Presence Of Hyperlipidemia Research Articles

Evaluation of cardiovascular risk factors in women with uterine leimyoma: is there a link with atherosclerosis?

Both uterine leimyoma (UL) and cardiovascular disease are public health problems affecting women at different age ranges. Smoking, obesity, and hypertension have been shown to be associated with UL in different random studies. However cardiovascular risk factors have not been evaluated systematically in patients with UL. Accordingly, we aimed to evaluate the cardiovascular risk factors and their relation with the presence of UL. One hundred and eighty nine patients with the pathological diagnosis of UL and one hundred and eighty nine age matched control subjects without UL were retrospectively included in the study from our data base of the pathology and gynecology departments. Controls were patients with intact uteri who had visited the same physicians for a routine checkup that included a pelvic examination and uterine sonogram and without mention of physical findings consistent with UL. The following clinical and demographic parameters were recorded; age, sex, hypertension, diabetes mellitus, and hypercholesterolemia. Current cigarette smoking was defined as active smoking within the past 12 months. Comparison of cardiovascular risk factors between with and without UL revealed that the presence of hypertension (80 (42.3%) vs 53 (28%) p=0.004) diabetes mellitus (33 (17.4%) vs. 16 (8.4%) p=0.009), smoking (31 (16.4%) vs. 11 (5.8%) p=0.001), were significantly higher in patients with UL than in control subjects. The mean-age and presence of hyperlipidemia were comparable between the two groups. Logistic regression analysis revealed an independent and positive association of UL with the presence of hypertension (odds ratio 2.02 CI: 1.25-3.27 p=0.004), diabetes mellitus (odds ratio 2.43 CI: 1.23-4.79 p=0.010), and smoking status (odds ratio 3.46 CI: 1.65-7.22 p=0.001). We have shown that major cardiovascular risk factors namely, hypertension, diabetes mellitus and smoking are significantly and independently associated with UL. Our findings highlight the possible association of UL with atherosclerosis.

Boston Naming Test: Gender Differences in Older Adults with and without Alzheimer’s Dementia

The study clarifies the relationship between gender and performance on the BNT by controlling for the effects of demographic and health risk factors. Participants were 468 outpatient individuals (153 diagnosed with probable Alzheimer’s Disease (AD) and 318 cognitively intact) enrolled in the Texas Alzheimer’s Research and Care Consortium cohort. Participants under went evaluations including medical examination, interview, neuropsychological testing, and blood draw. The neuropsychological assessment consisted of the Wechsler Digit Span, Logical Memory, and Visual Reproduction, along with the Trail Making Test, Boston Naming Test (60-item version), verbal fluency (FAS), and the Geriatric Depression Scale (GDS-30).To control for severity of cognitive impairment only mild AD as shown by a CDR global score of 0.5 or 1.0 were used. Control males outperformed females (F = 10.81, p < .000, ES = .20). AD males also performed significantly better than AD females (F = 17.13, p < .000, ES = .25). Gender differences remain after covarying for estimated IQ, age, education, and presence of hyperlipidemia and hypertension. Overall, within-group and between-group comparisons support prior findings that males perform significantly better compared to females on the BNT even after controlling for health and level of decline. Findings have implications for clinical practice and prospective test norm considerations.

Medical problems and risk factors of metabolic syndrome among radiographic knee osteoarthritis patients in the Japanese general population

