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Treatment of Type 2 Diabetes and Dyslipidemia with the Natural Plant Alkaloid Berberine
Abstract
Context: Berberine, a natural plant alkaloid, is usually used as an antibiotic drug. The potential glucose-lowering effect of berberine was noted when it was used for diarrhea in diabetic patients. In vitro and in vivo studies have then showed its effects on hyperglycemia and dyslipidemia. Objective: The objective of the study was to evaluate the efficacy and safety of berberine in the treatment of type 2 diabetic patients with dyslipidemia. Design: One hundred sixteen patients with type 2 diabetes and dyslipidemia were randomly allocated to receive berberine (1.0 g daily) and the placebo for 3 months. The primary outcomes were changes in plasma glucose and serum lipid concentrations. Glucose disposal rate (GDR) was measured using a hyperinsulinemic euglycemic clamp to assess insulin sensitivity. Results: In the berberine group, fasting and postload plasma glucose decreased from 7.0 ± 0.8 to 5.6 ± 0.9 and from 12.0 ± 2.7 to 8.9 ± 2.8 mm/liter, HbA1c from 7.5 ± 1.0% to 6.6 ± 0.7%, triglyceride from 2.51 ± 2.04 to 1.61 ± 1.10 mm/liter, total cholesterol from 5.31 ± 0.98 to 4.35 ± 0.96 mm/liter, and low-density lipoprotein-cholesterol from 3.23 ± 0.81 to 2.55 ± 0.77 mm/liter, with all parameters differing from placebo significantly (P < 0.0001, P < 0.0001, P < 0.0001, P = 0.001, P < 0.0001, and P <0.0001, respectively). The glucose disposal rate was increased after berberine treatment (P = 0.037), although no significant change was found between berberine and placebo groups (P = 0.063). Mild to moderate constipation was observed in five participants in the berberine group. Conclusions: Berberine is effective and safe in the treatment of type 2 diabetes and dyslipidemia.
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“Two cases of liver function abnormalities were reported in one study in the berberine group,(29) although two studies reported no increase or a decrease in liver transaminases with berberine.(32, 34)”
From Overall and sex-specific effect of berberine for dyslipidemia: systematic review and meta-analysis of placebo-controlled trials (2022) · cites this paper as [32]
In the citing paper
“Further analysis suggested that this was likely due to most participants in this subgroup having normal blood glucose levels, as berberine does not significantly affect normal values for these indicators (Zhang et al., 2008; An et al., 2014; Wang et al., 2016b).”
From Efficacy and safety of berberine on the components of metabolic syndrome: a systematic review and meta-analysis of randomized placebo-controlled trials (2025) · cites this paper as Zhang et al., 2008
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“It reduces the levels of blood glucose and glycated hemoglobin, improves the lipid profile in the serum, reduces body mass, and enhances insulin sensitivity [20,21].”
BackgroundRoy, D., Kaur, P., Ghosh, M., Choudhary, D., & Rangra, N. K. (2024) · Phytotherapy Research · doi:10.1002/ptr.8238 · Cited by 31
“While berberine is generally considered safe, high doses can cause gastrointestinal side effects and can interact with certain medications (Zhang et al., 2008).”
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Atheroprotective Effects and Molecular Mechanism of Berberine
Lü, X., Zhou, X., Li, A., Li, H.-J., He, C., Qin, W. D., Zhao, D., Li, P.-Q., Zhu, L., & Cao, H. (2021) · Frontiers in Molecular Biosciences · doi:10.3389/fmolb.2021.762673 · Cited by 23
A co-crystal berberine-ibuprofen improves obesity by inhibiting the protein kinases TBK1 and IKKɛ
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Self-citationClinically Effective Molecules of Natural Origin for Obesity Prevention or Treatment
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“Although some clinical studies carried out with berberine have reported adverse effects such as constipation, diarrhea, nausea, or abdominal discomfort [134–136], to date, no serious adverse effects have been reported.”
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Berberine improves intralipid-induced insulin resistance in murine
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“months of BBR treatment reduces fasting blood glucose and was accompanied by improved insulin sensitivity and decreased body weight [25].”
