Search Results (22)

Hypertriglyceridaemia is the third most common aetiology of acute pancreatitis and a leading cause of recurrence in specialized lipid clinics. The risk of acute pancreatitis rises steeply once triglycerides exceed approximately 10 mmol/L (≈885 mg/dL). Still, clinically meaningful risk may occur at lower levels in the presence of chylomicronaemia, metabolic stress, or pregnancy. This mini-review synthesizes contemporary evidence on epidemiology, mechanistic links between triglyceride-rich lipoproteins and pancreatic injury, and the practical distinction between secondary (acquired) and genetic drivers of severe hypertriglyceridaemia. We summarize acute management strategies aimed at rapid triglyceride reduction (including insulin-based approaches and therapeutic plasma exchange in selected scenarios) and focus on long-term prevention of recurrence through lifestyle interventions, correction of secondary contributors, and triglyceride-lowering pharmacotherapy. Finally, we discuss emerging RNA-targeted therapies against apolipoprotein C-III and angiopoietin-like 3, which are reshaping prevention strategies for familial and persistent chylomicronaemia and may reduce pancreatitis burden in the highest-risk phenotypes. Full article

Background/Objectives: The current study aims to estimate the frequency of abnormal renal status (ARS, defined as chronic kidney disease (CKD) diagnosis in electronic medical records or current albuminuria) in people with newly diagnosed diabetes mellitus (DM), to determine the associated risk factors, and to evaluate the level of compliance with good clinical practice recommendations. Methods: Cross-sectional study with 1030 adults diagnosed with DM in the last 4 years. Anthropometric, clinical, analytical, and lifestyle variables were collected. Multivariate analyses were performed to determine the factors associated with ARS. Results: Hypercholesterolaemia, metabolic syndrome, hypertension, obesity, hypertriglyceridaemia, and cardiovascular disease (CVD) were the most prevalent comorbidities. ARS was present in 11.5% of patients. The variables associated with ARS were male sex (OR: 1.78; 95% CI, 1.16–2.75), age ≥70 years (OR: 2.96; 95% CI: 1.92–4.56), hypertension (OR: 1.59; 95% CI: 1.03–2.44), CVD (OR: 1.73; 95% CI: 1.03–2.90), and hemoglobin A1c (HbA1c) ≥8% (OR: 2.26; 95% CI, 1.19–4.27). Among patients with hypertension and albuminuria, 80% received angiotensin-converting enzyme inhibitors (ACE inhibitor) or an angiotensin receptor blocker (ARB), compared to 60% of those with albuminuria without hypertension. The 42.4% patients with ARS were treated with sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and 72% with statins, but only 31.5% achieved the target low density lipoproteins cholesterol (LDLc) < 70 mg/dL. Conclusions: ARS in newly diagnosed patients with DM is less common than described in the literature, but risk factors for its development are highly prevalent. Adherence to good clinical practice recommendations was poor, especially in LDL cholesterol targets and the use of SGLT2i. Full article

