BIOCH€MtSTRY

STUDIES ON HYPERLIPIDEMIA AND LIPOPROTEII{EI|IA<br />

IN ISCHEMIC HEART DISEASE IN LARKANA DIVISION<br />

a!<br />

PROF. ZAFAR ALI PIRZADO<br />

A DISSERTATION SUBMITTEO tN PARTIAL FULFILMENT<br />

OF THE REOUIREMENT FOR DEGREE OF<br />

DOCTOR OF PHILOSOPHY<br />

IN<br />

<strong>BIOCH€MtSTRY</strong><br />

. ..DR.iI.A. KAZI INSTITUTE OF CHEiIISIRY,<br />

UNIVERSITY OF SINDH, JAMSHORO.<br />

JUIY 2000

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DEDIGATION<br />

DEDICAIED<br />

TO<br />

MY LAIE BROTHER<br />

n.i,,,iiln,f,rrnm<br />

WTIOSE UNIIMELY DEAIH<br />

MI,TERED OUR FAMILY

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ACtotowEDcE Elfl<br />

I m c6dttud6r b trr !F Arqrrywb o@itdl D ch.E.r, @u!s€ io D.!t<br />

ido fcrd ot adne, . p.n.a HsM tt&t6. \ ltrFnHslElpti6idE,16tu,I d@||l,@<br />

I f€sl cFd B. st dtm .nd dep s.$ of gEitrrrg lo oqs my sneF Doads dnd<br />

rhdkr to prEr€sor Dn ahdul Rrl|rn Mdor mysuid. md r...h, d.e my 6nt.n€ro<br />

urnd*y oi sillr, s . dud.nr d Msr.r5 d.ce, tu nb .u. c{td.6 .nd eduqodn<br />

rJRrlhod 0t! @E ot $dy.<br />

I hM cE t d*!E h rh.irjic p,.hct{a3 ol ch{nr. hdtctt c.t 9., 6D€d{V<br />

Pbresr Dr At[a H.ids Sorm, |llhodih.ir6oF.donb@u.d€oo€,rdtF6prd<br />

fadlili* dudnO ny 6*aEi p.riod, lhis rlt @td .o( hde b€€n posr* lo ery dn.<br />

r.m.|sihMkftjro rh6 Dt6.ror, Or Uhtdul|rl M, lhh.!i, Or M.A. Ka, hdid6 ol<br />

chen&ry ..n br

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,.<br />

OR T.A. XAZI II{SIITUTE OF qiENSIRY,<br />

UiTVERS|TY OF SINOII, JATSHORO<br />

CERTIFICATE<br />

Ihis is to c.fiiry tut fiG dBi! "StIdi.. otr E p.rtipid.ni. .rd<br />

Lipopretdtrdi. i! Ir.t.Dic E..n Dilar. tr t'bu Dhilior" sbDin€d by pref,<br />

:f.: 1lt Prado s . pini,l r.quiG!.m of Dg.ror of rrn@pry (pLD) in<br />

Bioctmsry tu @nptq. h dt r.A.$ .trd i, mnh pGqrs,g.<br />

PNOF, DR ll|- ATAI]I XAf,MTN<br />

,*,.k-**^*^<br />

o*@ \./!/_ ,*.<br />

*kr--'-"l*yg*o"n^

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i) A.rlNbdsd.dt<br />

ii) Lila of Fi!.nr<br />

iit Lirt orcflpbt<br />

iv) ult orAppddtt T|btd<br />

Y) Ltu of Nor.tio!<br />

Aiu ofd. Sitdy<br />

CEAPI?RONE INTIODUCfION<br />

l.l Pr@l€*of IHD<br />

1.2 &6nni@.d Se9.<br />

1.5 M)@did Lrh.cdon<br />

r.6 Revi$ofuidaur<br />

CONTENTS<br />

CEAPIERTIVO ATETROSCLEROSIS<br />

2.1 Dednirion ed Etiotory<br />

22 Art.rel@!tu rrd th. Chol. qot<br />

CEAPIERIITDE BII)ODIJTDS<br />

3.0 NdEl Coft.d.rtion ofupi& in Btood<br />

it<br />

xiri<br />

xrii<br />

xv:.ti<br />

I<br />

2<br />

3<br />

5<br />

n<br />

22<br />

24

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32 Chol6t.iotMobitizitiot<br />

3.3 CliricalAppiqct b rnd Bb.d Chol€ddol<br />

3 5 Rclationil'jp ofrriglydidc rjch<br />

LipopoLb io Adr@$lsD5i3<br />

3 3 StrucruE oflipoprcr.irt<br />

3 l0 V.ry rr* Dslriry LipoFoi.in (VLDL)<br />

3ll llry Darity Lipoprd$ (t DL)<br />

3.12 Rol. ofLDL b snlEl8ddi3.!d .t vctopndrof[tD<br />

3.13 High D4iry Lipoprcr.in G|DL)<br />

I 14 ApolipopftGim Apoprcr€i!,<br />

r.l5 Apolipopot in -B-48 dd Alor B-IOO<br />

r 16 Apolipoprotcin A- I<br />

3 17 AlolipoFodnec<br />

3.18 Apolitoprc&iFE<br />

CEAITERFOUR RTSK IiACTORS OT TED<br />

4l Rilk F..td3 of IHD<br />

4.3 Mehairn of Smotitrg Lartilg ro Hy!q-<br />

Lipiddia hd IIID<br />

a.a EnvironMtat Tobr@ smoke (ETS)<br />

45 Cig@rt. Snokina rad HrT€nadon<br />

4.7 Melt ri3h oflnadior ofHypqralion ..d IHD<br />

4.8 D.n y M|.rg€nem oaHyFtadoi<br />

49 Ht?cn€nsion sd Obeity<br />

27<br />

30<br />

3l<br />

12<br />

32<br />

32<br />

34<br />

34<br />

36<br />

37<br />

42<br />

5o<br />

5l<br />

55<br />

56

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4la Dia s . Rilt F.nor &r IliD<br />

4,16 Monou$rluded ldy A.idt<br />

4.17 Orcgr.6 F.ny Add!<br />

4.lE otn gr-3 FsyAdd!<br />

a.l9 Diart Ftyh.dol,<br />

CEAPTER FIIE<br />

PART.A<br />

5 Sidy toDrr.dD<br />

5.1 lHDPdi.ms<br />

5 1.2 Myoondid lr&rction<br />

MATEXIAL AND METBODS<br />

5.1.3 SwivoB of Mlq.rdid Iinrdion<br />

5.2 Ih. StrDto@ ofIf,D<br />

5 5 Sdiio.comoi. Gopj<br />

5.5.I EdEtion l $anrt<br />

5 5.2 Rdi&nti.l Slatus<br />

57<br />

57<br />

53<br />

60<br />

6l<br />

62<br />

63<br />

63<br />

65<br />

55<br />

65<br />

65<br />

65<br />

65<br />

65<br />

6<br />

6<br />

6<br />

66<br />

66

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5.5.4 Snoking Fabir<br />

5.5-6 Di.baiq<br />

s.5.? ramily shtdy ofIHD<br />

5.6 Ealuid cirsir<br />

5.? EdridlCdsi

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6 2 Cle$ifiqtion shovin8 Nornal W.ight, Ovd *igh |Dd<br />

Ob* ttlD paidts md @rmDl $bjdts b..ed or Bod,<br />

MaLdd 106<br />

6 J Show'ng Body Vs lndd of difLr.iL S@ioc.ftnic<br />

Cop6 of lIlD pdidtr rO7<br />

6.4 Cl4tifcdion of IUD plti€irs ad @ntrol objc.is bsed<br />

on difftut Fofdsion l group$ lO9<br />

6.5 Showing pFulae of Rik l.cld! obsed ir IHD<br />

prti.nb in diff.mt sio@'dic ctgg. I t5<br />

6.6 Shosing Bio.haDiel wji!16 in tHD p.ri.!nl dorg wirt<br />

th.ir contrclsubjErs 119<br />

6.? Shoaing R!ri6 ofTdd Clbld@yrtDl. LDT,/HDL,<br />

To1!l Cholest rcVApo B &d Apo:A-l/Apo: B i. IllD<br />

p.li. 3 .loig sirl rh.ir o'mol sbj.de t2t-22.<br />

6.8-9 ShNing BioclEnical wiau.! in N@lipiddic md<br />

Hr?cdipidenic IHD prdcrls alonS wilh th.tr @nbol $bjdts.<br />

69 SIF*ing nrios ofAF A- l/A!o:8, Tot l Chd.n@U<br />

Apo B, LDUHDL ed Toid Cholot€rc| 4lDL in<br />

Nmlipidhic ud HtTdlipidnic []D<br />

p!ti.n6 .lons with $ri 6.110l lubje.rs lU<br />

6. I l-r2 Showi.g Bio.hdicd vriibls ii IrD pdicr& dong Fth<br />

dEir oniol sbjEts in ditraar SociMnic cmp6. 125-26<br />

6.12 Showing R li6 ofr,DUHDI. Tord Chola|rel /HDl. Apo:<br />

A- l. /A!o:B Toitl Clbl..r.ml./Apo B ir IHD Dqii€rn! rnd<br />

@nrol sbj@tlof dif.ent S@jo@mmic grolps t27<br />

6.14 Sho*ing Aid&ni6t wi.!16 ofN@tipid.nic srt<br />

Hypdlipid€nic IllD pdi6l3 atong vith fi.ir @tnol sbje.rs<br />

in kbd €ls. 129

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6.15 Showing Biolmicil vuiibt$ of Nmlipidenic snd<br />

rlT.itipid.mic trD p€tiots doiS {irh d*n @nrol<br />

sbjd. in Swie.rs llo<br />

6.16 Showing Biochcmic.l vdilbld of Nonolipid€mic ed<br />

gyTedipid.hi. DtD pdidls riong wirh 1h.n @nrol sbjcts<br />

inBuinsclsr. t3l.<br />

6.17 Shoviis Biocr@i..lwirblg of Nmlipidqnic.d<br />

Hypdtipid.nic IIID paliars .]ong wirh OEn @ntDl sbjers<br />

iD Fm Nnd clas tJ2.<br />

6.18 Showing Bioch€hicd wiabl* ir IHD pdidts rlong wnh<br />

then @mrcl $bjet5ofdifr*g)r Ag. Grdrls 133.<br />

6 19 Sho*ing Rtlor oflolrl Ctbktiad /ttDq LDI. ttDL Totd<br />

ClFleedl /Apo B Dd Apo A-l/Apo B h IHD paid! ed<br />

thet @nrol sbjets in diffddr.g.erups 134.<br />

620 Shosins Biochdi@l wiabls of Nomolipid€nic md<br />

HyD.riipid.mic IHD pdi.t ! .lo.gwith coitrol $bjcd! ty<br />

AScg@p2040y6 136<br />

621 Showing Biehdiq.l @i!bl.! of Nomolipiddic ud<br />

Hy?dlipidcmic ItiD pe,!i6t! along with @ntrol sbj61! by<br />

Agee0p4l-50y6 111<br />

6.22 Sbowing Eiclmjc.l wi.bl6 of N@lipidemic &d<br />

ttrldlipidmic IHD prdols doigri0! @rrcl $bjds<br />

by fuegtup 5l-60 yqs Il8<br />

6 22 Showing Biochciioal v{iabl6 ofNomolipi.leni. dd<br />

HyFrlipid.nic IHD pdiqft atong wlh @nrol s!j6t by<br />

fue gdp 6l yqB ad.boE 139.<br />

6.24 Sho,ing Bi@h6i€l wiallee i. MALE<br />

tud FEMALE IHD pdienrs l4l<br />

625 Showing Bioch.midl wi.bl.! of IHD pati@ts with Hyp.rt€.$on 142.<br />

6 26 SlFwing bioch.nidl wiabl6 oflHD patrotr in<br />

Smkd &d Nor S@t6 l,l4

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6.2? Showing htucioicrl EirbL. dIHD pdis in<br />

D!!.re Mdlib!.<br />

6.28 Showins biehmic.l vei.bls ofIHD pri€d! in<br />

Rlrd .d U6.n loti.lion<br />

6.29 Shofi.g Diocbrirl wirbL. of IIID Fi.d. tri.g<br />

po.itiw Fdily Hindy ofr9cHEMIC HEART DISEASE (trtD)<br />

6.30 ShNirg biochdiel wi.bls of IHD Ddi6r! rlkin8 ditr€rsrr<br />

7..<br />

8.<br />

lo.<br />

t1.<br />

t2<br />

Ucnry tu! i.a v€dblc oilD@ipdi ai..Ded cth.. (Euid).<br />

CEAPIERSIVDII DSICIJSS()N<br />

CONCLUSTON<br />

tIE@MMENDATIONS<br />

FUTUTE ASPE CIS OF sTI'DY OF AIf,ER(rcENESTS<br />

EIBLIOGRAPEY<br />

A'PEIiDTES<br />

145.<br />

t4t.<br />

143<br />

150<br />

156<br />

't70<br />

t7l<br />

t72<br />

t71

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l<br />

2.<br />

1.<br />

LIST OT FIGUNDS<br />

A. DilSmmatic prclcntdion ofTriglycclid6 &d very<br />

lN ddlity litoFotdn<br />

Shosi.s.gq s ofIHD pdirt rlong *idr lt* codd rlbj.ds<br />

Sd( diltlittutid ofltlD pdiens .lory with 6md rubject .<br />

ShowiDg p.!@t g. of IHD psii.ft of IIID p.tidt!<br />

Alotrs witt rh.ir @inol &!j..r! bud d body olrt id.r.<br />

Sltowing craifcrion oflrD prdcnr. t r.d d<br />

dif.(ar siodonmic ltttus<br />

5. P@nt8g. of .bk fl.tor! obeMd ii nit. dd<br />

fddl. Dati.mr of IscltcEic IIe.n dit.r!c.<br />

6. Sho*iig por.oi.g. ofridr hda o[sEd i! ItlD pdiatu<br />

of diftr.d uio@mdic .h*<br />

ll0<br />

lll<br />

tt2<br />

ll!<br />

ll6<br />

7 Sho*ing @ielation b.twd LDLcholdtcroled tor.l cholesrercl 152<br />

8. Shori.a @rdrtion b.tlg rpolipopd.iFB .nd r,DlilloL$mt 153<br />

9 Shosilsdrd.donDa@pho.pholigid.ldr.Dlctol.dftl t5a<br />

10. SlbqinsddiionbawnLDLctolcd.'tl.rdI|DLolloled@l' 155<br />

I l. Showing @n Llion b.tlq HDLchol.aml tnd riigly6id6 156<br />

1t7

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IJAT OI GIAISI<br />

L Cndt |loeils fidrd C!.\l! ft..dd 6fsor<br />

TddtuLdrd 71,<br />

2. (lth.torirS arff.dr! fi.dnrdodlln<br />

apo*f C)<br />

l. C.pS.boriT rldd ont h.dlrit dl|n<br />

T6IF .(..i'a u<br />

a. cdlt osis drd crs h-hdoofr..u6<br />

TdtF&. !a<br />

5. cretiori.gffiqv.6..dr.n dlud<br />

ltuallolipid oL.lhorur)<br />

6. ftlhto'bgrddor!ftd'dddnn<br />

rdqin<br />

7. crqh |b.*ing r|ldud d'rv€ br.dndion drrurr<br />

Ith.dd 99<br />

I eTrnoeitarddcrt h.abinoc8rrD (trc r03<br />

Y2

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I<br />

2.<br />

l<br />

5<br />

8<br />

10.<br />

It.<br />

t2<br />

ll<br />

l5<br />

t7<br />

t8<br />

LTSI OF AIPENDIX TABLES<br />

Cliniql history ofNomsl @rrol subj6ts<br />

Cliniol histoiy oflnD p idts ofbbour clas<br />

Clinicrl hinory oflrD pdicrts of Sdi@ dN<br />

Clini6l history of IHD plli€nts ofBwin.$ clas<br />

Clinical hbtory of IHD pnianE ofFm OMer cl6<br />

Bbcndiol vdilbl* of 6Eol obj.(i!<br />

Bioch.miol vri.bl.s of IHD paii.lt3 oftxbM cl!$<br />

Biocn ni@l vuilbl6 ofDID pdi. s of Swic. clss<br />

Biochdidl vrirbl.s oflHD p.li6is of B6itB cla<br />

Bioch.mical wi.bl.s of IHD pai.n$ ofFm O{rcr cldg<br />

Bioch€mi.alv{isbl*ofNomolipidaniclHDp.ti4ts<br />

Bi@hemic.l wi.bl.s of Htpdlipid.nic IrD pati4ts<br />

Biochnic.l vri.ble!ofNomolipiddiclttDp6ncnts<br />

BiNh.nic wi.bl€s ofHtT€rlipid€mic IHD p!i.n$<br />

Biocnedical wi.bl*of Nomolipid.nj. IHD pali.nts<br />

Bioch€nicalvdiablesofHt?rlipid@icltiDpdicntg<br />

Biochemic.l wrilblesof Nomolipidemic IHD p.ti.t'is<br />

Bi@henical veiabl$of Htp€rlipid€miclIlDp.iients<br />

lviii

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20<br />

2l<br />

22<br />

21.<br />

26.<br />

21.<br />

24.<br />

3l<br />

12.<br />

33<br />

35<br />

36.<br />

Bio.hchical vai.blc! of o'n6l$bjd! by.gc 2040 y@<br />

Bacndic.l wi.bler of mlol $bi.crs by rg. 4l -50 y6<br />

Biochcmicd wi.bl.r of@ntrcl sbj.cts by ag. 5 160 y@!<br />

Biochcmic.l wirbld of6 rolubj€d5 by.e.6l y6..d sbos<br />

Bidh.hic.l vui.bl6 oflqD p.ticnts by agc 2G4O yar<br />

Bioch.nicalvsilble!ofIHDprli€ sbyage4l-50yds<br />

Bio.imic.! witbl* of IHD prricnr! by .gc 5l-60 yds<br />

Bi@hcmical v&i.bl6 of IHD Fri.nts br !g€ 6l y.s .nd aboE<br />

Bi*hchical vei.bld oftiD M.l. p.ti6t!<br />

BiochaDi€.I wi.bl.r of[lD Fcnulc Fli@ts<br />

Biochmicdl wi$l$ of Nomotqisie IIiD patieits<br />

Bieh.Eicd wi.Ua ofilrTsE8iv. IHD pdiqns<br />

BiochcFjc€l vdi.blc! ofNoNnokd IHD Pdi.nls<br />

Bioch@ical v{irbl.r of Smk . lHD pdi6ll<br />

Bicncnic.l wi.bla of Dialaic IHD pari@rs<br />

Biochcnical vdiablB ofNon-DirbcticlHD pati..tt<br />

Biod@ic.l vdilbla ofulls IHD prticd!<br />

Bi@hmicd wi$l$ of Rxr.l IHD pdricrr!

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ACTH<br />

AST<br />

CAD<br />

CHD<br />

CMCH<br />

CPK<br />

c\t)<br />

dL<br />

ECG<br />

FH<br />

Fig<br />

G<br />

HDL{<br />

IDDM<br />

IDL<br />

IHD<br />

LCAT<br />

LDH<br />

LDL<br />

LPL<br />

LRC{PPT<br />

LIST OF NOTATTON<br />

Ad@.rri@t&phic h.mre<br />

chsdk Mdicrl Collcsc Horpiral<br />

C..dbine pholphoki@<br />

Cmdry Vrelu Digg<br />

l.hilirl HIT@lbl6taolmia<br />

rlgrr Dtuhy lipoprot in Ctdcsssl<br />

In$lia dcp€nd.nl dillds mellit8<br />

lln6n di.le dtuity lipoFo&i.<br />

l-irhin Chola3r6ol Aayltr.ndr@<br />

Upid Rerdr Clinie col!@y Prinry P.ewnioi Tdd

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LRP LDLR@Fo. Pr.r.in<br />

uL Mi@lil&<br />

nVdL Milligm pc. d..iliG<br />

nL Millilitc<br />

tul/L Militulpdlfut<br />

MRFII MuldpL Ri* F&ror lrt Nlrilon Tiid<br />

NCEP Nltior.l Cholst rcl Etlrdtion ltogntn.<br />

NAI' lfi.crimi.b ..kiie iliNlali&<br />

NADP NcodMid. dai@ dinucl.olide plF+hd.<br />

NTDDM Noi iiIulh d.pdrd.d di6d6 ndliN<br />

PMRC P.lic.! Mcdiql Rsdr Cdrtl<br />

% Pdcqtrgp<br />

n SuplcMb6(Nunrbdofnt.d!)<br />

s.D stud.d Ddirion<br />

SEM Sl.ndddmrl|@<br />

rc Tor.l ctol€.r@l<br />

TG lriSlr€il.<br />

wDL v.ry low d.ruity lipoproLit<br />

W.H.O wodd HaIt Orgrizdkr

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A|MS OF TEE WORX<br />

A er.e Eldionship b.ts@ lipid i.lrtc ir diel md sn chol€saol |d r in<br />

Erious populaion *udi.s Bing dind .xpqin6i! dmdout rh. mrld ha b6<br />

d.mo.sra.d to br th. l*ding oe of ishdic had di5as (trD). h4qfiion<br />

studi* (by cnosins lipid @npolitim ofdid) dis?hy€d tt clin d IHD 616 &d chds€ in<br />

ftan som choLsi@l l@1. Th€ blod cholerhl leEl sraliarns vlry fron @nEy to<br />

ouiEy Upid prcfilc @l.dort in diffcrdr IHD srdi.c dmnlr t !i8 f@t<br />

rcl.tio.ship b.twd IHD nonrlity rales sid @n cholddol onccnftrion on tn€ onc<br />

hhd ad bc.l@ tot3l dddftl ondnidion dd low fiDL.l'ole{@l @n6taion<br />

ontheothd On. @ nor yet pd.eive a rhrdhold ldll ofcnobsl€rol @rc.nlrdion .bov.<br />

Nltidr tlte rtuk of EiD irc:qs. The blood crDl6t@l l@eh of lh. dift rqt DotrLtioB<br />

ec .lso dispulabl€ undd the diferdl @iddiology of life styl. ud gpogEphiml<br />

@ndition ofa @ ry dd food hrbiri bdDviN of ft. p@pl. nt6nriioid and<br />

inrr.,utiond, @ry sutrciar wig)ri ro @h a onm6.<br />

Th. Fmirsh.n Hdl Study and oth6 .gidediologic srdid sho*.d gtand<br />

incidde of IHD @ona vdjd! sudy gNps of poFiarid sl'o a. cigd€tc sok6,<br />

sutr riig from hrT.ndsio4 lddr blood SJuo*, obeity, ECG .bionnaliry, lrk of<br />

qcrcie dd sBs indi€t d irdivitu l ar lish rtt .m std Oc oE all lipid pofile<br />

(i.e. tu chole$erol. Triely.did€, rlDl{hol€ddol LDLcholdt€oD falh on bo'dq<br />

In fih @ndr of *udv. on€ should thi.k oor. us.tul 10 look dl !h.<br />

?idmiolosic.! pdda6 a dahid of rh.lHD tut f.dm dd dE bi@n@icil<br />

rut6 lik.. toral Flm cholGtqol. LDL, tlDl. VLDI" .polippretei. A-1,<br />

, apolipprct in-B, lipoprolcin p.nicle 3i2., oxidiz.d LDL .!d HDL $lE!.riotu and<br />

uiSlyqid. rich lipoprci.in pa.ti.l6, rhd s dhae rhe pEdiclability ofIHD in Ptti€tn3<br />

of rh. Dd sio@rcnic ondirioB of rlF ud€i dcvclo!€d @urfri4 like Palisl!..<br />

It ws tha.fq. rcmpting to !tudy the did!ry h.bit! ofth. inn$irrnb of lr.kat!<br />

divkion in gerdal, who rcside in urbm dd rual e&r naviDg difrsdl ecitl 8nd etnhic

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cuhe t€hwiu s th€ cr!,tis prudr of d.wloping IrD in !h. .6ludr Dd<br />

tomition l $d! of |ericltlni lo hduri.l dolmx whict h ort*i* . di!.$. of<br />

.fll|.|tr clr$ of pop|idid.<br />

With rhtu .!pcd, {F lsidion dIHD ioddot.s !d lipit Fofd. nltnldr of<br />

ilt iidividda b.lorEios ro nld ud uto !q @idnniq fir {od!d! of<br />

aioomic @di@ sto llfo.tcd ii Ct ddln Mqndl Colhsc Ho{itil (CMCI4<br />

Id(u s!.! ilv.dig@d i.ii.[y ! | prlc.ni

---

ABSTRACT<br />

IlE hy6dir*j€,nta qt riWt*henia guded in the @da Elttilp in<br />

Itrkna divishn wete ttuN bc be the causE ol lstr,rJnic H6ed Dis€a!€ fi.tD) tmt<br />

uhna4y esults n nwbitty aN notufty wilhin predonjne ly nate popdallon<br />

nt Fdianl* to 4e gn)p 45.6, F6|s &/si',esgrr€., as a prolbst r,6, /,aDili6bs.<br />

lr€,€drhe/ess typen€ns,o, and cbaate sn oking ad koit lite styte iuggested lo<br />

be Egg.avaling be dis€,ase.<br />

fhe patb.ts rcr't1€d io C.M.C.H t,,€'e cfydec! a@'ding b srrtftJr,nic<br />

status intr tou g.oups (i) Labou class (2) sevice ctass (3) Busir€ss c/ass /41<br />

,r r,fEs oDse^cd 6nat serun brcb ot rioirs induding Totat cho*.ller,<br />

hgtycoddes. mcAphdipid aN Total tipids tenained lngniticahlt highe. in he<br />

palbris as cornp€red b oon o/ s/r.irds.<br />

Moreov6. fre T&t 6&gatol aN low .tstsity lifr/ptobio c'tr,tasterot<br />

(Aq we/g signifrcAttty hjgher and High D€,lslv Ljpopoteins (HDL) wea towel<br />

D6' li,'e co,lrol s4ircts. it r.s t6 bv€l of a.r,tirr/pn aein a-1 dN<br />

A'oai,q$dain B hich disdayd a significart vatidjon in dnqst aI qe gnups<br />

€rd var(tus p/o,bssrbrr/ dass€s.<br />

f}€ dh ot Ap A-1/Ap B, Tdar Ct:plestuo{a.E: B tt€ls ds to bs,<br />

bw in the patienb as anpard & cod,o/ subFcts WheE '.J{./,t! a the r/tb of LDL<br />

ct'ot€$enwld- aN rotd cnob$t*HDL tfJr9 toud lrgnitca y hillh.<br />

7ne rEsr,/ib otgBse/,t g/dy ha€ dem ir'/!,d flf,t A@t@nbio A-1<br />

aN A'€lir€lp,otein-B aE the bdhet .I*dni@ing incticee b pdidjw of lHD ewn<br />

in nondidenb subi5.s.

---

sY oPsrs<br />

ChodLr M.dicd Colleg! Hoqrd, 0F plae of sdy i! 3inm.d d IrItu<br />

tr*rD i. oe oftlE divilior.l hatl qutrc. ofrlE Fovi@ of Sirdh c)|'m.ly dtLd<br />

(ulpd sindh) Thb divisiotr @npds ofrtue diftrcrs i.e rirur irel4 Sltldad sd<br />

JMb.b{d I! the nodL Slikr.pr 6d hcobrld rc siturtcd, in ih. alr tu 'tuvq IduJ'<br />

in th€ Wdt i! Sh.ndidkor rdjoinj.g ro Bd@cnke prcvircq while in th€ &urh is disrrid<br />

ljl{n h @pcdiivdy nort tor !d nMid climlticrtly ris orhr disdia!.<br />

The clitutc of rh. divirioN i! m.t ho(.d hmid ald n@ b rh. nin mo of lh!<br />

divilion. TIF o1hd @ps e wha! @nd (..p6i.tly in rh. .iF h.h) dd oit e.d3<br />

Gape *d) .nd othq g6irs. C!.vr is th6 rcrable tun of t-ko! This divisio. i!<br />

industiially urxld-ddeloped only trc flctorid luch a $g{ &d r.xtile &€ innall€d in<br />

Irkl s diltrid. Wlil. dlE dilrricL minty d.p.nd upon asndruro<br />

ftc ojdity ofdE popuhrion i6'dc b nr.t .6.rd l(e.r herd ed sdk i!<br />

agdotnrd 6m. P@plc @ livi.g under u ry8i6ic @idnioir in tinir.d .Miri6 of<br />

hafth liapondion rd €ducdior. nq. o. limir€d tls@, ofjob opFnuni6 du.<br />

lo p@r plMi.g ed d€velopnBt of fi€ |'.I. Thd€forc p@ptc k@p on nieraling nom<br />

place b pLa in le3rch ofjob for beti{ tiving<br />

Ix. sndy poFlhti@ w. @mpd$d of dids sio@rcnjc geps dep€nding<br />

upon tlEn pof..!ior\ $ch s taloo. ctrr., !..vi@ ctrsx hldns ct.!d hm o'M Ojd<br />

rird) .lts d ho@wiG<br />

Thc food h.bns ,@ oncludcd thmd rhe adnini$rrion of rh. qu€ri@irc<br />

The popul.tion u a tlds dN r.16 ih.e dier! pd {by i.. br..t6$ *,tich<br />

@ftp.ii. ofmili( r.q yosun wirh Fant (2-3) prerlr.d 6!b wlEd d ic. fN<br />

urns brrTridE Al rh. tun rri@ 'stt' siistev.ga$t di$ cootcdtum<br />

poit o.., E 6!y |ary wglr.bt.r d Fds prrp&r.d in tooa p6.k blD4p.d cn6.<br />

Oc.asion.lly they r.ke r€d Dqt trc io rlre dn6 a w..k picue is ats usd.

---

2J<br />

3)<br />

Th€ lunch in genq.l is th€ir in m.ll oflhe &y. Durine niel4 @k€d rics<br />

chapati wiih d..p lii.d potabq d v.er.ble d p.t@ e u*d. h a@ed @s<br />

oftlE LbdlE @!|3lm ni[( ra dd o'rin. cigtn m.&itrg d@dun dE<br />

Sdi@Clor<br />

Ihe f6d LldnS b.lwiM of thtu d8 deoo|d! 'foi lI|. dialrlid ofdEjob<br />

Fd in$!e, in b@kb$ dly Fd6 fi.d .gg/ti.d v.edrhL, butt6, JM rnd<br />

Jelly wirh bllayPllthr prc&dbly prcpa.€d qnh buntrbaspdi atong with G{<br />

At rhe lun h tim dodly rh dilh.r or oe nix.d dkh pr€pe€dt 8.n6slly ne.t<br />

ed di&r.r'l v.g.a.U6. Ch4ii/@*.d lie !5.d s opt. food. S.trd, yogEt<br />

in k i. l||d. p.oiieiry. M& r., Disir!, $ft riB (e's .rd D.t@) ir<br />

tutitr ly t*a ddn8 o6e h@! Thb ds .l$ r.lc .6ing ra At lh. niSh<br />

ncdchrp.ti with fri.d regd$lclr fri.d put*s, de€p fti.d Dot 106! nedrcglrrble<br />

dndr md scct dish a€ o@don lly t kd<br />

The fed r.&ing b.l'.vi@r ofrhir clB is dif€retr from othr.bs bdls of<br />

th€ir mrk odmrario. thh cl$! us ti.d Egfobtc., csg, bni4 liwr. bun6 wirh<br />

bMddprdhr ii rlE bret6d ud b.li* in r@d brolfilr Mo* ofrtd i.Ie<br />

lu6rr a dxn !bp6.irhq bdl8h n@ $€i. honB or ID(& M€d/p$try/frh<br />

s 0E p€n of th.n turch i. ..tdnion ro rt|d, fi.d wS.ilbLq F s re .]!o otra<br />

Nnh @kd ricdchapdi of$t.{trneflou. Thcy rdre tuch in g@p3. Mlk<br />

l.4 ryrup and soft drinks a. onlideed s prn of fteir nalr. S.eMlly<br />

aEilsue &uiii e de tatd duhg/.liq tunch. ThGn phr:i..I rcitty is<br />

mp.ritiwly loe d.pdding uponjob Mr. of lEn b!!iIB. TlEy d..p in<br />

th€it shop! dudng $n]@ s.ei. & nighl thcf t'L nc./ct pa! wirh ti.d<br />

v€ssabls\ d.cp fi.d neai Md ,wea dish ed .r l.!J! oie shs of milk or milk

---

t<br />

2.<br />

3.<br />

F|m OD6 flr.d Lrd)<br />

Thc food $king behdiod ofthir cl.!r '! tr?ic€lly dftrctti &om olhd das<br />

(b6ue of rich food). Ilrcy prcfer to la}€ buntr, ti€d d8d m..t rlonewith<br />

p6tha pr€p.rd in D6i Gfi6 (huttcr) i. th. b@tft8r A! thb group is da!<br />

@eitu ih€r!&rc @E thtr tllE 10 four di!h6 e Flpsr.d d lunch tift.<br />

DBi ci* is u5.d in njdity of th. ftmiliF. All sa&n l tuit! @ eil.bl. ar<br />

$.ir tutrli ti@ rL.d trld. 3topJmilt ta is tat6 d@ughod thc dly in<br />

rdditin 10 b@l6tt .!d lutuh. N.is$d* mldng slrd to h. ftir<br />

hobby/bbit ftcn di. rEl n a nigh rnd dl dE nembd! of lh. flijly dirc<br />

togdhd, ti€d med is dNt in rh. mnL! rlong with Ei.d Eg!r.bl6. Milt irtrlc<br />

quutily M g€ngally hign a @mry.d to with oihs prcf$ioMl cl.6!.3.<br />

As thir cl&$ i! tlE d.fnne prt oflDovc nc id.d cl^rs6, $d. dialy h.bib e<br />

3ihileb dxn r6pc(rirc chs ir qudny rd q@nityt<br />

n obsv.d 6ob dicly id.rq lduviN of aI qio@mni. gnp rhd dE<br />

fod i! o@ d ls 3imilu. Aid rh. lorllq of 66. food @p@n15 qry witn<br />

lhc qulity .nd qudnfty llolrsr' th. l@meided stc. of 6lori6 is s<br />

(s!b6r.4 Nrcuetuia.d<br />

Citohydld6 50{070 ofd.t c.tdic<br />

Ptoda tG2r, ofl. rt oldia<br />

Sodjun .dd olns ni6.k lCl5 nS/d.y,b@n.<br />

Dictaty hrhi$ aNrs il. inrq @io@mmic grups v!ry fion p..on to Fen<br />

lnd b.@m* F!.tically diffitulr ro mintlin rhe deired drr..imply by ldminircrina rh.

---

t e6 rt r.&.c &lgb .o .rar qdiry d qrdity of food cooton d. trln<br />

$dhbld&c..rlilityrort die* mdoanrnic gmrpr liviig ir Ed.!d ut r [e<br />

It $r! !'rptrs io &dy th. influ.n 6 of lifc rtle .nd dilrdy h|biL! ldoF.d by dE<br />

,nldy populdion Gidilg in Ida$ divirio'! on th. iypslipid.Dir lrd lh. padd@ of<br />

IHD.<br />

b di. Ggd tu' siEG|b srurt .r '!pai.d .hor4 *g! .irded ro<br />

|g tlF liDidn .rd co&D t[. F(iti@ 11. dlaikd 6rll! e giv.o ir GsL<br />

ll-12, lqc l2cl28). ]|d tt. Fw.lqE of d* ndo.. ii digro r ft@ l{ (Ft<br />

ut-lta. I l7-lt8I

---

.t<br />

!"".r(g<br />

i<br />

I<br />

t<br />

" EF<br />

iF<br />

a><br />

FI<br />

Fi

---

CHAPTER ONE<br />

INTRODUCTION

---

].I PREVALENCf, OF IEI)<br />

CHAPTER ONE<br />

INTRODUCTION<br />

C$rclli, Dirccbr of Fmingh.n study gmup Mjned rd lhousd cida$ of<br />

F minghm 10 del.mire rhe oNt of mljor cirdiovac{'la chdctdislics le.dirg to €od<br />

poinl. $c,h $ edD p61oris. @tun&y ini{frciacy, nyo@dial inf&ctio4 lllD de.ths<br />

atlsoeldotic srroke dbolic dret , hmuh.gic sistc @igBdrc h@n &iturc ed<br />

pqiph6.l v!ei& dire. lr addidon b rr sm srdi6 on psychost l inleoid<br />

deign€d lo not. bdEviou..l rqdacy $d d bosi.6s, dbs.!if!.1ioa ohpdilivads,<br />

inpati€nc. ud othd p€rsndjtv rrlir3 wd. als died dt.<br />

5*61 repons of tudi* rcglrdiig the cese ed pr€vdnoi ofIHD demost.ated<br />

by Fminglm Hdn Study (1981) group in U.S.A. @ncluded th.t sNs l*ls oflipids<br />

6peialy, tolil chol.(qol ee elascd in rh. populdion etrdiig nh tn. aitrnot of<br />

han in lhc €. @8c 45-54 rq! [U. IHD h r r.?on€d as for me $d 55o,ooo<br />

---

I2 DEFINMON AND SCOPE<br />

IHD is a condition of di6e .iiologi* ![ hwiig ii comon a dBturbme<br />

betrra oxra.n {pply dd ddned. Fl. rh. study grcup ofworld hqlrh orydizrion t<br />

(WHO) on !d'.'o!.1@!is rid IHD d.dn d IIiD s the 'c!rdi& digbititv' @tc ud<br />

dMic, diinS Aoh Ed!.rion d .r.cs of bhod $pply ro rl& ny@rdid ir Mi.tion<br />

with di!@ prcls! in thc dordy .n6.t !y!r@ [4]<br />

Th€ mn @@on @ of isohdir i! athq@l@ric di3.e of eriddi.l<br />

@re@y .icrica, which by Ed&ing ihe lumm of ih* v*!.b oau!6 e alslutc<br />

d€!lq& in ryoqdid pcrtulion in rhc b$.1 stde or linirs qpropdale inc'€s in<br />

pafirion *t!6 dtud fd fow ir DgrBLd. D.ldding upd $. nr. of dddop@1<br />

of thc .ndid ilrwiis .rd irs ulrinra l.Eity drc bd. clini.oparholosiol<br />

stndmm6 my qult, agnts pdon!\ 6r1$lc sgim Cd..rcdide @oory syndotu)<br />

.nd rwoddid infuction

---

I i! | lynploh wplq @odri'g of !.!ric ptoxridnd c]t6r pdn mitile Aon<br />

t4ior ildari. 0r! Fudolly Alb tun of i"tuirs iedm Mo|t 066 n i!<br />

Faidadcd by erid .d rdi6ld by r!d. Udslrils rdr ?iodic prh 6c i!<br />

@j..d @.drry .lh..$dqo.i+ mb.6md.ridic .rrylm it . ,qu...iig o pt€le<br />

like, rdrfitcnrl d slightly to th. kn, $.t .tDdr quic*ly dui.8 darid Dd drt<br />

ndid. ir . !.t pdtem rd &bsidc vitl G!r. s.wny pg6t of rh. p.!.itr he d41rc-<br />

cadio8n?hic .bnomdni.s rA6 nnd oi.(!ir., @ining 36% h|vc mmd ueirss or<br />

m{i.gloric rhMEbi.i

---

SoG tirc ir rrrdr@ k 6[.d Dcirfr..rid .ngio. ltiqn did. oonry<br />

srtd.on. Ef4 lo I sFdrc@ iil.nn dial. bawn dEiM p-rdi! ..d idt oyo@di.l<br />

infmnon H€re tlE laliat dev€lopr tc$r.nt.pisd6 ofegjn4 dmion ofdisonfon<br />

is ircracd md rlin omrr a! r6t.<br />

I s Myoordi.l btudior<br />

ll ir tlE drntopni.. &cq6tly ird fom of itldic han dier. ih.l urdly<br />

t@|r. Aom pqrpit$ 'rd*rion or eEi of !igni6@t porti@ of rl8 @rcM.y 0oe.<br />

Onc of th. t*o Ftr@ of nrlddi.l iehsnic l|€@* my rppd (!) r oinudt bft<br />

v€ntricult l6ion (!) nrti-foel rd of ishdic rcmsi' h both fom w€r€<br />

alheroi.hrctic Mosing pos.ibly Blocided with tlrcmbotic o@ulrlrioi, is slrnost<br />

alwy! pG.nl in one or mrc @jor rndid trlr}!<br />

t ir obviou th.r O* lhc .lBic Dlilm e .lo.dy id6 ..l.r€d. wlulwq<br />

dE fom of ItlD, rh@ is .l@sr dE r tdv.E nhdosrmii!.fcding me ilrn @<br />

of rh. @jor .rtadit'l mu.y t lntd [5].

---

.6 R,EVIEW OF LIITIIATURE<br />

Ar .xuimiion of lipid prof!. in 500 n le ed f€rle of 40-50 y@r rge<br />

tuMvors of my@ardid infarction w.rc .ompared wirh tho€ of 950 @itrols!<br />

ddonstdtcd 3CFlo hyldliid@i. Such 6ndio$ wde como.ly rc@rdcd in malo unde<br />

40 ycds of .g€ &d in f€nule undcr t0 ys ofsg. Elucidding hypcrtrigly@riddi.,<br />

@y bc a d ind.podst dsk fraff for coroEry dhao!.I.@sis jus B htter-<br />

Sinib.lyl43 p.dars eitl E{D wd. iNr$is@d by Grwis d.l. l9?4) [3] for<br />

lipid ad lipopret€in tbrcrnsliii6 rlon8 wirh @d.ol $bjd! ir cltdi.d Prholosy<br />

Dep.rtmdt, Portg{'ute Medical Sch@|. London HyTdlipid.mi! wB obcord it<br />

55% of ptidr! sd ?l% pati€lts wd. l.!s $d 40 y8 of age. Rai&d f.iglyqids<br />

ed .holdl.ol €o@t6tion in vsy low dcnsity lipopror€inr (WDL) rcrc the most<br />

frequ4l abrcmrlitiB follosrd by siscd clFl.ltqol @nr.nr of low dc$ily lipopbl€in<br />

(LDL). In,oung plrids HDL l.!rl! *@ ebmnrd s 6mp!.€d ro coitrct &bjdrs.<br />

IHD p.liats ard mrd $!jdt6 (id. url fqML) of.g. Brcup 35-70 wcc<br />

Mi.cd for total ..lblei.dol ud riglyqidG by (Bll)ffi d.l. t974 t9l od<br />

sigriftrt ditrd.lB v@ obstud in 3.ruh totst cholcs@t h r.tidt3 and onlrcl<br />

NbJeB depr in l@ale group of 3544 y4 of age phile s@n tdglyc€ridB $@<br />

lignificMdy .lmted in IHD pdiqi! ofsllage g.oups Th€ dthoB.orclud.d thar both<br />

told chol.stqol and riglrEride &. dd( hdor for IHD, ird€podal of!&h olh€r.<br />

Ih. r.hrionsnip br{w. fseiing da$ tot l cholcsr@l. ristr€ide<br />

@l6imio4 f.equcncr ed cdtuivdB of IHD * sudi€d. Chol6r@l snil<br />

tdgly6id. en@ nlios lrft hjgh.r in th. Brqp wnn IHD nr a% ebjc(i3 cEluar.d<br />

to. ch*1pAin d ln. Methodist Hqpitsl, H@cot! Tqrs wirtin .@ !9. 55 yaB IE<br />

uho' (Gotto l9??) ltol @.cluded ion rhi study rh't rhe @ of .rlit.ary @t otr<br />

valu$ to dcline hyTslipiddi. or hlp.rlipopror.irenia my be nirlading dd !uss61€d<br />

thd the DhFicim my 6nd it of g.eal.r vslod ro consi&r rhe r.turl tlalma lipid jd€h in<br />

the @ia.mqt of patiais of IllD

---

Th. !ffiity of @rcn.ry ath.rcsl€@t h inwrsely iifludc€d by th. plsma<br />

HDL cholest@l 6 disphyed in th. p!ti.nt! und€rgoing @6n&y egiogiiphy. Ir ss<br />

how.rcr r.ported Fon studie @ied our in 4l paridts hrving av€rq. sgc 3+61 ys<br />

(2E mm md 13 wm@) by (Jdldru d.l. 1978) [ll] at diagrostic uit in Alfeftd<br />

tl6pi$1, Mdbome Vi.tdi& AuriElia, thi n s indepaddt ofth€ efLct of!g. ed<br />

P6fu' d al (1e79) [l]l obw.d .Nirqn dd dgri6..tl ..,LrioBhiD bctw.c.<br />

rDL clDldtfrl dd rriSltuida i! rll pad.na oflrD tu€ing 3c70 tta of.gc gMp3<br />

.t ,ohB HopkiDs Hospitrl, B.lrimr.. Low lolL ofItDL choLdml l@ obenrd ro<br />

b€ asci.Ld witn bft min oren ry diBq Pltiats qtt triplc v.sel.nd Lft mii<br />

coronrry dise h.d lo*r l*k of tlDL chol*t€rol th.n did pridrr wirh rripl. vdd<br />

dteae withont l€lt @i! doiary dis..!.. Th. ffndinA olrhis srudy sgg.!r.d thNt low<br />

laclr of HDL choledsol s@ inponml risk Ado6 fo. the d*.lopmor of<br />

.0Eosclmstu ud .h.y @y bG @ftj for idadtins p.rient! d high rilk of cdt in<br />

d@ic plnf,s of (cAD).<br />

Thc b.tc@r HDL chd.nml rd ([lD) iddaE 6 inv6tig.l.

