Cholesterol How To Lower

Lower Cholesterol Book

Scott Davis' e-Book Beat Cholesterol in 30 Days is a useful compendium of information about natural methods and foods to avoid to lower LDL (bad) cholesterol. While the book is extremely useful in categorizing what helps and harms people in terms of diet, it's not so much a full-fledged system as opposed to a guidebook on foods that will improve and worsen your cholesterol levels. Once Davis realized that this all-natural cholesterol lowering program worked for him, he sought out other people who also had high cholesterol and put it to the test. He found that his method worked for over 93% of the people who tried it. Because of this success, he decided to make the program available to the public in the form of an e-book. Like all the other Blue Heron Health News promoted health guides, the Beat Cholesterol in 30 Days guidebook will help you achieve better health using an all-natural method. Unlike most prescription drugs, this program ensures a risk-free solution to a reduced cholesterol level in a short span of time. This book will provide you with all there is to know about your silent killer enemy: cholesterol. Continue reading...

Natural Cholesterol Guide Summary

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My Natural Cholesterol Guide Review

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The writer has done a thorough research even about the obscure and minor details related to the subject area. And also facts weren’t just dumped, but presented in an interesting manner.

This ebook does what it says, and you can read all the claims at his official website. I highly recommend getting this book.

Hypercholesterolemia and Atherosclerosis

Familial hypercholesterolemia is caused by the absence of or a defect in the LDL receptor. This results in an inability to clear LDL from the bloodstream, leading to severe hypercholesterolemia and accelerated atherosclerosis. Various models of this condition have been studied. Gene transfer of the corrected LDL receptor has been shown to be beneficial in both murine and human studies (5,103-106). Furthermore, it has been shown that delivery of the very low-density lipoprotein (VLDL) receptor (using modified helper-dependent adenoviral vectors) into the LDL receptor-deficient mouse model (107) could produce sustained lipid-lowering effects for up to 6 mo. Even more promising, in an ApoE-deficient mouse model, delivery of the ApoE gene using a helper-dependent adenoviral vector (18) resulted in decreased serum lipid concentrations and virtually

Anionexchange resins bile acid sequestrants

Colestyramine is an oral anion-exchange resin,8 which binds bile acids in the intestine. Bile acids are formed from cholesterol in the liver, pass into the gut in the bile and are largely reabsorbed at the terminal ileum. The total bile acid pool is only 3-5 g but, because such enterohepatic recycling takes place 5-10 times a day, on average 20-30 g of bile acid are delivered into the intestine every 24 hours. Bile acids bound to colestyramine are lost in the faeces and the depletion of the bile acid pool stimulates conversion of cholesterol to bile acid the result is a fall in intracellular cholesterol in hepatocytes, and an increase (up-regulation) in both LDL-receptors and cholesterol synthesis. The former has the predominant influence on plasma LDL-cholesterol, which falls by 20-25 . In many patients there is some compensatory increase in hepatic triglyceride output. Anion exchange resins therefore may be used first line for hypercholesterolaemia but not when there is significant...

Test Methodology 88 Hdl Cholesterol

Testing for HDL cholesterol (HDL-C) using either precipitation methods or homogenous assays. TEST METHODOLOGY 8-8. HDL CHOLESTEROL (continued) The American Diabetic Association states that type 2 diabetics can develop cardiac complications, especially patients who have had this disease over a long period of time and who demonstrate lipid abnormalities. Diabetics often have low HDL-C levels with elevated LDL-C and triglyceride levels. The National Cholesterol Education Program (NCEP) committee states that diabetics with elevated cholesterol develop plaque formation in their blood vessels leading to narrowing of the vessel lumen. In type 2 diabetics who exhibit elevated triglyceride levels, the cholesterol level needs to be less than 200 mg dL and the LDL-C level needs to be maintained at 100 mg dL or less in order to provide a low risk for plaque formation in the blood vessels. Because type 2 diabetics cannot move glucose from the bloodstream into the tissues for metabolism as...

Approach To High Cholesterol Definitions

HDL cholesterol High-density lipoprotein cholesterol. These guidelines recommend measuring lipid levels in all adults older than age 20 years every 5 years. The test performed can be either a fasting lipid panel (total. LDL and HDL cholesterol triglycerides) or a nonfasting total and HDL cholesterol, with subsequent fasting lipid panel if either total cholesterol is over 200 mg dL or if HDL cholesterol is less than 40 mg dL. Table 35-1 lists the ATP III classification of lipid levels. When dietary restriction alone does not lead to adequate LDL reduction, the addition of dietary soluble fiber and plant stanols sterols can be beneficial. Soluble fiber 10-25 g and of plant stanols sterols 2 g can be added to aid in cholesterol reduction. Referral to a dietician may be helpful as well. The first-line pharmacotherapy for LDL cholesterol reduction is a statin. Statins not only reduce LDL cholesterol but also reduce the rates of coronary events, strokes, cardiac death, and all-cause...

Cholesterol Lowering and SCD

Another important issue at a time when so many people are taking cholesterol-lowering drugs with the hope to improve their life expectancy is whether cholesterol lowering might reduce the risk of SCD. According to recent data standardized to the 2000 US population,2 of 719,456 cardiac deaths among adults aged > 35 years, 63 were defined as sudden cardiac death (SCD). In that study, SCD was defined as death occurring out of the hospital or in the emergency room or as dead on arrival with an underlying cause of death reported as a cardiac disease. Among those aged 35 to 55, about 75 of cardiac deaths were SCD.2 Another question is are we able to identify people at risk of SCD In other words, are the traditional risk factors of CHD predictive of SCD Several studies have recently tried to answer that question. For instance, in a prospective study in healthy men, investigators found that only C-reac-tive protein (CRP) was significantly associated with the risk of SCD whereas homocysteine...

Lovastatin Lowers Serum Cholesterol Levels

Chemists and biochemists have long sought a means of reducing serum cholesterol levels to reduce the risk of heart attack and cardiovascular disease. Because HMG-CoA reductase is the rate-limiting step in cholesterol biosynthesis, this enzyme is a likely drug target. Mevinolin, also known as lovastatin (see figure), was isolated from a strain of Aspergillus terreus and developed at Merck, Sharpe and Dohme for this purpose. It is now a widely prescribed cholesterol-lowering drug. Dramatic reductions of serum cholesterol are observed at doses of 20 to 80 mg per day. Derivatives of lovastatin have been found to be even more potent in cholesterol-lowering trials. Synvinolin lowers serum cholesterol levels at much lower doses than lovastatin.

Statins

The ability of statins to lower hsCRP was first described for pravastatin using data from the CARE trial (94,101). Subsequent confirmatory work has shown the effect of statins on hsCRP to be an important class effect. A meta-analysis of the effects of statins on nonlipid serum markers specifically CRP, fibrinogen, homocysteine, LDL-C oxidation, tissue plasminogen activator, plasminogen activator inhibitor, and platelet aggregation concluded that, of these, only CRP appears to be influenced by statin use (102). Indeed, studies of pravastatin, lovastatin, cerivastatin, simvastatin, and atorvastatin indicate that, on average, median hsCRP levels decline 15-25 as early as 6 wk following initiation of therapy (102) in persons with no history of CVD (48,103-106) and in patients with stable coronary disease (103,107) or ACS (90,108). Ezetimibe, a novel cholesterol absorption inhibitor that prevents absorption of dietary and biliary cholesterol without affecting that oftriglycerides and...

NSAIDS and Statins

Interestingly, the two groups of syndromes mentioned above share common treatments within each category. Inflammatory diseases are often treated with NSAIDS, and diabetics and patients with the metabolic syndrome often take statins. These two categories of medications have been analyzed for their role in cancer prevention.

Are Particular Interventions Within Cardiac Rehabilitation More Effective Than Others

In the last 10 to 15 years, there has been a large increase in the use of drug therapies in secondary preventive management in patients with CHD, notably lipid-lowering agents, such as statins, and beta-blockers. Meta-analyses show that the im Statins19 3 trials (17,617) 23 (15-30 ) 4 (2-6)

Complementary Drugs

HMG Co-A reductase inhibitors (statins) have been shown to reduce the incidence of fatal and non-fatal myocardial infarction, stroke and mortality (all causes), as well as the need for coronary artery bypass surgery. Since no single drug has been shown to be significantly more effective or less expensive than others in the group, none is included in the model list the choice of drug for use in patients at highest risk should be decided at national level.

