Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project.

OBJECTIVE: To explore the relationship between hypercholesterolaemia, age and BMI among females and males. DESIGN: Population-based cross-sectional survey. SUBJECTS: The data came from the initial surveys of the WHO MONICA Project. In all, 27 populations with 48 283 subjects (24 017 males and 24 266 females) aged 25-64 y were used for the analysis. MEASUREMENTS: Total cholesterol, weight, height, BMI, prevalence of hypercholesterolaemia (PHC) defined as cholesterol >/=6.5 mmol/l, and the prevalence of obesity (POB) defined as BMI >/=30 kg/m(2). RESULTS: PHC increased with age, with PHC in males being significantly higher than in females at age range 25-49 y and significantly lower than in females at age range 50-64 y. Age-related increase in hypercholesterolaemia was steeper in females than in males. There was a statistically significant positive association between hypercholesterolaemia and BMI. Multiple logistic regression analysis revealed a negative statistically significant (P<0.001) effect modification involving age and BMI on the risk of having hypercholesterolaemia both in females and males. The relation between PHC and BMI became weaker in higher age groups, with no statistically significant association in females aged 50-64 y. CONCLUSION: Public health measures should be directed at the prevention of obesity in young adults since the strongest effect of obesity on the risk of hypercholesterolaemia has been found in subjects aged 25-39 y.

[Decrease in cardiovascular disease mortality in the Czech Republic from 1984 to 1993 and its possible causes]. / Pokles úmrtnosti na kardiovaskulární onemocnení v Ceské republice v období 1984-1993 a jeho mozné príciny.

BACKGROUND: The objective of the investigation was to evaluate the ten-year development of the cardiovascular mortality rate in two population groups in the age bracket from 25 to 64 years, i.e. in subjects living in six districts which participated in the international WHO project MONICA and in the population of the whole Czech Republic. METHODS AND RESULTS: Data on the mortality rate in 1984-1993 for the age group from 25-64 years were provided by the Institute of Health Information and Statistics, information on the prevalence of risk factors was obtained in three cross-sectional studies implemented in six districts as part of the MONICA project in 1985, 1988 and 1992. In the mortality rate per 100,000 population in the six districts the following changes were revealed (in parentheses the values for 1984 and 1993 are given): men - a statistically significant declining trend in the from all caused mortality (849.3-742.5; p < 0.001) and cardiovascular mortality (367.2-280.4; p < 0.001) and cerebrovascular mortality (69.7-44.8; p < 0.001). In the mortality from ischaemic heart disease (215.7-170.6; ns) a declining trend was not recorded. In women aged 25-64 years in the six districts there was a statistically significant decline of the mortality from all caused (359.5-322.1; p < 0.001), the cardiovascular mortality (115.6-100.6; p < 0.001) and cerebrovascular mortality (31.1-23.6; p < 0.001). The mortality from ischaemic heart disease did not change (49.2-48.8; ns). In the population of the Czech Republic in men the following were detected: a drop of the from all caused mortality (907.1-784.8; P < 0.001), the cardiovascular mortality (383.5-308.4; p < 0.001) and cerebrovascular mortality (76.5-55.3; p < 0.001). Also in women of the Czech Republic a decline of the mortality from all caused was recorded (390.1-328.5; p < 0.001), the cardiovascular mortality (135.3-103.8; p < 0.001), ischaemic heart disease (58.0-48.6; p < 0.001) and cerebrovascular mortality (43.5-27.4; p < 0.001). In 1990 an increased cardiovascular mortality was recorded in men different from the trend during 1984-1993, statistically significant in the Czech Republic (p < 0.05) and in the six districts (p < 0.05). The reasons of this trend are not clear. The role of health services in the mortality drop is not clear, although available data indicate their improvement. Favourable changes were found in risk factors: during the period from 1985-1992 the prevalence of hypercholesterolaemia declined significantly in men and women, the prevalence of hypertension in women and the prevalence of smoking in men declined in the six districts. From nationwide data ensues that after 1989 significant changes occurred in the diet of the Czech population. The meat consumption declined by 1993 by 13%, the milk and dairy product consumption by 26.8% the butter consumption by 43.6% the consumption of vegetable fats increased by 16%, of vegetables by 8%, tropical fruit by 43.2%. These changes probably had an impact on the cholesterol level and BMI of the Czech population. CONCLUSIONS: In the declining cardiovascular mortality trend during 1984-1993 the following may have participated: improved medical care, dietary changes, improvement of the risk profile and other, in particular socioeconomic factors. With regard to the close temporal association of the investigated changes it may be assumed that this development is at least partly associated with changes of the political and economic position in the Czech Republic after 1989.

