Pre-Beta Lipoproteinemia : Its Bearing on the Dietary Management of Serum Lipid Disorders as Related to Ischemic Heart Disease

Abstract

Serum triglyceride and cholesterol levels were determined in 672 men aged 50-65, 83 of whom had ischemic heart disease. Simultaneously obtained samples of plasma were subjected to paper electrophoresis in albumin-containing buffer and stained for lipoproteins. The presence of a pre-beta band indicative of endogenous triglyceride and lipid staining material at the origin, indicative of dietary triglyceride, was observed. These procedures were also carried out in 50 students aged 20-25 and in 40 patients referred in consultation for gross serum-lipid elevations. With the exception of one patient in the last group, who had true fat-induced lipemia, all subjects with elevated triglyceride levels (greater than 5.2 mEq/liter) exhibited a pre-beta band, demonstrating that the commonly encountered triglyceride elevation in middle age is endogenous in origin. A pre-beta band was present in 30% of young men, but was of faint intensity. In middle-aged men, 84% with ischemic heart disease and 76% without it exhibited a pre-beta band of varying intensity. A positive correlation was observed between the intensity of staining of the pre-beta band and the serum triglyceride and cholesterol level. Reduction of serum triglyceride levels in subjects with gross hyperglyceridemia by caloric restriction or carbohydrate restriction or with the use of Atromid S alone was associated with a parallel reduction in intensity of the pre-beta band and associated reduction in cholesterol and triglyceride. The occurrence of this type of lipoprotein disorder of less severe degree in a relatively large percentage of the general population suggests that similar therapy may be effective in this group. It is believed that a serum cholesterol determination alone in subjects with elevated cholesterol levels is inadequate when dietary management is contemplated. For rational therapy, this determination should be supplemented with a triglyceride determination or paper electrophoresis of plasma lipoproteins, or both.