Dyslipidemia

Background: Hypercholesterolaemia increases the risk of atherosclerosis, subsequently IHD. Herbal-homeopathic
medicines are unexplored as lipid-lowering agents. This study presents safety and efficacy outcomes of homeopathic
Gautteria gaumeri Q, in treatment of hypercholesterolaemia.
Methods: This was a homoeopathic registry in real world population. A group of 29 subjects with mild to moderate
hypercholesterolaemia with or without statin therapy were included in the study at a single centre in Udaipur, India.
All subjects were given 10-15 drops of Gautteria gaumeri Q thrice in a day for 2 months and were followed
fortnightly.
Results: The sample demographics were similar to typical Indian demographics (age 43±14 years, height 166.5cm,
BMI 21kg/m2
) having age 49±6 years, gender ratio 0.81 with 13 (45%) males and 16 (55%) females, height
157.07±26.18 cms and weight 71.5±11.78 Kg. The comorbidity included diabetes (44.83%), hypertension (68.97%),
current smoking (44.83%) and CAD (31.03%). Thirteen (44.83%) subjects were taking statins for minimum 6
months. At baseline, mean TC, HDL, LDL, VLDL cholesterols and triglycerides were 223±25.8, 41.45±4.82,
150.9±25.97, 30.66±6.38 and 223±34.81 respectively. TC: HDL and LDL: HDL ratios were 5.44±0.82 and 3.69±0.77
respectively. At 2 months, TC reduced by 22.21 (9.96%), triglycerides, LDL and VLDL cholesterol demonstrated
39.55 (17.70%), 24.66 (16.34%) and 3.35 (10.91%) reduction respectively. HDL increased by 5.84 (14.09%).
Proportion of population at risk defined as TC >200, LDL >120, VLDL >30, HDL <30 and triglycerides >200 was
reduced by 17.24%, 31.04%, 13.79%, 100% and 31.03% respectively. (Baseline n=13). There were no ADRs in the
study. Gauttaria gaumeri was proved to be efficacious in treatment of hypercholesterolaemia.
Conclusions: Guatteria gumeri was observed to be efficacious in controlling hypercholesterolaemia. There was no
significant effect of statin therapy prior to starting Guatteria gaumeri Q. No safety issues were reported in the study.
Keywords: Cholesterol lowering, Dyslipidemia, Guatteria gaumeri, Hypercholesterolaemia, Hyperlipidemia, High
cholesterol, Lipid profile, Lipid lowering, Statins, Yumel

BACKGROUND:
Peroxisome proliferator-activated receptors (PPARs) have demonstrated a lot of important effects in the regulation of glucose and lipid metabolism and in the correct functioning of adipose tissue. Recently, many studies have evaluated a possible effect of PPARs on tumor cells. The purpose of this review is to describe the effects of PPARs, their action and their future prospective;

METHODS:
Narrative review aimed to synthesize cutting-edge evidence retrieved from searches of computerized databases;

RESULTS:
PPARs play a key role in metabolic diseases, which include several cardiovascular diseases, insulin resistance, type 2 diabetes, metabolic syndrome, impaired immunity and the increasing risk of cancer; in particular, PPARα and PPARβ/δ mainly enable energy combustion, while PPARγ contributes to energy storage by enhancing adipogenesis;

CONCLUSION:
PPAR agonists could represent interesting types of molecules that can treat not only metabolic diseases, but also inflammation and cancer. Additional research is needed for the identification of high-affinity, high-specificity agonists for the treatment of obesity, type 2 diabetes (T2DM) and other metabolic diseases. Further studies are needed also to elucidate the role of PPARs in cancer.

