Normal Total Cholesterol Levels Research Articles

Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults

Recent recommendations from the American Heart Association aim to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet. To examine time trends in cardiovascular health metrics and to estimate joint associations and population-attributable fractions of these metrics in relation to all-cause and cardiovascular disease (CVD) mortality risk. Study of a nationally representative sample of 44,959 US adults (≥20 years), using data from the National Health and Nutrition Examination Survey (NHANES) 1988-1994, 1999-2004, and 2005-2010 and the NHANES III Linked Mortality File (through 2006). All-cause, CVD, and ischemic heart disease (IHD) mortality. Few participants met all 7 cardiovascular health metrics (2.0% [95% CI, 1.5%-2.5%] in 1988-1994, 1.2% [95% CI, 0.8%-1.9%] in 2005-2010). Among NHANES III participants, 2673 all-cause, 1085 CVD, and 576 IHD deaths occurred (median follow-up, 14.5 years). Among participants who met 1 or fewer cardiovascular health metrics, age- and sex-standardized absolute risks were 14.8 (95% CI, 13.2-16.5) deaths per 1000 person-years for all-cause mortality, 6.5 (95% CI, 5.5-7.6) for CVD mortality, and 3.7 (95% CI, 2.8-4.5) for IHD mortality. Among those who met 6 or more metrics, corresponding risks were 5.4 (95% CI, 3.6-7.3) for all-cause mortality, 1.5 (95% CI, 0.5-2.5) for CVD mortality, and 1.1 (95% CI, 0.7-2.0) for IHD mortality. Adjusted hazard ratios were 0.49 (95% CI, 0.33-0.74) for all-cause mortality, 0.24 (95% CI, 0.13-0.47) for CVD mortality, and 0.30 (95% CI, 0.13-0.68) for IHD mortality, comparing participants who met 6 or more vs 1 or fewer cardiovascular health metrics. Adjusted population-attributable fractions were 59% (95% CI, 33%-76%) for all-cause mortality, 64% (95% CI, 28%-84%) for CVD mortality, and 63% (95% CI, 5%-89%) for IHD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of total and CVD mortality, but the prevalence of meeting all 7 cardiovascular health metrics was low in the study population.

Blood-lipid levels of 20 041 kindergarten children aged 3 to 6 in Tianjin

To understand the level of blood-lipid and prevalence of dyslipidemia of children aged 3 to 6 in Tianjin, so as to provide evidence for large-scale blood screening strategy and to develop intervention of dyslipidemia and cardiovascular in children. 20,041 children aged 3 to 6 from 48 kindergartens were involved in this study, in Tianjin. Peripheral blood was collected from right leech-finger of these children, after fatless breakfast. Total cholesterol (TC) and triglyceride (TG) of plasma were tested using Toshiba 120 Automatic Biochemical Analyzer. The average levels of TC and TG were (4.17±0.69) mmol/L and (0.86±0.44) mmol/L in these children. 11.4% of the children had either TC or TG dyslipidemia, with 7.1% had only TC dyslipidemia, 4.9% had only TG dyslipidemia, and 0.6% of them had both TC and TG dyslipidemia. The prevalence of TC dyslipidemia was significantly higher among girls than boys. The prevalence rates of TC dyslipidemia and TG dyslipidemia were different among age groups, but with no significant changes among age groups. The prevalence of TG dyslipidemia was significantly different, with obese children higher than those with normal or overweight children. Different residential areas seemed to be related to the difference on the prevalence of dyslipidemia. Prevalence of TC dyslipidemia was higher in urban than in rural areas. Prevalence of TG dyslipidemia was higher in rural than urban areas. The prevalence of dyslipidemia for children aged 3 to 6 was high in Tianjin, and showed differences among genders, age groups and residential regions. Screening and intervention programs on dyslipidemia should be undertaken routinely in children, in order to prevent adult atherosclerosis and coronary heart disease.

