Effect of pioglitazone on body composition and bone density in subjects with prediabetes in the ACT NOW trial.

AIMS: This study examined the effects of pioglitazone on body weight and bone mineral density (BMD) prospectively in patients with impaired glucose tolerance as pioglitazone (TZD) increases body weight and body fat in diabetic patients and increases the risk of bone fractures. METHODS: A total of 71 men and 163 women aged 49.3 (10.7) years [mean (s.d.)]; body mass index (BMI), 34.5 (5.9) kg/m(2) were recruited at five sites for measurements of body composition by dual energy X-ray absorptiometry at baseline and at conversion to diabetes or study end, if they had not converted. RESULTS: Mean follow-up was 33.6 months in the pioglitazone group and 32.1 months in the placebo group. Body weight increased 4.63 ± 0.60 (m ± s.e.) kg in the pioglitazone group compared to 0.98 ± 0.62 kg in the PIO group (p < 0.0001). Body fat rose 4.89 ± 0.42 kg in the pioglitazone group compared to 1.41 ± 0.44 kg, (p < 0.0001) in placebo-treated subjects. The increase in fat was greater in legs and trunk than in the arms. BMD was higher in all regions in men and significantly so in most. PIO decreased BMD significantly in the pelvis in men and women, decreased BMD in the thoracic spine and ribs of women and the lumbar spine and legs of men. Bone mineral content also decreased significantly in arms, legs, trunk and in the total body. CONCLUSIONS: Pioglitazone increased peripheral fat more than truncal fat and decreased BMD in several regions of the body.

Determinants of glucose tolerance in impaired glucose tolerance at baseline in the Actos Now for Prevention of Diabetes (ACT NOW) study.

AIMS/HYPOTHESIS: The aim of the study was to examine the determinants of oral glucose tolerance in 602 persons with impaired glucose tolerance (IGT) who participated in the Actos Now for Prevention of Diabetes (ACT NOW) study. METHODS: In addition to the 602 IGT participants, 115 persons with normal glucose tolerance (NGT) and 50 with impaired fasting glucose (IFG) were identified during screening and included in this analysis. Insulin secretion and insulin sensitivity indices were derived from plasma glucose and insulin during an OGTT. The acute insulin response (AIR) (0-10 min) and insulin sensitivity (S(I)) were measured with the frequently sampled intravenous glucose tolerance test (FSIVGTT) in a subset of participants. RESULTS: At baseline, fasting plasma glucose, 2 h postprandial glucose (OGTT) and HbA(1c) were 5.8 +/- 0.02 mmol/l, 10.5 +/- 0.05 mmol/l and 5.5 +/- 0.04%, respectively, in participants with IGT. Participants with IGT were characterised by defects in early (DeltaI (0-30)/DeltaG (0-30) x Matsuda index, where DeltaI is change in insulin in the first 30 min and DeltaG is change in glucose in the first 30 min) and total (DeltaI(0-120)/DeltaG(0-120) x Matsuda index) insulin secretion and in insulin sensitivity (Matsuda index and S(I)). Participants with IGT in whom 2 h plasma glucose was 7.8-8.3 mmol/l had a 63% decrease in the insulin secretion/insulin resistance (disposition) index vs participants with NGT and this defect worsened progressively as 2 h plasma glucose rose to 8.9-9.94 mmol/l (by 73%) and 10.0-11.05 mmol/l (by 80%). The Matsuda insulin sensitivity index was reduced by 40% in IGT compared with NGT (p < 0.005). In multivariate analysis, beta cell function was the primary determinant of glucose AUC during OGTT, explaining 62% of the variance. CONCLUSION: Our results strongly suggest that progressive beta cell failure is the main determinant of progression of NGT to IGT.

International variation in pancreatic cancer mortality for the period 1955-1998.

BACKGROUND: Pancreatic cancer is an important cause of cancer mortality in developed countries. This article examines time trends for pancreatic cancer mortality rates in 38 countries on five continents between 1955 and 1998. METHODS: We used the World Health Organization database on Age-Standardized World Population pancreatic cancer mortality rates by gender and fitted these data with linear regression models. This allowed us to (1) investigate the statistical significance of temporal trends; and (2) consider differences in trends among countries; and (3) predict future pancreatic cancer mortality rates. RESULTS: Over 44 years, pancreatic cancer mortality rates increased for females worldwide. Pancreatic cancer mortality rates for men increased in Southern Europe. In contrast, pancreatic cancer mortality rates for men in North America and Oceania increased until about 1975 and then decreased or remained stable. Our predictive models suggest that by 2005 the relative burden of pancreatic cancer mortality will have shifted away from Northern Europe and North America toward Southern Europe and Asia. CONCLUSIONS: Future research on pancreatic cancer should concentrate separately on the assessment of risk attributable to exposure to environmental factors, lifestyle factors, genetic determinates of pancreatic cancer, and the interactive influences of these factors on pancreatic cancer.

