Abnormal Lipids - Causes and Effects
Hypertriglyceridaemia: Therapeutic Targets, Genetic Causes, and Associated Neuropathy
Manchester University NHS Foundation Trust
1,396 participants
Jan 23, 2014
OBSERVATIONAL
Conditions
Summary
1. At target LDL-C levels, apoB100 concentrations will be higher than recommended levels in the following populations: 1. Tertiary centre lipid clinic patients with raised TG treated with statins. 2. Patients with type 2 diabetes treated with statins. 3. Patients with Chronic Kidney disease (CKD) stages 4 and 5 treated with statins. 2. Despite achieving LDL-C and non-HDL-C targets, a significant number of statin-treated patients have residual cardiovascular risk related to raised hsCRP. The relationship between hsCRP and Lp-PLA2 (markers of inflammation) and LDL particle number measured by apoB100 is stronger than that of measured and calculated LDL and non-HDL. In statin treated patients there will be higher levels of hs-CRP and Lp-PLA2 in patients achieving LDL targets but not apo B targets. 3. We hypothesise that non-diabetic patients with severe hypertriglyceridaemia (fasting serum triglyceride \>5.5 mmol/l) have evidence of greater nerve damage compared with matched controls. 4. LAL deficiency is underdiagnosed in patients with severe hypertriglyceridaemia, low HDL-C, hyperlipidaemias, non alcoholic fatty liver disease and idiopathic high liver enzymes.
Eligibility
Inclusion Criteria9
- Therapeutic target arm
- Statin treated patients with and without hypertriglyceridemia.
- Statin treated patients with type 2 diabetes.
- Statin treated patients with CKD stages 4 and 5.
- Nerve function arm
- Patients known to have severe hypertriglyceridaemia (defined as triglyceride >5.5 mmol/l) but not known to have diabetes and matched controls.
- Genetic screening arm
- Patients with a documented triglyceride level of more than 10 mmol/l at any time.
- Criteria for screening for FH and LAL deficiency include non-obese patients (BMI <30) with low HDL-C (<1.0 mmol/l male and <1.3 mmol female), high triglycerides >1.7 mmol/l, high total cholesterol >6.2 or LDL cholesterol >4.7 mmol/l; patients with raised liver alanine aminotransferase (ALT) (1.5 x above ULN) but no metabolic or viral disease or alcohol excess and patients diagnosed with NAFLD with or without hyperlipidaemia.
Exclusion Criteria5
- Pregnant and/or breast-feeding women.
- Significant liver impairment.
- Patients known to have active malignant disease.
- Patients treated with medications that could affect lipoprotein metabolism significantly (like atypical antipsychotics, chemotherapy).
- Untreated hypothyroid and hyperthyroidism (if treated and TFT normal could be recruited).
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Locations(1)
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NCT02195050