[Diagnostic image (303). A deeply tanned woman]. / Diagnose in beeld (303). Een sterk gebruinde vrouw.

A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a visit to Egypt. She was deeply tanned with hyperpigmentation on the metacarpophalangeal joints, palm of hand creases and buccal mucosa, due to Addison's disease.

Statins in type 2 diabetes mellitus: target on lipids and vascular wall function.

The typical dyslipidaemia in type 2 diabetes mellitus shows high levels of triglycerides, low levels of highdensity lipoprotein cholesterol (HDL-c) and small dense low-density lipoprotein (LDL) particles. In these patients low-dose atorvastatin (10 mg) results in a significant and relevant reduction in triglycerides and LDL-c. High-dose atorvastatin (80 mg) results in a better LDL-c reduction. The endothelial dysfunction is likely to be caused by factors related to insulin resistance and not by dyslipidaemia alone. The results from the DALI study (Diabetes Atorvastatin Lipid Intervention) on lipids and endothelial function are discussed, together with two invasive endothelial function studies in diabetics and hypertriglyceridaemic patients. The subgroup of diabetics in the large secondary prevention trials using statins are analysed with respect to total cholesterol lowering and death due to coronary heart disease and nonfatal myocardial infarction.

Primary and secondary prevention in cardiovascular disease: an old-fashioned concept?

OBJECTIVE: Is the concept of primary and secondary cardiovascular prevention an old-fashioned concept that needs to be re-defined? DESIGN: Discussion paper. RESULTS: Cardiovascular prevention means reduction of absolute risk for cardiovascular disease (CVD), irrespective of clinical stage. CONCLUSION: For the calculation of an individual probability to develop CVD all factors that contribute to the risk must be taken into account, including previous CVD events.

HDL antioxidant effects as assessed using a nonexchangeable probe to monitor particle-specific peroxidative stress in LDL-HDL mixtures.

High density lipoproteins (HDL) have been reported to inhibit oxidation of low density lipoproteins (LDL) based in part on observations that oxidative changes occur more slowly in LDL-HDL mixtures than in LDL alone. In the current studies, we developed an approach to discern particle-specific oxidation kinetics within mixed particle systems using the oxidation-labile fluorescent probe parinaric acid cholesteryl ester (PnCE) and applied this to the study of HDL inhibition effects. PnCE was introduced into acceptor lipoproteins by cholesteryl ester transfer protein (CETP)-mediated transfer from donor microemulsions. Incubation of PnCE-containing LDL and HDL with non-probe-containing HDL and LDL, respectively, followed by measurement of reisolated fractions, indicated that PnCE does not transfer appreciably between lipoprotein fractions. Oxidative loss of lipoprotein-associated PnCE occurred essentially in tandem with changes in conjugated dienes, suggesting that PnCE loss reflects the course of peroxidation of endogenous lipoprotein lipids. Using PnCE to separately monitor LDL- and HDL-specific oxidation within LDL-HDL mixtures, we obtained direct evidence that HDL inhibits both Cu(2+)- and Fe(3+)-induced peroxidation of LDL-associated lipids. Notably, in the presence of Cu2+, loss of HDL-associated PnCE fluorescence also was inhibited in LDL-HDL co-incubations, suggesting that LDL exert an antioxidant effect under these conditions as well. Thus, results obtained using this new methodology are consistent with previously reported antioxidant effects of HDL, but indicate that the behavior of individual lipoprotein particles may be more complicated than can be predicted from the collective behavior of the lipoprotein mixture.