BackgroundThe objectives of this study were to investigate the prevalence rate of metabolic syndrome (MetS) among knee osteoarthritis (OA) patients in the Japanese general population, and to analyze the relationship between MetS and knee OA. MethodsA total of 795 volunteers participated in this study. Based on the Kellgren–Lawrence (K–L) grade, participants were classified into two groups: the non-knee OA (non-KOA) group (K–L grade 0 or 1) or knee OA (KOA) group (grade 2–4). MetS was defined according to the Japanese Committee for the Diagnostic Criteria of MetS with a slight modification. The presence of hyperlipidemia, hypertension, diabetes mellitus and MetS were compared between the non-KOA and KOA groups. Furthermore, risk factors for MetS were analyzed by logistic regression analysis. ResultsThe prevalence rate of hypertension in the KOA group was significantly higher than in the non-KOA group (P = 0.025) in males. Those of hypertension (P < 0.001), hyperlipidemia (P < 0.001) and diabetes mellitus (P = 0.019) in the KOA group were significantly higher than in the non-KOA group in females. Aging was significantly associated with MetS in males; the odds ratio (OR) for age was 1.033 (P = 0.020), suggesting that a 1-year increase in age raised the risk of MetS. In females, the presence of KOA was significantly associated with MetS; the risk of MetS in the KOA group was 2.196 (P = 0.034) fold the risk in the non-KOA group. ConclusionThe prevalence rates of MetS and knee OA tended to increase with age in males; however, there was no association between MetS and knee OA. On the other hand, knee OA was significantly associated with MetS in females. Knee OA patients must be provided the best treatment approach because of their high risk for MetS, which promotes cardiovascular diseases.

Aspartame-fed zebrafish exhibit acute deaths with swimming defects and saccharin-fed zebrafish have elevation of cholesteryl ester transfer protein activity in hypercholesterolemia

Although many artificial sweeteners (AS) have safety issues, the AS have been widely used in industry. To determine the physiologic effect of AS in the presence of hyperlipidemia, zebrafish were fed aspartame or saccharin with a high-cholesterol diet (HCD). After 12days, 30% of zebrafish, which consumed aspartame and HCD, died with exhibiting swimming defects. The aspartame group had 65% survivability, while the control and saccharin groups had 100% survivability. Under HCD, the saccharin-fed groups had the highest increase in the serum cholesterol level (599mg/dL). Aspartame-fed group showed a remarkable increase in serum glucose (up to 125mg/dL), which was 58% greater than the increase in the HCD alone group. The saccharin and HCD groups had the highest cholesteryl ester transfer protein (CETP) activity (52% CE-transfer), while the HCD alone group had 42% CE-transfer. Histologic analysis revealed that the aspartame and HCD groups showed more infiltration of inflammatory cells in the brain and liver sections.Conclusively, under presence of hyperlipidemia, aspartame-fed zebrafish exhibited acute swimming defects with an increase in brain inflammation. Saccharin-fed zebrafish had an increased atherogenic serum lipid profile with elevation of CETP activity.

Neointima Formed by Arterial Smooth Muscle Cells Expressing Versican Variant V3 Is Resistant to Lipid and Macrophage Accumulation

Extracellular matrix (ECM) of neointima formed following angioplasty contains elevated levels of versican, loosely arranged collagen, and fragmented deposits of elastin, features associated with lipid and macrophage accumulation. ECM with a low versican content, compact structure, and increased elastic fiber content can be achieved by expression of versican variant V3, which lacks chondroitin sulfate glycosaminoglycans. We hypothesized that V3-expressing arterial smooth muscle cells (ASMC) can be used to form a neointima resistant to lipid and macrophage accumulation associated with hypercholesterolemia. ASMC transduced with V3 cDNA were seeded into ballooned rabbit carotid arteries, and animals were fed a chow diet for 4 weeks, followed by a cholesterol-enriched diet for 4 weeks, achieving plasma cholesterol levels of 20 to 25 mmol/L. V3 neointimae at 8 weeks were compact, multilayered, and elastin enriched. They were significantly thinner (57%) than control neointimae; contained significantly more elastin (118%), less collagen (22%), and less lipid (76%); and showed significantly reduced macrophage infiltration (85%). Mechanistic studies demonstrated that oxidized low-density lipoprotein stimulated the formation of a monocyte-binding ECM, which was inhibited in the presence of V3 expressing ASMC. These results demonstrate that expression of V3 in vessel wall creates an elastin-rich neointimal matrix that in the presence of hyperlipidemia is resistant to lipid deposition and macrophage accumulation.

