Relationship between plasma high-density lipoprotein cholesterol and anticonvulsant levels in epileptics

Plasma high-density lipoprotein (HDL) cholesterol is a recognized negative risk factor for coronary heart disease. In this study, therapy with phenytoin alone, carbamazepine alone, and phenytoin in combination with phenobarbital was associated with elevated plasma HDL cholesterol concentrations. The highest HDL cholesterol levels were seen in subjects treated with the combination of phenytoin and phenobarbital. Plasma HDL cholesterol levels were proportional to the serum phenobarbital and carbamazepine concentrations. In subjects treated with phenytoin alone, low plasma HDL cholesterol levels were associated with low drug concentrations. The results suggest direct links running from the serum anticonvulsant levels to the extent of hepatic microsomal enzyme induction, and further to the plasma HDL cholesterol concentrations.     

普伐他汀治疗高脂血症及对血浆D-二聚体的影响

目的 :研究普伐他汀对高脂血症病人降脂作用及对血浆D 二聚体的影响。方法 :高脂血症病人 36例 ,服用普伐他汀 10mg·d- 1,服药 4wk后若血清TC >5.2mmol·L- 1,则剂量加倍 ,疗程 12wk。服药前后每 4wk测TC ,TG ,HDL C ,LDL C及D 二聚体。结果 :治疗 12wk ,普伐他汀降低TC ,TG的总有效率分别为 94 %和 59% ,升高HDL C的总有效率为 54%。治疗 12wk后TC ,TG ,LDL C ,D 二聚体分别下降 ( 2 6± 12 ) % ,( 2 4± 2 0 ) % ,( 2 7±18) % ,( 4 0± 17) % ,HDL C上升 ( 15± 3) % ,差异有非常显著意义 (P <0 .0 1)。结论 :普伐他汀能够降低TC ,TG和LDL C ,升高HDL C ,且能降低血浆D 二聚体水平 ,从而改善凝血、纤溶系统的紊乱     

Long-term low-dose treatment with reserpine of cholesterol-fed rabbits reduces cholesterol in plasma,non-high density lipoproteins and arterial walls

The effects of long-term low-dose treatment with reserpine on plasma lipoproteins and arterial cholesterol were determined in cholesterol-fed rabbits. Hepatic low-density lipoprotein (LDL) receptors; uptake of LDL by liver, heart, and kidneys; plasma fibrinogen; blood pressure; and heart rate were also determined. Reserpine at 43 microg/kg. d was continuously infused subcutaneously via implanted minipumps for 6 weeks into conscious unrestrained male New Zealand White rabbits (n = 5) fed a 0.2% cholesterol-enriched diet. Compared with controls, reserpine (n = 4) significantly reduced the elevated levels of plasma total cholesterol and esterified and unesterified cholesterol throughout the study, and at 6 weeks of treatment these reductions were 42, 41, and 49%, respectively. The increased cholesterol in the aortic walls (n = 5) produced by the atherogenic diet was reduced by 73% (p < 0.004) and 125I-tyramine cellobiose-labeled LDL by 67 to 86% (0.05 < p <0.004), respectively. The aortic intimal-medial thickness ratio was reduced by 70%. The decrease in elevated plasma total cholesterol was mainly due to cholesterol reductions in both LDL (41%) and non-high density lipoprotein (HDL) of density < 1.019 g/ml (51%). HDL cholesterol and triglyceride levels were unchanged. Reserpine had no significant effects on the clearance of 125I-tyramine cellobiose-LDL from plasma and there was a trend towards an increase in hepatic LDL receptor expression. Heart rate was decreased by 28%. There were no significant effects on blood pressure, liver and heart lipids, hematocrit, or plasma fibrinogen. The results suggest that treatment of cholesterol-fed rabbits with reserpine at a low dose over a long period prevents increases in plasma atherogenic lipoproteins. Reserpine decreases the cholesterol in aortic walls and the intima-media thickness ratio. This anti-atherosclerotic effect of reserpine may have therapeutic implication.     

