Postprandial Hypertriglyceridemia Following a Single High-Fat Meal in Patients with Coronary Artery Disease and Normal Subjects: The Significance of the Postprandial Hypertriglyceridemia and the Effects of Fibrate on the Postprandial Hypertriglyceridemia

BACKGROUND AND OBJECTIVES: It has been recently reported that coronary artery disease (CAD) is more correlated with postprandial triglyceride (TG) levels than fasting TG levels. We performed this study to compare the patients with CAD to age- and sex-matched controls in regard to postprandial TG levels and to know the effects of fenofibrate on postprandial TG levels. MATERIALS AND METHOD: Serum TG, total cholesterol (C), HDL-C and LDL-C were measured before, and 2, 4, 6, 8, and 24 hours after a high-fat meal in 22 patients (mean: 60 yr) with CAD and 12 normal subjects (mean: 54 yr). The same parameters were also serially measured after the high-fat meal plus fibrate in 10 patients with CAD (mean: 59 yr). RESULTS: he patients group without fibrate showed that more prolonged and exaggerated hypertriglyceridemia following the meal than normal subjects, especially 4 to 8 hours after the meal and that lower HDL-C throughout the test duration. These changes were also persisted when hyperlipidemic patients were excluded out of the patients group. The patients with fibrate did not show such a significant elevation of TG levels 4 to 8hours after the meal compared when normal subjects. The time to reach the peak TG levels after the meal was 4, 6, and 4 hours after the meal in normal subjects, patients with CAD, and fibrate group, respectively. CONCLUSION: Coronary artery disease is clearly related with postprandial hypertriglyceridemia than fasting TG levels and postprandial hypertriglyceridemia can be somewhat prevented by fibrate.

Correlation between Levels of Serum Creatinine and Erythrocytic Malondialdehyde(MDA) and Antioxidant Enzymes in Patients with Diabetic Nephropathy / 대한신장학회잡지

Oxygen free radical activity is elevated in diabetes mellitus and has been implicated in the etiology of vascular complications and diabetic nephropathy is a serious microvascular complication in patients with IDDM. Despite intensive investigation, the pathophysiology of diabetic renal disease has not been fully elucidated. However, several clinical and experimental studies have suggested that endothelial dysfunction and changes of peritubular microcirculation might deteriorate renal function in patients with IDDM. We performed this study to examine the oxidative stress and correlation between levels of serum creatinine and erythrocytic MDA, SOD, catalase, GPX in IDDM patients with diabetic nephropathy. Twenty one patients with IDDM(diabetic duration >5 years) and persistent albuminuria(albumin excretion>1000mg/day) and 15 normal healthy controls were investigated prospectively for erythrocytic MDA(thiobarbituric acid assay) and antioxidant enzymes[SOD(Hyland et al.), catalase(Nelson and Kiesow), GPX(Palgia and Valentine)] and correlation to serum creatinine levels. Levels of erythrocytic MDA were significantly higher in patients with diabetic nephropathy than in normal healthy controls(p0.05) and group 2(r=0.12,p>0.05) but there was significant correlation between serum levels of creatine and erythrocytic MDA in group 3(r=0.96, p0.05). We concluded that increased oxidative stress and decreased antioxidative defense mechanism might be factors in the initiation of diabetic nephropathy and the oxidative stress correlated with higher serum levels of creatinine(more than 5mg/dL)(p<0.05).

A Case of Coronary Arteriovenous Fistula Confirmed by Echocardiography

Coronary arteriovenous fistula is relatively rare disease and originates more commonly in the right than in the left cononary artery. We report one case of cononary arteriovrnous fistula which we have experienced recently in 22 years old female, who has complained of dyspnea on exertion and intermittent anterior chest pain radiating to the left shoulder for several years. It was detected by transthoracic and transesophageal echocardiography and confirmed by cardiac catheterization and coronary angiography. In this case, the fistula was originated from the right coronary artery and drained into the posterior wall of the right ventricle, the coronary artery was dilated(diameter=1.5cm) and tortuous and significant shunt was measured(Qp/Qs=2.31). The opening of the fistula draining into right ventricle was obliterated with sutures.