Showing papers by "Raul D. Santos published in 2018"
Cardiovascular Institute of the South1, Alfred I. duPont Hospital for Children2, University of Texas Southwestern Medical Center3, Baylor College of Medicine4, Florida Atlantic University5, University of Lisbon6, University of Paris7, University of Pennsylvania8, Boston Children's Hospital9, University of Amsterdam10, Central European Institute of Technology11, Ohio State University12, Queen Mary University of London13, Vanderbilt University14, West Virginia University15, Copenhagen University Hospital16, University of São Paulo17, Erasmus University Rotterdam18, Washington University in St. Louis19, Osaka University20
TL;DR: The Expert Consensus Panel recommends that FH genetic testing become the standard of care for patients with definite or probable FH, as well as for their at-risk relatives, and more accurate risk stratification.
354 citations
University of California, San Diego1, Oregon Health & Science University2, Tulane Medical Center3, Columbia University4, University of Western Ontario5, University of Washington6, University of Kansas7, University of Pennsylvania8, National Institutes of Health9, University of São Paulo10, McGill University11
TL;DR: Concerted efforts to understand Lp (a) pathophysiology, together with diagnostic and therapeutic advances, are required to reduce Lp(a)-mediated risk of CVD and CAVD.
300 citations
Geneva College1, Imperial College London2, University of Gothenburg3, Sahlgrenska University Hospital4, University of Milan5, National Institutes of Health6, University of Western Ontario7, Emory University8, Children's Hospital Oakland Research Institute9, Leipzig University10, University of Toronto11, University of Graz12, Heidelberg University13, University of Copenhagen14, Copenhagen University Hospital15, University of the Witwatersrand16, University of Düsseldorf17, University of São Paulo18, Hartford Hospital19, Hacettepe University20, State University of New York System21, Columbia University22
TL;DR: Long-term statin treatment is remarkably safe with a low risk of clinically relevant adverse effects as defined above, and the established cardiovascular benefits of statin therapy far outweigh the risk of adverse effects.
Abstract: Aims
To objectively appraise evidence for possible adverse effects of long-term statin therapy on glucose homeostasis, cognitive, renal and hepatic function, and risk for haemorrhagic stroke or cataract.
228 citations
Imperial College London1, Central European Institute of Technology2, University of the Witwatersrand3, University of São Paulo4, University of Manchester5, University of Western Australia6, Saint Joseph's University7, Hamad Medical Corporation8, Sultan Qaboos University9, Medical University of Vienna10, Oslo University Hospital11, Institute of Chartered Accountants of Nigeria12, Gdańsk Medical University13, Hebrew University of Jerusalem14, Ljubljana University Medical Centre15, McGill University Health Centre16, Ege University17, University of Belgrade18, National University of Singapore19, University of Latvia20, University of Ioannina21, Capital Medical University22, National Health Laboratory Service23, Heidelberg University24, Kyrgyz State Medical Academy25, University of Basel26, Academy of Medical Sciences, United Kingdom27, Universiti Teknologi MARA28, University of Copenhagen29, University of Debrecen30, Vilnius University31, Sofia Medical University32, University of Zagreb33, University of Benin34, Mashhad University of Medical Sciences35, United Arab Emirates University36, National Taiwan University37, Khoo Teck Puat Hospital38, University of Malta39, The Chinese University of Hong Kong40, National Institutes of Health41, Universidad Autónoma de Guadalajara42, Tallinn University of Technology43, Slovak Medical University44, University of Helsinki45, Osaka University46, Medical University of Łódź47, Linköping University48, University of the Philippines49, Technische Universität München50, Hacettepe University51, Nanyang Technological University52, University of Milan53
TL;DR: FH is a recognised public health concern, with overall suboptimal identification and under-treatment, and efforts and initiatives to improve FH knowledge and management are underway, but support from health authorities and better funding are greatly needed.
161 citations
TL;DR: These observational data suggest that the achievement of LDL-C goals is suboptimal in selected countries outside Western Europe and efforts are needed to improve the management of patients using combination therapy and/or more intensive LLTs.
