| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| A cholesterol-rich diet accelerates bacteriologic sterilization in pulmonary tuberculosis Perez-Guzman, C., M. H. Vargas, et al. (2005), Chest 127(2): 643-51. Abstract: BACKGROUND: Hypocholesterolemia is common among tuberculous patients and is associated with mortality in miliary cases. Some in vitro studies have shown that cholesterol is necessary for the good functioning of macrophages and lymphocytes. STUDY OBJECTIVES: To determine whether a cholesterol-rich diet could accelerate sputum sterilization in patients with pulmonary tuberculosis. DESIGN: An 8-week follow-up, randomized, controlled trial carried out from March 2001 to January 2002. SETTING: A third-level hospital for respiratory diseases in Mexico City. PATIENTS AND INTERVENTIONS: Adult patients with newly diagnosed pulmonary tuberculosis were hospitalized for 8 weeks and randomly assigned to receive a cholesterol-rich diet (800 mg/d cholesterol experimental group) or a normal diet (250 mg/d cholesterol control group). All patients received the same four-drug antitubercular regimen (ie, isoniazid, rifampin, pyrazinamide, and ethambutol). MEASUREMENTS AND RESULTS: Every week, a quantitative sputum culture and laboratory tests were done and respiratory symptoms were recorded. Patients in the experimental group (10 patients) and the control group (11 subjects) were HIV-negative and harbored Mycobacterium tuberculosis that was fully sensitive to antitubercular drugs. Sterilization of the sputum culture was achieved faster in the experimental group, as demonstrated either by the percentage of negative culture findings in week 2 (80%; control group, 9%; p = 0.0019) or by the Gehan-Breslow test for Kaplan-Meier curves (p = 0.0037). Likewise, the bacillary population decreased faster (p = 0.0002) in the experimental group. Respiratory symptoms improved in both groups, but sputum production decreased faster in the experimental group (p < 0.05). Laboratory test results did not differ between the groups. CONCLUSIONS: A cholesterol-rich diet accelerated the sterilization rate of sputum cultures in pulmonary tuberculosis patients, suggesting that cholesterol should be used as a complementary measure in antitubercular treatment. |
| A cholesterol-rich diet causes a greater hypercholesterolemic response in pregnant than in nonpregnant rats and does not modify fetal lipoprotein profile Munilla, M. A. and E. Herrera (1997), J Nutr 127(11): 2239-45. Abstract: To determine whether pregnancy modifies the hyperlipidemic response to a cholesterol-rich diet, pregnant and virgin rats were fed a semisynthetic diet supplemented (CRD) or not (CD) with 2% cholesterol and 1% cholic acid and studied at d 20 of treatment and/or gestation. Plasma triglycerides, free fatty acids and glycerol and liver triglycerides were greater in pregnant than in virgin rats fed CRD. The increase in both plasma and liver cholesterol caused by CRD did not differ in the two groups. In rats fed CD, hepatic lipase activity in liver was lower in pregnant than in virgin rats, while in those fed CRD, virgin rats had lower activity than those fed CD. Plasma VLDL-triglycerides were higher and LDL-triglycerides lower in pregnant than in virgin rats fed CD. Among those fed CRD, pregnant rats had a higher triglyceride concentration in VLDL and HDL than virgin rats. Cholesterol concentration was higher in VLDL and IDL and lower in HDL in both groups fed CRD than in those fed CD, while cholesterol level in LDL was higher only in pregnant rats fed CRD than in those fed CD. Whereas placental cholesterol concentration was higher in pregnant rats fed CRD than CD, maternal CRD intake did not modify fetal plasma lipoprotein concentrations, fetal body weight or litter size, indicating a lack of cholesterol transfer by the rat placenta. Results therefore show a greater responsiveness to CRD in pregnant than in virgin rats, and we propose that CRD promotes greater liver VLDL-production and lower LDL removal in pregnant than in virgin rats. |
