| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| High-density lipoprotein (HDL), HDL2, and HDL3 cholesterol concentrations determined in serum of newborns, infants, children, adolescents, and adults by use of a micromethod for combined precipitation ultracentrifugation Asayama, K., A. Miyao, et al. (1990), Clin Chem 36(1): 129-31. Abstract: Cholesterol (C) concentrations in the two major subfractions of high-density lipoproteins (HDL2-C and HDL3-C) in sera from both sexes, ages ranging from newborns to adults, were measured by use of a micromethod for combined precipitation-ultracentrifugation. Sera were obtained from 91 boys, 68 girls, 15 healthy men, and 14 women. The HDL2-C concentration was higher in women than in men; the HDL3-C concentration was similar in these two groups. This sex-related difference, generally seen in adults, was found to begin at ages 11-15 y. The value of HDL2-C in females increased with age in a stepwise manner, whereas that in males increased up to ages 6-10 y but tended to decline thereafter. The HDL3-C concentration was higher in the adults than in the children. This micromethod for separating operationally defined HDL subfractions is of value for lipoprotein research in children. |
| High-density lipoprotein 3 physicochemical modifications induced by interaction with human polymorphonuclear leucocytes affect their ability to remove cholesterol from cells Cogny, A., V. Atger, et al. (1996), Biochem J 314 (Pt 1): 285-92. Abstract: 1. We have recently reported that a short incubation (60 min) in vitro of high-density lipoprotein (HDL) 3 with human polymorphonuclear leucocytes (PMNs) leads to a proteolytic cleavage of apolipoprotein (apo) AII and to a change in the distribution of apo AI isoforms Cogny, Paul, Atger, Soni and Moatti (1994) Eur. J. Biochem. 222, 965-973. Since PMNs have been observed to be present in the earliest atherosclerotic lesions for a number of days, we investigated the HDL3 physiochemical modifications induced by in vitro interaction for a long period of time (24 h) with PMNs and the consequences of the changes on the ability of HDL3 to remove cholesterol from cells. 2. The stimulated PMN modification of HDL3 over 24 h resulted in a partial loss of protein with no variation in lipid molar ratio and a loss of 50% of HDL alpha-tocopherol content. The decrease in total protein was due first to a complete degradation of apo AII, and secondly to a partial loss of apo AI. The apo AI remaining on the particles was in part hydrolysed and the apo AI-1 isoform was completely shifted to the apo AI-2 isoform. These apo changes were accompanied by a displacement of the native HDL3 apparent size toward predominantly larger particles. 3. The ability of PMN-modified HDL3 to remove 3H-labelled free cholesterol from cells was measured in two cell lines: Fu5AH rat hepatoma cells and J774 mouse macrophages. HDL3 which had only a limited contact with PMNs (60 min) showed only a small non-significant reduction in the efficiency of cholesterol efflux. On the other hand, compared with native HDL3, HDL3 modified by PMNs for 24 h had a markedly reduced ability to remove cholesterol from cells, regardless of the type of cell. 4. The results suggest that PMN-modified HDL3, if occurring in vivo, could contribute to acceleration of the atherogenic process by decreasing the cholesterol efflux from cells. |
| High-density lipoprotein and plaque regression: the good cholesterol gets even better Dansky, H. M. and E. A. Fisher (1999), Circulation 100(17): 1762-3. |
| High-density lipoprotein cholesterol and alcohol consumption in US white and black adults: data from NHANES II Linn, S., M. Carroll, et al. (1993), Am J Public Health 83(6): 811-6. Abstract: OBJECTIVES. High-density lipoprotein (HDL) cholesterol is known to be positively related to moderate alcohol consumption from studies in selected populations. This study describes the association in a representative sample of the US adult population. METHODS. Stratification and multivariate regression analyses were used to examine HDL cholesterol levels and alcohol consumption. RESULTS. Fewer women than men reported consumption of alcohol at any frequency. Similar percentages of Whites and Blacks reported alcohol