Journal of clinical lipidology最新文献

{"title":"Phytosterolemia: A case of paradoxical hypercholesterolemia in response to a mediterranean diet","authors":"Rahul Rege MD,&nbsp;Carol Kirkpatrick PhD,&nbsp;Alexandria Wolz RD,&nbsp;Eugenia Gianos MD,&nbsp;Saman Suleman BS","doi":"10.1016/j.jacl.2025.04.047","DOIUrl":"10.1016/j.jacl.2025.04.047","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Phytosterolemia is a rare autosomal recessive lipid disorder caused by variants of the sterol efflux transporter genes ABCG5 and ABCG8 leading to increased intestinal absorption and decreased hepatic elimination of plant sterols. Patients may be misdiagnosed with heterozygous familial hypercholesterolemia. Additionally, they may present with atypical responses to nutrition interventions recommended for atherosclerotic cardiovascular disease (ASCVD) prevention.</div></div><div><h3>Objective/Purpose</h3><div>To describe the clinical pathway of a patient who experienced increased total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after adopting a Mediterranean dietary pattern and outline diagnostic testing and management strategies for a rare lipid disorder.</div></div><div><h3>Methods</h3><div>We present a case report.</div></div><div><h3>Results</h3><div>HT is a 54-year-old post-menopausal woman who presented to preventive cardiology clinic for consultation for hypercholesterolemia. Baseline TC was 256 mg/dL and LDL-C was 148 mg/dL. HT was physically active with no history of smoking. Family history was negative for premature ASCVD. On physical exam, she had a BMI of 22.49 kg/m², a normal cardiovascular exam, and no xanthomas were noted.</div><div>HT's 10-year ASCVD risk score indicated low-risk (1.1%). HT was encouraged to follow the Mediterranean dietary pattern (MedDiet) to address her elevated LDL-C levels. HT demonstrated good adherence and increased her intake of whole grains, legumes, nuts, avocados, and olive oil. Follow-up laboratory results at two months demonstrated TC increased to 317 mg/dL and LDL-C to 203 mg/dL (see Figure).</div><div>The atypical response to the MedDiet resulted in further diagnostic testing, which revealed a significantly elevated beta-sitosterol level of 11 mg/L (normal &lt;5 mg/L) highly suggestive of phytosterolemia. HT was prescribed ezetimibe 10 mg, discontinued the MedDiet, and was educated on a low-plant sterol diet. After one month, TC was 193 mg/dL and LDL-C was 106 mg/dL. After 6 months on the treatment plan, TC decreased to 180 mg/dL, LDL-C decreased to 90 mg/dL, and beta-sitosterol decreased to 2.8 mg/L. She was encouraged to continue with the current therapeutic regimen and referred to a registered dietitian to assure optimal nutrition with a low-plant sterol diet</div></div><div><h3>Conclusions</h3><div>Though extremely rare, phytosterolemia should be considered in patients with hypercholesterolemia who have paradoxical responses to whole food, plant-based diets or those with early ASCVD without obvious etiology. In this patient, diagnosis was via laboratory assays that showed elevated plasma plant sterol levels, including beta-sitosterol. Variants of ABCG5 and ABCG8 genes can provide genetic confirmation. Lipid-lowering was achieved with a low-plant sterol diet and ezetimibe 10 mg.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e34-e35"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of baseline demographics on lipid profile in patients with ACS: Unmasking hidden drivers","authors":"Monika Bhandari MD,&nbsp;Pravesh Vishwakarma MD,&nbsp;Abhishek Singh MD,&nbsp;Rishi Sethi MD,&nbsp;Jyoti Bajpai MD,&nbsp;Akshyaya Pradhan MD","doi":"10.1016/j.jacl.2025.04.091","DOIUrl":"10.1016/j.jacl.2025.04.091","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Acute coronary syndromes (ACS) remain a major global cardiovascular challenge with evolving treatment paradigms. Despite advances in management, the influence of baseline patient demographics on lipid profiles at presentation has received limited attention.</div></div><div><h3>Objective/Purpose</h3><div>This study explores the associations between demographic factors and lipid profile in ACS patients.</div></div><div><h3>Methods</h3><div>In this single-center, retrospective study, we analyzed data from 1,671 consecutive ACS patients admitted for treatment. Baseline demographics—including age, gender, comorbidities (diabetes mellitus and hypertension), and smoking status—were examined in relation to lipid profile components (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) measured upon admission. Additionally, among the 853 patients who underwent coronary angiography, we evaluated the relationship between lipid levels and angiographic severity. Clinical presentations were categorized as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina.