Pioglitazone improves the cardiovascular profile in patients with uncomplicated systemic lupus erythematosus: a double-blind randomized clinical trial.

OBJECTIVE: We studied the effect of pioglitazone on insulin levels, inflammation markers, high-density lipoprotein (HDL) composition and subclasses distribution, in young women with uncomplicated systemic lupus erythematosus (SLE). METHODS: This double-blind trial included 30 premenopausal women (30 ±8 years old) with SLE, who were randomized to pioglitazone (30 mg/day) or placebo treatment for 3 months. Plasma and HDL lipids were determined by colorimetric enzymatic assays, insulin by radioimmunometric assay, inflammation by immunonephelometry and HDL size and subclasses distribution by a native 4-30% polyacrylamide gradient gel electrophoresis. RESULTS: Compared with placebo, pioglitazone significantly increased HDL-cholesterol plasma levels (14.2%), reduced fasting insulin plasma levels (23.6%) and the homeostasis model assessment-insulin resistance (31.7%). C-reactive protein (70.9%) and serum amyloid A (34.9%) were also significantly reduced with the pioglitazone use, whereas the HDL particle size was increased (8.80 nm vs. 8.95 nm; p = 0.044) by changes in the distribution of HDL(2b), HDL(3b), and HDL(3c) subclasses. The change in HDL size correlated with a rise in free and cholesterol-ester content in the HDL particles. CONCLUSION: Pioglitazone significantly enhanced insulin sensitivity, reduced inflammation, and modified HDL characteristics, suggesting a potential beneficial effect of this drug in patients with SLE with a risk to develop cardiovascular disease. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov Protocol Registration System, with the number NCT01322308.

C-reactive protein levels and their relationship with metabolic syndrome and insulin resistance in Mexican adolescents.

OBJECTIVE: To investigate the relationship of high sensitive C-reactive protein (hs-CRP) with metabolic syndrome components and insulin resistance in Mexican adolescents. METHODS: 325 adolescents, 182 girls and 143 boys, aged 12-16 years were studied. Standardized clinical measurements and plasma lipids, glucose, insulin and hs-CRP were determined. For metabolic syndrome (MS), the NCEP-ATP III definition was used. RESULTS: MS prevalence was 13%. The most frequent MS components were low HDL-C (50%), high triglycerides (35%), and high waist circumference (28%). hs-CRP median and 75th percentile values for all children were 0.42 and 0.97 mg/dl, respectively. The highest values of hs-CRP were found in children who had MS, p <0.007. hs-CRP was positively correlated with waist circumference, triglycerides, and negatively with HDL-C, p <0.01, and positively with insulin, p <0.001. In stepwise multiple regression analysis, body mass index and HOMA-IR accounted for 10.4% and 12.7% of hs-CRP levels, respectively. CONCLUSIONS: Body mass index and insulin resistance have an independent effect on high hs-CRP levels, and explain a large part of hs-CRP concentrations in adolescents. Central adipose tissue might induce an inflammatory state that could be identified from adolescence.

Effect of a high-monounsaturated fat diet enriched with avocado in NIDDM patients.

OBJECTIVE: To assess the effects of two controlled diets, one rich in oleic acid obtained from avocado and olive oil and the other rich in complex carbohydrates, on fasting and postprandial serum lipids and glycemic control in 12 women with NIDDM. RESEARCH DESIGN AND METHODS: A randomized crossover study was designed. During a 4-week baseline period, all patients received the isocaloric diets recommended by the American Diabetes Association. After this period the patients were randomly assigned to receive the two study diets alternatively during two 4-week periods. One diet was high in monounsaturated fatty acids (HMUFA) and the other was high in complex carbohydrates (high-CHO). There also was a 4-week washout period in between the two 4-week periods during which the patients followed the American Diabetes Association's isocaloric diet. Blood samples were obtained before and after each dietary period. RESULTS: Both diets had a minor hypocholesterolemic effect with no major changes in high-density lipoprotein cholesterol. The HMUFA diet was associated with a greater decrement in plasma triglycerides (20 vs. 7% in the high-CHO diet). Glycemic control was similar with both diets. CONCLUSIONS: Partial replacement of complex digestible carbohydrates with monounsaturated fatty acids (avocado as one of its main sources) in the diet of patients with non-insulin-dependent diabetes mellitus improves the lipid profile favorably, maintains an adequate glycemic control, and offers a good management alternative.