Background: Metabolic syndrome (MetS) is a syndrome that comprises central obesity, increased serum triglyceride (TG) levels, decreased serum HDL cholesterol (HDL) levels, raised blood pressure (BP), and impaired glucose regulation, including prediabetic and diabetic glycaemic levels. Recently, the association with endometrial cancer (EC) has been described but it is unclear if the risk associated with MetS is higher than the individual effect of obesity alone. This study investigates the association between MetS components and differing MetS definitions on EC risk and compares the risk of MetS with the risk posed by obesity alone. It also analyses how MetS affects the risk of EC development in the pre- and post-menopausal subgroups. Methods: A prospective cohort study was undertaken using data from the UK biobank. Multivariable Cox proportional risk models with the time to diagnosis (years) were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of MetS and its components on the risk of EC. A subgroup analysis was also undertaken for pre- and post-menopausal participants. Kaplan–Meier (KM) was undertaken to assess the difference in the risk of EC development in differing BMI classes, and in pre- and post-menopausal subgroups. Results: A total of 177,005 females from the UK biobank were included in this study. Of those participants who developed EC (n = 1454), waist circumference > 80 cm, BMI > 30 kg/m², hypertension > 130/80 mmHg, hyperlipidaemia and diabetes (HbA1C > 48 mmol/L were significant predictors of EC development, with waist circumference being the strongest predictor (HR = 2.21; 95% CI: 1.98–2.47, p < 0.001). Comparing the pre- and post-menopausal subgroup, hypertriglyceridaemia and diabetes were the strongest predictors of EC in the pre-menopausal subgroup (HR = 1.53; 95% CI: 1.18–1.99 and HR = 1.51; 95% CI: 1.08–2.12, p < 0.05, respectively). Raised waist circumference was not a significant independent predictor in the pre-menopausal subgroup. A KM curve analysis showed a clear distinction between those with and without MetS in the pre-menopausal group, suggesting a benefit of testing for MetS components in pre-menopausal women with obesity. Conclusions: Components of MetS, both independently and in combination, significantly increase the risk of EC. Screening those with obesity for MetS in their pre-menopausal years may help to identify those at the highest risk. Full article

Adult-onset spontaneous feline hypothyroidism (SH) is considered rare, but its prevalence is unknown. This study aimed to screen laboratory submissions for cats with laboratory suspected SH (LSSH) and to identify laboratory abnormalities associated with LSSH. Submissions to a commercial laboratory in Germany between January 2022 and April 2023 were prospectively screened for cats aged 3–12 years with low total thyroxine (TT4); in these cats, thyrotropin (TSH) was measured. Iatrogenic hypothyroidism was excluded by contacting submitting veterinarians. Creatinine, triglyceride and cholesterol concentration and red blood cell count (RBC) of cats with LSSH (low TT4, TSH > 0.53 ng/mL; i.e., [one sided TSH reference change value (76%) of TSH upper reference interval (RI)] + [TSH upper RI] = 0.53) were compared to euthyroid cats (TT4 within RI) and cats with suspected non-thyroidal illness (SNTIS) (low TT4, normal TSH (<0.3 ng/mL; upper RI)) by non-parametric tests. p < 0.05 was significant. In total, 31,572 submissions of cats were included, 25,169 (79.7%) were euthyroid, 3818 (12.1%) had SNTIS and 61 (0.2%) had LSSH. Cats with LSSH had higher creatinine (p = 0.002) and lower RBC count (p < 0.0001) than euthyroid cats as well as higher creatinine (p = 0.00035) than cats with SNTIS. Azotaemia (creatinine > 140 µmol/L) and anaemia (RBC < 7.2 × 10¹²/L) were present in 28/49 (57%) and 19/44 (43%) cats with LSSH, respectively. There was no difference between LSSH and SNTIS for the remaining parameters. In cats with low TT4, azotaemia and anaemia might indicate the presence of SH and reinforce the need for TSH testing. Hypercholesterolaemia and hypertriglyceridaemia are not indicators of SH. Full article

Background/Objectives: Hypertriglyceridaemia and systemic inflammation are prevalent in patients with schizophrenia and contribute to an increased risk of cardiovascular disease. Although elevated triglycerides (TGs) and remnant cholesterol are linked to inflammation in the general population and individuals with metabolic syndrome, whether they are associated in patients with schizophrenia remains unclear. Methods: Fasting levels of TG, cholesterol (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and remnant cholesterol)), and markers of systemic inflammation including high-sensitivity C-reactive protein (hsCRP), leukocyte counts and their differentials (neutrophils, monocytes and lymphocytes) were determined in 147 patients diagnosed with schizophrenia on long-term antipsychotic regimens and compared with 56 age- and sex-matched healthy controls. Apolipoprotein B and glycosylation of acute phase reactant (GlycA) signatures were assessed by NMR. Circulating cytokine levels were measured by a cytokine/chemokine multiplex assay. Results: Patients with schizophrenia had markedly elevated TG and remnant cholesterol relative to controls and had evidence of systemic inflammation with increased circulating hsCRP, GlycA, leukocyte, neutrophil counts and neutrophil-to-lymphocyte ratio (NLR). Unexpectedly TG and remnant cholesterol did not correlate with systemic inflammatory markers in patients with schizophrenia, and differences in inflammatory markers between controls and patients persisted after adjusting for the lipid profile. Interleukin (IL)-10 levels were increased in patients with schizophrenia, suggesting an anti-inflammatory signature. Conclusions: The discordance between TG, remnant cholesterol and systemic inflammation in patients with schizophrenia suggests these are likely independent contributors to cardiovascular risk in this population. Full article

