Comparison of lovastatin and gemfibrozil in normolipidemic patients with hypoalphalipoproteinemia

This study compared lovastatin and gemfibrozil therapy for effects on lipid and lipoprotein levels in 22 normolipidemic patients with reduced high-density lipoprotein cholesterol levels. Most patients had coronary heart disease. A randomized, crossover design consisted of two drug phases (lovastatin and gemfibrozil) alternating with placebo. Lovastatin reduced total and low-density lipoprotein cholesterol and apolipoprotein B levels by 28%, 34%, and 24%, respectively. These were unaffected by gemfibrozil. Both drugs reduced very low-density lipoprotein and intermediate-density lipoprotein cholesterol levels by 30% to 40%. Both caused small but significant increases in high-density lipoprotein cholesterol, but not in apolipoproteins A-I or A-II. Both significantly lowered ratios of total (and low-density lipoprotein) cholesterol-to-high-density lipoprotein cholesterol, but lovastatin more than gemfibrozil. Thus, for normolipidemic patients with low levels of high-density lipoprotein cholesterol, neither drug markedly raised high-density lipoprotein levels, but lovastatin produced the better overall change in lipoprotein cholesterol and apolipoprotein B levels.     

Reducing high blood cholesterol level with drugs. Cost-effectiveness of pharmacologic management

We performed a cost-effectiveness analysis of pharmacologic treatment of high blood cholesterol levels. Agents modeled were cholestyramine, colestipol, gemfibrozil, lovastatin, niacin, and probucol. Pharmacologic effectiveness was estimated from reported studies. Cost estimates reflect societal resource consumption. Annual costs for therapy ranged from $327 (niacin) to $1881 (lovastatin, 80 mg/d). Niacin was the most efficient agent for reducing low-density lipoprotein cholesterol levels, having an average cost over 5 years of $139 per percent reduction in low-density lipoprotein cholesterol level. Lovastatin (20 mg/d) was also efficient ($177 per percent reduction). Cholestyramine was least efficient at $347. For high-density lipoprotein cholesterol, niacin was most efficient, at $116 per percent increase in high-density lipoprotein cholesterol level, followed by gemfibrozil at $271. Analyses combining low-density lipoprotein cholesterol and high-density lipoprotein cholesterol effects suggest that niacin and lovastatin (20 mg/d) were most efficient for reducing cardiovascular risk.     

Effects of cyclosporine therapy on plasma lipoprotein levels

Accelerated atherosclerosis is a leading cause of death in long-term survivors of heart and renal transplantation and may be exacerbated by the frequent occurrence of posttransplant hyperlipidemia. Attempts to define the mechanism for hyperlipidemia in transplant recipients are confounded by dramatic changes in metabolism and nutritional status after transplantation, as well as by treatment with multiple immunosuppressive and antihypertensive drugs. To avoid these pitfalls and to determine if cyclosporine alone adversely affects lipid levels, we measured lipoprotein levels in a prospective, double-blind, randomized, placebo-controlled trial of cyclosporine in 36 men with amyotrophic lateral sclerosis. Plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol, and apolipoprotein B levels were measured at baseline, 2 weeks, 1 month, and 2 months. Significant increases of 21% in total cholesterol, 31% in low-density lipoprotein cholesterol, and 12% in apolipoprotein B levels occurred only in the cyclosporine group. Cyclosporine therapy alone adversely affects plasma lipoprotein levels by increasing total cholesterol levels, primarily due to an increase in low-density lipoprotein cholesterol level.     

Apolipoprotein A and high density lipoprotein cholesterol in childhood nephrotic syndrome

Plasma triglyceride, apolipoprotein A, total and high density lipoprotein cholesterol levels were estimated in childhood nephrotic syndrome. The plasma lipid concentrations within the nephrotic group were variable with elevation of both triglyceride and cholesterol present in 60%, triglyceride alone in 10% and cholesterol alone in 30% respectively. The mean plasma triglyceride and total cholesterol levels were significantly elevated in the nephrotic children. The increase in plasma triglyceride seems unrelated to the serum cholesterol concentration. The high density lipoprotein cholesterol was significantly reduced, whereas the apolipoprotein A concentration was elevated, probably suggesting the presence of an Apolipoprotein A-rich high density lipoprotein in nephrotic children.     

