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There is a general interest to know whether lipoprotein(a) [Lp(a)] is under hormonal control. Hypothyroidism is a well known cause of secondary hyperlipidemia, which mainly affects low density lipoprotein (LDL) cholesterol levels, but the result on the effects of L-T4 replacement therapy on the Lp(a) concentration is controversial. We studied 12 severely hypothyroid, hypercholesterolemic patients under basal conditions and during L-T4 treatment. We found a rapid decrease in both LDL cholesterol (5.71 +/- 0.62 vs. 4.37 +/- 0.44 mmol/L basally and after 1 month of thyroid replacement, respectively) and apolipoprotein-B (Apo-B) levels (1.89 +/- 0.02 vs. 1.52 +/- 0.17 g/L, respectively); these changes persisted for up 1 yr of analytical euthyroidism and paralleled the improvement in the thyroid status of the patients. In contrast, the plasma Lp(a) concentration did not change at any time (496 +/- 123, 464 +/- 128, and 441 +/- 110 mg/L under basal conditions and after 1 and 14-15 months of thyroid replacement, respectively), and the small fluctuations observed in some patients did not correlate with those in LDL cholesterol or Apo-B, and were not associated with any particular Apo(a) phenotype. In relation to HDL fractions, high density lipoprotein3 (HDL3) remained stable, but HDL2 cholesterol and phospholipid levels decreased during treatment, changes that were the inverse of those in postheparin plasma hepatic lipase activity. Patients in the present study were normotriglyceridemic, except one who was hypertriglyceridemic at diagnosis, but even in this patient, triglyceride levels were unaffected by T4 substitution therapy, as was postheparin plasma lipoprotein lipase activity. The changes observed in LDL, HDL2, and hepatic lipase activity delineate the lipoprotein-related response to T4 replacement therapy, whereas potential individual fluctuations in Lp(a) levels are probably more dependent on other factors, such as the production rate, which are not affected by thyroid hormones.

Lipids do not mediate the effect of gender on vitamin A levels. Apolipoprotein E polymorphism is an independent determinant of vitamin A levels in women. Pending confirmation by others, we propose that enhancement of this vitamin may contribute to the beneficial impact of the epsilon2 allele on human ageing and health.

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We evaluated the effect of periodical treatment with LDL-apheresis by adsorption to dextran sulfate (Liposorber LA-15) on several aspects related to LDL and Lipoprotein(a) metabolisms, in three homozygous familial hypercholesterolaemic patients with LDL receptor deficiency. The dextran sulfate columns retained apolipoprotein B-containing particles with high affinity and capacity, in such a way that the treatment of a volume of plasma equivalent to three times the patient plasma volume resulted in an 85% decrease of circulating LDL-cholesterol and Lipoprotein(a). The continuous treatment with LDL-apheresis was highly beneficial for these patients since an average plasma concentration lower than 200 mg dl-1 for LDL-cholesterol, and lower than 25 mg dl-1 for Lipoprotein(a) could be achieved by treating the patients once a week. After each apheresis treatment, plasma concentrations of these metabolites progressively returned to the pretreatment, steady-state, levels. The analysis of the rates of return allowed us to estimate the fractional catabolic rates. FCRs of LDL-cholesterol were 0.052, 0.049 and 0.047 pools day-1, and those of apolipoprotein B, 0.065, 0.045 and 0.050 pools day-1 in the three subjects, respectively. These values are much lower than those in normolipidaemic individuals as observed by others, and are in accordance with the LDL-receptor deficiency condition of our patients. Two of them had highly elevated Lipoprotein(a) plasma concentrations, and their FCRs of Lipoprotein(a) were calculated to be 0.112 and 0.066 pools day-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Fundamento: Los estudios sobre la prevalencia de Trastornos Bipolares Tipo 1 son escasos y están realizados con metodologías diferentes, lo que impide conocer el impacto de los mismos como problema de salud pública en España. Se determina la prevalencia de Trastornos Bipolares tipo 1 en España a través del consumo de carbonato de litio. Métodos: Se estima la prevalencia a través del calculo de las dosis diarias definidas por 100.000 habitantes y día de carbonato de litio (Grupo terapéutico, NOSAN), durante los anos 19961998, para cada una de las provincias españolas. Se ha dispuesto de los datos de las prescripciones indicadas por la Subdirección General de Planifrcaci6n Farmacéutica del Ministerio de Sanidad y Consumo. Resultados: Se estima una prevalencia de 70 casos por 100.000 habitantes y día para el conjunto de la población española. Conclusiones: El consumo de carbonato de litio por provincias y años permite estimar la distribución de los Trastornos Bipolares tipo 1 en España. Las cifras obtenidas sitúan a España en una prevalencia baja-media; aunque las diferencias metodológicas no permiten conclusiones definitivas.

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