269 I.C.A.
Iij SPANISH DIABETICS
islet-cell antibodies; P.C.A. parietal-cell antibodies; T.M.A. = thyroid microsomal antibodies. Average ages of patients with recent onset, insulin-dependent, or noninsulin-dependent diabetes and controls were 12.7, 37.2, 62.0, and 33.7 years respectively. Mean duration of diabetes was 25 days and 7.8 8 and 6.9 years, respectively. I.C.A.
=
correlation was found for each sex, the argument for the value of improving control would be considerably strengthened. Since we used similar methods for blood-sampling and for analysis of HbA1 (a - d and for H.D.L. cholesterol3 and yet could not show any inverse correlations in our groups, it is possible that the differences in our findings could be due to racial, dietary or geographical factors, but these apparent discrepancies may well be resolved by extended studies in patients on different forms of therapy. verse
=
*
and in a control group of 100 healthy blood-donors. We also looked for parietal cell and thyroid microsomal antibodies. We used immunofluorescence techniques,6 except for thyroid microsomal antibodies which were detected by a haemagglutination test’3 The results are shown in the table. The percentage of i.c.A. in the sera of our different groups of diabetics is very similar to those found by others.911 12 The distribution of parietal-cell antibodies between I.C.A.(+) and I.C.A.( -) diabetics did not show significant differences, but the distribution of thyroid microsomal antibodies in insulin-dependent diabetes shows a preferential grouping with I.C.A.( +) cases (6/20 compared with 14/87). The significance of I.C.A. remains speculative although it has been postulated that they are the expression of islet damage initiated, perhaps, by a virus and perpetuated by autoimmune mechanisms.14
B. J. BOUCHER
Metabolic and Endrocrine Unit, London Hospital Medical College, London Hospital E1 1BB
J. YUDKIN
LOWERING OF H.D.L. CHOLESTEROL BY ORAL CONTRACEPTIVES
SIR,-Professor Arntzenius and colleagues’ have studied high-density-lipoprotein (H.D.L.) cholesterol concentrations in a population survey of the city of Leiden, and found that in women on oral contraceptives the H.D.L.-cholesterol serum
concentration was about 10% lower than in women who do not use the pill. These Dutch workers are, rightly worried about these low H.D.L. levels which could increase the risk of coronary heart-disease. Arntzenius et al. stress that their results need to be confirmed because we’ and Albers et a1.6 had reported increased H.D.L.-cholesterol valued after oestrogen treatment. Our study2 ,
SERUM-H.D.L.-CHOLESTEROL
(MEAN±S.E.M.) BEFORE AND
DURING MEDICATION WITH ORAL CONTRACEPTIVES
Department of Internal Medicine, Cludad Sanitaria de la Segundad Social, Barcelona 23, Spain
R. PUJOL-BORRELL C. RICHART C. MARTIN
J. M. MARTINEZ-VAZQUEZ
Department of Immunology, Middlesex Hospital Medical School, London
G. F. BOTTAZZO *
Composition in g ethinyloestradiol/d-norgestrel. tStudent’s t test on paired values.
DIABETIC CONTROL AND H.D.L. CHOLESTEROL LEVELS
SIR,-Dr Calvert and colleagues (July 8, p. 66) suggest that of the effects of improved diabetic control is an increase in high-density-lipoprotein (H.D.L.) cholesterol levels, which
one
could reduce the vascular risks run by diabetics. In a similar study on diabetics reported to the Medical Research Society in December, 1977,1 and to be published in full elsewhere, we found no correlation between H.D.L. cholesterol and HbA, (a-) estimates of diabetic control. A significant positive correlation was found between HbA1 ,a - c) and H.D.L. cholesterol in male diabetics not on insulin. We found the expected significantly lower H.D.L. cholesterol levels in men than in women, and can confirm the lower levels in patients not on insulin, both in males and in females, thus emphasising the need for concern about oral therapy. Since Calvert et al. do not report separate analyses for men and women, it is not clear whether by chance better control in female patients, whose H.D.L.cholesterol would be expected to be higher than that in men, could have accounted for the inverse correlation reported with HbA, levels. If a significant in12. Del Prete, G. F., Betterle, C.,
Padovan, D., Erle, G., Toffolo, A., Bersani,
G. Diabetes, 1977, 26, 909. Bird, T., Stephenson, J.J. clin. Path. 1973, 26, 623. Bottazzo, G. F., Doniach, D., Poupplard, A. Acta endocr. 1976, suppl. 205, p. 53. 1. Welch, S. G., Boucher, B. J., Yudkin, J., France, M. W., Swindlehurst, C. A. Clin. Sci. mod. Med. 1978, 54, 21p.