[Is the recent decrease in cholesterolemia in the Czech Republic convincing evidence?]. / Je nedávný pokles cholesterolémie v Ceské republice prukazný?

BACKGROUND: The objective of the study was to evaluate the 8-year trend of serum cholesterol levels in six districts of the Czech Republic, to assess whether the reduction of mean values of total cholesterol recorded during the period between 1985 and 1992 was convincing and to discuss possible causes and consequences of this development. METHODS AND RESULTS: Three cross-sectional surveys of risk factors were implemented in independent random 1% samples of the population aged 25-64 years. In 1985 1256 men (respondence rate 81.5%) and 1317 women (85%) were examined, In 1988 1357 men (85.2%) and 1412 women (88.4%), in 1992 1142 men (73.2%) and 1211 women (76.7%). A detailed check of the deviations in estimations during different time intervals from reference values provided evidence that the analytical method did not have an impact on the revealed changes. In men the mean total cholesterol level was 6.21 (95% confidence limit 6.14-6.28 mmol/l in 1985; 6.29 (6.23-6.35) mmol/l in 1988; 5.99 (5.91-6.06) mmol/l in 1992. In women the mean value of the total cholesterol level was 6.19 (6.12-6.25) mmol/l in 1985; 6.23 (6.17-6.30) mmol/l in 1988; 5.95 (5.88-6.02) mmol/l in 1992. According to variance analysis (ANOVA) the serum cholesterol in 1992 was lower by 0.22 mmol/l (p < 0.0001) than in 1985 and by 0.28 mmol/l (p < 0.0001) lower than in 1988. The drop of cholesterol between 1988-1992 may have been caused by dietary changes recorded in the population. According to nationwide data after 1990 there was a marked drop of the consumption of meat and meat products, milk and dairy products and animal fats, while the consumption of vegetable fats increased. Despite these dietary improvements, in six districts in 1992 fats accounted for 37% of the energy intake, the P/S ratio was only 0.41 in men and 0.46 in women. In these districts in 1992 and 1993 a decline of the standardized mortality rate from IHD in men was recorded. CONCLUSIONS: During an eight-year period the mean serum cholesterol level of men and women decreased significantly in six districts of the Czech Republic. This change was probably associated with a restricted intake of foods which have an impact on the serum cholesterol level.

[Standardization of the methods of lipid determination according to WHO in the regional project of prevention of cardiovascular diseases in Friuli-Venezia Giulia]. / La standardizzazione dei metodi per la determinazione dei lipidi secondo l'OMS, nel progetto regionale di prevenzione delle malattie cardiovascolari del Friuli-Venezia Giulia.

