1
|
Behavioral factors predict all-cause mortality in female coronary patients and healthy controls over 26 years - a prospective secondary analysis of the Stockholm Female Coronary Risk Study. PLoS One 2022; 17:e0277028. [PMID: 36477657 PMCID: PMC9728905 DOI: 10.1371/journal.pone.0277028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/19/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The prognosis of coronary artery disease (CAD) is related to its severity and cardiovascular risk factors in both sexes. In women, social isolation, marital stress, sedentary lifestyle and depression predicted CAD progression and outcome within 3 to 5 years. We hypothesised that these behavioral factors would still be associated with all-cause mortality in female patients after 26 years. METHODS We examined 292 patients with CAD and 300 healthy controls (mean age of 56 ± 7 y) within the Fem-Cor-Risk-Study at baseline. Their cardiac, behavioral, and psychosocial risk profiles, exercise, smoking, and dietary habits were assessed using standardized procedures. Physiological characteristics included a full lipid profile, the coagulation cascade and autonomic dysfunction (heart rate variability, HRV). A new exploratory analysis using machine-learning algorithms compared the effects of social and behavioral mechanisms with standard risk factors. Results: All-cause mortality records were completed in 286 (97.9%) patients and 299 (99.7%) healthy women. During a median follow-up of 26 years, 158 (55.2%) patients and 101 (33.9%) matched healthy controls died. The annualized mortality rate was 2.1% and 1.3%, respectively. After controlling for all available confounders, behavioral predictors of survival in patients were social integration (HR 0.99, 95% CI 0.99-1.0) and physical activity (HR 0.54, 95% CI 0.37-0.79). Smoking acted as a predictor of all-cause mortality (HR 1.56, 95% CI 1.03-2.36). Among healthy women, moderate physical activity (HR 0.42, 95% CI 0.24-0.74) and complete HRV recordings (≥50%) were found to be significant predictors of survival. CONCLUSIONS CAD patients with adequate social integration, who do not smoke and are physically active, have a favorable long-term prognosis. The exact survival times confirm that behavioral risk factors are associated with all-cause mortality in female CAD patients and healthy controls.
Collapse
|
2
|
Gebhard C, Rhainds D, He G, Rodés-Cabau J, Lavi S, Spence JD, Title L, Kouz S, L'Allier PL, Grégoire J, Ibrahim R, Cossette M, Guertin MC, Beanlands R, Rhéaume E, Tardif JC. Elevated level of lecithin:cholesterol acyltransferase (LCAT) is associated with reduced coronary atheroma burden. Atherosclerosis 2018; 276:131-139. [DOI: 10.1016/j.atherosclerosis.2018.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/10/2018] [Accepted: 07/18/2018] [Indexed: 01/08/2023]
|
3
|
Eriksson SE. Secondary prophylactic treatment and long-term prognosis after TIA and different subtypes of stroke. A 25-year follow-up hospital-based observational study. Brain Behav 2017; 7:e00603. [PMID: 28127521 PMCID: PMC5256186 DOI: 10.1002/brb3.603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/29/2016] [Accepted: 10/10/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To assess long-term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given. MATERIALS AND METHODS Retro/prospective follow-up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011. RESULTS A total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first-line treatment had beneficial effects on survival: AC OR 0.67 (0.5-0.9), APT 0.67 (0.52-0.88) versus untreated. CONCLUSIONS Patients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.
Collapse
Affiliation(s)
- Sven-Erik Eriksson
- Division of Neurology Department of Medicine Falun Hospital Falun Sweden
| |
Collapse
|
4
|
Abstract
Type 2 diabetes is characterized by a gradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of postprandial glucose regulation. However, physicians continue to rely on fasting plasma glucose and glycated hemoglobin to guide management. There is a linear relationship between the risk of cardiovascular death and the 2-h oral glucose tolerance test, while a study confirms postprandial hyperglycemia as independent risk factor for cardiovascular disease in type 2 diabetes. At the same time, several studies show that postprandial hypertriglyceridemia may also be a cardiovascular risk factor. Interestingly, the simultaneous presence of postprandial hyperglycemia and postprandial hypertriglyceridemia has an additive effect in worsening endothelial function and inflammation. Evidence supports the hypothesis glucose postprandial hyperglycemia and hypertriglyceridemia may favor the appearance of the cardiovascular disease through the generation of an oxidative stress. Furthermore, clinical data suggest that postprandial hyperglycemia is a common phenomenon even in patients who may be considered in "good metabolic control". Therefore, physicians should consider monitoring and targeting postprandial plasma glucose, as well as glycated hemoglobin and fasting plasma glucose, in patients with type 2 diabetes.
Collapse
Affiliation(s)
- Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Rosselló, 149-153, 08036, Barcelona, Spain.
- Centro de Investigacion Biomèdica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain.
| | - Stefano Genovese
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
| |
Collapse
|
5
|
The role of hypertriglyceridemia in the development of atherosclerosis and endothelial dysfunction. Nutrients 2014; 6:1236-50. [PMID: 24667131 PMCID: PMC3967190 DOI: 10.3390/nu6031236] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/07/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022] Open
Abstract
A hereditary postprandial hypertriglyceridemic rabbit (PHT rabbit) is a new dyslipidemic model showing remarkably high plasma triglycerides with only limited elevation of plasma total cholesterol. In PHT rabbits, plasma triglyceride was markedly elevated postprandially compared with healthy Japanese white (JW) rabbits. In physiological experiments, the ring preparation of the thoracic aorta was suspended in an organ bath filled with modified Krebs-Henseleit solution, and the developed tension was recorded. Endothelial function was evaluated by acetylcholine-induced vasorelaxation in each preparation with intact endothelium. The acetylcholine-induced endothelium-dependent relaxation was diminished in PHT compared with JW rabbits, suggesting endothelial dysfunction in PHT rabbits. Histological examination was carried out in adipose tissue, liver and aorta. They were fixed in formaldehyde and embedded in paraffin. The tissues were sliced (4 μm) and stained using hematoxylin-eosin solution. In the adipose tissue, the visceral fat accumulated, and the size of adipose cells was enlarged in PHT rabbits. The liver of the PHT rabbit was fatty and degenerated. In aorta, increased intimal thickness was observed, suggesting the progression of atherosclerosis in the PHT rabbit. This study suggests the important role of postprandial hypertriglyceridemia in atherosclerosis. By using PHT rabbits, the effects of hypertriglyceridemia on health and diseases could be evaluated precisely.
Collapse
|
6
|
Identification of diacylglycerol acyltransferase inhibitors from Rosa centifolia petals. Lipids 2011; 46:691-700. [PMID: 21538210 DOI: 10.1007/s11745-011-3559-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 03/14/2011] [Indexed: 01/12/2023]
Abstract
Diacylglycerol acyltransferase (DGAT) catalyzes the final step of triacylglycerol (TAG) synthesis, and is considered as a potential target to control hypertriglyceridemia or other metabolic disorders. In this study, we found that the extract of rose petals suppressed TAG synthesis in cultured cells, and that the extract showed DGAT inhibitory action in a dose-dependent manner. Fractionation of the rose extract revealed that the DGAT inhibitory substances in the extract were ellagitannins; among them rugosin B, and D, and eusupinin A inhibited DGAT activity by 96, 82, and 84% respectively, at 10 μM. These substances did not inhibit the activities of other hepatic microsomal enzymes, glucose-6-phosphatase and HMG-CoA reductase, or pancreatic lipase, suggesting that ellagitannins inhibit DGAT preferentially. In an oral fat load test using mice, postprandial plasma TAG increase was suppressed by rose extract; TAG levels 2 h after the fat load were significantly lower in mice administered a fat emulsion containing rose extract than in control mice (446.3 ± 33.1 vs 345.3 ± 25.0 mg/dL, control vs rose extract group; P < 0.05). These results suggest that rose ellagitannins or rose extract could be beneficial in controlling lipid metabolism and used to improve metabolic disorders.
Collapse
|
7
|
Skjelbakken T, Dahl IMS, Løchen ML. Changes in body mass index and smoking habits have a different impact on hemoglobin concentration in men and women: a longitudinal follow-up of the Tromsø Study, 1994-2002. ACTA ACUST UNITED AC 2011; 7:230-9. [PMID: 20638628 DOI: 10.1016/j.genm.2010.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Body mass index (BMI) and smoking have been positively associated with hemoglobin concentration, and both are risk factors for cardiovascular disease. OBJECTIVE The aim of this study was to assess whether there were sex differences in how changes in BMI and smoking habits influenced hemoglobin concentration. METHODS In 1994-95 and 2001-02, a longitudinal, population-based study was conducted in the municipality of Tromsø, in northern Norway. Inhabitants aged > or =25 years were invited to participate. Participants replied to a questionnaire regarding health, physical activity, coffee and alcohol consumption, and smoking habits. Blood samples were drawn to analyze hemoglobin concentration. All analyses were performed separately for each sex. Differences between 1994-95 and 2001-02 were examined with t or chi(2) (McNemar) tests for paired data. Cross-sectional comparisons were made using 2-sample t tests. Different models of univariate and multiple linear regression analyses were used to investigate the impact of the various variables on hemoglobin change. RESULTS Data from a total of 2105 men and 2945 women were examined. At baseline, mean age was 58.9 years for men (range, 25-78 years) and 57.8 years for women (range, 25-82 years); mean BMI was 26.1 kg/m(2) for men and 25.8 kg/m(2) for women. In men, hemoglobin decreased with age, on average from 147.5 to 145.1 g/L. In women, hemoglobin decreased from 135.6 to 134.7 g/L, but increased with increasing age up to 54 years, and thereafter decreased gradually. Mean BMI increased 0.8 kg/m(2) in men and 1.2 kg/m(2) in women. In total, 394 of 2057 men (19%) and 499 of 2889 women (17%) stopped smoking or smoked fewer cigarettes per day. In a univariate regression model, an increase of 1 kg/m(2) in BMI was associated with an increase in hemoglobin of 1.1 g/L (95% CI, 0.84 to 1.27) in men and 0.4 g/L (95% CI, 0.30 to 0.56) in women. In another univariate model, smoking cessation was associated with a decrease in hemoglobin of 1.9 g/L (95% CI, -3.32 to -0.56) in men and 1.7 g/L (95% CI, -2.93 to -0.56) in women. In men who smoked less and had a BMI increase of >2.5 kg/m(2), hemoglobin decreased 0.3 g/L. In contrast, hemoglobin decreased 3.4 g/L in men who smoked less and lost weight (P for trend, < 0.001 by changing BMI). Women who smoked less had a decrease in hemoglobin independent of BMI changes. CONCLUSIONS The positive association between an increase in BMI and hemoglobin was stronger in men than in women. The effect of smoking reduction on hemoglobin was attenuated with increasing BMI in men, but not in women.