consumption. Age-adjusted mean HDL cholesterol levels were higher among alcohol drinkers than among nondrinkers in all sex-race strata. Mean HDL cholesterol levels of Whites and Blacks of both sexes increased consistently with increased frequency of consumption of beer, wine, and liquor. With age, education, body mass index, smoking, and physical activity controlled for, there were higher age-adjusted HDL cholesterol levels with increasing reported quantities of alcohol consumed. Daily or weekly use of alcohol led to an increase of 5.1 mg/dL in mean HDL cholesterol level, whereas consumption of 1 g of alcohol led to an increase of 0.87 mg/dL. CONCLUSION. Even if there is a causal association between alcohol consumption and higher HDL cholesterol levels, it is suggested that efforts to reduce coronary heart disease risks concentrate on the cessation of smoking and weight control. |
| High-density lipoprotein cholesterol and coronary artery disease: survey of the evidence Rifkind, B. M. (1990), Am J Cardiol 66(6): 3A-6A. Abstract: The epidemiologic evidence linking high-density lipoprotein (HDL) levels with coronary artery disease (CAD) is persuasive. Case-control studies have shown CAD patients to have lower HDL levels than control subjects. Several large-scale, observational epidemiologic studies in the United States and abroad have shown a strong independent inverse relation between HDL and CAD. Women have a lower incidence of CAD than men of the same age; this has been attributed to their higher HDL levels. Postmenopausal women taking estrogen replacement therapy have higher HDL and lower low-density lipoprotein (LDL) levels, and a much lower incidence of CAD. Statistical analysis suggests that much of this is attributable to HDL levels. In several clinical trials, reduced levels of total or LDL cholesterol have been accompanied by increased HDL levels. Cox proportional hazards analysis suggests that the increment in HDL levels made an independent contribution to the reduction in CAD risk. In several angiographic studies, the increase in HDL may have contributed to the decreased progression, increased stabilization and possible regression of coronary lesions. Despite this range of impressive evidence, a number of unresolved issues have prevented the emergence of a consensus regarding the prevention of CAD by increasing HDL levels. Between-population comparisons of HDL and CAD do not match the within-population relations. Animal research on the relation between HDL, atherogenesis and CAD has been relatively scanty. Although much evidence suggests that reverse cholesterol transport partially explains the protective effect of HDL, there are still doubts as to its role. Problems with measurement of HDL have inhibited widespread recommendations for its use in prevention programs.(ABSTRACT TRUNCATED AT 250 WORDS) |
| High-density lipoprotein cholesterol and coronary heart disease Young, C. E., R. H. Karas, et al. (2004), Cardiol Rev 12(2): 107-19. Abstract: There is a large body of evidence demonstrating an inverse correlation between circulating levels of high-density lipoprotein (HDL) cholesterol and cardiovascular disease risk. For every 1-mg/dL increase in HDL, it is estimated that the risk of cardiovascular events decreases by 2% to 3%. HDL is one of many factors that contribute to the regulation of the atherosclerotic process. HDL mediates reverse cholesterol transport and exhibits numerous beneficial properties, including antioxidant, antiinflammatory, and antithrombotic effects on the vasculature. Recent studies have expanded our understanding of the vasoprotective mechanisms of HDL to include enhanced nitric oxide production and improved endothelium-dependent relaxation. Progress has also been made in determining the molecular mechanisms that mediate reverse cholesterol transport. Recently published National Cholesterol Education Program Adult Treatment Panel guidelines have broadened the definition of low levels of HDL and encourage more aggressive screening and treatment of lipid abnormalities. Several therapeutic interventions can augment HDL concentrations, and there is increasing evidence that these interventions improve cardiovascular outcomes. Research focusing on defining the molecular roles of HDL will likely identify potential therapeutic targets for decreasing the incidence and progression of coronary heart disease. This review highlights the role of HDL in coronary heart disease, from basic mechanisms of action to recent clinical trial results. |