Prevalence and Impact of Hepatic Steatosis on the Response to Antiviral Therapy in Saudi Patients with Genotypes 1 and 4 Chronic Hepatitis C

Hepatic steatosis in hepatitis C virus (HCV)-infected patients has been shown to enhance the progression of liver fibrosis and decrease the response to antiviral therapy. We aimed to determine the role of HCV genotype 4 (HCV-G4) in the prevalence of hepatic steatosis, its impact on antiviral therapy, and its associations and predictive factors in comparison to HCV-G1-infected patients. Treatment-naïve HCV patients who were started on pegylated interferon a-2b plus ribavirin therapy in two centers in Saudi Arabia were included. The severity of steatosis was assessed using the METAVIR and NAS (non-alcoholic fatty liver disease [NAFLD] activity score) scoring systems. Sustained virological response (SVR) was studied in relation to the degree of steatosis. Associations between steatosis and multiple demographic, laboratory, and virological factors were examined. HCV-G1 and HCV-G4 patients were compared. A total of 116 patients (HCV-G4 85 [73.3%]; HCV-G1 31 [26.7%]) were included. The mean age was 50.4±10.7 years and 56.9% were males. In terms of steatosis grading using the NAS scoring system, 50% had steatosis grade 0, 26.7% grade 1, 14.7% grade 2, and 8.6% grade 3, while the overall staging of steatosis revealed that 43.1% had mild steatosis, 42.2% moderate, and 14.7% severe. Gamma-glutamyl transpeptidase (GGT), platelet count, body mass index (BMI), cholesterol level, presence of hyperlipidemia, liver histology stage, and grade were significantly correlated with hepatic steatosis in one or more of the statistical analyses. Twenty-two out of 55 patients (40.0%) had an SVR in the mild steatosis group, compared to 52.7% in the moderate group and 7.3% in the severe group (P=0.03). The HCV genotype did not correlate with steatosis or SVR. Our study confirms the high prevalence of steatosis in HCV-G4 and HCV-G1 patients, but with no difference in the grade or score of steatosis between the two genotypes. The grade of steatosis correlates with GGT, platelet count, and BMI, while the NAS score of steatosis correlates with response to antiviral therapy.

Thrombolysis for acute stroke in Australia: outcomes from the Safe Implementation of Thrombolysis in Stroke registry (2002–2008)

To report Australian outcomes from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register (SITS-ISTR). Observational study using data collected prospectively from December 2002to December 2008. Centres administering thrombolysis for acute stroke in Australia and worldwide. All patients treated with recombinant tissue plasminogen activator for acute stroke in participating centres, regardless of stroke severity, time of treatment and other clinical factors. Thrombolysis for acute stroke, administered according to local protocol. Functional outcome as 3-month modified Rankin score (mRS), and frequency of symptomatic intracerebral haemorrhage (ICH). During the study period, a total of 32countries participated, and confirmed baseline data were available for 581Australian patients and 20953patients in the rest of the world. Australian patients were older (median age, 73v 69years; P<0.001), were less independent before stroke (premorbid mRS of 0-1, 87.5% v 91.2%; P<0.005), and had more comorbidities and more severe strokes. Comparing the Australian cohort with the rest of the world, the odds ratio of 3-month mRS of 0-2was 0.98(95% CI, 0.88-1.08; P=0.63), the odds ratio of symptomatic ICH was 0.98(95% CI, 0.83-1.16; P = 0.85[by the definition used by the National Institute of Neurological Disorders]) and the odds ratio of death was 1.04(95% CI, 0.91-1.19; P = 0.54). Good outcome in the Australian cohort was predicted by younger age, presence of hyperlipidaemia, lower premorbid mRS, absence of infarct on early brain imaging, less severe stroke, and lower baseline blood glucose level. Clinical outcomes after thrombolysis in Australia were similar to those worldwide.

