Carotid Plaques Correlates in Patients With Familial Hypercholesterolemia.

Patients with familial hypercholesterolemia (FH) are at increased risk of premature cardiovascular disease. We compared factors associated with the presence of carotid plaques and carotid intima-media thickness (cIMT), markers of subclinical atherosclerosis, in 241 patients with FH (98, 40.7% men; mean age 41 ± 18.4 years). Patients with FH having carotid plaques (36.5%) had mean age, apolipoprotein (apo) B, glucose, apoA1, systolic blood pressure (SBP) and diastolic BP, waist/hip ratio (WHR), and body mass index higher than patients without plaques. Logistic regression revealed that apoB (odds ratio [OR] per 1 unit change 1.03,P= .005), high-density lipoprotein cholesterol (HDL-C; OR per 1 standard deviation [SD] change 0.59,P= .015), and non-HDL-C (OR per 1SD change 1.53,P= .04) were significantly associated with the presence of plaques. The cIMT correlated with obesity parameters, BP, apoB, glucose, high-sensitivity C-reactive protein, creatinine, γ-glutamyl transpeptidase, and alanine transaminase (P< .001). Regression analysis revealed that cIMT was significantly associated with apoB, SBP, and WHR. These results confirm the role of apoB-containing lipoproteins and low HDL-C with the presence of carotid plaques and apoB, BP, and WHR with cIMT.

Prognostic Value of Proinflammatory Markers in Patients After Kidney Transplantation in Relation to the Presence of Diabetes.

BACKGROUND: Patients who are receiving immunosuppressive treatment after kidney transplantation are at greater risk of developing new-onset diabetes after transplantation (NODAT). New biochemical markers that may contribute to a better assessment of the prognosis of renal failure for patients diagnosed with diabetes mellitus (DM) are needed. The aim of this study was to assess selected proinflammatory markers in patients after kidney transplantation depending on the prevalence of DM and to evaluate the predictive value of these cytokines. METHODS: A total of 82 patients were divided into 3 groups after kidney transplantation and were included in the analysis: group I, no DM; group II, DM diagnosed before transplantation; and group III, NODAT. Selected marker levels (platelet-derived growth factor, transforming growth factor ß1, tumor necrosis factor receptor II [TNF-RII], and high-sensitivity interleukin-6 [IL-6 HS]) were assessed by using enzyme-linked immunosorbent assays. For summary endpoint, a return to dialysis treatment and/or death of the patient was adopted. RESULTS: Patients with NODAT were characterized by higher levels of IL-6 HS and body mass index. There were no statistically significant differences in the levels of other assessed markers among the 3 analyzed groups. The summary endpoint was observed in 16 cases (19.5%). Patients with summary endpoint during the observation time at baseline had higher levels of TNF-RII (7180 vs 4632 pg/mL; P = .0002) and IL-6 HS (4.58 vs 2.72 pg/mL; P = .033). CONCLUSIONS: Levels of inflammatory markers in patients after kidney transplantation did not differ between groups with and without DM. In the study population, DM was not a significant risk factor for graft loss or death. Patients who experienced these complications at baseline were characterized by higher values of TNF-RII and IL-6 HS.

Cardiovascular disease and its risk factors in IDDM in Europe. EURODIAB IDDM Complications Study Group.

OBJECTIVE: To study the prevalence of cardiovascular disease (CVD), its risk factors, and their associations in IDDM patients in different European countries. RESEARCH DESIGN AND METHODS: The prevalence of CVD (a past history or electrocardiogram abnormalities) and its risk factors were examined in a cross-sectional study in 3,250 IDDM patients from 16 European countries (EURODIAB IDDM Complications Study). The patients were examined in 31 centers and were stratified between centers for age, sex, and duration of diabetes. The mean +/- SD duration of diabetes was 14.7 +/- 9.3 years. RESULTS: The prevalence of CVD was 9% in men and 10% in women. The prevalence increased with age (from 6% in patients 15-29 years old to 25% in patients 45-59 years old) and with duration of diabetes. The between-center variation for the whole population was from 3 to 19%. In both sexes, fasting triglyceride concentration was higher and HDL cholesterol lower in those patients with CVD than in those without. In men, duration of diabetes was longer, waist-to-hip ratio greater, and hypertension more common in patients with CVD. In women, a greater BMI was associated with increased prevalence of CVD. There was no association between insulin dose, HbA1c level, age-adjusted rate of albumin excretion, or smoking status and CVD. Waist-to-hip ratio, particularly in men, was positively associated with age, age-adjusted HbA1c, prevalence of smoking, daily insulin dose, albumin excretion rate, and fasting triglyceride concentrations. CONCLUSIONS: The overall prevalence of CVD in these IDDM patients was approximately 10%, increasing with age and duration of diabetes and with a sixfold variation between different European centers. CVD prevalence was most strongly associated with elevated triglyceride and decreased HDL cholesterol concentrations. CVD was also associated with albuminuria, but when adjusted by age, this association vanished. Increasing waist-to-hip ratio was associated with a number of adverse characteristics, particularly in IDDM men, reflecting the metabolic syndrome previously described in other populations.

