Attitudes and practices of primary care physicians in the management of elevated serum cholesterol levels.

We conducted a telephone survey of 102 randomly selected Ottawa family physicians to determine their attitudes and practices regarding the treatment of hypercholesterolemia. Of the 102, 56% routinely measured serum cholesterol levels in all their patients over the age of 30 years, and 24% did so for patients in more restricted age ranges. The level at which they started dietary therapy averaged 6.95 mmol/L (270 mg/dl); for 25% it was less than 6.22 mmol/L (240 mg/dl). The level at which they started drug therapy averaged 8.9 mmol/L (345 mg/dl); for only 15% was it 7.23 mmol/L (280 mg/dl) or less. Two-thirds were unable to give numerical values to the serum cholesterol levels at which they started diet therapy, and 38% used the upper limits of laboratory normal values as an indication to start therapy. Our findings contrast markedly with results reported for US family physicians, who treat hypercholesterolemia much more aggressively. The variability in practices must be addressed if public campaigns to lower serum cholesterol levels are to be undertaken.     

976例香港居民血脂与尿酸水平调查

对976例健康的香港居民(男569例,女407例)血胆固醇、甘油三酯、β—脂蛋白及血尿酸进行检测。结果表明:各项均值、高脂血症及高尿酸血症检出率均明显高于内地。并且血脂随年龄而增高,男性于50岁达高峰,女性则在70岁以后达高峰。40岁以前血脂男性高于女性,50岁以后则相反。50岁以后各组男女胆固醇均高于200mg/dl。血尿酸水平也随年龄而增高,但女性始终低于男性。     

Seasonal variability of serum lipids in adults: Tehran Lipid and Glucose Study

There are contradictory results regarding the pattern of seasonal variation of serum lipids. The aim of this study was to compare serum lipid levels in different seasons in participants of the Tehran Lipid and Glucose Study. This was a cross-sectional study among 2890 men and 4004 women 20-64 years old from the participants of Tehran Lipid and Glucose Study (TLGS) between 1999 and 2001. Mean values of serum lipids in different seasons were compared with Analysis of Covariance (ANCOVA) after adjustment for age, physical activity level, smoking, BMI and Waist-to-hip ratio. In men, there was a significant trend for change in the values of cholesterol, LDL-C and HDL-C in different seasons, with higher cholesterol and LDL-C values in winter than in summer (P < 0.05). In women, only the mean values of triglycerides were significantly different between different seasons with values lower in winter than in summer. There was a 26.2% relative increase in the prevalence of hypercholesterolemia (> or = 240 mg/dl) in winter than in summer in men. The corresponding increase in the prevalence of high LDL-C (> or = 160 mg/dl) was 26.7% and 24.9% in men and women, respectively (P < 0.05). The prevalence of high triglycerides (> or = _ 200mg/dl) in women significantly decreased (23.8%) in winter relative to summer (P < 0.001). This study showed that there is seasonal variability in serum lipid values and this variability is greater in men than women. The increase in the prevalence of high LDL in winter in both sexes must be considered in population screening and in the follow-up of hyperlipidemic patients.     

THE RELATIONSHIP BETWEEN SERUM LIPID LEVELS AND NUTRIENT INTAKE IN HEALTHY INHABITANTS OF URBAN AND RURAL SHANGHAI

The serum lipid levels (mean +/- SD) of 3312 healthy urban and rural inhabitants over 40 years of age in Shanghai were studied. The results were: cholesterol 166.7 +/- 30.9 mg/ml, triglyceride 81.1 +/- 42.3 mg/dl, HDL-cholesterol (HDLc) 57.4 +/- 11.6 mg/dl, HDL2c 20.6 +/- 9.8 mg/dl and HDL3c 37.1 +/- 7.8 mg/dl. Dietary surveys were carried out in 512 of these subjects and their average daily nutrient intake was estimated to be: total calories 2,577 Kcal, proteins 656 g (50.7 g of vegetable proteins), fat 69.1 g (P/S ratio 0.70), carbohydrates 423 g, cholesterol 282 mg, dietary fibres 23.5 g, sodium 4993 mg, potassium 2,618 mg and magnesium 575 mg. The serum lipid levels of urban and rural inhabitants were compared. Total cholesterol levels were significantly higher in urban inhabitants of all age groups and of both sexes, while triglyceride levels were significantly higher in urban inhabitants of certain age groups. However, HDLc levels, particularly HDL2c levels were significantly higher in rural inhabitants of most age groups and of both sexes. The above differences were probably the result of differences in dietary patterns and nutrient intake between urban and rural inhabitants.     