Long-Term Results of Eversion Carotid Endarterectomy

Carotid endarterectomy (CEA) is supported by level 1 evidence as the standard of care for symptomatic and asymptomatic extracranial carotid stenosis. Eversion CEA (ECEA) has been proposed as an acceptable alternative to the standard bifurcation endarterectomy in many patients; however, long-term follow-up of this technique has not been reported. This study was designed to analyze the long-term durability of ECEA in symptomatic and asymptomatic patients. From June 1989 to March 2002, 534 ECEAs were performed on 485 patients (60% male, 44% symptomatic, reoperative 1.0%). Preoperative characteristics, operative findings, and postoperative duplex data were entered prospectively into database. These data were retrospectively reviewed to determine the incidence of major adverse cardiovascular events (MACEs) within 30 days of surgery, late survival, and the late incidence of ipsilateral carotid disease. Variables associated with carotid restenosis were subjected to statistical analysis. The mean follow-up period was 8.86 years (95% confidence interval [CI] 6.56-9.16, median 6.6). MACEs occurred in 19 patients (3.8%), including 13 strokes (2.6%) and six deaths (1.2%). MACEs when added to surgical site-related complications yielded a <30-day complication rate of 5.3%. Survival by life-table analysis at 5 and 10 years was 75.2% and 50.1%, respectively. Recurrent stenosis of the ECEA site was noted in 20 patients (4.1%), with a mean time to recurrence of 4.4 years (95% CI 2.92-6.07, median 4.0). Statistical analyses failed to implicate any specific patient risk factor, symptomatic presentation, presence of hyperlipidemia or statin use, internal carotid artery diameter, or presence of residual disease as predictive of recurrent stenosis. The current study represents the longest follow-up to date of patients undergoing ECEA. The findings of this study support ECEA as a safe and durable long-term treatment for extracranial carotid disease presenting with or without acute symptomatology.

Early atherosclerosis and vascular inflammation in mice with diet‐induced type 2 diabetes

Obesity and type 2 diabetes increase the risk of atherosclerosis. It is unknown to what extent this reflects direct effects on the arterial wall or secondary effects of hyperlipidaemia. The effect of obesity and type 2 diabetes on the development of atherosclerosis and inflammation, in the absence or presence of hyperlipidaemia, was assed in wild-type (n = 36) and human apolipoprotein B (apoB) transgenic mice (n = 27) that were fed normal chow or 60% fat for 12 months. Fat-feeding caused obesity, glucose intolerance and elevated plasma leptin and soluble vascular cell adhesion molecule-1 (sVCAM-1) in both wild-type and apoB transgenic mice. In wild-type mice, plasma very low-density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C) were unaffected by fat-feeding. ApoB transgenic mice had mildly elevated plasma LDL-C (approximately 1 mmol L(-1)), which was slightly increased by fat-feeding. Sixty-four per cent of fat-fed wild-type mice vs. 7% of chow-fed wild-type mice had lipid-staining intimal lesions in the aortic root (P = 0.002). Eighty-six per cent of fat-fed apoB transgenic mice had lipid-staining lesions and the median lesion area was 8.0 times higher than in fat-fed wild-type mice (P = 0.001). Intracellular adhesion molecule-1 staining of the aortic endothelium was most pronounced in the fat-fed apoB transgenic mice. Our findings suggest that diet-induced type 2 diabetes causes early atherosclerosis in the absence of dyslipidaemia, and that even a moderate level of LDL-C markedly augments this effect.

Mclk1+/- mice are not resistant to the development of atherosclerosis.

BackgroundMice with a single copy of Mclk1 (a.k.a. Coq7), a gene that encodes a mitochondrial enzyme required for the biosynthesis of ubiquinone and other functions, live longer than wild-type mice. The prolonged survival implies a decreased mortality from age-dependent lethal pathologies. Atherosclerosis is one of the main age-dependent pathologies in humans and can be modeled in mice that lack Apolipoprotein E (ApoE-/-) or mice that lack the Low Density Lipoprotein Receptor (LDLr-/-) in addition to being fed an atherosclerosis-inducing diet. We sought to determine if Mclk1 heterozygosity protects against atherosclerosis and dyslipidemia in these models.ResultsWe found that Mclk1 heterozygosity did not protect against dyslipidemia, oxidative stress, or atherosclerosis in young (6 or 10 months) or older (18 months) mice. Furthermore, the absence of ApoE suppressed the lifespan-promoting effects of Mclk1 heterozygosity.ConclusionThese findings indicate that although Mclk1 heterozygosity can extend lifespan of mice, it does not necessarily protect against atherosclerosis. Moreover, in the presence of hyperlipidemia and chronic inflammation, Mclk1 heterozygosity is incapable of extending lifespan.