Alpha-tocopherol and probucol reduce autoantibody titer to MDA-LDL in hypercholesterolemic rabbits.

We considered the hypothesis that antioxidant supplementation that increases aortic antioxidant concentrations would reduce autoantibody titer to MDA-LDL, a measure that may indicate in vivo oxidation. We assessed autoantibody titer to MDA-LDL in rabbits before and after 5 months of treatment with a nutritionally adequate hypercholesterolemic diet alone (control) or supplemented with synthetic alpha-tocopherol or probucol. Aortic cholesterol and antioxidants were assessed at the end of treatment. alpha-Tocopherol supplementation increased the ratio of aortic alpha-tocopherol to cholesterol by 20-30-fold, while probucol supplementation increased the ratio of aortic probucol to cholesterol to 4-13 micromol/mol. Before treatment, MDA-LDL autoantibody titer averaged 5.09 +/- 0.24 with no difference among groups (p =.53 by ANOVA). However, after treatment, autoantibody titers differed among groups (p <.03 by ANOVA). Autoantibody titers were similar in rabbits supplemented with alpha-tocopherol and probucol (3.69 +/- 0.21 and 3.73 +/- 0.48, respectively, p = 0.81), and 26% (p <.009) lower in antioxidant supplemented rabbits than unsupplemented hypercholesterolemic rabbits (5.03 +/- 0.47). There was an inverse J relationship between autoantibody titer after treatment and aortic alpha-tocopherol/cholesterol and probucol/cholesterol, with minimum values for autoantibody titers above 8-10 micromol antioxidant/mmol cholesterol. The results of this study are consistent with inhibition of in vivo intra-aortic oxidation when aortic alpha-tocopherol or probucol exceed 8-10 micro;mol/mmol cholesterol.

Soy protein reduces the arterial low-density lipoprotein (LDL) concentration and delivery of LDL cholesterol to the arteries of diabetic and nondiabetic male cynomolgus monkeys.

We have previously shown that soy protein consumption improves lipoprotein concentrations and reduces the progression of atherosclerosis in cynomolgus monkeys. The mechanism for these beneficial effects is unclear. The purpose of this study was to determine potential mechanisms for the atheroprotective effects of soy and to determine if these effects extend to diabetic monkeys. We designed an experiment with a 2 x 2 factorial design in which adult male monkeys (N = 23) were fed an atherogenic diet with a protein source of either soy isolate or casein and lactalbumin, and the monkeys were either control or streptozotocin-induced diabetic. Diabetics had significantly increased fasting glucose and glycated hemoglobin (GHb) levels; this relationship was not affected by the type of dietary protein. Diabetics also had increased total (TC) and low-density lipoprotein cholesterol (LDLC) concentrations. However, soy consumption significantly reduced TC and LDLC concentrations in both control and diabetic monkeys. Plasma and arterial LDL metabolism was determined by injecting 125I-LDL at 48 hours and 131I-tyramine cellobiose LDL at 1 hour prior to necropsy. This allowed a determination of the arterial LDL concentration, permeability, and arterial LDL delivery. An increase in the whole-body plasma LDL fractional catabolic rate (FCR) was found with soy. Soy significantly reduced the arterial LDL concentration across all arterial sites by an average of 50%. Soy also significantly reduced the delivery of LDLC to all arterial sites by an average of 40%. While this was primarily due to the lower plasma LDLC concentration, LDL permeability in the carotid bifurcation and internal carotid arteries was also reduced. There was no additional effect of diabetes. These beneficial effects on plasma and arterial LDL metabolism would be expected to reduce atherosclerosis and were found in both control and diabetic monkeys.

Determinants of bioactivity of oxidized phospholipids. Specific oxidized fatty acyl groups at the sn-2 position.