吩噻嗪类药物引起精神分裂症患者高甘油三酯异常的机制研究

目的：探讨用吩噻嗪类药物治疗后的慢性精神分裂症患者血高油三酯异常特征的危险因素。方法：采用酶法对１１３例精神分裂症者、２５例脑器质性精神障碍患者和１００例健康人血清甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、总胆固醇（ＴＣ）的水平进行了对比分析。结果：血高ＴＧ与低ＨＤＬ－Ｃ浓度的变化为精神分裂症症患者最显著的脂质异常特征,其中阴性症状组和脑器质性精神障碍患者ＴＧ含量明显高于阳性症状组（Ｐ〈     

抗氧化型低密度脂蛋白抗体与糖尿病和代谢综合征的相关性

目的 通过测定血清抗氧化型低密度脂蛋白抗体(oxLDL Ab),探讨氧化型低密度脂蛋白(Oxidized LDLs)与糖尿病及代谢综合征(MS)的关系.方法 糖尿病患者78例(DM组),其中有代谢综合征患者71例为MS组,健康人18例为对照组.测定BMI、腰臀比(WHB)和TG、TC、HDL-C、LDL-C、载脂蛋白A、载脂蛋白B、脂蛋白(a)等血脂指标.酶联免疫吸附法测定血清oxLDL Ab(IgM和IgG型)浓度.硫酸右旋糖苷沉淀法测定HDL亚型.结果 初发糖尿病患者、糖尿病患者及代谢综合征患者的血清oxLDL Ab水平明显高于对照组,分别为(30.18±9.85)、(32.17±21.31)、(38.42±23.59)、(24.05±3.32)U/ml,差异有统计学意义(P<0.05);随着糖尿病病程的延长,糖尿病患者oxLDL Ab浓度有井高的趋势;经相对危险度估计,高oxLDL Ab浓度的人群患MS的相对危险度是正常浓度人群的2.57倍(95%可信区间1.76～3.75),χ2=23.51(P=0.000).结论 血清oxLDL Ab浓度与糖尿病及代谢综合征密切相关,糖尿病及MS患者血清oxLDL Ab水平明显升高,且随病程延长有逐步升高的倾向;测定oxLDL Ab浓度,可以用来判断与估计MS的患病危险度.     

Effects of micronized fenofibrate on insulin resistance in patients with metabolic syndrome

BACKGROUND AND OBJECTIVE: Metabolic syndrome is characterized by insulin resistance (IR) as well as dyslipidemia, ventral overweight, hypertension and elevated fasting plasma glucose. Since diabetic and prediabetic states are commonly associated with hypertriglyceridemia, fenofibrates have been used in such patients. The aim of this pilot open trial was to study the influence of micronized fenofibrate on insulin resistance and plasma insulin levels in prediabetic and diabetic patients. SUBJECTS: From 114 dyslipidemic patients, 31 with dyslipidemia and insulin resistance were selected to take part in the study. Of the 31 patients, 20 were nondiabetic and only 11 had noninsulin-dependent diabetes mellitus. Eighteen dyslipidemic patients acted as controls. METHODS: Insulin resistance was assessed in a short-term insulin tolerance test. Plasma insulin, antiinsulin antibodies, lipid parameters and the insulin sensitivity index (ISI) were measured at entry and after a 3-month therapy with 200 mg micronized fenofibrate daily. RESULTS: Three-month therapy with micronized fenofibrate resulted in significant ISI increase and was accompanied by a decrease in plasma insulin levels in dyslipidemic patients with metabolic syndrome. ISI also improved in patients with type 2 diabetes mellitus and there was an unexpected increase in plasma insulin levels. Antiinsulin antibodies were unchanged throughout the trial. Reductions in plasma triglycerides and total cholesterol exceeding 50% and 20%, respectively, were observed in patients with metabolic syndrome. These changes were accompanied by an increase in mean levels of plasma high-density lipoprotein (HDL) cholesterol (above 35%). CONCLUSIONS: Micronized fenofibrate is an effective drug in normalizing lipid-lipoprotein levels in patients with metabolic syndrome. After a 3-month fenofibrate therapy, insulin resistance was reduced in a group of patients with dyslipidemia and metabolic syndrome.     