Correlation of triglyceride level with acute coronary syndrome

The study was aimed to find out the correlation of serum triglyceride level with acute coronary syndrome. This cross sectional study was conducted in the department of cardiology, Mymensingh Medical College Hospital, from August 2009 to May 2010. Socio-demographic characteristics, smoking habit, hypertension, serum total cholesterol level, serum HDLc, Serum LDLc, TG level were important variable considered. A total number of 100 respondents consisted of 50 cases (patient) and 50 healthy persons (control). Investigations included ECG, cardiac enzyme (troponin I), FBS and lipid profile. The data were analyzed by computer with the help of SPSS. Chi-square Test, T-test & ANOVA test were used as test of significance. The mean level of TG in acute coronary syndrome (ACS) patients (cases) was 168.2±58.0 mg/dl and in control were 141.2±45.3 mg/dl. So serum TG level is significantly higher in patients with ACS (p=0.01). In multivariate regression analysis, there was a significant association of elevated TG with risk of ACS (relative risk) is the highest, compared with the lowest quarantile = 1.011; 95% confidence interval (CI = 1.002 - 1.020; P for trend = 0.01). The relation of TG level to HDLc was a strong predictor of ACS (RR in the highest) compared with lowest quarantile = 0.02; (95% CI = 0.003 - 0.173; P for trend <0.0001). The study revealed that high level of serum triglyceride is associated with ACS. Categorization of patients with ACS on the basis of TG level may be helpful for risk stratification and management.     

Relationship between iron deficiency anaemia and serum lipid levels in Indian adults

Both iron deficiency anaemia and dyslipidaemia are widely prevalent public health problems, especially in the Indian population. Some link has been suggested between the two potentially morbid conditions but a sufficient Indian study could not be found in this regard. This study was planned to find the changes in serum lipid profile in adult Indian patients with iron deficiency anaemia and the effect of oral iron therapy on them. Seventy patients with iron deficiency anaemia and 70 age and sex matched healthy controls, in the age group of 18-35 years were investigated for any possible changes in serum lipid profile ie, triglycerides, total cholesterol, high density lipoprotein cholesterol, very low density lipoprotein cholesterol and low density lipoprotein cholesterol. The patients were followed up after 3 months of oral iron therapy. The results are shown as mean +/- standard deviation. Triglycerides and very low density lipoprotein cholesterol levels were found to be significantly (p < 0.001) elevated in the iron deficiency anaemia group (151.87 +/- 48.06 mg/dl and 30.40 +/- 9.71 mg/dl) as compared to controls (109.99 +/- 30.81 mg/dl and 21.96 +/- 6.69 mg/dl), whereas levels of low density lipoprotein cholesterol were found to be significantly (p = 0.02) lower in patients (90.96 +/- 41.55 mg/dl) as compared to controls (105.24 +/- 26.45 mg/dl). However, after treatment (in 43 patients) there was significant (p < 0.001) reduction in the levels of triglycerides and very low density lipoprotein cholesterol (111.56 +/- 26.87 mg/dl and 22.30 +/- 5.36 mg/dl) when compared to their pretreatment levels (154.70 +/- 53.89 mg/dl and 30.93 +/- 10.84 mg/dl), whereas low density lipoprotein cholesterol levels did not show any significant change. These findings indicate that iron deficiency anaemia in Indian adults is attended by abnormal serum lipid profile, which responds significantly to iron therapy.     

Effect of a mixture of Acanthopanax senticosus and Elsholtzia splendens on serum-lipids in patients with hyperlipemia

The serum-lipids were determined in 31 hyperlipemia patients before and after treated with the mixture of Acanthopanax senticosus and Elscholtzia splendens. While the mean value of serum beta-lipoprotein decreased from 902 +/- 228 mg/dl to 608 +/- 189 mg/dl (P less than 0.001), the mean value of HDL-C increased from 52.6 +/- 12.5 mg/dl to 61.2 +/- 15.4 mg/dl (P less than 0.001). Thus the ratios of HDL-C to total cholesterol (HDL-C/TC) and to LDL-C (HDL-C/LDL-C) increased significantly, the arteriosclerosis index (AI) decreased significantly. The results indicate that the mixture of Acanthopanax senticosus and Elsholtzia splendens could improve the lipid-metabolism in hyperlipemia patients so that it might play a good role in preventing or alleviating arteriosclerosis.     