</div></div><div><h3>Results</h3><div>The mean age of the cohort was 56.29 ± 11.73 years, with a male predominance (81.5%). Patients under 40 years exhibited significantly higher mean levels of total cholesterol, LDL-C, and triglycerides compared to those between 41 and 60 years and over 60 years (p = 0.002, 0.001, and &lt; 0.001, respectively), potentially reflecting the more frequent use of lipid-lowering therapies in older patients. Females had higher levels of total cholesterol and HDL-C than males (p = 0.027 and &lt; 0.001, respectively). Diabetic patients (n = 475) and hypertensive patients (n = 538) demonstrated lower LDL-C levels relative to non-diabetics and non-hypertensive individuals (p &lt; 0.001), suggesting more aggressive lipid management and adherence to lifestyle modifications in these populations. Smokers (n = 799) presented with elevated total cholesterol and LDL-C levels compared to non-smokers (p = 0.002 and 0.02, respectively). In the subset undergoing coronary angiography, significant correlations emerged between angiographic severity and both total cholesterol and LDL-C levels (p = 0.005). Moreover, patients presenting with STEMI (68.7% of the cohort) had markedly higher total cholesterol and LDL-C levels compared to those with NSTEMI or unstable angina (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In this South Asian cohort of ACS patients, baseline lipid profiles varied significantly with age, gender, comorbidities, smoking status, angiographic findings, and clinical presentation. These findings highlight the importance of considering demographic factors in risk stratification and tailoring lipid management strategies to improve outcomes in ACS patients.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e65-e66"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"*Sitosterolemia due to a new combination of ABCG8 variants presenting as hemolytic anemia and thrombocytopenia: A case report","authors":"Natalie Bavli MD,&nbsp;Zahid Ahmad MD,&nbsp;FNU Anum MBBS","doi":"10.1016/j.jacl.2025.04.057","DOIUrl":"10.1016/j.jacl.2025.04.057","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Sitosterolemia is a rare autosomal recessive disorder caused by mutations in ATP binding cassette subfamily G member 5 or 8 (ABCG5/8), leading to excessive plant sterol absorption and accumulation. Patients can present with xanthelasma, tendon xanthomas, premature atherosclerosis, and hematologic abnormalities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;Here, we report a case of sitosterolemia in an adult male presenting with hemolytic anemia, macrothrombocytopenia, and hypercholesterolemia. His diagnosis was ultimately confirmed through genetic testing, which identified a new combination of ABCG8 variants&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Case Presentation: A 61-year-old man with a history of hypothyroidism, hypercholesterolemia, obesity, and metabolic dysfunction-associated steatotic liver disease (MASLD) was referred to the Hematology Clinic at UT Southwestern for the evaluation of hemolytic anemia and moderate thrombocytopenia. He was diagnosed with hypercholesterolemia in early adulthood and was taking Rosuvastatin 5 mg daily for several years.&lt;/div&gt;&lt;div&gt;On examination, he had splenomegaly and bilateral xanthelasma (Figure 1). Laboratory evaluation revealed LDL-C of 126 mg/dL, low hemoglobin and platelet count, elevated lactate dehydrogenase, and undetectable haptoglobin (Table 1). A peripheral blood smear revealed marked stomatocytosis and macrothrombocytopenia (Figure 2).&lt;/div&gt;&lt;div&gt;Given the combination of hemolytic anemia, macro-thrombocytopenia, and stomatocytosis, sitosterolemia was suspected. Serum plant sterol levels were markedly elevated (Table1). Genetic testing identified multiple heterozygous variants in ABCG8. A likely pathogenic c.250_280dup variant on one allele, and two variants (c.1721G&gt;A [p.Gly574Glu] and c.1723G&gt;C [p. Gly575Arg]) on the other which together cause a novel deletion and insertion of two amino acids. Cascade screening revealed his healthy sister carried c.250_280dup variant.