幽门螺杆菌感染与脑梗死关系的研究

目的　通过观察脑梗死病人血清幽门螺杆菌细胞毒素相关蛋白A抗体IgG(CagA Hp IgG)的阳性率 ,探讨幽门螺杆菌 (Hp)感染与脑梗死的关系。 方法　应用酶联免疫法 (ELISA)检测 78例脑梗死病人和6 0例对照组血清CagA Hp IgG以及血清总胆固醇 (TC)、甘油三脂 (TG)、载脂蛋白A(Apo A)、载脂蛋白B(Apo B)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)浓度。 结果　脑梗死组血清CagA Hp IgG阳性率 (5 2 5 6 % )显著高于对照组 (35 % ) (P <0 0 5 )。CagA Hp IgG阳性与阴性者间血脂水平比较差异无显著意义 (P >0 0 5 )。结论　Hp感染与脑梗死的发病密切相关。     

Are All Statins the Same?

Pitavastatin is the newest member of the HMG-CoA reductase inhibitor family and is approved as adjunctive therapy to diet to reduce elevated levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein (Apo) B, and triglycerides and to increase levels of high-density lipoprotein (HDL) cholesterol in adult patients with primary hyperlipidemia or mixed dyslipidemia. Pitavastatin undergoes minimal metabolism by cytochrome P450 (CYP) enzymes and, therefore, has a low propensity for drug-drug interactions with drugs metabolized by CYP enzymes or the CYP3A4 substrate grapefruit juice. In clinical trials, pitavastatin potently and consistently reduced serum levels of total, LDL, and non-HDL cholesterol, and triglycerides in patients with primary hypercholesterolemia where diet and other nonpharmacological measures were inadequate. Mean reductions from baseline in serum total and LDL cholesterol and triglyceride levels were 21–32%, 30–45%, and 10–30%, respectively. Moreover, a consistent trend towards increased HDL cholesterol levels of 3–10% was seen. Long-term extension studies show that the beneficial effects of pitavastatin are maintained for up to 2 years. Pitavastatin produces reductions from baseline in serum total and LDL cholesterol levels to a similar extent to those seen with the potent agent atorvastatin and to a greater extent than those seen with simvastatin or pravastatin. In the majority of other studies comparing pitavastatin and atorvastatin, no significant differences in the favorable effects on lipid parameters were seen, although pitavastatin was consistently associated with trends towards increased HDL cholesterol levels. Pitavastatin also produces beneficial effects on lipids in patients with type 2 diabetes mellitus and metabolic syndrome without deleterious effects on markers of glucose metabolism, such as fasting blood glucose levels or proportion of glycosylated hemoglobin. Pitavastatin appears to exert a number of beneficial effects on patients at risk of cardiovascular events independent of lipid lowering. In the JAPAN-ACS (Japan Assessment of Pitavastatin and Atorvastatin in Acute Coronary Syndrome) study, pitavastatin was non-inferior to atorvastatin at reducing plaque volume in patients with ACS undergoing percutaneous coronary intervention. Further beneficial effects, including favorable effects on the size and composition of atherosclerotic plaques, improvements in cardiovascular function, and improvements in markers of inflammation, oxidative stress, and renal function, have been demonstrated in a number of small studies. Pitavastatin is generally well tolerated in hyperlipidemic patients with or without type 2 diabetes, with the most common treatment-related adverse events being musculoskeletal or gastrointestinal in nature. Increases in plasma creatine kinase levels were seen in <5% of pitavastatin recipients and the incidence of myopathy or rhabdomyolysis was extremely low. In summary, pitavastatin, the latest addition to the statin family, produces potent and consistent beneficial effects on lipids, is well tolerated, and has a favorable pharmacokinetic profile. The combination of a potent decrease in total and LDL cholesterol levels and increase in HDL cholesterol levels suggest that pitavastatin may produce substantial cardiovascular protection.     

