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It has been shown that low-density plasma lipoproteins in patients with ischemic heart disease and hypertriglyceridemia are heavier in density, smaller in size, more negatively charged and more inclined to peroxide modification and aggregation than in healthy persons. The protein in the composition of such lipoproteins deviates towards the water phase, which may result in the masking of the domen, recognized by the BE-receptor and may lead to hyperlipidemia of a retaining character.

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Macrofocal myocardial infarction survivers with repeated cardiac accidents (sudden death and repeated myocardial infarction) in the post-infarction period (a 5-7-year follow-up) differ from similar patients with a stable course of the disease by a greater incidence and persistence of such risk factors as smoking and hyperlipoproteinemia. A thorough and maximally possible correction of these factors is necessary. Regular ergometric tests allow the identification of a high risk group for repeated cardiac accidents among patients with a history of an uncomplicated myocardial infarction. Of prognostic significance are such ergometric parameters as the cause of load cessation, the total displacement of the ST segment and the coefficient of consumption of the myocardial reserves. There has been no direct correlation between the incidence of ventricular arrhythmias revealed at the bicycle ergometric examination and the development of repeated cardiac accidents, which appears to be associated with the adequate symptomatic therapy aimed at maintaining the contractile function of the myocardium.

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Effect of heparin on the lipoprotein lipase activity was studied after its administration into fasting and fat loaded patients with heart ischemic disease, exhibiting various lipoprotein spectrum of blood. Heparin activated more distinctly the lipolytic enzymes in the patients kept on fatty diet as compared with the fasting patients. The difference was maximal in the patients with the IIa type of hypolipoproteinemia and minimal--in the patients with the IV type of the disease. The hypotriglyceridemic effect of heparin was found in all the groups examined; however, the least decrease in the triglyceride content occurred in the IV type of hypolipoproteinemia. These data demonstrate the relative deficiency of lipoprotein lipolysis in the type of hypolipoproteinemia studied.

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Long-term follow-up of 70 patients who had suffered myocardial infarctions included clinical, and regular ergometric examinations. For conducting therapeutic and rehabilitation procedures it suggested to study the changes in the following indices: myocardial reserve consumption coefficient, the total ST segment shift during the exercise. The results of 513 examinations showed that these indices may help practicing cardiologists in choosing the tactics of the therapy and rehabilitation of the patients with chronic ischemic heart disease.

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Lipolytic activity was distinctly increased in blood plasma of patients with ischemic heart impairment and various types of hyperlipoproteinemia after a test breakfast. The increase in lipolysis was due to elevation in the lipoprotein lipase activity in response to loading with lipids. Attempts to distinguish among the ischemic patients some subgroups on the basis only of the initial level of triglycerides in their blood plasma did not exhibit any differences in the enzymatic activity after the loading with lipids. This relationship was clearly noted in classification of the patients on the basis of the types of hyperlipoproteinemia. The earliest and the most pronounced increase in lipolytic activity in response to the loading with lipids was observed in the 11a type of hyperlipoproteinemia.

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The authors conducted a repeated examination of 150 patients suffering from ischemic heart disease with normolipidemia and types IIa, IIb and IV hyperlipoproteinemia. The content of alpha-cholesterol in these patients tended to fluctuate, just as the content of other blood lipid fractions. Its fluctuations were most marked in types 11b and IV hyperlipoproteinemia. Comparison of the alpha-cholesterol content in patients with ischemic heart disease with the results of population tests confirmed the information on its lower level in patients. A still greater difference between patients and healthy individuals was revealed when the percentage of total cholesterol for which alpha-lipoproteines accounted and the value of the cholesterol atherogenic index were compared. Reduced concentration of alpha-cholesterol was encountered not only in hyperlipoproteinemia, but also in normolipidemia. The level of alpha-cholesterol had a negative correlative connection with the content of triglycerides in the blood.