13. 14.
eight years ago with what was then a low-dose contraceptive pill. The pill contained chlormadinone acetate 3 mg and mestranol 0.1 mg and increased the serum-H.D.L.-cholesterol by about 10%. Dr 0. Frankman and I have lately evaluated (and will publish elsewhere) the effects of modern low-dose contraceptive pills on lipoproteins. Women (mean age about 20) were studied before and during treatment with three different combinations of ethinyloestradiol plus d-norgestrel. The women took the pill for at least two cycles, and blood-samples were drawn at the same time in the cycle. The table shows that H.D.L.-cholesterol concentrations fell by about 12%. There were no significant changes in very-low-density lipoprotein concentrations. These data clearly support the findings obtained in the Leiden population. It is important to bear in mind, as Arntzenius et al. stress, that oestrogens and oral contraceptives may differ in their effects. Further studies of long-term administration of contraceptive pills are needed.
was
done about
Gustaf V Research Institute, S-104 01 Stockholm, Sweden
King
STEPHAN ROÖSSNER
2 Welch, S. G., Boucher, B. J. Diabetologia, 1978, 14, 209. 3. Burstein, M., Samaille, J. Clin. chim. Acta, 1960, 5, 609. 4. Arntzenius, A. C., van Gent, C. M., van der Voort, H.,
Styblo, K. Lancet, 1978,i, 1221. 5. Roössner, S., Larsson-Cohn, H., Carlson,
Stegerhuck,
C. I.,
L. A., Boberg, J. Acta med. scand. 1971, 190, 301. 6. Albers, J. J., Wahl, P. W., Cabana, V. G., Hazzard, W. R., Hoover, J. J. Metabolism, 1976, 25, 633.
Iij SPANISH DIABETICS
islet-cell antibodies; P.C.A. parietal-cell antibodies; T.M.A. = thyroid microsomal antibodies. Average ages of patients with recent onset, insulin-dependent, or noninsulin-dependent diabetes and controls were 12.7, 37.2, 62.0, and 33.7 years respectively. Mean duration of diabetes was 25 days and 7.8 8 and 6.9 years, respectively. I.C.A.
=
correlation was found for each sex, the argument for the value of improving control would be considerably strengthened. Since we used similar methods for blood-sampling and for analysis of HbA1 (a - d and for H.D.L. cholesterol3 and yet could not show any inverse correlations in our groups, it is possible that the differences in our findings could be due to racial, dietary or geographical factors, but these apparent discrepancies may well be resolved by extended studies in patients on different forms of therapy. verse
=
*
and in a control group of 100 healthy blood-donors. We also looked for parietal cell and thyroid microsomal antibodies. We used immunofluorescence techniques,6 except for thyroid microsomal antibodies which were detected by a haemagglutination test’3 The results are shown in the table. The percentage of i.c.A. in the sera of our different groups of diabetics is very similar to those found by others.911 12 The distribution of parietal-cell antibodies between I.C.A.(+) and I.C.A.( -) diabetics did not show significant differences, but the distribution of thyroid microsomal antibodies in insulin-dependent diabetes shows a preferential grouping with I.C.A.( +) cases (6/20 compared with 14/87). The significance of I.C.A. remains speculative although it has been postulated that they are the expression of islet damage initiated, perhaps, by a virus and perpetuated by autoimmune mechanisms.14
B. J. BOUCHER
Metabolic and Endrocrine Unit, London Hospital Medical College, London Hospital E1 1BB
J. YUDKIN
LOWERING OF H.D.L. CHOLESTEROL BY ORAL CONTRACEPTIVES
SIR,-Professor Arntzenius and colleagues’ have studied high-density-lipoprotein (H.D.L.) cholesterol concentrations in a population survey of the city of Leiden, and found that in women on oral contraceptives the H.D.L.-cholesterol serum
concentration was about 10% lower than in women who do not use the pill. These Dutch workers are, rightly worried about these low H.D.L. levels which could increase the risk of coronary heart-disease. Arntzenius et al. stress that their results need to be confirmed because we’ and Albers et a1.6 had reported increased H.D.L.-cholesterol valued after oestrogen treatment. Our study2 ,
SERUM-H.D.L.-CHOLESTEROL
(MEAN±S.E.M.) BEFORE AND
DURING MEDICATION WITH ORAL CONTRACEPTIVES
Department of Internal Medicine, Cludad Sanitaria de la Segundad Social, Barcelona 23, Spain
R. PUJOL-BORRELL C. RICHART C. MARTIN
J. M. MARTINEZ-VAZQUEZ
Department of Immunology, Middlesex Hospital Medical School, London
G. F. BOTTAZZO *
Composition in g ethinyloestradiol/d-norgestrel. tStudent’s t test on paired values.
