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The assessment and prevention of cardiovascular risk (CVR) that persists in patients with dyslipidaemia despite treatment and achievement of goals specific to the plasma concentration of cholesterol linked to low density (c-LDL) is a clinical challenge today, and suggests that conventional lipid biomarkers are insufficient for an accurate assessment of CVR. Apart from their lipid content, there are other lipid particle characteristics. The results of this study show that there are a number of lipoprotein compounds that determine atherogenic potential and its influence on the CVR. However, such additional characteristics cannot be analysed by the techniques commonly used in clinical laboratories. Nuclear Magnetic Resonance (NMR) is a technique that allows a detailed analysis to be made of the amount, composition, and size of lipoproteins, as well as providing more information about the detailed status of lipid metabolism and CVR in dyslipidaemia patients. In this article a group of lipidologists from the Spanish Society of Arteriosclerosis review the existing evidence on the atherogenic mechanisms of particles and describe the technical basis and interpretation of the profiles lipoproteins obtained by MRI, with special reference to the test available in Spain (Liposcale®). Likewise, the main patient profiles are defined as such that an analysis would provide information of greater clinical interest. These include: a) Suspected mismatch between lipid concentrations and particles, a common situation in diabetes, obesity, metabolic syndrome; b) Early atherothrombotic cardiovascular disease (ECVA) or recurrent without CVR factors to justify it; c) Lipid disorders, rare or complex, such as extreme concentrations of c-HDL, and d) Clinical situations where classical analytical techniques cannot be applied, such as very low c-LDL values., (Copyright © 2020 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: Elective cesarean section (CS) was related to long-term adverse health effects in the offspring, but little is known about underlying mechanisms. Our study investigates the metabolic changes in both maternal and cord blood associated with CS in comparison to vaginal delivery (VD) to explore potential causal pathways., Methods: Samples obtained from PREOBE study participants were subjected to LC-MS/MS-targeted metabolomics comprising > 200 metabolites., Results: Elective CS showed an impact on both maternal and cord blood metabolomes. In maternal blood, the CS group showed lower levels of phospholipids (PL), principally ether-linked phosphatidylcholines (aaPC), pyruvic acid, branched chain keto-acids (BCKA), and other gluconeogenic substrates, but since the CS group showed different HDL levels in comparison to the VD group, we could not exclude contribution of the latter in the findings. In cord blood, the most remarkable finding in the CS group was the high levels of Cys; conversely, the lower levels of non-esterified fatty acids (NEFA), some tricarboxylic acid (TCA) cycle metabolites, gluconeogenic substrates, markers of β-oxidation, and the sum of hexoses were lower in CS-born babies in addition to tendentially lower levels of PL., Conclusions: We speculate that lower levels of maternal and fetal corticosteroids in CS, due to less stressful condition, cause metabolic perturbations at birth initiating future negative health outcomes. This further supports the early programming hypothesis.

Introduction and Objectives: Growth hormone (rhGH) is used in children with intrauterine growth retardation without catch-up growth. The Advisory Committee of Castilla y León was implemented in 2010 to watch for consistent application of the criteria for using rhGH. The aim is to assess anthropometric and clinical changes in children treated with growth hormone., Patients and Methods: A retrospective, longitudinal study of patients diagnosed with intrauterine growth retardation without catch-up growth in Castilla y León since 2010 who have received treatment for at least 3 years. Changes in anthropometric, clinical, and laboratory parameters were assessed., Results: Forty-three children with a mean age of 6.06 years (58.14%<5 years) were enrolled and treated with a mean dose of 0.038mg/kg/day. A significant increase was seen in height (-3.05 to -1.58SD). Both weight and BMI (14.51 to 15.80kg/m 2 ) increased throughout the study. Growth rate peaked during the first year of treatment (0.74SD). IGF-1 levels increased throughout the study (99.96 to 392.88ng/mL). There were significant increases in glycosylated hemoglobin levels in the first year, and in basal blood glucose and insulin levels during the second year. The LDL/HDL ratio decreased during the study period (1.70 to 1.50)., Conclusion: Treatment with rhGH promotes growth in children with intrauterine growth retardation. Peak effect occurs in the first 12 months of treatment, and is greater when growth hormone is started before the age of 5 years., (Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study., Methods: DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n=22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile., Results: Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n=2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n = 668) of those treated with statins were normal for all parameters., Conclusions: Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement., (Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Scope: Insulin resistance, a condition associated with type 2 diabetes mellitus, results from the interaction of environmental and genetic factors. The aim of this study was to explore the influence of the G972R polymorphism at the insulin receptor substrate 1 gene on insulin sensitivity in a healthy young population. Furthermore, we examined whether the presence of this single nucleotide polymorphism (SNP; GR or GG) interacts with dietary fat to modulate insulin sensitivity., Methods and Results: Fifty-nine healthy volunteers consumed three diets during 4 wk each following a randomized crossover design: a saturated fatty acid diet, a low-fat and high carbohydrate (CHO) diet or a MUFA diet. For each diet, we investigated peripheral insulin sensitivity with the insulin suppression test. Steady-state plasma glucose and plasma-free fatty acids concentrations were significantly lower in GR subjects after the intake of a CHO diet, than did homozygous GG subjects (p<0.05). However, no differences were observed after consuming the two other diets., Conclusions: Insulin sensitivity increased in GR subjects for the G972R polymorphism at the insulin receptor substrate 1 gene locus, after intake of a CHO diet. Increased knowledge of how these and other genes influence insulin sensitivity should increase the understanding of personalized nutrition., (Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: Excessive television (TV) viewing might play an important role in the development of cardiovascular disease (CVD). The aim of this study was to examine the independent associations between TV viewing and CVD risk factors in adolescents., Methods: A sample of 425 adolescents, aged 13- to 18.5-year-old, was included in this study. Body mass index (BMI), waist circumference (WC), glucose, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apolipoprotein (apo) A-1, apo B-100, and lipoprotein(a) levels were determined. A composite CVD risk score was computed based on age-, sex-, sexual maturation- and race-standardized triglycerides, HDL-cholesterol, LDL-cholesterol and glucose. TV viewing was self-reported., Results: Two hundred and twenty-five adolescents (53%) who spent >3 hrs/day watching TV were considered as the "high TV viewing" group. Ninety-nine adolescents (23%) from the total sample were classified as overweight according to International age- and sex-specific BMI values. The high TV viewing group had significantly less favorable values of HDL-cholesterol, glucose, apo A1 and CVD score, independent of age, sex, sexual maturation, race and weight status. There was a significant interaction effect of TV viewing x weight status (P = 0.002) on WC, and the negative influence of TV viewing on WC persisted in the overweight group (P = 0.031) but was attenuated in non-overweight adolescents (P > 0.05)., Conclusion: Excessive TV viewing seems to be related to an unfavorable CVD risk factors profile in adolescence. Reducing TV viewing in overweight adolescents might be beneficial to decrease abdominal body fat.