Collapse
Affiliation(s)
- Tove Skjelbakken
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
| | | | | |
Collapse
|
8
|
Johansson HE, Haenni A, Zethelius B. Changes in erythrocyte sedimentation rate, white blood cell count, liver enzymes, and magnesium after gastric bypass surgery. J Obes 2011; 2011:273105. [PMID: 22235366 PMCID: PMC3253464 DOI: 10.1155/2011/273105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/27/2011] [Indexed: 01/05/2023] Open
Abstract
Background. Roux-en-Y gastric bypass (RYGBP) is an established method for treatment of obesity, a condition of chronic inflammation with liver steatosis, characterised by increased erythrocyte sedimentation rate (ESR), white blood cell count (WBC), liver enzymes, and decreased magnesium (Mg). We investigated alterations, if any, in ESR, WBC, alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and Mg after RYGBP. Methods. 21 morbidly obese nondiabetic patients who underwent RYGBP surgery were evaluated preoperatively (baseline), then 1 year (1st followup) and 3.5 years (2nd followup) after RYGBP and compared to an untreated control group. Results. Body mass index, ESR, WBC, ALT, and GGT were all significantly reduced at 1 year in the RYGBP group (30%, 35%, 20%, 45%, and 57%, resp.) while Mg increased by 6%, compared to control group (P = 0.001-0.009). Conclusions. Obese patients treated by RYGBP show sustained reductions in ESR, WBC, ALT, and GGT possibly due to reduced liver steatosis and increased Mg.
Collapse
Affiliation(s)
- Hans-Erik Johansson
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University Hospital, 75185 Uppsala, Sweden
- *Hans-Erik Johansson:
| | - Arvo Haenni
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University Hospital, 75185 Uppsala, Sweden
| |
Collapse
|
9
|
Nordestgaard BG, Stender S, Kjeldsen K. Severe Hypertriglyceridemia, large lipoproteins and protection against atherosclerosis. Scandinavian Journal of Clinical and Laboratory Investigation 2010. [DOI: 10.1080/00365518709168149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
10
|
Faergeman O, Holme I, Fayyad R, Bhatia S, Grundy SM, Kastelein JJP, LaRosa JC, Larsen ML, Lindahl C, Olsson AG, Tikkanen MJ, Waters DD, Pedersen TR. Plasma triglycerides and cardiovascular events in the Treating to New Targets and Incremental Decrease in End-Points through Aggressive Lipid Lowering trials of statins in patients with coronary artery disease. Am J Cardiol 2009; 104:459-63. [PMID: 19660594 DOI: 10.1016/j.amjcard.2009.04.008] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 04/11/2009] [Accepted: 04/11/2009] [Indexed: 12/01/2022]
Abstract
We determined the ability of in-trial measurements of triglycerides (TGs) to predict new cardiovascular events (CVEs) using data from the Incremental Decrease in End Points through Aggressive Lipid Lowering (IDEAL) and Treating to New Targets (TNT) trials. The trials compared atorvastatin 80 mg/day with moderate-dose statin therapy (simvastatin 20 to 40 mg/day in IDEAL and atorvastatin 10 mg/day in TNT) in patients with clinically evident coronary heart disease or a history of myocardial infarction. The outcome measurement in the present research was CVE occurring after the first year of the trial. After adjusting for age, gender, and study, risk of CVEs increased with increasing TGs (p <0.001 for trend across quintiles of TGs). Patients in the highest quintile had a 63% higher rate of CVEs than patients in the lowest quintile (hazard ratio 1.63, 95% confidence interval 1.46 to 1.81) and the relation of TGs to risk was apparent even within the normal range of TGs. The ability of TG measurements to predict risk decreased when high-density lipoprotein cholesterol and apolipoprotein B:apolipoprotein A-1 were included in the statistical analysis, and it was abolished with inclusion of further variables (diabetes, body mass index, glucose, hypertension, and smoking; (p = 0.044 and 0.621, respectively, for trend across quintiles of TGs). Similar results were obtained in patients in whom low-density lipoprotein cholesterol had been lowered to guideline-recommended levels. In conclusion, even slightly increased TG levels are associated with higher risk of recurrence of CVEs in statin-treated patients and should be considered a useful marker of risk.
Collapse
Affiliation(s)
- Ole Faergeman
- Department of Medicine and Cardiology A, Arhus University Hospital, Arhus, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Parodi PW. Has the association between saturated fatty acids, serum cholesterol and coronary heart disease been over emphasized? Int Dairy J 2009. [DOI: 10.1016/j.idairyj.2009.01.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Hamsten A. Apolipoproteins, dyslipoproteinaemia and premature coronary heart disease. ACTA MEDICA SCANDINAVICA 2009; 223:389-403. [PMID: 3287836 DOI: 10.1111/j.0954-6820.1988.tb15890.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- A Hamsten
- Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden
| |
Collapse
|
13
|
Carlson LA, Rosenhamer G. Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. ACTA MEDICA SCANDINAVICA 2009; 223:405-18. [PMID: 3287837 DOI: 10.1111/j.0954-6820.1988.tb15891.x] [Citation(s) in RCA: 517] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Consecutive survivors of a myocardial infarction from the Southern Hospital, below 70 years of age, were randomized into a Control group (n = 276) and a Treatment group (n = 279). The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering. Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital. The concentration of serum cholesterol and triglyceride was lowered by 13% and 19%, respectively, in the Treatment group compared to the Control group. Total mortality was 82 cases in the Control group and 61 in the Treatment group, a 26% reduction (p less than 0.05). For patients above 60 years of age in the Treatment group the reduction in mortality was 28% (p less than 0.05). IHD mortality was reduced by 36% (p less than 0.01) in the Treatment group compared to the Control group. The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways. First, it only occurred in patients with a triglyceride level greater than 1.5 mmol/l (n = 216). Secondly, it was most pronounced in the 44% of the treated patients who had a lowering of the serum triglyceride by 30% or more, and in this subgroup the reduction of IHD mortality was 60% (p less than 0.01). For serum cholesterol there were no such relations. The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients, occurring in 50%, while hypercholesterolaemia only occurred in 13%. Caution should be exercised in the interpretation of the results as the trial was not blind. However, the fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was responsible for the beneficial effect of the treatment.
Collapse
Affiliation(s)
- L A Carlson
- King Gustaf V Research Institute, Karolinska Hospital, Stockholm, Sweden
| | | |
Collapse
|
14
|
de Faire U. Time for reestablishment of serum lipid lowering after myocardial infarction? ACTA MEDICA SCANDINAVICA 2009; 223:385-7. [PMID: 3376772 DOI: 10.1111/j.0954-6820.1988.tb15889.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
15
|
Simonsen T, Vårtun A, Lyngmo V, Nordøy A. Coronary heart disease, serum lipids, platelets and dietary fish in two communities in northern Norway. ACTA MEDICA SCANDINAVICA 2009; 222:237-45. [PMID: 3425379 DOI: 10.1111/j.0954-6820.1987.tb10665.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Coronary heart disease (CHD) mortality was registered in an inland and a coastal community in Northern Norway. Subgroups of healthy males from the communities were investigated further. The daily consumption of fish in the coastal and inland areas was 132.4 g and 55.1 g respectively, and the intake of eicosapentaenoic acid was 0.9 g and 0.25 g. The content of n-3 polyunsaturated fatty acids in platelet phospholipids and primary bleeding time were similar in the two groups. Linoleic acid was lower and saturated fatty acids were higher in phospholipids in men from the coastal area. Collagen-induced platelet aggregation was increased and serum triglyceride concentration was higher in men from the coastal area. CHD mortality during a 10-year period was higher in the coastal area for both sexes. This may be associated with differences in serum triglyceride levels and platelet fatty acid composition. This study indicates that a high consumption of lean fish is not sufficient to induce changes in blood lipids and platelet function associated with low CHD mortality and it does not seem to prevent high CHD mortality.
Collapse
Affiliation(s)
- T Simonsen
- Department of Internal Medicine, University Hospital, University of Tromsø, Norway
| | | | | | | |
Collapse
|
16
|
Dalaker K, Smith P, Arnesen H, Prydz H. Factor VII-phospholipid complex in male survivors of acute myocardial infarction. ACTA MEDICA SCANDINAVICA 2009; 222:111-6. [PMID: 3673663 DOI: 10.1111/j.0954-6820.1987.tb10646.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The presence of an activated form of coagulation factor VII--a factor VII-phospholipid complex--in male survivors of myocardial infarction is described. The level of this complex did not correlate with age or level of conventional risk factor score, but showed a highly significant positive correlation with serum triglycerides in all the subgroups as well as in the whole study population (r = 0.88, p less than 0.0001). Measurement of this form of activated factor VII may constitute a simple and promising method for additional screening of men at risk for cardiovascular disease.
Collapse
Affiliation(s)
- K Dalaker
- Research Institute for Internal Medicine, University of Oslo, Norway
| | | | | | | |
Collapse
|
17
|
Huhtasaari F, Asplund K, Wester PO. Cardiovascular risk factors in the Northern Sweden MONICA Study. ACTA MEDICA SCANDINAVICA 2009; 224:99-108. [PMID: 3421150 DOI: 10.1111/j.0954-6820.1988.tb16746.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In the WHO MONICA Study, determinants and trends in cardiovascular disease are monitored during a 10-year period in 40 centers in 27 countries. The Northern Sweden MONICA Center is located furthest to the north of all participating centers. In this report, baseline data on cardiovascular risk factors are presented. In the first population screening, 1,625 of 2,000 (81%) invited individuals participated. Diastolic blood pressure greater than or equal to 90 mmHg was recorded in 19% and 9% were on drug treatment for hypertension. Median cholesterol level was 6.10 mmol/l and the frequency of hypercholesterolemia was high. A body mass index of greater than or equal to 30, indicating severe obesity, was observed in 9%, a lower proportion than in most other European populations. Among men, the total proportion of tobacco consumers was 49%, including 22% snuffers. Of the women, 31% were tobacco consumers, very few being snuffers. Women had, in general, a more favorable cardiovascular risk factor profile up to the age of 45. Thereafter, the two genders were similar. By international comparisons, the population in northern Sweden is characterized by high serum cholesterol levels, intermediate blood pressure levels, a relatively low prevalence of severe obesity and a high consumption of smokeless tobacco.
