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In view of the controversies existing regarding the atherogenic potential of smoking, this study was conducted in 40 healthy young male Cigarette smokers and 40 age and weight matched male non smokers, to find out the difference in the serum lipid profiles of both the groups. Subjects in both the groups were in the age range of 25 and 35 years having no history of alcohol abuse or diseases like diabetes mellitus or obesity. The mean serum total cholesterol (177.3 +/- 32.5 mg/dL) and LDL cholesterol (100.2 +/- 31.0 mg/dL) were significantly higher in smokers (p < 0.05) whereas mean serum HDL- Cholesterol was (43.2 +/- 5.8 mg/dL) was significantly lower (P < 0.05). Mean triglyceride (170.8 +/- 59.7 mg/dL) was significantly higher in smokers than in nonsmokers (p < 0.01). In the fed state the total serum cholesterol level and triglyceride level was increased by 10.4 mg/dL and 51.1 mg/dL respectively in smokers whereas the increase was 4.8 mg/dL and 24.3 mg/dL respectively in nonsmokers. There was less rise of HDL cholesterol (1.9 mg/dL) in smokers as compared to that in nonsmokers (3.4 mg/dL) and in LDL-cholesterol (1.8 mg/dL) in smokers compared to nonsmokers (3.4 mg/dL) in fed state.
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PMID:Effect of cigarette smoking on lipid profile in the young. 1125 5

Atherosclerotic cardiovascular diseases (CVD), mainly coronary heart disease (CHD) remain the leading cause of death in adult populations of many countries. The following risk factors for atherosclerosis were identified: hypercholesterolemia, hypertension, cigarette smoking and obesity. Scientific reports and epidemiological studies have shown that atherosclerosis begins in childhood. Therefore consensus was obtained that the earlier the prevention begins the better results are achieved. But there are many controversies around early identification of hypercholesterolemia in children. Three options were considered: cholesterol mass screening, selective cholesterol screening and no screening at all. The most acceptable is selective screening performed in children of high risk families (CVD or hypercholesterolemia in the family). It is recommended by the US Expert Panel for the National Cholesterol Education Program for Children and Adolescents (NCEP-Peds). According to the NCEP-Peds, screening should include the following groups: I) children whose parents or grandparents have a history of CVD (under the age of 55 years), 2) children whose parents have a raised blood cholesterol concentration (above 240 mg/dl), 3) children with negative or unknown family history, but having other risk factors (hypertension, obesity, cigarette smoking, high-fat diet). The experts recommend that the examination should be performed in children after the age of 2 years. The NCEP-Peds guidelines set total cholesterol levels in serum for children and adolescents from families at risk, below 170 mg/dl, as acceptable. Total cholesterol level between 170 and 199 mg/dl is classified as borderline and 200mg/dl and above--as high.
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PMID:[Screening programme for hyperlipidemia in children and adolescents. Prophylactic aspects of atherosclerosis]. 1127 1

The aim of the study was to assess the plasma levels of endothelial injury markers in children from families with high risk of premature coronary heart disease (CHD) without other common CHD risk factors (hyperlipidaemia, obesity, hypertension, low physical activity). The study comprised 48 children, including 24 children from high-risk families (HR), according to the NCEP (National Cholesterol Education Programme) criteria: one or two parents had clinical manifestation of cardiovascular disease before the age of 65 years (mother) or 55 years (father). The control group included 24 healthy children with no familial history of cardiovascular disease. All the children were normolipidaemic according to the NCEP and the European Atherosclerosis Society criteria for children aged 2-19 years. In the HR group, the concentration of vWf was significantly elevated in comparison to that in the control group (p<0.0001). Plasma concentrations of ET-1 and TxB2 did not differ significantly between the HR group and the controls. Plasma concentrations of the 6-ketoPGF1alpha in the HR group and in the respective age and gender HR subgroups were significantly lower compared with those of the control group (p<0.00005). Concentration of vWf in the HR group was negatively correlated with the concentration of 6-ketoPGF1alpha (r = -0.47; p<0.05) and positively correlated with TxB2 (r=0.39; p<0.01). In a logistic regression analysis, we found that the 6-ketoPGF1alpha concentration in the lower quartile (< 16.1 pmol/L) was associated with a 3.4-fold odds of inclusion in the high-risk group versus the upper quartile (>23.0 pmol/L).
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PMID:Plasma levels of von willebrand factor, endothelin-1, prostacyclin and thromboxane in children from families with high risk of premature coronary artery disease. 1146 46