Nivel de conocimiento sobre factores de riesgo cardiovascular en una comunidad de Naguanagua, Venezuela

Associating the level of awareness concerning cardiovascular risk factors related to changes in clinical, anthropometric and biochemical markers regarding cardiovascular risk in people living in Naguanagua, Venezuela. 205 patients aged 18 to 77 years were evaluated; weight, height, waist circumference, blood pressure, glucose and serum lipid profile were measured. A survey assessed the patients' level of awareness regarding cardiovascular risk factors. A high frequency of abdominal obesity (67 %), being overweight and obese (38 %) and suffering from hypertension (26 %) was observed. Nearly 60 % of respondents claimed to know about cardiovascular risk factors, but only 14.7 % of them recognized the eleven factors considered to define such level of knowledge. More than half of the participants showed a low level of awareness concerning cardiovascular risk factors; average levels of total cholesterol, cholesterol LDL and triglycerides were significantly lower in the group having a high level of knowledge concerning cardiovascular risk factors. Extremely low levels of awareness regarding cardiovascular risk factor prevalence and high frequency concerning changes in clinical, anthropometric and biochemical markers for cardiovascular risk were higher in the group having a high level of knowledge of cardiovascular risk factors, thereby confirming the need for implementing strategies for raising Venezuelan communities' level of knowledge regarding cardiovascular risk factors and also encouraging them to adopt a lifestyle associated with reduced cardiovascular risk factors and self-care.

COMPLICATED COURSE OF ISCHEMIC HEART DISEASE IN A PATIENT WITH OBSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea (OSA) can activate pathological routes which can lead to insulin resistance, development of atherosclerosis and hypertension. The combination of hypertension and OSA has an additive effect on the development of atherosclerosis. As a number of studies have revealed, that the incidence of OSA in patients with myocardial infarction is likely to be high. We present a patient with acute myocardial infarction and no classical coronary artery disease risk factors: non-smoker, normal blood pressure, normal total and low-density lipoprotein cholesterol levels, borderline high-density lipoprotein cholesterol level, with good physical activity, no diabetes mellitus, no abdominal obesity, a negative family history. The only risk factor was untreated obstructive sleep apnea. The course of disease was complicated by subsequent in-stent restenosis and progression of atherosclerotic plaques, which led to the need for acute coronary artery bypass graft surgery complicated by consecutive in-anastomosis stenosis despite maximum cardiovascular therapy. One year of continuous positive airway pressure treatment was needed to stabilize his health condition, which is now stable for up to two years. Given the complicated course of ischemic heart disease in patients with OSA, we believe that OSA diagnosis would be advisable each time these patients with symptoms of myocardial infarction, ischemic heart disease and OSA are examined. Even more important, however, is proper treatment of the OSA when it is present.

The levels of adiponectin and leptin and their relation to other markers of cardiovascular risk in patients with psoriasis

A link between psoriasis and risk for cardiovascular disease (CVD) is supposed. Adipokines (adiponectin and leptin) playing roles in inflammation as well as lipid metabolism could have impact on CVD. We investigated links between adiponectin and leptin levels and several inflammation- and oxidative stress-related CVD risk makers in patients with psoriasis. Sixty patients with plaque-type psoriasis with normal total cholesterol levels belonging to three body mass index (BMI) categories: BMI < 24.9, BMI 25.0-29.9 and BMI ≥ 30.0 kg/m(2) were studied. Fasting blood samples were analysed for adiponectin, leptin, high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), oxidized low density lipoprotein (oxLDL), oxidized LDL/β(2) -glycoprotein complexes (oxLDL-β(2)-GPI) and standard blood lipid panel. In patients, adiponectin was negatively (P < 0.005), and leptin, oxLDL and oxLDL-β(2) -GPI levels were positively correlated to BMI (P < 0.005, P < 0.05, and P < 0.01, respectively). Patients had higher hsCRP and IL-6 levels as compared with the endemic reference values. High adiponectin was strongly associated with higher TNF-α and high density lipoprotein cholesterol (P = 0.001), and lower triglycerides (TG) (P = 0.01) as well as oxLDL-β(2) -GPI levels (P < 0.05). After multivariate adjustment, the association for TNF-α and TG remained significant (P < 0.01 for both). Multiple regression analysis also revealed that leptin concentration was significantly associated with hsCRP, oxLDL and TG levels. The data suggest that in addition to the strong effect of inflammation and LDL oxidation, adipokine level may be one of the mechanisms behind the close association between psoriasis and CVD. Given the significant relations of several markers with BMI, health consequences of excessive weight should be better communicated to patients with psoriasis.

