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OBJETIVO: Analisar o padrão de consumo alimentar avaliado por meio de escores de consumo e relacionar esses escores com os níveis de colesterol total e de lipoproteínas de baixa e alta densidades em população da área metropolitana de São Paulo. MÉTODOS: Estudo transversal realizado no município de Cotia, São Paulo, em amostra representativa de 1.045 adultos, foram determinados níveis de lipídeos séricos e a ingestão de alimentos por meio da freqüência de consumo alimentar. Foram utilizados escores de padrão de consumo, estabelecendo um peso para cada categoria de consumo baseado na freqüência anual, obtendo-se, assim, a distribuição quintilar do escore I (alimentos considerados de risco para doenças cardiovasculares) e escore II (alimentos protetores). Foram comparados os valores médios das lipoproteínas para cada um dos quintis pela análise de variância, e foram verificadas possíveis relações entre os escores de consumo e as frações de lipídeos séricos, mediante modelos de regressão linear múltipla (stepwise forward). RESULTADOS: Observou-se aumento significativo dos níveis médios de lipídeos, segundo quintis de consumo do escore I para colesterol total e para lipoproteína de baixa densidade-colesterol, e constatou-se um comportamento inverso e significativo dos níveis desses lipídeos séricos em relação ao escore II. O escore I correlacionou-se positivamente e significativamente a esses lipídeos, e o escore II apresentou correlação inversa e significativa com esses constituintes sangüíneos. CONCLUSÕES: Em estudos populacionais, a análise da freqüência de consumo de alimentos por meio de escores pode ser um método de escolha para avaliar qualidade de dieta e de seu potencial efeito nos níveis séricos de colesterol total e de lipoproteínas de baixa densidade.OBJECTIVE: To study food patterns assessed using scores of consumption and their relationship with serum total cholesterol (TOTAL-C), low density lipoprotein-cholesterol (LDL-C) and high density lipoproteins (HDL-C) concentration in the population of the metropolitan area of São Paulo, Brazil. METHODS: Data on food frequency consumption (FFC), serum lipids, and other covariates were available for a representative sample of 1,045 adults. A 12-month retrospective food frequency questionnaire was used. FFC was assessed using scores of consumption, which was obtained by grouping food according to their composition into two large groups: score I (known as risk food for cardiovascular diseases) and score II (known as healthy food). The association between the scores and serum blood lipoprotein levels among the study population was analyzed through multiple linear regression analyses. Modeling step-wise techniques were used to enter the covariates into the linear models. RESULTS: Increasing mean levels of TOTAL-C and LDL-C were seen from the lowest through the highest quintile of score I when compared to the score II, where decreasing mean levels of TOTAL-C and LDL-C were observed from the lowest to the highest quintile. The results of the linear regression analyses between serum TOTAL-C and LDL-C levels for both FFC score I and score II, after multivariate adjusting, showed a significant positive relationship with score I and a significant and inverse relationship with score II. CONCLUSIONS: In population studies, FFC analyses through scores can be the choice method to evaluate the quality of diet and its potential effect on serum levels of TOTAL-C and LDL-C.

OBJECTIVE: To identify the association between food group consumption frequency and serum lipoprotein levels among adults. METHODS: The observations were made during a cross-sectional survey of a representative sample of men and women over 20 years old living in Cotia county, S. Paulo, Brazil. Data on food frequency consumption, serum lipids, and other covariates were available for 1,045 adults. Multivariate analyses adjusted by age, gender, body mass index, waist-to-hip ratio, educational level, family income, physical activity, smoking, and alcohol consumption were performed. RESULTS: Consumption of processed meat, chicken, red meat, eggs and dairy foods were each positively and significantly correlated with LDL-C, whereas the intake of vegetables and fruits showed an inverse correlation. Daily consumption of processed meat, chicken, red meat, eggs, and dairy foods were associated with 16.6 mg/dl, 14.5 mg/dl, 11.1 mg/dl, 5.8 mg/dl, and 4.6 mg/dl increase in blood LDL-C, respectively. Increases of daily consumption of fruit and vegetables were associated with 5.2 mg/dl and 5.5 mg/dl decreases in LDL-C, respectively. Alcohol beverage consumption showed a significant positive correlation with HDL-C. CONCLUSIONS: Dietary habits in the study population seem to contribute substantially to the variation in blood LDL and HDL concentrations. Substantially CHD risk reduction could be achieved with dietary changes.OBJETIVO: Identificar a associação entre a freqüência de consumo de diferentes grupos de alimentos e níveis de lipídios séricos de adultos. MÉTODOS: As observações pertencem a um estudo transversal e correspondem a uma amostra representativa de 1.045 adultos de ambos os sexos, de 20 anos ou mais, residentes no município de Cotia, SP, Brasil. Foram determinados a ingestão de alimentos pela freqüência de consumo alimentar, níveis de lipídios séricos e outras variáveis. Foram elaborados modelos de regressão linear múltipla (stepwise forward) para LDL-C e HDL-C, ajustados por: idade, sexo, índice de massa corpórea, relação cintura quadril, nível educacional, renda familiar, atividade física, tabagismo e etilismo. RESULTADOS: O consumo de carnes (bovina, suína, aves, vísceras e carnes processadas), leite e derivados e ovos correlacionou-se positiva e significativamente com LDL-C. O consumo de frutas e hortaliças mostraram correlação inversa e significativa. O consumo de: carnes de aves, carnes vermelhas, ovos e leite e derivados foram associados com um aumento na LDL-C de 16,6 mg/dl, 14,5 mg/dl, 11,1 mg/dl, 5,8mg/dl, e 4,6 mg/dl, respectivamente. O aumento no consumo de frutas e hortaliças foi correlacionado com uma redução de 5,2 mg/dl e 5,5 mg/dl nos níveis de LDL-C, respectivamente. O consumo de bebidas alcoólicas se correlacionou positiva e significativamente com a fração HDL-C. CONCLUSÕES: Na população brasileira estudada observou-se que os hábitos alimentares parecem contribuir para as variações na concentração dos lipídios séricos de LDL-C e HDL-C. Redução nos riscos de doenças cardiovasculares podem ser alcançadas por meio de controle dietético.

Los estudios que vinculan al colesterol con el desarrollo de la aterosclerosis, datan de la década de los años 50, los factores de riesgo cardiovascular como la hipertensión arterial, la diabetes mellitus, el tabaquismo y la obesidad entre otros, han mostrado tener una fuerte asociación con el colesterol. En el presente artículo se aborda los elementos básicos actuales de la fisiopatología de la aterosclerosis relacionados con el colesterol y la pared arterial, se incluyó la fisiopatología de las lipoproteínas de baja densidad asociadas con el colesterol (LDL-c), los factores que influyen en su concentración entre los fluidos de la íntima y los extravasculares, el papel de las LDL-c modificadas en la íntima vascular, la contribución de la Lp(a) al desarrollo de la aterosclerosis, así como la participación de lipoproteínas de alta densidad asociados con el colesterol (HDL-c) y su transporte reverso como mecanismo que se opone al proceso aterosclerótico.The studies linking cholesterol to the development of atherosclerosis date back to the 1950s. The cardiovascular risk factors such as hypertension, diabetes mellitus, smoking and obesity, among others, have proved to have a strong association with cholesterol. In this paper the present basic elements of the physiopathology of atherosclerosis related to cholesterol and to the arterial wall are approached. The physiopathology of the low density lipoproteins cholesterol (LDL-c), the factors influencing on its concentration among the fluids of the intima and the extravascular fluids, the role of the modified LDL-c in the vascular intima, the contribution of Lp(a) to the development of atherosclerosis, as well as the participation of high density lipoproteins quit on cholesterol (HDL-c) and its reverse transport as a mechanism opposing to the atherosclerotic process are also included.