Collapse
Affiliation(s)
- F Huhtasaari
- Department of Internal Medicine, Kalix Hospital, Sweden
| | | | | |
Collapse
|
18
|
Prognostic importance of hemoglobin in hypertensive patients with electrocardiographic left ventricular hypertrophy: the Losartan Intervention For End point reduction in hypertension (LIFE) study. Am Heart J 2009; 157:177-84. [PMID: 19081416 DOI: 10.1016/j.ahj.2008.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 08/08/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prognostic importance of hemoglobin is controversial. We investigated the prognostic importance of baseline and in-treatment hemoglobin in the LIFE study. METHODS Eight thousand one hundred ninety-four LIFE patients with hypertension and left ventricular hypertrophy with available baseline hemoglobin measurements were randomized to losartan- or atenolol-based treatment and followed for 4.8 years for end points of all-cause mortality and composite of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction. RESULTS U-shaped relations were observed between deciles of baseline hemoglobin and all-cause mortality and the composite end point. In univariate Cox models, baseline hemoglobin in the lowest gender-specific decile (women/men: <12.5/13.4 g/dL) was associated with all-cause mortality (hazard ratio [HR] 2.01, 95% CI 1.64-2.64) and the composite end point (HR 1.53, 95% CI 1.27-1.85, both P < .001), whereas hemoglobin in the highest gender-specific decile (women/men: > or =15.0/16.2 g/dL) was not. The decrease in hemoglobin was higher (P < .001) in patients allocated to losartan- (14.3-13.8 g/dL) versus atenolol-based treatment (14.3-14.0 g/dL). In Cox models with the same gender-specific definitions for high and low hemoglobin as time-varying covariates with adjustment for treatment allocation and established risk factors and diseases, hemoglobin in the lowest decile was associated with higher rates of all-cause mortality (HR 3.03, 95% CI 1.89-4.85, P < .001) and the composite end point (HR 1.36, 95% CI 1.08-1.71, P < .01), whereas hemoglobin in the highest decile was not. CONCLUSIONS After adjusting for other risk factors, relatively low, but not high, hemoglobin during antihypertensive treatment was associated with higher incidence of all-cause mortality and the composite end point.
Collapse
|
19
|
Abstract
The aim of to study the effect of Ballota undulata (70% EtOH) extract on lipid profile on Rabbits. The plant extract was orally administered to the atherogenic rabbits (atherogenic diet + cholesterol powder supplement 400 mg/kg/body weight/day dissolved in 5 mL coconut oil) at dose of 1.2 g kg(-1) body weight/day. During the overall period of the experiment blood was collected and serum was analyzed for lipid profile. Animals were sacrificed; the heart and the liver were collected and kept at -20 degrees C until assayed. Biochemical analysis of blood serum and tissue (liver and heart muscle) level were made for cholesterol, phospholipids and triglycerides. In addition blood serum was analyzed further for HDL-Cholesterol. All the results were statistically analyzed using students t-test. Hypolipidaemic nature of Ballota undulata (70% EtOH) extract was studied in hyperlipidaemic Rabbits. The increased cholesterol levels were brought to normal by administration of Ballota undulata. Serum cholesterol levels dropped from 940.7 to 230.41 (75.55%) and further to 119.2 (87.32%) by the end of the experiment. Similarly, phospholipids and triglycerides levels were observed to be also reduced. The tissues lipids profiles of liver and heart muscle showed similar changes in those noticed in serum lipids. Ballota undulata possesses active hypolipidaemic constituents.
Collapse
Affiliation(s)
- Walid Sh Qazan
- Department of Animal Production, Faculty of Agriculture and Science, Jerash Private University, P.O. Box 311, Jerash 26110, Jordan
| |
Collapse
|
20
|
Vickers MR, Meade TW, Wilkes HC. Hormone replacement therapy and cardiovascular disease: the case for a randomized controlled trial. CIBA FOUNDATION SYMPOSIUM 2007; 191:150-60; discussion 160-4. [PMID: 8582195 DOI: 10.1002/9780470514757.ch9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The menopause is associated with an increased risk of developing cardiovascular disease. Oestrogen may influence various metabolic pathways which contribute to the pathogenesis of cardiovascular disease, and observational studies suggest that in postmenopausal women oral oestrogen replacement therapy confers some protection against coronary heart disease and to a lesser extent against stroke. What is not clear is the magnitude of the cardioprotective effect and the overall balance of long-term benefits and hazards. Research is also required to establish the relative effects of oestrogen replacement therapy and combined or opposed hormone replacement therapy (HRT) where progestogen is added to counter the proliferative action of oestrogen on the endometrium. A large randomized controlled trial is the only way to provide accurate estimates of the cardioprotective effect of HRT and of other long-term benefits and hazards. Feasibility studies undertaken through the UK Medical Research Council (MRC) General Practice Research Framework show that such a trial is acceptable to patients and their doctors. Recruitment and withdrawal rates indicate that a trial of sufficient size to show a 25% reduction in cardiovascular disease with 90% power at the 1% level would be feasible. The full trial is costly and it is proposed that the UK collaborates with other countries in a major international trial to complement the Women's Health Initiative trial in the USA. Feasibility studies in Europe are underway, the design and scientific rationale for the trial have been approved by the UK MRC and it is hoped that recruitment to the full-scale trial can begin soon.
Collapse
Affiliation(s)
- M R Vickers
- MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, St Bartholomew's Hospital Medical College, London, UK
| | | | | |
Collapse
|
21
|
Daradka H, Almasad MM, Qazan WS, El-Banna NM, Samara OH. Hypolipidaemic effects of Citrullus colocynthis L. in rabbits. Pak J Biol Sci 2007; 10:2768-2771. [PMID: 19070101 DOI: 10.3923/pjbs.2007.2768.2771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Aim of this research to study the effect of Citrullus colocynthis (70% EtOH) extract on lipid profile on Rabbits. The plant extract was orally administered to the atherogenic rabbits (atherogenic diet + cholesterol powder supplement 400 mg/kg/body weight/day dissolved in 5 mL coconut oil) at dose of 1.2 g kg(-1) body weight/day. During the hall period of the experiment blood was collected and serum was analyzed for lipid profile. Animals were sacrificed; the heart and the liver were collected and kept at -20 degrees C until assayed. Biochemical analysis of blood serum and tissue (liver and heart muscle) level were made for cholesterol, Phospholipids and triglycerides. In addition blood serum was analyzed further for HDL-Cholesterol. All the results were statistically analyzed using students t-test. Hypolipidaemic nature of Citrullus colocynthis (70% EtOH) extract was studied in hyperlipidaemic Rabbits. The increased cholesterol levels were brought to normal by administration of Citrullus colocynthis. Serum cholesterol levels dropped from 940.7 to 230.41 (75.55%) and further to 119.2 (87.32%) by the end of the experiment. Similarly, phospholipids and triglycerides levels were observed to be also reduced. The tissues lipids profiles of liver and heart muscle showed similar changes in those noticed in serum lipids. Citrullus colocynthis possesses active hypolipidaemic constituents.
Collapse
Affiliation(s)
- Haytham Daradka
- Department of Biology, Faculty of Agriculture and Science, Jarash Private University, P.O. Box 311, Jarash 26110, Jordan
| | | | | | | | | |
Collapse
|
22
|
Kishimoto Y, Oga H, Tagami H, Okuma K, Gordon DT. Suppressive effect of resistant maltodextrin on postprandial blood triacylglycerol elevation. Eur J Nutr 2007; 46:133-8. [PMID: 17385061 DOI: 10.1007/s00394-007-0643-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 01/18/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the physiological functions of soluble dietary fibre, the favourable efficacy, such as attenuating the absorption of saccharides or lipids, is expected. Resistant maltodextrin, a soluble dietary fibre, was investigated and found that it delays the glucose absorption and attenuates the postprandial rise in the blood glucose levels, however, the efficacy of resistant maltodextrin on lipid metabolism is not yet reported. AIM OF THE STUDY We conducted an animal experiment and a human experiment to investigate the effect of resistant maltodextrin on postprandial blood triacylglycerol elevation. METHODS 1. Rats were fed corn oil with or without resistant maltodextrin and the postprandial changes in triacylglycerol were examined. 2. We then conducted a dietary loading experiment on 13 healthy adult male and female subjects using a meal containing approximately 50 g fat. A beverage not containing resistant maltodextrin was used as a placebo; subjects consumed the loading meal and a beverage containing either 5 g or 10 g resistant maltodextrin; blood was periodically collected to see the changes in serum constituents. RESULTS 1. The corn oil administration experiment using rats showed that resistant maltodextrin dose-dependently suppressed elevation of blood triacylglycerol levels after corn oil administration. 2. The dietary loading experiment on 13 healthy subjects with 5 or 10 g of resistant maltodextrin showed that; in each administration group, resistant maltodextrin significantly suppressed postprandial elevation of blood triacylglycerol, RLP-cholesterol and insulin. CONCLUSION These results indicate that resistant maltodextrin ingested with fatty meals suppresses the postprandial elevation of blood triacylglycerol levels.
Collapse
Affiliation(s)
- Yuka Kishimoto
- Research Laboratory, Matsutani Chemical Industry Co., Ltd., 5-3 Kita-Itami, Itami City, Hyogo 664-8508, Japan.
| | | | | | | | | |
Collapse
|
23
|
Skjelbakken T, Wilsgaard T, Førde OH, Arnesen E, Løchen ML. Haemoglobin predicts total mortality in a general young and middle-aged male population. The Tromsø Study. Scandinavian Journal of Clinical and Laboratory Investigation 2007; 66:567-76. [PMID: 17101548 DOI: 10.1080/00365510600863895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The prognostic value of haemoglobin within normal references is seldom emphasized. The relationship between haemoglobin and mortality has been questioned because of the possible confounding of other risk factors. We investigated whether there was a curve linear relationship between haemoglobin and total mortality, and evaluated the possible modifying effects of smoking, body mass index, total cholesterol and systolic blood pressure. MATERIALS AND METHODS In all, 6541 men aged between 20 and 49 years were examined in 1974 in a prospective, population-based study from the municipality of Tromsø, Northern Norway. During 20 years of follow-up (127 120 person-years), 495 deaths were identified. RESULTS We found a U-shaped relationship between quintiles of haemoglobin and total mortality. Among the 35-49 years group, the multiple adjusted hazard ratios (95% CI) were 1.83 (1.31-2.57) in quintile 1 and 1.72 (1.23-2.41) in quintile 5, compared to quintile 3 of haemoglobin. Compared to the age-adjusted hazard ratios, the multiple adjustments tended to non-significantly enhance the association in the lowest quintiles and non-significantly attenuate the association in the highest quintiles. The relationship was most pronounced in smokers in a dose-response manner, but also present in non-smokers. CONCLUSIONS High and low haemoglobin levels have an independent prognostic effect on mortality, although a possible effect of residual confounding cannot be ruled out. Smokers in quintile 1 and quintile 5 of haemoglobin were at increased risk of dying.
