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Abstract
Violence is the leading cause of serious facial injuries in the UK. This paper outlines how and why the police and hospitals should, together, be doing more to protect the increasing numbers of victims. This paper is reproduced by kind permission of the author and the publishers of Policing Today, which is the journal of the Association of Chief Police Officers of England, Wales and Northern Ireland, Vol 3, Issue 2, June 1997. The majority of studies described in this paper were carried out by Professor Shepherd's research team at the University Hospital of Wales in Cardiff. Professor Shepherd chaired the Victim Support working party which produced the national guidelines 'Treating victims of crime', circulated in 1995 to all family doctors and A & E departments in the UK.
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Caro J, Klittich W, McGuire A, Ford I, Norrie J, Pettitt D, McMurray J, Shepherd J. The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin. BMJ (CLINICAL RESEARCH ED.) 1997; 315:1577-82. [PMID: 9437275 PMCID: PMC2127969 DOI: 10.1136/bmj.315.7122.1577] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate the economic efficiency of using pravastatin to prevent the transition from health to cardiovascular disease in men with hypercholesterolaemia. DESIGN Economic benefit analysis based on data from the West of Scotland coronary prevention study. Treatment specific hazards of developing cardiovascular disease according to various definitions were estimated. Scottish record linkage data provided disease specific survival. Cost estimates were based on extracontractual tariffs and event specific average lengths of stay calculated from the West of Scotland coronary prevention study. SUBJECTS Men with hypercholesterolaemia similar to the subjects in the West of Scotland coronary prevention study. MAIN OUTCOME Cost consequences, the number of transitions from health to cardiovascular disease prevented, the number needed to start treatment, and cost per life year gained. RESULTS If 10,000 of these men started taking pravastatin, 318 of them would not make the transition from health to cardiovascular disease (number needed to treat, 31.4), at a net discounted cost of 20m Pounds over 5 years. These benefits imply an undiscounted gain of 2,460 years of life, and thus 8121 Pounds per life year gained, or 20,375 Pounds per life year gained if benefits are discounted. Restriction to the 40% of men at highest risk reduces the number needed to treat to 22.5 (5601 Pounds per life year gained (undiscounted) and 13,995 Pounds per life year gained (discounted)). CONCLUSIONS In subjects without evidence of prior myocardial infarction but who have hypercholesterolaemia, the use of pravastatin yields substantial health benefits at a cost that is not prohibitive overall and can be quite efficient in selected high risk subgroups.
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Enoch P, Akehurst RL, Sheridan P, Savege P, Silverman S, Bennett W, McNee W, Metcalfe S, Wright JM, Wierzbicki AS, Reynolds TM, Davis AM, Mikhailidis DP, Winder AF, McMurray J, McGuire A, Raikou M, Morrison C, Wakeman AP, Leach RH, Lewis D, Wallis EJ, Ramsay LE, Yeo WW, Jackson PR, Pickin M, Haq IU, Betteridge J, Shepherd J, Thompson G, Kjekshus J, Pedersen TR. Use of statins. BMJ : BRITISH MEDICAL JOURNAL 1997. [DOI: 10.1136/bmj.315.7122.1615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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355
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Betteridge J, Shepherd J, Thompson G. Use of statins. Sheffield tables have shortcomings. BMJ (CLINICAL RESEARCH ED.) 1997; 315:1619. [PMID: 9437296 PMCID: PMC2127983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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356
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Packard CJ, Shepherd J. Lipoprotein heterogeneity and apolipoprotein B metabolism. Arterioscler Thromb Vasc Biol 1997; 17:3542-56. [PMID: 9437204 DOI: 10.1161/01.atv.17.12.3542] [Citation(s) in RCA: 260] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The apolipoprotein B containing lipoproteins VLDL, IDL, and LDL exhibit variation in their structure, function, and metabolism. These major lipoprotein classes can be fractionated into apparently discrete components by density gradient centrifugation or affinity chromatography. Examination of the behavior of subfractions in vivo reveals the presence of metabolic channels within the VLDL-LDL delipidation cascade so that the pedigree of a lipoprotein in part determines its metabolic fate. Evidence from VLDL and LDL apoB turnovers together with epidemiological data allows the construction of a quantitative model for the generation of small, dense LDL. This lipoprotein subspecies is one component of the dyslipidemic syndrome known as the atherogenic lipoprotein phenotype, a common disorder in those at risk for coronary heart disease. Understanding lipoprotein heterogeneity is an essential step in the further discovery of the pathogenesis of atherosclerosis and in the tailoring of pharmacologic treatment for subjects at risk.
