I have a 76 y/o male patient with history of low HDL-C who had an myocardial infarction in 1997. He has done well following a program of dietary changes and exercise but has not quit smoking. He recently was evaluated for horrific nocturnal gastrocnemius leg cramps not associated with exercise beginning this last June of 2020. His evaluation revealed an abdominal aortic aneurysm (AAA) measuring 3.1 x 3.2 with markedly low ABIs. He has also developed systolic hypertension in the past year with normal renal function. His HDL-C is 42 now and has been above 40 for the past 16 years of follow-up. He has reported some improvement of walking distance and an improvement of nocturnal leg cramps since starting telmesartan and calcium channel blocker amlodipine this past August. Interestingly he also had ischemic neuropathy symptoms bilaterally in lower extremities and either he has learned to tolerate these symptoms better or they are improved. I have been able to find one paper regarding low HDL-C and its association with AAA as follows but am interested in learning more about this association and how low HDL-C predisposes to AAA and some of the involved mechanisms that low HDL-C might be playing. This patient is to monitor his AAA on a 6 month basis. Obviously, the decrease in HDL-C would interfer with reverse cholesterol transport and allow for increasing atherosclerotic changes over time but could there be other mechanisms that are in play?
risks are classic:
Male sex
Older age
Smoker
Thank you for any and all suggestions and recommendations and/or discussions re:
low HDL-C and AAA.
Diego Martínez-López, Lídia Cedó, Jari Metso et al: Impaired HDL (High-Density Lipoprotein)-Mediated Macrophage Cholesterol Efflux in Patients With Abdominal Aortic Aneurysm—Brief Report. Arteriosclerosis, Thrombosis, and Vascular Biology. 2018;38:2750–2754. Article Impaired HDL (High-Density Lipoprotein)-Mediated Macrophage ...
Sincerely with gratitude,
Melvin R Hayden
University of Missouri School of Medicine
Columbia, Missouri
I forgot to add the original case report of this patient.
Here it is
Hayden MR, Tyagi SC.
Isolated low high density lipoprotein-cholesterol (HDL-C): implications of global risk reduction. Case report and systematic scientific review. Cardiovasc Diabetol. 2005; 4: 1.. doi: 10.1186/1475-2840-4-1
Dear Melvin R Hayden
AAA is a very important subject to be studied and related to the levels of
HDL, because it is known that low HDL levels predispose to AAA. However, I see few news published on the topic.
Helison Carvalho,
Thank you for your kind and thoughtful answer.
If you should run across any paper please share with me.
Melvin R Hayden
Please read the paper:
One-Carbon Metabolism and Alzheimer’s Disease: Focus on Epigenetics as it may also relate to T2DM as in the db/db model of obesity and T2DM. Also, read
Mitochondrial dysfunction remodels one-carbon metabolism in human cells
The aberrant Mt found in db/db brain may apply to impaired FOCM since the
folate and methionine cycles are present within the compartmental segregation of these cycles that function in parallel with the cytosolic cycels to submit information and SAM to the nucleus along with FORMATE.
melvin Hayden