Lipoprotein Lp(a) levels are highly heritable and are associated with cardiovascular risk. We performed a genome-wide linkage analysis to delineate the genomic regions that influence the concentration of Lp(a) in families from the Genetic Analysis of Idiopathic Thrombophilia (GAIT) Project. Lp(a) levels were measured in 387 individuals belonging to 21 extended Spanish families. A total of 485 DNA microsatellite markers were genotyped to provide a 7.1 cM genetic map. The variance component linkage method was used to evaluate linkage and to detect quantitative trait loci (QTLs). The main QTL that showed strong evidence of linkage with Lp(a) levels was located at the structural gene for apo(a) on chromosome 6 (LOD score=13.8). Interestingly, another QTL influencing Lp(a) concentration was located on chromosome 2 with an LOD score of 2.01. This region contains several candidate genes. One of them is the tissue factor pathway inhibitor (TFPI), which has antithrombotic action and also has the ability to bind lipoproteins. However, quantitative trait association analyses performed with 12 SNPs in TFPI gene revealed no association with Lp(a) levels. Our study confirms previous results on the genetic basis of Lp(a) levels. In addition, we report a new QTL on chromosome 2 involved in the quantitative variation of Lp(a). These data should serve as the basis for further detection of candidate genes and to elucidate the relationship between the concentration of Lp(a) and cardiovascular risk.

Mothers can strongly influence the development of their offspring, and if maternal resources are limited, they may influence optimal reproductive strategies. In birds, maternally deposited carotenoids are a prominent component of egg yolk and are vital for the development of the embryo. However, results of long-lasting fitness consequences of this early nutritional environment have been scarce and inconsistent. In addition, sex-biased sensitivity to different egg components is one of the mechanisms postulated to account for sex-linked environmental vulnerability during early life. However, this important aspect is usually not accounted for when investigating maternal investment in carotenoids. In this study we gave carotenoid (lutein) supplements to female Eurasian kestrels (Falco tinnunculus) before and during egg laying. The experiment increased female plasma carotenoids, but this effect was not apparent in hatchling and fledgling plasma carotenoid concentration. Also, results showed that carotenoid supplementation increased the high density lipoprotein to low density lipoprotein ratio in adult females, suggesting that dietary carotenoids may influence lipid metabolism. Furthermore, the effect of the treatment was manifested in several nestling health state parameters. Nestlings of carotenoid-supplemented females were infested by less intestinal parasite groups, had higher lymphocyte concentrations in blood plasma, and were less stressed (heterophile to lymphocyte ratio) than control nestlings. In addition, an interaction between the experimental treatment and nestling sex was apparent for globulin concentrations, favouring the smaller male nestlings. Thereby, suggesting that males benefited more than females from an increase in maternal carotenoid investment. Our study shows that an increase in carotenoids in the maternal diet during egg laying favours nestling development in kestrels, and may also affect nestlings in a sex-specific way.

Objectives: To provide current reference values for serum lipid and lipoprotein levels in Spanish adolescents according to age and sex., Methods: A cross sectional study conducted in five representative Spanish cities (Granada, Madrid, Murcia, Santander and Zaragoza) including a representative sample of 581 adolescents (299 male and 282 female), aged 13 to 18.5 years. Age- and sex-specific means, standard deviations and percentiles were determined for: Total (TC), high density lipoprotein (HDLc) and low density lipoprotein (LDLc) cholesterol, triglycerides, apolipoprotein A-1 and B-100, and lipoprotein(a)., Results: The 90th percentile for TC was 4.95 mmol/L for males and 5.19 mmol/L for females. HDLc levels were significantly higher in females of all age groups. LDLc levels ranged from 2.32 to 2.54 mmol/L in males and from 2.38 to 2.62 mmol/L in females, peaking at 13 years of age in both sexes. Triglyceride levels tended to increase gradually and to peak at 17 years of age for both sexes. Apolipoprotein A-1 and B-100 levels paralleled those of HDLc and LDLc values, respectively. The geometric mean for lipoprotein(a) levels ranged from 0.44 to 0.57 micromol/L in males and from 0.50 to 0.67 pmol/L in females., Conclusions: The present study provides reference data on the distribution of lipid and lipoprotein levels of Spanish adolescents.

