Biomedical subjects

H Schulte

Publications and source records attributed to H Schulte.

At least 91 records · Page 5Linked to original sources

PubMed1994

Sex-specific effects of the glutamine/histidine polymorphism in apo A-IV on HDL metabolism.

In Caucasians, a histidine for glutamine substitution (Gln-->His) at residue 360 in apolipoprotein (apo) A-IV leads to an electrophoretically detectable polymorphism whose contribution to lipid metabolism regulation is controversial. In this study of 426 male and 188 female coronary heart disease patients, we analyzed the impact of this polymorphism on lipid metabolism, particularly high-density lipoprotein (HDL). The frequency of the rarer apo A-IV (360:His) allele was .069. This polymorphism exerted opposite effects in men and women in terms of serum concentrations of total cholesterol; triglycerides; HDL cholesterol; LDL cholesterol; lipoprotein (Lp) A-I; and apo A-I, A-II, and B. Only the difference in Lp A-I levels between male apo A-IV (360:Gln/Gln) homozygotes and apo A-IV (360:Gln/His) heterozygotes was significant (P < .05). In randomly selected subgroups of 38 male and 15 female apo A-IV (360:Gln/His) heterozygotes and 104 male and 15 female apo A-IV (360:Gln) homozygotes, heterozygosity for apo A-IV (360:Gln/His) in both sexes was associated with lower plasma cholesteryl ester transfer protein (CETP) activity (P < .05) and higher serum apo A-IV concentrations (P < .01 in men). Moreover, only men had significantly higher mean plasma activity levels of lecithin:cholesterol acyltransferase (LCAT) (P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

Effects of two kinds of decaffeinated coffee on serum lipid profiles in healthy young adults.

OBJECTIVE: To investigate the effects of two kinds of decaffeinated coffee on serum lipid profiles in healthy young adults. DESIGN: Randomized controlled study with three study groups and a parallel design, consisting of two consecutive periods. SETTING: Outpatient clinical research center in a university clinic. SUBJECTS: 119 healthy students (60 male, 59 female) who were selected after a screening. All completed the study. Blood samples of three subjects (1 male, 2 female) were excluded from evaluation due to later diagnosed genetic anomalies of lipid metabolism. INTERVENTIONS: All subjects consumed 750-1000 ml of caffeinated filtered coffee per day for a 2 week wash-in period. During the 6 week test period one group continued drinking the caffeinated coffee, while the two other groups consumed different kinds of decaffeinated coffee. RESULTS: Consumption of both types of decaffeinated coffee did not lead to any significant changes in serum total and LDL cholesterol, triglycerides and apolipoprotein B. Furthermore, there were no significant differences in the reactions between the three groups. The diet did not change during the study. CONCLUSIONS: Switch from regular to decaffeinated coffee had no cholesterol-elevating effects, irrespective of the type of coffee.

Adult↗

PubMed1993

[Life-threatening diarrhea in atypical course of legionellosis].

After eating a meal of poultry a 41-year-old man fell ill with severe diarrhoea, persistent high fever of around 39 degrees C, dehydration and somnolence. On admission to hospital physical examination was normal except for signs of dehydration. The blood count showed a leukocytosis (13,300/microliters) with 60% stab-form neutrophils. The erythrocyte sedimentation rate was raised to 49/82 mm. Also increased were the serum concentrations of creatinine (3.5 mg/dl), creatine kinase (179 U/l), lactate dehydrogenase (298 U/l) and C-reactive protein (16.8 mg/dl). Bacteriological and virological examinations of blood and stool were negative. A normal fluid and electrolyte balance was re-established. But as there was no improvement, ampicillin was administered, 2 g three times daily, then ciprofloxacin, 500 mg two times daily, and finally combined with metronidazole, 500 mg three times daily. Despite this treatment a chest radiograph on the tenth day revealed an infiltration in the left basal lung segment, and the legionella titre became positive at 1:2045. The antibiotic treatment was changed to 150 mg roxithromycin two times daily. The fever fell within 3 days and the diarrhoea stopped after 5 days. He was discharged free of symptoms after 24 days.

Adult↗

PubMed1993

Glutamine/histidine polymorphism in apo A-IV affects plasma concentrations of lipoprotein(a) and fibrin split products in coronary heart disease patients.

