[Status and prospects of genetic studies of ischemic heart disease].
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Biomedical subjects
Publications and source records attributed to N V Perova.
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A comparative diagnostic examination of patients with chest pains in Moscow and Bordeaux revealed in both cities a higher level of total plasma cholesterol and apo B/A-I ratio in CHD patients with angiographically documented coronary atherosclerosis than in men without CHD. CHD patients from Bordeaux had higher levels of total and HDL cholesterol and a lower triglyceride level than patients from an analogous Moscow group. Both in Moscow and Bordeaux inhabitants the determination of the levels and the ratio of plasma apo B lipoprotein to A-I apolipoprotein proved highly informative for diagnosing atherogenous shifts in the lipoprotein system.
Coronary angiography and the assessment of blood lipoproteins were carried out in 43 patients with recent (not more than three months old) angina. A rise in cholesterol above 270 mg/dl and/or triglycerides above 200 mg/dl was demonstrated in 19. The level of alpha-cholesterol was below 35 mg/dl in 11 of 24 normolipidemic patients. The apoprotein B/apoprotein AI ratio was above 1.0 in 7 of 13 patients with normal cholesterol levels. Plasma phospholipid composition was disturbed in 4 of 6 patients with normal apoprotein B/apoprotein AI rations. Therefore, atherogenic changes in plasma lipoprotein composition were found in 95% of patients with recent angina.
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A total of 122 plasmapheresis procedures were given to 4 patients with inherited hypercholesterolemia for 4 to 12 months, with 7 to 14 days' intervals, using a cellular blood separator. The method has been shown to produce a 35 to 45% reduction in total cholesterol (CS), LDLPCS and VLDLPCS, and an 8 to 38% rise in HDLP CS, which improves general condition and working capacity of the patients, makes anginal attacks less frequent and severe and normalizes arterial BP in patients with arterial hypertension.
In current studies of dyslipoproteinemia (DLP) development great emphasis is laid on the type of nutrition, its quantitative and qualitative characteristics, harmful habits, their formation in childhood and an attempt to influence them. However the problem of the start of stable DLP development and the role of dietary habits is yet to be solved. A random subsample of 169 school children aged 13 to 16 in the Krasnopresnensky District of Moscow was examined, among them 73 boys and 96 girls. High values of mean alimentary cholesterol, total and saturated fats and low mean amounts of consumed polyunsaturated fats were revealed. It could be inferred that the examined population was characterized by a high risk of the formation of atherogenic DLP stability. An analysis of the findings showed a considerable increase in the consumption of total and saturated fats as well as food rich in cholesterol in the group of children with stable DLP forms confirming the effect of the environmental factors including the alimentary ones, on processes of DLP formation in childhood. Further investigation of DLP in children should be conducted in the form of prospective studies otherwise design of activities in early prevention of atherogenic DLP seems impossible.
Over the period of one year the authors examined the changes in the parameters of the plasma spectrum of lipoproteins and apolipoproteins in 46 patients with acute macrofocal myocardial infarction and 35 patients with labile angina. In six cases variations in these parameters were studied in the course of unstable angina and in the post-infarction period. It was established that myocardial infarction induced specific alterations in the plasma lipoprotein system not only in the immediate post-infarction period but also at more long-term periods. Myocardial infarction causes deep and prolonged disorders in the apolipoprotein system which may contribute to the progression of atherosclerotic damage to the coronary arteries.
The effect of an 8-week monotherapy with propranolol and pratsiol on plasma lipid levels and apo-Al and apo-B, apoproteins of high- and low-density lipoproteins (HDLP, LDLP) was studied in 20 patients with second-stage essential hypertension. Propranolol caused no significant changes in plasma lipid spectrum, however it produced a significant rise in apo-Al levels and reduced the cholesterol load index per weight unit of apo-Al in HDLP particles. Pratsiol treatment caused a significant reduction in plasma triglycerides, cholesterol of very-low-density lipoproteins, the cholesterol atherogenic coefficient and the apo-B/apo-Al ratio, and raised the level of HDLP cholesterol. The findings suggest that plasma lipoprotein effects should be taken into account in the choice of hypotensive agents.
