| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| Review of clinical studies on cholesterol-lowering response to soy protein Carroll, K. K. (1991), J Am Diet Assoc 91(7): 820-7. Abstract: Experiments on animals have shown that soybean protein has hypocholesterolemic and antiatherogenic properties. In human beings, substitution of soy protein for dietary animal protein or addition of soy protein to the diet lowers total and low-density-lipoprotein cholesterol levels in individuals with hypercholesterolemia. Reductions of 20% or more have been obtained with diets high in protein (about 20% of total energy) and relatively low in fat. Triglycerides are also decreased, particularly in subjects with hypertriglyceridemia, but soy-protein diets appear to have little effect on high-density-lipoprotein cholesterol levels. Responses are similar in men and women, but may be greater in younger than in older subjects. The hypocholesterolemic effect is thought to be mainly attributable to the protein itself rather than to nonprotein components of soy-protein preparations. The mechanism of action is not known, and it may not be possible to explain the observed effects in human beings and in experimental animal models by the same mechanism. Although the hypocholesterolemic response to dietary soy protein has been observed by a number of European research groups, substitution of soy protein for animal protein in North American diets has generally had little effect, for reasons that are still not clear. |
| Review: effects of dietary fatty acids and fibers on blood cholesterol Ghatak, A., G. Monte, et al. (1992), Jpn J Med Sci Biol 45(3): 99-111. |
| Revised guidelines for the treatment of elevated cholesterol levels in adults: a prime role for secondary prevention Blum, C. B. (1994), Coron Artery Dis 5(2): 175-7. |
| Revision of consensus cholesterol Erkelens, D. W. (1991), Ned Tijdschr Geneeskd 135(49): 2337-40. Abstract: A new text of the Dutch Cholesterol Consensus has been prepared by an expert committee, including general practitioners. Population screening is not advocated since the general cholesterol level in the Netherlands is higher than desired with regard to the atherosclerosis risk. Case-finding is advised in view of mutual enhancement of risk factor effects. Women and the elderly are not excluded from this strategy. Cholesterol levels should be measured repeatedly and if elevated, triglycerides and HDL-cholesterol levels should be measured also. If the cholesterol level is strongly elevated cholesterol synthesis inhibitors are medication of first choice. |
| RG 12561 (dalvastatin): a novel synthetic inhibitor of HMG-CoA reductase and cholesterol-lowering agent Amin, D., S. K. Gustafson, et al. (1993), Pharmacology 46(1): 13-22. Abstract: RG 12561 (dalvastatin) is a prodrug which converts to its open hydroxyacid form in the body. The Na salt of RG 12561 (RG 12561-Na) is a potent inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in the cholesterol biosynthetic pathway. It competitively inhibits rat liver HMG-CoA reductase with an IC50 value of 3.4 nmol/l. In the same assay, the IC50 values for other potent HMG-CoA reductase inhibitors, lovastatin-Na and pravastatin, were 2.3 and 8.9 nmol/l, respectively. In Hep G2 liver cells, RG 12561-Na, lovastatin-Na and pravastatin inhibited cholesterol biosynthesis from radiolabeled octanoate with IC50 values of 4 and 5 nmol/l and 1.1 mumol/l, respectively. In a rat ex vivo assay, orally administered RG 12561, lovastatin and pravastatin inhibited cholesterol biosynthesis in liver slices with ED50 values of 0.9, 0.5 and 12 mg/kg, respectively. In cholestyramine-fed hamsters, RG 12561 (0.1% in food for 18 days) reduced LDL cholesterol, whereas HDL was slightly increased. The reductions in the LDL/HDL ratio for RG 12561, RG 12561-Na, lovastatin and lovastatin-Na were 35, 76, 88 and 88%, respectively. At a higher dose, RG 12561 (0.4% in food) reduced serum cholesterol, LDL and LDL/HDL by 84, 97 and 91%, respectively. In WHHL rabbits, RG 12561 and lovastatin (5 mg/kg, b.i.d., 12 days) reduced serum cholesterol by 17 and 16%, respectively. These results demonstrate that RG 12561 is a potent cholesterol-lowering agent. |