Plasma lipoprotein levels and the prevalence of hyperlipoproteinemia in a Canadian working population

The lipids and lipoproteins — cholesterol (C), triglyceride (TG) and high-density, low-density, very-low-density and sinking pre-β-lipoprotein cholesterol (HDL-C, LDL-C, VLDL-C and SPB-C) — in plasma samples from 1620 fasting white adults and children from the Toronto—Hamilton area were analysed. The mean concentration of HDL-C was about 45 mg/dl in men and about 60 mg/dl in women, and the levels were constant throughout adult life in both sexes. Boys had higher mean HDL-C levels than men, but girls had lower mean HDL-C levels than women. Mean LDL-C levels, like total C levels, increased with age, from about 87 mg/dl in boys to 136 mg/dl in men, and from about 91 mg/dl in girls to 145 mg/dl in women. The mean levels of VLDL-C followed the TG patterns for age and sex, rising from about 7 mg/dl in boys to 26 mg/dl in men, and from about 11 mg/dl in girls to 19 mg/dl in women. SPB-C was detectable visually in 39% of the population and with the aid of densitometry in 54%; the levels were not related to age, sex or oral contraceptive use, and the median level was 3 mg/dl.

Prevalence estimates of hyperlipoproteinemia showed that type IV was the most common, and it was found more than three times as often in men as in women. This was in part due to the customary use of plasma TG cut-off points that do not reflect the large difference in TG levels between males and females. Type IIA hyperlipoproteinemia was found in about 2% of the adults and type IIb in a further 1%. Types I, III and V were all rare. The prevalence of types II and IV hyperlipoproteinemia was four times greater in women using oral contraceptives than in nonusers in the same age range.

     

Progress in lipid reporting practices and reliability of blood cholesterol measurement in clinical laboratories in Nebraska. Efforts to align results with the Centers for Disease Control, and feasibility of meeting National Cholesterol Education Program Guidelines

The National Cholesterol Education Program has recommended that all laboratories be consistent, precise, and accurate in the reporting and measurement of blood cholesterol levels. In a follow-up to a 1984 survey study, we assessed the changes in reporting procedures for measurements of blood lipid levels in 16 clinical laboratories in Nebraska. Using human serum reference materials of known cholesterol concentrations provided by the Centers for Disease Control, we also assessed the precision and accuracy of measurement of blood cholesterol levels in clinical laboratories in Nebraska. Fourteen of the 16 laboratories restudied in 1987 had altered the reference range for total serum cholesterol since 1984, 86% of whom lowered the upper limit of the reference range. Eleven of 16 laboratories expressed reference ranges for total serum cholesterol in terms of patient age in 1987, while only 7 of 20 did in 1984. Gender-based reference ranges increased from 0 to 5 from 1984 to 1987. Similar trends were seen in the reporting of high-density lipoprotein cholesterol and triglyceride concentrations. Reporting procedures varied greatly; only 1 laboratory used National Cholesterol Education Program risk levels for measuring total serum cholesterol levels. Fifteen laboratories met the National Cholesterol Education Program recommendation for precision (coefficient of variation, less than or equal to 5%) and 78% of laboratories obtained results that satisfied the current recommendation for accuracy (within 5% of "true value," as determined by the Centers for Disease Control).     

Comparative evaluation of the efficacy, safety, and tolerability of rosuvastatin 10 mg with atorvastatin 10 mg in adult patients with hypercholesterolaemia: the first Indian study

To compare the efficacy, safety and tolerability of rosuvastatin 10mg with atorvastatin 10 mg in adult Indian patients with hypercholesterolaemia, a prospective, open-label, comparative, phase III study was conducted. A total of 45 patients of either sex, between 18 and 80 years of age with hypercholesterolaemia, having LDL cholesterol (LDL-C) of 160 and < 250 mg/dl and triglyceride < 400 mg/dl, were included in this trial. After a dietary run-in period of 2 weeks, patients received either rosuvastatin 10 mg once daily or atorvastatin 10 mg once daily, for 6 weeks. The fall in the mean LDL-C levels after 6 weeks of treatment in rosuvastatin group (40.1%) was significantly more as compared to the fall in atorvastatin group (29.8%). Other secondary lipid parameters like total cholesterol (TC), HDL cholesterol (HDL-C), triglycerides, apo-B, apo-AI, and TC/HDL-C ratio also showed more beneficial changes from the baseline in rosuvastatin group than in atorvastatin group. Rosuvastatin 10 mg shows significantly better efficacy than atorvastatin 10 mg in reducing LDL-C levels and produces greater improvements in other elements of the lipid profile.     

