An assessment of serum lipid and lipoprotein levels in patients with ischaemic heart disease

A total of 166 patients who had one or more attacks of myocardial infarction and those with angina pectoris, forty-five relative of 18 hyperlipidemic survivors of ischaemic heart disease, and 330 healthy persons (controls) were investigated for serum lipid profiles. Fifty-six of the 166 patients were hyperlipidemic. The commonest abnormalities in lipoproteins were Types IIa, IIb and IV. 75.5% of the 45 relatives investigated were hyperlipidemic. The familial studies showed that hyperlipidemias occurred in the family members of persons with ischaemic heart disease suggesting that hyperlipidemia could play an important role in predisposing familial clustering of coronary heart disease. A family history of heart disease may be a useful marker for identifying persons who are more likely to have high levels of blood lipids for possible treatment.

Diagnosis of Familial Hypercholesterolemia Using DNA Haplotype Analysis in Three Large Families with Two Hyperlipidemic Parents

Since the cloning of the human LDL receptor (LDLR) gene, familial hypercholesterolemia (FH) can be diagnosed by recombinant DNA technology either using restriction enzyme mapping to detect major rearrangements of the gene or using restriction fragment length polymorphisms (RFLPs) and linkage analysis in family studies. Genotypes and haplotypes of four RFLPs (StuI, ApaII 5', PvuII, NcoI) were used to study the inheritance of the detective LDLR gene in three families. Diagnosis of FH based on the lipid levels alone was not possible because in these kindreds both parents exhibit elevated lipid levels. However, in two families using haplotype analysis, elevated cholesterol levels in certain relatives could be attributed to the inheritance of a defective LDRL gene and thereby distinguished from hypercholesterolemia due to familial combined hyperlipidemia. In the third family where both hypercholesterolemic parents carried a defective LDLR gene, a case of homozygous FH could be excluded in a child by demonstrating the inheritance of a normal LDLR gene.

Hyperlipidemia, pregnancy and pancreatitis

Hypertriglyceridemia is a recognized complication of pregnancy. In patients with familial hypertriglyceridemia, the biochemical changes are greatly enhanced during pregnancy and may be associated with acute pancreatitis, a potentially fatal triad. Three patients were studied, in one of whom previously undiagnosed hyperlipidemia resulted in a fatal attack of fulminant acute pancreatitis. In the other two patients, this complication was avoided by close monitoring and restriction of dietary facts. A history of episodic abdominal cramps, often beginning in early childhood, or the presence of lipemic fasting plasma should alert the clinician to the presence of severe familial hypertriglyceridemia. Early diagnosis allows for the institution of relatively simple management strategies, which diminish the risk of pancreatitis.

Atherosclerosis of the carotid arteries documented by duplex scan as a predictor of coronary artery disease in familial hyperlipidemias

The degree of atherosclerotic plaques in the carotid arteries was evaluated in 85 patients with familial hypercholesterolemia and in 43 patients with familial combined hyperlipidemia by means of Duplex scan which recognizes early atherosclerosis. In patients older than 40 years carotid atherosclerosis of moderate degree was associated with coronary heart disease in 90% of cases. The extent of elevated cholesterol, age, cigarette smoking, and hypertension determined the degree of carotid atherosclerosis.