[Influence of lovastatin on serum lipids in patients with primary hyperlipidemia phenotype IIa and IIb. I. Efficacy of lovastatin in the treatment of hyperlipoproteinemia]. / Wplyw lowastatinu na lipidy surowicy u pacjentów z hiperlipidemia pierwotna o fenotypach IIa i IIb. I. Skutecznosc lowastatinu w leczeniu hiperlipoproteinemii.

30 male patients, aged 18-70 years, with primary hyperlipoproteinemia (HLP) IIa (20 persons) and IIb (10 persons), with total serum cholesterol concentration above 6.5 mmol/l and triglyceride concentration below 3.9 mmol/l were treated with lovastatin for 12 weeks, after 4 weeks of wash-out and 4 weeks of placebo period. The lovastatin dosage varied from 20-80 mg daily. There were significant differences between groups in serum triglyceride, HDL-cholesterol and apolipoprotein AI concentration. After 12 weeks of treatment in patients with type IIa as well as with type IIb HPL significant decrease of total cholesterol (by 26.8% and by 33.6%, p < 0.001); LDL-cholesterol (by 39.1% and by 43.2%, p < 0.001); apolipoprotein B (by 22.9% and by 29.6%, p < 0.001) was found. Significant relationship between apolipoprotein B concentration and dosage of lovastatin was found. There were no differences in concentrations of HDL cholesterol and apolipoproteins AI and AII after treatment. The results of this study indicate that lovastatin efficiently decreases total and LDL-cholesterol concentration and apoprotein B level in patients with hypercholesterolemia as well as with hypercholesterolemia with mild hypertriglyceridemia.

[Examination of cortisol and insulin levels in serum of patients with primary hyperlipoproteinemia and phenotype IIa and IIb during lovastatin treatment]. / Badanie zachowania sie stezenia kortyzolu i insuliny w surowicy u pacjentów z hiperlipoproteinemia pierwotna o fenotypie IIa i IIb w trakcie leczenia lowastatinem.

Serum cortisol and insulin concentrations were determined in 30 patients with primary hyperlipoproteinemia (HLP) phenotype IIa (20 persons) and IIb (10 persons) during treatment with lovastatin. Lovastatin dosage varied from 20-80 mg daily. Serum insulin concentration did not change significantly after lovastatin treatment. Serum cortisol concentration significantly increased after 12 weeks of treatment. Cortisol concentration changes were different in HLP IIa and IIb patients. In HLP IIa cortisol concentration increased from 21.9 micrograms/dl to 28.1 micrograms/dl after 12 weeks of treatment, in HLP IIb cortisol level decreased from 31.3 to 24.1 micrograms/dl after 4 weeks of treatment and increased to 32.3 micrograms/dl after 12 weeks of therapy. Mean cortisol concentration was significantly higher in HLP IIa than HLP IIb patients. LDL-cholesterol concentrations changes after treatment correlated significantly with baseline cortisol concentration in HLP IIa group (r = -.34), changes in HDL-cholesterol concentration with baseline insulin levels in HLP IIb patients (r = -.54).

[Changes in the level of certain hemostatic factors during treatment with lovastatin in patients with primary hyperlipoproteinemia and phenotype IIa and IIb]. / Zmiany poziomu wybranych czynników ukladu hemostatycznego w trakcie leczenia lowastatinem pacjentów z hiperlipoproteinemia pierwotna o fenotypie IIa i IIb.

