Lipoproteins and cardiovascular disease: biological basis and epidemiological studies.

There is a long history to our understanding of the biological basis of lipoproteins in cardiovascular disease and to the key epidemiological studies in this field. Building on a wealth of laboratory evidence explaining the role of cholesterol and lipoproteins in the pathogenesis of atherosclerosis, epidemiological studies have characterized associations between serum lipid abnormalities and the risk of myocardial infarction. While elevation in total cholesterol has been associated with an increased risk of myocardial infarction, this information alone is not sufficient.

Making practical sense of clinical trial data in decreasing cardiovascular risk.

Clinical studies now affirm what epidemiologic evidence has long suggested-that a broad range of patients can benefit from lipid reduction, including those without overt coronary artery disease and only moderate lipid elevations. Together, these studies suggest that current goals for cholesterol reduction may not be sufficiently stringent to slow the epidemic of heart disease in this country and that aggressive lipid lowering may be just what the doctor should order.

Lipoprotein(a)-cholesterol and coronary heart disease in the Framingham Heart Study.

Background: Increased plasma lipoprotein(a) [Lp(a)] concentrations have been reported to be an independent risk factor for coronary heart disease (CHD) in some prospective studies, but not in others. These inconsistencies may relate to a lack of standardization and the failure of some immunoassays to measure all apolipoprotein(a) isoforms equally.

Methods: We measured plasma Lp(a)-cholesterol [Lp(a)-C] in a Caucasian population of offspring and spouses of the Framingham Heart Study participants, using a lectin-based assay (LipoproTM).

Cardiovascular disease: pathogenesis, epidemiology, and risk among users of oral contraceptives who smoke.

Smoking increases the risk of lung cancer and cardiovascular disease among persons of both sexes. The risk of cardiovascular disease is further increased among users of oral contraceptives who smoke, particularly those who are >/=35 years old or carry the coagulation factor V Leiden mutation. Other important cardiovascular disease risk factors in women include waist/hip girth ratio >0.

The new pathophysiology of coronary artery disease.

Our understanding of coronary artery disease risk and the atherosclerotic process has changed greatly in recent years. For example, it is now known that angiographically apparent coronary artery plaque is not the major cause of myocardial infarction (MI). Rather, it is unstable, soft plaque that cannot be seen angiographically that is prone to rupture and result in infarction.

Margarine intake and subsequent coronary heart disease in men.

Margarine is a major source of trans fatty acids, the intake of which has risen since the early 20th century. Some data indicate that consumption of trans fatty acids increases the risk of coronary heart disease (CHD). In 1966-1969, 832 men from the Framingham Study, age 45-64 years and free of CHD, were administered a single 24-hour dietary recall, from which we estimated total daily margarine intake.

Systemic side effects of topical beta-adrenergic blockers.

Glaucoma, a disease that affects between 1 and 3% of the population above the age of 60, is most commonly treated by topical beta-adrenergic blockers. Although effective in lowering intraocular pressure and helping to preserve sight, beta blockers also may have adverse influences on the cardiac, pulmonary, and central nervous systems, and on endocrine functions. Clinicians' awareness that their patients may be treated with topical beta blockers will help them to elicit this information and the history, prescribe the medicine correctly, and be cognizant of a possible role this medicine may have in any deterioration of a patient's systemic clinical status.

Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger. A prospective study.

Objective: To establish whether elevated lipoprotein(a) [Lp(a)], detected as a sinking pre-beta-lipoprotein band on electrophoresis of fresh plasma, is an independent risk factor for the development of premature coronary heart disease (CHD) in men.

Design And Setting: Prospective study of the Framingham offspring cohort.

Participants: A total of 2191 men aged 20 to 54 years old who were free of cardiovascular disease when they were examined between 1971 and 1975.

Lipids, risk factors and ischaemic heart disease.

Over 200 risk factors for cardiovascular disease (CVD) have now been identified. Among these, the three most important are (1) abnormal lipids, including the fact that there are more than 15 types of cholesterol-containing lipoproteins and four different types of triglyceride-rich particles, some of which are very atherogenic, (2) high blood pressure, and (3) cigarette smoking. In addition, many other factors including diabetes, haemostatic factors such as fibrinogen, factor VII, plasminogen activator inhibitors, and new factors such as apolipoprotein E4 and homocysteine, are known to increase the risk of developing clinical CVD.

Epidemiologic assessment of angina before and after myocardial infarction: The Framingham study.

Angina pectoris before and after MI was evaluated in a sample of 729 men and women from a general population in whom MI developed during a 36-year period of follow-up. Relations of AP to subsequent CHD events and mortality after initial MI were analyzed by proportional hazards regression models and were adjusted for covariates (age, sex, blood pressure, serum cholesterol, body mass index, glucose intolerance, cigarette smoking, and antihypertensive medications) obtained from routine biennial examinations preceding the initial MI. Comparisons of the influence of angina were made between pre-MI angina, post-MI angina, and absence of AP.