For many years, dyslipidaemias failed to receive the attention they deserve, both in Poland and across the world. In many cases, the most common recommendation given to patients suffering from lipid disorders was to change their diet and lifestyle. Despite multiple educational efforts undertaken by medical societies in Poland, including the signatories of the Guidelines, the knowledge of patients about this independent risk factor continues to be very limited even today. As a result, there are nearly 20 million hypercholesterolaemic patients in Poland. Furthermore, there are no medical (lipid) clinics specializing in
the treatment of lipid disorders, and existing outpatient clinics are not usually dedicated specifically to dyslipidaemias, but metabolic disorders
and/or endocrine conditions. Not uncommonly, patients receive treatment in cardiac outpatient clinics. The existing state of affairs stems partly from systemic constraints, which pose a hindrance to the establishment of a network of lipid outpatient clinics – even though a total of 70 lipidologists have already been certified by the Polish Lipid Association (PoLA). This is precisely why the problem of familial hypercholesterolaemia (FH) in Poland was not recognized as significant for many years. Few physicians were able to consider low density lipoprotein cholesterol (LDL-C) concentrations in excess of 190 mg/dl (4.9 mmol/l) or total cholesterol (TC) concentrations of 290 mg/dl (7.5
mmol/l) and more as potentially caused by genetically conditioned disease and, taking the matter further, classify patients presenting with such disorders into high and very high cardiovascular risk groups. This is why the treatment of patients with the most severe lipid disorders with apheresis is practically non-existent in Poland, with only three treatment centres available to patients. In contrast, in neighbouring countries (Germany, Czech Republic), nationwide FH registries have been kept for many years. Germany, in addition, has the largest number of medical centres offering apheresis treatment in Europe. It was first noted about a dozen years ago in the estimation of long-term (20-year) risk or lifetime
risk that dyslipidaemias represented an independent risk factor for cardiovascular (CV) events. It thus follows that optimal effective treatment of lipid disorders is as important as the therapy of diabetes
or arterial hypertension. What is more, even if dyslipidaemia treatment is undertaken, further challenges must be faced such as failure to use/prescribe statins at doses corresponding to the level of CV risk (the situation may affect as much as 80% of all treated patients), discontinuation of therapy, lack of effective combination treatment aimed at reducing residual risk or failure to ensure appropriate management of undesirable treatment-related effects.

In view of the situation outlined above, the PoLA, the College of Family Physicians in Poland (CFPiP) and the Polish Cardiac Society (PCS) have
jointly identified a need to draft the first guidelines regulating the management of dyslipidaemias and addressed to family physicians, as they are usually the first to diagnose lipid disorders and they are largely responsible for the initial therapeutic decisions and for the continuation of lipid-lowering therapy (LLT).

Background: Statins are the first-line anti-lipemic pharmacotherapy, having been shown to reduce both low-density lipoprotein cholesterol levels and cardiovascular events. Different statins demonstrate therapeutic equivalence in reducing total and LDL cholesterol Objective: Analyzing high-intensity statin therapy with atorvastatin and rosuvastatin to define therapeutic equivalence.

Objectives: The disruption of the reciprocal regulation between vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) has been associated with the pathogenesis of diabetic retinopathy (DR). This study assessed the levels of VEGF, PEDF, indices of glycemia, and lipid profile in diabetic patients with retinopathy.
Methods: One hundred fifty participants comprised 50 type 2 diabetic patients with DR, 50 without DR and 50 non-diabetic normotensive controls, aged 30–80 years, were randomly recruited for this case-control study. The study was carried out from November 2017 to December 2018. VEGF, PEDF, glycated hemoglobin (HbA1c), fasting plasma glucose, and lipid profile were determined using standard methods. Blood pressures (BP) and anthropometric indices were measured. Chi-squared test of independence, analysis of variance, and Pearson’s correlation were used to analyze data. Statistical significance was set at P < 0.05 and 95% confidence interval.
Results: Both diabetic groups had significantly higher (P = 0.001) systolic and diastolic BP, VEGF, PEDF, HbA1c, fasting plasma glucose, triglycerides, total, high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) levels and significantly lower (P = 0.005) VEGF/PEDF than the controls. However, the diabetics with retinopathy had significantly higher (P = 0.001) HDL-C, LDL-C, VEGF, and PEDF levels compared to the diabetics without retinopathy. There were no significant differences (P > 0.05) in the levels of VEGF, PEDF, and VEGF/PEDF in both groups of diabetics that had good glycemic control and poor glycemic control. There was also no significant difference (P > 0.05) in the levels of VEGF and PEDF between the dyslipidemic and non-dyslipidemic subjects in both diabetic groups.
Conclusion: DR is associated with higher levels of VEGF and PEDF while good glycemic control and dyslipidemia seem not to have a profound effect on VEGF and PEDF levels in diabetics with or without DR. Higher PEDF levels are associated with higher atherogenic risk in the diabetics with retinopathy.

