vitamin-b-12 and Hyperlipidemias

In the prevention of coronary heart disease the aim to achieve the target cholesterol and triglyceride levels and the maximal risk reduction leads to the combination of lipid lowering agents. The importance of the combination is supported by the fact that in monotherapy use of the high dose of the drugs, the lipid lowering effect is modest and the side effects are more frequent. The combined therapy is expected to be used more frequently despite the fact, that the improperly applied combination could have serious unfavourable effects. The authors review the advantages and drawbacks of the fibrate-statin combination, which could be used in the most frequent lipid abnormality, the high cholesterol and high triglyceride level, when the combination of micronized fenofibrate and fluvastatin is recommended. Beside the co-administration of other lipid lowering drugs (nicotine acid and resins), it is discussed the combination of statins and fibrates with a new, cholesterol absorption inhibitor, ezetimibe, a well tolerated drug with advantageous safety profile. Considering further metabolic risks the combination of lipid lowering drugs with glitazones, hormone replacement therapy, homocysteine reducing agents is as well highlighted.

Topics: Anticholesteremic Agents; Apolipoproteins; Azetidines; Cholesterol, HDL; Cholesterol, LDL; Coronary Disease; Drug Therapy, Combination; Ezetimibe; Fatty Acids, Monounsaturated; Fenofibrate; Fluvastatin; Folic Acid; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperlipidemias; Hypolipidemic Agents; Indoles; Lipids; Pravastatin; Simvastatin; Triglycerides; Vitamin B 12; Vitamin B 6

Topics: Adolescent; Adult; Age Factors; Aged; Angina Pectoris; Arteriosclerosis; Body Weight; Child; Cholesterol; Feces; Female; Follow-Up Studies; Forecasting; Heart; Heart Function Tests; Humans; Hyperlipidemias; Ileum; Intestinal Absorption; Intestine, Small; Lipoproteins; Male; Methods; Middle Aged; Myocardial Infarction; Postoperative Complications; Triglycerides; Vitamin B 12; Water-Electrolyte Balance; Xanthomatosis

Elevated homocysteine concentrations are a risk factor for atherosclerotic disease. Recently it was reported that lipid lowering with fibrates increases homocysteine by up to 40%. Since elevated homocysteine concentrations can readily be lowered by vitamin supplementation, a randomized, double-blind crossover study was performed to investigate the effect of fenofibrate plus folic acid, vitamin B6 and B12 versus fenofibrate plus placebo in hyperlipidemic men. The crossover study comprised a run-in period of 6 weeks, a first treatment phase of 6 weeks, a washout phase of 8 weeks and a second treatment phase of 6 weeks. Vitamins were given at doses of 650 microg folic acid, 50 microg vitamin B12 and 5 mg vitamin B6 per day for a period of 6 weeks. After fenofibrate plus placebo the increase in homocysteine concentration was 44+/-47%. After fenofibrate plus vitamins it was 13+/-25%, being significantly lower than without vitamins. The increase in homocysteine in response to fenofibrate may counteract the cardioprotective effect of lipid lowering. The addition of vitamins involved in homocysteine metabolism can prevent most of the homocysteine increase seen after fenofibrate plus placebo. Addition of these vitamins to fenofibrate may therefore be warranted for routine use.

Topics: Cross-Over Studies; Double-Blind Method; Fenofibrate; Folic Acid; Homocysteine; Humans; Hyperlipidemias; Hypolipidemic Agents; Male; Middle Aged; Pyridoxine; Vitamin B 12; Vitamins

Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-micromol/L increase is associated with an approximately 70% increase in relative risk of cardiovascular disease in adults. For patients with established risk factors, this risk is likely even greater.. Effects of increased dietary folate and recommended intakes of vitamins B-12 and B-6 on serum total homocysteine (tHcy) were assessed in individuals at high risk of cardiovascular disease.. This trial was conducted at 10 medical research centers in the United States and Canada and included 491 adults with hypertension, dyslipidemia, type 2 diabetes, or a combination thereof. Participants were randomly assigned to follow a prepared meal plan (PMP; n = 244) or a self-selected diet (SSD; n = 247) for 10 wk, which were matched for macronutrient content. The PMP was fortified to provide >/=100% of the recommended dietary allowances for 23 micronutrients, including folate.. Mean folate intakes at 10 wk were 601 +/- 143 microgram/d with the PMP and 270 +/- 107 microgram/d with the SSD. With the PMP, serum tHcy concentrations fell from 10.8 +/- 5.8 to 9.3 +/- 4.9 micromol/L (P < 0.0001) between weeks 0 and 10 and the change was associated with increased intakes of folate, vitamin B-12, and vitamin B-6 and with increased serum and red blood cell folate and serum vitamin B-12 concentrations. tHcy concentrations did not change significantly with the SSD.. The PMP resulted in increased intakes and serum concentrations of folate and vitamin B-12. These changes were associated with reduced serum tHcy concentrations in persons at high risk of cardiovascular disease.

Topics: Adult; Aged; Analysis of Variance; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Diet; Female; Folic Acid; Food, Fortified; Homocysteine; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Pyridoxine; Risk Factors; Vitamin B 12

Four female and five male patients (mean age 26 years) with hyperlipoproteinaemia type II A were treated with an anion exchange gel (Secholex) 9 g/day for 3 months and 15 g/day for 9 months. After these 12 months clofibrate 1.5 g/day was added to the therapy in 6 patients, whereas 2 patients continued with the resin alone for another 6 months, and one was withdrawn from the trial because of pregnancy. During the first year plasma cholesterol decreased averagely 18% from a mean pretreatment value of 461 mg/100 ml. Dosis of 9 g/day seemed to be as efficient as 15 g/day. When clofibrate was added, a further decrease of plasma cholesterol by 6% was observed, and the levels of triglycerides were reduced. Significantly increased concentrations of bile acids and a rise in the glycine/taurine ratio in duodenal aspirate were caused by the resin. On combined treatment the concentration of bile acids decreased to the pretreatment values, whereas the glycine/taurine ratio remained unchanged. During the trial slight transient changes in serum folic acid, fasting insulin, calcium, alkaline phosphatases, and vitamin B 12-absorption occurred. No changes in serum vitamin A, vitamin-K-dependent clotting factors, serum gastrin, gastric acid output, the absorption of glucose and iron, and faecal excretion of fat were observed. Serum insulin 30 and 60 minutes after an oral glucose loading decreased in the patients on combined treatment, whereas the insulin response remained normal in patients taking Secholex alone. Liver function tests and creatinine were unchanged during the trial. Apart from transient abdominal discomfort in two patients, no side-effects were discovered. The patients found the gel palatable.

Topics: Adolescent; Adult; Anion Exchange Resins; Bile Acids and Salts; Blood Glucose; Cholesterol; Clinical Trials as Topic; Clofibrate; Dextrans; Drug Therapy, Combination; Duodenum; Female; Folic Acid; Gastric Juice; Humans; Hypercholesterolemia; Hyperlipidemias; Insulin; Intestinal Absorption; Ion Exchange Resins; Lipids; Lipoproteins, LDL; Male; Phospholipids; Secretory Rate; Triglycerides; Vitamin B 12

The routine chemical assays are affected by sample haemolysis, icterus and lipaemia, collectively known as serum indices; however, little attention has been given to the consequences of these conditions on hormonal assays (immunoassays). In this study, we assess the impact of interferences from exogenous serum indices on various endocrine assays performed on the Abbott Architect i2000 system. The pool of 20 serum samples was derived from a hospitalised population. The diluted serum samples were spiked with red cell haemolysate, Intralipid and bilirubin. The interferences were studied at baseline; 12.5%, 25%, 50%, 75% and 100% of 5.0 g/L haemoglobin; 1% of 20% Intralipid; and 0.342 mmol/L of bilirubin according to the EP7-A2 guideline (Interference Testing in Clinical Chemistry; CLSI, USA). Aliquots were analysed in duplicate and/or triplicate for various hormones on the Abbott Architect i2000 immunoassay analyser. Serum ferritin (r2=0.84; P=0.074) and TSH (r2=0.81; P=0.52) levels showed a direct relationship with haemolysis and therefore overestimated because of the effects of haemolysis. The vitamin B12 level progressively decreased as the amount of haemolysis increased (r2=-0.76; P=0.136). There was a significant decrease in progesterone concentration owing to lipaemia (r2=-0.983; P=0.003). For icteric interferences, a strong inverse correlation was observed for folic acid and was shown to be statistically significant (r2=-0.94; P=0.017). Assays for ferritin, TSH, vitamin B12, folic acid and progesterone showed various degrees of interference because of the variability in serum indices.

