The finding of abnormal levels of sex hormones in men with coronary artery disease has led to the hypothesis that alterations in sex hormones may represent an important risk factor for myocardial infarction. In this study, the sex hormone profile of 28 young men (aged less than 40 years) with myocardial infarction was compared with 28 age- and weight-matched normal men. Although the mean total serum estradiol levels and the free estradiol index of the patients and controls were similar, the mean serum total testosterone level and the free testosterone index were significantly lowered in the patients with myocardial infarction (p less than 0.01). The ratio of serum estradiol to testosterone was significantly increased in the patients (p = 0.0005) and correlated with serum cholesterol, triglycerides, and plasma glucose. A significant inverse correlation was also demonstrated between total testosterone and serum cholesterol and triglycerides. Hence, the results of this study support the hypothesis that low plasma testosterone and an increased estradiol-to-testosterone ratio may be important risk factors for myocardial infarction.

Summary:Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients.The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.09 + 0.10 vs 6.18 + 0.09 mmol/l) and women (6.75 ± 0.30 vs 6.44 + 0.22 mmol/l) irrespective of glucose tolerance. In the entire group cholesterol levels on day 2 were significantly lower than the admission and 3 month values. Nevertheless there was a significant correlation between day 2 and 3 month values (P< 0.0005). Serum triglyceride levels on day 2 were influenced by glucose tolerance and were significantly lower than the 3 month values in patients with normal glucose tolerance but not in patients with abnormal glucose tolerance. However there was a significant correlation between day 2 triglyceride values in patients with both normal and abnormal glucose tolerance.These results suggest that serum cholesterol measured on admission after acute myocardial infarction may be reliably used to represent basal values in both men and women irrespective of glucose tolerance. Although cholesterol and triglycerides measured on day 2 vary with either the gender or glucose tolerance of the patients, these values are still a useful guide to the patients' basal lipid state.

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Summary:Serum total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I and apolipoprotein B were evaluated as potential indicators of the risk of coronary artery disease in young ( < 46 years) normocholesterolaemic, non-diabetic men who had previously sustained a myocardial infarction (n = 50) and in healthy age and sex matched controls (n = 122) with a similar socioeconomic background.Significant differences were observed between patients and controls in the mean concentrations ofserum total cholesterol, triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol and apolipoprotein B, as well as in the ratios of total cholesterol to high density lipoprotein cholesterol and apolipoprotein A-I to apolipoprotein B. No significant difference was demonstrated in the concentration of apolipoprotein A-I between the two groups. Stepwise discriminant analysis indicated that apolipoprotein B was the best discriminant between patients and controls. The percentage ofexact classification was 74% in patients and 66% in controls.When the patients were compared to a subset ofcontrols (n = 50) matched for age and total cholesterol, significant differences were demonstrated only in the mean concentrations of apolipoprotein B. Discriminant analysis confirmed that the best single discriminating variable was apolipoprotein B.The results therefore indicate that in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction, apolipoprotein B is superior to other lipid parameters studied, as a marker for coronary artery disease.

The Indian (Asian) population in South Africa has a high rate of coronary artery disease. Fasting serum lipid and lipoprotein levels were measured in 620 consecutive male survivors of myocardial infarction and compared with those of 524 healthy male volunteer controls, and the presence of hypercholesterolaemia and hypertriglyceridaemia in the patient group was related to other non-lipid coronary risk factors. All survivors and controls were below age 61 years. Total cholesterol, triglyceride and low-density-lipoprotein cholesterol concentrations varied significantly with age both in patient and control groups, whereas high-density-lipoprotein (HDL) cholesterol did not vary with age in either group. Using the 90th-percentile age-adjusted values of controls for total cholesterol (7.1 mmol/l) and triglyceride (3.0 mmol/l) as cut-off points, 287 (46%) survivors were hyperlipidaemic. Hypercholesterolaemia with or without associated hypertriglyceridaemia was the commonest abnormality: 125 (20%) patients showed hypercholesterolaemia without associated hypertriglyceridaemia; 73 (12%) had both hypercholesterolaemia and hypertriglyceridaemia and 89 (14%) hypertriglyceridaemia without associated hypercholesterolaemia. The frequency of hyperlipidaemia did not vary with age. HDL cholesterol levels below 0.66 mmol/l (10th percentile) were observed in 131 (22%) survivors. Obesity was significantly more frequent among hypertriglyceridaemic survivors, whilst diabetes and hypertension were seen more frequently in survivors with combined hypercholesterolaemia and hypertriglyceridaemia. No significant difference was noted in the frequency of smoking and family history of coronary artery disease in hyperlipidaemia and normolipidaemic patients.