| A cholesteryl ester hydrolase inhibitor blocks cholesterol translocation into the mitochondria of MA-10 Leydig tumor cells Gocze, P. M. and D. A. Freeman (1992), Endocrinology 131(6): 2972-8. Abstract: The present studies describe an unexpected action of a cholesteryl ester hydrolase inhibitor on MA-10 Leydig tumor cells. These studies were initially intended to use the inhibitor, diethylumbelliferyl phosphate, to block cholesteryl ester hydrolysis and, thus, determine the contributions of this form of cholesterol to steroidogenesis and reveal any direct hormone effects on cholesterol esterification. Although this compound acted as an effective inhibitor of the cholesteryl ester hydrolase in intact MA-10 cells, it inhibited steroidogenesis at lower concentrations and to a greater extent than could be explained by simple inhibition of the ester hydrolase enzyme. This compound proved not to be generally toxic, but blocked some process occurring between cAMP formation and cholesterol side-chain cleavage. The diethylumbelliferyl phosphate block of steroidogenesis was readily bypassed by 22-hydroxycholesterol. These data indicated that the compound inhibited cholesterol transport. The lesion in cholesterol transport was not general, but very specific; cholesterol translocation to the mitochondrial site of cholesterol side-chain cleavage was blocked by this organophosphate compound. |
| A church-based cholesterol education program Wiist, W. H. and J. M. Flack (1990), Public Health Rep 105(4): 381-8. Abstract: The leading cause of death among black people in the United States is coronary heart disease, accounting for about 25 percent of the deaths. The Task Force on Black and Minority Health formed by the Secretary of Health and Human Services in 1985 subsequently recommended increased efforts to reduce risk factors for coronary heart disease in the black population. A stated focus of the National Heart, Lung, and Blood Institute's National Cholesterol Education Program has been that of reaching minority groups. This report describes a pilot cholesterol education program conducted in black churches by trained members of those churches. Cholesterol screening, using a Reflotron, and other coronary heart disease risk factor screening was conducted in six churches with predominantly black members and at a neighborhood library. A total of 348 persons with cholesterol levels of 200 milligrams per deciliter (mg per dl) or higher were identified. At the time of screening, all were provided brief counseling on lowering their cholesterol and were given a copy of the screening results. Half of those identified, all members of one church, were invited to attend a 6-week nutrition education class of 1 hour each week about techniques to lower blood cholesterol. Information about cholesterol was also mailed to them. They were designated as the education group. Persons in the church were trained to teach the classes.(ABSTRACT TRUNCATED AT 250 WORDS) |
| A clinical analysis of cholesterol granuloma following chronic suppurative otitis media Fang, L., T. Zhang, et al. (2001), Lin Chuang Er Bi Yan Hou Ke Za Zhi 15(2): 64-5. Abstract: OBJECTIVE: To investigate the pathophysiological mechanism, clinical menifestation and radiographic diagnosis of cholesterol granuloma following chronic suppurative otitis media. METHOD: Six cases of CG following chronic suppurative otitis media, confirmed by surgery and pathology, were reviewed and analyzed. RESULT: CG frequently accompanied with other middle ear diseases, and was shown as a high signal intensity on both T1-and T2-weighted images in magnetic resonance imaging(MRI). CONCLUSION: It was postulated that the obstruction of pneumatized temporal bone air cell, caused by other middle ear diseases such as cholesteatoma and tympanosclerosis, might be the pathophysiological mechanism of CG. The evaluations of computed tomography (CT) and clinical manifestation were limited to distinguish CG from cholesteatoma or other neoplasm, while the MRI can be of great value to characteristic diagnosis. |
