Plasma apoprotein and lipoprotein lipid levels in vegetarians.

Low-fat, low-cholesterol, high-P:S-ratio diets greatly affect plasma lipid levels. There is no information as to whether such diets affect only lipoprotein levels or also levels of apoproteins and lipoprotein compositions. It is important to have information on the latter to understand diet-induced changes in the metabolism of lipoproteins. Since vegetarians regularly eat an extremely low-cholesterol, low-fat, and-high-P:S ratio diet, they represent an ideal group to study. Fifty-eight vegetarians who eat no animal products and live on a farm commune were examined. Venous bloods were drawn after 12–14 hr fasts and analyzed for lipoprotein-lipids by Lipid Research Clinic procedures and for apoA-I and apoB by radioimmunoassay. Their normal dietary intake was evaluated with 24-hr food diaries. They averaged 2200 kcal/day with 17% protein, 32% fat, and 51% carbohydrate. Negligible amounts of cholesterol (<10 mg/day) was consumed and the P:S ratio was 1.9. Average lipoprotein-cholesterol levels were depressed to about 60% of age- and sex-specific normal levels compared to a group of normolipemic free-living non-vegetarians of a like age and sex distribution. ApoA-I and apoB values were also decreased, but while LDL-cholesterol:apoB ratios did not change, HDL-cholesterol: apoA-I ratios appeared higher in the vegetarians. HDL-cholesterol:LDL-cholesterol ratios of vegetarians were also elevated. The data suggest that the vegetarian diet depressed VLDL and LDL levels without producing major changes in their compositions, whereas both the levels and compositions of HDL were altered. The changes in LDL levels, in HDL-cholesterol:LDL-cholesterol ratios, and in HDL-cholesterol:apoA-I ratios would each place vegetarians in a lower risk category for the development of clinically manifest atherosclerosis.     

Racial differences in serum creatine kinase levels

Total creatine kinase was measured in serum samples obtained from 307 asymptomatic healthy subjects, 112 men and 195 women, during screening visits to the Yale University Hypertension Clinic or the Yale-New Haven Hospital Primary Care Center or during pre-employment physical examinations at the Yale-New Haven Hospital Personnel Health Clinic. The group consisted of 147 blacks, 132 whites, and 28 Hispanics. Blood pressure was measured in all patients, and weight, height, and serum potassium and creatinine levels were determined in most. Any subject who had engaged in any vigorous exercise in the 12 hours prior to the visit was excluded. The mean total creatine kinase level for black men was 146.5 +/- 136.9 units/liter (median, 108 units/liter), the mean level for white men was 60.8 +/- 26.1 units/liter (median, 51 units/liter), and the mean level for Hispanic men was 84.5 +/- 70.6 units/liter (median, 57 units/liter). The mean level for black women was 66.4 +/- 50.0 units/liter (median, 53 units/liter), the mean level for white women was 37.0 +/- 18.2 units/liter (median, 32 units/liter), and the mean level for Hispanic women was 41.5 +/- 36.0 units/liter (median, 30 units/liter). Using the testing laboratory's normal values for total creatine kinase (8 to 80 units/liter for men and 5 to 50 units/liter for women), 37 black men (64.9 percent) and 49 black women (54.4 percent) had abnormal values for total creatine kinase. Although sex, race, diastolic blood pressure, serum creatinine level, and presence of hypertension correlated significantly with total creatine kinase levels in the entire population, only sex did so in blacks. Multivariate analysis using linear regression techniques clearly demonstrated that sex and race were the only variables that independently predicted the total creatine kinase level. These findings show that healthy asymptomatic blacks have higher total creatine kinase levels than whites or Hispanics, with the majority having values in the abnormal range. Thus, different normal values should be used for blacks, just as they are for men and women, and elevated total creatine kinase levels should be interpreted with considerable caution.     

Adverse effects of obesity on lipid and lipoprotein levels in insulin-dependent and non-insulin-dependent diabetes

We studied the association of obesity with lipid and lipoprotein concentrations in 92 patients (49 men, 43 women) with insulin-dependent diabetes (IDDM), in 305 patients (152 men, 153 women) with non-insulin-dependent diabetes (NIDDM), and in 122 nondiabetic control subjects (65 men, 57 women). Obesity (body mass index, BMI) was associated with abnormal lipid and lipoprotein levels only in the presence of diabetes, and lipid and lipoprotein changes were substantially more abnormal in patients with NIDDM than in patients with IDDM. In men and women with NIDDM, obesity was associated with low high-density lipoprotein (HDL) and HDL2 cholesterol and high total, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) triglyceride concentrations. In men with IDDM, obesity was related only to low HDL and HDL2 cholesterol and in women with IDDM to low HDL3 cholesterol. BMI and diabetes status had a statistically significant interaction (analysis of variance) with respect to HDL and HDL2 cholesterol and total and VLDL triglycerides, indicating that the effects of obesity on lipids and lipoproteins were more severe in patients with diabetes than in nondiabetic subjects. In conclusion, obesity and diabetes status have an unfavorable interaction that results in multiple pathologic lipid and lipoprotein changes, particularly in NIDDM.     