For the care of an expanding segment of the US population with multiple coronary risk factors, combination lipid-altering therapy is emerging as a treatment imperative. The most recent National Cholesterol Education Program's consensus guidelines emphasize long-term global coronary heart disease (CHD) risk status, designate patients with CHD risk equivalents (eg, diabetes, peripheral arterial disease, 20% or more 10-year absolute CHD risk) for aggressive lipid-altering therapy, and deem the metabolic syndrome (eg, obesity, insulin resistance, hypertension, elevated triglycerides, low levels of high-density lipoprotein cholesterol, small dense low-density lipoprotein particles) as a secondary target for intervention. With the advancing age of the US population and the high prevalence of diabetes, the metabolic syndrome, and CHD, increasing numbers of patients will require a more balanced metabolic attack attainable only through combination lipid-altering regimens. Many of these patients, as well as persons at heightened risk for cardiovascular disease because of a range of heritable conditions (eg, familial hypercholesterolemia, familial combined hyperlipidemia), will undoubtedly require binary or ternary regimens involving statins in concert with niacin, fibric-acid derivatives, or bile acid resins. Such approaches enable the clinician to exploit the complementary effects of these agents, allowing them to be administered at low, optimally tolerable doses that are consistent with superior efficacy and a lower risk of adverse events as compared with escalating doses of monotherapy.
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PMID:Combination lipid-altering therapy: an emerging treatment paradigm for the 21st century. 1148 48

It has been reported that intake of (n-3) polyunsaturated fatty acids (PUFA) reduces the risk of coronary heart disease and decreases biliary cholesterol saturation in the bile of gallstone patients. We investigated the effect of n-3 PUFA on cholesterol saturation index (CSI) and nucleation time (NT) in obese subjects who were losing weight. This was a double-blind, placebo-controlled clinical trial. Obese women (n = 35) with a body mass index (BMI) > or = 30 kg/m(2), with no prior history of gallstones or cholecystectomy by ultrasound were first studied to ensure absence of stones or biliary sludge. The women were then assigned to a hypocaloric regimen [5.02 MJ (1200 kcal)/d] and to receive 1200 mg/d of ursodeoxycholic acid (UDCA), 11.3 g/d of (n-3) PUFA or a placebo for 6 wk. BMI, CSI and NT were recorded at baseline and at the end of the experimental period. BMI decreased 5.75 +/- 2.7%/mo (range, 1.5-12.42%/mo) during the experiment. The CSI did not change in any of the groups. Cholesterol NT decreased significantly in the UDCA and placebo groups, but not in the (n-3) PUFA group. None of the women had developed gallstones at 6 wk. These results suggest that (n-3) PUFA maintain the CSI and NT in obese women during rapid weight loss, which probably results in the prevention of cholesterol gallstone formation.
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PMID:Fish oil (n-3) polyunsaturated fatty acids beneficially affect biliary cholesterol nucleation time in obese women losing weight. 1153 70