| A clinical comparison of calculated versus direct measurement of low-density lipoprotein cholesterol level Lindsey, C. C., M. R. Graham, et al. (2004), Pharmacotherapy 24(2): 167-72. Abstract: STUDY OBJECTIVES: To determine if, and to what extent, the low-density lipoprotein cholesterol (LDL) level is underestimated when it is calculated by the Friedewald formula compared with the LDL level measured by a direct method. A secondary objective was to determine and compare the percentages of patients meeting LDL goal using each of these two methods. DESIGN: Retrospective chart review. SETTING: Kansas City Veterans Affairs Medical Center. SUBJECTS: Patients aged 18 years or older and whose laboratory results reflected a complete lipid profile for 1 year. MEASUREMENT AND MAIN RESULTS: Calculated LDL level (C-LDL) was derived using the Friedewald formula and was compared with Wako method-derived direct LDL level (D-LDL) to ascertain whether a positive correlation existed. The absolute difference between the methods for each sample was determined and compared overall and for various subgroups. The number of patient samples achieving National Cholesterol Education Program-defined LDL goal was determined and compared for both methods. A total of 20,224 lipid profiles were generated and 19,343 were included in the analysis. A strong correlation was found between D-LDL and C-LDL (r = 0.94). The absolute difference between the two methods demonstrated an underestimation of C-LDL of 19.5 +/- 11.8 mg/dl. The degree of underestimation increased as the triglyceride level increased (p < 0.05). Age within the fifth and sixth decades resulted in significantly higher differences compared with age in the eighth decade or greater (p < 0.05). Female sex and elevated body mass index also resulted in increased discrepancies between the two methods (p < 0.05 for both). Seventy-six percent of the lipid profiles were derived from patients with coronary heart disease (CHD) or a CHD risk equivalent. Approximately one half of these patients met their LDL goal when LDL level was measured versus calculated (p < 0.0001). CONCLUSION: When compared with D-LDL, an underestimation of approximately 20 mg/dl was found with C-LDL, resulting in a loss of LDL goal attainment for half of the patients with CHD or a CHD risk equivalent. |
| A clinicopathologic study of primary cholesterol hepatolithiasis Kondo, S., Y. Nimura, et al. (1995), Hepatogastroenterology 42(5): 478-86. Abstract: BACKGROUND/AIMS: We conducted the present study in order to clarify the clinicopathologic features of primary cholesterol hepatolithiasis and compare them with those in primary calcium bilirubinate hepatolithiasis. MATERIALS AND METHODS: We reviewed the clinicopathologic features of 24 patients with primary cholesterol hepatolithiasis. The clinical symptoms were mild, and the median duration of symptoms was 5 years. RESULTS: In 22 patients complete stone clearance was obtained using percutaneous cholangioscopic lithotomy, partial hepatectomy, or their combination. The patients showed excellent clinical outcome (median follow-up period, 6 years) despite the absence of bilioenteric drainage. Stones have recurred in 4 patients, who remain asymptomatic. The histopathologic findings in 7 hepatectomized patients were compared with those in 7 patents with calcium bilirubinate hepatolithiasis. The inflammatory changes around the stone-containing duct, i.e., wall thickening, fibrosis, sludge formation, and glandular hyperplasia, were significantly milder in the cholesterol hepatolithiasis patients (p < 0.01 or p < 0.05). CONCLUSIONS: These clinical and histopathologic findings indicate that primary cholesterol hepatolithiasis should be regarded as a different clinical entity from calcium bilirubinate hepatolithiasis which has a close relationship with bile stasis and bacterial infection as etiological factors. |
| A clinicopathological study on intrahepatic cholesterol gallstones Akiyama, T., T. Nagakawa, et al. (1990), Jpn J Surg 20(5): 530-6. Abstract: In order to clarify the pathogenesis and process of the formation of intrahepatic cholesterol gallstones, we examined the clinical features, cholangiograms and pathological findings of eight patients with intrahepatic cholesterol gallstones. When examining the clinical features, one patient was found to have developed intrahepatic cholesterol gallstones 3 years after a complete lithotomy. The cholangiograms of two patients revealed small gallstones in the peripheral bile ducts of the lateral segment of the liver, and these bile ducts showed localized cystic dilatation and were tightly