Se comparó el efecto hipocolesterolémico de la colestiramina con la colestina, 2 fármacos de similar mecanismo de acción, en conejos Nueva Zelandia que recibieron estos productos incorporados al pienso en una dosis del 2 % durante 45 días. Al término del estudio se encontró en los grupos de animales que recibieron la colestiramina y la colestina una disminución significativa (p < 0,01) de las concentraciones del colesterol sérico con respecto a los niveles de pretratamiento y con el grupo control. Las reducciones del colesterol sérico obtenidas con ambos fármacos fueron 35,5 y 36 % respectivamente. El resto de las variables lipídicas estudiadas no sufrieron cambios de consideración. Los resultados demuestran que la colestina tiene un efecto hipocolesterolémico similar al de la colestiramina.The hypocholesteremic effect of cholestyramine was compared with that of cholestene, 2 drugs of similar action mechanism, in rabbits from New Zealand that were administered a 2 % dose of these products through the feed during 45 days. At the end of the study, a significant reduction (p < 0,01) of the serum cholesterol concentrations was found in the group of animals that received cholestyramine and cholestene compared with the pretreatment levels and with the control group. The serum cholesterol reduction obtained with both drugs were of 35,5 and 36, respectively. No considerable changes were observed in the rest of the lipidic variables. The results show that the cholesteremic effect of cholestene is similar to that of cholestyramine.

Background Determination of C-reactive protein (CRP) level has been suggested to improve cardiovascular disease (CVD) risk assessment. This study examines the utility of CRP levels to assess CVD risk in a community setting. Methods We performed a prospective observational cohort study on a community population sample. A total of 1949 men and 2497 women without CVD from the Framingham Heart Study underwent CVD risk factor assessment. Initial CVD events during 8 years of follow-up were recorded. Results There were 283 major CVD and 160 major coronary heart disease incident events. Age-, sex-, and multivariable-adjusted analyses generally used CRP level categories of less than 1, 1 to 3, and greater than 3 mg/L. In age- and sex-adjusted models, the traditional risk factors and elevated CRP levels indicated increased risk. The age- and sex-adjusted relative risk (RR) and 95% confidence interval (CI) of CRP level greater than 3 mg/L for major CVD was elevated (RR, 1.60; 95% CI, 1.19-2.14), with evidence of attenuation (RR, 1.22; 95% CI, 0.90-1.66) in multivariable models. The C statistic, a measure of the discriminatory capability of the prediction models, was 0.74 for prediction of major CVD with age and CRP level. In multivariable models that included traditional risk factors, the C statistic was 0.78, a value that was unchanged with the addition of CRP to the multivariable model. Similar relations were noted for major coronary heart disease events. Conclusion Elevated CRP level provided no further prognostic information beyond traditional office risk factor assessment to predict future major CVD and major coronary heart disease in this population sample. [ABSTRACT FROM AUTHOR]

Context Reduced intake of saturated fat is widely recommended for prevention of cardiovascular disease. The type of macronutrient that should replace saturated fat remains uncertain. Objective To compare the effects of 3 healthful diets, each with reduced saturated fat intake, on blood pressure and serum lipids. Design, Setting, and Participants Randomized, 3-period, crossover feeding study (April 2003 to June 2005) conducted in Baltimore, Md, and Boston, Mass. Participants were 164 adults with prehypertension or stage 1 hypertension. Each feeding period lasted 6 weeks and body weight was kept constant. Interventions A diet rich in carbohydrates; a diet rich in protein, about half from plant sources; and a diet rich in unsaturated fat, predominantly monounsaturated fat. Main Outcome Measures Systolic blood pressure and low-density lipoprotein cholesterol. Results Blood pressure, low-density lipoprotein cholesterol, and estimated coronary heart disease risk were lower on each diet compared with baseline. Compared with the carbohydrate diet, the protein diet further decreased mean systolic blood pressure by 1.4 mm Hg (P = .002) and by 3.5 mm Hg (P = .006) among those with hypertension and decreased low-density lipoprotein cholesterol by 3.3 mg/dL (0.09 mmol/L; P = .01), high-density lipoprotein cholesterol by 1.3 mg/dL (0.03 mmol/L; P = .02), and triglycerides by 15.7 mg/dL (0.18 mmol/L; P<.001). Compared with the carbohydrate diet, the unsaturated fat diet decreased systolic blood pressure by 1.3 mm Hg (P = .005) and by 2.9 mm Hg among those with hypertension (P = .02), had no significant effect on low-density lipoprotein cholesterol, increased high-density lipoprotein cholesterol by 1.1 mg/dL (0.03 mmol/L; P = .03), and lowered triglycerides by 9.6 mg/dL (0.11 mmol/L; P = .02). Compared with the carbohydrate diet, estimated 10-year coronary heart disease risk was lower and similar on the protein and unsaturated fat diets. Conclusion In the setting of a healthful diet, partial substitution of carbohydrate with either protein or monounsaturated fat can further lower blood pressure, improve lipid levels, and reduce estimated cardiovascular risk. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT00051350. [ABSTRACT FROM AUTHOR]

Background Although dyslipidemia and hypertension occur together more often than can be explained by chance, few studies have carefully explored the nature of the relationship between plasma lipid levels and the risk of developing hypertension. Methods We conducted a prospective study of 16 130 middle-aged and older female health professionals in 1992 who provided baseline blood samples and had no history of high cholesterol level (no treatment or diagnosis) or hypertension (no treatment, diagnosis, or elevated blood pressure). Plasma lipid levels were measured, and baseline risk factors were collected. Incident hypertension included a new physician diagnosis, the initiation of antihypertensive treatment, systolic blood pressure of 140 mm Hg or greater, or diastolic blood pressure of 90 mm Hg or greater. Results During 10.8 years of follow-up, incident hypertension developed in 4593 women. In multivariate-adjusted models, the relative risks of development of hypertension from the lowest (referent) to the highest quintile of baseline total cholesterol level were 1.00, 0.96, 1.02, 1.09, and 1.12 (P = .002 for trend); for low-density lipoprotein cholesterol level, 1.00, 0.97, 1.00, 1.02, and 1.11 (P = .053 for trend); for high-density lipoprotein cholesterol level, 1.00, 0.93, 0.87, 0.87, and 0.81 (P<.001 for trend); for non–high-density lipoprotein cholesterol level, 1.00, 1.06, 1.11, 1.12, and 1.25 (P<.001 for trend); and for the ratio of total to high-density cholesterol, 1.00, 1.10, 1.14, 1.20, and 1.34 (P<.001 for trend). Similar relative risks were noted for Adult Treatment Panel III clinical cut points and after the exclusion of obese or diabetic women. Conclusion In this large prospective cohort, atherogenic dyslipidemias were associated with the subsequent development of hypertension among healthy women. [ABSTRACT FROM AUTHOR]

