Long-Term Estrogen Therapy Improves Vascular Function in Male to Female Transsexuals

Objectives. This study sought to examine the effects of long-term estrogen therapy on vascular function in male to female transsexuals and to compare the findings with those observed in men and premenopausal women.

Background. Gender differences in coronary artery disease have largely been attributed to the beneficial effects of estrogen on vascular function and plasma lipids in women. However, the effects of estrogen on the male vasculature have not been widely studied.

Methods. We compared the effects of estrogen on vascular function in 14 male to female transsexuals, 14 age-matched men and 15 premenopausal women. Flow-mediated vasodilation and response to nitroglycerin were assessed in the brachial artery using noninvasive ultrasound.

Results. Flow-mediated vasodilation was similar in transsexuals and women but greater than that in men ([mean ± SE] 11.5 ± 1.3% and 9.4 ± 1.1% vs. 5.2 ± 1.0% respectively, p < 0.005). Responses to nitroglycerin were also greater in transsexuals and women than in men (21.6 ± 1.7% and 21.0 ± 0.9% vs. 14.5 ± 1.2%, respectively, p = 0.0005). These differences persisted even after adjusting for vessel size. Despite similar total cholesterol levels, transsexuals had high density lipoprotein cholesterol levels similar to those in women and greater than those observed in men (1.76 ± 0.12 and 1.82 ± 0.11 mmol/liter vs. 1.35 ± 0.07 mmol/liter, respectively, p < 0.005). Moreover, triglyceride levels were greater in transsexuals than in men and women, and low density lipoprotein cholesterol (LDL-C) particle size was smaller (25.7 ± 0.2 nm vs. 26.2 ± 0.1 and 26.6 ± 0.1 nm, respectively, p = 0.0001). Serum testosterone (an index of estrogen therapy in transsexuals) was markedly suppressed in transsexuals and similar to that in women. Univariate analysis revealed that there was a strong inverse correlation between serum testosterone and flow-mediated vasodilation (r_s = −0.48, p < 0.005). Multivariate analysis revealed that the best combination of predictors of flow-mediated vasodilation was serum testosterone, vessel size and LDL-C (R² = 0.3, p < 0.005).

Conclusions. Long-term estrogen therapy appears to improve vascular function in male to female transsexuals and occurs despite higher triglyceride levels and the presence of small, dense LDL-C. The beneficial effects of estrogen are not gender specific or solely mediated through endothelium-derived nitric oxide.

(J Am Coll Cardiol 1997;29:1437–44)     

正常临产妇血清载脂蛋白、HDL-C、Lp(a)水平检测

本文测定了 5 0 0例正常临产妇和 130例正常非孕青年女性的载脂蛋白、HDL- C、L p(a) ,以探讨其正常生理变化对孕妇保健的辅助诊断价值及合理指导孕妇的营养膳食的必要性。1　材料和方法1.1　试剂　 HDL- C测定采用日本第一化学试剂 ,一步直接法 ;apo A1、apo B测定用上海长征公司试剂 ,免疫比浊法 ;L p(a)测定用上海明华公司 (双试剂 ) ,单抗免疫比浊法。1.2　仪器　日产 OL YMPU S AU2 70 01.3　被测对象分四组　正常健康临产妇组为 5 0 0例 ,平均年龄 (2 6 .0± 3.9)岁 ,平产活婴 ,孕周为 37周～ 4 1周 ;妊高征组为 30例 (分为…     

Use of the Coronary Artery Calcium Score in Discussion of Initiation of Statin Therapy in Primary Prevention

Clinical guidelines for instituting pharmacotherapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD), specifically lipid management and aspirin, have long been based on absolute risk. However, lipid management in the current era remains challenging to both patients and clinicians in the setting of somewhat discordant recommendations from various organizations. All guidelines endorse the use of statins for primary prevention for those at sufficient absolute risk, and treatment recommendations are generally “risk-based” rather than exclusively targeting specific low-density lipoprotein cholesterol levels. Nonetheless, guidelines differ in relation to the risk threshold for initiation and the intensity of statin treatment. The key concept of the clinician-patient risk discussion introduced in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines is a process that addresses the potential for ASCVD risk reduction with statin treatment, potential for adverse treatment effects, patient preferences, encouragement of heart-healthy lifestyle, and management of other risk factors. However, operationalizing the clinician-patient risk discussion requires effective communication of the most accurate and personalized risk information. In this article, we review our treatment approach for the appropriate use of coronary artery calcium testing in the intermediate-risk patient to guide shared decision making. The decision to initiate or intensify statin therapy may be uncertain across a broad range of estimated 10-year ASCVD risk of 5% to 20%, and coronary artery calcium testing can reclassify risk upward or downward in approximately 50% of this group to inform the risk discussion. We conclude with 2 case-based examples of uncertain risk and uncertain statin therapeutic benefit to illustrate execution of the clinician-patient risk discussion.     