A comparative study of changes in plasma lipids, apo-A1 and apo-B under the effect of 2-week, 2-month and 6-month treatments with hydrochlorothiazide and pratsiol was conducted in 48 patients with arterial hypertension. Hydrochlorothiazide caused a significant increase in total cholesterol (CH), LDL cholesterol, apo-A1 and apo-B, and a decrease in cholesterol load of HDL particles as compared to placebo effects. Increased levels of HDL cholesterol were only noted in the early days of hydrochlorothiazide treatment. Pratsiol therapy produced a significant reduction of total triglycerides (TG), VLDL cholesterol, the cholesterol atherogenic coefficient, the apo-B/apo-A1 ratio, and increased HDL cholesterol. The activity of post-heparin lipoprotein lipase was not basically affected by hydrochlorothiazide, while pratsiol evoked a significant increase in its activity. The pratsiol-associated TG decrease was more pronounced in patients with elevated TG baseline, and the rise in HDL cholesterol, in those with initial hypo-alphacholesterolemia. Therefore unlike hydrochlorothiazide, pratsiol is associated with a favorable antiatherogenic trend of changes in the lipoprotein spectrum.
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Lipoproteinlipase (LPL) and lecithin-cholesterol-acyltransferase (LCAT) activity was studied in rats in conditions of drug-induced (Clofibrat, cholestyramine, aethinyloestradiol) changes in lipid metabolism. Comparison of enzyme activity in three models of changed lipoprotein metabolism has revealed that the only model used (with aethinyloestradiol) leads to the uniform changes (decrease) in LPA and LCAT. Clofibrat increased LPL activity, with LCAT activity remaining unaffected. Cholestyramine caused no changes in LPL activity, but increased LCAT activity. The results obtained suggest that synergism in LPL and LCAT activity changes is registered only when lipolysis of triglyceride-saturated lipoproteins leads to the increase in the number of particles, similar in their structure and properties to high density lipoproteins, the basic LCAT structure.
The priority trend in the activity of health service is prevention of the principal noncontagious diseases, cardiovascular diseases being a major part among them. The foundation of the All-Union Cardiology Research Centre of the Academy of Medical Sciences of the USSR and of Cardiology Institutes in the Union Republics has contributed significantly to studies of the prevalence of cardiovascular diseases, in the population of various regions of the country, and to development of organizational forms of mass prophylaxis. Organization of a unified cardiology service in the country has formed the basis for introduction of the research data to public health practice.
A combined study of possible atherogenic factors was carried out in 213 males subjected to clinical investigation including selective angiography of the heart's coronary arteries. Two sets of biochemical tests were used: the routine set including the measurement of the plasma lipid spectrum, and a more sophisticated procedure (93 cases) where plasma apoproteins A1 and B, and high-density lipoprotein phospholipid composition were assessed as well. A correlation of biochemical disorders to coronary atherosclerosis could be demonstrated in 68% of cases, using the first set, and in 98% with the second set. Abnormal apoprotein levels and high-density lipoprotein phospholipid composition were found to contribute significantly to lipoprotein atherogenesis even in cases of normolipidemia.
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Thirty-three patients with coronary heart disease (CHD) and angiographically documented coronary atherosclerosis were studied for the levels of lipids and apolipoproteins B and A1 (apo-B and apo-A1) in the blood plasma and apo-A1 in the preparations of two major subclasses of high density lipoproteins (HDLP)-HDLP2 and HDLP3. It was established that the apo-B/apo-A1 ratio was statistically higher in the group of CHD patients with clinical signs of atherosclerotic damage to the abdominal portion of the aorta and its branches than in CHD patients without clinical manifestations of disseminated atherosclerosis of the abdominal portion of the aorta and its major branches. This parameter may indicate the presence of a more severe atherosclerotic damage in CHD patients. Moreover, the CHD patients with a more extensive atherosclerotic damage displayed a decrease in the cholesterol load of HDLP3 particles in relation to the weight unit of apo-A1 and also in the amount of apo-A1 in HDLP2 which is suggestive of a weakening of the cholesterol-acceptor properties of HDLP3 and an impairment of their transformation into larger HDLP2 particles which transport cholesterol to the liver.