Topics: alpha-Fetoproteins; Carcinoembryonic Antigen; Chorionic Gonadotropin, beta Subunit, Human; Ferritins; Folic Acid; Follicle Stimulating Hormone; Hemolysis; Hormones; Hospitalization; Humans; Hydrocortisone; Hyperlipidemias; Immunoassay; Parathyroid Hormone; Progesterone; Prolactin; Reproducibility of Results; Thyrotropin; Thyroxine; Vitamin B 12

To explore the relationship between total plasma homocysteine (tHcy) concentration and central retinal vein occlusion (CRVO) in the acute phase in a Chinese population.. This was a matched case-control study, and participants were recruited between January 2008 and April 2012. The cohort included 68 consecutive patients with CRVO and 68 controls, matched for age and gender, aged 50 years and over. The total plasma homocysteine, vitamin B12 and folate levels and the presence of C677T MTHFR polymorphisms were analyzed in all patients and controls. Fasting venous blood samples were collected within three days after CRVO.. There were no significant differences (p = 0.134) in mean plasma tHcy between CRVO patients (10.73 ± 3.21 µmol/l) and controls (9.99 ± 2.57 µmol/l), nor were there any statistically significant differences when subjects were categorized by ischemic and nonischemic CRVO. However, six patients (27.3%) in the ischemic group and three patients (6.5%) in the nonischemic group were found to have hyperhomocysteinemia (p = 0.018). There were no statistically significant differences in serum folate (p = 0.503) or vitamin B12 levels (p = 0.419) between CRVO patients (folate, 5.97 ± 2.06 ng/ml; vitamin B12, 411 ± 122 pg/ml) and controls (folate, 6.18 ± 1.42 ng/ml; vitamin B12, 427 ± 115 pg/ml). The prevalence of the homozygous genotype of the MTHFR C677T mutation was not significantly different in patients than in controls.. We found no association between tHcy in the acute phase after CRVO and CRVO occurrence in a Chinese population, but hyperhomocysteinemia were associated with the development of CRVO.

Topics: Acute Disease; Aged; Asian People; Cardiovascular Diseases; Female; Folic Acid; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Hyperlipidemias; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Retinal Vein Occlusion; Risk Factors; Vitamin B 12

The aim of this retrospective study of patients with tongue pain who showed no improvement after initial treatment and examination was to find out if their lack of response correlated with serum concentrations of zinc, vitamin B12, folic acid, and copper, and if it was associated with coexisting systemic diseases. We studied 311 patients for whom we had data about serum concentrations of these elements, and recorded whether they had any systemic diseases and were taking medicines regularly. One patient (0.3%) had a copper concentration outside the reference range; 2 patients (0.6%) had folic acid concentrations outside the reference range. The corresponding number for vitamin B12 was 5 (2%), and for zinc 30 (10%). The systemic diseases with the highest rates were: hyperlipidaemia (n=53, 17%), gastritis or gastric ulcer (n=51, 16%), angina pectoris (n=39, 13%), diabetes mellitus (n=31, 10%), thyroid disease (n=31, 10%), mild mental disorder (n=27, 9%), hypertension (n=18, 6%), cerebral infarction (n=17, 6%), leiomyoma (n=15, 5%) and anaemia (n=15, 5%). Roughly 10% of the patients were deficient in zinc. This study suggested that the serum concentration of zinc was most important to the patients with tongue pain. Many patients had more than one systemic condition, and all were taking various drugs.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Angina Pectoris; Cerebral Infarction; Copper; Diabetes Complications; Female; Folic Acid; Gastritis; Glossalgia; Humans; Hyperlipidemias; Hypertension; Leiomyoma; Male; Middle Aged; Retrospective Studies; Thyroid Diseases; Vitamin B 12; Young Adult; Zinc