Hypercholesterolemia accelerates bone loss in postmenopausal women

Objectives To clarify the effect of lipid profiles on postmenopausal bone loss using a longitudinal method and to determine whether cytokines are involved in bone loss.Methods The subjects were Japanese residents participating in the Iwaki Health Promotion Projects. Women with one or more of the following factors were excluded: a history of surgical menopause, current or past users of bisphosphonates or current user of other drugs known to influence bone and lipid metabolism, and current medication for diabetes or hypertension. Consequently, 99 postmenopausal women (61.2 ± 7.7 years old) and 85 premenopausal women (41.2 ± 8.6 years old) were selected for this study. The osteo-sono-assessment index (OSI) of the left calcaneal bone was obtained twice at 1-year intervals and the annual percentage change in OSI was calculated. Serum total cholesterol, high and low density lipoprotein cholesterol, triglycerides, homocysteine and cytokines such as adipocytokines, interleukins and tumor necrosis factor-α were measured. Postmenopausal women were grouped into three groups according to their basal cholesterol level, and the relationship between basal cholesterol level and annual change in OSI was studied.Results The annual percentage change in OSI in postmenopausal women with a serum total cholesterol level ≥240 mg/dl was significantly higher compared to those with a normal total cholesterol level, suggesting that hypercholesterolemia accelerates postmenopausal bone loss. No significant differences were seen in any of the cytokines that presumably cause bone resorption.Conclusion These results showed that hypercholesterolemia has an inverse effect on bone loss independent of cytokines presumed to mediate bone loss.

Antioxidative Status, DNA Damage and Lipid Profiles in Korean Young Adults by Glutathione S-Transferase Polymorphisms

Oxidative stress leads to the induction of cellular oxidative damage, which may cause adverse modifications of DNA, proteins, and lipids. The production of reactive species during oxidative stress contributes to the pathogenesis of many diseases. Antioxidant defenses can neutralize reactive oxygen species and protect against oxidative damage. The aim of this study was to assess the antioxidant status and the degree of DNA damage in Korean young adults using glutathione s-transferase (GST) polymorphisms. The GSTM1 and GSTT1 genotypes were characterized in 245 healthy young adults by smoking status, and their oxidative DNA damage in lymphocytes and antioxidant status were assessed by GST genotype. General characteristics were investigated by simple questionnaire. From the blood of the subjects, GST genotypes; degree of DNA damage in lymphocytes; the erythrocyte activities of superoxide dismutase, catalase, and glu- tathione peroxidase; plasma concentrations of total peroxyl radical-trapping potential (TRAP), vitamin C, α- and γ-tocopherol, α- and β-carotene and cryptoxanthin, as well as plasma lipid profiles, conjugated diene (CD), GOT, and GPT were analyzed. Of the 245 subjects studied, 23.2% were GSTM1 wild genotypes and 33.4% were GSTT1 wild gen- otype. No difference in erythrocyte activities of superoxide dismutase, catalase, or glutathione peroxidase, and the plas- ma TRAP level, CD, GOT, and GPT levels were observed between smokers and non-smokers categorized by GSTM1 or GSTT1 genotype. Plasma levels of α- and γ-tocopherol increased significantly in smokers with the GSTT1 wild geno- type (p < 0.05); however, plasma level of α-carotene decreased significantly in non-smokers with the GSTM1 wild geno- type (p < 0.05). DNA damage assessed by the Comet assay was significantly higher in non-smokers with the GSTM1 null genotype; whereas DNA damage was significantly lower in non-smokers with the GSTT1 null genotype. Total cho- lesterol and LDL cholesterol levels were significantly higher in non-smokers with the GSTT1 null genotype than those with the GSTT1 wild genotype (p < 0.05). In conclusion, the GSTM1 null genotype or the GSTT1 wild genotype in non-smokers aggravated their antioxidant status through DNA damage of lymphocytes; however, the GSTT1 wild type in non-smok- ers had normal plasma total cholesterol and LDL-cholesterol levels. This finding confirms that GST polymorphisms could be an important determinant of antioxidant status and plasma lipid profiles in non-smoking young adults. Further study is necessary to clarify the antioxidant status and/or lipid profiles of smokers with the GST polymorphism and to conduct a study with significantly more subjects. (Korean J Nutr 2011; 44(1): 16 ~ 28)

