Browsing by Subject "Dyslipidemia"

Now showing 1 - 8 of 8
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    Analyzing the Clinical Outcomes of a Rapid Mass Conversion From Rosuvastatin to Atorvastatin in a VA Medical Center Outpatient Setting
    (SAGE, 2017-10) Naville-Cook, Chad; Rhea, Leroy; Triboletti, Mark; White, Christina; Pharmacology and Toxicology, School of Medicine
    Background: Medication conversions occur frequently within the Veterans Health Administration. This manual process involves several pharmacists over an extended period of time. Macros can automate the process of converting a list of patients from one medication to a therapeutic alternative. Objectives: To develop a macro that would convert active rosuvastatin prescriptions to atorvastatin and to create an electronic dashboard to evaluate clinical outcomes. Methods: A conversion protocol was approved by the Pharmacy & Therapeutics Committee. A macro was developed using Microsoft Visual Basic. Outpatients with active prescriptions for rosuvastatin were reviewed and excluded if they had a documented allergy to atorvastatin or a significant drug-drug interaction. An electronic dashboard was created to compare safety and efficacy endpoints pre- and postconversion. Primary endpoints included low-density lipoprotein (LDL), creatine phosphokinase (CPK), aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase. Secondary endpoints evaluated cardiovascular events, including the incidences of myocardial infarction, stroke, and stent placement. Results: The macro was used to convert 1520 patients from rosuvastatin to atorvastatin over a period of 20 hours saving $5760 in pharmacist labor. There were no significant changes in LDL, AST, ALT, or secondary endpoints (P > .05). There was a significant increase in alkaline phosphatase (P = .0035). Conclusions: A rapid mass medication conversion from rosuvastatin to atorvastatin saved time and money and resulted in no clinically significant changes in safety or efficacy endpoints. Macros and clinical dashboards can be applied to any Veterans Health Administration facility.
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    Association between cardiometabolic risk factors and COVID-19 susceptibility, severity and mortality: a review
    (Springer, 2021-06-26) Sharifi, Yasaman; Payab, Moloud; Mohammadi-Vajari, Erfan; Aghili, Seyed Morsal Mosallami; Sharifi, Farshad; Mehrdad, Neda; Kashani, Elham; Shadman, Zhaleh; Larijani, Bagher; Ebrahimpur, Mahbube; Medical and Molecular Genetics, School of Medicine
    The novel coronavirus, which began spreading from China Wuhan and gradually spreaded to most countries, led to the announcement by the World Health Organization on March 11, 2020, as a new pandemic. The most important point presented by the World Health Organization about this disease is to better understand the risk factors that exacerbate the course of the disease and worsen its prognosis. Due to the high majority of cardio metabolic risk factors like obesity, hypertension, diabetes, and dyslipidemia among the population over 60 years old and higher, these cardio metabolic risk factors along with the age of these people could worsen the prognosis of the coronavirus disease of 2019 (COVID-19) and its mortality. In this study, we aimed to review the articles from the beginning of the pandemic on the impression of cardio metabolic risk factors on COVID-19 and the effectiveness of COVID-19 on how to manage these diseases. All the factors studied in this article, including hypertension, diabetes mellitus, dyslipidemia, and obesity exacerbate the course of Covid-19 disease by different mechanisms, and the inflammatory process caused by coronavirus can also create a vicious cycle in controlling these diseases for patients.
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    Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease
    (Elsevier, 2018-07) Harlow, Kathryn E.; Africa, Jonathan A.; Wells, Alan; Belt, Patricia H.; Behling, Cynthia A.; Jain, Ajay K.; Molleston, Jean P.; Newton, Kimberly P.; Rosenthal, Philip; Vos, Miriam B.; Xanthakos, Stavra A.; Lavine, Joel E.; Schwimmer, Jeffrey B.; Pediatrics, School of Medicine
    OBJECTIVE: To determine the percentage of children with nonalcoholic fatty liver disease (NAFLD) in whom intervention for low-density lipoprotein cholesterol or triglycerides was indicated based on National Heart, Lung, and Blood Institute guidelines. STUDY DESIGN: This multicenter, longitudinal cohort study included children with NAFLD enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. Fasting lipid profiles were obtained at diagnosis. Standardized dietary recommendations were provided. After 1 year, lipid profiles were repeated and interpreted according to National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction. Main outcomes were meeting criteria for clinically actionable dyslipidemia at baseline, and either achieving lipid goal at follow-up or meeting criteria for ongoing intervention. RESULTS: There were 585 participants, with a mean age of 12.8 years. The prevalence of children warranting intervention for low-density lipoprotein cholesterol at baseline was 14%. After 1 year of recommended dietary changes, 51% achieved goal low-density lipoprotein cholesterol, 27% qualified for enhanced dietary and lifestyle modifications, and 22% met criteria for pharmacologic intervention. Elevated triglycerides were more prevalent, with 51% meeting criteria for intervention. At 1 year, 25% achieved goal triglycerides with diet and lifestyle changes, 38% met criteria for advanced dietary modifications, and 37% qualified for antihyperlipidemic medications. CONCLUSIONS: More than one-half of children with NAFLD met intervention thresholds for dyslipidemia. Based on the burden of clinically relevant dyslipidemia, lipid screening in children with NAFLD is warranted. Clinicians caring for children with NAFLD should be familiar with lipid management.
