Accuracy of global longitudinal and territorial longitudinal strain in determining myocardial viability in out of window period Anterior wall myocardial infarction patients

Funding Acknowledgements

Type of funding sources: None.

Background

Primary percutaneous intervention remains the principal treatment modality for anterior wall myocardial infarction (AWMI). However, a large fraction of patients especially in the developing countries present outside the window period (OWP) with no chest pain and akinetic left anterior descending (LAD) territory on echocardiography. Revascularization in these patients is primarily guided by viability status.

Purpose

This study was conducted to determine the accuracy of strain echocardiographic parameters compared to single-photon emission computed tomography (SPECT) in predicting myocardial viability in patients of AWMI presenting OWP.

Methods

All patients presenting with AWMI-OWP without ongoing chest pain and akinetic LAD territory on echocardiography from December 2020 to June 2021 were recruited. All patients underwent determination of both Global longitudinal strain (GLS) and territorial longitudinal strain (TLS) within 24-72 hours on AWMI. In addition, all underwent SPECT to determine the percentage of non-viable myocardium. On SPECT, a defect >5% myocardial territory showing severe reperfusion defect was considered as a marker of non-viability. 

Results

A total of 27 patients were recruited. The mean age of the population was 61.66 + 12.6 years. Acute left ventricular failure (LVF) and cardiogenic shock (CS) was present in 6 (22.2%) and 5 (18.5%) patients respectively. Out of 22 patients who underwent angiography, majority of the patients 19 (86%) had single vessel disease involving the LAD.

The mean left ventricular ejection fraction (LVEF) of the study group was 29.6 + 6.5%. The mean GLS and LAD territory TLS of the study group was -11.13 + 3.14% and -7.2 + 2.75% respectively. On SPECT, 8 (29.6%) patients had non-viable underlying myocardium.

Parameters that very significantly associated with non-viability on SPECT included past history of CAD (p = 0.004), smoking (p = 0.05) and presentation with LVF (p = 0.0008) and CS (p = 0.001).

The mean LVEF was significantly lower in the group with non-viability on SPECT (32.3 + 5.1% vs 23.1 + 4.5%; p < 0.001). Both GLS (-12.8 + 1.4% vs -7.1+ 2.3%; p < 0.001) and TLS (-8.7 + 1.4% vs -3.8 + 1.8%; p < 0.001) were significantly lower in group showing non-viability on SPECT.

On receiver operating curves, a GLS of > -10.45% and TLS of > -6.65%, both had a sensitivity of 87.5% and specificity of 89.5% in predicting non-viability on SPECT. Both showed good accuracy in predicting non-viability on overall quality model. (Figures 1 and 2)

Conclusion

Modalities like cardiac magnetic resonance, SPECT or positron emission tomography are resource dependent and take time to be performed. Hence, performing these investigations is challenging in unstable patients. Strain echocardiography provides GLS of the myocardium which has good sensitivity and specificity in predicting viability and can be performed safely and quickly in this high-risk group. Abstract Figure.  Abstract Figure. Overall quality model

Angiographic Profiles in Persistent Non-Valvular Atrial Fibrillation Patients

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Cardiology dept. PGIMER, Chandigarh

Background

The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established. Atrial ischemia due to obstructive CAD has been identified as one of the key risk factors, leading to AF. However, sufficient evidence exists as to the presence of myocardial ischemia on stress imaging, even without the presence of obstructive CAD in AF patients. Slow flow and coronary tortuosity on angiogram can lead to downstream myocardial ischemia independent of CAD. 

Purpose

We aimed to delineate the angiographic profiles in AF patients with attention to slow flow and tortuosity leading to ischemia in those without obstructive CAD. 

Methods

The study was a nonrandomised, prospective, single-centre observational study of consecutive patients of persistent non valvular AF. Symptomatic patients despite optimal medical therapy (OMT) for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with known CAD or prior history of myocardial infarction were excluded. Further angiographic analysis was done in those without obstructive CAD to determine incidence of slow flow (>27 corrected TIMI frame count) and tortuosity (presence of ≥3 fixed bends in an epicardial artery). 