filled with gallstones. Conversely, their other bile ducts which contained no gallstones showed an entirely normal cholangiogram. Pathologically, these two cases showed mild chronic cholangitis, and cholesterol crystals in the peripheral bile ducts. The other six cases showed moderate or severe dilatation of the bile duct and severe chronic proliferative cholangitis. From the above results, we proposed the following theory to explain the pathogenesis and process of the formation of intrahepatic cholesterol stones: The cholesterol crystals in the peripheral intrahepatic bile ducts may be a primitive form of intrahepatic cholesterol gallstones, and the formation of intrahepatic cholesterol gallstones may precede and cause such deformities of the bile ducts as strictures or dilatations. |
| A cluster of cholesterol-related genes confers susceptibility for Alzheimer's disease Papassotiropoulos, A., M. A. Wollmer, et al. (2005), J Clin Psychiatry 66(7): 940-7. Abstract: OBJECTIVE: Polygenic diseases are related to the complex interplay of genetic variations. We evaluated whether clusters of cholesterol- and lipid-related genetic variations are associated with Alzheimer's disease. METHOD: We analyzed 12 cholesterol-related single nucleotide polymorphisms and 48 control polymorphisms in 545 study participants (Alzheimer's disease group N = 284; control group N = 261). Diagnoses of Alzheimer's disease were made according to the NINCDS-ADRDA criteria. Multi-locus genetic association analysis was done with the set-association method. Dates of data collection were from January 2000 to December 2003. RESULTS: We identified a cluster of polymorphisms in APOE, SOAT1, APOE 5'-untranslated region, OLR1, CYP46A1, LPL, LIPA, and APOA4 conferring significant (p =.0002) susceptibility for Alzheimer's disease. This gene cluster reached a diagnostic accuracy of 74% and correlated significantly (p =.018) with the levels of the brain cholesterol catabolite 24S-hydroxycholesterol in the cerebrospinal fluid. CONCLUSION: Our results establish a novel approach for the identification of disease-related genetic clusters and demonstrate the need for multi-locus methods in the genetics of complex diseases. |
| A collaborative trial for the evaluation of blood cholesterol measurement in clinical laboratories in Italy Malavasi, B., A. Catapano, et al. (1992), Eur J Clin Chem Clin Biochem 30(3): 157-61. Abstract: A collaborative trial for the evaluation of blood cholesterol measurement in Italy was carried out, with the use of two lyophilized controls, whose target values, respectively 4.42 and 6.21 mmol/l, were established by means of "definitive" methodology (isotope dilution/mass spectrometry). Results from 480 participants showed a somewhat broad dispersion (CV 6.1% and 6.3% respectively), and a definite bias (-0.25 mmol/l and -0.61 mmol/l respectively) with respect to the target values. The different analytical systems were characterized by different combinations of inaccuracy and imprecision; however, the bias observed for the higher concentration sample was a constant finding. The behaviour of the control materials, in comparison with that exhibited by patients' sera, was assessed in a manual enzymatic procedure and in the Kodak Ektachem 700 and Technicon Chem 1 systems. The peculiar property of one control material to behave differently from patients' sera in some analytical systems, i.e. the lack of commutability, was found to be partially responsible for the observed bias in the three methods studied. The importance of testing for commutability of the control materials to be used for the control of accuracy is stressed. |
