Giovanni Abruzzese

Cross-over study on effects of Mediterranean diet in two randomly selected population samples

Two randomly selected population samples in Western Sicily, one rural (n 40) and one urban (n 40), were studied to evaluate the impact of dietary intervention on lipid, coagulative and fibrinolytic parameters. The two groups received the diets in a cross-over design with the following sequences: (a) baseline period; (b) 8-week dietary intervention period; (c) 8-week return to the original diet. During (a) and (c) all subjects consumed their usual diet. During the dietary intervention period (b), the rural sample consumed the urban sample’s diet, while the urban sample consumed the rural sample’s diet (the so-called “Mediterranean diet”). At baseline, after 8 weeks’ dietary intervention period and after 8 weeks’ return to the original diet, the following parameters were measured: blood glucose, total cholesterol, HDL-cholesterol, triglycerides, apolipoproteins A1 and B100, fibrinogen, factors VII and VIII, tissue plasminogen activator and plasminogen activator inhibitor Our results show a positive effect of the Mediterranean diet on lipid, coagulative and fibrinolytic parameters which play a key role in the pathogenesis of atherosclerosis and indicate that this dietary pattern may help in the primary prevention of CHD.

Activation of coagulation but normal fibrinolysis in patients with type IIa hyperlipoproteinemia

Abstract Disturbances in lipid metabolism such as hypercholesterolemia or hypertriglyceridemia are widely accepted risk factor for atherosclerosis (1). Recent studies have suggested that a hypercoagulable state and a reduced fibrinolytic activity may also be independent risk factors for atherosclerotic vascular disease and thrombo-embolic complications (2–3). Moreover these studies should be considered with the significant evidence that shows several complex interactions which occur between the lipid and hemostatic system. In fact a positive correlation was found between Factor VII coagulant activity and dietary fat intake and between platelet thromboxane production and serum total cholesterol levels (4–6). Finally, several authors suggest a positive correlation between impaired fibrinolysis and serum triglyceride levels, whereas studies on fibrinolytic system in hypercholesterolemic patients are very few (7–9). The aim of this study was to verify the existence of a thrombophilic state in patients with type IIa hyperlipoproteinemia without signs of atherosclerotic vascular disease in order to suggest an appropriate primary prevention.

Elevated levels of lipoprotein (a) in patients suffering from myocardial infarction with carotid atherosclerotic lesions.

The aim of the present study was to evaluate metabolic, coagulation and fibrinolytic parameters in 45 patients [31 men, 14 women, aged 56.5 +/- 3.5 years (mean +/- SD)] who had suffered myocardial infarction more than 6 months earlier, with or without carotid atherosclerotic lesions. After the extracranial carotid arteries had been evaluated using a B-mode Duplex scanning system, patients were subdivided into two groups: group 1 (n = 20) with carotid plaques or measurable intima-media thickness; and group 2 (n = 25) without carotid plaques or measurable intima-media thickness. Twenty-two age- and sex-matched subjects were recruited as controls (group 3). Groups 1 and 2 displayed significantly higher levels of total cholesterol, apolipoprotein B, human autoantibodies against oxidised low-density lipoprotein and the c fraction of the third component system, and significantly lower levels of high-density lipoprotein cholesterol and apolipoprotein A1 than group 3. However, serum levels of triglyceride and lipoprotein (a) were significantly higher in group 1 than in the control group. Moreover, groups 1 and 2 displayed significantly higher levels of factor VII, fibrinogen, fragment 1+2, thrombin-antithrombin complex and plasminogen activator inhibitor after venous occlusion, and significantly lower levels of tissue-type plasminogen activator after venous occlusion than group 3. Significantly higher levels of tissue-type plasminogen activator and plasminogen activator inhibitor before venous occlusion were observed in groups 1 and 2 and significantly lower levels of antithrombin III, protein C and protein S were observed in group 1 compared with the controls. Patients were also analysed according to levels of lipoprotein (a). The lowest levels of tissue-type plasminogen activator after venous occlusion and the highest levels fragment 1 + 2, the c fraction of the third component system, and plasminogen activator inhibitor after venous occlusion were observed in patients with the highest levels of lipoprotein (a). Our data demonstrate an activation of coagulation and deficient fibrinolysis in survivors of myocardial infarction, particularly in those with associated carotid atherosclerotic lesions. We speculate that this thrombophilic state may play a key role in the pathogenesis of atherosclerotic vascular disease and thromboembolic complications.