Nutrition of the heart and myocardial protein turnover

The recent interest in healthy nutrition for the heart has almost exclusively focused on cholesterol because of its role in the development of coronary artery disease. There is little appreciation of the fact that, in terms of general descriptors of energy metabolism, heart muscle functions not simply as a conformer in response to substrate availability,65 but that substrate utilisation is controlled by the physiological demands on the system. Likewise, there is little appreciation of the fact that the heart stores endogenous substrates such as glycogen and triglycerides, and it does so in response to changes in the dietary state.66 67 In contrast to skeletal muscle, starvation increases the tissue content of both glycogen and triglycerides in heart muscle, an observation consistent with a biologist's definition of true hibernation.

Carbohydrates as Biochemical Markers of Disease

Lipids are, by definition, organic compounds that are poorly soluble in solutions such as water and soluble in organic solutions such as ether. As a group of molecules that is defined functionally by solubility, lipids consist of diverse chemical structures. Chemically, lipids are either compounds that yield fatty acids when hydrolyzed or complex alcohols that can combine with fatty acids to form esters. Only a limited number of lipids are clinically important. This group includes fatty acids, triacylglycerols (or triglycerides), cholesterol, and phospholipids. The structures for some lipids molecules are reviewed in Figure 1-4. Simple lipids are the esters of the fatty acids with various alcohols. For example, triacylglycerols or triglycerides are the esters of the fatty acids with glycerol. The acyl moiety of triacylglycerols may be saturated (i.e., they contain no double bonds) or unsaturated (i.e., they contain one or more double bonds). Such chemical structure will influence...

Atr Gene Polymorphism And Atherosclerosisrelated Diseases

Coronary artery disease (CAD) is a major public health problem in industrialized countries. Dyslipidemia, arterial hypertension, and diabetes mellitus, the main risk factors for CAD apart tobacco consumption, are influenced by both environmental and genetic factors. Several studies have suggested that the activation of the RAS could be an important contributor to CAD. The best-documented of associations between the occurrence of CAD and polymorphisms in genes RAS component is the I D polymorphism of the ACE gene. After the initial work of Cambien et al. (67), who first suggested the potential role of the ACE D allele as an independent risk factor for myocardial infarction (MI), other case-control studies either confirmed or were in disagreement with their findings (68-70). The M235T variant of AG gene has also been associated with MI but, as in hypertension, with ethnic variability (19). A1166C polymorphism in AT1R gene does not seem to be a direct risk factor for CAD or MI, but, in...

Biochemical Mechanisms

Examples of futile cycles include the synthesis and degradation of proteins, the pumping and leakage of ions across membranes, and esteri-fication and lipolysis of fatty acids triglycerides. Since the activity of these futile cycles is difficult to assess in intact organisms, it has been difficult to determinate their importance in adaptive ther-mogenesis. A clear example of uncoupling as a means of increasing energy expenditure is that brought about by uncoupling protein-1 (UCP1), a mitochondrial inner-membrane protein that leaks protons across the mitochondrial inner membrane. The energy that is stored in the mitochon-drial proton electrochemical gradient is released 8 in form of heat and is not used to synthesise ATP. UCP-1 is expressed at very high levels in BAT, the primary function of which is to produce heat in response to cold exposure. Other homologues of UCP-1 (UCP-2, UCP-3, UCP-4, and UCP-5) have been found in other tissues, but they do not appear to play an...

Insights Cardiovascular Disease

Although clinical results have been ambiguous, there are several factors that may influence the experimental outcome. Only those with significant serological responses to the organism may benefit from therapy Mahdi et al. recently showed a correlation between elevated IgG responses to chlamydial Hsp60 and cardiovascular disease.(25) The type of antibiotic used may also have a significant effect. M. Hammerschlag discusses antibiotic treatment options for chlamydial infections, and such points must be taken in to consideration. In animal models azithromycin and rifampin elicited the greatest eradication, but drugs that specifically target a nonproductively growing chlamydia may result in greater eradication rates. Finally, because atherosclerosis is a multifactorial disease, combination therapies with both an antibiotic (e.g. azithromycin) and a cholesterol-lowering agent (statins) may provide the best analysis for this association.

Noninvasive Detection of the Presence of Atherosclerotic Disease

Pathology studies have documented that levels of traditional risk factors are associated with the extent and severity of atherosclerosis. However, at every level of risk factor exposure, there is substantial variation in the amount of atherosclerosis. This variation in disease is probably due to genetic susceptibility, combinations and interactions with other risk factors, including life habits, duration of exposure to the specific level of the risk factors and such factors as biological and laboratory variability. Therefore, no blood test exists that proves the presence of atherosclerotic disease. All the known traditional (e.g. hypercholesterolemia) and modern (e.g. elevated C-reactive protein) risk factors increase the likelihood of

Imaging Methods for the Detection of High Risk Individuals

For the identification of high-risk individuals, the absolute calcium score has to be interpreted within the context of age and gender. Thus each interpretation of the calcium score (e.g. the Agat-ston score) should describe the percentile allocated to the score.28,69,70 An overwhelming number of studies have shown that a calcium score, especially in the upper (usually > 75 ) percentile range, is a predictor of coronary cardiovascular events, independent of the traditional risk factors.70-81 There is in particular no correlation between the calcium score and LDL or HDL cholesterol,82 nor any correlation with CRP,83,84 even after adjusting for traditional risk factors.85 In an unselected population of subjects older than 55 years, 30 of the men and 15 of the women without risk factors had extensive coronary calcification.86 There is no or only a weak correla

Factors Affecting Myocardial Oxygen Supply

Blood Oxygenation and Oxygen Extraction Involving Tissue Ischemia. A normal and healthy heart extracts about 75 of blood oxygen at rest however, increased coronary blood flow and extraction results in an increase in oxygen supply. Ischemic heart disease develops when there is a deficiency in the supply of blood and oxygen to the heart and is typically caused by a narrowing of the coronary arteries, a condition known as coronary artery disease (CAD) or coronary heart disease (CHD). CAD is a consequence of the complicated pathological process involvingthe development of atherosclerotic lesions in the coronary arteries, in which cholesterol, triglycerides, and other substances in the blood deposit in the walls of arteries, narrowing them. The narrowing limits the extraction and flow of oxygen rich blood to the heart.

Use in Prevention and Therapy

Vitamin B6 has multiple beneficial actions in the prevention and treatment of coronary heart disease and peripheral vascular disease. It reduces the tendency for platelets to clump together, lowers LDL cholesterol and raises HDL cholesterol, and reduces levels of blood homocysteine.8,9

Interactions At Site Of Absorption

Significant cause of reduced absorption. Antacids that contain aluminium and magnesium form insoluble complexes with tetracyclines, iron and prednisolone. Milk contains sufficient calcium to warrant its avoidance as a major article of diet when tetracyclines are taken. Colestyramine interferes with absorption of levothyroxine, digoxin and some acidic drugs, e.g. warfarin. Sucralfate reduces the absorption of phenytoin. Interactions of this type depend on both drugs being in the stomach at the same time, and can be prevented if the doses are separated by at least 2 hours.

Regression of coronary artery disease as a result of intensive lipidlowering therapy in men with high levels of

BACKGROUND AND METHODS The effect of intensive lipid-lowering therapy on coronary atherosclerosis among men at high risk for cardiovascular events was assessed by quantitative arteriography. Of 146 men no more than 62 years of age who had apolipoprotein B levels greater than or equal to 125 mg per deciliter, documented coronary artery disease, and a family history of vascular disease, 120 completed the 2.5-year double-blind study, which included arteriography at base line and after treatment. Patients were given dietary counseling and were randomly assigned to one of three treatments lovastatin (20 mg twice a day) and colestipol (10 g three times a day) niacin (1 g four times a day) and colestipol (10 g three times a day) or conventional therapy with placebo (or colestipol if the low-density lipoprotein LDL cholesterol level was elevated). RESULTS The levels of LDL and high-density lipoprotein (HDL) cholesterol changed only slightly in the conventional-therapy group (mean changes, -7...

