[Results of the multicenter controlled study of the hypolipidemic drug polycosanol in Russia]. / Rezul'taty rossiiskogo mnogotsentrovogo kontroliruemogo issledovaniia gipolipidemicheskogo preparata polikosanol.

AIM: To compare efficacy and tolerance of polycosanol vs besafibrate in patients with hypercholesterolemia (HCE). MATERIAL AND METHODS: A multicenter controlled double blind randomised trial entered 113 patients with HCE. After 5 weeks of diet the patients were randomised into two groups. 59 patients of group 1 received polycosanol (10 mg/day), 54 patients of group 2 were given besafibrate (400 mg/day) for 8 weeks. RESULTS: The 8-week course of treatment was completed by 103 patients (91%): 57(97%) patients of group 1 and 46(85%) patients of group 2. In group 1 total cholesterol diminished by an average of 15%, LDLP cholesterol fell by 18%, triglycerides by 15%, while in group 2 a respective decrease was 8, 11 and 6%. Side effects in group 1 were mild. CONCLUSION: A hypolipidemic effect of polycosanol in a daily dose 10 mg is superior to that of besafibrate in a daily dose 400 mg.

[A trial of the clinical use of the Russian hypocholesterolemic preparation fenbutol--an analog of probucol]. / Opyt klinicheskogo primeneniia otechestvennogo gipokholesterinemicheskogo preparata fenbutola--analoga probukola.

Phenbutol, a Russian analogue of probucol, was studied by the single blind method by using placebo in 30 patients aged 36 to 65 years whose total serum cholesterol levels were more than 250 mg/dl after a month placebo therapy. The patients were divided into two groups: (1) 15 patients on placebo and (2) 15 patients on phenbutol, 500 mg twice a day for 5 months. Blood lipid parameters were monthly determined. The findings are in agreement with the data on the effects of probucol on lipids and its adverse effects. During the follow-up, phenbutol showed 17%, 14% and 10% decreases in total cholesterol and low density lipoprotein cholesterol and high density lipoprotein cholesterol, respectively, as compared with the baselines. These changes were greater than those in patients on placebo. In the first week of therapy with phenbutol, vomiting, appetite decrease, digestive disturbances were observed in 73% of patients. These adverse reactions did not require its withdrawal. Resting ECG Q-T interval became prolonged in 7 out of 15 patients receiving phenbutol (maximum 500 msec).

[Newly manifested angina pectoris: role of lipids, lipoproteins and apoproteins A1 and B in the prognosis of ischemic heart disease]. / Vpervye voznikshaia stenokardiia, rol' lipidov, lipo- i apoproteinov A1 i B dlia prognoza ishemicheskoi bolezni serdtsa.

In 151 patients with first angina, a prognostic value of various factors: lipids, lipo- and apoproteins AI and B was studied in relation to the development of clinical remission 1-1.5 years after the onset of the disease. In multifactorial discriminant analysis, the predictors of clinical remission turned out to be heart rate reached at the maximal exercise during bicycle ergometry, the number of diseased segments with any visible degrees of stenosis, the course of the disease within the first month, the number of diseased segments with 70% or more stenoses, the number of afflicted vessels with 70% or more stenoses, the power achieved during bicycle ergometry, high levels of high density lipoproteins, and age. A prognostic value of the same factors in poor prognosis (myocardial infarction or death) was examined in 124 out of 151 patients. The predictors proved to be low total cholesterol levels, the power achieved during bicycle ergometry, smoking, a history of smoking, the number of diseased segments with any visible degrees of stenosis, the number of diseased segments with 70% or more stenoses, and the conditions promoting the development of the first anginal episode.

[Primary angina pectoris: significance of clinical, bicycle ergometric and coronarographic data in the prognosis of ischemic heart disease remission]. / Vpervye voznikshaia stenokardiia: znachenie dannykh klinicheskogo obsledovaniia, veloérgometrii i koronarografii dlia prognoza remissii ishemicheskoi bolezni serdtsa.

By the first year of a follow-up, spontaneous clinical remissions (no anginal and ischemic episodes as evidenced by Holter monitoring, negative bicycle ergometric tests) in 52 (26%) out of 200 patients with primary angina pectoris. Possible predictors such as clinical signs, bicycle ergometric and coronary angiographic parameters were examined. A multifactorial stepwise discriminant analysis showed that the independent predictors of the clinical remission were heart rate and exercise power attained on bicycle ergometry, number of diseased coronary artery segments with 70% of more stenoses, disease pattern in the first month, existing and prior smoking, and myocardial infarction in the first 3 months of the disease onset.

[Plasminogen activator inhibitor and protein C: their relation to plasma lipids and lipo- and apoproteins in ischemic heart disease of different duration]. / Ingibitor aktivatora plazminogena i protein C: sviaz' s lipidami, lipo- i apoproteinami plazmy pri ishemicheskoi bolezni serdtsa razlichnoi prodolzhitel'nosti.