| High-density lipoprotein cholesterol and coronary, cardiovascular and all cause mortality among middle-aged Norwegian men and women Stensvold, I., P. Urdal, et al. (1992), Eur Heart J 13(9): 1155-63. Abstract: From 1977 to 1982 screening for cardiovascular disease was performed in three Norwegian counties. All those aged between 40 and 54 years were invited, of whom 23,690 men and 23,425 women (90%) attended. Smoking habits and previous cardiovascular disease were recorded; total cholesterol, high-density lipoprotein cholesterol (HDL cholesterol), triglycerides and blood pressure were measured. During subsequent follow-up (mean 6.8 years) 422 men and 54 women died from coronary heart disease, 514 and 114 from all cardiovascular diseases and 983 and 404 from all causes, men and women respectively. For men, mortality decreased with increasing HDL cholesterol, to a minimum of around 1.5 mmol.l-1 (58 mg.dl-1), whereafter mortality increased. This applies to coronary, cardiovascular and all causes of death, as well as to men with and without a history of disease. The association between mortality and HDL cholesterol in healthy men disappeared when total cholesterol was below 6.5 mmol.l-1 (251 mg.dl-1). The inverse association between mortality and HDL cholesterol in women was somewhat stronger than in men, both for coronary and cardiovascular diseases. The relative risks of coronary death, associated with an increase in HDL cholesterol of 0.5 mmol.l-1 (19 mg.dl-1), from the Cox proportional hazards regression, with other major cardiovascular risk factors as covariates, were 0.8 (95% confidence interval: 0.6, 1.0) and 0.8 (0.7, 1.0) for men with and without history of disease, respectively. Corresponding figures for women were 0.5 (0.3, 0.9) and 0.7 (0.4, 1.3). |
| High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study Sacco, R. L., R. T. Benson, et al. (2001), Jama 285(21): 2729-35. Abstract: CONTEXT: Elevated high-density lipoprotein cholesterol (HDL-C) levels have been shown to be protective against cardiovascular disease. However, the association of specific lipoprotein classes and ischemic stroke has not been well defined, particularly in higher-risk minority populations. OBJECTIVE: To evaluate the association between HDL-C and ischemic stroke in an elderly, racially or ethnically diverse population. DESIGN: Population-based, incident case-control study conducted July 1993 through June 1997. SETTING: A multiethnic community in northern Manhattan, New York, NY. PARTICIPANTS: Cases (n = 539) of first ischemic stroke (67% aged >/=65 years; 55% women; 53% Hispanic, 28% black, and 19% white) were enrolled and matched by age, sex, and race or ethnicity to stroke-free community residents (controls; n = 905). MAIN OUTCOME MEASURE: Independent association of fasting HDL-C levels, determined at enrollment, with ischemic stroke, including atherosclerotic and nonatherosclerotic ischemic stroke subtypes. RESULTS: After risk factor adjustment, a protective effect was observed for HDL-C levels of at least 35 mg/dL (0.91 mmol/L) (odds ratio OR, 0.53; 95% confidence interval CI, 0.39-0.72). A dose-response relationship was observed (OR, 0.65; 95% CI, 0.47-0.90 and OR, 0.31; 95% CI, 0.21-0.46) for HDL-C levels of 35 to 49 mg/dL (0.91-1.28 mmol/L) and at least 50 mg/dL (1.29 mmol/L), respectively. The protective effect of a higher HDL-C level was significant among participants aged 75 years or older (OR, 0.51; 95% CI, 0.27-0.94), was more potent for the atherosclerotic stroke subtype (OR, 0.20; 95% CI, 0.08-0.50), and was present in all 3 racial or ethnic groups studied. CONCLUSIONS: Increased HDL-C levels are associated with reduced risk of ischemic stroke in the elderly and among different racial or ethnic groups. These data add to the evidence relating lipids to stroke and support HDL-C as an important modifiable stroke risk factor. |