12 weeks of hypolipidemic therapy with lovastatin in patients with primary hyperlipoproteinemia phenotype IIa (20 persons) and IIb (10 persons), apart from decrease of serum total cholesterol, LDL-cholesterol and apolipoprotein B concentration caused significant decrease of antithrombin III, plasminogen and Factor VII activity. The mean decrease in antithrombin III activity (from 103.5 to 91.7% in HLP IIa and from 97.3 to 85.4% in HLP IIb) was significant in both groups, decrease of Factor VII activity (from 111.9 to 100.1%) was significant in HLP IIa and decrease of plasminogen (from 101.9 to 90.6%) in HLP IIb. There were no changes in fibrinogen concentration, prothrombin, Factor VIII activity and aPTT during treatment. Significant correlations of changes in blood lipids and changes in hemostatic factors after treatment were observed. The results of this study indicate that changes in blood lipids during hypolipidemic therapy are associated with significant changes in hemostatic factors.

[Influence of lovastatin on serum lipids in patients with primary hyperlipidemia and phenotype IIa and IIB. II. Changes of lipid composition of plasma lipoprotein fractions after lovastatin administration]. / Wplyw lowastatinu na lipidy surowicy u pacjentów z hiperlipidemia pierwotna o fenotypach IIa i IIb. II. Zmiany skladu lipidowego frakcji lipoprotein surowicy po podaniu lowastatinu.

In this study lipid composition of lipoprotein fractions LDL, VLDL and HDL was determined in 30 men with primary hyperlipoproteinemia phenotype IIa and IIb during lovastatin treatment. After 12 weeks of treatment in VLDL and LDL fractions decrease of percentage of cholesterol content and increase percentage of protein content was observed. The percentage of esterified cholesterol decreased in VLDL fraction and increased in LDL fraction during treatment. In HLP IIa significant decrease of percentage cholesterol content in VLDL and LDL fraction was observed. In HLP IIb decrease of percentage cholesterol content in VLDL and increase in percentage triglyceride content was found. Esterified cholesterol percentage decreased in VLDL fraction in HLP IIa. Lipids to protein ratio decreased significantly during treatment in VLDL and LDL fraction. The results of this study indicate that hypolipidemic treatment with lovastatin is associated with changes in lipid composition of lipoproteins, mainly with the decrease of percentage cholesterol content.

[Lipid disorders in non-insulin dependent diabetes--principles of treatment]. / Zaburzenia lipidowe w cukrzycy nieinsulinozaleznej--zasady leczenia.

Hyperlipoproteinemia is one of the main coronary risk factors. Lipid metabolism disorders occur in about 40-60% of patients with NIDDM. Hyperlipidemia in diabetics is related to diabetes control, presence of diabetic nephropathy, diet, some drugs and genetic factors. Lipid metabolism disorders in NIDDM comprise qualitative changes--usually increase of serum triglyceride concentration and decrease of HDL--cholesterol, and qualitative changes of lipoprotein composition, glycation and oxidation. The first steps of hypolipemic therapy are good control of diabetes, reduction of overweight, hypolipidemic diet, and if a goal level is not achieved--farmacotherapy. Hypolipidemic treatment should be relevant in reduction of cardiovascular diseases in diabetic patients.

[Lipids and primary prevention of coronary disease]. / Lipidy a pierwotna prewencja choroby wiencowej.

In this paper the data concerning the relationship between presence of lipid disorders and development of atherosclerosis are presented. The epidemiological studies showed that lipid disorders in young persons are of prognostic significance concerning future development of cardiovascular disease. Large, placebo controlled clinical trials demonstrated that reduction of serum cholesterol was associated with reduction in incidence of cardiovascular disease, however the decrease in total mortality (by 22%, p < 0.051) was observed only with statin treatment in WOSCOPS. Hyperlipidemia is associated with impairment of endothelial function, loss of endothelium dependent vasodilatation, development of inflammatory responses and impairment of anticoagulant function. Hypolipidemic therapy leads to improvement of endothelial function and stabilisation of atherosclerotic changes. Modification of all existing risk factors is of importance in prevention of cardiovascular diseases.