Neonatal plasma lipids as measured in cord blood

The status of cord blood screening of plasma lipids is reviewed, emphasizing the problems associated with the diagnosis of familial hyperlipoproteinemia (HLP), particularly type II (hyperbetalipoproteinemia), in the neonate. For 2937 neonates in this study the mean ± standard deviation (SD) of plasma cholesterol was 70.3 ± 16.9 mg/dl. The mean triglyceride level of 1805 neonates was 39.6 ± 19.3 mg/dl. The mean level of β-cholesterol in 240 neonates was 34.3 ± 10.9 mg/dl and the correlation between total and β-cholesterol was high (r=0.89). By convention, the upper limit of normal was defined as the mean + 2 SD, and these levels for total cholesterol, triglyceride and β-cholesterol were 100, 80 and 55 mg/dl respectively. Only by careful follow-up of hyperlipidemic neonates can the incidence of HLP and the worth of early diagnosis be assessed.     

Change in physician perspective on cholesterol and heart disease. Results from two national surveys

The National Heart, Lung, and Blood Institute sponsored national telephone surveys of practicing physicians in 1983 (N = 1610) and 1986 (N = 1277) to assess attitudes and practices regarding elevated serum cholesterol levels. The 1983 survey was conducted just before the release of the results of the Lipid Research Clinics Coronary Primary Prevention Trial, which showed that a reduction in the blood cholesterol level reduced coronary heart disease. In 1986, 64% of physicians thought that reducing high blood cholesterol levels would have a large effect on heart disease, up considerably from 39% in 1983. Whereas in 1983, physicians attributed considerably less preventive value to reducing the cholesterol level than to reducing blood pressure or smoking, this disparity was substantially smaller in 1986. The median range of blood cholesterol at which diet therapy was initiated was 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1986, down from 6.72 to 7.21 mmol/L (260 to 279 mg/dL) in 1983; the median for drug therapy was 7.76 to 8.25 mmol/L. (300 to 319 mg/dL) in 1986 and 8.79 to 9.28 mmol/L (340 to 359 mg/dL) in 1983. In 1986, 87% of physicians surveyed felt that medical evidence warranted the recommended treatment levels set forth in the 1984 National Institutes of Health Consensus Conference on Lowering Blood Cholesterol. These changes indicate that by 1986, physicians were more convinced of the benefit of lowering high blood cholesterol levels and were treating patients accordingly. The data also suggest areas for continued educational initiatives.     

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.     

Randomised study to compare the efficacy and safety of isapgol plus atorvastatin versus atorvastatin alone in subjects with hypercholesterolaemia

Soluble fibre has been shown to augment the cholesterol-lowering effects of low-fat diets in individuals with mild to moderate hypercholesterolaemia. Combination therapy with a statin poses advantages in certain settings and may allow use of lower doses of multiple drugs rather than maximum doses of a single drug. The primary objective of the study was to compare the efficacy of combination of isapgol and atorvastatin versus atorvastatin alone, in the same dose, in reduction of low-density lipoprotein cholesterol (LDL-C), total-cholesterol levels in hypercholesterolaemic patients after 12 weeks of therapy. In a 12-week study, 100 subjects from both sexes and of > 20 years having hyperlipidaemia, with LDL-C level > 130 mg/dl and total cholesterol > 220 mg/dl were included, and were randomised to receive either a combination of isapgol powder (Naturolax) 5.6 g twice daily and atorvastatin 10 mg once daily or atorvastatin 10 mg once daily alone orally. Serum levels of total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglyceride were assessed at 8 and 12 weeks. Ninety-seven patients completed the study. At the end of the 8th week, both the groups had a significant reduction in mean LDL-C (20.5% in isapgol + atorvastatin group and 16.0% among atorvastatin alone group) as compared to baseline. But between the groups, however, the difference was not significant. At the end of the 12th week fall in LDL-C at 31.4% for isapgol + atorvastatin was significantly greater than 22.8% among the atorvastatin group (p < 0.05). Serum total cholesterol, HDL-C and triglyceride were significantly lowered within the groups at 8th and 12th weeks but between groups, the difference was not significant. Comparison of adverse events profile in both the groups shows that more number of patients from atorvastatin alone group (n = 14, 28%) had adverse reactions than the number of patients from the combination group (n = 4, 8%; p < 005).     