Abstract: BackgroundLittle is known about the achievement of low density lipoprotein cholesterol (LDL-C) targets in patients at cardiovascular risk receiving stable lipid-lowering therapy (LLT) in countries ...
80 citations
University of Western Ontario1, Instituto Nacional de Saúde Dr. Ricardo Jorge2, University of Lisbon3, University of Paris4, Masaryk University5, University of Amsterdam6, University of North Carolina at Chapel Hill7, Harvard University8, University College London9, University of Western Australia10, university of lille11, Stanford University12, Erasmus University Rotterdam13
TL;DR: To further reform interpretation of FH‐associated variants, areas for improvement in variant submissions were identified; these include a need for more detailed submissions and submission of supporting variant‐level data, both retrospectively and prospectively.
Abstract: Accurate and consistent variant classification is imperative for incorporation of rapidly developing sequencing technologies into genomic medicine for improved patient care. An essential requirement for achieving standardized and reliable variant interpretation is data sharing, facilitated by a centralized open-source database. Familial hypercholesterolemia (FH) is an exemplar of the utility of such a resource: it has a high incidence, a favorable prognosis with early intervention and treatment, and cascade screening can be offered to families if a causative variant is identified. ClinVar, an NCBI-funded resource, has become the primary repository for clinically relevant variants in Mendelian disease, including FH. Here, we present the concerted efforts made by the Clinical Genome Resource, through the FH Variant Curation Expert Panel and global FH community, to increase submission of FH-associated variants into ClinVar. Variant-level data was categorized by submitter, variant characteristics, classification method, and available supporting data. To further reform interpretation of FH-associated variants, areas for improvement in variant submissions were identified; these include a need for more detailed submissions and submission of supporting variant-level data, both retrospectively and prospectively. Collaborating to provide thorough, reliable evidence-based variant interpretation will ultimately improve the care of FH patients.
78 citations
TL;DR: The subgroup of statin-treated FH patients had a similar magnitude of risk reduction for hard cardiovascular events with the PCSK9 inhibitor bococizumab as did patients without FH, with no evidence of statistical heterogeneity between groups.
38 citations
Curtin University1, University of Jyväskylä2, Griffith University3, The Chinese University of Hong Kong4, University of Manchester5, Capital Medical University6, Universiti Teknologi MARA7, University of Western Australia8, University of São Paulo9, National Taiwan University10, Royal Perth Hospital11
TL;DR: Findings indicate non-trivial levels of inadequate health literacy in samples of familial hypercholesterolemia patients, which are consistent with previous research in chronic illness and related to income as an index of health disparities.
Abstract: BackgroundHigh rates of inadequate health literacy are associated with maladaptive health outcomes in chronic disease including increased mortality and morbidity rates, poor treatment adherence and poor health. Adequate health literacy may be an important factor in the effective treatment and management of familial hypercholesterolemia, and may also be implicated in genetic screening for familial hypercholesterolemia among index cases. The present study examined the prevalence and predictors of health literacy in familial hypercholesterolemia patients attending clinics in seven countries.DesignCross-sectional survey.MethodsConsecutive FH patients attending clinics in Australia, Brazil, China, Hong Kong, Malaysia, Taiwan and the UK completed measures of demographic variables (age, gender, household income and highest education level) and a brief three-item health literacy scale.ResultsRates of inadequate health literacy were lowest in the UK (7.0%), Australia (10.0%), Hong Kong (15.7%) and Taiwan (18.0%) s...
34 citations
TL;DR: In Arabian Gulf citizens, FH was common in ACS patients, was undertreated, and was associated with a worse 1-year prognosis, which presented with a greater association with the composite ASCVD endpoint when compared with the "unlikely" FH group.
34 citations
TL;DR: The data suggest that the initiation or maintenance of PA attenuates the low-grade inflammatory state, independent of sex, body weight and smoking status, in adults.
