| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| Cholesterol management in high-risk patients without heart disease. When is lipid-lowering medication warranted for primary prevention? Grundy, S. M. (1998), Postgrad Med 104(5): 117-20, 123-4, 129. Abstract: A particularly important question for primary prevention of CHD is when to initiate cholesterol-lowering drugs in patients at risk. The two most important factors to consider are the serum LDL cholesterol level and the absolute risk, based on the presence or absence of other risk factors. The intensity of therapy can be modified according to the other risks at play. For example, diabetes mellitus is a particularly powerful risk factor for morbidity and mortality from CHD. Therefore, middle-aged or elderly diabetic patients can reasonably be treated as if they already have established CHD. Other risk factors are less dangerous, but when a patient has several such factors, intensive cholesterol-lowering therapy often is indicated. Except for patients at highest risk, a 3- to 6-month trial of nondrug therapy is warranted in an effort to achieve the target of therapy without drugs or with low doses of drugs. If patients are appropriately selected for therapy, cholesterol management for primary prevention of CHD should rival secondary prevention in reducing the burden this disorder imposes on society. |
| Cholesterol management in the era of managed care Grundy, S. M. (2000), Am J Cardiol 85(3A): 3A-9A. Abstract: Several large controlled clinical trials have documented that cholesterol lowering causes a marked reduction in major coronary events in patients with established coronary heart disease. Cholesterol lowering thus joins other proven therapies for risk reduction in secondary prevention. The need to include cholesterol-lowering therapy in secondary prevention has been endorsed as a new practice measure in the Health Plan Employer Data Information Set. This endorsement ensures that managed care will get behind the effort to better control cholesterol in patients with coronary heart disease. The next issue is whether managed care will support cholesterol-lowering therapy in primary-prevention patients. The patients at highest risk for developing coronary heart disease are those with noncoronary forms of atherosclerotic disease, type 2 diabetes, multiple risk factors, and risk factors plus evidence of advanced subclinical atherosclerosis. Such patients can be said to have coronary heart disease risk equivalents. These patients should be good candidates for aggressive cholesterol management. A strong case can be made for managed-care support for this approach. Support for treatment of patients at lower risk may be open to some question, but the current guidelines of the National Cholesterol Education Program provide a strong rationale for cholesterol management for primary prevention in the medical setting. |
| Cholesterol management in women and the elderly LaRosa, J. C. (1997), J Intern Med 241(4): 307-16. Abstract: Women, like men, die mostly of coronary atherosclerosis, although atherosclerotic death in women occurs 5-10 years later than in men. Major risk factors predict coronary risk in women and men. What evidence is available suggests that women, similar to men, benefit from cholesterol lowering. Older individuals with symptomatic coronary disease but a relatively good prognosis should be offered the same benefits from secondary prevention as younger individuals. |
| Cholesterol management of patients with diabetes in a primary care practice-based research network Fuke, D., J. Hunt, et al. (2004), Am J Manag Care 10(2 Pt 2): 130-6. Abstract: OBJECTIVE: To determine the proportion of diabetic patients with and without coronary heart disease (CHD) who attained the American Diabetes Association recommended low-density lipoprotein cholesterol (LDL-C) target level of < or = 2.60 mmol/L (< or = 100 mg/dL). STUDY DESIGN: Retrospective cross-sectional study. METHODS: Patients were identified by searching an electronic medical record database from March 1997 through March 2001. Search strategies included a problem list entry of diabetes mellitus or CHD, a medication in the antidiabetic or nitrate class, or a glycosylated hemoglobin value of > or = 7.0%. Additional information included patient demographics, last LDL-C level, and use of a lipid-lowering agent. RESULTS: The study identified 10,201 patients (4844 with diabetes