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.     

A study on dyslipidaemia in subclinical hypothyroidism

Subclinical hypothyroidism is characterised by elevated serum thyroid stimulating hormone (TSH) concentrations in association with normal free thyroid hormones. The aim of the study was to evaluate the prevalence and pattern of serum lipid alterations in patients with stable subclinical hypothyroidism in comparison to age- as well as sex-matched euthyroid group and also subgroup analysis between them in regard to age of presentation, sex, antithyroperoxidase (anti TPO) positivity, and TSH value. In this study, 100 patients of SCH were recruited, age ranged 17-68 years, majority (78%) being females, presenting mainly with non-specific symptoms and compared with 52 euthyroid control regarding lipid parameters. Of the subclinical hypothyroidism patients, only 10% had goitre and anti TPO was positive in 52% cases. Serum lipoprotein (a) above the age of 20 years, and total cholesterol, triglyceride and low density liporpotein cholesterol in the age group of 40-50 years were significantly elevated. In addition, total cholesterol, triglyceride and low density lipoprotein cholesterol levels in anti TPO positive cases and serum triglyceride and low density lipoprotein cholesterol in anti TPO negative patients showed statistically significant higher levels. In males only lipoprotein (a), but in females total cholesterol, triglyceride, low density lipoprotein cholesterol and liproprotein (a)--all were significantly elevated.     

Studies on serum lipid profile in hypertensive patient

The study was carried out to appraise the serum total cholesterol, triglyceride, HDL-C and LDL-C values in hypertensive patients for providing information to the health-policy planners and also to the clinical practitioners about the importance of routine monitoring of lipid profile in hypertensive patients for prevention of coronary heart disease and other consequences to combat morbidity and mortality and to reinforce the need to consider these parameters in daily clinical practice. It was a cross-sectional study. The study was conducted at Department of Physiology and Biochemistry of Mymensingh Medical College, Medicine Unit of Mymensingh Medical College Hospital and in the community of Sadar, Mymensingh District. The period of the study was January 2005 to December 2005. A total number of seventy subjects were included in this study. Out of them 40 (forty) were hypertensive patients and 30 (thirty) were normotensive & healthy controls. Most of the hypertensive patients (65%) were taking treatment irregularly. Serum total cholesterol, serum triglyceride and serum LDL cholesterol were greater in hypertensive than those of normotensive . The differences of mean of serum total cholesterol, serum LDL cholesterol in between two groups were statistically significant and in case of serum triglyceride it was statistically highly significant. Serum HDL cholesterol was less in hypertensive than those of normotensive. The differences of mean of serum HDL cholesterol in between two groups were statistically highly significant. Among 40 hypertensives the number of "Getting treatment- regular" & "Getting treatment-irregular" was 14 (35%) & 26 (65%) respectively and the values are not statistically significant. Similarly in patients "suffering less than 5 years" and "suffering 5 years & above" the differences are also not statistically significant. Conclusion: The observations of this study has revealed that most of the hypertensive patients are taking treatment irregularly and there was significant alteration of serum cholesterol, triglyceride, HDL-C and LDL-C in hypertensive patients. Therefore, for routine monitoring of hypertensive patients to prevent the coronary heart disease (CHD) and other consequences, the reinforcement of the investigations of these parameters may be recommended in daily clinical practice.     

