Comparação das frações HDL e LDL colesterol como fatores de risco para a aterosclerose carotídea

Gagliardi, Rubens José; Sanches, Marsal; Rasslan, Zied; Guedes, Marilda Lauretti S.

doi:10.1590/S0004-282X1995000500003

Resumos

Estudo prospectivo com o objetivo de verificar qual das frações do colesterol sanguíneo, HDL ou LDL, é mais significativa para o desenvolvimento da aterosclerose das artérias carótidas (AC). Constou de 125 indivíduos de ambos os sexos, com idade entre 45 a 75 anos, incluídos aleatoriamente. Em todos foi procedida a dosagem sanguínea do colesterol total e das frações HDL e LDL e estudo ultrassonográfico (através de ultrassonografia modo B) das AC. Os resultados mostraram que a presença de placa de ateroma, com ou sem estenose nas AC, é inversamente proporcional aos níveis de HDL. Estes achados foram estatisticamente significantes (x2=6,57 e x2=9,24, respectivamente para placa sem estenose e com estenose; x2 crítico = 5,99 para α=5%) . Foi também constatada associação entre a presença de placa aterosclerótica na AC e níveis sangüíneos elevados de LDL: quanto maiores os níveis de LDL, maior a proporção de indivíduos com placas, porém este achado não foi estatisticamente significante (x2=0,97, x2 crítico 5,99 para α =5%). Não foi encontrada nesta casuística relação entre níveis elevados de LDL e presença de estenose nas AC. Estes resultados, ainda que iniciais, sugerem que níveis baixos de HDL são mais aterogênicos para as AC comparativamente a níveis elevados de LDL.

aterosclerose; estenose; colesterol; artéria carótida

In order to find out whether there exists a relationship between HDL and LDL serum levels and atherosclerotic plaques in the carotid artery (CA), a prospective study was carried out involving 125 patients. They were aleatorily included, of both sexes and age between 45-75 years old. HDL and LDL serum levels were measured as well CA ultrasonographic mode B investigated. It was verified that the number of patients having atherosclerotic plaques in CA was inversely proportional to the HDL levels. We came up with the same ratio when the HDL levels were compared to the number of patients having CA stenosis. These results were statistically signifcant (x2=6.57 and x2=9.24 respectively; critical x2=5.99 to α =5%). A direct ratio was also found out in the relationship between the presence of atherosclerotic plaques in the CA and the LDL serum levels (greater in patients with plaques). However no relationship between LDL levels and the occurrence or not of CA stenosis in patients having plaques was demonstrated. The results were not statistically significant (x2=0.97 and x2=0.41, respectively, critical x2=5.99 to α =5%). The obtained results seem to be at least in part in agreement with literature findings. Statistically significative results in the comparison of HDL and LDL levels with the grade of stenosis of the CA were not found out (x2=11.78 and x2=4.03, respectively; critical x2=12.59 to α =5%).

atherosclerosis; stenosis; cholesterol; carotid artery

Comparação das frações HDL e LDL colesterol como fatores de risco para a aterosclerose carotídea

Comparative study of HDL and LDL cholesterol as risk factors for carotid atherosclerosis

Rubens José Gagliardi^I; Marsal Sanches^II; Zied Rasslan^III; Marilda Lauretti S. Guedes^IV

^IProfessor Adjunto- Doutor, responsável pela Liga da Aterosclerose

^IIInterno (6 ano)

^IIIProfessor Instrutor do Departamento de Clínica Médica

^IVProfessora Adjunta, chefe da Disciplina de Bioestatística (Departamento de Medicina Social)

RESUMO

Estudo prospectivo com o objetivo de verificar qual das frações do colesterol sanguíneo, HDL ou LDL, é mais significativa para o desenvolvimento da aterosclerose das artérias carótidas (AC). Constou de 125 indivíduos de ambos os sexos, com idade entre 45 a 75 anos, incluídos aleatoriamente. Em todos foi procedida a dosagem sanguínea do colesterol total e das frações HDL e LDL e estudo ultrassonográfico (através de ultrassonografia modo B) das AC. Os resultados mostraram que a presença de placa de ateroma, com ou sem estenose nas AC, é inversamente proporcional aos níveis de HDL. Estes achados foram estatisticamente significantes (x2=6,57 e x2=9,24, respectivamente para placa sem estenose e com estenose; x2 crítico = 5,99 para α=5%) . Foi também constatada associação entre a presença de placa aterosclerótica na AC e níveis sangüíneos elevados de LDL: quanto maiores os níveis de LDL, maior a proporção de indivíduos com placas, porém este achado não foi estatisticamente significante (x2=0,97, x2 crítico 5,99 para α =5%). Não foi encontrada nesta casuística relação entre níveis elevados de LDL e presença de estenose nas AC. Estes resultados, ainda que iniciais, sugerem que níveis baixos de HDL são mais aterogênicos para as AC comparativamente a níveis elevados de LDL.