[Treatment of lipid disorders for coronary heart disease prevention according to International Atherosclerosis Society recommendations]. / Zasady leczenia zaburzen lipidowych w prewencji choroby wiencowej w swietle nowych wytycznych Komisji Ekspertów Miedzynarodowego Towarzystwa Miazdzycowego (International Atherosclerosis Society).

In this paper the results of recently published primary and secondary prevention trials of coronary heart disease using statins are presented. Statins are effective in patients with high and mean serum cholesterol levels, in elderly patients in men and in women. The IAS Expert Group recommendations concerning hyperlipidemia treatment in coronary heart disease prevention are presented. Lowering LDL-cholesterol, the most atherogenic lipoprotein fraction is a goal of the treatment and LDL-cholesterol level is recommended for monitoring of efficacy of the treatment. Hypertriglyceridemia (1.7-4.5 mmol/l) is a coronary heart disease risk factor, however the role of triglyceride lowering in coronary heart disease prevention remains to be established by clinical trials. Assessment and treatment of all coronary risk factors is essential for prevention.

[Familial LCAT deficiency]. / Rodzinny niedobór LCAT.

Familial deficiency of lecithin-cholesterol acyltransferase (LCAT) was described by Norum and Gjone in 1967. LCAT (EC 2.3.1.43) is a serum enzyme involved in reverse cholesterol transport. LCAT deficiency is associated with percentage increase of free cholesterol and decrease of esterified cholesterol, and disturbances in lipoprotein particles structure, because cholesterol esters form the lipoprotein core. Lipid disorders involve also other organs, such as kidneys, cornea and erythrocytes; with clinical manifestations of proteinuria, usually associated with renal insufficiency, corneal opacities and haemolytic anemia. Gene encoding LCAT is localized in region q 21-22 on chromosome 16. It consists of 6 exons, divided by 5 introns and spans 4.2 bp. Familial LCAT deficiency is an autosomal recessive disorder. In LCAT deficient patients several mutations in all 6 exons have been described. Clinical manifestations of familial LCAT deficiency are highly variable, although no or only low LCAT activity is present and this may suggests that expression of the disease is modulated by additional environmental factors and genes of minor importance.

[Fibrate influence on lipids and insulin resistance in patients with metabolic syndrome]. / Wplyw fibratów na lipidy i insulinoopornosc u pacjentów z zespolem metabolicznym.

Dyslipidemia, central obesity, hyperinsulinemia and insulin resistance, arterial hypertension, impaired glucose tolerance and increased thrombogenicity are the main features if metabolic syndrome. Metabolic syndrome is associated with increased cardiovascular risk. Fibrate administration in metabolic syndrome, apart from favourable influence on lipid profile was associated with decrease of hyperinsulinemia nad insulin resistance, reduction of systolic and diastolic blood pressure and decrease of hemostatic factors, strong predictors of increased coronary risk--fibrinogen, an acute phase reactant and factor VII was observed. Fibrate treatment was associated with slight decrease of body weight. These favourable effects of fibrates may make them particularly suitable for treatment of dyslipidemia in persons with metabolic syndrome.

[Chronic complication of diabetes and homocysteine]. / Przewlekle powiklania cukrzycy a homocysteina.

Increased homocysteine levels are associated with increased risk of cardiovascular disease incidence and mortality in general population and with even greater risk in persons with diabetes mellitus. Among possible mechanisms of proatherogenic action of homocysteine increased procoagulant activity, increased oxidative stress and effect on proliferation of smooth muscle cells should be mentioned. However, the role of hyperhomocysteinemia in the development of microvascular complications is the subject of a few studies with controversial results. Some studies indicate the role of hyperhomocysteinemia in predicting micro- and macroalbuminuria and also retinopathy and neuropathy. Serum homocystine levels are dependent on age, renal function, and dietary intake of folic acid and B vitamins. The role of insulin in homocysteine metabolism is the subject of studies. Determination of the role of hyperhomocysteinemia in macrovascular and microvascular diabetes complications could be of importance in their prevention through dietary and pharmacological modifications of homocysteine levels.