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Dale R, Barton R, Shepherd J, Burrows A, Brooke D, Adshead G. Why are doctors ambivalent about patients who misuse alcohol? BMJ (CLINICAL RESEARCH ED.) 1997; 315:1297-300. [PMID: 9390061 PMCID: PMC2127822 DOI: 10.1136/bmj.315.7118.1297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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358
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Anber V, Millar JS, McConnell M, Shepherd J, Packard CJ. Interaction of very-low-density, intermediate-density, and low-density lipoproteins with human arterial wall proteoglycans. Arterioscler Thromb Vasc Biol 1997; 17:2507-14. [PMID: 9409221 DOI: 10.1161/01.atv.17.11.2507] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The specific interaction of lipoproteins with arterial wall constituents, particularly proteoglycans (APG), is believed to play an important role in the development of atherosclerosis. The objective of this study was to examine the interaction of apolipoprotein B (apoB) containing lipoprotein subfractions (VLDL1, Sf 60 to 400; VLDL2, Sf 20 to 60; IDL1, Sf 16 to 20; IDL2, Sf 12 to 16; LDLA, Sf 8 to 12; and LDLB, Sf 0 to 8) prepared by cumulative density gradient centrifugation with chondroitin sulfate-rich APG. Eighteen subjects were studied, and a similar pattern of interaction between the lipoprotein species and APG was found in all. The order of reactivity (as measured by increased turbidity due to insoluble complex formation) was IDL Sf 12 to 16 > or = LDL Sf 8 to 12 > LDL Sf 0 to 8 > IDL Sf 16 to 20 >> VLDL Sf 20 to 60 > VLDL Sf 60 to 400. When the subjects were divided on the basis of their LDL subfraction profile, the extent of insoluble complex formation was highest in the group in which small, dense LDLIII was predominant; intermediate in the group whose LDL was mainly LDLII; and lowest in the group with a high proportion of LDLI (the mean reactivity, AU at 600 nm. of APG with IDL Sf 12 to 16 and LDL Sf 8 to 12 was 0.66; 0.62 and 0.46, 0.43 and 0.20, and 0.21 for the three groups, respectively). Fibrate lipid-lowering treatment decreased the percentage of LDLIII and increased the percentage of LDLI within total LDL and reduced the reactivity of all apoB-containing lipoprotein fractions toward APG. Sialic acid content varied in different lipoprotein subfractions, being the highest in VLDL and lowest in LDL. However, across lipoprotein species, it did not significantly correlate with APG-binding reactivity, suggesting that other factors are important in determining the interaction of lipoproteins with APG. Modification of LDL arginine and lysine residues abolished the ability of the lipoprotein to interact with APG, a finding that supports the hypothesis that the interaction is dependent on key positively charged amino acids on apoB. These findings demonstrate that (1) the overall reactivity of apoB-containing lipoproteins is greatest in individuals with small, dense LDL and (2) within an individual, IDL of Sf 12 to 16 is the most reactive species, and this may in part explain the positive correlation between IDL and risk of coronary heart disease.
