Felix E. Moore

Serum Lipid Levels in Normal Persons Findings of a Cooperative Study of Lipoproteins and Atherosclerosis

Measurements of Sf 12-20, Sf 20-100, and total serum cholesterol made on 10,690 men and 3,404 women are reported and the relation of lipid level to race, source, age, sex, blood pressure, and weight is described. Distributions for men 40 to 59 are reported in detail. The groups studied, while not selected as representative of the population at large, were remarkably similar in their lipid levels. The lipid levels of only 2 of the 33 groups—Los Angeles and the prisoners—differed significantly from the average. No convincing explanation for either of these exceptions was discovered. The data in this study were mainly from a white population. Data for nonwhites came primarily from 2 aberrant groups and were too meager to allow a clear characterization of lipid levels. The levels for nonwhites from these 2 sources were closer to those of the white members of these groups than to the levels of the general population. Cholesterol levels for men and women were found to be about the same at age 20. For both sexes the level rises with age but at first the rise is much greater for men than women. Above age 50, however, the level is higher for women than men and the level for women continues to rise after that age—at least within the age series for this study. The level for men reaches a peak at age 55, after which it declines. The relation of age and sex with lipid level for Sf 12-20 and Sf 20-100 appeared to be similar to that for cholesterol. Correlations of lipid levels with blood pressure and weight were positive but very low. Hypertension or obesity, however, is associated with some elevation of lipid levels. Sf 20-100 was found to be the most sensitive of the 3 lipid measures to sex and race differences. In the age group 40 to 59 it was the only one that exhibited a definite race and sex differential. In addition, it had the highest correlation with weight and with blood pressure.

Diet, Serum Cholesterol, Protein, Blood Haemoglobin, and Glycosuria in a West Indian Community (St. Kitts, W.I.)

understand how a decision may be influenced by the patients particular circumstances and personality. It might be thought that the large quantity of testosterone given with the thiotepa played a part in producing the responses observed. The possibility cannot be excluded, and it is probable that this substance was partly responsible for the subjective benefit so often seen. If, however, testosterone was also responsible for the objective remissions produced, one would expect some relationship to exist between response to it at a previous stage and subsequent benefit from thiotepa (Table IV): this was not found. On the other hand, the fact that hypophysectomy and thiotepa were effective in similar types of disease suggested an endocrine basis for its action. We have been unable to note any relationship between the clinical outcome of treatment and the dose of drug administered or the marrow depression produced. This may mean either that similar clinical results could be obtained by a reduced dosage, with possibly a smaller mortality, or that our data are inadequate because of the small number of patients. Improved results might be obtained by increasing the maximum dose (285 mg.) of thiotepa in patients who at that level of dosage did not show a serious depression of their blood counts. This would certainly increase the lethal effect of the drug, and in view of the alternative and, as it seems to us, superior methods of treatment, could not be justified. Can the treatment be made safer ? Table III shows that a rapid fall in the blood count to levels necessitating cessation of therapy did not give much information about the ultimate depth of marrow depression. Thus 13 (56%) out of 23 patients able to tolerate doses between 166 and 225 mg. showed eventual severe depression, while those given 226 to 285 mg. showed a similar result. It must be concluded that about half the cases treated will suffer a dangerous degree of marrow depression, and it is difficult either to prevent it or to predict when it will occur. The only way to make treatment safer would be to raise the white-cell and platelet levels at which treatment is stopped. It is likely that this would reduce the number of remissions. We cannot recommend second courses of treatment. The mortality produced (5 deaths out of 13 cases) was high, though it must be admitted that these cases had very advanced disease and were in poor general condition. Summary The results of treatment with thiotepa and testosterone in 46 patients suffering from advanced breast cancer have been presented. The mortality rate was 11%, and an overall remission rate of 37 %, lasting an average of 7.5 months, was obtained. It appeared that premenopausal women with a slowly evolving disease and metastases in bone were more likely to respond to this form of therapy. The hazards and protracted nature of treatment were comparable to those from hypophysectomy, but it was concluded that the results were inferior to those of the operation. We wish to thank Dr. G. A. Lynch for his co-operation in producing the series; Dr. A. T. Barker, whose supervision of in-patients was invaluable; and Dr. G. F. Tinsdale and his staff, who performed many clinico-pathological studies, without which the investigation would have been impossible. We also thank the nursing staffs of the Northern Ireland Radiotherapy Centre and Ward 22 of the Royal Victoria Hospital, Belfast, for carrying out the large amount of work the treatment placed on them. Our appreciation also goes to Mrs. Convey for secretarial help.