LDL-C/HDL-C比值与早发冠心病患者冠脉病变严重程度及2年预后的相关性研究：一项多中心、大样本、观察性研究

目的比较早发冠心病患者低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)比值, 探讨其与早发冠心病患者冠状动脉(冠脉)病变严重程度和远期不良事件的相关性, 以及其在早发冠心病中的临床应用价值。方法本研究来源于PROMISE研究。PROMISE研究是一项前瞻性、多中心、观察性队列研究, 入选2015年1月至2019年5月确诊冠心病的患者18 701例。本研究纳入其中的早发冠心病患者3 861例, 根据LDL-C/HDL-C比值的中位数(2.4)将患者分为低LDL-C/HDL-C组(LDL-C/HDL-C≤2.4, n=1 867)和高LDL-C/HDL-C组(LDL-C/HDL-C>2.4, n=1 994)。收集基线资料, 并进行2年长期随访, 记录主要不良心脑血管事件(MACCE)的发生情况, 比较不同LDL-C/HDL-C水平早发冠心病患者之间的差异, 分析LDL-C/HDL-C比值与患者冠脉病变严重程度及MACCE的相关性。结果低LDL-C/HDL-C组年龄(48.5±6.5)岁, 男性1 154例(61.8%);高LDL-C/HDL-C组年龄(46.5±6...     

低密度脂蛋白胆固醇/高密度脂蛋白胆固醇、甘油三酯/高密度脂蛋白胆固醇和尿酸与冠心病的关系

目的探讨低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)、甘油三脂(TG)/HDL-C和血尿酸(UA)与冠心病的关系。方法检测203例经冠脉造影确诊的冠心病患者(冠心病组)和61例冠脉造影正常者(对照组)的血清总胆固醇、TG、LDL-C、HDL-C、UA含量,计算LDL-C/HDL-C、TG/HDL-C的比值。结果冠心病组的总胆固醇、LDL-C、LDL-C/HDL-C比值较对照组均显著升高,HDL-C显著降低(P<0.05)。而TG及TG/HDL-C比值两组间无显著差异。结论LDL-C/HDL-C和UA对冠心病有一定的预测价值,而TG/HDL-C比值的预测价值尚待研究。     

冠心病患者及其高危人群血脂检测对比分析

目的 根据美国国家胆固醇教育计划成人治疗组第三次指南(NCEP-ATPⅢ)提出的冠心病和高危人群的血浆低密度脂蛋白胆固醇(LDL-C)水平应控制在≤2.6mmol/L的标准,观察本地区冠心病和高危人群的LDL-C异常情况。方法 分析220例冠状动脉造影(CAG)确诊的冠心病患者(CHD组)及90例富含冠心病危险因素CAG阴性者(NCHD)的胆固醇(TC)、甘油三酯(TG)、LDL-C、高密度脂蛋白胆固醇(HDL-C)水平及异常率。结果 与非冠心病组相比,冠心病组的平均TC和LDL-C水平明显增高、HDL-C水平降低(P<0.05)。按NCEP-ATPⅢ,LDL-C≥2.6mmol/L和HDL-C≤1mmol。L为异常,冠心病组LDL-C和HDL-C异常率明显大于非冠心病组,分剐为67％vs 47％和50％vs 27％(P<0.001)。冠心病组患者LDL-C水平的迭标率为33％左右。结论LDL-C水平升高和HDL-C水平降低是本地区冠心病发生和发展的关键。冠心病及其高危人群在他汀类药物的应用应加强并且有很大空间。通过药物开发提高HDL-C水平在防治冠心病事件方面将有很好的前景。     