We previously described 3 bioactive oxidation products of 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine (PAPC) containing oxovaleroyl (POVPC), glutaroyl (PGPC), and epoxyisoprostane (PEIPC) groups at the sn-2 position that were increased in minimally modified/oxidized low density lipoprotein (MM-LDL) and rabbit atherosclerotic lesions. We demonstrated specific and contrasting effects of POVPC and PGPC on leukocyte-endothelial interactions and described an effect of PEIPC on monocyte binding. The major purpose of the present study was to determine the effects of structural changes on the bioactivities of these 3 lipids. We demonstrate herein that the group at the sn-2 position determines the specific bioactivity and that the substitution of stearoyl for palmitoyl at the sn-1 position or ethanolamine for choline at the sn-3 position of the phospholipid did not alter bioactivity. Oxidized PAPC, oxidized 1-stearoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine, and oxidized 1-stearoyl-2-arachidonoyl-sn-glycero-3-phosphorylethanolamine stimulated monocyte binding and inhibited lipopolysaccharide-induced expression of the neutrophil-binding molecule E-selectin. Furthermore, all oxovaleroyl phospholipids but not the glutaroyl phospholipids induced monocyte binding without an increase in vascular cell adhesion molecule-1 (VCAM-1) expression and inhibited lipopolysaccharide-induced E-selectin expression. In contrast, glutaroyl phospholipids but not oxovaleroyl phospholipids stimulated E-selectin and VCAM-1 expression. We further demonstrate that all parts of the phospholipid molecules are required for these bioactivities. Hydrolysis with phospholipase (PL) A(1), PLA(2), and PLC strongly reduced the bioactivities of POVPC, PGPC, and mixed isomers of PEIPC. PLD had a smaller but still significant effect. The effects of POVPC and PEIPC could be abolished by sodium borohydride treatment, indicating the importance of the reducible groups (carbonyl and epoxide) in these molecules. In summary, these studies identify 6 new bioactive, oxidized phospholipids that are increased in MM-LDL and, where measured, in atherosclerotic lesions. They thus suggest that a family of phospholipid oxidation products containing oxovaleroyl, glutaroyl, and epoxyisoprostane at the sn-2 position play an important role in the regulation of leukocyte-endothelial interactions, bioactivity being in part controlled by several types of phospholipid hydrolases.

Metabolic evidence for sequestration of low-density lipoprotein in abdominal aorta of normal rabbits.

In rabbits, atherosclerosis develops preferentially at branch sites compared with the adjacent uniform aorta. This study investigated the hypothesis that low-density lipoprotein (LDL) is "sequestered" (present in a form that exchanges slowly with plasma LDL) in the aortas of normal rabbits and that more LDL is sequestered at branch sites. Thus 33 normal rabbits were injected with LDL labeled with (125)I-labeled tyramine cellobiose ((125)I-TC) to trace both undegraded LDL and aortic LDL degradation products. For 25 rabbits, LDL was also labeled with (131)I to trace undegraded LDL alone. The time-dependent aortic (125)I-TC and (131)I accumulation was determined from 0.6 to 120 h after injection. Compartmental modeling provided metabolic evidence for sequestration of LDL at the branch (P < 0.01) and uniform (P < 0.005) abdominal aorta. Concentrations of sequestered LDL were 109 +/- 28% higher (P < 0.0005) for branch sites. LDL mean residence time was 23.5 +/- 3.1 h for branch sites, 7.6 +/- 3.5 h longer (P < 0.05) than for the uniform abdominal aorta. Enhanced retention of higher concentrations of sequestered LDL at branch sites could account for the increased susceptibility of these aortic sites to atherosclerosis.

In vitro lipid peroxidation of LDL from postmenopausal cynomolgus macaques treated with female hormones.

Premenopausal women and postmenopausal women given estrogen are protected from cardiovascular diseases compared with men. Previous studies investigated whether estrogen treatment protects low density lipoprotein (LDL) from in vitro oxidation as a potential mechanistic explanation for the beneficial effect of estrogen. Results of these studies are mixed, and very few studies considered aspects of LDL that influence LDL oxidation. This study investigated whether treating postmenopausal female cynomolgus macaques with conjugated equine estrogens (CEE), medroxyprogesterone acetate (MPA), CEE + MPA, or tamoxifen, a mixed estrogen receptor agonist/antagonist, would protect LDL from in vitro oxidation. LDL was isolated from monkeys fed an atherogenic diet for 12 weeks or the same diet with CEE, MPA, CEE + MPA, or tamoxifen added at levels equivalent (on a caloric basis) to those given to women. LDL was subjected to Cu(2+) (3 micromol/L) or 2,2'-azobis(2-amidinopropane) dihydrochloride (AAPH, 1 mmol/L) and LDL oxidation was determined by the lag time before rapid formation of conjugated dienes and by the maximal rate of conjugated diene formation (propagation rate). Lag times and propagation rates were not affected by treatment. Lag times for Cu(2+) oxidation were related to LDL tocopherol while lag times for AAPH oxidation were related to high density lipoprotein (HDL) cholesterol and to LDL molecular weight. Multivariate analysis showed that LDL alpha- and gamma-tocopherol together could explain 27% of the variation in Cu(2+) mediated lag time (P < 0.005) among animals while HDL cholesterol, LDL gamma-tocopherol, and LDL molecular weight combined could explain 40% of the variation in AAPH- mediated lag time (P = 0.0006) among animals. After adjustment for these predictors, LDL lag times were not affected by treatment. In conclusion, in monkeys treated with female hormones, multiple factors influence in vitro low density lipoprotein (LDL) oxidation; future work will be needed to determine whether estrogen alters oxidation of LDL in the artery.-Schwenke, D. C., J. D. Wagner, and M. R. Adams. In vitro lipid peroxidation of LDL from postmenopausal cynomolgus macaques treated with female hormones.