Cholesterol levels and prevalence of hypercholesterolemia in Mexican children and teenagers.

In Mexico, the incidence and prevalence of coronary heart disease has increased over the past three decades and has become the leading cause of death in some areas of the country. Hypercholesterolemia (HC) is a major risk factor for coronary atherosclerosis and most developed countries currently have public health strategies that attempt to reduce the level of cholesterol. In order to learn the mean total cholesterol values and the prevalence of HC, an epidemiologic survey was carried out in a representative population sample that included men and women aged 1 to 98 years, across the nation. In this report, we present the findings in children and teenagers of both sexes (n = 34369). Considering the country as a whole, the mean serum TC was 147 +/- 35 mg/dl, the prevalence of borderline hypercholesterolemia (TC between 170 and 199 mg/dl) was 14.7% and the prevalence of high risk hypercholesterolemia (TC > or = 200 mg/dl) was 6.7%. This cross sectional study demonstrated the existence of significant geographic differences in serum TC, with mean state values ranging from 133 mg/dl in the south to 164 mg/dl in the north. The prevalences of high risk hypercholesterolemia was as high as 18.2% in Baja California Norte and as low as 2.5% in the state of Morelos. These geographic differences in total cholesterol and prevalence of hypercholesterolemia were already present at one year of age and persisted throughout childhood and adolescence.

Cholesterol levels and prevalence of hypercholesterolemia in a Mexican adult population.

In Mexico, the incidence and prevalence of coronary heart disease (CHD) has increased over the past three decades and has become the leading cause of death in the country. Hypercholesterolemia is a major risk factor for coronary atherosclerosis and most developed countries currently have public health strategies that attempt to reduce the level of cholesterol. In order to determine the mean total cholesterol values and the prevalence of hypercholesterolemia, an epidemiologic survey was carried out in a representative national population sample that included men and women aged 1 to 98 years. In this report, we present the findings in all individuals older than 20 years (n = 33,558). Considering the country as a whole, the mean serum total cholesterol (TC) was 4.80 +/- 1.16 mmol/l, the prevalence of borderline hypercholesterolemia (TC between 5.17 and 6.20 mmol/l) was 22.8% and the prevalence of high risk hypercholesterolemia (TC > or = 6.20 mmol/l) was 10.6%. This cross sectional study demonstrated the existence of significant geographic differences in serum TC, with mean state values ranging from 4.43 +/- 1.05 mmol/l in the south to 5.48 +/- 1.36 mmol/l in the north. The prevalence of high risk hypercholesterolemia was as high as 24.8% in Baja California Norte and as low as 4.0% in the state of Guerrero. These large differences in mean TC values are probably diet related and reinforce the need to carry out prospective and intervention trials related to CHD and its risk factors.

Differential effects of obesity with and without hyperinsulinemia on plasma lipoprotein(a) concentrations in men.

To determine the association of in vivo concentrations of insulin, obesity, and gender with lipoprotein(a) [Lp(a)] levels, we used a cross-sectional population-based survey of a multistage random sample of the Mexico City adult population. We studied 423 normoglycemic, normotensive subjects from an original sample of 825, comprised of 239 men and 189 women with a mean age of 38.6 years (range, 17 to 90). All subjects were divided into 8 groups according to body mass index, fasting insulin, and gender. Lp(a) concentrations (mg/dL) were similar in obese women with and without high insulin levels (19.9 v 18.6), but hyperinsulinemic obese men had significantly lower Lp(a) levels than normoinsulinemic obese men (7.9 v 29.4). In addition, the proportion of obese men with Lp(a) concentrations of > or = 30 mg/dL was significantly higher in the normoinsulinemic than in the hyperinsulinemic (29.2% v 0.0%). The frequency distribution of Lp(a) levels was shifted to a lower range in hyperinsulinemic men compared with normoinsulinemic men. Our results show that in men, hyperinsulinemic obesity is associated with low Lp(a) levels, while obesity with normoinsulinemia is related to increased Lp(a) concentration. These observations were not found in women. These findings may explain the conflicting results reported by several studies.