only, 1243 with diabetes plus CHD, and 4114 with CHD only). A greater proportion of patients who had diabetes and CHD attained the LDL-C target goal compared with patients who had diabetes only (32.1% vs 18.1%; P <.001). Furthermore, patients with diabetes plus CHD were more likely to have a LDL-C level measured within the past year (50.2% vs 42.5% respectively; P <.001). Multivariate logistic regression analysis revealed several factors associated with LDL-C goal attainment, including prior history of CHD, lipid-lowering therapy, tight glycemic control, HMO insurance, and a family medicine provider. CONCLUSION: Although LDL-C goal attainment in patients with diabetes plus CHD was significantly better than that in patients with diabetes only, the prevalence of inadequate control in these high-risk populations is of national concern. |
| Cholesterol management: guidelines have changed, although diet is still central Stoy, D. B. (1994), Aaohn J 42(3): 102-7. Abstract: 1. The second report of the National Cholesterol Education Program's Adult Treatment Panel re-emphasizes low density lipoprotein cholesterol as the main target of cholesterol lowering therapy; dietary therapy as the first line approach to cholesterol management; and the reservation of drug therapy for clients at high risk for coronary heart disease (CHD). 2. In the new treatment guidelines, the type and intensity of cholesterol treatment, which now involves a greater emphasis on the high density lipoprotein cholesterol level, is guided by the client's CHD risk status. 3. Under the new recommendations, dietary management of high blood cholesterol, which is the cornerstone of cholesterol intervention, should also include greater attention to increasing the client's physical activity and losing weight if needed. 4. The new cholesterol intervention guidelines not only provide occupational health nurses with new directions for cholesterol intervention, but reinforce the critical role of nurses in providing a more holistic, integrated approach to risk factor reduction. |
| Cholesterol management--are guidelines effective? McBride, P. and G. Underbakke (1991), J Fam Pract 33(3): 237-9. |
| Cholesterol mania Hoekelman, R. A. (1992), Pediatr Ann 21(4): 215-6. |
| Cholesterol mania Sissman, N. J. (1992), Pediatr Ann 21(8): 473. |
| Cholesterol markedly reduces ion permeability induced by membrane-bound amphotericin B Matsuoka, S. and M. Murata (2002), Biochim Biophys Acta 1564(2): 429-34. Abstract: It is widely accepted that amphotericin B (AmB) together with sterol makes a mixed molecular assemblage in phospholipid membrane. By adding AmB to lipids prior to preparation of large unilamellar vesicles (LUV), we directly measured the effect of cholesterol on assemblage formation by AmB without a step of drug's binding to phospholipid bilayers. Potassium ion flux assays based on 31P-nuclear magnetic resonance (NMR) clearly demonstrated that cholesterol markedly inhibits ion permeability induced by membrane-bound AmB. This could be accounted for by a membrane-thickening effect of cholesterol since AmB actions are known to be markedly affected by the thickness of membrane. Upon addition of AmB to an LUV suspension, the ion flux gradually increased with increasing molar ratios of cholesterol up to 20 mol%. These biphasic effects of cholesterol could be accounted for, at least in part, by the ordering effect of cholesterol. |
| Cholesterol may act as an antioxidant in lens membranes Girao, H., C. Mota, et al. (1999), Curr Eye Res 18(6): 448-54. Abstract: PURPOSE: Oxidative damage has been considered as a major factor involved in cataract formation. We have recently shown that cholesterol oxides accumulate in human cataractous lenses. The biological significance of accumulation of oxysterols in the lens is still poorly understood. However, it has been proposed that cholesterol may act as an antioxidant. This study was designed to establish whether cholesterol may act as an antioxidant in the lens. METHODS: Bovine lens membranes (BLM) were oxidised by incubation with an azo-compound. Lipid hydroperoxides were measured by the FOX-assay, vitamin E was determined by HPLC, cholesterol and cholesterol oxides were isolated in a C18 column and quantified by gas chromatography. Susceptibility of liposomes and BLM to oxidation was determined by the fluorescence quenching of parinaric acid. RESULTS: Oxidation of BLM results in the production of lipid