BACKGROUND: The recognition of dyslipidemias as a major modifiable risk factor for atherosclerosis and coronary heart disease underlines the need to obtain precise and accurate assay results of plasma lipids. Today the use of automatic laboratory methods and of internal quality control favours the precision of the results but does not guarantee accuracy. The efficiency of a laboratory can be ensured by a standardization programme, systematically monitoring precision and accuracy by means of independent internal and external quality control, international reference standards (e.g. those of CDC-NHLBI and WHO) and protocols to identify and reduce the errors due to biological variability and pre-analytical factors. After the foundation of the Regional Project for Prevention of Cardiovascular Diseases in Friuli-Venezia Giulia, a lipid standardization programme was set-up, covering the 20 chemico-clinical laboratories of the Region. The programme was directed by the International WHO-MONICA-Lipid Reference Centres of Prague-Udine. METHODS: During the years 1993-1994, three sets of lyophilized human serum samples were dispatched to each laboratory for the blind evaluation of total cholesterol, triglycerides and HDL-cholesterol. The samples were obtained by the combination of three serum pools at least at different lipid concentration. The first set included 20 samples to be tested in 5 weeks, the second set included 30 samples to be tested in 8 weeks and the third set included 21 samples to be tested in 9 weeks. The assay results were sent to the Prague-Udine WHO-MONICA Centres where they were computerized and evaluated, particularly considering precision for each set, estimated by the variation coefficient (i.e. standard deviation/mean value of the measurements per cent) and accuracy (the bias was computed as mean of the measurement minus the reference value/reference value per cent). RESULTS: In the three assay series for total cholesterol, almost all the laboratories showed the variation co-efficient (precision) to be less than the WHO-MONICA limit of 3.7% (for a cholesterol level of 250 mg) (Tab. II) and in 8 cases out of 20, less than the CDC limit of 3%; the accuracy bias was less than the WHO-MONICA limit of 5% in 17 laboratories out of 20 and less than the CDC limit of 3% in 11 cases out of 20. For the HDL-cholesterol standardization programme the reference values were based upon the phosphotungstate method. However, the pools were also controlled by the other precipitation methods used in the 20 participating laboratories: 11 laboratories worked within the WHO-MONICA limits of precision and accuracy (respectively 6.5% and 7.5%) in at least two of the three sets. Concerning triglycerides, the regional laboratories showed a greater variability and, though most of the variation coefficients were within the WHO-MONICA limit of 5%, half of the accuracy biases were greater than the limit of 10%. The bias of the measurement average of all the laboratories was excellent for total and HDL-cholesterol, not quite good but acceptable for triglycerides. Laboratory performance improved progressively from the first to the last set, on more than one occasion. CONCLUSIONS: The lipid standardization experience carried out in the framework of the Regional Project for Prevention of Cardiovascular Disease demonstrates that it is possible to set up a wide and co-ordinated collaboration with laboratories of an entire region with positive and improving results. For this global quality control system, the resource allocated is limited but widely rewarded by the community benefits in terms of assay reliability and savings at medical care level, basic research and population studies.

The effect of body fat distribution on cardiovascular risk factors in the population of the Czech Republic.

A study of cardiovascular risk factors including anthropometry was performed as part of the MONICA project in 1988 in the population of six districts of the Czech Republic. In addition to probands' weight and height, the circumferences of waist and hips were measured to calculate the index of body fat distribution given as WHR (wast/hip ratio). In the age group of 25-64 years, WHR was significantly higher in men (0.936) than in women (0.836 - p < 0.001); in either sex, its value rose with increasing age. WHR values were statistically significantly higher in this group than those found in a Finnish population where males aged 25-64 years had a mean WHR value of 0.90 (p < 0.001), and women of the same age group had a mean WHR of 0.78 (p < 0.001). An analysis of the relationship between abdominal obesity and some cardiovascular risk factors revealed significant correlations between WHR and total cholesterol (men: r = 0.112, p < 0.001; women: r = 0.122, p < 0.001), HDL cholesterol (men: r = -0.184, p < 0.001; women = -0.23, p < 0.001); atherogenic index, i.e., total cholesterol/HDL cholesterol (men: r = 0.183, p < 0.001; women: r = 0.345, p < 0.001), systolic blood pressure (men: r = 0.295, p < 0.001; women: r = 0.263, p < 0.001), diastolic blood pressure (men: r = 0.32, p < 0.001; women: r = 0.237, p < 0.001). The closest correlation was demonstrated between WHR and BMI (men: r = 0.525, p < 0.001; women r = 0.345, p < 0.001). The authors believe WHR is an important parameter for cardiovascular risk assessment and should be determined on a routine basis. The frequent prevalence of abdominal obesity, as suggested by the high values of WHR, contributes to the high cardiovascular risk of the population of the Czech Republic.

[Small doses of the resin Colestid in the treatment of hyperlipoproteinemia]. / Malé dávky pryskyrice Colestidu v lécbe hyperlipoproteinémií.