3-Hydroxy-3-methylglutaryl--coenzyme A reductase inhibitors in the treatment of hypercholesterolemia

A new class of drugs, which inhibit de novo cholesterol biosynthesis, significantly reduces the blood cholesterol concentrations in hypercholesterolemic patients. Four separate inhibitors have lowered plasma total cholesterol and low-density lipoprotein (LDL) levels in humans by 20% to 40%: mevastatin (Compactin), lovastatin (mevinolin), pravastatin (CS-514, Eptastatin, and SQ 31000), and simvastatin (Synvinolin, MK-733). In addition to lowering total and LDL cholesterol concentrations, the plasma concentration of the potentially atherogenic B apolipoprotein is also reduced by 20% to 40%. The reduction in the levels of circulating atherogenic lipoprotein particles occurs as a result of decreased synthesis and enhanced removal of LDLs by the LDL receptor pathway in hepatocytes. Moreover, the levels of high-density lipoprotein cholesterol, which are inversely related to atherosclerosis, increase in concentration with treatment by these drugs. If the short-term safety of these drugs extends to ongoing long-term studies and if cardiovascular morbidity and mortality are affected by their use, this class of hypolipidemic agent will markedly facilitate the effective treatment of hypercholesterolemia.     

阿托伐他汀与洛伐他汀对老年高血脂症强化降脂治疗的疗效和安全性研究

目的观察阿托伐他汀与洛伐他汀治疗老年高血脂症患者的疗效及安全性。方法将112例老年高血脂症患者随机分成A、B两组,各56例。A组:给予阿托伐他汀,10 mg/d;B组:给予洛伐他汀,20 mg/d。治疗前、治疗第6周后检查两组患者血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、谷丙转氨酶(ALT)、肌酸磷酸激酶(CK)。结果两组均能显著降低TC、LDL-C、TG,升高HDL-C(P<0.05),A组作用强于B组(P<0.05)。两组均有良好的安全性。结论阿托伐他汀与洛伐他汀均能有效调整老年患者血脂水平,阿托伐他汀作用明显优于洛伐他汀,两者均有好的安全性。     

Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus

Recently, nicotinic acid has been recommended as a first-line hypolipidemic drug. To determine the effectiveness of nicotinic acid in dyslipidemic patients with non-insulin-dependent diabetes mellitus, 13 patients were treated in a randomized crossover trial. Patients received either nicotinic acid (1.5 g three times daily) or no therapy (control period) for 8 weeks each. Compared with the control period, nicotinic acid therapy reduced the plasma total cholesterol level by 24%, plasma triglyceride level by 45%, very-low-density lipoprotein cholesterol level by 58%, and low-density lipoprotein cholesterol level by 15%, and it increased the high-density lipoprotein cholesterol level by 34%. However, nicotinic acid therapy resulted in the deterioration of glycemic control, as evidenced by a 16% increase in mean plasma glucose concentrations, a 21% increase in glycosylated hemoglobin levels, and the induction of marked glycosuria in some patients. Furthermore, a consistent increase in plasma uric acid levels was observed. Therefore, despite improvement in lipid and lipoprotein concentrations, because of worsening hyperglycemia and the development of hyperuricemia, nicotinic acid must be used with caution in patients with non-insulin-dependent diabetes mellitus with dyslipidemia. We suggest that the drug not be used as a first-line hypolipidemic drug in patients with non-insulin-dependent diabetes mellitus.     

Normal cholesterol levels with lovastatin (mevinolin) therapy in a child with homozygous familial hypercholesterolemia following liver transplantation

Patients with homozygous familial hypercholesterolemia produce no normal low-density lipoprotein (LDL) receptors, and as a result, LDL accumulates in plasma, causing severe premature atherosclerosis. Two years ago, liver transplantation was performed in a child with homozygous familial hypercholesterolemia, restoring LDL receptor activity to about 60% of normal and reducing the LDL cholesterol level by 81%. However, the patient's lipoprotein levels remained significantly elevated for her age and sex. Treatment with lovastatin (mevinolin) one year after transplantation produced a marked improvement in the patient's lipoprotein profile. The total and LDL cholesterol levels fell 40% and 49%, respectively, to values within the normal range. The level of very low-density lipoprotein cholesterol fell 41%, and the level of total triglycerides declined 28%. While lovastatin therapy decreased the production rate of LDL by 35%, it did not affect the LDL fractional clearance rate. Thus, the combination of liver transplantation and lovastatin restored total and LDL cholesterol levels to normal in this patient with homozygous familial hypercholesterolemia.     