Palavras Chave: aterosclerose, estenose, colesterol, artéria carótida.

SUMMARY

In order to find out whether there exists a relationship between HDL and LDL serum levels and atherosclerotic plaques in the carotid artery (CA), a prospective study was carried out involving 125 patients. They were aleatorily included, of both sexes and age between 45-75 years old. HDL and LDL serum levels were measured as well CA ultrasonographic mode B investigated. It was verified that the number of patients having atherosclerotic plaques in CA was inversely proportional to the HDL levels. We came up with the same ratio when the HDL levels were compared to the number of patients having CA stenosis. These results were statistically signifcant (x2=6.57 and x2=9.24 respectively; critical x2=5.99 to α =5%). A direct ratio was also found out in the relationship between the presence of atherosclerotic plaques in the CA and the LDL serum levels (greater in patients with plaques). However no relationship between LDL levels and the occurrence or not of CA stenosis in patients having plaques was demonstrated. The results were not statistically significant (x2=0.97 and x2=0.41, respectively, critical x2=5.99 to α =5%). The obtained results seem to be at least in part in agreement with literature findings. Statistically significative results in the comparison of HDL and LDL levels with the grade of stenosis of the CA were not found out (x2=11.78 and x2=4.03, respectively; critical x2=12.59 to α =5%).

Key words:atherosclerosis, stenosis, cholesterol, carotid artery.

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Dr. Rubens José Gagliardi - Disciplina de Neurologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo - Rua Cesário Morta Jr. 122 - 01222-001 São Paulo SP - Brasil. Fax 001 8261288.

1. Ackerman RH.,Candia M. Identifying clinically relevant carotid disease.Stroke 1994, 25:1-3.
2. Airo R, Ferrari CM. High density lipoproteins and apolipoprotein A in cerebrovascular desease. Atherosclerosis 1985, 54:343-348,
3. Brown WV. Lipoproteins: what, when and how often to measure. Heart Dis Stroke 1992, 1:20-26.
4. Fermer JA. Papel do HDL colesterol e dos triglicérides na prevenção da aterosclerose. Lipid Digest 1992,1:4-7.
5. Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Hello P, Huttunen JK, Kaitaniemi P, Nikkilã EK. Helsinky heart study: primary prevention trial with gemfibrozil in middle age men with dyslipidimia. N Engl J Med 1987, 317:1237-1245.
6. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber T. High density lipoprotein as a protective factor against coronary heart disease: the Framingham Study. Am J Med 1977, 62:707-714.
7. Jürgens G, Kõltringer P. Lipoprotein (a) in ischemic cerebrovascular disease: a new approach to the assessment of risk for stroke. Neurology 1987, 37: 513-515.
8. Kanamaru K, Waga S, Tochio H, Nagatani K. The effect of atherosclerosis on endothelium dependent relaxion in aorta and intracranial arteries of rabbits. J Neurosurg 1989, 70:795-798.
9. Konishi M, Iso H, Komachi Y, Iida M, Shimamoto T, Jacobs DR, Terao A, Baba S, Sankai T, Masashi I. Associations of serum total cholesterol, different types of stroke, and stenosis distribution of cerebral arteries: the Akita pathology study. Stroke 1993, 24:954-964.
10. Lessa I. As doenças cerebrovasculares e as isquêmicas do coração como causa de morte no Brasil. Medicina Prat 1990, 4:65-68.
11. Martins IS, Coelho LT, Matos MS, Mazzilli RN, Trigo M, Wilson D. Dislipidemias e alguns fatores de risco associados em uma população periférica da região metropolitana de São Paulo, SP, Brasil: um estudo piloto. Rev Saude Publ. São Paulo 1989, 23:236-243.
12. Mittl RL, Broderick M, Carpenter JP, Goldbeg HI, Listerud J, Mishkin MM, Berkowitz HD, Atlas SW. Blinded-reader comparison of magnetic resonance angiography and duplex ultrasonography for carotid artery bifurcation stenosis. Stroke 1994, 25:4-10.
13. Murai A, Tanaka T, Miyahara T, Kameyama M. Lipoprotein anormalities in the pathogenesis of cerebral infarction and transient isquemic attack. Stroke 1981, 2:167-172.
14. Nagayama M, Shinohara Y, Nagayama T. Lipoprotein (a) and ischemic cerebrovascular disease in young adults. Stroke 1994, 25:74-78.
15. Ramires JAF. O perfil do HDL. Lipid Digest 1992, 1:2-11.
16. Ross R. Aterosclerose, In Wyngaarden JB, Smith LH, Bennett JC. Cecil tratado de medicina interna. Rio de Janeiro: Guanabara-Koogan. 1993, p.299-303.
17. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993, 362:801-809.
18. Shintani S, Kikuchi S, Hamaguchi H, Shiigai T. Higth serum lipoprotein (a) levels are an independent risk factor for cerebral infarction Stroke 1993, 24:965-969.
19. Thelle D. Women and coronary heart disease: a review with special emplasis on some risk factors. Lipid Rev 1990, 4:34-39.
20. Valentine RJ, Graybum PA, Vega GL, Grundy SM, Lp(a) lipoprotein is an independent, discriminating risk factor for premature peripheral atherosclerosis among white men. Arch Intern Med 1994, 154:801-806.
21. Yatsu FM, Kasturi R, Alam R. Gene polymorphism of apolipoprotein Al: the major protein of hight density lipoprotein in predicting stroke risk among white and black subjects. Stroke 1993, 24:1 26-1 32.

