| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| Clinical assessment alone will not benefit patients with coronary heart disease: failure to achieve cholesterol targets in 12,045 patients--the Healthwise II study Brady, A. J., J. B. Pittard, et al. (2005), Int J Clin Pract 59(3): 342-5. Abstract: Healthwise II, a nurse-led audit programme in primary care during 1999-2002, assessed the uptake of secondary preventative measures for coronary heart disease (CHD). Risk factors, cardiovascular medications and blood cholesterol were recorded; 'at risk' patients were invited for a review after 6 months. Of 17,570 patients assessed, CHD was clinically present in 12,045 (69%); in these, aspirin usage was high (78%) but fewer patients were on a beta-blocker (40%), angiotensin-converting enzyme inhibitor (27%) or statin (49%). Blood pressure (BP) was controlled (<140/90) in only 41% of patients. Total cholesterol was >5 mmol/l in 49% of all CHD patients, half of whom were taking a statin. In the statin users, total cholesterol was uncontrolled (>5 mmol/l) in 38%. At follow-up, BP control remained at 42%, statin use increased to 57% and cholesterol remained elevated in 46%. Simple assessment in an audit programme fails to trigger change, and risk-factor modification for CHD remains inadequate. |
| Clinical benefits and cost-effectiveness of lowering serum cholesterol levels: the case of simvastatin and cholestyramine in The Netherlands Martens, L. L., F. F. Rutten, et al. (1990), Am J Cardiol 65(12): 27F-32F. Abstract: To assess the cost-effectiveness of cholesterol-reducing therapy with cholestyramine and simvastatin in the primary prevention of coronary artery disease in The Netherlands, a model of coronary artery disease incidence was used based on multivariate logistic risk functions from the Framingham study. For men with initial cholesterol levels of 8 mmol/liter, the cost per year of life saved of cholestyramine, expressed in Dutch guilders (NLG; 1 NLG = $0.50), ranges from approximately NLG 208,000 to NLG 483,000, depending on the patient's age at initiation of therapy. For simvastatin, cost-effectiveness ranges from NLG 46,000 to NLG 98,000 per year of life saved among this group of men. Similar differences between simvastatin and cholestyramine therapy prevail among women, although the costs per year of life saved for both agents are considerably higher. These results suggest that (1) simvastatin is substantially more cost effective than is cholestyramine; (2) simvastatin therapy compares favorably with other generally accepted medical practices, especially if treatment is initiated at an early age; and (3) as its long-term safety record becomes more established, simvastatin may become accepted as a drug of first choice in the treatment of persons with elevated serum cholesterol levels. |
| Clinical characteristics and coronary risk factors of patients with low concentrations of serum low-density lipoprotein cholesterol and total cholesterol Lien, W. P., L. P. Lai, et al. (1998), J Formos Med Assoc 97(11): 745-9. Abstract: We investigated the clinical characteristics and coronary risk factors of Chinese patients with suspected coronary artery disease (CAD) having low serum concentrations of both low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). Of 1,450 patients with suspected CAD (age range, 30-92 years; 948 men and 502 women), 760 had established CAD. The patients were divided into three groups according to lipid profile patterns. Group 1 patients (n = 138) had low LDL-C concentrations (< 100 mg/dL) and low TC concentrations (< 160 mg/dL). They were characterized by lower triglyceride concentrations, lower frequencies of high TC/high-density lipoprotein cholesterol (HDL-C) ratios (> 5) and LDL-C/HDL-C ratios (> 5), and lower frequencies of a family history of CAD and obesity. Group 3 patients (n = 610) had LDL-C concentrations of 130 mg/dL or above and TC concentrations of 200 mg/dL or above, much higher than in group 1. The prevalence of CAD was 41.3% (57/138) in group 1. 46.7% (328/702) in group 2, and 61.5% (375/610) in group 3. Groups with higher TC and LDL-C concentrations had a higher CAD prevalence. Coronary risk factors of group 1 patients appeared to be low HDL-C concentration, high TC/HDL-C ratio, advanced age, cigarette smoking, hypertension, and diabetes mellitus. Among these risk factors, HDL-C and hypertension were independent predictors of CAD. Unlike in the other two groups, hypertension was the only independent nonlipid risk factor. We conclude that in therapy or prevention of CAD, the goals should be to reduce LDL-C concentration to below 100 mg/dL and the TC concentration to below 160 mg/dL. However, other risk factors should also be considered. |