Improved metabolic control does not change plasma lipoprotein(a) levels in adolescents with type 1 diabetes mellitus.

BACKGROUND: It has been found that lipoprotein(a)[Lp(a)] is an independent risk factor for coronary heart disease. Studies on the influence of metabolic control on plasma Lp(a) levels in Type 1 diabetics have reported conflicting results. The aim of this study was to investigate Lp(a) levels in carefully selected adolescents with Type 1 diabetes mellitus before and after improved metabolic control achieved during a 2-week Juvenile Diabetes Training Camp. METHODS: Patients with conditions that affect plasma Lp(a) concentrations were not included. Metabolic variables were determined at the beginning and at the end of the camp. Diet was designed to supply 40-60 Kcal/Kg/day. Physical exercise was performed in two 60-minute daily sessions. Intermediate action insulin was given twice daily, and rapid acting insulin was also administered to some patients. RESULTS: On the last day of the camp, fructosamine declined from 430-362.7 mg/dL (p < 0.001), mean levels of total cholesterol, LDL-cholesterol, and triglycerides also declined significantly (p < 0.001), and HDL-C increased (p < 0.05). In contrast, no significant changes in plasma Lp(a) concentrations were observed. CONCLUSIONS: The findings of this study in this relatively large group of well-defined adolescents with Type 1 diabetes mellitus suggest that improved metabolic control does not reduce plasma Lp(a) levels.

Prevalence of high blood pressure and associated coronary risk factors in an adult population of Mexico City.

BACKGROUND: Several studies have addressed arterial hypertension prevalence in Mexico. However, few include an analysis of other types of hypertension and their associated risk factors. The present work describes the prevalence of high blood pressure (HBP), isolated systolic hypertension (ISH) and diastolic hypertension (DH) and their association to certain risk factors of cardiovascular disease in an adult population of Mexico City. METHODS: A cross-sectional study was performed on 825 subjects aged between 20 and 90 years, selected by multistage cluster sampling. HBP was diagnosed by previous history if systolic blood pressure was > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg. The measurements taken included body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, levels of insulin, glucose, trigylycerides, total cholesterol, high and low density lipoprotein cholesterol, and lipoprotein(a). RESULTS: Prevalence adjusted by age for HBP was 19.4%, for ISH, 4.7%, and for DH, 4.1%. Age had an important influence on HBP and ISH with a highly significant X2t. The profile of metabolic variables was modified according to sex and type of hypertension. Thus, in DH, metabolic variables were more affected than in other types of hypertension. CONCLUSIONS: Results in HBP prevalence in the present study were lower than in other surveys performed in Mexico. It must be noted, however, that much care should be taken to choose the strategy of subject selection, since results of the prevalence of a disease depend on it to a great extent. The ISH and DH and their association to risk factors must be studied thoroughly because they constitute different clinical entities.

High blood pressure and cardiovascular risk factors in an adult population of Mexico City. Characteristics of the studied population.