Collapse
Affiliation(s)
- T Skjelbakken
- Institute of Medicine, University of Trømso, Trømso, Norway.
| | | | | | | | | |
Collapse
|
24
|
Skjelbakken T, Dahl IMS, Wilsgaard T, Langbakk B, Løchen ML. Changes in haemoglobin levels according to changes in body mass index and smoking habits, a 20-year follow-up of a male cohort. Eur J Epidemiol 2006; 21:493-9. [PMID: 16858617 DOI: 10.1007/s10654-006-9032-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2006] [Indexed: 12/01/2022]
Abstract
Haemoglobin level declines with increasing age in cross sectional studies. Little is known about the longitudinal changes of haemoglobin. Because both high or low haemoglobin levels increase mortality and morbidity we examined how changes in lifestyle factors like body mass index (BMI) and smoking habits influence cohort changes in haemoglobin level. In all, 4159 men aged 20-49 years at baseline were examined in 1974 and 1994-1995 in a longitudinal, population-based study from the municipality of Tromsø, Northern Norway. Mean haemoglobin was 148 g/l. There was no difference in mean haemoglobin after 20 years in any strata of age. Mean BMI increased 2.1 kg/m(2). The prevalence of smokers decreased 20.1 percentage points. In a multiple regression analysis increase in BMI was associated with increased haemoglobin change. Smoking cessation lowered mean haemoglobin 1.6 g/l compared to never smokers. Haemoglobin increased 0.8 g/l in smoking quitters whose BMI increased >2.5 kg/m(2) compared to a decrease of 6.7 g/l in weight reducers. There was a positive dose-response relationship between changes in cigarettes smoked per day and change in haemoglobin among consistent smokers. In conclusion, in contrast to cross sectional studies, mean haemoglobin did not change during 20 years ageing of relatively young men. This could be explained by higher BMI and less smoking. The increase in BMI affected haemoglobin change to such an extent that the reduction in haemoglobin due to smoking cessation was counteracted. Prospective studies are needed to address the health implications.
Collapse
Affiliation(s)
- Tove Skjelbakken
- Institute of Community Medicine, University of Tromsø, N-9037, Tromsø, Norway.
| | | | | | | | | |
Collapse
|
25
|
Yoshida Y, Imaki M, Nishida K, Tanada S. Epidemiological Study of Periodontal Disease and White Blood Cell Count among Employees in a Company. J Occup Health 2006. [DOI: 10.1539/joh.39.92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Seiki Tanada
- Faculty of Pharmaceutical SciencesKinki University
| |
Collapse
|
26
|
. HO, . NO, . CN. Serum Lipids and Lipoproteins Profile in Hypertensive Patients Reporting for Treatment at Central Hospital, Benin City, Nigeria. JOURNAL OF MEDICAL SCIENCES 2005. [DOI: 10.3923/jms.2005.284.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
27
|
Kusama M, Kaise H, Nakayama S, Ota D, Misaka T, Aoki T. Crossover trial for lipid abnormality in postmenopausal breast cancer patients during selective estrogen receptor modulators (SERMs) administrations. Breast Cancer Res Treat 2005; 88:9-16. [PMID: 15538041 DOI: 10.1007/s10549-004-5449-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The objective of this study was to evaluate the different profiles of serum lipids resulting from the administration of selective estrogen receptor modulators (SERMs). Postmenopausal primary breast cancer patients (n = 197) with node-negative, hormone receptor-positive who were treated at our department or in other related medical institutions from April 1997 through March 2001 were given adjuvant therapy. The adjuvant therapy included 1 year's administration of tamoxifen (TAM) 20 mg or toremifene (TOR) 40 mg. The profiles of serum lipids such as total cholesterol (TC), high-density lipoprotein cholesterol (HDL) and triglyceride (TG) were observed. After 1 year administration TC had significantly decreased (p < 0.001) both in the TAM group and the TOR group, but no significant difference was found between these groups (p = 0.249). HDL had significantly decreased in the TAM group (p < 0.001), while it had significantly increased in the TOR group (p < 0.001), and a significant difference was found between the groups (p < 0.001). TG had significantly increased in the TAM group (p < 0.001) but significantly decreased in the TOR group (p < 0.001). The medication was switched in those who still had abnormal lipid metabolism and given to them for another year. After 1 year from the crossover TC and HDL had increased to the levels of before administration (p < 0.001) and TG had decreased in those (n = 57) whose medication was switched from TAM to TOR. While TC had decreased and TG had increased in those (n = 23) whose medication was switched from TOR to TAM (p < 0.001). The above findings have suggested that TOR provides better profiles of lipid metabolism than TAM.
Collapse
Affiliation(s)
- Mikihiro Kusama
- The Third Department of Surgery, Tokyo Medical University, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
28
|
Lindquist P, Bengtsson C, Lissner L, Björkelund C. Cholesterol and triglyceride concentration as risk factors for myocardial infarction and death in women, with special reference to influence of age. J Intern Med 2002; 251:484-9. [PMID: 12028503 DOI: 10.1046/j.1365-2796.2002.00985.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the importance of serum cholesterol and triglyceride concentrations as predictors of myocardial infarction and death in women of different ages. DESIGN Prospective observational study, initiated in 1968-69. Setting. Gothenburg, Sweden, with about 430 000 inhabitants. SUBJECTS A population-based sample of 1462 women aged 38, 46, 50, 54 and 60 years at start of the study, followed up for 24 years. Main outcome measures. Within each age group, myocardial infarction and death were predicted by serum cholesterol and triglyceride concentrations and smoking in a multivariate model. RESULTS In the total population only serum triglyceride concentration was a strong independent risk factor for both end-points studied. Serum triglyceride concentration measured in 38- and 46-year-old women had no predictive value with respect to 24-year incidence of myocardial infarction or death. In 50-, 54- and 60-year-old women, high serum triglyceride concentration consistently predicted myocardial infarction and total mortality. Serum cholesterol concentration, on the other hand, showed evidence of direct association for 24-year all-cause mortality in the younger premenopausal group. Serum cholesterol had no predictive value for myocardial infarction or mortality in the peri- and postmenopausal ages. CONCLUSIONS There appears to be age-specificity in association between serum lipids and these end-points in women, serum cholesterol concentration being more important for younger women and serum triglyceride concentration more important for postmenopausal women as risk factors, observations which need further attention.
Collapse
Affiliation(s)
- P Lindquist
- Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
| | | | | | | |
Collapse
|
29
|
Kemmeren JM, Algra A, Grobbee DE. Effect of second and third generation oral contraceptives on lipid metabolism in the absence or presence of the factor V Leiden mutation. J Intern Med 2001; 250:441-8. [PMID: 11887980 DOI: 10.1046/j.1365-2796.2001.00906.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The effect of a second and third generation oral contraceptive and of the progestagens used in these pills on lipid metabolism was studied in the absence or presence of the factor V Leiden mutation. DESIGN A single centre, double blind randomized trial. SETTING University Medical Centre. SUBJECTS A total of 51 women without and 35 women with the factor V Leiden mutation. INTERVENTIONS A second generation (30 microg ethinylestradiol/150 microg levonorgestrel) or a third generation (30 microg ethinylestradiol/l 50 microg desogestrel) oral contraceptive. After two cycles of use and a wash-out period of two cycles, the participants received the corresponding progestagen-only preparation containing 150 microg levonorgestrel or 150 microg desogestrel. MAIN OUTCOME MEASURES Mean difference in changes between the treatment groups on total cholesterol, HDL, LDL, triglycerides and total/HDL cholesterol ratio. RESULTS Compared with levonorgestrel, desogestrel-containing oral contraceptives caused in women without the factor V Leiden mutation significant changes in HDL (0.43; 95% confidence interval [CI] 0.25-0.61), LDL (-0.55; 95% CI -0.90 to -0.20), triglycerides (0.19; 95% CI 0.06-0.32) and total/ HDL cholesterol ratio (-0.87; 95% CI -1.21 to -0.53). When the progestagen-only preparations were used, differential changes were found for HDL (0.16; 95% CI 0.03-0.29), LDL (-0.31; 95% CI - 0.56 to -0.05) and total/HDL cholesterol ratio (-0.55; 95% CI -0.84 to -0.26). Desogestrel-only caused changes opposite to those of desogestrel-containing oral contraceptives. For cholesterol and triglycerides, this effect was also found for levonorgestrel-only in comparison with levonorgestrel-combined oral contraceptives. Levonorgestrel appeared to induce the effect on HDL. Almost all results were similar for women with the factor V Leiden mutation. CONCLUSION It appears that desogestrel counteracts the effects of oestrogens to a lesser extent than levonorgestrel. Desogestrel-containing oral contraceptives have therefore a more favourable influence on cholesterol metabolism in comparison with levonorgestrel-containing oral contraceptives.