Context Serum total and low-density lipoprotein (LDL) cholesterol contribute significantly to atherosclerosis and its clinical sequelae. Previous analyses of data from the National Health and Nutrition Examination Surveys (NHANES) showed that mean levels of total cholesterol of US adults had declined from 1960-1962 to 1988-1994, and mean levels of LDL cholesterol (available beginning in 1976) had declined between 1976-1980 and 1988-1994. Objective To examine trends in serum lipid levels among US adults between 1960 and 2002, with a particular focus on changes since the 1988-1994 NHANES survey. Design, Setting, and Participants Blood lipid measurements taken from 6098 to 15 719 adults who were examined in 5 distinct cross-sectional surveys of the US population during 1960-1962, 1971-1974, 1976-1980, 1988-1994, and 1999-2002. Main Outcome Measures Mean serum total cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol, and geometric mean serum triglyceride levels, and the percentage of adults with a serum total cholesterol level of at least 240 mg/dL (≥6.22 mmol/L). Results Between 1988-1994 and 1999-2002, total serum cholesterol level of adults aged 20 years or older decreased from 206 mg/dL (5.34 mmol/L) to 203 mg/dL (5.26 mmol/L) (P=.009) and LDL cholesterol levels decreased from 129 mg/dL (3.34 mmol/L) to 123 mg/dL (3.19 mmol/L) (P<.001). Greater and significant decreases were observed in men 60 years or older and in women 50 years or older. The percentage of adults with a total cholesterol level of at least 240 mg/dL (≥6.22 mmol/L) decreased from 20% during 1988-1994 to 17% during 1999-2002 (P<.001). There was no change in mean HDL cholesterol levels and a nonsignificant increase in geometric mean serum triglyceride levels (P = .06). Conclusions The decrease in total cholesterol level observed during 1960-1994 and LDL cholesterol level observed during 1976-1994 has continued during 1999-2002 in men 60 to 74 years and women 50 to 74 years. The target value of no more than 17% of US adults with a total cholesterol level of at least 240 mg/dL (≥6.22 mmol/L), an objective of Healthy People 2010, has been attained. The increase in the proportion of adults using lipid-lowering medication, particularly in older age groups, likely contributed to the decreases in total and LDL cholesterol levels observed. The increased prevalence of obesity in the US population may have contributed to the increase in mean serum triglyceride levels. [ABSTRACT FROM AUTHOR]

Context Current guidelines for cardiovascular risk detection are controversial with regard to the clinical utility of different lipid measures, non–high-density lipoprotein cholesterol (non–HDL-C), lipid ratios, apolipoproteins, and C-reactive protein (CRP). Objective To directly compare the clinical utility of total cholesterol, low-density lipoprotein cholesterol (LDL-C), HDL-C, non–HDL-C, apolipoproteins A-I and B100, high-sensitivity CRP, and the ratios of total cholesterol to HDL-C, LDL-C to HDL-C, apolipoprotein B100 to apolipoprotein A-I, and apolipoprotein B100 to HDL-C as predictors of future cardiovascular events in women. Design, Setting, and Participants Prospective cohort study of 15 632 initially healthy US women aged 45 years or older (interquartile range, 48-59 years) who were enrolled between November 1992 and July 1995. All participants were followed up over a 10-year period for the occurrence of future cardiovascular events. Main Outcome Measure Hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever major cardiovascular events (N = 464) according to baseline levels of each biomarker. Results After adjustment for age, smoking status, blood pressure, diabetes, and body mass index, the HRs for future cardiovascular events for those in the extreme quintiles were 1.62 (95% CI, 1.17-2.25) for LDL-C, 1.75 (95% CI, 1.30-2.38) for apolipoprotein A-I, 2.08 (95% CI, 1.45-2.97) for total cholesterol, 2.32 (95% CI, 1.64-3.33) for HDL-C, 2.50 (95% CI, 1.68-3.72) for apolipoprotein B100, 2.51 (95% CI, 1.69-3.72) for non–HDL-C, and 2.98 (95% CI, 1.90-4.67) for high-sensitivity CRP (P<.001 for trend across all quintiles). The HRs for the lipid ratios were 3.01 (95% CI, 2.01-4.50) for apolipoprotein B100 to apolipoprotein A-I, 3.18 (95% CI, 2.12-4.75) for LDL-C to HDL-C, 3.56 (95% CI, 2.31-5.47) for apolipoprotein B100 to HDL-C, and 3.81 (95% CI, 2.47-5.86) for the total cholesterol to HDL-C (P<.001 for trend across all quintiles). The correlation coefficients between high-sensitivity CRP and the lipid parameters ranged from -0.33 to 0.15, and the clinical cut points for CRP of less than 1, 1 to 3, and higher than 3 mg/L provided prognostic information on risk across increasing levels of each lipid measure and lipid ratio. Conclusions Non–HDL-C and the ratio of total cholesterol to HDL-C were as good as or better than apolipoprotein fractions in the prediction of future cardiovascular events. After adjustment for age, blood pressure, smoking, diabetes, and obesity, high-sensitivity CRP added prognostic information beyond that conveyed by all lipid measures. [ABSTRACT FROM AUTHOR]

Background The “lipid criteria” consist of a triglyceride (TG) level of 130 mg/dL (1.47 mmol/L) or greater and a ratio of TG to high-density lipoprotein cholesterol (HDL-C) of 3 or greater. In Caucasians, the lipid criteria predict insulin resistance in individuals with a body mass index (BMI) of 25 kg/m2 or greater. Our goal was to determine whether TG levels or TG–HDL-C ratio predicted insulin resistance in African Americans with a BMI of 25 kg/m2 or more. Methods Of 125 African Americans, the 98 with a BMI of 25 kg/m2 or more participated. All subjects had frequently sampled intravenous glucose tolerance tests with insulin resistance determined by the insulin sensitivity index. Subjects were divided into the following tertiles by insulin sensitivity: 12.8 to 4.3, 4.2 to 2.3, and 2.2 to 0.2 mU/L per minute. Insulin resistance was defined as being in the third tertile. Across tertiles, the distribution of variables was compared by 1-way analysis of variance. Areas under the receiver operating characteristic curve were determined to identify variables that predicted insulin resistance. Results Fasting insulin level, BMI, and waist circumference increased across tertiles (all P<.01), but TG levels and TG–HDL-C ratio did not (all P≥.3). The mean ± SE areas under the curves for fasting insulin, BMI, and waist circumference were 0.85 ± 0.04, 0.72 ± 0.05, and 0.71 ± 0.05, respectively. For TG level and TG–HDL-C ratio, the areas under the curves were 0.55 ± 0.06 and 0.56 ± 0.06, respectively, meaning that the true-positive rate was nearly equal to the false-positive rate. Therefore, they could not be used as markers of insulin resistance. Furthermore, 17 subjects met the lipid criteria but only 7 were in the insulin-resistant tertile, making the sensitivity of these criteria to identify insulin resistance only 17%. Conclusion In African Americans, TG levels and TG–HDL-C ratio are not reliable markers of insulin resistance. [ABSTRACT FROM AUTHOR]