Diagnostic value of blood lipids testing in patients with high-normal and subclinical levels of TSH in prevention and treatment of dislipoproteinemia

The purpose of the study is to evaluate character of lipid profile changes in Novosibirsk populational sample of men and women (45–69 years) with subclinical and high-normal TSH levels. Current study was performed within the HAPIEE project “Determinants of cardiovascular diseases in Eastern Europe” of the Welcome Trust fond. Populational subsample of 280 subjects (125 men (44.6%) and 155 women (55.4%)) was analyzed. Received data showed that high-normal TSH levels within 1.71–4.05 mIU/l have been associated with higher levels of triglycerides, total cholesterol and LDL cholesterol, compared with low-normal TSH levels 0.17–0.47 mIU/l (р&lt;0.05). Women with subclinical hypothyroidism had significantly higher average levels of total cholesterol and LDL cholesterol compared with women without thyroid disorders.

ACHIEVING LIPID TARGETS IN TREATED HYPERTENSIVES. HOW FEASIBLE IS IT IN CLINICAL PRACTICE?: PP.23.448

Objective: Implementation of numerous guidelines remains a daunting goal for cardiologists. We sought to assess the percentages of treated hypertensives with raised lipid levels, who achieve the goals for Total Cholesterol (TC) and serum Low Density Lipoprotein Cholesterol (LDL-C) and to analyse the factors that may contribute to the goal failure. Design and Method: We conducted a cohort study with retrospective chart review, at the electronic medical record of our outpatient antihypertensive unit. Total of 210 treated hypertensive adults (aged = 57 ± 11 years, 55% = male), naive to previous lipid therapy with raised lipid levels and/or SCORE-risk>5% (using the low risk chart of the Fourth Joint Task Force), were included in the analysis from October 2007 to December 2008 (index time). Laboratory values of lipid panel were obtained right before and after the initiation of lipid pharmacotherapy, accompanied by verbal and written guidance for lifestyle modification. Results: Mean monitoring duration time was 12 months. Average levels of TC and LDL-C were found 235 mg/dl and 170 mg/dl respectively. The majority of patients (92%) received monotherapy with HMG-CoA reductase (statin). Within index time, 46% (97/210) attained optimal combined lipid values. The remaining 54% (113/210) of the total population did not reach the lipid goal; among them 68% (77/113) was due to stringent lipid target (established Cardio-Vascular Disease, Diabetes Mellitus, markedly increased lipid levels); another 20% (23/113) was due to inadequate therapy (low equipotency or low dose of statin) for the raised levels of lipid values; an 8% (9/113) quit treatment for personal beliefs and 4% (5/113) were intolerant. Conclusions: Achieving optimal lipid goals among hypertensives is amenable to both scientific analysis and clinical intervention but remains an odyssey. Renewed research and communication efforts must impart greater hope, confidense and increased access to treatment.