Collapse
Affiliation(s)
- J M Kemmeren
- Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, The Netherlands
| | | | | |
Collapse
|
30
|
Weber T, Berent R, Kirchgatterer A, Auer J, Mayr H, Schwarz C, Maurer E, Punzengruber C, Hartl P, Eber B. [Coronary artery bypass graft dysfunction--clinical presentation, laboratory and electrocardiographic parameters]. ACTA MEDICA AUSTRIACA 2001; 28:5-10. [PMID: 11253630 DOI: 10.1046/j.1563-2571.2001.01002.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The recurrence of symptoms after coronary artery bypass surgery is often caused by bypass-dysfunction. In this study we tried to determine factors related to the long-term patency of arterial and venous bypass grafts. We evaluated all patients with bypass grafts undergoing coronary angiography in the year 1998 at our hospital (163 patients, mean age 67 years, mean interval since the operation 79 months, a total of 341 venous bypasses (VBP), 386 peripheral venous anastomoses and 85 arterial (LIMA = left internal mammarial artery) bypasses. The data were collected by a retrospective analysis of the hospital records. Statistics were performed using the Wilcoxon-Mann-Whitney-U test. After an interval of 53 months LIMA-bypasses were patent without stenosis in 92%. Symptoms were caused in only 2% by a dysfunction of the LIMA-graft. The patency of venous bypass grafts decreased with time (5 years after the operation 74% were patent without stenosis, 5-10 years 56%, more than 10 years 35%, p < 0.01). We found clear relations between the function of the venous grafts and the clinical presentation (patent grafts without stenosis in 43% with acute coronary syndromes, in 57% with stable angina [p = 0.08] and in 86% with atypical angina [p < 0.0001 for the difference between each of the first two and the last syndrome]), the resting-ECG (65% patent VBP without stenosis with normal ST-segments and 49% with abnormal ST-segments, p < 0.01), the body-mass-index (70% patent VBP without stenosis with a BMI < 25 and 56% with a BMI > 30, p = 0.05) and the erythrocyte sedimentation rate after 2 hours (79% patent VBP with an ESR < or = 20 mm vs. 64% with an ESR > 49 mm, p = 0.02). The function of VBP after coronary artery bypass graft (CABG)-procedure depends primarily upon the interval since the operation. In addition, we found correlations with clinical presentation, resting-ECG, body-mass-index and erythrocyte-sedimentation rate as a possible marker of inflammation in bypass-atherosclerosis. Therefore, inflammatory processes seem to play an important role in the development of venous graft dysfunction.
Collapse
Affiliation(s)
- T Weber
- II. Internen Abteilung mit Kardiologie, I. Chirurgischen Abteilung für Herz- und Thoraxchirurgie des A. ö. Krankenhauses der Barmherzigen Schwestern vom Heiligen Kreuz, Grieskirchnerstrasse 42, A-4600 Wels.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
In the past, the relation between hypertriglyceridemia and coronary heart disease (CHD) has been uncertain. However, a recent multivariate analysis of 8-year follow-up data from the large-scale Prospective Cardiovascular Münster study found hypertriglyceridemia to be an independent risk factor for major coronary events after controlling for low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. Hypertriglyceridemia combined with elevated LDL cholesterol and high LDL:HDL cholesterol ratio (>5) increased the CHD event risk by approximately sixfold. Similarly, a large meta-analysis of 17 prospective trials reported hypertriglyceridemia to be an independent risk factor for cardiovascular disease. In this study, an 88 mg/dl (1.0 mmol/L) increase in plasma triglyceride levels significantly increased the relative risk of cardiovascular disease by approximately 30% in men and 75% in women; the corresponding rates were somewhat lower (14% and 37%) but still statistically significant after adjustment for HDL cholesterol level. These data and observations from patients in the Helsinki Heart Study and the Stockholm Ischemic Heart study, that the greatest coronary benefit during lipid-lowering drug therapy occurred among hypertriglyceridemic patients, argue strongly for an independent role for hypertriglyceridemia in CHD risk. In the recent Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial, the use of gemfibrozil to raise HDL cholesterol levels and lower levels of triglycerides without lowering LDL cholesterol levels reduced coronary events in men with established CHD, whereas preliminary results from the Bezafibrate Infarction Prevention Trial indicate a reduction in coronary end points in patients with elevated baseline triglyceride levels. To achieve the greatest possible reduction in CHD risk, antihyperlipidemic treatment strategies should also be aimed at reducing elevated triglycerides.
Collapse
Affiliation(s)
- P Cullen
- Institut für Arterioskleroseforschung, Zentrallaboratorium, Universität Münster, Germany.
| |
Collapse
|
32
|
Stavenow L, Kjellström T. Influence of serum triglyceride levels on the risk for myocardial infarction in 12,510 middle aged males: interaction with serum cholesterol. Atherosclerosis 1999; 147:243-7. [PMID: 10559509 DOI: 10.1016/s0021-9150(99)00190-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To study the influence of different levels of serum (s)-triglycerides in relation to s-cholesterol on the risk of myocardial infarction. DESIGN AND SUBJECTS A 6-13 (mean 10) year follow-up of 12,510 middle-aged men. Fasting s-triglycerides and s-cholesterol were measured at the screening examination. SETTING Section of Preventive Medicine at the Department of Internal Medicine, Malmö General Hospital, an urban hospital for 240,000 inhabitants in southern Sweden. INTERVENTION In minor groups of patients there were interventions addressing high lipid levels, high alcohol consumption, hypertension and glucose intolerance. MAIN OUTCOME MEASURE Myocardial infarction was used as an end-point. RESULTS 446 myocardial infarctions occurred. The cumulative incidence rates were for the lowest triglyceride quartile 1.2%, for the second 3.2%, for the third 4.1% and for the highest 5.6%. After adjustment for age, year of screening, body mass index, diabetes, smoking, hypertension and s-cholesterol there was a significant relationship between triglycerides and the relative risk for myocardial infarction (P for trend=0.0087). For increasing levels of triglycerides, adjusted for the above factors except cholesterol, the impact of a certain cholesterol value for the occurrence of myocardial infarction was increased (P for trend=0.0092). CONCLUSIONS The present study emphasizes the interaction between cholesterol and triglyceride values for the risk of myocardial infarction. It is concluded that at triglyceride values above 1.0 mmol/l and cholesterol above 6.8 mmol/l there is an increasing interaction between cholesterol and triglyceride levels that might be of importance when evaluating the cardiovascular risk of middle aged men.
Collapse
Affiliation(s)
- L Stavenow
- Department of Medicine, Malmö University Hospital, University of Lund, S-205 02, Malmö, Sweden
| | | |
Collapse
|
33
|
Toyota Y, Yamamura T, Miyake Y, Yamamoto A. Low density lipoprotein (LDL) binding affinity for the LDL receptor in hyperlipoproteinemia. Atherosclerosis 1999; 147:77-86. [PMID: 10525128 DOI: 10.1016/s0021-9150(99)00166-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We measured the binding affinity of low density lipoprotein (LDL) for the LDL receptor in patients with various types of hyperlipoproteinemia and investigated the effects of LDL lipid composition and particle size on receptor affinity. LDL (1.019 < d < 1.063) was isolated by sequential ultracentrifugation from the serum of normolipidemic controls and patients with hyperlipoproteinemia. Patients with type IIa hyperlipoproteinemia had LDL with a similar receptor affinity to that of normal LDL. However, patients with hypertriglyceridemia (type IIb and type IV hyperlipoproteinemia) had LDL with a low receptor affinity, and the degree of the reduction in affinity paralleled the severity of the hypertriglyceridemia. The LDL of hypertriglyceridemic patients was rich in protein and triglycerides, had a low content of cholesterol and phospholipids, and was smaller than normal, thus resembling the atherogenic lipoprotein known as small, dense LDL. These abnormalities were observed even in patients with mild hypertriglyceridemia regardless of their serum cholesterol levels. The degree of alteration in LDL lipid composition and particle size was strongly associated with the reduction of LDL receptor affinity. We also examined the effects of two lipid-lowering agents (bezafibrate and probucol) on the characteristics of LDL. LDL receptor affinity was only improved when the lipid composition and particle size were normalized by drug therapy. Although it has been reported that decreased cholesteryl ester transfer protein (CETP) activity results in the formation of small LDL, plasma CETP activity was normal in the hyperlipoproteinemic patients and the normalization of LDL characteristics by drug therapy was not accompanied by an increase of CETP activity. Our results suggested that an abnormal lipid composition and/or small particle size might cause a decrease in the receptor affinity of LDL. These structural and functional abnormalities were reversed by drug therapy, underlining the importance of treating hypertriglyceridemia for the prevention of atherosclerosis.
Collapse
Affiliation(s)
- Y Toyota
- Department of Etiology and Pathophysiology, National Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan
| | | | | | | |
Collapse
|
34
|
Chin LC, Huang TY, Yu CL, Wu CH, Hsu CC, Yu HS. Increased cutaneous blood flow but impaired post-ischemic response of nutritional flow in obese children. Atherosclerosis 1999; 146:179-85. [PMID: 10487502 DOI: 10.1016/s0021-9150(99)00135-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is well known that cardiovascular risk factors and dyslipidemia along with obesity can be identified early in life. Serum lipids and lipoproteins influence skin vessel reactivity in adults. The purpose of this study was to investigate the cutaneous microcirculation and its correlation to dyslipidemia in obese children. Thirty-four obese children and an equal number of age- and sex-matched healthy children were enrolled in this study. Laser Doppler flowmetry and dynamic capillaroscopy were performed to measure total cutaneous blood flow and nutritional blood flow, respectively. A significantly higher cutaneous baseline flow and peak flow after a 1-min arterial occlusion was noticed in obese group as compared to normal control. Results of dynamic capillaroscopy revealed values of resting capillary blood cell velocity that did not differ from controls but a significantly lower peak CBV after a 1-min arterial occlusion in obesity. Plasma lipids examination showed a high triglycerides and low high density lipoprotein cholesterol levels in obesity. Pearson analysis detected no significant correlations between pCBV, baseline flow and peak flow and dyslipidemia in obesity. These results may be explained by the fact that the duration of dyslipidemia in our study population was not long enough to cause vascular damage or the dyslipidemia was not pronounced enough to have an impact on skin vessel activity tests. It is also possible, that the combination of methods used in the present study was not sensitive enough to detect an existing correlations between flow values and high triglycerides/low HDL-cholesterol values in the obese group. Our results suggest that all the responses of the cutaneous microcirculation were mainly due to physiological compensatory rather than pathological reactions in young obese children. The results of cutaneous microcirculatory assessment in obese children provide follow-up parameters for assessing the risk of cardiovascular diseases later in life.