Datas de Publicação

Publicação nesta coleção
08 Dez 2010
Data do Fascículo
Dez 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ackerman RH.,Candia M. Identifying clinically relevant carotid disease.Stroke 1994, 25:1-3.

[2] 2. Airo R, Ferrari CM. High density lipoproteins and apolipoprotein A in cerebrovascular desease. Atherosclerosis 1985, 54:343-348,

[3] 3. Brown WV. Lipoproteins: what, when and how often to measure. Heart Dis Stroke 1992, 1:20-26.

[4] 4. Fermer JA. Papel do HDL colesterol e dos triglicérides na prevenção da aterosclerose. Lipid Digest 1992,1:4-7.

[5] 5. Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Hello P, Huttunen JK, Kaitaniemi P, Nikkilã EK. Helsinky heart study: primary prevention trial with gemfibrozil in middle age men with dyslipidimia. N Engl J Med 1987, 317:1237-1245.

[6] 6. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber T. High density lipoprotein as a protective factor against coronary heart disease: the Framingham Study. Am J Med 1977, 62:707-714.

[7] 7. Jürgens G, Kõltringer P. Lipoprotein (a) in ischemic cerebrovascular disease: a new approach to the assessment of risk for stroke. Neurology 1987, 37: 513-515.

[8] 8. Kanamaru K, Waga S, Tochio H, Nagatani K. The effect of atherosclerosis on endothelium dependent relaxion in aorta and intracranial arteries of rabbits. J Neurosurg 1989, 70:795-798.

[9] 9. Konishi M, Iso H, Komachi Y, Iida M, Shimamoto T, Jacobs DR, Terao A, Baba S, Sankai T, Masashi I. Associations of serum total cholesterol, different types of stroke, and stenosis distribution of cerebral arteries: the Akita pathology study. Stroke 1993, 24:954-964.

[10] 10. Lessa I. As doenças cerebrovasculares e as isquêmicas do coração como causa de morte no Brasil. Medicina Prat 1990, 4:65-68.

[11] 11. Martins IS, Coelho LT, Matos MS, Mazzilli RN, Trigo M, Wilson D. Dislipidemias e alguns fatores de risco associados em uma população periférica da região metropolitana de São Paulo, SP, Brasil: um estudo piloto. Rev Saude Publ. São Paulo 1989, 23:236-243.

[12] 12. Mittl RL, Broderick M, Carpenter JP, Goldbeg HI, Listerud J, Mishkin MM, Berkowitz HD, Atlas SW. Blinded-reader comparison of magnetic resonance angiography and duplex ultrasonography for carotid artery bifurcation stenosis. Stroke 1994, 25:4-10.

[13] 13. Murai A, Tanaka T, Miyahara T, Kameyama M. Lipoprotein anormalities in the pathogenesis of cerebral infarction and transient isquemic attack. Stroke 1981, 2:167-172.

[14] 14. Nagayama M, Shinohara Y, Nagayama T. Lipoprotein (a) and ischemic cerebrovascular disease in young adults. Stroke 1994, 25:74-78.

[15] 15. Ramires JAF. O perfil do HDL. Lipid Digest 1992, 1:2-11.

[16] 16. Ross R. Aterosclerose, In Wyngaarden JB, Smith LH, Bennett JC. Cecil tratado de medicina interna. Rio de Janeiro: Guanabara-Koogan. 1993, p.299-303.

[17] 17. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993, 362:801-809.

[18] 18. Shintani S, Kikuchi S, Hamaguchi H, Shiigai T. Higth serum lipoprotein (a) levels are an independent risk factor for cerebral infarction Stroke 1993, 24:965-969.

[19] 19. Thelle D. Women and coronary heart disease: a review with special emplasis on some risk factors. Lipid Rev 1990, 4:34-39.

[20] 20. Valentine RJ, Graybum PA, Vega GL, Grundy SM, Lp(a) lipoprotein is an independent, discriminating risk factor for premature peripheral atherosclerosis among white men. Arch Intern Med 1994, 154:801-806.

[21] 21. Yatsu FM, Kasturi R, Alam R. Gene polymorphism of apolipoprotein Al: the major protein of hight density lipoprotein in predicting stroke risk among white and black subjects. Stroke 1993, 24:1 26-1 32.