| Rhodopsin-cholesterol interactions in bovine rod outer segment disk membranes Albert, A. D., J. E. Young, et al. (1996), Biochim Biophys Acta 1285(1): 47-55. Abstract: Cholesterol modulates the function of rhodopsin in the retinal rod outer segment (ROS) disk membranes. One mechanism for such modulation is cholesterol modulation of the properties of the membrane bilayer. This has been explored previously. Another possible mechanism is an interaction between the sterol and the protein, which has not been previously explored. In this study, the fluorescent sterol, cholestatrienol, was used to probe interactions between cholesterol and rhodopsin in bovine ROS disk membranes. Cholestatrienol was incorporated into the disk membranes by exchange from donor phospholipid vesicles. Fluorescence energy transfer from protein tryptophans to cholestatrienol was observed indicating close approach of this fluorescent sterol to the tryptophan. The effectiveness of the energy transfer was measured by the quenching of tryptophan fluorescence by cholestatrienol. The quenching of tryptophan fluorescence was directly related to the cholestatrienol content of the membranes. Cholesterol was incorporated into the disk membranes by exchange from donor phospholipid vesicles. The effect of increasing membrane cholesterol on the ability of cholestatrienol to quench rhodopsin tryptophan fluorescence was determined. This quenching was inversely proportional to the membrane cholesterol content. Furthermore the observed quenching was greater than could be explained by a simple dilution of the cholestatrienol by the addition of cholesterol to the membrane. These data suggest an interaction between the sterol and the protein. The specificity of this interaction was explored by the addition of ergosterol, instead of cholesterol, to the disk membranes. Ergosterol was not able to inhibit the quenching of protein trytophans beyond that due to dilution of the cholestatrienol by addition of ergosterol to the membrane. The ability of cholesterol to compete with cholestatrienol for that interaction suggests a 'site' at which cholesterol contacts rhodopsin. The inability of ergosterol to compete with cholestatrienol for this 'site' suggested that the site was specific for the structure of cholesterol. |
| Rhythms in cholesterol, cholesteryl esters, free fatty acids, and triglycerides in blood of lactating dairy cows Bitman, J., D. L. Wood, et al. (1990), J Dairy Sci 73(4): 948-55. Abstract: Blood samples from six lactating dairy cows were analyzed to determine whether circulating neutral lipids exhibit rhythmic variations. Plasma neutral lipids were measured by quantitative TLC on every fourth integrated 15-min blood sample taken over 48-h periods. Cows were housed in an environmental chamber at 20 degrees C with 16 h light:8 h dark (lights on at 0700 h), fed daily at 0900 h, and milked at 0830 and 2000 h. Other variables monitored included: body temperature, ammonia nitrogen, urea nitrogen, glucose, triiodothyronine, thyroxine, somatotropin, insulin, cortisol, and prolactin. Mean concentrations of cholesterol, cholesteryl esters, free fatty acids, and triglycerides were 21.4, 175.4, 3.1, and 6.3 mg/dl, respectively. Visual and power spectral analysis of the pulsatile fluctuations in lipids indicated rhythms with periods of 2 to 3 h. Amplitudes of rhythms for free fatty acids and triglycerides were 60% of mean concentrations and for cholesterol and cholesteryl esters were 20% of mean concentrations. The presence of these rhythms was conserved when data were averaged across time by cow. However, because of nonstationary conditions, rhythms identified by spectral analysis were not statistically significant. There was no evidence of circadian patterns in circulating neutral lipid components. All other metabolic and hormonal variables except cortisol exhibited distinct circadian rhythms. |
| Rice bran oil and cholesterol metabolism Sugano, M. and E. Tsuji (1997), J Nutr 127(3): 521S-524S. Abstract: A range of human and animal studies have shown that rice bran oil (RBO) is an edible oil of preference for improving serum cholesterol levels and lipoprotein profiles with similarity to the more commonly used vegetable oils such as corn oil and safflower oil. Of particular interest is the observation that blending RBO with safflower oil at a definite proportion (7:3, wt/wt) magnifies the hypocholesterolemic efficacy, compared with the effect of each oil alone. Although the mechanism underlying this effect is not apparent at present, the blending may have a practical significance. The blending effect was reproduced in rats fed a cholesterol-enriched diet, and there was also a decrease in liver cholesterol. The occurrence of peculiar components such as gamma-oryzanol and tocotrienols could be responsible for the hypocholesterolemic effect of RBO. |