Few studies have examined the impact of weight history. Extant data from the Atherosclerosis Risk in Communities Study were used to compare risk factors for normal-weight (body mass index: 18.5–24.9 kg/m2) adults with a history of weight loss (n = 775) with those for persons with a history of weight maintenance (n = 5,164). In this 1987–1998 US study, the authors also compared risk factors for preobese (body mass index: 25.0–29.9 kg/m2) adults with a history of weight gain (n = 1,296) versus weight maintenance (n = 6,721). They used mixed-models regression to adjust for ethnicity, gender, age, education, field center, smoking, alcohol consumption, follow-up time, and follow-up body mass index. Compared with adults with a history of weight maintenance, adults with a 3-year history of weight loss had more favorable total and low density lipoprotein cholesterol levels and similar glucose, high density lipoprotein cholesterol, and triglyceride levels. In contrast, preobese adults with a 3-year history of weight gain had equivalent glucose and lipid levels at follow-up compared with adults with a history of weight maintenance. These findings suggest that, in addition to current weight, weight history may impact glucose and lipid levels. [ABSTRACT FROM AUTHOR]

Context: Low birth weight is associated with increased cardiovascular disease in adulthood, and differences in the molecular weight, composition, and quantity of lipoprotein subclasses are associated with coronary artery disease. Objective: To determine if there are novel patterns of lipoprotein heterogeneity in low-birth-weight infants. Design, Setting, and Participants: Prospective study at a US medical center of a representative sample of infants (n = 163; 70 white and 93 black) born at 28 or more weeks of gestational age between January 3, 2000, and September 27, 2000. This sample constituted 20% of all infants born during the study period at this site. Main Outcome Measures: Plasma levels and particle sizes of lipoprotein subclasses and plasma concentrations of lipids, lipoproteins (high-density lipoprotein [HDL] and low-density lipoprotein [LDL]), and apolipoproteins. Results: An elevated lipoprotein peak of a particle with density between 1.062 and 1.072 g/mL was identified using physical-chemical methods. This subclass of large HDL was enriched in apolipoprotein C-I (apo C-I). Based on the amount of the apo C-I–enriched HDL peak, 156 infants were assigned to 1 of 4 groups: 0 (none detected), 17%; 1 (possibly present), 41%; 2 (probably present), 22%; 3 (elevated), 19%. Infants in group 3, compared with those in the other 3 groups, had significantly (P<.001) lower mean birth weight (2683.7 vs 3307.1 g) and younger mean gestational age (36.2 vs 39.3 wk). After correction for age, infants in group 3 had significantly higher levels of total and large HDL cholesterol and of total and large LDL cholesterol and LDL particle number. However, infants in group 3 had lower levels of small HDL, very low-density lipoproteins, and triglycerides than infants in the other 3 groups. This lipoprotein profile differed from that in infants born small for gestational age, who had significantly higher triglyceride (P<.001) and apo B (P = .04) levels, but lower levels of total and large HDL cholesterol (P<.001) and apo A-I (P<.001). Conclusions: Because apo C-I–enriched HDL, and purified apo C-I alone, promotes apoptosis in vitro, increased amounts of this particle may have physiological significance and identify a novel group of low-birth-weight infants apparently distinct from traditionally classified small-for-gestational-age infants. [ABSTRACT FROM AUTHOR]

Background Substitution of dietary polyunsaturated for saturated fat has long been recommended for the primary prevention of cardiovascular disease (CVD), but only a few prospective cohort studies have provided support for this advice. Methods We assessed the association of dietary linoleic and total polyunsaturated fatty acid (PUFA) intake with cardiovascular and overall mortality in a population-based cohort of 1551 middle-aged men. Dietary fat composition was estimated with a 4-day food record and serum fatty acid composition. Results During the 15-year follow-up, 78 men died of CVD and 225 of any cause. Total fat intake was not related to CVD or overall mortality. Men with an energy-adjusted dietary intake of linoleic acid (relative risk [RR] 0.39; 95% confidence interval [CI], 0.21-0.71) and PUFA (RR, 0.38; 95% CI, 0.20-0.70) in the upper third were less likely to die of CVD than men with intake in the lower third after adjustment for age. Multivariate adjustment weakened the association somewhat. Mortality from CVD was also lower for men with proportions of serum esterified linoleic acid (RR, 0.42; 95% CI, 0.21-0.80) and PUFA (RR, 0.25; 95% CI, 0.12-0.50) in the upper vs lower third, with some attenuation in multivariate analyses. Serum and to a lesser extent dietary linoleic acid and PUFA were also inversely associated with overall mortality. Conclusions Dietary polyunsaturated and more specifically linoleic fatty acid intake may have a substantial cardioprotective benefit that is also reflected in overall mortality. Dietary fat quality seems more important than fat quantity in the reduction of cardiovascular mortality in men. [ABSTRACT FROM AUTHOR]

Context The scarcity of data addressing the health effects of popular diets is an important public health concern, especially since patients and physicians are interested in using popular diets as individualized eating strategies for disease prevention. Objective To assess adherence rates and the effectiveness of 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and cardiac risk factor reduction. Design, Setting, and Participants A single-center randomized trial at an academic medical center in Boston, Mass, of overweight or obese (body mass index: mean, 35; range, 27-42) adults aged 22 to 72 years with known hypertension, dyslipidemia, or fasting hyperglycemia. Participants were enrolled starting July 18, 2000, and randomized to 4 popular diet groups until January 24, 2002. Intervention A total of 160 participants were randomly assigned to either Atkins (carbohydrate restriction, n=40), Zone (macronutrient balance, n=40), Weight Watchers (calorie restriction, n=40), or Ornish (fat restriction, n=40) diet groups. After 2 months of maximum effort, participants selected their own levels of dietary adherence. Main Outcome Measures One-year changes in baseline weight and cardiac risk factors, and self-selected dietary adherence rates per self-report. Results Assuming no change from baseline for participants who discontinued the study, mean (SD) weight loss at 1 year was 2.1 (4.8) kg for Atkins (21 [53%] of 40 participants completed, P = .009), 3.2 (6.0) kg for Zone (26 [65%] of 40 completed, P = .002), 3.0 (4.9) kg for Weight Watchers (26 [65%] of 40 completed, P < .001), and 3.3 (7.3) kg for Ornish (20 [50%] of 40 completed, P = .007). Greater effects were observed in study completers. Each diet significantly reduced the low-density lipoprotein/high-density lipoprotein (HDL) cholesterol ratio by approximately 10% (all P<.05), with no significant effects on blood pressure or glucose at 1 year. Amount of weight loss was associated with self-r... [ABSTRACT FROM AUTHOR]