Collapse
Affiliation(s)
- L C Chin
- Department of Dermatology, Kaohsiung Medical College and Provincial Ping-Tung Hospital, Taiwan, ROC
| | | | | | | | | | | |
Collapse
|
35
|
El-Hazmi MA, Al-Swailem AR, Warsy AS, Al-Meshari AA, Sulaimani R, Al-Swailem AM, Magbool GM. Lipids and related parameters in Saudi type II diabetes mellitus patients. Ann Saudi Med 1999; 19:304-7. [PMID: 17277529 DOI: 10.5144/0256-4947.1999.304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-insulin dependent diabetes mellitus (type II DM) is frequently associated with abnormal levels of lipids, particularly in patients with poor diabetic control. This study was designed to investigate the influence of type II DM on levels of plasma lipids and other related parameters in Saudi patients. Saudi Arabia has a high prevalence of diabetes mellitus in the adult population. Since the Saudi population presents a unique group with different dietary habits, lifestyle and genetic make-up, we investigated the lipids, lipoprotein and apolipoprotein pattern in Saudi type II DM patients. MATERIALS AND METHODS This study was conducted on 2835 diabetic patients (1361 males, 1474 females) and 200 age-matched healthy adults from the same areas with no history of diabetes mellitus. Data collected included height, weight, body mass index (BMI), blood pressure and other relevant parameters. Lipids, lipoproteins and apolipoproteins were estimated, and correlation studies were carried out between these parameters. Lipids, lipoproteins and apolipoproteins were also correlated with the fasting blood glucose. RESULTS Our results showed significant elevation in cholesterol and triglyceride, apo A and apo B levels in the diabetic males and females compared to the controls. Approximately 37% of the total DM patients fell in the borderline risk group, while 28.4% fell in the high-risk group for development of cardiovascular disease. Lipoproteins did not differ significantly. Cholesterol, triglyceride, VLDL, LDL and Hb A1c correlated positively with glucose (P<0.05), while triglyceride, VLDL, HDL, LDL, apo A and apo B showed significant correlation with cholesterol, where all parameters increased with cholesterol except HDL, which decreased as cholesterol increased. CONCLUSION The findings point toward high prevalence of dyslipidemia in type II DM Saudi patients.
Collapse
Affiliation(s)
- M A El-Hazmi
- College of Medicine, King Saud University, Ministry of Health, and College of Science, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | | | | |
Collapse
|
36
|
Uptake of type IV hypertriglyceridemic VLDL by cultured macrophages is enhanced by interferon-γ. J Lipid Res 1999. [DOI: 10.1016/s0022-2275(20)33505-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
37
|
Lewis TV, Dart AM, Chin-Dusting JP. Endothelium-dependent relaxation by acetylcholine is impaired in hypertriglyceridemic humans with normal levels of plasma LDL cholesterol. J Am Coll Cardiol 1999; 33:805-12. [PMID: 10080485 DOI: 10.1016/s0735-1097(98)00667-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients with high triglyceride (of which very low density lipoproteins [VLDL] are the main carriers), but with normal low density lipoprotein (LDL) cholesterol levels, were examined for in vivo endothelium function status. BACKGROUND Very low density lipoproteins inhibit endothelium-dependent, but not -independent, vasorelaxation in vitro. METHODS Three groups were studied: 1) healthy volunteers (n = 10; triglyceride 1.24+/-0.14 mmol/liter, LDL cholesterol 2.99+/-0.24 mmol/liter); 2) hypertriglyceridemic (n = 11; triglyceride 6.97+/-1.19 mmol/liter, LDL cholesterol 2.17+/-0.2 mmol/liter, p < 0.05); and 3) hypercholesterolemic (n = 10; triglyceride 2.25+/-0.29 mmol/liter, LDL cholesterol 5.61+/-0.54 mmol/liter; p < 0.05) patients. Vasoactive responses to acetylcholine, sodium nitroprusside, noradrenaline, N(G)-monomethyl-L-arginine and postischemic hyperemia were determined using forearm venous occlusion plethysmography. RESULTS Responses to acetylcholine (37 microg/min) were significantly dampened both in hypercholesterolemic (% increase in forearm blood flow: 268.2+/-62) and hypertriglyceridemic patients (232.6+/-45.2) when compared with controls (547.8+/-108.9; ANOVA p < 0.05). Responses to sodium nitroprusside (at 1.6 microg/min: controls vs. hypercholesterolemics vs. hypertriglyceridemic: 168.7+/- 25.1 vs. 140.6+/-38.9 vs. 178.5+/-54.5% increase), noradrenaline, N(G)-monomethyl-L-arginine and postischemic hyperemic responses were not different among the groups examined. CONCLUSIONS Acetylcholine responses are impaired in patients with pathophysiologic levels of plasma triglycerides but normal plasma levels of LDL cholesterol. The impairment observed was comparable to that obtained in hypercholesterolemic patients. We conclude that impaired responses to acetylcholine normally associated with hypercholesterolemia also occur in hypertriglyceridemia. These findings identify a potential mechanism by which high plasma triglyceride levels may be atherogenic independent of LDL cholesterol levels.
Collapse
Affiliation(s)
- T V Lewis
- Alfred and Baker Medical Unit, Baker Medical Research Institute and The Alfred Hospital, Prahran, Victoria, Australia
| | | | | |
Collapse
|
38
|
Asplund-Carlson A, Lund E, Björkhem I, Carlson LA. Studies in hypertriglyceridaemia. VI: Serum lathosterol concentration is raised in hypertriglyceridaemic non-diabetic males with hyperinsulinaemia. J Intern Med 1999; 245:247-52. [PMID: 10205586 DOI: 10.1046/j.1365-2796.1999.0436e.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the cholesterol synthesis rate in primary hypertriglyceridaemia using the serum unesterified lathosterol concentration as an indicator. DESIGN A cross-sectional, case-control study. SETTING The Karolinska Hospital, Stockholm. SUBJECTS Randomly selected hyper- (n = 53) and normotriglyceridaemic (n = 57) males, 40-50 years, with a fasting serum triglyceride concentration (mean +/- SD) of 3.81 +/- 1.65 and 1.28 +/- 0.53 mmol L-1, respectively. The exclusion criterion was diabetes mellitus, defined according to the World Health Organization (WHO) guidelines. MAIN OUTCOME MEASURES To compare the fasting serum concentration distributions of lathosterol, a cholesterol precursor, in hyper- and normotriglyceridaemic groups. RESULTS Thirty-six per cent of the hypertriglycerdaemic group had raised serum lathosterol concentrations, based on the 90th percentile of the lathosterol distribution of the normotriglyceridaemic group. In the hyper- but not in the normotriglyceridaemic group, lathosterol concentration was directly correlated with serum insulin responses to oral (r = 0.38; P = 0.007) and intravenous (r = 0.41; P = 0.005) glucose challenges. CONCLUSIONS One-third of a randomly selected non-diabetic hypertriglyceridaemic population had an increased serum lathosterol concentration and this might indicate an increased cholesterol synthesis rate compatible with increased production of VLDL particles, possibly as the result of chronic hyperinsulinaemia.
Collapse
Affiliation(s)
- A Asplund-Carlson
- King Gustaf V Research Institute, Karolinska Hospital, Stockholm, Sweden
| | | | | | | |
Collapse
|
39
|
Agheli N, Kabir M, Berni-Canani S, Petitjean E, Boussairi A, Luo J, Bornet F, Slama G, Rizkalla SW. Plasma lipids and fatty acid synthase activity are regulated by short-chain fructo-oligosaccharides in sucrose-fed insulin-resistant rats. J Nutr 1998; 128:1283-8. [PMID: 9687545 DOI: 10.1093/jn/128.8.1283] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to evaluate the chronic effects of a short-chain fructo-oligosaccharide (FOS)-containing diet on plasma lipids and the activity of fatty acid synthase (FAS) in insulin-resistant rats. Normal male Sprague-Dawley rats, 5 wk old, were randomly assigned to two groups and fed either a sucrose-rich diet (S, 575 g sucrose /kg diet and 140 g lipids/kg diet) or a sucrose-rich diet supplemented with 10 g/100 g short-chain fructo-oligosaccharides (S/FOS). A third reference group (R) was fed a standard nonpurified diet (g/kg, 575 g starch, 50 g fat). After 3 wk the sucrose-fed rats (compared with the R group) were characterized by the following: 1) higher insulin responses after a glucose challenge (P < 0.05); 2) heavier liver (P < 0.001) and retroperitoneal adipose tissue (P < 0.01); 3) hypertriglyceridemia (P < 0.0001) and higher plasma free fatty acids (P < 0.0001); and 4) higher fatty acid synthase activity in the liver but a low activity in the adipose tissue (P < 0.001). The addition of FOS to the diet resulted in 11% lower liver weight than in the S group (P < 0.05) and tended to result in lower adipose tissue weight (P < 0.11). Plasma triglycerides and plasma free fatty acids were lower in S/FOS- than in S-fed rats (P < 0.05). Chylomicrons + VLDL, and intermediate density lipoprotein (IDL) concentrations did not differ between groups, nor was plasma cholesterol influenced by diet. Hepatic FAS activity was lower in S/FOS-fed rats than in the S-fed rats (P < 0.05). In adipose tissue, however, this activity tended to be greater in rats fed S/FOS than in rats fed the S diet (P < 0.07). In conclusion, in a rat model of diet-induced (57.5% sucrose and 14% lipids) insulin resistance, the addition of short-chain FOS prevented some lipid disorders, lowered fatty acid synthase activity in the liver and tended to raise this activity in the adipose tissue. Short-chain FOS, in addition to being a nondigestible sweetener with good bulking capacity, might be useful in the treatment of insulin resistance and hyperlipidemia.