Vitamin E combined with selenium inhibits atherosclerosis in hypercholesterolemic rabbits independently of effects on plasma cholesterol concentrations.

Several antioxidants inhibit atherosclerosis. This study investigated the hypothesis that combining vitamin E, a lipophilic antioxidant, with vitamin C, a hydrophilic antioxidant, and/or selenium, a cofactor of peroxidases that detoxify lipid peroxides, would inhibit atherosclerosis more effectively than vitamin E alone. We also considered whether regional variation in inhibition of atherosclerosis by antioxidants would be associated with regional variation in aortic lipophilic antioxidants. Rabbits were fed an atherogenic diet (control) or an atherogenic diet supplemented with vitamin E, vitamins E and C, vitamin E+selenium, vitamins E and C+selenium, or probucol (positive control). Supplements were as follows: vitamin E, 146 IU/d; vitamin C, 791 mg/d; selenium, 22 microg/d; or probucol, 406 mg/d. Vitamin C did not influence atherosclerosis. After 22 weeks of treatment, rank order of aortic atherosclerosis was control>vitamin E (with or without vitamin C)>vitamin E+selenium (with or without vitamin C)>probucol. Antioxidant treatment reduced aortic cholesterol concentrations 21% to 56%, 29% to 86%, and 19% to 75% for the aortic arch, descending thoracic aorta, and abdominal aorta, respectively (P<0.025 to P<0.0003 by ANOVA), with slightly greatly reductions for areas of atherosclerotic lesions. Some treatments reduced plasma cholesterol concentrations, but none altered the distribution of cholesterol among lipoproteins. Corrected for differences in plasma cholesterol concentrations, aortic cholesterol concentrations were reduced up to 72% (P<0.02) by the antioxidant treatments, with equal reductions by vitamin E+selenium and by probucol. Aortic alpha-tocopherol standardized by aortic cholesterol as a measure of aortic lipids was lower in the abdominal aorta than in the aortic arch of rabbits not given alpha-tocopherol and increased relatively more in the abdominal aorta than in the aortic arch with alpha-tocopherol supplementation. The results of this study suggest that vitamin E+ selenium inhibited atherosclerosis as effectively as an equally hypocholesterolemic dose of probucol by a mechanism(s) that is in part independent of effects on plasma and lipoprotein cholesterol concentrations. The tendency for greater efficacy of antioxidant treatments in the abdominal aorta than aortic arch may relate to the lower concentrations of alpha-tocopherol in the abdominal aorta of unsupplemented rabbits.

Aging, menopause, and free radicals.

As women undergo menopause, circulating concentrations of estrogen decrease. The relative estrogen deprivation in postmenopausal women is associated with physiological changes and increased risk of several diseases, including cardiovascular disease. Studies in animals have shown that exogenous estrogen inhibits atherosclerosis, the underlying cause of cardiovascular disease. Ongoing clinical trials will soon provide data for the effect of exogenous estrogen on cardiovascular disease in postmenopausal women. Estrogen has a number of effects that could influence atherogenesis and cardiovascular disease. Estrogens have favorable effects on lipoproteins, but such effects can only account for part of the protection from cardiovascular disease that appears to be conferred by estrogen. Evidence suggests that estrogens can have both prooxidant and antioxidant effects. However, the available evidence suggests that in vivo physiological concentrations of estrogen may have a modest antioxidant activity, and prooxidant activity is unlikely. The antioxidant activity of estrogens and inhibition by estrogens of cellular processes that are thought to promote atherosclerosis are likely to be additional mechanism(s) by which estrogen inhibits atherosclerosis and cardiovascular disease, but more work is needed. Studies of some effects of estrogens on atherogenic processes in isolated cells need to be extended to the whole animal. The influence of estrogen receptors on inhibition of atherosclerosis by estrogen needs to be clarified. Future studies should be designed to investigate separately the estrogenic and antioxidant activities of estrogens and estrogen analogs. Investigations of the antioxidant activities of estrogens should include careful consideration of the interaction of estrogens with endogenous antioxidants and fatty acid saturation, and more attention should be paid to the potential for estrogens to inhibit intraarterial oxidation.