Context The Framingham Heart Study helped to establish tools to assess coronary heart disease (CHD) risk, but the homogeneous nature of the Framingham population prevents simple extrapolation to other populations. Recalibration of Framingham functions could permit various regions of the world to adapt Framingham tools to local populations. Objective To evaluate the performance of the Framingham CHD risk functions, directly and after recalibration, in a large Chinese population, compared with the performance of the functions derived from the Chinese Multi-provincial Cohort Study (CMCS). Design, Setting, and Participants The CMCS cohort included 30 121 Chinese adults aged 35 to 64 years at baseline. Participants were recruited from 11 provinces and were followed up for new CHD events from 1992 to 2002. Participants in the Framingham Heart Study were 5251 white US residents of Framingham, Mass, who were 30 to 74 years old at baseline in 1971 to 1974 and followed up for 12 years. Main Outcome Measures "Hard" CHD (coronary death and myocardial infarction) was used as the end point in comparisons of risk factors (age, blood pressure, smoking, diabetes, total cholesterol, and high-density lipoprotein cholesterol [HDL-C]) as evaluated by the CMCS functions, original Framingham functions, and recalibrated Framingham functions. Results The CMCS cohort had 191 hard CHD events and 625 total deaths vs 273 CHD events and 293 deaths, respectively, for Framingham. For most risk factor categories, the relative risks for CHD were similar for Chinese and Framingham participants, with a few exceptions (ie, age, total cholesterol of 200-239 mg/dL [5.18-6.19 mmol/L], and HDL-C less than 35 mg/dL [0.91 mmol/L] in men; smoking in women). The discrimination using the Framingham functions in the CMCS cohort was similar to the CMCS functions: the area under the receiver operating characteristic curve was 0.705 for men and 0.742 for women using the Framingham functions vs 0.736 for men and 0.759 for women using the CMCS functions. However, the original Framingham functions systematically overestimated the absolute CHD risk in the CMCS cohort. For example, in the 10th risk decile in men, the predicted rate of CHD death was 20% vs an actual rate of 3%. Recalibration of the Framingham functions using the mean values of risk factors and mean CHD incidence rates of the CMCS cohort substantially improved the performance of the Framingham functions in the CMCS cohort. Conclusions The original Framingham functions overestimated the risk of CHD for CMCS participants. Recalibration of the Framingham functions improved the estimates and demonstrated that the Framingham model is useful in the Chinese population. For regions that have no established cohort, recalibration using CHD rates and risk factors may be an effective method to develop CHD risk prediction algorithms suited for local practice. [ABSTRACT FROM AUTHOR]

Growing evidence indicates that physi- cal exercise can prevent at least some of the negative effects on health associated with early menopause. Here we determine the effects of intense exercise on physical fitness, bone mineral density (BMD), back pain, and blood lipids in early postmenopausal women. After 26 months, significant exercise effects determined as percentage changes compared with baseline were observed for physical fitness(isometricstrength:trunk extensors [EG +36.5% vs CG +1.7%], trunk flexors [EG +39.3% vs CG ­0.4%], and maximum oxygen consumption[EG+12.4%vsCG­2.3%]);BMD(lumbarspine[DXA L1-L4, EG +0.7% vs CG ­2.3%], QCT L1-L3 trabecular region of interest [EG +0.4% vs CG ­6.6%], QCT L1-L3 cortical region of interest [EG +3.1% vs CG -1.7%], and total hip [DXA, EG ­0.3% vs CG ­1.7%]); serum levels (total cholesterol [EG ­5.0% vs CG +4.1%] and triglycerides [EG ­14.2% vs CG +23.2%]); and pain indexes at the spine. General purpose exercise programs with special emphasis on bone density can significantly im- prove strength and endurance and reduce bone loss, back pain, and lipid levels in osteopenic women in their critical early postmenopausal years. [ABSTRACT FROM AUTHOR]

Combination therapy to improve the total lipid profile may achieve greater coronary risk reductions than lowering low-density lipo protein cholesterol(LDL-C) alone.Anewextended-release niacin(niacinER)/lovastatin tablet substantially lowersLDL-C,triglyceride,andlipoprotein (a) levels and raises high-density lipoprotein cholesterol (HDL-C) level. We evaluated these serum lipid responses to niacin ER/lovastatin at all clinically reasonable doses. For primary comparisons, mean LDL-C level reductions from baseline were greater with niacin ER/lovastatin (1500/20 mg) than with lovastatin (20 mg) (35% vs 22%, P <.001) and with niacin ER/lovastatin (2000/40 mg) than with lovastatin (40 mg) (46% vs 24%, P<.001). Each 500-mg increase in niacin ER, on average, decreased LDL-C levels an addi- tional 4% and increased HDL-C levels 8%. The maxi- mum recommended dose (2000/40 mg/d) increased HDL-C levels 29% and decreased LDL-C levels 46%, tri- glyceride levels 38%, and lipoprotein(a) levels 14%. All lipid responses were dose dependent and generally additive. Graphs of the dose-response relationships as 3-dimensional surfaces documented the strength and consistency of these responses. NiacinER/lovastat in combination therapy substantially improves 4 major lipoprotein levels associated with atherosclerotic disease. Dose-response surfaces provide a practical guide for dose selection. [ABSTRACT FROM AUTHOR]

The relation between plasma lipid levels and Alzheimer disease (AD) and vascular dementia (VaD), and the impact of drugs to lower lipid levels remains unclear. To investigate the relation between plasma lipid levels and the risk of AD and VaD and the impact of drugs to lower lipid levels on this relationship. Cross-sectional and prospective community-based cohort studies. Participants Random sample of 4316 Medicare recipients, 65 years and older, residing in northern Manhattan, NY. Main Outcome Measures Vascular dementia and AD according to standard criteria. Elevated levels of non–high-density lipoprotein (HDL-C) and low-density lipoprotein cholesterol (LDL-C) and decreased levels of HDL-C were weak risk factors for VaD in either cross-sectional or prospective analyses. Higher levels of total cholesterol were associated with a decreased risk of incident AD after adjustment for demographics, apolipoprotein E genotype, and cardiovascular risk factors. Treatment with drugs to lower lipid levels did not change the disease risk of either disorder.We found a weak relation between non–HDL-C, LDL-C, and HDL-C levels and the risk of VaD. Lipid levels and the use of agents to lower them do not seem to be associated with the risk of AD. [ABSTRACT FROM AUTHOR]

Background: Although many studies have assessed the effects of estrogen and raloxifene hydrochloride on bone mineral density and serum lipid concentrations, there are few direct comparative data. Methods: Randomized placebo-controlled trial for 3 years, intention-to-treat analysis. Six hundred nineteen postmenopausal women with prior hysterectomy (mean age, 53.0 years) were studied in 38 centers in Europe, North America, Australasia, and South Africa. They were randomized to 60 mg/d or 150 mg/d of raloxifene, 0.625 mg/d of conjugated equine estrogen (CEE), or placebo. Bone density of the lumbar spine and proximal femur, biochemical markers of bone turnover, and fasting serum lipid concentrations were assessed for 3 years. Results: Compared with baseline, bone density in the lumbar spine progressively declined by 2.0% in the placebo group (P<.05), was stable in the 2 raloxifene groups, and increased 4.6% in the subjects receiving CEE (P<.001). Effects in both raloxifene groups were different from those observed in the CEE and placebo groups (P<.001). Bone density in the total hip showed similar results. Conjugated equine estrogen produced significantly greater depression of serum osteocalcin, bone-specific alkaline phosphatase, and urine C-telopeptide, compared with raloxifene. Each of the active treatments caused comparable depression of low-density lipoprotein cholesterol below placebo levels (P<.001 at most time points). Raloxifene did not affect high-density lipoprotein cholesterol, whereas CEE increased it by 13.4% compared with placebo at 3 years (P<.001). Triglyceride concentrations increased 24.6% in the CEE group at 3 years (P<.003), a significantly greater change than in the raloxifene groups, which were 4.9% and 8.0% above baseline (P&les;.002) but not different from placebo. Urinary incontinence was reported in 11 women receiving CEE, but in only 1 or 2 in each of the other groups (P&les;.01 compared with the other groups). Hernias occurred less frequently in those receiving 150 mg/d of raloxifene or CEE (P=.03 vs placebo). Conclusions: Raloxifene and CEE have beneficial effects on bone density and bone turnover, although effects of CEE are more marked. Raloxifene and CEE produce different patterns of lipid responses and have distinct adverse effect profiles. [ABSTRACT FROM AUTHOR]

