X-syndrome: Risk factors and progression of atherosclerosis

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subgroups according to Apo (a) phenotype (individuals with high and low molecular weight Apo (a) phenotypes). We conclude that thyroid autoimmunity does not seem to influence Lp(a) concentrations in either normal subjects or renal patients. THE ROLE OF CIRCULATING IMMUNE COMPLEXES FOR ATHEROGENESIS IN PATIENTS WITH ARTERIAL HYPERTENSION S. Mantov, K. Todorova, "1". Mircheva, R. Dineva. Medical Faculty,

Thracian UniversiO: Department of Internal Diseases, Stara Zagora. Bulgaria The vascular atheromatosis is common complication in patients with arterial hypertension (AH) and the immunologic factors play an important role for it. The purpose of the study was to establish the significance of the circulating immune complexes (CIC) for atherogenesis by exam of antiscleroticvascular antibodies (ASVA). We've studied 62 patients with arterial hypertension (AH), middle aged 38, by immunologic methods. We've established, that the patients with high levels of CIC were with significantly higher degree of possitivity of ASVA (56.25%+, p > 0.01) up to IV+ degree of possitivity in comparison with those with low and normal CIC. The authors discuss the role of CIC for atherogenesis and target organs vascular complications in patients with arterial hypertension (AH) and the possibilities to be used as prognostic tests for atberosclerotic complications. Key Words: Arterial hypertension, Atherosclerosis, Circulating Immune Complexes (C1C), Antisclerotic-vascular Antibodies (ASVA) ARTERIAL HYPERTENSION AND OBESITY AS RISK FACTORS FOR TARGET ORGANS VASCULAR COMPLICATIONS S. Mantov, T Mircheva, K. Todorova, R. Dineva. Medical Faculty.

Thracian University, Department of Internal Medicine. Stara Zagora, Bulgaria Humoral immunity was studied in 3 groups of patients - 82 women with systemic arterial hypertension, without obesity/AH/; 33 patients with obesity 2rid and 3rd degree, without AH /O/ and in 25 women with 2 risk factors/AH and Obesity/. The immunoassay tests included: Circulating immune complexes/CIC/, Total serum complement/CH50/, C3-component of complement and Circulating antitissue antibodies/CAA/- AVA & AVSA. The same parameters were studied in 100 age matched, healthy, normtensive women. We've found: (I) Significantly high levels of CH50 in the three studied groups, compared to healthy, but the highest of the levels in the group with combined 2 risk factors/All and Obesity/; (2) Significant increase of C3component of complement in the three studied groups, in comparison with healthy, but without significant difference among each of them; (3) Markedly high levels of CIC compared to healthy, hut without significant differences among the groups with 1 and 2 risk factors; (4) Nonsignificant increase of the degree of possitivity of the CAA in the patients with Obesity, and significant incrase in the group with All and the highest levels in the patients with 2 risk factors/AH and Obesity/. The authors discuss the role of the combined 2 risk factors for atheroselerosis/AH and Obesity/as a cause for deepening of the target organs' vascular complications as a result of the provoked significant changes of the humoral immunity's factors. Key Words: arterial hypertension, obesity, atherosclerosis, target organs' vascular complications, humoral immunity's factors, risk factors. INFLUENCE OF DIABETES AND ARTERIAL HYPERTENSION ON THE IMMUNE MECHANISM OF ATHEROSCLEROSIS S. Mantov, T. Mircheva, K. Todorova, R. Dineva. Medical Faculty,