The aim of this study was to revisit the complex relationship between inflammation, oxidative stress and lipid metabolism in dogs with hypercortisolism (HC). Fourteen dogs newly diagnosed with HC and an equal number of healthy counterparts of similar age and markers of oxidative stress (AOPP, TBARS, TAC, GSH, PON-1, and UA) and inflammation (NLR, PLR, SII, HPT, CHE, CP, and Hcy) were included in the study. To determine the lipid profiles, cholesterol, and triglyceride levels were measured, and the electrophoretic separation of lipoproteins was performed. The results revealed that dogs with HC had higher levels of AOPP and TBARS, but only greater levels of GSH among antioxidants. Uric acid levels were higher in HC dogs, suggesting a pro-oxidative role. Elevated NLR, PLR, SII, and HPT levels were detected, but they did not seem to be associated with inflammation. Notable changes were detected in the HDL fraction, alongside hypercholesterolaemia and hypertriglyceridaemia. Correlation analysis revealed links between lipid markers and both oxidative stress and inflammatory indices. In conclusion, the data acquired may prove useful in further understanding of the intricate pathophysiology of Cushing’s syndrome. Full article

The association between hyperlipidaemia and acute pancreatitis is unknown in dogs. This study aimed to investigate the association between hyperlipidaemia and other markers of cholestasis in dogs with suspect acute pancreatitis. Case records of dogs with suspect acute pancreatitis were retrospectively reviewed. Dogs that had pre-existing disorders or drug therapies associated with hyperlipidaemia, hypocholesterolaemia, or incomplete biochemical data were excluded. In total, 74 dogs met the inclusion criteria. There were 33 (44.6%) dogs with hypercholesterolaemia (HC) and 41 (55.4%) without (NC). Increased triglyceride concentrations were significantly (p = 0.005) more common in HC dogs (n = 13, 39.4%) compared with NC dogs (n = 4, 9.8%), but no value exceeded 5 mmol/L. The ALP activity was significantly higher in the HC group compared to NC group (932 (461–7271) and 380 (135–1312) IU/L, respectively, p = 0.001). There was a moderate positive correlation between cholesterol concentration and ALP activity (r = 0.498, p < 0.001) and a weak positive correlation between cholesterol concentration and gamma-glutamyl transferase activity (r = 0.296, p = 0.011). Cholesterol concentration was correlated with ALP and GGT activities suggesting an association between cholestasis and hypercholesterolaemia in dogs with acute pancreatitis. Full article

Background: Scientific societies disagree on serum uric acid (SUA) thresholds for the diagnosis of hyperuricaemia (HU) according to epidemiological or physiochemical criteria (SUA ≥ 7.0 mg/dL for men and ≥6.0 mg/dL for women [HU-7/6]; SUA ≥ 7.0 mg/dL for both genders [HU-7/7], respectively). HU is not included among the diagnostic criteria for metabolic syndrome or cardiovascular-renal-metabolic syndrome (CKM), although it promotes atherosclerosis and is associated with renal and cardiometabolic diseases. Both issues are of utmost importance and need to be clarified, hence the present study aims to assess the prevalence rates of HU and their associations with CKM factors. Methods: A cross-sectional observational study was conducted on a random population-based sample of 6489 adults. Bivariate and multivariate analyses were performed on the most well-known renal and cardiometabolic variables of the populations with and without HU-7/7 and HU-7/6. Results: The adjusted prevalence rates for HU-7/6 were 13.4% in adult population (18.4% in men; 9.6% in women) and 10.2% (18.4% in men; 3.8% in women) for HU-7/7. The main factors associated independently with HU for both genders were low estimated glomerular filtration rate, hypertension, hypertriglyceridaemia, and alcoholism, regardless of the criteria chosen, as well as albuminuria in women and central obesity in men. Conclusions: The prevalence rates of HU increase linearly with age for both genders. The associations of CKM factors with HU diagnosed according to physiochemical criterion are more similar between men and women than those using epidemiological criteria. Full article