Background: A Mediterranean eating pattern and diet enriched in monounsaturated fatty acids may result in a favourable daylong lipid profile., Methods: 19 Spanish males (aged 32 +/- 8 years) and 28 females (34 +/- 8 years) were matched to Dutch subjects on the basis of fasting capillary triglycerides (TGc), gender and age. TGc were self-measured at six fixed time points over three days. Daylong TGc profiles were calculated as areas under the curve (TGc-AUC)., Results: Anthropometric parameters and fasting plasma lipids were comparable between Spanish participants and Dutch subjects. Insulin sensitivity (expressed as HOMA) was highest in the Dutch females (1.41 +/- 1.09 vs. 2.09 +/- 1.23 in the Spanish females, p < 0.05). Daylong TGc values were not different between Spanish and Dutch participants. Male Spanish subjects showed the largest daylong TGc increase after lunch, while in the Dutch males, the largest TGc increase was seen after dinner. Total daytime dietary energy and total fat intake were comparable when analysed by gender. However, the Spanish participants had a higher intake of monounsaturated and polyunsaturated fatty acids as percentage of energy., Conclusion: There are no major differences in daylong triglyceridaemia between Dutch and Spanish subjects, despite different eating habits and a diet enriched in monounsaturated and polyunsaturated fat in the latter.

Nuts have been included in human diets for ages. They are very appreciated and used as a central component of sweets and desserts. However, during the last decades, scientific interest in those foods has increased enormously as many epidemiologic studies show protective effects of nut consumption on coronary heart disease in different population groups. To date, many clinical trials have analyzed the positive effects of nuts consumption (almond, walnut, pistachio, Macadamia nut, and pecan) on the lipid profile, decreasing total and low density lipoproteins (LDL) cholesterol. However, whether these effects are only due to their fatty acid composition or to any other bioactive compounds, such as tocopherols, phytosterols and phytoestrogens, it is still unknown. This paper, aims to review comparative composition aspects of nuts, such as the positive effects on body weight, lipoprotein metabolism, and protection against cardiovascular and cerebrovascular diseases. The inclusion of 25 g/day of nuts, mainly raw, into a prudent diet seems to be recommended. Further investigations, as actual information is still scarce, in order to dilucidate the relationship between nuts consumption and vascular diseases are proposed.

Background: Association of apolipoprotein E (apo E) polymorphism with atherosclerosis varies among populations. Our aim was to estimate the association of common apo E variants (epsilon2, epsilon3 and epsilon4 alleles) with plasma lipid concentrations and cardiovascular disease (CAD) risk in a Spanish Mediterranean population., Patients and Method: This was a cross-sectional study in 486 subjects (144 men and 342 women)from a general Mediterranean population (7-85 years). Apo E genotypes,anthropometric, biochemical and life-style variables were determined., Results: Frequency of epsilon2 and epsilon4 alleles was low (0.052; 95% CI, 0.038-0.066, and 0.063; 95% CI,0.048-0.078, respectively). Apo E polymorphism was associated (p = 0.016) with LDL-C concentrations (119.9; 138.1 and 146.6 mg/dl in carriers of the epsilon2, epsilon3/epsilon3,and epsilon4 alleles, respectively). These differences remained significant (p = 0.017) after adjustment for gender, age and life-style factors. Subjects carrying the epsilon2 allele had higher triglyceride concentrations than non-carriers (p = 0.019). Prevalence of CAD was 14.0% in epsilon4 carriers, 6.9% in epsilon2 carriers and 3.4% in epsilon3/epsilon3 homozygotes. The higher risk of CAD associated with the epsilon4 allele remained significant (OR = 5.88; 95% CI, 1.64-21.02) after adjustment for gender, age and life-style factors., Conclusions: In the Spanish Mediterranean population, epsilon4 allele was associated with higher LDL-C concentrations and with a higher risk of CAD.

Cholesteryl ester transfer protein (CETP) facilitates the exchange of triglycerides (TG) and cholesteryl ester between lipoprotein particles. Subjects with familial hypercholesterolemia (FH) have been reported to have higher CETP activities, which could contribute to the lower high-density lipoprotein-cholesterol (HDL-C) levels and increased cardiovascular risk observed in some of these patients. Several polymorphisms have been reported in the CETP locus; the common TaqlB polymorphism is associated, in normolipidemic subjects, with decreased CETP activity and levels and with increased HDL-C levels. No data is available on the influence of this polymorphism in FH subjects. We have examined the TaqIB polymorphism in a group of 101 FH heterozygotes from Valencia, Spain. We have observed a frequency of 0.43 for the B2 allele, similar to those reported in the general population. Based on analysis of variance (ANOVA), we found significant associations between the presence of the B2 allele and increased plasma HDL-C (P <.04) and apolipoprotein A-I (apoA-I) levels (P <.01). An opposite association was observed for low-density lipoprotein-cholesterol (LDL-C) levels, with the B2/B2 subjects having lower levels than B1/B1 and B1/B2 subjects. The plasma apoB levels followed the same trend as those for LDL-C. In addition, the response to a National Cholesterol Education Program (NCEP)-I diet was studied in 77 of these subjects. The TaqlB polymorphism did not have a significant effect over the individual dietary response for any of the variables examined, as demonstrated by the lack of significant gene by diet interactions. In summary, the CETP TaqlB polymorphism is associated with a less atherogenic lipid profile, consisting of lower LDL-C, higher HDL-C levels, and a lower LDL-C/HDL-C ratio in heterozygous FH subjects. Moreover, the B2 allele was associated with a lower appearance of arcus cornealis, xanthomata, and clinical arteriosclerotic disease in these subjects., (Copyright 2001 by W.B. Saunders Company)