Thracian University, Department of Cardiology, Stara Zagora, Bulgaria In order to evaluate the changes in humoral immunity due to one and two atherogenic factors (arterial hypertension and/or diabetes mellitus), we've studied 350 women, divided into four groups: (I) 65 insulin-dependent (type I) non-hypertensive diabetics; (2) 92 systemic hypertensive non-diabetic patients; (3) 64 hypertensive insulin-dependent diabetics; and (4) 129 nonhypertensive and non-diabetic women as a control group. All subjects had no coronary artery disease. The humoral immunity was evaluated by: (1) circulating immune complexes, (2) total serum complement, (3) C3-fraction of eomlement and (4)

cirrculating antitissue antibodies (antivascular and antisclerotic-vascular). The patients with atherosclerotic risk factors (diabetes and/or hypertension~ had significantly (p < 0.001) elevated levels of total complement, C3fraction and circulating complexes compared to the control group. Total complement and Circulating Immune complexes' levels were most elevated in patients with a combination of diabetes and hypertension. Similarly, these patients had the highest frequency of antitissoe antibodies. In summary, the parameters ofhumoral immunity were more significantly changed in patients with two risk factors (diabetes and hypertension) compared to patients with only one risk factor. It is possible that these immunological changes appeared earlier than the clinical symptoms of atherosclerosis and they could be used as an early prognostic test for predisposition to atherosclerotic vascular complications. Key Words: Arterial Hypertension, Diabetes mellitus, Immunological changes, Atherosclerosis TYPE I11 HYPERLIPOPROTEINAEMIA IN PATIENT WITH SEVERE HYPOTHYROIDISM ACCOMPANIED BY PRIMARY AMENORRHOEA M. Krsek, R. Ceska, A. Horinek, B. Horejsi, V. Weiss. 3"1 Department of Internal Medicine, I st Faculty of Medicine. Charles University, Prague. Czech Republic Type 111 hyperlipoproteinaemia (type 111 HLPJ is usually connected with apolipoprotein-E2/E2 (apo-E2/E2) phenotype which itself is not sufficient for its manifestation. Type Ill HLP is rarely detected before adulthood and its presentation at earlier age is more frequent in males. In females it usually does not manifest before the menopause. Hypothyroidism belongs to factors capable to aggravate or precipitate manifestation of type Ill HLE It could also affect hypothalamic regulations of endocrine functions. We report a rare case of profound hypothyroidism in 16-years old female presenting as severe dysbetalipoproteinaemia with apo-E2/E2 phenotype with typical clinical signs as xanthomata striata palmaris and eruptive xanthomas on elbows, knees, buttocks and hands. The initial serum levels were for total cholesterol 19.6 mmol/1 with HDL-cholesterol 1.0 mmol/l and for triglycerides 11.5 mmol/I. Electrophoresis showed typical "broad band". The examination of apo-E polymorphism revealed apo-E2/E2 phenotype. Hypothyroidism has been caused by chronic lymphocytic thyroiditis. Serum TSH levels at the time of diagnosis were extremely high more than 100 mlU,q and total T4 levels were undeteetable. In addition, in our case severe hypothyroidism during the puberty affected the function of hypothalamopituitary-ovarian axis and led to primary amenorrhoea and to the retardation of pubertal development. The causal treatment with levothyroxin in appropriate dose along to dietary advise led to complete normalization of lipid and lipoprotein serum levels (total cholesterol 3.48 mmol/1, HDL-cholesterol 1.48 mmol/I, triglycerides 0.94 mmol/l) and to disappearance of xanthomas. It led also to restoration of regular menstrual cycle and gradual normalization of somatic and sexual development. X-SYNDROME: RISK FACTORS AND PROGRESSION OF ATHEROSCLEROSIS L.T. Malaya, I.K. Kondakov, O.V. Zhmuro. Research Institute of therapy.

Kharkov. Ukraine The aim of the present study was to investigate role of independent risk factors, lipid metabolism parameters, insulin and cortisol plasma levels in development of atherosclerosis. Postmortem data had been studied in 60 pts with X-syndrome (age from 40 to 79 years). When alive, these patients had the following results: systolic blood pressure > 140 mm Hg, diastolic blood presure > 90 mm Hg; triglyceride plasma level > 1.7 mmol/1, total cholesterol plasma level > 5.2 mmol/1, blood glucose (after glucose loading) 6.7-10.0 mmol/I. Severity of atherosclerotic lesion was estimated using planimetry by aortal intimal lipoidosis degree. Biochemical parameters had been estimated by multifactorial analysis with planimetry data of the same patients. It was revealed that in dead patients with X-syndrome intimal lipoidosis area was equally large in all age subgroups (see Fig.). We revealed the following main factors leading to increase of intimal aortic lipid infiltration: eortisol plasma level (r = +0.69; p < 0.001), insulin plasma level (r = -0.36; p < 0.05), plasma triglycerides (r = +0.3; p < 0.05). Basal hypercortisolemia, as well as significant increase of the hormone plasma level during psychoemotional stress, lead to damage of vascular wall, either directly or due to lipoidosis in aorta (% from aorta area) permissive action