To a group of 24 subjects with hypercholesterolaemia (hyperlipoproteinaemia type II) for a period of three months the non-absorbable resin Colestid was administered in order to reduce levels of atherogenic lipids and lipoproteins. The Colestid doses were graded from 5 g in the first month to 10-15 g during the third month. Reduction of cholesterol levels and the LDL fraction was significant already during the first month of treatment. The greatest reduction of LDL cholesterol was 25% and of total cholesterol 15%. A favourable effect was recorded also in HDL cholesterol which increased. The rise of triacylglycerols was not significant. Differences in the serum lipid response or their fractions did not depend on sex (15 women, 9 men), the clinical symptomatology (IHD) or family-history of atherosclerosis or concurrent administration of fibrates (Lipanthyl in 7 patients). In view of the small doses the symptomatology of side-effects was poor. Four patients, however, did not complete three months of treatment. With regard to the economical aspect of therapy and the favourable effect of small doses the authors draw attention to this experience which can be used as a basis also when using combinations with other preparations of antihypercholesterolemic therapy in those patients where an adequate reduction of cholesterol and its LDL fraction is not achieved.

Cardiovascular risk factors in the Czech population.

In 1985 and 1988 as part of the WHO's MONICA project two surveys of cardiovascular risk factors were conducted in the population aged 25 to 64 years and resident in the six districts of the Czech Republic collaborating in MONICA. Over a period of three years, the prevalence of smoking decreased from 46% to 41.8% (p less than 0.05) in men. Daily cigarette consumption declined from 17.9 to 15.1 (p less than 0.001) in men and from 11.1 to 10.1 (p less than 0.05) in women. Despite the unchanged prevalence of hypertension during the three years' period the proportion of population with elevated BP levels declined from 22.25% to 19.1% in men (p less than 0.05), and from 16.8% to 14.0% (p less than 0.05) in women as a result of better hypertension control. The prevalence of obesity in men rose from 18.5% to 23.9% (p less than 0.001). The proportion of individuals with a total cholesterol level over 5.2 mmol/l rose from 78.0% to 83.1% (p less than 0.001) in men and from 75.9% to 80.6% in women (p less than 0.01). The changes were favourable only in those risk factors that were actively influenced by the preventive programmes "A Chance for Three Million" in smoking habits, and the "National Programme of Hypertension Control". The authors believe that consistent nationwide preventive programmes might exert a beneficial effect on the profile of risk factors of the whole Czech population.

Cholesterolaemia in school-age children and hypercholesterolaemia aggregation in the family.

The distribution of cholesterol values was established in a group of 2,000 Prague children aged 11-12 years. Of these, 100 children with cholesterol values exceeding the 95th percentile (HYPER), and 100 children with values between the 5th and the 10th percentiles (HYPO) were selected for follow-up. In addition to a thorough clinical and laboratory examination in children and parents, three-day food consumption was registered in children. Even though differing significantly from those assigned to the HYPO group in lipid spectrum parameters, HYPER group children did not show any abnormalities in carbohydrate metabolism or increased incidence of obesity. There is no significant difference in the energy values of food consumed by HYPER and HYPO children. Although a significantly higher proportion (in per cent) of total lipids and animal fat consumption was found in HYPER boys (p less than 0.05), the proportions (in per cent) of fatty acids, and the unsaturated/saturated fatty acid ratio in HYPER and HYPO children did no differ significantly. Parents of HYPER children showed significantly higher mean values of cholesterol, apolipoprotein B, LDL cholesterol and more unfavourable atherogenic index values. Hypercholesterolaemia aggregation in both parents was likewise significantly higher in children assigned to the HYPER group.

Blood thiocyanate levels and self-reported smoking habits compared in two large cardiovascular population studies.

