Cholesterol - Lipids - Hyperlipidemia

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Cholesterol

NIH - What Is 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 Article

High-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."

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Cholesterol - Lipids - Hyperlipidemia

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study (Neurology 2007) "Conclusions: Hemorrhagic stroke was more frequent in those treated with atorvastatin, in those with a hemorrhagic stroke as an entry event, in men, and increased with age. Those with Stage 2 hypertension at the last visit prior to the hemorrhagic stroke were also at increased risk. Treatment did not disproportionately affect the hemorrhagic stroke risk associated with these other factors. There were no relationships between hemorrhage risk and baseline low-density lipoprotein (LDL) cholesterol level or recent LDL cholesterol level in treated patients."

Statins and Hemorrhagic Stroke: Shedding Light on SPARCL "Comment: This post-hoc analysis confirms results of a large study of patients with recent stroke, which suggested that although atorvastatin is associated with a significant reduction in risk for subsequent stroke from any cause, it is also associated with an increased risk for hemorrhagic stroke. It seems reasonable to assume that these benefits and risks are a class effect of statins. Therefore, clinicians caring for stroke patients, particularly those with the predictors identified in this study — prior hemorrhagic stroke, male sex, advanced age, and stage 2 hypertension — should weigh the known benefits of statins in preventing ischemic stroke and cardiovascular events against the possibility that they may increase the risk for hemorrhagic stroke."

Very Low LDL May Mean More Cancer Risk: Risk Found in People Taking Statin Drugs; More Study Needed, Researchers Say "… a clear association was seen between statin use in high doses and liver abnormalities. “There was an important and significant relationship between the dose of statins given and the risk of liver toxicity,” Karas says. “I think this paper establishes that point quite strongly.” The analysis failed to show a similar link between statin dosage and muscle damage. It has long been suggested that in high doses statins raise the risk of a rare but potentially life-threatening muscle disorder known as rhabdomyolysis … It is not clear from the analysis if the increased cancer risk seen in patients with very low LDL had anything to do with statin use."

The role of coenzyme Q10 in statin-associated myopathy: a systematic review. (J Am Coll Cardiol. 2007) "The routine use of CoQ10 cannot be recommended in statin-treated patients. Nevertheless, there are no known risks to this supplement and there is some anecdotal and preliminary trial evidence of its effectiveness. Consequently, CoQ10 can be tested in patients requiring statin treatment, who develop statin myalgia, and who cannot be satisfactorily treated with other agents. Some patients may respond, if only via a placebo effect."

Age-related differences in the prevalence of potential drug-drug interactions in ambulatory dyslipidaemic patients treated with statins. (Drugs Aging. 2007) "CONCLUSIONS: Compared with younger patients, elderly dyslipidaemic patients are at a higher risk for clinically relevant pDDIs, mainly because of a higher number of drugs prescribed. In addition, patients aged >/=75 years were prescribed more drugs with a high potential for DDIs, especially drugs used for the treatment of arrhythmias and heart failure. The risk for adverse reactions associated with pDDIs may often be reduced by dose adjustment, close monitoring or selection of an alternative drug."

Safety of aggressive lipid management. (J Am Coll Cardiol. 2007) " … the long-term safety of combination with high-dose statins remains to be established. In order to optimize patient outcomes, clinicians should be aware of specific patient characteristics, such as advancing age, gender, body mass index, or glomerular filtration rate, which predict muscle and hepatic statin toxicity."

Does pravastatin promote cancer in elderly patients? A meta-analysis (CMAJ 2007) "Interpretation: Our findings suggest an association between pravastatin therapy and cancer in elderly patients. However, given the importance of this potential association, further verification is warranted."

Systematic Review of Statin Safety

Statins May Vex Bladder Cancer Therapy " Some bladder cancer patients may fare better if they're not taking cholesterol-lowering statin drugs, Belgian doctors say. Their findings focus only on bladder cancer patients getting immunotherapy with the bacille Calmette-Guerin (BCG) vaccine."

Myotoxicity associated with lipid-lowering drugs. (Current Opinion in Rheumatology 2007) "Summary: Management of myotoxicity requires an evaluation of risk factors prior to prescribing lipid-lowering drugs, attention to muscle symptoms, and withdrawal of drug in the event of significant abnormalities."

Drugs

Cholesterol-Lowering Drugs Bring Mixed Benefits "Higher doses of cholesterol-lowering statins may not be cost-effective for all heart patients, U.S. researchers find."

