RESUMEN
AIM: To elucidate associations between high level of lipoprotein(a) [Lp(a)] in children of persons with premature (onset <55 years, men; <60 years, women) coronary heart disease (PCHD) with own and parental characteristics. MATERIAL AND METHODS: We surveyed 133 families: probands (n=122, 80.7% men) with PCHD, spouses (n=95, 12.1% men) and native probands children (n=177, 55.8% men) aged 5-34 years. Factors associated with high ( more or equal 30 mg/dl) LP(a) were selected by logistical regression with adjustment for sex and age separately in younger (5-17 years, n=83) and adult (18-34 years, n=94) children. RESULTS: High LP(a) was high in 21 (25.3%) younger children. Factors independently associated with high LP(a) in this group were apoprotein B (apo B) (odds ratio [OR] 1.03, confidence interval (CI) 1.00-1.05, =0.025) and plasminogen 1.03 (CI 1.01-1.06, =0.027) of these children; high Lp(a) 8.92 (CI 1.98-40.2, =0.0044) and apo B 1.03 (CI 1.00-1.05, =0.047) of consort-parent; high Lp(a) 12.3 (CI 2.88-52.8, =0.0007), high education 5.59 (CI 1.36-23.1, =0.017) and atherogenic dyslipidemia (a-DLP) 0.16 (CI 0.04-0.74, =0.019) of proband-parent. LP(a) was high in 25 (26.6%) adult children. It was independently associated with own low density lipoprotein cholesterol (LDL-C) 1.71 (CI 1.09-2.69, =0.019); high Lp(a) 13.6 (CI 2.39-77.7, =0.0033) and LDL-C 3.38 (CI 1.28-8.92, =0.014) of consort-parent; high Lp(a) 26.9 (CI 5.48-132.3, =0.0001) and a-DLP 0.13 (CI 0.02-0.82, =0.030) of proband-parent. CONCLUSIONS: High Lp(a) levels in these groups of children of patients with premature CHD were associated with characteristics of both parents especially with their elevated Lp(a). Other predictors of high LP(a) were also plausible except high education of proband-parent which possibly reflected some unaccounted factors. Association of high Lp() of children of both age groups with atherogenic dyslipidemia of proband-parent requires confirmation.
Asunto(s)
Antitrombina III/metabolismo , Enfermedad de la Arteria Coronaria , Lipoproteína(a)/sangre , Plasminógeno/metabolismo , Adolescente , Adulto , Edad de Inicio , Niño , Hijo de Padres Discapacitados , Preescolar , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/etiología , Enfermedad de la Arteria Coronaria/metabolismo , Dislipidemias/epidemiología , Dislipidemias/etiología , Dislipidemias/metabolismo , Modificador del Efecto Epidemiológico , Femenino , Humanos , Metabolismo de los Lípidos , Masculino , Persona de Mediana Edad , Padres , Factores de RiesgoRESUMEN
AIM: To assess effect of transition from metabolic syndrome (MS) definition of International Diabetic Federation (IDF, 2005) to definition of Joint Interim Statement (JIS, 2009) on proportion of persons with MS among patients with premature coronary heart disease (CHD) and members of their families. MATERIAL: We examined 817 members of 375 families: 353-probands with premature CHD (65.7% men, 77.6% after MI, age 23-67 years); their 212 consorts (18.9% men, 5.7% with CHD, age 28-67 years), and 252 their children (52.4% men, without overt CHD, age 16-46 years). Parameters analyzed included body mass index (BMI), waist circumference, systolic/diastolic BP, serum high density lipoprotein (HDL) cholesterol (CH), triglycerides (TG). Impaired fasting glucose (IFG) and diabetes mellitus (DM) we defined according to ADA criteria. High BP was defined as prehypertension or hypertension (NHBPEP 4 report on high BP in children/adolescents or JNC 7 criteria, depending on age). RESULTS: Portions of individuals with MS according to JIS and IDF definitions were in the whole population 335/817 (41.0%) and 305/817 (37.3%), among probands 62.9% and 56.1%, consorts 37.3% and 36.8%, adult children 13.5% and 11.5%, respectively. All 305 persons with IDF MS satisfied JIS definition but JIS criteria identified MS in 30 more persons (25 with CHD). They were predominantly men (22/30), not obese (BMI range 19.1-29.1; median 25.5 kg/m2), with 3-4 AHA/NHLBI (2005) MS components, most had low HDL-CH (27); high TG (26), high BP (24), 14 persons had IFG, 5 - DM. CONCLUSION: In this heterogeneous population the use of JIS definition resulted in diagnosis of MS in small additional portion (9%) of persons with obvious high risk already requiring interventions because of CHD and/or level of CHD risk factors.