Gender differences in intima-media permeability to low-density lipoprotein at atherosclerosis-prone aortic sites in rabbits. Lack of effect of 17 beta-estradiol.

Premenopausal women are protected from coronary heart disease, and premenopausal nonhuman primates are protected from atherosclerosis, the underlying cause of coronary heart disease. Estrogen is thought to account for this protection in females, and part of this protection is independent of the effects on risk factors, including lipoprotein levels. This study considered the hypothesis that reduced intima-media permeability to low-density lipoproteins (LDL) may account for the protection from atherosclerosis and coronary heart disease in premenopausal females and that this effect might be mediated by estrogen. Intima-media permeability to LDL was determined in male and female rabbits made hypercholesterolemic by feeding them 0.5% cholesterol for 8 days. The diet of half of the female rabbits was supplemented with 17 beta-estradiol (4 mg/d) during cholesterol feeding and the preceding 4 weeks. Estrogen treatment in the female rabbits did not influence the intima-media permeability to LDL. However, intima-media permeability to LDL for branch sites of the abdominal aorta and aortic arch (regions highly susceptible to atherosclerosis) was 43% and 38% lower, respectively, in male rabbits than in female rabbits: (2.93 +/- 0.39 microL/h/g, (n = 8), vs 6.28 +/- 0.86 microL/h/g, (n = 16), P < .001, and 4.69 +/- 0.28 microL/h/g, (n = 8) vs 7.57 +/- 0.75 microL/h/g, (n = 16), P < .02). In contrast, intima-media permeability to LDL in 7 of 8 aortic sites relatively resistant to atherosclerosis did not differ between male and female rabbits. These data suggest that the protection from atherosclerosis associated with female sex and estrogen is mediated by mechanism(s) other than reduction in intima-media permeability to LDL.

Comparison of aorta and pulmonary artery: I. Early cholesterol accumulation and relative susceptibility to atheromatous lesions.

In rabbits, the pulmonary artery and the aorta are susceptible to atherosclerosis. However, susceptibility of the pulmonary artery, compared with the aortic arch, to atherosclerosis and the relationship between the accumulation of cholesterol during the early stages of atherogenesis and the development of atheromatous lesions for these arterial regions remain to be clarified. Cholesterol concentrations for the pulmonary artery and aorta were measured in normal rabbits and in rabbits fed a 0.5% cholesterol diet for 8, 12, and 16 days and 17 weeks. In normal rabbits, the rank order of arterial cholesterol concentrations was pulmonary artery>aortic arch>descending thoracic aorta, with concentrations of total and nonesterified cholesterol 17% and 25% (both P<.05) greater, respectively, for the pulmonary artery than for the descending thoracic aorta. Rank order remained the same during 16 days of cholesterol feeding, but differences between arterial regions were exaggerated. After rabbits were fed cholesterol for 16 days, total and esterified cholesterol concentrations were 57% and 920% (both P<.01) greater, respectively, for the pulmonary artery than for the descending thoracic aorta, with much smaller differences between the aortic regions. In contrast, after rabbits were fed cholesterol for 17 weeks, concentrations of total, esterified, and nonesterified cholesterol were similar for the pulmonary artery and aortic arch, but these forms of cholesterol were increased 100%, 130%, and 53% (all P<.03), respectively, for the aortic arch compared with the descending thoracic aorta. Cholesterol concentrations for the pulmonary artery were positively associated with those for the aortic regions during the first 16 days of cholesterol feeding, but for rabbits fed cholesterol for 17 weeks the associations were either negative or absent. These results indicate that relative rates of cholesterol accumulation in the pulmonary artery and aorta differ at different stages of atherogenesis and suggest that the balance between processes that deliver cholesterol to, and remove cholesterol from, the artery may change in different ways in these arterial regions during atherogenesis.

Comparison of aorta and pulmonary artery: II. LDL transport and metabolism correlate with susceptibility to atherosclerosis.