Hyperhomocysteinemia (HH) is an emerging risk factor for ischemic stroke but its role in outcome is controversial. We compare the risk factors, nature of stroke and outcome of patients with and without hyperhomocysteinemia.. CT proven ischemic stroke patients were included. The conventional risk factors such as diabetes, hypertension, hyperlipidemia, obesity, smoking, and family history of stroke were recorded. Dietary history was noted. Fasting serum homocysteine (Hcy), B12 and folic acid were estimated after 1 month of stroke. Severity of stroke was assessed by Canadian Neurological Scale (CNS) and outcome at 3 months by Barthel Index (BI) score into good (BI > or = 12) and poor (BI < 12). Serum Hcy, B12 and folic acid were also estimated in 200 normal healthy volunteers.. There were 198 patients with ischemic stroke whose median age was 56 years and 36 were females. In the study group, 41.4% patients were vegetarian, 55.1% hypertensive, 24.7% diabetic, 30.8% smoker, 61.1% sedentary and 28.8% obese. 23.2% had past history of stroke and 21.7% had stroke in their first degree relative. Serum cholesterol was elevated in 11.7% and LDL in 10.8% patients. Serum Hcy was elevated in 60.6% and serum B12 low in 25.7% and folic acid in 42.1%. Hcy levels correlated with serum B12 and LDL. Patients with hyperhomocysteinemia had significantly better outcome at 3 months. Hcy levels in stroke patients did not significantly differ from controls.. Hyperhomocysteinemia is found in 60.6% stroke patients, which is related to low serum B12 level. Patients with hyperhomocysteinemia had a better 3-month outcome.

Topics: Adult; Aged; Brain Ischemia; Comorbidity; Diabetes Mellitus; Diet, Vegetarian; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Hyperlipidemias; Hypertension; India; Male; Middle Aged; Obesity; Risk Factors; Severity of Illness Index; Smoking; Stroke; Tomography, X-Ray Computed; Vitamin B 12

The nephrotic syndrome is associated with heightened risk for arterial and venous thrombosis. Multiple derangements of hemostasis and acquired risk factors such as hyperlipidemia and hypertension contribute to this risk. The prevalence in the nephrotic syndrome of high circulating levels of homocysteine and of low levels of the B vitamins that are involved in its metabolism, which may play a role in thrombosis, is not well defined.. In 84 patients with nephrotic syndrome and 84 sex- and age-matched controls, hemostasis variables and the circulating levels of total homocysteine (tHcy), vitamin B(6), B(12) and folates were measured.. tHcy levels were higher, vitamin B(6) and vitamin B(12) levels were lower in nephrotic patients than in controls. The association of low vitamin B(6) levels with the nephrotic syndrome was independent of any other alteration associated with the disease. Eighty-two percent of patients with the nephrotic syndrome had vitamin B(6) levels falling in the lowest quartile of the normal distribution. Antithrombin deficiency, factor V Leiden, antiphospholipid antibodies, hypertension, dyslipidemia, were more frequent in patients with the nephrotic syndrome than in controls.. Patients with the nephrotic syndrome have multiple risk factors for thrombosis. We report that they frequently have low circulating levels of vitamin B(6), which associate with a heightened risk for venous and arterial thrombosis.

Topics: Adult; Antibodies, Antiphospholipid; Antithrombins; Factor V; Female; Folic Acid; Homocysteine; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Nephrotic Syndrome; Risk; Risk Factors; Vitamin B 12; Vitamin B 6; Vitamin B Complex

There is increasing evidence that plasma homocysteine level is an independent risk factor for atherosclerosis. Low levels of serum folates, cobalamin and pyridoxine are associated with increased risk of cardiovascular disease. Most dietary products contain cholesterol as well as methionine, so hyperlipidemia could be associated with a higher level of homocysteine and inversely with lower levels of B vitamins. The aim of this study was to investigate the differences in levels of lipids and vitamins affecting homocysteine metabolism in different groups of patients.. We examined 38 healthy persons, 55 patients hospitalised for cardiac surgery, and 62 patients without clinical evidence of atherosclerosis but with one of the atherosclerosis risk factors (hypercholesterolemia, NIDDM or chronic renal insufficiency). The levels of total cholesterol, triglycerides, vitamin B12, folic acid and vitamin B6 index in serum were determined using routine laboratory methods.. We found no association between lipids and B vitamins in any examined group. There were significant differences between concentrations of analysed parameters in all groups of patients as compared to controls.. The lack of correlation between the levels of lipid parameters and B vitamins in serum indicates that these may be independent, additional risk factors for atherosclerosis. Higher vitamin B6 deficiency in dialysis patients is probably caused by low intake combined with the increased requirements of uremic patients. Permanent monitoring of B vitamins in serum is necessary in patients with elevated risk of atherosclerosis, as well as long-term education, careful diet planning and supplementation.