肾衰养真胶囊对慢性肾衰竭大鼠脂代谢紊乱的影响

目的 观察肾衰养真胶囊对慢性肾衰竭(CRF)大鼠脂代谢紊乱的治疗效果并探讨其可能机制。方法 对50 只SD 雄性大鼠采用5/6 肾切除法制作CRF大鼠模型,随机分为空白模型对照组、吉非罗齐治疗组及肾衰养真胶囊高、中、低剂量治疗组;另设正常对照组。于喂药4周后,观察各组脂谱及脂蛋白谱,并用反转录聚合酶链式反应(RT-PCR)法检测心肌脂蛋白脂酶信使RNA(LPLmRNA)的表达。结果 两药均能降低总胆固醇、甘油三酯、低密度脂蛋白胆固醇,升高高密度脂蛋白胆固醇,同时LPLmRNA 表达上调,肾衰养真胶囊各治疗组之间无差异。结论 肾衰养真胶囊可通过促进LPLmRNA 转录而调节血脂水平,改善脂蛋白谱,这可能是肾衰养真胶囊改善CRF大鼠脂代谢紊乱的机制之一。     

Lipids, Lipoproteins and Apolipoproteins Abnormalities inPatients undergoing Dialysis

Patientswithchronicrenalfailureoftenhavehypertriglyceridemiaanddecreasedhigh-densitylipoproteincholesterol(HDL-C)concentrations[l'2].Whilecardiovasculardiseaseisamajorcauseofhighmorbidityandmortalityamongthesepatients['].Somestudiessuggestedthatabnormallipoproteinmetabolismwasoneofthecauses.InChina,fewreportswereavailableonlipids,lipoproteins,especiallyapolipoproteinsmetabolisminpatientsundergoingdialysis.Thepurposeofthisstudyistoobservethelipids,lipoproteinsandapolipoproteins(Apo)levelsinp…     

The hypolipidemic effects of gemfibrozil in type V hyperlipidemia. A double-blind, crossover study

Thirteen patients with phenotypic type V hyperlipidemia were treated with either gemfibrozil (Lopid) or a placebo in a randomized, double-blind, crossover study for two 8-week periods. A 4-week baseline period of a low-fat diet preceded the study and served as a dietary control period. A 4-week washout period followed the two 8-week periods. Compared with the placebo phase, gemfibrozil produced a significant reduction in the concentrations of total plasma triglycerides (21.03 vs 5.50 mmol/L) and very low-density lipoprotein triglycerides (14.40 vs 4.59 mmol/L) as well as in total plasma cholesterol levels (10.88 vs 5.62 mmol/L) and very low-density lipoprotein cholesterol (6.66 vs 2.15 mmol/L). Chylomicronemia was virtually abolished by the drug treatment. As expected in treated patients with type V hyperlipidemia, concentrations of low-density lipoprotein cholesterol rose after therapy with gemfibrozil (3.08 mmol/L) as compared with placebo (1.84 mmol/L); high-density lipoprotein cholesterol also increased (0.85 mmol/L after therapy with gemfibrozil, 0.62 mmol/L after placebo). The previously very low values for both of these lipoproteins increased at the same time that the total plasma cholesterol value decreased. We conclude that gemfibrozil is a well-tolerated and effective hypolipidemic agent for the treatment of patients with severe hypertriglyceridemia when used in conjunction with a low-fat diet.     

Treatment of primary moderate hypercholesterolemia with lovastatin (mevinolin) and colestipol

The introduction of inhibitors of cholesterol biosynthesis offers a new approach to treatment of hypercholesterolemia. One such agent, lovastatin (formerly, mevinolin), causes significant reductions in plasma cholesterol levels. This action can be enhanced by bile acid sequestrants. In this study, lovastatin and colestipol hydrochloride together were administered to ten patients with primary moderate hypercholesterolemia. Compared with a control period, the combined-drug therapy caused a 36% reduction in plasma total cholesterol level, a 48% decrease in low-density lipoprotein (LDL) cholesterol level, and a 17% increase in high-density lipoprotein cholesterol level. The reduction in LDL cholesterol level was due to three factors: a 27% decrease in the production rate of LDL, a 20% increase in fractional catabolic rate of LDL, and a 15% depletion of cholesterol in LDL particles. This major reduction in LDL cholesterol level produced by combined-drug therapy may be valuable for prevention of coronary heart disease in high-risk patients with primary moderate hypercholesterolemia.     

