| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| Patient education. Tips for cholesterol control in patients on hemodialysis Feiertag, P. N. (2003), J Ren Nutr 13(4): 303-7. |
| Patient perceptions about the influence of cholesterol on heart disease Allen, S. S., M. L. Bache-Wiig, et al. (1992), Am J Prev Med 8(1): 30-6. Abstract: National surveys have shown that adults need to known more about their own blood cholesterol levels and about specific methods for lowering blood cholesterol. We examine patient perceptions of cholesterol and heart disease after their participation in a cholesterol management program designed for the primary care setting. We counseled 221 patients and successfully interviewed 179 by telephone four weeks after their initial dietary counseling visit. Nine of 10 patients could report their cholesterol level, and 98% of patients could appropriately label it as borderline-high or high-risk. Ninety-seven percent of the patients could give one valid reason why cholesterol was important to their health. Many patients knew specific dietary recommendations from counselors. Patients positively reviewed counseling and the cholesterol management program. A large percentage of patients had already made changes in diet and eating habits at the time of the interview. Total cholesterol measurements showed a mean reduction of 8.5% postcounseling. |
| Patients' achievement of cholesterol targets: a cross-sectional evaluation Olson, K. L. and R. T. Tsuyuki (2003), Am J Prev Med 25(4): 339-42. Abstract: BACKGROUND: Despite incontrovertible evidence for the efficacy of cholesterol lowering, numerous studies suggest that patients are suboptimally treated. This study was conducted to determine the proportion of patients achieving recommended target lipid levels in a relatively unselected group of community-dwelling patients who were prescribed HMG-CoA reductase inhibitors (statins). METHODS: Community pharmacists identified participants who were receiving an HMG-CoA reductase inhibitor at the same dosage for a minimum of 6 weeks and enrolled them into the study. Participants had an interview to determine cardiovascular risk factors and level of cardiovascular risk as defined by Canadian dyslipidemia guidelines, and a fasting lipid profile was performed using a point-of-care cholesterol assessment device. RESULTS: During 2000, a total of 404 participants were enrolled from 16 pharmacies. The highest proportion (96%) of participants achieving low-density lipoprotein targets was in the low-risk group, and the proportion progressively decreased as cardiac risk level increased: 80% in the moderate-risk group and 82% in the high-risk group. The very-high-risk group had the lowest proportion (37%) of participants who achieved their target. CONCLUSIONS: Consistent with other studies, this study found that as cardiac risk increased, the proportion of patients achieving their target cholesterol values decreased, such that those at the greatest risk for cardiovascular disease (who had the most to gain from aggressive lipid-lowering interventions) were least likely to achieve their cholesterol targets. This suggests a need for more-aggressive approaches to the management of cholesterol, particularly in high-risk patients. |
| Patients' knowledge about fats and cholesterol in the Community Cholesterol Survey Project Kelly, R. B., J. A. Hazey, et al. (1992), Arch Fam Med 1(1): 75-81; discussion 82. Abstract: OBJECTIVE: The Community Cholesterol Survey Project assessed attitudes, knowledge, and behaviors relating to cholesterol. DESIGN: Survey. SETTING: Six outpatient primary care practice sites (two urban, two suburban, and two rural) in northeast Ohio. PARTICIPANTS: Four hundred seventy-seven site-, age-, and gender-stratified adult patients were enrolled from a total of 604 approached (79% recruitment). INTERVENTIONS: Self-administered questionnaire and structured dietitian interview. MAIN OUTCOME MEASURES: A knowledge score derived from responses to multiple-choice questions and a knowledge rating given by the study dietitian. Motivation and dietary health were similarly measured. RESULTS: Subjects did worse than random guessing