CD36null Mice the Fed Phenotype

The FA analog -methyl 15-(p-iodophenyl) pentadecanoic acid (BMIPP, shown in Fig. 1.2) has been used as a metabolic tracer for studying FA uptake and utilization in vivo. Its usefulness has been demonstrated extensively in studies on both humans and laboratory animals 114 . Like native FA, tissue extraction of BMIPP from the blood equilibrates within 2-3 minutes and BMIPP is incorporated into phospholipids, diglycerides, or triglycerides 115, 116 . The stable iodination of The 50-60 reduction observed in BMIPP incorporation into triglycerides in CD36-null muscle and adipose tissues was associated with a 2- to 3-fold increase in labeled diglycerides. Identical results were obtained with 3H palmitate in iso-

Relation of arterial geometry to luminal narrowing and histological markers for plaque vulnerability the remodeling

Matsuzaki M, Hiramori K, Imaizumi T, et al. Intravascular ultrasound evaluation of coronary plaque regression by low density lipoprotein-apheresis in familial hypercholesterolemia the Low Density Lipoprotein-Apheresis Coronary Morphology and Reserve Trial (LACMART). J Am Coll Cardiol 2002 40 220-227.

Exercise Effects on Lipids and Weight

In the Heidelberg study total cholesterol decreased by 10 (P < 0.001), and triglycerides by 24 (P < 0.001) high-density lipoproteins increased by 3 (P NS).7 The changes in the lipid profile are quantitatively moderate however, in addition to the total reduction there is a shift with exercise from the smaller more atherogenic LDL particles to the larger, less atherogenic particles rather than a marked reduction in the LDL cholesterol content.34 In a recent study a single 90-minute treadmill exercise activity in the afternoon decreased fasting triglyceride the next morning and postprandial triglyceride concentrations by 25 in lean and obese subjects about 16-18 hours after the exercise session. Obese subjects started at a higher level of triglycerides but had a similar relative reduction.35

Preanalytical Errors And Specimen Problems

So as to provide the most accurate information. Intake of food greatly impacts on glucose, triglycerides, certain hormones, and electrolytes, so length of fasting prior to specimen collection is a preanalytical factor that is commonly addressed prior to specimen collection and testing.6 Intake of certain foods or herbs may impact on therapeutic drug testing or other laboratory results but often is not within the control of laboratory personnel prior to specimen collection.7 The age of the patient may be an important variable for the test result. For example, bilirubin and alkaline phosphatase values are different in pediatric patients than in adult populations, so coordinated reference intervals are needed. This variation is addressed through the use of age-appropriate reference ranges, but the information on patient age is often obtained at specimen collection, in the preanalytical phase.

Atherosclerosis no longer a bland lipidstorage disease

Once resident in the arterial intima, mononuclear phagocytes change their character and acquire the characteristics of foam cells. After penetrating into the intima, the blood monocyte expresses scavenger receptors, allowing it to take up modified lipoproteins that accumulate in the subendothelial space. The scavenger receptors evade the usual homeostatic suppression by excessive cholesterol characteristic ofthe classic low-density lipoprotein (LDL) receptor. This untrammeled ability to take up lipoproteins leads to the formation of lipid-laden macrophages known as foam cells, the hallmark of the early atherosclerotic lesion, also known as the fatty streak. Macrophages within the artery wall can also divide and elaborate reactive oxygen species and proinflammatory cytokines that can sustain and amplify intimal inflammation (9,10). Several proinflammatory mediators likely participate in signaling proliferation and activation of the macrophages present in the plaque. One prominent...

The Impact of Fitness on Cardiovascular Diseases

Physical fitness can be measured easily and exactly, and has been shown to have a negative correlation to coronary heart disease. However, there is also a negative correlation between increasing fitness and risk factors like hypertension and hypercholesterolemia. Intervention by physical training has been shown to reduce these risk factors in studies at the Cooper Clinic in Dallas. If these confounders are corrected for, physical inactivity doubles the risk of coronary disease. In highly trained Norwegian skiers, a risk reduction of 4.8 was found compared to the least fit group in the study. In the same study, the quar-tile with the highest fitness had a relative risk of cardiovascular death of 0.4 compared to the quar-tile with poorest fitness.5 Large studies from the US also show a double risk in persons with low exercise capacity compared to those with a high exercise capacity.6 Still it may be questioned whether the training or the high fitness per se is protective. This is...

Could Levels ofCirculating Biomarkers ofInflammation Help Guide Therapy

A retrospective analysis of CRP levels in a large primary prevention trial, Air Force Coronary Atherosclerosis Project Texas Coronary Atherosclerosis Project, suggested that apparently healthy individuals with below median LDL levels but above median hsCRP levels derived benefit from statin therapy (39). Curiously, individuals with both below median LDL and below median hsCRP levels did not benefit from treatment, indicating that promiscuous use of statins in primary prevention likely would not prove cost-effective and would expose one-fourth of the apparently healthy population to potential risks and expensive drug treatment without benefit.

Conventional Lipoprotein Analyses

After visual observation of the specimen, the next most useful and reliable tests are determinations of triglyceride and total cholesterol concentrations. These are used as a decision point for the logical progression in the evaluation of a patient suspected of having an abnormality of plasma lip-ids. However, triglyceride and cholesterol values alone do not address the equally important lipoprotein deficiency states (e.g., decreased HDL levels). It also carries the uncertainty that the atherosclerotic risk will be overestimated in patients with a high cholesterol because of a high HDL cholesterol. Routine lipoprotein profile consists of measurement of serum cholesterol, triglycerides, LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C). This is supplemented in special clinical settings by Lp(a), Apo A-I, and Apo B-100 determination. The routine procedure for lipoprotein quantification is to determine HDL-C in the supernatant after precipitation of apolipoprotein-B-containing...

Familial HDLdeficiency and ABCA1

The major clue that ABCA1 is involved in cellular cholesterol removal and lipid efflux was the identification of mutations in the human gene as the defect in familial HDL-deficiency syndromes such as classical Tangier disease (Tab. 3.2) 6-8 . The most striking feature of these patients is the almost complete absence of plasma HDL, low serum cholesterol levels, and a markedly reduced efflux of both cholesterol and phospholipids from cells, strongly supporting the idea that both lipids are co-transported 128, 129 . The lack of ABCA1 function in these patients has a major impact on plasma HDL levels and composition. Thus plasma HDL from TD patients is composed of small pre- 5rmigrating HDL particles containing solely apoAI and phospholipids but lacking free cholesterol and apoAII 130, 131 . The low HDL levels seen in Tangier disease (TD) are mainly due to an enhanced catabolism of these HDL precursors 131-134 . In addition, the size of the HDL particle strongly correlates with the amount...

Saturated Fatty Acids Oleic Acid trans Fatty Acids and n6 Fatty Acids

Not all) epidemiological studies have shown consistent associations between the intake of saturated fatty acids and CHD mortality.1 However, the SCD endpoint is usually not analyzed in these studies. In addition, a clear demonstration of a causal relationship between dietary saturated fatty acids and SCD would require the organization of a randomized trial, which is not ethically acceptable. Thus, besides the effect of saturated fatty acids on blood cholesterol levels, the exact mechanism ) by which saturated fats increase CHD mortality remain unclear. If animal data, demonstrating a proarrhythmic effect of saturated fatty acids, are confirmed in humans, the first thing to do in order to prevent SCD in humans would be to drastically reduce the intake of saturated fats. In fact, this has been done in randomized dietary trials and, as expected, the rate of SCD decreased in the experimental groups.1 However, as written above about the same trials,1 the beneficial effect cannot be...

Pharmacokinetic Interactions

Although several studies have been published recently on possible pharmacokinetic interactions with statins, currently no useful polymorphisms for the prediction of the pharmacokinetics (and thereby predictions of efficacy and adverse effects) are available. Statins are highly extracted by the liver. The CYP enzyme system plays an important part in the metabolism of statins. Most statins (lovastatin, simvastatin, and atorvastatin) are predominantly metabolized by CYP3A4 (19,20). For this enzyme, no functional polymorphisms have been described so far (21). Simvastatin is given orally as a prodrug and is converted to the active form simvastatin hydroxy acid. Simvastatin is not only metabolized by CYP3A4, but also by CYP2D6 and CYP2C9 (22). Several studies have been published on the role of the CYP2D6 polymorphism in the efficacy of simvastatin. The in vivo activity of the CYP2D6 enzyme is characterized by extreme individual variability. The variability in the rate of metabolism by...