Collapse
Affiliation(s)
- N Agheli
- Department of Diabetes and INSERM U341, Hôtel-Dieu Hospital, 75004 Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Whitman SC, Sawyez CG, Miller DB, Wolfe BM, Huff MW. Oxidized type IV hypertriglyceridemic VLDL-remnants cause greater macrophage cholesteryl ester accumulation than oxidized LDL. J Lipid Res 1998. [DOI: 10.1016/s0022-2275(20)33868-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
41
|
McKenney JM, McCormick LS, Weiss S, Koren M, Kafonek S, Black DM. A randomized trial of the effects of atorvastatin and niacin in patients with combined hyperlipidemia or isolated hypertriglyceridemia. Collaborative Atorvastatin Study Group. Am J Med 1998; 104:137-43. [PMID: 9528731 DOI: 10.1016/s0002-9343(97)00311-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To assess the lipid-lowering effects and safety of atorvastatin and niacin in patients with combined hyperlipidemia or isolated hypertriglyceridemia. METHODS We performed a randomized, open-label, parallel-design, active-controlled, study in eight centers in the United States. We enrolled 108 patients with total cholesterol (TC) of > or =200 mg/dL, serum triglycerides (TG) > or =200 and < or =800 mg/dL, and apolipoprotein B (apo B) > or =110 mg/dL. Patients were randomly assigned to receive atorvastatin 10 mg once daily (n=55) or immediate-release niacin 1 g three times daily for 12 weeks (n=53). Patients were stratified based on low-density lipoprotein cholesterol (LDL-C): Patients with LDL-C > or =135 mg/dL were considered to have combined hyperlipidemia and patients with LDL-C <135 mg/dL were considered to have isolated hypertriglyceridemia. The primary outcome measure was percent change from baseline in LDL-C. Other lipid levels were evaluated as secondary parameters. RESULTS Atorvastatin reduced LDL-C 30% and TC 26% from baseline, and increased high-density lipoprotein cholesterol (HDL-C) 4%. Total TG were reduced 17%. Niacin reduced LDL-C 2%, TC 7%, increased HDL-C 25%, and reduced total TG 29% from baseline. There was a significant difference in LDL-C reduction, the primary efficacy parameter, between the two treatment groups (P <0.05, favoring atorvastatin), as well as a significant difference in the improvement in HDL-C (P <0.05, favoring niacin). The effect of atorvastatin was relatively consistent between patients with combined hyperlipidemia and isolated hypertriglyceridemia, whereas there was more variability between these strata in the niacin treatment group. Atorvastatin was better tolerated than niacin. CONCLUSION Atorvastatin may allow patients with combined hyperlipidemia to be treated with monotherapy and offers an efficacious and well-tolerated alternative to niacin for the treatment of patients with isolated hypertriglyceridemia.
Collapse
|
42
|
Kagawa K, Matsutaka H, Fukuhama C, Fujino H, Okuda H. Suppressive effect of globin digest on postprandial hyperlipidemia in male volunteers. J Nutr 1998; 128:56-60. [PMID: 9430602 DOI: 10.1093/jn/128.1.56] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We have reported previously that various edible protein digests inhibit dietary hyperlipidemia in mice, rats, pigs and dogs. Of the various digests tested, globin digest had the most potent inhibitory activity, and a tetrapeptide extracted from globin digest, Val-Val-Tyr-Pro, had activity 7000-fold greater than that of the parent digest. In this clinical study, we investigated the influence of globin digest on serum chylomicron triglyceride concentrations as an indicator of the effect of globin digest on fat absorption and catabolism in humans. Parallel and crossover trials were conducted in which men consumed a control high fat diet (25 g fat, 7.6 g carbohydrate, 1.9 g protein and 0.7 g sodium chloride) or the same diet supplemented with globin digest. The supplemented dosages were 1 and 4 g globin digest. In the parallel trial, 22 men were divided into three groups: control, globin digest 1 g and globin digest 4 g. The increases in chylomicron triglyceride concentrations at 1 h after ingestion of 1 or 4 g globin digest were significantly lower (P < 0.05) compared with the control group. The crossover trial involved six subjects who consumed the control high fat diet and the same diet supplemented with 4 g globin digest. Serum chylomicron triglyceride levels increased in both groups at 1 and 2 h after ingestion, but when subjects consumed 4 g globin digest the increases were suppressed to 75 (P < 0.05) and 42% (P < 0.05) of the increases in controls at the corresponding times, respectively. The areas under the curves of chylomicron and serum total triglyceride concentrations during the 4 h after ingestion of 4 g globin digest were 46 (P < 0.05) and 34% (P < 0.05) lower, respectively, than when the men consumed the high fat control diet. In these trials, globin digest reduced the increase in serum chylomicron triglyceride concentrations as a result of the ingestion of a high fat diet. This hypotriglyceridemic effect of globin digest may be valuable for preventing obesity and in lowering the incidence of cardiovascular diseases.
Collapse
Affiliation(s)
- K Kagawa
- Pharmacological Laboratory, Hankyu Kyoei Bussan Company, Ikeda, Osaka 563, Japan
| | | | | | | | | |
Collapse
|
43
|
Hänggi W, Lippuner K, Riesen W, Jaeger P, Birkhäuser MH. Long-term influence of different postmenopausal hormone replacement regimens on serum lipids and lipoprotein(a): a randomised study. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:708-17. [PMID: 9197875 DOI: 10.1111/j.1471-0528.1997.tb11982.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the influence of three different postmenopausal hormone replacement therapies on levels of serum lipids and lipoprotein(a) [Lp(a)]. DESIGN Open, randomised, controlled study. PARTICIPANTS One hundred and forty healthy, early postmenopausal women. INTERVENTIONS The women were randomised to receive continuous 17 beta-oestradiol, either orally (2 mg daily; n = 35) or transdermally (50 micrograms daily; n = 35), plus 10 mg dydrogesterone daily for 14 days of each 28-day cycle; or 2.5 mg tibolone daily (n = 35). Thirty-five untreated women acted as controls. MAIN OUTCOME MEASURES Fasting blood samples were analysed at baseline, 6, 12 and 24 months for low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, very low density lipoprotein (VLDL), total cholesterol, triglycerides, lipoprotein(a)[Lp(a)], apolipoproteins A-1, A-2 and B, fibrinogen, and antithrombin factor III. RESULTS At 24 months oral oestradiol increased mean HDL cholesterol (7%; 95% CI 1-14), compared with no change in the transdermal group and a decrease of 26.8% in the tibolone group (95% CI 22.9-30.5); oral oestradiol decreased mean LDL cholesterol (11.8%; 95% CI 6.3-19), compared with no change in the tibolone group. Changes in apolipoprotein A-1 and B showed a similar pattern to HDL and LDL cholesterol, respectively. Oral oestradiol increased serum triglycerides (30%; 95% CI 18-42) after 24 months, compared with no change in the tibolone and transdermal oestradiol groups. Tibolone decreased serum Lp(a) by 36.6% after 24 months (95% CI 8.3-56.2), oral oestradiol decreased levels by 29.4% (95% CI 2-51.1), compared with no change in the transdermal oestradiol group. CONCLUSIONS Oral and to a lesser extent transdermal oestradiol when sequentially combined with dydrogesterone, showed a beneficial influence on serum lipids regarding the cardiovascular disease risk, which was not seen with tibolone. The significance of Lp(a) levels on cardiovascular disease risk remains to be determined.
Collapse
Affiliation(s)
- W Hänggi
- Department of Gynaecology and Obstetrics, University of Bern, Switzerland
| | | | | | | | | |
Collapse
|
44
|
Fraser JD, Keller D, Martinez V, Santiso-Mere D, Straney R, Briggs MR. Utilization of recombinant adenovirus and dominant negative mutants to characterize hepatocyte nuclear factor 4-regulated apolipoprotein AI and CIII expression. J Biol Chem 1997; 272:13892-8. [PMID: 9153249 DOI: 10.1074/jbc.272.21.13892] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Using recombinant adenoviral vectors and a dominant negative mutant of HNF-4, we have examined the contribution of hepatocyte nuclear factor 4 (HNF-4) to endogenous apolipoprotein AI and CIII mRNA expression. Overexpression of HNF-4 leads to a 7.4-fold increase in apolipoprotein CIII expression, while infection with the dominant negative mutant of HNF-4 reduces the level of apolipoprotein CIII mRNA by 80%, demonstrating that endogenous HNF-4 is necessary for apolipoprotein CIII expression. Experiments using the hepatoma cell lines, HepG2 and Hep3B, indicate that HNF-4 is also involved in the regulation of apolipoprotein AI expression in these lines. However, the effect of HNF-4 on apolipoprotein AI expression is much more dramatic in cell lines derived from intestinal epithelium. Infection of the intestinal-derived cell line IEC-6 with the HNF-4 adenovirus resulted in a greater than 20-fold increase in the level of apolipoprotein AI mRNA. These results indicate that HNF-4 does regulate apolipoprotein AI and CIII mRNA expression and suggest that HNF-4 is critical for intestinal apolipoprotein AI expression.
Collapse
MESH Headings
- Adenoviridae
- Apolipoprotein A-I/genetics
- Apolipoprotein A-I/metabolism
- Apolipoprotein C-III
- Apolipoproteins C/genetics
- Apolipoproteins C/metabolism
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors
- DNA, Complementary/chemistry
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Genetic Vectors
- Hepatocyte Nuclear Factor 4
- Humans
- In Situ Hybridization
- Mutagenesis, Site-Directed
- Phosphoproteins/genetics
- Phosphoproteins/metabolism
- Promoter Regions, Genetic
- RNA, Messenger/metabolism
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/metabolism
- Receptors, Glucocorticoid/genetics
- Receptors, Glucocorticoid/metabolism
- Recombinant Proteins/genetics
- Recombinant Proteins/metabolism
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Transcription, Genetic/drug effects
- Tumor Cells, Cultured
Collapse
Affiliation(s)
- J D Fraser
- Ligand Pharmaceuticals Inc., San Diego, California 92121, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Mostaza JM, Schulz I, Vega GL, Grundy SM. Comparison of pravastatin with crystalline nicotinic acid monotherapy in treatment of combined hyperlipidemia. Am J Cardiol 1997; 79:1298-301. [PMID: 9164913 DOI: 10.1016/s0002-9149(97)00109-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pravastatin treatment of combined hyperlipidemia lowers low-density lipoprotein effectively; nicotinic acid lowers remnant cholesterol and raises high-density lipoprotein. A combination of these 2 drugs may be indicated for optimal treatment of lipoprotein abnormalities in combined hyperlipidemia.