Background and Aims: The present study was designed to investigate SNP rs17300539 in the ADIPOQ gene and its relationships with obesity, metabolic syndrome (MS), and serum circulating adiponectin. Methods: The present design involved a Caucasian population of 329 subjects with obesity. Anthropometric and adiposity parameters, blood pressure, biochemical parameters, and the percentage of patients with metabolic syndrome were recorded. The ADIPOQ gene variant (rs17300539) genotype was evaluated. Results: The percentage of patients with different genotypes of the rs17300539 polymorphism in this sample was 86.0% (n = 283) (GG), 11.2% (n = 37) (GA), and 2.7% (n = 9) (AA). The allele frequency was G (0.76) and A (0.24). Applying the dominant genetic model (GG vs. GA + AA), we reported differences between genotype GG and genotype GA + AA for serum adiponectin levels (Delta: 7.5 ± 1.4 ng/mL; p = 0.03), triglycerides (Delta: 41.1 ± 3.4 mg/dL; p = 0.01), fastingcirculating insulin (Delta: 4.9 ± 1.1 mUI/L; p = 0.02), and insulin resistance as HOMA-IR (Delta: 1.4 ± 0.1 units; p = 0.02). The remaining biochemical parameters were not related to the genotype of obese patients. The percentages of individuals with MS (OR = 2.07, 95% CI = 1.3–3.88; p = 0.01), hypertriglyceridaemia (OR = 2.66, 95% CI = 1.43–5.01; p = 0.01), and hyperglycaemia (OR = 3.31, 95% CI = 1.26–8.69; p = 0.02) were higher in GG subjects than patients with A allele. Logistic regression analysis reported an important risk of the presence of metabolic syndrome in GG subjects (OR = 1.99, 95% CI = 1.21–4.11; p = 0.02) after adjusting for adiponectin, dietary energy intakes, gender, weight, and age. Conclusions: The GG genotype of rs17300539 is associated with hypertriglyceridaemia, insulin resistance, low adiponectin levels, and a high risk of metabolic syndrome and its components. Full article

Acquired generalised lipodystrophy (AGL) is a rare disorder characterised by the gradual loss of fat that tends to generalise over time, the origin of which is still not fully clarified. The aim of this study was to offer a detailed description of seven patients with AGL (five women, 33.8 ± 18.6 years of age), evaluated over the last 14 years, in order to augment the knowledge of this disorder. The onset of the phenotype occurred during childhood and adolescence in five cases, and in adulthood in two cases. Three patients reported infections or vaccine administration prior to the development of lipodystrophy, and two subjects reported nodular swelling. The most frequent physical features were phlebomegaly, umbilical protrusion/hernia, and acanthosis nigricans. Skinfolds and body composition analysis showed the generalised absence of fat, with the exception of one patient in whom fat loss was spared in the trunk. The loss of fat in the palms/soles was observed in five subjects. Regarding metabolic comorbidities, throughout follow-up, two patients developed type 1 diabetes and one type 2 diabetes; three also presented hypertriglyceridaemia, one of whom developed acute pancreatitis, and no macrovascular complications were observed. Only one patient showed decreased complement C4. Autoimmunity was present in all cases, and six patients manifested Hashimoto’s thyroiditis, type 1 diabetes, autoimmune hepatitis, and/or celiac disease. Thus, there are certain clinical characteristics of AGL that may be considered important diagnostic criteria to differentiate this disorder from other lipodystrophy subtypes. Full article