The Carbohydrate Monounsaturated Fat Balance

Carbohydrate and monounsaturated fat together should provide 60-70 of energy intake. The metabolic profile of the patient and the need for weight loss should be considered when determining the proportion of carbohydrate and monoun-saturated fat intake. Indeed, high-carbohydrate diets increase postprandial levels of glucose and triglycerides and, in some studies, decrease plasma HDL cholesterol level when compared to isocaloric high-monounsaturated fat diets. On the other hand, high-monounsaturated fat diets may

Meat Meat Substitutes and Other Proteins

Two or three servings of fish per week are recommended because fish provides proteins and n-3 polyunsaturated fatty acids. Indeed, n-3 polyunsaturated fatty acids lower plasma triglycerides in type 2 diabetic patients and have been shown, in the general population, to have cardio-protective effects.

Macronutrient Composition of the Diet

A low-fat diet is considered the standard approach for the treatment of obesity. Based on several studies suggesting that there are benefits to restricting fat intake as well as calories, many programs also prescribe dietary fat goals to produce a 20-25 fat intake. High-fat diets are often highly palatable, but are energy dense and low in complex carbohydrates and water. Moreover, high-fat diets appear to be less satiating and the thermic effect of dietary fat is low, as compared to diets containing complex carbohydrates and or proteins. Thus, low-fat diets reduce the diet's energy density while maintaining satiety as a result of their high content of complex carbohydrate and protein. These characteristics lead to a modest but predictable weight loss, which is further marked in the more obese individuals. However, although low-fat diets can enhance weight loss and may be particularly useful in selected persons, they are not necessarily more effective than LCDs. A negative influence of...

Tracers for the study of triglyceriderich lipoprotein kinetics Chylomicrons

Triglyceride uptake from the circulation can under some circumstances occur independent of enzymes such as LPL and hepatic lipase. Saturation of transport appears to occur at plasma triglyceride concentrations of 400mg dL-1 (Brunzell et al. 1973, 1979) or lower (Nikkila & Kekki 1973). It is important to note that chylomicron-sized lipid particles can be removed via nonenzymatic pathways, particularly the reticuloendothelial system (Seidner et al. 1989). When large amounts of a lipid emulsion were administered to rats by bolus injection, there was evidence of non-enzymatic lipid clearance (Lutz et al. 1989). Karpe et al. (1997) concluded that, during mild chylomicronaemia after a high fat meal in normal subjects, the removal of triglycerides by non-lipolytic tissues was negligible. Quantitatively significant reticuloendothelial uptake may occur only at plasma triglyceride concentrations above those at which maximal rates of LPL-mediated triglyceride hydrolysis are observed, i.e....

Effects of Weight Loss on MetS Components

Effective for long-term weight loss are reduced-energy diets, consisting of a 500- to 1000-calorie day reduction. A realistic goal for weight reduction is to reduce body weight by 7-10 over a period of 6 to 12 months. Numerous studies have shown that significant improvement of several abnormalities of MetS, including dyslipidemia, hyperglycemia, and hypertension, can be observed, even with a modest amount of weight loss.6,10 For every kilogram of weight loss the following favorable changes occur fasting serum cholesterol, -1.0 LDL cholesterol, -0.7 triglycerides,-1.9 HDL cholesterol, +0.2 systolic blood pressure, -0.5 diastolic blood pressure, -0.4 and fasting glucose, -0.2 mmol L. The impact of weight reduction on diabetes mellitus is particularly impressive.10

Practical considerations

The study of lipoprotein triglyceride fatty acid kinetics has been challenging because of the unavailability, until recently, of primary pool tracers. When chylomicron or VLDL triglycerides are labeled with a precursor (e.g. oral ingestion of a labeled triglyceride or fatty acid in the case of chylomicrons oral or intravenous administration of labeled glycerol in the case of VLDL), the rate of tracer appearance into the primary pool is not known. Measurement of kinetics under non-steady state conditions is problematic because there is often ongoing tracer appearance at an unknown rate and therefore simultaneous tracer disappearance at an unknown rate. This problem can be circumvented with the direct administration of labeled chylomicrons (or a surrogate thereof, such as a lipid emulsion) or labeled VLDL. The relatively recent availability of such tracers should improve the reliability of measurements made under steady state conditions and should also make it possible to attempt...

Influence of Qualitative Modification of Dietary Fats

There has been clear understanding for decades that dietary fat subtypes have very different effects on many metabolic variables of importance in the etiology of MetS.16,17 While the differing effects of saturated versus polyunsaturated fatty acids (PUFA) on cholesterol were identified decades ago, effects of dietary fats on plasma triglycerides have been recognized more recently. Plasma triglyceride levels are increased by some fats but decreased by n-3 PUFA. Furthermore, evidence for differential effects of fat subtypes on insulin action was published and consistent results were obtained in animal intervention and human cross-sectional and prospective studies. Animal studies have shown that increasing the percentage of calories from some, but not all, fats leads to impaired insulin action (insulin resistance) without the necessity of overconsumption of calories. Saturated fats are deleterious while n-3 PUFAs are protective. Monounsaturated fatty acids and n-6 PUFAs are also,...

Influence of Carbohydrate Type and Content

The optimal types and amounts of carbohydrates in the diet remain controversial.18 It is now well established that low-fat, high-carbohydrate diets not only lower HDL and raise triglycerides but also generally produce higher postprandial glucose and insulin responses. However,metabolic consequences of carbohydrates depend not only on their quantity but also on their quality. The glycemic response of a given carbohydrate load depends on the food source, which has led to the development of the glycemic index, ranking foods by their ability to raise postprandial blood glucose levels.19 In addition, effects on blood glucose and lipid metabolism by carbohydrate-rich foods depend on fiber content and type. Controlled feeding studies have found benefits of whole grains on insulin sensitivity and glucose and lipid metabolism compared with refined grains. In addition, several epidemiological studies found that diets rich in whole grains may protect against CVD, stroke, and type 2 diabetes....

Insulin and Diabetes Mellitus

Energy is constantly required in human life, whereas it is supplied only by intermittent food intake. Therefore, food is usually ingested in excess of the immediate caloric needs, and the extra calories are stored in the form of hepatic and muscle glycogen, adipose tissue triglycerides, and to a certain extent as muscle protein. In turn, these fuel reservoirs are broken down during starvation to provide energy for the body. The amount of glycogen stored in skeletal muscle is about 400 g (1600 Kcal), the amount of glycogen in liver is about 75 g (300 Kcal), and the amount of triglycerides stored in adipose tissue is about 15 000 g (141 000 Kcal), at overnight fasting state in healthy men. Glucose and free fatty acids, which are stored as glycogen and triglycerides, respectively, are the two principal circulating fuels in humans. Endogenous glucose is produced by gluconeogen-esis in the liver and glycogenolysis not in skeletal muscle but in the liver 1 . Energy reservoirs in humans are...

Protein Metabolism in Diabetes Mellitus

Proteins are one of the major body fuels however, despite the large size of the protein pool, only about 15-20 of daily calorie consumption is accounted for by protein oxidation, while fat accounts for about 30 and carbohydrates for 50 or more. There is no 'storage' form for amino acids - in contrast to glycogen and triglycerides, which are the storage forms for glucose and free fatty acids, respectively. Body proteins are not a fuel reservoir in themselves instead, protein molecules have specific roles in maintaining organ structure and function. Both the synthesis and the degradation of proteins are metabolically expensive relative to other fuels, i.e. glycogen and triglycerides. Glycogen synthesis requires 3 ATP per glucose added, and one of these ATP is recovered during glycogenolysis. Triglycerides synthesis requires only 2 ATP per fatty acid molecule added. Formation of just one peptide bound requires at least four high-energy phosphates that are not

Dietary Nutritional Factors

High calorie intake has often been associated with an increased risk of prostate cancer. However, the interaction between various compounds (total fat, animal fat, saturated or un-saturated fatty acids, cholesterol, triglycerides, omega-3 fatty acids) is very complex (Wuermli

Pharmacological Prevention

Statins 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors have been shown to induce apop-tosis and inhibit tumor growth and metastasis in human cancer cell lines and animal models. In a case-control study, 100 patients with newly diagnosed prostate cancer and 202 controls were checked for any use of statins over a 7-year period through an electronic pharmacy database in the Veterans Administration system (Shannon et al. 2005). Statin use was associated with a significant reduction in prostate cancer risk (odds ratio, 0.38) and the effect was especially pronounced in Gleason scores 7-10. Further studies are needed to determine the role of statins in prostate cancer prevention.

