Cholesterol - Lipids - Hyperlipidemia

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Cholesterol

NIH - Cholesterol “Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries. This is called plaque. Plaque can narrow your arteries or even block them. High levels of cholesterol in the blood can increase your risk of heart disease. Your cholesterol levels tend to rise as you get older. There are usually no signs or symptoms that you have high blood cholesterol, but it can be detected with a blood test. You are likely to have high cholesterol if members of your family have it, if you are overweight or if you eat a lot of fatty foods. You can lower your cholesterol by exercising more and eating more fruits and vegetables.“

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."

NIH - High blood cholesterol and triglycerides (Medical Encyclopedia) “The medical term for high blood cholesterol and triglycerides is lipid disorder. Such a disorder occurs when you have too many fatty substances in your blood. These substances include cholesterol and triglycerides. A lipid disorder increases your risk for atherosclerosis and heart disease. Causes: High cholesterol and other lipid disorders can be inherited (passed down through families) or associated with: • Fatty diets • Disease such as diabetes, hypothyroidism, Cushing syndrome, and kidney failure • Certain medications, including birth control pills, estrogen, corticosteroids, certain diuretics, and beta-blockers • Lifestyle factors, including inactivity and regular, excessive alcohol use If you smoke and also have high cholesterol you have an even greater risk for heart disease. Lipid disorders are more common in men than women.”

NHS - Cholesterol “Cholesterol is carried in the blood by molecules called lipoproteins. There are several different lipoproteins, but the three main types are: • Low density lipoprotein (LDL). This is often known as bad cholesterol and is thought to increase arterial disease. It carries cholesterol from the liver to the cells and can cause a harmful build-up if there is too much for the cells to use. Normally, the blood contains about 70% of LDL, but the level will vary from person to person. • High density lipoprotein (HDL). This is often referred to as 'good cholesterol', and is thought to prevent arterial disease. It takes cholesterol away from the cells and back to the liver, where it is either broken down, or is passed from the body as a waste product. • Triglycerides are another type of fatty substance present in the blood. They are found in dairy products, meat and cooking oils. Triglycerides are also produced by the liver. Those who are overweight, have a diet that is high in fatty or sugary foods, or drink a large amount of alcohol, have an increased risk of having a high triglyceride level. The amount of cholesterol present in the blood can range from 3.6 to 7.8 mmol/litre. A level above 6mmol/litre is considered as high, and a risk factor for arterial disease. Government advice recommends a target cholesterol level of less than 5. However, in the UK, two in three adults have a total cholesterol level of 5 or above. In England, men, on average, have a level of 5.5, and women have a level of 5.6 … A high cholesterol level may only be revealed if you have symptoms of atherosclerosis. These can include: • angina, caused by narrowed coronary arteries in the heart, • leg pain on exercising, due to narrowing of the arteries that supply the lower limbs, • blood clots and ruptured blood vessels, which can result in a stroke or mini-stroke (transient ischaemic attack (TIA)), • ruptured plaques, which can lead to a blood clot forming in one of the arteries delivering blood to the heart (coronary thrombosis), and may lead to heart failure if a significant amount of heart muscle is damaged, and • thick yellow patches (xanthomas) around the eyes or elsewhere on the skin. These are cholesterol deposits and can often be seen in people with inherited, or familial cholesterol (where your family members have a history of high chloresterol).”

Highlighted Articles

Triglycerides Linked to Coronary Disease Risk (2008) “A new study showing that high levels of triglycerides were strong predictors of cardiac trouble strengthens the case for including measurement of the blood fats in prevention programs. "Triglycerides traditionally have been viewed as second-class citizens," said Dr. Michael Miller, director of preventive cardiology at the University of Maryland Medical Center and lead author of the report in the Feb. 12 issue of the Journal of the American College of Cardiology.. "LDL cholesterol has always taken center stage. We know that LDL is intimately involved in bringing cholesterol to scavenger cells, which deposit them to form plaques in the arteries. This study shows that triglycerides in and of themselves are also lipids to blame." “

Cholesterol Reducing Drugs (2008)“There are five main categories of cholesterol reducers: statins, bile acid resins, nicotinic acid, fibrates and ezetimibe. Most are available only by prescription, while nicotinic acid, a form of vitamin B3 (niacin), is available over-the-counter. However, niacin should only be taken under the care of a physician to monitor any side effects that could arise, such as severe upset stomach (nausea) and flushing. “

Visit InfoMedSearch's Home Page for all InfoMedLinks Cardiovascular Topics: Atherosclerosis, Atrial Fibrillation, Coronary Artery Disease, Cholesterol - Lipids, General Cardiovascular, Heart Failure, Hypertension, Myocardial Infarction (Heart Attack), Peripheral Artery Disease, and Stroke.