The pulmonary artery and the aorta are similarly susceptible to atherosclerosis in rabbits. However, the mechanism(s) that accounts for this is not yet known. This study investigated the hypothesis that one or more aspects of arterial low-density lipoprotein (LDL) transport and metabolism might explain the similar susceptibility of the aortic arch and pulmonary artery to atherosclerosis and the increased susceptibility of these arterial regions compared with the descending thoracic aorta. We determined permeability to LDL, rates of LDL degradation, and concentrations of undegraded LDL for the intima-media of normal rabbits and those fed cholesterol for approximately 8 days. Intima-media permeability did not differ between corresponding arterial regions of normal rabbits and rabbits fed cholesterol for 8 days and was similar for the aortic arch and pulmonary artery. Rates of LDL degradation and concentrations of undegraded LDL for the intima-media were influenced by cholesterol feeding. These measures were reduced in fractional terms but increased in absolute terms as a result of hypercholesterolemia, without differences between corresponding parameters for the pulmonary artery and aortic arch. However, permeability to LDL, rates of LDL degradation, and concentrations of undegraded LDL were increased for the intima-media of the aortic arch compared with the descending thoracic aorta. Similar, although not always significant, trends were evident for the comparison of the pulmonary artery and descending thoracic aorta. Differences in LDL transport and metabolism and changes after feeding cholesterol for 8 days parallel the relative susceptibility to atherosclerosis for the three arterial regions studied. These results support the role of arterial LDL transport and metabolism in atherogenesis and potentially provide a mechanistic explanation for the differences in susceptibility to atherosclerosis for these three arterial regions.

Effects of short-term hormone replacement therapies on low-density lipoprotein metabolism in cynomologus monkeys.

Estrogen replacement therapy reduces the risk of coronary heart disease in women and decreases the extent of atherosclerosis in monkeys. In our previous studies, estrogen treatment decreased arterial LDL degradation and accumulation, thus indicating one mechanism by which estrogen inhibits the progression of atherosclerosis. The influence of progestins on these processes remains nuclear. The objective of this study was to determine the effects of oral estrogen (conjugated equine estrogens) and progestin (medroxyprogesterone acetate) alone or in combination on arterial LDL metabolism after 12 weeks of atherogenic stimulus. This relatively short period of treatment was chosen to determine effects on arterial LDL metabolism before substantial subendothelial macrophage accumulation. In contrast to previous studies (16 to 18 weeks of treatment), when macrophages were present in the intima, neither estrogen nor progestin (nor their combination) had any effect on any index of arterial LDL metabolism. These results suggest that estrogen may preferentially reduce LDL metabolism in macrophages with little effect on cells of the normal artery. In contrast to arterial LDL metabolism, hepatic LDL uptake was significantly increased in animals treated with estrogen or estrogen plus progestin. Despite the increased LDL uptake by the liver, hepatic lipid content was significantly decreased by approximately 50% in both estrogen and estrogen-plus-progestin treatment compared with control and progestin-treated animals. The decrease in hepatic cholesterol content in hypothesized to be due to increased biliary secretion of cholesterol.

Selective increase in cholesterol at atherosclerosis-susceptible aortic sites after short-term cholesterol feeding.

In rabbits, the aortic arch and branch sites of the descending thoracic and abdominal aortas are susceptible to atherosclerosis. This study investigated the hypothesis that the reported focal increase in LDL concentration and mean residence time at susceptible aortic sites after feeding cholesterol for 4 to 8 days precede atherosclerotic change as indicated by increased aortic cholesterol concentration. Cholesterol concentrations for all aortic sites of normal rabbits were similar (approximately equal to 2.8 mumol/g). No change in aortic cholesterol concentration could be detected after feeding cholesterol for 8 days. However, after feeding cholesterol for 12 and 16 days, cholesterol concentrations for abdominal branch sites were increased compared with abdominal branch sites of normal rabbits (4.47 +/- 0.50, n = 8, and 4.85 +/- 0.33, n = 11, mumol/g, respectively, versus 2.87 +/- 0.27, n = 12, mumol/g; P < .025 and P < .005, respectively). In contrast, the cholesterol concentration of atherosclerosis-resistant nonbranch abdominal aorta was unchanged after feeding cholesterol for 16 days and was much less than that of the branch sites (2.72 +/- 0.12 versus 4.85 +/- 0.33, mumol/g, n = 11; P < .001). Cholesterol concentrations for other susceptible sites were also increased after feeding cholesterol for 12 and 16 days. Cholesterol concentrations for susceptible sites were linearly related to a combined measure of duration and extent of hypercholesterolemia (P < .001 to P < .0001), whereas no such relationship could be detected for resistant sites. Most (59% to 93%) of the cholesterol accumulating in susceptible aortic sites after feeding cholesterol for 12 and 16 days was nonesterified, suggesting that the increased cholesterol concentration did not reflect development of foam cells or the insudation of plasma lipoproteins. This study suggests that the reported focal increases in LDL concentration and mean residence time at susceptible aortic sites during cholesterol feeding precede atherosclerosis.