Effects on Metabolism and Energy Expenditure

Both the synthesis and the degradation of triglycerides and cholesterol are increased in TS, but the net effect is one of lipid degradation, as reflected by an increase in the plasma concentrations of free fatty acids and glycerol, and the decrease of serum cholesterol level. Serum triglyceride levels are usually slightly decreased 18 .

Smoking and Acute Myocardial Infarction Mechanisms

Tobacco smoke interferes with the cardiovascular system in the following ways Smoking increases the risk of thrombosis by increasing platelet aggregation, blood viscosity, and fibrinogen levels. C-reactive protein, a marker of inflammation, is also increased by cigarette smoking. The inhaled carbon monoxide produces carboxyhemoglobin, which leads to an imbalance between oxygen demand of and supply to the myocardium. Polycyclic aromatic hydrocarbons (PAH) and other toxic compounds damage the endothelium. LDL cholesterol is oxidized by cigarette smoke and it is the oxidized LDL cholesterol which exerts its atherogenic effect. VLDL cholesterol and triglycerides are also increased by inhaled cigarette smoke. In addition, cigarette smoke decreases the protective HDL cholesterol.

The Effects of Tobacco on Public Health

Whether smoking-attributable deaths from cancer exceed those from cardiovascular disease varies across the different EU countries, depending on the background risk of cardiovascular disease in specific countries or regions and the age of the population studied. Death rates from stroke are higher in central and eastern Europe than in the other regions, and death rates from CHD are generally higher in northern, central, and eastern Europe than in southern and western Europe.21 This relates to other risk factors for CHD and also to their syn-ergistic effects with smoking. This refers to the interaction between smoking and cholesterol levels, smoking being more dangerous for those who also have high blood cholesterol levels.21

Lipids And Lipoproteins

Lipids are either compounds that yield fatty acids when hydrolyzed or complex alcohols that can combine with fatty acids to form esters. For example, cholesterol ester forms from cholesterol and fatty acid. Lipids are carried in the bloodstream by complexes known as lipoproteins. This is because these lipids are not soluble in the plasma water. Thus they travel in micelle-like complexes composed of phos-pholipids and protein on the outside with cholesterol, cholesterol esters, and triglycerides on the inside. The four main types of lipoproteins are chylomicrons, VLDL, low-density lipoprotein (LDL), and HDL and are represented in Figure

Kip KE Faxon DP Detre KM Yeh W Kelsey SF Currier JW Reference

This study was performed prior to the availability of a number of systemic therapies for diabetic patients that would favorably affect their long-term prognosis, including better agents for glycaemic control, lipid-lowering therapy with statins, angiotensin-converting enzyme inhibitors, and beta-blockers. This study was also performed before the availability of coronary stents, and now drug-eluting stents, but these therapies are not useful in preventing late mortality in patients with coronary artery disease.

Perturbation of metabolic flux control the role of substrate overabundance

It is well known that increased circulating triglycerides and FFA are frequently associated with pathophysiology of insulin resistance and diabetes mellitus. Searching for the mechanism of their action on glucose metabolism, Sir Randle et al. (1963) observed that elevated circulating free fatty acids (FFA) impair skeletal muscle glucose uptake. The results of his studies allowed him to postulate the hypothesis that substrate competition for mitochondrial oxidation is the major mechanism involved in this action. According to this hypothesis, experimental challenge by FFA would first increase the intracellular glucose-6-phosphate

Cell Based Therapy for Myocardial Ischemia

The ability to culture and genetically engineer EPC ex vivo with vectors expressing therapeutic genes suggests that these cells may be ideally suited as a substrate for cell-based gene therapy for neovascularization of ischemic tissues. In this scheme, EPC genetically modified to express angiogenic growth factors could serve as a cell substrate for new vessel growth by vasculogenesis, driven by local proliferation and differentiation of the transplanted cells, and as a source of proangiogenic growth factors for growth of preexisting vessels by sprouting. This concept was recently validated by Iwaguro et al. (57). Using athymic mice with hindlimb ischemia, they showed that transplantion of murine EPC transduced ex vivo with an adenoviral vector expressing VEGF resulted in more efficient neovascularization and blood flow recovery compared to treatment with nontransduced EPC. The improved neovascularization in the animals treated with VEGF-transduced EPC appeared to be, at least in part,...

Clinical Features

Consideration of the mode of inheritance in progeria is important for genetic counseling and may help to understand the nature of the underlying mutation. Recessive diseases often appear to be caused by enzymatic deficiencies that lead to metabolic abnormalities. Dominant diseases often involve structural proteins. However, they may be due to partial deficiencies of rate-limiting enzymes (i.e., porphyria) or cell surface receptors (i.e., familial hypercholesterolemia) where half the normal level of the gene product can lead to a disease.

Nutritional Support

Catecholamines and cytokines, which are elevated in heart failure, are stimuli for free-radical production. Therefore, antioxidants and free radical scavengers, such as vitamins C and E, are therapeutic options in cardiac cachexia. This was proven by a study showing that muscle wasting in mice was prevented by an antioxidant 92 . Additionally, it was shown that antioxidants suppress the production of free radicals in leucocytes 93 . The presence of elevated levels of markers of oxidative stress in heart-failure patients correlates with functional class, reduced exercise tolerance, lower antioxidant levels, and worse prognosis, including cachexia 94, 95 . These patients also tend to have micronutrient deficiency through, e.g. urinary losses or therapy with diuretics. Deficiencies of specific micronutrients, such as selenium, copper, calcium, zinc, or thiamine, can also cause heart failure 96 . Thus, it is important to keep CHF patients on a diet with sufficient calories and with...

And the Cardiovascular System

A wide variety of cardiovascular pathologies are potentially amenable to treatment using gene therapy. Examples include myocardial ischemia, vein graft failure, atherosclerosis, hypercholesterolemia, peripheral ischemia, and hypertension. Gene transfer offers the potential for overexpression of candidate therapeutic genes in these conditions, with the ultimate aim of prevention, improvement, or regression of the condition. Gene therapy has two distinct modes of use. In monogenic disorders, in which a single mutated or absent gene has been identified as being causal, the aim of gene therapy would be to insert the corrected form of the gene into the appropriate target cell type to restore normal function. A number of monogenic cardiovascular diseases have been well documented, for example, in conditions such as hypertension (1) or hypercholesterolemia (2). However, the majority of cardiovascular conditions are complex, polygenic disorders, in which environmental factors, such as diet,...

Cell Based Gene Transfer

Typical changes in cells can occur during culture, the harvest and implantation steps each require individual invasive techniques, and the implantation step may in itself result in damage to the target site. Taken together, these drawbacks may underlie the relative paucity of clinical studies based on this approach. Nonetheless, cell-based gene transfer has been successfully used in a rodent model of vascular injury (3) and a murine model of hypercholesterolemia and atherosclerosis (4). Moreover, a pilot study utilizing cell-based gene transfer of the low-density lipoprotein (LDL) receptor in humans found a significant reduction in total cholesterol levels in individuals who have familial hyper-cholesterolemia (5). Thus it may be the case that further optimization of the techniques involved in cell-based genetic modification may yet result in more widespread use of this approach as a gene therapy tool.

HsCRP Metabolic Syndrome and Type 2 Diabetes Mellitus

Hdl Metabolic

Clinical practice, such as elevated triglycerides, low HDL-C, obesity, high fasting glucose, and high blood pressure (BP). In the Women's Health Study, e.g., after adjustment for multiple potential confounders, the RRs of incident hypertension for increasing hsCRP quintiles were 1.00 (referent), 1.07 (95 CI 0.95-1.20), 1.17 (95 CI 1.04-1.31), 1.30 (95 CI 1.17-1.45), and 1.52 (95 CI 1.36-1.69), respectively (p for trend of < 0.001) (73). hsCRP levels are also correlated with other components of the syndrome not easily assessed during routine office visits, such as fasting insulin, microalbuminuria, and impaired fibrinolysis. Indeed, among Women's Health Study participants without diabetes, hsCRP and BMI were the only independent correlates of fasting insulin level modeled as a continuous dependent variable. After adjustment for BMI and other risk factors for diabetes, the RR for elevated fasting insulin ( 51.6 pmol L) increased with the tertile of hsCRP (for hsCRP < 1.4, 1.4-4.4,...

