The Importance of Maintaining Regular Dietary Patterns to reduce CVD risk

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The Importance of Maintaining Regular Dietary Patterns to reduce CVD risk

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. An estimated 17.9 million people died from some form of CVD in 2019, accounting for 32% of all-cause mortality that year1. Associations between diet and risk of cardiovascular complications have long been established, largely relating to alterations in lipid profiles.

For as long as anyone can remember, breakfast has been considered the most important meal of the day. Previous studies2 have shown an association between skipping breakfast and increased CVD risk prompting recommendations that up to 30% of one’s daily energy intake should be consumed during the first meal of the day. It has been reported that over 25% of adults skip breakfast. These individuals are often socioeconomically disadvantaged, shift workers, individuals who work particularly long hours, those who suffer from depression or those with poor health literacy2. Another study3 showed that skipping breakfast, when compared with consuming a high-energy breakfast, was associated with a 1.6x and 2.6x higher probability of non-coronary and general atherosclerosis respectively, when all other CVD risk factor had been controlled. This suggests a close relationship between eating breakfast and reducing CVD risk, however, the mechanisms and magnitude of this relationship are poorly understood.

Small, dense low-density lipoprotein cholesterol (sdLDL-C) is a smaller form of LDL-C which boasts greater propensity for uptake by arterial tissue, increased proteoglycan binding, and increased susceptibility for oxidation4. sdLDL-C concentration is strongly associated with CVD risk, yet once again, the mechanisms of this association remain enigmatic. It is thought that all of the metabolic changes associated with alterations in sdLDL-C concentration collectively contribute to the increased risk of CVD, with the main drivers being its propensity for uptake by arterial tissues and its long circulatory stability4

Skipping breakfast and sdLDL-C

A recent study investigated the relationship between skipping breakfast and the effects on lipid parameters5. In a cohort of around 28’000 people from the Japanese population, this study looked at the several markers, including sdLDL-C, to develop an understanding of the importance of regular dietary patterns for reducing the risk of CVD.

The study participants were divided into two main categories: breakfast eaters and breakfast skippers. These categories were further subdivided to differentiate men and women, over and under 55 years old, and those who eat staple products (rice, pasta, bread, etc.) and those who did not. The participants contributed blood samples which were tested for several cardiovascular biomarkers: Creatinine, Liver ALT, Total Cholesterol, Triglycerides, direct LDL-C, HDL-C and sdLDL-C.

They found that around 26% of men and 16.9% of women skipped breakfast regularly. Of these, most were considered young and had significant increases in concentration of triglycerides, LDL-C and sdLDL-C compared with those who ate breakfast almost every day.

Table 1. Median concentration of triglycerides, LDL-C, and sdLDL-C for breakfast skippers and eaters5

Analyte Breakfast Skippers (mg/dL) Breakfast Eaters (mg/dL)
Triglycerides 103 93
LDL-C 124 122
sdLDL-C 34.7 32

This investigation also revealed that in this cohort, 20% of men and 27.3% of women did not regularly consume staple foods as part of their diet and had higher median sdLDL-C concentration.

Table 2. Median concentration of sdLDL-C in men and women who eat or skip staple food products in their diet5

Gender Staple Skippers (mg/dL) Staple Eaters (mg/dL)
Men 34.1 31.6
Women 25.8 24.7

The data from this study supports the finding that individuals who skipped breakfast had higher sdLDL-C concentrations than those who ate breakfast consistently. Skipping breakfast can therefore be associated with troublesome lipid parameters in both genders and all age groups in the Japanese population. This study suggests that eating breakfast every day is crucial to maintain beneficial lipid parameters and reduce the risk of developing CVD.

The data also show that individuals who skipped staple foods in their meals presented with higher concentrations of sdLDL-C and a higher sdLDL-C/LDL-C ratio, in men and postmenopausal women, when compared with those who included staple foods in their meals. It is becoming increasingly common to remove staple foods from one’s diet due to their high carbohydrate content and the prevalence of low-carbohydrate diets. This data exhibits the importance of maintaining a nutritionally balanced diet to help reduce the risk of developing CVD.