Background: A variety of studies have noted seasonal variation in blood lipid levels. Although the mechanism for this phenomenon is not clear, such variation could result in larger numbers of people being diagnosed as having hypercholesterolemia during the winter. Methods: We conducted a longitudinal study of seasonal variation in lipid levels in 517 healthy volunteers from a health maintenance organization serving central Massachusetts. Data collected during a 12-month period for each individual included baseline demographics and quarterly anthropometric, blood lipid, dietary, physical activity, light exposure, and behavioral information. Data were analyzed using sinusoidal regression modeling techniques. Results: The average total cholesterol level was 222 mg/dL (5.75 mmol/L) in men and 213 mg/dL (5.52 mmol/L) in women. Amplitude of seasonal variation was 3.9 mg/dL (0.10 mmol/L) in men, with a peak in December, and 5.4 mg/dL (0.14 mmol/L) in women, with a peak in January. Seasonal amplitude was greater in hypercholesterolemic participants. Seasonal changes in plasma volume explained a substantial proportion of the observed variation. Overall, 22% more participants had total cholesterol levels of 240 mg/dL or greater (&ges;6.22 mmol/L) in the winter than in the summer. Conclusions: This study confirms seasonal variation in blood lipid levels and suggests greater amplitude in seasonal variability in women and hypercholesterolemic individuals, with changes in plasma volume accounting for much of the variation. A relative plasma hypervolemia during the summer seems to be linked to increases in temperature and/or physical activity. These findings have implications for lipid screening guidelines. Further research is needed to better understand the effects of a relative winter hemoconcentration. [ABSTRACT FROM AUTHOR]

Context Adiponectin, a recently discovered adipocyte-derived peptide, is involved in the regulation of insulin sensitivity and lipid oxidation and, purportedly, in the development of atherosclerosis and coronary heart disease in humans. Objective To assess prospectively whether plasma adiponectin concentrations are associated with risk of myocardial infarction (MI). Design, Setting, and Participants Nested case-control study among 18 225 male participants of the Health Professionals Follow-up Study aged 40 to 75 years who were free of diagnosed cardiovascular disease at the time of blood draw (1993-1995). During 6 years of follow-up through January 31, 2000, 266 men subsequently developed nonfatal MI or fatal coronary heart disease. Using risk set sampling, controls were selected in a 2:1 ratio matched for age, date of blood draw, and smoking status (n = 532). Main Outcome Measure Incidence of nonfatal MI and fatal coronary heart disease by adiponectin level. Results After adjustment for matched variables, participants in the highest compared with the lowest quintile of adiponectin levels had a significantly decreased risk of MI (relative risk [RR], 0.39; 95% confidence interval [CI], 0.23-0.64; P for trend <.001). Additional adjustment for family history of MI, body mass index, alcohol consumption, physical activity, and history of diabetes and hypertension did not substantively affect this relationship (RR, 0.41; 95% CI, 0.24-0.70; P for trend <.001). Further adjustment for hemoglobin A1c or C-reactive protein levels also had little impact, but additional adjustment for low- and high-density lipoprotein cholesterol levels modestly attenuated this association (RR, 0.56; 95% CI, 0.32-0.99; P for trend = .02). Conclusions High plasma adiponectin concentrations are associated with lower risk of MI in men. This relationship can be only partly explained by differences in blood lipids and is independent of inflammation and glycemic status. [ABSTRACT FROM AUTHOR]

Therapy with niacin (nicotinic acid) is unique in that it improves all lipoprotein abnormalities. It significantly reduces low-density lipoprotein cholesterol, triglyceride, and lipoprotein(a) levels, while increasing high-density lipoprotein cholesterol levels. This makes niacin ideal for treating a wide variety of lipid disorders, including the metabolic syndrome, diabetes mellitus, isolated low high-density lipoprotein cholesterol, and hypertriglyceridemia. Niacin-induced changes in serum lipid levels produce significant improvements in both coronary artery disease and clinical outcomes. Niacin is currently available in 3 formulations (immediate release, extended release, and long acting), which differ significantly with respect to their safety and efficacy profiles. Immediate-release niacin is generally taken 3 times a day and is associated with adverse flushing, gastrointestinal symptoms, and elevations in blood glucose levels. Long-acting niacin can be taken once daily and is associated with significantly reduced flushing, but its metabolism increases the risk of hepatotoxic effects. Extended-release niacin, also given once daily, has an absorption rate intermediate between the other formulations and is associated with fewer flushing and gastrointestinal symptoms without increasing hepatotoxic risk. [ABSTRACT FROM AUTHOR]

Context: Kidney disease is associated with an increased risk for the development of cardiovascular disease and end-stage renal disease; however, risk factors for kidney disease have not been well studied. Objective: To identify predictors of the development of new-onset kidney disease. Design, Setting, and Participants: A community-based, longitudinal cohort study of 2585 participants who attended both a baseline examination in 1978-1982 and a follow-up examination in 1998-2001, and who were free of kidney disease at baseline. Main Outcome Measures: Kidney disease was assessed by the Modification of Diet in Renal Disease Study equation and defined by a glomerular filtration rate (GFR) in the fifth or lower percentile (≤59.25 mL/min per 1.73 m[sup 2] in women, ≤64.25 mL/min per 1.73 m[sup 2] in men). Stepwise logistic regression was used to determine the impact of risk factors on the occurrence of new-onset kidney disease. Baseline and long-term, 12-year, averaged risk factor models were explored. Results: At baseline, there were 1223 men and 1362 women, with a mean age of 43 years, who were free of preexisting kidney disease. After a mean follow-up of 18.5 years, 244 participants (9.4%) had developed kidney disease. In multivariable models, baseline age (odds ratio [OR], 2.36 per 10-year increment; 95% confidence interval [CI], 2.00-2.78), GFR (<90 mL/min per 1.73 m[sup 2]: OR, 3.01; 95% CI, 1.98-4.58; 90-119 mL/min per 1.73 m[sup 2]: OR, 1.84; 95% CI, 1.16-2.93), body mass index (OR, 1.23 per 1 SD; 95% CI, 1.08-1.41), diabetes (OR, 2.60; 95% CI, 1.44-4.70), and smoking (OR, 1.42; 95% CI, 1.06-1.91) were related to the development of kidney disease. In addition to baseline age and GFR, the long-term, averaged risk factors that were predictive of kidney disease included hypertension (OR, 1.57; 95% CI, 1.17-2.12), high-density lipoprotein cholesterol level (OR, 0.80 per 1 SD; 95% CI, 0.69-0.92), and diabetes (OR, 2.38; 95% CI, 1.45-3.92). Compared w... [ABSTRACT FROM AUTHOR]