BackgroundRoles of Therapeutic Bioactive Compounds in Hepatocellular Carcinoma
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“While investigations are undertaken via the large quantity of information on preclinical e ffi cacy, clinical studies are limited in the evaluation of berberines and andrographolide genuine potential as a carcinoma operator [179].”
BackgroundBerberine exposure triggers developmental effects on planarian regeneration
Balestrini, L., Isolani, M. E., Pietra, D., Borghini, A., Bianucci, A. M., Deri, P., & Batistoni, R. (2014) · Scientific Reports · doi:10.1038/srep04914 · Cited by 22
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Derosa, G., D’Angelo, A., & Maffioli, P. (2022) · Phytotherapy Research · doi:10.1002/ptr.7564 · Cited by 24
Berberine ameliorates nonalcoholic fatty liver disease-induced bone loss by inhibiting ferroptosis
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Jiao Tai Wan Attenuates Hepatic Lipid Accumulation in Type 2 Diabetes Mellitus
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“Among the main constituents in JTW extract, berberine, cinnamaldehyde, and cinnamic acid have also been demonstrated to exhibit beneficial effects in attenuating disturbances of glucose and lipid metabolism [17, 25, 26].”
BackgroundBerberine as a Bioactive Alkaloid: Multi-Omics Perspectives on Its Role in Obesity Management
Zieniuk, B., & Pawełkowicz, M. E. (2025) · Metabolites · doi:10.3390/metabo15070467 · Cited by 24
“Clinical trials echo these pre-clinical findings: treating patients with type 2 diabetes and mixed dyslipidemia with 1 g per day BBR for three months cut total cholesterol by about 18% and LDL-C by 21% [51].”
A comprehensive review of recent advances in the extraction and therapeutic potential of berberine
Huang, S., & Huang, G. (2025) · RSC Advances · doi:10.1039/d5ra02170g · Cited by 20
“23 The Nrf2 pathway is also involved in berberine inhibiting oxidative stress and improving the condition of diabetes.”
Lang, S., Popp, T., Kriegs, C. S., Schmidt, A., Balszuweit, F., Menacher, G., Kehe, K., Thiermann, H., Gudermann, T. W., & Steinritz, D. (2017) · Toxicology Letters · doi:10.1016/j.toxlet.2017.09.004 · Cited by 20
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“Zhang and collaborators (NCT00462046) tested berberine as a potential treatment for patients with newly diagnosed Type 2 diabetes and dyslipidemia (Y. Zhang et al., 2008).”
BackgroundNanomedicine-based potential phyto-drug delivery systems for diabetes
Bahloul, B., Henríquez, L. C., Jenhani, L., Aroua, N., Ftouh, M., Kalboussi, N., Vega‐Baudrit, J. R., & Mignet, N. (2023) · Journal of Drug Delivery Science and Technology · doi:10.1016/j.jddst.2023.104377 · Cited by 19
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Berberine inhibits glucose oxidation and insulin secretion in rat islets
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“It has been shown that berberine is a potent hypoglycemic agent with beneficial metabolic effects on peripheral tissues [6, 7], which is attributed to the activation of AMP-activated protein kinase (AMPK) [8, 9].”
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“The berberine sample size was estimated with reference to the STOP-NIDDM study [4] and Yifei Zhang’s study [11] on the use of berberine to treat type 2 diabetes with hyperlipidemia.”
MethodTian, X., Liu, F., Li, Z., Lin, Y., Liu, H., Hu, P., Chen, M., Sun, Z., Zhou, X., Zhang, Y., et al. (2019) · Frontiers in Pharmacology · doi:10.3389/fphar.2019.00019 · Cited by 19
Self-citationCheng, Z., Zhang, Y., & Liu, F. (2009) · Regulatory Peptides · doi:10.1016/j.regpep.2008.12.008 · Cited by 19
“Recent studies show that Berberine and its derivatives have a potential therapeutic effect on diabetes [12,13], hyperlipoidemia [14], and CNS disorders [15,16].”