Results

A total of 70 patients were recruited and followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49). Hypertension (74%) was the commonest comorbidity followed by obesity (35%) and diabetes (30%). At CAG, 32/70 (46%) had obstructive CAD, 17/70 (24%) had non obstructive (<50-70% stenosis) CAD and 21/70 (30%) had normal coronaries without atherosclerosis. Amongst patients without obstructive CAD (n = 38) slow flow was seen in 16/38 (42%) and coronary tortuosity in 11/38 (29%) patients. There ware no differences in terms of death, HF and FVR hospitalisations or stroke at follow up between the obstructive CAD vs no obstructive CAD. However in patients without obstructive CAD, hospitalisations for FVR was significantly increased in those having slow flow on CAG, 9/12 (75%) vs 7/26 (27%) in those without slow flow (p value = 0.005). The mean TIMI frame count was also significantly higher in those with FVR hospitalisations 35.3 ± 11 vs 25.8 ± 8.9  (p value = 0.005). TIMI frame count >31 had a sensitivity of 83% and a specificity of 69% for predicting hospitalisations for FVR on ROC curve(AUC = 0.71). 

Conclusions

CAD is closely related to AF and majority (70%) of our patients had evidence of atherosclerotic CAD on CAG in our study. A large proportion of patients with no evidence of obstructive CAD on CAG had slow flow or coronary tortuosity. Significantly increased hospitalisation for FVR seen in the slow flow group shows its significance and may lead to newer treatment modalities in future. Further larger studies looking at these aspects on CAG may give further insight as to the nature and prognosis of these entities. Abstract Figure 1: Flow diagram showing the patie

Observational study of Covid-19 patients presenting with acute coronary syndrome at a tertiary care center in India

Aim

Patients with Covid-19 are theoretically at a higher risk of ACS, as respiratory infections can often lead to coronary endothelial damage and plaque rupture. Initial reports during start of pandemic suggested decrease in STEMI patients, however this has been explained by iatrophobia rather than actual decrease. Data on pathophysiology and outcome of patients presenting with ACS is scarce. We did a prospective observational study to study epidemiology and outcomes of Covid-19 patients with ACS.

Methods

A total of 654 patients were admitted with Covid-19 at PGIMER, Chandigarh from August 2020 to February 2021, 35 (5.3%) consecutive patients of ACS were enrolled into the study. Acute myocardial infarction was defined as per fourth universal definition of myocardial infarction. Diagnosis of Covid-19 was established using RT-PCR from nasopharyngeal swab. Angiographic assessment was done by two interventional cardiologists.

Results

Mean age of patients was 59.5±11.8 years, males comprised majority (80%) of study group. Most common risk factor was hypertension seen in around 70% followed by DM in 57% patients. Most common symptom at presentation was rest angina seen >90% while history of fever was present in only 31.4%. STEMI was most common ACS seen in 45.7% followed by USA in 23% patients. CS was present in 15% patients at presentation while another 5% developed shock in hospital. Oxygen requirement was required in over half the patients while 25% patients succumbed to illness in hospital.Thrombolysis was done in half the patients of STEMI. In view of Covid-19 disease 71.4% required dexamethasone and remdesivir. Coronary angiography was done in around 20% patients, which revealed obstructive CAD in 83% patients with 60% patients having 100% occlusion of IRA. Percutaneous intervention was done in 66% patients. Hypoalbuminemia was commonly seen patients with mean albumin of 3.3 gm/dL. Low T3 syndrome was most common thyroid function abnormality seen in 37.1%.On univariate analysis age, BNP levels and albumin were able to predict 30-day mortality.

Conclusion

ACS can be first presentation of patients with Covid-19 as shown by our study only 30% patients had prior history of fever. Our data reaffirms that patients with Covid-19 and ACS have worse prognosis. Interestingly mortality in our study was comparable to western study, despite low rate of angiography and intervention thus underscoring individualization of therapy. We believe Type-2 myocardial infarction is common in pathophysiology of patients who benefit most from medical therapy.

Funding Acknowledgement

Type of funding sources: None.

Angiographic profiles in patients of persistent non-valvular atrial fibrillation from a tertiary care center in north india

Funding Acknowledgements

Type of funding sources: None.

Background

The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established. Atrial ischemia due to obstructive CAD has been identified as one of the key risk factors, leading to AF. However, sufficient evidence exists as to the presence of myocardial ischemia on stress imaging, even without the presence of obstructive CAD in AF patients. Slow flow and coronary tortuosity on angiogram can lead to downstream myocardial ischemia independent of CAD.