Topics: Adult; Aged; Aged, 80 and over; Arteriosclerosis; Cardiac Surgical Procedures; Case-Control Studies; Cholesterol; Female; Folic Acid; Homocysteine; Humans; Hyperlipidemias; Lipids; Male; Middle Aged; Risk Factors; Triglycerides; Vitamin B 12; Vitamin B 6; Vitamin B Complex

Hyperhomocysteinemia has been identified as a potential risk factor for atherosclerosis. This study examined whether a modest elevation of plasma total homocysteine (tHcy) was an independent risk factor for increased carotid artery intimal-medial wall thickness (IMT) and focal plaque formation in a large, randomly selected community population. We also examined whether vitamin cofactors and the C677T genetic mutation of the methylenetetrahydrofolate reductase (MTHFR) enzyme were major contributors to elevated plasma tHcy and carotid vascular disease.. In 1111 subjects (558 men, 553 women) 52+/-13 years old (mean+/-SD; range, 27 to 77 years) recruited from a random electoral roll survey, we measured fasting tHcy and performed bilateral carotid B-mode ultrasound. For the total population, mean tHcy was 12.1+/-4.0 micromol/L. Plasma tHcy levels were correlated with IMT (Spearman rank rs=0.31, P=0.0001). After adjustment for age, sex, and other conventional risk factors, subjects in the highest versus the lowest quartile of tHcy had an odds ratio of 2.60 (95% CI, 1.51 to 4.45) for increased IMT and 1.76 (95% CI, 1.10 to 2.82) for plaque. Serum and dietary folate levels and the C677T mutation in MTHFR were independent determinants of tHcy (all P=0.0001). The mutant homozygotes (10% of the population) had higher mean tHcy than heterozygotes or those without the mutation (14.2 versus 12.3 versus 11.6 micromol/L, respectively, P=0.0001). The inverse association of folate levels with tHcy was steeper in the mutant homozygotes. Despite this, the C677T MTHFR mutation was not independently predictive of increased carotid IMT or plaque formation.. Mild hyperhomocysteinemia is an independent risk factor for increased carotid artery wall thickness and plaque formation in a general population. Lower levels of dietary folate intake and the C677T mutation in MTHFR are important causes of mild hyperhomocysteinemia and may therefore contribute to vascular disease in the community.

Topics: Adult; Aged; Amino Acid Substitution; Arteriosclerosis; Carotid Arteries; Carotid Stenosis; Comorbidity; Diet; Female; Folic Acid; Gene Frequency; Genetic Predisposition to Disease; Genotype; Health Surveys; Homocysteine; Humans; Hyperhomocysteinemia; Hyperlipidemias; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Mutation, Missense; Obesity; Odds Ratio; Oxidoreductases Acting on CH-NH Group Donors; Point Mutation; Pyridoxine; Risk Factors; Smoking; Tunica Intima; Ultrasonography; Vitamin B 12; Western Australia