Treatment of hyperlipoproteinaemia type II a with a new anion exchange resin Secholex®

Summary Eleven patients with hyperlipoproteinaemia type II A, who were relatively resistant to hypolipidaemic drugs, were treated for four to six months with an anion exchange resin, Secholex^® (PDX chloride), 15 g per day. The mean monthly plasma cholesterol level decreased by 10–18% (p<0.01 andp<0.001 respectively) from its pre-treatment value of 431±50 mg/100 ml (mean ±95% confidence limits). The reduction of plasma cholesterol was due mainly to a decrease in low density lipoproteins (LDL) of 50 mg/100 ml (p<0.01). Very low density lipoproteins (VLDL) were moderately (p<0.05) reduced and high density lipoproteins (HDL) remained unchanged. The mean pretreatment plasma triglyceride level (110±30 mg/100 ml) did not alter significantly. Nine of the patients had previously received clofibrate and in them Secholex reduced plasma cholesterol by 17% and clofibrate by 6%. Excluding one patient on clofibrate who had an unexpected increase in plasma cholesterol, there was little difference between the efficacy of clofibrate and Secholex. After four months two patients withdrew from the trial because of constipation. There was slight transient increase in mean serum alkaline phosphatase and a decrease in serum uric acid during treatment with Secholex.     

Activation of lipoprotein lipase increases serum high density lipoprotein 2 cholesterol and enlarges high density lipoprotein 2 particles in rats

It is known that postheparin plasma lipoprotein lipase (LPL) activity correlates with serum high density lipoprotein cholesterol (HDL-C) levels in humans and animals. Furthermore, LPL has been reported to cause enlargement of HDL particle size in vitro. However, these effects have not yet been experimentally proven. The aim of this study was to determine whether LPL has a role in increase in HDL-C and enlargement of HDL particle by activating the LPL function with NO-1886, the LPL promoting agent. NO-1886 administration increased postheparin plasma LPL activity without influencing hepatic triglyceride lipase activity. NO-1886 increased serum HDL(2)-cholesterol (HDL(2)-C) concentration and enlarged HDL(2) particle size, but did not increase serum HDL(3)-cholesterol concentration or enlarge HDL(3) particle size. Also, serum HDL(2)-C concentrations were positively correlated with HDL(2) particle size (r=0.910). Our study demonstrates that the LPL activation induced with NO-1886 may cause production of HDL(2)-C by catabolism of triglyceride-rich lipoproteins and enlarges HDL(2) particle size in rats.     

抗氧化型低密度脂蛋白抗体与糖尿病和代谢综合征的相关性

目的通过测定血清抗氧化型低密度脂蛋白抗体（oxLDL Ab）,探讨氧化型低密度脂蛋白（Oxidized LDLs）与糖尿病及代谢综合征（MS）的关系。方法糖尿病患者78例（DM组）,其中有代谢综合征患者71例为MS组,健康人18例为对照组。测定BMI、腰臀比（WHR）和TG、TC、HDL-C、LDL-C、载脂蛋白A、载脂蛋白B、脂蛋白（a）等血脂指标。酶联免疫吸附法测定血清oxLDL Ab（IgM和IgG型）浓度。硫酸右旋糖苷沉淀法测定HDL亚型。结果初发糖尿病患者、糖尿病患者及代谢综合征患者的血清oxLDL Ab水平明显高于对照组,分别为（30．18±9．85）、（32．17±21．31）、（38．42±23．59）、（24．05±3．32）U／ml,差异有统计学意义（P〈0．05）;随着糖尿病病程的延长,糖尿病患者oxLDL Ab浓度有升高的趋势;经相对危险度估计,高oxLDL Ab浓度的人群患MS的相对危险度是正常浓度人群的2．57倍（95％可信区间1．76～3．75）,χ^2=23．51（P=0．000）。结论血清oxLDL Ab浓度与糖尿病及代谢综合征密切相关,糖尿病及MS患者血清oxLDL Ab水平明显升高,且随病程延长有逐步升高的倾向;测定oxLDL Ab浓度,可以用来判断与估计MS的患病危险度。     

