High tracking of apolipoprotein B levels from the prepubertal age to adolescence in Spanish children.

AIM: To assess tracking of lipid and apolipoproteins from the prepubertal age (baseline, 6-8 years old) to adolescence (follow-up, 13-16 years old) in Spanish children. METHODS: The sample population included 385 healthy children (179 boys and 206 girls). Tracking was estimated by correlations between baseline and follow-up levels, multiple regression models in which the follow-up lipid was the dependent variable and analysing the percentage of individuals who remained in the same lipid levels status from prepubertal age to adolescence. RESULTS: Correlations between baseline and follow-up levels for low density lipoprotein (LDL)-cholesterol and apolipoprotein B (apo B) were stronger in boys and for high density lipoprotein-cholesterol and apo A-I stronger in girls. Regression analyses showed that, after adjusting by body mass index (BMI), baseline LDL-cholesterol and apo B levels explain 23% and 39% of the variation of follow-up LDL-cholesterol and apo B levels, respectively, in boys and 13% and 22%, respectively, in girls. The strength of tracking for LDL-cholesterol and apo B was 79% and 89%, respectively, in boys and 72% and 82%, respectively, in girls. CONCLUSION: Apolipoprotein B showed the strongest tracking in both sexes, stronger than for LDL-cholesterol, which supports the importance of determining apo B levels as a marker of dyslipidaemia in children.

Association of the Q223R polymorphism with age at menarche in the leptin receptor gene in humans.

Although genetics clearly influences the onset of menarche, the association of age at menarche (AAM) with variants in genes related to energy homeostasis remains unexplored. Our aim was to analyze the relationship of the Q223R polymorphism in the leptin receptor gene (LEPR(Q223R)) with AAM in a population-based sample of healthy pubertal girls. The study included 338 Spanish girls aged between 11 and 17 yr. Data were collected on AAM. The Q223R polymorphism in LEPR was detected by TaqMan allelic discrimination assays. Girls carrying the RR genotype had a significantly younger AAM (11.5 yr) than those carrying the QR (11.9 yr) or QQ (12.0 yr) genotype (P < 0.05). Furthermore, we found a significantly higher frequency of the RR genotype in girls with an AAM of 11 yr or younger than in girls with an AAM older than 12 yr (23.9% vs. 7.8%, χ(2) = 11.17, P = 0.0008). Also, the RR genotype frequency in girls with an AAM between 11 and 12 yr was significantly higher than in girls with an AAM older than 12 yr (16.8% vs. 7.8%, χ(2) = 3.97, P = 0.0046). The Q223R polymorphism in the LEPR gene is associated with variations in AAM among Spanish girls, with the RR genotype being related to earlier onset.

Sex-specific association between leptin receptor polymorphisms and leptin levels and BMI in healthy adolescents.

AIM: To examine the relationship of three common polymorphisms in the leptin receptor (LEPR) gene, implicated in the regulation of body weight, with leptin levels and obesity-related phenotypes in a population-based sample of healthy pubertal children in Spain. METHODS: The study included 806 boys and girls aged 12-16 whose anthropometrical data and body composition were recorded. Serum leptin levels were determined by ELISA. The LEPR Q223R, K109R and K656N polymorphisms were determined by TaqMan® allelic discrimination assays. RESULTS: When analysing the Q223R polymorphism, we observed that female carriers of the RR genotype had significantly higher plasma leptin levels (18.2 vs. 15.1 ng/mL p = 0.016) and significantly higher mean BMI values (22.5 vs. 21.3 Kg/m² p = 0.032) than QR carriers. Furthermore, the frequency of the RR genotype in overweight-obese girls was significantly higher than that found in normal-weight girls. No significant differences were observed in boys. Neither boys nor girls showed significant differences when comparing leptin levels, anthropometric variables or body composition by K109R or K656N genotype. CONCLUSION: The fact, that the Q223R polymorphism in the LEPR gene is significantly associated with leptin levels and BMI only in girls, suggests a sex-specific influence of this polymorphism on these variables.

[Serum vitamin B12 levels in an adolescent population in Madrid]. / Concentración de vitamina B12 en suero en población puberal de la Comunidad de Madrid.