踝臂指数、趾臂指数、LDL-C/HDL-C在冠状动脉疾病中的应用价值

目的探讨踝臂指数(ABI)、趾臂指数(TBI)、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值(LDL-C/HDL-C)在冠状动脉疾病患者中的应用价值。方法纳入2011年10月-2013年2月于中国医科大学附属第一医院心内科住院治疗的160例患者,依据冠状动脉多层螺旋CT造影(CTA)检查结果将患者分为两组,其中对照组患者57例(冠状动脉狭窄程度≤25%),冠状动脉病变组患者103例(冠状动脉狭窄程度25%)。冠状动脉病变组患者中冠状动脉单支病变患者30例(单支病变组)、双支病变患者31例(双支病变组)、三支病变患者42例(三支病变组);轻度病变组患者55例(冠状动脉狭窄程度≤50%)及中重度病变组患者48例(冠状动脉狭窄程度50%)。对入组患者行ABI、TBI、LDL-C/HDL-C检查,分析冠状动脉病变不同亚组间ABI、TBI、LDL-C/HDL-C水平变化及其对判断冠状动脉病变程度的价值。结果对照组与冠状动脉单支病变组、双支病变组、三支病变组间ABI、TBI呈降低趋势,LDL-C/HDL-C水平呈升高趋势,组间ABI、TBI、LDL-C/HDL-C水平比较,差异均有统计学意义(P0.05);三支病变组与对照组、单支病变组ABI、TBI及LDL-C/HDL-C水平间比较,差异均有统计学意义(P0.05);双支病变组与对照组ABI水平间比较,差异有统计学意义(P0.05)。对照组与冠状动脉狭窄轻度病变组、中重度病变组间ABI、TBI呈降低趋势,LDL-C/HDL-C水平呈升高趋势,组间ABI、TBI、LDL-C/HDL-C水平比较,差异均有统计学意义(P0.05);中重度病变组与对照组ABI、TBI及LDL-C/HDL-C水平间比较,差异有统计学意义(P0.05);中重度病变组与轻度病变组及轻度病变组与对照组ABI水平间比较,差异有统计学意义(P0.05)。结论 ABI能较好反应冠脉病变程度,ABI值越低冠脉狭窄越重,但并不能全面反映冠脉病变范围;LDL-C/HDL-C、TBI对冠脉病变的判断有一定意义,但不适用于准确评价冠脉病变程度及范围。     

LDL-C/HDL-C比值对经皮冠脉介入术后患者心血管事件的预测价值

目的 评估低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)比值对经皮冠脉介入(PCI)术后患者心血管事件的预测价值.方法 选择急性冠脉综合征(ACS)并予前降支置入支架的患者119例,依据血浆LDL-C/HDL-C比值将患者分为3组,随访1年,评估三组患者心血管事件发生率,以及各危险因素与心血管事件发生率的关系.结果 ①与LDL-C/HDL-C比值较低的两组相比,比值较高组患者体重指数、女性患者百分率、吸烟人数及糖化血红蛋白、高敏C反应蛋(hs-CRP)、总胆固醇和LDL-C水平均明显升高,而HDL-C水平和他汀类药物使用率则较低(P＜0.05).②第1组风险比(HR)1.04,95％可信区间(CI)0.98～1.08,第2组HR 1.16,95％CI 1.08～1.20,第3组HR 1.27,95％CI 1.19～1.36(P＜0.05).随着LDL-C/HDL-C比值的升高,PCI术后1年患者心血管事件发生率也逐渐升高(P＜0.05).③Cox比例风险回归模型提示,LDL-C/HDL-C比值对PCI术后心血管事件风险的预测价值优于其他危险因素.结论 LDL-C/HDL-C比值对PCI术后患者1年内心血管事件再发具有一定的预测价值.     

