Since the relation between serum triglyceride level and coronary heart disease after adjustment for cholesterol and other risk factors remains controversial, the authors have tested the hypothesis that it could be different according to the level of serum cholesterol, i.e., that there may be an interaction between cholesterol and triglyceride level in prediction of coronary heart disease risk. The data of the Paris Prospective Study were used to carry out a survival analysis, by using the Cox model, with coronary heart disease death as the end point and triglyceride and different risk factors as the predictor variables. In this study, during a mean follow-up of 11.4 +/- 2.2 years, 157 coronary heart disease deaths occurred. Serum triglyceride level is not an independent predictor of coronary heart disease death after adjustment for serum cholesterol. However, when cholesterol, triglyceride, and their interaction term are introduced in the regression equation, all variables contribute significantly to the risk. This is also true when other risk factors are taken into account. As a consequence of this interaction, among the 3,585 subjects with a serum cholesterol level lower than 220 mg/100 ml, serum triglyceride level is an independent predictor of risk, even after adjustment for all other risk factors.
Obesity, hypertension, a high plasma level of glucose, and some llpid abnormalities (high plasma levels of cholesterol and triglycerides) often occur in the same individuals. Some authors have postulated that the elevated levels of plasma insulin in obese individuals may explain this association. To explore this hypothesis further, the relationships between body mass index, fasting plasma glucose and insulin, blood pressure, serum lipids, and apoproteins were Investigated in a group of 2144 healthy middle-aged men. Analysis of the data show that the associations between body mass index and blood pressure or lipid variables are largely independent of plasma glucose and Insulin. Plasma glucose is strongly related to blood pressure in nonobese subjects. Plasma Insulin is not associated with blood pressure independently of body mass index and plasma glucose; however, the simultaneous elevation of body mass index, plasma glucose, and insulin is strongly associated with blood pressure. The results also confirm that plasma insulin is positively related to triglycerides and negatively related to high density Iipoprotein cholesterol independently of plasma glucose and body mass index. (Arteriosclerosis 7:197-202, March/April 1987) I n a previous work using the data of the Paris Prospective Study I (PPS I), 1 we studied the relationship between blood pressure, heart rate, and plasma glucose and insulin levels obtained after an oral load of glucose. Analysis of the results demonstrated that in an active population of middle-aged men, glucose level was independently associated with blood pressure, whereas insulin was not. From that analysis, we concluded that insulin is unlikely to affect the blood pressure level. However, the results of recent clinical 2 ' 3 and epidemiologic 4 studies have emphasized the possible role of insulin as a determinant of blood pressure level and these observations are supported by physiopathological hypotheses stressing the effect of insulin on sodium transports. 5 On the other hand, other investigators have demonstrated an independent relationship between plasma insulin and some plasma lipids and lipoproteins 6 " 9 which could be explained by the effect of insulin on lipopro- Received July 7,1986; revision accepted November 24,1986. tein lipase and on VLDL synthesis. These observations are of clinical importance because if insulin is a determinant of either blood pressure or lipoproteins levels, it might at least partly explain the frequent association of obesity, hypertension, elevated plasma glucose, and lipids or Iipoprotein abnormalities in many individuals, particularly those from industrialized countries and would point to insulin's role in the determinism of coronary heart disease and suggest preventive measures. 1011The purpose of this analysis is to investigate the independent and interactive "effects" of body mass index (BMI), plasma glucose, and insulin on systolic (SBP) and diastolic (DBP) blood pressure and on some lipid parameters, after adjustment for the possibly confounding...
The relations between the fatty acids of cholesterol esters and some cardiovascular risk factors have been investigated in a sample of 3,348 middle-aged men examined at entry into the Paris Prospective Study 2. The partial associations between the risk factors and the various fatty acids have been evaluated using a special regression method that takes into account the structural dependencies among the percentages of fatty acids. The results show that palmitoleic acid is strongly associated with alcohol consumption and blood pressure and that its association with blood pressure is absent in nondrinkers. High density lipoprotein cholesterol and apolipoprotein A1 are negatively associated with palmitic and dihomogammalinolenic acids and positively associated with oleic and linoleic acids. An inverse relation of low density lipoprotein cholesterol and apolipoprotein B to these fatty acids is also observed. Simultaneous high levels of palmitic and dihomogammalinolenic acids and low levels of oleic and linoleic acids could then be related to profiles of lipids and apolipoproteins exposing one to a high risk of coronary heart disease. These associations may be of interest in interpreting the relations observed in other studies between the fatty acid composition of cholesterol esters or other lipids and coronary heart disease.
The objectives of the present work were to evaluate the effect of a methionine-supplemented diet as a model of hyperhomocysteinaemia on the systolic blood pressure (BP) and vasomotor functions of aortic rings in Wistar -Kyoto (WKY) and spontaneously hypertensive rats (SHR). WKY and SHR rats, randomised into four groups, were fed a normal semisynthetic diet or a methionine (8 g/kg)-supplemented diet for 10 weeks. Systolic BP was measured non-invasively. At the end of the experiment, plasma homocysteine, methionine, cysteine and glutathione levels were determined. Vasoconstriction and vasodilatation of aortic rings were measured. The methionine-supplemented diet induced a significant increase in plasma homocysteine and methionine concentration in both WKY and SHR rats, an increase in plasma cysteine concentrations in WKY rats and an increase in the glutathione concentration in SHR. The systolic BP of WKY rats fed the methionine-supplemented diet increased significantly (P,0·01), whereas systolic BP was reduced in SHR. An enhanced aortic responsiveness to noradrenaline and a decreased relaxation induced by acetylcholine and bradykinin were observed in the WKY rats fed the methionine-enriched diet. In SHR, the bradykinin-induced relaxation was reduced, but the sodium nitroprusside response was increased. In conclusion, a methionine-enriched diet induced a moderate hyperhomocysteinaemia and an elevated systolic BP in WKY rats that was consistent with the observed endothelial dysfunction. In SHR, discrepancies between the decreased systolic BP and the vascular alterations suggest more complex interactions of the methionine-enriched diet on the systolic BP. Further investigations are needed to understand the paradoxical effect of a methionine-rich diet on systolic BP.
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