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Cholesterol
"Blood is watery, and cholesterol is fatty. Just like oil and water, the two do not mix. To travel in the bloodstream, cholesterol is carried in small packages called lipoproteins (lip-o-PRO-teens). The small packages are made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol throughout your body. It is important to have healthy levels of both: -- Low-density lipoprotein (LDL) cholesterol is sometimes called bad cholesterol. High LDL cholesterol leads to a buildup of cholesterol in arteries. The higher the LDL level in your blood, the greater chance you have of getting heart disease. -- High-density lipoprotein (HDL) cholesterol is sometimes called good cholesterol. HDL carries cholesterol from other parts of your body back to your liver. The liver removes the cholesterol from your body. The higher your HDL cholesterol level, the lower your chance of getting heart disease."
Highlighted ArticleHigh-density lipoprotein as a therapeutic target: clinical evidence and treatment strategies.
"Niacin therapy, currently the most effective means for raising HDL levels, should be initiated in patients with isolated low HDL (HDL <40 mg/dL, LDL and non-HDL at or below National Cholesterol Education Program (NCEP) targets based on global cardiovascular risk evaluation). Patients who have both low HDL and elevated LDL should receive a statin or statin-niacin combination therapy, and patients with concomitant low HDL and elevated TGs should receive a fibrate initially, with a statin, niacin, or ezetimibe added thereafter as needed to help attain NCEP lipoprotein targets."
Cholesterol - Lipids
General Information
NEWS:
Cholesterol and Triglycerides: What You Need to Know "Elevated triglyceride levels can lead to heart disease, kidney disease, and pancreatitis. National guidelines suggest normal triglycerides levels should be less than 150 milligrams per deciliter."
Diet High in Saturated Fat May Reduce Protective Effect of HDL "The anti-inflammatory activity of HDL appears to decrease after consumption of saturated fat, but improves on consumption of polyunsaturated fat, a new study shows. The findings imply that the cardioprotective effects of HDL may depend not only on HDL level, but also on its behavior in the body in response to meals or other stimuli."
Drugs Aren't the Only Option "Our health-care system—really, a disease-care system—is set up to make it difficult for doctors to counsel patients about alternatives to drugs and surgery. This system is enormously frustrating for both doctors and patients. Usually, the doctor has only about five minutes to meet with you, and, besides, we doctors learn very little about nutrition as part of our medical training. Drugs and surgery are reimbursable, but diet and lifestyle training are usually not (although my colleagues and I are working to change that). … Most doctors believe that taking a pill is easy, but changing a lifestyle is really difficult, if not impossible. It turns out that the conventional wisdom is wrong—two thirds of patients who are prescribed statin drugs are not taking them just 12 months later, according to a 2002 study published in JAMA. Why? Because they don't make you feel better. In contrast, people are often able to make and maintain significant changes in diet and lifestyle because they feel so much better so quickly: sustained weight loss, improved sexual function, increased energy, decreased blood pressure, dramatic reductions in angina (chest pains) and better control of diabetes—none of which results from cholesterol-lowering drugs. For many people, these are choices worth making—not only to live longer, but also to feel better."
Heel hurts? See a heart doctor: Achilles tendon pain serves as warning signal for high cholesterol
High Cholesterol Drives Prostate Cancer
How Low Should We Go? Researchers Find No Clear Evidence For Ultra-low Cholesterol Targets
Lower the "Bad" Cholesterol for Your Own Good
ARTICLES:
Cholesterol - Frequently asked questions.
Getting LDL cholesterol down "The evidence from large clinical trials suggests that coronary events are highly correlated with the level of LDL cholesterol, and that lowering LDL cholesterol is a very good idea. A good target is LDL cholesterol below 2 mmol/L."