Influx, efflux, and accumulation of LDL in normal arterial areas and atherosclerotic lesions of white Carneau pigeons with naturally occurring and cholesterol-aggravated aortic atherosclerosis.

This study investigated the hypothesis that increased influx of low-density lipoprotein (LDL) accounts for the natural development of atherosclerosis in a characteristic (susceptible) site in the distal thoracic aorta of White Carneau (WC) pigeons and the exacerbation of atherosclerosis by cholesterol feeding. The influence of dietary cholesterol-induced changes in LDL composition on LDL influx into the artery was also investigated. As a measure of the influx of LDL into the artery, we determined the arterial accumulation of radiolabeled LDL after 1 hour. Nine 50-month-old WC pigeons with naturally occurring atherosclerosis and seven 14-month-old WC pigeons with atherosclerosis accelerated by 10 months of cholesterol feeding were studied. In the absence of atherosclerotic lesions, we found no evidence for increased accumulation of LDL at the susceptible site. In fact, more LDL accumulated in less susceptible normal arterial areas near the heart (approximately 90 nl/h per square centimeter) than in the susceptible distal thoracic aorta (approximately 35 nl/h per square centimeter). In the absence of atherosclerotic lesions, LDL accumulation (nanoliters per hour per square centimeter) was not influenced by hypercholesterolemia, although mass transport of LDL cholesterol into the artery was increased. Naturally occurring atherosclerotic lesions accumulated five times as much LDL as the adjacent normal arterial area (P < .001), whereas cholesterol-aggravated atherosclerotic lesions in different arterial sites accumulated four to 26 times as much LDL as the adjacent normal artery (P < .05). Cholesterol-aggravated atherosclerotic lesions at the most susceptible site accumulated five times as much LDL as naturally occurring atherosclerotic lesions in the corresponding arterial site (823 +/- 241 vs 175 +/- 45 nl/h per square centimeter, mean +/- SEM; P < .005). Arterial accumulation of LDL was influenced very little by changes in LDL composition induced by cholesterol feeding. In another study with young WC pigeons free of atherosclerosis and other WC pigeons with cholesterol-aggravated atherosclerosis, we injected differently labeled LDL 0.5 and 1 hour before sacrifice to investigate whether efflux of LDL from the artery was significant during a 1-hour period of LDL uptake. Although efflux of LDL from all arterial sites occurred during 1 hour, differential efflux could not account for regional differences in 1-hour arterial LDL accumulation. This study suggests that the characteristic susceptibility of the distal thoracic aorta of WC pigeons to atherosclerosis and the exacerbation of atherosclerosis by cholesterol feeding cannot be explained by differences in influx or efflux of LDL.(ABSTRACT TRUNCATED AT 400 WORDS)

Oral contraceptive treatment decreases arterial low density lipoprotein degradation in female cynomolgus monkeys.

The effect of oral contraceptive therapy on early events in atherogenesis was studied in female cynomolgus monkeys. After a 1-month dietary challenge, monkeys were randomized into three groups stratified by total plasma cholesterol and high density lipoprotein cholesterol concentrations. The monkeys were then fed a cholesterol-containing diet for 16 weeks. This relatively short period ensured that studies were done before any treatment-induced differences in arterial morphology occurred. Monkeys were treated with either diet alone (control group), with the addition of a monophasic oral contraceptive (equivalent to a human dose of 50 micrograms ethinyl estradiol and 500 micrograms norgestrel per day), or with a triphasic oral contraceptive (equivalent to a human dose of 30-40 micrograms ethinyl estradiol and 50-125 micrograms levonorgestrel per day). Twenty-four hours before necropsy, low density lipoproteins (LDLs) labeled with 131I and LDLs labeled with the residualizing label 125I-tyramine cellobiose were injected into the animals. The arterial LDL degradation rate, amount of undegraded LDLs, and total LDL accumulation were then determined. Although there were regional differences in LDL metabolism, both treatments decreased the rate of LDL degradation and LDL accumulation in the coronary arteries and other arterial sites. Treatment also resulted in significantly lower LDL molecular weights. Despite a trend toward a more atherogenic lipid profile (decreased high density lipoprotein cholesterol and increased total plasma/high density lipoprotein cholesterol ratio), oral contraceptive treatment may inhibit atherogenesis by decreasing arterial LDL degradation.