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359
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Cuchel M, Stott D, Bell L, Gaw A, McConnell M, Shepherd J, Packard C, Vergani C. 2.P.271 High plasma Lp(a) levels and low plasma HDL-cholesterol levels as risk factors for cerebrovascular disease in elderly men and women. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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360
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Shepherd J, Alcalde V, Béfort PA, Boucher B, Erdmann E, Gutzwiller F, van Hemert TJ, Jordan-Ghizzo I, Menotti A, Schioldborg P, Thompson DR, Turner M, Umlauf B. International comparison of awareness and attitudes towards coronary risk factor reduction: the HELP study. Heart European Leaders Panel. JOURNAL OF CARDIOVASCULAR RISK 1997; 4:373-84. [PMID: 9865670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND An international survey was conducted to assess public awareness and attitudes to coronary heart disease and to establish the frequency with which certain health-related behaviours are practised in five European countries. METHODS Members of the general public (n=5013), individuals at increased risk of coronary disease (n=2500), patients who had suffered a myocardial infarction (n=1256) and members of their families (n=1249) were interviewed in a study conducted in France, Germany, Italy, Sweden and the UK. Questions were asked about respondents' attitudes to their health and about their current health practices. RESULTS The survey revealed a considerable degree of indifference to coronary heart disease, despite the possession of a reasonable level of knowledge of the risks involved, even among patients who had suffered a myocardial infarction. At the same time, respondents declared themselves satisfied with the quality of advice about coronary health that they obtained from the medical profession and regarded these sources of information as highly credible. Media health campaigns, by contrast, had comparatively little impact. CONCLUSION A survey of five European countries shows that individuals possess reasonable levels of knowledge about coronary heart disease. They also have access to sources of heart health information that are perceived as highly credible. Nonetheless, such information has a very limited impact on their practice of health-related behaviours.
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Demant T, Packard C, Stewart J, Bedford D, Schwertfeger G, Bedyneck A, Seidel D, Shepherd J. 4.P.231 Metabolism of triglyceride-rich lipoproteins determines occurrence of atherogenic LDL phenotype. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)89758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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362
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Ardern H, Grimsditch D, Bedford D, Bedford D, Caslake M, Suckling K, Packard C, Shepherd J. 1.P.94 Characterisation of lipoprotein metabolism in the froxfield mixed hyperlipidaemic rabbit. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88274-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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363
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Shepherd J. 1.P.159 Assessment of liver function monitoring in the West of Scotland Coronary Prevention Study (WOSCOPS). Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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364
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Shepherd J. 1.P.158 Identification of the most appropriate recipients of pravastatin therapy in the West of Scotland Coronary Prevention Study (WOSCOPS) cohort. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88337-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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365
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Packard C, Norrie J, Ford I, Cobbe S, Shepherd J. 1.P.153 Influence of pravatatin and plasma lipids on clinical events, in the West of Scotland Coronary Prevention Study (WOSCOPS). Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88332-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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366
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Taskinen MR, Malmström R, Caslake M, Bedford D, Stewart P, Shepherd J, Packard C. 4.W23.5 Is insulin regulation of VLDL production defective in insulin resistance? Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)89509-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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367