The present report is a description of the characteristics of a studied population and of the methodology used in a study performed to investigate high blood pressure prevalence and cardiovascular risk factors among the adult population of Mexico City. A cross-sectional study was conducted from January 1991 to March 1992. Random samplings of multiple stages was used and 825 adult subjects were studied in Mexico City. The following measurements were registered: blood pressure, body mass index (BMI), waist-hip ratio (WHR), total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL-C) and low density lipoproteins (LDL-C), lipoprotein (a) (Lp(a)), glucose and insulin. Personal and family history of cardiovascular illness were investigated, as well as exposure to some risk factors such as smoking, alcohol consumption and sedentarism. The response rate was 86.6%. The prevalence of high blood pressure was 21.1%, and of non-insulin dependent diabetes mellitus was 8.7%. Frequency of dyslipidemia in the studied sample was 24.4% for high TG, 23.6% for low HDL-C, 23.6% for high LDL-C, 14.9% for Lp(a) excess (Lp(a) > or = 30 mg/dl; overweight and obesity were more prevalent among women. The diversity of living conditions among the population of Mexico City was included in the sampling strategy design, not only to register the high blood pressure (HBP) frequency in each stratum but to identify other cardiovascular risk factors which could be decisive in the development of HBP. Regarding the features of the studied population, BMI did not reveal differences among men, but their TG levels were higher and HDL levels lower than those of other populations. In women, the results obtained for BMI, WHR, lipids and lipoproteins were also higher compared with the mean reported for other populations.

Effect of the new diagnostic criteria for diabetes in the Mexico City study.

OBJECTIVE: To assess the effect of the new American Diabetes Association (ADA) diagnostic criteria for diabetes in the Mexico City survey. METHODS: The data available from the Mexico City study were included. This cross-sectional survey was conducted from January 1991 to March 1992 and involved 805 adults (20 years of age or older; mean age, 41 years). Survey procedures and results were previously published. Of the residents with diabetes, 74.2% had a previous diagnosis, and 25.8% were diagnosed on the basis of fasting plasma glucose (FPG) levels obtained during the survey. For the current report, these data were reanalyzed on the basis of the new ADA diagnostic criteria. RESULTS: The prevalence of newly diagnosed diabetes with use of the old and the new criteria was 23.1% versus 32.3% in men (P = 0.31) and 27.5% versus 36.3% in women (P = 0.32), respectively. The crude prevalence rate of diabetes increased from 8.7% to 9.3% (P = 0.42), and the age-adjusted rate increased from 10.6% to 11.2% for women (P = 0.64) and from 6.0% to 6.5% for men (P = 0.49). The prevalence of impaired FPG was 4.8%. Those patients with impaired FPG or newly diagnosed diabetes with FPG levels between 126 and 140 mg/dL had a more atherogenic risk profile than did those with normal carbohydrate metabolism. CONCLUSION: On the basis of the 1990 population census in Mexico City, the new ADA criteria will add 28,331 patients with diabetes (6.9%) to an already insufficient medical system. For those patients with impaired FPG or newly diagnosed diabetes on the basis of the new criteria, management should be focused on the control of the diverse and highly prevalent coronary risk factors.

Lipoprotein(a) and cardiovascular risk in adult Mexicans.

A cross-epidemiologic study concerning cardiovascular risk factors in a random sample population of Mexico City was carried out in 1991 and 1992. Lipoprotein(a) (Lp(a)) levels in 404 men and 311 women aged 20-90 years were determined by enzyme-linked immunoassay on fasting plasma. Men and women showed similar age-adjusted Lp(a) values. For the whole population the median Lp(a) was 6.9 mg/dL and the prevalence of high Lp(a) (> 30 mg/dL) was 14%. Small positive correlations between Lp(a) and plasma cholesterol (rs = 0.16) and low density lipoprotein cholesterol (LDL-C) (rs = 0.21), and a negative one with insulin (rs = -0.13) were found. In a multiple regression analysis, insulin and LDL-C were the variables that best explained the variation of Lp(a) in our sample. Our data show that Lp(a) in our population is similar to that found in other populations. An association of Lp(a) with myocardial infarction was observed (high Lp(a) was seen in 33% of atherosclerotic individuals versus 14% in healthy subjects) but did not reach statistical significance.

[Lipoprotein(a) and lipids in chronic renal insufficiency and kidney transplant]. / Lipoproteína(a) y lípidos en insuficiencia renal crónica y en trasplante renal.