&lt;/div&gt;&lt;div&gt;He was subsequently seen at the UT Southwestern Lipid Metabolism Clinic and was started on ezetimibe 10 mg daily in addition to the Rosuvastatin 5 mg daily. He consulted a nutritionist to transition his diet from a heart-healthy diet to a low plant sterol diet. At three months follow-up, his lipid profile and hemoglobin had improved, but platelet counts and markers of sterol absorption remain unchanged (Table 1).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;This case underscores key clinical features of sitosterolemia, including xanthelasma and hematologic abnormalities. His genetic findings expand the known spectrum of ABCG8 mutations: the c.250_280dup variant has not been previously reported in sitosterolemia, and while the c.1721G&gt;A (p.Gly574Glu) and c.1723G&gt;C (p.Gly575Arg) missense variants have been individually documented, their co-occurrence on the same allele, leading to a novel mutation, is unreported.&lt;/div&gt;&lt;div&gt;Improvement in plant sterol levels and platelet counts can ta","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e42-e43"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypercoagulability or coronary artery disease? Polygenic risk score unveils the mystery","authors":"Douglas Jacoby MD,&nbsp;Sohil Golwala MD","doi":"10.1016/j.jacl.2025.04.058","DOIUrl":"10.1016/j.jacl.2025.04.058","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>CB is a 58 year old nonsmoker without significant cardiovascular risk factors presented with a myocardial infarction with unclear etiology.</div></div><div><h3>Objective/Purpose</h3><div>To review a clinical scenario involving use of polygenic risk score (PRS) to clarify the etiology of cardiovascular event and further risk stratify to guide lipid management.</div></div><div><h3>Methods</h3><div>CB was seen in the office at Lipid Clinic at Penn for further evaluation.</div></div><div><h3>Results</h3><div>CB is a 58 year old nonsmoker male without family history of premature coronary artery disease (CAD) or any major cardiovascular risk factors, found to have extensive CAD when he presented with a STEMI s/p DES to RCA and PCI to PLA and PDA, along with non-critical lesions (30-40% stenosis) in LAD and Lcx. The STEMI occurred in the setting of COVID-19 infection, raising the question about true etiology.</div><div>Using conventional risk calculators, his 10-year ASCVD risk is estimated at about 6% (“borderline risk”), therefore underestimating his risk and extensive CAD. Some clinicians evaluating the patient focused towards hypercoagulability and thrombosis in the setting of his COVID infection, however that would not sufficiently explain his atherosclerotic disease.</div><div>Keeping in mind that the patient has two children and five siblings, it was important to assess his genetic risk despite lack of family history of CAD. His polygenic risk score for CAD riskshowed the 97th percentile risk, clarifying his cardiovascular risk factor and also prompting for more aggressive preventive treatment and cascade screening for family.</div></div><div><h3>Conclusions</h3><div>Cardiovascular disease is the leading cause of death in the United States and globally. While the Framingham Risk Score and the Pooled Cohort Equations (PCE) provide a useful construct to guide the use of medications for cardiovascular prevention, they miss certain opportunities at early intervention, especially for patients with significant genetic risk. Hence, incorporation of genetics into risk prediction frameworks offer a wide range of opportunity for early detection toward earlier and targeted risk reduction strategies.</div><div>Polygenic risk score (PRS) is a novel tool in precision medicine to quantify inherited risk for a given disease based on the cumulative impact of many common sites of DNA variation. Although we do not anticipate PRS to replace traditional guideline based approach, it may indeed be helpful - and akin to other CAD risk-enhancing factors - when there is clinical uncertainty. As seen in our case, using a PRS for CAD can help explain the etiology of CAD, modify treatment goals, and more effectively screen relatives for otherwise unrecognized cardiovascular risk.