No abstract

Background —Patients with coronary artery disease (CAD) commonly have low HDL cholesterol (HDL-C) and mildly elevated LDL cholesterol (LDL-C), leading to uncertainty as to whether the appropriate goal of therapy should be lowering LDL-C or raising HDL-C. Methods and Results —Patients in the Lipoprotein and Coronary Atherosclerosis Study (LCAS) had mildly to moderately elevated LDL-C; many also had low HDL-C, providing an opportunity to compare angiographic progression and the benefits of the HMG-CoA reductase inhibitor fluvastatin in patients with low versus patients with higher HDL-C. Of the 339 patients with biochemical and angiographic data, 68 had baseline HDL-C <0.91 mmol/L (35 mg/dL), mean 0.82±0.06 mmol/L (31.7±2.2 mg/dL), versus 1.23±0.29 mmol/L (47.4±11.2 mg/dL) in patients with baseline HDL-C ≥0.91 mmol/L. Among patients on placebo, those with low HDL-C had significantly more angiographic progression than those with higher HDL-C. Fluvastatin significantly reduced progression among low–HDL-C patients: 0.065±0.036 mm versus 0.274±0.045 mm in placebo patients ( P =0.0004); respective minimum lumen diameter decreases among higher–HDL-C patients were 0.036±0.021 mm and 0.083±0.019 mm ( P =0.09). The treatment effect of fluvastatin on minimum lumen diameter change was significantly greater among low–HDL-C patients than among higher–HDL-C patients ( P =0.01); among low–HDL-C patients, fluvastatin patients had improved event-free survival compared with placebo patients. Conclusions —Although the predominant lipid-modifying effect of fluvastatin is to decrease LDL-C, patients with low HDL-C received the greatest angiographic and clinical benefit.

ABSTRACT. The energy intake, expenditure, and deposition of 40 breast-fed and formula-fed infants were investigated at 1 and 4 mo of age to explore possible differences in energy utilization between feeding groups. Energy intake was calculated from 5-d test-weighing records or pre-and postweighing of formula bottles, in combination with bomb calorimetry of the milks. Total daily energy expenditure (TDEE) was determined by the doubly labeled water method. Sleeping metabolic rate (SMR) and minimal observable energy expenditure were measured by indirect calorimetry. Activity was estimated as the difference between TDEE and SMR. Energy deposition was estimated from dietary intake and TDEE. Energy intakes were significantly higher for the formula-fed than breast-fed infants at 1 mo (118 f 17 versus 101 f 16 kcal/kg/d) and 4 mo (87 f 11 versus 72 2 9 kcal/kg/d) (p < 0.001). TDEE averaged 67 f 8 and 64 k 7 kcal/kg/d at 1 mo and 73 f 9 and 64 f 8 kcal/kg/d at 4 mo for the formula-fed and breast-fed infants, respectively, and differed between feeding groups ( p < 0.04). SMR and minimal observable energy expenditure (kcallmin) were higher among the formula-fed infants at 1 and 4 mo ( p < 0.005). The energy available for activity and the thermic effect of feeding did not differ between feeding groups. Rates of weight gain (g/ d) and energy deposition (kcal/kg/d) tended to be greater among the formula-fed infants at 1 and 4 mo ( p < 0.06).Differences in weight gain, energy deposition, SMR, minimal observable energy expenditure, and TDEE partially accounted for the discrepancy in energy intake observed between breast-fed and formula-fed infants. The response to the varying levels of energy intake in infancy appear to be mediated through growth and basal-energy-requiring processes, but not through physical activity. ( CV, coefficient of variationAdaptations to varying levels of energy intake may affect an infant's body mass or composition, basal metabolism, activity, or thermogenesis. Although the response to severe energy restriction during infancy is well documented (I), the response to seemingly adequate but different levels of energy intake is not well understood. Energy intakes of breast-fed and formula-fed infants have been shown to differ after the first few months of life (2-4). Differing energy intakes between feeding groups imply that energy absorption, expenditure, and (or) deposition between groups also differ. In a previous study (3), we reported a 27% difference in energy intake between breast-fed and formula-fed infants at 4 mo of age, but did not observe statistically significant differences in length, body weight, or weight gain. Nor were anticipated differences in selected components of energy expenditure detected; SMR, TEF, and postprandial energy expenditure did not differ between feeding groups. Rates of MOEE were higher among the formula-fed infants, but the increment was insufficient to account for the differences in energy intake. Rates of weight gain tended to be greater among the 4-mo-old formulafed...

Although subjects with the epsilon4 allele had less reduction in LDL cholesterol with fluvastatin, they had similar benefit in terms of CAD progression.

Angiotensin-1 converting enzyme I/D polymorphism is associated with the response of plasma lipids and coronary atherosclerosis to treatment with fluvastatin. Subjects with DD genotype had a greater reduction in LDL-C, a higher rate of regression and a lower rate of progression of CAD.

In defibrillator recipients, shocks act as potent predictors of survival independent of several other risk factors, particularly ejection fraction.

No abstract

No abstract