A glutamine/histidine polymorphism at residue 360 in apolipoprotein (apo) A-IV that generates two electrophoretically detectable isoforms, apo A-IV-1 and apo A-IV-2, affects the plasma concentration of lipoprotein(a) (Lp[a]) in a healthy population. To verify this unexpected association we analyzed the effect of the apo A-IV polymorphism on Lp(a) serum concentrations in 275 male coronary heart disease patients. Allele frequencies of apo A-IV-1 and apo A-IV-2 were 0.917 and 0.083, respectively. In addition, apo A-IV-1/2 heterozygotes showed a 30% lower geometric mean concentration of Lp(a) than apo A-IV-1/1 homozygotes in this study. The relative frequency of Lp(a) concentrations > 20 mg/dl was significantly increased by a factor of 2.25 in apo A-IV-1/1 homozygotes. Other lipid parameters were not significantly affected by this apo A-IV polymorphism. Because of the relations between Lp(a) and the fibrinolytic system, we also analyzed the effect of the apo A-IV polymorphism on hemostatic variables. Apo A-IV-1/2 heterozygosity was associated with a 70% higher geometric mean plasma concentration of D-dimer, i.e., proteolytic fragments of cross-linked fibrin. Plasma concentrations of prothrombin fragments F1 + F2, fibrinogen, plasminogen, and plasminogen activator inhibitor-1 were unaffected. In conclusion, our results indicate a hitherto unappreciated role of the apo A-IV gene or a closely linked locus for the regulation of Lp(a) metabolism and hemostasis and also possibly for atherosclerosis and thrombosis.

Apolipoproteins A↗

PubMed1993

Unexpected findings concerning thromboembolic complications and anticoagulation after complete 10 year follow up of patients with St. Jude Medical prostheses.

Five hundred and four St. Jude Medical valves (SJM) were implanted in 435 patients between September 1978 and March 1982. There were 234 females and 201 males with a mean age of 52.8 +/- 10.1 years (range 12-83 years), who underwent 204 aortic, 163 mitral, 67 mitral plus aortic and one triple valve replacements. All patients were followed prospectively. Follow up was 100% complete and averaged 122.2 +/- 1.1 months for operative survivors. The total follow up for aortic patients was 1968.5, for mitral patients 1520.4, and for double valve replacement 573.9 pty. For the entire patient population the total follow up was 4080.8 pty. Early mortality was 2% after aortic, 4.3% after mitral and 5.9% after mitral plus aortic valve replacement. There were 68 late deaths representing a linearized incidence of 1.37%/pty in the aortic, 1.71%/pty in the mitral and 2.61%/pty in the double valve replacement groups. The corresponding cumulative survival after ten years at risk was 85% in the aortic, 78% in the mitral and 72% in the double valve replacement groups. The ten year event-free survival was 64% in the aortic, 57% in the mitral and 47% in the double valve replacement groups. The linearized incidence for thromboembolic events was 3.71%/pty taking all events into account, and 2.67%/pty taking only the first or most severe of several events into account for aortic, 5.1%/pty and 4.08%/pty for mitral, and 6.62%/pty and 5.40%/pty for double replacements, respectively. There were two cases of valve thrombosis, both with proven inadequate anticoagulation. When the prothrombin times measured with the different thromboplastize used in this patient group were converted to INR, the so far homogeneous values could be separated into three groups: INR = 3.0 to 4.5, 2.5 to 3.2 and 1.8 to 2.7. Low INR values caused only a marginal increase in the rate of embolism but a highly significant decrease in the rate of bleeding. These results suggest that the generally recommended INR of 3.0 to 4.5 is too high for the SJM. A large, multicenter, prospective randomized study is therefore proposed to establish the safe INR levels with low intensity anticoagulation after SJM implantation.

Adolescent↗

PubMed1992

Role of triglycerides in coronary artery disease: lessons from the Prospective Cardiovascular Münster Study.