INTRODUCTION: Serum vitamin B12 concentration levels in children are essential to establish values in order to compare different regions or countries, and for considering e the possibility of supplementing diets with group B vitamins as a secondary prevention against cardiovascular diseases. MATERIAL AND METHODS: A cross-sectional epidemiological study was carried out to asses serum vitamin B12 levels in school children, 13-15 years of age, in Madrid. Folate and vitamin B12 vitamin determinations were performed on fasting blood samples. Genotype C677T of methylentetrahydrofolate reductase (MTHFR) enzyme was determined by PCR. RESULTS: The mean vitamin B12 level obtained in our study was 503 pmol/l; CI 95 % CI (478-528 pmol/l). The median was 471 pmol/l; interquartile range (IR) (337-632 pmol/l). No statistically significant differences were found by age or C677T genotype for MTHFR. Serum vitamin B12 concentrations were significantly higher in females. Prevalence of vitamin B12 deficiency (< 224 pmol/l) was 6 % in males and 4 % in females. CONCLUSIONS: Reference values for serum vitamin B12 concentrations in an adolescent population are presented. Prevalence of vitamin B12 deficiencies is higher in males.

Saturated fat in the diet of Spanish children: relationship with anthropometric, alimentary, nutritional and lipid profiles.

OBJECTIVE: To compare the anthropometric, alimentary, nutritional and lipid profiles and global diet quality of Spanish children according to saturated fat intake. DESIGN: This was a cross-sectional study. Food data were collected using a food-frequency questionnaire. SUBJECTS AND METHODS: The sample included 1112 children of both sexes, aged between 6 and 7 years, selected by means of random cluster sampling in schools. The plasma lipid profile included measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apolipoprotein A1 (apoA1) and apolipoprotein B (apoB). Global diet quality was evaluated by the Dietary Variety Index (DVI) and the Healthy Eating Index (HEI). RESULTS: Energy intake, DVI and HEI of children from the lower quartile of saturated fat intake (LL) were higher (P<001) than in the remaining children (UL). However, there were no significant differences in average height or weight between groups. The UL children had lower intakes of meat, fish, vegetables, fruits and olive oil and a higher intake of dairy products (P<0.001). The intakes of fibre, vitamins C, D, B6, E and folic acid were higher in the LL children, who had lower intakes of vitamin A and calcium. The ratios LDL-C/HDL-C and apoB/apoA1 were lower (P=0.04) in the LL children (1.87 and 0.52, respectively) than in the UL children (2.02 and 0.54, respectively). CONCLUSIONS: The growth rate of children does not seem to be affected by the level of saturated fat intake. Furthermore, at the levels of intake observed in this study, diets with less saturated fat are associated with better alimentary, nutritional and plasma lipid profiles.

Variations in APOE genotype distribution in children from areas with different adult cardiovascular disease mortality in Spain.

We investigate whether a varying distribution of the APOE genotype could help explain regional differences in ischemic heart disease (IHD) mortality in Spain. APOE genotypes were examined by PCR in 1,274 randomly selected healthy children from four Spanish regions with different adult IHD mortality rates (northwest and central Spain with low rates and southeast and southern Spain with high rates). In the population as a whole the prevalence of the higher risk APOE*3/*4 genotype is 16.8% and the prevalence of the APOE*4 allele is 10.1%. In northwest Spain the frequencies of the APOE*3/*4 genotype (12.9%) and of the APOE*4 allele (8.3%) are smaller than in the other regions. The southeast region shows statistically higher frequencies of the APOE*3/*4 genotype (22.5%) and of the APOE*4 allele (13.2%) than in the other regions or in the group as a whole. We can conclude that Spain is not homogeneous in terms of APOE genotype distribution. Although the prevalence of the APOE*4 allele is generally low, there are areas with higher prevalence of the APOE*4 allele and a higher incidence of adult IHD mortality. This allows us to conclude that in Spain this genetic determinant can be associated with IHD mortality in relatively isolated populations.

Spanish children's diet: compliance with nutrient and food intake guidelines.