| Rice bran oil lowers serum total and low density lipoprotein cholesterol and apo B levels in nonhuman primates Nicolosi, R. J., L. M. Ausman, et al. (1991), Atherosclerosis 88(2-3): 133-42. Abstract: The hypolipidemic response of rice bran oil (RBO) was investigated in nonhuman primates fed semi-purified diets containing blends of oils which included RBO at 0-35% Kcals as dietary fat. The studies demonstrated the following: (a) the degree of reduction of serum total cholesterol (TC) and low density lipoprotein cholesterol (LDLC) was highly correlated with initial serum cholesterol levels of the monkey on the stabilization diet; (b) the content of rice bran oil in the diet was the predominant factor influencing serum TC, LDLC and apoB causing up to a 40% reduction in LDLC without affecting high density lipoprotein cholesterol (HDLC) when RBO was the sole dietary oil fed; (c) the cholesterol-lowering capabilities of RBO were not explained by its fatty acid composition. These studies suggest that RBO may be an additional vegetable oil which lowers serum cholesterol levels by unique mechanisms which will require further study. |
| Rising cholesterol levels in children with familial hypercholesterolaemia Kessling, A. M., M. Seed, et al. (1990), Biomed Pharmacother 44(7): 373-9. Abstract: Reference ranges (5th to 95th percentile) for fasting total serum cholesterol concentration were calculated for 571 unrelated children aged 4-19 years, without known predisposition to hypercholesterolaemia. Values were 3.31-5.81 mmol.l-1 for boys and 3.20-5.66 mmol.l-1 for girls, without significant differences between sexes at any age, compared to our laboratory reference ranges for men (3.46-6.87 mmol.l-1) and women (3.00-6.38 mmol.l-1). A further 85 children, each with a first degree relative with Familial Hypercholesterolaemia (FH), were studied. Initially, 39 had high cholesterol concentrations suggestive of FH. Repeated serial measurements were carried out in 18 of the 46 apparently unaffected children. Seven of these showed marked increases in serum cholesterol over 1-7 years, reaching concentrations above the 95th centiles of the appropriate reference ranges. The annual rate of increase was significantly higher than in the 11 who remained normocholesterolaemic. In 3 of these 7 children, diagnosis of FH was confirmed retrospectively, using recombinant DNA technology to show that each had inherited the defective allele of the LDL-receptor gene from an affected parent. Thus, serial cholesterol measurements may be needed to confirm or exclude FH in potential heterozygotes, while DNA studies can be used for definitive diagnosis in some families. |
| Rising incidence of coronary artery disease in China in parallel with rising 'normal' plasma cholesterol levels Cheng, T. O. (2004), Atherosclerosis 173(2): 371. |
| Risk determination of dyslipidemia in populations characterized by low levels of high-density lipoprotein cholesterol Bersot, T. P., G. M. Pepin, et al. (2003), Am Heart J 146(6): 1052-9. Abstract: BACKGROUND: Current guidelines for managing dyslipidemia qualify patients for treatment based on low-density lipoprotein cholesterol (LDL-C) levels and other risk factors for coronary heart disease (CHD). However, when LDL-C is the sole lipid criterion for initiating therapy, patients with levels below the treatment initiation threshold who are at high risk because of low levels (<40 mg/dL) of high-density lipoprotein cholesterol (HDL-C) might not be identified. Twenty percent of male patients with CHD in the United States fall into this category. The total cholesterol/HDL-C (TC/HDL-C) ratio predicts CHD risk regardless of the absolute LDL-C and HDL-C. METHODS: We compared guidelines based on TC/HDL-C and LDL-C with those recommended by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Both sets of guidelines were applied to 9837 adults (>20 years of age) in the Turkish Heart Study, which has shown that 75% of men and 50% of women in Turkey have HDL-C <40 mg/dL. RESULTS: ATP III guidelines identified 14% of Turkish adults, 20 years or older, as candidates for lifestyle treatment only and an additional 18% for drug treatment. In conjunction with ATP III LDL-C thresholds, the TC/HDL-C ratio (>3.5, patients with CHD; > or =6.0, 2+ risk factors, > or =7.0, 0 to 1 risk factor) assigned lifestyle therapy alone to 18% and drug treatment to an additional 36%. Among primary prevention subjects at high risk because of age (men > or =45 years; women > or =55 years), both sets of guidelines prescribed lifestyle therapy for only 5%; however, drug treatment was recommended for an additional 13% by ATP III guidelines and an additional 18% by TC/HDL-C and LDL-C. CONCLUSIONS: In populations at risk for CHD caused by low HDL-C, qualification of subjects for treatment based on either the TC/HDL-C ratio or LDL-C thresholds identifies more high-risk subjects for treatment than LDL-C threshold values alone, and use of the ratio, instead of risk tables, simplifies the approach for physicians. |