| High-density lipoprotein cholesterol and left ventricular hypertrophy in essential hypertension Schillaci, G., G. Vaudo, et al. (2001), J Hypertens 19(12): 2265-70. Abstract: OBJECTIVE: The proportion of left ventricular (LV) mass variability explained by blood pressure in essential hypertension is small, and several non-haemodynamic determinants of LV mass have been identified or hypothesized. This study examines the possible relation between blood lipids and LV mass in hypertension. DESIGN: Never-treated non-diabetic hypertensive patients. SETTING: Hospital hypertension outpatient clinics in Umbria, Italy. PATIENTS: We investigated the association between high-density lipoprotein (HDL)-cholesterol and echocardiographic LV mass in 1306 never-treated subjects with essential hypertension. Subjects with previous cardiovascular events, diabetes and current or previous antihypertensive or lipid-lowering therapy were excluded. RESULTS: HDL-cholesterol showed an inverse association with LV mass (r = -0.30, P < 0.001). No association was found between LV mass and total or low-density lipoprotein cholesterol. With multiple linear regression analysis we tested the independent contribution of several potential determinants of LV mass in women and in men. Average 24 h blood pressure (both pulse and mean), body mass index, height, stroke volume, age (all P < 0.01) and low HDL-cholesterol (P < 0.0001 in women, P < 0.001 in men) were associated with a greater LV mass in both sexes. Triglycerides showed a weak univariate association with LV mass in women (r = 0.11, P < 0.02), which did not hold in a multivariate analysis. CONCLUSIONS: Low HDL-cholesterol is an independent predictor of LV mass in untreated hypertensive subjects. Common hormonal and metabolic mechanisms, including insulin resistance, could explain this association, which may contribute to the adverse prognostic significance of low HDL-cholesterol levels. |
| High-density lipoprotein cholesterol and longevity Nikkila, M. and J. Heikkinen (1990), Age Ageing 19(2): 119-24. Abstract: Serum total cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides were studied in three groups: (1) 85 healthy subjects aged 85-89 years, (2) 62 patients without coronary artery disease aged 38-62 years, and (3) 323 patients aged 32-69 years with triple-vessel disease diagnosed by coronary angiography. The mean values for total cholesterol were significantly higher in patients with triple-vessel disease than in those without coronary artery disease and in the elderly. Total cholesterol was over 6.5 mmol/l in 32% of the elderly, in 31% of patients without coronary artery disease and in 42% of patients with triple-vessel disease, but these differences were not significant. HDL-cholesterol and the ratio of HDL/total cholesterol were significantly higher in the elderly than in the patients without coronary artery disease and patients with triple-vessel disease. Serum HDL-cholesterol was over 1.0 mmol/l in 92% of the elderly, in 69% of patients without coronary artery disease and in 46% of patients with triple-vessel disease, the differences being significant between all groups. |
| High-density lipoprotein cholesterol and other risk factors for coronary heart disease in female runners Williams, P. T. (1996), N Engl J Med 334(20): 1298-303. Abstract: BACKGROUND. Official guidelines from the Centers for Disease Control and Prevention assert that the majority of health benefits from physical activity are obtained by walking 2 miles (3.2 km) briskly most days of the week (the energy equivalent of running 8 to 12 km per week). The objective of our study was to examine the dose-response relation in women between risk factors for coronary heart disease, particularly the concentration of high-density lipoprotein (HDL) cholesterol, and vigorous exercise at levels that exceed the official guidelines. METHODS. The number of kilometers run per week reported by 1837 female recreational runners in a national cross-sectional survey was compared with medical data provided by the women's physicians. RESULTS. In these cross-sectional data, plasma HDL cholesterol concentrations were higher by an average (+/- SE) of 0.133 +/- 0.020 mg per deciliter (0.003 +/- 0.0005 mmol per liter) for every additional kilometer run per week, an amount nearly identical