HDL-C水平与PCI围术期心肌损伤的相关性研究

目的：近期研究表明HDL-C水平与心血管风险的相关性在不同LDL-C水平的患者中结论不一致。本研究旨在阐明HDL-C水平与LDL-C已达标患者择期PCI术后心肌损伤之间是否存在相关性。 方法和结果：连续入选2529例PCI术前cTnI水平正常的患者,而LDL-C水平已达标（LDL-C<70mg/dl）患者HDL-C与PCI术后心肌损伤之间的相关性。结果发现HDL-C水平不能预测PCI术后心肌损伤的发生。但对于LDL-C<70mg/dl的患者亚组,HDL-C每升高1mg/dL,PCI术后cTnI升高>1倍正常上限的风险下降3%（OR 0.97,95%CI 0.95-0.97,p=0.004）,PCI术后cTnI升高>3倍正常上限的风险下降3%（OR 0.97,95%CI 0.95-0.97,p=0.022）,PCI术后cTnI升高>5倍正常上限的风险下降3%（OR 0.97,95%CI 0.95-0.97,p=0.017）。 结论：较高的HDL-C水平可降低LDL-C已达标患者择期PCI术后心肌损伤的发生风险。     

PPARγ基因多态性与2型糖尿病脂代谢的关系

目的 探讨PPARγ基因多态性与2型糖尿病患者脂代谢异常的关系.方法 本研究共纳入191例2型糖尿病患者.以rs1875796为遗传标记,应用多聚酶链-限制性片段长度多态性(PCR-RFLP)技术检测PPARγ基因rs1875796的基因型.应用氧化酶法测定入组患者血浆甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HLD-C)和低密度脂蛋白胆固醇(LDL-C)的水平.结果 2型糖尿病患者PPARγ基因rs1875796的等位基因频率与TC、HDL-C和LDL-C水平无明显相关.但经性别分层后,女性2型糖尿病患者的TC、LDL-C水平与PPARγ基因rs1875796的等位基因频率呈显著性相关(分别为χ2=9.378,P=0.002和χ2=11.187,P=0.000 8).携带C等位基因个体的TC水平和LDL-C水平明显高于携带T等位基因的个体.结论 女性2型糖尿病患者TC、LDL-C水平与PPARγ基因ts1875796多态性可能有关.     

血清超敏C反应蛋白与低密度脂蛋白胆固醇联合检测在2型糖尿病大血管病变中的

目的 探讨2型糖尿病大血管并发症患者血清超敏C反应蛋白（hs-CRP）与低密度脂蛋白胆固醇（LDL-C）水平的变化及其临床意义.方法 检测200例有或无大血管并发症的2型糖尿病患者及40例健康人的血清hs-CRP、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、LDL-C浓度.结果 2型糖尿病患者无论有无大血管并发症,其hs-CRP、TC、TG、LDL-C水平均明显高于正常对照组（P＜0.05）,大血管并发症组hs-CRP、LDL-C水平明显高于无大血管并发症组（P＜0.05）.大血管并发症组血清hs-CRP水平与LDL-C水平呈明显正相关（r=0.47,P＜0.05）.结论 hs-CRP及LDL-C可作为2型糖尿病并发大血管病变危险性的重要实验室指标.两者联合检测对2型糖尿病并发大血管病变的预测及早期诊断有重要的临床价值.     

脂蛋白（a）、脂蛋白（a）/HDL-C与PCI术后支架内再狭窄的相关性研究

目的 探讨脂蛋白（a）[LP(a)]、 LP(a)/高密脂蛋白胆固醇（HDL-C）比值与支架内再狭窄的相关性。方法 回顾性分析93例支架植入术后再次行冠状动脉（冠脉）造影治疗的患者,其中支架内再狭窄组49例,非再狭窄组44例,分析两组间血脂参数[低密脂蛋白胆固醇（LDL-C）、HDL-C、LDL-C/HDL-C、LP(a)、LP(a)/HDL-C]是否有差异性;分析LP(a)、LP(a)/HDL-C与LDL-C/HDL-C的相关性;将LP(a)/HDL-C按比值高低分为三组,低LP(a)/HDL-C、中LP(a)/HDL-C、高LP(a)/HDL-C组,根据三组的再狭窄发生率及LP(a)、LP(a)/HDL-C与LDL-C/HDL-C的相关性探讨LP(a)、LP(a)/HDL-c比值与支架内再狭窄的关系。结果 (1)两组患者LDL-C及HDL-C比较无差异（P>0.05）;(2)支架内再狭窄组的LDL-C/HDL-C、LP(a)及LP(a)/HDL-C均高于非再狭窄组（P<0.05）;(3)LP(a)、LP(a)/HDL-C均与LDL-C/HDL-C有明显相关性,且LP(a...     

