[Values of high-density lipoprotein cholesterol in the pediatric population and risk of thrombosis]. / Valores de colesterol HDL en la población infantil y riesgo trombótico.

INTRODUCTION: There is evidence of the protective effect of high-density lipoprotein (HDL)-cholesterol against atheroma plaque formation and of its role in cholesterol efflux from cells, as well as its anti-oxidative and inflammatory modulating response properties. Low HDL-cholesterol levels have been associated with a prothrombotic state. OBJECTIVE: To determine the relationship between HDL-cholesterol and lipidic and hemostatic parameters. PATIENTS AND METHODS: We studied 110 children (50 girls, 60 boys) aged between 6 and 7 years old. Lipid profile, D-dimer, plasminogen activator inhibitor (PAI) and fibrinogen were determined. RESULTS: The mean values of the studied parameters were as follows: total cholesterol (192.92+/-26.01 mg/dl), HDL-cholesterol (72.87+/-15.69 mg/dl), low-density lipoprotein-cholesterol (109.46+/-23.30 mg/dl), triglycerides (56.24+/-20.35 mg/dl), apolipoprotein B (91.96+/-14.93 mg/dl), apolipoprotein A1 (168.4+/-24.55 mg/dl), lipoprotein(a) logarithm (1.76+/-1.36 mg/dl), plasminogen activator inhibitor-1 logarithm (PAI-1) (3.77+/-3.93 U/ml), D-dimer logarithm (5.53+/-0.49 ng/ml) and fibrinogen (268.61+/-48.59 mg/dl). When the sample was divided into two groups according to HDL-cholesterol levels, children with lower levels showed significantly higher values of total cholesterol/HDL-cholesterol, fibrinogen and PAI. HDL-cholesterol levels were directly and significantly associated with total cholesterol and apolipoprotein A1 and negatively and significantly associated with the total cholesterol/HDL-cholesterol ratio, fibrinogen and PAI. CONCLUSION: The children studied had high HDL-cholesterol levels, which could be responsible for the high total cholesterol levels. High values of HDL-cholesterol are significantly associated with a reduction in thrombotic risk.

[Correlation of lipid profiles and anthropometric variables with serum lipoprotein(a) levels in childhood]. / Correlación de los perfiles lipoproteicos y variables antropométricas con concentraciones séricas de lipoproteína(a) en la infancia.

The aim of the present study was to evaluate lipoprotein(a) distribution in children and to assess its association with lipid profile and anthropometric variables. We studied 98 children (44 girls and 54 boys) with ages ranging from 6 to 7 years, who were included in an epidemiological study on the prevalence of hypercholesterolemia in children in the province of Biscay. The following parameters were determined: weight and height, body mass index, lipoprotein(a), and lipid profile. Lipid profile included total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, apolipoprotein B, and apolipoprotein A1. The mean and median serum lipoprotein(a) levels were 13.07 and 5.56 mg/dl respectively and were 11.43 and 3.92 mg/dl for boys and 15.09 and 8.32 mg/dl for girls. Lipoprotein(a) concentrations > 30 mg/dl were found in 7.4% of the boys and in 11.4% of the girls. The mean values and prevalences of lipoprotein(a) > 30 mg/dl were lower in boys than in girls but these differences were not statistically significant. A positive correlation was found between lipid profile (LDL-cholesterol, apolipoprotein B and LDL-cholesterol/HDL-cholesterol index) and lipoprotein(a) levels. When evaluating anthropometric variables, we found a statistically significant inverse correlation between weight and lipoprotein(a). In view of the cumulative effect of cardiovascular risk factors and the results of this study, we believe that lipoprotein(a) determination should be considered in children with an unfavorable lipid profile.

[The determinants of exercise tolerance in patients with hypertensive cardiopathy]. / Determinantes de la tolerancia al ejercicio en pacientes con cardiopatía hipertensiva.

