Changes in ischemic findings in ECG, obesity and serum lipids and the relations among them were investigated in Sada Town, a typical agricultural and mountaineous area in Shimane Prefecture, where the mortality rate from ischemic heart disease had increased.
Compared with 1983, the percentage of ischemic findings in ECG in 1990 increased, and a marked elevation of total serum cholesterol level, and relative and absolute lowering of HDL cholesterol level were observed in 1990.
By observing the relations of total serum cholesterol, HDL cholesterol and the atherosclerotic index to the ischemic findings in electrocardiograms (ECG), it was found that males showed a significantly lower HDL cholesterol level and higher atherosclerotic index than the control group.
In males, a relation between obesity and ischemic findings in ECG was observed. In females, a relation between obesity and the atherosclerotic index was observed; however, no relations were observed between ischemic findings and obesity.
These results support the hypothesis that a marked elevation of the total serum cholesterol level, relative and absolute lowering of the HDL cholesterol level and obesity have an effect on the recent increase of male deaths due to ischemic heart disease in Sada Town, Shimane Prefecture.

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浮腫性硬化症は皮膚の硬化性変化を特徴とする稀な結合組織疾患といわれているが, 当科入院インスリン非依存型糖尿病患者63例中7例の項部・上背部に, 指圧痕を残さない浮腫状に盛りあがった皮膚の硬化・硬結を認めた.男性2例・女性5例, 平均年齢52歳, 3年から20年の糖尿病歴, コントロール不良・肥満・網膜症・蛋白尿・神経障害・心血管障害を半数以上に, 免疫グロブリン高値を2例に認めた.3症例の皮膚生検で浮腫性硬化症に特徴的な所見, すなわち真皮の著明な肥厚・コラーゲン線維増生・膨化・走行の乱れ・皮下脂肪組織への浸潤, 酸性ムコ多糖の沈着を証明し, 糖尿病性浮腫性硬化症と診断した.本症は糖尿病患者では稀な病変でなく, 診察に際し項部・背部の皮膚変化に注意を払うこと, また本症を認めたら糖尿病性合併症を伴う頻度が高いので, その検索を速やかに行うとともに, 免疫グロブリン系の検討を行うことが重要と考えられた.

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Serum cholesterol levels in 31, 237 males and 78, 191 females were measured in order to estimate the prevalence of hypercholesterolemia (serum cholesterol; higher than 240mg/dl) in 9 districts of the Shiga prefecture. The daily cholesterol and fat intakes (polyunsaturated and saturated fatty acids) of 11, 375 Shiga residents were also analyzed in order to study the relationships between hypercholesterolemia and food intake.
The prevalence of hypercholesterolemia in urban and rural Shiga was 9.2% (corrected value by population pyramid in Japan: 10.0%), 5.8% (6.3%) in males and 18.6% (10.2%), 12.4% (7.3%) in females. The prevalence of hypercholesterolemia in the Shiga prefecture—male 14.9% (8.5%), female 6.9% (7.6%)—was approximately equal to the Japanese average. However, the prevalence of hypercholesterolemia among females in urban Shiga was even higher than among females in metropolitan Japan. Among 50% of aged urban female residents, the prevalence of hypercholesterolemia was higher than 220mg/dl; among 25% of these residents, it was higher than 240mg/dl.
The daily intake of cholesterol (387mg) and fat (57.0g) by Shiga residents was similar to the Japanese average. But the daily intake of animal fat was higher, and the P/S ratio (polyunsaturated to saturated fat ratio) was lower in Shiga than the Japanese average. Cholesterol, fat and animal fat intake was highest in the highest prevalence area of hypercholesterolemia (the Ohtsu area) and lowest in the two lowest prevalence areas.
These results suggest that hypercholesterolemia is quite high among aged urban females in the Shiga prefecture and support many previous reports that the high intake of cholesterol, fat and animal fat is related to a high prevalence of hypercholesterolemia.

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We examined age-related changes of serum lipids and their distribution in each lipoprotein fraction in normolipidemic healthy adults (182 males, 191 females) including 59 octogenarians and 23 nonagenarians. Lipid distribution was analyzed using the agarose gel electrophoresis-enzymatic staining method. The relationship between the lipoproteins, postheparin lipolytic activity and sex hormones was examined in 76 randomly chosen subjects.
The total cholesterol (TC) levels peaked in the 7th decade in males (190mg/dl) and in the 6th decade in females (203mg/dl). It then decreased gradually in both groups. The triglyceride (TG) levels in males showed no changes except for a slight decline in the 10th decade. The TG levels in females increased with age and exceeded those of males after age 70.
The TG distribution showed characteristic changes after age 80. In males, VLDL-TG (%) remained at about 60% for ages 20-59, then decreased to 36.8% at the 9th decade and 25.6 at the 10th decade. LDL-TG (%) was nearly 30% for ages 20-59, and then increased to 50.2% at the 9th decade and 63.5% at the 10th decade. In females, the changes of VLDL-TG (%) and LDL-TG (%) were similar to those in males, but the degree of change was smaller.
Lipoprotein lipase activities of postheparin plasma did not change remarkably in either sex. Hepatic triglyceride lipase (H-TGL) activites in males were constant at about 8μmols FFA/ml/hr for ages 20-59. They then decreased remarkably to 3.3μmoles after age 80. In females, the activities also decreased after age 60. H-TGL activities showed a positive correlation to VLDL-TG (%) (male: r=0.679, p<0.001, female: r=0.323, p<0.05) and a negative correlation to LDL-TG (%) (male :r=-0.574, p<0.001, female: r=-0.347, p<0.05).
The levels of DHEA-S decreased steadily with age in both sexes, and were very low after age 80. DHEA-S showed a significant correlation to VLDL-TG (%) (r=0.516, p<0.01), LDL-TG (%) (r=-0.501, p<0.01) and H-TGL activities (r=0.596, p<0.001) in males.
In conclusion, the increase in LDL-TG (%) and the decrease in VLDL-TG (%) detected after age 80 were characteristic age-related changes in the distribution of serum lipids. We suspect that these changes resulted from the stagnation of the remnant derived from TG-rich lipoproteins, and that the stagnation was affected by the decline of H-TGL activities and DHEA-S levels.

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