for seven of 12 knowledge questions regarding label reading, fats, and cholesterol. In particular, the meaning of "hydrogenated" and the relative energy content of fats was poorly understood. Knowledge scores and ratings were significantly correlated (r =.52). Knowledge ratings were higher in those who were receiving a cholesterol-lowering diet or who had received other advice or treatment from their physician for high cholesterol level. By analysis of variance, knowledge measures were found to have significant independent positive associations with higher social status (P <.001) and living in a suburban area (P <.05). Motivation and dietary health demonstrated similar relationships to social status. CONCLUSIONS: To make use of patients' motivation for change, it will be essential to provide education at an effective level. Instruction in label reading or creation of more meaningful food labels may have the greatest impact. A particular challenge is the education of less advantaged patients to promote healthy nutrition practices. |
| Patients with high cholesterol levels benefit most from early withdrawal of corticosteroids Rigotti, P. (2002), Transplant Proc 34(5): 1797-8. |
| Patient-specific prompts in the cholesterol management of renal transplant outpatients: results and analysis of underperformance Garthwaite, E. A., E. J. Will, et al. (2004), Transplantation 78(7): 1042-7. Abstract: BACKGROUND: Renal transplant recipients have an increased risk of cardiovascular disease compared with age- and gender-matched controls. It is recommended that "high-risk" patients are treated with hydroxymethylglutaryl CoA reductase inhibitors to reduce cholesterol levels. METHOD: We evaluated the effect of a computer-based decision support algorithm in delivering patient-specific prompts to manage cholesterol in renal transplant outpatients. Data were analyzed retrospectively for a 2-year period with attention to changes in cholesterol levels, prescribing patterns of statins, and causes of underperformance. RESULTS: At baseline, 36.7% of patients achieved a total serum cholesterol level less than 5.0 mmol/L, compared with 67.2% at 2 years, with mean values of 5.6+/-0.1 mmol/L and 4.8+/-0.1 mmol/L (P<0.0001). At baseline, 24% of the patients were receiving statin therapy, increasing to 61% at 2 years. There were no significant changes in creatinine phosphokinase, trough cyclosporine levels, or total cyclosporine dose. Alkaline phosphatase levels increased (166.1+/-3.6-184.6+/-6.1 mmol/L, P=0.009), but remained within the normal clinical range; creatinine clearance increased (58.6+/-1.0-61.0+/-1.2 mL/min, P=0.05). For patients followed concurrently in two units without the algorithm, serum cholesterol measurements decreased from 5.57 mmol/L and 5.34 mmol/L to 5.31 mmol/L and 5.27 mmol/L, respectively (P=0.05), both higher than that achieved contemporaneously at St. James's. Underperformance depended less on medical noncompliance than with systematic features of the methodology and patient preference/collaboration with treatment. CONCLUSIONS: The introduction of the algorithm coincided with a significant reduction in cholesterol levels, an increase in the number of patients receiving appropriate therapy, and no serious adverse effects. Our results illustrate the positive effect of computer-generated prompts and decision support software. |
| Pattern of red blood cells and platelets cholesterol and fatty acids in homozygous familial hypercholesterolemic patients treated with LDL-apheresis Stefanutti, C., G. Lucani, et al. (1998), Clin Ter 149(3): 231-3. Abstract: Two homozygous familial hypercholesterolemic patients were treated with dextran-sulfate cellulose LDL-apheresis (DSC-LDL/A). We evaluated qualitatively and quantitatively, red cell and platelets membrane cholesterol and fatty acids, before and after LDL-apheresis. Fatty acids and cholesterol of red blood cells and platelets were determined by gas-chromatographic technique. We failed to observe any quantitative or qualitative modification, as far as the youngest patient (MD) is concerned. Only in the oldest patient (SM), docosaesanoic acid (22:6) values, were significantly reduced by LDL-A on quantitative basis. In the same patient, also mirystic acid (14:0) values, were significantly decreased as determined by qualitative method. The above mentioned fatty acids were significantly changed in platelets on treatment with LDL-apheresis performed on weekly basis. |