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e43-e44"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of blood cholesterol screening, elevated levels, and medication use among adults – United States, 2019-2023","authors":"Magdalena Pankowska MPH,&nbsp;Ahlia Sekkarie PhD,&nbsp;Omoye Imoisili MD,&nbsp;Fleetwood Loustalot PhD,&nbsp;Kerui Xu PhD","doi":"10.1016/j.jacl.2025.04.078","DOIUrl":"10.1016/j.jacl.2025.04.078","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Elevated levels of total blood cholesterol are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Blood cholesterol levels increase with age, and disparities exist across sociodemographic characteristics. Clinical guidelines and recommendations encourage regular screening and management of blood cholesterol to reduce the risks of ASCVD in adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;This study assessed recent national and state-level trends in the age-standardized prevalence of self-reported blood cholesterol screening, high blood cholesterol, and medication use among United States (US) adults aged ≥ 18 years using data from the 2019-2023 Behavioral Risk Factor Surveillance System (BRFSS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;BRFSS is a system of health-related telephone surveys conducted among non-institutionalized US adults. Age-standardized prevalence of blood cholesterol screening during the preceding 5 years, high blood cholesterol among those who had ever screened, and medication use were assessed by sex, age group, race and ethnicity, educational attainment, and state of residence, including the District of Columbia. All percentages were age-stratified or age-standardized using the 2000 US census. The absolute (percentage point) and relative (percent) changes from 2019 to 2023 were calculated, and linear trends across survey periods were assessed using orthogonal polynomial coefficients. This analysis used SAS-callable SUDAAN to account for complex sampling design and weighting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After excluding respondents with missing cholesterol or sociodemographic data, the final analytic samples for 2019, 2021, and 2023 were 371,144, 385,954, and 383,892, respectively. From 2019 to 2023, there was a slight decrease in the prevalence of adults who reported of having blood cholesterol screened during the preceding 5 years, decreasing by 0.5% from 86.0% to 85.6% (-0.4 percentage points, p = 0.026). Among adults who had ever screened, the prevalence of high blood cholesterol increased by 13.7%, rising from 29.2% to 33.2% (4.0 percentage points, p &lt; 0.001). Among adults told to have high blood cholesterol, the prevalence of medication use remained at approximately 41.5%. The prevalence of screening, awareness, and medication use for high blood cholesterol varied by sociodemographic characteristics and state of residence. Notably, 34 US states experienced a significant increase in the prevalence of high blood cholesterol.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This analysis highlights the population-level disparities in screening, awareness, and treatment for high blood cholesterol. To achieve the Healthy People 2030 goals of reducing blood cholesterol and increasing treatment in US adults with high blood cholesterol, clinicians, policymakers, and public health practitioners should consider interventions that enhance awareness about the","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e57-e58"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute pancreatitis events among patients with severe hypertriglyceridemia: A retrospective study","authors":"Eric Young PhD,&nbsp;Monica McClain PhD,&nbsp;Oiza Aliu PharmD","doi":"10.1016/j.jacl.2025.04.007","DOIUrl":"10.1016/j.jacl.2025.04.007","url":null,"abstract":"<div><h3>Funding</h3><div>This study was funded by Ionis Pharmaceuticals.</div></div><div><h3>Background/Synopsis</h3><div>Severe hypertriglyceridemia (sHTG), caused by genetic disorders like familial chylomicronemia syndrome or secondary causes like diabetes, obesity, renal disease, hypothyroidism, and certain medications, can lead to acute pancreatitis (AP), a potentially life-threatening complication. Contemporary data on sHTG-associated AP events and their recurrence are limited.</div></div><div><h3>Objective/Purpose</h3><div>To describe AP event patterns in patients with sHTG.</div></div><div><h3>Methods</h3><div>This was a retrospective descriptive cohort study of AP events among patients with sHTG (triglyceride levels [TG] ≥ 500 mg/dL) using electronic medical records from the TrinetX Dataworks USA network between January 2015 – September 2024. Patients were stratified by TG levels ≥ 500 - ≤ 880 and &gt; 880 mg/dL. Patients had at least a 12-month baseline period before the index event (first TG ≥ 500 mg/dL), at least two TG measurements ≥ 500 mg/dL during the patient identification period (January 2016 – September 2023) and were followed at least 12 months after the index event. AP was defined based on ICD-10 code (K85) and stratified as 0, 1, ≥ 1, and ≥ 2 during follow-up. Triglyceride levels and medications were defined using LOINC and RxNorm codes respectively.