| A combination of high concentrations of serum triglyceride and non-high-density-lipoprotein-cholesterol is a risk factor for cardiovascular disease in subjects with abnormal glucose metabolism--The Hoorn Study Bos, G., J. M. Dekker, et al. (2003), Diabetologia 46(7): 910-6. Abstract: AIMS/HYPOTHESIS: Type 2 diabetes is not only associated with hyperglycaemia, but also with disorders of lipid metabolism. The aim of this study was to investigate the association of triglyceride and non-HDL-cholesterol concentrations with cardiovascular disease in subjects with normal and abnormal glucose metabolism. METHODS: Subjects were 869 men and 948 women aged 50 to 75 who participated in the Hoorn Study, a population-based cohort study that started in 1989. Glucose metabolism was determined by a 75 g OGTT. High fasting triglyceride and non-HDL-cholesterol concentrations were defined as above the median of the study population. RESULTS: After 10 years of follow-up, the age- and sex-adjusted hazard ratios for cardiovascular disease were 1.35 (1.11-1.64) and 1.71 (1.40-2.08) for high triglycerides and high non-HDL-cholesterol, respectively, after mutual adjustment. After stratification for glucose metabolism status, the hazard ratios for cardiovascular disease for non-HDL-cholesterol were 1.70 (1.31-2.21) in normal glucose metabolism and 1.56 (1.12-2.18) in abnormal glucose metabolism. Triglycerides were not a risk factor in subjects with normal glucose metabolism, with a hazard ratio of 0.94 (0.73-1.22), but in subjects with abnormal glucose metabolism, the hazard ratio for cardiovascular disease was 1.54 (1.07-2.22). In subjects with abnormal glucose metabolism, the hazard ratio for the combined presence of high triglycerides and non-HDL-cholesterol was 2.12 (1.35-3.34). CONCLUSION: Our data suggest that in people with abnormal glucose metabolism, but not in those with normal glucose metabolism, high triglyceride concentration could be associated with the risk of cardiovascular disease, particularly in people with high non-HDL-cholesterol. |
| A combination of serum low albumin and above-average cholesterol level was associated with excess mortality Okamura, T., T. Hayakawa, et al. (2004), J Clin Epidemiol 57(11): 1188-95. Abstract: BACKGROUND: There is no population-based prospective study concerning the relation between serum albumin and mortality in a non-Western population, and few previous studies included the subgroup analysis stratified by serum cholesterol level. METHODS: A 13.7-year cohort study was conducted on 6,957 males and females aged 30-59 years from 300 randomly selected areas throughout Japan, who participated in the National Survey on Circulatory Disorders in 1980. RESULTS: In the group with median and above of total cholesterol, one standard deviation (SD) increment of serum albumin (2.6 g/L for males and 2.4 g/L for females) was inversely associated with all-cause mortality for both males and females (relative risk RR = 0.68 and 0.81: 95% confidence interval CI = 0.53-0.87 and 0.68-0.98), and with cancer mortality for females (RR = 0.74; 95% Cl = 0.57-0.96);and the lowest category of serum albumin (< or = 43 g/L) showed the highest cardiovascular mortality for males (RR = 5.04; 95% CI = 1.04-24.5) among the three albumin categories. These relationships were not evident in the group with total cholesterol level below median. CONCLUSION: A combination of a low albumin level and above average cholesterol level, even both within the clinical normal range,is associated with excess mortality in the Japanese general population. |
| A combination therapy with simvastatin and ursodeoxycholic acid is more effective for cholesterol gallstone dissolution than is ursodeoxycholic acid monotherapy Tazuma, S., G. Kajiyama, et al. (1998), J Clin Gastroenterol 26(4): 287-91. Abstract: Inhibitors of 3-hydroxy,3-methylglutaryl coenzyme A (HMG-CoA) reductase have been reported to decrease the cholesterol saturation index (CSI) in duodenal bile in humans and to prevent formation of cholesterol gallstones in animal studies. We performed a prospective study to evaluate the role of HMG-CoA reductase inhibitors as gallstone-dissolving agents. Fifty patients with radiolucent gallstones in a gallbladder opacifying at drip infusion cholecystography were treated with either 10 mg/day simvastatin plus 600 mg/day ursodeoxycholic acid (group 1, n=26) or 600 mg/day ursodeoxycholic acid alone (group 2, n=24) for 12 months. The ratio of solitary to multiple gallstone cases was 21:29. Plasma lipid levels were assessed and ultrasonographic examination of the gallbladder was performed at baseline and at 3-month intervals during treatment. Duodenal bile sampling was performed in five patients in each group at baseline and after 12 months of treatment. Plasma cholesterol decreased significantly in group 1 but not