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Calculation of LDL cholesterol by the Friedewald formula may be inaccurate for assessment of cardiovascular risk in patients with type II diabetes and may not be appropriate for management of lipoprotein abnormalities in those diabetic patients.

Physical activity improves one's lipid profile and increases physical fitness. The present study was aimed at determining the association of amount and intensity of leisure time physical activity with serum lipid profile and physical fitness. A total of 537 healthy men aged 20-60 years were recruited in a quota sampling frame for measurement of physical activity energy expenditure at two different levels. The Minnesota Leisure Time Physical Activity Questionnaire was administered. Serum lipid and lipoprotein levels were measured, and all participants were given an exercise test. Physical activities with an intensity greater than 7 kcal/minute were significantly associated (p < 0.01) with a higher level of high density lipoprotein (HDL) cholesterol and a lower atherogenic index (total cholesterol:HDL cholesterol). Independently of other confounding variables, each average 100 kcal/day expended in leisure time physical activity with an intensity greater than 7 kcal/minute during the previous year was associated with an increase of 2.09 mg/dl (0.054 mmol/liter) in HDL cholesterol and a decrease of 0.23 in atherogenic index. However, only physical activity with an intensity greater than 9 kcal/minute was associated with decreases in total cholesterol, non-HDL cholesterol, and log(triglycerides). Better physical fitness was associated with physical activities of intensities above 5 kcal/minute. There is a threshold in the intensity of exercise associated with serum lipid profile (7 kcal/minute) and physical fitness (5 kcal/minute). Above the former threshold, the relation between amount of physical activity and lipid levels is linear for total cholesterol, HDL cholesterol, non-HDL cholesterol, and atherogenic index and is logarithmic for triglycerides.

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Background and Purpose:The role of lipoprotein abnormalities in the development of ischemic cerebrovascular disease has not been sufficiently clarified. The aim of this study was to identify the lipoprotein profile in ischemic cerebrovascular disease and the possible role of apolipoprotein E polymorphism.Methods: The relation between the concentrations of lipoprotein(a), intermediate density lipoproteins, apolipoprotein A-I, apolipoprotein B, apolipoprotein E, and other lipoproteins was studied in 100 men with ischemic cerebrovascular disease (48 atherothrombotic, 28 lacunar, and 24 of unknown type) and in 100 healthy age-matched men as a control group.Results: Patients with ischemic cerebrovascular disease had significantly higher levels of lipoprotein (a), lipids carried by intermediate density lipoproteins, and low density lipoprotein cholesterol and lower levels of high density lipoproteins than control subjects. Patients with atherothrombotic infarction had higher total serum cholesterol and low density lipoprotein cholesterol concentrations than patients with lacunar infarction. To assess lipoprotein abnormalities in normolipidemic subjects, a subgroup of 38 patients with ischemic cerebrovascular disease and 53 control subjects, both with serum cholesterol levels <5.2 mmol/l (200 mg/dl) and triglycerides <2.3 mmol/l (200 mg/dl), was analyzed. Serum lipoprotein (a), lipids carried by very low density lipoproteins and intermediate density lipoproteins, and low density lipoprotein triglycerides were significantly higher in normolipidemic patients compared with normolipidemic control subjects, whereas high density lipoprotein cholesterol levels were lower. Apolipoprotein E polymorphism in our ischemic cerebrovascular patients differed from that of the control group, with the e4 allele being more prevalent.Conclusions: Increased serum lipoprotein (a) levels and intermediate density lipoprotein abnormalities together with decreased high density lipoprotein levels are major risk factors for ischemic cerebrovascular disease, even in normocholesterolemic and normotriglyceridemic subjects. Finally, the e4 allele could probably be a predisposing genetic marker for ischemic cerebrovascular disease. (Stroke 1992;23:1556-1562 KEY WORDS • lacunar infarction • lipids • lipoproteins • risk factors