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Lipoproteins in atherosclerosis

1951; Elsevier BV; Volume: 11; Issue: 3 Linguagem: Inglês

10.1016/0002-9343(51)90171-4

1555-7162

Hardin B. Jones, John W. Gofman, Frank T. Lindgren, Thomas P. Lyon, Dean M. Graham, Beverly Strisower, Alex V. Nichols,

Cardiac Imaging and Diagnostics

1.1. Serum lipoprotein patterns as studied ultracentrifugally in the human indicate lipoprotein transport may be interpreted as reflecting varying degrees of a lipid metabolic error. 2.2. The nature of several lipid transport disturbances have been described for a variety of experimental procedures in the rabbit. In all disturbances there is a strong positive correlation between elevation of the Sf 10–30 class of lipoproteins and the rate of development of atherosclerosis. Lipoproteins of the classes of Sf 10 and less and Sf 40–50 and higher do not show this correlation. Total serum cholesterol is positively related to the development of atherosclerosis only in those experimental procedures which allow for the increased serum cholesterol to be largely in the Sf 10–30 class. 3.3. A critical comparison has been made, in which the analysis of total cholesterol and Sf 12–20 lipoproteins was done on aliquots of the same serum sample, of both levels in normals vs. atherosclerotics, using myocardial infarctions as the test group. The over-all correlation of Sf 12–20 lipoprotein levels with atherosclerosis is two to four times as great as that for serum cholesterol levels with atherosclerosis. 4.4. The Sf 12–20 lipoprotein levels are associated with atherosclerosis, independently of their relationship with serum cholesterol. The Sf 12–20 levels account for the bulk of the over-all predictive segregation of atherosclerotics from normals. 5.5. The serum cholesterol level is very much less, if at all, associated with atherosclerosis, when considered independently of its association with the Sf 12–20 levels. 6.6. One-year follow-up studies of patients with coronary artery disease indicate that early recurrence of myocardial infarction is significantly associated with elevated Sf 12–20 lipoprotein levels. An approximate estimate of recurrence rate as a function of Sf 12–20 level may be made from the data on thirty-nine recurrences in the follow-up study. At 50 mg. per cent Sf 12–20 the chance of recurrence is ~6 per cent in one year; at 110 mg. per cent the chance is ~18 per cent. 7.7. In acute myocardial infarction the prognosis for survival is worsened with highly elevated Sf 12–20 lipoprotein levels, as determined during the acute phase. 8.8. Follow-up studies show that the reduction of Sf 12–20 lipoprotein levels by dietary restriction of fats and cholesterol gives a significant degree of protection against recurrent myocardial infarction in patients with coronary artery disease whose levels before dietary restriction ranged above 80 mg. per cent. 9.9. The only pharmacologic agent which rapidly shifts the lipoprotein pattern in humans in the direction of normality is parenteral heparin. The possibility is considered that a deficiency of heparin or a heparin-like substance may be involved in causing the basic lipid metabolic defect in humans.