| Pattern of the distribution of total cholesterol and cHDL cholesterol Spanish children and adolescents: RICARDIN Study Brotons Cuixart, C., R. Gabriel Sanchez, et al. (2000), Med Clin (Barc) 115(17): 644-9. Abstract: BACKGROUND: The RICARDIN Study multicenter study of cardiovascular risk factors in children and adolescents has described the standards of normality of blood cholesterol levels in the Spanish school population. The objective of the present study was to compare mean values of cholesterol between different regions of Spain, and to compare the global mean with a pool international study. Also, the pattern of total cholesterol and cHDL by age and sex using mathematical model is described, and comparison with two international studies carried out in USA and Japan is performed. SUBJECTS AND METHODS: 10,683 children aged 6 to 18 were selected from 7 different Spanish provinces (Madrid, Vizcaya, Lugo, Badajoz, Murcia, Asturias and Barcelona). Blood samples were obtained by capilar puncture (Reflotron). RESULTS: Mean values of total cholesterol was different among provinces, and globally, were lower than the international pooled population, although the pattern observed in each population was very similar. Total cholesterol curve for Spanish boys showed a curvilinear trend that can be estimated through a cubic function that explains 89% of observed data, while for girls the best estimate was obtained through an inverse function (R2 = 0.40). cHDL for boys showed a cubic function as the best estimate (R2 = 0.90), while for girls the best estimate was obtained through a quadratic function (R2 = 0.59). CONCLUSIONS: There are important physiological variations of total cholesterol level by age and sex in children and adolescents. The pattern of cholesterol does not follow a linear model but a curvilinear one, that need to be considered in clinically assessing individual determinations of cholesterol, since highest percentiles can vary by age and sex. |
| PBR, StAR, and PKA: partners in cholesterol transport in steroidogenic cells Hauet, T., J. Liu, et al. (2002), Endocr Res 28(4): 395-401. Abstract: Acute stimulation of cholesterol transport into mitochondria involves the cAMP-dependent protein kinase (PKA), peripheral-type benzodiazepine receptor (PBR), and the steroidogenesis acute regulatory (StAR) proteins. We investigated the respective role of these proteins in hormone-induced steroidogenesis. Oligonucleotides antisense, but not sense, to PBR and StAR reduced their respective levels in steroidogenic cells and inhibited hormone-stimulated steroid formation in MA-10 mouse Leydig tumor cells. In search of the proteins regulating PBR we identified a protein, PAP7, which interacts with PBR and the PKA regulatory subunit RIalpha, is present in adrenal and gonadal cells and is found in mitochondria. Overexpression of the full length PAP7 increased the hormone-induced steroid production. However, inhibition of PAP7 expression reduced the gonadotropin-induced steroid formation. In search of a PBR functional antagonist that would facilitate the studies on the biological function of PBR, we screened a phage display library. A 7-mer competitive PBR peptide antagonist was identified, which when transduced into Leydig cells inhibited the benzodiazepine and hormone-stimulated steroid production suggesting that the endogenous PBR agonist/receptor interaction is critical for the hormone-dependent steroidogenesis. These data indicate that hormone-induced cholesterol transport and the subsequent steroid formation is a dynamic multistep process involving protein-protein interactions. |
| PDGF receptor inhibition prevents cardiac allograft arteriosclerosis in cholesterol-fed rabbits Lemstrom, K., R. Sihvola, et al. (2001), Transplant Proc 33(1-2): 318. |