---

lHD, hrT.rt miot\ dialcl6 ncllitu! Dd r.llrirc w.igl lw oroidered lo @un fo.<br />

the relarjonslljp b.twa agiognphjcdly d.dn d CAD.nd sm. of the t oM rist<br />

6ctm wirh sp@i6c .rrdlion ro lipid fr!.lioro to .riluare th. Blue tr predicting $e<br />

Sig'jfi@l ditrdoG in rist fccloB b.rw6 d.l.s .nd fsnalB wd€ obwed<br />

LDL chol€srerol and age wcrc sld€d by mulri@iar€ anrlysk in n€n *ine the nlio of<br />

HDUtolal chol€sl€rol, rchiiv. w.ignq fmily hitory, age ed smoting w. el€€1.d in<br />

wono ln &nal6, the b6r on€lstion wss fi. Btio oftiDutotrl cholcat@l and was<br />

fou.d signinddy b.nd rhd HDL chol4Lrol ln nrls th€ LDL cholestml, lot'l<br />

cnoblrrol dd the atio oflDutotil cholcei.ol wd. signiffut on uhivedate ar.lysis,<br />

This indi€l€d thd rg€ ed q e sch po*Grntl dsk facrds tlEr thee Mbout rhe<br />

Snoking sho*d lignifot.tr61on yolrg.r ag. grdp ud dst of BID B<br />

higha ir this lge 8rcup ii fetul6 How.6 rlE polilive fmily hisrory in younad .9.<br />

gup E no.g wiablc of any oE t of [&rioslmtic han diw The pario$<br />

witl posiliv. hmily hi5lory l@ tlun8d ir lgc !d hrd hjgh6 tor.l cnol6tml l*ls<br />

ud lovq r.rios ofrlDubtal chol.sqol. ft. hypaaion wa tgrifditb 6dat d<br />

ed fdnd to b. d irgonal dlk f..lor for d.vdopMt .rd Foamsis of IHD<br />

A @bp&atirc sudy of lipid ld€h *a Mi€d @r by (Kcs.cloot 6 al. 1982) [18]<br />

in r61m populatiotu ofB.lgiun (F3208). *lh popuhion (n=1279) ofKoE<br />

win r.spar to their life styl€ sd di.t.ry h&il3 to D'wl€ne of IllD, dflondr.red<br />

stu cholendol vrlu€i @k€dly lowd in Ko@ popdrrion thm the B€lsjd in both<br />

oal€ ed fsMle tubj.€ls ed rhi! wls @iclusivcly .trribur.d to E low consuption of<br />

gtu{red &l by the Kor€d popul.rion A dan population smn cholesftlvdue of<br />

about 160 n9dlas io Kor€d.pparcd to b! conp.libl. wirn d.ellent gendd holrh dd<br />

wirh rh€ ai€ne of[lD or oih.r alh.romtous dis&' tlDL4 ulud w@lowh<br />

Kor€s th{ B.lgie pi.ticulely in f.n.i.s tIDLC to lotrl chol6rsol 6rio wa hrder<br />

in an €e<br />

gtuups ir m.l. ebj.d3 in Kor6 th!tr Bclsiun.<br />

The infu€oe ofdid o. liDid lcvck I mdt.dlv .ot€d h boib rhe @ulri4<br />

b@ue ofnar@ dd 6nsritu..6 of did \{@ diffoor For inslee Ue Kol@ dici

---

a odor.l rd vqy low in frt .id do n oitdnnd ont loa of {t rolrt qtdi.<br />

i,r.lc. &d tC, ofrh.r ir potlErn! .d bt 09-201. B!dd, .t€. ltd trst be|e<br />

.nnrbb o"ly r.cqtt ntd w u.d ir r!.y rndl qu||iili6. Tlr djd prcr.rr !dl@<br />

|E oyto.tab.nd 6d. Thc Bdgi6 poFi.rid q* Liolt *.n.rn dia vitii tr<br />

&4lltiig 4On of d|. tord oldi. i rt |In ooirliiig rbour tro tM !$nr.d fn.<br />

ThG Ko{4 .lit ir r@dd to t hdvily ldt d lttd M e hary dSrar<br />

rn&a! .l l..d to rlE !.m adan .. !r Bdgi.n! hn Kol! n e!'iar E Er mtd<br />

t2ll. Nd dE chr8.d ditr.ry hd'it tr tltc Kor..n.nd BdSio h.r dbm 0E wlcd<br />

difi.rsrc6 ir ddr [9kl proflc!. For i'!r!E Bdlis h.w d@!.d oiMFioi of<br />

stu r!.d tut, &id! ud hrE insr.rcd tlE coollq&d of polfut tunrld tu, th.a<br />

cltDgc in Adsh Dbjd! |||r bM|gh ddqe i! cnobd@l bvd ty . t|E of 16<br />

ig/dl duins p.!. dad.. Colgnidt lbrt lity d!. to IHD ht ba rCdt.d<br />

drnif q.|t dda!.d t22"231.<br />

,l9.ti€. p.rrolB liviB in Cdiftmi!.nd srmi hs dFl.raol lcvdr ofrDod<br />

50 ng/dl !d 40 nrg/dl Itighd n p.dhdy rhd rtloe livi"g in r!po\ dphadri"g il*<br />

inFrllGof di.i BI d.rmi n ofUF eu cholarid lcvd ii o.iaLl Doprl.lion.<br />

sinihrt dr cmDG.Iiw tudy of tu ud tyDc or it corurtr|.d i! nt iDriB rd in<br />

Kor!., lhowd tld IHD i! mE gtelqd in rt PltiliptiB l||& ir KoE doc to<br />

elt .d tu @t|sFion tqn cooNt oil .rd pig. Ho*6r. co!|tF niw lipid<br />

dis.ihlioi in d* Philippincs ud Koiu pogrLlion E ergSla.d to bc ('amiEd<br />

l1Al.<br />

It r cto.r-r.cliotrd tdp of5?2 $tnFontlic dr ow rF$a4 !ds!.d fo.<br />

i* of lHD B tnd ft( *dl .d$lirhcd iivar. id.riod olHDL.fll rL d* ofEtD<br />

wina.g.20-6i, y..r! tlfrFdto U.S- Atfrtr Scnd of^6r{..c Mcddtr,Isrr.,<br />

U.5.,{. Uln d d. (l9El) I25l ot crv.d td ndo ofbtd crtoLd@l,4lDl tr$Fid<br />

pftdi.ror of IHD *t6 @nD.rd eidt d|. Lvd of d$d told cloL.laol o. HDL<br />

ctFL..@l dm. Tlr. d..dirai6 of HDL cnokdcd Lirl ldp. ro i.lonit 0be<br />

nynptonEiic Fbir .l d* of h.vios staio!.raidr |nd arbl6 d|c clinidir lo<br />

d.i8tr rdq irc !|g!G lh! n y l!&cc d|c dlt or idqniry dD!. p.dsnr sio aodd<br />

onddgo tunl|e. .v.lu.don $dr .! qqdlc rol.r|nct lcl'

---

a satdy on apolipopretcin A-l ud apolipopor.ir ,B in rh. d6m lw.ls of<br />

hul@ arhdoscldotic i. G4d Horpild, Voie, lr.ly @.si.d @r by (Arig&o et<br />

al. 1978) [2] on m.lc IHD pad.nrs with . nd agc 5r.6 y6s In $ch snrdid 65<br />

patiars *qe swivors ofnyoc.rdid i.fr.clion ard 15 w€.. of egim pdtoris against 65<br />

@nrol subjeb. lt B obercd rhat th. .polipoprorcin B lcv.h e hjSlE ed apo A- I<br />

ld€ls e lows in athdolclc@iic rhan ir control€vd rh. plalm lipid leels ofpatisns<br />

w.rc nomal 4 hoB .oiclud.d thir protein cont€nt of lipopror€in sered b€ri€r<br />

predjcto. in arhrosldolic patiois thd the plllm lipid level.<br />

raser er .l (1980) f6l conduct d a .ompmtiv€ dudy on 29 paidts of Mr<br />

nyesdial infarclion and 79 @nrrol sbj@ts of.O44 y@s of.ge ro deimine levds of<br />

apoliFoEin A-l in r.la!io. io h! rid( flclor i. snoking. HDL chol.srml md<br />

apolipoprotein A-l l€r€ls *d. obs.d lowr in rhc p.nd! ths in lhc @drol s.oup<br />

Alo A-l ladt w. .ls da@ircd lowr in 3mot6 ll|u ir nonMok6. Th€ etlDr<br />

$gg6t d $.t loB l€vels of.po A-l d {cll u HDL clDl6t6ol re iddition l<br />

chdctdisriB ofih. bLtcton plridls dd wh6 rlE 6rablih.d risk f..roB i . smoling<br />

rnd hyFlipi&mi. @ r.t6 i.ro aeounr.<br />

Alolpopoteis a . befid disrininltn in ny('wdi.l JBircE we reFrre

---

in f€mal6 ed rpolipoprot.in A-l .nd liDL cholenml ld€k w€ h,iSh€r in fqd€r s<br />

@mpaftd lo nal6 Alolpopror.in A-l ad HDL ctol6tsol w* l()w in mkd a<br />

6npd.d to .@mk 6 lNd cF A-l wa !.oirivdy ordat€d viin stlrolic ard<br />

di.nolic bl@d pl€$rc. ft w cmbdcd thlr +otpogror.ir A-l @y b. a b.ttd<br />

disiniidor b€t'g dh@slmric $bj..r5 ud @.t ol5 tho tDL clDldfrl.<br />

IE indiqrivc pce.t B for CAD (Apo A-l dd aro B) {* sggdr.d to b.<br />

mte lal@}le tlDn 3qu lipi& for tlE ctrlu.tion of {rn@e.ld6is. A 3nrdy E<br />

qi.d oui in thj! r6p61by (Fruqld ci .1. 1982) [28] ii c&diolosio H$lld Lille,<br />

Fl@., by investigarins 2?3 p.ticrtr (en ud wohd) hlving !g€ 43-54 te6 who<br />

u.dffd corcorry &aiognpty od obldcd rh.t lhc lq.ls of .po Al wre lowq and<br />

apo B wd. nighq in palicnts a! contar.d to contrcl $bj@is dd @ncluded thlt<br />

deteminalioo of apo A-l Dd .po B md th.ir ntio q€ valuaue in trlsing tn. ntk of<br />

IHD.<br />

M&iejko et al. (1983) [29] condud.d a sldy on 108 nule $bj.d! unddgoir8<br />

di.gnod. dondy &giognpny for chcJ prb or os!.

---

chol$ierol, cig&€ne soting md blmd pssure to $e IllD, md ir M found ro b.<br />

high*t mong lne low €@iodic clsg Ch.imd ofth€ Oslo Hern Study r.pon.d<br />

th.t mo'bidiry dle lo nyowdid infrciioa (Mr) ..d rotal ddrov.$lu incid.ft6<br />

dd.ri.d with lowEcd bl@d lipid leh lrd e*!.don of sokn|g.<br />

Tl'. liDid tercn djni6 d il€d 3806 h8ing age 35-59 y@s vnh inilid ld.l of<br />

plalm chol6t6ol of 265 ng/dl ad LDL clolqrftl 190 ng/dl or gr.lrq in $. rtudy<br />

sft l6rcd 06 lO y@ of p.nod The plrlicipd$ we adnlMe.d cl'olst@l<br />

lowaing dtugs. IE Lipid Re@h CliniB Corciaty Prior.y Prqeftion Tdd (LRC-<br />

CPPT) sllts gave 6Bist nr pictur€ ofthc rcldio.dlp ofrhe IHD imidde to cheg*<br />

in chol€$dol ld€ls The lipid r*rch clinica or @rorary prinury pB.ntion trill<br />

relulrs showed thlr nlucing lotal chol.stdol by lo*d.8 LDL cholestdol .m dininish<br />

the iicidoe of IHD norbidity md nondity in mfl at high rist be@s of ni*d LDL<br />

cholBtml lw.ls Th€e clinicd tri.l provid.d strong did.rce for a cNrd role of th*<br />

lipide in lhe p.thog€Gis oflriD [] I l<br />

Plis@ levds of tord chol6r@la.d LDL clFl6lqol @ @rcL..d wirh rh.<br />

pcv.l.@ ofIHD 01. tId ldch ofLDL pr€dipoe ro pdnatle IrD [2] but 'nrl'y<br />

p.li6r! with IIID do @t h.E .lmr.d LDL o. otiq dded.ble a!rcmDiiri6 in<br />

lipoprotcin lipid ldel [33-]41. Tlris tr.r ha iNpircd rol@l for otlB a!tunndjn.s io<br />

pl4m lipoprctein tl'ar mighl dphin .cel.ftr.d .rhftelftsis ir $ne indMduth. The<br />

@ncoidlaon ofLDL apo B ha ben rcpon.d ro diflqotiaL EID palimt ftom nomd,<br />

bet€r rha bral cnohsrml, triSlyclnde or LDL chol6r€rol The study M th.cfoE<br />

@ied o on 282 nal. subj61! of.g€ 26-58 ycas el€cled Aon Medic.l Centr. Della!,<br />

T€xa in the p!tid1! of IHD ro ddmin @.@tatrou ot LDL .po B i.<br />

no@lipid€njcs dd lt!.dipidmics ro.xmin th. posbility of apo B of LDL to<br />

u.6vd 3 meiabolic d€f6r in IHD prd6t3 qnich .mot be dd6r€! by LDL<br />

dea$r@Enr alore. h q4 rcpod.d by fi. hoB (v.gt aid Gtuidy 1984) [32] rhlt<br />

ldcb of LDL alDlipoprcr.in B (Apo B) we $Fior pr.didr ot n* in<br />

hrpdr.iglqidmic pdi.rll3 a @mp6rcd ro m@lipid@nc II|D patlons [32].<br />

Rdd@ et al (1985) [35] $ss6tcd noi thc snrdy d.bded oi 6s md ed 42<br />

smd who udftnt ob ry .rtcrioglphy for ssp*t€d oroD,ry dtw w@<br />

11

---

Mined for relarionship b€t*m plsd lipoprot€ins &d wdity of [lD h no the<br />

turc for st6ity of lrh@slddis w ilron8 rcllt d to the LDL cnobstdol ud<br />

eolipopmtenr -B @r@ trlios ..d h gmq it ws Elat€d to rhe tiglysid.<br />

@'@!irjG in dafu i.!dn€di!& d.d6ity lipoprercir (!DL). T1|il study indicrl.d<br />

tnc impon.@ of i.iglydids dch lipoprol.itu .g WDL and n5 ttl|lMt i. th.<br />

d*loprun of @rcMy lri|roslruir in woftn.<br />

Tn Niaiion b.tr@ ch.lgtdol a.d mn lity in 10059 Ituli md. civil<br />

w&ts .ged 40 tss and .bove rcvsl€d rhar 3Tlo .L.th we duc to ItlD h .<br />

nulriEiabl. o.ltsis s low @n€nt6tio. of llDL cholestercl qB morc pEdictiw of<br />

nonalily tbm a I'ign @ne.tnrion oflot.i cholsr€rol. Monality rat6 rose wfth tolal<br />

.holdr€rol conmtrdion abow 241 ngldl and HDL chole$€rol Ms invsely assialed<br />

with total monality. Il ws @rcluded Eon thc dna of l5 yds folow up of l$neli heln<br />

di*e study by (GoE aoun .r d l98s) [36] $d $as.ded thar HDL clnl.ltqol is s<br />

key wjalle, and proid€d r tunhd ilrdionon fi.r unqudin€d '@mdd.don for na<br />

di.lrty.hang6 in rtDle population dy b. Fdrnlrc. IIB 'r

---

m€n fr.e of dis4e io d.tmire th€ slocirrion bdwn cl€valed l€veh of irtmeditre<br />

ddfty lipopmr€in (IDL) ed IHD al DcpamEn of Mcdid,r., Univeiry of Totuto,<br />

L.rch ofIDL, apo B, dglyqidd, \4-DL niglyccdde ofrh. tariors sith ItiD<br />

*ee grqte ard HDL cholcrsot ws Mginaly towtl rlBn tho* tubjKs wirhout<br />

dis.d. Sn@ldlg qs notcd to bc Milt d qiih d incr@ in ilE ladr of pt.s<br />

melyqidc €sp&illy WDL tdgly6id6\ IDL rrigly.did. dd IDL .po B It hs b*.<br />

ponulated th.r moking may qeft pan ofir! afi.@g.ric efei by producing hcq!.d<br />

l€ids ofvLDLl€l|jMr! St ind.i at. (1987)1391 r@oned thar rhc .s@i.rid of rDL<br />

wilh d@noned CAD my be inponer in @Nidhrior of th. rehrion hip of<br />

ltTedndyedddir to trh.rcsl€rosi9 Sine th€ tujodty ofiriglr@ddc dch lipopror.i.<br />

de lbund in the IDL &aclid\ ihcs findirys @y b. inpoidl i. udelleding ih.<br />

rcI. of riglyqide dch lipoprckiB in |lhtuA@is<br />

A 20 y6 folop up otthe Donolo - T€t Aviv prc5p.c,riE CAD dudy ffii.d @t<br />

ro obsd€ rel.tiondip ofrotal chol€$ed dd HDL chol.lrqol wjih th€ @if6tadon ol<br />

IHD by h.ering @h br,l chol6l@t Md ltDL chot.lrtul in 29t5 ot ns (1454<br />

ne. &d l43l won .) ag.d 35-64 y4. Tt€ 'rd sn tor.l choldqol at nrry<br />

eJ

---

tn 0E Bnd$ r€gioral h6n study of ?735 n n ag.d 40-59 y€sr s.tecred al<br />

Endon non go.rsl p@iic in 24 tow i. E glld W.l6 ad Scothd *4<br />

e@in.d to slqs rhe rol. of smn @b@r6lion of rool clblentrol. HDL &d<br />

rrislyqid€s h pr.dicling djor IrD. Th. dnoB (Po@k d.t. l9s9) [41] @trctuded<br />

rh.r hn clbLndol @ndrBtion b $e nDn ustut singt. tirid 'r@tmt in<br />

iddliS,ing patidis ar hieh dsk of IIiD The inver!. srociation ofrDl choldleiol<br />

@lml.arion wirh rist of[tD B confrrEd but oft.lg prldicdE vdu.. hov€ver<br />

@h tnglycqid.r w€r€ foud nor ro bc ..tevmr 10 tn. p,rdiclion of IHD in m.t.<br />

tlgh lotd clDl6terol is d irlon&r ad allo o&Uc,tuk frdor for IltD in<br />

young md middl. .g€d adutt3 bur iB inponec s r risk fador for tHD in ih€ eld.,tv is<br />

uieftrii For iNr4e (crrbd ei !r. t98e) !t4l corctuded rh.r roiat chol.lrqol ld.l<br />

dc not @ffis.nv pr.di.r IHD dsr in .lddt na\ hoBtr ornq i^qt8.roB h.G<br />

found fi.t hjgh blood chol.lrftl rmains a signifiqir risk facror for IHD in eldeny<br />

patiot3. T*o r.qr polic, rcpom havc hn op€n rh. ponibiti,ly $ar dicr!,y iratrHl of<br />

high blood chol€sr.rcl @y b. nehfij agl in old age [4t-46].<br />

rm y€d follow up riudy @nducr.d in the @hdn of2146 wbite nen.aed 60_?9<br />

'qa who had e s.r r.!on d hjsrdy of rHD ,r t(riq p6tue.1c utD srudy in<br />

C.lifohi. in ordcr b ryirc rhe .sdsriotu b.rrq tout chotGrml t*ls and<br />

nodaliry Aom IHD in €ldcdy tule popltado.. Rubi, €r .r (1990) [4]l @ictude

---

sss.sr.d by (BroM 1990) [4?] M.ny rd.tq d disd! w.r. csi.d out to<br />

undmwd 1h€ ctr d of clDl6t6ot on @rcn ry wsts and rbele studiB dDw€d th.l<br />

di.B Itd in chol.3l6ol rld !.tud.d frr prod@ high twd! ofclbLdaol in rhe blood<br />

md hi8n blood cholqtqol b nasry for rh. d.v.lopmat of dh.ros.t@sis.<br />

Convdrcly, wh.n didary chol6r@l w r.duc.d in qlEimdbl eiEd! nol ont nd<br />

.rnft*.I@tic l6ioN A b ltpd but distilg ledom *@ 3.sr ro r€gB {4S1.<br />

In d eady s!tu€y of IIID in wen @drie3 includins U.S.A srDwcd snh rowq<br />

b&* lift clor.ddr rcvcl td loB 116 ortHD [49] 3initdy th. Fminshn 3tudy<br />

&moNllrt d . wqd fold inc@!.d dlk fo. lItD eong indivi.tud, wilh mh<br />

chol.$qol > 310 ns/dl conp&ed to rho* wih chotessol vatu.! < t9o h8/dt 1501<br />

Ac.oding to thc Poling !roj..r R6ar.n coup r.901ts '@ *irt sry clbt.s.rcl<br />

l€@L > l,O rB/dl had a signif@rrly ircrc.$d nek oflttD and l@ wirh cnohb.ol<br />

l€vel > 268 ng/dlhad. doubl. ds& ofCAD @!Dar.d to thoe wilh l6ds of< 2ls ne/dl<br />

[51]<br />

Th€ Multiple Rist F&tor I ervcntion Tnal (MRFIT) produced ba!.line ed 6<br />

y6 nodality drr. on nor. th.n 325,ooo wnftc Nh3 se!.d for,bdy Drnjcip.lion.<br />

Ma win histalr s.M .hot6r@t tdd dnwcd s idas iD tuk tur IIiD @rr.tity<br />

mgiog fton morc iha 8 riD* grqrd in the young.n ag. group ro 2_4 in€s 8@ts in<br />

55-57 te old grdp Th. M&tity om tG 3hrply h th. n dt. {g.d go4a wirh<br />

tu r.rcl >220 mydt [52].<br />

In the !!6rly publhhcd Lipid Lca.eh Clini., t6d.na Sfrrdy, 2541 M agcd<br />

,1c69 w@ fouoqd for td y6B lo d.lmie rlF .sqi.rion b

---

FsoN Ih@ crc tlfe w€ll l@gnia4 nodifiau. tuk f.dol' for CAD prc!€l€@.<br />

High blood l€vcl of bral .hold€rct or its surcgar€, LDl.chot*terct, high blood<br />

F6$E .'d ciga.tl. @ti.g.<br />

Both qpdimotsl od clilicrt c@h $udis Ngg.n.d . fo{rth poteitidly<br />

rcdiilbl. ris& f!.Nor i.€ low lael ofrDl{holeltdol in e bloo

---

cnobtqol a risk L.tor for lIlD ..d @nctuded sig'inmtly betr.r indiGtor rh.. bral<br />

cholestdol berw.o paii.nts win singlc double dd ripl. orcn.ry rrdy disle Md<br />

To d.hire th€ pFv.iqe of dydipiddi.r in th. pt€s.@ of @qistdr IID<br />

md total chol.sr@l < 200 mg/O, . ret.osperiw csc @nrrol srudy of rOOO paiieots<br />

(hq 6d woha hcsng !s. 26-77 tlc who uf,da w@i dilgmsric @rcMry<br />

egognphy B pqfoo.d Of355| plria s wfth rol|t.lDt.l,.et2& ftgtdL, jgr ot<br />

th€ md 6d 44% offic womd had dgiogrplliicaly dmistat€d IIiD,<br />

Multipl. logislic r.grBsion o.lys @€ated th HDL cholcddol, hlDct$io.<br />

&d ig€ in @ and VLDL in 9@a ll* sig'ifiurty aisi.l.{t wirh IHD. |i6<br />

adj8tnfl of oths tuk fl.ton rr hrs ban sss.5l.d by (rdxd a it. t99o) [62] for<br />

@mpler€ d.tmirution oftipid dd lipoprctei, .,.lrsis iD pari@rs wirh lIiD in co tur<br />

to tle suidclirg r@nllMd.d br (N C.E p) $ar dE hish rora] .hol6r@l &d low HDL<br />

chol6tml .lsiat€d with indasd rist of tflD e &linbta to b. ch..red for ..dudion<br />

IIDL cholsldol hs bd onlid.rcd s ed!$6ogdic lipoprordn @nr.inins<br />

rwo Nrtirl lpoprc! tu A-t dd A-2. AFtipoprctcin A_l wa @Bidd.d bv em<br />

authos ro be . rajor di$rinin.ie fador in IrrD p.ridr [64]. Thj! study ws @nducted<br />

in 43 nal. Fridil ofSl y6 of lgc unddgoing @rcnd, brls sra.ry ed 54<br />

@ntrcl n lc srbje.s of46 rE of$. 1o ass th. ddJle of |po A_l .rd the<br />

disininat. poE of th$. apopror.iro with rtm of oths lipid sld lipoprot.ii. ,IlE<br />

con@tdiioN of apo A-l ii the by p!.r paliots wcre signfistty lowd (ll3 mg/dt)<br />

rhe rhos in $c mrrct(145 6s/d) Bu.d dat O99o) t6lj octudcd $at rh. dtu<br />

h apolrpopror€in A.l obed€d in 6rcd.y by pN psti€ors shosEd th. b.sr di$imindt<br />

pow fo' subj..ts wnh .dvMed sthqom.<br />

lX. hypcrclbLs@ldir sirh or wi$on Miarcd hr"dt igt6id@i. ws rlE<br />

@mon ab.om,liry i! rh€ r.tdrs oftHD,6 r.!on.d by (s*d.re €t.t.19t) [6t<br />

ftom ln€ cohprative ltudy of tipid profit. in nomd and ervivors of ny$ddial<br />

inf.tctioi iD lndi& imigreB of Souti AAi@ The urhos prdi.eld 4l% &ryivos<br />

rc hrT.dipidhic, 20.2 p.ricrrs drolld tryps.not6t.rotdi! *irholr Nci.rion wnh<br />

17

---

hyp.nriglyqid@ja ed 12% h.d borh *ltil. 14% 3ho*d hypdniglycdid@i. withdt<br />

.!,3ocirtion eilh hyprchol€.tcrclmi. dnoting lhe.omon fnding mng ih6c Indie<br />

imnigretl of Sodh AAi@ ed wfiur.d for Seneir. inv€stigtrion of<br />

ht?dtdglysidema n Lhis population group.<br />

I1l. 19? p.ria|ts @oprting rtudy grcut 9@ ebdiide

---

vith nr@rdi.l in6.cdon [70,7l].<br />

Inithl clinical ad .?iddiologi. srudi6 bctw6 pLs rot.l clDlbtul ed IHD<br />

risk nave bd f@$sd on rh. .th@86crty of tn. @na nlion of cnoEstdol in tte<br />

bw de6ny tpoprot€in (LDL) Dd d@rc!&d chol6r.rol in high dqsity lipoFoteit<br />

(HDL) hav€ bd .sci.lcd qirh IHD dsk [7]1. Upopror.in @nposiiion ed<br />

netabolim in relation to l}ID. Cotuem is fodssd on ihe prctein @npondrs of<br />

lpopiorciro knoM a! .polipoproteiN or lpopotciN s sek6 oflHD [?4]. Howd€r<br />

$cn dudi6 have ben confn€d nainly ro the adult populalioi, ierennebs i, a bitui.l<br />

(Black ed whit€) populrion of cbildro $ p.rt of Bogdus Han Study dmin€d {d<br />

confmed thal the p.rhologic ptdBor ofl H.D orign.tc in childhood Wtite cbildren<br />

Ooys) showed lo*d @neitrrio. or.ro A-l ud 6tios of cholqr@l io apo B qithin<br />

LDL cholBlqol rhs did bl&t .hildr€r md bl&k gi.b hav€ lowd A9o A-l wtile gils<br />

ol borh n6 h.ve highq con6r6rion of lpo B thd bots<br />

ft wa obsd in rh. sr@ing t.d for dadirg i.qa!.d LDL chole.cml, apo<br />

B is sgeior to total cholccdol. t w nj@ for.po A-l @Mtr.rioA fieapo Al 10<br />

aFB ntio, ed LDL choldcbl to .poB 6tio in child@ F. slrcngly rdat d to<br />

pderft.l incidre of my@did i.flElion. It a @nclud€d by (Sdniven dd<br />

Belqra 1995) [72] rhat a . sl:l6ing 16r, !!o B L $psio. to rolal chol6terol in<br />

iddliting childro *nh iE@!.d LDL chol.sr@I. S@ing stit€iB risht h.<br />

enetded lo id€mit indindu.h with !dv@ .ro B $d alo Ar prcfr16 espeialt tho*<br />

non hjgn .isk f.nilis rith a hi$ory orpmtturc CAD.<br />

!r a nulli-innitudood study, Pdhobiologic.l Dct mireis of Arhqoel@ss it<br />

Youlh (PDAY), w. iiri.t€d to doahdt th€ n.turil history of arh@scldosis,<br />

rchtio8tip io risk factoB dd pathobioloSJ ofldion dd€loprcnt in anei6 ddns$6<br />

of 2000 young subjecls having a8c 15-34 y.rs dicd du. ro homicides, .aod€rfs or<br />

suicid.! Poltnorrw dlk faclor irclld.d erum lipoprorei., smd $io.}mt€<br />

Gnokins), sly.ohenoelobin (diah.teo, clEns* in sm.ll E..l arr.d.s (19!.rrdsion) od<br />

apoprorein iscfoos. Th. tufior sfons (19e5) I?t] '.poftd fron rhe study tnat the<br />

devdopftot of athm*l.@sis at m dly.g€ showd $e r€@Snized risk factoB fo. IIID<br />

Miated pirh l6ion d*looncnr in rh. rneri8.<br />

19

---

CHAPTER TWO<br />

ATH€ROSCL€ROsI5

---

2I DETINUION AN'D EIIOITOGY<br />

CHAPTER TWO<br />

ATHEROSCLEROSIS<br />

Th. a1h€rcEcl.@sie is detuEd I r widcly p@sloi .nqial lsion cheacteiz.d by<br />

patctry thickding due to @muhrion oa arr ed lay6 of @I6gd IL fbcs, lr€st in<br />

sidct laryilg popul.tion.<br />

Alt@elddi3 is r lifi lo'a p.osi.r dEr hesis a.lr i. lif., thc L.$ny d@<br />

delay b.twn the snqn orsrl of alhcrcsl.otic pla{u. d@siiior in lh.orcndy &rdis<br />

dd 3udd.o o@rd@ of 6diov{ole irchdic €dr rEd. thi dise diffiolt 1o<br />

snrdy. B6&le q l.ra. proponioo oflh. populal'or wiin afecl.d rt66 hs no eaily<br />

d.tectabl. indiqtion ofiis pene. ln 1904, Mlchmd prcpoed thc tm lih@scldosis<br />

(Gr@k !rh6., m!sh) ro d6ieDl. rh. tw. of.ndio$ldosis cha..rdiz.d by eorynous<br />

lipid @nuldion in rhe i im[3|].<br />

AtlEoel@sis r gddic rh iiMr.d bt Lob6lcin in 1933, Ff6 ro a onbq<br />

of dif.dl morbid pr('{Es, atl of which prcdu@ tbrctajnS of lh. v.sl wall<br />

Infomttion dbout atb6$cle.oric orc@$ b d€riv€d fron four surs Clinical<br />

p.thological coneldioq €pidflioloeical studi6, qpdilMLl dinal models dd cellular<br />

p.thobiolosy Hisn concennlioi ofchol$t.olin the blood l€id to d@osilion h tne<br />

rnedrl *dl &d dalt'il devdolMl of d .thdosd@lc AlNquG. Th. potari.l for<br />

depoitioi i3 .ggnvat€d by ns tad€rcy for paire di!..ge b

---

6b|@ tissc Fole..don t7,].<br />

Hi!.oloric.l asiidid of {|. ilty lot rlFs kqlizcd $ic}6itB or it itu<br />

|gid.d wih nr ryF r lo Dc i'n !.dlubr. Tra d.gaF.liE lcioN Rrl!! iln $.<br />

|tlEsddoric rsdr e cn&.iaircd by .dmrdon of lipid, DdEit dDl.n@l bu<br />

pholptolipid! rnd ti!'taid6 r! ds F€sn h tl. "dL of atqicd @ltirs ir ltE<br />

n.|lwirE of n I d llse |n4hr t?8].<br />

hny rulr dE arli.d niaeopialb rlcorliz.d lcdoru & fdid A06<br />

chldhood ds.rdr. tu rh. cl'ild gNr! dE $nic .rci b..oE .@ $gdy .ftdcd.<br />

In d|. @ro ry |nay ir., d4{di!. tu9 tr6L! .ppd itr tltc $t!d. r dE dru of<br />

pltqty. Epiran olosicd .td maholoic.l !adi6 d ot66v.lid .r88pd lhr 3dE<br />

tuty nE t! disiding 4t b rc uddso r{rardon sltih cdE potrs lo ln|tur.<br />

.tltaBdftrb pltq!.. Th. Lrd .de ofcvqrt ocam in lta toF LIiN slE dcg!.<br />

of .(Doluft ro 'di( ndo6' fo( .dEoseEi!' id! || ItyFlipiddi.<br />

0tyFdFlcaad4i.), dSual. m*iq, hiC blood p|KF .d di.b..4 ldlifu' it<br />

gar t?el.<br />

21

---

2.2 ATEEROSCLETOSIS AND TEE Cf,OLESTEROL CONNECrION<br />

Elerd.d blood choldtdol .!|g athdom in rh. &.t ed @rcury an€ri$ in<br />

na.y qpedmoid spdi6 dd sp€.ific.lly ii im In gcnerrl high.r rhe onmtrations of<br />

.hol€sr.rol, grat€rth..n6tof arh.romrou3iovolv€mnt.<br />

A sand fac1, slongly suppon.d by epid.niological and expeiMtil $udi6,<br />

thl nigb di€t.ry iniale ofslunred r.t h ! l€.ding.tuse ofhjd blood chold€ol(dd of<br />

IHD) ad hflce rh€ pr@$ of athcroelordis would .l$ develop &udingly The id€t<br />

thal .thqoscle.osis night be a rd€sible Droc* @me fro6 autopsy s11ldi6 on pffins<br />

*ho ddured $arvdion durirA World Wa IL ln thc rrudics, se\@ly Binded drets u@<br />

ascided witt l6s ath.ro$l@tic diru. F on the alow ob*tuaion it we @rcluded<br />

that arheos.ldosis @hs fron intd..tion ofvsour ri* flcroB. By alt€riq rhe risk<br />

facton (6p€i'Iy lipid i'tala in did), 6. sdity ofltllms*sis @ be reduced [7sl.<br />

GeI@liad @icd oG hyT.dipi&hi. ed th. nsk of IHD s. Ns of ..dy<br />

d€rn is elrniEly tw d.vdotMr of rhc twnticth C..rury Althougn dh@el@ris<br />

w p'gn in E5tptid Mumi6 ad rhc $icrdn of dE nin.t@lh C..tuy.okd tne<br />

fatty d€posits of inirid p!.{uc i! @rci.ry enai6, .lhao$lnsis &d hat atta.k 94<br />

ncn dirgrcs.d .r d. tu of the 6rnry<br />

In 1908. lparowlti, i!rc3d91.d lhe €f*t. of dinr.l food on th. n€raloliq ed<br />

Ed nrdion of herlibms dn|l3 by fadinS dbbits witt food thar ee @l Ennnl ro<br />

thm sch a n€! milt dd .gg! Md for th. nrn drc $clsflly induc€d loe<br />

ath@$hr6is €xperinntaly thst r€embled rh. huM fom. I. l9t 0, WDdu (cied by<br />

BoM leel) [80] descnb.d th. p.c!.nc. ofcholdl€rol io fi€ l6iom of disded arldies.<br />

Mmy lubsquent studid hw. @nfimcd th.r tF dd esteridcd chol6i@l i@NLtes<br />

n the aon4 @ro.ary aneri* and @rcbol vdels.<br />

Stukr(q (lelGl2) dnd WBsclkj. (1913) dcoonsr'ar.d tblt only chol.lrqol<br />

@nt injng f@ds w* .th.os.nic Anilschkow od Chalatow (l9l3n4) produced<br />

hypalip'demia ed uhimat€ly thc tylicil l6jons of thc aona ud @ronary anqies by<br />

f€.ding Ebbits pur. cholcai.rol ii v.gctlbl. oil, thd.by povirg lhar cholerdol m in<br />

hcl rhe arh€rogsic @nstituol offi.F food!. The offir proctie ofmrui.g lipidr<br />

22

---

Dd lipopot.,B in ln. blood to obrain u$tu| infomlon ahout erdiov.slf tuk hd nt<br />

odgin in th6e dp6ilMts of 7s yds ago [82].<br />

Th. asecialid betw€o choldr.ol @r@ntr.tion in @m Dd sthq$clqolis if,<br />

hurlan ".r r€cogni,ld d { innqitcd @ndition in individulh lhtr involv.d xd$omtle<br />

hypdcholat€roledia prmlure CAD ud nrrc€rdid in6..iioB. hdit.bt, thc<br />

ob@tion of fanr gLqle..d th. id6ifc.ri6 of cnob*et 6!6 in rh.p d.polib in<br />

lh. @rcnry rnqis d@ anqrd@ ofth. ncdi..l prcfssd lo dE rdlrioNhip b.rwa<br />

di.bry far rd blood fipiil5 Ddriobt cholcn@l !d devdopf,Ei of dhd@ldotic<br />

phq!6 dd IHD inhu|r@ Supponing eid.@ c.e nom utopsy 3tudi.s ofc.ioi!ry<br />

.rtcric! @41€d . si9i6@n pditiv. concldon bet'd hish *tun crbksftl<br />

corc4tdtion ed the sedty of .thaosqldolir, qpqFd $ Fr@t g. of thc lurfe of<br />

coronary aneri€s .ovdrd *ith ni&d rlhoo$l@tic l$io6 [34-86]<br />

Sddd studi.s l$E snoMth progresion ofwde alhdosldonc bioos w*<br />

relddcd, prcvqt€d dd (or) r€v6!.d in rh. rt@r no'Ieys od thst h..li.s of ihe<br />

dnEg.d lnqid odo$dim &hievcd by $bs6dn bMig ofbloo

---

CHAPTER THREE<br />

BLOOD LIPIDS

---

CHAPTER THREE<br />

BLOOD LIPIDS<br />

ThG ldn tolal lipid! ci@laL in thc blood of hellhy/nof,Nl ubj.ct d 6oG lo00<br />

ng/dl ed dhribul€d in dif€r€'n fr.oriotu u. rcponed a ud€r<br />

3. Notud Co!@lniir oa litidr b nl@d<br />

15C250 ng/dl<br />

Bdow 120 ng/dl,<br />

5Gl50n8/d.<br />

Lipi& !ft a d inponltt ingrdion of the food p@idiIg tuiiM 6loti6<br />

per mla Thce we s rnnspon of frt $luble vitanin5! . p|n of PLm ddbraa<br />

and &,r5 s inNLtor i. ihe body. Ihe .x€t of lipi& is h,adou .nd haw bd rcponed<br />

r rbt hclor for IHD ed chol€lilhiai8 [90]<br />

3 t CEOLESTEROL<br />

Chol.3@l ir . Mhldric .tcohol s !rcdld<br />

cyclop. .nopdnydropha$dme @nd.ns.d nng 3ysi@ .td ir . naibd of8@p of<br />

@mpoun& qllcd st oids (* 6surc b.low).<br />

24<br />

of oidl ongh .d . daidiE of

---

Polar'<br />

head HO<br />

,uJn<br />

,ofu,<br />

,"L,,<br />

,,Ln"<br />

'oJn<br />

6"i<br />

rnDru<br />

Steroid<br />

nucleus<br />

"cH, AIkyl<br />

6ide<br />

chain<br />

ll onco 0@6 csrdified .i position thG pidi .lo.g cbin fltty acids which tuy b.<br />

etuEt.d or nnerurai.d a.d mmonly @maiB 16 ot I 8 erb@ aions<br />

lr is nostly tdsporEd in th. blood $ d ingrcdidl of lipid prctein @mpla<br />

CholBldol is nol us.d for .ndg), bll $rvG! $ r sttucru6l @mpond of all ce!<br />

m6bra.es. Ir is a pNursor ofbil. .cid5 .id lll thc aLoid hmon.s li foms est.6<br />

with fafiy acids for th€ir rrmlpon and d.tu insul.ring ef.d in lh. cmt8l n.ryous<br />

Acc.yl CoA (adiv.4sn.) b th. pdm.y sb3tae fot'.holdeol tiottn66is<br />

It is mli.ly syrlh6zed in thc liq, srEll i .lrirc !ki4 td@al .on \ owi.r! ondom<br />

ud l.$is e|c. Choletcrc! ir minlv qubolir.d by th.li€ dd qqd.d ii rh. bil. s bil.<br />

.cids Total son cbol6l6ol b dbtflbut.d dorg tlne clB€ in difr4.nt podr.ge<br />

conccntrarion ror ils hnsrorratio. wnhin thc body (Mumy el tl ( 1988) [92]

---

Mon lipoprct.in choLsr@l is in thc fom of cholcsrdy' linol4t md folftn in<br />

plald by th. !.tid of tlE er2)rft ldilhi! clDlgtdol &j-ttu5f.@ 0-cAD l*<br />

@md is cholgtay' oLdq vnicl i. tlE prcdud of fi. i .&dlul! ooym &9<br />

@e.4m. A !.rlttusf@ (ACAT) Cii!t.q, (194) Iel!.<br />

3.2 CEOLESTEROLMOBII,NZATION<br />

ThGrc is inh€ren individud vullility ir th. rcgulatioi of the pl|@ cnoLsldol<br />