OBJECTIVE: To compare the diet of Spanish children against the nutrient and food intake guidelines. To calculate an index of overall diet quality and check its validity against nutrient intake. DESIGN AND SETTING: Cross-sectional study in four cities in Spain, where information on food and nutrient intake was obtained from schoolchildren through a food frequency questionnaire. PARTICIPANTS: The sample included 1112 children (overall response rate of 85%) attending public and private schools and aged 6-7 y. Children were selected through random cluster sampling in schools, and stratified by sex and socioeconomic level. MAIN OUTCOME MEASURES: Mean nutrient intake, number of food servings, and the percentage of children who meet recommended nutrient and food-serving intake levels. The overall dietary quality was assessed using the Healthy Eating Index (HEI). RESULTS: Mean micronutrient intake exceeded 100% of the recommended dietary allowances, except for vitamin B6, which registered a mean intake of 77.1%. For almost all children, intake of saturated fat was above, and that of carbohydrate below, the recommended level, in contrast to the relatively high compliance with the recommendations for poly- and monounsaturated fatty acid, salt and fiber intake (69.7, 43.7, 40.7, and 30.1%, respectively). Consumption of food servings for each of the five American pyramid food groups came close to or exceeded USDA guidelines, with the exception of cereals, with 5.4 servings per day. The mean score obtained in the HEI was 64.6. Children who complied with all the food guide pyramid recommendations registered a higher dietary variety and a healthier nutritional profile. CONCLUSIONS: Children aged 6-7 y show scant compliance with the macronutrient goals for healthy eating. Micronutrient intake is adequate in general, yet there are small groups of children with risk of deficient intake of vitamins B6 and D. While Spanish children's eating habits are reasonably in line with American food guide pyramid guidelines, consumptions of cereals and fruit should be improved.

Food sources of nutrients in the diet of Spanish children: the Four Provinces Study.

The aim of the present study was to assess the principal food sources of energy and nutrients among Spanish children. We used a cross-sectional study design, based on results obtained from a food-frequency questionnaire. The sample included 1112 children, aged 6-7 years, from Cadiz, Madrid, Orense and Murcia, Spain. Children were selected through random cluster-sampling in schools. We analysed the percentage contributed by each food item to total energy and nutrient intake. The most important food sources were: white bread in the case of carbohydrate (13.4 %); olive oil in the case of total lipids (18.3 %) and monounsaturated fatty acids (29.2 %); whole milk in the case of protein (10.2 %) and saturated fatty acids (14.9 %); chips (French fried potatoes) in the case of polyunsaturated fatty acids (30.4 %). The greatest proportion of Na, consumed in excess, came from salt added to meals. Ham ranked second as a source of saturated fats. Fruits and green leafy vegetables proved to have great relevance as sources of fibre and vitamins, though with regard to the latter, it was observed that fortified foods (breakfast cereals, dairy products, fruit juices, etc.) had come to play a relevant role in many cases. In conclusion, the nutritional profile of Spanish school-aged children aged 6-7 years could be improved by nutritional policies targeted at limiting their consumption of ham (cured or cooked) and of salt added to meals, replacing whole milk with semi-skimmed milk, encouraging the consumption of products rich in complex carbohydrates already present in children's diets (bread, pasta, rice) and promoting less fatty ways of cooking food.

Greater dietary variety is associated with better biochemical nutritional status in Spanish children: the Four Provinces Study.

BACKGROUND AND AIM: Although dietary variety has been associated with a better nutritional profile, its possible role in obesity raises doubts about its overall health benefits. In this study, we examined the association between dietary variety and anthropometric variables, food intake and various food intake biomarkers in Spanish children. METHODS AND RESULTS: This was a cross-sectional study of 1112 children aged 6-7 years from Cadiz, Murcia, Orense and Madrid, who were selected by means of the random cluster-sampling of schools. Information concerning food and nutrient intake was obtained using a food frequency questionnaire, and a dietary variety index (DVI) was calculated on the basis of the number of different foods consumed more than once a month. The anthropometric variables (weight and height), and plasma lipid and vitamin levels were determined using standardised methods. Our results show that the body mass index (BMI) did not vary substantially as a function of DVI: it was 16.9 in the lowest DVI tertile and 17.2 in the highest (p=0.20). Unlike BMI, the DVI positively correlated (p<0.05) with the plasma levels of alpha and beta-carotene, lycopene, retinol, alpha-tocopherol and vitamin E, with energy intake, and with most of the foods, particularly vegetables, fruit and sausages (respective correlation coefficients of 0.43, 0.26 and 0.23). CONCLUSIONS: Dietary variety is associated with a better food and nutritional profile in Spanish children. Nevertheless, the presence of a positive association between the DVI and energy intake, and the consumption of sausages and pre-cooked products calls for the recommendation of a varied diet of healthy foods, such as cereals (especially whole grains), fruits and vegetables.

Gender-specific effects of apolipoprotein E genotype on plasma lipid levels in a population-based sample of 6-7-year-old children in Spain.