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    Low HDL-C is a non-fasting marker of insulin resistance in children
    (De Gruyter, 2022-06-02) Zevin, Erika L.; Peterson, Amy L.; Dodge, Ann; Zhang, Xiao; Carrel, Aaron L.; Pediatrics, School of Medicine
    Objectives: Childhood obesity and associated comorbidities, including insulin resistance, are increasing in the United States. Our objectives were to (1) determine the prevalence of insulin resistance in children seen in dyslipidemia clinic and (2) evaluate which aspects of the lipid profile correlate with insulin resistance. Methods: Children and adolescents seen in a specialized pediatric dyslipidemia clinic without secondary diagnoses known to alter the lipid panel were included. Simultaneous fasting lipid panel, insulin, and glucose levels were available in 572 children (50.5% male). Results: Mean patient age was 15.0 ± 3.6 years with the majority being over 10 years of age (92.5%). Mean BMI was 29.8 ± 8.1 kg/m2 and BMI standard deviation score was 1.80 ± 0.9. Mean HOMA-IR was 6.2 ± 5.7 with a range of 0.4-49.3, and interquartile range of 2.7-7.6. Triglyceride level had a positive correlation with HOMA-IR (p<0.001). HDL-C negatively correlated with HOMA-IR even controlling for triglyceride level by multivariate analysis (p=0.001) and HDL-C <30 mg/dL predicted IR with 41.5% PPV. Conclusions: In children and adolescents with dyslipidemia, insulin resistance is common and significantly correlates with reduced HDL-C levels. Non-fasting samples are easier to obtain in children and low HDL-C, which is minimally affected on non-fasting samples, could be an easily obtained indicator of IR. Increasing detection of insulin resistance in children with dyslipidemia may provide greater opportunities for lifestyle interventions and possible pharmacotherapy to modify cardiovascular risk.
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    Management of Dyslipidemia as a Cardiovascular Risk Factor in Individuals with Nonalcoholic Fatty Liver Disease
    (Elsevier B.V., 2014-07) Corey, Kathleen E.; Chalasani, Naga; Department of Medicine, IU School of Medicine
    Nonalcoholic fatty liver disease (NAFLD) is the most frequent cause of liver disease in the United States and is associated with an increased risk of cardiovascular disease (CVD) and cardiovascular (CV) mortality, independent of traditional cardiovascular risk factors. CVD is one of the most common causes of death among individuals with NAFLD and management of NAFLD must extend beyond liver disease to include CVD risk modification. Clinicians should assess CVD risk with the Framingham Risk Score (FRS) and screen for CVD risk factors including dyslipidemia, diabetes mellitus (DM), hypertension, tobacco use and the metabolic syndrome (MetS). CVD risk factors, particularly dyslipidemia, require aggressive medical management to reduce the high risk of CVD events and death in individuals with NAFLD.
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    Repeat cross-sectional data on the progression of the metabolic syndrome in Ossabaw miniature swine
    (Elsevier, 2016-04-13) McKenney-Drake, Mikaela L.; Rodenbeck, Stacey D.; Owen, Meredith K.; Schultz, Kyle A.; Alloosh, Mouhamad; Tune, Johnathan D.; Sturek, Michael; Department of Cellular & Integrative Physiology, IU School of Medicine
    Ossabaw miniature swine were fed an excess calorie, atherogenic diet for 6, 9, or 12 months. Increased body weight, hypertension, and increased plasma cholesterol and triglycerides are described in Table 1. For more detailed interpretations and conclusions about the data, see our associated research study, "Biphasic alterations in coronary smooth muscle Ca(2+) regulation during coronary artery disease progression in metabolic syndrome" McKenney-Drake, et al.
