Drug and Alcohol Elsevier Scientific
Dependence, 29 (1991) 183 - 187 Publishers Ireland Ltd.
1X3
Plasma cholesterol and triglycerides in heroin addicts Sergio Maccaria, Carla Bassia, Patrizia
(Accepted
We examined
total
cholesterolemia,
triglyceridemia,
Zanoni” and Angelo Cesare Plancher”
September
high density
7th,
1991)
lipoproteins-
(HDL) cholesterolemia,
ap”lilloproteins
A
I
and B, body mass index, albuminemia and alanine aminotransferase in 60 heroin addicts. After comparing 2:s control subjects with the heroin addicts the result was that the latter have significantly lower mean values of total cholesterolrmia and of HDL cholesterolemia and higher values of triglyceridemia. They also have significantly higher prevalences of’ r’ases of hypocholesterolemia and of hypo-HDL-cholesterolemia. Within the addict group there is no linear correlation between total cholesterolemia and body mass index; there is, however, an inverse linear correlation between total cholestrrolemia and alaninc aminotransferase. Therefore, the alterations found in the lipid pattern of heroin addicts are not due to malnutrition but hypothetically to liver diseases which are frequent in these patients. Key words:
heroin
addicts;
total
hypocholesterolemia;
hypo-HDL-cholesterolemia;
main risk groups for HIV infection. In AIDS patients hypertriglyceridemia, independent of the patients’ nutritional status, was found, but there were no significant alterations in total cholesterolemia (Grunfeld et al., 1989). Experimental studies on rats demonstrated that the administration of morphine raises total plasma cholesterol levels (Bryant et al., 1987). In a group of 140 patients with hypocholesterolemia there were no cases of heroin addiction (Muller et al., 1987); but we believe that plasma lipid levels assessments are often disregarded in heroin addicts because of seemingly little clinical importance in these patients. In our study we found that heroin addicts often have lower cholesterolemia and higher triglyceridemia than normal subjects.
Introduction In states of calorie and protein malnutrition there are significant alterations of plasma lipids and lipoproteins; in Nigerian children with kwashiorkor, low plasma levels of cholesterol, triglycerides, beta- and pre-beta-lipoproteins were found (Onitri et al., 1975); in a group of 129 patients monitored for 14 months in a Veteran Administration nursing home of the United States a direct linear correlation was found between total cholesterolemia and body mass index (Rudman et al., 1988). Low total plasma cholesterol levels are notoriously associated with severe liver diseases; hypertriglyceridemia may be found in less severe liver diseases, such as steatosis. Heroin addicts often have a very irregular life style and poor eating habits; they also often suffer from severe liver diseases, such as chronic viral hepatitis. Heroin addicts are amongst the Correspondence to: Sergio ment, Santa Maria Nuova 0376-8716/91/$03.50 Printed
and Published
Maccari, Hospital,
01991
Elsevier
in Ireland
Patients
Publishers
and Methods
In 60 heroin addicts of both sexes consecutively admitted to a general medical department in order to overcome the critical withdrawal period in hospital (by an individual programme for
Third Medical DepartReggio Emilia, Italy, Scientific
hypertriglyceridemia
Ireland
Ltd.