Cocaine and Marijuana Use Among Young Adults With Myocardial Infarction

Background

Substance abuse is increasingly prevalent among young adults, but data on cardiovascular outcomes remain limited.

A significant correlation between the plasma levels of coenzyme Q10 and vitamin B-6 and a reduced risk of coronary artery disease

Coronary artery disease (CAD) is the leading cause of death worldwide. The purpose of this study was to investigate the relationship between plasma levels of coenzyme Q10 and vitamin B-6 and the risk of CAD. Patients with at least 50% stenosis of one major coronary artery identified by cardiac catheterization were assigned to the case group (n = 45). The control group (n = 89) comprised healthy individuals with normal blood biochemistry. The plasma concentrations of coenzyme Q10 and vitamin B-6 (pyridoxal 5’-phosphate) and the lipid profiles of the participants were measured. Subjects with CAD had significantly lower plasma levels of coenzyme Q10 and vitamin B-6 compared to the control group. The plasma coenzyme Q10 concentration (β = 1.06, P = .02) and the ratio of coenzyme Q10 to total cholesterol (β = .28, P = .01) were positively correlated with vitamin B-6 status. Subjects with higher coenzyme Q10 concentration (≥516.0 nmol/L) had a significantly lower risk of CAD, even after adjusting for the risk factors for CAD. Subjects with higher pyridoxal 5’-phosphate concentration (≥59.7 nmol/L) also had a significantly lower risk of CAD, but the relationship lost its statistical significance after adjusting for the risk factors of CAD. There was a significant correlation between the plasma levels of coenzyme Q10 and vitamin B-6 and a reduced risk of CAD. Further study is needed to examine the benefits of administering coenzyme Q10 in combination with vitamin B-6 to CAD patients, especially those with low coenzyme Q10 level.     

Chitooligosaccharide ameliorates diet-induced obesity in mice and affects adipose gene expression involved in adipogenesis and inflammation

Chitooligosaccharide (CO) has been reported to have potential antiobestic effects in a few studies, but the antiobesity properties of CO and its related mechanisms in models of dietary obesity remain unclear. We investigated the effect of CO on body weight gain, size of adipocytes, adipokines, and lipid profiles in high-fat (HF) diet-induced obese mice and on the gene expression in adipose tissue using a complementary DNA microarray approach to test the hypothesis that CO supplementation would alleviate HF diet-induced obesity by the alteration of adipose tissue-specific gene expression. Male C57BL/6N mice were fed a normal diet (control), HF diet, or CO-supplemented HF diet (1% or 3%) for 5 months. Compared with the HF diet mice, mice fed the 3% CO-supplemented diet gained 15% less weight but did not display any change in food and energy intake. Chitooligosaccharide supplementation markedly improved serum and hepatic lipid profiles. Histologic examination showed that epididymal adipocyte size was smaller in mice fed the HF + 3% CO. Microarray analysis showed that dietary CO supplementation modulated adipogenesis-related genes such as matrix metallopeptidases 3, 12, 13, and 14; tissue inhibitor of metalloproteinase 1; and cathepsin k in the adipose tissues. Twenty-five percent of the CO-responsive genes identified are involved in immune responses including the inflammatory response and cytokine production. These results suggest that CO supplementation may help ameliorate HF diet-induced weight gain and improve serum and liver lipid profile abnormalities, which are associated, at least in part, with altered adipose tissue gene expression involved in adipogenesis and inflammation.     