Regional differences in arterial low density lipoprotein metabolism in surgically postmenopausal cynomolgus monkeys. Effects of estrogen and progesterone replacement therapy.

To determine if arterial lipoprotein metabolism may be involved in mediating well-known anatomic regional differences in susceptibility to atherosclerosis, arterial low density lipoprotein (LDL) metabolism and extent of atherosclerosis were studied in 17 ovariectomized female cynomolgus monkeys. The animals were fed an atherogenic diet for 18 weeks, during which time one group received 17 beta-estradiol and cyclic progesterone treatment (n = 9) and the controls received no hormone replacement therapy (n = 8). As reported previously, hormone replacement markedly reduced the accumulation of LDL in coronary arteries without affecting plasma lipoprotein patterns. We report here that LDL metabolism differed among arterial sites. LDL accumulation, LDL degradation rate, and the concentration of undegraded LDL were greatest in the coronary arteries and carotid bifurcations compared with the aorta, iliac arteries, and cerebral arteries. Although hormone replacement decreased indexes of LDL metabolism, there was no effect on intimal thickness or indexes of endothelial injury, such as leukocyte adhesion and endothelial cell turnover rate. There were, however, regional differences in these morphological parameters. The intima was thickest in the aorta, and leukocyte adhesion and endothelial cell turnover rates were greatest in the carotid bifurcation and thoracic aorta. The decreased accumulation and metabolism of LDL caused by hormone replacement therapy was specific to the arterial system and did not occur in the liver or other peripheral tissues.

Accumulation of 125I-tyramine cellobiose-labeled low density lipoprotein is greater in the atherosclerosis-susceptible region of White Carneau pigeon aorta and further enhanced once atherosclerotic lesions develop.

Previous studies have suggested that greater arterial concentrations of undegraded low density lipoprotein (LDL) and/or greater arterial rates of LDL degradation may play role(s) in determining regional differences in arterial susceptibility to atherosclerosis in rabbits (Schwenke and Carew, Arteriosclerosis 1989;9:895-918). The White Carneau (WC) pigeon is also useful for investigating potential mechanism(s) that might account for regional variation in arterial susceptibility to atherosclerosis because atherosclerosis develops predictably in the aorta at the level of the celiac bifurcation (atherosclerosis-susceptible celiac site). In this study we sought to determine whether the 125I-tyramine cellobiose (125I-TC) content 1 day after injecting 125I-TC-LDL ("125I-TC-LDL accumulation") would be greater in the celiac site in arteries of WC pigeons and whether 125I-TC-LDL accumulation would be exaggerated by cholesterol feeding. Because 125I-TC remains trapped in cells after cellular degradation, arterial sites that either degrade LDL at higher rates or contain higher concentrations of undegraded LDL or both will demonstrate greater 125I-TC-LDL accumulation. Young WC pigeons were studied while consuming a cholesterol-free diet and after consuming a cholesterol-containing diet for 1, 2, 4, and 8 weeks. In pigeons fed a cholesterol-free diet, 125I-TC-LDL accumulation in the celiac site was equivalent to 0.24 +/- 0.02 micrograms LDL cholesterol/cm2 aortic surface/day compared with only 0.14 +/- 0.02 micrograms LDL cholesterol/cm2/day for the adjacent aorta, which is resistant to atherosclerosis (atherosclerosis-resistant site) (p less than 0.025). In atherosclerotic lesions excised from the celiac site, 125I-TC-LDL accumulation was equivalent to 21 +/- 10 micrograms LDL cholesterol/cm2 aortic surface/day compared with 0.66 +/- 0.17 micrograms LDL cholesterol/cm2/day for the adjacent atherosclerosis-resistant site (p less than 0.001). During cholesterol feeding, 125I-TC-LDL cholesterol accumulation in the celiac site as a whole increased 30-fold compared with a fivefold increase in plasma LDL cholesterol. In comparison, 125I-TC-LDL cholesterol accumulation in the adjacent atherosclerosis-resistant arterial site increased at the same rate as the plasma LDL cholesterol, while 125I-TC-LDL cholesterol accumulation in two other relatively atherosclerosis-resistant arterial sites that we studied increased relatively little during cholesterol feeding. The results of this study suggest that differences in arterial 125I-TC-LDL accumulation, both those present in normal animals and those induced by cholesterol feeding, may contribute to the characteristic regional variation in arterial susceptibility to atherosclerosis in WC pigeons.(ABSTRACT TRUNCATED AT 400 WORDS)