from January 2000 to December 2001). The subjects of control group were 40 male individuals who had no androgenetic alopecia, no risk factor of coronary artery disease and no coronary artery disease. RESULTS: 1. There were significant differences in the serum total lipid, phospholipid, triglyceride between the patients and the control group. But there were no significant differences in serum LDL-cholesterol, HDL-cholesterol, and total cholesterol between the two groups. 2. There were significant differences in the serum total lipid, phospholipid, triglyceride between frontal baldness patients and the control group (p<0.05). But there were no significant differences in the serum LDL-cholesterol, HDL-cholesterol, and total cholesterol between the two groups. 3. There were significant differences in the serum total lipid, phospholipid, triglyceride, LDL-cholesterol, and total cholesterol between vertex baldness patients and the control group (p<0.05). But there were no significant differences in serum HDL-cholesterol between two groups. 4. There were no significant differences in the serum total lipid, phospholipid, triglyceride, LDL-cholesterol, HDL-cholesterol and total cholesterol between androgenetic alopecia patients who were increased serum testosterone and the control group. CONCLUSION: These data suggest that androgenetic alopecia involving the vertex scalp is associated with significantly increased total cholesterol and LDL-cholesterol for risk factors of coronary artery disease. We recommend that dermatologists should investigate the lipid parameters, especially total cholesterol and LDL-cholesterol in vertex baldness patients.

Lipoprotein(a) and Lipoprotein(a) Phenotype in Restenosis after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND: The purpose of the study was to investigate prospectively the relation of lipoprotein(a)[Lp(a)],apoproteins and serum lipid parameters to restenosis after percutaneous transluminal coronary angioplasyt(PTCA). METHODS: One hundred and forty-five patients who received successful PTCA were enrolled and their serum levels of lipids, apoproteins and Lp(a) were measured before PTCA. After 6 months of follow-up, the patients were reevaluated for the development of restenosis by coronary angiography, treadmill test or thallium scan. RESULTS: A total 137 patients could be followed. Restenosis occurred in 71 patients(52%). Clinical parameters(e.g. age, sex, hypertension, diabetes, smoking) and angiographic parameters(e.g. lesion site, type and degree of stenosis) were not significantly different between the group without restenosis and the group with restenosis. Lipid parameters and apoproteins were not associated with restenosis. Lp(a) and Lp(a) phenotype analysis showed no significant difference between the two gruops. CONCLUSION: Serum lipid parameters, apoproteins and Lp(a) concentration are not associated with restenosis after PTCA and cannot be used as predictios of restenosis.