Apolipoprotein E gene polymorphism and total serum cholesterol level in Iranian population

Apolipoprotein E (APOE) is known as a major regulator of blood lipid levels in humans. A number of APOE gene allelic variants have been reported including E2, E3 and E4. Recent studies suggested a role for APOE in obesity and increased Body Mass Index (BMI) and plasma lipid levels in obese children. The aim of this study was to examine the association between APOE genetic variants and the BMI and lipid profile in an Iranian cohort. Samples were obtained from subjects who participated in a study based on the WHO-designed MONICA (multinational monitoring of trends and determinants in cardiovascular disease) study for coronary artery disease risk assessment in Zone 17 of Tehran. The study was approved by the local ethical committee. Informed consent was obtained from all subjects included in this study. Subjects (n=320) were recruited. The level of triglyceride (TG) and total serum cholesterol was tested for all subjects in this study. Genotyping for APOE was carried using polymerase chain reaction-Restriction fragment length polymorphism (PCR-RFLP)technique. Levels of significance were determined using contingency tables by either Chi-square or Fisher exact analysis using the STATA (v8) software. The analysis of regression and significance of differences for level of cholesterol and TG was established by one-way analysis of variance followed by Dunnett post hoc multiple comparison tests using SPSS software Version 11.5. The frequency of allele E2 was significantly higher in patients with total serum cholesterol level <200 mg/dl (P 0.01 OR 2.1 95% CI 1.1-4.2). The association found in this study between allele E2 and lower total cholesterol level had been reported in previous studies. We have also observed that the frequency of genotype E2/E3 and E2/E4 was significantly higher in patients with normal total serum cholesterol level compared to patients with abnormal cholesterol (P=0.003 OR 2.4 95% CI; 1.3-4.6). Our data needs to be repeated in a larger population with more information for serum LDL and HDL levels and their subgroups.

Lipidic profile: evolution, tendency and tracking from infancy to adulthood. PECNA Study

Cardiovascular diseases start during infancy, although the clinical manifestations show themselves during adulthood. Since the year 1987 a (PECNA) study has been underway in Navarra to analyse the epidemiology of the cardiovascular risk factors of the infant-juvenile population. This paper presents the evolution of the lipidic profile from 4 to 23 years of age, the tendency from 1987 to 1993, the evolution of the prevalence of hypercholesterolaemia seric cholesterol >200 mg/dl and the tracking from infancy to adult age. Outstanding amongst the results are the differences between the lipidic profile in both sexes, as well as the observed fall in the average levels of total seric cholesterol and in the prevalence of hypercholesterolaemia. With regard to the tracking, it is concluded that between 50% and 55% of individuals belonging to the extreme quintile of the distribution of the lipidic variables persist at this level six years later.

The Effect of a High-Intensity Interval Training Program on High-Density Lipoprotein Cholesterol in Young Men

This study examined the impact of an 8-week program of high-intensity interval training on high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and the atherogenic index (TC/HDL-C) in 36 untrained men ages 21-36 years. Participants were randomly assigned to an interval training group (n = 20) or a control group (n = 16). Participants in the experimental group performed 3.2 km of interval running (1:1 work:rest ratio) 3 times a week for 8 weeks at an intensity of 90% of maximal heart rate ( approximately 423 kcal per session). Results indicated significant pre- to posttraining changes in HDL-C (1.1 vs. 1.3 mmolxL, p < 0.0001) and TC/HDL-C (3.8 vs. 3.1, p < 0.0001) but no significant changes in TC (3.9 vs. 3.8 mmolxL, p > 0.05) with interval training. It was concluded that an 8-week program of high-intensity interval training is effective in eliciting favorable changes in HDL-C and TC/HDL-C but not TC in young adult men with normal TC levels. Our findings support the recommendations of high-intensity interval training as an alternative mode of exercise to improve blood lipid profiles for individuals with acceptable physical fitness levels.