with that previously reported for men (0.136 +/- 0.006 mg per deciliter 0.004 +/- 0.0002 mmol per liter per kilometer per week). Among women who ran less than 48 km per week, mean plasma HDL concentrations were significantly higher with each 16-km increment in distance. Women who ran more than 64 km per week had significantly higher mean concentrations of HDL cholesterol than did women who ran less than 48 km per week. They were also significantly more likely to have HDL cholesterol concentrations greater than 100, 90, or 80 mg per deciliter (2.6, 2.3, or 2.1 mmol per liter) than were women running less than 64 km per week. HDL cholesterol concentrations increased significantly in relation to the number of kilometers run per week in premenopausal women who were not using oral contraceptives and in postmenopausal women, whether they were receiving estrogen-replacement therapy or not. CONCLUSIONS. Substantial increases in HDL cholesterol concentrations were found in women who exercised at levels exceeding current guidelines; higher HDL cholesterol concentrations could provide added health benefits to these women. |
| High-density lipoprotein cholesterol and premature coronary heart disease in urban Japanese men Kitamura, A., H. Iso, et al. (1994), Circulation 89(6): 2533-9. Abstract: BACKGROUND: The objective of this study was to examine the relation of high-density lipoprotein cholesterol (HDL-C) to coronary heart disease in Japanese men whose serum total cholesterol is low by Western standards. METHODS AND RESULTS: A prospective, observational study based on 7.7 years of follow-up for incidence of coronary heart disease and stroke was conducted. The subjects were 6408 middle-aged male workers aged 40 to 59 years at baseline in urban companies in Osaka, Japan, whose mean serum total cholesterol was 5.10 mmol/L. Mean HDL-C adjusted for age, total cholesterol, systolic blood pressure, alcohol intake, cigarette smoking, and body mass index was 1.27 to 1.28 mmol/L for men who developed coronary heart disease (n = 46) or definite myocardial infarction (n = 21) compared with 1.46 mmol/L for those free of cardiovascular disease (n = 6256; difference, P <.01). There was no significant difference in mean HDL-C between stroke cases (n = 33) and those free of cardiovascular disease. The incidence rates of coronary heart disease and definite myocardial infarction, adjusted for the other risk factors, were three to four times higher in the lowest HDL-C quartile (< 1.24 mmol/L) than the highest quartile (> or = 1.66 mmol/L), and there was a significant dose response for definite myocardial infarction. Serum total cholesterol was positively and significantly associated with coronary heart disease incidence. Furthermore, the inverse association for HDL-C was apparent among men with total cholesterol < 5.69 mmol/L (mean total cholesterol, 4.76 mmol/L) and men with total cholesterol > or = 5.69 mmol/L (mean total cholesterol, 6.26 mmol/L). CONCLUSIONS: Coronary heart disease incidence is inversely related to HDL-C in urban Japanese middle-aged men, whose mean total cholesterol (5.10 mmol/L) is relatively low. |
| High-density lipoprotein cholesterol and risk of ischemic stroke mortality. A 21-year follow-up of 8586 men from the Israeli Ischemic Heart Disease Study Tanne, D., S. Yaari, et al. (1997), Stroke 28(1): 83-7. Abstract: BACKGROUND AND PURPOSE: While there is overwhelming evidence relating low levels of HDL cholesterol (HDL-C) with coronary heart disease, the association with cerebrovascular disease is not clear. The aim of the present report was to assess the association between HDL-C levels and ischemic stroke mortality obtained from a long-term follow-up in the Israeli Ischemic Heart Disease Study. METHODS: The subjects of this report are 8586 men, tenured civil servants and municipal employees, aged 42 years or older at the time of HDL-C measurements in 1965. They were followed up for mortality for 21 years. Death due to cerebrovascular disease included the International Classification of Disease, 9th Revision, codes 430 to 438, of which presumed ischemic stroke included codes 433 to 438. RESULTS: During the 21-year follow-up, 295 men died from cerebrovascular events, of which 241 deaths