A large number of studies have been published on very-low calorie diets and markedly hypocaloric dietary regimens for treatment of obesity. However, scanty data are available on moderately hypocaloric diets based on the Mediterranean diet model. We evaluated the efficacy and safety of a moderately hypocaloric Mediterranean diet (MHMD) by assessing changes in body composition and in metabolic profile in 19 obese women, aged 32+/-4 years, body weight 84.7+/-9.6 kg, body mass index (BMI) 33.67+/-2.61 kg/m2. The energy content of the diet (mean 6.5 MJ/day) matched the resting metabolic rate and its content in macronutrients (55% carbohydrate, 25% fat, 20% protein, 30 g fibre) was based on the Italian Recommended Dietary Allowances (LARN). Based on the Mediterranean diet model, available nutritional indices like the animal/vegetable protein ratio, the Cholesterol/Saturated Fat Index, the Glycaemic Index, the Atherogenic Index, the Thrombogenic Index and the Mediterranean Adequacy Index were taken into account in elaborating diets. At baseline and after 2 months, body composition by dual energy X-ray absorptiometry, metabolic profile, uric acid, fibrinogen and oral glucose tolerance test (OGTT) were assessed. Following MHMD, body weight decreased to 78.1+/-10.5 kg and BMI to 31.18+/-2.74 kg/m2. Total (-4.9+/-0.9 kg) and segmental fat mass decreased, no significant loss of total and segmental lean body mass was observed. No decrease of fasting blood glucose (5.05+/-0.45 vs 4.98+/-0.43 mmol/l, NS), of the area under the curve (AUC) for glucose (29.50+/-6.24 vs 28.07+/-5.29, NS) as well as of HDL-cholesterol (1.30+/-0.30 vs 1.33+/-0.33 mmol/l, NS) and of triglycerides (1.70+/-1.00 vs 1.46+/-0.66 mmol/l, NS) was observed. However, a significant decrease of basal insulin (11.48+/-6.77 vs 8.07+/-4.17 mU/ml, p<0.01) as well as of the AUC for insulin (263+/-118 vs 208+/-82,p<0.005), of total (5.40+/-1.04 vs 4.97+/-0.92 mmol/l,p<0.05) and LDL-cholesterol (3.36+/-1.07 vs 2.90+/-0.74 mmol/l,p<0.005), of uric acid (0.30+/-0.06 vs 0.28+/-0.05 mmol/l,p<0.01) and fibrinogen (359+/-78 vs 324+/-87 mg/100 ml, p<0.0001) was observed. In conclusion, MHMD prevents loss of fat-free mass and improves metabolic parameters in obese people. We advocate a wider use of nutritional indices and body composition assessment as tools for quality control of hypocaloric diets.
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PMID:Use of quality control indices in moderately hypocaloric Mediterranean diet for treatment of obesity. 1171 86

Heart disease is the primary cause of on-duty deaths in firefighters, but little is known about their lipid profile. We evaluated the lipid profile in relation to other cardiovascular disease risk factors in 321 firefighters at a baseline examination. Prospective comparisons were performed for 285 firefighters, who were enrolled in a statewide medical surveillance program, and had complete follow-up data for 4 years. The average cholesterol level in firefighters declined from 224 mg/dL at baseline (1996-1997) to 214 mg/dL at the follow-up examination (P < 0.0001). Conversely, both obesity (body mass index > or = 30; 34% versus 40%, P = 0.008) and triglycerides (> or = 200 mg/dL; 27% versus 35%, P = 0.047) increased over time. The proportion of firefighters taking lipid-lowering medications increased from 3% at baseline to 12% at follow-up (P < 0.0001). Cholesterol levels declined significantly, and treatment rates for elevated cholesterol increased over time. Despite repeated examinations, a considerable number of firefighters had persistently elevated cholesterol, and only a minority were receiving adequate treatment.
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PMID:Lipid profile of firefighters over time: opportunities for prevention. 1222 76

