Despite a dramatic increase in the prevalence of coronary heart disease (CHD) within the Kuwaiti population, hyperlipidemia, which is an important risk factor for CHD, is inadequately characterised. Since over half of all patients seen at Kuwait’s Mubarak Teaching Hospital had elevated plasma cholesterol and/or triglyceride levels, the hospital opened a Lipid Clinic Service (LCS). The LCS provides a specialized diagnostic and therapeutic service to patients with primary hyperlipidemia. This report presents our preliminary observations on the first 150 patients seen at this clinic during the first 6 months of operation (March–September 1995). A nationality survey of the clinic attendees revealed that 46.7% were Kuwaitis, 4.0% other Gulf Arabs, 34.0% other Arabs (predominantly Egyptians) and 15.3% South Asians (predominantly Indians). Patient referrals came to the clinic from neighboring polyclinics (38.7%), hospital outpatient clinics (25.3%), clinical biochemistry laboratory (16.7%), hospital dietetic service (5.3%) as well as other sources (14.0%). Of the 117 patients with primary hyperlipidemia, 48.7% had predominant hypercholesterolemia, 23.9% were classified as mixed hyperlipidemia, and 27.4% had predominant hypertriglyceridemia. Over 75% of the men, and 22% of the women smoked regularly. About a third of the women were postmenopausal. The pattern of observations in the 28 patients with diabetes, incidentally seen in the clinic, was similar to that in the nondiabetic subjects with primary hyperlipidemia. The constellation of biochemical risk factors for CHD (higher triglyceride and uric acid and lower high density lipoprotein levels, coupled with a tendency towards central obesity and cigarette smoking) was more common in the men than in the women. This may account for a higher risk of CHD in men. Lipid and metabolic profiles did not differ between Kuwaitis and other nationals, suggesting that similar factors underlie the disorder in all patients. These features, similarly, did not differ between the pre- and postmenopausal women. This preliminary report on the first 150 patients seen in the LCS in Kuwait demonstrates a need for this type of specialized service in the country.
Plasma levels of lipoprotein(a) [Lp(a)], tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1) were assessed in addition to anthropometry and levels of glucose, total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and apo A1 and B in 73 patients (36 men and 37 women) with primary hyperlipidaemia (group NDHL) in Kuwait. Lp(a) levels (212 mg L-1, 8-600 mg L-1, median and range) were similar to those obtained in a matched group of 32 non-insulin-dependent diabetes mellitus (NIDDM) patients with hyperlipidaemia (218 mg L-1, 50-610 mg L-1) and slightly higher, although not significantly so (P = 0.06), than levels seen in 68 healthy normolipidaemic control subjects (182 mg L-1, 70-488 mg L-1). tPA levels (8.4 ng mL-1, 3.8-18.4 ng mL-1, median and range) in group NDHL were lower than in the diabetic group (11.4 ng mL-1, 5.2-14.2 ng mL-1) but higher than in the healthy control subjects (7.4 ng mL-1, 2.8-12.6 ng mL-1). PAI-1 levels in group NDHL (40.4 ng mL-1, 8.6-55 ng mL-1, median and range) were higher than in the control subjects (32.5 ng mL-1, 14.6-46.4 ng mL-1) but lower than in diabetic patients (43.8 ng mL-1, 15.6-55 ng mL-1). Hyperlipidaemia phenotype (hypercholesterolaemia or hypertriglyceridaemia) did not influence tPA and PAI-1 levels, but Lp(a) levels were significantly lower with hypertriglyceridaemia. Gender, cigarette smoking and racial origin (Kuwaitis, other Arabs or South Asians) did not affect Lp(a), tPA and PAI-1 levels, but tPA levels were higher in postmenopausal subjects. Low-density lipoprotein (LDL) levels (whether in total cholesterol or as apo B) correlated significantly (P < 0.05) with Lp(a) levels. tPA levels were correlated with age and the plasma levels of glucose and uric acid (P < 0.05); this correlation with glucose may explain the high levels associated with diabetes, whereas the age association might account not only for the differences observed between group NDHL and the younger control group but also for the higher levels in the postmenopausal women. PAI-1 levels correlated with tPA and triglyceride (TG) levels in the groups of subjects (normo- and hyperlipidaemic). In the normolipidaemic control group, the significant associations of tPA and PAI-1 were with body mass, expressed as the body mass index or the waist-hip ratio. These results suggest that different factors influence the plasma levels of the prothrombotic factors Lp(a), tPA and PAI-1 in healthy control subjects and in patients with hyperlipidaemia. In the latter, hyperlipidaemia phenotype, age, glycaemic status and uric acid levels are important determinants of the levels of these prothrombotic variables, whereas in the healthy, young control population, body mass was the single important association with tPA and PAI-1.
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