28 citations
TL;DR: In conclusion, severe OSA decreasedlipolysis of triglyceride-rich lipoproteins and delayed removal of remnants and CPAP treatment may be effective to restore the lipolysis rates.
Griffith University1, University of Jyväskylä2, Curtin University3, The Chinese University of Hong Kong4, University of Manchester5, Capital Medical University6, Universiti Teknologi MARA7, University of Western Australia8, University of São Paulo9, St Mary's Hospital10, National Taiwan University11
TL;DR: The findings indicate the importance among FH patients of specific beliefs about taking medication and generalized beliefs about medication overuse and treatment in predicting medication intentions.
TL;DR: FH affects 1 in 263 in ELSA-Brasil and affects disproportionally more Brown, and Black, than White (1 in 156), than White(1 in 417).
TL;DR: Although the TSH variability within the reference range is associated with NAFLD in univariable models, once adjusted for metabolic syndrome factors no significant association is noted.
Abstract: Introduction: Thyroid hormones are involved in the regulation of body composition, lipid metabolism, and insulin resistance. Thus, it is possible that they might play a role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). However, the role of thyroid function on NAFLD is not well defined. In this study, we evaluated the relationship between thyroid-stimulating hormone (TSH) levels, within the reference range, and presence of NAFLD in asymptomatic individuals. Study Design: We included all individuals evaluated at a preventive clinic of the Hospital Israelita Albert Einstein, between 2014 and 2015. The prevalence of NAFLD (analyzed by abdominal ultrasound), according to TSH quartiles, within the reference range, was determined. The association between TSH quartiles and NAFLD was analyzed by logistic regression adjusted for possible confounders. Results: We evaluated 10,539 individuals (73% male, age 43.4 ± 9.4 years). The prevalence of NAFLD was 34, 38, 38, and 39% in the first to the fourth TSH quartiles (0.46–1.44, 1.45–1.97, 1.98–2.68, and 2.69–4.68 mUI/L, respectively, p for trend < 0.001). At univariate analysis, higher TSH levels were associated with the diagnosis of NAFLD. When data were adjusted for the metabolic syndrome characteristics (waist circumference, HDL-cholesterol and triglycerides levels, presence of diabetes, and systemic arterial hypertension), the association was no longer significant. Conclusions: Although the TSH variability within the reference range is associated with NAFLD in univariable models, once adjusted for metabolic syndrome factors no significant association is noted.
TL;DR: The perception of cardiovascular (CV) risk is essential for adoption of healthy behaviors and subjects underestimate their own risk.
Abstract: BACKGROUND The perception of cardiovascular (CV) risk is essential for adoption of healthy behaviors. However, subjects underestimate their own risk. HYPOTHESIS Clinical characteristics might be associated with self-underestimation of CV risk. METHODS This is a retrospective, cross-sectional study of individuals submitted to routine health evaluation between 2006 and 2012, with calculated lifetime risk score (LRS) indicating intermediate or high risk for CV disease (CVD). Self-perception of risk was compared with LRS. Logistic regression analysis was performed to test the association between clinical characteristics and subjective underestimation of CV risk. RESULTS Data from 5863 subjects (age 49.4 ± 7.1 years; 19.9% female) were collected for analysis. The LRS indicated an intermediate risk for CVD in 45.7% and a high risk in 54.3% of individuals. The self-perception of CV risk was underestimated compared with the LRS in 4918 (83.9%) subjects. In the adjusted logistic regression model, age (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.10-1.47 per 10 years, P = 0.001), smoking (OR: 1.99, 95% CI: 1.40-2.83, P < 0.001), dyslipidemia (OR: 1.21, 95% CI: 1.01-1.46, P = 0.045), physical activity (OR: 1.66, 95% CI: 1.36-2.02, P < 0.001), and use of antihypertensive (OR: 1.49, 95% CI: 1.15-1.92, P = 0.002) and lipid-lowering medications (OR: 2.13, 95% CI: 1.56-2.91, P < 0.001) were associated with higher chance of risk underestimation, whereas higher body mass index (OR: 0.92, 95% CI: 0.90-0.94, P < 0.001), depressive symptoms (OR: 0.46, 95% CI: 0.37-0.57, P < 0.001), and stress (OR: 0.41, 95% CI: 0.33-0.50, P < 0.001) decreased the chance. CONCLUSIONS Among individuals submitted to routine medical evaluation, aging, smoking, dyslipidemia, physical activity, and use of antihypertensive and lipid-lowering medications were associated with higher chance of CV risk underestimation. Subjects with these characteristics may benefit from a more careful risk orientation.