Effects of Gender, Gonadectomy and Sex Hormones on Growth and Plasma Cholesterol Level in Rats

Background/Aims: No studies have clearly demonstrated how sex hormones are involved in the observed gender difference in growth and plasma cholesterol levels in animals fed hypercholesterolemic diets. This study was conducted to determine the effects of gender, gonadectomy (GNX), and sex hormones on growth, plasma cholesterol and cortisol levels in Sprague-Dawley rats. Methods: In the first of two experiments, equal numbers of male and female 4-week-old rats were divided into three groups: sham-operated control, GNX, or GNX + 17α-methyltestosterone (MT). The rats were fed a hypercholesterolemic diet for 4 weeks. In a second experiment, 24 GNX females were equally divided into three groups: control, 17β-estradiol (E₂), or MT. These rats were fed a normocholesterolemic diet for 3 weeks. Results: The average total plasma cholesterol level in female rats was twice that in male rats. MT administration to GNX male and GNX female rats decreased plasma cholesterol levels by 23 and 45%, respectively. Weekly intramuscular injection of E₂ markedly suppressed growth while increasing plasma cortisol levels in GNX female rats. Conclusion: Testosterone decreases plasma cholesterol levels in rats fed a hypercholesterolemic diet and E₂ suppresses growth of rats, inducing the secretion of hormones that increase with stress.

Effect of short term intensive multitherapy on carotid intima-media thickness in patients with newly diagnosed type 2 diabetes mellitus

Controlling plasma glucose levels, blood pressure and lipid levels is proven to reduce the risk of vascular complications in patients with type 2 diabetes mellitus. This has prompted intensive multitherapy targeted at several macrovascular risk factors. Carotid intima-media thickness (cIMT) is a reliable measure of early atherosclerosis. We sought to determine whether a 6-month intensive mutiltherapy program resulted in better goal attainment than usual care and its effect on the development of cIMT among patients with newly diagnosed type 2 diabetes mellitus. The study randomly assigned 220 patients with newly diagnosed type 2 diabetes mellitus to intensive or traditional therapy groups. The clinical parameters, such as fasting plasma glucose, total cholesterol, triglyceride, blood pressure, body weight and insulin were assessed at the baseline and after the 6-month therapy. cIMT of the patients was also obtained. The average levels of fasting plasma glucose, hemoglobin A1c, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in the intensive group were significantly lower than those in the control group at the end of 6-month treatment. By 6 months, a higher proportion of patients in the intensive therapy group than in the control group attained goals for fasting plasma glucose (FPG), TC, LDL-C and hemoglobin A1c. With intensive multherapy the level of carotid intima-media thickness in the intensive therapy group was lower than that in the control group ((0.88 +/- 0.26) mm vs (0.96 +/- 0.22) mm, P < 0.01). The evidence from this clinical trial demonstrates that intensive glucose, lipid and blood pressure control in patients with newly diagnosed type 2 diabetes is associated with diabetic macrovascular benefits. Intensive multitherapy allows more patients to achieve aims of control and may reduce macrovascular complications and delay disease progression.

Marcadores de riesgo cardiovascular en escolares de cinco departamentos de la región oriental en Colombia

Cardiovascular disease is a public health problem globally; it represents the second cause of mortality in Colombia. This highlights the importance of identifying risk markers from the time of childhood, in order to diminish mortality rates proactively. The lipid profile, homocysteine and C reactive protein plasma concentrations were determined in order to identify relationships between these markers and age, sex and school type. A descriptive study was undertaken in 600 schoolchildren, aged 5 to 14, where the lipid profile, and the plasmatic concentrations of homocysteine and C-reactive protein were evaluated. Higher average levels of total cholesterol, low density cholesterol and triglycerides were observed in females (p<0.05) as compared with males. The prevalences of high lipid were higher in females than in males--7.9% vs. 3.0% for total cholesterol; 11.6% vs. 4.7% for low density cholesterol and 6.9% vs. 5.7% for triglycerides. Children in private schools had higher levels of lipid than those in public ones (p<0.05). The prevalence of homocysteine levels above 6.3 micromol/L was higher (64.3%) in males than in females (56.1%). No statistically significant differences with respect to sex, age or type of school were observed when comparing the prevalence of high levels C-reactive proteins. The prevalence of high lipid profile levels in female schoolchildren suggested a policy of adopting intervention measures at an early age. Other factors require further investigation, such as the homocysteine levels observed in males and the C protein levels in order to detect their contribution to cardiovascular disease.