| Clinical correlates of gallstone composition: distinguishing pigment from cholesterol stones Diehl, A. K., W. H. Schwesinger, et al. (1995), Am J Gastroenterol 90(6): 967-72. Abstract: OBJECTIVES: The prevalence of cholelithiasis has been established in population-based surveys employing ultrasonography, and major risk factors have been identified. However, the clinical and epidemiological features that distinguish patients with pigment gallstones from those with cholesterol stones have received little attention. METHODS: We prospectively surveyed 551 patients undergoing cholecystectomy for gallstones at two teaching hospitals. Clinical and epidemiological data were collected during patient interviews and by chart review. Gallstones were collected at surgery; physical measurements were recorded, and stone composition was determined by visual inspection and infrared spectroscopy. RESULTS: Patients with pigment stones were older than patients with cholesterol stones (p < 0.00001). Almost all patients under age 40 yr old had cholesterol stones, but most patients over 70 had pigment stones. Cirrhosis was strongly associated with pigment gallstones (p < 0.00001), although alcohol consumption was unrelated. Univariate analyses suggested associations of stone composition with male sex, diabetes mellitus, educational attainment, and use of thiazides or oral contraceptives, but these were not significant in a logistic regression that adjusted for age, cirrhosis, and other variables. Patients with pigment cholelithiasis had stones that were generally smaller in diameter and fewer in number than those with cholesterol stones. CONCLUSIONS: Compared to patients with cholesterol gallstones, those with pigment stones are older and more likely to have a diagnosis of cirrhosis. In addition, their stones are smaller in size and fewer in number than those from patients with cholesterol cholelithiasis. |
| Clinical disorders associated with abnormal cholesterol transport: mutations in the steroidogenic acute regulatory protein Stocco, D. M. (2002), Mol Cell Endocrinol 191(1): 19-25. Abstract: The transport of cholesterol to the inner mitochondrial membrane of steroidogenic cells constitutes the rate-limiting step in trophic hormone regulated steroid biosynthesis and requires de novo protein synthesis. Several years ago a candidate regulator protein was purified and its cDNA cloned from MA-10 mouse Leydig tumor cells. Expression of this protein resulted in an increase in steroidogenesis in unstimulated cells and it was named the Steroidogenic Acute Regulatory protein or StAR. Mutations in the StAR gene were found to be the cause of the potentially lethal disease in humans known as congenital lipoid adrenal hyperplasia (lipoid CAH), a condition characterized by an almost complete inability of the newborn to synthesize steroids. The defect in steroid synthesis in lipoid CAH is caused by the failure of affected individuals to transport cholesterol to the inner mitochondria membrane, thus proving the essential role of StAR in cholesterol transport. StAR null mice display a phenotype that is essentially identical to the human condition. In summary, both naturally occurring disorders in humans and genetic manipulation in mice have demonstrated that the StAR protein is an absolute requirement in the rate-limiting step in steroidogenesis, the transfer of cholesterol into the mitochondria. |
| Clinical effects of cholesterol supplementation in six patients with the Smith-Lemli-Opitz syndrome (SLOS) Elias, E. R., M. B. Irons, et al. (1997), Am J Med Genet 68(3): 305-10. Abstract: We describe the clinical effects of cholesterol supplementation in 6 children with the RSH-"Smith-Lemli-Opitz" syndrome (SLOS). The children ranged in age from birth to 11 years at the onset of therapy, with pretreatment cholesterol levels ranging from 8 to 62 mg/dl. Clinical benefits of therapy were seen in all patients, irrespective of age at onset of treatment, or severity of cholesterol defect. Effects of treatment included improved growth, more rapid developmental progress, and a lessening of problem behaviors. Pubertal progression in older patients, a better tolerance of infection, improvement of gastrointestinal symptoms, and a diminution in photosensitivity and skin rashes were also noted. There were no adverse reactions to treatment with cholesterol. This preliminary study suggests that cholesterol supplementation may be of benefit to patients with the SLOS. |