TL;DR: This study aimed to evaluate the impact of physical activity on the course of hepatic steatosis in adults and found that physical activity improves the chances of survival in adults with HS.
Abstract: Background and Aim
This study aimed to evaluate the impact of physical activity (PA) on the course of hepatic steatosis (HS) in adults.
Methods
HS status (ultrasonography) and PA levels were evaluated in 5860 subjects at baseline and after approximately 2.5 years (range: 19-50 months). At follow-up possible exposures to different PA levels were: those who remained inactive, became inactive, became active, remained active. After follow-up, subjects were then classified according to the four possible states (outcomes): “remained without HS”, “developed HS” (subjects without HS at baseline), “remained with HS”, or “reverted HS”.
Results
After multivariate adjustments individuals without HS that became or remained physically active were less likely to develop HS compared to those who remained physically inactive (OR = 0.75; P = 0.04, and 0.75; P = 0.03, respectively). Among those with HS at baseline, becoming and remaining physically active beneficially improved the HS status (OR = 0.64; P = 0.01, and 0.66; P = 0.01, respectively). However, the significance was lost when adjusted for changes in body mass index.
Conclusion
Higher levels of PA were associated with prevention and treatment of HS, with evidence of effect mediation by changes in body mass index.
TL;DR: In middle-aged participants without CVD or lipid disorders requiring medication, the worst lipid profile was determined by the highest levels of TRL-C and their cholesterol-rich remnants in migraineurs without aura for both sexes.
Abstract: IntroductionRecent studies have explored the relationship between dyslipidemia and migraine in a cardiovascular context. Thus, we aimed to evaluate the possible association between lipids, lipoprot...
TL;DR: HDL-C and its subfractions are inversely associated with the defining features of metabolic syndrome, insulin resistance, and systemic inflammation, and the HDL2-C/HDL3-C ratio measured by vertical auto profile is significantlyassociated with the former factors even after comprehensive adjustment for HDL-C.
University of Kansas1, Johns Hopkins University2, Baptist Hospital of Miami3, Brigham and Women's Hospital4, Wake Forest Baptist Medical Center5, Columbia University6, Tufts University7, Johns Hopkins University School of Medicine8, University of São Paulo9, Universidade Federal do Rio Grande do Sul10
TL;DR: Among middle-aged to older individuals with untreated LDL-C <70 mg/dL, subclinical atherosclerosis remains moderately common and is associated with cigarette smoking.
TL;DR: Patients with FH in three specialist centres in the southern hemisphere exhibit a high prevalence of non-cholesterol cardiovascular disease risk factors, and older age, male sex and smoking were more common among subjects with CAD.
TL;DR: Despite best efforts with traditional therapies, individuals with HoFH remain severely undertreated and seldom achieve target or even acceptable LDL-C levels, and it is uncertain whether this is due to effectiveness of ezetimibe in reducing LDL- C in HoFH.