The Third Report of the National Cholesterol Education Program's Adult Treatment Panel (ATP III) has an extensive section on nonpharmacologic therapy for those with abnormal blood lipids. ATP III focused on the high-saturated fat atherogenic diet, obesity, and sedentary lifestyle and recommended a program of therapeutic lifestyle change (TLC). This review discusses several issues, including 1) why ATP III changed from the Step I and Step II diets to TLC; 2) the benefits of keeping trans fatty acid intake low and the addition of viscous fiber and plant stanol/sterol esters to reduce low-density lipoprotein cholesterol beyond that seen with the Step II diet; 3) the de-emphasis on total fat and a sharper focus on the kinds of fat ingested in the new guidelines; 4) the endorsement of regular physical activity and weight loss as important first steps in reversing the unwanted metabolic effects of the metabolic syndrome; and 5) the emphasis of health-promoting aspects of the diet that include, among other things, fish and omega-3 fatty acids. At all stages of TLC, ATP III encourages the referral to registered dietitians or other qualified nutritionists for medical nutrition therapy. TLC and the ATP III guidelines should provide guidance to practitioners who wish to get low-density lipoprotein cholesterol to goal (whether or not drugs are used), prevent or treat the metabolic syndrome, and improve the overall health of the patient.
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PMID:Therapeutic lifestyle change and Adult Treatment Panel III: evidence then and now. 1236 90

Androgens, diet, race and obesity are thought to play some roles in the pathogenesis of prostate cancer. We wanted to evaluate if there were any inter-relationships between prostate specific antigen (PSA), serum testosterone, serum cholesterol, HDL, triglycerides, body mass index (BMI) and race, in older patients with and without prostate cancer (CaP). We evaluated 308 patients referred to urologists in private practice offices and clinics with and without prostate cancer with regard to race, serum PSA, age, serum testosterone, full lipid profile, height and weight, and stage of cancer. We used multivariate analysis, Fisher's exact test and t-tests as well as logistic regression analysis. Data was analyzed using SPSS computer software, and P-values<0.05 were considered statistically significant. Significantly higher levels of serum testosterone were found in black men with CaP than black men without CaP (526+/-28 vs 404+/-19, respectively.) We also found significantly higher levels of serum testosterone in white men with CaP than white men without CaP (409+/-20 vs 302+/-14, respectively, P<0.05). HDL was higher in black men than white men, and triglycerides were higher in white men than black men. Cholesterol was similar across all groups, but BMI was highest in white men with CaP. We also found a significant association between BMI and pathological stage of prostate cancer patients among both black and white men (P<0.05). Our study demonstrated that black men who developed CaP had higher serum testosterone levels, on average, than white men who developed CaP. Furthermore, BMI was highest in white men developing CaP compared to black men, but we found a significant association between pathological stage and BMI in both black and white patients. Although it is controversial whether obesity is considered to be a risk factor for prostate cancer, this small pilot study suggests that BMI may play a role in the progression of the disease once it is established.Prostate Cancer and Prostatic Diseases (2001) 4, 101-105
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PMID:A pilot study analyzing PSA, serum testosterone, lipid profile, body mass index and race in a small sample of patients with and without carcinoma of the prostate. 1249 46

Human immunodeficiency virus protease inhibitors are associated with metabolic abnormalities that may increase risk of atherosclerotic vascular disease, including dyslipidemia, insulin resistance, and central obesity. Dyslipidemia, characterized by hypercholesterolemia and hypertriglyceridemia, small low- and high-density lipoprotein particles, and in some cases lipoprotein(a) excess, can be severe and has been associated with endothelial dysfunction and carotid atherosclerosis. The mechanisms underlying protease inhibitor-associated dyslipidemia have not been elucidated completely, but appear to involve hepatic overproduction of very low-density lipoproteins and to a lesser extent, impaired clearance. Insulin resistance appears to mediate part of the adverse lipoprotein changes observed in patients taking protease inhibitors. Ongoing epidemiological and surrogate endpoint studies are investigating the atherogenicity of these medications. Until the risk associated with use of protease inhibitors is better understood, identifying patients at high risk for adverse vascular events such as heart attacks, cardiac death, and stroke is a high priority. This article reviews the lipid and lipoprotein abnormalities associated with use of protease inhibitors, possible mechanisms for protease inhibitor-associated dyslipidemia, its potential atherogenicity, and use of the National Cholesterol Education Program Adult Treatment Panel III Guidelines for the management of patients with dyslipidemia.
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PMID:Dyslipidemia in the era of HIV protease inhibitors. 1263 93


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