The Four Major Statin Groups

The four major primary- and secondary-prevention patient groups who should be treated with statins were identified on the basis of randomized, controlled clinical trials showing that the benefit of treatment outweighed the risk of adverse events. The four treatment groups include:

·         Individuals with clinical atherosclerotic cardiovascular disease.

·         Individuals with LDL-cholesterol levels >190 mg/dL, such as those with familial hypercholesterolemia.

·         Individuals with diabetes aged 40 to 75 years old with LDL-cholesterol levels between 70 and 189 mg/dL and without evidence of atherosclerotic cardiovascular disease.

·         Individuals without evidence of cardiovascular disease or diabetes but who have LDL-cholesterol levels between 70 and 189 mg/dL and a 10-year risk of atherosclerotic cardiovascular disease>7.5%.

Cardiovascular Mortality Patients With Diabetes

Xanthoma

A xanthoma is a deposition of yellowish cholesterol-rich material in anywhere of body parts, but typically develop on both the joints and tendons in various disease states can include:

·         Diabetes

• Hyperlipidemia: high blood cholesterol levels
• Metabolic disorders: These are genetic conditions affecting body’s ability to break down chemicals and maintain life. Examples include porphyria, Krabbe disease, or congenital adrenal hyperplasia.
• Cancer: a type of condition in which malignant cells grow at an uncontrolled rate
• Cirrhosis: scarring of the liver

Risk Factors for Xanthoma

In addition to the medical conditions described above, there are other risk factors that may increase your chances of developing xanthoma including:

·         High cholesterol or triglyceride levels can increase your risk of xanthoma, as can being an older adult.

Does T2D affect lipid Composition and Arterial Stiffness in Male Youth?

Do you need to understand your cholesterol level?

Probably for early primary prevention from cardiovascular diseases especially those with T2D.

Recent studies suggest HDL (which is good cholesterol) exists as numerous subpopulations with distinct protein/lipid compositions that are not reflected in the HDL cholesterol range (HDL-C).

In this study, we sought to evaluate HDL subpopulations in adolescents with type 2 diabetes (T2D) to determine if changes in HDL composition are associated with early vascular disease. 

Dyslipidemia management, What's new ?

A novel dual-effect, small-molecule therapy that plays 2 crucial roles in the central control pathways for lipids and carbohydrates.

The first involves inhibition of adenosine triphosphate citrate lyase, the enzyme crucial for the production of adenosine triphosphate citrate essential to the synthesis of both fatty acids and cholesterol.

The second effect attributable to this single, small molecule is the activation of adenosine monophosphate activated protein kinase (AMPK)—resident in the liver, striated muscle, and the brain—the protein that is at the heart of the directional control of energy substrates. It is effectively a sensor of the energy-depleted form of adenosine triphosphate (ATP) (i.e., AMP) and thus is able to redirect energy substrates at the time of need, such as during skeletal muscle activity. Its effect is concerted in several coordinated pathways, all of which increase the uptake and consumption of glucose and fatty acids and inhibit anabolic processes. These include increased beta-oxidation of fatty acids, gluconeogenesis, and increased numbers of mitochondria in the cell.^[3] There is evidence that AMPK also plays a role in the increased metabolic activity of mitochondria, at least in response to acute exercise, an activity that would contribute further to the consumption of fatty acids. In this setting, AMPK increases the activity of the peroxisome proliferator-activated receptor (PPAR)-gamma coactivator-1

(PGC)-alpha, a transcription factor with a recognized role in the regulation of genes involved in ketogenesis and gluconeogenesis. This activity suggests that possible synergy could exist with PPAR-gamma agonists. At the same time, the activation of AMPK decreases the synthesis of cholesterol and of fatty acids and, thus, of triglycerides. Also, the complement of the Glut-4 glucose transporter in striated red muscle fibers is increased by translocation, an effect associated with exercise.^[4,5] In addition, AMPK appears to increase the phosphorylation of glucose by hexokinase in muscle cells, favoring the flux into muscle.^[4]

This array of metabolic-regulatory activities would suggest multiple effects of this agent, 

clearly on cholesterol metabolism, but also on diabetes and hypertriglyceridemia. 

Source 

Does lipid composition is a marker for Arterial Stiffness in Male Youth with T2D?

Early changes in the lipid and protein compositions of specific HDL subspecies in adolescents with T2D that are related to early markers of arterial disease. These findings suggest that analyzing the composition of HDL, rather than HDL-C, may be useful in assessing cardiovascular risk in this population.

Source

Statin & Dementia

AMSTERDAM — Two new studies may have somewhat allayed concerns about cognitive dysfunction being a possible adverse effect of statins.
The first study of 58,000 patients showed a dose-related inverse relationship between statin use and new-onset nonvascular dementia. The second report, in 5221 patients with atrial fibrillation, found a lower incidence of dementia in patients taking statins compared with those not taking statins.
Source.

Breakthrough :FDA approves atorvastatin/ezetimibe combo tablet

The US Food and Drug Administration (FDA) has approved a new lipid-lowering combination tablet that includes atorvastatin, which went off patent in 2011, and ezetimibe
The combination, is approved for the treatment of elevated LDL-cholesterol levels in:

1- patients with primary or mixed hyperlipidemia as an adjunct to dietary changes,

2- as well as for reducing cholesterol levels in patients with homozygous familial hypercholesterolemia (FH) 

Source