The atherogenicity of homocyst(e)ine--H(e) --emerged from many studies showing an association between moderately elevated levels and vascular occlusive disease. The aim of this study was to evaluate whether high homocyst(e)ine levels were associated with carotid atherosclerosis. Carotid atherosclerosis was defined as an intimal media thickness of internal and carotid bifurcation of at least 2 mm on the near and far walls as determined by B-mode ultrasonography. The study population included 91 patients: group 1 (61% males, mean age 64+/-10 years, 57% with history of hypertension) with ultrasound evidence of carotid atherosclerosis and 100 with normal carotid walls--group 2 (36% males, mean age 52+/-15 years, 27% with history of hypertension). Homocyst(e)ine levels (mol/L) were determined by high-performance liquid chromatography with a fluorescent detector. Body mass index, dyslipidemia, smoking, diabetes, serum creatinine, plasma folic acid and vitamin B12 were not significantly different in the two groups. Homocyst(e)ine levels (micromol/L) were significantly higher in patients with carotid ather osclerosis than in those with normal arteries (11.7+/-6.5 micromol/L, 95% CI 10.4-13.1 vs 8.07+/-4.4 micromol/L, 95% CI 7.2-8.9, p<0.0001). By multiple regression analysis H(e) levels were positively correlated with male gender (p<0.02), age (p<0.001), and negatively with folic acid (p<0.0001). By logistic regression the independent predictors of carotid atherosclerosis were male gender (OR 2.65), hypertension (OR 2.55), age (x10 years, OR 2.15) and H(e) levels (x1 micromol/L, OR 1.11). This study confirmed homocyst(e)ine is associated with carotid atherosclerosis. Consequently the authors recommend H(e) levels be screened in all patients at risk for atherosclerosis.

Topics: Age Factors; Body Mass Index; Carotid Artery Diseases; Carotid Artery, Common; Carotid Artery, Internal; Chromatography, High Pressure Liquid; Creatinine; Diabetes Complications; Female; Fluorescence; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Hyperlipidemias; Hypertension; Logistic Models; Male; Middle Aged; Regression Analysis; Risk Factors; Sex Factors; Smoking; Tunica Intima; Tunica Media; Ultrasonography; Vitamin B 12

To examine the relationship between coronary heart disease (CHD) and serum lipid, plasma homocysteine (HCY) as well as the factors related to HCY metabolisms.. The mutation of the 677C-->T transition of 5, 10-methylenetetrahydrofolate reductase (MTHFR) was determined by PCR-based assay. Whole-blood and plasma folate and plasma vitamin B12, as cofactors of MTHFR, were determined by radio-immunologic assay. Plasma HCY was determined by HPLC.. Patients with CHD had elevated plasma HCY concentrations (17.38 +/- 1.94 mumol/L vs 10.25 +/- 1.57 mumol/L, P < 0.01). In patients with myocardial infarction (MI) and family history (FH) of CHD, plasma HCY were elevated even higher (P < 0.05). Plasma HCY concentrations had significant non-linear inverse correlation with plasma folate and B12 concentrations, i.e. the lower the serum folate or B12 concentrations, the higher the plasma HCY concentrations (P < 0.01). Patients with homozygous mutants had higher plasma HCY concentrations. Patients with CHD had increased serum Chol and LDL-C and Apo-B levels (P < 0.01, P < 0.05 and P < 0.05 respectively). But plasma HCY concentrations had no correlation with serum lipid levels. 24.1% of the patients had high lipid and high HCY level, 25.9% had high lipid level and normal HCY level, 20.4% had normal lipid and high HCY level, and 29.6% had normal lipid and HCY level.. HCY may have strong association with the genesis of CHD. Low plasma folate and B12 concentrations may induce Hyperhomocysteinemia [HH(e)]. Plasma HCY concentrations have no correlation with serum lipid levels, so HCY may be an independent risk factor. CHD may be induced by different mechanisms and can be classified into hyperlipidemia, HH (e) and normolipidemia, and normohomocysteinemia.

Topics: 5,10-Methylenetetrahydrofolate Reductase (FADH2); Adult; Aged; Coronary Disease; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Hyperlipidemias; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Oxidoreductases; Point Mutation; Risk Factors; Vitamin B 12