@n@t.rtio! in rApotr to clugc! in dic$ry cholGtqol (Tllscll, l9t8 &d Mccill,<br />

l9?9) [94, 9s]. Hog.c 6t in ptudpl.s & ryplidue in mnnd h6rn $tj.ds, 6G<br />

80.2 of dlm chol6t6ol 6hd 6om adoSeru sl)l|@ r.8|'ds of di.r and dE r6t<br />

t deirtd fton dia.ry choleitul. wilFn sd Lindsy, (1e65) [%]. Comd etd Lia<br />

(1974) [9?], ob3ded thn.pprcnnar.ly 4cY' of choledml inriic was.brcrb.d ir ln.<br />

intlk ws bdwr I l0 od 1000 mg/dl. The abtuted chola&iol is initidly tmpo.led<br />

in chyloni@n u clDl6teryl 6rd. Ndqthds tne chol.n@I, tuinty i. orhd<br />

lipopdir5, 6pci.Iy in LDl-lipo!rcr.in ir Eporrcd rc bc ei!!.d *irh rlE<br />

dev.lopDd of tlh@el66is. rrg. incta$ in pbs cltold.rol duing clFl6r@l<br />

Hing n iinibit d du. to lihit€d opa.iry of ahs+lio4 th@gh dcr.rion of clDlecdol<br />

in bile, ad by tupF.ssiw etr€c,r of dici.ry cholBtdol o. hepalic cholcsrdol syntlEsis<br />

te3l<br />

Nonnd sd lt?mhol.lt6ol.ojc ctldcn dD*ed ! vei.blc rcspons by pblm<br />

cl'olGldol lo hid dier,ry cno|6r.rol Borh mmd ard I'ypcrchol6taolic chittrd<br />

qnibit.d low d.rol snneis b rrady rrtrc s ms.€d ry irdol b{hE , wtF rtev<br />

vq€ IGpl on hidr .lDlestdol di.r' Ir ws $gged.d rhd in .ddidon ro lihir€d aberprio4<br />

a€ed bek inhibition of synth6t, and pdlibly itlmed biliary qcrction play 6le in<br />

linidrg qasive in r€e h plarm chol€nfol [99].<br />

26<br />

ala<br />

'5/ q/ 2-.6't-

---

3J CLINIC'TL AT?ROACf, TO EIGE AIIOD CIOLESIDROL<br />

nE tm LyFlnol6.6l.nit ai! !c u..d ,yNnync!|, wirl hiSh<br />

@rn.dd of LDL dbl..r..ol. h ov.. .[ polutrions, LDL clFl.raol<br />

coicat!|tioB e hiSht corEud wirt robl clF|d@l coo..dndoitq drttd|8h in<br />

inditi(fud pni.dtr lhtu it rca i...*sily rruc. A duifcrti@ o ru cholBraol<br />

@@|tdioq b.!cd d Ndon l Chol.ddol Atu dotr PFs'|'|m (NCEP)<br />

L drown bdow:<br />

'souEdldoN<br />

*iiclt pre|l! ilE @NQoodi"8 v.h.., for od<br />

choL..@l l"DI- cholcd@l d[t dr6 rlc lan clEl..r6ol co.rocldion to tlE doE<br />

of brDddtoLsdolmn tlo0l.<br />

cf,oLDsIttoL<br />

320<br />

24<br />

2m<br />

clissrFrcaTtoN or stl't)lt cEolrsTERoL<br />

u)Lcf,ol,u ttoI cf,otrsTttoL EYtttcf,ottg<br />

220<br />

t60<br />

t30<br />

27<br />

tlsh<br />

lnslt<br />

Mnd

---

ChoLd..ol<br />

Frlty !ci& driqg<br />

Dil|ny<br />

Cldeol<br />

)|<br />

E(rdrlb.<br />

l|i&<br />

Ctdldiol<br />

6dv Gdi..<br />

At!8<br />

LqofBtogatr<br />

(FdryI)<br />

CATSB G BCDBT TINE I|I([I CBItr,B8Tts&I,<br />

r.?od..d tor Grrdry tlol<br />

a

---

Ca|lscs olborderlin<br />

high chole*crol<br />

LD!.rcc.pior ____---------'<br />

Dcft.livc<br />

LDL particles<br />

svF-<br />

Ovcr produclon of<br />

VLDL p€drcl€s<br />

b{tr €tcd<br />

\4DL lo LDL<br />

EDrichnent ofLDL<br />

C.!r. otttibry aon r.t E Frtt Li.$ldh<br />

ecprcdu@d non Gtutdly t901<br />

with clolerbol .stcrs

---

Epi.laDiolosj..l inldi6 nMst ess.$ dd for a I ng/dl inci@ in clbLsml<br />

coI@t6ilons ov€r mod€rd. rsa6 $c rtt of IED inc@s by l%. Tnur m ircrce<br />

from 200-240 mg/dl should 6ie the dst for IHD by aQpl..<br />

Rcat @iddioLogioi &d clinicll snrdi6 htE erql.d de inponar@ of<br />

iidividual lipoprot.itu in pr.dictins tuture IHD wnil. low d.niry lipop'oLii (LDL) de<br />

athmsoic aid hjd ddny [poDs&i! (tDL) rc inEBdy o@lit.d eirn th.<br />

o@rco@ of arhsoeldoric IliD Most ofth€s s1udi6 s@ b8.d 6 @mDuisoB of<br />

fie $MwB of fryowdi.l inf&ction with mrml $Dj€di a r.pon€d by (D€B&kq<br />

1982) IloU tl|.t tlE alolipoproeis @Dpocition ed @n .it-.rion or pdri@lr<br />

lipoprotein cl6!.! lrc inpo.tant for ath@g€nicity.<br />

3 4 TtrIGLYCERIDE<br />

S€run triglyccide @nccntraliom vrri6 iiS.twd 50- | 50 na/d d.patding upon<br />

tne dialry hta*., e $e @jor lipid! Ed swe 3 d6s/ $bcrr$. i' $e tis ud<br />

peiph.rsl tis$6, pa.ticuldly ruscles En r8l/ is stor.d in th€ fom ofitbcyl gtcdol in<br />

f.l d€posirs Tnglt@id. nol@n6 e 6npos.d of tl@ f y tids lnicd by.3d<br />

b@ds ro a tt@ ..rbo. alcohol, gly@l<br />

BidrinlEst of niglydid.s Glyercl<br />

pnosph.le p.tlMy) tate phe in lis.,<br />

.dip@ rise l.drtilg n nmry glad5, int slin.l mu@sa ruscL ed lddney, atd uc<br />

hydrclt*d by lipoproEnr tpe €i4n (LPL) i o gl$el snd f.tty .cids. Clyc.rol<br />

cnt6 h.padc ety@lyric p6th*.y od 6tty @ds {. t*d !p by .dip@ or nu$le cdls<br />

for c!1iliz.ti@ How.r thcir t@sport in th. body is thrcud lipoproLins a thcir<br />

insedi6i!. Trislrsdd6 msidy e€ Facnt it chylonicotu and vst low ddily<br />

lipoprot.i. (wDL) rh* p.nicl6 e buord bed& orrh. hid sidqid. @ntdrr<br />

which mates .pproxjm.tely 90% by w.ight oflhe chyloniqon tnd 70Pl. by w.igh of<br />

(v€ry low dftity lipoprotrin) (wDL) n021.<br />

30

---

1.5 REL{TIONSEIT OT TEE TRIGLYCERIDE RICII UPOPROTEIN IO<br />

ATEEROSCLEROSIS<br />

Ii is obsNed in cenain studid rhai elwared plsm ftigly.side concentr.tion<br />

(rcl.r.d ro wDL rdgt€i&) o p.ri..n5 wirh prsn.r@ IHD ehile HDL chol6t@l<br />

d616don u€ inv*ly rol&red to !lsn. trirl'@ddc h pcm.nrrc IHD Pdidls,<br />

thd. ee in r€a.d @m of \'LDL dely.did* md cholgLol, itu@sd @nc. of<br />

clbl6rftl in IDL a0€.ts t r$. of wDL ldnM,r hryi.a iNss.d cm. of sdl LDL<br />

putid.! nch in Apo B ard rclltiv.ly poor in chotestdyl csts ed r.duc.d @nc. ofHDL<br />

Th. H.l$rki non snrd datr Mouted for @duction of t.iglysi& nch lipopro€it nEy<br />

rcd!@ ttD dlt 0011. RmDl3 of rish/c6d. nch lPoprot€in hwc b@ tnoudt ro be<br />

athcrcgoic for s*nl @ons givo b.low:<br />

i) Lipopor.ii r€lmbling wDL rcl|mt3 de eci.ted with 6pid dddopndt of<br />

fdry $.6t! fonoqcd by .lhdoel@lic ldon3 in .t{dinaLl adtuk.<br />

ii) TIE a.dmuldion ofchylomicron md VI-DL io dysbei!- lipoprolorcnis ctusd<br />

by nutttion in apo E ftat imp.i. iftq&dons with liFp@tdn @!'106 is<br />

Milr.d witb orantt!rc dt@sd@ric dis.e.<br />

iii) I. Gofnss [04] pioi*ring !tudi$, d€nonetr.Ld ind.lsd mounl! of s.ll<br />

VLDL panicls dd IDLS, (Ms.d by ultr@ rituee), a qdl a LDL luve ba<br />

swilr.d wirh Drs rurc II.ID.<br />

iv) Philip €r al (1993) 0051 r€pod€d the 'elatiotuhip betw€4 the @rc. or wDL<br />

.4!ts $ rnd prcerBion of IHD, 4du!t d by @rcM.y sSiognlhy<br />

3,6 PEOSPIIOLIPIDS<br />

PnoAholipid! ct)lFltdion b tlE blood is ItG250 n€/dl in Ae fom .nd in<br />

mdbMeq tut up tlE Elt majdity ofthc srface ofth.lipopol.m, forning .lipid<br />

l.ycr ih.t acts d e int.rf..e wth w{rd bofi rhe polf da@.nvirontElt Dd th. nonpolr<br />

lipids of lipoproftin 6e Phospholipids h.s rh. s@ sly@l btddFE d<br />

riglydide blr h.w two tury &ids &d ! phosphlr. @naining nd4le tusdy the<br />

pholphalidyl choli.. tn&U to ih. bacl6on..<br />

31

---

Phosphlridyl cholinc 0@ithin) i! rh. mior phdpholipid in dma od h $ur of<br />

linol..l. for chol4tc.i eq.r fomrion.<br />

3 7 LIPOPROTEINS<br />

nre najor plald lipids e.s. chol6t6ol, cholastgr'l erd, trist@ide and<br />

ph6pholipids a inelublc in v!rs. They e etri€d ir pts!fu 3 lipopro&i*<br />

(macrcnol@ule compldd of lipids bound to wiety oflpoproteii!). E!.n noat! wftin<br />

a difr6gl ddrity mg. in th. ulnreiirifilge. All th. ligoprcton cbs e sb-<br />

€|4!ifi.d on th.i. d@lity gndidt .rd v!i.s in onpolitioA siz., dmity rnd tun.dd.<br />

S*.al @jordas d€fn€d by rh6 ptys@-chmicd chdrct€ri ics, @: ch/onimtur<br />

asy lo* dcdty lipoprorcb (wDL), low dsity lipopdcin o.DL) .nd hid d*ity<br />

lipoporein (rDL) I 106l<br />

].8 SIAUCIURE OF LIX'PROTEINS<br />

Lipop.otciB e sph.ri..l pdlicl* @de up of hundr.dt of lipid and prctd.<br />

molals Th.y r. l@t sdld thd rcd blood c€lk dd e vilible ody with .lelron<br />

micrcsDe. wha ujgb€id. rich lipoprotciB e F$en in rsy hiel @ncd EEo.3,<br />

plafr. appqc b be nlbid or den nillq ro $e Dk d eye The mjor liPide of the<br />

lipoproldm e clbl*lml rrigtqide &d phosrholipi& Tdglyqide dtd clDl6t tyl<br />

ellr @.stituic lhc qe of [poprolein. Ph@phonpid! md Ac ciol6t@1, @w rh.<br />

surfe ol pdticl€, wh€re thcy act as the int€rf!@ belwn th€ pla!@ and coro<br />

@oponqns *iil. apoprentN (.polipop.otoN) o@Py rh. $.fi& of the lipoptot iro.<br />

Th.e FoteiB, whil. sing s !trh@ b.tvq lipid td .4@3 oviffidq Dlay<br />

ihpodot/frcial rcle in th. rGgulariotu of lipid tr.rlpod and lipoproi€in m.t bolbm<br />

(Gi bdg 1994) I9ll.<br />

32

---

di<br />

F!<br />

E;<br />

aor<br />

gs<br />

.E:<br />

I ES<br />

6:3<br />

q3l<br />

s:5<br />

r= 55<br />

! E*=<br />

d sE<br />

B<br />

d<br />

g<br />

9-<br />

---

3.9 CSYI.oM|CRONS<br />

Chylomimm &€ s.cr.r.d ftom int.ltiG dd t@lponed in inr6tin l lFp\<br />

onlair ndly rynthsized Apo'848, .po Al. cpo A4 dd also a.quir€ apo E !d.poc<br />

lipoFoliB (cl, cll a cm) Aon hish &nsity lipopro&ii (HDL). hto $. bl@4 $e<br />

int€raor wnh Upoprotein lips& on th€ surf.a of .ndotheli.l ..ll! minly ii nuslc od<br />

.dpoF tise. Hydrclysis of th. thdsds of trirly@dde rul@16 in th. chyloni@ns<br />

to mrcglyqido .41 6ny &idr. TIE lrydrolrrlc prcducts drhr de ondizql (ii tueL)<br />

or c8rrifr€d for stoBge (in adipo€ rislue) F@ fltty eds t@sporr.d in the blmd lre<br />

bdnd 10 Albmin On lnnd undd .6ling odnion de ti.n poncd b li6 wh€rc th.y<br />

m ondiad d rc-6&dn€4 eqcted a \4-DL particlB [0?]<br />

90/. of th. clryloni.rcn triglr@id. prniclcs s rdo!.d into thc bl@d s c<br />

t/onicDn .emer. Duing rmut fdllioq C-tpoproteire od Nrfr@<br />

phospnolipids ee rdnlfdr€d to tlDL. ApoE r@inr with rdal whjch tho is laLn lo<br />

the lis by tlE E4oB th @s a thc podlircly chdg.d rc8i@ of prct in dch ir<br />

ugininc sd lysin. rclidu6. Hepatic lipe tunhd tyd.oly4 r8id.ttial '!lr1Mt<br />

tdgltqidB &d phorpholipids lhus f&ilital€ @ptor biding rloE for itt .tdr@ wirh<br />

rhe LDL Gegtor dd LDL @plo. rcli cd protin {ith tn. @nPlete d.gr.dadon of the<br />

Clryloni{jd al$ tdpon did.ly chol*dol a.holcd.ql 6td stfltdiz.d ir<br />

inrestiial mu@sal alls. Clrylonimn r€Mts @nraning chol$tcryl cst€G e<br />

nydobz.d h n€pato.ytic lyssm (livd) ud rcls!.d cholee@l is t6 fd€d to oth.r<br />

osrs ofrhc c€U wh.c n is qqa.d i o fi. bile. TIE choldrftl @ als b. sdel.d (a<br />

cholesteryl sler) within \T .DL pdrricLr or deposited wirhin lhe a[ [r03]<br />

3.10 V.r] low d.6ity lipopnr.itr (VLDL) d.nbolirr<br />

M.raboli$ of wDL poG& in two stc?s. Lipoptolei lipe @s th.<br />

hydro$t but dE riSltsidq of suld vt DL {a tlo*ly hydrclt{€d d* lo l* @nt .t<br />

of lh. pnthl6 with cD4@ (LPL) tege l4-DL rcmn.nls [te chylonicon telrrfu$ ue<br />

t ta !p nlidy by livr vialh. LDL @ptor ald d.gnd€d rcDMl panicl6 e<br />

34

---

!P<br />

E gE<br />

91i<br />

I<br />

o;<br />

s\<br />

iin<br />

E<br />

= l<br />

o<br />

i<br />

o<br />

:-<br />

=.=<br />

qd<br />

.io<br />

oi<br />

o)=<br />

o<br />

ot<br />

(D<br />

_f<br />

o<br />

a.<br />

r t-o.D<br />

q)<br />

(D<br />

o<br />

tll

---

Hydrcly&d by h.gdic lipe, l@sing ri.ir aloprcr.iN E sd c ud d@st rll dr.t<br />

idslyqides and b@ft LDL. (Low doaily lipoproLi.) [15] I! ne.lrhy p.trons 50% of<br />

\4-DL p.nicl6 rc @nvqt€d ro t DI. b@e of lhci l@g.r *!y tire LDL Nnbq<br />

incrces morc thd rh.ir pr€clmB [ 109].<br />

3.ll rd d.Bily lipopnt in (LDL)<br />

Th€ major chold€rol c&ryirs lipopd€in of tu is low dolty lipoprot€in<br />

Thc per6n @positim ofLDL is 25% prcrdA 0l% pho4holipid, 03% uielydidc and<br />

4?% choldterol. LDL is a sphdic.l lipop.otdn p.ni.le hlving 1.063 dosty &d mostly<br />

@ntlin chol.ndtl 6td i. lo il! noFpolu 6rq its $rfre lipoForon cdsiti dnod<br />

.rl€Nively 900/0 apoproreins B- 100 i e. one .po B noldul. per LDL plnicle Th. LDL<br />

p..ticl6 e d6ved fron v6y lry dflity lipopror.it (VLDL). TIE lver ddoF alo<br />

B 100 in to ihc trjglyc.ride rich lipoprct in cdled wry low dcGity lipoprol.in. Ihes<br />

paniclB se Gposibl. for sspoflins ldgltqid. tuly &id3 &ob ih. liE to paipheral<br />

tiss4 for tuiiliarion. Whd rry low ddlity lipoProGis 4t r i o th. 6tilhti.s, rbey<br />

@m. in @nt..t with lipoproEin lipas (LPL), & Gn4me th.t lrytlroltu t rhe d8lycdid6<br />

dd ..1e4 htty @ds for ds$c utjli2rion. VLDL .ls 6.ry t{o orhd etNps of<br />

rpprcteins, the apo C and .po E. Apo C tr is &iiv.tor of liPoprct€in lipaa ud this<br />

Aoprorein plats rc|. h rlE dilpoirion of VLDL Ana,@v.l of non of dE<br />

lrigly*ride fron WDL, . Gidual panicl€, c.llcd "l'-DL tmui ImtiN in the<br />

cirorldim ud is @n@ncd to LDL. ThN dE propotlon of VLDL dMd3 ovtt d<br />

ro LDL er.dudly inllu.!6 thc @@.tr!tion of @n LDL Uealy sbour two third of<br />

llMor!.rc r!t6 up by rhc li6, a.d ore rhird gG to LDL fomlon lflhienq<br />

Droporiron of \/LDL is lEs{om.d to LDL, rhd rh. @@tnlion of LDL nla rthe<br />

doits of I/I,DL p.nicle incr.r&e by Ii!6, m@ \4-DL *ill go lo LDL I I l0].<br />

Lw d@sity lipoptutin (LDL) hlvc nuch longs stry ine it thc blood thd th€<br />

WDucnybmison remtitq b.€ue th. LDL hck lpoq ad e t.t n uP bv th€ liq<br />

or to $m .xtol by othr lis6 orly $rcugl ilt iftdacrion of @ptor bMi.8 moidv<br />

on lipoprct€in B-lo0 (prc!@bly l!.ting in lpo 848) with th. LDL rcceplot. Th. LRP<br />

(LDL '€e?tor prot€in) dc rct intlri.r .(f.di!tly vith LDL P.till6.<br />

36

---

Ar Lrd ?5% of cirot.ti.a LDL ir rmov.d vi! liv6 by My of LDL te€flor<br />

altholg! a lmrllr firction is mov€d by .oHeeptq pdhwAy Ir LDL ft.prd b a<br />

glycoprctein witn a ml6d.. *€ighl approxira.t.ly 160,000 kd d'rt is p@nt on eu<br />

$f!6 oanady all ii!9c in lh. body I I I I ].<br />

3.12 Ro|. of LDL i. .thdoi..6lt .!d itr tn dddoDo.ll ofIED<br />

A hign .onc. of md chol€sraol is a djor nsk fa.tor for IHD Grcwing<br />

evi&n@ indics. rnr rhis n* ie nEdirt d throu8h tnc nrjor clDlestqol ct ying<br />

lipoprorein of mq th. tow dosity lipoprctrir The Natioral Chol.ltml Education<br />

P@gM. (NCEP) idanifi.d LDL s mjd dnqogsnc lpoprct in !.d tlE Pnmry<br />

rargct fo. choldtqol lowcring 6.rapy [! 001<br />

Muldtle n6h&im .trd lt?€chohdqoldia, ..9 di€! lgjng, b!m6 .nd<br />

gd.ti6 LDL r*ploc &. dlo inpon4! d d.fd in ficn structure or d*@!.d<br />

mnh.r l.ading ch.ngB ir LDL bindiig .hlt.LristiB ce!.d by .ltd.tioN in<br />

eolipopml.in B 6'nd o. strud@. S*ol litu3 of 4idlhe unddlic the @nduion<br />

that LDL is s tujo. que of.lhcoelqolis. Studis in laloElory dmtls! €pid.miologic<br />

4idcc, D6rholoeic indig.rio.!, goclic b?.rchot.9qoldia md dudis in nodel<br />

.) Aoio.l n.gch<br />

Nudms studi.! in l.bor.tory dinrls di.d oul bv rcsdch$ indiot d lhal<br />

inlj@ in citoLrsg t+oFc'Lii r@nbling to huM LDL Fodue<br />

atlErdctqosis. Tltis iod6e cd bc boueht .ftnd by djetuv chol$Lrol o. br<br />

8a.ric def..is 0 r 1r lrl.<br />

b) EDid.niologi.Evid..c.<br />

Mdy 3ludi6 sond *id. H.d ! p61iw @reLtlon betw@ ct)lFltllid of<br />

totat cholesrml md imidel@ of IIID LDL is ndq chokslerol @]ing<br />

lipopolon in &run dd its @n@r.rron k ligl y corcbrql to lold cholBtercl.<br />

rt s@ns lik ly rhsr to$l chol6tNl - IliD liik .{€nd to LDL, noME LDL<br />

chol.3r€rol com6t6tion @ found to b. ind@.nd@tlv aieciat€d wilh IHD<br />

dmts s r€ton.d by (K.t! l9?o rnd Keml d d 1979) 0 l4-l | 51.

---

iD<br />

Biochdi.d Anbab of Frtq n.qud<br />

i) Sndia of dn@Fldoti. pl.qB obtlir€d ar !|c@psy provide additioul<br />

didd@ Ae tn rdh3 of chcnicsl dulylis of pbqu6 @ @Nistdt w$ a<br />

phw odgin chol6t€rol, and tlE fatty &id @mpeilion of chol6t€ry1 $ld<br />

oh.i..d Aom da4e clo6€t rMbled to rh'r pren in phsa. Funhd<br />

apoprotein Bl00 hs b.h d.t@Ld in dhm!.I€rotic lcaioN..d LDL p.nicles<br />

hrE bd idaif.d in d4ud 016ll?1.<br />

D "Pdholoeic ddmi@$ of !ihs6.l@$s in tlt sludy of young adulls<br />

dying in-@iddl rdal€! srrong poiriv. con lation b.twa rhc s@ly<br />

ol athdosl@3is .nd @M.tralion of LDL md VLDL cnob*dol .l the<br />

lime ofdath (PADY) I 181<br />

Clinic.l Eyp.r.bolBt mLbir<br />

Vdy sftry si.t.@ that LDL b dnqoSdjc @m lioa teo fom of<br />

hyp.rchol6tdol@ia duc io fasili.l nutllioo<br />

Idilid hypachot6tsolcmja (FlO in which tDL @.pros s. den ictt on a<br />

gdetic h6sb, rcsliing rra{y inclgs in LDL cnobnftl co!@taiion .d<br />

ath.rogoees is.nhDced Dd prmtur.IHD i3 omoq wcn *td atr cted<br />

bdividu.l' d d.void of ott6 trtD trlk ftdo6 (Gold Ston l9R) [ I I e].<br />

F.mili.l .t€fddve apoprotein B lo0 inrck3 a mui.tion in $€ .poprotein 8-100<br />

mol@le thll !@lud6 i1s r@gniti@ by th. LDL r.cc os @n .quddy, LDL<br />

panicl6 e rctained in th. plass. .nd LDL .hoLddol @ndrdion e high ed<br />

patioi3 e p.o.c to pr.tutur€ Il{D [r20-l2l].<br />

TIE 6nr $cp in alhdo8en6s ir ardo$.li.l d4!9. tld thie dfsge RIll! in<br />

plal€ld lgsr.gation or lhc injurcd endothelisl surrae wh@ thc plstders r.lee<br />

groMh fidoB th|l oe prclifdrion of sDooth mlslc @ft. Wldle LDL is<br />

n@lsry for th. fom.tion of tury nqt{. Thft is grcwitg *id€ne that oth€.<br />

lID tuk frcloB (sokii& lr'?dtc@on .nd di.bcte) ad minly to prohot<br />

3A

---

convqsion offrtty $r*k3 into dbod plaqua 0221.<br />

IX. poFirljoB in stich LDL @rcqnrJion e loq thc .ledoptr61 of<br />

advded nl'.beld6h i! rdati@ly @ eM who othq risk fldos @ 6.q!dl<br />

nfc cigd€tt. mking, Iryp€nolioi od dirbaas mlitur a $gges.d by (Iodd<br />

1986.d Robcts 1968) [123-124].<br />

Loe ondlrldom of HDL chol.3t€ol dloig with high @@ntntion of LDI"<br />

pre@rc dE aornuli@ of tuy l!.k B*!r HDL dat irs p.or!.dw .fi.d<br />

agli.n tbe dcv.lopn4t of IHD tn@d int€ficrior wiil LDL lhat pronol.<br />

r.se clblcddl Edport frd th. sr6.r ortn. e[.d e88€3r lry flDL<br />

cno|6tml @Eatntion B mjor nsk fa.ro. fo. IHD otrly wha dP LDL<br />

oreittr.ion de rdrdv.t lri8h 0251.<br />

t<br />

LDL<br />

FATTY STREAK<br />

I<br />

I<br />

J<br />

FIBROUS PLAQUE<br />

T{DL<br />

. LDL<br />

. SMOKING<br />

. HYPERTENSION<br />

.DIABETES MELLITUS<br />

Role ofLDL in arherog€fl€sis and r€latioD to olher risk factors. [1m]

---

3.13 [i!h D.$iq Ltpopror.itr (UDt)<br />

Th. rm nDL ha ha ued ro deib. plasd Upoprottn s.pdlt d by lsidy<br />

ort6hniqu.s TheF includ* not only !.9ridion by ullrl-hfiitugEtio4 elerrepnorBis,<br />

bur als lipoprot.ir! that ue sdl loluble .ft€r poliodc pr6ipilaiio!. HDL ue<br />

polydispa. rad heErog.Ms *ith Bpc(l 10 size, lipid and apopdcin @ntar<br />

AtproxitrEr.ly tO./. by w€irh of IIDL ie prorcia 3Pl. pho$holipi4 20q.<br />

cholesr@l lnd 5% iriglyeride. Th€ thdphofiid @Bilts of leirhin ud spbinAomy.lin<br />

in a 5 I r.tio. liv€r dd intsdn @ involled in th€ orcdu.non of HDL. Evida@<br />

indi6t6 thtr rh. nar@ Ahqiol pbs HDL pardcls e mt dir.ctly @etcd fiom<br />

abore $!rc bul e daiwd non dis.oidd - sh.p.d pr@rs fod!\ @sislirg offlDL<br />

apolipopror.inq lecinif, &d frd chol*tml. T@dotution of the diMidd fom ioto<br />

sphqicil prnicl€ app@1ly involB thc..tion ol th. .nzrd. ldithir - cnobtsol acyl<br />

r@sre@ o-CAT), ",tich 6drs in rlE fom.lion of chol6tqol 6t{ froh tlF te<br />

cholestdol. Th€ c5ol6Lrol c51q tha.ntcB th. w. offi. @njcl€ and lpopmtein A-l<br />

is u adittor oflhe LCAT sysrd [26].<br />

Ano1hd sl)ll@ of I.IDL {@poMts appds to b. $e srqid. rid! vsy low<br />

dmity lipoFobin &d chyloni@G. It nrs han dmnfited thtt lipolysis of VLDL<br />

tdslycqidc or chylonicrcN by lipoprol€in lipse (a dzrf,€ !.1rv.ted by apo CD rl$<br />

re$lts in th. r&sfq of lpolipoprcl€iN (C-lipoprct€irs) od phoaholipid to liDL [ 109]<br />

In nom'.I $bje.t! tlE plas hrjflifc oftlDl- i! .hout fdr &y.. HDL pmicld<br />

appes to b. sphqical and mg€ in siz lrry &on {pproximtdy 7G120 A" it dima.t<br />

consbdng ofe apok hydrcphobic lipid coc dd slubilizins nore pola surfle cqt of<br />

phoanolipid .d slobllr .pop.orci8 *ith .poLr rc8ionr thlr in tun @ db€dcd in thc<br />

fipid @rc. n is h@vicar liFprct€ir hlving d@iry ofI06]-1.021sr nn, nlente $th<br />

alpha dobility ii elerophoreric m.di. and do nol folt d the d@Bity comody nsd in<br />

tn€ anibticd ultr.-entritugd nEthod to ct@c16ize ti. otha plls lipoprotein.<br />

nE prctein 6mpon6ts of EDL e heifts.lM @ristjng of at len lw<br />

f.nili6 of.polipoFoeif,s. A ed C. ApoliDoprcteir A-l ud.po:A-Il m.k upo@90%<br />

oflhe brai prct.in ofrDl and @dning is apo: Ci dnlisring ofthr€. diftrcnt p.plids,<br />

(cl Cn .nd CIn) Thc C .pop,otdn ddily qctErs. b.t\€, HDL dd **ly ^rmcd<br />

40

---

chylomi@s dd VLDL. Urd. is knoM rcelrding rla dt of dcgrld.do! ofFot.in<br />

and lipid @npoMts ofHDL. Studies in 6io.ls suggp$ rhn liver and kidn.y lte$n$<br />

Mt be inpoftd in nDL ncubofso 27, 1281<br />

3 14 ATOUP]OPROIIIN/APOPROTEIN<br />

Thc srhd proteiE otth. lipoprorcin e c.llcd apoprotcia d .tolipoprot€iB.<br />

They provide sEldural dability to tlle lipoptutci., &d ds phy critic.l rel$ in<br />

detmining th. ma$olic f.r. ofihe prticld on wli.h rh€y r.3idc. Th.4op.ot€i6 @<br />

MnEd i. D srbiriry dph.lcrici odd T<br />

X.y e grdped a@diog to tlEi. a$oo.boN<br />

sth thc majo. lipop.ot€in cla$ dd d.sigra&d by the lbbPliation spo"[129].<br />

Apolipoproteirs have following metat'olic fi.nctions.<br />

I Tmspon ad r€djstdbution of lipi& to voour tisws.<br />

2. Solubilis chol.sleol srd tngbsnde by i'nda.li.g with th€ olhd dajor cls of<br />

l<br />

5<br />

lipids f@.d in fipoprct.iro (DlDlpholipids).<br />

As a @factor for .nzymes of lipid ner.bolism such as l4fiin choldtcrol<br />

&yllra!f..e (LCAT) ..d lipopolin ljpa$ (I,PL)<br />

Maint@c. of doclurc of liFpmr.in.<br />

Apolipopror.ins bind 1o a[ urhe r€*ploB ud th$ del€mirc fi. sil* of<br />

upolc .rd rda ofdegr.dllion oflipoprot@s [ 130]<br />

315 AX)UIOPROTEIN B.'T AND AI''O BI|,O<br />

aDGBat: Th. .poprotcin thlt k etitt fo. lhe .gcnblv ed sefion of<br />

chylodjc.oN is lpo B-43. Ils 'u@ deriv€d lion thG f.ct riiat it @nltnute 48% ofthc<br />

Mitrordinal od ot rlo B- 100, vnich ii rhe Mjor .lopro&in of !I'Dl. IDL &d LDI-<br />

6npo!in8 approximal€ly lv , 60 f''d 95% of the prct.in in thele f6pt tivc<br />

lipopror.in ll ll.<br />

apopsr.id Bl(lo: b rlE lds.st of 4oPolcins siih ! nol@]s *igl of<br />

5o0,oOO daltos ln hmm .po B- IOO is synth*ized in signifiFt quditid oily h tivd<br />

Apo B-IOO epon dly b.6gry tur tnc Mbly &d sd.rioa of \'LDL fron dE lisr<br />

&d w.! s th. binding prolcin for fiG LDL @pror on c.ns tbolSrtoul bodv ll32l

---

I 16 AIQPROTEIN a-l Is rb. mjor .loprotdn pr.st on HDL @istiMing.Soul<br />

70% to 8e/. ofthc toi.l prorcin na$. Compomt ofHDL (Apo A'l)is ql'thdiz€d in<br />

livd ed th€ flI i.l61irc Apo A'l i! e a.tivrror ofth€ €tztmc lAiihin cholBr€rol<br />

acttasfee (LCAI, -ni$ c.iti66 &@ cnobslfrl in plasm Ato A.l de Pby .<br />

criiic.l role in miitainjng th. int€erity of tlDL panicla in fie plasma dd thdef@<br />

prclongrng th.i. lifc tne in th. cir.datioi,<br />

AIo A-I|] is the sond @st sbuiddt .loprol.iB ir HDL. Siritd lo apo A-I,<br />

apo A-II is syntherizld in both the livd ed sm.ll inlestine in hu@s. APo A-W<br />

sy h€lied orly in the $n ll i ciim in hlnN Apo A-IV pby. rclc in th..qlivdion<br />

of ldithin chol6raol scyl rmf6e 0-CAT) ard pGibly iLilitlt6 t6.5f.r oforlF<br />

apolipoproleinr b.twa tlDL &d chylomicrcn s n tu t Dinor conPonfl of HDL ed<br />

3.I? ATOUPOPROITIN.C<br />

Ttse sc lhc C spoprotiins, nsrcd s Aro (C-L c-tr !i C-u) with linil&<br />

larf t|aB bot with dtdn t nFtabotic rc16 od .[ fi* .poliFProrei6 de tnth.siz.d<br />

ir rh.livd only. Apo-Cl is ihe firor componal of VLDI.IDL lnd liDl-dd ils<br />

tuncrin i5 rci ycr rcport€d<br />

AFO C-tr: is ! onlritudr of \,LDL ed ir de D'!gt o. IDl. HDL, &d<br />

chylomdors Apo C-II i! D Blotial ac'livlror ofth..izyne lipoPrcto.lipe (DL),<br />

rtrich lv

---

3I' AMPROTEIN E<br />

AloEi..r hdiad ir $.li€||d nfi'od ! r Flt d.n the fipo?roLiB. X<br />

qps to Egul.tc |q@rd of rdmnt lipoproi.id ion tb€ pL6m by th. liu Apo E<br />

6 bind lo both lEperid IiLc nol@L. tl|d !r. pr.gr o dE xtne or.ll ellr .trd rh.<br />

tDL 'tc.Ord. Th. D.li.d! r'||o L.*.po E a@ tuud b hE drlnqrn dc',rlim of<br />

chylonidon rci nr ed VLDL @.ntr in fi. plm.. R*otly, di@ thrt hck lpo E,<br />

lbE !Gv@ lrrD6lhdaa.sldl .trd dt !tt6o.cl..od! [135]-<br />

43

---

TABLE.B<br />

CEATAC IER|SnCS OF Mrr,fOR A'()IJPiOPTOTEIN<br />

A?OU?OPIOIEN IIDOPIOTIINS<br />

28016<br />

r74t4<br />

64000<br />

514000<br />

&o Gll 8900<br />

Ap". C-m E800<br />

34t45<br />

r.Dq D{. vtDL<br />

RrDnd!..d Am Gi$tds H.N (l994)

---

CHAPTER FOUR<br />

RI5K FACTORS<br />

OF IHD

---

4I RII|K FACTORS OF IEI)<br />

CHAPTER FOUR<br />

O.lhe bsi3 ofcpidqDiolosicat ed gen tic studiB ofIHD, n is aponcd 1h!t the<br />

d.vcloDn€nt of IHD is inllucrE€d by c.n.in ftclos lern€d $ isk f&cb6. ft b 84Gr.Iy<br />

a.kmwledeed that IHD t. nultifadodal dis4se, a wi.ty olfi.toB iNolv.d in the<br />

d4loplMr attd clinicd @i&s.ton of thrs disd* e 8i@ hdow. viz. nodi6.ble<br />

(ad,ibl.) ad mt nFdifi. e (irMiblc) 0361<br />

i) Rit d robl .d LDL dEldhl<br />

iiD<br />

B)<br />

c)<br />

D)<br />

E)<br />

F)<br />

G)<br />

lN ler€k of HDL ch.lMl C) Familrti.ioryoflHD<br />

Daldes M.tlu3 (Undd@ rol by di./dtu€)<br />

Ob6ity (3dl. os q.igln)<br />

the possibility ol pBotina or d.l.y'r8 dr. d*dop! dt of IHD ha b@<br />

gugScsted by mr€cling or @droning ihce d* ftclo6 erPcoidly ffi liPidt.<br />

42 SMOKING<br />

SEokirg u RLI Ftaor fo. IED<br />

cisdren moldns is rcponed to be oie of the nrjor @!es of athcrc..l€onc<br />

diqF ed ssselring dd( frctor ro. rHD. ror i'!t&e, (CaBtG|M d al 198?) 014,<br />

dalmtr.t€d .igddlc mld.g 6 s sig'ifcrm l€ading @F of danh &d mtbidity ln<br />

S*dih $tuilde 3rdy of moking fouowcd up for 16 FB dd d. sohla wa<br />

45

---

dilplay€d r6pdiblc fot llrD 0]4 TIE cigat€tte soking a . nsl( hcror @n@,n8<br />

I}ID is wid.ly ltudi€d. .ll ovr rh. wodd undd veous $citl ard gset'{hjcil<br />

o.tliriotu with adapt.t'on ofnum€rcus lif. style. Il ms rcpon.d thii.lnost on iillion<br />

p€ople i. th. United Sl!t6 diet tom CYD in 198? @Nntilg for 46% ofrll d.alh!<br />

Arptuxitu .ly 2OO,OOm ofth@ dqlhs wG dircdly c4!.d by ciSiuate soti4 Th.<br />

inprcvaat in 6.die nst AdN, prnioL.ly deliE ( cigucn. mking ard sm<br />

choleterol &e r.tPotuible fo. mre of tn deline in ll{D rtd 5G6{2. @tribudon in<br />

d*line M attribut.d to ch6a.! in lir. $yle 0381<br />

The poplliiion .$ibuhu€ to tisk of<br />

,mokirg b IlrD ( .. lh€ psdllge of IriD mnality .lt ibqtthl. oily to soking is<br />

15 6%) Tlrc Blim.l€d DrdenabL dath! i. U S.A. fom IllD alorc r.laied to tu}jng<br />

*@ ov6 9o,0o0 pq yd .rd n@ ot rhae @!ttd b.forc rlE 4c of 65 yds [ 139]<br />

cildnd md C@k (1e34) il40l dintted 0E delnF b I}rD nonality ri16 in<br />

the onDmliv€ studig ofnedic€l iftdcntion! dd ch.ngEs in lif. sryl€ dd 24"/. of ovd<br />

all ddi.e lar rcl.r.d ro r.duction in ciBe.tte sokirg ir th. Unitcd Siaies.<br />

The rcslts of l0 6hon nldics rcponed d niSnd incid€nce of ny@di.l<br />

in&dion dd IHD da$! .mng mrcB, .vd.8irg 7cl0 dd $oc lh6 rhll ofnon<br />

mt* i.c rchtis tist (RR) - 1.7. Thc d€sE ofdlk of wkirs Bs rd.r.d to<br />

nunbd of cisuen. snoked, dd hqns 3notirg wa asciai.d witlt liEi risk oa dalh<br />

od myocddill infddioo nE ircid.tua of noddny &d nonality du€ to IHD BD<br />

displ.yed l* @mpsatiwly in thos who nwr sttrted mking sd found b b. declin.d<br />

mne th. ptridt3 by p€Mding for nopping fie mldng lad @nclud.d 10 r.c3d<br />

pr()6 of ddiovrei& diff 04ll Thc ilvcsigrtion r.?oru of @ting a . nst<br />

Lclor regdding hen disee noibidig ud notulity sl@.d on by publc hohh<br />

wi@ prddriv. cddiology in rh. Nalior.l Hdt Lune bd Blood Inslitnt. mdud.d<br />

(X. R) reldirc risk pum€td of IHD dons uok6, non smokcs md those sloPped<br />

rmkj!8 The d. of IHD in cll@r snrok ts t leponed rcrc thd th@tim6 lo fioe<br />

*to bw. rvd mtd ad in@s..t risk *s @t nol.d in tho* wio only sotc pip6<br />

d osas &d h.v. rcvd bo drlr.nc nokd ciglrc$c mkrs h!!n mda 60 yd<br />

ha beo repon d oic of lhe thr€e djor .isk hctoB for IHD but b ta.Nbl€ who stoP<br />

snokins ci8arcn. sd IrD nsk dslincd 10 fi! ld€l ofnon smoter [ 142].<br />

6

---

Vodrtion in blood lipid ldd dons snok6 dd @n sok6 in nul. ed fem.l.<br />

w6e@nd!d.d ar PMRC. tdoc(P.t) !.d obsEd ligni6ordy lowr l6dr of HDL<br />

ed hignd @n@Inioi of \,LDL dd pl.@ ldgt*nd. in smok6 The lipid &d<br />

lipoprotein hrels v* .ho d€poderr upon th€ numb$ of cig,rdt.s lmok d pq day<br />

sgg.rtinS th. clo* Mialion rnh cigu€n. mkirS $.t €nl6e IHD relt. Aom<br />

its etr .r' lpon rne d's liDid. ad . po*ibl. @ ofc!@recir 0431.<br />

For iBt{@ a 3t!dy died out .r Holy f.mily H6pital Am.d ro!@s lmitutc<br />

ofratholoS/ (ArID in 8? mkqs dd 3t non notdr ii* ffom othq rilk 6ctoB of<br />

IHD. Signi6ody irco!.d lold clFlca&rol. nigbqidq LDL rnd ronl choldfrl b<br />

HDL 6tio &d dq@..d HDL chot.lrcol d6tr.tid qw otwcd i! wk6 a<br />

onpd.d to non-mokdr, rh. aurhor (Kn n er al. 193) @nclud.d th,l ciedefic<br />

snokirg incr@ th. l*l ol *on rord clbld.rol, rielr@id., low d€nsity<br />

lipopre|ii 0-DL) dd ro$l chole..@l ro rDL otio Dd d.c@*d tlDL cholgrftl<br />

ll.l.4l. A dose Epone rclrtiorsirip dist betm ciSu.tte moldr8 dd ffi lipid<br />

pro616 Thc n€avier lhe snoking lh. higitd rhe srum lipide *apr HDL cholBtdol<br />

4.1 Met .is of Sdotin! radiltro hwdlipid.Di.ud rgD.<br />

Snoring &d ht?dlipid€nia ac wI krown ntk f.cloB of IIID Fot<br />

uitl€G:tuding $e rcldonfip oons $lokins. hrT.dipiddi. and IHD, rollowins<br />

dpliEtioa w@ prepd.d ro IIID atuis<br />

Th. in@sd otlon motund. ii thc bl@d of sotd doag6 the sdorheliun<br />

th( Mel.ratinA tn€ cntry ofctoletqol in ro dE wrll ofthe ..t€ry<br />

Th. cdhoxy h.ioglobi. fodncd crar6 rdatire @x.Dj. in tlE ris. imluding<br />

Sooking o{m@s pl el€t aggregation.<br />

Th. .i@rire a!$d.d {ion smkc irducB cddia. dlryth.oia tluourl ii!<br />

Smkils dru3 thc adiviry of lEithin cholet lol .cylffits{de (LCAT), thc<br />

ef,zyme involvcd in the conv€6ion of cnolqtqol ro choldeol €slers ed i3<br />

65ori.l for HDL m.di.ted Movd of choLc@l fron ldiphdd tise.<br />

47

---

The ab$lb.d niotiE Am .jgscrl. mok , 3tiruld. 1he sdon of<br />

cpi!.rhn e, oni$l 3trd gbwr[ hlmoic. This drh.ft.d harFod srclion &livil6<br />

the addylate qde of ldipoe li$c Ner lhe lipolr$ of ltor.d tdacjElydol ed<br />

relels of f€e fdry rcid! o@8. rhe rcldcd fre htty rodr lte imediat€ly bouid to<br />

pllM albmjn .nd truported lo v$io8 n$u* ofthe body p.nicalsly lis H.p.ric<br />

uielyqide (\,I-DL) eyndt {tis ir dinubed d@ lo inda!.d innu ofte 6lty eid!<br />

ll45r49l<br />

Plilm HDL @nmn tion vdi6 invgsly filh $c d$@ tiSltqjdc Dd<br />

wDL and nijoi lpoprot in oI HDL, lhe C-lpoprcteir is dqiv.d in parl ftom lh.<br />

c.lalolis of \4,DL. Smkirg ako dr6 th. HDL cholc$.rol The *d rohDis<br />

wha€by @kin8.lr@ rDL b ttr ro bc d.tdni'Ed. Hovlw, it lbs ben sgaBrcd<br />

.hd 3mting $ppB HDL bt Edui.8 rDL.poFoidd a rdl a dtd HDL<br />

phoaholipid srfa.! @nstitudt!. Orha 3ludi6 prcpos.d $ etrecr of ncoinc h<br />

rcducingtlDI-3sub6!.tionof trDL., 050-15ll.<br />

4{l

---

The ed.ctr ofcigrae f,oldng llpolr th. dma lipib dd lipop.otrin e girql<br />

bdw, sssBti.S the poadble pbydolos/ of lvFlipidan |nd rpop(or.iMn tla4.<br />

CiSar6ttc sinoking<br />

I<br />

Abseptid ofNicotinc b to fic body<br />

J<br />

Secretior of Crt€cholirdincs and oiher harm@es<br />

I<br />

Actiyation of.da yLdc cyclasc in adipce ticsur<br />

i<br />

Rel€$c offtcc fatty aaids fiom adip@e tissu€<br />

TriSlycarid. iD the plasma bor|lr(l to alhdin<br />

I<br />

LDoreissd slatlBis of liSlyc€tide md VLDL by lii€r<br />

I<br />

horEasld plasEa VLDL atd Eiglycsidcs<br />

I<br />

D€€L5s€d HDL<br />

49

---

4.4 Et|vimnnedil Tob.cco Snok€ (f,TS)<br />

Th. .tr€ds of @ircltr@tal bb.@ mok on han di*@ ue deib.d and<br />

th. uthtrs (Fi.lding, 1988 .rd Glar2 l99l) 052, l5ll @Elud.d thr dnoDtur d<br />

tobam lmolc h linl€d ro hdn dis@ monatly dd .dirmt€d rh 37@0 darhs in<br />

U S.A *er. duc to €nviromtal tot!@o 3mke dposurc Epidcmiological ltudi€t<br />

iidiera a @i$a do!. r.spor!. .ffcd rdrr.d ro a9@e ro ste. E!id.@<br />

indi@le that non moks e mp slitive to mok ircludhg @diov.$ld etrdt .nd<br />

thlr side rem sdok coitsiro lighd @nentation ofdbon monoxide. P@ple with<br />

*turilg IHD ard dposd 10 @nolnMt robr@ mk h.rc dqa!.d ddre nrdron<br />

ad nsa!.d qrboxy lEmoslobin. PBirc Fokhs is.n impon m dst facro. for han<br />

di$F modidiry ed mo.tality<br />

4.5 CIGARDTTE SMOKING AND FYPERTDNSION<br />

Cigrdrc sold.g @t ly nisr blood pBre. By mking ot y 1wo cigu.tt 3,<br />

blood p'tsr., puls nl., plam ACTH, c.nisl. .ldolt @e ed c.rdlbbhifts @<br />

It b sgacared fiat rhc .tredr ofmo&in8 on blood pllsc my be short lircd,<br />

bul r€p.{ted moking during rhe d.y r€$lts in hjghq ava.g. pr€s$re rhal tuy<br />

dsnult prcmt odri&d h]Tendion. Snokirg.le rcduq th..fr€dilltB ol<br />

tD"qtsion tFllner (drusr. Snotirs i.duq hq.dc dEym6 of the .taoch'oft<br />

sysLm wl ch incrce hasiic n tabolis ofnedicdioo I I ta, 155].<br />

50

---

..6 SYPERTENSION<br />

Eypd&trrio! n Ri't ltctor foi tED<br />

Hypqtfllion b mng the d.in dodii.ble .bt fddo6 of ED litc hyFdipiddiq<br />

mtins rld diab.r6 nrdlir8 h $bj.ds hwiig 'l@ t!& otE of dw f..r6, di{ k<br />

morcthm.dditiv.!561581. Thft tu aidc@ of. rclarion !.t*4..tun lipi& ed<br />

bl@d prcsc, ind.p@dq of confounding vdiablq sch d !9. ud body t|N indd<br />

Th. ddr ihM in r!bl€@ tm mm th.r 41000 $bj.cts For in$.@ 0E audy of<br />

(zavdoni .1a1. 1989) 0591h.v. rcpo.ted ligniftrtly nbed 3t31olic dd dbtolic blood<br />

ptBgE i' stj.d! whohlE ni!.drdgly.qd. crd rcd!.ed HDL ctol€n@l WUiN<br />

a d. 0983) 0801 hrrc sugs€sr.d th.t ttc dpr*ion "r.nnid dt lpiddic<br />

ht!€n*ios" b. u5.d to dq@b.. Endtore of *6nd hyP.ncao b.foE the 39. of<br />

60,@s in two d rcrc ,bling who .lto 3hw oE or 'e of thrc PG'ibL liPid<br />

abmmditiB TIE dyslipideni! nont ily foud i5 LDL chol.lcrol $d itiglvcdid.<br />

c@qndion. IE lyidtrft oos in !t@lh$ 15% of p4pl. ritlt lDldi4do ttd<br />

'n<br />

mund 50to wnh cr.lt fanild htTension.<br />

By dtding 3au lipidd tn €f61 on blood prcs. wrs 3ludied bv wdld Halth<br />

OBEi'rtion wH.O na pith }04lqcholddldnj. who @i!td liiad lowaing dtu8 or<br />

pl@bo found r 25% reduclioi in lh. incid@ ofhyPsts3ion in th€ mo thos w@<br />

l'a..d *nh [Did loweins dDg s @P&.d snn o ioh..