184
disintoxication), we measured the levels of total cholesterolemia, triglyceridemia, HDL (highdensity lipoproteins) cholesterolemia, plasma apolipoproteins Al and B, body mass index, albuminemia and alanine aminotransferase (ALT). As for body mass index, in order to eliminate the variants constituted by age and sex, we calculated for each patient the difference between the patient’s real body mass index and the value which expresses the 85th percentile of the general population of the same sex and age. The control group consisted of 23 healthy subjects, of both sexes, with mean age similar to that of the addicts. HDL-cholesterol was determined by the following method: chylomicrons, VLDL (very low-density lipoproteins) and LDL (low-density lipoproteins) were precipitated by adding phosphotungstic acid and magnesium ions to the sample; centrifugation left only the HDL in the supernatant; their cholesterol content was determined enzymatically. Apolipoproteins Al and B were determined by reagents of Beckman Instruments, Inc. (Diagnostic System Group, Brea, CA); this method measures the rate of increase in light scattered from particles suspended in solution as a result of complexes formed during an antigen-antibody reaction. Differences were examined between the two groups regarding total cholesterolemia, HDLcholesterolemia, triglyceridemia, apolipoproteins Al and B, using Student’s t-test. The same research was carried out by comparing the two subgroups of HIV-negative and HIV-positive heroin addicts separately with the control group, and also by comparing the HIVnegative addict subgroup with that of the HIVpositive. In the total addict group we investigated the possible existence of direct or inverse linear correlations between total cholesterolemia and each of the other seven available biological parameters. The statistical procedure adopted was the regression line calculated with the method of least squares. Finally, we determined the prevalence of cases of hypertriglyceridemia (over the 95th percentile of the general population, after hav-
ing taken into account age and sex) (The Lipid Research Clinics Program Epidemiology Committee, 1979), total hypocholesterolemia (under the 5th percentile) and hypo-HDL cholesterolemia (under the 5th percentile) (La Rosa et al., 1986) in the addict group, in the control group and in the two subgroups of HIVpositive and HIV-negative addicts. These observed frequencies (or prevalences) were compared by using the chi-square method. Results Statistically significant differences were found between the addict group and control group in total cholesterolemia and HDLcholesterolemia, which were lower in the addicts, and triglyceridemia, which was higher, in the absence of a difference in weight and body mass index. There were no statistical differences in apolipoproteins Al and B. There were significant differences between the HIV-negative subgroup (18 patients) and the control group in total cholesterolemia and HDL-cholesterolemia levels which were both lower in the HIV-negative subjects, while there were no differences in triglyceridemia, apolipoprotein Al and B levels. The HIV-positive subgroup (36 patients) showed significant differences in comparison with the control group in total cholesterolemia and HDLcholesterolemia, both being lower in the HIVpositive group, and in triglyceridemia which was higher, while there was no change in the apolipoproteins Al and B. As to the biological parameters examined, no significant differences were found between the two subgroups of the HIV-positive and HIVnegative addicts (Table I). Within the total addict group the following linear correlations emerged. (1) The direct type between total cholesterol and apolipoprotein B: P < 0.001; correlation coefficient, r = 0.7591; regression line, y = 1.007x + 65.61 (x = apolipoprotein B, y = total cholesterol); (2) The inverse type between total cholesterol and ALT: P < 0.02; correlation coefficient, r = 0.3061; regression line, y = -0.088x + 157.10 (Z =
Table I. Mean values + S.D. of the 5 biological Every group (total heroin addicts; HIV-negative dent’s f-test. N.S. = not significant.
parameters pertinent addicts; HIV-positive
to the lipid pattern (number of cases in parentheses). addicts) was compared with the control group hy Strr-
Addicts
Total
Chol.
(mgidl) HDL-Chol. (mgidl) Triglyc. (m&h) Al-“’ :I 1 (mgidl) Apo H (mgidl)
Controls
Total
HIV-negative
HI\‘-positive
149.74 f 32.79 (58) P < 0.001
139.17 f (18) P < 28.43 zt (7) P < 99.28 * (18) N.S. 118.17 * (6) N.S. 60.00 * (6) N.S.
153.85 l 31.56 (34) P < 0.001
31.73 f 7.43 (22) P < 0.001 105.33 f 41.71 (58) P < 0.02 124.21 zt 35.82 (19) N.S. 73.16 f 27.40 (11) N.S.
32.63 0.001 3.87 0.001 42.5.5 31.30 30.39
ALT, y = total cholesterol). (3) The direct type between total cholesterol and HDL-cholesterol: P c 0.05; correlation coefficient, r = 0.4605; regression line, y = 2.34x + 65.73 (x = HDLcholesterol, y = total cholesterol). No correlation was found between total cholesterolemia and body mass index. As regards the comparisons between the prevalence of cases of hypertriglyceridemia, hypocholesterolemia and hypo-HDL-cholesterolemia the following significant differences
Table II. Prevalence of cases of hypertriglyceridemia, of the three groups of patients with the control group
( > 95th percentile) Hypocholesterolemia (< 5th percentile) Hype-HDLcholesterolemia (< 5th percentile)
24.80
total hypocholestrrulemia and h3I”)-HDL-cholestrrc,lerni;t. by the chi-square method. N.S. = not significant.
Total
HIV-negative
3158 N.S.
Not determined
16/58
7118
P < 0.05
P < 0.02
10121
517 P < 0.002
P < 0.005
X.48 0.001 42.75 0.01 38.21
f
22.79
* 8.51 * :
Dependence, 29 (1991) 183 - 187 Publishers Ireland Ltd.