Influence of socio-health variables on the cognitive state of mind of the geriatric patients of a health centre

To determine the influence of age, education, admission in nursing homes and chronic diseases (arterial hypertension, diabetes, hyperlipidaemia, anxiety and depression) on the cognitive state of the population over 65 years of age. A study was made of a geriatric outpatient population (patients living at home or institutionalised) with chronic diseases, who showed cognitive deterioration and depressive symptoms. The cognitive mini-exam (CME) and the geriatric depression scale (Yesavage) were administered. One hundred and forty-seven patients participated, with an average age of 71.4 years and a similar proportion of men (74; 50.3%) and women (73; 49.7%). Thirty-four subjects (23.1%) were living in nursing homes. The most prevalent diseases were hypertension (50%), anxiety-insomnia (30%), diabetes (22%), arthrosis (22%), depression (13%) and hypercholesterolaemia (12%). Half of the patients (79; 53.7%) were following treatment with more than three medicines; 60 (40.6%) with between two and three medicines, and only 8 (5.5%) were taking no medication. The percentage of subjects living in an institution increased with age. The consumption of medicines was also higher amongst the more elderly. The scores on the cognitive scale (CME) decrease with age and were also lower amongst subjects who live in institutions (above all if they suffer from depression). The patients who took psychotropics had lower scores on the CME. Although performances on the CME are lower amongst subjects with a low level of education, the differences do not reach statistical significance. The presence of hyperlipidaemia also decreased the results of the CME. The socio-health factors that altered performance negatively in the cognitive mini-exam are advanced age and institutionalisation. These results are also significantly influenced by depressive disease, hyperlipidaemia and the consumption of medicines that affect the cognitive state.

Expansion rate of nonaneurysmatic abdominal aorta: Over 10 years of follow-up CT studies

Expansion rate of the nonaneurysmatic abdominal aorta (NAA) is completely unknown. The purpose was to evaluate the expansion rate of the NAA and the factors influencing its enlargement. 114 subjects without aortic disease were entered into this retrospective study (mean age: 58.7 years). In all subjects, follow-up CT studies were obtained for more than 10 years after initial CT studies (mean: 147.0 months). The diameter of the abdominal aorta was measured at two sites (suprarenal and infrarenal abdominal aorta), and the growth rate was calculated at each site. The growth rate of NAA and the factors influencing its enlargement were evaluated. In 68 (59.6%), the suprarenal segment of NAA increased in size with a mean growth rate of 1.3 mm/10 years. In 49 subjects (43.0%), the infrarenal segment of NAA increased in size during the follow-up period with the mean growth rate of 1.0 mm/10 years. The mean growth rate was significantly higher in the suprarenal segment ( p = 0.002). The suprarenal segment of NAA and presence of hyperlipidemia were significant risk factors for NAA enlargement. NAA enlargement is more likely to occur in the suprarenal segment than in the infrarenal segment. The presence of hyperlipidemia was also a significant risk factor for NAA enlargement.