Controlling lipid levels in diabetes

Coronary heart disease (CHD) is associated with a 2- to 4-times greater risk of morbidity and mortality in patients with type 2 diabetes than in non-diabetic individuals. Dyslipidaemia is an important CHD risk factor in diabetic patients. The key atherogenic features of diabetic dyslipidemia are elevated levels of serum triglycerides, low levels of high density lipoprotein (HDL) cholesterol, and the preponderance of small, dense low density lipoprotein (LDL). As a result, treatment guidelines for diabetic dyslipidaemia recommend elevated LDL cholesterol and triglyceride levels and low HDL cholesterol levels as targets of therapy. Unfortunately, however, these lipid abnormalities often persist dispite best efforts to control hyperglycaemia, improve diet, and increase physical exercise, and therefore demand specific therapeutic intervention. Statins are the first choice for LDL cholesterol lowering as they are effective and well tolerated, and do not have adverse effects on glycaemic control. Furthermore, recent evidence suggests that statins may also be employed to treat moderately elevated levels of triglycerides. An increasing number of primary and secondary prevention trials have shown that lipid-lowering therapy with statins can significantly reduce the risk of CHD events in patients with diabetic dyslipidaemia.     

Racial differences in diabetes self-management and quality of care in Texas

AimTo assess racial/ethnic differences in diabetes self-management behaviors and quality of care in Texas.MethodsThis cross-sectional study assessed self-management behaviors and quality of care in 1720 adults with diabetes in the 2002–2004 Texas Behavioral Risk Factor Surveillance Survey. Multiple logistic regression models were used for assessing the independent association between race/ethnicity, self-management behaviors, and quality of care variables controlling for covariates. SAS (SAS Institute Inc, 2002-2003) was used for statistical analysis.ResultsEighteen percent of Hispanics, 14% of Blacks, and 10% of Whites reported never performing home glucose testing. Seventeen percent of Hispanics, 11% of Blacks, and 10% of Whites reported never doing home foot exam. Thirty-two percent of Hispanics, 21% of Blacks, and 16% of Whites did not have an A1C test in the prior 12 months. Twelve percent of Hispanics, 10% of Blacks, and 6% of Whites did not have a dilated eye exam in the prior 12 months. Fifty-four percent of Whites, 42% of Blacks, and 40% of Hispanics received a flu shot. Forty-nine percent of Whites, 30% of Blacks, and 26% of Hispanics received a pneumonia shot. In adjusted models, Hispanics were more likely to be sedentary (OR, 1.64; 95% CI, 1.08–2.49) compared to Whites. Blacks did not differ significantly from Whites (OR, 1.46; 95% CI, 0.92–2.34). Hispanics (OR, 1.61; 95% CI, 1.01–2.57) and Blacks (OR, 1.83; 95% CI, 1.10–3.03) were more likely to get an annual foot exam by a provider compared to Whites. Hispanics (OR, 0.54; 95% CI, 0.34–0.85) and Blacks (OR, 0.58; 95% CI, 0.35–0.98) were less likely to get a pneumonia shot compared to Whites.ConclusionsHispanics have poorer access to care and poorer health status compared to Whites or Blacks. Controlling for socioeconomic and access to care variables eliminated disparities in self-management but did not eliminate disparities in quality of diabetes care.     

Effects of amlodipine on plasma lipid and lipoprotein levels in hypertensive patients.

Lipids and lipoprotein levels were determined in the plasma of 20 adult hypertensive patients, after 12 weeks treatment with amlodipine. No significant variation was observed in the mean values of the lipids and lipoprotein fractions before and after amlodipine treatment for the patients on either 5 mg or 10 mg of amlodipine. A further long-term study has been suggested in order to confirm the inertness of amlodipine on lipids and lipoprotein metabolism.     