肾衰养真胶囊对慢性肾衰竭大鼠脂代谢紊乱的影响

目的 观察肾衰养真胶囊对慢性肾衰竭(CRF)大鼠脂代谢紊乱的治疗效果并探讨其可能机制。方法 对50只SD雄性大鼠采用5／6肾切除法制作CRF大鼠模型．随机分为空白模型对照组、吉非罗齐治疗组及肾衰养真胶囊高、中、低剂量治疗组；另设正常对照组。于喂药4周后，观察各组脂谱及脂蛋白谱，并用反转录聚合酶链式反应(RT-PCR)法检测心肌脂蛋白脂酶信使RNA(LPLmRNA)的表达。结果 两药均能降低总胆固醇、甘油三酯、低密度脂蛋白胆固醇，升高高密度脂蛋白胆固醇．同时LPLmRNA表达上调，肾衰养真胶囊各治疗组之间无差异。结论 肾衰养真胶囊可通过促进LPLmRNA转录而调节血脂水平，改善脂蛋白谱，这可能是肾衰养真胶囊改善CRF大鼠脂代谢紊乱的机制之一。     

Reduced plasma high-density lipoprotein and increased platelet activity in arterial versus venous blood

Plasma lipid and lipoprotein pattern and platelet activity were studied in blood samples derived from veins and arteries of 10 healthy male subjects. A significant reduction in plasma high-density lipoprotein (HDL) cholesterol, triglyceride and protein levels, as well as in plasma apolipoprotein A-I, was found when lipoproteins were derived from arterial blood in comparison to venous blood. All other lipoproteins were not significantly changed. Platelet activity measured as plasma beta-thromboglobulin levels and as collagen-induced platelet aggregation and 14C-serotonin release in platelet-rich plasma was markedly elevated when platelets were derived from arterial blood. Since reduced plasma HDL concentration and platelet activation are known risk factors for atherosclerosis, our study may suggest a further explanation for the presence of atherosclerotic lesions in arteries but not in veins.     

老年高血压病患者血胰岛素水平与糖、脂代谢异常的关系

目的　探讨老年高血压病患者高胰岛素血症与血糖、血清脂质水平之间的关系。方法　对 78例老年高血压病患者(观察组 )及 60例老年对照组 ,进行了血清甘油三酯 (TG)、总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL -C)、低密度脂蛋白胆固醇(LDL -C)、载脂蛋白AI(ApoAI)、载脂蛋白B(ApoB)、脂蛋白 (a) [Lpo (a) ]、空腹血糖 (FPG)及胰岛素 (INS)的测定。 结果　观察组血清TG、LDL -C、Lpo(a)、INS、FPG含量明显高于对照组 ;观察组血清HDL -C、ApoAI水平和胰岛素敏感性指数 (ISI)明显低于对照组。结论　老年高血压病患者胰岛素、血脂和血糖代谢异常的共存是该病发生、发展的危险因素 ,也是心、脑血管疾病的危险因素 ,故在降压治疗的同时 ,应考虑纠正其胰岛素、糖及脂代谢的异常。     

帕金森病与血脂水平的临床分析

目的研究帕金森病患者血脂水平的变化,及不同性别、年龄的帕金森患者血脂水平的差异。方法纳入2011年7月-2013年6月在盛京医院神经内科住院及老年门诊就诊的帕金森病患者116例作为观察组,再纳入同时期的健康体检者116名作为对照组。抽取受试者空腹肘静脉血,采用全自动生化分析仪检测受试者血清总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、载脂蛋白A、载脂蛋白B的水平。并进一步按年龄、性别进行分层分析。结果与对照组比较,观察组患者血清总胆固醇、甘油三酯、低密度脂蛋白及载脂蛋白B的浓度显著降低(P0.05),而高密度脂蛋白和载脂蛋白A水平在两组间差异无统计学意义(P0.05)。分层分析结果显示,与男性帕金森病患者比较,女性帕金森病患者的血清总胆固醇、甘油三酯、低密度脂蛋白及载脂蛋白B的浓度显著升高(P0.05);与低年龄组(≤65岁)帕金森病患者比较,高年龄组(65岁)帕金森病患者的血清低密度脂蛋白及载脂蛋白B的浓度显著升高(P0.05)。结论帕金森病患者的血清总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白及载脂蛋白B水平有所降低,以男性帕金森病患者的血脂水平降低更明显。     

Lipids and lipoproteins in patients undergoing coronary-artery surgery

Fasting blood samples were obtained from 290 patients who were undergoing elective coronary-artery graft procedures, and cholesterol, triglyceride and high-density lipoprotein cholesterol levels were measured. The 1983 National Heart Foundation of Australia's Risk Factor Prevalence Study was used as a source of age- and sex-matched "control" data. Of these patients, 80% had cholesterol levels of greater than 5.5 mmol/L; in 55% of patients, the level exceeded 6.5 mmol/L. Only 4% of patients who received a graft showed hypertriglyceridaemia alone (triglyceride level, greater than 2 mmol/L). Combined hyperlipidaemia (cholesterol level, greater than 5.5 mmol/L and triglyceride level, greater than 2.0 mmol/L) was present in 52% of subjects. Low-density lipoprotein cholesterol levels exceeded 3.5 mmol/L in 69% of men and in 71% of women. In terms of five 10-year age intervals, mean plasma triglyceride and cholesterol levels were elevated significantly in patients who had undergone a coronary-artery grafting procedure compared with those of subjects in the National Heart Foundation study. The mean high-density lipoprotein cholesterol levels were markedly-lower compared with those of the subjects in the National Heart Foundation study. Of those patients whose plasma cholesterol levels were less than 5.5 mmol/L, 97% of patients had high-density lipoprotein cholesterol levels that were less than the mean level for subjects in the National Heart Foundation study. Thus, a very-high proportion of patients who underwent coronary-artery bypass surgery had lipid abnormalities which required intervention postoperatively.     

