No abstract

Thyroid substitution treatment in patients with hypercholesterolaemia and subclinical hypothyroidism decreases total plasma cholesterol by 0.4 mmol/l, but plasma levels remain elevated in most patients. Further treatment with dietary restriction and cholesterol synthesis inhibitors should then be considered.

Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation may be beneficial in the treatment of several psychiatric disorders, including depression. A small number of studies have suggested that there may also be cognitive and mood effects in healthy samples. The purpose of the present study was to investigate the effects of n-3 PUFA on depressionrelevant cognitive functioning in healthy individuals. Fifty-four healthy university students were randomized to receive either n-3 PUFA supplements or placebo for 4 weeks in a double-blind design. The test battery included measures of cognitive reactivity, attention, response inhibition, facial emotion recognition, memory and risky decision-making. Results showed few effects of n-3 PUFAs on cognition and mood states. The n-3 PUFA group made fewer risk-averse decisions than the placebo group. This difference appeared only in non-normative trials of the decision-making test, and was not accompanied by increased impulsiveness. N-3 PUFAs improved scores on the control/perfectionism scale of the cognitive reactivity measure. No effects were found on the other cognitive tasks and no consistent effects on mood were observed. The present findings indicate that n-3 PUFA supplementation may have a selective effect on risky decision making in healthy volunteers, which is unrelated to impulsiveness.

The combined data suggest that treatment with HMG-CoA reductase inhibitors prevents stroke in middle-aged persons. Because stroke is especially common in older age, these data reinforce the need for clinical trials to evaluate the effect of HMG-CoA reductase inhibitors in preventing stroke in the elderly.

No abstract

The development of superior sagittal sinus thrombosis is multifactorial. Patients with thyrotoxicosis and a large goiter may be predisposed to the development of superior sagittal sinus thrombosis through hypercoagulability and stasis of the local venous blood flow.

Abstract-There is controversy regarding the relation between hypertriglyceridemia (HTG) and endothelial function. This study was designed to investigate endothelial function in a patient group with chronic HTG, before and during lipid-lowering therapy by atorvastatin. In addition, the effects of acute HTG on endothelial function were studied in normolipidemic individuals. Eight male patients with chronic HTG were studied before and after 6 weeks of lipid-lowering treatment with 80 mg atorvastatin once daily. Ten age-matched control subjects were studied at baseline and immediately after a high-dose infusion of artificial triglycerides. The endothelium-dependent response to serotonin was attenuated in the HTG group, whereas the response to acetylcholine was comparable to the response in the control group. The response to the endothelium-independent vasodilator nitroprusside was comparable in both groups. In response to atorvastatin therapy, serum triglyceride and cholesterol levels decreased significantly by 43% (paired t test, Pϭ0.017) and 38% (paired t test, Pϭ0.012), respectively. After 6 weeks of treatment, the forearm blood flow response to serotonin improved from 63% to 106% (ANOVA, PϽ0.001). Induction of acute HTG in the control subjects did not affect the forearm blood flow responses to serotonin and nitroprusside; however, the response to acetylcholine was paradoxically increased. In conclusion, patients with chronic HTG have an impaired endothelium-dependent vasodilation to serotonin that is normalized after 6 weeks of lipid-lowering therapy by atorvastatin.

Abstract-Type III hyperlipoproteinemia (HLP) is mainly found in homozygous carriers of apolipoprotein E2 (apoE2, Arg1583 Cys). Only a small percentage (Ͻ5%) of these apoE2 homozygotes develops hyperlipidemia, indicating that additional environmental and genetic factors contribute to the expression of type III HLP. In the present study, first, the prevalence of type III HLP among apoE2 homozygotes was estimated in a Dutch population sample of 8888 participants. Second, 68 normocholesterolemic and 162 hypercholesterolemic apoE2 homozygotes (type III HLP patients) were collected to investigate additional factors influencing type III HLP expression. In the Dutch population sample, apoE2 homozygosity occurred with a frequency of 0.6% (57 of 8888 individuals). Among the 57 E2/2 subjects, 10 type III HLP patients were identified (prevalence 18%). Comparison of normocholesterolemic E2/2 subjects and type III HLP patients showed that the latter had a significantly increased body mass index (25.6Ϯ4.0 versus 26.9Ϯ3.8 kg/m 2 , respectively; Pϭ0.03) and prevalence of hyperinsulinemia (26% versus 63%, respectively; PϽ0.001). Multiple linear regression analysis demonstrated that most of the variability in type III HLP expression can be explained by fasting insulin levels (partial correlation coefficient Ϸ0.50, PϽ0.001). In contrast to men, apoE2 homozygous women aged Ն50 years had significantly higher plasma lipid levels than their counterparts aged Ͻ50 years. These data demonstrate that the expression of type III HLP in E2/2 subjects is elicited to a large extent by hyperinsulinemia. In addition, in female apoE2 homozygotes, the expression increases with age; this increase is most likely due to the loss of estrogen production. Key Words: type III hyperlipoproteinemia Ⅲ apolipoprotein E Ⅲ hyperinsulinemia F amilial dysbetalipoproteinemia (FD) is an inborn error of metabolism characterized by defective apoE, leading to the impaired clearance of remnant lipoproteins by the liver. 1,2 FD subjects are characterized by an accumulation of chylomicron and VLDL remnants in the circulation. These socalled ␤-VLDL particles are enriched in cholesterol esters and apoE. 3,4 ApoE is a ligand for the receptor-mediated uptake of chylomicron and VLDL remnants by the liver. 5-7 Three alleles encode for 3 apoE isoforms: apoE2 (Arg1583 Cys), apoE3 (Cys112, Arg158), and apoE4 (Cys1123 Arg). 8 In contrast to the other 2 common apoE isoforms, apoE2 displays Ͻ1% binding affinity for the hepatic LDL receptor (LDLR). 9,10 More than 90% of all FD subjects are homozygous carriers of apoE2 (Arg1583 Cys). 1,11 In white populations, apoE2 homozygosity occurs with a frequency of Ϸ1%. 2 Despite the accumulation of remnants in the circulation, most (Ͼ95%) apoE2 homozygous subjects are normolipidemic or even hypolipidemic because of low LDL cholesterol levels. 11-13 However, apoE2 homozygosity together with the presence of additional environmental and/or genetic factors that interfere with normal lipoprotein metabolism will often result in a hyperlipidemic phen...