As the first large scale study of its kind, this analysis provides clear insight into the increased risk of CVD associated with not only skipping breakfast, but failing to maintain a nutritionally balanced diet. The major limitation of this analysis is that it only includes individuals from the Japanese population and the same affects may not be seen in populations from other ethnicities. Therefore, further in-depth analysis is required to confirm these findings in other ethnicities


Randox sdLDL-C Assay

The Randox sdLDL-C assay employs the clearance method which displays good correlation with the gold standard in sdLDL-C quantification, giving laboratories increased confidence in their results first time, every time. Supplied as liquid ready-to-use reagents, this this test can be applied to a wide range of clinical chemistry analysers, producing results in as little as 10 minutes. Relevant controls and calibrators are also available from Randox as part of the Acusera range.

Randox sdLDL-C Assay Key Features

  • Direct, automated test for convenience and efficiency.
  • Rapid analysis results can be produced in as little as ten minutes, facilitating faster patient diagnosis and treatment plan implementation.
  • Liquid ready-to-use reagents for convenience and ease of use.
  • Applications available detailing instrument specific settings for a wide range of clinical chemistry analysers.
  • sdLDL-C controls and calibrator available.


  1. World Health Organization. Cardiovascular Diseases. World Health Organization. Published June 11, 2021.
  2. Ofori-Asenso R, Owen AJ, Liew D. Skipping Breakfast and the Risk of Cardiovascular Disease and Death: A Systematic Review of Prospective Cohort Studies in Primary Prevention Settings. Journal of Cardiovascular Development and Disease. 2019;6(3):30. doi:
  3. Uzhova I, Fuster V, Fernández-Ortiz A, et al. The Importance of Breakfast in Atherosclerosis Disease. Journal of the American College of Cardiology. 2017;70(15):1833-1842. doi:
  4. Rizvi AA, Stoian AP, Janez A, Rizzo M. Lipoproteins and cardiovascular disease: An update on the clinical significance of atherogenic small, dense LDL and new therapeutical options. Biomedicines. 2021;9:1579. doi:
  5. Arimoto M, Yamamoto Y, Imaoka W, et al. Small dense low-density lipoprotein cholesterol levels in breakfast skippers and staple food skippers. Journal of Atherosclerosis and Thrombosis. 2023;30. doi:

For more information on our sdLDL-C assay or any of our other products, please contact us at:




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What you need to know this National Cholesterol Month

October 2018 marks National Cholesterol Month, an entire month devoted to raising funds for the charity HEART UK, and raising awareness of the dangers of high cholesterol.

But how much do we actually know about cholesterol? Do we even know what it is?

Many people are confused about how cholesterol differs from fat, which is understandable, given that cholesterol is found in foods that are sometimes high in fat.

But cholesterol is actually a type of lipid, as is fat. Like fat, cholesterol is essential for a range of bodily functions, but unlike fat, cholesterol can’t be exercised off, sweated out or burned for energy.

The body does require a small amount of blood cholesterol to build the structure of cell membranes, and make hormones like oestrogen, testosterone and adrenal hormones.

It also helps your metabolism work efficiently. For example, cholesterol is essential for your body to produce vitamin D and bile acids to help you digest your food. It is carried in the blood by proteins, with which it combines to make lipoproteins.

The 2 main types of lipoprotein are:

  • High-density lipoprotein (HDL) which carries cholesterol away from the cells and back to the liver, where it’s either broken down or passed out of the body as a waste product. For this reason, HDL is referred to as “good cholesterol”, and higher levels are better.
  • Low-density lipoprotein (LDL) which carries cholesterol to the cells that need it. If there’s too much cholesterol for the cells to use, it can build up in the artery walls. For this reason, LDL is known as “bad cholesterol.”

This cholesterol in the body comes from two main sources: the liver and diet. The liver, other organs and other cells in your body product about 75-80% of the cholesterol in the blood, while our diet contributes to about 20-25% of our cholesterol levels.