in group 2. In solitary gallstone cases, no significant difference in dissolution rates was observed between groups 1 (3 of 9, 33%) and 2 (4 of 12, 33%). In contrast, the dissolution rate in multiple gallstone cases was significantly higher in group 1 (12 of 17, 71%) than in group 2 (3 of 12, 25%) (p < 0.01). Bile cholesterol saturation index was significantly decreased (p < 0.01) but did not significantly differ between the two groups. These results suggest that combination therapy with simvastatin and ursodeoxycholic acid is more effective for cholesterol gallstone dissolution than ursodeoxycholic acid monotherapy in patients with multiple gallstones. |
| A combined community strategy to reduce cholesterol and other risk factors Sperber, A. D., A. Galil, et al. (1996), Am J Prev Med 12(2): 123-8. Abstract: Our primary objective was to conduct an integrated program to reduce coronary risk factors in the population of an Israeli kibbutz. The population-based objective was to reduce the mean community total cholesterol level. The individual-based objective was to provide counseling and treatment for individuals at high risk and to reduce individual total and low-density lipoprotein cholesterol levels. The intervention included food policy changes in the central kibbutz kitchen, health education programs aimed at all age groups, and health counseling for individuals at risk. Evaluation was by questionnaire at baseline and at the end of two years, blood lipoproteins, and monitoring of all food purchased by the kibbutz. Fifty-three percent of the adult population (100 of 187) had borderline to high baseline total cholesterol levels. At one year, 27% of these were in the normal category. Egg consumption dropped by 6%, liquid oil by 7%, and red meat by close to 19%. Consumption of fish, chicken meat, and vegetarian patties increased. Consumption of 1% milk increased by almost 300%. We conclude that an integrated health education program targeting individuals and the community together can be effective in reducing risk factors for coronary artery disease. |
| A common Ile 823 Met variant of ATP-binding cassette transporter A1 gene (ABCA1) alters high density lipoprotein cholesterol level in Japanese population Harada, T., Y. Imai, et al. (2003), Atherosclerosis 169(1): 105-12. Abstract: Recently, variants in ATP-binding cassette transporter A1 (ABCA1) were demonstrated to be associated with increased level of high density lipoprotein cholesterol (HDL-C) and decreased risk of coronary artery disease (CAD) in Caucasians. However, this is not universally applicable due to the ethnic or environmental differences. In this context, to clarify the effect of ABCA1 in Japanese, we evaluated the phenotypic effects of I/M 823 and R/K 219 variants on the plasma level of HDL-C in 410 patients recruited in our hospital. Subjects with M 823 allele had significantly higher level of HDL-C than those without M823 allele (49.0+/-15.1 vs. 44.9+/-11.5 mg/dl, respectively, P<0.05). This statistical significance did not change even after multiple regression analysis. In contrast, there was no difference in HDL-C level among the genotypes in R/K 219 polymorphism. Further, in our study population an inverse relationship was shown to exist between HDL-C level and incidence of CAD. However, no positive association was observed between those variants and susceptibility to CAD. In this study, we provide evidence that I/M 823 variant, not R/K 219 variant, in ABCA1 is one of the determinants of HDL-C level, suggesting the importance of this gene on lipid metabolism in Japanese. |
| A common lecithin: cholesterol acyltransferase gene variant (Ser208-->Thr) Stocks, J., C. J. Cooke, et al. (2000), Atherosclerosis 149(1): 219-20. |