AIM: The effects of gender on the association between apolipoprotein E genotype and plasma lipid levels remain unclear in children. The aim of the present work was to evaluate these gender differences in a large population-based sample of 6-7-y-old children, free of the effects of sex hormones. METHODS: Lipid levels and apo E genotypes were studied in a sample of 1255 (631 M, 624 F) Caucasian schoolchildren, aged 6-7 (mean age, 6.7) y in Spain. RESULTS: A significant effect of the apo E genotype on plasma total cholesterol, LDL-C (low-density lipoprotein cholesterol) and apo B levels was observed. Taking the homozygous epsilon3epsilon3 genotype as reference, the presence of the epsilon2 and epsilon4 alleles is associated with substantially lower and higher plasma levels, respectively, of these variables. It was found that the effect of the apo E polymorphism on total cholesterol, LDL-C and particularly on apo B levels was greater in girls than in boys. CONCLUSION: At this prepubertal age, the influence of the apo E genotype on total cholesterol, LDL-C and apo B levels is more evident in girls than in boys. This difference in effect is not due to sex hormones. In our opinion, the earlier increase in adrenal androgens in girls than in boys at this age related to pubertal maturation could be responsible for these differences.

Dietary patterns among children aged 6-7 y in four Spanish cities with widely differing cardiovascular mortality.

OBJECTIVE: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6-7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. DESIGN AND SETTING: Cross-sectional anthropometric and dietary survey in four cities in Spain. SUBJECTS: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. OUTCOME MEASURES: Body mass index (BMI), overweight (BMI>17.6 kg/m(2)), obesity (BMI>20.1 kg/m(2)) and intake of food and nutrients. RESULTS: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9-34.5%) and obesity (8.5-15.7%). They also had a moderately hypercaloric diet (range, 2078-2218 kcal/day), marked by an excessive intake of lipids (45.0-47.3% kcal), particularly saturated fats (16.6-16.9% kcal), proteins (17.0-17.3% kcal), sugars (20.0-21.9% kcal) and cholesterol (161.6-182.9 mg/1000 kcal/day), and a low intake of complex carbohydrates (17.5-18.1% kcal) and fibre (19.6-19.9 g/day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg/m(2); P=0.0001) and ponderal index (0.58 kg/m(3); P=0.0001) and a higher intake of energy (104 kcal/day; P=0.007), cholesterol (16.00 mg/1000 kcal/day; P=0.0001) and sodium (321 mg/day; P=0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. CONCLUSIONS: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences. SPONSORSHIP: This study was partly funded by grants from the International Olive Oil Board (Consejo Oleícola Internacional), Comunidad Autónoma de Madrid, Fundación Pedro Barrié de la Maza, and Fundación Eugenio Rodríguez Pascual.

[Clinical manifestations of heterozygote familial hypercholesterolemia in Spain. Study of 301 cases from the central and northern areas]. / Manifestaciones clínicas de la hipercolesterolemia familiar heterozigota en España. Estudio de 301 casos de la zona centro y norte.

RATIONALE: To characterize clinical manifestations of familial hypercholesterolemia (FH) in Spain. PATIENTS AND METHODS: A group of 301 cases of FH from central and north regions of Spain. RESULTS: With a mean (SD) cholesterol level of 346 (58) mg/dl, only 7.6% of the patients have xanthomas and 20% ischaemic heart disease. 51% have a familial history of ischaemic heart disease. CONCLUSIONS: Different from the results of literature, xanthomas are very infrequent in FH in Spain, so diagnosis should be suspected from other data. The high prevalence of familial history of ischaemic heart disease supports the usefulness of this feature as a marker for diagnosis and prevention.

[The 4 Provinces Study: its principal objectives and design. The Researchers of the 4 Provinces Study]. / Estudio Cuatro Provincias: principales objectivos y diseño. Investigadores del Estudio Cuatro Provincias.

INTRODUCTION AND OBJECTIVES: Spain shows an important variation in the geographical distribution of ischaemic heart disease and cerebrovascular disease mortality. In this article, the primary objectives and design of the Four Provinces study are described. In this study we analyzed the contribution of environmental factors (diet, lipid profile and plasma antioxidants), acting in childhood, to explain differences in cardiovascular mortality rates between different provinces in Spain. METHODS: An ecological design was projected in which the units to study were four Spanish provinces with a wide variation in cardiovascular mortality in adulthood. The design compares diet, anthropometric variables and biological markers (particularly plasma lipids and antioxidant levels) in 6-7-year-old children, between the two provinces with the highest cardiovascular mortality rates and the two provinces with the lowest. The information for each province is collected in a cross-sectional manner in a representative sample of children from each province. DISCUSSION: Evidence from the literature concerning Northern European countries suggest the contribution of environmental factors during early age in the development of cardiovascular disease in adulthood. The "Four Provinces" study will provide, for the first time, information about the influence of factors in early childhood of cardiovascular risk in a Mediterranean country. The study will also offer interesting data about food intake during school age in four provinces and it will allow us to estimate values of population of the variables of interest in those provinces.