HDL Cholesterol - How To Get More of a Good Thing
Should we lower cholesterol as much as possible? Rapid Responses
JOURNAL ARTICLES:
Antiatherogenic Small, Dense HDL -- Guardian Angel of the Arterial Wall? (Nat Clin Pract Cardiovasc Med. 2006) "Atherogenic dyslipidemia is a major risk factor for premature development of cardiovascular disease. This state represents an imbalance in favor of circulating levels of proatherogenic, cholesterol-rich, apolipoprotein B (apoB)-containing lipoproteins, such as LDL, rather than antiatherogenic apolipoprotein AI (apo AI)-containing HDL. Large, prospective, epidemiological studies reveal that low HDL-cholesterol concentrations constitute an independent predictive risk factor for coronary heart disease (CHD); indeed, CHD risk is elevated by approximately 3% in women and 2% in men for each decrement of 0.0259 mM (1 mg/dl) in HDL-C. The imbalance between circulating levels of atherogenic lipoproteins (LDL, VLDL and intermediate density lipoprotein) relative to those of HDL is associated with induction of endothelial dysfunction, which is in turn intimately related to inflammation and OXIDATIVE STRESS ."
Circulating oxidized LDL is associated with parameters of the metabolic syndrome in postmenopausal women. (Atherosclerosis. 2006) "CONCLUSION: Ox-LDL concentrations are associated with individual components of the MS and are significantly higher in postmenopausal women with MS compared to healthy postmenopausal women."
Curcumin induces changes in expression of genes involved in cholesterol homeostasis. (J Nutr Biochem. 2006) "These changes in gene expression are consistent with the proposed hypocholesterolemic effect of curcumin."
Dietary cholesterol, eggs and coronary heart disease risk in perspective (Nutrition Bulletin 2006) " . the scientific evidence to support a role for dietary cholesterol in CHD is relatively insubstantial in comparison with the incontrovertible link between its circulating blood relative in low density lipoprotein (LDL) cholesterol and CHD.. numerous studies have shown that dietary cholesterol can increase serum LDL-cholesterol, but the size of this effect is highly variable between individuals and, according to over 30 years of prospective epidemiology, has no clinically significant impact on CHD risk. ."
Different effects of atherogenic lipoproteins and blood pressure on arterial structure and function: the bogalusa heart study. (J Clin Hypertens (Greenwich). 2006)
Egg consumption, serum total cholesterol concentrations and coronary heart disease incidence: Japan Public Health Center-based prospective study. (Br J Nutr. 2006)
High Cholesterol Drives Prostate Cancer
Hypercholesterolemia does not alter endothelial function in spontaneously hypertensive rats. (J Pharmacol Exp Ther. 2006) "In humans hypercholesterolemia and hypertension are associated with endothelial dysfunction. Here we assess whether hypercholesterolemia induces endothelial dysfunction in rats with pre-existing hypertension. . In summary, even in the presence of pre-existing hypertension, hypercholesterolemia fails to modify NO-dependent and PGI2-dependent endothelial function in SHR rats; it also does not induce a robust inflammatory response. Both are prerequisites for the development of atherosclerosis."
Increased inflammatory markers in children with familial hypercholesterolaemia. (Eur J Clin Invest. 2006)
Lipoprotein(a) and Incident Ischemic Stroke. The Atherosclerosis Risk in Communities (ARIC) Study (Stroke 2006) "Conclusions--A high Lp(a) concentration is associated with a higher incidence of ischemic stroke in blacks and white women, but not in white men."
Lipoprotein(a) and lipid profile in patients with atrial fibrillation. (Med Sci Monit. 2006) "Conclusions: Although some studies have tried to show a possible relationship between AF and high Lp(a) levels, we found no such relationship in our study, although ethnic differences could explain, at least in part, these results in our patients when compared with other ethnic populations."
Rural-urban difference in lipid levels and prevalence of dyslipidemia: a population-based study in Khon Kaen province, Thailand. (J Med Assoc Thai. 2006) " CONCLUSION: This present study demonstrated a significant difference in urban vs. rural lipid levels and the prevalence of dyslipidemia. Migration to urban centers and adopting an urban lifestyle is likely related to the rising lipid level and prevalence of dyslipidemia."