Hyperlipidemia Impairs Osteoanabolic Effects of PTH

Epidemiological and in vitro studies have suggested that hyperlipidemia/oxidized phospholipids adversely affect bone. We recently found that oxidized phospholipids attenuate PTH-induced cAMP and immediate-early gene (IEG) expression in MC3T3-E1 cells, raising concerns that clinical hyperlipidemia may attenuate osteoanabolic effects of PTH in vivo. Thus, we studied whether intermittent PTH treatment has differential osteoanabolic effects in wildtype (C57BL/6) and hyperlipidemic (LDLR(-/-)) mice. Consistent with our previous in vitro studies, induction of IEGs in calvarial tissue, 45 min after a single dose of recombinant hPTH(1-34), was attenuated in LDLR(-/-) mice compared with C57BL/6 mice. Daily hPTH(1-34) injections for 5 wk significantly increased total and cortical BMD and BMC, assessed by pQCT, in C57BL/6 mice. However, this induction was completely abrogated in LDLR(-/-) mice. Similarly, PTH(1-34) failed to increase BMD in another hyperlipidemic mouse model, ApoE(-/-) mice. Histomorphometric analysis showed that trabecular bone of both mice responded similarly to PTH(1-34). Structural parameters improved significantly in response to PTH(1-34) in both mouse strains, although to a lesser degree in LDLR(-/-) mice. With PTH(1-34) treatment, osteoblast surface trended toward an increase in C57BL/6 mice and increased significantly in LDLR(-/-) mice. PTH(1-34) did not alter resorption parameters significantly, except for the eroded surface (ES/BS), which was reduced in the C57BL/6 but not in the LDLR(-/-) mice. These results show that PTH(1-34) has adverse effects on cortical bones of the hyperlipidemic mice, suggesting that the therapeutic effects of PTH may be compromised in the presence of hyperlipidemia.

Evaluation of subclinical coronary atherosclerosis in mild asymptomatic primary hyperparathyroidism patients

Although there is sufficient data supporting the increased cardiovascular risk in patients with advanced stage of primary hyperparathyroidism (pHPT), it is not clear whether same is valid for patients with subclinical forms of this disease. In this study we aimed to evaluate coronary atherosclerosis burden of asymptomatic pHPT patients by using tomographic coronary calcification scoring. Thirty-one mild asymptomatic pHPT patients (28 female, 3 male; mean age: 54.4 +/- 12.1 years) and 19 gender- and age-matched normotensive healthy controls (17 female, 2 male; mean age: 50.6 +/- 5.8) constituted our study population. Asymptomatic pHPT patients were subdivided according to presence of hypertension (19 hypertensive and 12 non-hypertensive patients). All subjects in study population underwent tomographic coronary calcification scoring by using 16-multidetector computed tomography (16-MDCT). Median tomographic coronary calcification score was comparable between the whole group of pHPT patients [0.0 (Interquartile Range, IQR:18.70] and the controls [0.0 (IQR: 0.90). Median tomographic coronary calcification scores of pHPT patients with hypertension was 0.90 (IQR: 75.0) HU, whereas no calcification was noted in coronary arteries of normotensive pHPT patients. Calcification scores of hypertensive pHPT patients were significantly higher than both normotensive pHPT patients (P = 0.014) and controls (P = 0.046). There was no significant difference regarding calcification scores of normotensive pHPT patients versus controls. In the binary logistic regression model, only the presence of hyperlipidemia was found to be independently associated with presence of calcification on coronary arteries (relative risk 6.56, 95% CI 1.18-36.56, P = 0.032). These results suggest that mild asymptomatic pHPT with serum calcium levels in the high-normal range does not constitute an independent risk factor for coronary atherosclerosis. The combined presence of classic cardiovascular risk factors determines the severity of coronary atherosclerosis in these patients.

Factors Associated with More Advanced Steatosis in Patients with Non Alcoholic Fatty Liver Disease (NAFLD)