| Clinical effects of direct adsorption of lipoprotein apheresis: beyond cholesterol reduction Bosch, T. and C. Keller (2003), Ther Apher Dial 7(3): 341-4. Abstract: Direct adsorption of lipoproteins (DALI) from whole blood is the first LDL hemoperfusion technique for extracorporeal LDL and Lp(a) elimination without initial plasma separation. Thus, this technique is characterized by high user-friendliness. In a long-term multicenter study, LDL and lipoprotein (a) (Lp(a)) reductions were 69% and 64%, respectively, per session. Adverse effects were rare, as 95% of the sessions were uneventful. Biocompatibility studies showed only minor blood-adsorber interactions for most parameters; however, there was a significant bradykinin generation. After a single session, significant reductions of plasma viscosity, erythrocyte aggregation and adhesion molecules were documented. A retrospective analysis of 18 chronic DALI patients revealed that in the majority of patients, symptoms like angina and dyspnea as well as their general status and subjective well-being improved significantly. Moreover, the objective cardiovascular event rate (MACE) decreased from a total of 26 in the 3-year period prior to DALI to 6 during a mean follow-up of 3.8 years during chronic DALI therapy. Thus, the average event rate of 0.48 per patient year at baseline could be significantly reduced to 0.09 (P < 0.004) by DALI. This impressive improvement of symptoms and coronary events can hypothetically be related to the improvement of hemorheology and the transformation of unstable into stable plaques by DALI LDL apheresis. |
| Clinical effects of mandibular fixation on cholesterol intake and serum lipids: a case study Harkey, A. L. (1990), J Am Diet Assoc 90(1): 102-3. Abstract: With cholesterol and saturated fat intake strictly controlled and monitored, the opportunity arose to study the effect of stress on the elevation of cholesterol levels (7). Results indicate significant increase in fasting lipids preoperatively (Table 1). Postoperatively, lipid levels dropped immediately and leveled out to a normal range for this patient and were maintained through the 6-month follow-up blood analysis. As lipids increased, the cardiovascular risk factors remained fairly consistent because of a similar elevation of all lipids. This supports the research that stress releases catecholamines, which raise free fatty acid levels in the blood stream (8,9). This case study does suggest that there is a relationship between elevated serum lipid levels and emotional stress (10). A total liquid diet for 6 to 8 weeks can modify cholesterol intake. This case study is unique because the patient consumed only low-cholesterol, low-saturated fat foods and liquids and nutritional supplements and was acutely aware of meeting nutritional requirements (6). The average patient undergoing oral surgery with mandibular fixation typically selects whole milk products, ice cream, and other high-cholesterol liquids in order to increase total caloric intake. |
| Clinical efficacy of the direct assay method using polymers for serum high density lipoprotein cholesterol Shirai, K., T. Nema, et al. (1997), J Clin Lab Anal 11(2): 82-6. Abstract: The clinical efficacy and accuracy of the homogeneous assay method for the serum high density lipoprotein (HDL)-cholesterol determination were evaluated. The principle is as follows: low density lipoproteins (LDL) and very low density lipoproteins (VLDL) were coated by polymers and polyanion to be blocked from cholesterol esterase and cholesterol oxidase. The reaction of these enzymes for HDL cholesterol was enhanced with a detergent, and HDL cholesterol was selectively measured. Both within-run (n = 3, 20 times) and between-run (n = 3, 7 days) CVs were < 2%. The repeated freezing and thawing (4 times) of three distinct sera resulted in no changes of HDL cholesterol values. Additions of lipid emulsion (Triglyceride = 100 mg/dl) and free bilirubin (20 mg/dl) gave no effect. Linearity was found up to 300 mg/dl. Increases in HDL cholesterol values by the addition of VLDL (total cholesterol (TC) = 300 mg/dl) or LDL (TC = 300 mg/dl) to the tested sera were < 0.5%. The correlation coefficient of the new method with a precipitation method was 0.995 (n = 64). HDL-C values for patients with hyperlipidemia (Type IIa, IIb, or III, IV, and V) by this method were comparable with those obtained by the precipitation method. From these results, we concluded that the new method meets the requirements for accuracy, precision, ease of handling massive samples, and was clinically useful. |