OBJECTIVE: To establish the prevalence of lipid and lipoprotein (a) abnormalities in patients under hemodialysis or who underwent renal transplantation. METHODS: Forty dialyzed patients, 64 transplanted and a comparison group of 77 subjects of the general population paired by gender and age were studied. RESULTS: The most prevalent disorder in the hemodialysis was hypoalfalipoproteinemia followed by Lp(a) excess while the least common disorder was hypercholesterolemia. The transplanted patients had the lowest prevalence of Lp(a) excess and a higher proportion of hypercholesterolemia when compared to hemodialysis patients but similar to that of controls. CONCLUSION: Our results confirmed some previous findings observations of others but differed in that hypoalfalipoproteinemia and not hypertriglyceridemia was the predominant abnormality in the hemodialysis patients.

Lipoprotein(a) levels in children and adolescents with diabetes.

OBJECTIVE: To determine lipoprotein(a) in children and adolescents with IDDM and assess its relation with Lp(a) levels in their first degree relatives. RESEARCH DESIGN AND METHODS: In a cross-sectional study we included 141 IDDM patients, (58 male and 83 female) with mean ages 12.2 +/- 2.8 and 12.6 +/- 3.1 years, respectively. Patients with microalbuminuria, hepatopathy, thyroid dysfunction, infectious disease, acute decompensation or surgery three months prior to the study, were excluded. Clinical history, physical examination, blood chemistry, glycosilated hemoglobin, microalbuminuria and lipid profile including total cholesterol triglycerides, HDL-C, Apo A-I, Apo B and Lp(a) were determined. Parents and non-diabetic siblings were also studied when feasible. RESULTS: Mean plasma concentration of total cholesterol, HDL-C and Apo A-I were significantly higher in diabetic boys compared to their non-diabetic sibs. Mean Lp(a) plasma values and the prevalence of Lp(a) > 30 mg/dL were similar in the IDDM patients, their healthy sibs and parents. Hypercholesterolemia and hypertriglyceridemia were more frequent among the IDDM patients. No correlation was found between HbA1, and Lp(a) concentrations. However, a correlation was observed between Lp(a) plasma concentrations of parents and their diabetic and healthy offspring. CONCLUSION: Diabetes mellitus does not seem to affect Lp(a) levels. These data are consistent with a genetic regulation of Lp(a) plasma levels.

[Diabetes mellitus and ischemic cardiopathy: their relation to changes in plasma lipids and other coronary risk factors]. / Diabetes mellitus (DM) y cardiopatía isquémica: su relación con alteraciones en los lípidos plasmáticos y otros factores de riesgo coronario (FRC).

Atherosclerosis is more common and severe in DM. The purpose of this study was to compare the blood lipids profile and the prevalence of different coronary risk factors (CRF) in a mexican population with CHD (coronary heart disease) and DM compared with non DM patients. All had a history of myocardial infarction. Patients with nephropathy or other secondary causes of dyslipidema were excluded. There were two groups of 45 patients, 32 males, 13 females; age was 60 +/- 1 (SEM), body mass index (BMI) 26 +/- 6. Diabetes duration was 10 +/- 1 years. Diabetic individuals referred smoking in 58%, high blood pressure 55%, obesity (IQ greater than 27) 42%. There were no statistical differences with the non DM group. The mean values of total cholesterol, LDL cholesterol and triglycerides were similar in diabetics and non diabetics. HDL cholesterol was significantly lower in diabetic females (p less than 0.01). Hypoalphalipoproteinemia (HDL-C less than or equal to 30 mg/dL) was the most common abnormality in both groups (52% DM vs 38% nonDM) (p less than 0.01) Type IV phenotype was present in 40 vs 29% (NS). Lipid values were not related to BMI, metabolic control or diabetes type of treatment. To conclude, non insulin dependent diabetic patients with CHD have a high prevalence of CRF. Lipid abnormalities, particularly hypoalphalipoproteinemia and hypertriglyceridemia, could be a cause for the increased atherogenic risk, particularly in females.