Paradoxical effects of fenofibrate and nicotinic acid in apo E-deficient mice

Atherosclerosis is a complex vascular disease initiated by abnormal accumulation of plasma lipoproteins in the subendothelial space. Elevated levels of plasma triglycerides (TG) and low-density lipoprotein (LDL)-cholesterol as well as low concentrations of high-density lipoprotein (HDL) play a causal role in the development and progression of atherosclerotic lesions. We have shown that apolipoprotein E-deficient (apo E-KO) mice have elevated triglyceride levels plus diminished HDL concentrations. Drugs such as fenofibrate and nicotinic acid are well known to reduce TG and increase HDL levels in humans. In this study, we investigated the beneficial effects of fenofibrate and niacin on lipid profile and atherogenesis in apo E-KO mice and their wild-type counterparts. Animals were fed with a cholesterol-enriched diet supplemented with fenofibrate (0.1% wt/wt, n = 8) or nicotinic acid (0.5% wt/wt, n = 8) for 14 weeks. Body weights were recorded weekly, and plasma lipid profiles were determined at 4-week intervals. The hearts and aortas were collected and fixed for histologic and morphometric evaluations of atherosclerotic lesions. Fenofibrate treatment in apo E-KO mice paradoxically increased total cholesterol and TG by 65% and 44%, respectively, and decreased HDL-cholesterol levels by 35% as compared with controls. Similar effects of fenofibrate on cholesterol levels, but not on TG concentrations, were observed in C57BL/6 mice. Fenofibrate-treated mice had lower body weight as compared with controls. Niacin had no effect on body weight gain but failed to decrease TG or to increase HDL levels in either apo E-KO mice or their wild-type counterparts. Neither fenofibrate nor niacin significantly influenced atherogenesis in apo E-KO mice as compared with controls. In conclusion, this study shows that neither niacin nor fenofibrate has beneficial lipid-modifying and antiatherosclerosis activities in mice. Identification of mechanisms underlying paradoxical effects of fenofibrate on lipoprotein metabolisms in apo E-KO mice merits further investigation.     

Synthesis and Hypolipidemic Activity of 3-Imino-l-oxoisoindolines in Rodents

A series of substituted 3-imino-l-oxoisoindolines derivatives demonstrated significant hypolipidemic activity, lowering both serum cholesterol and triglycerides levels after 16 days of dosing at 20 mg/kg/ day ip in CF₁ mice. 2-Butyl-3-butylimino-l-oxoisoindoline lowered serum cholesterol levels 52% and serum triglyceride 42%. 2-Pentyl-3-imino-l-oxoisoindoline lowered serum cholesterol levels 42% and serum triglyceride 61%. These derivatives resulted in better activity than the parent compound, 3-imino-1-oxoisoindoline. These studies showed that compounds with N-alkyl substitution of nitrogen atoms in the ring and outside the ring possessed potent hypolipidemic activity at the low dose of 20 mg/kg/day ip in normolipidemic CF₁ mice. Studies with 2-butyl-3-butylimino-l-oxoisoinodine in rats showed that serum cholesterol was reduced 60% and serum triglyceride 43% after 14 days of dosing at 20 mg/kg/day, orally. Treatment with this agent lowered lipid levels in the liver and aorta tissue, with increases in lipid levels in the small intestine tissue. Higher levels of cholesterol and phospholipids were excreted in the feces of treated animals compared to the control. Cholesterol levels of the very low-density lipoprotein (VLDL) and high-density lipoprotein (HDL) fractions were reduced, whereas the HDL cholesterol levels were elevated significantly. This ratio of low-density lipoprotein (LDL) cholesterol:HDL cholesterol levels suggests that the agent may be effective in treating hyperlipidemic states in humans.     