The levels of plasminogen activator inhibitor (PAI), protein C (pC), total cholesterol (TC), high and low density lipoprotein cholesterols (HDLC and LDLC), apolipoproteins A1 (apoA1) and B (apoB) were measured in 45 patients with coronary heart disease angiographically documented and 10 healthy subjects without coronary heart disease and coronary atherosclerosis as evidenced by coronary angiography and provocative tests. Twenty three patients had primary angina (PA) with a duration of less than 3 months, twenty two patients presented with chronic coronary heart disease (CCHD) with a duration of more than 4 months. In general, a negative correlation between PAI and HDLC levels in the patients under study (r = -0.413; p = 0.02), it was higher in PA (r = -0.687; p = 0.02), but disappeared in CCHD (r = 0.027). The content of PAI correlated with the cholesterol index (r = 0.654; p less than 0.001 in the whole group), more greatly in PA (r = 0.865; p = 0.001) than in CCHD (r = 0.506, NS). There was a good correlation between the levels of pC and apoB in the whole group (r = 0.606; p less than 0.001) and in PA (r = 0.662; p = 0.001), but not in CCHD (r = 0.288, NS). The content of pC also correlated with a apoB/apoA1 ratio (r = 0.445; p = 0.002 in the whole group of patients). This correlation was significantly positive in PA (r = 0.455; p = 0.044), but not in CCHD (r = 0.022). Thus, higher levels of PAI coincided with atherogenic changes in those of HDLC, and an increase in the content of pC was in agreement with that of apoB. The interrelationships are particularly typical of early stages of CHD.

New-onset angina pectoris: initial characteristics and results of a 6 to 12-month follow-up.

173 patients, aged 46.8 years on the average, were examined in the first 3 months after onset of angina pectoris. 97% of them presented at least one of risk factors (smoking, arterial hypertension, overweight, dyslipoproteinaemia), in 79% two or more risk factors were present simultaneously. A greater than 70% stenosis of one coronary artery was present in 51%, in 10% the stenosis was smaller than 70%, in 4% the coronary arteries were intact. In 131 patients without a history of myocardial infarction, vasospastic angina, overweight, and simultaneous presence of 3 or 4 risk factors occurred more frequently than in 42 patients with a history of myocardial infarction. In the first month, complications were registered only in patients with unstable angina pectoris (5 out of 41, i.e., 12%). During the later period of follow-up in 102 patients, complications occurred in 5% and complete clinical remission was registered in 35%. In patients with remission, positive exercise tests and haemodynamically significant stenoses of 2 or 3 coronary arteries were less frequently found on initial examination than in patients with sustained angina pectoris.

Peritoneal macrophages: a model for detecting atherogenic potential in patients' blood serum.

Human and mouse peritoneal macrophages cultured in the presence of the blood serum of patients with documented coronary heart disease showed a 2- to 3-fold rise in levels of intracellular cholesterol ester and a 1.5- to 2-fold increase in those of free cholesterol and triglycerides. This effect was observed in 83% of cases, whereas the serum of healthy subjects induced the accumulation of lipids in macrophages only in 28% of cases. These data accord with previously published observations obtained on smooth muscle cells of human aortic intima. A direct correlation was found between the accumulation of cholesterol in macrophages and in cultured smooth muscle cells of human aortic intima. The accumulation of lipids in macrophages was dose dependent and increased with time. It is assumed that a culture of peritoneal macrophages may serve as a model for identifying an atherogenic potential of patients' blood serum.

[Subfractionated conversions of high density lipoproteins in vitro in sera with various lipid spectra]. / Subfraktsionnye perekhody lipoproteidov vysokoi plotnosti in vitro v syvorotkakh s razlichnymi lipidnymi spektrami.

Using gradient gel electrophoresis, the interconversions of high density lipoproteins (HDL) upon heating for 24 hours at 37 degrees C of blood sera obtained from dyslipidemic patients, were studied. It was shown that during incubation of normolipidemic, hypercholesterolemic and hyperalphacholesterolemic sera, the portion of large particles of HDL2 subclass (HDL2b) is increased with a simultaneous decrease in the portion of the smallest particles of HDL3 subclass (HDL3b and HDL3c). Contrariwise, in hypertriglyceridemic and hypoalphacholesterolemic sera the portion of the largest HDL2b particles is decreased, while that of middle-sized HDL3a is increased. Hence, hypertriglyceridemia and hypoalphacholesterolemia are not associated with an intensive conversion of small HDL3 particles into large HDL2 ones, which may be the reason for the decreased cholesterol transport function of HDL.