Smoking, alcohol consumption, lipid and lipoprotein levels

The lipid profiles of 1165 French Canadian men (aged 42 to 59 years) were studied and related to drinking and smoking habits. Alcohol consumption and smoking were closely related, smokers consuming twice as much alcohol as non-smokers. When relative body weight, total cholesterol, triglyceride and alcohol consumption were controlled in a covariate analysis, plasma levels of high density lipoprotein (HDL) cholesterol, HDL2 and HDL3 differed significantly between smokers, ex-smokers and nonsmokers. Ex-smokers had higher levels of HDL cholesterol than nonsmokers who had higher levels than smokers. The higher levels of HDL in ex-smokers could be explained by the confounding effects of alcohol intake. Alcohol users had significantly higher levels of HDL cholesterol, HDL2 and HDL3 than nondrinkers. Men who drank the equivalent of more than 3 ounces of absolute alcohol per week had significantly higher levels of HDL cholesterol and HDL3 than those who drank less than 3 ounces or did not drink at all. HDL2 levels were only significantly different between nondrinkers and those who consumed more than 3 ounces per week. These results show that smoking and alcohol have strong but opposing effects on HDL and its subfractions in middle-aged French Canadian men.     

Racial differences of incident diabetes postpartum in women with a history of gestational diabetes

AimsThe aim of the present study was to investigate the race-specific association between a history of gestational diabetes mellitus (GDM) and incidence of type 2 diabetes and evaluate how the risk changed over different years after delivery.MethodsWe performed two large cohorts - the Coronary Artery Risk Development in Young Adults (CARDIA) cohort and the Tianjin GDM Observational Study. The multivariate cox regression model was used to assess the risk of incident postpartum diabetes between women with and without prior GDM.ResultsDuring a mean follow-up of 13.8 years, 405 women developed type 2 diabetes. After adjustment for multiple confounding factors, Chinese women with GDM had a higher risk of incident diabetes within 5 years postpartum than African Americans with GDM compared with Chinese and African Americans without GDM (Hazard ratio 71.5 in Chinese vs. 9.29 in African Americans). When the risk of incident diabetes was analyzed within 10 years, white women with GDM seemed to have a higher hazard ratio than African American and Chinese women with GDM compared with non-GDM women of different races. In comparison to African American women without GDM, the highest risk of type 2 diabetes over 10 years postpartum appeared in Chinese women with GDM, followed by African American women with GDM, and the smallest risk was seen in white women with GDM.ConclusionsDifferent genetic backgrounds and other risk factors among women of different races might contribute to the racial differences in the incidence of diabetes postpartum among women with GDM.     

Serum lipid and lipoprotein levels and metabolic control in insulin-treated diabetics

Summary Serum lipid and lipoprotein levels were evaluated in 50 insulin-treated diabetic outpatients (25 male and 25 female) and in 46 normal volunteers (22 male and 24 female). In these groups metabolic evaluation was carried out by assaying fasting plasma glucose, glucose in urine and glycosylated hemoglobin (G-HbA₁). No differences were observed in the lipid and lipoprotein patterns between diabetic patients and normals. HDL values were significantly lower in male subjects, diabetic and normal, as compared to females, but there were no differences between the diabetic and the normal group. G-HbA₁ was significantly correlated to fasting plasma glucose and glucose in urine, but also to WS-TG and VLDL-TG. Fasting plasma glucose too was correlated to WS-TG and VLDL-TG. Moreover, a negative correlation was found between HDL-Ch and WS-TG and VLDL-TG. These results show that sufficiently well-controlled insulin-treated diabetics do not have altered plasma lipid and lipoprotein levels. In particular, in these patients HDL-Ch values can be normal, because insulin levels are sufficient to activate lipoprotein lipase and to guarantee an adequate plasma VLDL clearance.     

Racial/ethnic and educational-level differences in diabetes care experiences in primary care

AIMS: To assess potential racial/ethnic and educational-level differences in the degree to which patients with diabetes who receive primary care from a Veterans Affairs Medical Center report that experiences with the diabetes care system are consistent with the Chronic Care Model (CCM). METHODS: A cross-sectional mailed survey of 296 patients included the Patient Assessment of Chronic Illness Care (PACIC), which measures components of the care system suggested by the CCM. RESULTS: Among 189 patients with complete information, non-white veterans had more than twice the odds of indicating that their diabetes care experience is in line with the CCM [measured by overall PACIC score > or =3.5] (OR 2.3; 95% CI 1.3-4.1). Non-white veterans were more likely to report high levels of assistance with problem solving and follow-up. Patients not completing high school had three times the odds of reporting care in line with the CCM (OR 3.0; 95% CI 1.2-7.6). Associations were also seen with implementation of the CCM in the areas of patient activation, perceived care teams, collaborative goal setting, and collaborative problem solving. CONCLUSIONS: Non-white patients and those with less than a high school education had more than twice the odds of reporting that the diabetes care system is in line with the CCM.     

