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Objective: To define racial differences in lipoprotein and apolipoprotein levels in girls aged 9 to 10 years. Design: Baseline analysis of a prospective cohort study. Setting: Three clinical sites. Subjects: A total of 1871 black and white girls, aged 9 to 10 years, with complete maturation data (pubic hair and areolar development and menarche) and an 8-hour fast before blood draw. Main Outcome Measures: Anthropometric measures and serum lipid, lipoprotein, and apolipoprotein levels. Results: All analyses were adjusted for maturational differences between blacks and whites (areolar or pubic hair development and menarche). The mean body mass index was marginally higher in black girls than in white girls (18.9 vs 18.3 kg/[m.sup.2]; P=.002), while the sum of skinfolds (34.5 vs 34.8 mm; P=.77) was equivalent. However, both body mass measures were skewed higher at the upper percentiles in black girls. The low-density lipoprotein cholesterol level was similar between black and white girls. Mean triglyceride values were higher in white girls than in black girls (0.92 vs 0.79 mmol/L [8] vs 70 mg/dL]; P [is less than] .001); however, these differences were most pronounced in the upper percentiles. Conversely, mean high-density lipoprotein cholesterol and apolipoprotein A-I levels were higher in black girls than in white girls (1.44 vs 1.37 mmol/L [56 vs 39 mg/dL] and 147 vs 138 mg/dL, respectively; both P [is less than] .001); and again the differences were most evident at the upper end of the distributions. Conclusions: Racial differences in the mean levels of triglycerides, high-density lipoprotein cholesterol, and body mass in girls in the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) at age 9 to 10 years were predominantly the result of differences observed at the upper end of the distributions. The reported black-white differences for mean high-density and low-density lipoprotein cholesterol and triglyceride levels in adult women are comparable to (NGHS) results. Distributional characteristics of these risk factors as well as trends in lipids, lipoproteins, and apolipoproteins, will be evaluated in an ongoing longitudinal assessment that covers the full maturational period. Arch Pediatr Adolesc Med. 1997;151:84-90, There may be racial differences in blood levels of cholesterol and triglycerides in prepubertal girls. Researchers measured blood levels of cholesterol and triglycerides, height-to-weight ratios, and skinfold thickness, a measure of body fat, in 1,871 black and white, 9- to 10-year-old girls. Black girls tended to be heavier for height than white girls while body fat content was similar. White girls averaged higher triglyceride values than black girls. Black girls averaged higher high-density lipoprotein cholesterol and apolipoprotein A-1 levels, a cholesterol component, than white girls. Low-density lipoprotein cholesterol levels were similar.

Objective: To explore genetic mechanisms for pregnancy-associated pancreatitis and hyperlipidemia in two sisters. Design: Case history. Setting: Tertiary care facility with outpatient follow-up. Patients: Two sisters with acute pancreatitis and the acute respiratory distress syndrome were admitted (patient 1) or transferred (patient 2) to an intensive care setting with severely elevated triglyceride levels. Patient 1 was in the last trimester of pregnancy; patient 2 was 1 month postpartum. Both patients were of French Canadian ancestry. Intervention: Acute treatment was directed at stabilizing both patients medically (with fat restriction) and one patient surgically (patient 2). Treatment with fat restriction, weight loss, and gemfibrozil was continued after hospitalization. Results: Through DNA sequencing, we detected a mutation at amino acid residue 188 of lipoprotein lipase (LPL), reflecting product from one allele of the LPL gene in which a glutamine residue was substituted for a glycine (gly188 [right arrow] glu). Conclusion: LPL plays a key role in regulating triglyceride levels in pregnancy. Mutations of LPL may place the patient at risk for pancreatitis. This heterozygous LPL mutation, gly188 [right arrow] glu, is prevalent in certain ethnic groups and may be a common cause of pancreatitis associated with pregnancy., Pregnant women with an inherited genetic mutation may be at greater risk for an inflammatory disorder of the pancreas called pancreatitis. Researchers presented the medical histories of two French Canadian sisters with pancreatitis, one pregnant and one three weeks after delivery. Both sisters had a genetic mutation on a gene that codes for an enzyme important to fat metabolism, lipoprotein lipase. Both had elevated triglyceride and cholesterol levels during the pancreatitis episodes. One patient had a tear in her small intestine, went into respiratory failure, had a burst artery to the spleen, and had blood poisoning associated with the pancreatitis episode. The women lost between 9 and 10 kilograms of weight and their triglyceride and cholesterol levels dropped significantly after one year on a diet limited to 25 grams of fat per day. Both of their babies are healthy.