Human apolipoprotein A-I gene promoter mutation influences plasma low density lipoprotein cholesterol response to dietary fat saturation.

Previous studies have shown that the A to G transition occurring at position -75 bp upstream of the transcriptional start site in the human apolipoprotein A-I gene may affect plasma high density lipoprotein cholesterol (HDL-C) levels and low density lipoprotein cholesterol (LDL-C) response to changes in amount of dietary fat. We have examined the response to dietary fat saturation as a function of this mutation in 50 men and women. Subjects were first fed a saturated (SAT) fat diet (35% fat, 17% SAT) for 28 days, followed by a diet rich in monounsaturated fatty (MUFA) acids (35% fat, 22% MUFA) for 35 days and a diet rich in polyunsaturated (PUFA) fat (35% fat, 13% PUFA) for 35 days. All meals were prepared and consumed at the study sites. Lipoproteins were measured at the end of each diet period. The allele frequency for the A allele was 0.13. Subjects carrying the A allele had higher plasma cholesterol, LDL-C and triglyceride levels than those homozygotes for the G allele. As compared to the SAT diet, a PUFA diet induced significantly greater plasma total (P = 0.003) and LDL-C decreases (P = 0.001) in G/A women (-1.62 and -1.32 mmol/l, respectively) than in G/G subjects (-0.87 and -0.74 mmol/l for plasma and LDL-C, respectively). Multiple regression analysis demonstrated that in women, the variability in LDL-C response from a diet rich in SAT fat to a diet rich in PUFA was primarily due to LDL-C levels (during the SAT phase), accounting for 55.1% of the variance, waist to hip ratio (W/H; 11.4%) and the G/A polymorphism (10%). Whereas in men the major determinant of this response was smoking (21.4%). In conclusion, the G/A polymorphism appears to have a small but significant effect on plasma LDL-C responsiveness to changes in dietary fat saturation specially in women.

[Diet and atherosclerosis]. / Dieta y aterosclerosis.

The relationship between diet and atherosclerosis is due to the diet influence on lipoprotein composition. However, because of the multifactorial basis of the atherosclerosis, diet components have another potential intervention mechanisms in the atherosclerosis process, such as the influence on other cardiovascular risk factors (hypertension, obesity, diabetes) or the influence on the coagulation system and the relationship endothelium-platelets. We will review the effect of diet components on these factors, specially its effects on the haemostasia system, which alteration is responsible for provoking ischemic heart disease. We have to consider that the main objective when treating dyslipidaemias, besides of avoiding acute pancreatitis in cases of strong hypertrigliceridaemia, is to prevent arteriosclerosis development and its clinical manifestations such as ischemic heart disease. Besides, we know that genetic, in addition to provoke familial susceptibility to atherosclerosis, has an essential importance in the response to ambiental factors as diet is.

Effects of dietary fat saturation on eicosanoid production, platelet aggregation and blood pressure.

The effects of dietary fat saturation on eicosanoid urinary excretion, platelet aggregation (PA) and blood pressure (BP) were studied in 42 healthy subjects. They consumed four consecutive diets differing in their fat saturation [saturated (SFA); monounsaturated (MUFA); polyunsaturated n-6 (PUFA n-6); and polyunsaturated n-6/n-3, (PUFA n-3)]. Each diet period lasted 5 weeks. There were no differences in 24-h 2,3-dinor-6- keto-prostaglandin F1 alpha excretion among dietary periods. A significant effect was noted regarding the excretion of 11-dehydro-thromboxane B2 (P < 0.0001). During the PUFA n-6 phase the excretion was significantly higher than during SFA and MUFA periods. Dietary fatty acid composition had a significant effect on ADP (1 mumolL-1) and collagen (2 mgL-1) induced PA. Dietary fat also had a significant effect on systolic and diastolic blood pressure (P < 0.0001). Both were significantly higher during the SFA period than during the other three periods. Our findings suggest that changes in dietary fatty acids may have mild, but significant, effects on eicosanoid production, platelet aggregation and blood pressure.