Purpose

We aimed to delineate the angiographic profiles in AF patients with attention to slow flow and tortuosity leading to ischemia in those without obstructive CAD.

Methods

The study was a nonrandomised, prospective, single-centre observational study of consecutive patients of persistent non valvular AF. Symptomatic patients despite optimal medical therapy (OMT) for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with known CAD or prior history of myocardial infarction were excluded. Further angiographic analysis was done in those without obstructive CAD to determine incidence of slow flow (>27 corrected TIMI frame count) and tortuosity (presence of ≥3 fixed bends in an epicardial artery).

Results

A total of 70 patients were recruited and followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49). Hypertension (74%) was the commonest comorbidity followed by obesity (35%) and diabetes (30%). At CAG, 32/70 (45%) had obstructive CAD, 17/70 (24%) had non obstructive (<50-70% stenosis) CAD and 21/70 (30%) had normal coronaries without atherosclerosis. Amongst patients without obstructive CAD (n = 38) slow flow was seen in 16/38 (42%) and coronary tortuosity in 11/38 (29%) patients. There ware no differences in terms of death, HF and FVR hospitalisations or stroke at follow up between the obstructive CAD vs no obstructive CAD. However in patients without obstructive CAD, hospitalisations for FVR was significantly increased in those having slow flow on CAG, 9/12 (75%) vs 7/26 (27%) in those without slow flow (p value = 0.005). The mean TIMI frame count was also significantly higher in those with FVR hospitalisations 35.3 ± 11 vs 25.8 ± 8.9  (p value = 0.005). TIMI frame count >31 had a sensitivity of 83% and a specificity of 69% for predicting hospitalisations for FVR on ROC curve(AUC = 0.71).

Conclusions

CAD is closely related to AF and majority (70%) of our patients had evidence of atherosclerotic CAD on CAG in our study. A large proportion of patients with no evidence of obstructive CAD on CAG had slow flow or coronary tortuosity. Significantly increased hospitalisation for FVR seen in the slow flow group shows its significance and may lead to newer treatment modalities in future. Further larger studies looking at these aspects on CAG may give further insight as to the nature and prognosis of these entities.

HIV counseling and testing in a tertiary care hospital in Ganjam district, Odisha, India

BACKGROUND

Human immunodeficiency virus (HIV) counseling and testing (HCT) conducted at integrated counseling and testing centers (ICTCs) is an entry point, cost-effective intervention in preventing transmission of HIV.

OBJECTIVES

To study the prevalence of HIV among ICTC attendees, sociodemographic characteristics, and risk behaviors of HIV-seropositive clients.

MATERIALS AND METHODS

It was hospital record-based cross-sectional study of 26,518 registered ICTC clients at a tertiary care hospital in Ganjam district, Odisha, India over a 4-year period from January 2009 to September 2012.

RESULTS

A total of 1732 (7.5%) out of 22,897 who were tested for HIV were seropositive. Among HIV-seropositives, 1138 (65.7%) were males, while 594 (34.3%) were females. Majority (88.3%) of seropositives were between the age group of 15-49 years. Client-initiated HIV testing (12.1%) was more seropositive compared to provider-initiated (2.9%). Among discordant couples, majority (95.5%) were male partner/husband positive and female partner/wife negative. Positives were more amongst married, less educated, low socioeconomic status, and outmigrants (P<0.0001). Risk factors included heterosexual promiscuous (89.3%), parent-to-child transmission 5.8%, unknown 3.1%, infected blood transfusion 0.8%, homosexual 0.5%, and infected needles (0.5%).

CONCLUSIONS

There is need to encourage activities that promote HCT in all health facilities. This will increase the diagnosis of new HIV cases. The data generated in ICTC provide an important clue to understand the epidemiology in a particular geographic region and local planning for care and treatment of those infected with HIV and preventive strategies for those at risk especially married, young adults, and outmigrants to reduce new infections.

