[Analysis of nutritional habits in patients with familial combined hyperlipidemia]. / Analýza nutricních návyku pacientu s familiární kombinovanou hyperlipidémií.

BACKGROUND: Our objective was to analyze dietary habits of patients with the IIb phenotype of familial combined hyperlipidaemia. These patients were instructed on the proper composition of their diet and they thought that they adhered to these recommendations. METHODS AND RESULTS: The authors examined 41 patients with IIb phenotype of familial combined hyperlipidaemia. Based on their seven-day dietary records their daily intake was calculated and compared with recommended daily allowances as regards energy intake, intake of plant and animal proteins, fats, linoleic acid, carbohydrates, calcium, iron, potassium, fibre, vitamin A, thiamin, pyridoxine, vitamin C, E, cholesterol and NaCl (Progana programme). With the above results the total serum cholesterol, serum triglyceride, HDL and LDL serum cholesterol and nutritional status (body mass index, percentage of body fat and waist hip/ratio) were compared. When the energy intake was acceptable (99% of the recommended allowance), the fat intake was excessive (138%) as well as the intake of animal protein (148%), cholesterol (145%) and NaCl (159% of the recommended allowance), while the intake of plant proteins and fibre and some vitamins was inadequate. A statistically significant relationship was revealed only as regards the linoleic acid intake and total serum cholesterol (inverse relationship at the 95% probability level, r = 0.43), the other investigated relationships were insignificant. The body mass index values (in men and women 26) and the percentage of body fat (22% in men and 34% in women) are above the recommended range. CONCLUSIONS: Dietary errors in the investigated group thus did not pertain, to the quantity of the diet but its composition. From the results ensures that doctors should pay great attention to explaining dietary principles to their patients.

[Silent myocardial ischemia in outpatients being treated for hyperlipoproteinemia]. / Nemá ischémie myokardu u pacientu ambulance pro lécbu hyperlipoproteinémií.

BACKGROUND: Hyperlipoproteinaemias, in particular those associated with hypercholesterolaemia, are in a causal relationship with the development and acceleration of atherogenesis. One of the serious forms of coronary heart disease is silent myocardial ischaemia--an asymptomatic objectively confirmed ischaemic episode. The objective of the present study was to 1. assess the prevalence of this disease in subjects with hyperlipoproteinaemia and 2. to assess the optimal diagnostic procedure to detect it. METHODS AND RESULTS: The group comprises 57 subjects selected at random (23 men and 34 women) from the out-patient department for genetics and treatment of hyperlipoproteinaemias. In all subjects an ergometric loading test was made and 24-hour ambulatory ECG monitoring. Suspected silent myocardial ischaemia (i.e. positive results of the two examinations) was confirmed by load scintigraphy of the heart muscle. Silent myocardial ischaemia was proved in 3 of 23 examined men (13%) and in 4 of 34 women (11.8%). CONCLUSIONS: Prevalence of silent myocardial ischaemia is significantly higher in high risk subjects--with hyperlipoproteinaemia than in the general asymptomatic population. The best screening test for its detection is a loading test and ambulatory ECG monitoring, supplemented by loading scintigraphy of the heart muscle.

[Duolip Forte--experience during a 6-month period of administration]. / Duolip forte--zkusenosti z sestimesícního podávání.

Duolip forte (ethophylline clofibrate, tablets à 500 mg) produced by Merckle Austria was administered to 20 patients with different types of hyperlipoproteinaemia for a 6-month period in amounts of 500 mg/day. Before onset of treatment and during treatment the patients adhered to a defined hypolipidaemic diet. The total cholesterol level during administration increased from 7.71 +/- 1.71 mmol/l to 8.23 +/- 1.34 mmol/l (p = 0.05). The LDL cholesterol level rose from 4.93 +/- 1.70 mmol/l to 5.53 +/- 1.34 mmol/l (n.s.). Apolipoprotein B declined from 1.99 +/- 0.39 g/l to 1.80 +/- 0.30 g/l (n.s.). HDL cholesterol rose from 1.09 +/- 0.32 mmol/l to 1.53 +/- 0.56 mmol/l (p = 0.01). The triglyceride level declined from 5.71 +/- 5.60 mmol/1 to 3.72 +/- 4.32 mmol/1 (n.s.). The lipid metabolism parameters were evaluated already after three months of Duolip treatment but the values did not differ significantly from values assessed after 6 months of administration; therefore only the final values are given. In the course of six months of Duolip administration the body weight of the patients did not change and no serious side-effects were observed which would call for discontinuation of treatment. Duolip forte is evaluated as a safe, but as compared with other available drugs of the clofibrate series, less effective hypolipidaemic agent.

[Combined therapy of hyperlipoproteinemia. Colestipol and gemfibrozil in the treatment of heterozygous familial hypercholesterolemia]. / Kombinovaná lécba hyperlipoproteinémií. Colestipol a gemfibrozil v lécbe heterozygotu familiární hypercholesterolémie.

Combined concurrent treatment with two or more hypolipidaemic agents is a modern trend in the pharmacotherapy of hyperlipoproteinaemias. Aggressive treatment of hyperlipoproteinaemias can lead not only to the arrest of progression but also to regression of the atherosclerotic process. The authors submit experience assembled with the treatment of 14 heterozygotes with familial hypercholesterolaemia by a combination of colestipol (Colestid Upjohn, Belgium) with gemfibrosil (Loped Parke-Davis, USA), 15 g and 1200 mg resp. per day. One month of administration of this combination of hypolipidaemic agents led to a drop of total cholesterol by 21% and of LDL-cholesterol by 30%. At the same time the authors recorded a marked and statistically significant increase of HDL-cholesterol by 23%. Favourable changes were observed also as regards apolipoprotein concentrations. The apolipoprotein A-1 level increased by 32%, while the level of the atherogenic apolipoprotein B declined by 30%. The triglyceride level declined also. It did not prove possible even by combined treatment to reduce the level of apolipoprotein(a). Combined treatment with colestipol and gemfibrosil was well tolerated by the patients and in none of the patients treatment had to be discontinued because of undesirable side-effects.

[Colestipol in the treatment of heterozygous familial hypercholesterolemia]. / Colestipol v lécbe heterozygotu familiární hypercholesterolémie.

In the specialized clinic for disorders of the lipid metabolism 27 patients, 8 men and 19 women, heterozygotes with familial hypercholesterolaemia were treated for 8 weeks with Colestid (colestipol bags a 5 g, Upjohn, Belgium). The administered dose was 15 g colestipol per day. After colestipol treatment the authors recorded a statistically significant decline of total cholesterol by 18% and of LDL-cholesterol by as much as 27%. The apolipoprotein B concentration declined during treatment by 9% and concurrently there was a favourable rise of apolipoprotein A-1 by 20%. The authors recorded also a slight rise of the HDL-cholesterol concentration which, however, was not statistically significant. The serum triglyceride level increased slightly after colestipol treatment. It did not prove possible to influence the lipoprotein(a) level by colestipol administration. As compared with other hypolipidaemic agents from the group of ion exchange resins, the patients tolerated Colestid surprisingly well. Only one female patient discontinued treatment because of dyspeptic complaints, severe constipation.