1X3
Plasma cholesterol and triglycerides in heroin addicts Sergio Maccaria, Carla Bassia, Patrizia
(Accepted
We examined
total
cholesterolemia,
triglyceridemia,
Zanoni” and Angelo Cesare Plancher”
September
high density
7th,
1991)
lipoproteins-
(HDL) cholesterolemia,
ap”lilloproteins
A
I
and B, body mass index, albuminemia and alanine aminotransferase in 60 heroin addicts. After comparing 2:s control subjects with the heroin addicts the result was that the latter have significantly lower mean values of total cholesterolrmia and of HDL cholesterolemia and higher values of triglyceridemia. They also have significantly higher prevalences of’ r’ases of hypocholesterolemia and of hypo-HDL-cholesterolemia. Within the addict group there is no linear correlation between total cholesterolemia and body mass index; there is, however, an inverse linear correlation between total cholestrrolemia and alaninc aminotransferase. Therefore, the alterations found in the lipid pattern of heroin addicts are not due to malnutrition but hypothetically to liver diseases which are frequent in these patients. Key words:
heroin
addicts;
total
hypocholesterolemia;
hypo-HDL-cholesterolemia;
main risk groups for HIV infection. In AIDS patients hypertriglyceridemia, independent of the patients’ nutritional status, was found, but there were no significant alterations in total cholesterolemia (Grunfeld et al., 1989). Experimental studies on rats demonstrated that the administration of morphine raises total plasma cholesterol levels (Bryant et al., 1987). In a group of 140 patients with hypocholesterolemia there were no cases of heroin addiction (Muller et al., 1987); but we believe that plasma lipid levels assessments are often disregarded in heroin addicts because of seemingly little clinical importance in these patients. In our study we found that heroin addicts often have lower cholesterolemia and higher triglyceridemia than normal subjects.
Introduction In states of calorie and protein malnutrition there are significant alterations of plasma lipids and lipoproteins; in Nigerian children with kwashiorkor, low plasma levels of cholesterol, triglycerides, beta- and pre-beta-lipoproteins were found (Onitri et al., 1975); in a group of 129 patients monitored for 14 months in a Veteran Administration nursing home of the United States a direct linear correlation was found between total cholesterolemia and body mass index (Rudman et al., 1988). Low total plasma cholesterol levels are notoriously associated with severe liver diseases; hypertriglyceridemia may be found in less severe liver diseases, such as steatosis. Heroin addicts often have a very irregular life style and poor eating habits; they also often suffer from severe liver diseases, such as chronic viral hepatitis. Heroin addicts are amongst the Correspondence to: Sergio ment, Santa Maria Nuova 0376-8716/91/$03.50 Printed
and Published
Maccari, Hospital,
01991
Elsevier
in Ireland
Patients
Publishers
and Methods
In 60 heroin addicts of both sexes consecutively admitted to a general medical department in order to overcome the critical withdrawal period in hospital (by an individual programme for
Third Medical DepartReggio Emilia, Italy, Scientific
hypertriglyceridemia
Ireland
Ltd.