Abstract: Homozygous familial hypercholesterolemia (HoFH) is characterized by extremely elevated low-density lipoprotein cholesterol (LDL-C) levels (usually 4–5-fold normal) and appearance of xanthomas, aggressive atherosclerotic cardiovascular as well as aortic and supra-aortic valve diseases, before the age of 20 years.1 The severity of the HoFH phenotype and its ominous consequences correlate with LDL-C levels. The latter are influenced primarily by the type of familial hypercholesterolemia (FH)-causing molecular defect. The gravest phenotypes result from homozygous or compound heterozygous mutations in the LDLR gene (low-density lipoprotein receptor) encoding null or negative alleles that are associated with <2% of LDLR activity. Less severe forms are encountered in homozygotes or compound heterozygotes for LDLR -defective alleles encoding LDLRs with 2% to 25% activity, or variants in other genes, such as APOB (apolipoprotein B), PCSK9 (proprotein convertase subtilisin kexin type 9), or rarely LDLRAP1 (LDL receptor adaptor protein-1).2
See accompanying article on page 592
HoFH patients have been treated mainly with statins, ezetimibe, and, when available, lipoprotein apheresis.2 Unfortunately, despite best efforts with these traditional therapies, individuals with HoFH remain severely undertreated and seldom achieve target or even acceptable LDL-C levels. The residual LDLR expression and consequent function certainly play a role in LDL-C reduction induced by statins.3 For instance, Stein et al3 encountered significantly greater LDL-C–lowering effects of rosuvastatin in HoFH patients who had receptor-defective alleles in comparison to those with receptor-negative ones, namely, 23% and 14% lowering, respectively. On the contrary, despite effectiveness of ezetimibe in reducing LDL-C in HoFH, it is uncertain whether this is …
TL;DR: Diabetic women with very high ASCVD risk status need to be aggressively treated to lower their risk of cardiovascular events, and a sex gap on dyslipidemia treatment in the region is shown.
Abstract: Little is known about sex gap in the management and outcomes of dyslipidemia among diabetics in the Arabian Gulf. The aim if this study was to determine sex differences in the management and outcomes of dyslipidemia in diabetic patients in the Arabian Gulf. This study was derived from the Centralized Pan-Middle-East Survey on the management of hypercholesterolemia. Patients recruited were aged ≥18 years on lipid lowering drugs for ≥3 months (stable medication for ≥6 weeks). Outcomes were based on the joint Consensus Statement of the American Diabetes Association and American College of Cardiology Foundation. Analyses were performed using univariate and multivariate logistic regression techniques. The mean age of the cohort (n = 3336) was 57 ± 11 years and 45% (n = 1486) were females. Females were less likely to be on rosuvastatin (7.6% vs 12%; P < 0.001), atorvastatin (41% vs 46%; P = 0.005) and combination hypolipidemic therapy (5.6% vs 2.8%; P < 0.001) but more likely to be on simvastatin (51% vs 39%; P < 0.001) than males. Females, especially those with very high atherosclerotic cardiovascular disease (ASCVD) risk status, were also less likely to achieve LDL-cholesterol [adjusted odds ratio (aOR), 0.58; 95% confidence interval (CI): 0.40–0.86; P = 0.006], non-HDL-cholesterol [aOR, 0.68; 95% CI: 0.46–0.99; P = 0.048] and apolipoprotein B [aOR, 0.64; 95% CI: 0.44–0.92; P = 0.016] lipid targets. Diabetic women were less likely to be on optimal hypolipemic therapy and consequently less likely to attain lipid goals compared to men. This shows a sex gap on dyslipidemia treatment in the region. Diabetic women with very high ASCVD risk status need to be aggressively treated to lower their risk of cardiovascular events.
TL;DR: The economic impact of hospitalizations due to CAD attributable to FH in the Brazilian Unified Health Care System (SUS) from 2012--2014 was estimated to be R$ 985,919,064, of which R$ 29,053,500 and R$ 51,764,175, respectively, were Estimated to be attributable toFH.