Perception of medical students about pharmacology and scope of improvement

Pharmacology is a subject taught in the medical curriculum in India over a period of one and half years along with pathology, microbiology and forensic medicine. The present study was planned to know the opinion of medical students regarding pharmacology and to assess the proposed teaching schedule and methods of teaching pharmacology. The study was conducted in a private medical college in eastern India among the medical undergraduate students in 5th semester. Total 74 students participated in the study. A pre-designed, pre-tested, semi-structured questionnaire was given to the students and data was collected after one hour. Collected data was compiled, tabulated and analyzed in SPSS (version 16.0). The subject was perceived as interesting and useful by majority of students and most of them were in opinion to integrate pharmacology with the clinical subjects. Lecture in whole class was the most preferred teaching method according to the students and teaching with chalk and board they preferred most. Rational use of medicine, clinical trial, pediatric and geriatric pharmacology are the important topics the students felt to be included in the curriculum. Regular assessment of teaching methods by the students and taking suggestions from the students about improving the teaching method and redesigning the curriculum can help a lot in improving the learning capacity of the medical students and that will give benefit for the society as a whole.

Abducens nerve palsy in a patient with scrub typhus: a case report

Abducens nerve palsy is a known but rare complication of a few bacterial and viral infections like Mycoplasma pneumonia, cytomegalovirus, Epstein-Barr virus, Hanta virus, herpes zoster, and measles. Abducens nerve palsy due to scrub typhus is extremely rare and so far only one case has been reported in the literature. Scrub typhus is a febrile illness caused by rickettsia, Orientia tsutsugamushi, a gram negative intracellular obligate parasite which is endemic in Asia. This disease can present with wide range of clinical manifestations with involvement of any organ system, alone or in combination. Central nervous system involvement is very common and includes meningism, altered sensorium to focal neurological deficits. We present a rare manifestation of Scrub typhus in the form of sixth cranial nerve involvement which responded to the treatment with doxycycline.

Dipylidium caninum infection in a child: a rare case report

Dipylidiasis is a zoonotic parasitic infestation caused by the dog tapeworm Dipylidium caninum. Human dipylidiasis has been rarely reported in English literature. Young children are mostly at risk of acquiring the infection due to their close association with dogs and cats. We report a rare case of Dipylidium caninum infection in a 4 year old male child. The diagnosis was based on microscopic examination of stool. Confirmation of the proglottid segments was done by histopathological examination. To the best of our knowledge this is the first human case of Dipylidium caninum reported from this part of the country.

Tuberculosis cutis orificialis (TBCO): a rare manifestation of tuberculosis

Tuberculosis of the oral cavity is a very rare disease and accounts for less than one percent of all cases of tuberculosis. Primary lesions are extremely rare. Presentation is as a single ulcer, may be painful, however multiple painless ulcers have been described. Tongue is the most common oral site involved. The palate, buccal mucosa, floor of the mouth, gingiva, and lips are other possible sites. We hereby report a case of TBCO, a very rare manifestation of tuberculosis.

Phenylpropanoid sucrose esters: plant-derived natural products as potential leads for new therapeutics

Natural products are regarded as vital key source of lead compounds for drug discovery due to their structural diversity and broad array of biological activities. Phenylpropanoid sucrose esters are naturally occurring compounds isolated from various plants and are structurally characterized by a sucrose core connected to one or more Ph-CH=CH-CO- moieties through an ester linkage. These compounds were extensively used in folk medicine and are found to possess many biological activities such as antitumor, antibacterial, antioxidant, antiviral, anti-inflammatory, neuro-protective and glycosidase inhibitory activities. This extensive review, which is the first of its kind on phenylpropanoid sucrose esters, aims to provide an up-to-date account of naturally occurring known phenylpropanoid sucrose esters with special focus on their sources, structures, biological and pharmacological activities.

Profile of patients of leptospirosis in sub-Himalayan region of North India

CONTEXT

Leptospirosis is an emerging zoonosis world wide; it is being reported in many areas of south-east Asia now. A recent surge in the number of patients with leptospirosis has been noted in the Sub-Himalayan region of North India which was uncommon. We present here a case series of 13 patients who were positive for leptospirosis either by IgM Elisa or PCR method.

AIMS

To study the profile of leptospirosis in a sub-Himalayan state of North India i.e. Himachal Pradesh.

SETTINGS AND DESIGN

This was a retrospective study of leptospira positive patients who were admitted in IGMC, Shimla. The study was conducted in Indira Gandhi Medical College, Shimla situated at a moderate altitude in North India.

METHODS AND MATERIAL

All patients presenting in Medical College Hospital during three months from 1st August to 31st October who tested IgM positive or borderline or PCR positive for leptospirosis were taken into the study. Their presenting complaints, examination findings and lab findings were recorded and analyzed based on the Faine's criteria and modified Faine's criteria. Patients with clinical features of Leptospirosis and who tested positive for IgM Leptospirosis were taken as IgM lepto can be falsely positive.