| Clinical evaluation of a selective inhibitor of cholesterol synthesis: pravastatin Alessandri, C. and F. Peverini (1992), Minerva Med 83(11): 677-93. Abstract: The recent introduction in clinical practice of a new class of drugs able to reduce the endogenous synthesis of cholesterol has undoubtedly made a noteworthy contribution to the treatment of hypercholesterolaemia which, as is well known, is one of the greatest risk factors in the natural history of atherosclerotic disease and of its cardiovascular complications. A last generation drug belonging to this family is pravastatin which differs from the other substances inhibiting the activity of the key enzyme of cholesterol metabolism, HMGCaA reductase, because of certain features of the molecule, such as hydrophilia and the fact it is already pharmacologically active at the moment of oral administration. Pravastatin, which is probably a special category of HMGCoA reductase inhibitor, has shown, in numerous experimental studies and controlled clinical trials, a notable effectiveness in reducing in a highly selective fashion the synthesis of cholesterol in the liver cells and consequently the number of cholesterol-rich lipoproteins in the systemic circulation, without also determining significant biologically negative side-effects. |
| Clinical evaluation of two kinds homogenous assays for determination of high-density lipoprotein cholesterol Yan, S. K., F. Q. Ren, et al. (2002), Zhongguo Yi Xue Ke Xue Yuan Xue Bao 24(3): 325-8. Abstract: OBJECTIVE: To evaluate the clinical efficacy of two kinds homogenous assays for direct determination of high-density lipoprotein cholesterol (HDL-C) based on the principle of polyanion polymer/detergent (PPD method) and polyethylene glycol-modified enzyme (PEGME) method. METHODS: The two homogenous methods were compared with the precipitation method (PTA-Mg2+ method), their precision, accuracy, specificity and interference were also analyzed. RESULTS: Both homogenous HDL-C assays were precise, having a within-run CV < 3%, day-to-day CV < 3% and total CV < 4%. The HDL-C values measured by the two homogenous methods correlated well with those by PTA-Mg2+ method (X): Y = 0.9316 X + 0.1063, r = 0.9762 for PPD method (Y); and Y = 0.9106 X + 0.1368, r = 0.9894 for PEGME method (Y). The linearity studies showed the two homogenous methods to be linear up to 4.14 mmol/L. The lowest detectable concentration of the two methods was apparently 0.08 mmol/L. Recoveries of the two methods were 94.1%-106.2%. Hemoglobin did not interfere with the HDL-C results in the two homogenous methods, whereas icteric samples with total bilirubin > 200 mg/L showed discrepancies. Lipemia up to triglyceride concentration of 17.0 mmol/L did not interfere with the two homogenous HDL-C assays. CONCLUSIONS: The two new homogenous HDL-C assays meet the requirements for accuracy, precision, ease of handling with massive sample, allow full automation, and are clinically useful. |
| Clinical goals and performance measures for cholesterol management in secondary prevention of coronary heart disease Lee, T. H., J. I. Cleeman, et al. (2000), Jama 283(1): 94-8. Abstract: Guidelines from the National Cholesterol Education Program (NCEP) recommend reduction of low-density lipoprotein cholesterol (LDL-C) to 100 mg/dL (2.59 mmol/L) or less in patients with established coronary heart disease (CHD). However, the National Committee for Quality Assurance (NCQA) is implementing a new performance measure as part of the Health Plan Employer and Data Information Set (HEDIS) that appears to endorse a different target. The new HEDIS measure will require managed care organizations seeking NCQA accreditation to measure and report the percentage of patients who have had major CHD events who achieve LDL-C levels less than 130 mg/dL (3.36 mmol/L) between 60 and 365 days after discharge. These different LDL-C thresholds emphasize the difference between a clinical goal for the management of individual patients (< or =100 mg/dL) and a performance measure used to evaluate the care of a population of patients (<130 mg/dL). This article discusses the rationale for each threshold and explains the use of 2 different thresholds for these 2 purposes. Both the NCQA and NCEP expect that the new HEDIS measure will encourage managed care organizations to develop systems that improve secondary prevention of CHD. |
