Physician recognition of hypercholesterolemia in patients undergoing peripheral and carotid artery revascularization.

Numerous studies have shown that patients with peripheral and carotid atherosclerosis have a high prevalence of hyperlipidemia, and clinical trials using either angiography or ultrasonography have now demonstrated regression of both femoral and carotid arterial plaque during lipid-lowering therapy. However, whether patients with peripheral and carotid atherosclerosis receive adequate attention to lipid risk factors has not been studied. To evaluate physician recognition and management of hypercholesterolemia in these two patient populations, we reviewed the charts of 80 consecutive patients undergoing revascularization for symptomatic peripheral and carotid occlusive disease at a university medical center between 1990 and 1993. Physician practices were assessed for each patient by noting whether hypercholesterolemia was (1) screened for during the hospitalization and, if present, (2) documented as a problem, (3) managed in-hospital, or (4) given appropriate intervention at discharge. While 73% of patients received some type of lipid case-finding perioperatively, less than one quarter of these were assessed for hyperlipidemia by the physician during the initial history. Moreover, of the 66% of screened patients found to be hypercholesterolemic, only 16% had documentation of the problem, only 24% received in-hospital management, and only 13% received intervention at discharge. These findings suggest that patients with documented peripheral and carotid atherosclerotic vascular disease probably receive inadequate attention to lipid risk factors and indicate the need for greater awareness and management of lipid disorders in these two patient populations by all involved physicians.

Effects of dietary broccoli and butylated hydroxyanisole on liver-mediated metabolism of benzo[a]pyrene.

Groups of male Wistar rats were given either a basal diet or diets supplemented with 10 or 25% broccoli or 0.8% BHA. Liver fractions were assayed for cytochrome P-450, for aryl hydrocarbon hydroxylase (AHH), glutathione-S-transferase and epoxide hydrolase activities and for benzo[a]pyrene (BaP) metabolism. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis of liver microsomes was also performed. Mean relative liver weight in the BHA group was significantly higher than that of the control and 10% broccoli groups but not significantly higher than that of the 25% broccoli group. Gel electrophoresis of liver microsomes indicated a diet-dependent variation in intensity in a band that corresponded in mol wt to those of certain cytochrome P-450s. Diet-dependent increases (20-90% over control) in cytochrome P-450 and in the activities of AHH, glutathione-S-transferase and epoxide hydrolase were observed in livers from rats given broccoli-supplemented diets. Except for AHH activity, such increases also occurred in the group fed BHA. Analysis of BaP metabolites revealed that the proportion of 4,5-diol formed relative to the major diols identified was unchanged in the broccoli- or BHA-treated groups relative to the control group. The proportion of 9,10-diol formed was unchanged in the broccoli-fed groups but was significantly higher in the BHA group than in the control group. The proportion of cis and trans-7,8-diol formed was unchanged in both broccoli-fed groups but was significantly lower in the BHA group. In comparison with the control group, the ratio of phenol I (comprising primarily 9-OH-BaP) to total phenols (primarily 9-OH and 3-OH) was significantly decreased by about 30% in the 25%-broccoli group and by about 70% in the BHA group. Qualitative differences in the phenol-II peak (comprising 3-OH and 7-OH phenols) were also observed between samples from the controls and those of 25%-broccoli- and BHA-fed rats. The implications of these findings are discussed with respect to the effects of broccoli and BHA on benzo[a]pyrene toxicity.