In two representative population surveys (n1 = 1712, n2 = 3757, age-range: 25-64 years) from six towns in Northern Badenia (FRG) self-reported smoking habits and blood thiocyanate levels were compared. In Survey 1 the smoking prevalence was 44.1% in males and 32.9% in females, in Survey 2 45.0% in males and 26.5% in females. In agreement with previous studies it was proved that thiocyanate measurements allow to distinguish groups of non-smokers from smokers, whilst not being specific enough to reflect precisely the quantity of tobacco consumption of the individual. A quadratic regression of thiocyanate levels on cigarette consumption provided a better fit and a higher correlation coefficient than linear regression, indicating a saturation effect, i.e., there is no further increase of thiocyanate levels when more than about 30 cigarettes daily are consumed.

International study on the comparability of Apo A-1 and Apo B methods.

Apo A-1 and Apo B levels have become increasingly important as a mean of assessing risk and susceptibility to cardiovascular diseases. These proteins are measured routinely in numerous clinical and research laboratories due primarily to the ability to mechanise the immunological assay method and to the ready availability of commercially produced antisera and standards which are often sold in kit form. However, if these variables are to be used to assess the clinical risk of disease reliably, the test methods should have a low degree of imprecision and inaccuracy, to reduce false positive and negative results. The 'normal' and 'pathological' ranges for both proteins also need to be clearly defined. In order to be able to define clinical ranges and establish quality control limits on both a national and international level the inaccuracy and imprecision of the different methods used to assay the parameters need to be established. Since the technical expertise and the equipment and reagents used vary between laboratories, and because there is no internationally recognized calibration material, a survey conducted to establish imprecision and inaccuracy must include many laboratories to take these variations into account. At the WHO Collaborating Lipid Reference Centre, The Institute for Clinical and Experimental Medicine in Prague, Czechoslovakia, we have been involved in the external quality control programme for cholesterol, triglyceride, HDL-cholesterol and thiocyanate methods for more than 15 yr. Although the Centre was originally created as a European Reference Centre, laboratories participating in our quality control scheme now come from Asia, the USA and New Zealand as well as Europe due to their involvement in the large scale population studies like 'MONICA', 'ERICA' and 'CINDI'. In addition we also cooperate with some laboratories expected to join WHO projects and with others running either national or their own research programmes. Due to the increasing need to learn more about the methods used for Apo A-1 and Apo B assays in both research and preventive schemes for cardiovascular diseases, we decided, following the combined IUIS and NHLBI-CDC Apolipoprotein standardization surveys, to arrange for an international survey to determine the precision and relative accuracy of EIA, ELISA, INA, TURB and RID methods. Our survey originally intended to include only European laboratories but the number of participants increased (Table I) and we believe it supplies complementary information to the IUIS-NHLBI-CDC surveys because both research and routine clinical laboratories were included in our survey.

[The development of cholesterolemia in the Czech population 1985-1988]. / Vývoj cholesterolémie v populaci CR v období let 1985-1988.

The authors followed up the development of serum cholesterol levels in the population aged 25-64 years in six districts of the CR. These districts collaborate since 1984 in the international WHO programme, MONICA. The mean total cholesterol levels increased during 1985-1988 in men from 6.21 mmol/l to 6.28 mmol/l (ns), in women from 6.18 mmol/l to 6.22 mmol/l (ns). During the same period in the population of the six districts the number of subjects with total cholesterol values of 5.2 mmol/l or less declined from 21.9% to 16.8% (p less than 0.001) in men and from 24.0% to 19.4% in women (p less than 0.01). It is important that the greatest change was recorded in the age group of 25-34 years--in men from 38.7% to 27.7% (p less than 0.01) and in women from 46.6% to 36.7% (p less than 0.05). In the investigated population in 1988 cholesterol levels of 6.5 mmol/l and more were recorded in 39.4% of the men and 36.9% of the women, values of 7.8 mmol/l and more in 10% of the men and 9.6% of the women. If in our population, within the framework of prevention of IHD, recommendations of the European Society for Atherosclerosis will be applied, preventive provisions will be necessary in more than 80% of the adult population.

[The effect of elevated blood glucose levels and body weight on the metabolic profile in type 2 diabetes after long-term therapy]. / Vliv zvýseného krevního cukru a hmotnosti na metabolický profil dlouhodobe léceného diabetu 2. typu.