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Thirty-six healthy males and 157 males with ischemic heart disease were examined. Healthy males had statistically significant changes in the daily rhythm of cholesterol, triglycerides, glucose, and total blood serum lipids, while the rhythms of nonesterified fatty acids, total phospholipids, and overall content of beta- and pre-beta-lipoproteins were statistically insignificant. Patients with ischemic heart disease had statistically significant rhythms of cholesterol, triglycerides, total lipids, and total phospholipids, while the daily rhythms of nonesterified fatty acids, glucose and the overall content of beta- and pre-beta-lipoproteins in blood serum were statistically insignificant. Desynchronization of the acrophase of the daily rhythm of the overall content of beta-and pre-beta-lipoproteins as compared to the findings in healthy individuals was encountered.

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Examination was conducted of 180 healthy males 35 to 44 years of age, working as leading engineers, and of 174 patients with ischemic heart disease selected according to sex and occupation. A comparative analysis was made of the frequency of the main risk factors and some peculiarities of the labour activity and behaviour of patients with types II and IV hyperlipoproteinemia and those with normal lipid level. It is shown that a combination of known risk factors, behaviour peculiarities and conditions of labour activity is typical of patients with type IV hyperlipoproteinemia, which may promote the development of ischemic heart disease. Patients with normal blood lipid livel merit special attention. Additional factors contributing to the development of ischemic heart disease in these cases should be searched for.

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The blood lipid content and lipoprotein spectrum were repeatedly tested in 216 males with ischemic heart disease for follow-up periods of 4 to 5 years. Irrespective of the type of hyperlipoproteinemia, the blood triglyceride level was marked by the greatest individual fluctuations and the level of total cholesterol by the least fluctuations. Comparison of the clinical course of ischemic heart disease with the peculiarities of the changes in the blood lipid content revealed a higher incidence of recurrent myocardial infarction and sudden death among individuals with type IIa hyperlipoproteinemia. Recurrent vascular catastrophes were observed not only in patients with stable hypercholesterolemia but also in individuals with its labile form. It is concluded that repeated tests for the blood lipid content provide for more reliable diagnosis of hyperlipidemia and the type of hyperlipoproteinemia, which is of unquestionable practical importance.

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The results subsequent to an examination of 250 males aged 30-47 suffering from ischemic heart disease and doing strenous mental work are presented. Two variants were used in phenotyping: the first was based on not too high criteria for the cholesterol and triglycerides level (250 and 140 mg%, respectively), the second one having as a groundwork upper limits of the normal value estimated by the authors (250 and 190 mg%, respectively). It was found that, depending upon the actual value of the upper normal limit for triglycerides hyperlipidemia is demonstrable in 64 or 56% of the males. Of most frequent occurrence were the II and IV types of hyperlipoproteinemia with the latter type prevailing in both variants. Most patients with ischemic heart disease demonstrated a fall of alpha-lipoproteins, as ascertained by their separation through disc-electrophoresis in polyacrylamide gel.

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The effect of Misclerone (clofibrate) was studied in 127 patients with different types of hyperlipoproteinemia treated with the drug for 1 month and longer. On the basis of the obtained data it was concluded that Misclerone is effective both in patients with isolated disorders in cholesterol metabolism (Type II), and in those with cholesterol and triglycerides metabolism disorders (Types IIb and III), and in those with prevailing triglycerides metabolism disorders (Type IV). The efficacy of the drug in Type II hyperlipoproteinemia is determined by the degree and nature of metabolic disorders of low density lipoproteins.

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Diurnal fluctuations in the level of cholesterol, phospholipids, triglycerides, NEFA and sugar in the blood of practically healthy subjects and in patients with ischemic heart disease, attended by hyperlipoproteinemia of the II and IV types, were studied. Investigations were made at 9 a.m., 3 and 9 p.m. The variations of the lipid fractions and sugar in the blood of practically healthy individuals and of patients with hyperlipoproteinemia showed no essential differences. There were minimal diurnal changes in the cholesterol level, a tendency towards an increase in the level of phospholipids, a statistically significant rise in the content of triglycerides and sugar in the blood and large fluctuations in the level of the NEFA, both upwards and downwards. In patients with hyperlipoproteinemia of the II type variations in the blood cholesterol and phospholipids levels occurring in the course of the day proved to be of the same nature as in the case of normal lipoproteinemia, with no diurnal rise of the sugar level, while the NEFA content showed a distinct upward tendency. In patients it was only the blood cholesterol and triglycerides level that remained at a statistically significant higher level throughout the day.

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