---

€twd blood pr€sr. a told cno|sr.ol lw.ld6@s.d with rge, sd womm it<br />

inos$d firh as.. TIE irc n! tol.l clbl6r@l d ttiCy@ide lal wftn bbod<br />

Dru!@ wsr grcat.r in ovw.ight thf ir l@ Nbj.ds Thb lu8gest.d thrt body ms!<br />

D itsdf or f&rors {lsiat€d with body tr85! @ rdl.d to @MmtNnt .lcv.rion of blo.d<br />

p@rc od blood lipids Body .s indd modifi.d lhe cbrion wh6. as ooking sd<br />

pt'ysical .ctMty md &onol @nsmprion hd little intlu€@ on lh. alsi.lio.<br />

Sdm lipi& hwe a dird cf€cr on adotn.li.l inldion atd ratt iNqdeliioN<br />

showed lhsl norul veule ione Equir€s . tunc,ioning odoinct.l [tit$ ud<br />

dsdopnat of arhaoru tuy unrtdli. @reD.y !e3p!e4 (Dr*td.t d. ls9l) tl63l<br />

ttt?en nsion put d .xt6 3lr.in io thc long ffi on th€ hatt md !nod, Nsing<br />

pronarurc lging rnd hedding of rh. t t ri4 and ProB of dn@m. fonnrrion is<br />

6hrc.d Thrc h did.ne lhAt ondizld LDL b rhe liDid eial€d with d.f@tis<br />

endorlrelid tunclioa be..@ h o'nriblt6 to ath€rom a.ldothelbl cels el€e<br />

oiygd d.nv.d fr€ 6dic.ls in dE fon of $pd did. @ons rh.. n[' oridizc LDL<br />

Oxidiad LDL n.y lnd act o. qdoth.lilt ell6 to inhibh .ndoth.liun dep€nddr<br />

rcldlrion by wesl m6l6ih ircludi.s r.dudion of..dothlim ddiv.d dtnc on&<br />

srrnhdr o d.e ltsl. Endothdid dystunction hduc€d by hypaclolBt@lmj! n<br />

apidly cotrecLble in oromry andis Md in pdiph€rr! shtll blood Gsels by 'tduction<br />

of bott tor.l ad LDL cll61ml *ith dng r@rlmi liprcit|Mr i. @rouv<br />

sodil.rioo my .ontriblte to r€du.,lion in IltD aid rh. Bodilaiio. in pdiphsil<br />

afuid ity .xplain .cductron in blood pltsse. Cors4udnty, tnc drug tratnd of<br />

hypmhol*tmldi. my ad .itlB by Gducin8 fi. alfuin of LDL .v.itaht. for<br />

oxidation or by tunclioninesmmijoNdd To@phqol(liiein E) pot&ts agdNi<br />

chol6tdol indlc.d cdo$dj.l dySn rioi in @ddltdj.l cdls by P@oriig LDL<br />

52

---

Epideniological rcLalions betwefl blo{d pressure ei scrum lipids<br />

RcDoiedbY Good€ [1961<br />

Study No. of Lipid fi'acrions positi\€lv<br />

subiccts aisooiated vith blood pressure<br />

Tecums€h 3064 Total chol€slerol, lriglvcrride<br />

Cornmunity he€.lth<br />

South€m Califomia 4839 Total oholestcrol, tielyc€ridc<br />

Lipid Research Clinics Triglyceride + \|LDL &<br />

ProgrammePrcvalence 1747 cbol€stcrol.<br />

Frdrningham 5127 Total chol€sterol<br />

Tromso 16144 Total oholest€rol, LDL<br />

Zavarcni<br />

Williams<br />

f'4 Triglycedde<br />

6128 LDl-ohol€.st€rol<br />

VLDL = Vcry low ddsily lipoprot€itr Coftlttion witl tvstolic<br />

HDL = High dersity lipoprcteh Blood prcssurc is sirftdcalv<br />

LDL = L.w d6ity lipop.otein siSDific$t<br />

53

---

4.7 "M6b.nbn ofr|l. irtm.(io! of[yD.]t ntlo!.nd ItrL<br />

utT.rtcNion &d h}'acholdaroldi! e two @jor nsk f.cio6 for lh.<br />

devclopment ofath@Flerosis thlr qu€ IHD A del€ie b3lm@.n!t! bciwar Frun<br />

lipids, platelas, h€nodllMic f.clors viz. Olood v6Fl shd is d€pflddl on bl@d flov<br />

Bt., bl@d vis3ity dd fie onpli.nc€ of bl@d vs.l itser ed rh. blood t!$.1*d)<br />

t l66l<br />

HtT.nadon is ft.qu.lrt lgiltcd with lbmmal .nucturrl or tulclio!.I<br />

.h&g6 i. lhc v.srld val i.c. ddothdirl iDjury, c.I ndblw.hrn liri6 (ioi<br />

ln$pon.d E?tor), prclil@iion.rxl gtuwll of lreid a[5, pldd.t dtstunclion<br />

ord lipop.olcin deposition and cl*r'e Thc meheis of tlE i mrion of<br />

hyT..tcDsion md hlpqcnobsteolemja that &c.lmre th€ dddopmnt of&iD ir gH<br />

i) HtTert4ion nay be 'Mdlted with qdoth€lid injury or its dystunctron<br />

Altr€d o.loth.li.l tunction l in&grity my p..dispos to plntd.t dgst%ation 4d 3lt .€d<br />

vt$l w.[ ! @n@ s,tich nim!|.t. proliftRt on dd sos4h of !tsot]& c.ll.<br />

ii) Eler€d stM total chol*rqol mt '4lad. lipid d.?oidon .nd formtio. of<br />

rlhfteLotic plaqua h tyFrtolion th. rd. of.l@ of fipoprorcin fton 1he<br />

!!sl wlU @ Gduced d $tucfilol ldrprltion of blood v*s.l in cbonic httcnolo4<br />

$ch a incEa*d nele tu &d oin61iv. lisc nald4 roy l.d b teduc.d<br />

claBne of lipoprotein non lhe bl@d v4s€l $tU. Th€ m@hess rcsull in inc€i$d<br />

d.oo.ition! and a@mubnon of lioids ii the blood $els<br />

iii) Adrd.rBic acliElion (rdrci.lin. sr€tion) i! the synpdh.lic nFous sFt€n<br />

my b. irrclv.d in both lh. dd.lopmdt of hy?eddson md ln. .lhtotu of lipid<br />

m.ralolis. A nmbs offi.ro6 .trd hoth lipopror.in h.t bolis .nd blood prc$r.<br />

Dic.ry irnEn6 wtich 6i* blood p|g$rq tuy al$ de blood [ldr Eld.!.d blood<br />

pllsc ard blood lipids @y bc rd.l.d g.naic.ly Synp3rndic 'Efuu! sysrn<br />

iifu.@ @y l..d e i.cite in bl@d pGuE.nd mn lipitls. Thq€ .rc nunbs or<br />

w.y! by which adradgi€ mh&im inilde lipid mctabo[s For instMe th..cl@<br />

of lle faty rcids ton tiglyo€ddes by th€ influ@ of.d..nditc ot th. lctivity of<br />

lipoprotcin lip{e GPL) The eeyme thd hydrclt%s trielFsid€s to li€e fany rcids.<br />

u

---

dto autc dE !r ld! of vl-DI..p|El'gof LDL clbLddol.nd di6<br />

^dGdittc<br />

of cltoLdaol ii $c blood. Ar iMa|. in \4^DL rytdE& inoas tn@d digt6id.<br />

l.vd, rll cnoLdcd. Ad.lESic trEdtti.i 'fly .L!o rducc th lcvd of HDL 06t-<br />

r691.<br />

4,E DIETA||Y M NAGEMEI{T O8 EY?ERTINSTON<br />

GlnHi6 tu dE drDgsiE of |tyPalclid 9@ Fovid.d d Da.dio'!<br />

Ev.lu.rie.ttd TotEt ofhigh blood pr6elr.. Thc 1988 ,oid Ntriod Coimin .<br />

Epdt IlTOl rdvoc{- ioi pl'.trlr..ololic rltc|py (lodim lrd dcoltol r.si.rnr\<br />

wi8h. @ntrol .nd conlol of oltd ddbv|gLr dlt n ro.r) n tu foud.riod for .t|ti<br />

hyFtatiw t arun ii prti.ot! sitlt nild ltyD€totliot<br />

Tlt d.b Am dB 356222 Flor siltdri ldrory of ho.piLlizdi@ d<br />

nyq.rdid innrdioa ,io 94 r@c!.d ft( mltigL N* F.cor lilavqri@ T.id<br />

(MRTIF) ddirat! tt ftt for n|on lity ton trD oudrF r of fofiow up tniy.<br />

SirDla d d (1989) 07ll a€s.a.d {u. dtc liglr..llr rylolic or dnrolic blood<br />

pnlcrn" gral4 b dE rit& ofl}D. Mor!ov!. d|c .!9at pornd dffi thl. law<br />

clFL.tdol l.'d h€ diih. sdi..t3 ofdd( br Dodrlity non [u2\<br />

4.9 EYPERTENSTON AND OEf,SITY<br />

TIE &|hdr (Kqrd e. .l .1966 .d Fouid a d. t984 [?3, t't4l Fopor.d<br />

noln ftir srdi6 drt otqdty ir.! irnpo'l|tn naor irt* d.vdopnFr of htFr4i6<br />

ud ditDe6 ndliu !d borh e .gin d sith IllD. Il dlo .o rit{6 lo rlE<br />

d.vnior of Dlood Utid Lvd! 6p.ddt rij"g riglyqid. !d loEirg HDL crFLdaol.<br />

A.qdils ro Gillm (1987) tlt5l rt. upF body ob.dy i. .gid.d qith m<br />

iEar.d .irt fo. IHD. Tlc odi.. di{ @t by (Ksrd a d. 196, !761 dro*.d tur<br />

wishr 8'in itt al' tdlt lift oofiibrrd rtu|,|t t to dE dddo!'d of hypqtdirD<br />

l ainlift. wdShtrcdll'ioo LrSdy |qffirt*.hroon liric!. Th. blood prt.i!! of<br />

lMy p.dcn! sirh nild byD€rddoi ddqg virt oldi: Edidid G€ b.ftF<br />

d.ir|blc vdShr i! Err.d

---

Ex€rcie f.cilil8td w€ight r€duction !!d is d importsl @mpondt ofw.ight lo$<br />

..d wcidt @itrol prog.'m6. W.i8h @ntrclt e3sftl to th. dD€plnot of both<br />

blood ptlsse ed blood lipid le*. TIE los offew pound! do.s oh6. p i6rs @<br />

s.re a ! powertul €ialyst in r€d@irg blood pr€src sd blood choL ml l.vd,<br />

including \'LDL ed LDL choledaol l.wle lt also rdes HDL cholBLrol l€v.l [ 176].<br />

4IO DIABETES MELLITUS<br />

Di.bd6 M.llitur $ Rtul F.cto.lor IED<br />

Diaber.! is ! dirord.r not only of wbohydnr. m.tlbolistr blt also of proi.n<br />

&d lipid neralolim. Fo! iBtde two Mjo. @nplietione of didbet€s @Uilu3 &€<br />

lrhdosladis md lcr@iddb 0E dirod* of lilid iEr.lolis nE doniMt<br />

hrldliiddi. in di.b.t6 is hypenristdid@ir Th. s4ft lipoprctein lipe (DL)<br />

is rclivated by intulin thus iisllin d.t hncy assdat€d wilh unconftou€d diabctB E.y<br />

l..d to €l€Etion ofetud riglysidd lone tiM to th.l.v.l of l0o m moL4ile 07?-<br />

r?81.<br />

In nosi prtioq *n@ di.b.r6 i! und.i ltena!1. gly@ic o rol pdtisliig<br />

htFnriglyqid@i! is du. ro ovd prcd!.lroD of wDL by livd 0?91 Non 61dified<br />

frlty &ids divins fton adipo* tisle md !k l€t.l iusl. e th€ oajor @on for<br />

iicd!.d h€gatic 6gty@dde stntlcis Th* ne*ly sydheciAl $iglyeridB 6om the<br />

fiq c vrtl- is U

---

lipoprcteir nelalolisn bul th. rojor rigD6@e of trot.inurh in di.b.t6 &e dle to<br />

g.na.ljr4d ir.rt& in Belu p.nnability ard tllu nr.@nol@16 sch a LDL my<br />

entr th. lnqial sbintima at incrcastd ralcs, m efiGc1 dd.d fid lbetted by ht?€n.nrion<br />

s€vsal population studi4 harc dhom thal toi.l dd t-DL dolBtqol ld€ls<br />

@rdat€ politively win body wiglr. In prc{.dil! sdi.s, n ha hen obs*d th.r<br />

wh€i prni.ipets 8lioed w.ight then tod ctrol6Lrol l.vel Ms als iNrced &d wh€.<br />

tlEy lost w.iglt mm clbl.nfrl l*.b dq€sed [1841 Thce alsillio6 bE ba<br />

obw.d in n€tlbolic wed $udies in 6era-analFi! of detuire induc.d wejghl lo$.<br />

W€igtu lo$ @ft.d duing clolBterol lowdng di.t .y nodmedon a oM in the<br />

Di€r Han F6)ility Studr, th. Mohipl. Rist Fador rmdarioo Tdd (MRTIF) $d<br />

Lipid R6crch Clinics CorcDiy Pdrury kcv€ntion Ttial (LRC-CPPT) 0811861. The<br />

Fluilghs shdy hs dintr.d rh!. for *ery l0 lb wiSln g'it! loltl chol€$ml lml<br />

iie66 ? sg/dl in nd ed 5 ng/dl ir woM (A!hlc, dd K.ml, l9?4) 08?1.<br />

tlDL chol€n.rol ld.h e iNq!.ly alsiltcd vith body weidt sd tiSlysids<br />

ed I.DL e. positircly a.siltcd. Weight redu.:tion .ithd $mgh coldic rcsrriction or<br />

crloric dpoditu.. hs be. rhoM 10 lows tdgly€erid. lcvels dd Eis HDL<br />

chole$tuI l*ls. ln goE.l ob6. individ!.b (m@ d woM) h!v. 510 dg/d<br />

consisr.ndy low€r HDL cholBicrol ld!l! a omp.Ed with lcd @ntq P!tu 4d<br />

l5-llo ms/dl lddq tdslycc.ds l@*. The .ddinois of q@is to *eighl los<br />

prc8rdm..nh,l@ rhe irtu in HDL clEl.ndol l*.h noE thd the w.i8ht<br />

€duction alo@ obeftld by (wood.1.l. l99D [188].<br />

4.12 Ob6itr<br />

c.lodc inbd@ eailrng dnd q6iE irn ke o. ind.qu.l€ dPad'turc<br />

pmot6 w.iglt g{ii Exceslive body wogh, dm @nf€s lHD risk thrcugh rNising<br />

iotal dd LDL choldrot ed rislrqid. l.@l [t89]. The domi@t ef..t h<br />

tttgstigbsid@i! but in N*.ptible iidisdu.le it?6chol6tdoldi. is de oberEd<br />

due to inqdsed LDL fom.don. Th€.ds of nt?€drigly@dd@i. tu incr€Md hePstic<br />

57

---

\4-DL poduclroi dd this rc$li. &om u ndss.d rd6c of .(at@ff.d free flfly<br />

scids froft 'dipose 1i$iu€ which i. rm ltinulales h€palic tdslyc€ride prcduolioi [190].<br />

ob€sity h!5 h€q foud to ill.lte r0r!l body oxtga oenptio. ad in ium rcqui..s m<br />

irda!.d @di& dt Fr to fttfll dE naltolic ..q -ur@ot. Oh€ity slps t 3ig'!itr61<br />

'sstuion uith tlood Dr6eG atd c$dioweid incidaat h €bi! .pidhiologi€t<br />

studi* dd fier€ ar. sm didd@ rhil w.ish lo$ Iowdt blood pr6tut€ [l9ll.<br />

Slts h4 be! id@ii6cd B @trtibuine Actor to lh. d€vdoPndt of han<br />

dise but is di6@I ro es hs .fl€cis quditdively [l92]. llE inp.ct of evs] dly<br />

dar on blood pBM ard l@t nr€ hs b.6 w.I dmumoted [193-ls4]. Many<br />

h.lm6 c rclesd dlrins cB n|ilty adren lio.. @ndan lie dd cr.li$l ln<br />

gftr.l .drdalift h.! dE gr6re3t etr61 in i@ing lsrt n ., blood P..!3@ dd<br />

@di!c out put r€slting incB!€d mtoc$dial oxygd dmsnd. Th* hmon t adiv.le<br />

ln. .dipo€ tise cuing th€ lipolystu of storld tiglyoridd ard rcl@ of ii€e fdty<br />

ei& oM TIE rcles€d ia 6tty 8id! e tn6pon.d 1o vris tisd of lh. body<br />

Fniolsty livq thrcud pl|sm .lb@in 3 thcn @iq. H.P.rit tisbqidd ftr.Dl)<br />

rrntlElis h sriml.t€d d@ lo iturr*d irl|lu of Ae hny &id. Tbe I,LDL l€lj1Mts<br />

u€ ithdogenic panicle whicn @*r thc ltherogn*it Celisol itur€es fatty .od in<br />

bl@d md g.{rjc &idity. Strs oot or y .tr .rs pltysic.lly, brn n als afr.('3 th6 By of<br />

lninriig ad feling. tl95l<br />

5€

---

FIBCT @ lto\tB RSr.FACICRS OF IIID ON SRIrM<br />

IIKERTOIBNII<br />

CAT.'SE VI,DL ' LDL HDL<br />

l.<br />

2.<br />

I DDI'I<br />

OBESTTY<br />

a, srREstt<br />

5. HYTMI,RM|IA 1<br />

it t<br />

.IItrDI=hd!.dad'ff...(ItE I).<br />

*NIDDM - Noo ilrlbdr.nd.d drhc.. (Ir!.4.<br />

1<br />

t<br />

t<br />

59<br />

)toRttAL I€RMAL<br />

t<br />

t<br />

rs!&o.d ioo Mgb Il"4<br />

J

---

4.14) DrEr AS RISK FACTOR rOR tED<br />

Di€tary nodiiqtion tl,qrty r@msd€d for hyFchol6tddd| .trd<br />

htpdaloa th. *d! tmM caiding dlt A.rm fo. d.vdopnF|r and p@d.@ or<br />

IHD had .educ€d to hdf tne dt6 of |lID in Unit d stal4 0e6]. Th. wld *id.<br />

coiDanriw dudi.! bdwe.n food MsnDtion md EiD incid.ncet sh@ed sigrifi.mily<br />

mdlred ecirrior of fed h.bhs and IHD Nstonthch.bilsof imisr.! !, wno<br />

.doF.d rhe food cnoie ofrhe w phe ofuting, showd tulcd diE re@ in nr6 or<br />

lIiD bawa rh. Fw dvi|lmar ud dvc Dla.e, egS.sing rh. di.n ry ir$tc a a<br />

ds.tivc hclor GDoftiblc oftlEir IltD 1|16 Th* prelp.dirc obs.Mtroi.l.|d tc'<br />

the clo* relation of diaary iniat€ dd thc $b€q@t deldopoqr ofliiD. In vdious<br />

c4 @firol studi.s of the dsl fsdoB sh G hlT.dipiddi! ad htlqtd3ion peEil<br />

eoiglh.@ rhrn .6ntot, ur. nro o.drc..d cr{ |q$n of di.r.ty h.hiB for<br />

rh. c.e of ItlD d*lopnat dd il! petl.@. By.ltci.a diel{y ilrlt. of lp€ifc<br />

@nstitudts of di€r llio chlngEs lh. l.wls of risk f.cto , rctably ffi .hol4tqol<br />

ld€b.nd blmd oB$G. the cld iil!.@ ofdiet on blood cholBtqol l€v.h, bl@d<br />

prcgre .nd a. omic ch.rgE o dis.4 pregBnon *@ mt d ir sind trbdd3 of<br />

hllru.lh6cd@st in n! hqlE d ud p'g snd fte frdoB w. rodit.d tl8t.<br />

Metalolic atudicN in hur@ shoBrd, 0!t the chugpt in etunted fatt, &ids Dd<br />

chol€$.ol i ake r€slted in chrng€s oflhc bl@d chold.rol ldcls. SinilNrly ch.ngd in<br />

sdiun iitalc sd catotic @nt€m ofrh. di.r @dd prod@ ptldi.taue ch.n86 ir blood<br />

plBs@ sinihdy '*qd prd4 of lowi.g llID r.td by dia.nd dog iftqvolid<br />

ri.i! ofdie sbjds vith hypsctol€st oldli. or hndrsion hlE b+n obrd€d by<br />

lowcrina cholBtcrol Dd bl@d pBlur. This prcvids !n.vid@ for th€ dict-[lD<br />

rhcory d the rcldioNhip inemdi.& st€ps bctwen did ud IHD tuk r.ctoB [90]. The<br />

qlsttutvG rel.toBhip b.rwa di€ir.y conporents and cn$lkhcd risk li.lo6 muld<br />

b. . guid. lift to rtak dom il'c pcvs i@ ol:<br />

rotlt ud low d.n!it, lipoprot.in cholcsi,.ol (LDL), tdglyqid.s md ldgh dGity<br />

lipopot@ cholBt rcl (HDL), hid bl@d pr€sur€, ob.lity ud dialeles ncllitu3<br />

i) ChaneE in $t!6td falty .cid! i|idc.xphnq 60-8ry. of th. cnrn8. in tot l<br />

clDl€srcrol lcrl obsrd by di.tlry @dif6Iid.

---

ii)<br />

iii)<br />

Be lira int*c of c.lodca, povtu, nomf.t, proton ad sgrr .tur @ntrollinS<br />

for etDt d fary &i&, 3how.d no relatioBhip wtb IHD hciden d r.te<br />

A sierif@r posidw 6r.lri@ b.lv€ rod chol..t@l .!d HDL clDlesrml<br />

in school childio of agc 1619 y6 w obla€d i! clNi@ri study &d in<br />

Bogalue dudy in both white dd bl..t ctildr€n b't 6r in Japd* ma liirg in<br />

rl.wd Tlds o@ agrin @ft|ud6 rh.t otilllltMt lppars lo b. n@ inponal<br />

the Ssaic<br />

in det€mining *run lipid l€vcl!. A pan noi orhs influ€.cing rbl(<br />

f.clors, r€lario'ship for wiation in mm lipid-prot.i! .nd IHD r.rc!,<br />

@vnom.nt wa ob@cd to b. mm etr.NiE rha aq.iic<br />

in detcminilg lipid<br />

ld€ls in wdoa sbja16 b€lonsiig ro dif€r€nt dvircM.ntd coidnioN 034]<br />

Didary fdsr @mpoed of tdgbsidca, $* ue 8ly6ol 4t.B ofllrc. frny rcids<br />

(slunt 4 rcrcuehr..td..d pob!.5inna&d tltty &i&).<br />

Arih.l f.r is rich ir ehlntcd fattl. &ids. Fq. htty &ids &. @monly p..gt i..<br />

lauric lcid (C 12 0), mrdstic aci& (c l4:0), palnitic eid (cl6:0) .nd tldic acid (cl8:0)<br />

Salu6r.d frtty &ids Eie LDL clol.d.rol l4tr! by.cdlcirg LDL @plor..'rivity.<br />

094 The fatty &ids havins clah l6gth 12-16, d nF lhe sfu chol6rdol ld.l<br />

wlnle medim chlii lridrcdd6 onr.iiing fitty ei& (c3:0-cl0:0) do rct 6i* th.<br />

tot l o. LDt-.tol6rdoll*l tngasd, ingcaton of l0 gD ofstuntcd tuty @& for<br />

svqal we€ks ois! tolal ud LDL la€k E"lo nsi/dlll98l.<br />

,1.16 Monoonrtlnad F.trt Acirb<br />

Monou@tuat d f$iy &i& ae sb.ltcgoriz.d by the positio.d imd ofrhe double<br />

bond ciemtr@tulrurat€d ed ttu mmuneanrcd Afiy &i&.<br />

.) Cb-nonolnstunt.d htty .cidr: The nod @mon ciemno-unsturared fiiiy<br />

eid b ohic &id (Cl8:l). thee ubhuitous in both din l rnd v.sdable f!t. Low<br />

satur.l.d far (v.!€idrl€ oils) with nor! thd 5orl. of thei. tuty 4id! F olire oil,<br />

61

---

efr()M oil, $nfo*d oil ed @oh oil. llw fnty &idr re @trrl in rhar ftithd<br />

ois n6lorq totd sd LDL cholqlqol le.b 0991 Dat Ngli 4.iemon@Natuald<br />

fatty &id! od low in lcru6t€d faty lcids, @nsunad during the 1950t (6n*) h<br />

Meditded rceroa h.w b*n deqia&d wnh bP ,{td oflHD [200].<br />

b) TdnsMonomutlnr.d Frttt Acidr:<br />

Tralr cohng!..d honounsaiur.L! ee found in 4n!in mat f.ts N w.I $<br />

htdrog...r.d v€g.trbl. oib. In poqs of nydroS.n li@ veg.t bl. otu wnh<br />

und6inbL cn&clqisiq (c I hudr

---

{r8 OE.gr }F.lit .cid&<br />

The omon long chah meg! 3 fitty eids @ ei@$peitdoic (EPA C20:4)<br />

dd do@eh€JlMdc (DHA c20:4) .nd doelFx.mic (DHA. c22:6). Th* e<br />

predonimdy fqird in 6!h oil ad $e tt8dible oiL rctrbly ca.ola oil &d elt@<br />

oil,h.Ea!hon6chinom.sr3'turyrcidlimloc .od(Cl8r3). NdsthdscMui6<br />

with hjst di.t ry ft.lc of lory cnrin omc& 3 hity ei& h.v. low ol4 of IHD [205]<br />

4 19 tt ilry Inyrod.rdr<br />

Di.t .y phtrol@k e fourd ir thc uN.!mif.bl. fr..lion of ltSci|llc &ls<br />

Phtlolterol! m found in .ll wg.lsbl. oih lnd in high @n6tBnon in @n oil ed tie<br />

bre oil. Tne nigh @nt6r ofptr),to3t€rc| qplu $e er.rl6 thd pr€dictcd cholst€rol<br />

lowe.iig ptupsri* orth* oils wlF $bnihlcd fd frt5 hisld n s!turr.d finy &id5.<br />

Plrrlon@l 6bp@n& h.E prcduc.d .ftcrir lMirg of tot l &d LDL clbl6tdol nl<br />

popuhtions @mnins hishq qudnn.s of did.'1 ohol.stdol [204].<br />

D.rsry fba m bG cltr.ctqiz.d ir rct6l mts €.9 dig.*ible. non digdiblc, elubl.<br />

iislublc dd @dddidr.y, Fib6 *hi.h b eluble in wlis h.E the lipid lowsing ef€cI<br />

a shoM in the studi* of(K.y 1982) [206] prnicdely LDL ctoledqol. Diily inr.te<br />

oro.t b6 (ll gm btd 6bs. 6 8nn $lubl. rb.r) or o.l nEl (5 gm lotd 6bd, 3<br />

grun $lublc fhd) 6 106 $tal ad LDL choLddl lad! by 5 6s/dl 120?1.<br />

63

---

Th. t Lr ofDd€n ob[ir t6 ototjddE lgu DqEn oldic. fr@<br />

frt in0!.!6 rdsly6id6 nd HDL. Er6irc rnobdnre inbtc b dicl tdd ro Ei$<br />

ldglycliilet rid loE IiDL Lvd *lr.d lN qudttitns oftu! e tlfd in dE dilas C,..<br />

l* rhs 25% of c.lqic. tw tu s lmc tLn (t/6 of 6|.dn tuu qnobdtnd). h<br />

@trlolipid@ic aubjc6l!, thc n grtudo of tnSl!@ddc rft. don ftom low itn*6 of<br />

didlry tu.ttd higl orto|l!/drdc dict! rod r. rie 3Glo0 !E ofLiEtlcid.! |'d 106<br />

l4 lu/dl of HDr.dblc*dl {2081.<br />

64

---

CHAPTER FIVE<br />

MATCRIAL<br />

AND<br />

MCTHODS

---

P,rxT-.r i MATERJAL<br />

5. STUDY POPT'LAIION<br />

5.I. IUD PATIDNTS<br />

CHAPTER FryE<br />

MATERIAL AND METHODS<br />

Both m and Fomn p icnr! of|g! 20'70,es ircluded in th.6tudy ofllD,<br />

wde €hher ldhitt€d or .nending 6 out pali.nt in @ron ry (re unit ofchsndlo Medic0l<br />

Coll.ge HGph.l (cMclt, LskM.<br />

Tb€ plliots we clilically obeid in ro fouowinA rhc groupr.<br />

ii) Myo@did inbrdim<br />

nl swiwB of ny(rdi.l in6r.don<br />

5.2 TEE SYMPTOMS OF ItrD<br />

a) lrpic.Iy hisiory of chdt plii &@npei.d by<br />

b) El6lro@diorraphic chdses i.c rbnomal B.C.G<br />

4 T8icd ns in @tdi& €r4na:<br />

i) CErinirc pnosphoti@ (CPK) (ii) kdlt D4/d6g€|@ (LDrO<br />

(iiD A5p.rtd. td@in& (Asn.<br />

Thc !tudy ebje.rs w4 clsrifed .@rdil8 to !gp, s.'d ocqrytond gtups<br />

5.3. AGE GROT'PS

---

5.4<br />

1S<br />

sf,x cRours<br />

SOCIOBCONOMiC GROUPS<br />

(in) BwiN cla!<br />

TlE p@n l history of paii€nr r€gfding !g!, !e! pra@l o@D6tio4 rclid.ntid<br />

a@ (ru6!u'!d), height, body w.idt, pltrsi@l aclvity, .duqlio4 di.tiry &d<br />

cieEett€ mkiig hdbits w@ coU€cEd tltr@gh the adninltBlior of<br />

qu.lti@irc prcp..rd speilily for th. plrpos.<br />

5.5.1 Eduqriour sr.aur Alsst l0 of 3tudy in elel.<br />

'qs<br />

5 5.2 lLitldrii St h.: T6 y4 3r.y .r oD. pl..q 9g tlka d 6. 6idqE ofthc<br />

s.5 I Urb.!: Ar d@ ofroM @minc B @nddd€d B ulu<br />

5.5 4 Sootitrg b.bib: Ciss.tt. mk.F, no. sok@ u q{mt4 w@<br />

int M@ed for th€ infomtion on thc nunbq of cigr.ett6 putrcd pd &y<br />

C.stim of@old.g fo. th. p!!r tm y€d wse t.kd a q-smotet<br />

5 5.4 Eyp.rt !riv.: HtFrtcnrion in $e irditdual diagnos.d s thc sysiolic bl@d<br />

prNre pdsistently above 160 m Hg or dirstolc blood presw rbov. 90 m<br />

Hg d on rerrtndr of hyFr&ruion in study poPirrion y@ c@t d s<br />

5.56 lr'{b..i6: Dilb.rd rdlitu a dirgrd.d d the bdis of ioplircd du.@<br />

tol€la@ tesr or bcing ralcd for dirbd.3, in ln sdy l@ drned as dirb.rics<br />

& the Me dre aI @F dilt tic I}lD plridrs als undfldr onl 81u.4!.<br />

66

---

5,5.7 Ftn y nirtory of IUD<br />

4,6<br />

5.1<br />

5.3<br />

5.9<br />

the fanily htto.y of IHD n l.lidt! q4 t ho politivc if tn. blood rcLtcd hd<br />

b6 infi6.d Aon lhe dire (trlD)<br />

EXCLUSION CRITTRIA<br />

The pali4ts on lipid lowding drugA<br />

n€phmtic ctrttrc@, F.gMd ft$l6.rd<br />

htlollryidkn\ cnrchic rc..| f.ilure,<br />

Gnilid hrTcdipiddi6 94 dcluded<br />

ETEICA! CONSIDERATION<br />

i) Prior to 3tudy, r @n*nt ofvdious g@pe in thc study a ohlin€d fton a!<br />

tne @trfl.d incloding d€ rtlatdds of p.tqnt<br />

n) Th€ sdy prerool hN bd.ppw.d br Lh€ hdltd idniiist dion.<br />

CONTROL SUEJECTS<br />

A$mdy hahhy nor@l aDjFis of l[. !.m B@g6phic.l @ wftn<br />

6mpdt bl. .gc od sio€@mic at.nB mrdy hon tL ltt nduts i.e.<br />

(rel.dEs or fmily tiedi) dd r.dddls fiom rte rclcvur @ ed populnion or<br />

Let&a ud adjoinins a@ s!r. eLci.d d @nlrolt<br />

Thir .1c.1@rdiosnphs (E.C.G) B@ mmd. rh.y wre @mlcroivq non<br />

uotq, .onnilb.tie dd h*i.g .altirc f.iit hito.y of o.did.gbr<br />

dis€e, dd thdcforc me on my m.d,cliion w@ studi€d dudng th. s@<br />

ptriod d that of p|riqt!.<br />

Blood SuDl€: Colelior .od $ont.<br />

Blo.d sd6 ddM 6on u rnidbid vdn oftllc p.lidts ud @ iol $bj61s<br />

in siiiinA position in thc nomjng .nd os nigln fasting of 12-14 h@n b.twa<br />

0840Itr - 10.00lu Ning plasrio dilposbl€ striogps Tlt€ blood mpl* collccl.d<br />

b a p.edqn d gbs luter tovid.d etn pbstic $@ ops w. alow.d to clot<br />

for nc hoa |l 3?bc. Blood er we s€96.d.d by uing clinql @tdtu€l .t<br />

67

---

the sp..d of 1500 rrn.p for trcal minr.!, qlre lcpt d l8cc rill tt at'un liq<br />

of lipid. rld lipop.Dr.id.<br />

AI tlE co!F@ gh!.w€ including ov€ft. |||d dE !{npl. 6n .riig hotda<br />

.lobg eith ihcir qt. 9@ cl€d!.d !y ioE nitg in 8N nitnc &id for 24 houd,<br />

e!5h.4 ritE d'ih&iori4d ea..|nd o€ &i.4 plidto tht u.<br />

5.10 Q.dlty Cd.nl<br />

i) Tl'. Lbondy qr.lity @ntrl t!g'G n|ctudd ibplic.L of md6 .!d<br />

rcpo.t r@ .v€ng. ofthe dupliclt! rtras.<br />

D AI !.n t! lipid d...''indi@ snr c.ni.d oul in th. !.m Lbdtory.<br />

iii) Tnc coffitrl F!..dr6 br tlc lidd dindid irctutld ltc u of ft3l<br />

sted.rd lolution with q.t! si6, IlE ffnal conmtnlid B deiltd iom ihe<br />

stadatl o$m&tu ct D8rctd.<br />

60

---

P,.ir-e MEI-lloDs<br />

ii)<br />

All th. ch6ic.ls usd h !r.l9ic.l meinod! w.r. of {alytical 9..d.<br />

sppli.d by the Muhiorjoi.l Chdic€l SuppI.B.<br />

Th. damiDlrion of biet@i.tl wirNd nom the s of th. sddy<br />

popql.lion (D6tidrs ed @mrcl sbj..r!) lw $.d @ l! pindpL<br />

d.rcdb.d by the bioch.nicd srutud Lits.<br />

5.I. ESTIMATION OF SERUM TOTAL CEOLESTEROL<br />

sdn rotd .hol€$6ol ws cridt d @rding ro th. m.0rod of Si€dcl a d.<br />

(1931) by u3i.g B..llines MtnnlEin GDbH 63m, Mrllhcin 31, w CqrDny.<br />

Kn (C . No.32?574 Monto6l Choldrdl)<br />

Chol6t@l dc6 in fie mm !dpl. t htdrclys€d into fr* clol€st@l by rh.<br />

r.1ion of clrcl.s@l €s.@. ctFl.sl@l on{be didi6 dl rhc clbl€3r@l<br />

0:@ + Ubmr.d) ro 4 crE|dro|on wirt rlE prcdu.rid of htdmga Fond.,<br />

wl ch by th. ..ri@ olpeuils. &d in th€ pr€s.@ of +mircph.n@ne ud<br />

phdol b @nvefled into a piil @lou@d producr, 4(P-b@oquinoft'nonoiftno)<br />

ph.Mrc.<br />

TIE ra.rion oc.s a fo[@i:<br />

Ed@e<br />

Chol*tdol 6rd + q Chdd@l<br />

6;e----------r><br />

Ch.les@l + RCOOE<br />

2H:Or+4sircphcneonc P@xida:e 4.(P-bdoquinonedonoinino!<br />

.rhenol DhenMn; I aH,O<br />

69

---

Pr.prlion of qg@t $lutioi:<br />

Th. cotnd! ofbotrL (Car. No.237t74) $pplied by Boctuingq M&nh.ir in dE<br />

@nqtotioB giw! b.low:<br />

ldsbuf€r (Phosphlre) (100 n. noll pH 77), M!$$ium A!p!.t t6 (50<br />

m.mvl-), a{ircpi@n. (l n.rc!L), ediM .hold. (10 n.iovl) phaol<br />

(6 n.mvl-) 1,4-dicl'loropnool (4 n.ml,'L), Mrc,(y polyc€rhoxy-n{k@<br />

(0.3%), cholc(qol 6t€@ (0.4 U/n ), chol6rsol on.b* (0.25 U/nl) ud<br />

psond8e (02 U/n ) ws€ dblolv.d in dislild Ml€r to mk 100 ml in<br />

volumtric flrlt. Thir e{gBrt in elulion fom *a fiabl€ a. 2-8qC Ln!@n!€<br />

fd foor *err. Th. @ga B ady for e.<br />

Th.€e t6t tub$ for mple tur&k q@ t.l@ in dupli.aE ed lab€l.d a t6t<br />

spl." d6drd .nd blut Eeh tube M 6I.d ud pEpu.d s ftntioncd in<br />

llhilr fom ed prcced.d .ful|y b s{e @nditions fo.ddmdon of loi.!<br />

Trble dDwing contsts t.I€n for 6tid.tion.<br />

The @nt€nts of thc tub6<br />

Radhgs wc r*@ ar<br />

tr r2 sr sr<br />

*.r. nir.d bd indbtt.d<br />

500 @ in Bd$h 8nd<br />

70<br />

for l0 ninut* !t 37.C.