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Shepherd J, Alcalde V, Befort PA, Boucher B, Erdmann E, Gutzwiller F, van Hemert TJE, Jordan-Ghizzo I, Menotti A, Schioldborg P, Thompson DR, Turner M, Umlauf B. International Comparison of Awareness and Attitudes Towards Coronary Risk Factor Reduction: The HELP Study. ACTA ACUST UNITED AC 1997. [DOI: 10.1177/174182679700400510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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368
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Shepherd J. 2.P.259 Attitudes towards coronary risk factor reduction: The HELP study. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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369
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Millar J, Watson T, Stewart J, Forster L, Shepherd J, Packard C. 4.P.266 VLDL triglyceride kinetics in mixed hyperlipidaemia. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)89795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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370
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Caro J, Klittich W, McGuire A, Norrie J, Ford I, MacMurray J, Whitehouse A, Pettitt D, Shepherd J. 1.P.139 The cost-effectiveness of preventing initial coronary events with pravastatin: Results of the West of Scotland coronary prevention study economic analysis. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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371
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Shepherd J. Careers in academic medicine. Specialist training programme in oral surgery is good model for other specialties. BMJ (CLINICAL RESEARCH ED.) 1997; 315:608-9. [PMID: 9302984 PMCID: PMC2127411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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372
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Ind T, Iles R, Shepherd J, Chard T. Serum concentrations of cancer antigen 125, placental alkaline phosphatase, cancer-associated serum antigen and free beta human chorionic gonadotrophin as prognostic markers for epithelial ovarian cancer. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:1024-9. [PMID: 9307529 DOI: 10.1111/j.1471-0528.1997.tb12061.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the prognostic significance of elevated levels of cancer antigen 125 (CA125), placental alkaline phosphatase (PLAP), free beta human chorionic gonadotrophin (hCG) and cancer-associated serum antigen (CASA) in women with primary epithelial ovarian carcinoma. DESIGN A two year follow up study of survival. SETTING A tertiary care gynaecological oncology unit. PARTICIPANTS One hundred and eleven women with histologically confirmed epithelial ovarian cancer. MAIN OUTCOME MEASURES Survival over a two year period. RESULTS Stage corrected log-rank chi 2 tests demonstrated a significant effect on survival for all four tumour markers (CA125 P = 0.0142; PLAP P < 0.0001; CASA P = 0.0098; hCG P = 0.0002). This was confirmed when each variable was fitted together with disease stage in Cox proportional hazard models. When fitted as multiple variables in a Cox proportional hazard model, the addition of free beta-hCG and CASA to disease stage, PLAP concentrations and CA125 levels did not demonstrate further prognostic value. CONCLUSIONS Levels of all four markers correlate with survival in patients with epithelial ovarian cancer. The combination of PLAP and CA125 concentrations together with disease stage may be used to predict survival but the addition of hCG and CASA levels do not give additional prognostic information.
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Wallace AM, Stirling HF, Kelnar CJ, Shepherd J, Toft AD. An investigation of hyperandrogenism and obesity presenting during late childhood. Ann Clin Biochem 1997; 34 ( Pt 5):564-8. [PMID: 9293317 DOI: 10.1177/000456329703400516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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374
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Sattar N, Greer IA, Louden J, Lindsay G, McConnell M, Shepherd J, Packard CJ. Lipoprotein subfraction changes in normal pregnancy: threshold effect of plasma triglyceride on appearance of small, dense low density lipoprotein. J Clin Endocrinol Metab 1997; 82:2483-91. [PMID: 9253322 DOI: 10.1210/jcem.82.8.4126] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A detailed longitudinal examination of plasma lipoprotein subfraction concentrations and compositions in pregnancy was performed with the objective of discovering the pattern of change in lipoprotein subfractions. Plasma triglyceride, cholesterol, very low density lipoprotein (VLDL1), very low density lipoprotein (VLDL2), intermediate density lipoprotein (IDL), low density lipoprotein (LDL) and its subfractions (LDL-I, LDL-II, LDL-III), and high density lipoprotein-cholesterol (HDL cholesterol) were quantified in 10 normal pregnant women from 10 weeks of gestation and at 5 weekly intervals thereafter, until 35 weeks of gestation, together with circulating hepatic