were due to presumed ischemic stroke. Individuals subsequently experiencing a fatal ischemic stroke had a marginally lower age-adjusted mean HDL-C (1.05 mmol/L) and a significantly lower (P <.001) age-adjusted mean percentage of serum cholesterol contained in the HDL fraction (%HDL) (19.3%) than counterparts surviving the follow-up period (1.06 mmol/L and 20.6%, respectively). Decreasing age-adjusted rates of ischemic stroke mortality were observed with increasing %HDL: 14.6, 14.0, and 11.8 per 10,000 person-years in the low, middle, and upper tertiles of %HDL, respectively. In multivariate analysis, a low concentration of HDL-C appeared to be significantly predictive of ischemic stroke mortality. The relative risk associated with a 5% decrease of %HDL was 1.18 (95% confidence interval, 1.03 to 1.34). Men at the lower tertile of HDL-C levels experienced a 1.32-fold increase of covariate-adjusted ischemic stroke mortality risk compared with counterparts at the upper tertile. CONCLUSIONS: In this prospective study of middle-aged and elderly men from a healthy, working population, we have demonstrated an independent negative association between HDL-C and ischemic stroke mortality during a long-term (21-year) follow-up. |
| High-density lipoprotein cholesterol and risk of stroke Sheikh, K. (2001), Jama 286(13): 1573-4. |
| High-density lipoprotein cholesterol and risk of stroke in Japanese men and women: the Oyabe Study Soyama, Y., K. Miura, et al. (2003), Stroke 34(4): 863-8. Abstract: BACKGROUND AND PURPOSE: Evidence of an inverse relationship between serum high-density lipoprotein cholesterol (HDL-C) and the risk of stroke is sparse in Asians and in women. The purpose of this investigation was to examine the relationship in a long-term cohort study of Japanese men and women among whom stroke occurrence is higher than in Western countries. METHODS: A prospective cohort study was performed involving 4989 participants (1523 men, 3466 women) 35 to 79 years of age at baseline with approximately 10 years of follow-up in a rural area of Japan. End points included all stroke incidence and ischemic stroke incidence. RESULTS: During follow-up, 132 participants developed stroke, including 81 ischemic stroke cases. Age-adjusted incidence rates per 10,000 person-years for all stroke in subjects with low HDL-C (<30 mg/dL 0.78 mmol/L) were 103.4 in men and 49.3 in women, which were remarkably higher than in subjects with high HDL-C (>or=60 mg/dL 1.56 mmol/L) (26.4 in men and 15.5 in women). A similar relationship was observed for ischemic stroke. Multivariate-adjusted relative risks for all stroke incidence and ischemic stroke incidence were 2.89 (95% CI, 1.35 to 6.20) and 2.92 (95% CI, 1.17 to 7.32), respectively, for low versus high HDL-C participants. The relationships were independent of sex, age, body mass index, blood pressure, serum total cholesterol, alcohol consumption, and smoking. CONCLUSIONS: This 10-year follow-up study of Japanese men and women demonstrated that lower HDL-C levels were related significantly and independently to increased risk of all stroke incidence and ischemic stroke incidence. |
| High-density lipoprotein cholesterol and the role of statins Chong, P. H., R. Kezele, et al. (2002), Circ J 66(11): 1037-44. Abstract: Low levels of high-density lipoprotein cholesterol (HDL-C) are currently considered to be a major risk factor for the development of coronary artery disease (CAD). Deficiencies in the HDL metabolic pathway promote atherosclerosis and contribute to CAD. Low HDL-C levels are included in the Framingham 10-year risk assessment for CAD although they are not yet targeted for therapy. Recent clinical trials have shown benefits from raising HDL-C, particularly in patients with lower baseline levels. The statin class of drugs, used primarily to lower the level of low-density lipoprotein-cholesterol, may be able to raise the HDL-C level as well. Statins could potentially affect HDL-C by different modes of action, most importantly by altering reverse cholesterol transport. Among the currently available statins, simvastatin has demonstrated the most consistent ability to raise HDL-C level, but further large-scale studies at an early stage will be needed to prove the antiatherogenic effects of this class of drugs. |