| Pecans lower low-density lipoprotein cholesterol in people with normal lipid levels Morgan, W. A. and B. J. Clayshulte (2000), J Am Diet Assoc 100(3): 312-8. Abstract: OBJECTIVE: To compare serum lipid profiles and dietary intakes of people with normal lipid levels who consumed pecans and those who did not consume nuts. DESIGN: Eight-week, randomized, controlled study of pecan treatment group vs control group. SUBJECT: Nineteen people with normal lipid levels completed the study; 10 had been randomly assigned to the pecan treatment group (7 women, 3 men, mean age = 45 +/- 10 years) and 9 to the control group (8 women, 1 man, mean age = 37 +/- 12 years). INTERVENTION: The pecan treatment group consumed 68 g pecans per day for 8 weeks plus self-selected diets. The pecans contributed 459 kcal and 44 g fat daily. The control group avoided nuts and consumed self-selected diets. MAIN OUTCOME MEASURES: Total serum cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total triglyceride levels were measured at the time of entrance to the study (baseline), week 4, and week 8. Computer analyses were done on five 3-day food records. STATISTICAL ANALYSIS: Comparisons were made using analysis of variance or paired t test. RESULTS: LDL-C was lowered in the pecan treatment group from 2.61 +/- 0.49 mmol/L at baseline to 2.35 +/- 0.49 at week 4 (P <.05) and to 2.46 +/- 0.59 at week 8 (P <.05). At week 8, total cholesterol and HDL-C in the pecan treatment group were significantly lower (P <.05) than in the control group (total cholesterol: 4.22 +/- 0.83 vs 5.02 +/- 0.54 mmol/L; HDL-C: 1.37 +/- 0.23 vs 1.47 +/- 0.34 mmol/L). Dietary fat, monounsaturated fat, polyunsaturated fat, insoluble fiber, magnesium, and energy were significantly higher in the pecan treatment group than in the control group. Body mass indexes and body weights were unchanged in both groups. APPLICATIONS: Pecans can be included in a healthful diet when energy intake and potential weight gain are addressed. |
| Pectin feeding influences fecal bile acid excretion, hepatic bile acid and cholesterol synthesis and serum cholesterol in rats Garcia-Diez, F., V. Garcia-Mediavilla, et al. (1996), J Nutr 126(7): 1766-71. Abstract: This study was designed to investigate the effects of pectin on cholesterol and bile acid metabolism and to elucidate the mechanisms involved in its hypolipidemic effect in rats. The key regulatory enzymes in cholesterol and bile acid metabolism, 3-hydroxy-3-methylglutaryl-CoA reductase (HMG-CoA reductase) and cholesterol 7alpha-hydroxylase, were determined. Circulating, hepatic, and biliary lipid concentrations and fecal bile acid excretion were also measured. Male Wistar rats were fed a fiber-free or a pectin-supplemented (7 g/100 g) diet for 4 wk. Bile flow and the biliary secretion of both bile acids and cholesterol were not significantly different than controls in pectin-fed rats. The addition of pectin to the diet resulted in lower serum and liver cholesterol concentrations (-27 and -17%, respectively). Fecal bile acid excretion (+168%) and the hepatic activity of cholesterol 7alpha-hydroxylase (+70%) were significantly higher in pectin-fed animals. HMG-CoA reductase activity was also significantly greater (+11%) in the presence of dietary pectin. Results of our study indicate that pectin, by enhancing fecal bile acid excretion, may cause increased hepatic synthesis of bile acids and liver depletion of cholesterol in rats, which results in a higher rate of cholesterol synthesis and reduced serum cholesterol concentrations. |
| Pectin isolated from prickly pear (Opuntia sp.) modifies low density lipoprotein metabolism in cholesterol-fed guinea pigs Fernandez, M. L., A. Trejo, et al. (1990), J Nutr 120(11): 1283-90. Abstract: The effect of prickly pear soluble fiber on low density lipoprotein (LDL) metabolism was investigated by feeding male guinea pigs either a nonpurified diet containing 0.25% cholesterol (HC diet) or the HC diet + 1% prickly pear pectin (HC-P diet). Plasma cholesterol levels were significantly decreased by the HC-P diet, with a 33% decrease in LDL levels (p less than 0.02) and an increase in LDL density. Hepatic free and esterified cholesterol levels were reduced 40 and 85%, respectively (p less than 0.002), by the HC-P diet. Hepatic microsomal 3-hydroxy-3-methylglutaryl coenzyme A reductase levels were not different. 