Abstract: Objective: Cardiovascular diseases are the leading cause of death in Brazil, imposing substantial economic burden on the health care system. Familial hypercholesterolemia (FH) is known to greatly increase the risk of premature coronary artery disease (CAD). This study aimed to estimate the economic impact of hospitalizations due to CAD attributable to FH in the Brazilian Unified Health Care System (SUS). Subjects and methods: Retrospective, cross-sectional study of data obtained from the Hospital Information System of the SUS (SIHSUS). We selected all adults (≥ 20 years of age) hospitalized from 2012-2014 with primary diagnoses related to CAD (ICD-10 I20 to I25). Attributable risk methodology estimated the contribution of FH in the outcomes of interest, using international data for prevalence (0.4% and 0.73%) and relative risk for events (RR = 8.56). Results: Assuming an international prevalence of FH of 0.4% and 0.73%, of the 245,981 CAD admissions/year in Brazil, approximately 7,249 and 12,915, respectively, would be attributable to an underlying diagnosis of FH. The total cost due to CAD per year, considering both sexes and all adults, was R$ 985,919,064, of which R$ 29,053,500 and R$ 51,764,175, respectively, were estimated to be attributable to FH. The average cost per FH-related CAD event was R$ 4,008. Conclusion: Based on estimated costs of hospitalization for CAD, we estimated that 2.9-5.3% are directed to FH patients. FH can require early specific therapies to lower risk in families. It is mandatory to determine the prevalence of FH and institute appropriate treatment to minimize the clinical and economic impact of this disease in Brazil.
TL;DR: The data suggest that FH cascade screening programs can predict family enrollment based on IC features, and this information may be useful for devising better and more effective screening approaches for at-risk individuals.
Abstract: Resumo Fundamento: O rastreamento genetico em cascata e o metodo mais economicamente viavel para a identificacao de individuos com hipercolesterolemia familiar, mas as melhores estrategias para o recrutamento de individuos em risco em um programa de rastreamento deste tipo nao sao inteiramente conhecidas. Objetivo: Identificar os melhores preditores de recrutamento familiar em rastreamento genetico, usando caracteristicas derivadas de probandos testados. Metodos: Foram inscritos 183 casos indices com resultado genetico positivo, que tiveram familiares rastreados de janeiro de 2011 a julho [...]
TL;DR: In this article, the association between high-density lipoprotein cholesterol subfractions and carotid intima-media thickness in the baseline assessment of the Brazilian Longitudinal Study of Adult Health participants from the Sao Paulo investigation centre was evaluated.
Abstract: INTRODUCTION High-density lipoprotein cholesterol comprises a group of heterogeneous subfractions that might have differential effects on atherosclerosis. Moreover, prior investigations suggest that the presence of diabetes (T2D) modifies the impact of some subfractions on atherosclerosis. In this study, we aimed to evaluate the association between high-density lipoprotein cholesterol subfractions and carotid intima-media thickness in the baseline assessment of the Brazilian Longitudinal Study of Adult Health participants from the Sao Paulo investigation centre. METHODS We evaluated 3930 individuals between 35 and 74 years without previous cardiovascular disease not using lipid-lowering drugs. High-density lipoprotein cholesterol subfractions (HDL2-C and HDL3-C) were measured by vertical ultracentrifugation (vertical auto profile). The relationship between each high-density lipoprotein cholesterol subfraction and carotid intima-media thickness was analysed by multiple linear regression models. RESULTS Total high-density lipoprotein cholesterol, as well as HDL2-C and HDL3-C, was negatively associated with carotid intima-media thickness after adjustment for demographic data (all p < 0.001) and traditional risk factors (all p < 0.05). When stratified by T2D status, the HDL2-C/HDL3-C ratio showed a negative association with carotid intima-media thickness in participants with T2D ( p = 0.032), even after fully controlling for confounding variables, including total high-density lipoprotein cholesterol. CONCLUSION HDL2-C, HDL3-C and HDL2/HDL3-C ratio are inversely associated with carotid intima-media thickness after adjustment for traditional risk factors. Association of the HDL2-C/HDL3-C ratio is modified by the presence of diabetes, being more pronounced in diabetic individuals.
TL;DR: Switching from a risk-based strategy to a benefit-based approach, while keeping the same rate of statin use in the population, is expected to promote substantial changes in statin eligibility in subjects at intermediate cardiovascular risk, modifying the subpopulation to be benefited by the treatment.