[Coronary risk factors in a group of patients with insulin dependent diabetes mellitus--examination of the EURODIAB IDDM Complications Study Krakow]. / Czynniki ryzyka chorób ukladu krazenia u pacjentów z cukrzyca insulinozalezna--Badanie EURODIAB IDDM Complications Study Kraków.

Cardiovascular complications are the main cause of disability and deaths in insulin dependent diabetic patients. The main aim of the EURODIAB IDDM Complications Study was to assess the prevalence of diabetes complications and of risk factors of these complications. In this study the data on cardiovascular diseases and their risk factors in patients included in the EURODIAB IDDM Complications Study--Krakow are presented. The study population included insulin dependent clinic attenders, aged 15-60 years, diagnosed before the age of 36 years. A random sample of up to 140 patients stratified by age, sex and duration of diabetes was chosen. Within each centre the study population consisted of all eligible IDDM patients living in a defined catchement area, who had attended the center at least once during the preceding 12 months. The studied sample included 120 patients (61 men and 59 women). Mean (sd) age of patients was 34.0 (9.6) years, mean duration of diabetes 14.2 (9.8) years, mean Hb A1c concentration 6.6 (1.5)%. The prevalence of cardiovascular diseases was assessed using standardized questionnaire and resting electrocardiogram. Blood pressure was measured with "random zero" sphygmomanometer. Electrocardiogram was assessed according to Minnesota code. Serum cholesterol and triglyceride concentration were determined by enzymatic methods. Albumin excretion rate was determined in 24 hours urine collection. Albumin concentration was assayed by immunoturbidimetry. Cardiovascular diseases were observed in 8.3% of patients. Arterial hypertension (WHO dfn) was found in 11.7% of patients, systolic blood pressure > or = 140 mm Hg in 9.2% of patients and diastolic blood pressure > or = 90 mm Hg in about 5% of men and 2% of women. Hypercholesterolemia (serum cholesterol > or = 6.5 mmol/l) was found in about 20% of patients, hypertriglyceridemia (serum triglyceride 2.2 mmol/1) in 16.4% of men and 10.2% of women. 41.0% of men and 28.8% of women were current cigarette smokers. Microalbuminuria (defined as albumin excretion rate 20-200 micrograms/min) was observed in 23% of men and 15.3% of women.(ABSTRACT TRUNCATED AT 250 WORDS)

[Beclobrate (Turec) in the treatment of primary hyperlipoproteinemia. I. Effect on cholesterol, lipid and apoprotein levels]. / Beklobrat (Turec) w leczeniu pierwotnej hiperlipoproteinemii. Czesc I: Wplyw na stezenie cholesterolu, lipidy i apoproteiny.

The effects of a new fibric acid derivative--beclobrate (Turec, Zyma) on serum lipid and apoprotein concentrations in 63 patients with primary hyperlipoproteinemia were examined. Beclobrate was given in the evening, 100 mg, once daily. After 3 months of beclobrate treatment mean total cholesterol concentration in serum decreased from 9.35 to 7.73 mmol/l (17.3%), mean LDL-cholesterol concentration from 6.32 to 5.38 mmol/l (14.9%), mean HDL-cholesterol concentration increased by 0.21 mmol/l (15.3% of initial value). The greatest decrease was observed in triglyceride concentration--by 50% of the initial value. Apoprotein B concentration decreased by 19.7%, apoprotein A1 and A2 concentration increased by 20.3% and 26.8% respectively. Higher initial values of total cholesterol and triglyceride concentration in serum were associated with greater concentration decrease after beclobrate treatment.

[Beclobrate (Turec) in the treatment of primary hyperlipoproteinemia. II. Results of the treatment in relation to the type of hyperlipoproteinemia]. / Beklobrat (Turec) w leczeniu pierwotnej hiperlipoproteinemii. Czesc II: Zaleznosc wyników leczenia od postaci hiperlipoproteinemii.