The incidence of atherosclerotic coronary artery disease (CAD) was assessed in 4,576 male participants of the Prospective Cardiovascular Münster (PROCAM) study, aged 40-64 years, over a 4-year follow-up period. In this time, 122 study participants developed atherosclerotic CAD (89 definite nonfatal myocardial infarctions and 33 definite atherosclerotic CAD deaths). Univariate analysis revealed a significant association between the incidence of atherosclerotic CAD, and high-density lipoprotein (HDL) cholesterol (p < 0.001) and triglyceride (p < 0.01) levels. The relation to HDL cholesterol remained after adjustment for other risk factors. By contrast, the relation between the incidence of atherosclerotic CAD and triglycerides disappeared if, in a multivariate analysis by means of a multiple logistic function, cholesterol or HDL cholesterol was taken into account. However, the data suggested that hypertriglyceridemia is a powerful additional coronary risk factor, when excessive triglycerides coincide with a high ratio (> 5.0) of plasma low-density lipoprotein (LDL) cholesterol to HDL cholesterol. Even though the prevalence of this subgroup was only 3.7%, it included a quarter of all atherosclerotic CAD events observed.

Adolescent↗

PubMed1992

Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience). Prospective Cardiovascular Münster study.

The incidence of atherosclerotic coronary artery disease (CAD) was assessed in 4,559 male participants (aged 40 to 64 years) from the Prospective Cardiovascular Münster study, over a 6-year follow-up period. During this time, 186 study participants developed atherosclerotic CAD (134 definite nonfatal myocardial infarctions and 52 definite atherosclerotic CAD deaths including 21 sudden cardiac deaths and 31 fatal myocardial infarctions). Univariate analysis revealed a significant association between the incidence of atherosclerotic CAD and high-density lipoprotein (HDL) cholesterol (p less than 0.001) and triglycerides (p less than 0.001). The relation to HDL cholesterol remained after adjustment for other risk factors. By contrast, the relation between the incidence of atherosclerotic CAD and triglycerides disappeared if, in a multivariate analysis by means of a multiple logistic function, cholesterol or HDL cholesterol were taken into account. However, the data suggested that hypertriglyceridemia is a powerful additional coronary risk factor, when excessive triglycerides coincide with a high ratio of plasma low-density lipoprotein cholesterol to HDL cholesterol (greater than 5.0). Even though the prevalence of this subgroup was only 4.3%, it included a quarter of all atherosclerotic CAD events observed.

Adult↗

PubMed1992

The importance of triglycerides: results from the Prospective Cardiovascular Münster (PROCAM) Study.

In the PROCAM study hypertriglyceridaemia was much more common among men (18.6%) than women (4.2%). Prevalence increased with age in women, but remained nearly constant at about 20% in men aged 35 years or more. In a multiple regression analysis a strong negative correlation between triglycerides and HDL cholesterol was found. A positive relationship was observed with cholesterol, blood glucose, factor VIIc, and PAI-1 in both sexes. Only in men, triglycerides are positively correlated with Apo A-I, body mass index, cigarette smoking, and alcohol consumption. Postmenopausal women showed higher triglyceride levels than premenopausal women. No independent relationships were observed to age, blood pressure, Lp(a), Apo A-II, Apo B, AT-III, protein C, fibrinogen, and oral contraceptives. A longitudinal analysis of data from 4474 male PROCAM participants aged 40-64 years with a follow-up of 4 years did not identify triglycerides as an independent risk factor, but the data suggest hypertriglyceridaemia is an additional risk factor for CHD, when excessive triglycerides coincide with a high ratio of plasma cholesterol to HDL-cholesterol and with low HDL-cholesterol values.

Adolescent↗

PubMed1992

Comparative effects of a recommended lipid-lowering diet vs a diet rich in monounsaturated fatty acids on serum lipid profiles in healthy young adults.

This crossover study investigated the effects of two fat-reduced diets, one rich in monounsaturated fatty acids (MUFAs), the other rich in polyunsaturated fatty acids (PUFAs), on serum lipid profiles in 38 healthy young adults initially on a typical western diet. After being randomly assigned to two groups, the subjects received the MUFA or PUFA diet for 3-wk and then the other diet for 3 wk. Both test diets led to significant reductions in serum cholesterol, LDL cholesterol, and HDL cholesterol (P less than 0.001). Both reduced apolipoprotein B (P less than 0.001) and apolipoprotein A-I concentrations (P less than 0.01 for the MUFA, P less than 0.001 for the PUFA diet). Apolipoprotein A-I was significantly higher on the MUFA than on the PUFA diet. The ratio of apolipoprotein A-I to B significantly increased on both diets. Thus, a low-fat, MUFA-rich diet is as effective as a low-fat, PUFA-rich diet in lowering total and LDL cholesterol, but both also lowered HDL cholesterol concentrations. The MUFA-rich diet may be more advantageous than the PUFA-rich one because it does not lower apolipoprotein A-I concentrations as much as the PUFA-rich diet.