Serum levels of polyunsaturated fatty acids are low in Chinese men with metabolic syndrome,whereas serum levels of saturated fatty acids,zinc, and magnesium are high

The purpose of this study was to examine the hypothesis that serum levels of phospholipid (PL) fatty acids (FA) and minerals are associated with the components of metabolic syndrome (MetS) in the Chinese population and the profiles of changes may differ from patients with MetS from Western countries. The levels of serum PL, FA, and minerals were examined in 201 subjects (52 with MetS and 149 healthy controls without any MetS components) in China. The saturated FA proportion in serum was significantly higher, whereas the proportion of total polyunsaturated FA (PUFA), n-3 and n-6 PUFA (22:6n-3: −16%, P = .006; 20:4n-6: −36%, P < .001), and estimated δ-5 desaturase were significantly lower in the MetS group compared with those that are not MetS. Subjects with MetS had higher levels of serum Zn (P = .037) and Mg (P < .001) than subjects without MetS. The proportion of n-3 PUFA was significantly negatively correlated with body mass index and waist circumference. In conclusion, serum PL FA composition and serum minerals in Chinese men with MetS differed significantly from that of healthy individuals, reflecting a decrease in n-3 and n-6 PUFA, especially 22:6n-3 and 20:4n-6, and an increase in saturated FA, magnesium, and zinc. These changes may reflect improper dietary intake in subjects with MetS, and dietary modification could be useful to prevent MetS and as an adjunctive therapy.     

三省(区)成人血脂异常与心血管病危险因素和心功能的相关性

目的通过描述中国三省(区)成人TC边缘升高、TG边缘升高、HDL-C减低和LDL-C边缘升高的分布特点,探讨血脂相关指标边缘升高或减低与心血管病危险因素和心功能的相关性,为成人健康管理提供理论依据。方法采用流行病学横断面的研究方法对中国河北省、浙江省和广西壮族自治区(三省区)18~74岁汉族成人的身体健康状况进行随机、分层、整群抽样问卷调查和体格检查。结果三省(区)成人总胆固醇边缘升高率为15.0%;甘油三酯边缘升高率为0.7%;高密度脂蛋白-胆固醇减低率为18.5%;低密度脂蛋白-胆固醇边缘升高率为9.5%。三省(区)TC边缘升高、TG边缘升高、HDL-C减低率、LDL-C边缘升高率与很多心血管病危险因素有关。多因素线性回归分析显示:TC边缘升高与年龄正相关。HDL-C减低与居住地农村、肥胖、农民职业负相关。多因素Logistic回归显示:TC边缘升高与年龄、初中正相关;居住地农村与TC边缘升高负相关。HDL-C减低与居住地农村、腰围、丧偶负相关。LDL-C边缘升高与年龄、文化程度初中、高中和大学正相关,与农民职业负相关。TC边缘升高组的CO、CI、SI、SV、LVET、SVR、LCW平均水平减少;高密度脂蛋白-胆固醇减低组CI、SV和LCW的平均水平减少(P<0.05);SI、SVR、LVET平均水平增加(P<0.05);低密度脂蛋白-胆固醇边缘升高组CI、SI平均水平减少(P<0.05);LCW、SVR、LVET、SV平均水平增加(P<0.05)。结论我国三省(区)18~74岁成人血脂相关指标边缘升高或减低比例较高,与心血管病危险因素和心功能有关。对血脂相关指标边缘升高或减低成人进行健康管理具有重要的公共卫生意义。     

氟伐他汀治疗50例冠心病伴高脂血症的临床疗效分析

目的分析与探讨采用氟伐他汀对冠心病伴高脂血症的治疗效果。方法选取本院2009年8月至2011年8月期间收治的冠心病伴高脂血症患者共50例,对其给予氟伐他汀40mg进行治疗,疗程持续6周,观察患者在治疗前与治疗后的TG、TC、HDL-C、LDL-C以及肝肾功能、血糖值、12导联静息心电图等,观察治疗效果。结果通过6周的治疗后,患者的TC降低有效率为29.0%,TG降低有效率为32.2%,LDL-C降低有效率为30.5%,HDL-C升高有效率为37.0%,治疗前后差异性具有统计学意义。患者合并冠心病的症状在通过6周的治疗后,有明显的好转。结论采用氟伐他汀对冠心病合并高脂血症患者进行治疗疗效良好,不良反应少,值得在临床上进行推广与应用。