Background: Some studies have found that postmenopausal women have increased plasma homocysteine levels while others do not. The aim of this study was to know if homocysteine levels are increased in Spanish postmenopausal women., Patients and Methods: In 100 postmenopausal women (age: mean [SD] 56 [6] years) homocysteine, creatinine, folic acid, vitamin B12 and lipoproteins were determined. Controls were 50 premenopausal women (age: 29 [6] years), 50 men with similar age to postmenopausal women, and 50 men with similar age to premenopausal women. All the subjects of the study were healthy., Results: Homocysteine concentrations were higher in postmenopausal compared with premenopausal women (8.6 [2.1]; 95% confidence interval [CI], 8.2-9.1 vs 7.7 [1.6]; 95% CI, 7.2-8.1 micromol/l; p < 0.05), but were not different between both men groups. Hyperhomocysteinemia was found in 9 postmenopausal but in any premenopausal women (9% vs 0%; p = 0.03). Low density lipoprotein cholesterol values were higher (155 [32]; 95% CI, 148-161 vs 111 [32]; 95% CI, 101-120 mg/dl; p < 0.05), and high density lipoprotein cholesterol lower (54 [12]; 95% CI, 52-57 vs 64 [18]; 95% CI, 59-69 mg/dl; p < 0.05) in postmenopausal than premenopausal women. In postmenopausal women homocysteine levels were negatively associated with folic acid and positively associated with creatinine levels, but there was not association with age, vitamin B12 serum levels and lipoproteins., Conclusion: In postmenopausal women increased homocysteine concentrations, together with hypercholesterolemia, could contribute to the raise of their cardiovascular risk.

Background: To analyse whether the molecular diagnosis in FH patients is useful to predict the response to treatment with simvastatin in a south European population., Subjects and Method: A randomised clinical trial with no control group, with 20 mg/day of simvastatin was conducted in 27 genetically diagnosed FH subjects (11 male) from 8 FH families, randomly selected from 30 FH families with a molecular diagnosis. Clinical features and lipid parameters at baseline and after simvastatin treatment were compared between subjects classified as null mutations (FH Valencia 1 and 2; n = 11) and defective mutations (n = 16)., Results: FH with null mutations (FH Valencia 1 and 2) have a poor response to simvastatin treatment. The mean reduction of plasma LDLc levels in subjects with null mutations were significantly lower (32.6% [9.5] vs 42.8% [12.2]; p = 0.03) than in subjects with defective mutations. Baseline and after treatment plasma HDLc values were also significantly lower in FH group with null mutations. No statistically significant differences were found at baseline, after treatment and in the response to treatment between males and females., Conclusions: FH subjects with null alleles (FH Valencia 1 and 2) showed a poor response to simvastatin treatment. The type of LDL receptor gene mutation could predict the response to simvastatin in our south European FH population.

Unlabelled: The apolipoprotein (apo) E phenotype and its influence on plasma lipid and apolipoprotein levels were determined in men and women from a working population of Madrid, Spain. The relative frequencies of alleles epsilon(2), epsilon(3) and epsilon(4) for the study population (n=614) were 0.080, 0.842 and 0.078, respectively. In men, apo E polymorphism was associated with variations in plasma triglyceride and very low-density lipoprotein (VLDL) lipid levels. It was associated with the proportion of apo C-II in VLDL, and explained 5.5% of the variability in the latter parameter. In women apo E polymorphism was associated with the concentrations of plasma cholesterol and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) related variables. The allelic effects were examined taking allele epsilon(3) homozygosity as reference. In men, allele epsilon(2) significantly increased VLDL triglyceride and VLDL cholesterol concentrations, and this was accompanied by an increase of the apo C-II content in these particles. Allele epsilon(4) did not show any significant influence on men's lipoproteins. In women, allele epsilon(2) lowered LDL cholesterol and apo B levels, while allele epsilon(4) increased LDL cholesterol and decreased the concentrations of HDL cholesterol, HDL phospholipid and apo A-I. These effects were essentially maintained after excluding postmenopausal women and oral contraceptive users from the analysis., In Conclusion: (1) the population of Madrid, similar to other Mediterranean populations, exhibits an underexpression of apo E4 compared to the average prevalence in Caucasians, (2) gender interacts with the effects of apo E polymorphism: in women, it influenced LDL and HDL levels, whereas in men it preferentially affected VLDL, and (3) allele epsilon(2) decreased LDL levels in women, while it increased both VLDL lipid levels and apo C-II content in men, but, in contrast to allele epsilon(4), it did not show an impact on HDL in either sex.