Context: Although low levels of high-density lipoprotein cholesterol (HDL-C) increase risk for coronary disease, no data exist regarding potential benefits of administration of HDL-C or an HDL mimetic. ApoA-I Milano is a variant of apolipoprotein A-I identified in individuals in rural Italy who exhibit very low levels of HDL. Infusion of recombinant ApoA-I Milano–phospholipid complexes produces rapid regression of atherosclerosis in animal models. Objective: We assessed the effect of intravenous recombinant ApoA-I Milano/phospholipid complexes (ETC-216) on atheroma burden in patients with acute coronary syndromes (ACS). Design: The study was a double-blind, randomized, placebo-controlled multicenter pilot trial comparing the effect of ETC-216 or placebo on coronary atheroma burden measured by intravascular ultrasound (IVUS). Setting: Ten community and tertiary care hospitals in the United States. Patients: Between November 2001 and March 2003, 123 patients aged 38 to 82 years consented, 57 were randomly assigned, and 47 completed the protocol. Interventions: In a ratio of 1:2:2, patients received 5 weekly infusions of placebo or ETC-216 at 15 mg/kg or 45 mg/kg. Intravascular ultrasound was performed within 2 weeks following ACS and repeated after 5 weekly treatments. Main Outcome Measures: The primary efficacy parameter was the change in percent atheroma volume (follow-up minus baseline) in the combined ETC-216 cohort. Prespecified secondary efficacy measures included the change in total atheroma volume and average maximal atheroma thickness. Results: The mean (SD) percent atheroma volume decreased by -1.06% (3.17%) in the combined ETC-216 group (median, -0.81%; 95% confidence interval [CI], -1.53% to -0.34%; P = .02 compared with baseline). In the placebo group, mean (SD) percent atheroma volume increased by 0.14% (3.09%; median, 0.03%; 95% CI, -1.11% to 1.43%; P = .97 compared with baseline). The absolute reduction in atheroma volume in the combined trea... [ABSTRACT FROM AUTHOR]

Context: Exposure to cardiovascular risk factors during childhood and adolescence may be associated with the development of atherosclerosis later in life. Objective: To study the relationship between cardiovascular risk factors measured in childhood and adolescence and common carotid artery intima-media thickness (IMT), a marker of preclinical atherosclerosis, measured in adulthood. Design, Setting, and Participants: Population-based, prospective cohort study conducted at 5 centers in Finland among 2229 white adults aged 24 to 39 years who were examined in childhood and adolescence at ages 3 to 18 years in 1980 and reexamined 21 years later, between September 2001 and January 2002. Main Outcome Measures: Association between cardiovascular risk variables (levels of low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides; LDL-C/HDL-C ratio; systolic and diastolic blood pressure; body mass index; smoking) measured in childhood and adulthood and common carotid artery IMT measured in adulthood. Results: In multivariable models adjusted for age and sex, IMT in adulthood was significantly associated with childhood LDL-C levels (P = .001), systolic blood pressure (P<.001), body mass index (P = .007), and smoking (P = .02), and with adult systolic blood pressure (P<.001), body mass index (P<.001), and smoking (P = .004). The number of risk factors measured in 12- to 18-year-old adolescents, including high levels (ie, extreme age- and sex-specific 80th percentile) of LDL-C, systolic blood pressure, body mass index, and cigarette smoking, were directly related to carotid IMT measured in young adults at ages 33 through 39 years (P<.001 for both men and women), and remained significant after adjustment for contemporaneous risk variables. The number of risk factors measured at ages 3 to 9 years demonstrated a weak direct relationship with carotid IMT at ages 24 to 30 years in men (P = .02) but not in women (P = .63). Conclus... [ABSTRACT FROM AUTHOR]

Context: Carotid artery intima-media thickness (IMT) is associated with cardiovascular risk factors and is recognized as an important predictive measure of clinical coronary atherosclerosis events in middle-aged and elderly populations. However, information on the association of carotid IMT in young adults with different risk factors measured in childhood, adulthood, or as a cumulative burden of each of the risk factors measured serially from childhood to adulthood is limited. Objective: To examine the association between carotid IMT in young adults and traditional cardiovascular risk factors measured since childhood. Design, Setting, and Participants: A cohort study of 486 adults aged 25 to 37 years from a semirural black and white community in Bogalusa, La (71% white, 39% men), who had at least 3 measurements of traditional risk factors since childhood, conducted between September 1973 and December 1996. Main Outcome Measure: Association of carotid IMT with risk factors, including systolic blood pressure, lipoprotein levels, and body mass index. Results: Male vs female (0.757 mm vs 0.719 mm) and black vs white (0.760 mm vs 0.723 mm) participants had increased carotid IMT (P<.001 for both). In multivariable analyses, significant predictors for being in top vs lower 3 quartiles of carotid IMT in young adults were childhood measures of low-density lipoprotein cholesterol (LDL-C) level (odds ratio [OR], 1.42, corresponding to 1-SD change specific for age, race, and sex; 95% confidence interval [CI], 1.14-1.78) and body mass index (BMI; OR, 1.25; 95% CI, 1.01-1.54); adulthood measures of LDL-C level (OR, 1.46; 95% CI, 1.16-1.82), high-density lipoprotein cholesterol (HDL-C) level (OR, 0.67; 95% CI, 0.51-0.88), and systolic blood pressure (OR, 1.36; 95% CI, 1.08-1.72); and long-term cumulative burden of LDL-C (OR, 1.58; 95% CI, 1.24-2.01) and HDL-C (OR, 0.75; 95% CI, 0.58-0.97) levels measured serially from childhood to adulthood. An increasing trend in carotid IMT a... [ABSTRACT FROM AUTHOR]

Context: Individuals with exceptional longevity have a lower incidence and/or significant delay in the onset of age-related disease, and their family members may inherit biological factors that modulate aging processes and disease susceptibility. Objective: To identify specific biological and genetic factors that are associated with or reliably define a human longevity phenotype. Design, Setting, and Participants: In a case-control design, 213 Ashkenazi Jewish probands with exceptional longevity (mean [SD] age, 98.2 [5.3] years) and their offspring (n = 216; mean [SD] age, 68.3 [6.7] years) were recruited from 1998 to 2002, while an age-matched control group of Ashkenazi Jews (n = 258) and participants from the Framingham Offspring Study (n = 589) were accepted as control groups. Main Outcome Measures: Detailed questionnaires, physical examination, and blood samples were taken, including assessment of lipids and lipoprotein subclass levels and particle sizes by proton nuclear magnetic resonance. Samples were also genotyped for the codon 405 isoleucine to valine (I405V) variation in the cholesteryl ester transfer protein (CETP) gene, which is involved in regulation of lipoprotein and its particle sizes. Results: High-density lipoprotein (HDL) and low-density lipoprotein (LDL) particle sizes were significantly higher in probands compared with both control groups (P = .001 for both), independent of plasma levels of HDL and LDL cholesterol and apolipoprotein A1 and B. This phenotype was also typical of the proband's offspring but not of the age-matched controls. The HDL and LDL particle sizes were significantly larger in offspring and controls without hypertension or cardiovascular disease, (P = .001 and P = .008, respectively). Furthermore, lipoprotein particle sizes, but not plasma LDL levels, were significantly higher in offspring and controls without the metabolic syndrome (P<.001). Probands and offspring had a 2.9- and 3.6-fold (in men) and 2.7- and 1.5-fold (in... [ABSTRACT FROM AUTHOR]