胰岛素抵抗及血清生长激素水平对重型肝炎预后影响的研究

目的 研究胰岛素抵抗及血清生长激素（GH）水平对重型肝炎预后的影响.方法 观察组选择重型肝炎36例,正常对照组20例,采用放射免疫法测定空腹血清胰岛素和GH水平,计算胰岛素敏感性指数（ISI）,分析各型重型肝炎与血清胰岛素、ISI和GH的关系.结果 重型肝炎患者血清胰岛素和GH水平较正常对照组显著升高（P＜0.05）,并随亚急性重型肝炎（亚重肝）、急性重型肝炎（急重肝）、慢性重型肝炎（慢重肝）的病情加重而升高,重型肝炎患者ISI水平显著低于正常对照组（P＜0.05）,并随着亚重肝、急重肝、慢重肝的次序降低.慢重肝的空腹血清胰岛素和GH水平显著高于亚重肝（P＜0.05）;亚重肝、急重肝、慢重肝的肝损害与胰岛素水平呈正相关系（r＝0.537,P＜0.01）,与GH水平呈正相关系（r＝0.317,P＜0.05）,与ISI呈负相关系（r＝-0.412,P＜0.01）,ISI与GH呈负相关系（r＝-0.3765,P＜0.05）.结论 重型肝炎患者存在高胰岛素血症、胰岛素抵抗和高GH血症,他们与肝功能损害程度及其预后有关.     

Antioxidant effects of a dietary supplement: Reduction of indices of oxidative stress in normal subjects by water-soluble chitosan

The effect of water-soluble chitosan, a natural polymer derived from chitin, on indices of oxidative stress was investigated in normal volunteers. Treatment with chitosan for 4 weeks produced a significant decrease in levels of plasma glucose, atherogenic index and led to increase in high density lipoprotein cholesterol (HDL). Chitosan treatment also lowered the ratio of oxidized to reduced albumin and increased total plasma antioxidant activity (TPA). There was good correlation between TPA and oxidized albumin ratio. The results indicate that oxidized albumin ratio represents a potentially useful marker of oxidative stress. In in vitro studies, albumin carbonyls and hydroperoxides were significantly decreased in a time-dependent manner in the presence of chitosan, compared with controls (p < 0.05). Chitosan also reduced two stable radicals in a dose- and time-dependent manner. The results suggest that chitosan has a direct antioxidant activity in systemic circulation by lowering the indices of oxidative stress in both in vitro and in vivo studies. This may confer benefits additional to the reduction in plasma carbohydrate and increase in HDL levels. It may also inhibit oxidation of serum albumin commonly observed in patients undergoing hemodialysis, resulting in reduction of oxidative stress associated with uremia.     

Gemfibrozil in hyperlipidaemic patients with peripheral arterial disease: some undiscovered actions

The effects of gemfibrozil were assessed in 27 hyperlipidaemic patients with stable peripheral arterial occlusive disease. Gemfibrozil (600 mg twice daily) was administered for 12 weeks after 2 weeks of placebo medication, thus enabling patients to act as their own controls. Serum cholesterol levels were reduced by a mean of 11.3%, triglycerides by 42.3% and low density lipoprotein cholesterol by 19.9%. Small but significant increases in HDL3 and apolipoprotein A-II also occurred. New findings included significant reductions in plasma lipid peroxides and Factor VIIc levels and a mean increase of 19% in antithrombin III concentrations. Furthermore, plasma fibrinogen levels increased by a mean of 17.6%, a potentially adverse effect of gemfibrozil that has not been previously reported.     

A study of dyslipidemia and platelet adhesiveness in non-insulin dependent diabetes mellitus

The present study included 50 controls (age 34-64 years) and 50 NIDDM subjects (age 32-72 years) from the diabetic clinic of Government Medical College, Nagpur. It was undertaken with the aim of investigating obesity indices (i.e. body mass index, skin fold thickness, waist hip ratio and % fat in the body); lipid profile (including serum total cholesterol, triglyceride, VLDL, LDL and HDL-cholesterol) levels and platelet adhesiveness in both the groups. On comparison, plasma glucose levels were higher in NIDDM (P > 0.05); obesity indices, cholesterol, triglyceride, VLDL, LDL and platelet adhesiveness index were higher, and HDL levels low in NIDDM group as compared to controls (P < 0.01). Obesity, dyslipidemia and increased platelet adhesiveness are interconnected and make diabetics more susceptible to arterial disease with increased risk of vascular episodes.     