After three months of beclobrate treatment (100 mg once daily) of 63 patients with primary hyperlipoproteinemia (HLP) significant decrease of total cholesterol concentration was found in type IIa by 12.9%, IIb by 23.7%, IV by 20.8%. LDL cholesterol concentration decreased in type IIa by 15.4%, IIb by 8.3%, in type IV non significant increase of LDL cholesterol by 21.6% was observed. Decrease of initial triglyceride level in type IIa by 36.1%, IIb by 41.2%, in type IV by 56.6% was found. HDL-cholesterol concentration increased in all examined HLP types in IIa by 19.5%, IIb by 19.3%, IV by 14.5%. Also initial apolipoprotein A1 and A2 levels increased in all HLP types examined, namely in type IIa respectively by 21.2% and 12.4%, IIb by 25.1% and 11.0%, in type IV by 23.6% and 34.9%. Serum apolipoprotein B concentration decreased significantly in type IIa by 20.5%, IIb by 28.4%, however in type IV a slight increase of apoprotein B level was observed. Comparison of HLP types response to beclobrate treatment revealed that the HLP types examined are significantly different in change size of LDL cholesterol concentration, triglyceride concentration and apoprotein B concentration after treatment.

[Myocardial infarction incidence and mortality among urban and rural populations during the 3-year period]. / Zachorowalnosc i smiertelnosc spowodowana zawalem serca populacji wielkomiejskiej i rolniczej w okresie 3-letniej obserwacji.

In years 1984-1986 3639 men and 1885 women were registered with suspected myocardial infarction from right-side Warsaw, simultaneously 2371 men and 917 women with the same suspected disease were registered from the Tarnobrzeg province population. The myocardial infarction diagnosis was confirmed in 54% of men and 43% of women from the Warsaw population as well as in 77% of men and 66% of women from Tarnobrzeg province population. In Warsaw the standardized incidence due to myocardial infarction increased during years of study from 466 to 588/100,000 among men and from 178 to 206/100,000 among women. The analogous increase among the Tarnobrzeg province population was 302 to 559/100,000 among men and 64 to 195 among women. Fatality during 28 days from the onset of the disease did not show any relationship with year of study and corresponded yearly among men to 45% and among women to 37% in Warsaw and to 42% among men and 33% among women in the Tarnobrzeg province . High fatality was noted during first 24 hours of hospitalization (Warsaw: 36% among men and 26% among women, Tarnobrzeg: 39% among men and 32% among women). The highest fatality was noted in the youngest of analysed groups.

[Effect of inter-population differences in the levels of selected factors on the differences in arterial blood pressure]. / Wplyw miedzypopulacyjnych róznic w poziomie wybranych czynników na róznice w cisnieniu tetniczym krwi.

According to the Pol-MONICA program the random selected population samples were studied in inhabitants of Warsaw or the Tarnobrzeg province . After excluding from analysis the subjects treated with the hypotensive++ or hypolipemic drugs the differences between populations studies with regard to range of mean pressure value, except systolic pressure (RRs) in women, appeared significant ones. In populations studied the arterial blood pressure (CTK) was influenced by: age, sex, education, family history with regard to the circulatory system, the alcohol intake, smoking, heart action frequency the Quetelet coefficient value, triglyceride concentration and daily sodium intake. After analysis of inter-population differences in values of above factors the mean RRs values in populations studied did not differed significantly whereas differences in mean values of diastolic pressure (RRr) were highly statistically significant.

[Regional differences in drug use in relation to the causes]. / Regionalne zróznicowanie w spozyciu leków w zaleznosci od przyczyny.

The purpose of the study was in comparison of drug use in the treatment of coronary disease or hypertension in the random selected representative population sample of Warsaw and Tarnobrzeg province . In the study women and men aged 35 to 64 years were included according to POL-MONICA studies. Among 2646 subjects studied in Warsaw 23% used drugs whereas among 2722 subjects from the Tarnobrzeg province the drug users represented 12.1%. The most frequently used drugs in the treatment of coronary disease were nitrates, curantyl and beta-blockers. The drug use in subjects with coronary disease (DDD/1000 inhabitants/day) was 4.5-fold higher in Warsaw than in the Tarnobrzeg province . The most frequently drug used in treatment of hypertension in Warsaw were beta-blockers and diuretics, whereas in the Tarnobrzeg province among men diuretic and composed drug preparations; women in the last region used frequently composed drug preparations and smooth muscle relaxants. The relationship between the use of particular drug groups and the region was significant in women. The hypotensic drug use in Warsaw was twice as high as in the Tarnobrzeg voivodship despite similar frequency of hypertension in both regions.