Purpose: Nonalcoholic Fatty Liver Disease (NAFLD) is a spectrum of disorders that range from simple hepatic steatosis without significant inflammation or fibrosis to nonalcoholic steatohepatitis with varying degrees of inflammation and fibrosis. Strong epidemiological, biochemical, and therapeutic evidence supports the premise that the primary pathophysiogical derangement, in most patients with NAFLD, is insulin resistance. The main aim of the study was to look at different factors in patients with NAFLD like age, gender, body mass index (BMI), hyperlipidemia (HLP) and Hgb A1c level and the degree of association between these factors and the degree of steatosis as evidenced by liver biopsy. Methods: We included 44 patients diagnosed with NAFLD as evidenced by biopsy and we reviewed their charts. 33 patients (75%) had NAFLD only whereas 11 patients (25%) had NAFLD and diabetes. Patients' factors including age, gender, BMI, the presence of HLP and Hgb A1c level (which was included also for non diabetic subjects) were recorded and the association between these factors and the degree of steatosis as evidenced by the biopsy were statistically analyzed where the degree of steatosis was defined as mild, moderate and severe if steatosis involves 5–33%, 33–66% or more than 66% of the hepatocytes respectively. Results: Chi-square was used to test for the association between age, gender, BMI, the presence of HLP and Hgb A1c level in one hand and the degree of steatosis on liver biopsy in the other hand. All analyses were performed using the SAS System for Windows, Version 9.1.3. Our analysis showed that women had a higher prevalence of more advanced steatosis (moderate and severe) when compared to men (94% vs 66%, respectively) with a P value of 0.03, on the other hand, other factors mentioned above didn' t show significant statistical association with the degree of steatosis. Conclusion: Although it is well established that factors like obesity, HLP and DM are related to the pathogenesis of NAFLD, these among other factors didn' t show statistical association in our study with the degree of steatosis with the exception of gender where female gender was associated with more advanced steatosis on biopsy. Large clinical studies are needed to confirm these findings and examine if other factors come to affect the degree of steatosis.

Hyperlipidemia in glycogen storage disease type III: Effect of age and metabolic control

While the presence of hyperlipidaemia in glycogen storage disease (GSD) type Ia and Ib is generally accepted, few investigators have adequately assessed lipid profiles of GSD III in children, in whom the presence of hyperlipidaemia may be most prominent. We analysed the lipid profiles in 44 GSD III patients from 6 months to 30 years of age. Hypertriglyceridaemia and hypercholesterolaemia were common in children younger than 3 years of age. Hypertriglyceridaemia correlated negatively with age, and may reflect increased severity of hypoglycaemia in this younger population. The presence of hyperlipidaemia during childhood in these patients identifies another GSD population that could be at risk for early cardiovascular disease (CVD). Consequently, the outcome of clinical trials investigating the vascular effect of hyperlipidaemia in GSD applies to types other than GSD I.

CONCURRENT COMPARISON OF OUTCOMES OF PRIMARY ANGIOPLASTY AND OF STENT PLACEMENT IN HIGH-RISK PATIENTS WITH SYMPTOMATIC INTRACRANIAL STENOSIS

To compare the long-term outcomes of treatment of symptomatic intracranial stenosis using primary angioplasty or stent placement. Both primary angioplasty and stent placement have been proposed as treatment modalities, but long-term outcome comparisons are not available. We determined rates of technical success and rates of major stroke, second procedure, or death in patients with symptomatic intracranial stenosis (>or=70% in severity and/or medication failure). Pre- and posttreatment angiographic stenosis was measured by independent reviewers. Angioplasty was used preferentially in patients with more technically challenging lesions. Kaplan-Meier analysis was used to determine the rate of major stroke-free survival and major stroke- or repeat procedure-free survival between the two treatment modalities over periods of 12 and 24 months. Cox proportional hazards analysis was used to determine the differential risk of major stroke or death after either angioplasty or stent placement. Twenty-two patients (mean age, 62 +/- 13 yr) were treated with primary angioplasty and 22 patients (mean age, 58 +/-14 yr) with stent placement. The mean stenosis (+/-standard deviation) decreased from 76 +/- 13% to 28 +/- 18% in the primary angioplasty-treated and from 68 +/- 9% to 17 +/- 13% in the stent-treated group. There was no difference in time to major stroke or death (log-rank statistic, 0.44; P = 0.5), and time to major stroke, repeat procedure, or death (log-rank statistic, 0.78; P = 0.4) between the two treatment groups. At 12 months, major stroke-free survival was 95% (+/- standard error of 4%) for the stent-treated patients and 93% (+/- standard error of 7%) for the angioplasty-treated patients. There was no significant difference in the risk of major stroke or death between angioplasty and stent placement (P = 0.996) using Cox proportional hazards analysis after adjusting for age, gender, race/ethnicity, presence of hyperlipidemia, qualifying event, preprocedure stenosis, and target vessel. The results of primary angioplasty and primary stent placement were comparable at intermediate follow-up examination after the procedure. The results highlight the need for carefully designed, randomized clinical trials to determine the precise value of stent placement in the intracranial circulation.