Self-citationBandala, C., Carro-Rodríguez, J., Cárdenas-Rodríguez, N., Peña-Montero, I., Gómez-López, M., Hernández-Roldán, A. P., Huerta-Cruz, J. C., Muñoz-González, F., Ignacio-Mejía, I., Domínguez, B., et al. (2024) · Nutrients · doi:10.3390/nu16142284 · Cited by 18
“Another study reported that glycosylated hemoglobin decreased after BBR treatment (0.5 g b.i.d.), and there were significant improvements in blood glucose and lipid levels [88].”
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“Zhang et al. reported that a daily intake of 1 g of BBR resulted in a 20 % reduction in blood glucose, a 12 % decrease in HbA1c, and an improvement in lipid profiles among 116 diabetic subjects [52].”
Yang, Y., Ni, W., Cai, M., Tang, L., & Wei, W. (2014) · Journal of Receptors and Signal Transduction · doi:10.3109/10799893.2014.917324 · Cited by 18
“In addition, BBR has been shown to reduce serum TC, TG, LDL-c and VLDL-c in animals fed a high-fat diet (16).”
BackgroundBerberine: Is it a Promising Agent for Mental Disorders Treatment?
Shayganfard, M. (2022) · Current Molecular Pharmacology · doi:10.2174/1874467215666220509213122 · Cited by 18
Woodfield, A., Gonzales, T., Helmerhorst, E., Laws, S. M., Newsholme, P., Porter, T., & Verdile, G. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms232415811 · Cited by 19
“In type 2 diabetics with dyslipidaemia, the BBR treatment was associated with a decreased fasting plasma glucose, fasting plasma insulin and HOMA-IR in addition to improvements in triglyceride, cholesterol and low-density lipoprotein cholesterol levels compared to the placebo-treated participants [176].”
Feinberg, T., Wieland, L. S., Miller, L. E., Munir, K. M., Pollin, T. I., Shuldiner, A. R., Amoils, S., Gallagher, L., Bahr-Robertson, M. K., & D’Adamo, C. R. (2019) · Trials · doi:10.1186/s13063-018-3032-6 · Cited by 19
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The human gut microbiome – a new and exciting avenue in cardiovascular drug discovery
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Self-citationDiscovery of C-9 Modified Berberine Derivatives as Novel Lipid-Lowering Agents
Li, D., Yu, P., Xu, H. W., Wang, Z., Xiao, W., & Zhao, L.-G. (2020) · Chemical and Pharmaceutical Bulletin · doi:10.1248/cpb.c20-00453 · Cited by 18
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Wang, M., Yang, Q., Li, Y., Zhao, Y., Zou, J., Luan, F., Peng, X., Huang, Z., & Liu, F. (2025) · Chinese Medicine · doi:10.1186/s13020-025-01222-x · Cited by 17
“A randomized trial showed BBR, though effective for lowering blood sugar, increases hypoglycaemia risk when combined with oral hypoglycaemics [261].”
Self-citationBerberine and Adiposity in Diabetes-Free Individuals With Obesity and MASLD
Lei, L., Wang, B., Zhao, L., Li, J., Yan, X., Jiang, J., Wang, L., Ren, G., Li, Y., Cheng, X., et al. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.54152 · Cited by 19
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“Its pharmacological and biochemical mechanisms of action have been established [6,7].”
BackgroundYang, X., Ding, W., Chen, Z., Lai, K., & Liu, Y. (2024) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3762 · Cited by 18
“142,143 These metabolic improvements attributed to berberine are, at least in part, the result of its promotion of autophagy.”
BackgroundJin, Z., Gao, P., Liu, Z., Jin, B., Song, G.-Y., & Xiang, T. (2018) · Chinese Journal of Integrative Medicine · doi:10.1007/s11655-018-3014-2 · Cited by 17
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Inhibition of PPARγ by Natural Compounds as a Promising Strategy in Obesity and Diabetes
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“Berberine has shown antihyperlipidemic and antihyperglycemic effects, increased insulin secretion and sensitivity, suggesting a potential application in the prevention or treatment of diabetes [52, 53]; anti-inflammatory and antitumor effects were also described [54, 55].”