lipase (at 10 and 35 weeks) and serum estradiol concentration. Median concentrations of VLDL1 (19-109 mg/dL), VLDL2 (17-103 mg/dL) and IDL (26-124 mg/dL) increased in parallel (maximum increase around 5-fold) as plasma triglyceride increased with advancing gestation. This contrasts with observations in the normal non-pregnant female, where higher concentrations of plasma triglyceride are associated with preferentially higher VLDL1 concentrations. The rise in IDL was also remarkable as this does not normally accompany changes in plasma triglyceride. LDL mass increased by 70% (200-353 mg/dL) between 10 and 35 weeks, and in 6 of the 10 women studied, the LDL subfraction pattern was modified towards a smaller denser pattern in a manner suggestive of a "threshold" transition, with the proportion of LDL-III increasing at the expense of LDL-II, whereas in the other 4 women, LDL subfraction profile remained unchanged throughout pregnancy. Interestingly, this "threshold" transition, if it occurred, did so at varying gestational ages and triglyceride concentrations for different women. The likelihood of LDL subfraction change and the final concentration of small, dense. LDL-III were related to the 10-week triglyceride concentration (R2 = 36.7%, P = 0.063) and to the rate of change in triglyceride for a given increment in estrogen (R2 = 48.6%, P = 0.025). In addition, VLDL1 mass exceeded 100 mg/dL during pregnancy only in those individuals in whom LDL profile perturbation was evident (chi 2, P < 0.001). LDL profile change was evident at the lowest triglyceride concentrations in the 2 individuals with the highest increments in triglyceride corrected for estrogen. On the basis of these longitudinal observations, we conclude the following: 1) as plasma triglyceride increases in pregnancy, there are parallel rises in median concentrations of VLDL1, VLDL2 and IDL, around 5-fold; 2) as a result of this progressive increase in plasma triglyceride, in particular in VLDL1, the LDL profile is altered in some individuals towards smaller, dense particles; 3) in general, the higher the initial (booking) fasting plasma triglyceride concentration or the larger the rate of change in triglyceride for a given increment in estradiol, the greater the probability of change in LDL profile towards smaller denser species; 4) significantly, LDL subclass perturbation towards smaller denser species occurs not in a gradual and progressive manner but exhibits "threshold" behavior; and finally, 5) this threshold is achieved at differing gestational ages and triglyceride concentrations for different women.
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Malmström R, Packard CJ, Watson TD, Rannikko S, Caslake M, Bedford D, Stewart P, Yki-Järvinen H, Shepherd J, Taskinen MR. Metabolic basis of hypotriglyceridemic effects of insulin in normal men. Arterioscler Thromb Vasc Biol 1997; 17:1454-64. [PMID: 9261280 DOI: 10.1161/01.atv.17.7.1454] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The mechanism by which acute insulin administration alters VLDL apolipoprotein (apo) B subclass metabolism and thus plasma triglyceride concentration was evaluated in 7 normolipidemic healthy men on two occasions, during a saline infusion and during an 8.5-hour euglycemic hyperinsulinemic clamp (serum insulin, 490 +/- 30 pmol/L). During the insulin infusion, plasma triglycerides decreased by 22% (P < .05), and serum free fatty acid decreased by 85% (P < .05). The plasma concentration of VLDL1 apo B fell 32% during the insulin infusion, while that of VLDL2 apo B remained constant. A bolus injection of [3-(2)H]leucine was given on both occasions to trace apo B kinetics in the VLDL1 and VLDL2 subclasses (Svedberg flotation rate, 60-400 and 20-60, respectively), and the kinetic basis for the change in VLDL levels caused by insulin was examined using a non-steady-state multicompartmental model. The mean rate of VLDL1 apo B synthesis decreased significantly by 35% (P < .05) after 0.5 hour of the insulin infusion (523 +/- 87 mg/d) compared with the saline infusion (808 +/- 91 mg/d). This parameter was allowed to vary with time to explain the fall in VLDL1 concentration. After 8.5 hours of hyperinsulinemia, the rate of VLDL1 apo B synthesis was 51% lower (321 +/- 105 mg/d) than during the saline infusion (651 +/- 81 mg/d, P < .05). VLDL2 apo B production was similar during the saline (269 +/- 35 mg/d) and insulin (265 +/- 37 mg/d) infusions. No significant changes were observed in the fractional catabolic rates of either VLDL1 or VLDL2 apo B. We conclude that acute hyperinsulinemia lowers plasma triglyceride and VLDL levels principally by suppressing VLDL1 apo B production but has no effect on VLDL2 apo B production. These findings indicate that the rates of VLDL1 and VLDL2 apo B production in the liver are independently regulated.
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