Based on an analysis of data obtained in a group of 145 men and women with type 2 diabetes perssiting for 10.1 +/- 6.6 years who were hospitalized on account of unsatisfactory compensation of diabetes, the authors provided evidence that the fasting blood sugar level is associated with a reduced response of C peptide to an alimentary stimulus, while the excessive weight of the patients has a bearing on the elevated concentration of C peptide on fasting and causes their insulin resistance. The body weight has a bearing on the level of risk factors, i.e. HDL cholesterol, uric acid and in women also triacylglycerols. The elevated blood sugar level influences in a mirror image manner the sodium and potassium level. The relations between the blood sugar level and glomerular filtration draw attention to the interference with the water economy even at blood sugar levels which are still tolerated. The trend of rising potassium levels must be foreseen in case of a poor compensation even in case of insulin treatment of diabetes. The risk of elevated potassium should be taken into account also with regard to indications of antihypertensive treatment. The authors also draw attention to the need of acloser compensation of type 2 diabetes. Early adjustment of the energy metabolism in diabetics deserves priority. When insulin treatment is needed, the all-day requirement should be met by 2-3 doses.

[The importance of C-peptide determination in the treatment and prognosis of type II diabetes]. / Význam stanovení C peptidu pro lécbu a prognózu diabetiku II. typu.

The concentration of C peptide which is an indicator of the secretory capacity of the beta-cells of the pancreas was assessed in 109 patients with type II diabetes, hospitalized on account of prolonged difficulties as regards compensation. The values on fasting, the maximal values after stimulation following an experimental meal and increments were greater than in age- and weight-matched controls. In diabetic patients some highly significant relationships were revealed between the C peptide concentration on fasting and indicators of the risk of ischaemic heart disease [IHD]. They included HDL cholesterol, the body mass index and uric acid. The relationship between the maximal C peptide concentration and serum sodium may be associated with a greater disposition for hypertension. Thirty-one patients with symptoms of an ischaemic myocardial lesion had a significantly elevated C peptide concentration on fasting. The increments of C peptide concentration after an alimentary stimulus correlated indirectly with indicators of the actual and long-term compensation of diabetes. In relation to the reduced increments also the need of insulin therapy was reflected. Data obtained by examination of the C peptide concentration in the blood of type II diabetics can contribute to the objectivization of needs of insulin treatment and to the detection of the link between cardiovascular risk and hyperinulinaemia.

[Metabolic characteristics of patients with chronic renal failure in long-term diet therapy and substitution with keto analogs of essential amino acids]. / Stoffwechselverhalten bei Patienten mit chronischer Niereninsuffizienz unter diätetischer Langzeittherapie und Substitution mit Ketoanalogen essentieller Aminosäuren.

12 patients suffering from chronic renal failure did receive for 12 to 22 months a special protein-poor diet containing 20 g of high-class proteins and essential amino acids (4.8 g/d). During this period the serum levels of albumin, transferrin, immunoglobulins, hemoglobin and ferritin did remain unchanged, whereas the levels of C3 was reduced significantly. The glucose metabolism and the serum levels of cholesterol and triglycerids were constant. The results show no metabolic changes during long-term protein-poor diet containing minimal doses of essential amino acids.

Methods of total cholesterol measurement in the baseline survey of the WHO MONICA Project.

In the WHO MONICA Project (Monitoring of Trends and Determinants of Cardiovascular Disease) total cholesterol was measured in representative samples from 51 study populations in 26 countries. The biochemical measurements were done locally by the collaborating centres' laboratories. Differences in measurement procedures among the populations were found in the following factors: fasting status, posture of the subject, tourniquet use, use of serum or plasma, storage conditions, and the analytical method itself. This paper gives an overview of the methods used, and discusses the possible effects of the differences on the comparability of the results. The use of a posture other than that recommended and the use of EDTA (ethylene diaminetetraacetate) plasma are considered to be the most important factors, and were found in 9 out of the 51 populations.

International quality assurance schemes for cholesterol.