71st EA8 Congress and Satellite Symposia

Pre-congress, Delphi Posters of cortisol on catecholamines. Moreover, increase in cortisol secretion in X-syndrome patients closely correlates with hypertriglyce-ridemia, that accelarates development of atheroclerosis. The role of insulin sems to be a "buffer" of some kind, and it contribute to adequate glucocortieoid response in X-syndrome patients. 7O

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Our group in the cardiac rehabilitation center chose a group of 70 patients who were referred after cardiac surgery and CABG or post-MI and followed them for 3 months. Before starting the course of rehabilitation (including interventional actions on modifying their dietary, mental and physical activity habits), their 14 hour fasting blood samples were sent for serum cholesterol (T.eho), triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) and in the same manner 12 weeks later after completion of the course, the same samples were taken and measured. the following data was obtained using student's t-test. Results: T.cho, TG and LDL had decreased in 70°/,, 62% and 7 6 0 of patients and in 86% patients, HDL showed an increase. T.cho, TG, LDL and HDL was normalized in 35%, 30%, 68% and 65%, sequentially atter finishing their 3 month course which overall showed a 20 mg/dL, 56 mg/dL, and 20 mg/dL decrease sequentially (P-value < 0.05) in average and 10 rag/alL increase in averages of serum HDL (P-value < less than 0.05). The insignificant decrease in T.cho, TG and LDL in this study probably needs following up more samples or a vast study, but the increase in HDL in all patients and normalization of lipid profile in most of them shows the importance o f rehabilitation in cardiac patients and the need for its continuity.

Fig. Age dynamics of intimal lipoidosis in aorta (% from aorta area)

BODY FAT DISTRIBUTION, SERUM LIPIDS, BLOOD PRESSURE AND CORONARY ARTERY DISEASE IN ADULTS OF ISFAHAN, IRAN

N. Mohammadifard, N. SarrafZadegan, E Sajadi, N. Abdar. Isfahan Cardiooascular Research Center, lsfahan. Iran Centeral obesity is a major metabolic syndrom in obese people and some studies shows no relation between the central obesity and the obesity in the other parts of body. This study has tried to compare body mass index (BMI) and waist to hip ratio (WHR) in cardiac and healthy people to obtain their effect in the incidence of acute mycardial infarction (AMI) and also to determine the relation of WHR and BMI with serum lipids and blood pressure and prevalence of central obesity in heatlhy people of Isfahan. So, this study is an analytic case control study and carried out in lsfahan during 1991-1994. In this study there were 3085 samples including 1122 AMI patients hospitalized in university hospitals as case group and 1963 healthy samples as control group, chosen from lsfahan population aged 3069 years old. The data was gathered by measuring weight, height, wasit and hip girths and also total cholesterol (T.cho), triglyceride (TG), LDLcholesterol (LDL-C), HDL- cholesterol (HDL-C), systolic blood pressure (SBP) and diastolic bloold pressure (DBP) by WHO standardized methods. Then data was analyzed by stepwise multiregression, t.student, chi square and aoova tests in SPSS software. Results was showed that the mean of WHR in men and women wih AMI has been significantly more than in healthy one (0.97+0.09, 0.83-t-0.1 in case and control groups, respectively). The frequency of AMi in people with high WHR was significantly more than people with normal WHR (men: OR = 5.49, C! = 3.03-7.2 & women: OR = 6.92, CI = 1.6--10.3). While no significant differences in mean of BMI in both groups and the frequency of AMI in people with high and normal BMI were not seen. Serum lipids except for HDL-C have a significant positive relation with WHR and HDLC has a significant negative relation (P < 0.05), but BMI has a significant positive relation only with T.cho and TG. Although WHR has a significant positive relation with LDL-C/HDL-C ratio, BMI doesn't have. Analysis of variance showed the lowest mean values ofcardiovacular disease (CVD) risk factors were consistently seen in subjects who had both BMI and WHR in the lower tertile, except for HDL-C, and the highest in subjects with both BMI and WHR in the upper tertile. The prevalence of central obesity is 5 4 0 and 10% in healthy women and men, respectively. As the relation between high WHR and AMI and some major CVD risk factors is more than BMI, measuring WHR in anthropometric measurments specially in CVD patients is important.