hydroperoxides, consumption of endogenous vitamin E and formation of cholesterol oxides. Cholesterol presents some important characteristics generally ascribed to an antioxidant molecule: its presence in liposomes increases the vesicle resistance to oxidation and its oxidised forms are stable as they are unable to stimulate further propagation of peroxidation reactions. Moreover, the protective effect of cholesterol in liposomes is comparable to that of vitamin E, suggesting that cholesterol possibly acts by intercepting the peroxyl radicals formed during lipid peroxidation. CONCLUSIONS: Although cholesterol oxides may present a variety of noxious effects in the cells its presence in lens membrane is likely to be associated with the expression of its antioxidant effect, contributing to maintain lens transparency. |
| Cholesterol measurement and treatment in community practices Hudson, J. W., C. W. Keefe, et al. (1990), J Fam Pract 31(2): 139-44. Abstract: A study was designed to examine the cholesterol measurement and treatment activities of primary care physicians in community practices. Three family practices of comparable size (one faculty practice and two community small-group practices) participated in the study. A random sample of 450 adult patients (150 from each site) was drawn from patient logs using a time series sampling method. Charts were reviewed for serum lipid evaluations, documentation of coronary heart disease risk factors, lipid-lowering activities, and other coronary heart disease risk-factor interventions. Sixty-seven percent of the sample had cholesterol measures recorded. No differences were found in the rates of measurement for men and women. Multiple, detailed serum lipid evaluations were common, and recognition of high cholesterol as a problem even before 1980 was apparent. Almost one half (47%) of individuals with cholesterol greater than 5.2 mmol/L (200 mg/dL) had a charted intervention, 64% if cholesterol greater than 6.2 mmol/L (240 mg/dL). Diet was the most common intervention (73%), and medication was used in only eight cases. Nonpharmaceutical interventions appeared to be undercharted. An analysis of interpractice variations revealed strikingly consistent results, although some interesting differences were noted. These rates are at least double previously reported rates and suggest that primary care physicians play a major role in this national priority. |
| Cholesterol measurement as a screening test: a category error Borgers, D. (2003), Z Arztl Fortbild Qualitatssich 97(1): 19-26. Abstract: The measurement of cholesterol levels is a routinely used test which, is claimed to be also a screening test. However, true screening for familial hypercholesterolemia in young people must be distinguished from the so-called risk factor screening among adults, which in Germany is performed both systematically in the whole population and even more so incidentally. This risk factor approach to the measurement of cholesterol is neither a screening test nor does it aim to detect a disease early, but the rationale is a risk factor medicine approach, which has to be evaluated according to its own requirements. The technical efficiency of cholesterol measurement as a screening test is so low, that the notion of screening represents a misnomer and a category error. The measurement of risk factors in a screening context and as a method of individual primary preventive medicine has led to unsolvable problems. A consensus has been achieved, that only a multiple risk factor approach is worthwhile, though the individual and the community approach are both only marginally effective in primary prevention, as has been shown in meta-analyses. Prescription for chemoprophylaxis with statins has shown a relevant risk reduction, but has only been evaluated as a high-risk approach with a cardiovascular risk of 2-3% per year. |