Comparison of the effects of high doses of rosuvastatin versus atorvastatin on the subpopulations of high-density lipoproteins. (Am J Cardiol. 2007) "In conclusion, our data show that both statins, given at their maximal doses, favorably alter the HDL subpopulation profile, but also that rosuvastatin is significantly more effective in this regard than atorvastatin."

Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. (JAMA. 2007) " CONCLUSIONS: Statin therapy is associated with regression of coronary atherosclerosis when LDL-C is substantially reduced and HDL-C is increased by more than 7.5%. These findings suggest that statin benefits are derived from both reductions in atherogenic lipoprotein levels and increases in HDL-C, although it remains to be determined whether the atherosclerotic regression associated with these changes in lipid levels will translate to meaningful reductions in clinical events and improved clinical outcomes."

Influence of a Lipid-Lowering Therapy on Calcified and Noncalcified Coronary Plaques Monitored by Multislice Detector Computed Tomography: Results of the New Age II Pilot Study. (Invest Radiol. 2007) " CONCLUSIONS:: Statin therapy led to a significant reduction of noncalcified plaque burden that was not reflected in calcium scoring or total plaque burden. This finding might explain the risk reduction after the initiation of statin therapy. Using multislice detector computed tomography, physicians have the potential to monitor medical treatment in patients with coronary atherosclerosis."

A review of high-dose statin therapy: targeting cholesterol and inflammation in atherosclerosis. (Eur Heart J. 2007)

Consumer Reports Best Buy Drugs: Treating Elevated Cholesterol and Heart Disease - The Statins

Optimal treatment of dyslipidemia in high-risk patients: intensive statin treatment or combination therapy? (rev Cardiol. 2007)

Exercise

General Information

Adding Omega-3 Fatty Acids to Stable Statin Therapy Reduces Triglyceride Levels, Without Raising LDL "The addition of an omega-3 fatty-acid supplement to statin therapy in patients with persistent hypertriglyceridemia significantly reduced triglyceride levels and non-HDL-cholesterol levels, all without a significant increase in LDL-cholesterol levels [1]."

Is There a Role for Fibrates in the Management of Dyslipidemia in the Metabolic Syndrome? (Arterioscler Thromb Vasc Biol. 2007)

High-density lipoprotein as a therapeutic target: a systematic review. (JAMA. 2007)

Statins Reduce the Risk of Lung Cancer in Humans - A Large Case-Control Study Of US Veterans (CHEST. 2007)

Management of hypertriglyceridemia. (Am Fam Physician. 2007)

Coenzyme Q(10) and statins: Biochemical and clinical implications. (Mitochondrion. 2007)

[New insights and perspectives for management of dyslipidemia.] (Rev Med Interne. 2007)

How Low Should We Go on LDL?

Intake of fish oil, oleic Acid, folic Acid, and vitamins B-6 and e for 1 year decreases plasma C-reactive protein and reduces coronary heart disease risk factors in male patients in a cardiac rehabilitation program. (J Nutr. 2007) "Therapeutic lifestyle changes, effected through a CR program comprising regular exercise and the intake of a combination of dietary nutrients, reduced a variety of risk factors in MI patients, which supports the rationale for nutritional programs in the secondary prevention of coronary heart disease."

Fenofibrate: a review of its use in primary dyslipidaemia, the metabolic syndrome and type 2 diabetes mellitus. (Drugs. 2007)

Guidelines

NGC - VA/DoD clinical practice guideline for the management of dyslipidemia. (2006)

Immunotherapy

Internet Sites

Treatment Information

Anticoagulation Resource

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

NIH - Cholesterol Lowering Medicines

NIH - How to Lower Your Cholesterol Level

NIH - The Benefits of Cholesterol Lowering

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Intake of phenol-rich virgin olive oil improves the postprandial prothrombotic profile in hypercholesterolemic patients (American Journal of Clinical Nutrition 2007)

Macadamia Nut Consumption Modulates Favourably Risk Factors for Coronary Artery Disease in Hypercholesterolemic Subjects. (Lipids. 2007)

How effective are dietary interventions in lowering lipids for adults with dyslipidemia? (J Fam Pract. 2007)

Effect of plant sterols and exercise training on cholesterol absorption and synthesis in previously sedentary hypercholesterolemic subjects. (Transl Res. 2007) " These findings suggest that exercise does not modulate lipid levels by altering to cholesterol absorption or synthesis, whereas plant sterols favorably alter levels of LDL cholesterol by suppressing intestinal absorption."