Asunto(s)
Enfermedad Coronaria , Diabetes Mellitus , Hipertensión , Clasificación Internacional de Enfermedades , Síndrome Metabólico , Obesidad , Adolescente , Adulto , Edad de Inicio , Anciano , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etiología , Diagnóstico Precoz , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Masculino , Síndrome Metabólico/clasificación , Síndrome Metabólico/complicaciones , Síndrome Metabólico/epidemiología , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/etiología , Selección de Paciente , Evaluación de Programas y Proyectos de Salud/tendencias , Mejoramiento de la Calidad , Factores de RiesgoRESUMEN
AIM: To elucidate associations between high low density lipoprotein cholesterol (LDL-C) in children of persons with premature coronary heart disease (PCHD) and their own and parental characteristics. METHODS: We examined members of 282 families: probands (n = 262, 70.1% men) with PCHD (onset before 55 [men] or 60 [women] years), their spouses (n = 192, 19.2% men), and children of probands (n = 372, 55.8% men) aged 5-38 years. We defined high LDL-C in children aged 5-17 years as a90 percentile (Lipid Research Clinics Program Prevalence Study), in children aged 18-38 years - > or = 3.36 mmol/l. Factors related to children's high LDL were selected by logistic regression with sex and age adjustment. RESULTS: High LDL-C was found in 40/155 (25.8%) children aged 5-17 years. It was independently related to non-smoking of proband's spouse, higher own body mass index (BMI), LDL-C of proband and his spouse, lower heart rate of proband. High LDL-C was revealed in 85/217 (39.2%) children aged 18-38 years. It was independently related to metabolic syndrome of parent-nonproband, higher level of LDL-C of both parents, lower height of proband. INTERPRETATION: Most associations of high LDLAC of offsprings of patients with PCHD including negative relation to height and heart rate of proband are plausible. Association with parental nonsmoking can be result of analysis of unreliable data from small group but also reflect better economical conditions and more atherogenic nutrition of nonsmokers in Russia.
Asunto(s)
LDL-Colesterol/metabolismo , Enfermedad Coronaria , Hiperlipidemias , Síndrome Metabólico/complicaciones , Síndrome Metabólico/metabolismo , Fumar , Adolescente , Adulto , Edad de Inicio , Índice de Masa Corporal , Niño , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Enfermedad Coronaria/metabolismo , Enfermedad Coronaria/fisiopatología , Femenino , Humanos , Hiperlipidemias/complicaciones , Hiperlipidemias/epidemiología , Hiperlipidemias/metabolismo , Hiperlipidemias/fisiopatología , Masculino , Síndrome Metabólico/epidemiología , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Padres , Prevalencia , Factores de Riesgo , Fumar/efectos adversos , Fumar/metabolismoRESUMEN
AIM: to elucidate own and parental predictors of arterial prehypertension (PreHT) and hypertension (HT) in children of patients with premature manifested before 55 years in men or before 60 years in women) coronary heart disease (CHD). METHODS: We surveyed 276 families: 258 probands parents with premature CHD, their 214 spouses and 362 native probands children aged 5-37 years. In persons aged 17 years we used criteria of 4 th Report National Education Program Working Group on High BP in Children and Adolescents, in persons 18 years - 7 th Report Joint National Committee (USA). Predictors were selected by logistical regression with adjustment for sex and age. RESULTS: PreHT/HT was revealed in 26/143 (18.2%) children aged 5-17 years. Their own (body mass index [BMI], waist circumference, glucose) and parental (diastolic BP of proband) predictors related to the presence of PreHT/HT with <0.1 in univariate analysis were included in stepwise regression procedure. PreHT/HT was independently associated only with higher own BMI: odds ratio (OR) of top vs bottom tertile 10.2 (95% confidence interval [CI] 1.99-52.8; p=0.005). PreHT and HT were found in 75/219 (34.2%) and 40/219 (18.3%) children aged 18-37 years, respectively. Their own (BMI, waist circumference, glucose, triglycerides and total cholesterol) and parental (waist circumference, BMI, diabetes mellitus, PreHT/HT and triglycerides of proband; education level, alcohol consumption and oral hormonal contraceptive drugs use of spouse) predictors selected in univariate analysis with <0.1, were included in stepwise regression procedure. HT was independently associated with higher BMI (OR top vs bottom tertile 19.9 [95% CI 4.34-90.8]; <0.0001) and glucose (OR top vs bottom tertile 7.85 [95% CI 2.73-22.6]; <0.0001) of children, and PreHT/HT of probands (OR 2.80 [95% CI 1.13-6.94]; =0.026). CONCLUSION: PreHT and HT (age group 5-17 years) and HT (age group 18-37 years) in children of persons with premature CHD were independently related to own "metabolic" risk factors (BMI in both age groups and basal glucose in adult children). Association of preHT/HT of proband with HT in their children became manifested later in childrens life (18-37 years).
Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Hipertensión/complicaciones , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Niño , Preescolar , Enfermedad de la Arteria Coronaria/etiología , Progresión de la Enfermedad , Femenino , Humanos , Hipertensión/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Factores de Riesgo , Federación de Rusia/epidemiología , Fumar/efectos adversosRESUMEN
PURPOSE: To elucidate risk factors concordance between spouses in families of patients with "premature" coronary heart disease (CHD). METHODS: We examined 174 spouse pairs. There were 174 probands with "premature" (onset before 55 years) CHD aged 32-63 years and 174 their spouses aged 28-63 years. Among probands 18.4% had angina pectoris only and 81.6% had history of myocardial infarction. There were 10 patients with CHD among spouses (5.75%). Characteristics studied included alcohol consumption, tobacco smoking, education, body mass index (BMI), waist circumference (WC), heart rate, systolic and diastolic blood pressure (DBP), total, low and high density lipoprotein cholesterol, triglycerides (TG), apoproteins -I and B, lipoprotein (a), blood glucose and insulin, homeostasis model assessment-insulin resistance (HOMA IR), fibrinogen, activity of plasminogen activator inhibitor type 1. Concordance of variables of continuous and ordinal type was estimated by Spearmanis rank correlation coefficients adjusted for sex and age. Pairs were divided according to proband age (32-47 and 35-63 years) and spousal concordance for characteristics studied was evaluated separately in 2 groups distinguished by age of proband (probands 32-47, spouses 28-53 years, and probands 48-63, spouses 35-63 years) with presumably different duration of marriage/cohabitation. RESULTS: Registered characteristics of spouses except apo -I correlated positively. Correlations between 9 characteristics were significant: education, insulin, HOMA IR, WC (R=0.608, 0.424, 0.421, 0.294; all p=0.0001), glucose (R=0.261; p=0.0007), TG and fibrinogen (both R=0.222; p=0.0036 and 0.0063, respectively), BMI and DBP (R=0.195 and 0.185, respectively; both p<0.016). All correlations were similar in groups of "younger" and "older" pairs with exception of PAI 1 activity (R = -0.035 and 0.320, respectively; p=0.042). CONCLUSION: In families of patients with premature CHD we found various degree of spousal concordance for risk factors mostly those considered to be related to metabolic syndrome. Correlations between risk factors levels in groups with presumably different duration of marriage were similar suggesting that concordance was due to assortative mating.