EFFECT OF CARDIAC REHABILITATION ON LIPID PROFILE N. M~ohammadifard, N. Abdar, E Sajadi, N. Sarrafzadegan. Cardiac Rehabilitation Unit, Cardiooascular Research Center, [sfahan, Iran Hyperlipidemia plays a strong role in coronary artery disease and is the second major risk factor in our population in Isfahan.

THE SEPARATE TRANSPORT O F UNSATURATED FATTY ACIDS, o)-9, ¢0-6, (a-3 BY LIPOPROTEINS V.N. Titov. National Cardiology Research Centre, Moscow, Russia At phylogenesis lipoproteins have formed passive and active transport o f exogenic unsaturated fatty acids (FA) to cells. From enterocytes (o-9 is being transported together with saturated FA along the way: chylomicrones - hepatocytes, VLDL, IDL - free FA + albumin - eaveolar liquid endecytosis - cell (passive way). Polyenic to-6 FA transport to cells occurs in LP of high density along the way: enterocyte -apoA-I HDL - association of apoA-I with membrane proteins - transesterification of to-6 FA between phospholipides of HDL and that of cell membranes (passive way). Active transport o f to-3 FA to cells is formed by passive transport improving; LP of high density as well as LP of low density take pan in this transport which is a receptor one. The first stage o f active transport is a transesterification of (o-3 FA from polar phospholipids into nonpolar cholesteryl ester under action o f lecitin - cholesterol acyltrasferase. Then cholesteryl esters transferring protein (CETP) activates the transfer o f to-3 FA esterified by cholesterol from HDL to VLDL; apoB-100 forms LDL accepting cholesteryl esters. Apo-B receptor of humans and animals sensitive to atherosclerosis is a key stage of the active transport of t~-3 FA to cell. After hydrolysis in lysosomes proteins transfer free cholesterol onto cell membrane and it (cholesterol) diffuses into blood plasm. In blood HDLs accept cholesterol and esterify next FA by it forming cholesterol circulation in m-3 FA transport to cells. At to-3 FA transport blocking cells synthesize' eukozanoids only from to-6 FA, which come passively.

LYPANOR AND ZOCOR: COMPARATIVE EFFECTS UNDER THE ISHEMIC HEART DESEASE V. Tashchuk, i. Makoviichuk, T. Kulyk, P. lvanchuk, L. Sidorchuk.

Bukooinian Medical Academy, Cherniutsi, Ukraine With the purpose of comparison of hypolipidemic efficiency o f Lypanor and Zocor in a short corrective course (14 days) we investigated 72 patients with ishemic heart desease. In the dynamic of observation all patients were made the pairing stress tests (transesophageal electrocar-diostimulation and stressechocardiography) and the analysis of lipidemic spectrum of blood with use 6fanalyser "Paragon Electroforesis Manual" (Sweden). The results, given in the table, show that the medicines o f modern generation of hypolipidemic remedies Lypanor and Zocor even during a short course o f treatment are most effective. Thus the initial levels of total cholesterol and triglycerides are the criterion o f prescription o f these remedies. Our own investigations allow us to recommend Lypanor in a short course of treatment in cases of hypertriglyceridemia. Zocor causes the substantial decreasing of total cholesterol, but on the level of antyatherogenic changes o f lypoproteins o f different density it is less effective under short course o f treatment.

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