* Objective: To compare the low-density lipoprotein (LDL) cholesterol-lowering efficacy of low-dose combinations of cholestyramine and fluvastatin. * Design: Randomized, double-blind, parallel group, placebo-controlled trial with a 24-week double-blind treatment period divided into three phases. * Setting: Office-based clinics. * Patients: Hypercholesterolemic, with LDL cholesterol of 4.14 mmol/L or greater (greater than or equal to160 mg/dL) and plasma triglycerides of 3.39 mmol/L or less ([less than or equal to]300 mg/dL). Four hundred sixty patients were screened; 224 patients were randomized into a double-blind treatment period; 203 completed the study; 6 dropped out because of adverse events. * Intervention: Patients were treated with 10 mg or 20 mg of fluvastatin alone, 8 g or 16 g of cholestyramine alone, or combinations of these fluvastatin and cholestyramine dosages (six treatment groups). * Measurements: Changes in lipid variables, particularly LDL cholesterol. * Results: The 10-mg and 20-mg fluvastatin monotherapy groups showed considerable reductions in LDL cholesterol initially -20.1% [SD, 8.8%] and -20.2% [SD, 10.1%],respectively);these reductions were maintained. Reductions in LDL cholesterol that resulted from the addition of cholestyramine, 8 g/d, to 10 mg of fluvastatin and 20 mg of fluvastatin were greater than those observed with monotherapy (10-mg fluvastatin - [10-mg fluvastatin plus cholestyramine], 9.1%; 95% Cl, 3.8% to 14.4%) and 20-mg fluvastatin - [20-mg fluvastatin plus cholestyramine], 11.6%; Cl, 6.5% to 16.8%). The increase in cholestyramine dose to 16 g/d in the three combination groups provided only a modest additional response. * Conclusions: Low-density lipoprotein cholesterol reductions of about 25% to 30% can be achieved with low-dose combination therapy with fluvastatin and cholestyramine. The addition of low-dose resin appears to produce greater overall cholesterol reduction than does a simple doubling of the fluvastatin dosage. The low-dose combination treatment was highly successful in achieving the goals of the National Cholesterol Education Program guidelines., Low doses of fluvastatin used in combination with cholestyramine appear to effectively reduce low-density lipoprotein (LDL) cholesterol levels. The effects of various doses of fluvastatin or cholestyramine used alone or in combination were measured in a group of 203 people with elevated LDL cholesterol levels. Groups receiving either 10 milligrams (mg) or 20 mg of fluvastatin showed similarly lower cholesterol readings after 4 weeks of treatment. Each of these groups was then given an 8 gram daily dose of cholestyramine along with their 10 mg or 20 mg dose of fluvastatin. LDL cholesterol levels dropped even further. LDL cholesterol levels dropped by 25.2% in those taking 10 mg fluvastatin with 8 grams of cholestyramine compared with a 6.2% drop in LDL levels in those taking 20 mg fluvastatin only. This suggests the lower dose of fluvastatin, used in combination with cholestyramine is sufficient. Lower doses also decrease the risks of side effects.