The aim of this study was to analyse the in vivo effect of a diet rich in extra-virgin olive oil and a fish-oil supplement on plasma and lipoprotein fatty-acid composition and on LDL susceptibility to oxidative modification in free-living Spanish male patients with peripheral vascular disease. A total of 12 patients were included in the experimental group which received extra virgin olive oil and a fish oil supplement (group OF). On the other hand, 13 patients which had refined olive oil as the main visible fat were considered as Control group. Plasma triglycerides decreased significantly after three months of dietary intervention. The LDL and plasma fatty-acid pattern in the group OF was characterized by a significant increase in n-3 polyunsaturated fatty acids, mainly 20:5 n-3 and 22:6 n-3. The slopes of LDL oxidative susceptibility were similar between baseline and endpoint values in both groups. However, the uptake of oxidized LDL by macrophages was significantly reduced in OF patients in comparison with the Control group. In conclusion, the daily intake of about 40 g/d of extra-virgin olive oil in combination with a daily supplement of 16 g of fish oil for 3 months in patients with peripheral vascular disease leads to a plasma-lipid profile less atherogenic than in patients having refined olive oil as the main visible food fat. The simultaneous consumption of alpha-tocopherol and natural antioxidants provided by extra-virgin olive oil seems to have a protective effect on the LDL susceptibility to oxidative modifications in spite of a higher proportion of n-3 polyunsaturated fatty acids., (Copyright 1999 Harcourt Publishers Ltd.)

Background: The lipid factor is currently considered to be the main agent responsible for cardiovascular risk in young individuals. This is already present during infancy in proportions that give rise to concern, and is growing, as has would seem to have been shown by several national studies. This study analyses the prevalence of hyperlipidemia in children within the province of Caceres according to several different criteria, and describes changes according to age groups and sex, comparing the overall results with those of other national studies., Methods: A cross-sectional descriptive study of a representative and proportional sample of 2,150 children aged 2 to 6 years old in the province of Caceres (N = 91,083). The following were determined: total cholesterol, fractions, apolipoproteins and risk coefficients (enzymatic technique)., Results: 27.9% of children presented total cholesterol values of > 200 mg/dl; 7.5% of females and 4.7% of males had figures of more than 230 mg/dl. Levels of C-LDL > 130 mg/dl appear in 26.4%, Apo-B > 75 mg/dl in 65.5% and C-NO-HDL > 165 in 8.4%. C-HDL- < 35 mg/dl was found in 3.3% of individuals, while Apo-A < 100 mg/dl was only found in 0.3%. The ratios between CT/HDL > 3.5 and LDL/HDL > 2.2 were found to be 36.1% and 39.8%, respectively. The prevalence of hyperlipidemia is higher in females and pre-puberty stages., Conclusions: Overall, and independently of the criteria used, the proportion of cases of hyperlipidemia is high, and is above the levels cited in other Spanish studies. The prevalence of hyperlipidemia is highest in females before puberty, who display the most discriminatory risk coefficients, and best identify the change in the lipid profile at puberty.

Background: To assess long-term effectiveness of a multifactorial intervention at the work-site on serum cholesterol levels., Methods: Individualized face-to-face counseling was given to 1,555 employees (76.7% male; mean age = 42.3 years) by occupational physicians at four work-sites. After 3 years, a blinded assessment of the adequacy of the intervention was done. Implementation of the intended intervention by physicians was assessed as adequate in two work-sites (927 employees) and inadequate in the other two (628 employees). Observed changes in serum cholesterol were analyzed in the followed-up individuals. Follow-up rates at each work-site were 78.6% and 44.5% for the adequate intervention, and 85.5% and 60.4% for the inadequate intervention. Changes in serum cholesterol were controlled for potential confounding factors (pre-test levels of risk factors, age, sex, body mass index, educational level, marital status, physical activity and alcohol consumption) by multiple linear regression procedures., Results: When the intervention was adequately performed, serum cholesterol was significantly lowered with a mean reduction of 14.3 mg/dl (95% C.I.: 11.0 to 17.6) in those employees with baseline levels > or = 200 mg/dl., Conclusions: Adequacy of implementation of work-site programs determines their long-term effectiveness in reducing mean serum cholesterol levels.

Background: The aim of this study was to assess the familial aggregation of lipid levels in schoolchildren of Cuenca city, Spain., Subjects and Methods: A cross sectional study was made including 307 both sexes schoolchildren 9-12 years old recruited in three schools of Cuenca city, and 346 of their parents. Sociodemographics variables, weight, height, body mass index, systolic blood pressure, diastolic blood pressure and fasting plasma total cholesterol, LDL-C, HDL-C and triglyceride concentrations were determined., Results: Father-daughter and mother-daughter Spearman rank correlations coefficients in total cholesterol and LDL-C levels showed values ranging from 0.34 to 0.42 (p < 0.01). Correlation coefficients between both parents and between parents and sons were not significant. By stepwise multiple regression analysis it was found that parents' total cholesterol levels explained almost 30% of cholesterol variability in daughters and 10% in sons. This proportion was about 25% for LDL-C in daughters and was not significant in sons. Parent-children aggregation of HLD-C and triglycerides was weak., Conclusions: Parent-daughter aggregation of lipid and lipoprotein levels was stronger than parent-son, which has been evidenced mainly in total cholesterol and LDL-C. It has been found no evidence of relation between parents.

Background: The aim of study was to know the lipoproteins distribution in children and adolescents from the Autonomous Community of Madrid, Spain, and to compare with other studies., Material and Methods: The sample included 3,635 children and adolescents (1,853 males and 1,782 females), 4 to 18 years of age. We measured total cholesterol and triglyceride levels with enzymatic methods, the HDL-cholesterol concentration in the supernatant after precipitation of the rest of the lipoproteins, and LDL-cholesterol concentrations were calculated by Friedewald formula., Results: Total cholesterol levels were 174 +/- 25 mg/dl (4.50 +/- 0.64 mmol/l), triglycerides 60 +/- 24 mg/dl (0.67 +/- 0.28 mmol/l), LDL-cholesterol 100 +/- 22 mg/dl (2.59 +/- 0.58 mmol/l), HDL-cholesterol 61 +/- 13 mg/dl (1.6 +/- 0.34 mmol/l). 19.23% of the children studied had cholesterol levels above 200 mg/dl (> 5.18 mmol/l), and 41.5% of them had levels higher than 180 mg/dl (> 4.66 mmol/l)., Conclusions: The cholesterol levels as well as the HDL-cholesterol levels in the student population of Madrid, Spain, were higher when compared to other studies. Less variation was found in the LDL-cholesterol concentrations.