RESULTS

Out of total 13 patients there were 3 males and 10 females, age range was from 24 to 78 yrs and mean was 44 yrs. Predominant complaints were fever, jaundice, myalgia, and headache. All had contact with animals or contaminated environment. LFT's were deranged in 12 and renal functions were deranged in all. Ten had positive results for IgM against leptospira while 2 had borderline positive result. One patient was positive by PCR method using G1, G2 primers. Ten patients had Weil's syndrome and this was the main presentation of leptospirosis in our group, one had acute respiratory distress syndrome (ARDS) and needed ventilator. There were no deaths. All responded to injectable ceftriaxone and oral doxycycline. Applying Faine's criteria only 7 were positive, but using modified Faine's criteria all 13 were positive for leptospirosis.

CONCLUSIONS

Leptospirosis was unexpectedly found to be positive in many of our patients who were having pyrexia during the monsoons. A recent surge has been noted in the number of cases with leptospirosis in this state. The possibility of co-infection especially with scrub typhus must be considered in cases with atypical presentation and severe illness. Most of the patients were from rural background with poor hygienic conditions. There was no mortality and main complication was Weil's syndrome in 77 percent.

Leptospirosis presenting as acute respiratory distress syndrome (ARDS) in sub-Himalayan region

Indira Gandhi Medical College, Shimla receives referred patients of pyrexia with multi-organ dysfunction during the monsoon season from all over the state of Himachal Pradesh. Most common etiologies of pyrexia are enteric fever, scrub typhus, malaria, viral, tubercular, and some patients of dengue fever from adjoining states. Leptospirosis has not yet been reported in sub-Himalayan state of Himachal Pradesh, India. We present here a case of leptospirosis presenting as ARDS, proven on IgM Elisa and confirmed by PCR. Leptospirosis is a new etiology in this region for patients presenting with pyrexia and ARDS.

Changing pattern of human group A rotaviruses: Emergence of G12 as an important pathogen among children in eastern India

BACKGROUND

Rotavirus genotypes, G1-G4 and G9 are associated with childhood diarrhoea throughout the world. In our previous study, we detected G1, G2, G4 and three G12 strains from Kolkata, India.

OBJECTIVES

To study the prevalence of G- and P-genotypes of rotaviruses associated with dehydrating diarrhoea in children admitted to two leading hospitals in eastern India.

STUDY DESIGN

An active surveillance was conducted for elucidation of rotavirus infection in two leading hospitals in Kolkata, West Bengal and Berhampur (GM), Orissa, India, separated by 603km from January 2003 to April 2005. The rotaviruses were detected by RNA electrophoresis in polyacrylamide gels. G- and P-typing of the positive samples were accomplished by amplifying VP7 and VP4 genes by RT-PCR and genotyped by seminested multiplex PCR methods. Sequencing, sequence analysis and phylogenetic analysis of VP7 genes of G12 strains were carried out to understand the variations between the strains isolated from different parts of the world.

RESULTS

The genotypic distribution varied remarkably from our earlier study period (1998-2001) with G1 (53.8%) being the most predominant strain followed by G2 (22.5%), G12 (17.1%), G9 (2.1%) and not a single G3 or G4 isolate was detected separately. 35.2% samples exhibited mixed P-types followed by P[4] (31.7%), P[8] (21.8%) and P[6] (9.8%). The phylogenetic analysis of G12 strains revealed that the G12 strains detected from different parts of the world clustered into three different lineages. Though VP7 sequences of G12 strains isolated from Kolkata and Berhampur are conserved, their P-types were different.

CONCLUSION

During this study period we reported emergence of G12 strains as an important pathogen among children in eastern India, thus necessitating its inclusion in future polyvalent vaccine to control rotavirus diarrhoea.

An open randomized comparative study of oral itraconazole pulse and terbinafine pulse in the treatment of onychomycosis

BACKGROUND

Onychomycosis is a recalcitrant disease of the nails caused by dermatophytes, yeasts, and molds.

AIMS

To compare the clinical efficacy of oral itraconazole pulse therapy and oral terbinafine pulse therapy in onychomycosis.