* Objectives: To determine the efficacy of psyllium in reducing serum cholesterol levels in patients on high-or low-fat diets. * Design: Double-blind, placebo-controlled, 16-week parallel trial. The study included an 8-week baseline period and an 8-week treatment period. * Patients: Healthy men and women, 21 to 70 years old, with primary hypercholesterolemia (total serum cholesterol [greater than or equal to] 5.7 mmol/l [220 mg/dL]). Thirty-seven participants followed a high-fat diet and 81 participants followed a low-fat diet. * Intervention: Participants were randomly assigned to either psyllium, 5.1 g twice a day, or placebo. * Measurements: Fasting lipid and apolipoprotein concentrations, including direct low-density lipoprotein (LDL) cholesterol quantification; nutritional analyses of 4 days of 7-day food records to monitor dietary compliance; and physical examinations, clinical chemistry and hematologic studies, and urinalysis to assess treatment safety. * Main Results: Psyllium recipients in both the high-and low-fat diet groups showed small but significant decreases (P < 0.05) in total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Total cholesterol and LDL cholesterol levels decreased 5.8% and 7.2%, respectively, in psyllium recipients on high-fat diets and 4.2% and 6.4%, respectively, in psyllium recipients on low-fat diets. No significant difference was seen in LDL cholesterol response when psyllium recipients on low- and high-fat diets were compared (P > 0.2). No significant reductions in lipid levels were observed in placebo recipients. Based on the National Cholesterol Education Program LDL cholesterol classification system, 39% of the psyllium recipients improved in LDL cholesterol classification (P < 0.0001) compared with 20.3% of placebo recipients (P > 0.2). * Conclusions: Psyllium produces a modest but significant improvement in total cholesterol and LDL cholesterol levels in persons on either low-fat or high-fat diets. Psyllium, when added to a prescribed low-fat diet, may obviate the need for typical lipid-lowering medications or may prove to be a valuable adjunct to other treatments in patients with moderately elevated LDL cholesterol levels., Treatment with psyllium may decrease blood levels of cholesterol in patients with hypercholesterolemia who are on a low-fat or high-fat diet. Hypercholesterolemia is the presence of abnormally high levels of cholesterol in the circulating blood. Psyllium is a naturally occurring substance that contains water-soluble fiber. Among 118 patients between 21 and 70 years old with hypercholesterolemia, 59 were treated with 5.1 grams of psyllium twice a day and 59 were treated with a placebo, an inactive substance. Approximately one-third of the patients in each group were on a high-fat diet, and approximately two-thirds were on a low-fat diet. Treatment with psyllium caused a significant drop in blood levels of total cholesterol and low-density lipoprotein cholesterol. This decrease occurred both in the patients on a low-fat diet and those on a high-fat diet.

Children with hypercholesterolemia may not experience more psychological difficulties than other children. Hypercholesterolemia is increased blood levels of cholesterol. A study compared psychological functioning in 18 children with hypercholesterolemia and their families to that in 14 children with normal blood levels of cholesterol and their families. No difference in psychological functioning was seen between the two groups of children and their families. Families of children with hypercholesterolemia who maintained a well balanced diet were better organized than those who with a fair-to-poor diet. They were also closer and had fewer conflicts. Families of children with hypercholesterolemia may benefit from family therapy in addition to nutritional counseling.

The American Academy of Pediatrics Committee on Nutrition and the National Cholesterol Education Program recommend that blood cholesterol levels be tested in children with family histories of cardiovascular disease before the age of 56 or with parents whose total cholesterol levels are 240 milligrams per deciliter or higher. Children's cholesterol levels should be below 170 milligrams per deciliter. These recommendations and related health aspects are discussed in this article. A screening program for any disease should depend on: (1) the severity of the disease; (2) the ability of the test to accurately identify the disease; (3) the availability of effective treatment; (4) the acceptability of the screening program; and (5) the sensitivity, specificity, and predictive value of the test. Coronary artery disease is widespread, and several lines of evidence indicate that childhood cholesterol levels predict adult disease. These are reviewed. Both dietary change and drugs can lower cholesterol levels in children, but such diets can be hard to maintain, and the drugs can cause side effects. Children identified with high cholesterol can be treated as 'abnormal' by parents and others, and may be offered extreme diets that actually jeopardize their health. False positive results on the screening test can be minimized by offering it only to carefully defined populations, such as those with particular family histories. Options for childhood screening programs include not to screen children; screening only those with family histories of premature atherosclerosis or identified risk factors, such as high blood pressure and obesity; or screening all pediatric patients. The authors' approach is to screen all patients. Different recommendations for treatment are made, depending on the family history of cardiovascular disease. Thus, children with strong family histories are more likely to receive medication, while those without such histories are more likely to just receive advice concerning diet and risk factors. (Consumer Summary produced by Reliance Medical Information, Inc.)

A sex analysis OBJECTIVE -- Hypertriglyceridemia is commonly observed in association with diabetes. Despite cross-sectional studies and isolated longitudinal analyses in patients without coronary artery disease, the suggestion that triglyceride [...]