Are risk factors for patellofemoral and tibiofemoral knee osteoarthritis different?

Objective: To determine whether patellofemoral (PF), tibiofemoral (TF), and combined patterns of knee osteoarthritis (OA) differ in their strengths of associations with any of the known risk factors for knee OA, and especially to evaluate whether body mass index (BMI) correlates with all 3 patterns, or only with tibiofemoral disease, as previously suggested.

Methods: We obtained anteroposterior and lateral knee radiographs on 608 participants at the 22nd biennial examination of the Framingham cohort study (1992-3). The presence or absence of OA in the TF and PF compartments of each knee was scored, and subjects were classified on the basis of the pattern of compartmental involvement in their 2 knees.

Protective effect of fruits and vegetables on development of stroke in men.

Objective: To examine the effect of fruit and vegetable intake on risk of stroke among middle-aged men over 20 years of follow-up.

Design: Cohort.

Setting: The Framingham Study, a population-based longitudinal study.

Determinants of change in total cholesterol and HDL-C with age: the Framingham Study.

Objective: The purpose of the study was to assess the determinants of change of total cholesterol and high density lipoprotein cholesterol (HDL-C) change in an adult population.

Methods: The prospective cohort was examined at baseline and eight years later. A total of 2,222 men and 2,677 women age 20-79 years at baseline were included.

A prospective investigation of elevated lipoprotein (a) detected by electrophoresis and cardiovascular disease in women. The Framingham Heart Study.

Background: Sinking prebeta lipoprotein is a putative marker for elevated levels of lipoprotein (a). Although prospective data suggest that increased plasma lipoprotein (a) is an independent risk factor for coronary heart disease in men, no prospective studies are available in women.

Methods And Results: From 1968 through 1975, sinking prebeta lipoprotein was determined by paper electrophoresis in 3103 women Framingham Heart Study participants who were free of prevalent cardiovascular disease.

Left ventricular mass and risk of stroke in an elderly cohort. The Framingham Heart Study.

Objective: To evaluate the association of echocardiographically determined left ventricular mass (LVM) with incidence of stroke or transient ischemic attack in an elderly cohort.

Design: Cohort study with a follow-up period of 8 years.

Setting: Population-based sample.

Effects of gender and menopausal status on the association of apolipoprotein E phenotype with plasma lipoprotein levels. Results from the Framingham Offspring Study.

Apolipoprotein (apo) E phenotype is an important genetic determinant of plasma low-density lipoprotein (LDL) cholesterol and apo B levels. We have determined apo E phenotype by isoelectric focusing and plasma lipid, lipoprotein cholesterol, apo A-I, apo B, and lipoprotein(a) levels, as well as LDL particle size, in 2258 men and women participating in the Framingham Offspring Study. Apo E phenotype (E2/2, E2/4, E3/2, E3/3, E3/4, and E4/4) was not associated with plasma lipoprotein(a) levels but was associated with plasma LDL cholesterol levels, apo B levels, and LDL size in men and with plasma total cholesterol, LDL cholesterol, and apo B levels in women.

Factors associated with low and elevated plasma high density lipoprotein cholesterol and apolipoprotein A-I levels in the Framingham Offspring Study.

A decreased high density lipoprotein (HDL) cholesterol level (< 35 mg/dl) has been shown to be a significant independent risk factor for coronary heart disease (CHD). Moreover, increased HDL cholesterol levels (> or = 60 mg/dl) are associated with a decreased CHD risk. Levels of HDL cholesterol and apoA-I, the major protein constituent of HDL, were measured in plasma from fasting participants in the Framingham Offspring Study (1,584 men and 1,639 women, mean age 49 +/- 10 years).

Effects of age, gender, and menopausal status on plasma low density lipoprotein cholesterol and apolipoprotein B levels in the Framingham Offspring Study.

Plasma low density lipoprotein (LDL) cholesterol, non-high density lipoprotein (HDL) cholesterol, and apolipoprotein (apo) B, the major protein constituent of LDL, were measured in 1,533 men (mean age 49 +/- 10 years) and 1,597 women (mean age 49 +/- 10 years) participating in the 3rd examination cycle of the Framingham Offspring Study. Mean plasma levels of LDL cholesterol and apoB were higher in men than in women (136 versus 132 mg/dl, P < 0.0001; and 109 versus 95 mg/dl, P < 0.

The effect of platelet-derived growth factor on the cellular response of the periodontium: an autoradiographic study on dogs.

Platelet-derived growth factor (PDGF) is a polypeptide growth factor considered to have a role in the proliferation and migration of fibroblasts at a wound healing site. The aim of this investigation was to determine if PDGF, when applied to root surfaces, would stimulate the proliferation of fibroblasts and further enhance regeneration. Six mongrel dogs with healthy periodontia were selected for this study.