Przez lata zaburzenia lipidowe w Polsce i na świecie nie były traktowane z należytą uwagą, a w wielu przypadkach ich występowania najczęściej zalecana była dieta i zmiana stylu życia. Pomimo wielu działań edukacyjnych towarzystw medycznych w Polsce, w tym także „sygnatariuszy” niniejszych wytycznych, wiedza pacjentów na temat tego niezależnego czynnika ryzyka jest także wciąż bardzo ograniczona. W efekcie tego w Polsce mamy prawie 20 milionów osób z hipercholesterolemią. Nie istnieją kliniki zaburzeń lipidowych, a funkcjonujące poradnie najczęściej nie są dedykowane temu problemowi, ale zaburzeniom metabolicznym i/lub chorobom endokrynologicznym, a sami pacjenci nierzadko leczeni są po prostu w poradniach kardiologicznych. Wynika to także z ograniczeń systemowych, które wcale nie ułatwiają stworzenia sieci poradni lipidowych, pomimo istnienia grupy prawie 70 lekarzy lipidologów certyfikowanych przez Polskie Towarzystwo Lipidologiczne. To
właśnie dlatego przez lata w Polsce problem hipercholesterolemii rodzinnej (familial hypercholesterolemia– FH) nie był rozpoznawany
jako istotny i mało kto potrafił skojarzyć stężenia cholesterolu LDL (low density lipoprotein) >190 mg/dl (4,9 mmol/l) czy cholesterolu całkowitego 290 mg/dl (7,5 mmol/l) i więcej jako takie, których przyczyną może być choroba uwarunkowana genetycznie, i idąc dalej
– zakwalifikować takich pacjentów do grupy dużego i bardzo dużego ryzyka sercowo‑naczyniowego.To właśnie dlatego w Polsce leczenie
aferezą pacjentów z najpoważniejszymi zaburzeniami lipidowymi praktycznie nie istnieje (tylko 3 ośrodki). Tymczasem za naszą
zachodnią (Niemcy) czy południową (Czechy) granicą rejestr hipercholesterolemii rodzinnej tworzony jest od wielu lat, a w Niemczech liczba ośrodków wykonujących aferezy jest największa w Europie. Już kilkanaście lat temu zwrócono uwagę, że w ocenie ryzyka odległego (20‑letniego) lub tzw. lifetime risk zaburzenia lipidowe są niezależnym czynnikiem ryzyka wystąpienia incydentów sercowo‑naczyniowych, stąd ich optymalne i skuteczne leczenie jest równie ważne, jak terapia cukrzycy czy nadciśnienia tętniczego. Co więcej, nawet w przypadku
podjęcia leczenia dyslipidemii stoją przed nami wyzwania pod postacią niestosowania / nieprzepisywania odpowiednich dawek statyn w odniesieniu do ryzyka sercowo‑naczyniowego (co może dotyczyć nawet 80% leczonych pacjentów) czy też dyskontynuacji leczenia, braku skutecznego leczenia skojarzonego mającego na celu redukcję ryzyka rezydualnego czy też właściwego postępowania w przypadku wystąpienia działań niepożądanych związanych z leczeniem. Dlatego właśnie Polskie Towarzystwo Lipidologiczne (PTL) wraz z Kolegium Lekarzy Rodzinnych w Polsce (KLRwP) oraz Polskim Towarzystwem
Kardiologicznym (PTK) wspólnie zdecydowały o konieczności przygotowania pierwszych wytycznych dotyczących postępowania
w zaburzeniach lipidowych, dedykowanych lekarzom rodzinnym, bo to właśnie oni najczęściej po raz pierwszy diagnozują zaburzenia
lipidowe i to na nich w dużej mierze spoczywa odpowiedzialność za pierwsze decyzje terapeutyczne oraz kontynuację leczenia hipolipemizującego.