| A common PCSK9 haplotype, encompassing the E670G coding single nucleotide polymorphism, is a novel genetic marker for plasma low-density lipoprotein cholesterol levels and severity of coronary atherosclerosis Chen, S. N., C. M. Ballantyne, et al. (2005), J Am Coll Cardiol 45(10): 1611-9. Abstract: OBJECTIVES: We sought to determine the effects of PCSK9 variants on plasma low-density lipoprotein cholesterol (LDL-C) levels, severity of coronary atherosclerosis, and response to statin therapy in the Lipoprotein Coronary Atherosclerosis Study (LCAS) population. BACKGROUND: Mutations in PCSK9 cause autosomal-dominant hypercholesterolemia. We hypothesized that PCSK9 variants could affect plasma LDL-C in individuals with polygenic hypercholesterolemia. METHODS: We sequenced all 12 exons and boundaries to detect novel polymorphisms, and genotyped 372 subjects in LCAS and 319 subjects in a second independent population for six polymorphisms, including novel leucine repeats, by fluorescently tagged markers. We reconstructed haplotypes using a Bayesian algorithm. RESULTS: Permutation test results showed statistically significant differences in global haplotype distribution among the tertiles of LDL-C (odds ratio OR: 2.36, 95% confidence interval CI: 1.90 to 4.32, p = 0.005) and minimum lumen diameter of coronary lesions (OR: 1.83, 95% CI: 1.01 to 3.55, p = 0.045). Regression analysis identified haplotype 3 as an independent determinant of LDL-C levels (adjusted R2 = 2.2%, F = 9.37, p = 0.002). Haplotype structure analysis identified E670G as the determinant variant, exerting a dose effect (GG > EG > EE) and accounting for 3.5% of plasma LDL-C variability (F = 14.6, p < 0.001). Plasma total cholesterol, apolipoprotein B, and lipoprotein (a) levels were also associated with the E670G variant. Distributions of the E670G genotypes in an independent normolipidemic and the hyperlipidemic LCAS populations were significantly different (F = 7.2, p = 0.027). No significant treatment-by-genotype interactions were detected. The false positive report probability was between 2% and 8%. CONCLUSIONS: Haplotype 3 encompassing the E670G variant is an independent determinant of plasma LDL-C levels and the severity of coronary atherosclerosis. |
| A community-based education program for serum cholesterol reduction in urban hypercholesterolemic persons--comparison of intensive and usual education groups Iso, H., M. Konishi, et al. (1991), Nippon Koshu Eisei Zasshi 38(9): 751-61. Abstract: A community-based education program was conducted for persons found to be hypercholesterolemic by screening during cardiovascular surveys, in an urban population, to evaluate the feasibility and effect of the program in primary prevention of coronary heart disease. The subjects were men and women aged 40-64 living in the suburbs of Osaka whose serum total cholesterol was between 240 and 299 mg/dl in both the 1988 and the 1989 surveys. Persons with hypothyroidism, those taking medication for hypercholesterolemia or hypertension, and with a history of stroke and coronary heart disease were excluded. Of the 111 persons who were eligible, 104 persons were recruited for the program on March, 1989. The 104 persons were randomly assigned to either an intensive education group (n = 51) or a usual education group (n = 53). For the intensive education group, seven education classes were held from April to November, 1989. Lectures, practice sessions, interviews, and spot cholesterol measurements were conducted in a local community center. The usual education group received a letter with results from the 1989 survey and dietary instruction in April 1989 and an education class in September 1989. Mean serum cholesterol in the intensive education group showed a 10.0 mg/dl greater reduction in September 1989 and a 9.0 mg/dl greater reduction in March 1990 than in the usual education group (p less than 0.05) while mean HDL-cholesterol did not change in either groups. The intensive education group reported a larger decrease in the dietary frequency of chicken egg, poultry skin and small fishes, foods which are rich in saturated fat and cholesterol. The frequency of fatty meat, butter and fish eggs was low in both groups and did not differ between the two groups after the one-year program. These results indicate that a population-based education program is feasible and effective in reducing serum total cholesterol of hypercholesterolemic persons. |