Lipid disorders rank high among the risk factors known to be associated with development of cardiovascular diseases which constitute a great socio-economic problem in many countries. Blood lipid lipoprotein and apolipoprotein measurements belong in all types of medical services to the most important ones not only because of their diagnostic but also of predictive value. Especially the measurement of blood cholesterol concentration is used in different studies and population screenings as an aid in establishing the degree of the risk of the development of cardiovascular disease. Accurate methods and uniform decision cut-points are needed for identifying individuals at high risk for comparability among results from different places and for preventing false diagnostic decisions based on inaccurate measurements. International Reference and/or Standardization Centres are of utmost importance helping to bring methods into uniform accuracy and precision limits everywhere. Local reference and standardization centres can be created with their assistance. Using the example of control of total cholesterol methods this paper describes some of the activities of the WHO Lipid Reference Centre at the Institute for Clinical and Experimental Medicine (IKEM) in Prague Czechoslovakia which shows comparability to the Centres for Disease Control (CDC Atlanta) standardization basis and mentions several other standardization centres in different countries.

[Metabolic and ultrastructural changes in the myocardium during heart arrest in patients undergoing surgery for ischemic heart disease]. / Metabolické a ultrastrukturální zmeny v myokardu pri srdecní zástave u nemocných operovaných pro ischemickou chorobu srdecní.

The authors give an account of metabolic changes in the ultrastructure of the myocardium which develop during cardioplegic arrest of the heart muscle by cold during aortocoronary reconstruction operations. Using the technique of arteriovenous differences before myocardial ischemia and after its termination, the assessed differences in arterial blood and blood from the sinus coronarius as regards the blood sugar level, lactate, pyruvate, potassium, phosphorus, unsaturated fatty acids and triglycerides. The results revealed a marked disorder of the carbohydrate and ion metabolism and severe impairment of the ultrastructure of the heart muscle during cardiac arrest.

[Hyperglycemia, hyperinsulinism, atherosclerosis]. / Hyperglykémie, hyperinzulinismus, ateroskleróza.

The paper deals with a group of 117 patients with clearly defined clinical signs of atherosclerosis following myocardial infarction appearing in middle age, analyzes relationship between indicators of saccharide metabolism and cardiovascular morbidity within a ten-year period, and discusses its potential cause. Fasting levels taken at 120 minutes after the administration of glucose and the sum of the fasting level and three stimulated levels of blood sugar, or insulin (IRI), were compared with 54 controls as well as within the group of patients. Compared with the control group, the patients had glycemia levels elevated. In the group of patient with ischaemic heart disease (glycemia levels especially the sum but also glycemias at 120 min.) were elevated in persons with signs of ischaemic disease of lower extremities, with hypertension, in cases with increased serum triacylglyceroles, with increased energy intake (including fasting levels). The sum of insulin kept increasing in cases with familial disposition to atherosclerosis, with clinical progression of atherosclerosis over a period of 5 years (non-fatal reinfarctions). This had a highly significant correlation with linoleic acid in total serum lipids suggesting correlation with cardiovascular morbidity. This finding stresses the necessity of a comprehensive view of deviations in sacharide metabolism, especially as regards the relationship between elevated glycemia and cardiovascular morbidity, and between insulin and mortality-causing factors.

[HLA antigens in type II diabetics]. / HLA antigeny u diabetiku II. typu.

The study examined the relationship between class I HLA antigens and type II diabetes with regard to insulin secretion and hyperlipoproteinemia. Out of 28 HLA antigens of A, B and C loci, 46 type II diabetics had statistically more significant HLA Cw1 - 15.9% as compared with 6.3% of the control group, the relative risk being 2.81. These patients were younger than the other diabetics but showed no difference in insulin secretion or hyperlipoproteinemia. Diabetics with HLA Cw4, just as patients after myocardial infarction with concomitant hyperlipoproteinemia, were also found frequently to have hyperlipoproteinemia (89 percentage cases as compared to 63% of the other diabetics). The findings may be indicative of potential genetic heterogeneity of type II diabetes. The paper stresses the necessity of establishing suitable genetic characters for early diagnosis of diabetes and its development.