184
disintoxication), we measured the levels of total cholesterolemia, triglyceridemia, HDL (highdensity lipoproteins) cholesterolemia, plasma apolipoproteins Al and B, body mass index, albuminemia and alanine aminotransferase (ALT). As for body mass index, in order to eliminate the variants constituted by age and sex, we calculated for each patient the difference between the patient’s real body mass index and the value which expresses the 85th percentile of the general population of the same sex and age. The control group consisted of 23 healthy subjects, of both sexes, with mean age similar to that of the addicts. HDL-cholesterol was determined by the following method: chylomicrons, VLDL (very low-density lipoproteins) and LDL (low-density lipoproteins) were precipitated by adding phosphotungstic acid and magnesium ions to the sample; centrifugation left only the HDL in the supernatant; their cholesterol content was determined enzymatically. Apolipoproteins Al and B were determined by reagents of Beckman Instruments, Inc. (Diagnostic System Group, Brea, CA); this method measures the rate of increase in light scattered from particles suspended in solution as a result of complexes formed during an antigen-antibody reaction. Differences were examined between the two groups regarding total cholesterolemia, HDLcholesterolemia, triglyceridemia, apolipoproteins Al and B, using Student’s t-test. The same research was carried out by comparing the two subgroups of HIV-negative and HIV-positive heroin addicts separately with the control group, and also by comparing the HIVnegative addict subgroup with that of the HIVpositive. In the total addict group we investigated the possible existence of direct or inverse linear correlations between total cholesterolemia and each of the other seven available biological parameters. The statistical procedure adopted was the regression line calculated with the method of least squares. Finally, we determined the prevalence of cases of hypertriglyceridemia (over the 95th percentile of the general population, after hav-
ing taken into account age and sex) (The Lipid Research Clinics Program Epidemiology Committee, 1979), total hypocholesterolemia (under the 5th percentile) and hypo-HDL cholesterolemia (under the 5th percentile) (La Rosa et al., 1986) in the addict group, in the control group and in the two subgroups of HIVpositive and HIV-negative addicts. These observed frequencies (or prevalences) were compared by using the chi-square method. Results Statistically significant differences were found between the addict group and control group in total cholesterolemia and HDLcholesterolemia, which were lower in the addicts, and triglyceridemia, which was higher, in the absence of a difference in weight and body mass index. There were no statistical differences in apolipoproteins Al and B. There were significant differences between the HIV-negative subgroup (18 patients) and the control group in total cholesterolemia and HDL-cholesterolemia levels which were both lower in the HIV-negative subjects, while there were no differences in triglyceridemia, apolipoprotein Al and B levels. The HIV-positive subgroup (36 patients) showed significant differences in comparison with the control group in total cholesterolemia and HDLcholesterolemia, both being lower in the HIVpositive group, and in triglyceridemia which was higher, while there was no change in the apolipoproteins Al and B. As to the biological parameters examined, no significant differences were found between the two subgroups of the HIV-positive and HIVnegative addicts (Table I). Within the total addict group the following linear correlations emerged. (1) The direct type between total cholesterol and apolipoprotein B: P < 0.001; correlation coefficient, r = 0.7591; regression line, y = 1.007x + 65.61 (x = apolipoprotein B, y = total cholesterol); (2) The inverse type between total cholesterol and ALT: P < 0.02; correlation coefficient, r = 0.3061; regression line, y = -0.088x + 157.10 (Z =
Table I. Mean values + S.D. of the 5 biological Every group (total heroin addicts; HIV-negative dent’s f-test. N.S. = not significant.
parameters pertinent addicts; HIV-positive
to the lipid pattern (number of cases in parentheses). addicts) was compared with the control group hy Strr-
Addicts
Total
Chol.
(mgidl) HDL-Chol. (mgidl) Triglyc. (m&h) Al-“’ :I 1 (mgidl) Apo H (mgidl)
Controls
Total
HIV-negative
HI\‘-positive
149.74 f 32.79 (58) P < 0.001
139.17 f (18) P < 28.43 zt (7) P < 99.28 * (18) N.S. 118.17 * (6) N.S. 60.00 * (6) N.S.
153.85 l 31.56 (34) P < 0.001
31.73 f 7.43 (22) P < 0.001 105.33 f 41.71 (58) P < 0.02 124.21 zt 35.82 (19) N.S. 73.16 f 27.40 (11) N.S.
32.63 0.001 3.87 0.001 42.5.5 31.30 30.39
ALT, y = total cholesterol). (3) The direct type between total cholesterol and HDL-cholesterol: P c 0.05; correlation coefficient, r = 0.4605; regression line, y = 2.34x + 65.73 (x = HDLcholesterol, y = total cholesterol). No correlation was found between total cholesterolemia and body mass index. As regards the comparisons between the prevalence of cases of hypertriglyceridemia, hypocholesterolemia and hypo-HDL-cholesterolemia the following significant differences
Table II. Prevalence of cases of hypertriglyceridemia, of the three groups of patients with the control group
( > 95th percentile) Hypocholesterolemia (< 5th percentile) Hype-HDLcholesterolemia (< 5th percentile)
24.80
total hypocholestrrulemia and h3I”)-HDL-cholestrrc,lerni;t. by the chi-square method. N.S. = not significant.
Total
HIV-negative
3158 N.S.
Not determined
16/58
7118
P < 0.05
P < 0.02
10121
517 P < 0.002
P < 0.005
X.48 0.001 42.75 0.01 38.21
f
22.79
* 8.51 * :