[Postprandial lipemia in the non-insulin-dependent diabetes mellitus patient. Effect of gemfibrozil]. / Lipemia postprandial en el paciente con diabetes no insulino-dependiente. Efecto del gemfibrozil.

The postprandial (PP) elevations in triglyceride rich lipoproteins are potentially atherogenic. To describe the characteristics of PP lipemia after a fat load in non insulin dependent diabetes mellitus (NIDDM) and evaluate the response to a fibric acid derivative, seven males with NIDDM were studied for 12 hours after the ingestion of a fat load (65 g of fat/square meter of body surface). Plasma glucose, and triglycerides and cholesterol levels were measured in total plasma and in the different lipoprotein fractions. The fat load study was repeated after four weeks of treatment with gemfibrozil (GEM) 600 mg x 2. PP triglyceridemia correlated significantly with the fasting triglyceride concentrations. Basal triglyceride levels diminished significantly with the use of gemfibrozil and so did the magnitude of the PP triglyceridemia. Otherwise the curve patterns of lipemia were similar before and after the use of the fibrate; only the triglyceridemia persisted for a longer period of time. Patients with NIDDM may have a significant PP lipemia which is not likely related to the diabetes per se as to the increased triglyceride levels frequently observed in these patients.

[Microalbuminuria and macrovascular risk factors in insulin-dependent diabetic children]. / Microalbuminuria y factores de riesgo macrovascular en niños diabéticos insulino-dependientes.

OBJECTIVE: To investigate the prevalence of microalbuminuria in children and teenagers with IDDM and its relationship with other variables. METHODS: We studied 160 IDDM children and teenagers with a mean age of 13 +/- 4 years from our endocrine department outpatient clinic. A complete medical history was obtained as well as a fasting blood sample for glycemia, glycosilated hemoglobin and lipid profile and a urine sample for microalbuminuria using laser immunonephelometry. RESULTS: 13 patients (8%) had microalbuminuria (20-200 micrograms/min) and 5 (3%) clinical proteinuria (> 200 micrograms/min). The abnormal excretion was more prevalent in females with the poorest metabolic control, the longest duration of diabetes, and the highest age (13-18 years). The presence of microalbuminuria or clinical proteinuria associated with a more atherogenic risk profile compared to patients with a normal urinary albumin excretion. CONCLUSIONS: There was a poor metabolic control in our IDDM population. In addition, our current findings in a population with a relatively short duration of their diabetes point out the need to improve an integral management strategy to prevent or delay the late complications associated with IDDM.

[Postprandial lipemia in subjects with primary hypoalphalipoproteinemia and hypoalphalipoproteinemia associated with diabetes]. / Lipemia postprandial en sujetos con hipoalfalipoproteinemia primaria e hipoalfalipoproteinemia asociada a diabetes.

The postprandial (PP) elevations in triglyceride rich lipoproteins (TRL) are potentially atherogenic. We compared PP lipemia in non insulin dependent diabetes mellitus (NIDDM) with hypoalphalipoproteinemia (HA) and patients with primary HA. Eight males in each group, mean age +/- SD 54 +/- 10 years, were studied for 12 hours after the ingestion of a fat load (65 g of fat/square meter of body surface). Plasma glucose, triglycerides (TG) and cholesterol (C) in plasma and in the different lipoprotein fractions were measured. The PP triglyceridemia was significantly greater in NIDDM patients with HA and correlated with the fasting TG concentrations. The curve pattern of the lipemia (% delta) was otherwise similar in the patients with secondary or primary HA; only the triglyceridemia persisted for a longer period of time in the latter but was otherwise similar to that of the NIDDM patients with lower basal triglyceride values. Patients with primary HA may have a disturbed metabolism of triglyceride rich lipoproteins which have a delayed depuration during the postprandium. Basal HDL-C in patients with HA cannot predict the PP triglyceridemia.