We have reviewed the genetic basis of chylomicronaemia, the difference between monogenic and polygenic hypertriglyceridaemia, its effects on pancreatic, cardiovascular, and microvascular complications, and current and potential future pharmacotherapies. Severe hypertriglyceridaemia (TG > 10 mmol/L or 1000 mg/dL) is rare with a prevalence of <1%. It has a complex genetic basis. In some individuals, the inheritance of a single rare variant with a large effect size leads to severe hypertriglyceridaemia and fasting chylomicronaemia of monogenic origin, termed as familial chylomicronaemia syndrome (FCS). Alternatively, the accumulation of multiple low-effect variants causes polygenic hypertriglyceridaemia, which increases the tendency to develop fasting chylomicronaemia in presence of acquired factors, termed as multifactorial chylomicronaemia syndrome (MCS). FCS is an autosomal recessive disease characterized by a pathogenic variant of the lipoprotein lipase (LPL) gene or one of its regulators. The risk of pancreatic complications and associated morbidity and mortality are higher in FCS than in MCS. FCS has a more favourable cardiometabolic profile and a low prevalence of atherosclerotic cardiovascular disease (ASCVD) compared to MCS. The cornerstone of the management of severe hypertriglyceridaemia is a very-low-fat diet. FCS does not respond to traditional lipid-lowering therapies. Several novel pharmacotherapeutic agents are in various phases of development. Data on the correlation between genotype and phenotype in FCS are scarce. Further research to investigate the impact of individual gene variants on the natural history of the disease, and its link with ASCVD, microvascular disease, and acute or recurrent pancreatitis, is warranted. Volanesorsen reduces triglyceride concentration and frequency of pancreatitis effectively in patients with FCS and MCS. Several other therapeutic agents are in development. Understanding the natural history of FCS and MCS is necessary to rationalise healthcare resources and decide when to deploy these high-cost low-volume therapeutic agents. Full article

Many drugs affect lipid metabolism and have side effects which promote atherosclerosis. The prevalence of cancer-therapy-related cardiovascular (CV) disease is increasing due to development of new drugs and improved survival of patients: cardio-oncology is a new field of interest and research. Moreover, drugs used in transplanted patients frequently have metabolic implications. Increasingly, internists, lipidologists, and angiologists are being consulted by haematologists for side effects on metabolism (especially lipid metabolism) and arterial circulation caused by drugs used in haematology. The purpose of this article is to review the main drugs used in haematology with side effects on lipid metabolism and atherosclerosis, detailing their mechanisms of action and suggesting the most effective therapies. Full article

Aims: Both metabolic syndrome (MetS) and frailty are associated with increased all-cause mortality, yet the complex interplay between these two conditions has not adequately been elucidated. We aim to analyse the relationship between MetS and frailty through a systematic review of the literature with meta-analyses. Methods: A literature search was conducted via MEDLINE and EMBASE. Studies were included if validated frameworks for defining frailty and MetS (presence of at least 3 out of the five constitutive components: abdominal obesity, high fasting blood glucose, hypertension, hypertriglyceridaemia, and low high-density lipoprotein level) were utilised, in addition to the inclusion of participants aged 60 or older. Results: Eleven studies were included, all observational. All were in community-dwelling older people, 9 cross-sectional and 2 longitudinal. Most of the studies used Fried’s frailty phenotype. The prevalence of frailty ranged from 0.9% to 14.8% in population-based studies and 35.6% in the outpatient clinic setting. The prevalence of MetS was also higher in the outpatient clinic setting at 47.5%, compared to 17.5–41.0% in the community-dwelling populations. The meta-analysis of 11 studies showed that MetS was associated with an increased risk of frailty (pooled OR 1.73, 95% CI, 1.41–2.13). Conclusion: This systematic review and meta-analysis suggest that frailty was more prevalent in older people with MetS compared to older people without MetS. The study findings suggest the importance of frailty screening in older people with MetS and a distinct role of managing MetS in preventing frailty in older people. Full article