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    Selective sex‐based differences in the association between angiogenic and Alzheimer’s Disease biomarkers in a preliminary cohort of rrAD participants
    (Wiley, 2025-01-09) Lutshumba, Jenny; Wilcock, Donna M.; Lee, Tiffany; Zhu, David C.; Scheel, Norman; German, Dwight C.; Zhang, Rong; Trout, Amanda; Stowe, Ann M.; Neurology, School of Medicine
    Background: Vascular contributions to cognitive impairment and dementia (VCID) and Alzheimer’s disease (AD) are the two most common forms of dementia, with overlapping risk factors including cardiovascular risk factors such as hypertension and dyslipidemia. The etiology of both VCID and AD shows sex‐based differences, as well as sex‐based differences in cardiovascular risk factors. However, how sex differences influence AD and angiogenic biomarkers in older adults who have high cardiovascular risk factors is not known. Method: AD and angiogenic biomarkers for VCID were measured from the plasma of a subgroup (n=96) of participants from the ‘risk reduction for Alzheimer’s disease’ (rrAD) two‐year clinical trial (NCT02913664; completed Jan. 2022; n=513 total participants). rrAD participants had a family history of dementia or subjective memory complaints, hypertension, and dyslipidemia. The subgroup in the study included 31 males and 65 females (aged: 71‐85). Baseline values for AD biomarkers: Total tau, pTau181, Aβ40, and Aβ42, angiogenic biomarkers: Tie‐2, VEGF‐A, VEGF‐C, VEGFR1, and VCID biomarkers: bFGF, VEGF‐D, PlGF were analyzed using Meso Scale Discovery (MSD). Nonparametric analysis evaluated the sex differences in biomarkers, linear regression evaluated the relationship between AD biomarkers and angiogenic biomarkers in both sexes. Result: We found sex‐based differences in AD biomarkers such that females had a higher expression in Total tau and Total tau/Aβ42 (p=0.0021, p=0.0003, respectively) while pTau181 was higher in males (p=0.0216). pTau181/ Aβ42 and Aβ42/40 ratios showed no sex differences, nor did baseline angiogenic biomarkers. There was, however, a selective sex difference in the association between angiogenic and AD biomarkers. In females, Total tau is associated with VEGF‐D (R2= 0.0746, p=0.0277), and Tau/Aβ42 is associated with VEGF‐A and VEGFR‐1(R2= 0.0747, p=0.0275; R2= 0.0973, p=0.0114, respectively). In males, pTau181 and pTau181/Aβ42 are associated with VEGF‐D (R2= 0.2637, p=0.0031; R2= 0.1799, p=0.0174, respectively), Aβ42/Aβ40 is associated with VEGF‐C (R2= 0.1491, p=0.0319), and Tau/Aβ42 is associated with bFGF (R2= 0.1458, p=0.0340). Conclusion: There is a selective sex‐based difference in plasma AD biomarkers and their association with angiogenic biomarkers in this preliminary cohort of older adults with high risks of developing Alzheimer’s disease and related dementias.
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    The Impact of Glomerular Disease on Dyslipidemia in Pediatric Patients Treated with Dialysis
    (MDPI, 2025-01-27) Zitnik, Edward; Streja, Elani; Laster, Marciana; Pediatrics, School of Medicine
    Background/objectives: Children on dialysis have a 10-fold increase in cardiovascular disease (CVD)-related mortality when compared to the general population. The development of CVD in dialysis patients is attributed to Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) and dyslipidemia. While the prevalence of dyslipidemia in adult dialysis patients has been described, there are limited data on prevalence, severity, and risk factors for pediatric dyslipidemia. Methods: Data from 1730 pediatric patients ≤ 21 years receiving maintenance hemodialysis or peritoneal dialysis with at least one lipid panel measurement were obtained from USRDS between 2001 and 2016. Disease etiology was classified as being glomerular (n = 1029) or non-glomerular (n = 701). Comparisons were made across etiologies using both linear and logistic regression models to determine the relationship between disease etiology and lipid levels. Results: The cohort had a mean age of 15.2 years and were 54.5% female. Adjusting for age, sex, race/ethnicity, modality, time with End Stage Kidney Disease (ESKD), and body mass index (BMI) and using non-glomerular etiology as the reference, glomerular disease [mean (95% CI)] was associated with +19% (+14.7%, +23.8%) higher total cholesterol level (183 mg/dL vs. 162 mg/dL), +21% (+14.8%, +26.6%) higher low density lipoprotein cholesterol level (108 mg/dL vs. 87 mg/dL), and +22.3% (+15.5%, +29.5%) higher triglyceride level (169 mg/dL vs. 147 mg/dL). Glomerular disease [OR (95% CI)] was associated with 3.0-fold [2.4, 3.9] higher odds of having an abnormal total cholesterol level, 3.8-fold [2.8, 5.0] higher odds of having an abnormal LDL-C level, and 1.9-fold [1.5, 2.4] higher odds of having an abnormal triglyceride level when compared to non-glomerular disease. Conclusions: Pediatric dialysis patients have a high prevalence of dyslipidemia, particularly from elevated triglyceride levels. Specifically, patients with glomerular disease have an even higher risk of dyslipidemia from elevated non-HDL cholesterol and triglyceride levels than patients with non-glomerular disease. The long-term impact of this unfavorable lipid profile requires further investigation.