Monounsaturated and polyunsaturated n-6 fatty acid-enriched diets modify LDL oxidation and decrease human coronary smooth muscle cell DNA synthesis.

Proliferation of smooth muscle cells (SMCs) plays an important role in atherosclerotic lesion progression. The purpose of this investigation was to examine the effect of diets differing in fatty acid composition on human coronary SMC entry in the cell proliferation cycle. Twenty-four healthy men and women were placed on four consecutive diets lasting 5 weeks each: (1) saturated fatty acid (SFA)-rich diet with palm oil; (2) monounsaturated fatty acid (MUFA)-rich diet with olive oil; (3) polyunsaturated fatty acid (PUFA) n-6-rich diet with sunflower oil; and (4) PUFA n-3-rich diet (3.8 g/d). All diets supplied 35% of calories as fat. Compared with the SFA diet, all unsaturated diets reduced LDL cholesterol. Resistance of LDL to oxidative modification was significantly increased during the MUFA period (P < .05). Human coronary SMCs were cultured and induced by sera derived from the different groups. 3H-Thymidine incorporation into doubling DNA was significantly (P < .01) reduced during the MUFA and PUFA n-6 periods but not during the PUFA n-3 diet with respect to the SFA diet. This effect was more pronounced in women than in men. In conclusion, the MUFA-enriched diet reduced SMC DNA synthesis and LDL levels and protected LDL from oxidation. Therefore, these combined effects suggest that an oleic acid-rich Mediterranean diet could be better than PUFA (n-6)- or PUFA (n-3)-rich diets in the prevention of atherosclerosis.

[Secondary prevention of myocardial infarction in Spain. The PREVERSE study]. / La prevención secundaria del infarto de miocardio en España. Estudio PREVESE.

INTRODUCTION AND OBJECTIVES: We present the results from the PREVESE Study, conducted in two phases: the first to identify the secondary prevention measurements recommended in Spain in patients who were discharged after a myocardial infarction; the second, 6 months later, to determine their evolution. METHODS: Data was collected from 1,242 patients in 39 hospitals. An analysis was made of the patients background, risk factors, working status, diagnostic procedures used during hospitalization, laboratory findings and drug therapy prescribed at discharge. At the second control, the risk factors status, diagnostic or assessment tests performed during the 6-month period, working status, mortality and cardiac events were revised. RESULTS: The previous history and risk factors studied showed a high risk profile among patients after myocardial infarction. Among the drug therapies prescribed at discharge the small percentage (6.7%) of lipid lowering prescriptions should be highlighted. An improvement in the risk factor profile was found at the six month checkup with a substantial reduction in the number of smokers, a very low number of hypertensives and an improvement in physical activity. There was no improvement in total-cholesterol levels. CONCLUSIONS: The implementation of preventive measures is not similar in all risk factors. An improvement is reached in prevention of smoking habit and hypertension, but not in the treatment of abnormal levels of hyperlipidemia.

[Pravastatin increases the activity pf the LDL receptors in lymphocytes of individuals with heterozygous familial hypercholesterolemia]. / La pravastatina aumenta la actividad de receptores de LDL en linfocitos de individuos con hipercolesterolemia familiar heterocigota.

An investigation was conducted on the effects of pravastatin, an inhibitor of the HMG CoA reductase, on lipoproteins concentrations and degradation of LDL (low density lipoproteins) in 14 patients with familial hypercholesterolemia (FH). Therapy with pravastatin for twelve weeks, 20 mg every 12 hours, and a low fat (30% calories) and cholesterol (less than 300 mg/daily) diet decreased serum concentrations of LDL cholesterol and apolipoprotein B by 35.5% and 24%, respectively (p < 0.001 for both parameters). On the other hand, apolipoprotein A-1 concentrations increased by 15.1% (p < 0.05) and HDL cholesterol (high density lipoproteins) by 6.8%; concentrations of apolipoprotein A-II did not change. LDL degradation in peripheral lymphocytes increased by 41.3% (p < 0.05) and a correlation was observed (p < 0.05) between percentage of LDL degradation and percentage in the LDL cholesterol decrease. Likewise, a positive trend (p = 0.057) was observed between increases in LDL degradation and aging. These findings indicate that pravastatin favorably influences the lipoprotein profile and that this effect is mediated, at least partly, by an increase in cellular capacity of LDL degradation.