Sequence Variations in PCSK9, Low LDL, and Protection against Coronary Heart Disease (NEJM 2006) "Background A low plasma level of low-density lipoprotein (LDL) cholesterol is associated with reduced risk of coronary heart disease (CHD), but the effect of lifelong reductions in plasma LDL cholesterol is not known. We examined the effect of DNA-sequence variations that reduce plasma levels of LDL cholesterol on the incidence of coronary events in a large population. . Conclusions These data indicate that moderate lifelong reduction in the plasma level of LDL cholesterol is associated with a substantial reduction in the incidence of coronary events, even in populations with a high prevalence of non-lipid-related cardiovascular risk factors."
Stroke mortality and the apoB/apoA-I ratio: results of the AMORIS prospective study. (J Intern Med. 2006) "CONCLUSIONS: These observations link the apoB/apoA-I ratio to the risk of fatal stroke in a similar fashion as for myocardial infarction and other ischaemic events. Our findings indicate that the apoB/apoA-I ratio, which indicates the 'cholesterol balance', is a robust and specific maker of virtually all ischaemic events."
Structural and functional variations in human apolipoprotein E3 and E4. (J Biol Chem. 2006) "There are three major apolipoprotein E (apoE) isoforms. Whereas APOE-e3 is considered as a longevity gene, APOE-e4 is a dual risk factor to atherosclerosis and Alzheimer's disease."
Study of the correlation between blood lipid levels and the severity of coronary atherosclerosis in a Chinese population sample. (Acta Cardiol. 2006) " CONCLUSION: Serum lipid levels correlate positively with the severity of coronary artery atherosclerosis in a Chinese population sample. Patients with higher levels of serum TC, LDL-C and non-HDL-C have more severe coronary atherosclerosis, compared with those with low levels of serum TC, LDL-C and non-HDL-C."
The independent correlation between high-density lipoprotein cholesterol and subsequent major adverse coronary events (American Heart Journal) "Conclusion: There is substantial evidence from clinical trials that lowering low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular risk. There is less evidence for the salutatory effects of raising high-density lipoprotein cholesterol (HDL-C). . High-density lipoprotein cholesterol measurements and change in HDL-C predicted major adverse coronary events in this urban practice, which provides support studying interventions targeting HDL-C for cardiovascular risk reduction."
The role of high-density lipoprotein cholesterol in the prevention and possible treatment of cardiovascular diseases. (Curr Mol Med. 2006)
The significance of low-density-lipoproteins size in vascular diseases. (Int Angiol. 2006) "Low density lipoproteins (LDL) comprise in humans two different main fractions: large, buoyant and small, dense particles. Small, dense LDL particles correlate negatively with plasma HDL levels and positively with plasma triglyceride concentrations and are associated with the metabolic syndrome and increased risk for cardiovascular disease. LDL size seems to be an important predictor of cardiovascular events and progression of coronary heart disease (CHD). In addition, several studies have suggested that therapeutic modulation of specific LDL subclasses may be of great benefit in reducing the atherosclerotic risk. Therefore, LDL size measurement may be of potential value in the clinical assessment and management of patients at high risk of CHD, a category that comprises individuals with non-coronary forms of atherosclerosis: peripheral arterial disease, carotid artery disease, abdominal aortic aneurysm. ."
Triglycerides and the Risk of Coronary Heart Disease. 10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies (Circulation 2006)
Visceral adipose tissue accumulation, secretory phospholipase A(2)-IIA and atherogenecity of LDL. (Int J Obes (Lond). 2006) "Objective:The aim of the present study was to investigate the combined impact of visceral adipose tissue (VAT) and secretory group IIA phospholipase A(2) (sPLA(2)-IIA) concentrations on the atherogenicity of low-density lipoprotein (LDL) particles among men. . Conclusion:Both VAT and sPLA(2)-IIA levels modulate the atherogenecity of LDL by accounting for the reduction in their size and their susceptibility to oxidation."
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