Foods high in saturated fat which can ultimately increase cholesterol levels include butter, hard margarines, fatty meat and meat products such as sausages, full fat chees, milk, cream and yoghurt.

Eating these foods in excess can therefore lead to a high level of cholesterol in the blood, called hyperlipidaemia.

High cholesterol itself doesn’t cause any symptoms, but it does increase your risk of serious health conditions including cardiovascular disease, heart attack and stroke because it builds up in the artery walls, restricting the blood flow to your heart, brain, and the rest of the body.

Given its vital role in the body, the serious conditions it can cause should it get too high, and the fact that if high, it does not produce any symptoms, it is extremely important to regularly monitor your cholesterol through blood testing.

Randox offers a range of cholesterol tests to ensure that individuals with high cholesterol get the earliest and most accurate diagnosis. In fact, Randox is responsible for more than 15% of all cholesterol tests carried out across the globe. Randox are tackling the need for better cholesterol testing with our wide range of niche and high-performance assays including sdLDL Cholesterol, Lipoprotein (a) and HDL3 Cholesterol.

For more information about National Cholesterol Month, or cholesterol testing at Randox, please contact the Randox PR team by emailing or phone 028 9442 2413





Biotin Supplementation Interference in Health Diagnostic Testing

Continuing our theme of Biotin (Vitamin B7) this month, we turn our attention to its role in diagnostic testing.

With as many as 20% of people taking biotin-containing supplements, including high profile celebrities such as Kylie Jenner, Kim Kardashian and Vanessa Hudgens, it is important to know the effects it can have on particular blood tests, should you visit your GP or local hospital.

Whilst there are various diagnostic health tests out there, including fertility hormone tests, prostate tests, and tests for troponin – a marker released into the blood during a heart attack – that are known to be affected by elevated levels of biotin, there are other tests available, including those provided by Randox, that are not impacted.

The reason that so many non-Randox tests are impacted by biotin is that biotin is widely used throughout the biotechnology industry in the development of diagnostic tests.

ELISA tests in particular (tests that measure the reaction of antibodies to identify a substance) often make use of antibodies labelled with biotin, to detect toxins or other foreign substances within the body.

In most instances, the biotin will bind with high affinity to a protein called streptavidin. This affinity of streptavidin for biotin is the strongest non-covalent biological interaction known, and is therefore particularly useful in binding antibodies within diagnostic tests.

But with more and more people exceeding the recommended daily dosage for biotin (30 micrograms) by taking up to 10,000 micrograms of biotin in supplements marketed for beauty reasons, many diagnostic tests are being measured inaccurately. Excess biotin in the blood can block the binding of biotin-labelled antibodies to streptavidin within the tests, and the substance being tested won’t be measured accurately.

Laboratory professionals have known about this potential problem for some time. In late November 2017, the FDA (Food and Drug Administration) published a safety notice to make the public and healthcare practitioners more aware that biotin can “significantly interfere with certain lab tests and cause incorrect test results.”

The FDA even reported on one particular case in which a patient died following falsely low troponin (marker of a heart attack) results when the troponin test used was known to have biotin interference. Biotin supplements masked the true diagnosis of a heart attack.

Many patients taking biotin supplements have also been misdiagnosed with a condition called Graves’ disease, an autoimmune condition characterised by an overactive thyroid. In these cases, biotin supplementation led to falsely low levels of thyroid stimulating hormones, and falsely high levels of other thyroid hormones. This particular profile of hormones led to a Graves’ disease diagnosis, in spite of a lack of symptoms, which in Graves’ disease would usually include muscle weakness, a quickened heartbeat, sleeping problems, diarrhoea, weight loss and poor tolerance of heat.

In pregnant women, tests that are impacted by biotin interference may produce falsely low levels of beta HCG, more commonly known as the ‘pregnancy hormone’ as it released by the placenta after conception. With low levels of beta HCG, and therefore no confirmation of pregnancy, pregnant women could be exposed to X-rays and CT scans that may harm the developing foetus.

