A sedentary lifestyle adversely affects the successful prevention of coronary heart disease (CHD). Due to the methodological difficulties of it's quantitatively measuring daily physical activity, little is known about it's effect on serum lipid levels in the elderly. In this study we used the Life Corder (Kenz, Nagoya Japan), which is a pedometer that memorizes the patient's daily physical activity for up to 42 days semi quantitatively. We analyzed 33 elderly (over 65 year-old) men with CHD who visited our outpatient clinic. We measured the daily physical activity (mean step count/day (S), calculated mean energy of physical activity/day and calculated mean total energy expenditure/day (TE)), and exercise tolerance (VO_2max/kg, ATVO₂/kg) using treadmill exercise stress test. Serum lipid profiles were analyzed enzymatically after at least 12 hours fasting. The levels of serum total cholesterol were inversely correlated with TE: r=-0.45, P=0.0095. The levels of serum HDL cholesterol were significantly correlated with S: r=0.46, p=0.0084. Triglyceride did not correlate with the parameter of daily physical activity. Exercise tolerance did not correlate with serum lipid profiles. In elderly patients, daily physical activity was related to the serum lipid profile, which suggests that the improvement in daily physical activity could support secondary prevention by improving the lipid profiles in elderly patients with CHD.

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The effects of postprandial hyperlipidemia on coronary heart disease have been previously reported and to evaluate postprandial hyperlipidemia, fresh cream loading has generally been used. However, the high percentage of energy derived from fat in fresh cream does not reflect the situation of fat intake among Japanese people, and acute adverse effects often appear after fresh cream loading. To evaluate postprandial hyperlipidemia under conditions more closely resembling the Japanese daily diet, we newly devised an oral fat-rich meal for loading, the “Kisei-meal”, which consisted of 40g of bread with 30g of butter served as toast and 200g of milk (energy: 462 kcal, protein: 8.7%, fat: 65.5%, carbohydrate: 25.8%). The test meal was given to inhabitants (male/female: 5/15, age: 59±9 years) of Kisei-cho in Mie Prefecture. Blood was obtained after overnight fasting, and at 1, 2 and 4 hours after the test meal. Serum lipids, lipoprotein, plasma glucose, fasting plasma insulin and apolipoprotein concentrations were measured.
After loading, a variety of lipid concentration pattern changes were observed. Most showed some increases in remnant like particles-cholesterol (RLP-C) and triglyceride levels. However, in the two subjects who had triglyceride levels exceeding 150mg/dl in the fasting state, and in the three subjects whose fasting triglyceride levels were lower than 150mg/dl, triglycerides rose continuously and exceeded 150mg/dl at 4 hours after the meal load, and these five subjects all had elevated RLP-C levels (≥7.5mg/dl) at 4 hours after the meal. Significant positive correlations between homeostasis model assesment (HOMA) in the fasting state and area under the curve (AUC) of triglyceride (p<0.01), and negative correlations between the low density lipoprotein-cholesterol (LDL-C)/apoB ratio in the fasting state and AUC of triglyceride or RLP-C concentrations (p<0.001) were recognized. These results suggest that after the Kisei-meal load, the remaining triglyceride-rich lipoprotein induced a change in low density lipoprotein composition. We anticipate that our newly devised oral fat-rich “Kisei-meal” for loading will contribute to the evaluation of Japanese postprandial hyperlipidemia.

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