Treatment of coronary spastic angina with a statin in addition to a calcium channel blocker: a pilot study

Combined therapy with a statin and a calcium channel blocker, which can improve lipid metabolism and reduce oxidative stress, may attenuate coronary vasoconstriction in patients with coronary spastic angina (CSA). After 6 months of therapy with benidipine and pravastatin, an acetylcholine provocation test was performed a second time in 25 patients with CSA. The patients were divided into 2 groups according to whether the result of this second test was positive (n = 13) or negative (n = 12). The test was designated as positive when the intracoronary injection of acetylcholine induced angiographically demonstrable total or subtotal occlusion (positive-test group). In the negative-test group, significant decrease in the plasma levels of low-density lipoprotein (LDL) cholesterol (-20.7 +/- 11.1%, P < 0.01 versus baseline) were observed along with a dramatic increase in the serum level of high-density lipoprotein (HDL) cholesterol (26.8 +/- 13.2%, P < 0.01 versus baseline). Furthermore, a significant decrease of the malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, a marker of oxidative stress, was also observed (-22.6 +/- 14.1%, P < 0.01 versus baseline) in this group. In the positive-test group, however, no significant changes were found in any of the aforementioned parameters. The results showed that improvement of lipid metabolism, especially an increase of HDL cholesterol level and a reduction of MDA-LDL, may inhibit vascular contractility.     

Serum cholesterol and coronary heart disease: Auckland general practitioners' attitudes and practices in 1986

The relationship between elevated serum cholesterol and coronary heart disease, is now generally accepted as being causal. To examine current attitudes and practices regarding the treatment of high serum cholesterol, questionnaires were sent to a randomly selected sample of general practitioners in the Takapuna health district during 1986. The response rate among the 92 doctors in general practice at the time of the study was 80%. The majority of general practitioners (82.5%) believed that there was a casual relationship between high serum cholesterol and coronary heart disease and that reducing levels would help prevent coronary heart disease. Almost all general practitioners (96%) were screening some groups of patients for high serum cholesterol, with most screening those with symptomatic coronary heart disease or associated risk factors, and 15% screening all patients. Although almost 90% of general practitioners had patients on diet therapy and one third had patients on drug treatment, there was wide variation in attitudes regarding the serum cholesterol levels meriting dietary or drug treatment. This suggests that there is still considerable confusion as to when and how to treat high cholesterol levels and that specific national guidelines for the detection and management of high serum cholesterol are required as part of a comprehensive programme to prevent coronary heart disease.     

The Effect of Nutritional Supplements on Serum High-Density Lipoprotein Cholesterol and Apolipoprotein A-I

One of the factors contributing to the increased risk of developing premature atherosclerosis is low plasma concentrations of high-density lipoprotein (HDL) cholesterol. Multiple potential mechanisms account for the cardioprotective effects of HDL and its main protein apolipoprotein A-I (apo A-I). Diet has an important role in modulating HDL cholesterol level. The widespread use of nutritional supplements may also alter the biology of HDL. In this review, we discuss the effect of select nutritional supplements on serum HDL cholesterol and apo A-I levels. Some nutritional supplements, such as phytosterols, soy proteins, and black seed extracts, may increase HDL cholesterol levels, while others such as cholic acid and high doses of commonly used antioxidant vitamins may downregulate HDL cholesterol levels and reduce its cardioprotection. Multiple mechanisms are involved in the regulation of HDL levels, so changes in production and clearance of HDL may have different clinical implications. The clinical relevance of the changes in HDL and apo A-I caused by nutrient supplementation needs to be tested in controlled clinical trials.