Adult↗

PubMed1992

Nonsynonymous polymorphic sites in the apolipoprotein (apo) A-IV gene are associated with changes in the concentration of apo B- and apo A-I-containing lipoproteins in a normal population.

The aims of this study were to detect polymorphic sites in the apolipoprotein (apo) A-IV gene, to establish their frequencies, to determine potential haplotypes, and to investigate the role of these polymorphisms in lipid metabolism. A sequencing study of four individuals led to the identification of two synonymous mutations (codons 9 and 54) and three nonsynonymous mutations (Val-8----Met, Gln360----His, and Thr347----Ser) and of a VNTR polymorphism within a series of three or four CTGT repeats in the noncoding region of exon 3. Frequencies of these polymorphisms were determined in 291 students by using naturally occurring (BstEII for the synonymous mutation in codon 54, HinfI for Thr347----Ser, and Fnu4HI for Gln360----His) or artificially introduced restriction-enzyme cutting sites (BstEII for the synonymous mutation in codon 9 and MamI for Val-8----Met), subsequent to PCR amplification. The four-base deletion/insertion polymorphism and its localization cis or trans to the mutations in codons 347 and 360 were studied by direct sequencing of PCR-amplified DNA from 87 students. Frequencies of the rarer alleles were .007 for apo A-IV-8:Met, .04 for the synonymous mutation in codon 9, .14 for the synonymous mutation in codon 54, .16 for apo A-IV347:Ser, .07 for apo A-IV360:His, and .39 for the four-base of insertion. Apo A-IV360:His in all cases was cis-localized to the (CTGT)3 repeat and apo A-IV347:Thr; and apo A-IV347:Ser was cis-localized to the (CTGT)4 repeat and apo A-IV360:Gln. Four haplotypes formed from these three polymorphic sites were thus found. The apo A-IV347:Ser allele was associated both with significantly lower plasma apo B concentrations in both sexes and with significantly lower LDL-cholesterol concentrations in men. Heterozygous carriers of apo A-IV360:His exhibited significantly higher concentrations of LDL-cholesterol and lower Lp(a) concentrations, compared with apo A-IV360:Gln homozygotes. We could not confirm the previously reported association of apo A-IV360:His with elevated HDL-cholesterol concentrations. In the population, the Val-8----Met polymorphism was not associated with significantly different lipid concentrations, but in a family study the Met-8 allele was associated with lower HDL-cholesterol and higher LDL-cholesterol concentrations. In conclusion, our results indicate an important role of the apo A-IV gene locus in the metabolism of apo B and, to a lesser extent, apo A-I containing lipoproteins.

Adult↗

PubMed1992

[Relationship between lipid metabolism disorders and age of first manifestations of coronary heart disease].

In 509 male patients, age less than 45 years, with angiographically documented coronary artery disease (CHD) we found (in contrast to age-matched controls: 459 participants of the PROCAM study) an increased amount of total cholesterol (259 vs. 221 mg/dl), LDL-cholesterol (185 vs. 142 mg/dl), Apo-B (138 vs. 118 mg/dl), lipoprotein(a) (12 vs. 5 mg/dl) and uric acid (6.4 vs. 5.8 mg/dl); HDL-cholesterol (40.5 vs. 46.8 mg/dl), Apo-A-I (122 vs. 143 mg/dl) and Apo-A-II (38 vs. 43 mg/dl) were significantly lower. These differences in lipid-metabolism between CHD-patients and controls in the younger group were essentially more pronounced than in older individuals of a group of 423 male patients over the age of 45 years who suffered from CHD and 545 age-matched PRO-CAM participants. Among the extent of the disorder in lipid metabolism, the apolipoprotein E-polymorphism, and the age of onset of CHD there exists a significant correlation which proves the special importance to therapeutically influence disorders of lipid metabolism especially in younger patients.