</div></div><div><h3>Results</h3><div>A total of 65,510 patients had sHTG (≥ 500 - ≤ 880 vs. &gt; 880 cohort; 52,417 vs. 13,153). Of these, 1,287 patients (1.9%) had ≥ 1 AP events. The median follow-up time was 54.3 months vs. 53.1 months for the ≥ 500 - ≤ 880 vs. &gt; 880 cohort. The mean age (SD) was 49.6 (14.2) years, and 32.9% were female. A higher proportion of patients in the &gt; 880 cohort (4.0%) had ≥ 1 AP events than in the ≥ 500 - ≤ 880 cohort (1.5%). Patients with ≥ 1 AP events were more likely to have diabetes (51.3% vs 34.0%), and renal disease (13.3% vs 9.1%), compared with patients with no AP events. The mean number of AP events among patients with at least one event was greater than 3 for both cohorts.</div></div><div><h3>Conclusions</h3><div>This study highlights the increasing rates of AP with higher triglyceride levels (&gt; 880 mg/dL) and the prevalence of secondary sHTG causes among sHTG patients with AP. Further, the results show that most patients with an initial AP event experience multiple AP events during the study period. The increasing burden of AP in sHTG patients emphasizes the need for effective strategies and management to prevent its occurrence.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e4-e5"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic and racial disparities in type 1 diabetes adult patients admitted with diabetic ketoacidosis according to large national data set","authors":"Fernando Mateo MD,&nbsp;Sila Mateo Faxas MD,&nbsp;Muayad Alzamara MD,&nbsp;Fayaz Khan MD,&nbsp;Amin Eshghabadi MD,&nbsp;Godbless Ajenaghughrure MD,&nbsp;M Kenan Rahima MD","doi":"10.1016/j.jacl.2025.04.072","DOIUrl":"10.1016/j.jacl.2025.04.072","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Racial and socioeconomic disparities significantly impact healthcare outcomes in adults with type 1 diabetes mellitus (T1DM), particularly in the incidence and severity of diabetic ketoacidosis (DKA).</div></div><div><h3>Objective/Purpose</h3><div>This study evaluates disparities in hospitalization rates, clinical outcomes, and healthcare resource utilization among adults admitted with DKA.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis using a national inpatient database 2017-2021, identifying adult hospitalizations for DKA in patients who has T1DM. Patients were stratified by race (White, Black, Hispanic, Asian, and other) and socioeconomic factors such as insurance type. Baseline demographics and clinical outcomes were compared. Multivariate logistic regression models were used to assess disparities in mortality, length of stay (LOS), and hospitalization costs.</div></div><div><h3>Results</h3><div>A total of 729,784 adult DKA hospitalizations with T1DM were included. Caucasian patients represented the largest proportion (60.8%), followed by African American (22.7%), Hispanic (10.4%), and Asian (0.9%) patients. Insurance status varied significantly by race, with Medicaid being the predominant insurance among Black (44.5%) and Hispanic (40.1%) patients, while private insurance was more common among White (31.9%) and Asian (35.9%) patients (P &lt; 0.001).</div><div>Clinical outcomes also varied significantly. In-hospital mortality was highest among Asian patients (1.8%, OR 1.89, P = 0.003), while White (1.1%), Black (0.8%, OR 1.1, P = 0.18), and Hispanic (0.9%, OR 1.3, P = 0.005) patients had lower mortality rates. The need for invasive mechanical ventilation was highest in Asian patients (4.4%, OR 1.3, P = 0.04) compared to White (3.5%), Black (2.9%), and Hispanic (2.7%) patients. Asian patients also had the longest LOS (4.5 days, OR 1.23, P &lt; 0.01) and highest hospitalization costs ($15,209, OR 1.48, P &lt; 0.01) compared to White patients (LOS 3.8 days, cost $10,556). Hispanic patients had higher total costs ($11,835, OR 1.27, P &lt; 0.01), while Black patients had the lowest hospital costs ($10,225, OR 1.06, P &lt; 0.01)</div></div><div><h3>Conclusions</h3><div>Socioeconomic and racial disparities significantly impact DKA-related hospitalizations and outcomes in adults with T1DM. Black and Hispanic patients experience higher rates of admission and worse clinical outcomes, while Asian patients have greater resource utilization and higher mortality risk. Addressing these disparities requires targeted interventions to improve access to preventive care, reduce financial barriers, and enhance diabetes management in vulnerable populations.