| Risk factors and pathogenesis of cholesterol gallstones: state of the art Amigo, L., S. Zanlungo, et al. (1999), Eur Rev Med Pharmacol Sci 3(6): 241-6. Abstract: The aim of this article is to present an update of selected aspects of the pathogenesis and risk factors of cholesterol gallstones, a highly prevalent Western disease. The etiology of cholesterol cholelithiasis is considered to be multifactorial, with interaction of genetic and environmental factors. Mechanisms of cholesterol lithogenesis include biliary cholesterol hypersecretion, supersaturation and crystallization, stone formation and growth, and bile stasis within the gallbladder. Each of these various steps could be under genetic control and/or be influenced through intermediate pathogenic steps linked to a variety of environmental factors. |
| Risk factors for a major coronary event after myocardial infarction in the Scandinavian Simvastatin Survival Study (4S). Impact of predicted risk on the benefit of cholesterol-lowering treatment Wilhelmsen, L., K. Pyorala, et al. (2001), Eur Heart J 22(13): 1119-27. Abstract: AIMS: To analyse (1) the prognostic importance of clinical findings and lipids in patients with a previous myocardial infarction and (2) the relative and absolute benefit of simvastatin in patients at low, medium and high predicted risk. METHODS: The 4S was a double-blind, randomized, clinical trial of long-term treatment with simvastatin or matching placebo in patients with myocardial infarction or angina pectoris, serum total cholesterol 5.5-8.0 mmol x l(-1), and serum triglycerides |
| Risk factors for atherosclerotic vascular disease in patients on maintenance hemodialysis--with especial respect to reverse cholesterol transport system and hyperhomocysteinemia Kimura, H. and H. Yoshida (2002), Rinsho Byori 50(8): 793-801. Abstract: Hemodialysis (HD) patients have a high mortality rate due to vascular disease (VD). Therefore, we investigated the effect of uremic dyslipidemia on VD in HD patients, with special consideration of the reverse cholesterol transport (RCT) system including high-density-lipoprotein cholesterol (HDL-C), cholesteryl ester transfer protein (CETP) and its genetic (D442G) mutation. In 414 HD patients, a sub-median HDL-C level (< 48 mg/dl) was an independent risk factor for VD. In the lower HDL-C status, the CETP mutation leading to CETP levels was independently associated with VD. In 210 selected patients, the CETP level was an independent protective factor against VD among those with higher HDL-C levels (> 45 mg/dl). We also measured serum homocysteine (Hcy) levels and examined its association with VD considering that hyperhomocysteinemia is a newly identified risk factor for atheroma. HD Patients (n = 545) had about 3 times the Hcy levels of the general population. A common C677T mutation in the gene of methylenetetrahydrofolate reductase (MTHFR) involved in Hcy metabolism was independently and directly related to serum Hcy levels with TT genotype patients having the highest levels. Patients with the TT genotype were younger and had a shorter duration of dialysis than those with the CT or CC genotype after adjustment for age at the initiation of dialysis, although there was no difference in VD prevalence among the genotypes and no association between Hcy levels and VD prevalence. In conclusion, lower HDL-C and CETP status was a risk factor for VD in HD patients, suggesting the importance of RCT. Serum Hcy levels were markedly increased in HD patients and the TT genotype may be associated with higher mortality. However, a large-scale prospective study is required to clarify whether hyperhomocysteinemia or the TT genotype is a VD risk factor among HD patients. |
| Risk factors smoking, serum cholesterol and blood pressure analyzed. Excess risk also in the "moderate" groups Wilhelmsen, L. and A. Rosengren (2002), Lakartidningen 99(49): 4966-73. Abstract: Results of a prospective population study of a random sample of about 7,500 men aged 47-55 years at baseline and followed-up for 27 years are presented. All results are based upon the baseline examination. Among men who smoked 1-14 cigarettes/day there were more events of lung cancer, myocardial infarction, stroke and all-cause mortality than in any of the other smoking categories. More events of myocardial infarction, stroke and all-cause mortality were found among men with serum cholesterol 6.00-6.99 mmol/L than among men with 7.00-7.99 and > or = 8.00 mmol/L. Similarly, more untoward events occurred in men with systolic blood pressures 140-159 mm Hg than in groups with higher levels. These results are due to the relatively low excess risk having been found among many individuals, giving rise to large effects in the population. They underscore the importance of avoidance of smoking even among those smoking "moderately", and to reduce cholesterol and blood pressure levels even among those with only moderately elevated levels. Non-pharmacological measures are indicated to reduce these levels. |