血浆致动脉粥样硬化指数与2型糖尿病患者大血管病变的关系

目的探讨血浆致动脉粥样硬化指数(AIP)与2型糖尿病(T2DM)患者大血管病变的关系。方法选择90例2型糖尿病患者与20例正常对照者,2型糖尿病患者按有无大血管并发症分成两组测量身高、体重,计算体重指数(BMI),测量血压、血脂,计算AIP(指TG/HDL-C比值的对数值),并进行统计学处理。结果与正常对照组比较,T2DM组呈现出TG升高,HDL-C降低,AIP值明显升高,其中,AIP值变化最明显(P<0·001);T2DM组中,有大血管并发症与无大血管并发症相比,大血管并发症组BMI、TG、TC、HDL-C、LDL-C、AIP差异有显著性(P<0·05),其中,AIP值差异最显著(P<0·001)。结论AIP间接反映LDL-C颗粒直径的大小,可作为2型糖尿病患者发生大血管并发症危险性的一个指标。     

Significance of small dense low-density lipoprotein-cholesterol concentrations in relation to the severity of coronary heart diseases

We have investigated the clinical significance of small dense low-density lipoprotein-cholesterol (sd-LDL-C) concentrations in coronary heart disease (CHD). We measured the LDL size by gradient gel electrophoresis and quantified sd-LDL-C concentrations by a newly developed rapid assay using heparin-magnesium precipitation in 225 consecutive CHD patients without any lipid-lowering medication and 142 healthy middle-aged subjects as controls. The LDL size was markedly smaller and sd-LDL-C levels were significantly higher in CHD patients than in controls of both sexes, whereas LDL-C levels were comparable between CHD and controls. The LDL-C levels were significantly higher in a subpopulation of 84 patients with acute coronary syndrome than in other patients groups, while LDL size and high-density lipoprotein-cholesterol (HDL-C) were not found to vary among the patients. The sd-LDL-C increased as the number of diseased vessels or Gensini atherosclerosis score increased. Among the 123 stable CHD patients, multiple logistic regression analysis revealed that sd-LDL-C levels were significantly associated with the clinically severe cases requiring coronary revascularization independently of LDL-C, HDL-C and apolipoprotein B. The sd-LDL mass plays a more important role in the progression of CHD than the LDL size, and the sd-LDL-C concentration serves as a powerful surrogate marker for the prevention of CHD.     

2型糖尿病患者血8-羟基脱氧鸟嘌呤水平与大血管并发症的关系

目的初步探讨氧化应激在2型糖尿病患者大血管并发症中的作用。方法 2型糖尿病患者78例,分为大血管并发症组(32例)和无并发症组(46例)。检测两组患者血TG、TC、LDL-C、HDL-C、糖化血红蛋白(HbAlc)和8-羟基脱氧鸟嘌呤(8-OHdG)水平。同期检测65例健康体检者(对照组)血8-OHdG水平。结果 2型糖尿病患者血8-OHdG水平明显高于对照组[(2.78±1.33)μg/L vs (0.72±0.93)μg/L,P<0.05]。大血管并发症组血8-OHdG据平较无并发症组有上升趋势,但差异无统计学意义[(2.93±1.37)μg/L vs (2.67±1.30)μg/L,P>0.05];大血管并发症组TG水平和病程明显高于无并发症组,差异有统计学意义(P<0.05)。血8-OHdG水平与TG和病程呈正相关(P<0.05),而与TC、LDL-C、HDL-C及HbAlc水平无明显相关(P>0.05)。结论 2型糖尿病患者氧化应激水平增高。2型糖尿病患者大血管并发症的发生可能与病程、血脂关系更密切,脂代谢异常是糖尿病氧化应激的重要影响因素。     