Background: Diabetes constitutes an important faction of the health and economic burden worldwide and its occurrence continues to rise especially in developing countries. Aim: To study the distribution in dyslipidemia occurrence over a period of 1 year in a diabetic and non-diabetic population in Ngaoundere.. All participants provided a written consent and were subjected to a questionnaire. Blood pressure and anthropometric parameters were measured and venous blood collected for fasting blood glucose, lipid profile, glycated hemoglobin and uric acid analysis using commercially acquired kits. Data were organized and analyzed using an Excel spreadsheet and SPSS version 20.0. respectively, with statistical significance considered at p < 0.05. Results: Of the 321 participants enrolled, 191 were diabetic and 130 non-diabetic having sex ratios (F/M) of 1.3 and 1.1 respectively. Compared to the 73.3% dyslipidemia, 28.9% hypercholesterolemia, 15.6% hypertriglyceridemia and 28.9% mixed hyperlipidemia reported by the authors in the same diabetic population a year earlier, the occurrence of dyslipidemias, hypercholesterolemia, hypertriglyceridemia and mixed hyperlipidemia were 59.7%, 49.5%, 7.0% and 3.2%. Likewise, similar trends were observed with the corresponding non-diabetic control groups. 39 patients (20.4%) and 29 controls (22.3%) had knowledge on cholesterol, while 9.9% of diabetic participants had tested for blood cholesterol levels at some point. Conclusion: We observed meaningful drops in the occurrence of hypertriglyceridemia, mixed hyperlipidemia, and a rise in hypercholesterolemia among diabetics and nondiabetics, with a low level of awareness on dyslipidemias. Much is needed in sensitizing and controlling cardiometabolic risks towards improving the management of diabetic patients in our context.

Virgin Coconut Oil (VCO), extracted from fresh coconut kernel possess similar fatty acid composition to that of Copra Oil (CO), a product of dried kernel. Although CO forms the predominant dietary constituent in south India, VCO is being promoted for healthy life due to its constituent antioxidant molecules. High fructose containing CO is an established model for insulin resistance and steatohepatitis in rodents. In this study, replacement of CO with VCO in high fructose diet markedly improved the glucose metabolism and dyslipidemia. The animals fed VCO diet had only 17 % increase in blood glucose level compared to CO fed animals (46 %). Increased level of GSH and antioxidant enzyme activities in VCO fed rats indicate improved hepatic redox status. Reduced lipid peroxidation and carbonyl adducts in VCO fed rats well corroborate with the histopathological findings that hepatic damage and steatosis were comparatively reduced than the CO fed animals. These results suggest that VCO could be an efficient nutraceutical in preventing the development of diet induced insulin resistance and associated complications possibly through its antioxidant efficacy.

Worldwide, nonalcoholic fatty liver disease (NAFLD) has reached epidemic proportions and in parallel, hepatocellular carcinoma (HCC) has become one of the fastest growing cancers. Epidemiological studies have not only shed light on the prevalence and incidence of the disease but have also unmasked important environmental risk factors, including the role of diabetes and dyslipidemia in disease pathogenesis. Genetic association studies have identified single nucleotide polymorphisms implicated in NAFLD-HCC, many of which are part of lipid metabolism pathways. Through these clinical studies and subsequently, translational and basic research, the role of statins as a chemoprotective agent has also emerged with ongoing clinical trials assessing their utility in HCC prevention and treatment. In this review, we summarize the recent epidemiological studies describing the burden of NAFLD-HCC in different patient populations and countries. We discuss the genetic and environmental risk factors for NAFLD-HCC and highlight the chemoprotective role of statins and aspirin. We also summarize what is known about NAFLD-HCC in the cirrhosis and non-cirrhosis populations and briefly address the role of surveillance in NAFLD-HCC patients.