DIABETIC CONTROL AND H.D.L. CHOLESTEROL LEVELS
SIR,-Dr Calvert and colleagues (July 8, p. 66) suggest that of the effects of improved diabetic control is an increase in high-density-lipoprotein (H.D.L.) cholesterol levels, which
one
could reduce the vascular risks run by diabetics. In a similar study on diabetics reported to the Medical Research Society in December, 1977,1 and to be published in full elsewhere, we found no correlation between H.D.L. cholesterol and HbA, (a-) estimates of diabetic control. A significant positive correlation was found between HbA1 ,a - c) and H.D.L. cholesterol in male diabetics not on insulin. We found the expected significantly lower H.D.L. cholesterol levels in men than in women, and can confirm the lower levels in patients not on insulin, both in males and in females, thus emphasising the need for concern about oral therapy. Since Calvert et al. do not report separate analyses for men and women, it is not clear whether by chance better control in female patients, whose H.D.L.cholesterol would be expected to be higher than that in men, could have accounted for the inverse correlation reported with HbA, levels. If a significant in12. Del Prete, G. F., Betterle, C.,
Padovan, D., Erle, G., Toffolo, A., Bersani,
G. Diabetes, 1977, 26, 909. Bird, T., Stephenson, J.J. clin. Path. 1973, 26, 623. Bottazzo, G. F., Doniach, D., Poupplard, A. Acta endocr. 1976, suppl. 205, p. 53. 1. Welch, S. G., Boucher, B. J., Yudkin, J., France, M. W., Swindlehurst, C. A. Clin. Sci. mod. Med. 1978, 54, 21p.
13. 14.
eight years ago with what was then a low-dose contraceptive pill. The pill contained chlormadinone acetate 3 mg and mestranol 0.1 mg and increased the serum-H.D.L.-cholesterol by about 10%. Dr 0. Frankman and I have lately evaluated (and will publish elsewhere) the effects of modern low-dose contraceptive pills on lipoproteins. Women (mean age about 20) were studied before and during treatment with three different combinations of ethinyloestradiol plus d-norgestrel. The women took the pill for at least two cycles, and blood-samples were drawn at the same time in the cycle. The table shows that H.D.L.-cholesterol concentrations fell by about 12%. There were no significant changes in very-low-density lipoprotein concentrations. These data clearly support the findings obtained in the Leiden population. It is important to bear in mind, as Arntzenius et al. stress, that oestrogens and oral contraceptives may differ in their effects. Further studies of long-term administration of contraceptive pills are needed.
was
done about
Gustaf V Research Institute, S-104 01 Stockholm, Sweden
King
STEPHAN ROÖSSNER
2 Welch, S. G., Boucher, B. J. Diabetologia, 1978, 14, 209. 3. Burstein, M., Samaille, J. Clin. chim. Acta, 1960, 5, 609. 4. Arntzenius, A. C., van Gent, C. M., van der Voort, H.,
Styblo, K. Lancet, 1978,i, 1221. 5. Roössner, S., Larsson-Cohn, H., Carlson,
Stegerhuck,
C. I.,
L. A., Boberg, J. Acta med. scand. 1971, 190, 301. 6. Albers, J. J., Wahl, P. W., Cabana, V. G., Hazzard, W. R., Hoover, J. J. Metabolism, 1976, 25, 633.