Asunto(s)
Enfermedad Coronaria/epidemiología , Síndrome Metabólico/epidemiología , Esposos , Adulto , Factores de Edad , Consumo de Bebidas Alcohólicas/efectos adversos , Angina de Pecho/epidemiología , Factores de Coagulación Sanguínea/análisis , Índice de Masa Corporal , Colesterol/sangre , Enfermedad Coronaria/sangre , Educación , Humanos , Insulina/sangre , Resistencia a la Insulina , Lipoproteínas/sangre , Síndrome Metabólico/sangre , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Factores de Riesgo , Fumar/efectos adversos , Estadísticas no Paramétricas , Triglicéridos/sangre , Circunferencia de la CinturaAsunto(s)
Enfermedad Coronaria/prevención & control , Fenofibrato , Hiperlipidemias/tratamiento farmacológico , Hipolipemiantes , Adulto , Anciano , Colesterol/sangre , Diabetes Mellitus Tipo 2/complicaciones , Quimioterapia Combinada , Femenino , Fenofibrato/administración & dosificación , Fenofibrato/farmacología , Fenofibrato/uso terapéutico , Fibrinógeno/análisis , Homocisteína/sangre , Humanos , Hiperlipidemias/sangre , Hiperlipidemias/complicaciones , Hipolipemiantes/administración & dosificación , Hipolipemiantes/farmacología , Hipolipemiantes/uso terapéutico , Resistencia a la Insulina , Lípidos/sangre , Masculino , Persona de Mediana Edad , Placebos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Factores de Riesgo , Triglicéridos/sangreAsunto(s)
Bezafibrato/farmacología , Clofibrato/farmacología , Gemfibrozilo/farmacología , Hipolipemiantes/farmacología , Lipoproteínas/sangre , Femenino , Humanos , Hipertrigliceridemia/sangre , Hipertrigliceridemia/tratamiento farmacológico , Hipertrigliceridemia/metabolismo , Masculino , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
Hipercolesterolemia/dietoterapia , Adulto , Colesterol en la Dieta/administración & dosificación , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Ingestión de Energía , Ácidos Grasos Monoinsaturados/administración & dosificación , Ácidos Grasos Insaturados/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
An organized community numbering 1563 men aged 20 to 59 years engaged in scientific activity were entered into an experimental and prophylactic study. The intervention measures were exercised in a high risk group with dyslipoproteinemia, borderline hypertension and coronary heart disease (CHD), mainly at the expense of alterations in nutrition. The three-year prophylaxis resulted in a 7-percent decrease in blood plasma cholesterol and a 13-percent fall in triglycerides. The prevalence of arterial hypertension declined by 3 and the excess body weight by 3.7 percent, which led to a 33-percent decrease in CHD risk development calculated with the aid of the R. P. Prochorskas risk logistic function. Advantages of the individual strategy of CHD prevention are discussed.
Asunto(s)
Enfermedad Coronaria/prevención & control , Adulto , Colesterol/sangre , Dieta Reductora , Humanos , Hipertensión/dietoterapia , Lipoproteínas/sangre , Masculino , Persona de Mediana Edad , Factores de Riesgo , Triglicéridos/sangreRESUMEN
In the organized population, 364 male subjects aged 20-59 years (those with dyslipoproteinemias and borderline hypertension and patients with coronary heart disease) were on diet for 6 months, which resulted in a significant drop in plasma cholesterol, triglycerides, systolic and diastolic blood pressures, and body weight by 7.7%, 17%, 3%, 3.7%, and 5.3%, respectively. The portion of fat in the diet was reduced from 40% to 36% of total caloric value and that of sugar was decreased from 13% to 10%, at the same time complex carbohydrates and protein were increased from 8% to 12% and from 15% to 17%, respectively. A multiple stepwise regression analysis was used to define whether different variables were significant in lowering the risk factors.
Asunto(s)
Enfermedad Coronaria/prevención & control , Docentes , Hiperlipidemias/dietoterapia , Hipertensión/dietoterapia , Obesidad/dietoterapia , Adulto , Enfermedad Coronaria/etiología , Dieta Reductora , Ingestión de Energía , Humanos , Hiperlipidemias/complicaciones , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Moscú , Obesidad/complicaciones , Factores de RiesgoRESUMEN
The authors presented the results of a study of the level of blood plasma apo-B and apo-A-I in random samples (by age decades from 20 to 60) of the organized male population (n = 309) and additionally of CHD patients who were not entered into the random samples (n = 82). Age differences in the level of blood plasma apo-B and apo-A-I were noted; a significant positive correlation with age of the level of apolipoprotein B at the age of 20 to 59 and a negative correlation of apo-A-I in males aged 20 to 39 were revealed. By the percentile distribution of apo-LP-B and A-I the relative borders of their high and low values were defined in random samples of males aged 20 to 39 and 40 to 59. Significant differences in the prevalence of high and low levels of apo-B and apo-A-I were demonstrated among patients with CHD and persons without this pathology.