| Cholesterol measurement by reflotron dry chemistry in infants, children and adults Lapinleimu, H., J. Viikari, et al. (1994), Scand J Clin Lab Invest 54(1): 61-5. Abstract: Cholesterol values measured with the Reflotron dry chemistry (Boehringer Mannheim, Mannheim, Germany) and enzymatic (CHOD-PAP) routine method in 4150 venous blood samples from 580 infants aged 7 months, 1778 children aged 13 months to 19 years, and 1792 adults aged 18-63 years showed good correlation between the two assay systems (r > 0.92). However, the mean cholesterol concentrations were 4.5%, 3.7% and 2.3% lower in infants, children and adults, respectively, if measured with the Reflotron analyser as compared with values obtained with the CHOD-PAP method. These differences in the values were greater when cholesterol values were low (significance for the slope of regression line, p < 0.001). Values were below the detection limit of the Reflotron assay (2.59 mmol l-1) in 104 (4.4%) and 4 (0.2%) of all paediatric and adult samples, respectively. When measured with the CHOD-PAP method, 75 (72%) and 3 (75%) of these same samples showed values which exceeded the 2.59 mmol l-1 detection limit. We conclude that Reflotron dry chemistry analyser is precise in fast measurement of serum cholesterol both in all paediatric subjects and adults. A particular problem in paediatric age groups is that about 4% of children have values below the detection limit of the Reflotron analyser. |
| Cholesterol measurement in children Einhorn, P. T. and B. M. Rifkind (1993), Am J Dis Child 147(4): 373-5. |
| Cholesterol measurement in general practice--the attitude of Norwegian practitioners and their own practice? Graff-Iversen, S. (1990), Tidsskr Nor Laegeforen 110(13): 1744-5. |
| Cholesterol measurement in high-risk patients McCance, A. (1992), Br J Hosp Med 48(1): 62. |
| Cholesterol measurements in patients' sera stored at 4 or -20 degrees C for 24 h before analysis with a Kodak Ektachem 700 analyzer Hartley, T. F. and R. S. David (1992), Clin Chem 38(6): 1191-2. |
| Cholesterol measures to identify and treat individuals at risk for coronary heart disease Natarajan, S., H. Glick, et al. (2003), Am J Prev Med 25(1): 50-7. Abstract: BACKGROUND: Low-density lipoprotein (LDL)-based guidelines are currently used to initiate and monitor cholesterol-lowering therapy. METHODS: Using stratified analyses, data from the Framingham Heart Study and the Coronary Primary Prevention Trial were evaluated to determine whether (1) cholesterol levels (total cholesterol TC or LDL low-density lipoprotein) better discriminated risk for coronary heart disease (CHD) than cholesterol ratios (LDL/HDL high-density lipoprotein or TC/HDL); and (2) whether changes in ratios better predicted risk reduction than changes in levels. RESULTS: Individuals with similar LDL/HDL ratios had similar risks for CHD regardless of whether they had high LDL levels or low LDL levels (23% vs 23% for the CPPT, 13.8% vs 14% for FHS men, and 8.6% vs 10.9% for FHS women). Among men with similar initial LDL/HDL ratios and similar changes in LDL/HDL ratios, risks for CHD did not differ (20.3% compared with 21.0%; p =0.96) between those with the largest and smallest reductions in LDL levels (21.3% compared with 6.5%). Among men with similar initial LDL levels and similar LDL reductions, a 20% reduction in risk for CHD was seen (19.5% compared with 24.5%; p =0.005) between those with the largest and smallest reductions in LDL/HDL ratios (23% compared with 4.6%). TC/HDL had predictive ability similar to LDL/HDL. CONCLUSIONS: Cholesterol levels do not provide incremental predictive value over cholesterol ratios in identifying people at risk for CHD. Changes in ratios are better predictors of successful CHD risk reduction than changes in levels. Future guidelines should consider incorporating ratios in initiating and monitoring successful lipid-lowering therapy. |
| Cholesterol mediated changes in beta-glucuronidase activities of rat theca interstitial cells and granulosa cells Patil, S. and A. Kanase (1995), Indian J Exp Biol 33(5): 321-4. Abstract: Effects of steroid hormones on beta-glucuronidase activities of granulosa cells and theca interstitial cells were studied in vitro in the presence and absence of cholesterol in minimum essential medium (MEM with Hank's salts). Conspicuous fall in the enzyme activities of both these cells were noticed during first 10 min of incubation in MEM without cholesterol and remained lower throughout the experiment. Addition of cholesterol to incubation medium maintained beta-glucuronidase activities of both the cells as observed in the cells of immature ovary immediately after isolation. 17 beta-estradiol did not affect beta-glucuronidase activities of these cells, while testosterone and progesterone suppressed the enzyme activities of these cells in the presence of cholesterol. |
| Cholesterol metabolic disorders and Alzheimer's disease Hao, J. W. and L. Li (2005), Sheng Li Ke Xue Jin Zhan 36(1): 64-6. |