| Clinical inquiries. Should we treat elevated cholesterol in elderly patients? Korsen, N., E. Nowicki, et al. (2002), J Fam Pract 51(8): 680. |
| Clinical inquiries. What is the target for low-density lipoprotein cholesterol in patients with heart disease? Stevermer, J. J. and S. E. Meadows (2002), J Fam Pract 51(10): 893. |
| Clinical inquiries. What levels of cholesterol should be treated for primary prevention? Seaton, T. L. and S. Meadows (2002), J Fam Pract 51(5): 423. |
| Clinical issues in cholesterol testing Cooper, G. R. and G. L. Myers (1991), J Med Assoc Ga 80(5): 301-3. Abstract: Lipid investigators have begun to examine the biological sources of variation in serum cholesterol levels and to seek ways to accurately measure the total cholesterol (TC) level in the serum of a patient. A person's TC level varies primarily because of the effects from seasonal changes, behavioral changes, and illness. Results of studies of the effect of seasonal changes indicate that serum TC and obesity increase during winter and decrease during summer. Behavioral sources of variation include diet, alcohol intake, smoking, and exercise. Clinical sources of TC level variation include all illnesses. The physician can help control sources of variation by recognizing their causes, by advising of the effect that behavioral risk factors have on cholesterol levels, and by using the average of results for multiple specimens to estimate the true value of serum cholesterol in a patient. |
| Clinical practice. Low HDL cholesterol levels Ashen, M. D. and R. S. Blumenthal (2005), N Engl J Med 353(12): 1252-60. |
| Clinical prevention of coronary heart disease through cholesterol-lowering therapy Grundy, S. M. (1997), Curr Ther Endocrinol Metab 6: 520-6. |
| Clinical reality of lowering total and LDL cholesterol Frye, R. L. (1997), Circulation 95(2): 306-7. |
| Clinical remission is associated with restoration of normal high-density lipoprotein cholesterol levels in children with malignancies Dessi, S., B. Batetta, et al. (1995), Clin Sci (Lond) 89(5): 505-10. Abstract: 1. Serum lipids and lipoprotein profiles were determined in children affected by different types of malignancies (leukaemias or lymphomas and solid tumours) both before any treatment and after remission of the disease following chemical or surgical therapy. 2. At the time of diagnosis, children bearing tumours showed hypertriglyceridaemia and reduced concentrations of plasma high-density lipoprotein cholesterol levels, the decrease being particularly prominent in patients with haematological tumours. Children bearing solid tumours displayed an increase of total cholesterol, while those with haematological cancer showed decreased phospholipid levels; low-density lipoprotein cholesterol in neoplastic patients was not significantly different from control values. High triacylglycerol and low high-density lipoprotein cholesterol levels were also evident in cancer patients divided according to age into three groups (0-5, 6-10 and 11-15 years) when compared with age-matched control subjects. Similarly, high triacylglycerol and low high-density lipoprotein cholesterol levels were also observed in both male and female children when patients were divided according to sex and compared with corresponding controls. 3. Clinical remission after therapy was accompanied by an increase of high-density lipoprotein cholesterol levels compared with values observed at diagnosis. In contrast, post-treatment levels of triacylglycerol were higher than those observed before therapy. These results support the hypothesis that alterations of high-density lipoprotein cholesterol levels may be related, at least in part, to the rate of tumour growth, while modifications of triacylglycerol levels may be mediated by different mechanisms. |