Changing trends (1986–2003) in the use of lipid lowering medication in patients hospitalized with acute myocardial infarction: A community-based perspective

ObjectivesThe objectives of this community-wide observational study were to describe nearly two decade long (1986–2003) trends in the use of lipid lowering therapy in patients hospitalized with acute myocardial infarction (AMI) and clinical and demographic factors associated with underutilization of this treatment regimen. MethodsA total of 9429 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 10 annual periods between 1986 and 2003 comprised the study population. Hospital medical records were reviewed to ascertain the prescribing of lipid lowering agents during hospitalization for AMI. ResultsThe mean age of the study sample was 70 years, 58% were men, and the average total and LDL serum cholesterol levels were 203 and 114 mg/dL, respectively. There was a marked increase in the use of lipid lowering therapy in greater Worcester residents hospitalized with AMI between 1986 (<1%) and 2003 (76%). Increasing use of lipid lowering medication was observed both with regards to the maintenance of this therapy in patients who were already on this treatment regimen and in the new initiation of lipid lowering medication in patients who had not been previously treated with this therapy. Several patient demographic and clinical factors, including advanced age and an initial AMI, were associated with the failure to be prescribed lipid lowering therapy during hospitalization for AMI. ConclusionsThe results of this study suggest encouraging increases over time in the use of lipid lowering therapy in patients hospitalized with AMI. Despite these encouraging trends, several high-risk patient groups remain suboptimally treated.

EFFECT OF PROCESSED RICE WITH BROWN RICE EXTRACTS ON SERUM CHOLESTEROL LEVEL

SUMMARY 1 Brown rice and rice with rice germ are rich in functional components such as g-oryzanol. g-Oryzanol has been reported to decrease the serum cholesterol level. In the present study, we examined the effects of processed rice enriched with brown rice extracts (test diet) on the serum cholesterol level. 2 The study subjects took the test diet three times a day for 30 days, and blood samples were taken before and after the test diet period. 3 Compared with the initial baseline level, the total cholesterol (TC) level decreased significantly after the 30 day test diet period. Triglycerides, high-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol levels did not change significantly during the 30 days compared with the corresponding baseline levels. 4 Subanalyses showed that subjects with a baseline TC level greater than 200 mg/dL showed significantly lower TC levels on day 30, but subjects with a normal TC level did not show any significant differences. 5 The results suggest that the enriched functional components of the test diet can possibly adjust the serum cholesterol level, but only in people with an already high TC level. A diet rich in brown rice extracts could be beneficial as a functional food to lower cholesterol.

Use of DNA polymorphisms of the apolipoprotein genes to study the role of genetic variation in the determination of serum lipid levels.