Cardiovascular Disease

Endothelial cell activation in response to infection with C. pneumoniae has been characterized by cDNA microarray analysis. Coombes and Mahony isolated mRNA from uninfected and infected endothelial cells 18 h postinfection and generated cDNA probes to an array of 268 human genes, including cytokines, growth factors, and receptors.(24) Data obtained from the array support earlier findings of IL-8 and MCP-1 activation. In addition, many growth factors that may induce proliferation of smooth muscle cells were upregulated in response to infection. Interestingly, Kothe et al. found that pretreatment of macrophages and endothelial cells with HMG-CoA inhibitors, cholesterol lowering agents, resulted in less secretion of IL-8 and MCP-1.(25) Krull et al. showed a marked increase in protein tyrosine phosphorylation, MAPK activation, and activation in endothelial cells shortly after infection with a respiratory isolate of C. pneumoniae.(26) Activation of these signal transduction cascades...

Diagnosis and Management of MICS and Wasting Syndrome in CKD

Although epidemiological evidence strongly links inflammation to poor outcome in individuals with renal insufficiency, it must be recognised that as yet there are no randomised clinical trials to indicate improvement of cachexia and its outcome by inflammation-reducing approaches. However, some treatment modalities may target inflammation directly, or they may focus on oxidative and carbonyl stress or endothelial dysfunction. The following approaches may be considered (1) Statins (HMG-CoA reductase inhibitors) have been shown to decrease CRP levels independently of their lipid-lowering effects and may be associated with reduced mortality in CKD patients 180, 181 . (2) Angiotensin-converting enzyme inhibitors may have anti-inflammatory properties in both the general population and in CKD patients 182 , and are associated with delayed progression of chronic renal failure and improved outcome in these individuals 18 . (3) Vitamin E may have anti-inflammatory effects, and its...

Biochemical Phases of Cachexia

In the normal fast, hypoglycaemia stimulates the production of glucagon, which induces glycogenolysis in the liver and in the muscle to produce glucose. But if glycogen stores can supply glucose only for 12-18 h, then hypoglycaemia stimulates the production of epinephrine, which in turn starts lipolysis in fat stores. About 160 g fat (triglycerides, FFA, glycerol) day can be transformed into glucose to maintain vital processes. But, if the requirement for energy is prolonged,

The Team Approach

Albumin and thyroxine-binding prealbumin (TBPA) (also known as transthyretin), provides information about the duration of malnutrition. Measurement of the essential fatty acids, total cholesterol, lipoproteins, and triglycerides establish the nutritional status of these important nutrients. Carbohydrate nutritional status may be evaluated through laboratory testing of fasting glucose, glycated hemoglobin, and tolerance to glucose loading. Micronutrient status may be assessed through laboratory testing of plasma levels of vitamins and minerals and through functional testing of the processes to which micronutrients contribute. Functional laboratory testing includes the assessment of the organs, such as the kidney, liver, heart, and bone, which may be affected by inadequate nutrition.

Extent of the Problem of Non Adherence

Maintain behavior change in terms of promoting health and it has a beneficial effect on mortality, morbidity, and quality of life. However, despite these proven benefits, many eligible patients fail to attend among those offered CR, the reported uptake rates range from 15 to 50 .3 An evaluation of lifestyle changes among CHD patients in five European countries found that approximately 50 of patients changed lifestyles in accordance with recommendations.4 Similarly, there is evidence that only 50 of patients adhere to cardiac medication (e.g. statins, ACE inhibitors) 1 year after commencing treatment, and of those taking the drug, approximately 50 follow the treatment sufficiently to gain a therapeutic benefit.5 To date the majority of research on adherence among cardiac patients has focused on exercise adherence.6 There is less evidence regarding adherence to other behavioral recommendations of CR.

Twodimensional studies of human lipoproteins

Lipids are transported in human blood plasma by lipoproteins consisting of a nonpolar core where triacylglycerols and cholesteryl esters are hidden surrounded by a monolayer facing the water composed of phospholipid, cholesterol and proteins, giving these lipid-rich structures water solubility. Blood plasma lipoproteins are classified on the basis of their density, which in turn is a reflection of their lipid content. The greater their lipid contents the lower their density. There are three different classes used in infrared studies. These are VLDL (very-low-density lipoprotein), LDL (low-density lipoprotein) and HDL (high-density lipoprotein). Biosynthesis of VLDL cholesterol, triglycerides and apolipoproteins takes part in liver hepatocites. These particles have apoB-100, apoC and apoE proteins. VLDL is converted into LDL, cholesteryl ester-rich particles that have a single molecule of apoB-100. LDL carries cholesterol from liver to peripheral tissues where it is used in membrane...

Periodontal Disease And Mortality

Cardiac Tn1

Changes in the oral cavity and to identify risk factors for oral disease.,M t linical examinations were performed and alveolar bone level measurements were determined trom full-mouth radiographs. The mean percentage ol alveolar bone loss and the mean probing depth were determined for each subject. A recent study of data from this subject population sought to determine whether periodontal disease status was a significant predictor ol mortality independent of other baseline characteristics within the population.1 Irom the original sample ol 804 dentate, medically healthy subjects, a total of 166 died during the study. Periodontal status at the baseline examination was a significant predictor of mortality independent ol other factors such as smoking, alcohol use, cholesterol levels, blood pressure, family history of heart disease, education level, and body mass, lor those subjects with the most alveolar bone loss, having an average of greater than 21 alveolar bone loss at baseline, the...

Plant Sterols Natural Cholesterol Fighters

The practical development of plant sterol drugs as cholesterol-lowering agents will depend both on structural features of the sterols themselves and on the form of the administered agent. For example, the unsaturated sterol sitosterol is poorly absorbed in the human intestine, whereas sitostanol, the saturated analog, is almost totally unabsorbable. In addition, there is evidence that plant sterols administered in a soluble, micellar form (see page 261 for a description of micelles) are more effective in blocking cholesterol absorption than plant sterols administered in a solid, crystalline form.

The Gastrointestinal Tract

The pancreas contains both exocrine and endocrine cells. Pancreatic fluid contains sodium bicarbonate, which neutralizes the acidic gastric fluid, increasing the pH to approximately 8. Pancreatic proteolytic enzymes attack proteins that are carried in the gastric fluid. Arginine- and lysine-containing peptides are cleaved by trypsin tyrosine-, phenylalanine-, and tryptophan-containing peptides are cleaved by chymotrypsin elastase cleaves peptide bonds associated with alanine and serine and carboxypeptidase removes amino acids at the C-terminal of peptides. Pancreatic nucleases hydrolyze nucleic acids, which are also contained in the gastric fluid, into smaller, more absorbable units. The secretion of pancreatic fluid into the duodenum is regulated by gastrointestinal hormones. Secretin controls the release of sodium bicarbonate, and cholecystokinin controls the release of the cata-bolic enzymes. The pancreatic hormones, produced in the islets of Langerhans, also contribute to nutrient...

Congenital Partial Lipodystrophy Type 1 Dunningam Syndrome

Atrophy of the subcutaneous fat layer usually manifests at puberty, involving the arms, legs, and buttocks. The subcutaneous adipose tissue of the face, neck, and intra-abdominal area may be preserved, giving patients a silhouette of visceral obesity. An increase in intramuscular fat has been reported. Insulin resistance, reduced glucose tolerance, overt diabetes, hypertriglyceridaemia, and low levels of HDL cholesterol are associated with Dunningam syndrome and lead to early onset of atherosclerotic vascular diseases. Acute pancreatitis and liver steatosis may complicate the clinical picture. The identification of missense mutations on chromosome 1q 21-22, involving genes encoding lamins A and C, in affected members of a family suggests the molecular basis of the disease 33 . Lamins provide structural integrity to the nuclear membrane, such that mutations in the HDL cholesterol Triglycerides

Insights into FABP Function from Null Mice

Body weight gain, an unusual dissociation 77 . The I-FABP knockout mice gained more weight and had higher levels of serum triglycerides 77 . This could indicate an involvement of the protein in lipid absorption, metabolism, or secretion, which requires further investigation. An intriguing finding in this model was that the effects on weight and serum triglycerides were observed only in male mice 77 . This gender dependency suggests a previously unexplored interaction between I-FABP and sex hormones. role in the development of hypercholesterolemia-induced atherosclerosis, likely at the level of the macrophage. Indeed, recent bone marrow transplantation studies showed that macrophage-expressed A-FABP, rather than adipocyte A-FABP, was likely to be primarily involved in the development of dietary atherosclerosis 84, 85 . K-FABP was also found to be expressed in macrophages, however unlike the compensatory upregulation of expression observed in adipose tissue of the ap2- -mice, macrophage...