Background: The prevalence of biliary lithiasis was studied in a sample of rural female population by calculation of the risk factors associated and the correlation between biliary lithiasis and serum lipoprotein concentrations., Methods: Two hundred forty-nine women between the ages of 20-75 years in whom complete anamnesis and calculation of the Quetelet index (QI) were performed, were the subjects of this study. The investigation of biliary lithiasis was carried out by echography. Serum lipoprotein concentrations were determined by sequential ultracentrifugation., Results: The prevalence of biliary lithiasis in the population studied was of 10.4%. A tendency to increase by age was observed and a peak between 50-60 years of age (p < 0.05) was registered. Biliary lithiasis was more frequent among the obese population (p < 0.05). With respect to lipoprotein parameters, all the lipid values of the different fractions demonstrated to be higher in the lithiasic population, although only the differences in cholesterol vehicled by very low density lipoproteins (C-VLDL) achieved statistical significance) (p < 0.001)., Conclusions: The prevalence of biliary lithiasis in the female population studied is similar to that reported in other Western populations, and an increasing tendency in the prevalence of biliary lithiasis with age and obesity was observed. The levels of C-VLDL are higher in women with biliary lithiasis than in those without.

Objective: To evaluate compliance with dietetic treatment and its influence on levels of cholesterol and lipoproteins in hypercholesterolaemia in young children, over a period of two years., Design: A descriptive longitudinal study., Setting: Two paediatric clinics at the "Soria Norte" Health Centre., Patients: 47 patients between 3 and 10 years old, with overall cholesterol levels > 185 mg/dl and C-LDL > 110 mg/dl., Measurements and Main Results: 51% of the children correctly followed the dietetic advice given and at the 6 months follow-up showed an overall decrease in cholesterol and C-LDL. This decrease was less significant at a year from the start of the treatment., Conclusions: Diet is an efficacious treatment of hypercholesterolaemia in children. However, it is difficult to maintain over a long period.

As part of an epidemiological study on cardiovascular risk factors among children and adolescents in Navarra, the following parameters: total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and C/HDL and LDL/HDL risk quotients were determined in 5,829 children. These children, of both sexes and between the ages of 4 and 17 years, were selected at random from the school population in our community. Average values and percentiles of these parameters were obtained for each group according to age and sex as a previous step to define the health condition or "lipid risk" in our population. When determining the correlation of these biochemical parameters with the anthropometrical parameters of BP, age, weight, height, Quetelet Index, body mass surface, skinfold thickness and the percentage of subcutaneous fat (after the necessary logarithmic transformations, adjusted to each age and sex group by Z-scores) we find that none of the correlation coefficients are significant. The triglycerides and the HDL-cholesterol have a low, but significant. The triglycerides and the HDL-cholesterol have a low, but significantly, correlation with the other lipid parameters. The lipid risk quotient (C/HDL, LDL/HDL) shows a higher correlation with LDL-cholesterol than with total cholesterol.

Several epidemiological and necroscopic evidences suggest that, despite that the ischemic cardiopathy (IC) can be generally detected only since the fourth decade of life, it starts during the first years of life and adolescence. We have studied 278 teen-agers, with 13-14 years of age, attending the 8th school year (primary education) in five schools of Alcoy. 117 were males and 161 females. Levels of lipoprotein (a) (Lp[a]), total cholesterol (TC), cholesterol linked to high density lipoproteins (C-HDL) and its subfractions (C-HDL2 and C-HDL3), triglycerides (TG), apoproteins A-I and B (Apo A and Apo B) were determined. Cholesterol linked to low density lipoproteins (C-LDL) was calculated using the Friedewald-Fredrickson's equation. Mean values and standard deviation were: Lp(a) = 29.99 +/- 33.61 mg/dl., TC = 160.4 +/- 25.4 mg/dl., C-HDL = 54.0 +/- 12.3 mg/dl., C-HDL2 = 8.7 +/- 6.5 mg/dl., C-HDL3 = 46.2 +/- 18.6 mg/dl., TG = 72.6 +/- 26.8 mg/dl., C-LDL = 91.6 +/- 22.0 mg/dl., Apo A = 136.4 +/- 24.2 mg/dl., Apo B = 60.7 +/- 21.7 mg/dl. 38% teen-agers had Lp(a) levels higher than 30 mg/dl., 7.5% had levels of TC higher than 200 mg/dl., 12.8% had levels of C-HDL equal or higher than 40 mg/dl. and 4.7% had levels of C-LDL equal or higher than 130 mg/dl. From our study, we can conclude that, despite that the levels of TC, C-LDL and C-HDL in these teen-agers are within relatively normal limits, there is a high percentage with levels of Lp(a) actually considered as a risk factor.