BackgroundAryaeian, N., Sedehi, S. K., Khorshidi, M., Zarezadeh, M., Hosseini, A. F., & Shahram, F. (2020) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2020.102331 · Cited by 17
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“…traditional Chinese medications like berberine, cordycepin and more, research studies are needed to target lipid metabolism and fibrotic pathways, such as berberine, cordycepin, and breviscap-ine, but they need more research studies (Zhang et al. 2008; Chang et al. 2016a, b; Lan et al. 2021, 2022).”
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“Recent studies revealed that BBR has various pharmacological activities such as antimicrobial [7], antidiabetic [8], antihyperlipidemic action [9], antitumor [10], antiinflammatory [11], and antiparasitic [12].”
BackgroundThe Efficacy and Safety of Chinese Herbal Decoction in Type 2 Diabetes: A 5‐Year Retrospective Study
Tian, J., Lian, F., Yu, X., Cui, Y., Zhao, T., Cao, Y., & Tong, X. (2016) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2016/5473015 · Cited by 16
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Factors Affecting Insulin-Regulated Hepatic Gene Expression
Guan, H.-P., & Chen, G. (2014) · Progress in molecular biology and translational science · doi:10.1016/b978-0-12-800101-1.00006-5 · Cited by 15
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“plant contains berberine [3], which demonstrates anti– neoplastic activities and is used for the treatment of type 2 diabetes [4, 5].”
BackgroundLiu, L., Cheung, S. C. K., Lan, L., Ho, S. K. S., Chan, J. C. N., & Tong, P. C. Y. (2010) · Cellular Signalling · doi:10.1016/j.cellsig.2010.05.020 · Cited by 14
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“In clinical conditions, high dose (up to 1.5 g/day) is needed that may lead to adverse gastrointestinal effects (Zhang et al., 2008).”
BackgroundInfluentialVahedi‐Mazdabadi, Y., Shahinfar, H., Toushih, M., & Shidfar, F. (2023) · Phytotherapy Research · doi:10.1002/ptr.7998 · Cited by 14
“Insufficient information caused an unclear risk of bias in four studies in the “ other bias ” domain (Dong et al., 2017; Li et al., 2022a; Sun, 2017; Y. Zhang et al., 2008).”
BackgroundMethodInfluentialChen, C., Lin, Q., Zhu, X., Xia, J., Mao, T., Chi, T., Wan, J., Lu, J., Li, Y., Cui, J., et al. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.646306 · Cited by 14
Berberine and lycopene as alternative or add-on therapy to metformin and statins, a review
Hedayati, N., Oskouei, Z., Tabeshpour, J., & Naeini, M. B. (2021) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2021.174590 · Cited by 14
Irudayaraj, S. S., Jacob, J., Sunil, C., Duraipandiyan, V., Savarimuthu Ignacimuthu, S. J., Govindasamy, C., & Packiam, S. M. (2021) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2021.114883 · Cited by 14
Nanophytomedicine Based Novel Therapeutic Strategies in Liver Cancer
Kumar, S., Fayaz, F., Pottoo, F. H., Bajaj, S., Manchanda, S., & Bansal, H. (2019) · Current Topics in Medicinal Chemistry · doi:10.2174/1568026619666191114113048 · Cited by 14
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“…berberine reduced TG levels in 7 arms (Di Bisceglie et al., 2020; Gu et al., 2010; Meng et al., 2012; Perez-Rubio et al., 2013; Wei et al., 2012; Zhang et al., 2008), TC levels in 6 arms (Di Bisceglie et al., 2020; Gu et al., 2010; Meng et al., 2012; Wei et al., 2012; Zhang et al., 2008; Zhao…”
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Thermogenic Fat as a New Obesity Management Tool: From Pharmaceutical Reagents to Cell Therapies
Cheng, Y., Liang, S., Zhang, S., & Hui, X. H. (2024) · Biomedicines · doi:10.3390/biomedicines12071474 · Cited by 13
“Consistent with these processes, berberine also induced a thermogenic program in BAT and WAT via AMPK/PGC-1 α [103].”