---

Sto.L ChoLrr@l Sr.!d.rd lolItlo!<br />

Thh B prcpded by di$olvirS 1.0 Irn of cholsr@l i. 90 n t of dd.l &.ti.<br />

&id in a rcllmtd. flsI lrd tlE lolun w !d! lo 100 il *ith h. ThG<br />

etnioB @n !?ori! ro l00o n€/dl ofclol{.!.@|.<br />

WaU|! CrCdrd.l Str.d!r{ S.ardo.<br />

Thc e@ Flrdd !y t ldng 10, 2q l0 dd lo d of lto.l rltd.rd shrtion h<br />

loo tr volutrEtic fs& ed rh. rclun€ ,@ o.& lo 100 il vith gh.i.l.stic<br />

&id. nE$ ddds& cor..pondcd to 100, 200, lm ed 4oo n8/dl of<br />

cioLsr@l r6p6liwly.<br />

At$rb.@ of sd.<br />

i Coratr,tidof c.td.td<br />

(ndd0<br />

O.O2 nd of e.l trid.rd E ucd itr ttE .m ny u d*Sed tu gu $npl.<br />

T1 .b!orb.!@ ohrin d *ri. plott d .g.ii{ tlE @o..dtIi@ ofctol..t@|.<br />

71

---

F<br />

(.)<br />

z<br />

dl<br />

o<br />

d)<br />

0.8<br />

0.6<br />

0.5<br />

0.4<br />

0.3<br />

o.2<br />

0.1<br />

o<br />

FIGURE - ,I<br />

STANDARD CURVE FOR SERUM T.CHOLESTEROL<br />

ToTAL CHOIESTEROL (ms/dl)<br />

72

---

5.2. ESTIMATION OF SERI'M EDI.CEOLESTEROL<br />

Sdm liDL cholBtdol ws csdnated @ording to thc ndhod Ppon€d by<br />

BuBt€in d sl (1970) usins Bollingd lttlDtEii W G.moy kit (Crt NO<br />

543004)<br />

Reeat $pplicd uw p..t!..d .d ady lo @. Th. r@nditut€d slulioN<br />

w@ n!U. r 2-8"C foi si{ s!.k.<br />

rDL cholesteol is meer.d .ftr sNm low d@ity lipoproi.in LDL and vdy<br />

tow ddity lipopret€in (wDL) e el€cliwly plc.iph .d our by uins<br />

phdphotunggic @d .nd mrndun io$ $ th. spl€ dd d@td bt<br />

qdn€rioi. TIE high d4ity lipop.otch cl'ol€$6ol @md h th $FEtl|r<br />

a da.mircd dzymelic.ly.<br />

Phosphounsstic acid (l.4 d.mL/L) ed Maen6iun chloridc (8.6 m.noul)<br />

ln a $dl qrituse tube" 0 5 nd !.M sde m nircd vith I bl Fcipitrtt<br />

@eft Gh6phoru.ss!. dd od msGi6 dtlo.iL) TIF co .,!l! of0E nt v@<br />

mix.d on vonq rhlks. rloe€d lo sbnd for 5 6inut6 .t 30oC<br />

Ihe @nt nrs wcr. a.tritugpd for l0 dinur€s in the mtritug. !t 4000 r.p.m. Thc<br />

cld $Ftutdr coot.iiing rlDL cnolBr@l w cp@t€d inn diat ly,<br />

TdoDL alrl<br />

73

---

cd.trld..<br />

It oito..oflbE qb E dd'.d{tuUd h . Erd od Id<br />

Iduic2r s?dqrtudra 5q)u.<br />

HD[. doL..'d (ryfd)- lr.9 r lborbr.. dnpL<br />

I! c.. dL ryd r- d & d. !o ligb ltlrd. .@ 6.<br />

?.dD r.r dtd r:r db cgx rn|! d.di. d 6 F.d@d<br />

F!..turl'|rrq.cn Tl.nltu(frdErdfildty1<br />

7a

---

S.3. ESTIMAIION OF SERUM LDI-CSOLI]STEROL<br />

By rddition ofcert.ia dphipsthic polysds (gjv.n below) LDL w.! prccipital.d<br />

our which wd thd solubiliz.d by (sdius citate dd sodim chbndc). Il'cir<br />

choldtdol Fa.tiotr d!*hircd fttrEtic€Iy by tlE ndhod of chol.nsol<br />

Raaats us€d r@ provid.d in sdy to u$ nite by BiGM.ddx, rtue. Ih.<br />

r.r86t' h.tl the fo[o*irg coopolitions<br />

I LDl-Precipitatins t6s6i: Polycrclic dionic !urf.@ adire agdt (0.4 8/L), poly<br />

ondeoed poly ctrlic luda.c sdiv. rg€ot, poly $bstitut d dioxu. (12.4<br />

m.movL) md imi&alc butra pH 6 l0 (25 n nor/L).<br />

2 LDL Soluhilti.g rag@i: Trilodiun citntc (0r5 moVL) ud ud sdiun<br />

cNdide(0.r1 {d/L)<br />

3 Chold@l .nzlc Egs : Chol*r€.ol .me (4.0 t u/L), clEldfrl ond&<br />

(1.0 U/L) md p@xid.* (80 U/L)<br />

4 Colour.€e4l u) Pol!$ium pholpanr. pH 7 5 (0 2 mdVL, phdolQOmoulr.<br />

polyerhy'a€ sly@l-morc-€ths (4.0 s/L) dd polyeuyld. sly@l nono-alkyl<br />

.thq (10 sr-} @) Ph€iyl a3-dih.lhyl4dino-p,@le (0 08 noyl).<br />

Pr.Drnlio! ot Crlour Retdt<br />

One r of @lu Eg@t B &d I r ofoEytre mixnft M lddc

---

@npld. pEipnadon. Ccrt.itua.d for 5 minut€s.t ,O00 rp.m.!d ih. rBid!.<br />

w6 l.'kd md Fdi$olvcd by rddins the sollbilizing @spni (tisodium chrite<br />

dd sodiun ohond.).<br />

b) fhre relt tubes for mple sdtr.s wlre bkcn in duplidl€ dd l$clt.d s t.!t<br />

sdpl., *andard and bl..l. E!.h tube w 6[ed ed gepded d tunion d ii<br />

tlbuLr fom dd proc.6d.d q&lt in thc @. odnion for 6rin don of LDL<br />

TdL slDwirg 6tq'r! trt n for cnin rim.<br />

.|€bdd]7.cfdtrEDilc<br />

r.r urr. shddd Bbj.<br />

l0 1.0 l0 r0 1.0<br />

R€.ding w* tlm.t 500 m uling Borsh & l,r$ Sp..rMic 21,<br />

LDL cl'oLdml (m8/d) =<br />

Ab$.t{E ofr!'dsd<br />

C@6t6tion of dddi.d h 38.? &d dilution frclor is 10, o. @unt of srum<br />

dilutio. mde for p@ipilcrio. and &lubili:{ion.

---

5.'. ESTIM TTON OF SERUM AMLTPROTf,IN 4.1<br />

Sdn apolipoprotei! An M dinat€d by imuocnoric.l s$y @rdin8 to<br />

the mdhod 'eponed by Gil&rd .t sl uriig rh. odon Diagnoslic4 Espoo, Finland<br />

kjl (car. No. D-26t.<br />

TurbidineEic l||e!|ltffir of rlE nnige. .ntuy Eation b.*d on<br />

inlllllcpEipit don a f* $psirioi of prniodde dna.rd lh6 @ring<br />

rh. d.gE to whi.h dtb $lpeneion blo*! lsnt dons. gi6 p.lh Cltlidinary)<br />

by sing spdtrophoronctd. Th. mount ofbl@ked lidt is propo.tioml tolhc<br />

con dtBtion ofpanicl$.<br />

,,q.polipoprcr.in A-l butr., Apolipoprotcin A-l eti sru re.gdr, |polipoprolch<br />

rcfccn@ aid sodium cdorid. elutior (0 */.).<br />

Pnlrdtu! oa.trli!@D ug6t<br />

Conl@ts of6e bonl€ @iuirilg (l n ofapolipopotin A- I .mis.M 6gdt<br />

M diluted wirh 40 r of.polipop.ot.ir A-l b!trd sitt th. arjo of l:41. Mixcd<br />

gcntly dd allortd to $and for 15 ninut r.l 30.C. IE mtimm qgot .id<br />

r*o$tirution wa sable ar 2-8 0c tmpditurc.<br />

Afls tnordirg the ltm ratrpci.luc dE !.m 6 diluled with N&l 0 9,/c in<br />

lh. ratio of r: r 5 .rd rhorqght nix.d.<br />

On. tube @h fo. spl..id blrnt wd€ t kd. 0.03 n ot dilut.d cNo mde<br />

M dded ro the nrb€ @t€d a! $mplc .nd blanl. In ofrpolipoprotcin. A-l<br />

b!fr€r M add€d in bldl tub.3!d I mlofdihted dti!!'m qgot B added in<br />

77

---

sple n$e. All tlE tube6 wc.llow.rt to sl&d at l{PC for 30 nitutB. Uliig<br />

nic@wn.q lberb.@ a eg!!d .grird (4olipoprcteb A-l butrd)<br />

blet in Bo.ftinga M...rrdn photoDad :Ol0 rt . Brdagth of3,O m<br />

Fl)mb: ^A=At Ao<br />

Wl@ Al = Abetb.@ of 1e!. splc<br />

Ao = A!e6.@ ofbhrl<br />

A = Ch.nge ofabrerhiw<br />

The mple colMradoi $r! 4durl.d Oom th€ si&dad cw€ prcpeed fo.<br />

a) Rcouftutio! of.pollpopret ln rd.r.nc.<br />

I0n ofredbtil|! mtd ws sddcd to apolipopror.in r€frde vir! by swiding<br />

g6tly ed M 8lo{€d to it d for I hdr d 30"C (Shatins sbtnd b. .widd)<br />

Rsns lnd id ir lrlblc for !t l.r!l 2 mmts r. 2-8.C.<br />

b) PEpddDn ol dm.dr.o!@E tbr of.poltDoDtltdtr<br />

Alolipoprd.in rcfdag vft pcprd by dihning uin 0 t/. N.d slulion 6<br />

s.No DIL(moN coNcEMRATloN ar.lipopdi! -A-l<br />

L l:48 0.3l2xc<br />

2. l:24 0 625xC<br />

l. l:12 l.25OxC<br />

4 l:6<br />

2.50OxC<br />

3.t50rc<br />

7A<br />

2a<br />

56<br />

|2<br />

225<br />

337

---

C - @€|!di@ ofapoliropror.in A-l *hki L.qud lo 0.9 s& a drd.d 06 dE lid<br />

oftpop.otdn rdet@<br />

C) PnFn i.. ofr..td.rd .||'.<br />

Ardiporro..tu A-l tu&rlt of n,56,ll\Ds d!31 ogll|lrc! Ft?.rd<br />

for rt d.nl olc 0.03 d ofat ryo: an i.!&tl ru rt dcd a .leib.d br ..tm<br />

rnplc Th..[dg. in.hor!.!r. ( A).tt!i"d {4 plond !s{!* or..poadiis<br />

co$€rmaiotu ofr.&6cc $rd.d @ . snph $p.r.

---

Eo€<br />

i5 0.4<br />

2<br />

6<br />

E<br />

o<br />

o,<br />

Qoe<br />

FIGIJRE .2<br />

STA},IDA'D CIJflE FOR APOTIPOPM]TN A1<br />

APOUFOPROTEIN Al (mg/dl)<br />

's

---

ESTIMATION OF SERT]M AP]OLIPOPROTEIN.B<br />

serum Apolipoprot.in B ws €srimt d by imuno.lmiol 3$|y lMrdirg 10 the<br />

rEliod r@ned by Glford .t d uliig the orion Di.grlonic!, EAoo, liilod<br />

Turbidimeric dellljmdr of rh. orig€n dibody @.lion bed o.<br />

imunoprdipiration wnich t .6rc s6posi@ of p.niculaL mlrra dd thd<br />

n.edng the dceE ro which thi! spsion bloct! [gl* .16g r grv6 p.rh<br />

(tlrlidindty) by uing spetrophodnaq. TlE .lN'n of bloct.d lel$ h<br />

proponiond ro rn. @n@t rlion of p.dicld<br />

Apolipoprolcin-B butrd, Apolipoprotein - B mi'edm regdt, ApolipoFotein<br />

Efercncq Sodiun.l qide solutioi 0 9r'lo<br />

Pr.p.ntio! of utirru ugdt<br />

contdls of rhc boile @it ining (l nt or lpolipoproriin-B r im asq )<br />

wrr dilurcd {irh 40 ni of .polipopror.iFB hrtrr wfth rh. Btjo of r :41. Th6 ir<br />

wF mix.d sddy md alosld to 3tand for 15 minur$ .t 3@C IlE rmistm<br />

rc.8.rt was stabl. dl 2-8oc.<br />

T!. mm M dilut€d wirh N.cl $hti@ (0 9/.) in tlE 6tio of l:15 dd<br />

lhorcugNy mn€d.<br />

One tob. e\ for bla,k and 3rrplc 10 b. erlyed w.rc rrlq 0.1n ofdilded<br />

@m srnpl. M add.d i. tut tub.. 0.9 n of ililut d stism 6gent B<br />

.dd.d in splc tube. AI rh. tub€ s@ .Iosrd to n nd rt l@C tonp€.r@<br />

fo. 30 mitul* Using nidodwttB, abettd@ w* n].s..d agritur bldl<br />

E1

---

(ryo: B buf.r) ir B@l[ined Menldm pholom.td - 4010 I a Mvddsth or<br />

Fomul| aa= Ar-Ao<br />

Vh@ A' - abrorbre oft6t<br />

Ao = Ahorbae otbhtl<br />

aa - Chsgc in !be!b!E<br />

TIE mplc @M.trton w cv.]uI.d Aob tlE nddrd om F!p.t!d ror<br />

r) R@lrriaoato.ot.DoupoDnr.ilrd.6@<br />

1.0 nn ofr.dinill.d mtd {B rdtlcd i. {olipoprot it Eto!@ vid by s ing<br />

ssnly &d w., r[]ow.d lo dxd for oB hou .t roon €nF.l@. (Slbti.g<br />

shoid b. r@idd). h ir $hl. for.t l4n 2 noida d 2{'C.<br />

b) Pnpndo! oIddI.Mt .od.rdtntlo! of liDoDrtLr.<br />

Apolirop.otdn rcftrre E pr.?sld by dilutjiS *ith 0.9% $btion of$diu<br />

dnqid. s fo[ows:<br />

S.NO DIUTION CONCENTMTION T'OrIX)PROTE|N -A<br />

L li24 O.62xC<br />

2. l:12 l.2to,€<br />

3. |6 2.500{c,<br />

5 1:3<br />

3.750|€<br />

5.000xC<br />

a2<br />

45<br />

t80<br />

270<br />

360

---

C{dd..dTolqd'Jr|ii.+lnOz|t'Lridort t|lof<br />

|0.IF .ndlrtEla<br />

q lnratdr-addr.<br />

Ag&ot !.iJ d. d44 tq rrq 270 d !o {td ra !..d ro<br />

FrF! .brLi sr. 0.r d d.n ad|H a- !d r dEnd t<br />

Ib &re h..dt-. ( aA) ff ra ded..8tu ooddr d<br />

Elt

---

E 0.6<br />

F<br />

o o.4<br />

z 6<br />

o lD ^"<br />

FIGURE - 3<br />

STANDARD CIJR\/E FOR APOUPOPROIEIT{ B<br />

200<br />

APOLIFOPROTEIN B (Mg/dD<br />

u

---

5.6. ESI'II\4ATION OF SERUM TRIGLYCT.RIDES<br />

Sdn trialyarid* lr@ €ljn[l.d tt $. 6zy@ric @lodnddc mdnod using<br />

conxd l$ontories, Knickqbotd, SAE Ba'.d@ (15), Sp.in ltn (Car<br />

No. 8-230)<br />

Snn iriglydide Me in@b.r.d wth !n €izrd. o*ing riglycdide M$le<br />

..tivity. thit lib@le dycaol ud &.. Ary &id!. T1E giy@l is tunhq<br />

orvar.d b BltqoLl-ph6ph.lc by gl}tdl ti|e !d ATP. The<br />

slyqoll-Phosphat ed NAD uc did onvat d by dycdol-l-phoa.he<br />

d.nydrce@ into djnydreiy..GioF ph$pnrre Dd NADH + E. th.<br />

NADH+H lib@t€d ud! with 2-Fiodo-phdyln-p-nitrophqyl<br />

5-ph.nyl-tdr@liun chjo.id€ (lNT) i! the pqe@ of diaphons to ptudu@ a<br />

@low€d fom,4 r'bich my b. mqsured at 500 M rld i! dirdly prcpofliool<br />

ro th. tdglyqidc @l@l''ion.<br />

Th. $oc c..rioB @ 3hoM a fouo$:<br />

t Tndvarid. + Hvdrcle hixtur. - Glv@l + Frttv ei&.<br />

ii) Clycol +AI? Gly@l tine Glycqol-l-phcphib + ADP<br />

N)<br />

Cil@!l-Pho$h.e + NAD Givcol.l!P-<br />

NADH+H+ INT<br />

P+NADII+H<br />

I1r. followiig @gsn slurionr wse sgplied by do,r[t.$ lllodory in the<br />

@r@.r.tioN 8i@ Hq:<br />

85

---

TdSt@idc tlydrcle (lm U/rJ). Glt@ol kit@ (l(l0 U&) Clyercl-l_P<br />

d.hydrogde (4000 U/L) Drpho@ (ro0 U/L).<br />

Td!.(lrydrcxyndhyl)&iimnahn. (50 n.dovl, pB 3.5)<br />

I Dilulnt raa@t (5oo n dclcsp in0.1dscl,/L). ed ntT (05 n motr-),<br />

magn€lium d odde (a n-t /L). ATP (0.4 mVL) ud N D (1 t m noVL)<br />

fEp.'rrion otiorlilg M!r!t<br />

7.5' ofrdsbf€rMgdt of (50 movl) ru 4h.d to orc ouvn|ric Eldt<br />

vid @ntdnins (trisbqid. hydrel8., gltqoll-P-d.hydrosde ald stcsl<br />

kire) .nd nixed gpntly to di!!olv. @.tcitu nis wting rcrgdl k stibl. for<br />

3 days al-10.C t€mpdtr@.<br />

An aqutu $ldion of sbt@l .quivdat lo 200 ng/dl of tflolq' (o!rc oil) ws<br />

M sith @h b.tch of mn splc .! . dltd.td ofltiSbcid..<br />

Thre. re$ rube for smple &.lydt v€r. laLo h duplicate od hbclcd 4 lest<br />

Mplq si!.ddd ard blant EI.h tub. wu 6ued and prcfl,cd a mdtioncd in<br />

l.buld fom and p@d.d d..lly in thc se @ndiioB for eltin.rion of 5.'m<br />

Trblc shosing 6'nats dd for Bdoxion

---

. Tdglrdid. Sbrdld<br />

a. boi.irn3?tn 6.i'a<br />

Lt opL Sr.d.rr d.<br />

Ttrrsls2t<br />

1,0 1.0 1.0 t.0 1,0<br />

Radilgs ew r.ta d 540 M in Bdrldr rd Lsb Sp..|'onc 2l<br />

Spctrcpnob@r€r.<br />

s.rum Tdst6id! (nrldl) =<br />

PnDrnlb! ofsl.!.hd C.n<br />

o.m o.02 -<br />

0,01 0.o2 -<br />

r.0 2.0 20 )0 r,0<br />

Th. d.ndrd clrw ws pFp.rd by t*ing d.nd.rdt ol dif€rst cmadrdios<br />

50, 100, Itq 20o, 250 .!d l00 'ng/dl fo0owld ad Dra€d.d a in d! ce or<br />

gm smlc.l*ih.d tto€<br />

A gr.ph M plotLd uling .b$rbr||c. rstind @6t!.!ion of sltfudt.<br />

a7

---

E<br />

8 o.+<br />

E o.s<br />

z<br />

@<br />

o o.2<br />

o.1<br />

FIGURE .4<br />

STANDARD CUFVE FOR TRIGLYCERIDES<br />

tm t50 m<br />

TRIGLYCERIoES (ms/dl)<br />

E6

---

5.7. ESTIMATION OF SERI'M PEOSPf,OUPIDS<br />

Rqg!!c<br />

Sdm phospholipils ** dim.tcd r.ddiig to ite 'dnod r?on€d by (zilv6_<br />

sni a d, 1950) uing Bodriigd Mu.lEn GrbE MrnnlEir! w. C@Dy, kit<br />

(Cil NO:I24974)<br />

Phorpholipids e pqjl$t.d pith tlicl o.qc.t c &id ed oxidi4d to phoryhat€<br />

Bith p€c onc {id rnd Mmg6 p@iida Phosphd. fmt ! colo €d @mpld<br />

virh rclttdite a.d vod.t. in $c pr6.@ oa.itric eid.<br />

All thc Fr3.nts wre $pplicd by Bocluirgd M€tudM in thc cdosrnnon grvd<br />

below Amooiun vddat€ (21 m.dol&), Ntnc .cd (028 N) Ash@iuD<br />

nolybdatc (40 n.@VL), sulphudc eid (2.5 N) Tdcldorclc.lic eid (209/d): 20<br />

gn oft ichlo.oa.€ric &id qs dislvld in dao.jz€d w!.r 8nd dilut.d to 100 n t<br />

in volum.t c fsk Dd pqlllloric eid (70,a) rldrogdF.oi& (3@,4)<br />

PbdplDnu St r.Lrd<br />

a) stock.tud{d (25 4/Pi/dl)l<br />

o lo9? g purc diied potssim dihyd'ogd phorphat M dholvcd in watd.nd<br />

t ml of lo N snphnic rcid w..! add.d volum€ M rEd. up to 100 nl with w.ld<br />

b) wo*iig St .datd (5 mg P'ldl)<br />

20s ofs@k d&{hrd wsdilut.d to lm d witheald.<br />

l) D.prct.iinalion:<br />

lna |0n Mtituge tube pip.tte<br />

Srnple 0I r<br />

lricl ororeric&id 2.0t<br />

89

---

tr) Dirslid<br />

l,6ad .nd dlo*ql lo st !d fd l0 Di.!t6 d 25.C, tta @tif|sEd for l0<br />

dDnd d aaoo .p.c cld oF .tE oh!io.d.<br />

Th@ td nD. for srpL dulylir w€ t kd ir dupli.d. ed lah.Ld s t6t<br />

edpL,30d.rd |lrd H.d. Frd tut ru 6lcd ud pr.Fr.d a 't.dtioi.d in<br />

rrhd{ rom rd F!e.d.d 6.rt i! (a im cddnioi! for .din don of<br />

T.blc lhdirg @.tq& t*d for ..rib.rio.<br />

2. Pt qb@.l|rtrl<br />

3. hldi.rtl(tot6)<br />

Plo4holDdPi n!/dl -<br />

Pho4[olipid nE/dl - Pto.tholitid Pi ntgidl x 25.<br />

r.r -r|. Sl-.tr<br />

0.I 0.t -<br />

0.1 0.1 -<br />

o.t oJ or 0-5 0t<br />

90

---

0-l rl of eh of thc J|d|!tlr rllr'r uta dd l,s4d ir!tut a deih.d br<br />

lou pholphoru .rd Edi.gr v* dd lgriln blek n 530 m in B&sh |'d Lomb<br />

Sp.clMic 2l SFtophoronetor. A lnph w plott 4 urlrg a!6o6.M w$g<br />

on q|lndon ofpbo.thoru! n ub.d.<br />

9l

---

z<br />

E<br />

o lo<br />

0.,f5<br />

o.4<br />

0.35<br />

0.3<br />

o.25<br />

o2<br />

0.15<br />

0.1<br />

0.05<br />

FIGURE - 5<br />

SIANDARD CURVE FOR PTIOSPHO UBD<br />

5to<br />

PHOSPHOLIPID<br />

15 20<br />

(PHoSPHoRUS) (m€y'dl)<br />

a.

---

5.'. ESTIMATION OF SERTIM TOTAL LIIIDS<br />

A kir oblri.ed fiom B@lrings M.itlEin (Cat. No:124303) Bls used tur th€<br />

esdn.non oftotd lipids b tu<br />

wla rhe blood lipi& m rdt.d wth oMitot.d slphlric eid, tn y &.<br />

oxidiz.d to kdoM rhat $bequauy grv€s pink @lou wnh t phosgnovojnin<br />

i) Sllphdci eid col6lrat€d (E. M*ck)<br />

D Cd@.aelrr Phoatoiic eid - 14 mvlveillin<br />

- ll @vL<br />

in) Lipid dand.rd 1000 ns/dl<br />

Tlre rest nrba for mple e.lylis wcrc klq in dupljde and l.b.Ld d &$<br />

spL, sia.d..d sd blanl. Elch obe wa 6l.d ud prcp4! a mdijon€d in<br />

l$olu tum Dd pro.c.d.d qrdt in 9rc @tdirN for caimtion ofiold<br />

lipids.<br />

I.bl€ shosing onl.nts tlkd tur .sination.<br />

Trt oD|. srr&d lul<br />

TrTrsrs2B<br />

1,.O '.O r.O 7.O 2.0<br />

0.0t 005 -<br />

93<br />

0.05 0.ol -

---

All thc tub6 *se phsg.d win gls w@l ..d @Dtq|l' of d€ tub. v4 nix€d<br />

dd dtld.d in boi[4 w.td b.lh for |0 ninut *<br />

AOq molin& 0.1 n frm rhc dig6r.d nirfirrc of.!.lr tub. ws ttu3&ncd ro<br />

@ftsponding d.i€d tube8. To.llttte tubes 25n ofcolour r€ag.nt sar addedi<br />

hix€d &d rllowed ro si&d for 30 niNt6 rt 20-3@C for thc colod<br />

dddoplFr. TIE i.talily of @lo{r * malcd €.ils tt U!|lin.<br />

Be$[ drl t nb lpcdronic 2l' Sp.drophoto'fia rt 5]0 d.<br />

ltFErnr olsr.ld.rd C!F.<br />

TIE *ul!d dtu a pr€p.rld !y dilliing in di6!r.r't o@madm 2@, ()0,<br />

600. 800 Md l0o0 ds/dl 6ins thc lipid si{dld (1000 ms/itl) prcvid.d with the<br />

kit (cat. No. 124303) obt.incd fton Bocluinspr Mannh€i4 tulowtd ud<br />

p.oe€d.d B in thc c& of mm spL .l&iH alorc.<br />

A grth vd plon€d odng .bdt6re .gd.!t oFraid of sandrdr.<br />

94

---

- --'€*<br />

F o.3<br />

ut<br />

o<br />

z<br />

16 02<br />

o<br />

.o<br />

o.1<br />

ii! Il<br />

I i,i il<br />

tl<br />

tl<br />

llr*ili<br />

iilnit<br />

FIGUBE - 8<br />

STAI.IOAND CURVE FOR TOTAL UPIDS<br />

,$o 600<br />

TOTAL LlPlDs (mg/dl)<br />

e5<br />

1000

---

5.9 f,STIMAIION OFSERUM URIC ACID<br />

sdd uic aci.l w €sriMt.d seording to dre rErhod .€port€d by (Ceaw.y<br />

.ir.d by vad.y, le6e) [2]61.<br />

ProteiB @ pMiphal€d by tui86ti. ei4 protcii ne. 6lraE is tr.aLd wilh<br />

phGphoturgtic &id ir thc pcse of edi@ cdboMrq Rlrluc€d<br />

plbsplbtuB3lic &id giB hlu. @lN. TIE intasity of tlE oldr ir dn€dy<br />

prcponioiil to qostty of ldc &id pllgt<br />

sodim trsrt|t. 00e/6), qrlplruric ldd (2,3 10, $di@ csnode 0d,6 w/v)<br />

Tungstic &id: 50 nls of lcelo sdius tung$are *a.dded to 50 n of23N<br />

sulplu.ic &id snd a drop ofphdphodc eid a mixcd. Th. volun w$ tutle<br />

up ro 800 nl *ilh dtniled *ard.<br />

50 gn of ediun tungsate (tulrtdal. &e) wB dh$lltd in .bdt 400 n or<br />

drcilled qtd. {0 n of35% pholthonc eid 6 !dd.d !d rcnuxcd gant for<br />

tro hous. Aie @oling lre3fcn.d 10.500 n lolundf,c n{*. volune<br />

Mde up to rh. h.rt with distilled witd<br />

b) Wortina m|!tto!<br />

Th. srck phsphorugnic eid $brio. m dnut d l:lobdd€us<br />

In r v.sl€d and dri€d rhal bd]6, l0o mg oluc tid wa wi8h.d. ln .tutha<br />

balG 60 ha oflthiuE qrtbDt m dislvcd in 15-20 nl ofdisdlcd *ds.<br />

96

---

Ihe solution *6 helt d 10 ab@t 60eC dd Dourcd ilto tlE uoc ed bqker<br />

Srir€d md wmed to dislrc th..onte.ts and trerfdEd to 100 n{ volmt.ic<br />

iak. 2 t! ,|f,6 fon ld.!yd. &d I .nl 5d, ..dic acid w. rdded &d de<br />

voluhe *a mad. uo 10 100 n wilh di$ill.d {.r4.<br />

d) wod.ing $rd. (0.02 [gbl)<br />

Sl@l etutior wN dilutcd l:50 i.c I ntl of $et nlld.rd (l ru/n ) *s diluted<br />

to 250 d wnh disrill.d wra<br />

ln a @.t.itug€ $bc 0.6 n smn sd. a 54 t tug€tic eid M added<br />

qhil. 3h.kin& thd corrituged. Cl.rr $pm.t&t wa us€d for r$qy.<br />

n@ 161 tub6 fo. elyds ,a l!16 in duplic.l. atd l.!d.d s t d spl.,<br />

srod&d dd bldl. Erch tub. *s 6lled ed pregard a nalio.cd in tdul&<br />

{otu and broeed.d .x&rlv in the se @nditiotu for estimtion of sdm uric<br />

T.bb anoving @ntot! r.ta for .stinldonl<br />

Td lupL St.dln B|u|.<br />

TrT2SrS2r<br />

97

---

TIE @.t6t! of dE tub6 wq. hir.d ud dlo*rd to nad ar 25oC for 30<br />

minur6. Absrbr'E w@ m4$rcd aginn bl.rk in B@eh ad rant<br />

Sp*trcnic 2l Spe.ircphormetcr !t ?00 m.<br />

Aborh@of imdc x ms ofudc eid ii swded uled<br />

Uric acid (nre/dl) = x 100<br />

Ab3od@e of d.nddd SDple siz<br />

Alerb.@of Smpl€ 0012<br />

x- x 100<br />

Ab8ooan@ ofsieda.d 0.1<br />

Fr Fcp&.tim<br />

of sio.!.rd N. I nl of noct u.io..id s&drd (l hyr{) s<br />

diluild ro 100 nl wirh distill.d wrd (0.01 mg/n ).<br />

folloqins 'M6<br />

nrb€s wcr. ser up in rh€<br />

sr sr s.! sa s5 66 B<br />

0.5 1.0 t 5<br />

36<br />

7.t to r.5 1.0 0s 0.0 3.0<br />

To *ch tub. 06 n of loqo lodium o.boDtc lolov€d by 06 nn of<br />

pholphorug$ic &id wft ldded. Th. ontent! wrc nfied dd allowcd to dmd<br />

|l 25'C for lO sirulB .nd colours !@ 6d .1 700 m in Boust! dd Lnb<br />

Spetrcnic 2 I Spccrophor@dcr.<br />

cnph M plon€d t*ing @n€ntoiions vdss.

---

p<br />

ut<br />

oz<br />

o<br />

o<br />

'|<br />

0.9<br />

0.4<br />

o.7<br />

0.6<br />

o.4<br />

0.3<br />

o.2<br />

o-'l<br />

0<br />

FIGURE - 7<br />

STANT)ARD CURVE FOR URIC ACID<br />

456<br />

URIC ACID (mg/dl)<br />

e9

---

5.I0. FJTIM TION OF SERIIM GLUCOSE<br />

Sdn gl!@s @ .rtina!€d @rding to rh. nEthod rcpoa.d by (R!$.1 cned<br />

The ald.hyde group ofrlu@s @rd@6 wilt Onhobludine in Slacial ac€th @d<br />

*tn ha..d at r00oc .rd th. bl@ grd N{l!@sie prcdld of 6ir dt ion<br />

triich *6 n1€ecd pholoher.riduy.<br />

i) Onnotoluidb. qgeft<br />

1.5 grd thiour€! *s dislv.d in 940 n gh.id ac€tic acid, 60 r.l of pure<br />

ortlE-toluidift s rdd.d *irn nimrg Th. slutin 8 cott{ in r broM<br />

bod. Th. @gat *|! diwd.d if iG @l@r b@tu d.rkr<br />

ii) Glrd. rL .<br />

!) $dr na!d.rd: (10 6s/ol)<br />

Oie srM pxre diicd Mg6t gr!d. slu@s€ els dislv.d in 02% tqucou!<br />

b@i. sbti@ and rclu@ Md. uP 10 l0o t iI. @lun lnc6aL<br />

b) worli4 rl!.@ Sond.rd (r00 Dy'd!)<br />

lon of$ock stMddd ks dibt.d to 100t with 0 2% ,qu@usb€@iclcid<br />

Tt@ Lrl tubes for mn @lysi! s* ttlcn in duplietc ed bb.I.d a t€sl<br />

@plq stod.d dd bl&k. E!.h tub. w3 6n d dd prcpt.d s mddon.d in<br />

labdr fom ,nd pro...d.d d.il, in l[e s.m @'dnio6 for tl!. slinul.rion of<br />

The t!bl. showing thc cont@$ trld fo. eslin4ion.<br />

100

---

L Onboblulrj!. olar<br />

T..r ri. SLr-'a lbt<br />

tl TzSr St E<br />

Th. @.tens of tubq wd€ nhd .td hded in . boli.8 wncr bath for 12<br />

miNt ! ud @ld to rcm t npr.ture.<br />

n..dii€r elrc dor tt 630 d uils &u!dr rd btrD spcdqic 2l<br />

Sp..iio9hotma6-<br />

PI.m gl@(hs/dl) =<br />

Prqrdoo of .t r.lrrd .W.<br />

5.0 5.0 ,.0 s.0 5.0<br />

Glucos! slution l% M trk t| |nd wo.ring $rnd!td! of t0 nB/dl, 100 tte/dl,<br />

150 ng/dl 200 mg/d! 250 d€/dl !d 100 ig/dl 9@ t !p|..d. w.!b.d od<br />

oqdlcd tdrnt 9w*tl4$ lblM:<br />

10'l

---

h!-d-l2ta56h<br />

!0 rm llo ,o llo 3ln 0.0<br />

l6ddb O, l, L5 ,a ,,t t,|) -<br />

DllH* 9! 9.0 l5 L0 ?J 7.O l0<br />

Atqrd dO@ d nu ..A d. r!! e rd Focca.'t ! b. FD<br />

glit o|..!d r.dlgrsrfttd.a i 5!0 d ud8 Bdrd |ldLd 8p..t6i6 2l<br />

SFc.qtffi. A tn* E dd.d t- odal d..-J o dfc<br />

ltlrr ooe.ddi6 60 d,.da.<br />

t@

---

!,1<br />

o<br />

z<br />

@<br />

o d)<br />

0.8<br />

0.7<br />

0.6<br />

o.4<br />

0.3<br />

0,1<br />

0<br />

FIGURE . 8<br />

STANDAFD CURVE FOR GLUCOSE<br />

150 200 2fi<br />

GLUcosE (mg/dl)<br />

100

---

CHAPTER SIX<br />

R€SULTs<br />

AND<br />

OBSCRVATION

---

CHAPTER SIX<br />

THE RESULTS AND OBSERVATIONS<br />

IAILDI AND FIG. I<br />

Sho* rh€ dislribxtion of @flrol objdts md IHD p&rians a@ding ro ase !.d<br />

s !trd il wa obcrucd rhat rl@g€ sgc ofnule p.ti.nr wa 49 Md avqag€ of<br />

't4 &@le plticn$ wa 51.9 yd'<br />

wl|d eltz.d io !gc, 26t palials (22, sft < 40 y6 of agc and<br />

'@diIg<br />

729 p.tidts (?3%) w€re > ,10 y€m of ag. &d it wa obered th.r prMl€.e of IHD<br />

wa high lbov€ rh€ as. of 40 yem old So for s h @ncdcd it wa obw.d tlEr tn<br />

dw w$ prcdmiMt (?5%) in m.lc p.ri6ts rhd lhc fd'.lc plti@ts (25olc).<br />

Signifiddy rcrc md i.nictcd Aon lIlD (P < 0 0ol) s cohp&€d tu f.mdcs The md.<br />

forule idio qs 4:l if, th€ .tudy. Th.F wa. signif.dl di0..oG in th€ age of mal.<br />

padsns 3 @mpred to fan l. patidtu. Fanrl6 w6. mrc rg.d in fi. sudy<br />

TABLE.'-3<br />

rhe wenge body ia ind* (BMI) or IHD P.ti€iB dd cof,tol sbj€.rs a<br />

snomin rh.llble2 is24 8 kg/n'z$d 2l.4tglmz qpelNsy.<br />

h ws tufthq obF€d thnt IllD DAndl!<br />

(23%) wcle o€ wiSht h.vins body<br />

mNs indA (2t-29) whil. (llooj w ob.s wiln - lO (k8lm'i body ms ind* Thc<br />

.mh.r of ovcr soght .ql ob* palol! wa signiEqdy high (P< 0.001) a ompd.d<br />

to @nrol $bje.Ns t $Sgads th.r tlE obeitt ald dd wdght nly bG lh. es of<br />

IIID.<br />

104

---

TAiLEI<br />

9HOI/UNG AOE AND SEX, OF tHo pATtEXtS ALOleWlt tttElR CONIRO! aU&r€CTS<br />

AGE<br />

(YeaE)<br />

sEx<br />

v.lF.B.4i!3.d s rs...n<br />

16<br />

8.&1.24<br />

4A+O.73<br />

(n=r58)<br />

5111.4<br />

158(7E%)<br />

44122%)<br />

5Or1.G<br />

49!0.4<br />

(n=745)<br />

.53.910.67<br />

(n=251)<br />

743\75%l<br />

25q2s96)

---

IAELE.2<br />

EI.ASSIFICAIION AHOWNG NORMA! WEIGIIT, OVER II/EIGIfT AND OEEAE<br />

IHD PATIENTS Artlo CONTRO! SUBECTS BAAED ON IOOY l 33 NEx<br />

2<br />

3<br />

6dm1<br />

NonmlB.M.l<br />

11v25)<br />

(2129)<br />

Obe!a<br />

(> 30)<br />

v.rE m.4.c€d c r 6 o,r.<br />

21,o.14<br />

18q89.116)<br />

2q9.9%)<br />

02(0.9e%)<br />

.P< 0.001 v.rB G drtldqlt jcrii€nt sdic..ldto 4*d.<br />

106<br />

24.4!O_12<br />

4]q4O!6)<br />

?29123%)'<br />

328 (33%)'

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Tn @np66ri€ iddy of body<br />

'ts idd of difaar sio@nmic sr@ps i.e.<br />

busin$ cla va (25 8) ad rhal of h@s wiB w (26.6) $om in r!bl+3. The BMI<br />

ofbolh thc clas6 was hid'd d the l.bour or @i@ clas md norc clos io ob$ity,<br />

$g8dling IHD prev.l@c h rh* cle3.<br />

TABLF.4<br />

The disrriburion of IHD paidts showing p@al€ie of nsk flcloB assiated<br />

with difrd€ir sci{]€ionic grupr along wirh l|.t.n @ntrol $bje.ts lhoM h (TabL 4<br />

!trd Fig. 4). Signifst difad€ in nsnbd of p.d6rr (P < 0.001) w@ Died eith<br />

reged io ih.n l)@paliom.<br />

ln fie labour cls, lkil€d l$oureG w@ (2lolo) whilc unshn.d hbour€rs r@<br />

(?7t fte shl€d lrbour* l@ dnv63 by pref*ioB. It ie sagcdcd thrr utukill.d<br />

l.b@r ds is mrc preF to IHD baa& of hair so*iig a pd l@.d nor.d &m<br />

quetio@irc dd Q@/t of th@ w€r. hrT.rt nsir 6 hr?dloson tu onc of O. ftajm<br />

n* fsclor of IIiD.scid.d wft ht?crlipiddi.. Cmp&.tivcly skjll.d l.bouss wd.<br />

found 16 i.Iicted do. to lh.i. highd physiql ldiity lhlr nry be prol6lilg Aom lHD<br />

ln rh€ si@ cl4s (28'lt w..c b&t 6plor@s, (46!r) *ft 4rigltcd lhe job of<br />

sDedilion od (32%) wrc ascutcd wih vdiols sundry dltis of lh. otre @tire'<br />

Amng th* prof.$ion l oricdrrid it w obsv.d rh.r th. sbid3 adrn d 'ith<br />

$m BpoBlnni6 {4 iilicr€d rh IHD my be th. r.@n of st@ I @d<br />

p&u.td Whil€ th. olhq Sroup which h @nPt dircly innid€d noe i.e. (10%) tbu<br />

th. brni< coplotes, bequ* of l6s phtsic.Iy adive &d lEaly Mokjng nay bc<br />

atriblt.d to tna lroup of Scdi@ cL$.<br />

TIE tutribs of oadcna of bu'iB cl*s w 220 (22%). Tnc bo

---

CLAAS|FICATION OF IHD PATIENTS AND @NTTTOIT SUEJECTS BASBD ON DIFENBIT<br />

r&rtalgloN Lcx)IJ?s<br />

lt (0?r)<br />

t@<br />

SlilLdt bd udlLdtidt<br />

Eorddat€ s46rdtEt okt<br />

37A3b (e4'<br />

'4Itt/o)<br />

2X<br />

Irdlri. SE[&!m<br />

eo(5r..9 a(tt

---

SHOWING AGE AND<br />

ALONG WITH THEIR<br />

(coNTRoL (n) = 202<br />

FIGURE NO. 1<br />

SEX OF IHD PATIENTS<br />

CONTROL SUBJECTS<br />

PArlENrs (n) = se6)<br />

9!!0di

---

FIGURE NO. 2<br />

SEX DISTRBUTION OF IHD PATIENTS ALONG<br />

WITH THEIR CONTROL<br />

(CoNTROL (n) = 202 PATIENTS (n) = 996)<br />

||l<br />

Fem€1.