125I-LDL binding to hepatic membranes was increased 1.7-fold by the HC-P diet (p less than 0.001), with receptor affinity (Kd) being unaltered and receptor number (Bmax) being significantly increased (p less than 0.001). These data suggest that prickly pear pectin may act by a mechanism similar to that of bile acid-binding resins in lowering plasma cholesterol levels. The observed reduction in LDL and hepatic cholesterol levels and increase in LDL density and hepatic apolipoprotein B/E receptors are responses suggesting an increased demand on hepatic cholesterol from increased excretion of bile acids and interruption of the enterohepatic circulation. |
| Pediatric cholesterol testing Fitzsimmons, L., M. Shively, et al. (1992), J Cardiovasc Nurs 6(3): 86-7. Abstract: This article discusses a recent study in which current total cholesterol values of 295 adults were compared to baseline (childhood) values obtained 16 years earlier when subjects participated in a school health screening and intervention program. Results demonstrated that adult total cholesterol values were significantly related to childhood values. Findings do not support limiting pediatric cholesterol testing to children with positive familial histories of either hyperlipidemia or early manifestations of coronary artery disease. Current recommendations regarding pediatric cholesterol testing may soon require reevaluation. |
| Peptide analog of apolipoprotein E increases clearance of lipoproteins and decreases level of serum cholesterol Lokhov, P. G., O. M. Ipatova, et al. (2001), Vopr Med Khim 47(2): 227-35. Abstract: Apolipoprotein E mediates lipoprotein binding to the low density lipoprotein (LDL) receptor and to the LDL receptor-related protein. Apolipoprotein E 139-158 peptide increases micellar binding and endocytosis by hepatocytes. The lipophilicity of the peptide was increased by modification of its N-terminus by acylation with palmitic acid ether. The peptide mediates acute clearance of the lipoproteins and decreases the cholesterol level in rat blood. Total cholesterol level, high density lipoprotein cholesterol and apolipoprotein B were measured in the serum after intravenous administration of the acylated peptide. |
| Peptide-induced formation of cholesterol-rich domains Epand, R. M., B. G. Sayer, et al. (2003), Biochemistry 42(49): 14677-89. Abstract: The peptide N-acetyl-LWYIK-amide causes the reorganization of bilayers of phosphatidylcholine and cholesterol to produce domains enriched in cholesterol. At a cholesterol mol fraction of 0.5, addition of N-acetyl-LWYIK-amide results in the formation of cholesterol crystallites. Addition of this peptide to mixtures of 1-stearoyl-2-oleoylphosphatidylcholine with lower mol fractions of cholesterol results in an increase in the enthalpy of the chain melting transition of the phospholipid, indicating the depletion of cholesterol from a domain in the membrane. The peptide binds to membranes both with and without cholesterol. However, (1)H magic-angle spinning (MAS) nuclear Overhauser effect spectroscopy (NOESY) indicates that in the presence of cholesterol the peptide has greater penetration into the bilayer. (13)C MAS NMR indicates that the peptide has stronger interactions with the A ring of cholesterol than it does with the interior of the bilayer. These results are in contrast with those of another peptide, N-acetyl-KYWFYR-amide, which does not promote the formation of cholesterol crystallites and does not show preferential interaction with cholesterol by NMR. Therefore, cholesterol can promote the insertion of N-acetyl-LWYIK-amide into a membrane and this peptide will sequester cholesterol into domains. These properties help to explain the observation that this sequence is found to be important in causing the fusion protein of human immunodeficiency virus (HIV) to sequester into raft domains in biological membranes. |