[Metabolic control and the prevalence of dyslipidemia in children and adolescents with insulin-dependent diabetes mellitus]. / El control metabólico y la prevalencia de dislipidemia en niños y adolescentes con diabetes mellitus insulino-dependiente.

Cholesterol, triglycerides and lipoprotein levels were assayed in serum of 152 children and teenagers with IDDM and in 228 non-diabetic siblings. A poor control of diabetes, reflected by high levels of glycosylated hemoglobin and/or high fasting blood glucose, was associated with statistically significant increases in total cholesterol, LDL-cholesterol and triglycerides, and a reduction in HDL-cholesterol. Mean total cholesterol levels in diabetic patients (171 +/- 33 mg/dL for males and 199 +/- 53 mg/dL for females) were statistically higher than those in their siblings (158 +/- 30 mg/dL and 164 +/- 33 mg/dL respectively). The prevalence of hypercholesterolemia (HC) and hypertriglyceridemia (HTG) were higher in the diabetic patients but statistically significant exclusively in females (prevalences of 40% vs 12% for HC and 30% vs 9% for HTG with a p value < 0.005). The diabetic patients in good metabolic control had similar lipid levels to those of their non-diabetic siblings. These data support the hypothesis that poor control of blood glucose is associated with atherogenic lipid profiles. The prevalence of hypercholesterolemia is impressively high in our diabetic population and indicates that all IDDM patients should have a serum lipid and lipoprotein analysis done annually; blood glucose control and dietary guidelines should be improved in these cases.

Apo(a) phenotyping and long-term prognosis for coronary artery disease.

OBJECTIVES: Identify whether the plasma concentration of Lp(a), apo(a) size or a greater affinity for fibrin predict the likelihood of cardiac death, non-fatal myocardial infarction, unstable angina, the need for additional revascularization, and stroke (MACCE). DESIGN AND METHODS: We analyzed the clinical prognosis of 68 patients with coronary artery disease included in a case-controlled study which evaluated Lp(a) concentration, apo(a) size, and Lp(a) fibrin-binding. Cohort was conducted over a median of 8 years. We used Kaplan-Meier survival tables to evaluate cardiovascular and cerebrovascular events in the follow-up period. RESULTS: Apo(a) isoforms of small size are predictors of MACCE. We find an association between Lp(a) concentration and apo(a) fibrin-binding with major adverse cardiovascular and cerebrovascular events, although without statistically significant results. CONCLUSIONS: Small-sized apo(a) isoforms are an independent risk factor for MACCE in patients with coronary artery disease in follow-up. Lp(a) plasma concentration and apo(a) fibrin-binding were associated, although not significant.

High-density lipoproteins are abnormal in young women with uncomplicated systemic lupus erythematosus.

Little is known about qualitative abnormalities of high-density lipoproteins (HDL) in systemic lupus erythematosus (SLE). We studied distribution and composition of HDL subclasses in 30 premenopausal women with uncomplicated SLE, and 18 controls matched for age and sex. Plasma and HDL lipids were determined by colorimetric enzymatic assays, HDL size distribution by native gradient polyacrylamide gel electrophoresis (PAGE) and apolipoproteins in HDL by sodium dodecyl sulphate denaturing PAGE. Compared with controls, SLE patients had significantly lower proportions of HDL(2b) (-14.7%) and higher proportions of HDL(3b) (+8.8%) and HDL(3c) (+23.3%). Cholesteryl ester (-18%) and apolipoprotein AI (-9%) were lower, whereas triglycerides (+32%) and apolipoprotein E (+27%) were higher in SLE HDL (P < 0.05; for all). In the whole population, stepwise regression analysis showed that only insulin concentrations (R(2) = 0.327) and plasma total apo AI (R(2) = 0.114) accounted independently to the variance in HDL size. This study shows that HDL distribution and composition are abnormal in non-complicated SLE patients. These HDL abnormalities have been reported to be associated to impaired atheroprotective properties of HDL and prevalence of coronary heart disease. Therefore, they may contribute to the premature atherosclerosis observed in young women with SLE.