---

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FIGURE NO. 3<br />

FIGURE SHOWING PERCENTAGE OF IHD<br />

PATIENTS ALONG WTH THEIR CONTROL<br />

SUBJECTS AASEO ON BODY MASS INDEX<br />

t|1

---

815<br />

I<br />

FIGURE NO. 4<br />

CLASSIF|CATION OF IHD PATIENT€<br />

BASED ON DIFFERET SOCIO ECONOMIC<br />

STATUS<br />

25_5<br />

Socio economic claSsea<br />

ll3<br />

155

---

cls ofthe sciety filh higl int'lc ofd.h dict fono*ed by low.$ phylical acljtty<br />

wnich wa .vid.nt fron ligh BMl may h. thc crus ofIHD.<br />

nE hds*iv.s, lheplnof deryscio@nodcds.rd c.mrbe set@t€d<br />

ton dEir @nt6p..l5 in living @|ditioi. It n d opiiion inn obdiry, nl6 d.ldop€d<br />

d@ 10 p@r @alovqoee dd hi8n i |k.of didmybcthcoeof IllD in thb<br />

IABI,D'<br />

Th€ pddoe of lrypqlmio^ lmokin& diat€t6 ndlitu! sd p$itiE 6nily<br />

hjstory of IHD in dif.@t scioa@mic 8rclp shoM in (t blF5 Dd Fi8. 6). slgs€s.d<br />

th.r husin* ds il @npssn to otlF grcup3 lft mc .tr .Ld.<br />

Th. bBilB @l|!|Nity i3 @@ni.!Iy well of da in r[. sicty. Tlrn<br />

lctiviter &c nonly confned ro ho6c rnd busin6! The di.t is dch (hjgh inkke of<br />

c€loris). Most of rh€d de ob* h.vitg high BMI rhd the ndbcB oI othd $cio<br />

sononic .l$s, (54%) w. 'or.{t s !nok6, (45'l.) w hr?endlirc, (250l") w<br />

dirbeli. dd r@rd€d positiw frrily hino.y of IHD 96 (304/0). lrw physisl activity,<br />

hiel 6tdic itnllc ed oq wisln oblcrv€d & ihc r€4on.d c&al f.do6 for<br />

rhe eoi@ cls is @nD.ntiwlv dorc .du€t.d dB eong ln. othq<br />

scioMnodic clas*s fte l$!.ndsion @rd.d M (42.e/.) whil. the nmbs or<br />

sotor ws highe3l(s8vt 6 cdp.r.d to oihd cles Mostly thie ch$ h residitg in<br />

th. urbe eA due to theit job sligmat Di.b.Ls w nored l3V/.ra1nQT/.) Nith<br />

positiE 6mily hbtory ofCHD<br />

Ir t .orcd rhd ihe risk f..loB roS.tlE sit! urbu lif. dylc nqy b. the c.@ or<br />

dydipiddia $d thci. bnichon in th. lHD.<br />

FTGURE-S<br />

Showing pd@nage of difsat dsk factoB i.e. ttFn€tsio4 soking diala6<br />

oellifu3 ard f.nily hicory of IrD i! nd. md f.dle IIiD p.rlolt AI rhe mjd r*k<br />

fr.rm ** norc p@d@t in nul. p.!q$ a @Dpu€d to fdlc p.li@c<br />

114

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i<br />

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FIGURE NO. 5<br />

SHOWING PERCENTAGE OF RISK<br />

FACTOR.OBSERVED IN i'ALE AND<br />

FEIIALE PATIENTS OF ISCHEMIC HEART<br />

DISEASE<br />

{Male (n = 743) Female {n = 253)<br />

ttc<br />

Dl.b.re lrc nu<br />

Smoldn! F.niry Hbtory ot tXO

---

FIGURE NO.6<br />

SHOWING PERCENTAGE OF RISK<br />

FACTORS OBSERVED IN IHD FATIENTS<br />

OF DIFFERENTSOCIOECONOMICCLASS<br />

ll]

---

TABLE.G?<br />

compealivr l€v.ls of lipids rnd lipoporeiir in notud md IHD pati€nrs lw<br />

|ssed The m€d v.lu4 of total cholet€rol, tdgltr€ridcs, LDl,-chol8tqol,<br />

.polipopotein-8, phospholipid! &d rot l lipi& wr€ sigifc.tnly higns in pdisns *hile<br />

HDl-chol61€ol lrd apolipoprolein A-l w.rc sigiific$dy lows (P < 0.00t) in tlE<br />

latidis 6 onpd.d to @ntrol $bje.t! sgg*tine $ ir gddl rh€ rhq.d l@ds of<br />

lpid, IipoprctciN and apopor.in! (drllipiddi.) e @irt.d wlh th. dcvelopnd of<br />

IIID<br />

Stun u.i. eid w ngnifistly hjgnd in rhc p.ti..ts 6 @np...d ro onrolt<br />

sggBting $at hypd uridir i! .9ciaLd wilh lrypdlipidcmj! !d IrD.<br />

Sinndy tlE Elios of rolll choldtdoyHDl, LDlrlDIn rorll choL{@y<br />

Tolipoprorcin- B rd .lolipopror.in Alhlolipoprot.in-B a shM in (Trbte?)<br />

afiriburd ro tn. .i!t ddmi,urrs of IHD.<br />

rarLf.+9<br />

Sho* dE @m valo6 of tor.l clDl6tcrcl, r.iCyqi

---

TAEIT{<br />

6<br />

7<br />

10<br />

SIiOWING BIOCHEMICAL VARIABLES IN IHD PANEMA AIONGII\IITH<br />

THEIR CONTROI AUBJECTS.<br />

HDL Chol€sl€rol<br />

LDL{hol€st6.ol<br />

TotalLipid<br />

v.r!e.F.dd.d ! rs..,n,<br />

20211.6<br />

12912.O<br />

50io.06<br />

121t1.7<br />

12911.6<br />

10411.4<br />

1a2r2.O<br />

7Ur'.7<br />

5.0ro.9<br />

8511.7<br />

- P< 0.05 Tn. v.lu6 s !td3d..lty clnfkd s mp.6d ro d r.t.<br />

119<br />

237!1.U.<br />

15911.03.<br />

37j0.25.<br />

172t1.U.<br />

109iO.95.<br />

142lo.73'<br />

205ii.3.<br />

974!7.7*<br />

6.510.7'<br />

801t.6

---

(2021<br />

sHol/MNG RATIOG 0F t CltOtEStEftOu|l0t^0t/HDt cHoLEsIERd<br />

t C}IO(.€STERoU PO:A AlD Apoll/ pO:B N |rO PAT|ENTA ALOatGinTH<br />

THEIR CONIFOI 6I,6JECTS,<br />

Vdc .ts o@rs..d s r s.._n_<br />

?< 0.01 V.r6 .e i4isrk [y {ntffotr & dr!.!d to drtd.<br />

1m

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TABLE.lO<br />

The ntios ofApo An/Apo B, Totrl €hol€srmlApo B w* dgniffcrDdy loq<br />

wlErc a rhe ario! of LDI-/HDL-C ad lor.l Ctd6t@lHDI-C lNft fdnd lo b€<br />

sisDfonb hishs (P < 0.001) in ndrblipi.tqric s w.I.! b,T.nipiddic IttD p.ddns<br />

a @npd€d to @nlrc| $bjets. Ir b uggBr€d tlur ihc rio. d€ indi6 of[tD who<br />

othr lipid vdiabl$ do not snow sisifcDt diferee.<br />

TAB|,DII.I3<br />

The biclrmiql wilblq of difddr ecio@nomic grcups of IHD psrjots<br />

.long with thet @ntol slbj*ts &€ Dr.Mlcd in rh€ labl4 nsrion d a!ov...<br />

It ws obwcd rhnr s.M T0Ll choldrmt, tdglyqid6, pholphotipid!,rot l<br />

lipid!, LDLcholddol !d .polipotre&iFB !* ignifonly hign e . O.OO|) *n "<br />

HDl.{hol.*ml ud Apolipoprolcin Al 9@ sigrifq.tty low e < OOOI) in rhe<br />

pdidrs ofal sciooooonic clss6 s 6mp.r.d ro @nircl 3!bj6ts.<br />

S.lm uric add ws sienifcotly 6ied in the Ddidts of .n rhe !@idchnic<br />

cllg 6 @p...d to @nrol *nnc du@* showcd m iigiifrq!|l ctwge<br />

It h $g86Ld &or rlE rbov. oh.dv.li@ tt[. ht?.dri@ir ..d dFudd@ir is<br />

4iocdt€d Nith 4h oth.r ed dFlipid.iir is tne @jor contdburor ed @si* fector<br />

Of IIID.<br />

Sinndy 6tios of lipi& lipoprdeB a.d alop.or.in of vuiou prcfe6ioD,l<br />

d,.s ofdE p.riart! w@ sig.i6@nly .trcld s shoM in fi. Gabte 13) e8lcaing s<br />

lddniE rbk @ks in thc atudy potdalion.<br />

123

---

IABIE IO<br />

Stlol/6 RATIO€ OF Att^-l/ PO:B, T.C/APCB, tDf4JtOfClllD<br />

IC/HDL{ N |I|(,iSOIJPDEXIC NO IIYPERI'IOEIIIG IHD PATIEMIS<br />

AIONGWTTH I+€IR CONIRO! 6UBJECTS<br />

v.l{6.b otc.q.d s ae...n,<br />

SUEJECTS LD(C/HDL.C<br />

r P< 0.00l Vdq .F ltCniaqrn G hFld io drult $Dj.da<br />

1A

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RAIIO OF |DUNDL TCIiOIES IEROUHDL APOA-1/APO:B AND T.CHOLESTER/aPo:B<br />

IN IHD PATIENTS Of DIFFERENT IOCIOECOiIOI'IC GROUP<br />

c<br />

HOL<br />

'P< 0.0!1 V.ros .6 ggntt*nt s Mo.6d lo @ir,ot suti€.rs<br />

127

---

TABLE-I{-l?<br />

Shows the biocn@icd vdiabl.! in fer difl€rsn scio6omnic clse! S.rum<br />

lotal cholcat€rol, ldglyerid*, totsl lipid phqpholipid! ed unc &id 3hosld no<br />

!i8nif@t difq€@ in nmoUpi.lciio plticn$ of lalN c|8s. sinild ob!.ry.tions<br />

wdc not.d in sie cL!s, b{!in$ cla ud 6m o9@ clai Wl.6 LDL-<br />

clDlcatfrl dd apo B w@ qisnic.!.dy Itd lnd HDldFl.cerol ald eo A-l w@<br />

Ii9i66dy low (P < omD i! .U tlE prdal3 of diN sio@rcnic cbs a<br />

6np!.d ro @nrrol $bj€a!.<br />

HrT.dipiddic p.riots of.ll th. profdioi.l cl|g slDwd dsnifiqdly 6i!.d<br />

ld.lt (P < 0 00D of lipidx lipoprotcinr, .polipoproEins dd uric acid *c€fl HDL .Id<br />

apo An *hich 3how€d sigrifi@tly low kEl! $ @npeed to @ntrol ubj.cl!.<br />

11M! obswed thlt lipoprorcin! lnd lpopmtdN e ris* nat*6.vfl io the<br />

iomUpiddic pati€r'ts hNing rcmal erum cnoblt@l d triglraridB md bioqb@ic.l<br />

vaiablc 6 s[om in lh. (T!bl. l+17) {dG rigrifi@tly high (P < 0.001) in .ll lh.<br />

htT.rltid@ic p.lie s a cmpd.d to coitmb.<br />

Il w eagcsed tl!.t dytlipidait s lte 6qul Ador ob@cd i.<br />

m@liid@j. * wt 6 ttT.tlpldhic p6ridl..<br />

TABLF-Is-I9<br />

Shows $e bio.lMicd wists of GID pations aldg with th€ir..!p6tire<br />

conkol h fou diflqot grcup3 20,40 ydq 4l-50, 5l-60 dd 6l-md.bovc Thcsrum<br />

l*le of toral cholesml, 1dgly6id6, phospholipidr, LDLchol€slerol ed apo B w@<br />

sierifioott nised (P < 0001) B @npscd to @nr'ol ,ith rh. cxccation of<br />

tlDl4tdqi@l dd apo An ehich wcr. iigifMtly t w (P < 0.001) ir th. pltidi5 of<br />

.gr glolp 20-40 &d 4l-50 ydi<br />

Mo@q, m sienif@r clulgc in !d!m lolll .holcd@l LDL4, rrislyqidd,<br />

p6pho[id .,rd tor.l lipid *@ ob@!d in ln. age goup 5l-60 y4 whiL<br />

!9olipopbr.i+B v6 siatrmody ni!.d !trd HDL&d !po: A-l G.lowa in th.4.<br />

grolp of 5l-60 r@i Smn uric eid w.! ligiifdnt nis€d ir the p.tidt3 ofdl.g.<br />

8roups .! @npa@d to @n1rclsubje4sl<br />

It wa obs(€d th,l smn lipid! including LDLC in the eldd populnion did not<br />

124

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AHOWING BIOCHEMICAL VARIABLES IN IHD PATIENTS ALOM;WTTH THEIR<br />

COIIIROL SUBJECTS OF DIFF€RENI ACE CROI'P!<br />

v.ls3 .E .rtE s.d a r 5...m No ot ob.eN.uo. 15 clv.n In p.cn!|.!}3<br />

c<br />

133

---

TABIE.I'B<br />

STIOWING BIOCH€MICA! VARIABLES IN IHD PAIIENIS AIONOWTH THEIR<br />

CONIROL SUBJECTTT OF DIFFERENI AOE OiOUPS<br />

v.ru.3 .E oa@€d e r .,..m No, ol ob..ry.llonr tr clv- ln p.6dh6ls<br />

c<br />

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t33<br />

15112,5

---

SHOWING FATIOS OF T.CHOLESTEROIJHoL. !o!HDL, T CHOTESTEROUAPO:B<br />

AND APO:AI /APO:S lN IHO PATIENTS ALONGWITH CONTROL SUBJECTS<br />

IN DIFFERENT AOE OROUPS<br />

' P < 0 01 v.ruG !c sr.rldlcary sronfih..I

---

sho*td signfi@t ditrqqe in rh. prrid3 of agc 6l y6 ed .bore s,lile HDL<br />

chol6tftl dd lpolipopror.iB (apo A-l sd lpo B) lhowqd si8rfic.r cn6se in rh.<br />

patimls ed cont.ol $bjet. Sugg6ting a tuk indi@roi .M whd othq lipid<br />

wi.bl* wqe ir nomal mg..<br />

Sinihdy rand of lipids, lipoprorciro and |poprcLinr in ditrddt 0a€ groups<br />

obswed in $e study shoM in (Trbe-|g) wele signifimdy all€r€d oSgenirg a additive<br />

tuk indicaton in ditr r.nt agc groups<br />

TABLE-2O-23<br />

shovs the bieh€nicrl vsiablB if, iotulipiddic .nd hwedipiddic trD<br />

paliets ed @ntrol sbj@rs in four Ag. groups ftom 20-60 trs rDd alorc. S€nn<br />

cnoblt@l tdglyedd6, pholpholipid bd ro$l lipids in nmolipid@ic pdtie.ts rnd<br />

@nfol $bje1s a shoM in Crlbb 20'21). *dc simil& wift d HDL ed a!o: A-l<br />

ws. si8.fiqdly low a.d l,DL ad a9ofipopot.in-B w@ lianm@dy higha SeM<br />

uic eid ws sig.inc..tly 6i!.d in dE e3. Iroup 20-,10 tls ir mtulipidqnic p.lidls.<br />

AI drc.bow ndtion.d lipid wilbla w4 3igtlifdt|' rs.d (P < 0 00D h rll<br />

thehypqlipidemic A.rial. of2G50 ya a @mpr..d ro @Eol grqp<br />

laue 22-21, shom thc biochcni..l wi.bla of mmlipiddic alrd hypenipidaDic<br />

prri6$ sd rld @.l.ol $bj6r! ofag. t1.60 !.d an ydB and abow.<br />

smn cl'olenml, rigly.sid.t phdpholipi& LDr. chol$t@l .nd toial lipi&<br />

did not sho*d ey signi6st ditr.ffic in lh. nomollddic pati€i'ts of age 5l tss<br />

dd rbov€ r'hil. .poB ws 3ig.it6tly d!.d ud HDL dd fuo An w@ si8'ifmdy<br />

Iow (P < 0 01) ir th. paticnts s comp{ld ro 6 rcL h is foond rhat ot y sig.inml<br />

dnddce wer€ observ€d ii lipoprct€ins nd lpopoteiis in Domolipdqnic paifls<br />

vhile al lhe ndtiored variabl* wcrc liSrifiontly high q.6l tlDL..d apo Al which<br />

w sigiidcmdy low in .ll th. hypdlipid.mic plldrs.<br />

ll ws sussested fiom the obsrcd drts thst lipi4 lipoproteins ud<br />

a?olipopro&irs wq. signiftutly rlisd in .ll th. |gc Sroups ir6pedv€ ofyoug€r or<br />

.ldd t'r?enip'ddic pati..t3.<br />

135

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TAALE-A<br />

TIE bioolErni.l v.rirbks of IHD pdild! in ldc rd ftrnd. indicied d|d tord<br />

dDklraol, rigtccidd .nd tord lieid! re ildnclnb hiSl h tond6 (P < 0.05) $<br />

6'ip|nd io rnrl6 wltib ff HDL clEl!3qd E dsniiqmly hidE ir tuDld (P <<br />

0.05) $ cqlp.rld to EL pdiat.<br />

It w ml.d tur nir.d l.vd! oflaun HDI-C in ftdrl. pdial! my b. da to<br />

mnd di&act i.c. tuulc s lMtoe (.drcsqr). ld lcvdt orHDL in o||n vu dlc<br />

to gadd. Wtil. ni!.d lc,rd. of gu cloLr.ol t i8lyc..rih. !d lo.d lipi& my b.<br />

dE lo li8h6 rs. of fad6 (nta|ofoD.g.) a dlp.rd to r lc. Mo|E€ adng<br />

h.hib of ftod6 e diftrd .d tt y an Mq {!t B o6viu frm l[(i. BIO<br />

(Id'L4). Tlta. .Ia.d vd!.. ii sun lipib e Esotty dE lo ot dty. qetdE<br />

i.t lc of dica, lov plty,iql ldivity or €i ndd.<br />

TAILE.IS<br />

Biodlsdql rui.bh. of hyraradE (4'a%) ||rd rDFiypdadE (56%) trD<br />

p.ri6s @ 3hom in rh G.bh.26), lr 6 otsrrd dd sun tol|l chol..rq!|,<br />

tislyqiL., l,DLcrFbd@l lId Gm |Flipofmtd'} B coic.d.|lioB lw<br />

dgti66q nir.d ii lyFtcds s @tprcd to 'rdnF.atdB WilG 'qw HDL<br />

crrob&rd ||td |cuh .po A-t lw i8ri6..trdy lo*.. in |tyFiadG.<br />

Itr c& of rhorlblipidl lot l lipi& uic &il |nd dM!., m igt'iEqnt<br />

dif..src6 wc! ot6..v!d in boilt trF of $c pniant<br />

rb inpon d fndi"8 sotg iyFladw !!d Mlb.criw *r, dE.llqd ndo<br />

oflord dFLn@l |o rDr- dEl.iqol tud{ lignif{n|y d|.d (P < 0.05).<br />

ft b obsv.d AoD ft rbovr &n d[. ItyFtadon .id \tp.tliPiddn ii ScEd<br />

.d hypadol.d..olcnir in D|nicllu coodn wfth a.t dlE.<br />

IE iyDqtaion i! mioly ftd..r.d ton ll nodifc.dd ofrc iy.. For<br />

iilllrc inc.!.!. itr c.lo.ic id*ddt or coft. i'n lq EFkint &d lodd ttrar ii Oi!<br />

lio.don my b. irpndtd in lrypalalnm.<br />

It b .ss!.d tl h:/p€lipidcni. it .sidql litl liyp.riqtdon *ii.h tu dt<br />

6id ri3t n (d of IrD.<br />

14

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---

SHOWING BIOCHEMICAL VARIABLES OF IHD PAT]ENTS WITH HYPERTEI{SION<br />

2<br />

3<br />

5<br />

6<br />

E<br />

9<br />

10<br />

V.lu6 .re e4r6sod $ r s...m No. ol ob$MiloN te ei€n l. p.Er'|h6&<br />

HDL Cholosl€roi<br />

TotalLipid<br />

T.Cholesl€rouHDL<br />

'P< O.05 Tn. v.ru* .E lLlrluquy 5biment<br />

P < 0.001<br />

142<br />

230rr.3<br />

160.5+1.9<br />

36*1.0<br />

152r1.8<br />

115r1.9<br />

142r't.2<br />

2@t2.1<br />

90217.2<br />

6,210.11<br />

6.3813.1<br />

24312.5'<br />

177x1.5'<br />

30+1.1.<br />

173t2.O'<br />

9912.0.<br />

'15711.r<br />

208}2.3<br />

925*4.0<br />

6.7r0<br />

8.1:t3<br />

'12<br />

3'

---

IABLE.25<br />

Bi@h.mic.l vdi.hl* of mot@ (45vt ltd mn-6mk6 (5t'l.) of IHD p.te'n<br />

llF sd valu6 of sm lor l clFlcs.rol, lrigtqidd, LDL !d +o B w<br />

obw.d tigf,iffcsdy njs€d ir th. sok B s @np&€d ro non-mt6 Miile stun<br />

tlDL dd apolipoprcteins Al wrc sigiifiodly lowd ii sot@. Th. &om ld.h of<br />

phospholipi&, totd lipids dic rcid &d rju@e wde found umhdgcd,<br />

rh. nrio of rot t clol6tdoyHDL cholcrml .!d LDL{holBt rcUHDL uw<br />

obs.d in ftc sot6 !d mFmt.r. smk6 had dgifc!.tly hishs niio, (P <<br />

0 0ol) ! @npr.d ro @n @t6. H6viq th. MErilg hisla rhc nr,o wa obsvrd<br />

$Ag6ting non Fdiriw bdi..rd of IHD jn ihis ftdy.<br />

thc anoking habit mons rh. 3tudy populitioi, ws rbout (46%) rc0ed€d th€<br />

ef6t oflif. yle on srun lipid l€vcb. Neveiheles the lipid ldels wqe .qually rtre.led<br />

du€ lo dietary ditrctw6 a obwcd ii lh. mkeB dd non{nok $<br />

IAELE 2T<br />

Show! thc bier@icd Ei.ln! of I}ID Drti.,'ls strairs nom did€r6 n IinE<br />

Amns E IHD pitiars (65%) wc .o! ditb.riG &d (35%) *ft diltcr* rne<br />

rociNlj' d.pad diab€rs CNDDII rr?.II) p.ti@tsw6. includ.d in rhe $dydd<br />

the dialenc pali.nc ahowed lbmm0l gl!@s rolde@ at the tine of s.lqins<br />

The d.d v.lues of tiglyqid€!, LDt clDl6t€rol sd .po B w€n fodd<br />

sisrifio y nised in dilbetic EiD pati.nti 6d HDL, apo: An w@ sigrff@tly low€r.<br />

No !i8ni6st clEg! wN obw.d in @n rotd cholesml tlFud lot.l cholBtdol<br />

a slighdy Ei!.d in didiri6. Signifdlt 6j!.d l*€ls or sn du.@ s@<br />

obecd (P < 0.001) in diaberiGIHD pdi6B s't'il. mn phGpholipid,tot l lipid .nd<br />

uric eid t*k *16 simnu 6 rhlr of tur dilbclics.<br />

It w& obwed thar netllolic dmmality is dscial€d in ft. trdspo.t of [prd!.<br />

The diei!.y influoce .mor h€ tuLd oui in the deelopndt ofdi.b.tcs which tu 4 mjor<br />

143

---

TABLE-26<br />

2<br />

3<br />

4<br />

5<br />

6<br />

7<br />

8<br />

9<br />

10<br />

SHOWING BIOCHEMICAL VARIAAES Of IHO PAIIENTS IN AMOXERA<br />

ArD |{OX€MO|GRa<br />

velu6 €E €xF8*sl a. r s.6.n No. ol ob$rluoN ls glv€n In plEnrh*is<br />

Triglycsido<br />

HDLCholost€rol<br />

LDL4holeslsrcl<br />

Toral Lipid<br />

T.Chol€stgrcUHDL<br />

LDUHDL<br />

- P< 0.05 Tna val06 ao st llslelly slOnmqd.<br />

224t30<br />

1574.0<br />

16211.7<br />

11212.1<br />

1Ur2.5<br />

198t2.4<br />

902+7.8<br />

5.6+1<br />

23912.6-<br />

18013 9'<br />

32rU.9'<br />

173+1_9-<br />

9A€.4_<br />

142*1.9-<br />

20512.2<br />

96549.1<br />

7.4611.5'<br />

5.4i16"

---

TABIE.2'<br />

1<br />

2<br />

3<br />

5<br />

6<br />

7<br />

a<br />

9<br />

10<br />

SHOWNG BIOCHEMICAL VARhALES OF IHD PATIENTS I'{<br />

DIABETES MEIUIU3<br />

vdu6 @ .r0|6€d $ f s..m l.|o. ol o!..to.ii,oG as giH in p.6ln6rt<br />

Triglyc€ide<br />

HOL Chol€sl€rol<br />

LOL4holesl€ml<br />

ToralLipid<br />

-P< 0.05 Th€ wl6.E slr dioltdgnlfrenl.<br />

Ot+Dt BETIC<br />

145<br />

232*2.0<br />

16511.9<br />

38iO.a<br />

160i2.1<br />

10811.7<br />

130j1.6<br />

2Ut2.6<br />

89018,0<br />

6.010.6<br />

84.$0.9<br />

237r2.2<br />

224121'<br />

31.4rO.9'<br />

17312 0'<br />

94+1.3"<br />

14811.5"<br />

217!2.4<br />

9oa+9.0<br />

6.410.54<br />

15610.7'

---

caual frclol for @ife$lrion ofIHD A! indi€i.d in tn. (Ia!|. s),lDu* wiv$ dd<br />

wi@ cLs ** hor€ di{bdica<br />

TABtI.23<br />

Bicndical wirlL. of ud .d utbs IIiD prdats @ shoM i. rh.<br />

Gl6lq2e) Frco ahe br.l study popuhtion (66%) vw ulbon ud Pa%) vw ru..|<br />

Tlr. '1@ ralu6 for to|3l ciol.s.ol, LDL chol6rml a{d apolipopror.iieB<br />

9@ found to be signid@ily Eicd in tur.l populations. In urbd patiats sdn<br />

tiDLcl$l6t@l dd .polipoprotin A-l *@ lignifi@tly low d onpq€d to N6l<br />

S@n phospholipi.li, 1ot.l lipids, uno roid .nd slucos *s appMtly sone in<br />

both the study popul.tion.<br />

It m foud that lh.6i!.d la.ls of ffi.hol6t@l LDL ad 3po B @yb.<br />

due b nigh irht ofnilt ald hill producn (d*idE). fte M.l p@pl* e Mi.ly<br />

d.p.rddt oi agiontu ud h.rc th.i. oM nilk Th. nigh b€lr ofHDL ad l|o A-l<br />

ir lh. nxal poFnadon @y hc d@ ro hgh phFicri .itivity a poo. E n pon fi.iliti6<br />

t-w BMI wa obsdlrld i! turd popll.tion st'jl. body N indq of !rb.r<br />

popul.ii@ wa hjgh. l[gh prcrdft. of di$da w obsrtd in ultd popubtion<br />

linilrly nmb6 of hjgh mok4 ws morc in urbe rhat nay be c.e of risd<br />

ttiglyeddd ed low rDL.<br />

TABLE.29<br />

The rabl€ d'o$ the bioch@ic.l v{ilbla of IIID pati@is with p$iliv. or<br />

n.garivefrdnyhi$ory of$€ dii.e,(2ttrlt gN. positi* hslory shile (7]%) u@ with<br />

Sdm Figltqid.a alolipoprotcin-B Dd LDr,

---

llttE-tl<br />

sS0wtMl6|ocr€$c tv Ar aEa oF H0 paIENftt tN n |.^touit lt PoF(tanox<br />

v.l! s oq!..d - *ico 15. otohsvddr acd h F nF*<br />

2<br />

3<br />

5<br />

6<br />

7<br />

E<br />

I<br />

10<br />

Totelchol6d€.ol<br />

Trigto€rid€<br />

HOL Choldt rd<br />

*'ffi,<br />

lffij-<br />

I<br />

[:;;".<br />

| -,.n *<br />

-P

---

TABLE-"<br />

1<br />

2<br />

3<br />

5<br />

6<br />

7<br />

E<br />

9<br />

10<br />

SHOWING BIOCHEMIAAL VARIABIES OF IHD PATIENTS HAVING<br />

POSFTVE FAMILY HISIORY OF ISCHEXIC HEART DTSEASE.<br />

v.l@ .6 oo.e.d { * .,..n xo. ot ob.p. oB b gtv.n h p.Ernn sE<br />

Total Chol63t€rol<br />

rdglyc€rid€<br />

HOL Chol€8t8rol<br />

LDL4hol€!t610l<br />

TorulLipid<br />

'P< 0.05 lh. v.l!e o d.ditc.lly dg.nc.d<br />

232t2.3<br />

15711.9<br />

3411.0<br />

16211.8<br />

10811.7<br />

r3&12.0<br />

201r2.1<br />

911'9.2<br />

6.010.1<br />

86.5a1.1<br />

|aCTIEI'IC HEA' DiSEASE<br />

241e.O<br />

16411.7'<br />

3510.9<br />

t7111.6'<br />

96i2.0<br />

1Qr2_2.<br />

205d2.6<br />

92618.0<br />

6.4tO.3<br />

a7{.2

---

TAELf-3i'<br />

BioclEniQt wisblg ofIHD p.licntt uliig dict .y 6l i.quir.d dudry fllilg th.<br />

q!6tioMir€ i.e Eeellue oil b&r.rprd gne or de$i she b shoM in fi. (T!bl€ I l)<br />

io a6s in. & of dicLry &r if&y on ldun lipids and lipoprctu!<br />

Thc majodry of the pstiqis (t67t Pw cdMing b@p.ri gn@ cirhd in<br />

sllndlrd bnnd3 or loop pa.& ba$lp|ri $e (hrdrcsended oil) and (31%) wcrc using<br />

oil du. to .wsos s a p@rioir.y m.|le *r'ib llMioins p!tic'|t' (137.) vft<br />

@llsins FrE d.si sh* (tu[ of {n)ntcd frny eidr).<br />

Signif.dtb 6ied ldds of LDl+hol6t@l .td .polipo9ro&tn - B w. found in<br />

th. p.li€nk udrg d€.si gn€ s @D9dcd to oil |ls.<br />

No sig.i6@t dj&t!l@ in tdgltqdd6r pnospholipid or rot.l lipid wq.<br />

ob&Ncd in bMpatigh€ us6.nd oit u!.6 r'tile, toal cholesi@llDL, apo-B and<br />

triglyceide were signiff@dy nisd in bdapiti eh€ ws aB conparcd to oil ulcs<br />

It w ob*r€d thd high lalr of erum lipi& md lipopoprot.itu in th. 6e of<br />

d.si gh6 lgs re0*ted tb. hign @abnt oflrurdcd &rry @ds *tich.ff@Ld $*<br />

!dck. Beap$i sh* l|g do slbw.d 6L.d l6ds oflipid ald lipopror.in bor not to<br />

tt. aran of dNi glE l!s.<br />

Ol os h.s mre Mci.l .ft.t on lipids ad lipoprot iB a @mpu.d to<br />

h ws obwd that th€ goup of pari.nts using oil dDwed conpaBtircly low<br />

l€veb of srum lipid or lipoproLi$ B @mpecd to brupdi gn4 or ddi gh@ u*6. In<br />

N. popuhtion @ of legetahle oil in di.t ir low (31.2) miily b€ep of .coDnic fador<br />

6 @npd.d to bMpati she ue (52r.<br />

Mrjodty of dE d6si slE u6 B @dcd in qu6iioMiE t lonsld io tunl<br />

149

---

s.No<br />

2<br />

6<br />

7<br />

8<br />

S}iO{I'INC; AECHEI'ICA! VARIASICA N HD PANENIS IAKINO DIFFEREI{T<br />

olEtARY FATS r... VEroEI AlCrOltEE/l[r{ IP '| OflEADEaat OHEC<br />

vrlc fr .g!...d G r r,..n tlo- ot obd.0dB b cfid In p.drh..lr<br />

Total Choleltsrol<br />

Tdglyc€rid€<br />

HDL Chols8t€rol<br />

LOL{hol€d€rol<br />

TorrrlLipid<br />

23t2.3<br />

160,2.4<br />

4210.9<br />

14912.r<br />

107t1.6<br />

13111.5<br />

1912,5<br />

e69r5.9<br />

23412.1<br />

16412.2<br />

3rl{E-8-<br />

165},.2-<br />

1Grl.7<br />

t4€r1.e-<br />

mlt2.7<br />

*2t12.5<br />

- P< 0.05 In {lB .E dnki..l, jqiidd a @llp.!d lo coi!!l.<br />

150<br />

254t2.O.<br />

17912,5'<br />

30t0.7.<br />

171t2.1.<br />

9411.4.<br />

154t1.5-<br />

mr2.a<br />

9181't4.0

---

CORRELATIONS BETWEN DMERf,NTBIOCSEMICALYARIAELES<br />

t2<br />

FIGURE.'<br />

Th€ corcl.tion b.tw-n diff66r bioch.micd vrirbl* shoM in th.6gur€ 8 ro<br />

Shos t po3itive otr€lAdon b.teEi LDL{hoLi@l ad btal.hole3l@l io lh.<br />

IliD ptride Tn @.fE.idt of @rchtion b.tw.sr LDL .nd totd choldtsol M<br />

NGURE-'<br />

Shos @d.llrior b.trrd rpolipoprorciFB rd LDL clDLd@l in IllD prridts.<br />

Th. co€6ciqn of@rd.rion *! r{,32<br />

FIGURE.IO<br />

Snowr th. @@Ltid bct9q phoahotprd |nd LDr. dbldml in rHD<br />

Fdd$. Thc co.fi.iat of@rd ion*a.=o.2E.<br />

FIGURT.II<br />

Slb* thc 6@llrlio bctwa LDL cnol.dml !,i gDL cl!oksl@|. A ncgrtivc<br />

@r.l.rjon w obw.d bagq lh. rr|lo vai.bl6 in rh IHD p.lial.. Th. @6cidn<br />

of@rr.l.rion *$ F -{.21.<br />

FIGTJRT.I2<br />

Shos rh. oncLion bctwa HDL clbl.nrol Dd tdg'6id6 in IHD p.l,qtt<br />

A rcglriv. 6n.l.rion w6 oblad bctsE rh. rvo wirblo. I1lc @.6cior of<br />

@nd!ti@ wa. = -0.21.<br />

151

---

a<br />

-5 t.0<br />

FIGURE NO.8<br />

co.r.l.llon betw..n LDL-C and Tot l cholostarol<br />

In IHD P.fenlr.<br />

!DL-C - t.l + O..l T.cft.Lt ..l t Fora<br />

, ,,":,i "i"t I<br />

lr<br />

2ro l0<br />

lot lchol€t @l{nt/dl}<br />

,sl

---

E<br />

:<br />

FIGURE NO.g<br />

Corrclatlon botwe.n Apollpoprotaln-B<br />

ln IHD D'[enll'<br />

t<br />

f r I<br />

oo llo<br />

r"d--C (n!d0<br />

tE5<br />

$<br />

lx<br />

and LDL'C<br />

I<br />

*"<br />

rrl

---

i<br />

FIGURE O.1O<br />

co.r.hl5n b.ir..n Ffo.frhoglld |hd tDL.c<br />

In IHD P.{.nb.<br />

Ft ! la,,t,.oja lD|- r F 0I'<br />

rri<br />

f I<br />

I<br />

it.<br />

Lr||aF d)<br />

rsl<br />

t

---

3<br />

€fio<br />

FIGURE NO.11<br />

Corr€htlon b.tw.on LDL-C ad HDL.C<br />

In IHD p.tenE.<br />

LoLa .2io2a. l.||aHDL4, F.ozt

---

.l<br />

_!<br />

FIGURE NO.12<br />

Co.|!l.dor b.tyve.n tlOL- C .nd Trlglycrrldo.<br />

lt IHD PatLnt .<br />

tlDl4. rltla - OL ld!t4ld- , F -ori<br />

t_<br />

0l0ltlo<br />

s'* tr<br />

tnah-ld- t'{al<br />

t9t

---

CHAPTER SEVEN<br />

DtscuSStoN

---

CHAPTER SEVEN<br />

DISCUSSION<br />

An.r&rnoa lo.d.blirh rh. 6urc of r.run drol.d..ol coi.qnndon mtitcla.d<br />

unda lh. FMiliig coidniod of lifa t.!,L of tlE poF&rid rlddirB in t rtm dividoq<br />

ln.t Mh! IHD, w r|i. Firc .in rc inwniga. gu lipid Lvd! h mmd @fiid<br />

objcd! lttd Fdar! of IHD !?orud ii Chltdtr M.diol Cnn€c Horpir.r (MCH),<br />

11* *o* ro b. d*ib.d ilh in tso dar rr!.r, frdy dE ptdi'niEy dldy<br />

inwlving, thG d.trdldianid of dE lipid lcrdr ir qidins d|lMcrs of lif. ry'c<br />

ldoprd by llE ropoLdd. S@tdt 0E .ftd of diliry i'ntr. bdlvior on Oc<br />

..ofruhih of !fu lipid! rl|.! Drcj..r B tu csd hcd for{r d6do9nt6n ofIHD.<br />

D.r..rid of rlE !i* p.rllnaa! rh|l te.d ro !E dddo!|En of IltD in t.'.<br />

(|o,dopd .6 of dtc co.ltt y for dadLd |ady h|' d b.ar rqorr.d by dE w}d dn<br />

3il. th. pl& h xticl|hi! rolt lLi b€r 6id dr tld rhc drBlbld Lldr ofrlc rq<br />

of fi. tudy r@ I8G2OO ng/dl D!8.a.d to b. bdow tt dll tcvd! nootrld<br />

Itt l..oftnclddioB b. ..nicving dcicd .lblcdaol 400 ntg/dl<br />

"r.. rldurittg<br />

hiSh diday iddc ofc.lod.!, {tnr.d tu |'d dlok3aol !851. Suc|| $rqrF iBinud.d<br />

{t r dt poF|]aior of tn ttdr ra ir &..dy urdB tlE d|Ig of tl& |@itEdrioi<br />

dE lo p6. dioeon@b @o.tli$ ilDM ir (Lbb I l-!2, p.g. 126127), wls. n i3<br />

obsEd tltr o! y budtg d{r, sil@bridt wdl o4 w !|@ iiti.rd by oD<br />

.d iidrst d nighd l!v.k of .l|oLn@l rh$ rhc Fnr.l .lloLd@l B *dl s rh odE<br />

ItolF qepl btd lordynm ouE6 in dt |ady gro!9. TIE lranpa ro |!de {E lE8.<br />

toll of rltEool€.oli, td...d di!4!. !d rtcoftnqd|lio$ of2m h8/dl(5.2 m.nbyl) i3<br />

..98-.d. Th. trm cllol.n.'ol of 0ir dlX in Uiird KiSdotn poF |dor ir 234 trtt/dl<br />

(6n.mr4} ftir Ep.et! !r.p i! pr6q iE mdniF bdrt t t6 ir Uiircd Slrrcs of<br />

Affii6 Alro dE Edtilh HyFIpklai. Asirion ha .do/.d rttc tr8.. of (5.2<br />

157

---

m.mol{-) md qtdoMd 1h. rccd io .ir.r ri3t fAdoB for popul.rion s a eholc, bur in<br />

addition ha @onwnd.d thlt rh. sbj.cri yith roid cholarml grans rhs 23a ng/dl<br />

{6.2 ftmol,l,) 3holld r*ivc individu.liz.d oo.<br />

A coostus @nfc.@ on lowcring blood cholcataol to p..vat ton hen<br />

diss." h.ld in 1984, !nd.. $€ sponsship of rh. NHLll, ml.d rhal chol6t@l<br />

.o@tr.!oo > 200 hg/dl rG Mci.t.d wirh itur*iIg nsk of dwdoping prmtur€<br />

CAD and th. @n6lBtion ..p@nB morc 1he 5@/o of th. A@iqs. Tt pam.l rle<br />

.orclud€! lhn 0E bl@d chol.lr@l Lvc|3 of @3t of Affiics ec dddinlly hisb<br />

bducof Itghdia!'yint.tcofcdori.!, dud.dfrr .dcholetdot. Ald!@mad€d<br />

low di.tgy intat. oftotd f.! otur .d f.l Dd choLshl to ting blood cbdrdd<br />

l4k to < 200 nra/dl ofthc adc Ah6o popr .tion .d I8O mSldl in lho$ who &<br />

youngd tn$ l0 yd3 [2,] I I<br />

Thc @|M$s p.ftl prcpo.d . i.r of @t otrvds for ror.l clDl€tdol<br />

Modcntcnsl HiSh d*<br />

2-t9<br />

20-29<br />

3Gl9 220 ngl.ll<br />

240 n|aldl<br />

The *p€rt plml of Ndoi.l Chol6l@l Eduotion Pmd (NCEP) id.nri6.d<br />

@l@tl'llion of choldt@l < 200 nA s d.sinbl., ta9q 20G219 aE/dl G Mc. lift<br />

hig[ &d > 240 og/dl, a hid. A 240 ng/dl, tu nsr of IHD b rwi@ d[r .l 200 ng/dl<br />

[45. ]15,2r41.<br />

s.vcr.l qe @ftrol $udi.! @mprisins IHD p.tidt3 a srouD ofnor$l @ rcI,<br />

have snom th apolipoprot i. A-l l.vdr ue d*ad.d Md rhos of.polipopre&h-B e<br />

inss&d (D. B&k.r .r cr 1982 ard kicBdo.f.l al. 1986) 00t, 2091. rr hu ba<br />

obeFrd ir rh. prcst 3tudy rhar rhc @n ld.ls of {olipoprorci. An rc jgnmoftU<br />

lowq ed rpolpoprorciFB dc 6iscd in rhe IHD pilidrrs $ cobp!&d ro @naol $bjcds<br />

io sddd snom in (TaU.6 Dd ll). Tt. r.duc.d lcveb of lhn apo Al Dd .ld.tcd<br />

lev.l! or lpo B w.r€ obw.d in IHD pltidrs r.pon d [roud Dsy 3rudi6 ladins 10<br />

158

---

sgsBtion of bcnr n&t6 for rirk of d.rcloping lnD. This c||need lwd of<br />

lpolipoprot€in I obe.vcd in rc@lipiddic p.ti.dt (Arcg@ €t .1. 1978 md vdgdi<br />

er al 1978) [2, 210]. h rh.rcrorc rpp.ir $ar .poupoprot.in @y b. moE relMf th&<br />

sff lipids in disdiniEling beivEn plriol lnd nodnt @inrol sbjcds The @lrs<br />

indidted in (Tabl68) rc0.d signifiorty tow t*k of dpo An srd elMred ld€rs of aDoB<br />

in mmolipidmic 4d hlpdlipiddic IHD p|ticnt3 dd @rrrol sbj€cts. Als (Bittolo er<br />

al. 1930) [2] l] d€mllldcd low l.vcls of apo An ed high lwels of apo B in EtD<br />

pati€ft eM wbo pldm lipid l.vek Ghol€ndol lid rdglyqidet v* nomd. The<br />

prct€in @ntfft of lipop.ot iN !.em rhcrcfore to b. b.tt€. disrininaror in alhdosldoric<br />

p.tierrc froh ontrol thd .loe! fiG plis lipid ldds. Tn inportu@ of.to B w be<br />

appreiated by 3igni6tut ditr M6 in ir! i..,r conaifitioN obs*€d who tn€ lllD<br />

patian w6e @npacd to cholcrcol n.lch.d @nr.ol. Ovcr produdj@ ofapo B (nat be<br />

rhe etre.t ofn lruritio. sch.! Vii. E ard vir C d.fciocy) wnid c€|s tlE in6as.d<br />

fu of LDL duc ro irs bodiicdiot\ wq- tddiDg th. '!!@ c[ot6r@t trspon Aon<br />

|ne draial w.[ thtugh.tuity of .po B td inrdrliri.t sb6t!..sj ha bq $g6t€d to<br />

c.& lh. prdnare 6reo.y 1h@$l@5i3 !a in iolmlipid@ic p.d6n! wirh<br />

devaEd .to B lclds [63.6a1<br />

Oud.r!isi..g@'nsihlh.sudyof tov.rc*d ..grdingrhesigDidc$ily<br />

hishd Lwb of alo:B ..d low l4d! oflpo A-l in p!i6l3 of IrD $gsr.drs p@da@<br />

of @huririon inlrt D popul.tion.<br />

SMy of(D.dyp.rc a dl. 1982) [212] 3hosld d1 by u!in8 6tio of aloliFprot€in<br />

A-l/apolipopror.in B, about (85./d offi. IHD p&i6|3 or tE trhy.ge ed s nqrcned<br />

