Modulation of high-density lipoproteins in a population in istanbul, Turkey, with low levels of high-density lipoproteins.

The extent to which high-density lipoprotein (HDL) cholesterol levels can be increased in patients with low HDL cholesterol is important because low HDL cholesterol levels increase the risk of coronary heart disease (CHD). During the past 14 years, we have assessed risk factors in Turks, a population in which extremely low HDL cholesterol levels (mean 36 mg/dl in men, 42 mg/dl in women) are a prime CHD risk factor. Although genetically determined to a significant extent, these low HDL cholesterol levels can be modulated by lifestyle factors, as in other populations. We measured the HDL cholesterol levels in men and women residing in Istanbul at 3 time points: 1990 to 1993, 1996 to 2000, and 2003. The mean HDL cholesterol levels increased from 45.3 +/- 9.5 mg/dl in 1990 to 1993 to 49.7 +/- 12 mg/dl in 2003 (p <0.0001) in women, but were virtually unchanged in men (38 +/- 8 vs 39 +/- 10 mg/dl). In contrast to previous years, the HDL cholesterol levels in women in 2003 were markedly affected by education level and socioeconomic status, averaging 56 +/- 9 mg/dl in those with a university education and 48 +/- 12 mg/dl in those with a primary school education. Part of this difference could be explained by less smoking and more exercise and lower body mass index (average 25.6 +/- 4.9 vs 29.7 +/- 5.1 kg/m(2)) of the highly educated women. It is important to note the increase in the prevalence of obesity between the 1990 to 1993 interval and 2003 in men and women, including a remarkable change from 9.4% to 45.2% among women with a primary school education. None of these factors affected the HDL cholesterol levels of men by >2 mg/dl at any of the 3 points. In conclusion, because CHD risk changes by as much as 2% to 4% per 1 mg/dl difference in HDL cholesterol level, the 8 mg/dl difference may reflect as much as a 20% to 30% reduction in CHD risk associated with the benefit of higher education in women. Why education failed to affect the HDL cholesterol levels in Turkish men remains unclear.

Eficacia de las medidas higiénico-dietéticas en el tratamiento de la hipoalfalipoproteinemia aislada en pacientes con enfermedad arterial coronaria / Efficacy of hygienic and dietary therapy in coronary patients with isolated hypoald alipoproteinemia

Objetivo: La hipoalfalipoproteinemia (HA) es un trastorno relativamente frecuente en los pacientes con enfermedad arterial coronaria (EAC), que se asocia a un mayor riesgo de padecer nuevos episodios coronarios y de mortalidad por esta causa. Método: En este estudio se han incluido 60 pacientes con EAC previa e HA aislada (c-HDL < 0'90 mmol/L, y perfil lipídico normal) que fueron visitados correlativamente en una Unidad especializada de lípidos. Los pacientes fueron distribuidos al azar en un grupo de intervención y un grupo de control. Los casos eran sometidos a un régimen de intervención no farmacológica consistente en medidas higiénico-dietéticas, mientras que los controles eran remitidos a sus respectivos centros de Asistencia Primaria para recibir los cuidados habituales. Resultados: Se demostró un aumento significativo del c-HDL en todos los pacientes, siendo mayor en el grupo de intervención, aunque las diferencias entre los dos grupos no fueron significativas. El fibrinógeno disminuyó en los pacientes del grupo de intervención, especialmente en aquellos que dejaron de fumar. Conclusión: Las medidas higiénico-dietéticas son útiles para corregir las concentraciones plasmáticas bajas de c-HDL y disminuir el fibrinógeno en aquellos pacientes con EAC e HA (AU)

[Efficacy of hygienic and dietary therapy in coronary patients with isolated hypoalphalipoproteinemia]. / Eficacia de las medidas higiénico-dietéticas en el tratamiento de la hipoalfalipoproteinemia aislada en pacientes con enfermedad arterial coronaria.

OBJECTIVE: Hypoalphalipoproteinemia (HA) is a relatively frequent disorder found in patients with coronary artery disease (CAD). It is associated to a greater risk of suffering recurrent coronary episodes and of mortality caused by this disease. METHODS: We selected 60 patients with previous CAD and isolated HA (HDLc concentration < 0.9 mmol/L, and desirable lipidic profile) that were consecutively seen in a specialized lipid clinic. Subjects were randomly included in the two groups of cases (group of intervention) and controls. Cases were treated with non-pharmacological measures which included changes in lifestyle and dietary habits. Control subjects were referred to their general practitioners in order to receive conventional medical care. RESULTS: It was demonstrated a significant increase in the HDLc concentration in both groups, being greater the improvement in the group of intervention, but the differences in the increase in the HDLc between both groups were not significant. Fibrinogen was lower in the patients of the group of intervention, especially in those patients that gave up smoking. CONCLUSION: Changes in lifestyle and dietary habits are useful to correct the low HDLc plasma levels and to reduce fibrinogen levels in those patients with CAD and HA.