We present the results of the first epidemiological study on lipidic levels among a healthy population from Extremadura. The study included 1.128 subjects, 520 males and 608 females, distributed by age and sex. Average total cholesterol levels were 228 +/- 40 mg/dl among middle-age and 215.6 +/- 43 mg/dl among women. We observed a significant reduction of these figures in ages above 60. In addition, we observed significant differences in HDL-Ch levels between men and women from all ages, with higher values among women and we only observed significant differences regarding total cholesterol levels between men and women in the 20-29 and 40-49 age-groups. Total cholesterol levels were higher than 220 mg/dl in more than half the studied population between 40 and 60 years of age and higher than 250 mg/dl in 20% of the subjects in such age groups. These data suggest the need for dietary changes in near 70% of the population if cholesterol levels are to approach the recommendations of the Sociedad Española de Arteriosclerosis.

We have studied 2,224 children and adolescents of both sexes, ranging between 2 and 18 years of age, at five schools in the city of Madrid. We determined the lipid profile: total cholesterol (T-C), cholesterol bound to high density lipoproteins (HDL-C), cholesterol bound to low density lipoproteins (LDL-C), cholesterol bound to very low density lipoproteins (VLDL-C), triglycerides (TG), apolipoprotein AI and apolipoprotein B100 (Apo A1 and Apo B100, respectively). In relationship to age and sex, in males, as age increases, there is an elevation in LDL-C and TG and a diminution in T-C, HDL-C, Apo AI and Apo B100. There are no changes in VLDL-C. In females, there is a diminution in LDL-C, TG, Apo-B100 and an increase in HDL-C, Apo AI and T-C, with the increase in T-C being found only in those older than 15 years.

The relationship between hyperlipidemia and a parental history of heart attack and other related disorders was studied in 2224 two- to 18-yr-old children in Madrid (Spain). Children were divided into three groups: those with a parental history of heart attack (first group), a parental history of stroke, hypertension, diabetes mellitus or hypercholesterolemia (second group), and no parental history of disease (third group). The number of children with higher than normal levels of total cholesterol (greater than 200 mg/dl), LDL-cholesterol (greater than 135 mg/dl) and/or apolipoprotein B100 (greater than 75 mg/dl) was significantly higher in the first and second group (positive parental history) than in the third (no parental history). Children and adolescents with a parental history of heart attack (first group) had significantly higher mean levels of total cholesterol and LDL-cholesterol; in the 2- to 13-yr age group a significantly higher level of apolipoprotein B was also found. Children and adolescents belonging to the second group had a significantly higher level of LDL-cholesterol, and a significantly higher level of apolipoprotein B was also found in the 2- to 13-yr age group. However, only 15% of children with hypercholesterolemia had a parental history of heart attack or other related disorders. This percentage was 41% when second-degree relatives were included in the family history. We conclude that a parental history is not enough to detect children with an abnormal lipid profile who might be at risk for early development of coronary arterial disease.

A group of 572 young cadets from the General Military Academy in Zaragoza (AGEMZA) with a mean age of 19.9 years was studied in two different situations: on admission to the AGEMZA, when physical activity was very intensive (A) and after 8 months, by which time they had all received identical diets and physical activity was considerably reduced (B). On both occasions they were asked about their smoking habits and their personal and family histories. Their height and weight were recorded and a sample of venous blood was taken to determine the lipid, biochemical and haematological profiles. We found that more smokers had a family history of sudden death or acute myocardial infarction than the non-smokers. The smokers also showed a lower HDL cholesterol level (54.3 +/- 9.8 mg.dl-1 +/- SD) than the non-smokers (59.4 +/- 10.9) (P less than 0.0001) and a higher level of triglycerides (75.4 +/- 24.7 mg.dl-1) than the non-smokers (65.4 +/- 21.1 mg.dl-1). The smokers had a higher white cell count (8194 +/- 1981 vs 7332 +/- 1672 cells. 10mm-3) (P less than 0.001), a higher haemoglobin value (14.9 +/- 0.9 vs 14.6 +/- 0.9 g.dl-1) (P less than 0.004) and a higher haematocrit value (44.2 +/- 2.3 vs 43.6 +/- 2.7%) (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The effects on plasma lipoproteins of four fat-modified diets were assessed in 11 nuns in a contemplative order in the Mediterranean region of Spain. Diet 1 [high polyunsaturated fatty acid (PUFA), low monounsaturated fatty acid (MUFA), low ratio of PUFAs to saturated fatty acids (P:S)] and diet 3 (low PUFA, high MUFA, low P:S) induced significant, directly comparable reductions in total plasma (12% and 13%, respectively) and low-density-lipoprotein (LDL) cholesterol (24% and 19%, respectively). Diet 2 [high PUFA, high MUFA, low saturated fatty acid (SFA), high P:S] induced greater decrements (23% and 30% in total plasma and LDL cholesterol, respectively). Diet 4 (low PUFA, low MUFA, high SFA, low P:S) induced a significant increase in LDL cholesterol of 11%. No significant changes in high-density-lipoprotein cholesterol were observed with these diets. Because the effects of PUFAs and MUFAs are comparable, no recommendations on modifying the habitual, high-MUFA-containing Mediterranean diet need be made other than, perhaps, a reduction in the overall intake of SFAs.