Adult↗

PubMed1991

Relationship of lipoprotein(a) to variables of coagulation and fibrinolysis in a healthy population.

In the Prospective Cardiovascular Münster (PROCAM) study, serum lipoprotein(a) [Lp(a)] and its relationship to pro- and anticoagulatory as well as fibrinolytic indices were determined in a large group of employees: 864 men (m) and 373 women (f), ages 16-65 years. Univariate statistical analysis showed Lp(a) concentration to be associated with fibrinogen concentrations in both sexes (m: r = 0.08, P less than 0.05; f: r = 0.20, P less than 0.001), but not with euglobulin fibrinolysis activity, tissue-type plasminogen activator, plasminogen activator inhibitor type 1 (PAI-1), or the split products of cross-linked fibrin (d-dimer). In women only, Lp(a) was significantly correlated with antithrombin III (r = 0.15, P less than 0.01) and Protein C (r = 0.17, P less than 0.01). Further sex-related differences were seen in the relationship between Lp(a) and age (m: r = 0.05; f: r = 0.23, P less than 0.001) and body mass index (m: r = 0.01; f: r = 0.19, P less than 0.001), primarily as a consequence of remarkable differences of Lp(a) concentrations between postmenopausal (mean = 79.4 mg/L) and premenopausal women (mean = 51.5 mg/L, P = 0.001). Multiple-regression analysis demonstrated a significant negative correlation of Lp(a) to PAI-1 (m: beta = -0.12, P less than 0.01; f: beta = -0.14, P less than 0.05) and a positive correlation to cholesterol (m: beta = 0.18, P less than 0.001; f: beta = 0.17, P less than 0.01) and systolic blood pressure (m: beta = 0.08, P less than 0.05; f: beta = 0.11, P less than 0.05).

Adolescent↗

PubMed1990

Adrenaline and noradrenaline as possible chemical mediators in the pathogenesis of arteriosclerosis.

We studied the relationships between adrenaline and noradrenaline and factors associated with arteriosclerosis to determine whether catecholamines contribute to the atherogenetic process. We investigated the effects of adrenaline and noradrenaline on cultures of vessel wall cells from rats and analyzed plasma catecholamine levels in humans exposed to atherogenic risk factors, undergoing hemodialysis treatment or following myocardial infarction or stroke. I. Cultured endothelial and smooth muscle cells from vessel walls exhibited enhanced proliferation when exposed to adrenaline or noradrenaline. This indicates that catecholamines trigger the activation of vascular wall cells in vitro. Such activation, the unspecific mesenchymal reaction, is the predominant characteristic change in early atherogenesis. II. In individuals subjected to the atherogenic risk factors smoking, essential hypertension and mental stress, plasma adrenaline concentrations were statistically significantly elevated. Mental stress also caused significantly elevated plasma noradrenaline levels. Plasma noradrenaline concentrations were also elevated in smoking and hypertensive individuals when compared with certain controls, but the differences failed to be statistically significant. III. In dialysis patients, plasma adrenaline and noradrenaline concentrations showed a positive correlation with the activity of the sclerotic process; i.e., plasma catecholamine concentrations increased with the severity of the disease. IV. Patients with persisting arteriosclerotic vascular disease, i.e., patients who had had a myocardial infarction or stroke, had significantly elevated plasma adrenaline and/or noradrenaline levels as late as one year after the event. The results of our investigations suggest that adrenaline and noradrenaline may act as chemical mediators during atherogenesis in man, thus contributing to the development and subsequent complications of arteriosclerosis.

Arteriosclerosis↗

PubMed1990

Modelling the Helsinki Heart Study by means of risk equations obtained from the PROCAM Study and the Framingham Heart Study.

Data from the Prospective Cardiovascular Münster (PROCAM) study have been used to develop a mathematical model that accurately predicts the outcome of treatment in a primary prevention study (the Helsinki Heart Study). The PROCAM study identified 8 major risk factors for coronary heart disease: age, total plasma cholesterol level, plasma high density lipoprotein (HDL)-cholesterol level, systolic blood pressure, smoking, diabetes, angina pectoris, and a family history of myocardial infarction. A single risk factor such as total plasma cholesterol level is not sufficiently sensitive to identify individuals at high risk of coronary heart disease. The total cholesterol:HDL-cholesterol ratio is recommended for clinical use. On the basis of these data, a primary prevention strategy for coronary heart disease in West Germany has been proposed to optimise the cost-effectiveness of such treatment. Future research should focus on the identification of feasible and sensitive risk factors for coronary heart disease. Fibrinogen and apolipoproteins have already attracted interest in this regard but more definitive studies are required to confirm their role as risk factors for coronary heart disease.