Lipid peroxidation,antioxidants, lipid profile,and HbA1c in diabetic patients

Diabetes mellitus is characterized by hyperglycemia together with biochemical changes in glucose, lipid profile, lipid peroxidation, and antioxidants status. This study aims to assess lipid profile, lipid peroxidation, antioxidants, and glycated hemoglobin (HbA1c) in type 1 and type 2 diabetic subjects. Type 1 and type 2 diabetic patients were selected from the subjects attending OPD in Nepalgunj Medical College, Nepal, for medical checkup. Fasting blood sugar (FBS), lipid profile, lipid peroxidation (malondialdehyde), and antioxidants status (reduced glutathione and vitamin E) were estimated in both groups and were compared with healthy controls. Low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratio was calculated to assess the cardiovascular risk factors. When type 1 diabetic patients were compared with type 2 diabetic patients, it showed statistically significant increase in the levels of HbA1c, triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C), whereas statistically significant decreased level was found in malondialdehyde (MDA). FBS, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), reduced glutathione (GSH), vitamin E, and HDL/LDL ratio were not significant. Early diagnosis of dyslipidemia and oxidative stress can be used as a preventive measure for the development of microvascular and macrovascular complications in type 1 and type 2 diabetes mellitus.     

Effects of pioglitazone on lipid and lipoprotein metabolism

Type 2 diabetes is associated with an increased risk of cardiovascular disease (CVD). A major contributing factor to this risk is the abnormal lipid profile known as dyslipidaemia, which is characterized by low HDL cholesterol (HDL-C), raised triglycerides (TGs) and a predominance of small, dense LDL cholesterol (LDL-C) particles. Statins are now widely used first-line in patients with type 2 diabetes due to their proven efficacy in reducing LDL-C and cardiovascular risk. However, despite the use of statins, the absolute risk of CVD in patients remains elevated, highlighting the need to target all aspects of the diabetic lipid profile such as raised TGs or low HDL-C levels. Insulin resistance is thought to be central in the pathogenesis of diabetic dyslipidaemia; therefore, improving insulin sensitivity with a thiazolidinedione offers an attractive treatment option. Indeed, pioglitazone, a member of the peroxisome proliferator-activated receptor-gamma family, has been shown in clinical trials to improve both blood glucose levels and the lipid profile when used either as monotherapy or in combination with other oral antidiabetic agents. In the monotherapy setting, pioglitazone has been associated with greater decreases in TGs and increases in HDL-C when compared with glibenclamide or metformin. Studies investigating the effects of pioglitazone add-on therapy to either metformin or sulphonylurea treatments have shown sustained improvements in serum levels of TGs and HDL-C and favourable effects on LDL-C particle size. In comparison with rosiglitazone, pioglitazone has different and potentially favourable effects on plasma lipids. The recent PROspective pioglitAzone Clinical Trial In macroVascular Events study has given weight to the hypothesis that the beneficial metabolic effects of pioglitazone may be associated with reductions in cardiovascular risk in patients with type 2 diabetes.     

Defective antioxidative activity of small dense HDL3 particles in type 2 diabetes: relationship to elevated oxidative stress and hyperglycaemia