| Risk of myocardial infarction attributable to elevated levels of total cholesterol among hypertensives Glazer, N. L., N. L. Smith, et al. (2005), Am J Hypertens 18(6): 759-66. Abstract: BACKGROUND: Although cholesterol is an important risk factor for coronary heart disease (CHD) among hypertensives, the burden of CHD among hypertensives that may be due to elevated cholesterol has not been well documented. This study aimed to estimate the proportion of incident myocardial infarction (MI) among hypertensives that may be attributable to elevated total cholesterol, and to investigate how well the National Cholesterol Education Program Adult Treatment Panel III (ATP III) classification method represents risk of MI among hypertensives. METHODS: A population-based, case-control study of patients aged 30 to 79 years enrolled in a health maintenance organization, treated pharmacologically for hypertension, and who were not using lipid-lowering medication. Cases were diagnosed with an incident fatal or nonfatal MI between 1986 and 2000 (n = 1535). Controls were randomly sampled and frequency-matched to cases by sex, 10-year age category, and year of event (n = 3743). Subjects' most recent total cholesterol values were categorized according to ATP III guidelines. RESULTS: Overall, 31% (95% confidence interval: 23-39) of incident MIs among hypertensives could be explained by total cholesterol level above the optimal level of 200 mg/dL. Among participants in the highest ATP III risk stratum, 41% (95% confidence interval: 9-62) of the incident MIs were attributable to total cholesterol levels >160 mg/dL, but total cholesterol >or=200 mg/dL accounted for the majority of these excess events. CONCLUSIONS: The ATP III risk stratification approach improves detection of the CHD burden due to elevated total cholesterol among hypertensives at highest risk. A strategy to improve cholesterol control in hypertensive patients might prevent a substantial part of the burden of morbidity and mortality from MI. |
| Risk of nosocomial infections and effects of total cholesterol, HDL cholesterol in surgical patients Canturk, N. Z., Z. Canturk, et al. (2002), Clin Nutr 21(5): 431-6. Abstract: BACKGROUND AND AIMS: Changes of lipoprotein pattern in plasma occur in many acute infections. The aim of this study was to analyse the role of total cholesterol and HDL cholesterol in postsurgical patients with nosocomial infection. METHODS: Four hundred and eighteen patients admitted to our department and operated on for various diseases are included in this prospective study. Various conventional risk factors for nosocomial infections were recorded. Biochemical parameters with plasma total cholesterol and HDL-cholesterol (HDL-C) levels were measured. RESULTS: In our study, the most frequent infection was surgical site infection. There was an increased association between low HDL-C level and nosocomial infections such as surgical site and pulmonary infections. HDL levels may be used as predictive parameter for surgical nosocomial infections. CONCLUSIONS: HDL-C levels seem to be one of the risk factors for postoperative nosocomial infection. Although total cholesterol level was not significantly increased, it may be also associated with the infection risk. Screening of lipoprotein pattern in patients undergoing operation may be useful for ascertaining of risk for nosocomial infection. |
| Risk reduction in relation to cholesterol reduction Boot, K. (1999), Am J Med 107(3): 294-5. |
| Risk status of screened population based on elevated serum cholesterol values Weitgasser, R. (2002), Acta Med Austriaca Suppl 56: 14-6. Abstract: The mean value of serum total cholesterol was 208 +/- 42 mg/dl for the study population. Sixty-five percent of investigated subjects had elevated cholesterol levels > 200 mg/dl. The percentage of subjects with low to moderate elevated cholesterol levels between 200-250 mg/dl was 40%, and 2% had a cholesterol higher than 300 mg/dl. Grouping the cholesterol levels by age and sex resulted in a high percentage of subjects with serum cholesterol > 200 mg/dl for the cardiovascular high-risk age group of 45-65 years old men and 55-75 years old women. Remarkably high was this percentage for women in this age-group; 71% had a cholesterol level > 200 mg/dl. In 59% of investigated women and 52% of men cholesterol should be lowered. |