Leisure time exercise and lipid and lipoprotein levels in an older population

Plasma lipid and lipoprotein levels were measured in 1,019 men and 1,273 women, aged 50 to 89, who were classified according to whether they reported participation in regular strenuous exercise. In men and women, strenuous exercisers had significantly (P less than .01) higher age-adjusted high-density lipoprotein (HDL) cholesterol levels than nonstrenuous exercisers, and male strenuous exercisers also had lower plasma triglyceride levels. Adjusting for differences in cigarette smoking, alcohol consumption, or obesity did not alter these results. A subgroup of 498 consecutive men and 615 consecutive women that completed a more detailed exercise questionnaire were classified into categories of light, moderate, heavy, or no exercise. In men, age-adjusted HDL cholesterol levels were higher and triglyceride levels lower with higher exercise-intensity categories (P for trend less than .001). In the heavy exercise category, HDL cholesterol levels were 15% higher and plasma triglyceride levels were 41% lower than in the sedentary group. In women, HDL cholesterol levels were significantly higher and triglyceride levels lower at the more moderate levels of exercise. In both genders results among exercise-intensity groups did not change after adjusting for age, cigarette smoking, and alcohol consumption. In men, adjusting for obesity did not significantly alter the intergroup differences, whereas in women adjusting for body mass index or waist-to-hip ratio reduced differences in HDL cholesterol levels between exercising and sedentary participants to nonsignificance. We conclude that exercise levels attainable by older adults may significantly improve HDL cholesterol levels and could theoretically reduce the risk of ischemic heart disease.     

Racial differences in AIDS knowledge among adults.

Adults 18 to 65 years of age (N = 1237) were interviewed by telephone to explore differences in AIDS knowledge between black and white Americans. Adjusted odds ratios were calculated to determine the association between race and AIDS knowledge. Results show no discrepancies between black and white respondents in the level of knowledge about proved HIV transmission modes (odds ratio [OR] = 1.31, 95% confidence interval [CI] 0.90-1.90). Racial differences in the level of knowledge of preventive measures (ORadj = 1.39, 95% CI 1.00-1.94) are due primarily to differences in educational attainment and not to race. However, lack of awareness of the difference between asymptomatic individuals infected with human immunodeficiency virus (HIV) and persons with AIDS (PWAs) remained significantly higher for black than for white respondents (ORadj = 1.81, 95% CI 1.32-2.50) after adjustment for educational attainment. This lack of awarenes may facilitate exposure of a larger proportion of black respondents to HIV. Racial disparities in the level of knowledge about unproved transmission modes also remained after adjustment for educational attainment (ORadj = 1.92, 95% CI 1.37-2.70). To interpret unexplained differences in knowledge, factors related to unaccounted-for socioeconomic confounding and to the effect of several variables involved in the communication process are discussed.     

Body composition, lipid and lipoprotein levels in childhood-onset systemic lupus erythematosus

OBJECTIVES: Systemic inflammation, corticosteroid therapy, and reduced physical activity are risk factors for altered body composition in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess whether body composition differs between childhood-onset SLE patients and healthy controls, and to investigate the impact of disease characteristics and lifestyle factors on body fat mass, serum lipids, and lipoproteins. METHODS: Fat mass and lean tissue mass were measured in a cross-sectional study of 68 childhood-onset SLE patients and 68 matched healthy controls by dual-energy X-ray absorptiometry (DXA). The influence of disease, glucocorticosteroids, disease activity and severity, physical activity, and dietary intake on fat mass was evaluated by multiple linear regression analysis. Serum lipid and lipoprotein levels were measured. RESULTS: Patients had a significantly higher fat mass [mean (SD) 35.3 (10.8) vs. 30.9 (11.1)%; p = 0.024] and lower lean mass [39.7 (9.8) vs. 44.4 (1.5) kg; p = 0.003] than controls. Corticosteroid use and the disease itself were significant independent predictors of greater fat mass, while disease activity, physical activity, and dietary intake had only a minor influence. Mean high density lipoprotein (HDL) cholesterol and apolipoprotein A1 (apo A1) levels were significantly lower (p<0.001), and the mean apo B/apo A1 ratio significantly higher (p = 0.004), in patients than in controls. CONCLUSION: Childhood-onset SLE patients had a higher fat mass and lower lean mass than healthy controls and corticosteroid use was an independent predictor of increased fat mass. Patients had a more proatherogenic lipid profile, which will contribute to the increased risk of coronary heart disease in SLE patients.