A comparative study of the total cholesterol (TC) and its fractions was carried out in 3 groups of males. The first group consisted of (C) 53 healthy males (18 between 30-39 years old, 17 between 40-49 and 18 between 50-65); the second group (M) was of 57 male doctors (19 between 30-39 years old, 21 between 40-49, and 17 between 50-65); third group (E) was of 94 males with myocardial infarction (22 between 30-39 years old, 32 between 40-49, and 40 between 50-65). TC was significantly lower (p less than 0.02 and p less than 0.001) in both the lower ages ranges in Group E compared to Groups C and M in all age ranges. Group M showed significantly lower (p less than 0.001) in Group E compared to Groups C and M in all age ranges. Group M showed significantly lower HDL-C (p less than 0.01) and to group M in the lowest age range (p less than 0.005). LDL-C was significantly higher (p less than 0.001) in Group M compared to C in the higher age range. VLDL-C was higher (p less than 0.05) in Group E compared to C in both the higher age ranges (p less than 0.05) as well as to the middle age range of Group M (p less than 0.05). The indexes TC/HDL-C and LDL-C/HDL-C were significantly higher in Group E compared to Groups C and M in all age ranges. These indexes were significantly higher (p less than 0.01 and p less than 0.05) in Group M compared to group C in all age ranges.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum cholesterol, triglyceride, apoprotein Al and B, low-density and hig-density lipoprotein (LDL, HDL) cholesterol levels were quantitated, in two or more consecutive sample collections, in 289 middle aged males to assess the potential for misclassification of dyslipemia, according to the Sociedad Española de Arteriosclerosis and the USA National Cholesterol Education Program guidelines. They were grouped according to serum cholesterol values (less than 5.17 mmol/l, between 5.17 mmol/l and 6.17 mmol/l, and greater than 6.17 mmol/l) and misclassification was arbitrarily identified with different levels of the considered parameters. With cholesterol less than 5.17 mmol/l, misclassification was identified in 18.2% of the subjects, mainly with hypertriglyceridaemia or low HDL-cholesterol values. With cholesterol greater than 6.17 mmol/l there is a clear misclassification although obviated partially by the usual performance of complete routine lipoprotein analysis. Potential for misclassification is more evident when cholesterol was between 5.17 mmol/l and 6.17 mmol/l. To avoid such misclassification, HDL and LDL-cholesterol and serum cholesterol and triglyceride values should be measured in all subjects. Some data on the total cost in a general population screening are also presented; cost that on the author's opinion might be better invested under the control of a centralized institution.

Plasma lipids and lipoprotein cholesterol distribution were measured in 60 normal pregnancies studied longitudinally at 12, 20, 28, and 36 weeks of gestation and 3 and 40 days postpartum. Total cholesterol, unesterified cholesterol, phospholipids, triglycerides and cholesterol in low- and very-low-density lipoproteins rose progressively during pregnancy. Maximal values were reached at 36 weeks for total cholesterol, unesterified cholesterol and low-density lipoprotein cholesterol and at partum for triglycerides, very-low-density lipoprotein cholesterol and phospholipids. High-density lipoprotein cholesterol was hardly affected by pregnancy. During the second half of pregnancy and postpartum period, high-density lipoprotein cholesterol was consistently and negatively correlated with triglycerides and very-low-density lipoprotein cholesterol. In each period studied total cholesterol showed very high positive correlation with low-density lipoprotein cholesterol but a weak correlation with high-density lipoprotein cholesterol.

We have studied 1,939 healthy children of both sexes (1.003 boys and 936 girls), aged from 4 to 18 years, of the city of Fuenlabrada (Madrid). The following parameters were determined: blood pressure, weight, height, triccipital folds, the rohrer index, total cholesterol, triglycerides, lipoproteins, blood sugar and uric acid. The results of the blood pressure have been expressed by means of percentiles in relation with age, weight, and height. The correlation coefficients have been statistically significant for the height, weight, age, triccipital skinfolds, triglycerides and C-VLDL. We have relationed our results with other national and international studies.

The lipid-lowering agent pirozadil was tested in 1185 hyperlipidaemic subjects during a 2-4 months' intake. Plasma triglycerides were found to decrease by 30.8%. The reduction of plasma cholesterol (by 20.8%) was mainly due to a fall in low-density lipoprotein cholesterol by 23.7%, while high-density lipoprotein cholesterol increased up to 32.2%. Pirozadil was effective and well-tolerated in patients with both hypercholesterolaemia and hypertriglyceridaemia.

In studies carried out on 401 individuals from different Spanish regions, blood lipoprotein levels do not show a clear relationship to amounts of animal fat intake because diet habits change in old age. But in these persons there was a significant and positive correlation between actual LDL levels and animal fat intake when they were 40-45 years old. Similar results are obtained with HDL, but correlations are inversely proportional. Our study leads to the interpretation that diet habits during the first phase of the adult life span are determinant for the lipoprotein profiles in older ages, which can still be observed in very old individuals.

Unlabelled: Familial aggregation of coronary heart disease (CHD) and coronary risk factors (CRF) were evaluated by clinical history in adult relatives of children surveyed for CRF. Population was divided into two groups: Group I included 2,153 children without parental history of CHD. Group II included 266 children of 112 families with parental history of early CHD (before 56 years). In 105 cases the patients were the fathers and in 7 cases the mothers. All the patients were admitted to a coronary care unit. Familial aggregation of CHD was 9.7 times more frequent in paternal families of group II (p less than or equal to 0.0001) than in group I; there was no differences in maternal families. Higher prevalence of hyperlipidaemia, blood pressure hypertension, smoking habits, diabetes and obesity in fathers of group II was observed. Children in group II showed increased levels of C-LDL and decreased levels of C-HDL compared with those of group I. The prevalence of CRF was also significantly higher in children of group II, although in the 33% of the children of group II no CRF was detected., Conclusion: a substantial proportion, but not all cases, of familial aggregation of CHD could be explained by known CRF.