Changing Patterns of Cachexia in the HAART

Prior to 1996, only a small percentage (3 ) of patients developed hypercholesterolaemia, hyper-triglyceridaemia, and diabetes. The main fat disturbances in cachexia are a decrease in cholesterol levels, an increase of triglycerides, and a global loss of fat together with lean tissue in any body region. These patterns can be clearly distinguished from lipodystrophy (Table 6). HDL cholesterol Triglycerides Hyperlipidaemia (cholesterol, triglycerides)

Nutritional Counseling for Patients with MetS

MetS has been identified as a target for dietary therapies to reduce CVD risk other than LDL cholesterol lowering by the NCEP ATP III.13-15 Clear evidence from metabolic studies, epidemiological studies, and clinical trials supports the consumption of unsaturated fats from natural liquid vegetable oils and nuts at the expense of saturated and trans fats (rather than simply lowering total fat) in the treatment of various components of the MetS (e.g. dyslipidemia, insulin resistance, and

Markers of inflammation

This relationship also bears out in women. In a prospective nested case-control study involving postmenopausal women enrolled in the Women's Health Study, Ridker and colleagues 21 showed hsCRP to be the most powerful predictor of cardiovascular risk compared with other inflammatory markers, baseline lipid levels, and homocysteine. Women in the highest quartile had a relative risk of 4.4 (95 CI, 2.2-8.9, P < .001) compared with those in the lowest quartile. Addition of hsCRP to cholesterol measurement increased the area under the receiver operating characteristic (ROC) curve from 0.59 to 0.66 (P < .001). Furthermore, in women who had LDL levels less than 130 mg dL (the target level recommended for primary prevention by the National Cholesterol Education Program), those who had elevated baseline CRP were still at increased risk for future events with a 3.1 relative risk in the highest quartile compared with the lowest (95 CI, 1.7-11.3, P .002) after adjustment for traditional risk...

Prognostic Role of BNP and NTproBNP Across Spectrum of ACS

A substudy ofthe Orbofiban in Patients with Unstable Coronary Syndromes-Thrombo-lysis in Myocardial Infarction 16 (OPUS-TIMI 16) trial was among the first to evaluate the prognostic capabilities of BNP in a large population of patients across the entire spectrum of ACS (45). In this study, BNP was measured in 2525 patients at a mean of 40 h after presenting with STEMI, NSTEMI, or unstable angina. BNP levels on admission correlated with age, male gender, white race, hypertension, CHF, peripheral vascular disease, hypercholesterolemia, and smoking status. In addition, elevated levels of BNP were associated with Killip class > 1, electrocardiogram (ECG) changes, elevated creatine kinase-MB, and chronic kidney disease. A plasma concentration of BNP > 80 pg mL was a powerful

Triglyceride Total Protein and Live Weight Determination

Virgin males and virgin females were randomly collected from the vials and bottles and prepared as described previously in the Materials section to control for density. Six replicates per line per sex, each containing a pool of 10 flies, were used for the experiment. Twenty-four hours after collection, flies were weighed and homogenized. The homogenization protocol is the same as in Clark and Keith (68). Briefly, adults were homogenized on ice using 25 pL of homogenization buffer (discussed previously). The homogenates were cen-trifuged in a microcentrifuge at 2000 rpm for 2 min. The lipid layer on the surface was resuspended with the supernatant and the homogenate were distributed in 0.5 mL tubes. Live weight, triglycerides, and total proteins were measured for each sample, following the protocols listed as follows 2. Triglycerides were assayed spectrophotometrically using the Vitros DT60 II reader (Johnson and Johnson Clinical Diagnostics, Inc.) and Vitros TRIG DT slides. The Vitros...

Ongoing Clinical Antiinfective Trials

Finally, another large randomized trial, entitled PROVE-IT, is also underway. In this study, > 3,000 patients presenting with acute coronary syndrome are randomized in a 2 x 2 factorial fashion to one of two statins, pravastatin or atorvastatin, in different relative doses, and then to an intermittent course of gat-ifloxacin or placebo. The primary endpoint is major cardiovascular clinical endpoints after at least 18 months' follow-up. The study has combined the evaluation of two different statins, each with very different lipid-lowering potencies but potentially similar antiinflammatory effects with the testing of a quinolone with potential bactericidal antimicrobial activity. This study will potentially answer a number of questions regarding the importance of inflammation and infection in the pathogenesis of acute coronary syndromes in relationship to lipid-related risk. It is the first major clinical trial testing an agent other than azithromycin.

Nicotinic acid and derivatives

Nicotinic acid acts as an antilipolytic agent in adipose tissue, reducing the supply of free fatty acids and hence the availability of substrate for hepatic triglyceride synthesis and the secretion of VLDL. Nicotinic acid lowers plasma triglyceride and cholesterol concentrations, and raises HDL-cholesterol. Flushing of the skin (preventable by low-dose aspirin) and gastrointestinal upset commonly occur the unpleasantness may be diminished by gradually building up the oral dose over 6 weeks and in time tolerance develops. Rarely there is major disturbance of liver function.

Impact of SCP2SCPx on Cholesterol Metabolism

The procedure, which led to an 8-fold increase of SCP-2 protein levels in the liver, decreased HDL-cholesterol and increased LDL-cholesterol concentrations with no effect on VLDL-cholesterol. LDL receptor expression and cholesterol synthesis were repressed whereas hepatic cholesterol concentrations were increased. The latter finding would imply an altered hepatic cholesterol balance in which a net increase in hepatic cholesterol is established in the presence of downregulated supply of cholesterol to the liver via the LDL receptor pathway and repressed cholesterol de novo synthesis. Since the SRB1 cholesterol uptake pathway was not affected, one could consider decreased VLDL secretion or repression of bile acid synthesis. However, VLDL concentrations, CYP7A1 expression and fecal excretion of bile acids were unaffected, whereas biliary cholesterol concentrations and bile acid secretion rates were increased. The SCP-2-overexpressing mice had a higher...

Guide To Further Reading

Hooper L et al 2001 Dietary fat intake and prevention of cardiovascular disease systematic review. British Medical Journal 322 757-763 Jonsson B 2001 Economics of drug treatment for which patients is it cost-effective to lower cholesterol Lancet 358 1251 Knopp R H1999 Drug treatment of lipid disorders. Medical Journal 320 459-460 Primatesta P, Poulter N 2000 Lipid concentrations and the use of lipid lowering drugs evidence from a national cross sectional study. British Medical Journal 321 1322-3125 Sacks F M, Pfeffer M A, Moye L A et al 1996 The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. New England Journal of Medicine 335 1001-1009

Statistical Analyses for Triglyceride Total Protein and Live Weight

For all three assays, analysis of covariance (ANCOVA) was used to detect genetic phenotypic variation due to food source and gender, with body weight and total proteins as covariates. The results of feeding flies for 10 d in the control, palmitic acid, soy, and beef diets are shown in Table 1. The seven dietary conditions used in this chapter and when the assays were performed are summarized in Fig. 1. The significant results (i.e., p < 0.05) of these metabolic experiments were that triglycerides were significantly lowered in female flies and pooled male and female flies after 10 d on the beef diet (p 0.0233 and p 0.0075, respectively). Also, the total protein significantly increased almost two-fold in male flies fed soy for 10 d (p 0.0132) and significantly increased by more than 50 in pooled flies fed beef for 10 d (p 0.001). None of the other conditions produced significant effects in triglyceride levels or total proteins, and none of the three diets significantly affected live...

Functional Anatomy of Brown Adipose Tissue

All this allows for a fast and highly regulated transformation of the potential energy contained in triglycerides into heat, also accounting for brown adipocyte anatomy given the enormous demand for oxidisable substrate (the lipid vacuoles), and that lipolysis can take place only on the surface of the vacuoles, a multilocular organisation is essential to increase the contact surface between lipids and hyaloplasm. Such ready substrate availability would be useless without a large number of mitochondria - which large size and abundance of cristae make very efficient - ready to carry out the oxidation process.