Collapse
Affiliation(s)
- J M Mostaza
- Veterans Affairs Medical Center, Department of Clinical Nutrition, Center for Human Nutrition of the University of Texas Southwestern Medical Center at Dallas, 75235-9052, USA
| | | | | | | |
Collapse
|
46
|
Dart A, Sherrard B, Simpson H. Influence of apo E phenotype on postprandial triglyceride and glucose responses in subjects with and without coronary heart disease. Atherosclerosis 1997; 130:161-70. [PMID: 9126660 DOI: 10.1016/s0021-9150(96)06062-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Apolipoprotein E phenotypes and fasting lipid and other biochemical parameters were determined in 51 patients with recently diagnosed coronary heart disease (CHD) and 164 control subjects. The age of the participants was 62.5 +/- 6.6 (S.D.) and 63% were male. Forty-eight CHD cases and 51 control subjects were also studied for 8 h after a fat-rich meal. Apo E phenotypes did not differ significantly between CHD cases and control subjects although there was a tendency for under-representation of E2/E3 in the cases (6% versus 16%). Fifteen CHD cases and 37 (of 164) control subjects had at least one epsilon 4 allele. Fasting plasma triglyceride concentrations were not different between CHD cases and controls but were significantly elevated in subjects with an epsilon 4 allele. CHD cases did, however, have a significantly elevated fasting insulin compared with controls. Postprandial triglyceride responses were not different between CHD cases and controls. However, postprandial triglyceride responses were elevated in subjects (CHD cases and controls) who had an epsilon 4 allele. In multivariate analysis, both epsilon 4 allele status and body mass index (BMI) were significant determinants of postprandial triglyceride responses. Postprandial glucose responses were also elevated in subjects with an epsilon 4 allele. When comparison of CHD cases and controls was restricted to those without an epsilon 4 allele, CHD cases showed a borderline significant (P = 0.05) difference in time course from controls, with a slower decline in plasma triglyceride from the peak response. Fasting and postprandial triglyceride and postprandial glucose responses are strongly dependent on the presence of an epsilon 4 allele. The elevation in postprandial triglyceride responses associated with an epsilon 4 allele can obscure differences associated with the presence of CHD and suggests that although elevated postprandial triglyceride response may be a risk factor for CHD, it is not the major reason for the association between the possession of an epsilon 4 allele and coronary disease.
Collapse
Affiliation(s)
- A Dart
- Alfred Baker Medical Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
47
|
Alaupovic P, Mack WJ, Knight-Gibson C, Hodis HN. The role of triglyceride-rich lipoprotein families in the progression of atherosclerotic lesions as determined by sequential coronary angiography from a controlled clinical trial. Arterioscler Thromb Vasc Biol 1997; 17:715-22. [PMID: 9108785 DOI: 10.1161/01.atv.17.4.715] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We have demonstrated previously in a subset of Monitored Atherosclerosis Regression Study (MARS) subjects with hypercholesterolemia (190 to 295 mg/dL) and documented coronary artery disease that lovastatin significantly reduces cholesterol-rich lipoprotein B (LpB) but has little effect on complex, triglyceride-rich apolipoprotein (apo) B-containing LpBc (the sum of LpB:C, LpB:C:E and LpA-II:B:C:D:E) particles defined by their apolipoprotein composition. This differential effect of lovastatin on apoB-containing lipoprotein families offered the opportunity to determine in the same subset of MARS subjects the independent relationship of LpB and LpBc with the progression of coronary artery disease. Subjects randomized to either lovastatin (40 mg twice daily) or matching placebo were evaluated by coronary angiography before randomization and after 2 years of treatment, and the overall coronary status was judged by a coronary global change score. In the lovastatin-treated group, there were 22 nonprogressors (69%) and 10 progressors (31%), while in the placebo group 13 subjects (42%) were nonprogressors and 18 (58%) were progressors (P < .03). In the lovastatin-treated group, lipid and lipoprotein parameters did not differ between progressors and nonprogressors except for LpBc and LpA-II:B:C:D:E particle levels, which were statistically higher in progressors (P = .02). In the placebo-treated group, progressors differed from nonprogressors by having significantly higher levels of triglycerides (P = .03) and apoC-III in VLDL + LDL (P = .05), the characteristic constituents of triglyceride-rich lipoproteins. In the placebo- and lovastatin-treated groups combined, progressors had significantly higher on-trial levels of triglycerides (P = .003), VLDL cholesterol (P = .005), apoC-III in VLDL + LDL (P = .008), apoC-III (P = .01), apoB (P = .03), and total cholesterol (P = .04) than nonprogressors. Even after adjustment for treatment group, progressors in the combined placebo- and lovastatin-treated groups had significantly higher levels of LpBc, LpA-II:B:C:D:E, triglycerides, and apoC-III in VLDL + LDL than nonprogressors. Progressors in the placebo-treated, lovastatin-treated, and combined treatment groups had lower levels of LpA-1 but not LpA-I:A-II than non-progressors, and this difference reached statistical significance (P = .047) in the combined sample adjusted for treatment group. Results of this study show that elevated levels of triglyceride-rich LpBc in general and LpA-II:B:C:D:E in particular contribute significantly to the progression of coronary artery disease. Furthermore, they provide additional evidence for the potentially protective role of LpA-I particles in the atherogenic process and suggest that apolipoprotein-defined lipoprotein families may be more specific prognosticators of coronary artery atherosclerosis progression than lipids and apolipoproteins.
Collapse
Affiliation(s)
- P Alaupovic
- Lipid and Lipoprotein Laboratory, Okalhoma Medical Research Foundation, Oklahoma City, USA
| | | | | | | |
Collapse
|
48
|
Napoli C, Lepore S, Chiariello P, Condorelli M, Chiariello M. Long-term Treatment With Pravastatin Alone and in Combination With Gemfibrozil in Familial Type IIB Hyperlipoproteinemia or Combined Hyperlipidemia. J Cardiovasc Pharmacol Ther 1997; 2:17-26. [PMID: 10684438 DOI: 10.1177/107424849700200103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Pravastatin inhibits 3-hydroxy-3-methylglutaryl-coenzyme A reductase. It prevents mevalonate synthesis, reducing endogenous cholesterol production, and reduces cholesterol content in the liver, thus resulting in a down-regulation of low-density lipoprotein receptor production. Gemfibrozil reduces very low-density lipoprotein production and low-density lipoprotein-cholesterol level and increases very low-density lipoprotein catabolism. Therefore, it was suggested that combination therapy with both drugs could effect greater reduction of cholesterol levels as compared to pravastatin alone. The present study was carried out to evaluate the efficacy and safety of pravastatin as a monotherapy or in combination with gemfibrozil in the treatment of patients with familial type IIb hyperlipoproteinemia or familial combined hyperlipidemia. METHODS AND RESULTS: Forty-one patients were included in the study. All patients initially followed 6 weeks of hypolipidemic diet; subsequently they were randomized and received either 20 mg once daily of pravastatin alone (n = 13) or 20 mg of pravastatin together with 600 mg of gemfibrozil twice daily (n = 14). As a control, 14 patients were treated with diet only. The treatment lasted 24 months and clinical evaluation and laboratory tests were done at given time points. Both groups of treated patients showed an early reduction (3 months) of total (about 30% P <.01 vs controls), low-density lipoprotein (about 35%, P <.01 vs controls) and very low-density lipoprotein cholesterol levels (about 18%, P = NS). In contrast, high-density lipoprotein cholesterol levels increased significantly in patients treated with pravastatin and gemfibrozil (about 20%, P <.05 vs controls). Pravastatin treatment alone reduced the level of serum triglycerides as efficiently as in combination with gemfibrozil. Data showed a sustained normalization of lipid profile until 24 months. However, this effect was achieved in patients that had rather low levels of triglycerides. During the treatment we did not observe any difference in the incidence of possible drug-related side effects. Severe myopathy or rhabdomyolysis was not observed at the doses of the drugs used in our study. CONCLUSIONS: Therapy with pravastatin and in combination with gemfibrozil resulted in significant and sustained normalization of lipid profile in high-risk patients with familial type IIb hyperlipoproteinemia or familial combined hyperlipidemia.
Collapse
Affiliation(s)
- C Napoli
- Division of Cardiology, Federico II University of Naples, Naples, Italy
| | | | | | | | | |
Collapse
|
49
|
Mailly F, Fisher RM, Nicaud V, Luong LA, Evans AE, Marques-Vidal P, Luc G, Arveiler D, Bard JM, Poirier O, Talmud PJ, Humphries SE. Association between the LPL-D9N mutation in the lipoprotein lipase gene and plasma lipid traits in myocardial infarction survivors from the ECTIM Study. Atherosclerosis 1996; 122:21-8. [PMID: 8724108 DOI: 10.1016/0021-9150(95)05736-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Using polymerase chain reaction (PCR) based techniques, we have identified individuals in the ECTIM study of myocardial infarction survivors (cases) and healthy matched controls who are carriers for a mutation of the gene for lipoprotein lipase (LPL) which alters amino acid 9 from aspartic acid to asparagine (LPL-D9N). The frequency of carriers in the cases from Belfast and France (3 separate centres) was 2.5 and 3.7%, respectively (mean 3.3%, 95% CI 1.9-4.7) and in the controls 2.0 and 2.9%, respectively (mean 2.7%, 95% CI 1.6-3.8%), but this difference was not statistically significant. In the cases, carriers of the allele for LPL-N9 had higher levels of several plasma lipid traits including total triglycerides (TG) (30%), very low density lipoprotein (VLDL) cholesterol (19%), apo E (24%), apo C-III (17%), lipoprotein particles (Lp) containing both apo E and apo B (LpE:B) (32%), and particles containing both apo C-III and apo B (LpCIII:B) (39%), and this effect was consistent in cases both from Belfast and from the French centres combined. By contrast, in the controls there were no differences in any lipid trait between carriers and non-carriers of the mutation that was consistent between the French centres and Belfast. There were no significant differences in the levels of any measured factor between cases and controls that could explain the different effect on plasma lipid traits associated with the mutation. However, compared to the non-carriers, in both cases and controls who carried the mutation, plasma TG concentrations were higher in those whose body mass index (BMI) was above the mean of the sample (26.0 kg/m2), with statistically significant interaction seen between BMI and genotype and levels of apo C-III, and lipoprotein particles containing both apo C-III and apo B (P < 0.02). The data suggest that carriers for the LPL-N9 mutation have a mild genetic predisposition to developing hyperlipidaemia and an atherogenic lipid profile, but that this requires the presence of other genetic or environmental factors for full expression, one of which appears to be increasing obesity.
Collapse
Affiliation(s)
- F Mailly
- Department of Medicine, UCL Medical School, Rayne Institute, London, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Prisco D, Caciolli S, Del Pace S, Gensini GF. State-of-the-Art Review : Sex and Cardiovascular Risk Factors. Clin Appl Thromb Hemost 1996. [DOI: 10.1177/107602969600200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Domenico Prisco
- Clinica Medica Generale e Cardiologia, University of Florence, Florence, Italy
| | - Sabina Caciolli
- Clinica Medica Generale e Cardiologia, University of Florence, Florence, Italy
| | - Stefano Del Pace
- Clinica Medica Generale e Cardiologia, University of Florence, Florence, Italy
| | - Gian Franco Gensini
- Clinica Medica Generale e Cardiologia, University of Florence, Florence, Italy
| |
Collapse
|