Hepatic Lipase Influences Plasma Lipid Profiles and Lipoprotein Ratios in Regional Hospital Patients with Ischemic Stroke

Background: Stroke is the second most common cause of death and disability in developed Countries. Ischemic stroke is the most common, with an estimated incidence of approximately 80%.Studies have shown that dyslipidemia, including high levels of plasma or serum total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C) and apolipoprotein B (ApoB) and low levels of high density lipoprotein-cholesterol (HDL-C) is a risk factor for the progression of atherosclerosis and the development of cardiovascular disease. Attempts are being made to include the use of lipoprotein ratios to optimize the predictive capacity of lipid profile in risk evaluation.Objective: The objective of the present study is to evaluate the effect of hepatic lipase activity on lipid profiles and lipoprotein ratios in ischemic stroke patients.Methodology: Two hundred healthy and ischemic stroke subjects were recruited in the study after obtaining informed written consent. They were divided into six groups considering age classes. Group 1-3 were control subjects (n=100) and 4-6 were ischemic stroke subjects (n=100). Weight, height, hepatic lipase activity and plasma lipid profiles were measured and lipoprotein ratios calculated using Excel software. Statistical analyses were performed using GraphPad prism computer software version 5.00 and SPSS version 22 software programme.Results: Hepatic lipase activity in the stroke subjects was significantly (P<0.0001) lower than control subjects (P=0.0001, 20.21 ± 0.3706 µmol/h/ml vs 30.50 ± 0.3928 µmol/h/ml). The stroke subjects had significantly (P<0.05) higher SBP, DBP and BMI compared to the control. Abnormal plasma lipid parameters were obtained in the stroke subjects compared to the control subjects. The stroke subjects had significant (P<0.0001) elevated TC, TG, LDL-C, VLDL-C, Non- HDL-C, CRI-I, CRI-II, AC, TG/HDL-C and AIP as well as lower HDL-C and HDL-C/LDL-C. LDL-C/HDL-C ratio (0R=490488439.6, 95% CI=0.078 - 3.102E+18 P=0.000) is the major risk factor for the development of ischemic stroke.Conclusion: Hepatic lipase activities were lower while higher BP, BMI and dyslipidemia were obtained in the ischemic stroke subjects

Serum lipoprotein ratios as markers of insulin resistance: A study among non-diabetic acute coronary syndrome patients with impaired fasting glucose.

Background & objectives: Recent data suggest that insulin resistance can predict cardiovascular disease independently of the other risk factors, such as hypertension, visceral obesity or dyslipidaemia. However, the majority of available methods to evaluate insulin resistance are complicated to operate, expensive, and time consuming. This study was undertaken to assess whether serum lipoprotein ratios could predict insulin resistance in non-diabetic acute coronary syndrome (ACS) patients. Methods: Ninety non-diabetic patients with impaired fasting glucose admitted with a diagnosis of ACS were included in the study. At the time of admission fasting glucose and insulin concentrations were measured. The homeostatic model assessment-insulin resistance (HOMA-IR) was used for insulin resistance. The fasting serum total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C) levels were checked, and then TC/HDL-C and TG/HDL-C ratios were calculated. The areas under the curves (AUC) of the receiver operating characteristic (ROC) curves were used to compare the power of these serum lipoprotein ratios as markers. Results: Lipoprotein ratios were significantly higher in patients with HOMA-IR index > 2.5 as compared to patients with index <2.5 (P < 0.05). Both TG/HDL-C and TC/HDL-C ratios were significantly correlated with HOMA-IR (P<0.05). The area under the ROC curve of the TG/HDL-C and TC/HDL-C ratio for predicting insulin resistance was 0.80 (95% CI, 0.67 to 0.93), 0.78 (95% CI, 0.65 to 0.91), respectively. Interpretation & conclusions: The findings of this study demonstrate that serum lipoprotein ratios can provide a simple means of identifying insulin resistance and can be used as markers of insulin resistance and cardiovascular diseases risk in adult non-diabetic patients.

Pattern of Abnormal Serum Lipids and Lipoprotein Ratios in Nigerian Hypertensive Patients Seen in Clinical Practice.

Background: Hypertension is a major health problem worldwide. Its role, and other well-known coronary risk factors, especially dyslipidemia, in atherogenesis have informed estimation of cardiovascular risk. Hitherto, low density lipoprotein (LDL-C) and high density lipoprotein (HDL-C) are prominent in guidelines but attempts are being made to include the use of lipoprotein ratios to optimize the predictive capacity of lipid profile in risk evaluation. This study aimed to describe pattern of lipids abnormalities, including the common lipid ratios used in clinical practice and to understand if they differ more with abdominal obesity which compared with peripheral obesity in subjects with systemic hypertension. Materials and Methods: Two hundred and eleven new adult hypertensive patients were studied in a hospital-based cross-sectional study. Serum lipids were measured and lipoprotein ratios calculated. SPSS IBM 20 was used to analyze data. Results: Mean age was 57.35±12.66 years. The prevalence of abnormal serum lipids in this study population was: elevated LDL-C (58.0%); elevated total cholesterol (38.9%); low HDL-C (31.4%); and elevated triglyceride (22.0%). For ratios of lipid profile, Castelli risk index-I (CRI-I) and Castelli risk index- II (CRI-II) were abnormal in 31.2% and 27.9%, respectively. Coronary disease risk ratio and atherogenic index of plasma were abnormal in 12.6% and 12.1%, respectively. Seven subjects (3.5%) had atherogenic lipid triad of low HDL-C, elevated LDL-C and high triglyceride with all the 7 subjects having abdominal obesity. Irrespective of the measure of obesity employed, LDL-C had the highest sensitivity. Conclusion: Lipids abnormalities were common in our hypertensive subjects, the commonest being high LDL-C. CRI-I and CRI-II demonstrated higher prevalence than the CDR and AIP as well as higher sensitivities, though their use may under-estimate the burden of dyslipidemia in our patients. Finally, irrespective of the measure of adiposity, lipids profiles in our study population were comparable.

Association of serum lipoprotein ratios with insulin resistance in type 2 diabetes mellitus.

Background: The fasting serum total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) levels are used to calculate following lipid ratios: TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C. Cholesterol retention fraction (CRF), non-HDL-C, LDL-C, TG and waist circumference (WC) one considered as markers for the identification of individuals with an increased risk for cardiovascular diseases (CVD). These individuals frequently show insulin resistance as well. We analyzed the association of lipoprotein ratios with the homeostasis model assessment of insulin resistance (HOMA-IR). Methods: Type 2 diabetes mellitus (T2D) patients (92) and 40 age match healthy controls were randomized from the Tapho Primary Health Care Unit and the area in the same district. The HOMA-IR was used to calculate for insulin resistance. The areas under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum lipoprotein ratios markers. Results: All lipoprotein ratios, lipid profile, blood pressure, and WC were significantly higher in T2D patients as compared to healthy controls (P<0.05). TC/HDL-C ratio, TG/HDL-C ratio, non-HDL-C, WC, TG, and TC were significantly correlated with HOMA-IR (P<0.05) as obtained by Spearman correlation analysis. The largest AUC of the ROC curve was obtained with the TC/HDL-C ratio as one parameter. Conclusion: TC/HDL-C ratio, TG/HDL-C, ratio, Non-HDL-C, WC, TG, and TC can be used as the markers of insulin resistance and CVD risk in T2D patients.