Aims/hypothesis Elevated oxidative stress, hyperglycaemia, and dyslipidaemia involving low levels of HDL particles are key proatherogenic factors in type 2 diabetes mellitus. We examined the relationship of oxidative stress, and the degree of glycaemia and triglyceridaemia, to antioxidative function of HDL particle subspecies in type 2 diabetes.Subjects and methods Five HDL subfractions (2b, 2a, 3a, 3b, 3c) were isolated by density gradient ultracentrifugation from well-controlled type 2 diabetic subjects (n=20) and normolipidaemic, non-diabetic controls (n=10). Specific antioxidative activity (capacity to protect LDL from oxidation on a unit particle mass or on a particle number basis), chemical composition and enzymatic activities were measured in each subfraction. Systemic oxidative stress was assessed as plasma levels of 8-isoprostanes.Results Specific antioxidative activity of small dense HDL3b and 3c particles in diabetic patients was significantly diminished (up to –47%, on a particle mass or particle number basis) as compared with controls. Plasma 8-isoprostanes were markedly elevated (2.9-fold) in diabetic patients, were negatively correlated with both specific antioxidative activity of HDL3 subfractions and plasma HDL cholesterol (HDL-C) levels, and were positively correlated with glycaemia and triglyceridaemia. Paraoxonase 1 activity was consistently lower in diabetic HDL subfractions and was positively correlated with HDL3 antioxidative activity. The altered chemical composition of diabetic HDL3 subfractions (core cholesteryl ester depletion, triglyceride enrichment) was equally correlated with diminished antioxidative activity.Conclusions/interpretation Antioxidative activity of small dense HDL is deficient in type 2 diabetes, is intimately linked to oxidative stress, glycaemia and hypertriglyceridaemia and primarily reflects abnormal intrinsic physicochemical properties of HDL particles.     

Effect of insulin treatment on plasma oxidized LDL/LDL-cholesterol ratio in type 2 diabetic patients

OBJECTIVE: In type 2 diabetes mellitus, oxidized LDL/LDL-Cholesterol ratio, an accurate estimation of in vivo LDL oxidation, has been reported elevated and associated with macrovascular disease. Because insulin therapy induces significant modification of lipid metabolism, in type 2 diabetes, we evaluated the effect of insulin treatment on oxidized LDL/LDL-C ratio in type 2 diabetic patients and analyzed the results in comparison with the modifications induced by insulin on glycaemia, plasma lipids and LDL receptors. RESEARCH DESIGN AND METHODS: Plasma oxidized LDL concentrations were measured by sandwich ELISA in 21 type 2 diabetic patients before and 3 months after the introduction of insulin therapy, and in 27 age-matched controls. RESULTS: Type 2 diabetic patients had, compared to controls, significantly increased oxidized LDL/LDL-C ratio (P<0.0001). Three months after insulin treatment, oxidized LDL/LDL-C ratio was significantly reduced (21.1+/-4.7 vs. 24.0+/-5.8 U/mmol, P<0.01). This reduction was strongly associated, in multivariate analysis, with reduction of LDL(TG/cholesterol ratio) (P=0.008), and to a lesser extent with the decrease of LDL fructosamine (P=0.034), but not with the increase of the number of LDL receptors. CONCLUSIONS: In the present study we demonstrate for the first time a lowering effect of insulin therapy on oxidized LDL/LDL-C ratio in type 2 diabetic patients. This decrease is mainly associated with the reduction of LDL TG-enrichment, and to a lesser extent with the decrease of LDL glycation, but not with the insulin-induced increase in number of LDL receptors.     

The long-term effects of rosiglitazone on serum lipid concentrations and body weight

OBJECTIVE: Although rosiglitazone, an insulin sensitizer, is known to have beneficial effects on high density lipoprotein cholesterol (HDL-C) concentrations and low density lipoprotein (LDL) particle size, it has unwanted effects on total cholesterol (TC) and LDL cholesterol (LDL-C) concentrations and body weight in some short-term studies. The aim of this study was to evaluate the long-term effects of rosiglitazone on serum lipid levels and body weight. DESIGN: Open labelled clinical study. PATIENTS AND MEASUREMENTS: We prospectively evaluated fasting serum glucose, haemoglobin A(1c) (HbA(1c)), lipid profiles and body weight at baseline and every 3 months after the use of rosiglitazone (4 mg/day) for 18 months in 202 type 2 diabetic patients. RESULTS: TC levels increased maximally at 3 months and decreased thereafter. However, overall, TC levels remained significantly higher at 18 months than those at baseline. LDL-C levels from the 3-month to the 12-month timepoint were significantly higher than those at baseline. However, after 15 months, LDL-C concentrations were not significantly different from basal LDL-C concentrations. HDL-C levels increased after the first 3 months and these levels were maintained. The increment of change in HDL-C was more prominent in patients with low basal HDL-C concentrations than in patients with high basal HDL-C concentrations. Body weight increased after the first 3 months and these levels were maintained. CONCLUSIONS: HDL-C and body weight increased and remained elevated for the duration of the study. There was an initial increase in LDL-C but this attenuated and by the end of the study was not significantly elevated above baseline levels.     