BackgroundNutraceuticals and Supplements in Management of Prediabetes and Diabetes
Derosa, G., D’Angelo, A., Angelini, F., Belli, L., Cicero, A. F. G., ROS, R. D., Pergola, G. D., Gaudio, G. V., Lupi, A., Sartore, G., et al. (2024) · Nutrients · doi:10.3390/nu17010014 · Cited by 17
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“BBR has strong pharmacological effect on various metabolic and chronic inflammation diseases, including diabetes mellitus [11], dyslipidemias [12], and microbial infections [13 – 15].”
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“Furthermore, BBR has recently been demonstrated to significantly reduce fasting and postprandial blood sugar in patients [42].”
BackgroundInfluentialLi, Y., & Zhu, C. (2020) · Molecules · doi:10.3390/molecules25081957 · Cited by 13
“The conventional dosage forms of BER for oral administration cannot reach the therapeutic concentration with only a few administration times; it usually takes several months to take therapeutic effect [14].”
BackgroundKasinathan, D., Elango, S., Manikandan, R., & Prabhu, N. M. (2015) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2015.04.003 · Cited by 13
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“…placebo-controlled, multicenter trial demonstrated that berberine monotherapy is effective and safe for treating newly diagnosed diabetes patients with dyslipidemia, resulting in significant reductions in blood glucose, blood lipids, body weight, and blood pressure within 3 months [180].”
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“Berberine Hydrochloride is an isoquinoline plant alkaloid originally gained from rhizoma Coptidiscoptidis, Hydrastis Canadensis, and berberis aquifolium with antibiotic, anticancer, anxiolytic, antiamnesic, analgesic, anti-inflammatory, and antipsychotic and antidepressant activities (Kulkarni & Dhir, 2010; Meeran, Ka…”
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“Therefore, conventional medicines are often used to mitigate the intensity of pain and inflammation [1].”
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“[29] described similar results when Type 2 diabetic patients and dyslipidemic patients were treated with berberine compared with placebo.”
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“It is known that plant alkaloids have medicinal values for the management of diseases such as diabetes and dyslipidemia [4-6].”
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“A clinical trial by Zhang et al. [101] demonstrated that berberine significantly reduced fasting and postload plasma glucose levels, as well as HbA1c levels in patients with T2DM, with the side effects being extremely mild.”
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“This opens up the possibility of using them as a biosynthetic platform for these commercially important alkaloids (Robbins et al. 2013; Rubio-Piña and Vázquez-Flota 2013; Zhang et al. 2008).”
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Metadata
- Authors
- Zhang, Y., Li, X., Zou, D., Liu, W., Yang, J., Zhu, N., Huo, L., Wang, M., Hong, J., Wu, P., Ren, G., & Ning, G.
- Affiliations
- Shanghai Jiao Tong University (CN)
- Second Military Medical University (CN)
- Department of Endocrinology (J.Y., G.R.), Min-Hang Hospital, Shanghai 201100, People’s Republic of China
- Corresponding author
- Ning, Guang
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-07-01
- Volume
- 93
- Issue
- 7
- Pages
- 2559-2565
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1969395627
- Cited by
- 573
- References
- 23
- Citations by year
- 2026: 30 · 2025: 27 · 2024: 28 · 2023: 33 · 2022: 41 · 2021: 54 · 2020: 46 · 2019: 42 · 2018: 33 · 2017: 23 · 2016: 29 · 2015: 32 · 2014: 34 · 2013: 31 · 2012: 25
- FWCI
- 14.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Berberine and alkaloids research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Natural Antidiabetic Agents Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Keywords
- berberine, type 2 diabetes, dyslipidemia, glucose-lowering effect, insulin sensitivity, glucose disposal rate, hyperinsulinemic-euglycemic clamp, HbA1c, serum lipids, triglycerides, LDL cholesterol, total cholesterol, plant alkaloids, constipation, drug safety, antidiabetic therapy, lipid-lowering therapy
- MeSH terms
- Adult, Aged, Berberine, Diabetes Mellitus, Type 2, Double-Blind Method, Female, Glycated Hemoglobin, Humans, Insulin, Insulin Resistance, Cholesterol, LDL, Male, Middle Aged, Triglycerides, Dyslipidemias
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