Abstract: Guidelines have recommended statin initiation based on the absolute cardiovascular risk. We tested the hypothesis that a strategy based on the predicted cardiovascular benefit, compared with the risk-based approach, modifies statin eligibility and the estimated benefit in a population in primary cardiovascular prevention. The study included 16,008 subjects (48 ± 6 years, 73% men) with low-density lipoprotein cholesterol levels of 70 to
TL;DR: The findings indicate that measurement of NC may be useful for an earlier identification of unfavorable atherogenic metabolic profile in middle-aged individuals at lower cardiovascular risk level.
Abstract: Neck circumference (NC) is associated with traditional cardiovascular risk factors (CVRF), but its usefulness to identify earlier atherogenic risk has been scarcely examined. Associations of NC with non-traditional CVRF were investigated in participants at low-to-moderate risk from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). 807 individuals (35–54 years) without obesity, diabetes or cardiovascular disease was stratified into quartiles of NC (cut-off for men: 36.5; 37.9 and 39.5 cm; women: 31.4; 32.5 and 34 cm) and traditional and non-traditional risk factors (lipoprotein subfractions by Vertical Auto Profile, adiponectin, leptin, E-selectin) were compared across groups. In linear regression models, associations of NC with non-traditional risk factors were tested for the entire sample and for low-risk group (≤ 2 CVRF). In both sexes, BMI, waist circumference, systolic and diastolic blood pressure, fasting and 2-h plasma glucose, HOMA-IR, triglycerides, leptin, E-selectin, small dense LDL-cholesterol, IDL-cholesterol, VLDL3-cholesterol and TG/HDL ratio increased significantly, while HDL2-cholesterol and HDL3-cholesterol decreased across NC quartiles. In linear regression models, a direct association [β(95% CI)] of NC with leptin [(0.155 (0.068–0.242); 0.147 (0.075–0.220)], E-selectin [(0.105 (0.032–0.177); 0.073 (0.006 to 0.140)] and small-dense LDL [(1.866 (0.641–3.091); 2.372 (1.391–3.353)] and an inverse association with HDL2-cholesterol [(− 0.519 (− 0.773 to − 0.266); − 0.815 (− 1.115 to 0.515)] adjusted for age were detected for men and women, respectively. Our findings indicate that measurement of NC may be useful for an earlier identification of unfavorable atherogenic metabolic profile in middle-aged individuals at lower cardiovascular risk level.
TL;DR: HRQoL is not reduced in both index cases and first-degree relatives of individuals at high risk of FH undergoing genetic cascade screening in comparison with their non-affected counterparts.
TL;DR: Self-reported fasting duration had no significant impact on the lipid profile results, including triglyceride levels, and no changes on the cardiovascular risk stratification using the Framingham risk score nor changes in the prevalence of metabolic syndrome were noted.
Abstract: Objective We sought to investigate the impact of self-reported fasting duration times on the lipid profile results and its impact on the cardiovascular risk stratification and metabolic syndrome diagnosis. Subjects and methods We analyzed data from all consecutive individuals evaluated in a comprehensive health examination at the Hospital Israelita Albert Einstein from January to December 2015. We divided these patients in three groups, according to the fasting duration recalled ( 12h). We calculated the global cardiovascular risk and diagnosed metabolic syndrome according to the current criteria and estimated their change according to fasting duration. Results A total of 12,196 (42.3 ± 9.2 years-old, 30.2% females) patients were evaluated. The distribution of cardiovascular risk was not different among groups defined by fasting duration in both men and women (p = 0.547 for women and p = 0.329 for men). Similarly, the prevalence of metabolic syndrome was not influenced by the fasting duration (p = 0.431 for women and p = 0.166 for men). Conclusion Self-reported fasting duration had no significant impact on the lipid profile results, including triglyceride levels. Consequently, no changes on the cardiovascular risk stratification using the Framingham risk score nor changes on the prevalence of metabolic syndrome were noted.