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e53-e54"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes in patients admitted with diabetic ketoacidosis & hypernatremia, according to a nation-wide dataset","authors":"Mohammad Amin Eshghabadi MD,&nbsp;ReyhanehSadat Rahimi MD,&nbsp;Sila Mateo Faxas MD,&nbsp;Gregory Pierce BS,&nbsp;Brenda Pierce MD,&nbsp;Natalie Assaf BA,&nbsp;Michael Fatuyi MD,&nbsp;Borna Mansouri MD,&nbsp;Jason Pichardo MD,&nbsp;Fayaz Khan MD,&nbsp;Mohammed Najdat Seijari MD,&nbsp;Muayad Alzamara MD,&nbsp;Shahla Mallick MD,&nbsp;M Kenan Rahima MD,&nbsp;Mian Hammas MD","doi":"10.1016/j.jacl.2025.04.087","DOIUrl":"10.1016/j.jacl.2025.04.087","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>The association between diabetic ketoacidosis (DKA) and hypernatremia underscores a complex interplay of metabolic derangement. DKA, characterized by insulin deficiency, induces hyperglycemia and osmotic diuresis, potentially leading to dehydration and hypernatremia.</div></div><div><h3>Objective/Purpose</h3><div>There's limited scientific evidence examining outcomes among patients presenting with DKA and hypernatremia.</div></div><div><h3>Methods</h3><div>We utilized the National Inpatient Sample from 2017-2020 to identify patients admitted with DKA and hypernatremia. Primary endpoints: inpatient mortality; secondary endpoints: cardiogenic shock, cardiac arrest, intubation rate, length of stay, and total hospital charges. Multivariable logistic regression analysis adjusted for various factors was employed.</div></div><div><h3>Results</h3><div>Among 1,239,020 DKA hospitalizations, 6.9% (n = 85,999) had hypernatremia. Hypernatremia patients were slightly older (mean 55.7 vs. 45.1 years), male and Caucasian predominance (54.1% vs. 50.7% and 46.8% vs. 55.7%). While comorbidity prevalence was similar between groups (Obesity, COPD, Dyslipidemia, AFib, HTN, PVD, prior CVA, nicotine use &amp; EtOH use). Hypernatremia was associated with significantly worse outcomes: higher mortality (10.2% vs. 2.6%, OR 1.9), increased rates of cardiogenic shock (2.1% vs. 0.8%, OR 1.7), cardiac arrest (4.4% vs. 1.2%, OR 2.2), intubation (24.7% vs. 4.7%, OR 4.3), longer LOS (10.3 vs. 4.5 days, IRR 1.67), and higher cost ($32,702.86 vs. $12,869.73, IRR 1.77). All results were statistically significant (p &lt; 0.01) and adjusted for various factors.</div></div><div><h3>Conclusions</h3><div>Although comorbidity profiles were similar, the hypernatremia group had worse outcomes, including higher mortality, adverse events, prolonged hospital stays, and increased resource utilization. Clinicians should recognize hypernatremia as a negative prognostic factor in DKA management, necessitating tailored interventions to mitigate adverse outcomes.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e63"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerated atherosclerosis post liver transplant associated to MetALD: atherogenic dyslipidemia post-transplant as a forgotten risk marker.","authors":"Prajwal Reddy MD,&nbsp;Peter Pollak MD,&nbsp;Carlos Vergara MD","doi":"10.1016/j.jacl.2025.04.044","DOIUrl":"10.1016/j.jacl.2025.04.044","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>The impact of liver transplant in the change of lipids metabolism is well known. However, primary prevention strategies are not implemented as aggressively in this population.</div></div><div><h3>Objective/Purpose</h3><div>To illustrate accelerated atherosclerosis post-liver transplant and a gap of care.</div></div><div><h3>Methods</h3><div>Case Presentation: The patient is a 65-year-old male with a history of Metabolic Dysfunction- and Alcohol-Associated Liver Disease (MetALD) status post orthotopic liver transplant one year before this presentation, came to the emergency department (ED) complaining of severe chest pain, an ECG was obtained noting ST-Elevation Myocardial Infarction (STEMI) of the inferior leads (Figure 1) and was taken emergently to the cardiac catheterization laboratory where he underwent percutaneous coronary intervention (PCI) to the right coronary artery (RCA) and also noted to have severe multivessel disease of the left system (Figure 2) which compared with his coronary angiogram a year prior represented significant accelerated atherosclerotic disease.