So, what can be done? Suggestions have been made that patients taking biotin supplements should be made to wait before any diagnostic testing is conducted, so that the biotin clears from their system.

But this “Wait and Watch” approach certainly would not work in emergencies. In the case of a heart attack, testing must be conducted as soon as possible to allow for diagnosis, immediate medical intervention and follow-up testing.

At Randox, we are convinced that the risk of analytic interference by biotin supplementation is a serious problem that needs to be more widely recognised and promptly addressed.

In the GP setting, general practitioners must ask their patients if they are taking any biotin supplements and inform the testing laboratory if interference from biotin is a possibility. They should also consider that lab results not matching with a patient’s signs and symptoms may be caused by biotin interference.

In the acute care setting however, it is imperative that biotin technology is not used in diagnostic testing to protect patients from misdiagnosis and subsequently, further health problems.

This is why Randox’s patented Biochip Array Technology does not use biotin technology in its development. This revolutionary methodology, free from Biotin-Streptavidin is not impacted by elevated levels of biotin from biotin supplementation in the same way as Biotin-Streptavidin tests.

So if you have been taking biotin supplements for hair or nail growth, to ease symptoms associated with Multiple Sclerosis, for epilepsy or for a range of other health conditions, and your diagnostic testing has been conducted using Randox Biochip Array Technology, you can rest assured of true, accurate, and reliable results.

Randox Biochip Array Technology is interference-proof.

For further information on the Randox Biochip, visit

For any additional questions, please contact Randox PR by email: or by phoning 028 9442 2413






Health Theme August 2018: The role of Biotin / Vitamin B7

How much do you know about Biotin? Taken by a wealth of celebrities including Kylie Jenner, Kim Kardashian and Vanessa Hudgens for its hair and nail-strengthening properties, this vitamin has grown in popularity in recent years.

Commonly known as Vitamin B7, Biotin is a water-soluble vitamin found in bodily enzymes which metabolise fat and carbohydrates.

It therefore plays an important role in cell growth and in maintaining a steady blood sugar level, and also assists in various reactions, including the movement of carbon dioxide around the body. It is often recommended as a dietary supplement for strengthening hair and nails, and as such is often found in many cosmetics and health products for the hair and skin.

Due to its key role within the body, the National Academy of Medicine (formerly the Institute of Medicine) recommends a dose of 30 micrograms of biotin each day, from a range of food sources including beef or pork, egg, yeast, whole wheat bread, avocado, salmon, cauliflower or cheese. Raw egg whites however contain a particular protein that blocks the absorption of biotin, so people who regularly consume a large number of eggs may become biotin-deficient.

Those suffering from biotin deficiency disorders therefore are often prescribed biotin supplements – up to as much as 300 milligrams per day for Multiple Sclerosis patients, for whom the B group vitamins are vital in managing symptoms. Biotin in particular is very useful in cases of progress MS because it supports nerve cell metabolism.

There are also some inherited metabolic disorders which, due to a deficiency in the enzymes which process biotin, prevent the body’s cells from using it effectively.

Usually, however, biotin deficiency occurs simply from an absence of the vitamin in the diet, particularly in breastfeeding mothers. Symptoms of deficiency include:

  • Conjunctivitis
  • Dermatitis in the form of a scaly red rash
  • Neurological symptoms in adults including depression, lethargy, hallucination, numbness and tingling of the extremities
  • Brittle and thin fingernails
  • Hair loss (alopecia)

Supplements may also be recommended to those suffering from alcoholism, patients who have had partial removal of their stomach, burn patients, epileptics, elderly individuals, athletes, and pregnant women, who have a higher risk of biotin deficiency. It is estimated that as many as 20% of people consume Biotin-containing supplements.

While biotin supplements may help pregnant women and some people with other health disorders, it is of course incredibly important to eat a balanced and healthy diet that includes all the vitamins and minerals necessary for normal body function.

Take time to consider how you can incorporate appropriate and safe amounts of biotin into your daily diet.

For further information, please contact Randox PR by email: or by phoning 028 9442 2413






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