This study aimed to investigate the associations of microRNA (miRs) signatures with cytokines, serum lipids, and disease activity in patients with psoriatic arthritis (PsA), ankylosing spondylitis (AS), and rheumatoid arthritis (RA). In total, 65 patients (PsA n = 25, AS n = 25, RA n = 15) and 25 healthy controls (HC) were enrolled into the study. The expression of miR-223-5p, miR-92b-3p, miR-485-3p, miR-10b-5p, let-7d-5p, miR-26a-2-3p, miR-146b-3p, and cytokines levels were measured in sera. DIANA-mirPath analysis was used to predict pathways targeted by the dysregulated miRs. Disease activity scores were calculated. Lipid profile, uric acid, glucose level, and C-reactive protein (CRP) concentrations were determined in the blood. Based on lipid profiles, the PsA group had hypertriglyceridaemia, and RA patients revealed mixed dyslipidaemia, while in AS, no specific changes were found. miR expression analysis revealed upregulation of miR-26a-2-3p and miR-10b-5p in PsA, miR-485-3p in AS, and let-7d-5p in RA. Several correlations between disease activity indexes, metabolites levels, and expression of miRs were observed in PsA, RA, and AS patients. Finally, in ROC analysis, miR-26a-2-3p/miR-485-3p, and let-7d-5p/miR-146b-3p tandems revealed high sensitivity and specificity in distinguishing between PsA, AS, and RA. Our study illustrates the superiority of miR expressions in distinguishing between RA, PsA, and AS. In PsA, a unique regulatory pathway exists through miR-26a-2-3p, miR-223-5p, miR-10b-5p, and miR-92b-3p that converges proatherogenic metabolism and disease activity. Full article

Acute pancreatitis (AP) is the most common gastrointestinal indication requiring hospitalisation. Severe hypertriglyceridaemia (HTG) is the third most common aetiology of AP (HTGAP), with a complication rate and severity that are higher than those of other aetiologies (non-HTGAP). The aim of this study was to evaluate the supposedly higher complication rate of HTGAP compared to non-HTGAP. The secondary objectives were to find different biomarkers for predicting a severe form. This was a retrospective study that included patients admitted with AP in a tertiary department of gastroenterology and hepatology. The patients were divided into two groups: HTGAP and non-HTGAP. We searched for differences regarding age, gender, the presence of diabetes mellitus (DM), the severity of the disease, the types of complications and predictive biomarkers for severity, hospital stay and mortality. A total of 262 patients were included, and 11% (30/262) of the patients had HTGAP. The mean ages were 44.4 ± 9.2 in the HTGAP group and 58.2 ± 17.1 in the non-HTGAP group, p < 0.0001. Male gender was predominant in both groups, at 76% (23/30) in the HTGAP group vs. 54% (126/232) in non-HTGAP, p = 0.02; 53% (16/30) presented with DM vs. 18% (42/232), p < 0.0001. The patients with HTG presented higher CRP 48 h after admission: 207 mg/dL ± 3 mg/dL vs. non-HTGAP 103 mg/dL ± 107 mg/dL, p < 0.0001. Among the patients with HTGAP, there were 60% (18/30) with moderately severe forms vs. 30% (71/232), p = 0.001, and 16% (5/30) SAP vs. 11% (27/232) in non-HTGAP, p = 0.4 Among the predictive markers, only haematocrit (HT) and blood urea nitrogen (BUN) had AUCs > 0.8. According to a multiple regression analysis, only BUN 48 h was independently associated with the development of SAP (p = 0.05). Diabetes mellitus increased the risk of developing severe acute pancreatitis (OR: 1.3; 95% CI: 0.1963–9.7682; p = 0.7). In our cohort, HTGAP more frequently had local complications compared with non-HTGAP. A more severe inflammatory syndrome seemed to be associated with this aetiology; the best predictive markers for complicated forms of HTGAP were BUN 48 h and HT 48 h. Full article