El género femenino es un predictor independiente de la mortalidad intrahospitalaria en pacientes con infarto agudo de miocardio con elevación del segmento ST revascularizado mediante una angioplastia primaria

The aim of this study was to determine the influence of gender on in hospital outcome in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary angioplasty (PA). Prospective study of a cohort of patients consecutively admitted to the Coronary Unit of a tertiary hospital in the period of January to October 2004 with the diagnoses of IAMEST and treated with PA. Consecutive sample of 86 patients with this diagnosis divided into two groups based on sex: 52 men and 34 women. In both groups, we analyzed the baseline clinical-demographic characteristics, extension of the coronary disease (ECD), success of the PA, appearance of heart failure (HF) and in-hospital mortality in the first 28 days after admission. We analyzed predictors of mortality in a multivariate model. The women were older (70+/-8 versus 65+/-11; p=0.02) and had greater prevalence of diabetes (37% versus 18%; p=0.002) and hypertension (58% versus 37%; p<0.001) than the men while the men had greater frequency of smoking (34% versus 22%; p=0.001). There were no differences in the presence of hyperlipidemia, ECD or the success of PA. Women had a higher incidence of HF on admission (22% versus 12%; p=0.01) and in-hospital mortality (17% versus 8%; p=0.002). In the multivariate analyses, female sex and HF on admission continued to be predictors of in-hospital mortality. In our study, female gender was an independent predictor of in-hospital mortality in patients with IAMEST treated with PA.

Hyperlipidemia in Rabbit Hemorrhagic Disease

Clinically healthy rabbits were inoculated with rabbit hemorrhagic disease virus (RHDV) and the kinetics of their serum lipid parameters and liver enzymes were monitored. After RHDV inoculation, hyperlipidemia was observed (P(triglyceride)<0.0001, P(cholesterol)=0.0003) along with significant increases in serum aspartate aminotransferase, alanine aminotransferase and gamma-glutamyltransferase (P<0.0001). An exponential increase in serum triglyceride was also seen. Thus, the presence of hyperlipidemia (from 30 h post-inoculation) in the infected rabbits points to impairment in lipid metabolism. This is the first demonstration that RHDV infection leads to hyperlipidemia, probably due to the disorder of liver enzymes associated with lipid metabolism.

Hiperlipidemias e fatores dietéticos: estudo transversal entre nipo-brasileiros

This study aimed at evaluating the association between hyperlipidemia and dietary patterns of Japanese Brazilians with and without hypothyroidism from Bauru, city in the State of São Paulo. We evaluated 1,330 individuals by means of demographic and dietary measurement, whom were gotten through standardized questionnaires previously tested. Clinical examination and laboratory data were anthropometry, blood pressure, fasting and 2-h glucose load, lipid profile and TSH and free T4. The chi-square and the odds ratio were used to evaluate associations between hyperlipidemia with studied variables. The prevalence of hyperlipidemia was 81.5% and it was associated with smokers, overweight, hypothyroid, hypertensive and glucose intolerants. We observed, in crude analysis, relationships with the presence of hyperlipidemia and fat saturated, oleic acid and dietary fiber from grains and cereals. After adjusting for the control variables, we observed relationships between hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) with habitual intake of total fat, oleic acid, saturated fat, trans fat, dietary fiber and alcohol. As a conclusion, changes in the style of life, particularly in the dietary habits, can improve lipidic profile and that lipids intake can be a risk factor for hyperlipidemia. Prospectives studies will help test the hypothesis in Japanese Brazilians from Bauru.