AndersG. Olsson

RISK FACTORS FOR ISCHÆMIC HEART-DISEASE IN NORMAL MEN AGED 40: Edinburgh—Stockholm Study

Abstract 107 healthy men in Edinburgh and 82 in Stockholm, all aged 40 and selected at random, took part in a study aimed at identifying factors which might explain why, in men of this age, the mortality-rates from ischaemic heart disease are three times greater in Edinburgh men. Clinical measurements and electrocardiographic procedures were standardised, and steps taken to eliminate interlaboratory differences. Edinburgh men were shorter and fatter; had higher systolic and diastolic blood-pressures; smoked more cigarettes (but the number of cigarette smokers in the two groups was similar); drank more alcohol; had more E.C.G. abnormalities and lower exercise tolerance. They had higher levels of total serum-triglycerides and triglycerides in very low (V.L.D.L.), low (L.D.L.), and high (H.D.L.) density lipoproteins. Triglyceride clearance (assessed by an intravenous fat-tolerance test) was similar. Serum-cholesterol and L.D.L.-cholesterol concentrations were similar in both cities but cholesterol in V.L.D.L. was higher, and cholesterol in H.D.L. was lower, in Edinburgh men. The relative linoleic-acid content of plasma-triglycerides and of plasma-cholesterol esters were lower in Edinburgh men, and their subcutaneous adipose tissue glycerides had a lower polyunsaturated/ saturated fatty-acid ratio and a strikingly lower relative linoleic acid content. Edinburgh men had a greater total plasma-insulin response to a standardised glucose-tolerance test. The glucose response was the same in both cities. Plasma free fatty-acids and free glycerol were reduced by a lesser extent in Edinburgh men in response to a glucose load. Although the high incidence of ischaemic heart-disease in Scotland may be due to many factors, some of which are well established, this study points out metabolic factors which may provide new information on the pathogenesis of ischaemic heart-disease.

The effect of serum lipid regulation on the development of femoral atherosclerosis in hyperlipidaemia: a non-randomized controlled study.

Abstract. The development of femoral atheroma after 1 year of treatment with diet and nicotinic acid plus fenofibrate was studied in 45 asymptomatic, hyperlipidaemic, middle‐aged male subjects in a non‐randomized controlled study. The median serum very low density lipoprotein (VLDL) cholesterol concentration and the low density lipoprotein (LDL) cholesterol concentration were lowered by 67% and 36%, respectively, in the treatment group. The median serum high density lipoprotein (HDL) cholesterol concentration was increased by 23%.

Left ventricular diastolic function is related to glucose in a middle-aged population.

Abstract. Holzmann M, Olsson A, Johansson J, Jensen‐Urstad M (Karolinska Institute, Karolinska Hospital, Stockholm, Sweden). Left ventricular diastolic function is related to glucose in a middle‐aged population. J Intern Med 2002; 251: 415–420.

Effects of nicotinic acid on serum cholesterol concentrations of high density lipoprotein subfractions HDL2, and HDL3, in hyperlipoproteinaemia

Abstract. Nicotinic acid was given in a 4‐g daily dose for 6 weeks to 41 weight‐stable patients of mean age (f SD) 52 +_ 9 years, with type IIa, type IIb or type IV hyperlipoproteinaemia (HLP), in order to study its effects on serum cholesterol concentrations of high density lipoprotein (HDL) subfractions 2, and HDL3,. The triglyceride and cholesterol levels of serum very low density (VLDL) and low density (LDL) lipoproteins decreased during treatment (P < 0.001). Serum HDL and HDL, cholesterol levels increased by 37% and 135%, respectively. These changes were positively correlated (r = 0.93; P < 0.001). There was no significant change in mean serum HDL, cholesterol concentration. A negative correlation existed between changes in HDL, and HDL, cholesterol levels (r = −0.54; P < 0.001). Multiple stepwise linear regression analyses revealed that the initial HDL, cholesterol predicted more than 30% of the increase in HDL, cholesterol. Changes in the concentrations of HDL, and HDL, cholesterol after 6 weeks of drug treatment were not related to the type of HLP, neither were these effects of nicotinic acid correlated with changes in VLDL or LDL lipid levels. The concept has previously been proposed, on the basis of in vitro data, that HDL, is formed from HDL, particles in the blood. Our results suggest that, in man, this reaction is stimulated in vivo by prolonged nicotinic acid therapy.

FREQUENCY OF ISCHÆMIC EXERCISE E.C.G. CHANGES IN SYMPTOM-FREE MEN WITH VARIOUS FORMS OF PRIMARY HYPERLIPÆMIA

Abstract Serum cholesterol and triglycerides were measured in approximately 12,000 men attending a screening centre. 130 symptom-free men (aged thirty-five to sixty-five) were selected from the top 2% with the highest lipid values. They, and 59 normolipaemic controls, were studied by recording electrocardiograms (E.C.G.) before and during exercise. The frequency of so-called ischaemic E.C.G. changes (ST-segment depressions Minnesota code 4·1-4·4) increased with age both in controls and in the hyperlipaemic group. Ischaemic E.C.G. changes were significantly more common in all types of hyper-lipaemia (types IIA, IIB, III, and IV) than in controls. The high frequency of the exercise E.C.G. changes in symptom-free hyperlipaemic men reinforces the argument for early treatment of hyperlipaemia to prevent ischaemic heart-disease.

The relation of coronary and peripheral arterial disease to the severity of femoral atherosclerosis in hypercholesterolaemia

Abstract. Objectives. The extent of atherosclerosis in the superficial femoral artery and the severity of arterial disease in the aorto‐iliac and femoro‐popliteal arterial districts were related to clinical diagnosis of coronary and peripheral atherosclerosis in hypercholesterolaemic patients.

Prevalence of femoral atherosclerosis in asymptomatic men with hyperlipoproteinaemia

Abstract. Sixty‐two male subjects with primary hyperlipoproteinaemia of type IIA (n = 18), type IIB (n = 18) or type IV (n = 24) underwent femoral arteriography to investigate the degree of atherosclerosis. All except two were free from symptoms of peripheral arterial disease. The presence of atheroma was determined according to a standardized consensus procedure based on visual interpretation. Atherosclerosis were graded by means of a scoring system, whereby an overall atherosclerosis score (OAS) was calculated for each patient, based on four consecutive segments of the femoral artery. Thirteen type IIA (72%), 14 type IIB (78%) and 18 type IV (75%) patients had femoral atherosclerosis, and the mean OAS in the patients with hyperlipoproteinaemia of these types were 0.58, 0.75 and 0.49, respectively, all with a standard error of the mean about 0.05. The atherosclerosis score increased the more distal the arterial segment, being most prevalent in the lower inferior segment. The OAS was higher in patients of above median age, in those with systolic or diastolic blood pressure above the median and in smokers. Multiple stepwise regression analysis showed that low density lipoproteins cholesterol was highly significantly related to OAS among smokers.