| A community-based, randomized trial of ezetimibe added to statin therapy to attain NCEP ATP III goals for LDL cholesterol in hypercholesterolemic patients: the ezetimibe add-on to statin for effectiveness (EASE) trial Pearson, T. A., M. A. Denke, et al. (2005), Mayo Clin Proc 80(5): 587-95. Abstract: OBJECTIVE: To determine the extent of reduction in low-density lipoprotein cholesterol (LDL-C) level and improvement in National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) LDL-C goal attainment when ezetimibe was added to ongoing statin therapy in a diverse population of community-based patients. PATIENTS AND METHODS: In this multicenter, double-blind, placebo-controlled trial (from January 2003 to August 2003), hypercholesterolemic patients (from 299 US primary care and specialty practices) with LDL-C levels exceeding NCEP ATP III goals were randomized (2:1) to receive ezetimibe (10 mg/d) or placebo in addition to their ongoing statin therapy for 6 weeks. RESULTS: In a study of 3030 randomized patients, ezetimibe added to statin therapy significantly reduced the LDL-C level by an additional 25.8% in the total population, compared with an additional 2.7% reduction with placebo plus statin (treatment difference, -23.1%; P<.001); the treatment difference ranged from -19.9% to -24.0% (P<.001) in each NCEP ATP III risk category subgroup. Significantly (P<.001) more patients (71.0%) treated with ezetimibe added to statin reached their NCEP ATP III target LDL-C level compared with those treated with placebo plus statin (20.6%). The addition of ezetimibe also resulted in improvement in other lipid parameters and high-sensitivity C-reactive protein levels. These benefits were consistent across sex, race, age, statin brand, and dose subgroups. Ezetimibe plus statin therapy was well tolerated, with a safety profile similar to placebo plus statin. CONCLUSION: Across multiple subgroups, ezetimibe added to statin therapy consistently produced significant additional improvements in LDL-C levels and goal attainment, as well as in other lipoproteins, compared with addition of placebo. The addition of ezetimibe to statin therapy should be considered for patients not achieving their NCEP ATP III LDL-C goals while receiving statin therapy alone. |
| A community-wide survey of physician practices and attitudes toward cholesterol management in patients with recent acute myocardial infarction Yarzebski, J., C. F. Bujor, et al. (2002), Arch Intern Med 162(7): 797-804. Abstract: BACKGROUND: Physicians' current attitudes and practices toward the management of high cholesterol levels in patients with recent acute myocardial infarction are not well defined. OBJECTIVE: To examine threshold levels of serum cholesterol and other factors that influence physicians' decision to prescribe lipid-lowering drugs and initiate dietary therapy in patients with recent acute myocardial infarction. METHODS: Community-wide questionnaire survey of general internists, cardiologists, and family physicians practicing in the Worcester, Mass, metropolitan area. RESULTS: Among the 257 responding physicians, lipid-lowering drug therapy was more likely to be initiated in younger patients at lower total serum and low-density lipoprotein (LDL) cholesterol levels than in older patients (P =.03). Younger physicians were more likely to initiate dietary and lipid-lowering drug therapy at lower total and LDL cholesterol levels than their older counterparts. Younger physicians also considered LDL cholesterol level the most important factor in initiating lipid-lowering drug therapy in contrast to older physicians who favored total cholesterol level (P =.001). General practice physicians were more likely to initiate dietary therapy at lower total cholesterol levels, but tended to initiate lipid-lowering drug therapy at higher total and LDL cholesterol levels compared with internists and cardiologists. Physicians reported that the most important factors that interfere with patients' use of lipid-lowering medication were concerns about medication costs, issues related to polypharmacy, and failure to recognize the importance of lipid-lowering drugs. Several physician-associated factors, including perceived importance of other cardiac drugs and provider responsibility, were associated with the nonuse of lipid-lowering medications. CONCLUSION: Educational and practice-based efforts remain necessary to remove potential barriers to the implementation of effective long-term cholesterol management in patients with recent acute myocardial infarction. |