Atherogenic lipoprotein changes in diabetic nephropathy

Cardiovascular risk is increased in patients with diabetic nephropathy. The aim of this study was to examine the relative impacts of albuminuria and renal failure, the two important features of diabetic nephropathy, on potentially atherogenic lipoprotein changes in this condition. The subjects were 160 non-diabetic healthy controls and a total of 200 type 2 diabetes patients with various degrees of nephropathy. The diabetic patients were divided into four groups by urinary albumin/creatinine ratio (U-ACR) and serum creatinine (S-Cr) levels: DM-1 (U-ACR< 30 mg/g, N=85), DM-2 (U-ACR=30-300 mg/g, N=48), DM-3 (U-ACR > 300 mg/g, N=29) and DM-4 (S-Cr>177 micromol/l or 2.0mg/dl, N=38). Lipids in very low (VLDL), intermediate (IDL), low (LDL), and high density (HDL) lipoproteins were measured following ultracentrifugation. VLDL-cholesterol (VLDL-C) was elevated (by 73-100%) in diabetic patients and it did not differ among the stages of nephropathy. IDL-C was higher as the nephropathy stage was advanced, and the elevation was significant in the DM-3 (by 75%) and DM-4 (by 131%) groups. LDL-C was not elevated in diabetic patients and was not different among the stages of nephropathy. Reduction of HDL-C was significant in DM-1, DM-2 and DM-3 (by 12-16%) and it was more exaggerated in DM-4 (by 35%). Multiple regression analyses indicated that elevated S-Cr, but not U-ACR, was an independent factor associated with raised IDL-C and lowered HDL-C in diabetic patients. These results indicate that diabetic patients with nephropathy show multiple lipoprotein changes, and that renal failure has greater impact than albuminuria on abnormalities in IDL and HDL. These lipoprotein alterations may contribute to an increased cardiovascular risk in diabetic nephropathy, especially in diabetic renal failure.     

Direct adsorption of low-density lipoprotein by DALI-LDL-apheresis: results of a prospective long-term multicenter follow-up covering 12,291 sessions

Direct adsorption of lipoproteins (DALI) is the first low density lipoprotein (LDL)-apheresis technology by which atherogenic LDL and lipoprotein(a) (Lp(a)) can be selectively removed from whole blood without plasma separation. The present follow-up was carried out to evaluate the clinical efficacy, selectivity and safety of long-term DALI apheresis. The follow-up was carried out in an open, prospective uncontrolled multicenter clinical design. Included were 158 drug-resistant hypercholesterolemic patients from 28 apheresis centers. These patients underwent 12 291 DALI sessions between January 1997 and March 2002. The patients suffered from severe atherosclerosis and their mean LDL-C was 188 mg/dL before the sessions. Mean follow-up was 25 +/- 16 (range 1-56) months during which 78 +/- 53 sessions were carried out. In most treatments, DALI 750 (63%) or DALI 1000 (30%) adsorbers were used. On average, 7423 +/- 1495 mL blood was processed at a flow rate of 84 +/- 16 mL/min in 102 +/- 25 min. Acute reductions by the single DALI sessions averaged 69 +/- 12% for LDL-C, 41 +/- 18% for TG, 15 +/- 10% for HDL-C, 19 +/- 11% for fibrinogen and 62 +/- 24% for Lp(a) (in patients with Lp(a) > 30 mg/dL). Adverse events were recorded in only 3.9% of the sessions. In this 5-year follow-up, long-term therapy with DALI was safe, effective and selective as LDL-C and Lp(a) could be reduced by >60% per session in approximately 100 min treatment time while HDL-C decrease and the incidence of AE were low.