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Cholesterol - Lipids - Hyperlipidemia

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Older Patients Face Higher Mortality, CHF Hospitalizations With Rosiglitazone Over Pioglitazone

Effects of Vitamin D Supplementation in Atorvastatin-Treated Patients: A New Drug Interaction With an Unexpected Consequence. (Clin Pharmacol Ther. 2008)

Early Communication About an Ongoing Safety Review of Ezetimibe/Simvastatin (marketed as Vytorin), Simvastatin (marketed as Zocor) and Ezetimibe (marketed as Zetia)

Hyperlipidemia, statin use and the risk of developing rheumatoid arthritis. (Ann Rheum Dis. 2008)

Prevalence of Musculoskeletal Pain and Statin Use. (J Gen Intern Med. 2008)

Well, Well, Well: A few more words about statins risks "John Carey, in the Jan 17 Business Week cover story, reports that a large, government-funded clinical trial on cholesterol-lowering medications showed no statistically significant reduction in mortality risk at all. There's more. Experts like Dr Rodney A Hayward, professor of internal medicine at the University of Michigan, are now saying that current evidence supports ignoring LDL cholesterol completely when assessing heart disease risk. Even Pfizer's own numbers (with the help of a little math by John Carey) tell us that for 99 out of 100 people taking Lipitor there is no measurable benefit-and that's based on an industry-sponsored trial, one which used carefully selected patients with multiple risk factors, which likely explains the findings of the government study showing no significant benefit at all. . Where statins do help, they help not so much because they successfully lower cholesterol levels, but very likely because they also reduce inflammation, which is a somewhat different problem, and one that so-called unproven alternative approaches specialize in. The sad victory of those bent on convincing us that alternative ways of achieving heart health are ineffective is that too many of our mothers and fathers now have, thanks to the supposedly life-saving statins, experienced Alzheimer-like memory losses, muscle losses significant enough to make walking past the mailbox a chore, and feeling young and amorous a very dim memory. Yet, almost unbelievably, some are still calling for wider use of statins. "

Tendon Problems a Possible Adverse Effect of Statin Therapy "Those who might be at greater risk, write lead investigator Dr Isabelle Marie (Rouen University Hospital, France) and colleagues, include patients with metabolic disorders, patients who exert themselves physically throughout the day, and patients taking other drugs that might increase the toxicity of statins, such as steroids or antibiotics like fluoroquinolone. The authors stress, however, that statin-associated tendon impairments are extremely rare, and none have been reported in pre- and postmarketing studies, including all the large statin trials."

Drugs

Fenofibrate: treatment of hyperlipidemia and beyond. (Expert Rev Cardiovasc Ther. 2008)

JUPITER Halted: Rosuvastatin Significantly Reduces Cardiovascular Morbidity and Mortality

Doubt Cast on 2 Drugs Used to Lower Cholesterol "Two widely prescribed cholesterol-lowering drugs, Vytorin and Zetia, may not work and should be used only as a last resort, a panel of four cardiologists told an audience of more than 5,000 people at a major cardiology conference on Sunday. Instead, physicians and patients should rely more heavily on older cholesterol-lowering drugs called statins, which have proven benefits and can be cheaper, the panel said. "The strongest recommendation we can make on this panel is to go back to statins," said Dr. Harlan M. Krumholz, a cardiologist at Yale. "They work." "

Cholesterol Drug Has No Benefit in Trial, Makers Say "A clinical trial of Zetia, a cholesterol-lowering drug prescribed to about 1 million people a week, failed to show that the drug has any medical benefits, Merck and Schering-Plough said on Monday. The results will add to the growing concern over Zetia and Vytorin, a drug that combines Zetia with another cholesterol medicine in a single pill. About 60 percent of patients who take Zetia do so in the form of Vytorin, which combines Zetia with the cholesterol drug Zocor."