Prevention of progression of coronary atherosclerosis by treatment of hyperlipidaemia: a seven year prospective angiographic study

The progression of coronary atherosclerosis was assessed by repeat angiography in 28 patients and 20 controls with hyperlipidaemia (serum cholesterol concentration greater than 7.2 mmol/l (278 mg/100 ml) or serum triglyceride concentration greater than 2.0 mmol/l (177 mg/100 ml), or both) and symptomatic coronary artery disease of two or three vessels. Twenty eight patients (26 men and two women) were treated with diet and drugs (clofibrate or nicotinic acid, or both) to lower lipid concentrations. Twenty men taking part in a simultaneous study served as non-randomised controls. They received medical treatment for coronary artery disease but no treatment to reduce lipid concentrations. The initial levels of coronary risk factors and the angiographic state were comparable in the two groups. In the 28 patients total cholesterol, total triglyceride, and low density lipoprotein cholesterol concentrations were reduced by an average 18%, 38%, and 19% respectively by treatment for hyperlipidaemia and high density lipoprotein cholesterol concentration was increased on average by 10%. The treatment maintained these concentrations during a follow up of seven years. By all criteria coronary lesions progressed significantly less in the patients than the controls: the angiographic state remained completely unchanged in nine (32%) of the patients compared with only one (8%) of the surviving controls; of the arterial segments at risk, 46 (16.5%) progressed in the patients compared with 50 (38.2%) in the controls (p less than 0.001); and the coronary obstruction increased less in patients than in controls (p less than 0.05). Cardiac survival was 89% in seven years in the patients compared with 65% in five years in the controls (p less than 0.01). The anginal symptoms diminished or remained stable in 16 of the 24 patients who survived until the end of the study. The progression of coronary atheromatosis was significantly greater in those patients who during the seven years of treatment had an average total cholesterol concentration, VLDL plus LDL cholesterol concentration, or ratio of LDL to HDL cholesterol concentration above the respective median value than in those with the corresponding values below median. On the other hand, the patients with HDL cholesterol concentrations above the median during treatment showed less progression than those with lower HDL cholesterol concentrations. The increase in coronary obstruction was inversely related to the average HDL cholesterol concentration during treatment. The progression was not, however, related to LDL cholesterol concentration during treatment.(ABSTRACT TRUNCATED AT 400 WORDS)     

老年人血清总胆固醇及甘油三酯水平的初步探讨

通过检测160例,发现老年人正常血清总胆固醇(Tch)水平比一般成年人高,但60岁以后不再随年龄而继续升高。患肥胖症、高血压、冠心病的老年人,其Tch与正常老年人组无显著差异,而TG则具显著差异。     

Correlation between coagulation function, tumor stage and metastasis in patients with renal cell carcinoma: a retrospective study

Background  The coagulation function in carcinoma patients is abnormal, but in renal cell carcinoma the extent and relationships of coagulation function remain unclear. This study retrospectively investigated the relationships between coagulation function, clinical stage and metastasis in patients with renal cell carcinoma.

Methods  A total of 350 consecutive patients admitted to our Urology Department from 2004 to 2010 were diagnosed with renal cell carcinoma by histolopathologic examination and were included in this study. A total of 231 cases of renal benign tumors were considered as the control group. Fibrinogen, prothrombin time, activated partial thromboplastin time and international normalized ratio were evaluated in all subjects. Tumor size, clinical stage, lymph node metastasis, and distant metastasis were evaluated using radiologic imaging, intraoperative findings, and histological studies.

Results  The preoperative plasma fibrinogen levels of patients with renal cell carcinoma ((383.9±146.7) mg/dl) were significantly higher than those of the control group ((316.7±62.0) mg/dl) (P <0.01). We divided the renal cell carcinoma group into stages Ia, Ib, II, III, and IV. The fibrinogen values were (315.6±64.6) mg/dl, (358.3±91.1) mg/dl, (465.6±164.7) mg/dl, (500.0±202.1) mg/dl, and (585.8±179.7) mg/dl, respectively. There were no significant differences in fibrinogen values between stage Ia and control groups. However, results of other stages showed significant differences when compared to control group values (P <0.01). Using the cutoff value of 440 mg/dl, which defines hyperfibrinogenemia, plasma fibrinogen levels had a positive predictive value of 39.8% and a negative predictive value of 93.3% for predicting distant metastasis, with a sensitivity of 64.7% and specificity of 83.3%.

Conclusions  Preoperative plasma fibrinogen levels are elevated in patients with renal cell carcinoma with distant metastasis or lymph node metastasis. Potential metastasis is more likely if the tumor size larger than 4 cm. Increased preoperative plasma fibrinogen levels, especially hyperfibrinogenemia, may be an indicator of metastasis.