| Percent cholesterol absorption in normal women and men quantified with dual stable isotopic tracers and negative ion mass spectrometry Bosner, M. S., L. G. Lange, et al. (1999), J Lipid Res 40(2): 302-8. Abstract: Percent cholesterol absorption was measured in 94 normal subjects aged 17- 80 years while consuming diets generally low in cholesterol (mean intake = 226 +/- 126 mg/day). A new dual stable isotope method was used where a cholesterol tracer containing 6 extra mass units was given intravenously and another tracer with 5 extra mass units was given orally during a standard test meal. The ratio of tracers in plasma was determined by negative ion mass spectrometry of pentafluorobenzoyl sterol esters. Absorption values ranged widely from 29.0% to 80.1% with mean 56.2 +/- 12.1 (SD) %. Cholesterol absorption was significantly increased in African-Americans (63.4 +/- 11.8% vs. 55.1 +/- 11.9%, P = 0.027) but was similar for women (53.3 +/- 11.9%) and men (57.6 +/- 12.1%). It was not related to plasma lipoproteins, age, apoE3/E3 or E3/E4 genotype, or chronic dietary intake of energy, fat, or cholesterol quantitated from 7- day food records. However, dietary cholesterol intake was positively related to plasma cholesterol (P = 0.036) and triglycerides (P = 0.026). The milligram amount of dietary cholesterol absorbed (but not percent absorption) was positively correlated with fasting plasma insulin (r = 0.525, P < 0.0001), C-peptide (r = 0.367, P = 0.0003) and glucagon (r = 0.421, P < 0.0001) independent of gender, body fat percent and age.The efficiency of intestinal cholesterol absorption and the milligram amount of dietary cholesterol absorbed were not related to plasma cholesterol or LDL cholesterol in individuals consuming a low-cholesterol low-fat diet. The dominant factor determining dietary cholesterol absorption was intake rather than absorption efficiency. Dietary cholesterol and fat were strongly and independently related to hormonal measures of insulin resistance.-Bosner, M. S., L. G. Lange, W. F. Stenson, and R. E. Ostlund, Jr. Percent cholesterol absorption in normal women and men quantified with dual stable isotopic tracers and negative ion mass spectrometry. |
| Percentage body fat as a predictor of raised cholesterol level Hamilton, G. T. (1991), Br J Gen Pract 41(352): 478. |
| Percentage change rather than plasma level of LDL-cholesterol determines therapeutic response in coronary heart disease Thompson, G. R., J. Hollyer, et al. (1995), Curr Opin Lipidol 6(6): 386-8. Abstract: We have analysed 11 trials which used quantitative angiography to assess the effects of lipid-lowering therapy on coronary atherosclerosis. Linear regression, weighted for the number of patients studied, showed that the change in per cent diameter stenosis was significantly correlated with per cent reduction in LDL-cholesterol (r = 0.74, p < 0.0005), but not with the LDL-cholesterol concentration during the trials. These findings have important implications for the secondary prevention of coronary heart disease. |
| Percentile reference values of lipid risk factors of ischaemic heart disease: cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides in individuals aged 20 to 60 years in Plovdiv region Vulkov, I. (1997), Folia Med (Plovdiv) 39(2): 37-45. Abstract: 1408 men and 1069 women aged 20 to 60 years selected at random from the Plovdiv region were studied during an epidemiological screening. Statistical analysis of the data was carried out using a SPSS/PC+ program. The percentiles (reference values and intervals) of the lipid risk factors were determined. The reference intervals and values at the 75th and 90th percentile for both sexes showed a prevalence of cholesterol, HDL-cholesterol and LDL-cholesterol for women, and of HDL-cholesterol at the 90th percentile for men below the age of 45 years. The derived percentile reference values for cholesterol, LDL-cholesterol and triglycerides are higher than the respective values for some European and American populations. A moderate and high lipid risk was identified for women over the age of 40-45 and in men in the age range 20-60 from all age groups. The established reference values for individuals of both sexes aged 20 to 60 years make it possible to diagnose and monitor dyslipidemias. They can be used for the purposes of the educational lipid program of the Plovdiv region population. |