Exercise

High Cholesterol: Exercise for a Healthy Heart

Effect of T'ai Chi Chuan Training on Cardiovascular Risk Factors in Dyslipidemic Patients. (J Altern Complement Med. 2008) “Conclusions: A 12-month TCC training program significantly improves aerobic capacity and CHD risk factors in patients with dyslipidemia.”

General Information

Wider cholesterol drug use may save lives “People with low cholesterol and no big risk for heart disease dramatically lowered their chances of dying or having a heart attack if they took the cholesterol pill Crestor, a large study found. The results, reported Sunday at an American Heart Association conference, were hailed as a watershed event in heart disease prevention. Doctors said the study might lead as many as 7 million more Americans to consider taking cholesterol-lowering statin drugs, sold as Crestor, Lipitor, Zocor or in generic form. … However, some doctors urged caution. Crestor gave clear benefit in the study, but so few heart attacks and deaths occurred among these low-risk people that treating everyone like them in the United States could cost up to $9 billion a year — "a difficult sell," one expert said. About 120 people would have to take Crestor for two years to prevent a single heart attack, stroke or death, said Stanford University cardiologist Dr. Mark Hlatky. He wrote an editorial accompanying the study published online by the New England Journal of Medicine. "Everybody likes the idea of prevention. We need to slow down and ask how many people are we going to be treating with drugs for the rest of their lives to prevent heart disease, versus a lot of other things we're not doing" to improve health, Hlatky said.”

Cholesterol drug cancer warning “However, Professor Terje Pederson, the lead author of the study, said that the study findings could simply be due to random chance. An analysis by Oxford University, which combined these findings with those from other similar studies, found no overall evidence that the drug caused cancer. This view was backed by the British Heart Foundation, which said that it was important that patients taking statins continued to do so unless told to stop by their doctor. Dr Mike Knapton, from the charity, said:"There is no suggestion that statins increase the risk of cancer. “

Analyses of Cancer Data from Three Ezetimibe Trials (NEJM 2008)

Take Steps to Reduce Cholesterol

High Cholesterol: Cholesterol-Lowering Medication

How Drug That Blocks Cholesterol Absorption From The Diet Works “A new study in the June issue of Cell Metabolism, a Cell Press publication, sheds light on the action of the drug ezetimibe (trade name Zetia), which is used to treat high cholesterol. Ezetimibe is unique among cholesterol-lowering drugs in that it works by cutting the amount of cholesterol taken in from the diet rather than by blocking cholesterol's manufacture in the body.”

Cholesterol in women at high cardiovascular risk is less successfully treated than in corresponding men : The Skaraborg Hypertension and Diabetes Project. (Eur J Clin Pharmacol. 2008)

Guidelines

New NICE Guidelines Are Set To Reduce Premature Deaths In People Who Have Inherited High Cholesterol

NGC - Screening and management of hyperlipidemia. (2007)

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

Almonds reduce biomarkers of lipid peroxidation in older hyperlipidemic subjects. (J Nutr. 2008)

Other

Other Treatments

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Fish oil in the treatment of dyslipidemia. (Current Opinion in Endocrinology, Diabetes & Obesity 2008)

Benefits of fish oil supplementation in hyperlipidemia: a systematic review and meta-analysis. (Int J Cardiol. 2008)

Prescription Omega-3 Fatty Acids and Their Lipid Effects: Physiologic Mechanisms of Action and Clinical Implications (Expert Rev Cardiovasc Ther. 2008)

Role of n-3 fatty acids in the treatment of hypertriglyceridemia and cardiovascular disease. (Am J Clin Nutr. 2008) “n-3 Fatty acids (FAs) when used in doses of 3-4 g/d eicosapentaenoic acid and docosahexaenoic acid have profound effects on triacylglycerol (TG) concentrations.”

Omega-3 fatty acid concentrates in the treatment of moderate hypertriglyceridemia (Expert Opin Pharmacother 2008) Results/conclusions: P-OM3 are effective in reducing triglycerides by 30% in this population and are likely to be combined with other drugs (e.g., statins) to treat combined dyslipidemia.”

Surgery

Transplantation

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