Background: We sought to assess how cholesterol levels at different ages modify the remaining lifetime risk of coronary heart disease (CHD). Methods: We included all Framingham Heart Study participants examined from 1971 through 1996 who did not have CHD and were not receiving lipid-lowering therapy. At index ages of 40, 50, 60, 70, and 80 years, participants were stratified by total cholesterol level and by cholesterol subfractions. Lifetime risk of CHD was calculated with death free of CHD as a competing event. Results: Among 3269 men and 4019 women, 1120 developed CHD and 1365 died free of CHD during follow-up. At each index age, lifetime risk of CHD increased with higher cholesterol levels, and time to event decreased. At age 40 years, the lifetime risks of CHD through age 80 years for men with total cholesterol levels less than 200 mg/dL (<5.20 mmol/L), 200 to 239 mg/dL (5.20-6.19 mmol/L), and 240 mg/dL or greater (≥6.20 mmol/L), respectively, were 31%, 43%, and 57%; for women, the lifetime risks were 15%, 26%, and 33%, respectively. Lifetime risks contrasted sharply with shorter-term risks: at age 40 years, the 10-year cumulative risks of CHD were 3%, 5%, and 12% for men, and 1%, 2%, and 5% for women, respectively. Conclusions: Lifetime risk of CHD increases sharply with higher total cholesterol levels for men and women at all ages. These data support an important role for cholesterol screening in younger patients, and they may help target high-risk patients for lifestyle modification or drug therapy. [ABSTRACT FROM AUTHOR]

Context: Little prospective long-term information is available on the effect of a ketogenic diet on plasma lipoproteins in children with difficult-to-control seizures. Objective: To determine the effect in children with intractable seizures of a high-fat ketogenic diet on plasma levels of the major apolipoprotein B (apoB)–containing lipoproteins, low-density lipoprotein (LDL) and very LDL (VLDL); and the major apolipoprotein A-I (apoA-I)–containing lipoprotein, high-density lipoprotein (HDL). Design, Setting, and Patients: A 6-month prospective cohort study of 141 children (mean [SD] age, 5.2 [3.8] years for 70 boys and 6.1 [4.4] years for 71 girls) with difficult-to-treat seizures who were hospitalized for initiation of a high-fat ketogenic diet and followed up as outpatients. This cohort constituted a subgroup of the 371 patients accepted into the ketogenic diet program between 1994 and 2001. A subset of the cohort was also studied after 12 (n = 59) and 24 (n = 27) months. Intervention: A ketogenic diet consisting of a high ratio of fat to carbohydrate and protein combined (4:1 [n = 102], 3.5:1 [n = 7], or 3:1 [n = 32]). After diet initiation, the calories and ratio were adjusted to maintain ideal body weight for height and maximal urinary ketosis for seizure control. Main Outcome Measures: Differences at baseline and 6-month follow-up for levels of total, VLDL, LDL, HDL, and non-HDL cholesterol; triglycerides; total apoB; and apoA-I. Results: At 6 months, the high-fat ketogenic diet significantly increased the mean plasma levels of total (58 mg/dL [1.50 mmol/L]), LDL (50 mg/dL [1.30 mmol/L]), VLDL (8 mg/dL [0.21 mmol/L]), and non-HDL cholesterol (63 mg/dL [1.63 mmol/L]) (P<.001 vs baseline for each); triglycerides (58 mg/dL [0.66 mmol/L]) (P<.001); and total apoB (49 mg/dL) (P<.001). Mean HDL cholesterol decreased significantly (P<.001), although apoA-I increased (4 mg/dL) (P = .23). Significant but less marked changes persisted in children obser... [ABSTRACT FROM AUTHOR]

Hyperinsulinemia is associated with multiple metabolic disorders including high triglyceride level, low high density lipoprotein (HDL) cholesterol level, hypertension, and impaired glucose tolerance (IGT). This metabolic constellation is also called the insulin resistance syndrome. All previous data on clustering of these risk factors are, however, based on insulin levels. Therefore, the authors examined the association of insulin sensitivity estimated by means of a frequently sampled intravenous glucose tolerance test and the minimal model with the number of metabolic disorders (dyslipidemia [high triglyceride level or low HDL cholesterol level or both], hypertension, and IGT according to the World Health Organization criteria). Of 153 nondiabetic subjects aged 53–61 years who had participated in a previous population-based study, 79 had no disorders, 55 had one disorder, 16 had two disorders, and 3 had three disorders. Insulin sensitivity index (S1) decreased with the increasing number of disorders (4.1, 3.5, 1.8, and 1.4×10−4 min−1 μU−1 mL−1, in subjects with 0, 1, 2, and 3 disorders, respectively; p<0.001 for trend). Similarly, fasting (7.5, 7.8, 15.3, and 22.0 μU/mL; p<0.001) and 2-hour insulin levels (39.9, 49.0, 98.7, and 149.6 μU/mL; p<0.001) increased by the increasing number of disorders. The relations of S1 and fasting and 2-hour insulin levels with multiple metabolic disorders were independent of sex, obesity, and body fat distribution. Furthermore, these associations were similar in men and women and in lean and obese subjects. The authors conclude that a clustering of cardiovascular disease risk factors in nondiabetic subjects is not only associated with hyperinsulinemia but also with insulin resistance. Am J Epidemiol 1997;146:315-21. [ABSTRACT FROM AUTHOR]

The authors analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study in order to examine associations between parity and lipoproteins. Of 2,787 women recruited in 1985–1986, 2, 534 (91%) returned in 1987–1988 and 2, 393 (86%) returned in 1990–1991 for repeat evaluations. Two-year change (1987–1988 to 1985–1986) in high density lipoprotein (HDL) cholesterol was significantly different among the parity groups. HDL cholesterol decreased in women who had their first pregnancy of at least 28 weeks duration during follow-up (mean ± standard error, −3.5 ±1.2 mg/dl), and this change was significantly different from the increase in women parous at baseline who had no further pregnancies (2.5 ± 0.3 mg/dl) and in nullipara (2.4 ± 0.3 mg/dl). There was a nonsignificant trend for a greater decrease in HDL2 cholesterol fraction in the primipara compared with the other groups. The HDL cholesterol decrease remained significant after controlling for race, age, education, oral contraceptive use, and changes in body mass index, waist-hip ratio, physical activity, smoking status, and alcohol intake. Change in HDL cholesterol was also significantly different among the parity groups in analyses of pregnancies that occurred during the subsequent 3 years of follow-up. There were no differences for change in LDL cholesterol or triglycerides. Potential mechanisms for a detrimental effect of pregnancy on HDL cholesterol include hormonal, body composition, or life-style/ behavioral changes. Am J Epidemiol 1996; 144: 247–54. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to the article "Unique lipoprotein phenotype and genotype associated with exceptional longevity," by Nir Barzilai and colleagues in an earlier issue.

Presents a response by Nir Barzilai and colleagues to a letter to the editor about their article "Unique lipoprotein phenotype and genotype associated with exceptional longevity," in an earlier issue.

Offers observations on preventing heart disease. Risk factors for atherosclerosis; Effects of lowering serum cholesterol levels on coronary heart disease (CHD); History of the study of CHD factors in children and adults; Articles in this issue whioch address this opic, includibng those by Li and colleagues and Raitakari and colleagues; Results of their studies; Possiblity of a clinical trial in young persons; Necessity of moving forward in preventing CHD.

This letter to the editor comments on a study by Dr. Ridker and colleagues and discusses the role of apolipoproteins and cholesterol in predicting cardiovascular events.

This article presents an editorial about the effects of diet on blood pressure and lipids. There are many concerns regarding the effect of dietary sodium restriction on blood lipid levels. The study in this issue by Appel and others is discussed. This study reports the results of the OmniHeart randomized trial, which examines the effect of varying protein, monounsaturated fat, and carbohydrate intake with the basic Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure and lipid levels. A description of the DASH diet is included. Several issues were raised as a result of this study. It is speculated that this study is not representative of the public.

Presents a letter to the editor about low-fat diets.