A study was made of 45 patients with arterial hypertension, no prior angina or myocardial infarction, mean age 64 +/- 5 years, and ejection fraction > 50%. Twenty (group I) had congestive heart failure while 25 (group II) were asymptomatic. Testing following remission of symptoms revealed impaired exercise tolerance (VO2 max < 20 ml/kg/min) in 22 (subgroup A-80% from group I), and normal tolerance in 23 (subgroup B). Of ventricular function indexes, only peak filling rate correlated significantly with VO2 max (r = 0.65). Of 32 patients with thallium-201 negative in ergometric tests, the 12 in subgroup A had a higher degree of hypertrophy (p > 0.01). Nine thallium-positive patients had lower VO2 max (p > 0.05) than did 17 thallium-negative patients with a similar degree of hypertrophy. Thus, in hypertensive patients, exercise tolerance depends on prior congestive heart failure, diastolic dysfunction, degree of hypertrophy and silent regional ischemia.

Comparative study of gallopamil versus nifedipine in patients with ischemic heart disease.

In order to compare the anti-ischemic activity of gallopamil and nifedipine, a cross-over, double-blind, randomised trial was carried out in 30 male out-patients with a history of stable exertional angina, proven coronary disease and a positive stress test (ST-segment depression > or = 1 mm). After a first 1-week wash-out period on placebo, the patients were randomised to gallopamil, 150 mg/day (50, 50 and 50) or nifedipine, 30 mg/day (10, 10 and 10) for 28 days. After a second 1-week wash-out period active treatments were crossed for another 28 days. At the end of each drug or placebo period, a physical examination, laboratory tests and a stress test were performed. Oral short-acting nitrates were permitted throughout the trial periods. Twenty-one patients finished all periods of the study. Both drugs reduced the maximum ST-segment depression during the exercise test: from 2.45 +/- 0.97 mm (placebo) to 1.95 +/- 0.82 mm (gallopamil, P < 0.05) and from 2.50 +/- 0.93 mm (placebo) to 1.75 +/- 0.84 mm (nifedipine, P < 0.05). Gallopamil but not nifedipine increased stress tolerance significantly: from 486 +/- 156 s (placebo) to 598 +/- 138 s (gallopamil, P < 0.05) and from 509 +/- 113 s (placebo) to 567 +/- 191 s (nifedipine, NS). No significant differences were found between drugs. Both calcium antagonists, gallopamil and nifedipine, showed similar efficacy in treating myocardial ischemia.

[Clinical and angiographic expression of myocardial ischemia in stable angina as a function of its coronary reserve]. / Expresión clínica y angiográfica de la isquemia miocárdica en la angina estable en función de su reserva coronaria.

We have studied the distribution of the coronary reserve, evaluated by serial effort tests, in patients with proved coronaropathy, determining the correlation between clinic (effort and mixed angina) and coronary reserve (fixed and variable), assessing angiographic findings in function to that reserve. We took 120 patients with stable angina to whom 2 effort tests were performed, basal and after vasodilator drugs. It was considered variable reserve if in the second test the S-T descend improved greater than or equal to 1 mm for a similar of greater double product and fixed when it didn't improve. In all patients coronarography was performed. Seventy two patients (60%) showed fixed reserve, 58 with effort angina (80%) and 14 (20%) with mixed. Forty eight showed variable reserve, 40 (80%) with mixed angina and 8 (17%) with effort. The group with fixed reserve had a greater S-T max. descent (2.9 +/- 0.9 vs 2.2 +/- 0.4) (p less than 0.001), a lower double product max. (221 +/- 44 vs 284 +/- 37) (p less than 0.001) and a lower maximal oxygen consumption (MVO2 7 +/- 2 vs 11 +/- 2) (p less than 0.001) than the variable reserve group. Considering the angiography, the fixed reserve group had more number of vessels affected (1.9 +/- 0.7 vs 1.4 +/- 0.5) (p less than 0.01), a higher angiographic score (4.88 +/- 2.4 vs 2.2 +/- 1.2) (p less than 0.001), a lower ejection fraction (59 +/- 8.5 vs 65 +/- 7.5) (p less than 0.001), more multivessel and descending anterior artery lesion than the variable reserve group.(ABSTRACT TRUNCATED AT 250 WORDS)