RESUMO

The aim of the current study of 18 hyperandrogenic women was to determine the affects of ketoconazole (KTZ), an oral synthetic antifungal imidazole derivative that inhibits gonadal and adrenal steroidogenesis, on lipids, lipoprotein cholesterols, apolipoproteins, endogenous sex steroid hormones, and their interactions. Eighteen hyperandrogenic women, ages 18 to 35, with a history of severe acne and/or hirsutism, were randomly divided into two groups of nine, both receiving KTZ (group 1, 400 mg/d; group 2,800 mg/d) for 10 days. In groups 1 and 2, KTZ therapy reduced cholesterol (10%, P less than or equal to .01; 19%, P less than or equal to .05) and low-density lipoprotein (LDL)-cholesterol (13%, P less than or equal to .05; 33%, P less than or equal to .025), and increased apolipoprotein (apo) A1 (7%, P less than or equal to .005; 13%, P less than or equal to .01). KTZ, 800 mg/d, decreased apo B (21%, P less than or equal to .005), and lowered the ratio of LDL-cholesterol to high-density lipoprotein (HDL)-cholesterol (40%, P less than or equal to .01). KTZ therapy more than doubled the levels of estradiol (E2) in both groups (136%, P less than or equal to .01; 171%, P less than or equal to .01) and, in the high-dose group, decreased the levels of free testosterone (FT) (48%, P less than or equal to .05) and dehydroepiandrosterone-sulfate (DHEA-S) (36%, P less than or equal to .005). The reductions of total and LDL-cholesterol appear to be attributable to the increases in E2 and possibly to the decrease in FT. KTZ therapy may have beneficial effects on atherogenic lipid and lipoprotein patterns in women with hyperandrogenicity.

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RESUMO

Plasma lipids, lipoproteins, and anthropometric measurements were assessed in 996 Venezuelan school children (ages 13--18 years) (441 in private, 555 in public schools, Merida, Venezuela) with cross-cultural comparisons to 419 13--18-year-old American school children from suburban Cincinnati, Ohio. Although there were no systematic differences in plasma cholesterol and triglyceride between public and private Venezuelan school children, low density lipoprotein cholesterol (LDL-C) levels were higher and high density lipoprotein cholesterol (HDL-C) levels lower in public than private school children. Within Venezuelan schools, and between sex, female children had consistently higher total plasma cholesterol, marginally higher HDL-C, and appreciably higher LDL-C than males. There were no consistent cross-sectional changes in lipids and lipoproteins in Venezuelan school children with age. Within sex, cross-cultural comparisons with Cincinnati school children revealed 2 major, consistent differences; Venezuelan children had higher fasting plasma triglyceride and lower HDL-C levels, not attributable to systematic differences in Quetelet index, laboratory methodology, subject selection, or sampling technique. Total plasma cholesterol and HDL-C were similar for Venezuelan and Cincinnati school children. Maintenance of comparable LDL-C but lower HDL-C levels by Venezuelan children into adulthood might, speculatively, be associated with augmented risk for coronary heart disease.

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RESUMO

This study was designed to focus upon within-culture differences in plasma lipids and lipoproteins in Venezuelan schoolchildren having different socioeconomic and nutritional backgrounds and also to provide cross-cultural comparisons of lipids, lipoproteins, and anthropometric measurements between Venezuelan and American schoolchildren. The study was carried out in 1298 schoolchildren, ages 7 to 12 years, 428 in private and 870 in public schools in Merida, Venezuela, with comparison to 472 public schoolchildren in the (Cincinnati, OH) Princeton School District. Within Venezuelan schools, private shcoolchildren were heavier, taller, had marginally higher Quetelet indices, and had considerably higher fasting plasma cholesterol, plasma high-density lipoprotein (C-HDL), and plasma low-density lipoprotein (C-LDL) levels. These lipid-lipoprotein differences were highly significant after adjusting (by covariance analysis) for Quetelet index, sex, and age. Children from private Venezuelan schools ingested more total calories, more protein, more fat, and more carbohydrate. When the diet compositions were calculated as percentage of total calories, the private schoolchildren ingested nearly twice as many calories as fat and a somewhat lower proportion of calories as carbohydrate, with a comparable proportion as protein, when compared to the public Venezuelan schoolchildren. Male-female comparisons within Venezuelan schools revealed patterns of sex-related lipoprotein differences which were qualitatively similar to those in Princeton schoolchildren. Thus, 7- to 12-year-old females had higher total plasma cholesterol and triglyceride, lower C-HDL, and higher C-LDL. Within sex, cross-cultural comparisons of lipids, lipoproteins, and Quetelet indices revealed two major differences. Venezuelan children had significantly higher fasting plasma triglyceride and lower C-HDL levels, differences not attributable to systematic differences in measures of ponderosity, because Quetelet indices in Venezuelan and Cincinnati schoolchildren did not differ appreciably. In regard to total and low-density lipoprotein cholesterol, Venezuelan and Princeton public schoolchildren were remarkably comparable, although Venezuelan private schoolchildren had somewhat higher plasma cholesterol and C-LDL levels than did Princeton public schoolchildren. We speculate that increasing "westernization" and "urbanization" of Venezuelan society is associated with convergence of Venezuelan and American pediatric plasma lipid and lipoprotein levels. Maintenance of comparable total plasma cholesterol and C-LDL levels with lower C-HDL into adulthood in Venezuela would, in fact, suggest augmented risks for coronary heart disease for Venezuela within this lipid-lipoprotein frame of reference.

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To assess the relationship between altitude, atherogenic, and anti-atherogenic lipoprotein cholesterols (low- [C-LDL] and high [C-HDL] density lipoprotein cholesterols, respectively), 136 and 94 Venezuelan Mestizos living at 1,000 and 3,500 in elevation were studied. The two groups did not differ in regard to height, weight, ethnic origin, social or economic status, nutritional patterns, age, or occupation. Both groups had a high level of daily physical exertion, an imperative in their subsistence rural agricultural economy. Due to the mountainous terrain, high altitude residents were thought to have increased levels of physical activity. Males and females at high altitude had significantly lower plasma total cholesterol and C-LDL levels, and slightly lower C-HDL levels than those at low altitudes. It is speculated that reduced coronary heart disease event rates at high altitude might be related to lower levels of the atherogenic lipoprotein cholesterol, C-LDL.

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