Coronary Disease↗

PubMed1990

Primary prevention of coronary heart disease in the Federal Republic of Germany. Analysis of cost-effectiveness.

The cost-effectiveness of a primary prevention strategy for coronary heart disease is reviewed in this paper. Five subgroups were identified, depending on the degree of medical intervention required to achieve a target low density lipoprotein (LDL)-cholesterol level of less than 4.15 mmol/L. One group required no intervention and, apart from initial screening costs, no further treatment costs were incurred. The cost-effectiveness of medical intervention in the other groups was calculated by use of mathematical models to predict the incidence of coronary heart disease. According to this analysis, life-years saved per 1000 individuals and cost per life-years saved increased as the intensity of intervention increased. In individuals in whom a reduction in total cholesterol was required, life expectancy did not improve substantially, but the onset of coronary heart disease was deferred until an older age. Cholesterol-lowering interventions are unlikely to result in important savings to the health care system, as the benefit of treatment is rather reflected in terms of reduced mortality and improved quality of life. Total costs (in Deutschmarks [DM]) per life-year saved in this analysis were DM30,000-40,000 in men and DM86,000-110,000 in women.

Coronary Disease↗

PubMed1990

Lipoprotein(a) is an independent risk factor for myocardial infarction at a young age.

We quantified lipoprotein(a) [Lp(a)] immunochemically in young (less than 46 y) male survivors of myocardial infarction and in age-matched controls recruited from participants of the Prospective Cardiovascular Münster (PROCAM) study. We further determined apolipoprotein E polymorphism and measured triglycerides, total cholesterol, high- and low-density lipoprotein cholesterol (HDL and LDL), and apolipoproteins AI, AII, and B in the serum of these subjects. Lp(a) concentrations in serum were not correlated with other well-recognized risk factors for early myocardial infarction such as apolipoproteins AI and B, LDL cholesterol, and HDL cholesterol. Apolipoprotein E polymorphism did not affect Lp(a) concentrations, but had a major influence on apolipoprotein B concentration. Lp(a) concentrations were not influenced by age. Our data suggest that (a) an increased concentration of Lp(a) constitutes an independent risk factor for early myocardial infarction and (b) the concentrations of Lp(a) and LDL cholesterol (apolipoprotein B) in serum are under separate metabolic control.

Age Factors↗

PubMed1989

Diabetes mellitus and hypertension in the elderly: concomitant hyperlipidemia and coronary heart disease risk.

Age is an important factor in predicting risk of myocardial infarction (MI). Age is currently treated as an independent variable in assessing risk, but it is also related to other major risk factors including hyperlipidemia, hypertension and diabetes, all of which increase in prevalence with age. Current evidence indicates that a combination of 2 or more of the major risk factors predisposes a person to a high risk of MI. In the experience of the Prospective Cardiovascular Munster study, patients with diabetes alone have twice the risk of MI, but those with diabetes and hyperlipidemia have about a 15-fold increased risk. Similarly, patients with hypertension alone have twice the risk of MI, but those with hypertension combined with hyperlipidemia have approximately a 15-fold increased risk.

Adult↗

PubMed1989

European lipid guidelines: therapeutic recommendations. European Atherosclerosis Society.

The European Consensus Conference has classified persons with hyperlipidemia into 5 groups on the basis of cholesterol and triglyceride levels. Plasma cholesterol concentration alone is not sufficient for the assessment of myocardial infarction risk; other risk factors must be considered for a more sensitive prediction. Guidelines for risk assessment of coronary heart disease and treatment regimens for each of the 5 hyperlipidemia groups, as outlined in the Policy Statement on coronary heart disease of the European Atherosclerosis Society, are described. It is emphasized that therapeutic goals for patients with hyperlipidemia depend to some extent on the presence or absence of other risk factors; plasma cholesterol and low-density lipoprotein cholesterol target levels may be lower in those with associated risk factors.

Age Factors↗