Cloned DNA probes for the apolipoprotein B (apoB) gene and the gene cluster for apoA-I/C-III/A-IV were used to detect restriction fragment length polymorphisms (RFLPs) at these two loci. Samples have been obtained from clinically well individuals, and the RFLP genotypes of each individual have been determined. The data show that at the locus for apoB, genetic variation associated with an RFLP detected by the enzyme XbaI (but not that associated with RFLPs detected by MspI or EcoRI) is involved in determining the normal levels of serum total cholesterol and low density lipoprotein (LDL) cholesterol. In our study, genetic variation associated with the XbaI RFLP accounts for 14% of the total phenotypic variance in cholesterol levels. Information from all three RFLPs can be used in conjunction to give a better definition of the underlying genetic variation. Data from a second study show that genetic variation in the apoA-I/C-III/A-IV gene cluster, associated with the PstI RFLP, is involved in determining the level of apoA-I and, to a lesser extent, the levels of high density lipoprotein (HDL). When genotypes from three RFLPs were used in conjunction as a haplotype, genetic variation in this gene cluster was shown to account for 16% of the phenotypic variance in apoA-I concentration and for 8% of the phenotypic variance in HDL concentration in our sample. These associations suggest that the isolation and sequencing of the apoB and the apoA-I/C-III/A-IV genes from different individuals will give useful information about how changes in the DNA sequence of these genes may lead to alterations in the levels of their respective apolipoproteins, in the level of the lipoproteins with which they are associated and, possibly, in the levels of lipids in the serum.

Cardiovascular risk factors in patients with subclinical hypothyroidism

Overt hypothyroidism is disease associated with accelerated arteriosclerosis and coronary heart disease. Whether subclinical hypothyroidism (SH) is associated with increased cardiovascular risk is contraversial. As SH is a high prevalence thyroid dysfunction, specially in older women, it is important to evaluate cardiovascular risk factors in these patients and that was the aim of this study. We examined 30 patients with SH and 20 healthy controls. Subclinical hypothireoidism was defined as an elevated thyrotropin (TSH) (> 4.5 mU/L) and normal free thyroxine (FT4) level. In all the participants we determined body mass index (BMI), blood pressure, TSH, FT4, antibodies to thyroid peroxidase, antibodies to thyroglobulin, total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglicerides, total cholesterol/HDL cholesterol ratio and LDL/HDL cholesterol ratio. Mean BMI in patients with SH was significantly higher (p < 0.05), as well as diastolic blood pressure (p < 0.01) compared with the controls. Average levels of total cholesterol (5.40 +/- 0.62 vs 5.06 +/- 0.19 mmol/l, p < 0.01) and triglycerides (2.16 +/- 0.56 vs 1.89 +/- 0.24 mmol/l, p < 0.05) were also significantly higher in the group with SH. Individual analysis revealed that the percentage of patients with SH having borderline elevated total cholesterol (63.33%), hypertrigliceridemia (43.33%) and elevated total cholesterol/HDL cholesterol ratio (26.67%) were significantly higher than the percentage in the controls. No significant correlation between TSH and lipid parameters was detected. Subclinical hypothyroidism was associated with higher BMI, diastolic hypertension, higher total cholesterol and triglicerides levels and higher total cholesterol/HDL cholesterols ratio. This might increase the risk of accelerated arteriosclerosis in patients with SH.

Effects of Extended-Release Niacin on Lipoprotein Particle Size, Distribution, and Inflammatory Markers in Patients With Coronary Artery Disease

In this study, niacin was added to existing therapy for 3 months in 54 subjects with stable coronary artery disease. Average total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride levels were similar between groups. Three months of niacin treatment increased total HDL by 7.5% and decreased triglycerides by 15% compared with baseline values (p <0.005 for each), whereas total cholesterol and LDL levels remained unchanged. Addition of niacin resulted in a 32% increase in large-particle HDL (p <0.001), an 8% decrease in small-particle HDL (p = 0.0032), an 82% increase in large-particle LDL (p = 0.09), and a 12% decrease in small-particle LDL (p = 0.008). Niacin decreased lipoprotein-associated phospholipase A2 and C-reactive protein levels (20% and 15%, respectively, p <0.05 for the 2 comparisons). No significant changes from baseline were seen in any tested parameter in subjects who received placebo. In conclusion, addition of niacin to existing medical regimens for patients with coronary artery disease and already well-controlled LDL levels favorably improves the distribution of lipoprotein particle sizes and inflammatory markers in a manner that would be expected to confer atheroprotection. The effect of altering lipoprotein particle distribution and inflammatory markers on surrogate markers of atherosclerosis and clinical cardiovascular events in this population remains unclear.