</div></div><div><h3>Results</h3><div>During admission to the ED, lipid profile was obtained showing total cholesterol of 225 mg/dL, high-density lipoprotein (HDL) of 37 mg/dL, Calculated low-density lipoprotein (LDL- C): 157 mg/dL, triglycerides: 168 mg/dL, non-HDL C: 188 mg/dL, Apolipoprotein B: 122 mg/dL, Apolipoprotein A1 103 mg/dL, Lipoprotein (a): 7 nmol/L. The patient was not on any lipid-lowering therapy before this event. During his pre-transplant workup one year prior, the patient had coronary angiography, which only revealed mild nonobstructive disease in his right and left coronary system (Figure 3). Interestingly, his lipid panel concomitantly was not abnormal, as illustrated in Table 1.</div><div>The patient was discharged with a plan for possible coronary artery bypass grafting evaluation and with aggressive lipid-lowering therapy, including high-intensity statin and a PCSK9 inhibitor, in addition to his guideline-directed therapy post-myocardial infarction.</div></div><div><h3>Conclusions</h3><div>Atherogenic dyslipidemia post-liver transplant has been a described mechanism that contributes to the higher risk of cardiac-associated adverse events; this case of accelerated atherosclerosis in a patient with a history of MetALD-associated liver disease illustrates the need for early aggressive primary prevention strategies post-transplant that include the use of evidence-based lipid-lowering therapies.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e32-e33"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"† Elevated HDL in familial hyper-alpha-lipoproteinemia: Atheroprotective or atherogenic?","authors":"Jenna Mahoney DO,&nbsp;Samir Mehta DO,&nbsp;Myrna Sutera ACNP,&nbsp;Stephen Meng MD,&nbsp;Zahra Manji DO","doi":"10.1016/j.jacl.2025.04.045","DOIUrl":"10.1016/j.jacl.2025.04.045","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Familial hyper-alpha-lipoproteinemia (HALP) is a heterogenous genetic lipid disorder that is found in only 8% of the population and manifests as elevated high-density lipoprotein (HDL) levels above the 90th percentile. HALP is due to mutations in various genes including cholesteryl ester transfer protein (CETP), hepatic lipase, or apolipoprotein C-III (APOC3).</div></div><div><h3>Objective/Purpose</h3><div>While epidemiological studies have noted an inverse relationship between high HDL and the development of coronary artery disease, recent data have shown a lack of causal atheroprotective effects. Thus, the purpose of this case is to highlight a patient with significantly elevated HDL and peripheral vascular disease.</div></div><div><h3>Methods</h3><div>Patient is a 64-year-old female with past medical history of peripheral vascular disease of the right lower extremity status post angioplasty with subsequent development of left lower extremity pseudoaneurysm status post resection and thrombectomy, hypertension, type 2 diabetes, alcohol and tobacco use, and CKD Stage 4 who presented to the advanced lipid clinic for management of elevated lipoproteins. Patient's labs were significant for a total cholesterol (TC) of 375 mg/dL, HDL of &gt; 200 mg/dL, triglycerides (TG) of 66 mg/dL, and a low-density lipoprotein (LDL) of 175 mg/dL. Apolipoprotein A-I was elevated at 231 mg/dL.</div></div><div><h3>Results</h3><div>Patient was uptitrated to a high intensity statin with improvement in her lipid panel with a TC of 191 mg/dL, HDL of 120 mg/dL, TG of 57 mg/dL, and LDL of 60 mg/dL, achieving target LDL &lt; 70 mg/dL. Abdominal ultrasound was obtained to rule out secondary causes of elevated HDL and was unremarkable. Tobacco and alcohol cessation were advised.</div></div><div><h3>Conclusions</h3><div>CETP exchanges cholesteryl esters from HDL in exchange for TG, making HDL smaller and more TG-rich. Studies have shown that in vitro addition of CETP and hepatic lipase, which hydrolyzes phospholipids and TG, into CETP-deficient patients led to the development of very small HDL particles that were able to remove cholesterol from lipid laden macrophages. Conversely, larger HDL molecules seen in CETP-deficient patients did not have such anti-atherogenic properties. This case highlights the importance of recognizing HALP in the setting of elevated HDL, but also of excluding secondary causes of elevated HDL, such as primary biliary cirrhosis and high dose niacin. Genetic testing and evaluation of coronary artery disease via cardiac catheterization should also be considered.</div><div><strong>Previously Published:</strong> Circulation, American Heart Association Scientific Sessions 2024</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e33"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}