The study sought to define the relation of plasma total homocysteine to biological and clinical variables and to serum vitamin concentrations in patients with primary hyperlipidaemia. Fasting plasma total homocysteine was measured in 219 men and 159 women; vitamin concentrations were available for about 60% of the sample. Men had significantly higher plasma total homocysteine than women [median (25th, 75th percentiles) 9.4 (8.2, 11.5) mumol L-1 vs. 8.5 (7.0, 10.2) mumol L-1; P = 0.0001]. Plasma total homocysteine was lower in women taking lipid-lowering drugs than in women who were not taking drugs. Serum folate and vitamin B12 concentrations were normal for all but one and four subjects respectively. Correlations (P < or = 0.06) were found between plasma total homocysteine and age, triglyceride concentration in women, uric acid concentration in men, serum folate, vitamin B12 and creatinine concentrations. In multiple regression analysis, the association between plasma total homocysteine and sex and between plasma total homocysteine and use of lipid-lowering drugs disappeared when creatinine concentration was entered into the analysis. This study shows that plasma total homocysteine is related to vitamin concentrations within the normal range, suggesting that plasma total homocysteine may be modifiable by diet in hyperlipidaemic subjects with normal vitamin nutrition. Sex-related differences appear to be related to men's higher creatinine concentration. Whether lipid-lowering drugs interact with total homocysteine concentration requires further study.

Topics: Adult; Age Factors; Aged; Cardiovascular Diseases; Female; Homocysteine; Humans; Hyperlipidemias; Hypolipidemic Agents; Male; Middle Aged; Regression Analysis; Sex Factors; Vitamin B 12

Topics: Adult; Aged; DEAE-Dextran; Dextrans; Humans; Hypercholesterolemia; Hyperlipidemias; Middle Aged; Radioimmunoassay; Vitamin B 12; Vitamins

Topics: Alloys; Anemia; Animals; Beer; Cobalt; Enzyme Inhibitors; Food Contamination; Heart Diseases; Heme; Humans; Hyperlipidemias; Iron; Joint Prosthesis; Lipids; Neoplasms; Tissue Distribution; Vitamin B 12

The first partial ileal bypass operation specifically for the reduction of plasma lipids was performed by us in 1963. Since then we have operated upon and followed for more than three months 126 hyperlipidemic patients. Clinical metabolic studies, before and after the procedure, have demonstrated a 60% decrease in cholesterol absorption, a 3.8-fold increase in total fecal steroid excretion, a 5.7-fold increase in cholesterol synthesis, a 3-fold increase in cholesterol turnover, and a one-third decrease in the miscible cholesterol pool. Circulating cholesterol levels have been lowered an average 41.1% from the preoperative but postdietary baseline. An average 53% cholesterol reduction has been achieved from a pretreatment baseline using a combination of dietary and surgical management. Plasma triglycerides have been reduced in primary hypertriglyceridemic patients (type IV) an average of 52.6% from their preoperative but postdietary baseline. One patient died in the hospital and there have been 13 late deaths over the past 10 years. Four cases of postoperative bowel obstruction required reoperation. Diarrhea following partial ileal bypass is, as a rule, transistory and not a significant problem. No appreciable weight loss results from partial ileal bypass, which is an obvious distinction from the results of the far more massive jejuno-ileal bypass procedure for obesity. We have not encountered hepatotoxic, lithogenic, or nephrolithiasis complications in our partial ileal bypass patients. Sixty-nine per cent of our patients with preoperative angina pectoris have postoperative improvement or total remission of this symptom complex. Serial appraisal of followup coronary arteriographic studies offers preliminary evidence for lesion regression. It is concluded that partial ileal bypass is the most effective means for lipid reduction available today; it is obligatory in its actions, safe, and associated with minimal side effects.

Topics: Adolescent; Adult; Angina Pectoris; Angiocardiography; Child; Cholesterol; Diarrhea; Feces; Female; Follow-Up Studies; Humans; Hyperlipidemias; Ileum; Male; Middle Aged; Postoperative Complications; Steroids; Triglycerides; Vitamin B 12

Topics: Aged; Arteriosclerosis; Cholesterol; Choline; Drug Combinations; Fatty Acids; Female; Flavin Mononucleotide; Heparin; Humans; Hypercholesterolemia; Hyperlipidemias; Male; Middle Aged; Niacinamide; Phospholipids; Triglycerides; Vitamin B 12

Topics: Bile Acids and Salts; Cholesterol; Diet; Fats; Fats, Unsaturated; Humans; Hyperlipidemias; Lipids; Nutrition Assessment; Salts; Vitamin B 12

Topics: Acetoacetates; Animals; Blood Coagulation; Blood Coagulation Factors; Diet; Fatty Acids; Fatty Acids, Essential; Glucose; Hyperlipidemias; Inositol; Rabbits; Vitamin B 12