METHODS

A randomized single-blind clinical comparative study was undertaken on 120 patients of onychomycosis during the period March 1999-February 2002. Sixty patients were randomly assigned to receive oral itraconazole 100 mg, two capsules twice daily for seven days a month and the other group of sixty patients received oral terbinafine 250 mg, one tablet twice daily for seven days every month. Four such monthly pulses were administered for each drug. The patients were evaluated at 4-weekly intervals till sixteen weeks and then at 24, 36 and 48 weeks.

RESULTS

We observed a clinical cure rate of 82% and mycological cure rate of 90% in the group of patients treated with itraconazole while the group with terbinafine showed clinical and mycological cure rates of 79% and 87% respectively. This difference was not statistically significant.

CONCLUSIONS

Both oral itraconazole and terbinafine are effective in the treatment of onychomycosis when administered in the pulse dosage form. Terbinafine is more cost effective while itraconazole has a broader spectrum of antimycotic activity.

Itraconazole pulse therapy in onychomycosis

A prospective study of 30 clinically and mycologically diagnosed cases of onychomycosis was carried out for a period of twelve months from May 1996 to April 1997. Itraconazole pulse therapy was given for the 1st week followed by 3 week drug-free period, for 1st 3 months for the finger nail cases and 4 monthes for finger nail + toe nail and toe nail cases. Patients were evaluated at baseline, week 4, week 12, week 16, week 24, up to 12 months and assessed as cleared or markedly improved with clinical and mycological success. The result of our study is very much encouraging. It suggests that the use of itraconazole pulse therapy will maintain the continuous treatment efficacy and is cost effective than continuous therapy.

Preferential survival of mice expressing the Qa-2 antigen

The Ped gene, a gene that influences the rate of embryonic cleavage division, birth weight, litter size and weaning weight, is at least partially encoded by gene(s) that specify the Qa-2 antigen. Two congenic strains of mice, B6.K1 (Qa-2 negative) and B6.K2 (Qa-2 positive), which differ only at the Q region of the mouse major histocompatibility complex (MHC), were tested for the effect of the presence or absence of Qa-2 antigen on litter size, duration of gestation and embryo survival. It was confirmed that B6.K1 (Qa-2 negative) mice have smaller litters than do B6.K2 (Qa-2 positive) mice. In addition, the duration of gestation for the B6.K1 mice was found to be longer than the duration of gestation for the B6.K2 mice. Finally, a comparison of the relative survival of Qa-2-positive and Qa-2-negative mice in a single uterine environment showed the preferential survival of mice expressing the Qa-2 antigen. Thus, the presence of Qa-2 antigen appears to be advantageous for reproductive success.

Day-long glucose, insulin, and fructose responses of hyperinsulinemic and nonhyperinsulinemic men adapted to diets containing either fructose or high-amylose cornstarch

Ten hyperinsulinemic and 11 nonhyperinsulinemic men consumed a typical American diet containing 20% of calories either as fructose or as high-amylose cornstarch for 5 wk in a crossover design to determine their effects on indices of glucose tolerance. Blood glucose, insulin, and fructose were determined before and 30, 60, 90, 120 and 180 min after breakfast, lunch, and dinner. Glucose responses were significantly lower 60 and 120 min and the insulin response lower 60 min after the meals containing fructose. Hyperinsulinemic men showed a tendency toward decreased insulin sensitivity after consuming fructose on the basis of an increased insulin-to-glucose ratio and decreased insulin binding to erythrocytes. These results generally show a beneficial effect of fructose on glucose tolerance; however, recommendations for including large amounts of fructose in the diet should also be based on a complete evaluation of the effect on other metabolic risk factors.

Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or high-amylose cornstarch

Ten hyperinsulinemic and 11 nonhyperinsulinemic men consumed for 5 wk each in a cross-over design a diet, similar to one currently consumed in the United States, with 20% of the kilocalories from either fructose or high-amylose cornstarch to determine the effects of the two diets on various blood metabolites considered to be risk factors associated with heart disease. In the hyperinsulinemic men the intake of fructose as compared with cornstarch significantly increased total triglycerides and their lipoprotein distribution; total and very-low-density lipoprotein cholesterol; apoproteins B-100, C-II, C-III; and uric acid. In the nonhyperinsulinemic men total triglycerides, total and low-density lipoprotein cholesterol and uric acid were significantly greater after the consumption of fructose than after cornstarch. The results indicate that in a diet high in saturated fatty acids and cholesterol, fructose increases the levels of risk factors associated with heart disease, especially in hyperinsulinemic men.