| High-density lipoprotein cholesterol and treatment guidelines Tonkin, A. (2001), Am J Cardiol 88(12A): 41N-44N. Abstract: Setting consistent guidelines for the treatment of lipid abnormalities must take into consideration several factors and must balance the need for precision (favored by specialists) and practicality in the patient setting (favored by general medical practitioners). The appropriate populations for treatment should be clearly defined, and usual threshold levels, target levels, and treatment should be well established. Plasma high-density lipoprotein cholesterol (HDL-C) has not been widely incorporated in guidelines as a significant abnormality predictive of cardiovascular risk and as a therapeutic target. However, that view is changing in the light of recent improved understanding of the importance of each lipid fraction abnormality, including HDL-C, in the pathophysiology of atherosclerotic disease. In addition, clinical trials have demonstrated the apparent benefit of increasing low levels of HDL-C in reducing cardiovascular events. The use of guidelines incorporating threshold and target levels for managing HDL-C in high-risk populations is becoming seen as a practical means of improving the outcome for patients, especially for special groups, such as the elderly and those with type 2 diabetes mellitus. |
| High-density lipoprotein cholesterol and triglyceride response with simvastatin versus atorvastatin in familial hypercholesterolemia Wierzbicki, A. S., P. J. Lumb, et al. (2000), Am J Cardiol 86(5): 547-9, A9. Abstract: The clinical and biochemical determinants of high-density lipoprotein (HDL) and triglyceride response to simvastatin and atorvastatin were assessed in 150 patients with severe hyperlipidemia treated in a randomized open-trial format design. Triglyceride reduction was only dependent on HDL:apolipoprotein A1, change in apolipoprotein B, and dose response, whereas an increase in HDL was dependent on initial LDL, change in LDL or dose response, and therapy with simvastatin. |
| High-density lipoprotein cholesterol and triglycerides as therapeutic targets for preventing and treating coronary artery disease Gotto, A. M., Jr. (2002), Am Heart J 144(6 Suppl): S33-42. Abstract: Epidemiologic and clinical trials show that elevated triglycerides and low levels of high-density lipoprotein cholesterol (HDL-C) are independent risk factors for coronary heart disease (CHD). However, adjustment for covariates frequently weakens or abolishes the predictive significance of triglycerides, whereas the evidence for HDL-C is more consistently strong. Data indicate that there is a 2% to 3% decrease in coronary risk for each 1 mg/dL increase in HDL-C, whereas the benefit of triglyceride lowering appears to occur largely in patients with the highest baseline levels. The 2001 National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines for detecting and treating high blood cholesterol reflect our improved understanding of triglycerides and HDL as CHD risk factors. However, the guidelines place more emphasis on lowering triglycerides than on raising HDL-C by identifying non-HDL-C (ie, low-density lipoprotein cholesterol LDL-C + very-low-density lipoprotein cholesterol VLDL-C) as a secondary target of therapy. In clinical practice, VLDL-C is the most readily available measure of atherogenic triglyceride-rich remnant lipoproteins. On the basis of the available epidemiologic and clinical evidence, refinement of the NCEP guidelines to include more emphasis on raising HDL-C levels should be considered. Novel drugs are being developed that have the potential to increase HDL-C concentrations and/or improve the functionality of HDL. |
| High-density lipoprotein cholesterol and vascular stiffness at baseline in the activity counseling trial Havlik, R. J., D. Brock, et al. (2001), Am J Cardiol 87(1): 104-7, A9. Abstract: In a middle-aged patient population, age was associated with stiffer vessels and high-density lipoprotein cholesterol with more elastic vessels. High-density lipoprotein cholesterol may be an indirect indicator of aerobic capacity or of less atherosclerosis, suggesting mechanisms for preserving vascular integrity. |