.onfols @ @r€dly clasi6.d. Thi! h$ sub!.qu.ntly b.a orfm€d by (tdroiq et at<br />

1986). [213], wlD fouod our thc lpo A-l.ndapoB dtio(AporA-VApoB) wq€ tn best<br />

p'll@14 (+ 1Cel' su@s) to ca&gory p idis or @rtrob to rhe cod*l groups. Advds<br />

6n@t6tions of.po B dd apo A-l ad s apo B €ri.h.d LDL ps$d de diddt lons<br />

beforc clinicnl synprom begirs [?2].<br />

Ihe obwariom of study Gglrdiig reldionfip of .po A- l of rDL fld EDL{ s<br />

risk 6.10.6id our in L!rl@ i! in @Bisat *ith rh. fndings Eponed by (AssJl1m<br />

er al. ( 1983) [27]. In lh. pr6dr study, th. sFircR ofrh. IHD had lne .leEled ldds of<br />

159

---

apo B hd E

---

&wu the pdatuim of lipoprcr!tu ilno..t d.l w.I nd will prmor. th. s.qMe of<br />

doB thlr wil .ssid.d wirh h]Fclol6rfttdi! .@ if dDtdtmt !.vds @ mr<br />

high€r. It k $89*t€d th.t ttE d€Sndrion (didaton of the LDL pulicl.) b n qs€rv<br />

siep lor LDL lo be $Is up by ma.rcphle* Bhich in tuh bc@@ fod c.lh tne<br />

prog€nitor of fatty slrdl {2181<br />

In vivodpeituntqLDLoxidlrionpor.itidluvebeeo .ltrtlilh€dba.lualeif it<br />

o b. chdg.d. LDL panicl6 @niliring potuistunlld &lry ei& @ nor. [reL ro<br />

undd ao otdltion th.r t-DL @'n ining cith6 nom$ldrfrt€d or s.!nr.d finy rjds<br />

In.dditio! to uNnntcd tuy&id @nr6t,. hign DiGrutriq @orar ofde pbr!<br />

(vit. C) 3!d oflh. LDL potcrd it*lf {nr: AedvnrD tppd to r.r!d th. oxirtr jE<br />

pro€' Bdre of po\1J@n6t€d f y &id oilr de dct in edonddr thc irDad of<br />

rski.g po[usatuored oils on LDL oidrrion b€con r didot indju.tified.<br />

Ever if orc sgr€s oi fia athsolclsolir !riF! non nultipte Mules, th.t in e,sy<br />

ce on offi.r ddemindr f.qor i! choLsrdol. tud in d€rv ce @r€tion of<br />

dct.mmt @* is sigri6c.,n ro.nBt or 4n lo B* thep|1B3[81]. D.r.rio..don<br />

of .rtdid *an ftowh the ...mut.!ior of LDL clol€nftt is tlE gd6l opjdon<br />

A(erdirgly rhc clol.srfrl cdrying tipopretci. iiducc/hmr rhc prcg4is of<br />

lrh@eldoric l6ion in tne iffie!.d r.t. |t which LDL &e l.kd up ir ro th. anay val<br />

Tni! @Mpr could be r€ld.d k' lipid innttdior tt}loth4is by rBpping a t rhrugn<br />

@eptors wirhjn €Uulr sttuc-rurc. Th. orhd po$ibility ofdet€dontion of .rtdid wdl<br />

would b. ih. pl.telet aggr€garion du€ to LDL, @mulrion or ilrdlg.d cndofi.lial aus<br />

in sch . my a ro lriggd l6ion fomtion or l.si@ pregr*ion. Ir tji! @nrqt of<br />

dpl![rioq both e Mi.rcd pirh tipop.otcir ..1di.t *.ll i a.ctioa !d in .ddiri@ ro<br />

loEing t[. lipop.old ladi n highr posibly inq6E at lndi.t wdl l.td duing<br />

rlhdogsrBb. Ir is rcpon€d tur rcn of $. fom elx i rrh@s.tdoric ldi@ e<br />

ddiv.d fton cimldory @m.yd [ltO, I17, r2oi.<br />

Morc r*nt siudi€s hrv. cs$blidt.d rhar d. fo@ .ett conk ry to die<br />

qclwiv€ly fiom sdootn ruscle ell, u. d.riv€d iom cnolatory nonocyr* firt !dh@ to<br />

ddothcliun dd p6etr.re ifto $b+odothli.t epr@ ed late up lipopretcin ro beome<br />

loaded Bith cholGterol 61ss. LDL ald !|I-DL lipoFotei. bind tigln! ro r..!DtoB on rl,e<br />

161

---

iorstldll!@ph.g6 rd e l,ld up npidly ladit|g ro foD .dl fo@.lioi in nro<br />

ll2ll<br />

coldrt.ln (1980) [21]l ob&Ncd up rik or LDL (n.t've).t low 6t€ W th.<br />

odophagetno@'1€s in @ltue @fi!ry to gredin6s of th...U fo. LDL upbk€ du.<br />

to th. athBog@ic uturc of LDL. Thca. cdL doM r€gubl. fi.ir LDL E€pioB Dd<br />

tha.6y For..N thqNd6 .g.ind smgc ofq6 clolBtqol ..td&<br />

For in$.ft., lhc pdi6t qith ht!6chd.dmltrj! tuy bG .l gra.d rirk if<br />

c.dotheljal injury k presdt, but th. LDL d4ton muld bc d.tminins @se If on<br />

cs Fdet .ndothclial darEg. or plal€la ager€gtion io addiiioos to ral<br />

hyFrchol6lftl@i., tnc i.r€.\adion high b€ me etr€diE md s6ci€n imp.d on fi.<br />

presNon of dE digs dd IHD d* [216] Sd@l rfu(|i6 Iare slDM th.t<br />

Dliqidam!, Mh a o- rocoph@l or Buty' @rcxy totuqlc, conplddy d.si.d thc<br />

prc6s of LDL mdinelioB LDL hodifotioG djd .ot ratc ph@ a ats@ of md.llic<br />

ioN in m€dia or if, prcsc@ of meul binding ch€lalor is .dd.d. Tlc atudies hire turth€r<br />

sh.M that inhibitor of liporyg@ Glfc.tr€ly inhibit rh. adod€lial cdl irduc.d<br />

oxid.rie nodifclrion ol LDL .F:8. Innibitd of pl$pholips A-2 @ .ff6tiE in<br />

bl@lins modifcrion. Oxiddivdy nodifcd t-DI. dight initirr. .d!6os*is br tm<br />

L LDLondi&d ir .ytoroxic to cul|lild adolhelirl cdb dd othd @lb in the @ltor.<br />

Aid th. po&ibility ofi'du..d .ndo0Flid iniuy by qidizd LDL itr vivo y nor<br />

2 Tn s@nd rEh.nis is reld.d to rbdlhy of li|lmphrgB ud monocftB. All<br />

three of$. major c.I typ6 in thc .!t drl *a[ m ola..hmolaclic fadoc but<br />

it re@iff uncld whi.h of th6. pl.ys rol€ in vivo. lt ha b6 shoM thl<br />

didatiwly mdifed LDL L a.tdly chdob.tic for ft..ircddory mnoclts.<br />

It is wi(Uy @tt.d thar rlE prrrd of idd!.lidd difqq6 in rsblily ofIHD<br />

e rdated priMily 10 @onic .rd @ltur.l h.roB lrd nor io lriric fi.bs. Tti hld<br />

lcd ro lhe b.li.fthn th. sp@i6c c!@ of dis.* is relaLd to hbirs ofating, phyeiql<br />

@livity ed smoking wiihin th€ populatioi [ 163-165].<br />

162

---

Subseq@n €piddiologi..l $udi6 of th. pooul.rior b.lo4.d to aI dE qio<br />

@@dc g.oup &.1 rg. group! mging 2060 &d $ov€ indier.d in (Table 18) sho$rd<br />

low o@.tr.tions of liDL in prlids rhe fi.ir @fioI, hav. €o$ilr@rly @nfmed<br />

th€ inv€fe 4sociarion of HDL wilh IHD, Glrdon .t sl. t977 ud ca$elt €r at {19831<br />

[2]?, 50] noted sinila. oberltion Md i.v6. srcciarioi with HDL cholesreol dd<br />

pr€ldene of ItlD, &d rhat w.s in lgt.ftnt with the obwtion fodd in oDr study<br />

Then@ serun HDL l*.1in IHD p i.tu wa! signin dlly lower N €onp.@d ro @hkol<br />

ebjecls {Tabl€-6). rh. findings ofprcs.nt srudy shown i. (T.blcl3) ud (!ig. l1), rhar<br />

low HDL ldels w. r@mpdi€d Bnh tdglyrdidc in p.icntc onp&€d ro @.t ols<br />

(Ta,bl€-6, ll 12) suggested & rilk flctor for |llD. P.imaty distlrbme Bponnu€ for<br />

lw nDL may uliinai.ly lie in tnglycdiilB n t.bolim and HDL c@ld b€ . m€dialor<br />

b.twm the baic nlallolic dcfccr sd v.slr l*im !031.<br />

Also low HDL or nish<br />

triglye.id6ldel in IHD piti@r k wMlmcd b6&* rh* my bc pots ialy nodifiahL<br />

thiough soking c.stiol\ .@bic dftisq wiglll r.duciioA &d flt modidcdion in<br />

dier, (Min6 et al. l eeo) 1621.<br />

h is qrcpos.d by tlc G]omost I%8 (cned by rrvy d d 1980) [44 $.1 HDL<br />

sm 6 . @ir for th€ rc@vtl of choldrml &om rhc Fiphdil tisq rha.ty<br />

t ansfening it to rh. livd, whd. i1 ir @v.n.d ro bil. eidr .rd qq!r.d. Afthoan rhs<br />

prcposd of tdds.holsr.rol tmpon. b @mp.tible lnh *hd w trN, h S@ld be<br />

snaed upd direc:l pr@f in vivo adl th. h@h&in op@rca in th€ ptupos.d M<br />

Illis "cholcar@l rerae trulpo.t" m6luim k no doubl us€tuI to rmov€ clnl616ol<br />

fron the s's&n &d n€gadw @ft.Ilrioi bcrwn tlDL l€vcls dd $e nsk night b.<br />

mpoadt io iedoving cholBt rolfron an.rid wall ltowwd s slil l&k ey dired<br />

didde that by ch&ghg LIDL l€vels in d individud will d$ d&ge rhe dslq whft d ii<br />

ce of LDL, we do havc auch cvidoca In umd qpdmot!, by oising LDL,<br />

ath€rosclerosis 6uld b€ indu@d but no su.h obFEation i! available that shows the r.isine<br />

HDL l*ls @uld b€ b..encial a! th.aparicNlly [541<br />

The 6tios TorNl chol.ltmuHDl and LDUIIDL w.rc also detmined ir the<br />

p@ql study wae sig.i66dy hiSlq (P < 0 001) ii IHD panots s @op&€d 10 @nnol<br />

$bj4ts shom in (T.bl. 6) W.lsd .r .l 1980 lnd wtry.e et al 098D I2t9-220)<br />

163

---

$gg6ted thar iftrodu.rion ofLDUHDL .nd tobl cltoldtdoyllDl, ndo s m rdditionrl<br />

ptu ta md ftr fo. IAD h dticip.i.d by m@uin8 th. raliG [21q220]. Sinildt<br />

(Xdd dd C.$€[i 1978) P]l sg8€3l.d rhal th.$ nrid @ nor. inponut lhq ttDL<br />

choLrt@laloe in pr€dicliig th. dlk of IHD Ac@rding to th* wlGn md with<br />

(e.5) rohl chol.ndot/HDl Brio e.r dolbl. !w6s. rirL Mo@s (Kohkond 1983)<br />

[2211 rcponed rh. sisni6c!@ ofth* ntid d follow:<br />

Total chol€rr.oL/HDLcholcrtsol<br />

J.4a<br />

4.98<br />

9.95<br />

t21<br />

1.O5.<br />

A&o (Doiircglu.t.l. l9o) 16ll obd.d in hir 3tlo dlr tobl clblgr!reyHDlod<br />

LDUIDL rdi6 wc aigiiftudy nis.d $ conplr.d ro @ntrol ebjccrs aid<br />

$€8*rcd il8r..rios v4 fcrd to b. mr. mhi€ inidroE of IHD dig@ TIE<br />

&diig ofrh. pte lrudy & in r@.{.@ sitt tlE 6.dingr oflie turtss.<br />

In.ddirion ro individud rnn., ch.ndainie tit. s.!.g!, f.nily hi*ory, s{m<br />

sial oqowc tuy hc tlE cue of [lD dftloptum *ih rhir otlgE rioA D<br />

etid@iolo$/ of th. ru61 a.d urh$ liG stylc.nd rh. iit fa.rN och d mkilg,<br />

htlsttuioa di.t!.y i ate b€lr.viour, dirb.ta ob6ity ud sioonomic onditions<br />

(ompltionrl liabilhiA) w@ !tudi.d ro ad lh. dyllipid.sia h @nr.ol $bj€('s and<br />

pati€ms inplior.d with ditr€eit @qp.rion Thc bl@d sri dMir€d for rh.n<br />

bidhdic.l vsi.bl$u.indid.d in cT.blc ll.lt).<br />

It wa obswed thlt lipid prcfi1. of .ll fi. pati€nts b.longi4 to difol<br />

socio4o.omic clases r€siding in ruEl or ude *s rcl.tivdy rllered $d lh.ir Bpediv.<br />

conlrob dd the l*€ls of total chol.ltdol, LDL Dd lpo B (indepoddt indi6) wde<br />

nirn ir emusr .lss !in* rh.ir dliqrion with indifddr di.rary habit! oflaldng noh fmd<br />

(eturar.d fat ad clDl61€ol) .d withNl hrvine ruch phrsicd adiviry ob*Fed ion<br />

lhe quAtio@irc adninidd.d cfuol b. tul.d dl rh. o& of ou€tine withoul<br />

164

---

sppl.rEurio. of vihi6 and miffidr wni.ll a B in htlcdipidqDi! hoslq rhc<br />

sitrdion of poo. sioqn@ic dd ech d l.!ou cls ard wi@ ct s is mr diF.mr<br />

nom the afiEd ds s for th€ ld€k of lipids &. otucrDcd o.ty, stieh dift6@ in<br />

@nentr.iion wa not.rl Nl lhes. Brcups w€r€ noFdiib.lic dd nomordliv€<br />

Nacrlh€l* rh€e pali.nrs Eponed d€ 50/d mokd. rhis suggests rhat bdN& of<br />

tBlturnid crd phJ6icrly ls aaiv. fly be rlE @d fr.ror for dystipiddi! rd<br />

smking aggnv.r.d n [6,]01<br />

SNn triSly@.id6 w@ roud to be 3isnifdrly hishq (p < o.oo1) ii i[ ihe<br />

ieh€dic pali.nB d 6mpe€d to onrrct lubjeoh (TdlF6). Th. re@m€nded sluca of<br />

srum itiglyeride w@ found ro be t 29j2.O mg/dl h @nirol lrd 159 ng/dl in psd s.<br />

Grudr d d (1989) [222] dDw€d in rnen $dy rhlr pl.m rigtydid* sc<br />

chtcd sith body waight &d (Phitip d d. ( t 98O [222] h.rc @n hr.d !E Bi!.d l.v.t, of<br />

rngltqride dd chol.ltdol in rh6 EiD p.tidt!. Triglydid. lesls e ate in0udc.d by<br />

nch @bonydrai. diel {nd d invqsc rclalioft b€twq HDL &d riglyqid€ have bccn<br />

sugg61€d by (Nik*ila cl ol. 0 9?3) [] ?91.<br />

The H*i.li Hon study hs prcvided datr eggBtiig rl,al ..dwing rhe<br />

@.cnrador or riSlyqide ijch lipop.ot.iB my '€due IHD n* I41 toll Msy<br />

mrk4 h.w epon.d d abnornul eld.rion of rdgtrsid.s in IHD paieit, olrourgd<br />

agc grcup3 whil. iomolipid€mic ed old age groups did not !ho* dif.l!@ ihan onrol<br />

[68,69] Sinil& $udi$ @nduct€d ar rrrks. lNw ale in agr.eh.,rr wilh the ob!.Mliors<br />

Th. na wha oftu phosptFlipi& in rfiis study *4 shon in (T.!lM) 6d<br />

sie,j6@t ns i.lh€ hn phospholipids (p < O.OOI) in D.tiql! of IHD M ob$d.d 6<br />

conpr.d wirh conrrol 3ubj{ts K.nncl .1 al. l979dd Tdlokjdrh €t at. 09s2) [l15,<br />

2241 d€moNrFicd th. sn ldcts of phosphotipi& of patiat3 dgnif@tty ri€d s<br />

@mpdld to @.rrol. Tl@ is sDidchblc didap rt r in ihc g.n6t of adEom nol<br />

o.ly clblBtqol is pr@.r blr .long *irh olnd [pids! phosphotipid e .t$ pr€gl. Tte<br />

linding ofrhis eudy h in .3r*@1with $. pubtished dara [l<br />

A risk {..tor for IHD nsy be defn d s my ctua thal is shoM in My<br />

epid€mioloeic study to b. ssiarqvrcsponibl. tor d.lrloDndr of tED. this definitiotr<br />

r65<br />

t 5].

---

ir lddilion to $. iDdividual l8its ctrFctdisris like so! age &d f.nily hinory. includB<br />

$m sid 8clo.V*p@E, q4t d civil srlrus! .ducalionrl ld4 o@!slio4 digjous<br />

afrliatiol alni. odsin ad pove.ry. Duriry cddhood gm indi.61 alsisrio4 tife<br />

w.nts (ltrcs dd shin) od direl cs.l f!do. lik€ Ntrition i... high snu6r.d fat itnate<br />

(uin'd ftt, o€3 f.r dd nilk wftn rd), hieh chol*t€rol inrake, hisl sdt intr&€, rich tuod<br />

in tms of dlorics, .otre oBunflio4 cigs.ne moking, d@hol !b!s &d physical<br />

actMty hiv. bd shoM io iiflud@ IHD rist by eldatirg abnomatty $rum lipid<br />

@@ntnioN Dd blood pr€sG. Dr@1 oiud f!.tos which cho8. rh. iftid.M of<br />

dis€& $b!.q!6dy.n6 thei. rbdic.iion For ion i@. v.g.rais dia ir r.ot@dre<br />

b...@irisloqin salwtedf.! tt dn€.r .&qcl frdor<br />

Slss .t rh€ Mrk pl4 My b. th. ffipL of i.dn€.r rtt fscror of IltD, bur<br />

agatl mainly b6tue ir pronotes irf.!!€d cigtrdr. Moking or orh6 habi$ thal de.t<br />

n* ditutly e g rl@holisdnch brcwed milk 1€. with $gar [19,195]<br />

fror prdadw poiir ofvicw, ih. mst imoofim risk frcros uc rhoe whch &€<br />

*.tirl for th. oct:n|l!@ of IllD .nd th o be nodit.d. In g@E] th* fldm<br />

vould b. iut i.n! blood fipids bl@d p|lgrc ..d mt{ing h.birs. WhF s n n d@<br />

lhd .8c. s Dd hfedity rnich @ nor b. dta.d, bd rh* provid. inpdam<br />

rfomdon rh.r will in!@e ihc rtk |su6t ba*d on olhd risk f.doR 12281.<br />

Thc .fr€ct of scial *polure mdrion€d rbove w.s dudi.d on rh. biocn@ic.l<br />

vdiabl€ in Fticnts ofElD, rcsiding in Nnl sd utlan ee4 diab€ria! ud oon diab€rics.<br />

smok6 Dd nor smok ri lryFrt€oriv.! ud nomordsive<br />

Il B obwed lion rhe rdlts iodiar€d in (Tade 28) thit l*.ls of roral<br />

chol.n@l is signifiody ldsn b unl $bjc.t! dh lh. ulld (trD pnidi!) cl@b<br />

sgg6t thc nutriliv. €ff..t ofr.li4 lot ofniu &d blnq s th.ry t*p rh. &in'sk for rnis<br />

Dlrpoe ud th* dimah e f.d @tton j..d &d oit ejdnd.n yi.td of fany s.€ds ro<br />

6q6c th. frt onr€in of nilh sinihrly olhq tipid t*ls $ch s LDL cholot@I, HDL<br />

cholstcrol, ipolipoprobin Al and apo B w@ found altden Dd inprircd in @mp&ist<br />

to ihci. urb.n ouf,t€r pdrs. However, rh. urb.n population have 3hoM hid body mss<br />

indd &d totd lipi& sggelrira les phy3i..tty rclire tu$ly b€&!. of tmspoft f.. iy<br />

av{ilabl€ in wtd '@ @uld b. rh. qus ofrh€n buitilB obsnrd fion rhei, ns<br />

i66

---

indd The simjl& obwation wde Fponcd by &rho6 [6,22,24, ad 5 t].<br />

IlE er.d of lif. st/e qp€ially ! hlbn of ciglr.n mokins rdt61s ins.e in<br />

t.iglyqide lryd3 4 otwd ton (T.Uc 26) in mt6 rl$ nor€d by wious eork6<br />

050,1511 Sinil{ly dam. tDL in 5ho*6 ws fou.d ro be sieDiftsrty tow dd<br />

inv€n.ly r.lor.d 10 rriglyerid* in @mDejlon ro non{nok B. For insran@ rh€ lmoks<br />

t.*. noE far in their food in rhe &m of nan ud egAs whilc non-mks rake mor fri in<br />

the fom of c*€q sw.ct3 ed ch@hi6. Smok6 oftqtt qNre norc f!! to .couirc<br />

tu cdo.i6 in fom ofd€? ti.d f@d. Con@miraftly nn. Frc.ption orsrckd tuy<br />

difld Aon non-snokq Md or$qu€ndy food st6tion @y ditr€r dd difdd@ ofliDid<br />

l.veb in ce of ditr€rd dierary b€h.viour @ rot be Nl€d ql [] 47, 217, 2l8l<br />

Tr@ds in hrT.rt nsion @si.g vui ion in biochoic.l wiabrs u. 3hom in<br />

(T.Uc25) indic{cd $d hish totat ctok3el !d LDl-{hot.nftt.nd .poA ed bw<br />

l4l3 of HDL clbl.nhl &d apo A-t in tt?€ndsjw p.riql! than rlE nooorcnsiB<br />

sugS.nins m inlc.rcrion ber\|6 go.ti., dircmdd ud lii€ dyle facton lhal<br />

'hpli6t€d the g...iic mur{rion in rhc dct mitudon of rh. bl@d pr€surc [160,162],<br />

subs.quddy li|i nyl. f.dm $cn a lodiun irtrta nilt ra sd @tre hrvc bd<br />

6cl.r.d *nh lpid l4li md stsrolic a.d dj.nolic vebbitiry in bt@d pr.sge in tu)dom<br />

populatioN aged 20-84 y.di S@kin8 habil, wial .tss, psycb@otionat !rr.5! and<br />

oihcr cabn6 qpended at work rd spons Nesed ftom qusrrioMire and Aom th€<br />

edFis of sn smpl. impticared th. ht?en4ion d rhe c.!!d f.dor [169l.<br />

The blood la.b of tipids da@incd in dialaic (NDDM).d no._di6dic<br />

parbrs of I}lD .e?on.d on plgc 146 (Table24 i.diet€d hietF @ldmrion of<br />

triglycqid€s (224 og/du in diabeic paiiot eldared .bove t5O nB/dl The<br />

hypalriglyqid€mia his.! LDL dd low @neinftrion ofHDL .holdr€rot ed.po A-l<br />

h @opeien ro noD dialdis tHD pdidis sss.srcd ild.paddll d* facror for lne<br />

dalopdat orIHD !7?-|t8l. A @jor @nf@ndins f..ror ir ob6iry obe.wd fion lhe<br />

body ms iidq (BMl) ofdiah.riB dd nd-disb€iic. T1E $o B w@ al$ found 6ied<br />

in di.beiics thd .on-dilbai€ patient!<br />

Th* obwrdoB l@ @sisrdr wirh rcports slbnnGd by (cordd 4 d. (te77)<br />

[217]. nE.f..r of tirc 5ry'..'d did!'y bcluvi@ €oor b. rut.d on in th. dacloDnan<br />

'167

---

of obditv rhat lads ro rh. @n-inslin d.Mdql di$d6 in rh. rurd ed urhd<br />

popularion oflrkaB dMsion $ the scial €xpo$rc qus for tte clinical nrnif$tltion of<br />

IHD. [4?l<br />

Sdn udc &id d u ind.tendefl p'ldicrq of IIID sl8cned by mst ofth.<br />

work€ro ic nol th. ftncl beus. rn d.tiE nsk ofstuh uric &id in ddclopmd ot[lD<br />

is quitc snEll. Th. ra$n i obviou non l[. irfudB on its Foduction or r.$l<br />

cleabnce ofuri. acid that sg8.st rh€ ssiltion ofuno rcid in the dweloprdl of lHD<br />

co not b. inde?€rd.ir ri* f8cror od pr$ dvough mey olnd risk f.doc [225]. It sill<br />

b. rdvie!|. ro @intdn tt. lorls of sn dic &id bclow I ng/dl by lhc dictry<br />

i etuentiom dd iluid conMptioo, dril i is rtudied rhd ht?crun@i. is piMily<br />

eci.t.d with de8pffirrive vr@l,r ditae and is only sndary to oths a$oodr@r<br />

sirh ob.siry &d ltr?.nrigltc.iddia d pd NStgdtioB ob*rycd by (w!rL.l tl l9?7)<br />

[227]. Roh of @m udc cid in pld.ld adh.s\@s dd prcpos.d ftchaism involved<br />

in athns.l@stu o not nn€ our .rtaid v|gltr deg*arion/ddEs. [228].<br />

The n e 6mn uric &id in @ntrol subi..tr it .omp&i$n with four eciomnodic<br />

grcupe of I}lD p!ri.it! ws f@.d lo bc 5.0 :t 0.9 mg/dl 4 3hoM in lall€ 12 ln rh.<br />

pr*m $udy the rdu.s of sm utic &id wse signifiqtly. high (p < 0 05) s @npdcd<br />

b m rcl$bjels F.w r€s.rrch* $ovcd i.lh.ir 31udi., sgnilialt de in &rm urjc<br />

dd in palie.ts or IIiD s onpdd sitt ontrol sbj.ds [2]1 2331 In Pa*jnt<br />

reirosp.clive dd ptospeqivc sludi.s wr. Qri.d out Edid Beg er .1. [230] h!rc<br />

corelatad bisi smn uric dd l.vels ir ltlD paliots Sh.nit4.t d 1973 rd Baig (1931)<br />

1229, 2341 h.ve si@ . nomd ltlte of!d. ldd in @ntrol sbjdrs $ 5 6r08l.d 5 5 r<br />

o 12 ng/dl rcspectively Multi c.nter study of dsk factots mndu.l.d bv p.tittd M€diql<br />

od R.sch Cowil (PMRC) (1980) h.v. 8rv€n thc wlu6 4 E I 1 4 o8/dl in nomd<br />

obi613 od shom si9i6tut @t laijon filh IfiD<br />

Iron ln€ follow up study subnin d by Tal0mci and R.uneq (cited bv Bead)<br />

t2251 in ! gronp stu.ly of 2753 nul* a.d 20 I I f.n'al* lgcd 3c 59 for ix vqrs rhev fouid<br />

high IHD .oflatily io b?nd@mjc individuals .ncr onito ins for folow up tine, ts.,<br />

@rdiovddlr hedicatio4 ch4t p.i4 ECG che8.n rytolic bl@d p.€sr€ choldtcrol<br />

.nd wkins by tuhivoa& rc86lion ddysie Thev @.clud!d th.l O@8)l prclininrv<br />

168

---

dvtb ltdr qrd -'d -r! uic.d r - ij{dd ri* tda 6.<br />

nt ifrr@ oa rrn cuid.|,rElr rlt<br />

'l..d..<br />

b. L (FhlV) !.fl.d<br />

fruah editco.r F2'.2341.<br />

IL ffi|. dFt .& e b .!.adrca ri6 rb turdc d.ov.<br />

b'dgaar<br />

IO

---

col{cLUsIoN<br />

The nyFrlipiddb .rd IHD study @icd o in lh. lopulation oflldrm divirion<br />

10 rsK rne n* f&toB by 5.U admiri$d.d ql6tioMirc includ.d:<br />

L Ag., s,q scirl sr.tud di€tary habit+ leslty of eids& (rur.!ude), f&ily<br />

hinory pilh kl1lM hyp.dipid@i!4HD, pb'sicrl !.rivity, bodr ma irdor ot6ity,<br />

hr?enmioa and di.bct rneuinr! (qpc2).<br />

2 Al th. r.lcvdt biochcnic.l Ei.tl€ a polsibl. ddmimts of t'rlslipidmii<br />

lading ro the d.dopm|t of lHD vft d.rmimd i! popu].lio ard..s{icd<br />

with thc rbove risk 6cloa d. 3lbm in t$16, 6gur€s, di|ltm &d csuls<br />

(r.bL l-30odns@t.<br />

3 Th. .vc.g. torsl choLdml Lvdr dbsrtd in nudy potuLlion wa 18G200<br />

ng/dl $gg6r.d ro b. b.low th. rbr l4l a pd rcpo.t of @Ds.Ns @nfd.ne<br />

ed Eomrcodation to pr.Ml IHD.<br />

4 The di.t!.y prttn t gndudly w6t.mi,.d. Ew.g sm. tudif.d ftst food<br />

taling di.n!, $ch s dap 8i€4 ovd brding rq in P{c mlrr qith ddriion of sg&<br />

was th.n main sqrce of biDnl ht ald cnobttdol, Bulted dyiipiddit, ob.silv<br />

dd diab€r* ndlitu!.<br />

5 M.l. IHD p.nab (csPei.Iy in lrbolt g@p) s4 .trc.acd by mrhg dd<br />

fende pali.its w@ .ft.t€d by di.bct4 ..d tt?dtd$on.<br />

6 The dis.@ ws domi.st in nal. prri4B > 40 y..rt ofrg€ md female pni4ls ><br />

7 Ih.$!di.sofapolipoproi.irlddrudElDinrti4i.dihat .polipoprct€inA'l sd<br />

apo lipoporein B de b.tt r risk pEdictoF in th. pr*nt $udv of eciosnonc<br />

onditioB .rd life sayl.. AFlipoprot iFB ffi lo b. songly ei.l.d vilh<br />

wdorlslr d* fis low d*ig lipoproLin (LDL) or hull ddsitv lipoproteit<br />

(IDL) lcv.l!<br />

8 In si.mnonic groupr the bui|B clN poPll.tion 6 fourd @E inlicLd to<br />

trD (2rZ) in omplisn ro otls $cio@ndic guF.<br />

170

---

RECOMMf,NDATIONS<br />

l Aspecrs ofath€rog€r..ir, b.r$e ii rnry indrn6, the pBdae ofllD due to<br />

hypq chol.smldir'hyFlipid.mi. k rct cl4ly @n luire ..d n !d tunhd<br />

study in udo9rding th. rc|. of iiitidiv.6doB dtd Pc6dirc ']..glc<br />

2 Furtls '€ech ir n .d.d to look for b.n ft .id o.cd or eridid$t viimin<br />

$pdmt. Mo * . e lttD p@tiw dh di.,lEd eit[ nuiq waalDl6<br />

dd enh *nich provid. lh& dtondr.t!, .rdFur! in loE dl]g tnr. d b.<br />

a.hjercd Bing egploMrliion<br />

3 A lea. tMbq of ht?.rtdldrc violitu in thi! study bdn'g lo d*Joptrl of IHD<br />

w@ obs4rd dle to nrB!, int lc of desive s.lt, satunred fr$ dd ttting<br />

shong ra br@ed in miltq cignlil. mokii& oE uodtt s€ddbry If. a.d<br />

dirbet€s. All scn indiidu.l necd prcp4 @ ofdidlry halits and rcdu.noN of<br />

weid! soking @setioq lo adopt.s tB.ntivc mqsdddt.<br />

4 An aM€o6s of h€rifiy turrition i3 vdy much cs.e ial lo maini.i! the stoddd of<br />

lipids and httst*ion. woM e by drd hdge r€sporoible fo. th6 Nlritionrl<br />

h.bits of rhe 6nilx tlErdoo il wil b. WrcPiate ro mate eoM @rc<br />

iiformtir dd .du6t d io lrovid. b3loctd Nliirion<br />

171

---

FTJRTEf,R ASPECTS OF STI] DY OF ATEDROCENESIS<br />

l. Ir closing thi! !&rio\ it m!. bc erc llla! $@ is ot y linft.d dida@ for<br />

2<br />

t.<br />

oxid.riv. nodificaiid ofLDLc ir vivo. Addilional so.t i! odd€d how€r, lo<br />

ch{a.1qiz od qu4dt th* tudiicd fomr ofLDL .holdt4ol imncr in ordq<br />

ro @iim th.ir pNUc rcb nr .lll.'ogffiis.<br />

Anioxidants pr*nt in vdioN fiuits Dd vcgebbl€s sown undq difr4€it<br />

@logicil @.drtjdr sd e aLbL tuy be ti.d for lh. bhibitory prl'6 of LDL<br />

rbditc.dor ..d degnddion in vit o, h adod.lid c€Uulr ql!l6 .rd ii Ditt l<br />

qpsim.dr to onclude the possibl. mrhi.im of aLh€'ogd.lie.<br />

Thqe d. o.!!y cl|€mta.lic frcroB for the mnoqidndoph.gc but n rsnia<br />

to pin poirl dE reL ii vivo.<br />

Cenain @lluld e.4m.e sh s (lhospholipM An ard lipoxygeie pmxjddive )<br />

c.e .fl€.live modificdi@ rlong witn pdxidatioc lh. d.SB|lrion of LDt<br />

4oprotcin-B Th. inra-rdarion of $ch nodiicdion MdB to tE dd@hcd.<br />

Reeln $udics hav€ shoM thal inhibrtoB oflh.s oz'nes efcdively inlibit ln<br />

ell induccd onda!rc tu.lifcatioi<br />

The inhibnoB ofpnorpholipe A2 e.&ctE in bl@*j!g tlE nodifcdjoojud a<br />

ef€div. !s dri-diddts<br />

The i6h&is of "Chol6t6ol Ft* Itdpon' d a 3bong Nsari@ @r.lali@<br />

bds@ ltDL ldds in plts and IHD nsL n..dr turthd dldv b $. odh.nim<br />

o!@tivc in vivo. B*N!e srill it h nor src $at chlngng rDL l*l! in an<br />

individud sr! ch.nge thc d* of IHD ed nt lh€r.pelnc .mc!.r is v.r lo b€<br />

172

---

BIBLIOGRAPHY

---

BIELIOGRATEY<br />

Cadiovasold dil€e .d nultifa.tqirl rbk chilldge ofth. 1930s<br />

An He@t J 1983: tu(5 Pt 2): I t9l-200.<br />

2 Coscn$s @rfer@ riwqilg blood chol6t@l to prelqt nan di@e<br />

JAM/ 1935: 253(t1): 208L6.<br />

3. Btu*rld E, Is€b!.!d KI, P.ras&4 .a .1. H@isb pirctplc 4 i*ml<br />

r.dbt@. Nd Yort Mcc6w-t6ll, 1983;95.<br />

4 Kis. JA Anddsn WA<br />

Attd.Mk Fdtlog, |oLl, Ns Yorti Mo.by, 1935; l: 57.<br />

5 Robbins SL Coid SR.<br />

Robbihs Ntlblogc basis oJdie6.,<br />

2nd.d Philadelphia WB S&rd6. l9?9 p 20&00.<br />

6. Cftic Parniei r\n, cosrrs \ c@vidd n4 d .1.<br />

Rbt fa.toB dd F6!hr@ ofcoonrry h.rr di$e ir puei. Ri@.<br />

(:i@ldi@ 1970: 1431- 54t4.<br />

? Goldn.in n" Hrzdd WR Sch.on HG, BiqrM EL; Motulsty Ac<br />

Hl,p.dipiddis in oMdy ha.r dig&.. Upid l@ls in 5m wirc6 of<br />

nyoordirl i edion.<br />

, Clii Inv€s 191:52:(7): 1533-43.<br />

8 L4is B, chlir 4 OaH€y CM .1a1.<br />

S@n lipoFol€in alnomrlilica in p.1icn$ pnh ischemic hdn disese:<br />

@mpodsoru win . @nnol populalio..<br />

BW !974i t: 1a9-93.<br />

9 BtumdD, Allrqa t €blKd.l,<br />

Sdm chol6lqol ad riglrqidB in-pdiar! $fting Aom iich&Eic han<br />

di3c& e|d in lElihy $bjds<br />

hh.reltuis 1977: 23: t97-201<br />

l0 Cino AMj Gorry c& IlEnpsn JR a at.<br />

Rel ionshjp hdw€en plasma lipid conc.ftdrioro md €mncry .ncry di36!. io<br />

496 parn s.Ci@latih 1977: 56(5): 87543.<br />

113

---

ll ,o*iN Pt, HeFr RW, N.!r.l PI<br />

S€vedty of @m@y arh@sqlmsir r.l .d to lipopotein oncanrudon<br />

BMJ 1973:2( 3,1): 383-9t.<br />

12. AEg@ A Binolo Bon P, Cruzo lro C. a d<br />

PLlm l*ls ofatolipoFdcin-Al dd lpolipop.ordr-B in hum slheos.l@3i'<br />

afGry 1923: 1: 3854?-<br />

13. Pgmn TA Bultley B4 Acruf SC, d d.<br />

Th. as$idi@ of IN l@b of HDL chol€sr@l .nd &rsiogspnic.ll, d.f.cd<br />

@bnuy .rtqy diste.<br />

An J F?neniol 1979: 10t: 285-9J.<br />

14. Goldboun U. Medalie JH.<br />

Hisn d@ily lipoprct in chol.lt€ol (IDL) ad iftidde of @n.ry hcan<br />

dis*: the lsdi hdr dis.e cudy<br />

J Epi&niol 1979: lln: 29G30A<br />

15 Bonigd L,E, Cd$n t-A<br />

Rier &sm fd i$tr.nic vlgl.I danh! fd m in rb. $dr noh po{cdiE<br />

lltct@ltur 1930: 36: 389-'10E.<br />

l6 F.gd G, Wikludo O, Olofr&n SO, a .1.<br />

Stun apolipoprctein l*.h in rchrion ro @nc Dt!rydial in&rclion &d irs dsk<br />

Atheloelmsis I 9a0 : 36: 67-2 L<br />

17. Holoca DR El€rtback t l, Frt! RL, .t d .<br />

tusdalion of risk 6dor Ei.bld.rd c@n ry art6y djs€e doo)lMl.d pirh<br />

cttulaiat t:6t:293-9.<br />

18. K6lddr r{ t4 CS. Ptr* ll. a d<br />

A oDladivc sdy of mn litidr bawe Bdgum ad K(D<br />

CiNLltiM t9a2: 6t: 7919.

