480 V. BLOOD LIPIDS 



Barr and collaborators 772 demonstrated that patients who have survived 

 coronary occlusion, or who have other evidence of atherosclerosis, exhibit 

 an abnormal distribution of proteins and lipids in the plasma. These 

 variations from normal include a reduction in albumin and a-lipoprotein, 

 along with an absolute increase in the ^-lipoprotein fraction. Increases 

 also take place in other components of Cohn's Fractions I and III. These 

 changes can occur without the development of a hypercholesterolemia or 

 any significant elevation in the cholesterol : phospholipid ratio. This 

 ratio does not deviate from normal in the atherosclerotic group, namely 

 about 0.50 for the a-lipoprotein-containing fraction and approximately 

 1.40 for the fraction which contains the /3-lipoprotein. Such changes in 

 protein and cholesterol distribution are known to occur in conditions which 

 predispose to an early and extensive atherosclerosis. In many cases of 

 diabetes, these changes may be recognized before any vascular complica- 

 tions are demonstrable. Such data would seem in general to support the 

 Gofman hypothesis that it is not cholesterol per se which may be the of- 

 fender in atherosclerosis, but rather the nature of the cholesterol-protein 

 lipoprotein in the blood. Although Gertler et al? n are of the opinion that 

 blood cholesterol is increased in coronary disease, and that the level of 

 phospholipids is augmented, they suggest that the important consideration 

 is the ratio of these components rather than their absolute amounts. 



f. The Effect of Lipotropic Factors on Atherosclerosis: A number of 

 reagents which are known to cause the reduction of liver lipids under certain 

 fixed conditions have also been shown to haye definite effects on athero- 

 sclerosis. 



(a') Choline. — Although Duff and Meissner 774 were unable to demon- 

 strate that choline exerted any effect on the atherosclerosis, produced 

 by feeding cholesterol, in the rabbit, several investigators noted beneficial 

 results when choline therapy was employed. 774-777 Moreover, Morrison 

 et al. m reported that choline appears to have a beneficial effect in counter- 

 acting atherosclerosis in the human patient. Hermann 779 found a reduction 

 of 20% in the blood cholesterol in 1 1 1 patients suffering from atheromatous 



772 D. P. Barr, E. M. Russ, and H. A. Eder, Am. J. Med., 11, 480-493 (1951). 



773 M. M. Gertler, S. M. Gam, and E. F. Bland, Circulation, 2, 517-522 (1950). 



774 G. L. Duff and G. F. Meissner, Circulation, 4, 468-469 (1951). 



775 A. Steiner, Arch. Pathol, 45, 327-332 (1948). 



776 L. M. Morrison and A. Rossi, Proc. Soc. Exptl. Biol. Med., 69, 283-284 (1948). 



777 L. M. Morrison, Geriatrics, 4, 236-238 (1949). 



778 L. M. Morrison and W. F. Gonzalez, Proc. Soc. Exptl. Biol. Med., 73, 37-38 (1950). 



779 G. R. Herrmann, Exptl. Med. and Surg., 5, 149-159 (1947). 