Other

Other Treatments

Beneficial effects of periodontal treatment on metabolic control of hypercholesterolemia. (South Med J. 2007)

Experimental

Flaxseed reduces plasma cholesterol levels in hypercholesterolemic mouse models. (J Am Coll Nutr. 2007)

Radiotherapy

Supplements-Vitamins-CAM

Red yeast rice: Popular cholesterol-lowering option could carry risks " "There is some evidence that red yeast rice can help lower your "bad" (LDL) cholesterol. However, the FDA has warned that the following red yeast rice products could contain a prescription medication known as lovastatin: …"

Effects of CoQ10 supplementation on plasma lipoprotein lipid, CoQ10 and liver and muscle enzyme levels in hypercholesterolemic patients treated with atorvastatin: A randomized double-blind study. (Atherosclerosis. 2007) "In conclusion atorvastatin definitely decreased plasma CoQ10 levels and supplementation with CoQ10 increased their levels. These changes in plasma CoQ10 levels showed no relation to the changes in serum AST, ALT and CK levels. Further studies are needed, however, for the evaluation of CoQ10 supplementation in statin therapy."

Effects of flaxseed oil supplementation on plasma adiponectin levels in dyslipidemic men. (Eur J Nutr. 2007) "CONCLUSIONS: Dietary ALA has no effect on plasma adiponectin concentration in dyslipidemic men."

Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. (Am J Cardiol. 2007) "In conclusion, results suggest that coenzyme Q10 supplementation may decrease muscle pain associated with statin treatment. Thus, coenzyme Q10 supplementation may offer an alternative to stopping treatment with these vital drugs."

Role of prescription omega-3 Fatty acids in the treatment of hypertriglyceridemia. (Pharmacotherapy. 2007) "In patients with triglyceride levels above 500 mg/dl, approximately 4 g/day of EPA and DHA reduces triglyceride levels 45% and very low-density lipoprotein cholesterol levels by more than 50%. Low-density lipoprotein cholesterol levels may increase depending on the baseline triglyceride level, but the net effect of EPA and DHA therapy is a reduction in non-high-density lipoprotein cholesterol level. Alternatively, patients may receive one of the fibrates (gemfibrozil or fenofibrate) or niacin for triglyceride lowering if their triglyceride levels are higher than 500 mg/dl. In controlled trials, prescription omega-3 fatty acids were well tolerated, with a low rate of both adverse events and treatment-associated discontinuations. The availability of prescription omega-3 fatty acids, which ensures consistent quality and purity, should prove to be valuable for the medical management of hypertriglyceridemia."

Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis (The Lancet 2007) "EPA is a promising treatment for prevention of major coronary events, and especially non-fatal coronary events, in Japanese hypercholesterolaemic patients."

Safety considerations with niacin therapy. (Am J Cardiol. 2007) "Niacin has beneficial effects on plasma lipoproteins and has demonstrated clinical benefits in reducing cardiovascular events and atherosclerosis progression. The side effects of niacin, however, have limited its use in general clinical practice. An understanding of cutaneous flushing based on the best available evidence should enhance patient education efforts and improve adherence. Although serious hepatic toxicity from niacin administration has been reported, it is largely confined to the use of slow-release formulations given as unregulated nutritional supplements. … Overall, the perception of niacin side effects is often greater than the reality. As a result, a valuable medication for cardiovascular risk is underused."

Prescription omega-3 fatty acids for the treatment of hypertriglyceridemia. (Am J Health Syst Pharm. 2007) "CONCLUSION: P-O3FA has demonstrated an efficacy and safety in adult patients with high and very high triglycerides adjunct to diet, and the reduction in serum triglyceride levels was dependent on the baseline triglyceride levels. A large controlled clinical trial is necessary to determine if P-O3FA can be used to reduce CHD risk, either as combined with hydroxymethylglutaryl-coenzyme A reductase inhibitors or as monotherapy."

Effect of Raw Garlic vs Commercial Garlic Supplements on Plasma Lipid Concentrations in Adults With Moderate Hypercholesterolemia (Arch Intern Med. 2007) "Conclusions None of the forms of garlic used in this study, including raw garlic, when given at an approximate dose of a 4-g clove per day, 6 d/wk for 6 months, had statistically or clinically significant effects on LDL-C or other plasma lipid concentrations in adults with moderate hypercholesterolemia."

Dietary supplementation with flaxseed oil lowers blood pressure in dyslipidaemic patients. (Eur J Clin Nutr. 2007) "Conclusions:We observed a hypotensive effect of ALA, which may constitute another mechanism accounting in part for the apparent cardioprotective effect of this n-3 fatty acid."

Surgery

Transplantation

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