[Hypoalphacholesterolemia: dynamics of the subfractional spectrum of high density lipoproteins during their interaction with fibroblasts and hepatoma Hep-G2 cell line]. / Gipoal'fakholesterinemiia: Dinamika subfraktsionnogo spektra lipoproteidov vysokoi plotnosti pri vzaimodeistvii s fibroblastami i gepatomoi linii Hep-G2.

Using gradient gel electrophoresis, the dynamics of subfractional spectrum of high density lipoproteins (HDL) according to the particle size was studied during HDL interaction with hepatoma Hep-G2 cells and human skin fibroblasts. It was found that incubation of sera obtained from normolipidemic donors with cholesterol-loaded fibroblasts results in a decrease of the proportion of all small-sized particles of the HDL3 subclass, i.e., HDL3a, HDL3b and HDL3c as well as in an increase in the proportion of large-sized particles of the HDL2 subclass (HDL2a and HDL2b) due to cholesterol acceptance by HDL. In contrast, incubation of the same sera with hepatoma Hep-G2 cells causes a decrease in the proportion of HDL2b and a release of smaller cholesterol-deficient HDL3a particles. The dynamics of subfractional spectrum of HDL in hypoalphacholesterolemic sera is somewhat different, i.e., incubation with fibroblasts results in a decrease of the proportion of HDL3b and HDL3c; that of HDL2a is increased. The HDL2b fraction is unchanged. After incubation of the same sera with hepatoma Hep-G2 cells, the proportion of HDL2b does not fall as in the case of normolipidemic sera, but shows a marked increase. It is concluded that hypoalphacholesterolemia is characterized not only by a low HDL level in the plasma, but also by the formation of HDL2b-deficient particles which less effectively interact with liver cells.

[Electrostatic potential on the surface of low density lipoproteins from the plasma of patients with ischemic heart disease: estimation using a fluorescent probe]. / Elektrostaticheskii potentsial poverkhnosti lipoproteidov nizkoi plotnosti plazmy krovi bol'nykh ishemicheskoi bolezn'iu serdtsa: issledovanie s pomoshch'iu fliuorestsentnogo zonda.

Fluorescent probe I-aniline-8-naphthalene sulfonate was used to evaluate the LDL surface potential values in patients with coronary artery atherosclerosis. The more negative charge was found on the LDL surface in patients with atherosclerosis of three coronary arteries as compared with that of healthy persons.

[Activity of main enzyme reactions of lipoprotein metabolism in the plasma of patients with ischemic heart disease]. / Aktivnost' osnovnykh fermentativnykh reaktsii obmena lipoproteidov v plazme krovi u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Evaluation of activity of main enzymatic systems involved in metabolism of lipoproteins, lipids and apoproteins in blood plasma of patients with heart ischemic disease, demonstrated that dissimilar alterations occurred in activity of the enzymatic systems responsible for transformation of lipoproteins in blood plasma. These alterations appear to be of great importance in the course of atherogenous impairments of lipoprotein metabolism found in the patients even in absence of distinct hyperlipidemia.

[Comparative characteristics of the basic blood lipid and apolipoprotein spectrum in groups of patients from Moscow and Bordeaux with ischemic heart disease]. / Sravnitel'naia kharakteristika spektra osnovnykh lipidov i apolipoproteinov krovi v gruppakh bol'nykh ishemicheskoi bolezn'iu serdtsa iz Moskvy i Bordo.

A comparative diagnostic examination of patients with chest pains in Moscow and Bordeaux revealed in both cities a higher level of total plasma cholesterol and apo B/A-I ratio in CHD patients with angiographically documented coronary atherosclerosis than in men without CHD. CHD patients from Bordeaux had higher levels of total and HDL cholesterol and a lower triglyceride level than patients from an analogous Moscow group. Both in Moscow and Bordeaux inhabitants the determination of the levels and the ratio of plasma apo B lipoprotein to A-I apolipoprotein proved highly informative for diagnosing atherogenous shifts in the lipoprotein system.

[Indicators of the atherogenic properties of plasma lipoproteins and coronary atherosclerosis (selective angiography data)]. / Pokazateli aterogennosti lipoproteidov plazmy krovi i koronarnyi ateroskleroz (po dannym selektivnoi angiografii).

A combined study of possible atherogenic factors was carried out in 213 males subjected to clinical investigation including selective angiography of the heart's coronary arteries. Two sets of biochemical tests were used: the routine set including the measurement of the plasma lipid spectrum, and a more sophisticated procedure (93 cases) where plasma apoproteins A1 and B, and high-density lipoprotein phospholipid composition were assessed as well. A correlation of biochemical disorders to coronary atherosclerosis could be demonstrated in 68% of cases, using the first set, and in 98% with the second set. Abnormal apoprotein levels and high-density lipoprotein phospholipid composition were found to contribute significantly to lipoprotein atherogenesis even in cases of normolipidemia.