---

19. thw K Yu ry tr KY,.. at.<br />

A rcpon of nuririoi su.!€y<br />

Kq@ J Ntt 1969; 3: L<br />

20 PstY' chu sK<br />

Food @.snptio. Dd {triri@ S{tu y in Ko@ @t aJs.<br />

Kdw J Nttr t9?6: 9: 37.<br />

2l Atrn 84 Ry@ LrE Ch6g SK d.l,<br />

A .rdon *id. f@d @NBption $tucy h ((E<br />

Hw &i (KM) !977; 1: 13.<br />

22 K6r€l@r tI Pdt BC, L@ Cs, €t st.<br />

A @np&.tive !tudy ofbl@d pr*lure sd sodiM inhte iD B€lgium and Ko@<br />

Eu, J Cantiot 1980: tt: 169-<br />

,. Joo€gs Jv, vuytne.& K Blas tE .r d.<br />

IX. pdtfl offood Md nodality in Bdgiun<br />

brcet 1977: l: 1069.<br />

24 Vs Hane Kcsdoor tt<br />

An .pid€miologicrl $ftq of.ilt ti.rds for IHD i! 42,804 l@<br />

Th€ saD chol*eol !d!e.<br />

A.la Ctdiol (BN) 1972: 27: 52?<br />

25. Uhl-cs, Trena RG Hichnd.tRIr;CLrt D<br />

R.l.!on h.rrq hi8,l &Gi,ry lipoprci.in choLsad .d @ory art6y diss<br />

in . synptonvric mq. An J Ca.lio! tgst; ls(j): s,j-!o,<br />

26 Fqger c, Wiklund O, Ob8son SO, d sl.<br />

Muhiwiate ddrsk oftu .potipopro&iB a'd .ist facrd. i rddion b qne<br />

ny@rdial inftt rion.<br />

Art liNref(is t98t: l: 27t9.<br />

27 Asham c, Funt(€ tt Sclri*sH<br />

Th. relarjonship ottlDLapliDoprociro A-t dd HDLclDl6tml to ,tut fador3<br />

of c@Mry nan dis@ in 6Epoy .trtptoyd i. W6t6lir.<br />

J Clin Ch.n Cti, Aie,.n t9B2: 20: 2A7-9.<br />

175

---

28 Fruch.n rcr P&r. E C&h@ C; Ct vly V; Bsr-md lrd<br />

Lipopoteinq apolipopo&ins ed ooroi!ry fisy diee<br />

RicCAnhb 1982; I2(l): Iol-a<br />

29. M&i.jlo,t, HdM DR Kottt BA.r.l<br />

ApolipoFot in An a ! mdt6 of alsiogEphicdt 6G!.d odry ltqy<br />

NE gl J M.d 1983: 309: 38t,<br />

r0. P.d Laa,{ Hdgchld IItrtu<br />

Th. OJo study: cHD ri* &.rG, sio@@nic hfudE ., .'d intddriotu<br />

An IL@1 J 1983: ,06: l2o@tt<br />

31. The lipid rcsch clinic! @roirry piitury p'lMnoi nial R6ulG (LRC-CPPT).<br />

JAM) 19U:25t:35t-U.<br />

12. V.g. GI" Grudy SM.<br />

Comp{tuon of lpolipoprcrein-B lo Chol6i@l in rry ddsity lipopo|ins of<br />

prti.nts Pilh Coontry he.rt diss.<br />

J Lipd Pes I9u: 2tr 58e92<br />

33. Wil$n Pw' Cdi6 RJ, Clltdli WP, a d.<br />

Pr*lcie ofcoon!ry han diss* in thc FEningll@ offlpdng sdy Sody of<br />

Iipoprot€in cnob$dob,<br />

An J C@diol I9a0: 4: 619-ia<br />

3a Oodon P. Cddli WP, Eorddd MC,.r.l.<br />

Prdicting @onrry hon dis.e h middl. lged Dd old6 pcsn& Ilt<br />

Fnmingnen Siudy.<br />

JAMA 1977: 238: 497-9.<br />

3 5 Rqrdon MF, N.d.l P.,. cnig Jtl .r d.<br />

LipoprorEir pdj.rorof th€ !.Eiry of @!.ry tnqt di5.e in M Dd *oM<br />

Ciralqlin I 935 : rl : 88 I 4,<br />

36. Cotdbourt U, HoltM E, Nofeld HN,<br />

Tocl dd hiSh dafty lipoproefi cholcJ@l h tlE gu !d rok of mdt litv:<br />

didc@ ofa thrdhold cfiG.l<br />

BMJahhRcsl:d l98J Apr 2': tg0(6171): 123913.<br />

t76

---

37. Sclmidl SB, wai.ru Ac, M@!ii8 RA €t al.<br />

Lipoproteir &d qolipoprotcin L!€l! in &giogpdiicdly d.6ned @oNy<br />

An J Codiot I98S: 5t: 1159-62.<br />

18 Avog@-Pi Bor.GB; Clzl.ioc; Quirci-cB<br />

AE lpolipopotciN hdrd disini@roB thM lipids fd a{r@!clhsh2<br />

Iata I 979; t 6 t 22) : 901 -3.<br />

le sldFG, L Schw.rrz.d S. Shund !r d.<br />

The Mci.tion of in@s.d l*.h of irl.mFdisrc ddny fipoprcreiru wirh<br />

smothg ed wilh C.AD<br />

cnatktiM I 987 : 7t: | 2,L30.<br />

t|(r Blrffi D W.isbon.t, M6hi.n N, d d.<br />

Relarion of @m bd clDldd.l .nd hig! daity tipopr.reir chotcr@l<br />

p@dta$ b lh. imiddce ot d.finiG @oney dat3: Twrrry tE fouow up of<br />

fie ilonolo-T€l Aviv pbsp-rire c@ftry rnqy di!.e sudy.<br />

AmJ(Wiol t98?: t9: 1271-a<br />

41. P@!.* sJ. Shpca.{c, Phillips AN.<br />

Con sf.tio8 of nigh d63iry tipopmt ins .hol.d@I, riglyc*ida md rord<br />

chol6terol in ischhic han dse,<br />

aW l9a9: 29t: 1002<br />

42 Ens6 SC. HgolM I Fos Op, a d.<br />

r&h de.siy lipopotcin cloldr@l.nd nyosdirt i.firdion.d $dda derh, .<br />

pospdliw ce @,rhl srudy in niddlc sgcd md ofrhe odo !i!dy.<br />

Atro, 1979: t: 1704t,<br />

43 Rubir SM SidEy S, Bla.l Df,t a il.<br />

rtih blood clDlBi@l in trlddty @n sd th. dc* tuk for @rcmry he.n<br />

Am hnm M.d | 990: 1 tJ : 9 t6-20.<br />

1n

---

aa CirbrAIl SdIlC, Lindbcrg B.<br />

Sccnjtrg a 3ynpt@ciic adulB for 6di& ri* md@.<br />

The wo.hol€d@tl@1.<br />

AN Inlzm Me.l 1989: 110: 622-9.<br />

45. Ctrdon DJ, Rilkind BM<br />

Tratirg high blood cnobd@l in lh. otd6 pdiq<br />

an J &diot t989: 63(t 6): 48H-52H 46.<br />

46 Bsl:me R. R..d W<br />

Is @n cnolgldot l*t (.laded) . dsk fidor for CHD in ddqty.<br />

JALL4 t990: 26J: 293-6.<br />

Cliniql trirk i@luding e updde on th. Hctrinki H.a,t Siudy.<br />

An J C4dol 1990: 6n: (6): | 1A-15,1<br />

43. znilPC, Sol@JR<br />

R.lrdon bara [pid! .!d dha$.t@d!r .pidlriolosic didqE .nd .tinj@t<br />

AnJCodiol r99o: 66: z-t2,<br />

Cooi.ry hon die!. in s.v.n @nri.s.<br />

Ctrcullnid 1970: 4t : t st9.<br />

C{diov.toi|[ dises sd nulii6.1di.l .i.t.<br />

An Ec61J t9'3i 106: 9t-t203.<br />

51. Thc P@li.g prcjecr R6arch cdp.<br />

R€ladonship ofblood prsruq !s!m chole$6ot, mking h.bi! Glativ€ weisht<br />

ad Ecc.brhdiriq to incid@ or djor cor@ry dors: n,.i rcpdr of<br />

JAtuDis tgrA:31: 20l-6<br />

174

---

52 Kdn l WB, Thon ! IlE, (jctsb.rg.<br />

os rll &d cmily ha.r diee nuratiry r!16 in rct.lion io mjor iisk flqlois<br />

i. 325.000 @n eEened fd {E MFRIT.<br />

An Ed J 1936: ll2: 82136,<br />

53 Pckl@ I, Lim S. Hei$ C, .a al.<br />

Td y* mdtalily tun csdiovalarl& dire in rctdion b chol€rt@l ld€l<br />

aeng n6 wi0' ed yiil'oul pr.adiig ddiovrdL. dis€el<br />

NEAI JM.d I90: 322: !?0047.<br />

54 tuilind BM.<br />

High d4ity lipopbreil chol€srqol ed c.ronary ln€ry disse: sry€y of tne<br />

Ah J Cu.Aol 1990; 66: 3A-6A,<br />

55. l{illih Mj Koiwta fj Nr€ela K; Si{o T<br />

righ d4ity lipoprereir chotesrercl od riStr@ride! s markd ofeeiogDahi.. y<br />

.5.6eed @ona.y .nqy djsas.<br />

Br Hutl J 1990: 6i: 7B-8t.<br />

56 xomhod D, NsiEn 4 Mmij A .r at.<br />

robl ed HDL chole$.rol ard rh.i d.Llion in ddcdy md in FiltMd, tr|ly &xt<br />

An J F4kLniol 1990; tJ t: j.<br />

5? KGyi 4 A.dden JT, crcod. F<br />

Snm chole.rtulr6po@ io cl|rg6 in ri. di.r pqti@t& ,&'rrd faty eid in<br />

Met4bolifi 1965: t1: 776-87.<br />

Body sidr. di€r atd sfu chold.rcl in 871 niddt. aged @ duiry to y6<br />

offollow up (rh. ZuFh€n nudy).<br />

An J Ctin Nut r9B, te: J9 t-8.<br />

t7a

---

59 Fdrn@ SP, HaltcllWL, Willim pr.<br />

Chmges ir pla.n. high ddlity lipopio&ii cholqLol ans .hdg6 in .igardt<br />

An J hjdehiot<br />

1986; 121: 70e10.<br />

60 MaDdi A Cipoo..i.& Fe[i t 6sl.<br />

R.cor nqds h @oney ncut dil@c dd othd Cddiowarlf dis*. in traly.<br />

C@diolog/ 1985: n: 88:9!j.<br />

6l Dhtogb ICC, Soarlq Bulur H.<br />

C@ry h6n dtua* ..d tipoFo&iit<br />

Tr* JMedBiol Res 1990: t,<br />

62 Millo M, Mad L4 (wirdvict<br />

Dydipidcnis wirh d.sirsbt. plasn! roLt chote$aot lwt &d $giogrpr,jic.Uy<br />

ocnoNnr|d oon ry rnay djsl..<br />

An Jcadiol 190:6t: I-5.<br />

63 BtudMq Mdn dF, a!g.rJl-.<br />

Sludy of lipoproEin p.nicl6 Lp A-I dd Lp A-U in p.licnb bef@ mn.ry<br />

clinch€D 1990;36: l88t9l.<br />

Low som apotipoFoicin A-l in ror. nyo @di.l infdcdon mi@tr wilh<br />

llmTl HDL clDLn@t<br />

Athercstfuis t9A6t i9: 37-12.<br />

65. S.rd6$n M, vyrlilinsln S, tut t I<br />

Lipid ed lipopturcin a!rcmtn'.s in Sdrh Afi6 Indie Md sirh myowdi.j<br />

C&diologJt l99l; ?t: 34&56.<br />

66 Rom Prl! C'6 Cq Ragetq d.l.<br />

Relation of mm lipopr

---

6? Calin tts, Robqti WC.<br />

R.ldion of sn lor.l ddes@l .Dd trjglFqidc l4ls lo tlE mrd dd .nqn<br />

or@oMry ln6id @wing by .th.Gcldolic phque il comiary h6n dike.<br />

amJMed t9a2: 7t: 227-31<br />

Tte rdgly@dde isue . vid fron fthiighnd<br />

,4m lleqt J 1986; I | 2: 432-?-<br />

69. Sesd.tg lvl, Dsi RK vllniti.Sum. S, €r al,<br />

Sns lipoprot inr ed rpolipo!rcr6iN in young N@qlDl$rmtdiq mn-<br />

di.bedc lndis M wiih nyo€di.l innrdion.<br />

P.^ngd M.d J I 991 : 6r: ! 594-<br />

?0. tude4 WF. Mtrdsini, R ud Salznmnic a .1.<br />

Alolipopd.iB ed lipidr $ disiijuros of lccity of coroD!ry h@! dire.<br />

Al@eLtuis I 980: 37: I 57-42<br />

?l oniririAc,lowE<br />

ConD.ntiv. leM alolipopbt in dudie ir i&h.,nic n@t dice .nd @nEot<br />

clinchim tcta t980: t0E:25-30,<br />

72. Srjnivds SR Bffisn CS<br />

Scu.polipoFo&n A-t .ndD N d.lt6 of 6!oty a.t6y di!* ri3k in any<br />

life. Th. Bogalus H€.n rtudy.<br />

Cli, Ch'n 1995: 4: t594i.<br />

73. KdnEl WB, C.$.lti wp, CtrdonT,.rsl<br />

Smn chol.stqol, lipopor.ir! and !iJ( of c@i{y han di!.$., The Fminghm<br />

AM tntn M..t t97 t: 7t: t_t2.<br />

?4 grM MS, Cildstd ,L.<br />

A @plor mcdi.t d p.rhmy lor cholddl homoo.ris laic@ .tr8d; 2t r.r?_<br />

181

---

?5 SnorgrP<br />

Nefil hinory !'d 'tut 6..ors tu any IU|M ilcwdqucir. IGIE pdlblo8i..l<br />

detmi..n$ of !$do&ld6i! ir youth (PDAY' R.!.ad gro!p)].<br />

ClinCl@ 1995:1t:1314.<br />

Symposiun on did s s dsk frdq h ca.dioBqld orlas.<br />

Pre Ntnsa I 97 2i t t : 29?-302_<br />

PdnobgJ of .rhmscl@li3<br />

Br M.d Eull 1990; .t6: 9@45<br />

78. t&[ .'RW. Bstet cE.<br />

Chole$6o1, trielyeddc md pholpholipid @ft€nr of inrin4 n€di. Md<br />

dhtu*ldtic fany sat b hlll@ thtr&ic aonr<br />

JCbhlws I 6:1t:51}23.<br />

79. Fsggiono A Ro$ &<br />

Snrdi6 of ht?@hol.d.rot@i, h rh. rcn-hm pdrut : Fany SlHr @nmion<br />

atlE@Ldis 1981: t:34I.<br />

80. B|iMBG<br />

R.sr6id of rl|isql@$.<br />

An J M.1t I99t: 9A 24-<br />

8l Mdched Circd by Ro€f.14 L<br />

Arh.@l.dis !d rh. choLetut c.|ncdi@: d.ludon of. clirjcd apptictrid.<br />

Clin Clcn 1989: Jt: 52t13t.<br />

AflaiNke a wt oldcprobt6.<br />

Nw Yort: M&milld, t9tl; 2!2.<br />

at. Katz LN, StMbr J<br />

ErFin.nrd dttft st@ir SFingF.ld:<br />

Chtrl* C, Tho@ 1953:3-5.<br />

142

---

84. Th.nnhlls Sr, Magdd.nz rt<br />

Tie diftdt clinidl gdps of X&ttodro! djg$: . . clinjc.l, phtsiologiol<br />

AM Ltem Med l93a: t I: 7404<br />

85. Mull€r C.<br />

X$tlbmaiat'Wftholesrftlehi.,uSi pccroris.<br />

,1c1a Me.l Sq.A l93a: a961wr: 75-Et.<br />

86 Solb.rg LA St oie lP.<br />

PJ* nd@ dd dlEw|folic Lriotu. A aid of &ta'pdy odid<br />

l,t riMLrcit 1983: 3(3): 187-98.<br />

Principlc! oftlE pdhogtrsis of.llFog.n*h. ri: Bnuedd E . He@t dine: a<br />

tertb@to!.ardrrw ta nedici@ 2nd€d Phil.delphic wB Sundn, 1984;<br />

I l8l-204<br />

88. Bcnike Jr, rriy Rl. Kd*y SF. d.l<br />

Efco of tlEdly wirh .tol6tybnin. d pr%r*ion of osuy anaioi.ldis:<br />

Gullt ofrlE NqLBI D!. II cnnsy iit.va|ri@ sady<br />

Qtudai@ 19u:69: 3tr21<br />

3e BLnlcnhom Dll N€sin sA Johen RL, S{|r@q .r .1. Bo.6cisl .ff..b of<br />

6nbin d @lestipolni&ii rhqrpy o. @onary stn l@l@si! Bnd @ronuy<br />

vdrow byPa g6lis.<br />

JA|U 198?:2t7:323840<br />

q Mwr{yRK. EotE rs biElcnisttt.UsA: Mccns^fiil, 196: 21G84.<br />

S@nd!ry tyFlipid@ia.<br />

tuMed. Au 1990: 46: 1005-21.<br />

e2. Murly R( G.Md DK Mrya PA.<br />

M.tdbolisn of lipt.t: tqtb@t ol bio.henist y 2r" d<br />

Cdifohir: Appletoo & Ldq 1988: t98-253,22633

---

Lipogo&in f,a.bolilb .!d its .ercioilhip lo dhqelm$.<br />

McdClinNd ! Am l99l Jq ?8(l): 120<br />

Di.t dd phsm lipid! {. !pp.{isl<br />

An J Clihi L\ttti 1928: 3t: 97749,<br />

95 McCillHC.<br />

Th. rddion$ip ofdidry clFldad to 'u cldldtaol @rr.ddi@ rld ro<br />

th6!Fl€@.is in M<br />

AnJClinN ri 1979i 32: 266+?02,<br />

96 Wils rD, t indcy CA<br />

S&dy m irn@ ofdiaay cnoba@l @ crskdcol fir.Doli@ in $c ilo(opic<br />

JClihlMs 1965: U: 1805-13.<br />

97 Co@r WE, Un DS.<br />

Th. ifleni!.| rt o.prin of dilr.ry dbl€r@l by hyF!||oldtqol@ic (trT. tr)<br />

.nd 'mno&n@ldic h||l4l<br />

J Clb Itud 19?a: t3: 1062-7A<br />

98 Scnoifeld c, Wnztum rL.<br />

Dia ald dtq th.rqt ilryErupqtu!.ncda N@tuN ard,bug idenetatkn.<br />

Nq Ydk Aadgric P.B!, 1918<br />

99 Mrninr.dNcn t circd W AntE d.l<br />

Diet, w lipids an alewhmis, AtiMl Fatuctt in hutu tdino,.<br />

Nd Yo.k: Acrd.mic PBs, 198.<br />

Rolc of lw{adry lipoFo&is in dlEogefi !|d d.vdopM of dDMry<br />

Cli, Chen ! 995 ; 0 ( 1) | 39-46.<br />

l0l D.B&ks G, ro!ffi & Delyp@ J.P.<br />

Disinin dE vilu6 of lipidr rd .FFd.iB ir @.!ry h&t dila&.<br />

Ald.'@l.Bis 1982: 4: 197-203.<br />

18.1

---

ItndEladoship of rrislrside wiit tipoPreir ed higrr dtuity tipoprorii<br />

(HDL)<br />

ln J Otdid 1990 S4p 4; 66(6): 20A-214<br />

l0l Hav€lR<br />

McCoIun A*rd tsnirq l99l: niSlydidedch lipogrotdB &d atlE@lmrie<br />

-@psspcdig<br />

lnJCli"N r !991: 5 1):795-4,<br />

104 Cof@ IW, Gluid F, Tanplh A.<br />

Lipoprcteins, @rcnd) hd dilce dd alhso$leGis<br />

P lanol R4 1951 : l : 589607<br />

105. Philipc N\ W|l6 D, H.rel R t.<br />

Plud lipopret.iro .{d pogqlion oa c@wy dtdy dw, walu.t.d by<br />

dgiogrlal'y md oli.ical aqtrs<br />

Cilad.nim !993: E8: 2762-7A<br />

106 Lindg'6 FT, ,.|e LD, Hdch FT.<br />

nE irebtion ..d qlltunirc d.ltsi! of lou lipoFla{tu. In: Abd r,Fdr @rd<br />

tpop€reiro. N€w Yort: ,onn Wil.y & Sotu, 1972; l8 |.<br />

l0? B.rgnan EN, Havcl R , Wolfe BM.<br />

Qu!ftit riE studiB ofihe m.taloliln of chylo6i@ ri8lr@dd6 and cholenaol<br />

by liq ad od6 h.Fric tie. ofdt .9 mddoe!.<br />

J CIb IMS ! 97 t : 50: l 34 1-9.<br />

108 H&d RJ, trrmihon RL.<br />

Hepdocrric lipopffi.in reptos dd intE@lluld lipoprord. c.rlbolhn.<br />

Eepdolq, 1988 : 8: J 689-7U.<br />

109. Shali S, Bndy Sq Baldtom A d d.<br />

Role of h.p.tic lip& in rhe uo.kc .rd FEenng of qbylomi@n lq11Mt3 in 6r<br />

J lipi l reNd.h !981: 26 16304.<br />

185

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ll0. ltv.lRJ<br />

Th. fomdio. of LDL b..heims .d F$lalion.<br />

J ltpid Ret I9A1: 2t: 1570-a<br />

lll. Mccill IIC Ir, McM.lu C4 (rulti a d.<br />

Rd.tio.lhip of lipoFoei4 cholan@l @6ttnid b aT

---

l13 Pdholoeidl d.rhimnr! of .tt€@lhsis in yourh (PDAD llgch gop<br />

R.l.do.snip of nhsosl@ris in young na ro *M lipopor.ii clDler@l<br />

@n dralion.nd sohrg ./,,4M,4 1990:261: 3018-24.<br />

l19 Gold-Sr€ii JL, Breh MS.<br />

IlE wt tholic b6B d i,h.nkn abd@. 5rh .d. Nq Yo* tvtccasllu, 19?3i<br />

6111t3<br />

120 Vc$cI- Cnndy SM.<br />

ln vivo €videre for reduc€d bitrding ofLDL io e..ploB s r @F of primry<br />

hodqd. hylacholdr@ldia<br />

J CL" lbls:t 1986: n: I4ttL1.<br />

l2l lDdrity II. M.il€y RW, Weis Ctr bqKlla.t<br />

Fanilill d.fcqiv. .FlilEpror.ir B- lOO: r D'rlrion ofaFtipoFo&in B lhd @s<br />

ht?€Fchol6t oldia.<br />

J Uptd RB 1990: 3t: 1t3r-9-<br />

122 Winlov€ CP, Pdkr KH. Ewins AR<br />

Rccaible .r!d i@ersibl. inrencrjone berws ctdtin md pllsm lipopoteis.<br />

BiaLd Biophts ,1ctu !98t: EJt: 37,t-s0.<br />

123 ToddcF<br />

Ci8...ite @Bnprion pd tddl of *! s in veiN d ri6.<br />

J F,pi&hiot Coktut, H.dth t9B6: 32: 2BtLg3.<br />

I24 RobstsnwB, Sfong tP<br />

Ah.o&lrorir i. Fy^ rirb tt?dr4ion dd di.beG mlitus<br />

Iab htun t968; 78: 5$n L<br />

I25. Millc ct MUcr NE<br />

Pl$n. hi8h dmiry tipopot in @aandldon.nd dddopr|Grn ofi$h&nic h.fi<br />

IMl 1975: t: 16-9.<br />

126. Ta AIL Snall DM.<br />

Pl$m high d4ity lipoponin<br />

N E tl J M.tl 1973: 29t: t232_<br />

147

---

12? Letl Rl Pi&dd BM<br />

Tnc stu.dre tutrdior .rd D.rrbolis of hiShndity lipoFonin (t d.!|s tt?ror).<br />

Cituldie t9a0 NN: A( 2): IY4-a.<br />

128 Pi@rto ZA Sargi s4 Mrl't I, MaM AR.<br />

ttrel dasity lpoFd.in dbLdaol narlolim .rd n5 mb i! ietenic hdr<br />

Patid@JMed Ret 1999: 3t: 3&1!.<br />

Apolipoprolein dd@id!tu of lipoproEir ict.lolis and indi6 of crcMry<br />

risk<br />

BrHea J I9U: tl:58504.<br />

l3o. M{ ey RW. Lwfty, rdl sc, a rl<br />

PldM lipoF.reinx rpopot is 3fidG dd filrdd<br />

J Lipi.l Res 1931: 2t: 1277-91<br />

lll Gdo AIt, PowI rU, t!.vd RA<br />

ItM.did t'r ttt pl4tu nppoxiu wMs 4 anotgt ws yqk:<br />

,@tLnic Pr6s. 1986.<br />

ll2. Powd l-lt4 w.llie SC, Pa'RJ.<br />

A rcvd fom of tils 3pdifc RNA p!4sing PlrdlB .potipoFlrci! A.{8 in<br />

Cell 1987: t0:33t,<br />

133. K6trq cll4 (nippilg c, cr..H, ct sl<br />

Ihe rej. of LCAT md clDl.slerol €Nt$ rnftfd pot€ins for the HDL snd LDL<br />

$ucai.e and nalbolism.<br />

Ad, Erp Med Biol t 987 : 2 I 0: 79.<br />

I34 ArltcsadaL K Fishd EA Chcn X d rl<br />

MelEim ol nypdrigltqid.mi. i! huM .po C m rusgdic si@:<br />

DihinjslEd VLDL frdioDl cdrlotic ..L 'gid.d qirh iMe$d .po: Cm ud<br />

G(llc.d apo E or lh. p.nil..<br />

JClin Lt ett 1992;'e(t: !'d9!900.<br />

168

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l3s Zil'ang Stt R.ddict rJ,\ Pi.dBnii4 a rl<br />

SponnItu hyp.rcholcdftlhii ,nd lrt ial tdions in na h*jng<br />

aloliporrcreiF E.<br />

Sciuu 1992: 2t8: 163,<br />

nrc tegled w.b oforofiry dsk f!.r6.<br />

An J Me.l 191: ,0: 3610<br />

136 W lim BK Dsi.l<br />

CardiovBo|e nrk hcto6 (rh€ Frmhghd ,udy).<br />

CircaAi@ 1929: E: |J.<br />

ll? C{stdsan4 pdst ga C, Eklund C.<br />

Mdt lirt in r.riion b dg.!tf. .rd pipc $o&hg |6,../s ohs4trion of 25@O<br />

J Epi.leniot CM@iD E.dA BAL : 1G72,<br />

I33 Strkrysli PA KlrEl WB, D Agosiio RE.<br />

CI&g4 in tut frcros bd th€ d.ctin. in mndity tm erdiovej.r dis.e.<br />

(dE F60ingh.m hert *udy)<br />

NEndJMed I99O; j22: 16354.<br />

139 cnldiu cA Botrib R, Sr||npfa ML<br />

cisr€tr. soking and rilk ofsnok. i, niddlc .g€d mn€.<br />

NEIAIJMed t98a; t: O3Z1t.<br />

140, CildmdL, C@kF.<br />

The d.clire in i$chcnic hai disae ndtdity rd6<br />

A@lht mMed I9E4: t't:82136.<br />

lal. Robin$n K Co.roy Rlet lvtuloty R.<br />

wlE. dtB tnc ti3t of aol. oren ry lqn dige in d{m&d fr ro rhrr in tuF<br />

smr4 A r.t.osp6-1ive srudy of fliots adnitrcd io hdpird with a 6js .pilode<br />

of Dyoddial inf$.rior or u!r*aDt. &gje<br />

RrHq J 1989;62: t6-9,<br />

189

---

142 C.dclli WP, Ctrien Rt, Wils@ pWT, d al<br />

lncidde of qon4y h€ln di!€e, lipoFotcin clDlBr.rel l€veh dd cigderle<br />

JA,IA 1986: 2t6: 2835-8,<br />

l4l. Siddiqd SA Sdm r,t F.yt'ad-Dn<br />

Etrecl of sokina on lipid prefile of smolGs sd non*nok@<br />

Pak d4 J M.d Res l$a: 2r: 26L71,<br />

144. Kha A KhanlA Bashir N.<br />

Efclr ofcigarcn. sdoki.g on lipid profil€.<br />

PatisaAl6ed FM I,t ,t Jt993:1t: tt9.<br />

l4t. Aslrup Pi Kj.ld*n K<br />

Cirton no@xidq sotn|& ed dtdtscrdb.<br />

Med(:lih Nonh An 1971; tt(2):323-50.<br />

ra6. Stondd S, &tup p, (jddsn K.<br />

TIE .ftd of€rbo. @nondc on cholcs@t in rhc @di. walk ofnbbirr<br />

AltEtMledis I 97 7 : 2a: 35747.<br />

147 Bdlchcio ci Comd wE Sonja LC, a al<br />

Plana lipid dd lipoprorcin proffls ofcielrd. smokd,<br />

E no@Mr of hypdlipjdoia ,nd d.pBdon of rDL.<br />

AnJCtdiol 1983: s2: 6Z|.40.<br />

148. Cry.rPE, Haynond MW. ShrI SD.<br />

No.€pinqh.in. a.d epincptrine cla* lh. adren€rgic nediado. of snorjns<br />

@ciat€d hdodynM'c and nalbotic d€|ns<br />

N b1g J Med t976; 29t: j73-7.<br />

149 Bizzl4 T@d MT, M€dcs A.<br />

Son. EF(tsof thedd of nicotim rd phr6 FFA rd tise Eigty6id6.<br />

P hatuolog 1 972 ; 7: 2 I 625_<br />

150. B.€KB()tr@nAI.Dafl6G<br />

Efd of tuking on sm ldek of HDL aF!rcrein3<br />

Athercslnsis J 979: 34: 339_4 3.<br />

190

---

l5l Motrat RI<br />

Etrcd5 of c63.tjon of mting on s€M lipids &d hi8h ddity lipoprorin<br />

,4rhabslmsis 1989: 7r: 85-9_<br />

I52 Fi.lding IE Phq@ KJ.<br />

H€alih €fefi of inrcldrry smohnS<br />

N ElAl J M.d lW: tt9: 115240.<br />

153. Clartz SA tmlcy WW.<br />

l*ia moking &d h..n di'€er cpidmiotogy, pn sioto5/ !d bi@hdisry<br />

Ctdldion lt9l : 33: t- I 2.<br />

154 McBrid€ PE<br />

Th. lE ith @n5.qu@ of snDting: tudio!|$|f (,lsl..<br />

Med lin N$th Am 1992: 76(2): 33tj 3.<br />

I55 MM SJ. J.B cD, Wst RS, d.l<br />

Eldition of mblhtory systotic blood pBur. in hy?.ndiv. wkd.<br />

J,4M1 !991: 265: 2226-8,<br />

156 Nalon JD, W.ntwoni D<br />

S@m chol$ttut, blood pc$uq cige€tle mok.g ard dearh Aom e@nary h€.n<br />

Arch JrtemMe.l 1992: tt2: j6.61.<br />

lst cnqui ME Coos B, Hotd Bek MJ, .t al.<br />

clu.rEins of c]dio8orh. di$& dsk fadoR.<br />

Prev Med 193o: 9: J23-33.<br />

158 C.d.tli Wp. Arddn A.<br />

A poDullion .l .isk: pEv.t.rce of hiSh chol6r.rel l*ls in hr!.rcf,lire p.li.nh<br />

in thc FMirgle study.<br />

An J M.d 1986: N: 2]32,<br />

159 Z.vrcni, L BonmE& pagti@ M.r.l<br />

Rtt f.dG for c@n ry..tdy ds.e in ha|tn pel$s wirh hypai@tiMia<br />

and nomal glu@se idffe.<br />

N EtEI JM.d 1939: 320: 702-6<br />

191

---

160. Willids R( tturt SC, rtuptic PN, d .1.<br />

F.fr ili.l d$lipiddjc hypsi.Bio.<br />

JAIA !$a: 259: t5?9-E6<br />

16l. ColMittcof Prircip.l InsdigdG<br />

A ceFllirc rial in the Fimry p.sonion of IrD udng cloffbEr€.<br />

A, H@t J !978: 40: 10@.<br />

162. Bo@KtI Th.ll. DS<br />

A!&ciatio! bava blood pr€3.e ud 5fu tipib in a popul.riotr Th. Ttllm<br />

Cndldt'on 1991: 3l: I305Jt.<br />

163 Dqtf EZ.ih6Att, Md!@.<br />

Cod.dion of .flloth.lirl dFtun.dor in cooi..y dm ciutdion of<br />

ht?rc[o161@l€nic pdidls by L{€jnine.<br />

ltut 1991: 33r: l51G5O.<br />

164 Ohe Y, P€t Mn IE, H{d$r DC<br />

Hypercholelr.blmia i&l!.g mdottElial $pgonde dior pro{irdion.<br />

J Clb IMs 1993: 9t(6): 251Cj t.<br />

Attul@b or lipopocin futuc.d ddoitdi.l dysnmrio poreri.l<br />

Mtuni@ liddlying ..dudion ii EDRF/nitric onde actiiiy.<br />

Citubim 1992: 8t: 1927-38.<br />

Anqi.l tuncdon i. h{th |Id dis..<br />

Edinburgh: ChuchjllLiviisslonq 1982<br />

16Z Srcts FIv[ Da VJ.<br />

AdMergic efrc.1s on plsm lipoprot in oerabotilm Sp€ulanoN on mdh.oisN<br />

Ah JMed 1986: 80: A): 7 t-9.<br />

163 Dly Jl. M€tc.lf€ t, Sinpson N<br />

Ad@gic Mh$b4 in rlr @drd of pt sm Lpid! in M.<br />

An J M.d I9E1: 76 914,<br />

192

---

169.<br />

t70<br />

l7l<br />

| 71.<br />

t14.<br />

t15<br />

t?6.<br />

vicld J, Da T' Bcna MD.<br />

M€chdkn of $. imdaclioi of I'Wstcrsion ed hwdchol.$.rol€ni. ii<br />

arle@lmlir Th. .f6ts of .rtihr?dt Niv€ agerts<br />

An ILdJ 1988: tt& t725.<br />

toitu Ndiool comh€.<br />

Th. 1988 rFrr of lh. Joi N.rioi.l Comioe on d.r..aio'! .wtuldio rld<br />

&artrnt of hid bl@d prcsse.<br />

Arcll lntem M..l 1988: a: 1023-38,<br />

St& d J. N..lon ,D, W@tBqih DN.<br />

Blood F@E (iysofic ad di^xolic) Dd dlk of Iarll 6reay hc.n djgs.<br />

IlWleNa l 9: 13:2-12-<br />

St.mld ,, Wa|tldnh DN, Naro Dl<br />

Is th. rcbtioBhip b6}d tu cholBr.rol rnd rilk of prcmahrft dedh non<br />

onnsr h..n di*e @rtirsur rnd 8r.d.d? fndinss in 356222 prinary strt@o<br />

of th. ruldpl. high frcrd idddrion r.i.l (MRFr)<br />

J .U 1986:256 2823-8.<br />

Kaml w'B N.don.tD&X*l WB.<br />

orer.ll .nd oroury nen di!€4 in abionlo mjor tut frctoG<br />

An Hean J 1986; l12:825-36<br />

r.lfuiniq Buzisoll C, Boiadoort R.i d.<br />

Inelin rc'3r|'c. in Mti.l h$efidlid<br />

NbAIJMe.l l 7; JI1:350-7.<br />

Gillom RF.<br />

The Mci|lion of body far distibqtion with htT.ncilio4 bypetenriv. had<br />

diee, @oony h.{rt dise, diab€t$ md cddiovaslr dlk flotos in nd dd<br />

MM ag.

---

l??. DqiigbnPN.<br />

S..od|ry lqDqlipidsni!<br />

BrM.d fuA t99O: /16 lNr2l<br />

178. I{!d RJ, Gold Sr.x tL.<br />

Maabnc @tttol @,.1d!@.<br />

Ei[ Gd Phibdclphi.: sada!, r9dti 39-49r.<br />

l?9. NiklihE.A<br />

Triglyqid. nnlbol&d in di!... ndlio!<br />

Prog, Bids Pbffil 1973: * 2?!-299.<br />

180. Dr[ii$on PN.<br />

Str hith ddity lipoprcrdi 6ol.d6ol in diD.... 'rdli!t!. Ar udrli. of<br />

i{ro.r*hicl| infuqa.it colEt lirl<br />

Ctn Cl6 t b J9B0: la: I L21<br />

t8l. Nillih BA<br />

High dglirt liF rDi.in i. di|bca6.<br />

Dldbet8 loal: 3& a2-1<br />

lE2' Wi!b@', PE DrdnSon PN,Idbb M.<br />

tnthqE of Foidui. d vei! disrc, bh.d Fa|r. ltd lipoFdlia in<br />

ielin d.4odqr di.b..B m..<br />

DW 1989: ta: 161&51.<br />

lE3. Ioc SL, Cloc CF, M&.t MB.<br />

PLtm lipid .trd @lsrtuih n tor orfrintr ltdi! d.Frl|6n dirD.rd<br />

nillitu! widr hidslhrniMi1<br />

&UJ I9a9: 2r& $74O<br />

Dia .!d lift dylc lFdifiorio !d it! driodhip !o dlEsd@i!.<br />

M.dAb N6th,ln 191, n: 197-221<br />

l8t. C.ssiul. AQ, C|!b.Lh G, Flmlr 11 .. d<br />

Th. rultipL .i* n ro. intata|ioi l'id w. I|n6\drion on bbod lipid!.<br />

PnwtMd l98l; IC: Ur75,<br />

104

---

lE6. N.rion l Di€t-H4r Study R.!sh Grolp finalrctolt.<br />

Ctalati@ 1963: 37: 1-428.<br />

18? &hlcyFw, K.@l \VB<br />

Rcl.rio. ofwight changs to clutrg.s in .th6oslalg@ic tziti nE Fmingho<br />

J Clrd Dis 1971: 27: Iot-l l,<br />

188 W@d PD, Sr.f.rid lifl. willin Pt<br />

Th. effcds on plalm lipoP'o&iN of . prudan *ign! tlduing dja snh d<br />

wnhour ded*, in oG ftith M .rd vond.<br />

N EiEI J Med 1991: 32t: 4614.<br />

The dergeic ofob6ity.<br />

Me.l Sei Sporl3 Exetc 198J: I t: 32t0.<br />

Di.tdy epidmiology<br />

An J Clia Nd, 1962; 2A I 15 l-7.<br />

l9l. t||vlit f,J Itubar ltB dd Flbitz RR<br />

Wcigla .d htFtalion<br />

.4n lntem Med 1983: %: at'.<br />

I92 Elior x-C. and Bell t C<br />

Ilie han dd motional sr.s<br />

l,n HuLl, NN fdlt i!.c. ctu Hill 1982: 1837J982.<br />

l9J Hr$f.ld GA, Pr&k€ring TG and Kl.incr HD<br />

Situ{ion.l vdiadod of blood pr.sc in mbuhlory hn.nsiw pdio|l<br />

tll/U: t982:12 !36<br />

194 Meucl S, kllf! D<br />

Psy.lbphysiologic radivity ii coooy han di!a* .nd *nitl hvPdtdion<br />

Hed b@r of Sr* Fdiviry ud Crinovlg|g dilas.<br />

ttet Ydk.Jotn ||i lddSN1985:p 105<br />

195

---

195 Tlylor CB., Sallis, J.F Drd N...I., R<br />

The rclaion hip ofPhrlictl r.dvny ud qdi$ ro runrl helth<br />

Psbli ,@hh Rep. 1985: 100: 195.<br />

HrTdtipidmia lrtsrdlion .nd Cei!ry hon di!a$<br />

ne L@.a l99s: Jat.262-6.<br />

197. Spady DK. and Diel$Iry t.M.<br />

Dieury saluted iriglyqidca sppr4 hcparic low dtuity lipoprotein .€@flors h<br />

lh. Hqnesta.<br />

Prc. NatL Acel S'ci. US.A. 1985, E2: 4528J0.<br />

I93 Heg*edD.Nt MccodyR.B. sd MyefrM.L.<br />

Quaiftadve €trdts ofdi.try 6t on r..r|n chol.dml ir M<br />

atu J clitu Nttr, t95,7: 28-295<br />

19. Minen FH. Gnody S.M.<br />

conpdienof effcd5of di.firy!!ltl. .4 mD{Nerd.d ddpolyu!'tnntd<br />

Atty &ids on plam lipid. .i|d llolrotdn ir M.<br />

J. Lipi.l Ret l9a5: U: 19t-202.<br />

20o Kcys A Andm. ,.T and Crad. F<br />

PEdidion ofsdn Chol6r@l E9o.s ofM lo chdg6 in fals in the di.r<br />

L@t 1957: 1:966,<br />

201 Mer6 \4rH And@.S, AgpleWhit.TtL d.l,<br />

The Echnical @nmire. Food f.tr and oih.<br />

vtl4d1insta D.C. flp lnstitute olSlbrtdiag dtd&n e Ah IN. t988.<br />

202. Hum6JE, Apple Whitc TH.<br />

I(elssol of ire! fa{y ei& lwil.biliry in th. u.s.A diel<br />

,4m J Cb^ Nuni. t99l : g: J63-69.<br />

203 Lichen$€in AIl. AlssLN4 qr.$W.r.l<br />

Hydrcgatstion impAirs tlrc hypolipidenic .f..1 of c@ oil in hunM.<br />

Hydroesstior\ tus 6ny aid! adl ph6dr lipids<br />

AtuiNLr: Itt@b I99t: lt: lt.U!.<br />

190

---

204 Grurdy SM., DoleMA.<br />

Diady innu.n@! on Sdn lipi& rnd lipoproGi.!<br />

J Ltpid Res. 1990: .t1: M9-72.<br />

205 Dtrrb€rg t. Beg J.O, Stotr n . d .l ,<br />

Ei@sapdtr&miceidandprcvmiionofthrcmbori3.nd .th€ro3.Itu$.<br />

La@t78;2: 117-19.<br />

206 KayRM.<br />

J Liptl Res. 1982: 23: 22142.<br />

207 tupein CM Kds JM., teb DR .t d<br />

Od podu(t3 and lipid lo*din& A Far rrlyri!.<br />

JAM,4 1992; 267: t317-25.<br />

?03 Hdis wS. Comr WE rrd lnlck SB.<br />

Di.ldy inflo.m of ortoMr&. on !d!n lipid.<br />

Metahlis l9a1: Jt: l0!6t9.<br />

209. r,nssdtri Crdn tqN.dflileM.t.l<br />

Atulysis of rtul ftdqs i. tl2 wivw of l! nydtdid inn dion to.pit liz€d<br />

Attt@L@it 1986. 59: 75-93.<br />

210 Vdgai, C, Tnvo.o lnd Di%!.di N,<br />

Str ldrl lipid!, lipoP'llljn c.hol.!r6l ApoA-l rd .!o-B in clidioi!$lr<br />

Clitu Cletu Actu 1978:87:127-33<br />

211. Binolo Bo4 Cr@llto O .dl Rowi E<br />

R€l.tondip betw6.tFprd.ins ud chchic.l @npoM& of lipoFoteh in<br />

Athewbrcsis 1980; 37r 69-76,<br />

212. Deslt?@F D€B@k€r, Rorlcnd d al.<br />

Lipid dd lpopoLin lewl in my@.rdirl iifrrclion 3uftvoB<br />

A.t+cn liol I98I; 2r:95-I02.<br />

197

---

213. Ldro6 A Moiidi lrhqgr4 a.l<br />

t !!l orlcun lipid!, lpo A- 1, |DoB|trd&n di.cirddiv. v.h.r itr CXID.<br />

,tltls@la6ts I 9E6: tt: 2 I 5-2 t.<br />

2la GMdy SM<br />

ChoLdaol u.l6wry lEr disrc. A ||cw.n<br />

J. AnMaIls 1986: 2ti 2EI9-5E.<br />

Chol.nay' ..16 l.qruLlio h .Eopll.g. @ftal tDn @td nE!.|.d<br />

uFL.td dcgdlion of ltyFdtoLdaolodc Vr,Dts.<br />

J Ad Ot^ l9E0; 22J.1839.<br />

216. Stdlh.g D.<br />

Lipofrctltn .id Pnnos*i! of df*lmdg<br />

Cidldnn 1987; rt 103-<br />

rDra I F!r..riE ndd.t hr CgD.<br />

An J Mtd 1977: 6:t: ?0r,<br />

218 18tn A@d Synpciu![ Mrid|| A..dm! of Clinicd Bietditry.<br />

At[mg.c'il Orirbdq oi ltd Etiolog/.!.1Ri* n a6r.<br />

Clin Clctu tt9t: aU: tt2-JJ.<br />

Squ Upop.d.in .nd CAD<br />

Atlr|@bbds I9&: t4. 2694.<br />

PLlm lpa B, vLDl. LDL !d HDL u ri* i..dr ii fi. do/dopctqr ofCHD<br />

Atlr.w&l.dit l98t; 3r: 1I l-2,1.<br />

221. Kohto6 D.<br />

Obsvti@ d rDr.Chok qd id rccohnuirdG fd oratcnr<br />

H.Nt Ftd Hoqitd J ln,: tt: gl-91.<br />

ts

---

22. ( '.d,C.t.d.l.<br />

ADdiorxioof ltrTatiglyqid.rir by proS.iio"rl dog<br />

Itut )989; t: 1290,<br />

223. Philip GB.<br />

Sd h.mm, drt h.tor .nd CvD.<br />

An J M.d. 1987; 6!: !7.<br />

Sq@ rDL ClFlcdftl h Nonh lrdiD!<br />

lsinMal J 1982: 26:519,<br />

225. BedJT.<br />

Seu uic &id.!d 6uay hen ililas.<br />

Ae II@'J I9a3; ,06. 379.<br />

A.hdqlqqi! ed Ertt iediolirn<br />

ItZ J LH. 1979; t: 1t<br />

HyFui@i. !.ri* nd..<br />

Arle- Eq.Md, Aht 1977: ftA 312.<br />

228 ltdLDS.<br />

Nlli@l Ha[[ Ssqing Sqaic., Odq Norw.y.<br />

Cq&tktg/ 190: n: 2-7,<br />

229. B.gJA<br />

Studi6 on Ss h.t!F@ a . dlt ndor ftr hyo.rdid iifirclid.<br />

198t, MPUI lens AM.S.]. IllnMt 4 Kqadn.<br />

230 Beis M.Ar siddiqui M.K Att|li S.A" a d<br />

S.M uic &id in hc.lth ..d CHD.<br />

Pdtistol J, Mal Ret, 1970, 9: 50,<br />

Bl@d lipidr dd Eic mid rdltionrhjpr<br />

JAl,tl 1961, tto: 850<br />

1S

---

212. Coo Pt. Sh$n ll,B. It.(inin FE . .1.<br />

Hypm.imia in p.n ry |!d Gd hlT.n@ion<br />

N. E EI L M.d 1963i t7t: 157.<br />

231. Gdtld t!,{4 \4,hh. PD.rd Wim{ HH<br />

Coroiiry B.$ Dir.$.<br />

A^ J Med. Sct. !961, W: 377.<br />

84. Sn hiia U, Hrirlcr Z. |nd A.y&. d.<br />

Cliniel .d biochdlicd F!61. in t5 o||b pdi.rnr ofcoron y ndl di*e<br />

PdtistutJ M./. R.t t97ai tt 9.<br />

235. PMRC Momgnph No.l<br />

MuIi €rq trty of d* n b.r 6r 6!nry H{t di|at<br />

P.ridrn M.d R.. Cdmil l9EO.<br />

236. vdLy Ir, Gosa bcr AIl Bdl M.<br />

Pn *{ Oinic.l Bio.linf|tr,<br />

? 4 Vilt6 fl.b.liM, P. 10?, t980.<br />

2l? rdyRl.dRift.dEu<br />

Tb. Slfl.n!., turtioo rd h$lin of |tt! d.ddty lipoFt|tii oDL). A<br />

ctui t980:52: (W M.<br />

2@

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APPEND,ICCS

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II/EIGHT HEIGXT<br />

HISTORY OF OIABETES II.I FAUILY/DhAENC<br />

HISIORY OF IHD IN FATIILY<br />

socro EcoNoMtc coNDtTtoN<br />

DEPAiITEI{' OF BIOCNEMBTRY<br />

CMNDNA MEDICAI COIIEOE. IARKAIIA<br />

iD<br />

STUDY POPULATION<br />

D. SPECLATIY D Mil* (N.rlvo) iDButr. llD ECO Iv) T.. (sr.d.l)<br />

EOticATloN P.nod of s1!dt)<br />

ANY OT}iER INFORIIATION<br />

Anin.lF.t-