单中心就诊2~18岁儿童胆固醇水平异常发生率及病因分析

目的: 探讨单中心就诊患儿血浆胆固醇水平异常情况及分布规律。方法: 回顾性分析2016年6月至2019年6月在北京大学第一医院有胆固醇检测结果的2~18岁儿童血浆胆固醇水平。总胆固醇(total cholesterol, TC)采用胆固醇氧化酶法,低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)采用清除法检测,计数资料比较应用卡方检验。结果: 调查有效数据11 829例,其中男性7 087例, 女性4 742例。TC升高儿童1 822例(15.4%), LDL-C升高儿童1 371例(11.6%),HDL-C降低儿童2 798例(23.7%), 胆固醇水平异常儿童总和4 427例(37.4%)。非常见继发性高脂血症病因就诊儿童7 835人,其中TC升高儿童731例(9.3%), LDL-C升高儿童561例(7.2%), HDL-C降低儿童1 886例(24.1%),胆固醇水平异常儿童总和2 576例(32.9%)。不同疾病就诊儿童中,胆固醇异常发生率差异有统计学意义(P<0.05)。TC升高及LDL-C升高发生率的前三位主要就诊原因均分别为“血脂异常”“泌尿系统疾病”“营养性疾病”。除小儿内科外,其他科室送检的1 257例患儿血脂检测样本中,300例存在胆固醇水平异常(23.8%), 其中高胆固醇血症患儿 70例(5.6%), 高低密度脂蛋白血症患儿44例(3.5%), 低高密度脂蛋白血症患儿224例(17.8%)。在非常见继发性高脂血症病因就诊儿童中,因LDL-C≥140 mg/dL (3.6 mmol/L) 需要进一步排除家族性高胆固醇血症的患儿共365例,占该部分患儿的4.6%。结论: 就诊儿童胆固醇异常发生率高,在原发病诊治的同时加强胆固醇管理不仅有助于控制继发性高胆固醇血症,也为及时发现家族性高胆固醇血症提供可能。     

Low-density lipoprotein subclass patterns and risk of myocardial infarction

The association of low-density lipoprotein (LDL) subclass patterns with coronary heart disease was investigated in a case-control study of nonfatal myocardial infarction. Subclasses of LDL were analyzed by gradient gel electrophoresis of plasma samples from 109 cases and 121 controls. The LDL subclass pattern characterized by a preponderance of small, dense LDL particles was significantly associated with a threefold increased risk of myocardial infarction, independent of age, sex, and relative weight. Plasma levels of high-density lipoprotein cholesterol were decreased, and levels of triglyceride, very low-density lipoproteins, and intermediate-density lipoproteins were increased in subjects with this LDL subclass pattern. Multivariate logistic regression analyses showed that both high-density lipoprotein cholesterol and triglyceride levels contributed to the risk associated with the small, dense LDL subclass pattern. Thus, the metabolic trait responsible for this LDL subclass pattern results in a set of interrelated lipoprotein changes that lead to increased risk of coronary heart disease.     

2005-2009年某电力企业作业工人血脂异常变化趋势分析

目的了解2005-2009年某电力企业作业工人血脂异常情况及变化趋势。方法清晨、空腹抽取工人外周静脉血检测总胆固醇、甘油三酯,高密度脂蛋白和低密度脂蛋白含量,计算工人血脂异常的检出率。结果2005年,2007年和2009年分别检测了756,711和538名工人,血脂异常的检出率分别为19.58%,33.61%,39.28%,呈逐年上升趋势（P〈0.01）,且煤工、粉尘作业人员血脂异常比例最高。男工和女工血脂异常检出率比较,男工普遍高于女工（P〈0.01）。结论电力企业煤工、粉尘作业人员长期接触职业性有害因素,血脂异常检出率明显升高并呈逐年上升趋势。因此,应针对该职业人群加强健康教育和采取一定预防保健措施,以便保护该职业人群的身心健康。