Clinical Outcome and Reverse Epidemiology

Reverse Dialysis

Many recent studies have suggested that protein-energy malnutrition and inflammation in maintenance dialysis patients are associated with a decreased quality of life and increased hospitalisation and mortality, especially from cardiovascular diseases 10,27,28,123 . Epidemiological studies indicate that hypoalbuminaemia and increased serum CRP are strong predictors of poor clinical outcome in the CKD population 36, 37 . Compared to traditional risk factors, such as obesity, hypercholesterolaemia, and hypertension, hypoalbuminaemia per se, which is generally considered an indicator of MICS, has one of the most striking and consistent associations with the prediction of clinical outcome in these individuals 146 . In highly industrialised, affluent countries, protein-energy malnutrition is an uncommon cause of poor outcome in the general population, whereas over-nutrition is associated with a greater risk of cardiovascular disease and has an immense epidemiological impact on the burden of...

ABCA1 in Macrophage Lipid Transport

Abca1 Ebox

The most likely endogenous ligand for LXRa and LXR 5 is 27-hydroxycholester-ol, since CYP27-deficient cells are not able to upregulate ABCA1 in reponse to sterols and since overexpression of CYP27 activates LXR RXR 202 . The earlier described LXR ligands 20(S)-hydroxycholesterol, 22(.R)-hydroxycholesterol, and 24(S),25-epoxycholesterol are not present in cholesterol-loaded macrophages, rendering them unlikely to be natural ligands of LXR 202 . In contrast to LXR RXR, the zinc finger transcription factor ZNF202 is a transcriptional repressor of ABCA1 gene expression, which also prevents the induction of the gene by oxyster-ols by recruiting the universal co-repressor KAP1 (KRAB domain-associated protein 1) 203 . Due to the strong upregulation of ABCA1 expression in response to oxysterols, LXR agonists have been proposed to be promising candidates for therapeutic activation of ABCA1 199, 204-206 (Fig. 3.7). It stands to reason that especially under disease conditions such as NIDDM,...

Tests For Liver Function

The clinical laboratory offers several tests for the assessment of liver function. The enzymes alkaline phosphatase, ALT, AST, GGT, and 5'-nucleotidase are helpful in the assessment of the proper functioning and inflammatory status of the liver. Because the liver is the site for metabolism of carbohydrate, protein, and lipids, as well as for the synthesis of many proteins, the conjugation of bilirubin, and detoxification of drugs and other substances, the liver may be assessed by measurement of total and direct bilirubin, total protein and albumin, cholesterol and triglycerides, and urea and ammonia.1 Correlation of laboratory results across time is an indication of accuracy and appropriateness of results. In this case, increased levels of enzymes and bilirubin and lowered protein correlate with liver disease. The extent of the increased alkaline phosphatase and the presence of increases in both total and direct bilirubin help to specify this liver disorder as obstructive jaundice.2-5

Proposed Application Of Bnp In

At the present time, adequate data do not exist to define the proper role of BNP and NT-proBNP in stratifying patients to more aggressive interventional therapy, and the clinician must consider plasma levels of these peptides in the context of other biomarkers and clinical factors before assigning a patient to a proper level of care. More research is needed to identify appropriate pharmacological and interventional strategies for high-risk patients with ACS and elevated levels of BNP or NT-proBNP. In the meantime, we propose the algorithm in Fig. 7 for patients with ACS. Patients who present with ACS and have elevated cardiac troponin or who are in a high TIMI risk category have been shown to benefit from an early interventional approach. In patients with a low TIMI risk score who have a normal troponin result, aggressive intervention may be considered for those patients who have BNP levels > 80 pg mL (cut point based on studies using the Biosite and Bayer assays). Otherwise, a...

Longevity Studies With Mated Males and Females

Thep values were calculated using a mixed model analysis of covariance (covariates live weight LW and total protein content Pro for triglycerides TG live weight and total triglyceride content for protein and total protein and triglycerides for live weight). The mean numbers are shown with the standard deviations in parentheses. Con, control diet PA, palmitic acid diet BF, beef diet NS, not significant compared with control. Thep values were calculated using a mixed model analysis of covariance (covariates live weight LW and total protein content Pro for triglycerides TG live weight and total triglyceride content for protein and total protein and triglycerides for live weight). The mean numbers are shown with the standard deviations in parentheses. Con, control diet PA, palmitic acid diet BF, beef diet NS, not significant compared with control.

Metabolic Abnormalities

The most important carbohydrate abnormalities are insulin resistance, increased glucose synthesis, gluconeogenesis and Cori cycle activity, and decreased glucose tolerance and turnover. The main pathological changes of protein metabolism include increased protein turnover, muscle catabo-lism, and liver and tumour protein synthesis, while muscle protein synthesis is decreased. The main abnormalities found in lipid metabolism are enhanced lipid mobilisation, decreased lipogene-sis, decreased lipoprotein lipase activity, elevated triglycerides and decreased high-density lipopro-teins, increased venous glycerol, and decreased glycerol clearance from the plasma 5,7,8 .

Exercise Training in Coronary Artery Disease

Training Coronary Artery Disease

A rare genetic disorder (lysinuric protein intolerance - LPI) serves as a proof-of-concept model In a patient with LPI markedly reduced L-arginine serum levels and endothelial dysfunction were described. A 30 min intravenous L-arginine infusion led to a dramatic improvement of endothelial function.16 Clinical intervention studies with oral L-arginine supplementation documented an improvement of endothelium-dependent vasodilation in several clinical situations like hypercholesterolemia, hypertension, diabetes, and chronic heart failure.17-19 The effect of L-arginine supplementation on vascular function is dose-dependent as evidenced by diverging results of low-dose and high-dose studies in patients with stable CAD While 9g day had no effect on vasomotion in patients with stable CAD,20 studies with either high-dose intracoronary L-arginine administration or 21g day oral supplementation showed a significant improvement of endothelium-dependent vasodilation.21

Expression Profile in Other Eukaryotes

ACBP is expressed at high levels in the larval midgut of fruit fly 28 , the tobacco horn worm (Manduca sexta) 48 , and silkworm 49 . The larval midgut is involved in fatty acid absorption, and in the tobacco horn worm the expression in the midgut appears to be increased by feeding 50 . It is therefore tempting to speculate that ACBP plays a role in fatty acid absorption. However, in rat intestine high expression of ACBP is found in water and electrolyte-transporting cells (see above). The silkworm expresses at least two different ACBPs. The pheromone gland form (pg-ACBP) is expressed at very high levels in the pheromone gland, at low levels in most larval tissues, in adult fat body and in ovary. Midgut ACBP (mg-ACBP) is only expressed in the midgut of larvae and in the pheromone gland of the adult female 49 . The pheromone gland contains large lipid droplets containing a mixture of triglycerides also containing A10,12 hexadecadienoate, a precursor for the sex pheromone...

Molecular Imaging Using Radiotracers

PET has shown interesting promise for imaging atherosclerosis. Thus far only 18-fluorodeoxyglucose (FDG) has been used in assessing atherosclerosis with PET. FDG is a fluorine-18 (18F)-labeled modified derivative of glucose. Lederman et al. first demonstrated marked increased FDG uptake in experimental atherosclerosis (132). Several studies in humans have examined FDG uptake in the region of the aorta (133-135). However, these studies yielded little information regarding frequency, location, and intensity of uptake. Although subsequently, one study found a correlation between certain risk factors for CAD, such as age and hypercholesterolemia, and the magnitude of FDG uptake in the abdominal aorta, iliac arteries and femoral arteries (136).

Test Methodology 66 Electrolytes

The ISE system that dilutes the sample with diluent prior to analysis with the electrode is termed indirect. It is compromised by hyperlipidemia or hyperproteinemia as those large lipid or protein molecules in unusually high amounts displace some of the volume of the plasma within the dilution. For example, if triglycerides are > 350 mg dL and or total protein is > 10 g dL, interference may begin to be experienced. The effect of hyperlipidemia or hyperproteinemia is to falsely lower the measured sodium and sometimes chloride levels due to this dilutional effect. Lipemia, or creamy appearance of blood plasma due to exogenous triglycerides, is generally at its most pronounced within 2 hours after ingestion of a meal but can persist for up to 8 hours. These exogenous triglycerides are also termed chylomicrons. The standard collection of routine laboratory tests of samples obtained in the early morning after an 8- to 10-hour fast avoids lipemia and its potential analytical...

Lipoatrophy Associated with Multiple Symmetric Lipomatosis Launois Bensaude Syndrome or Madelung Collar

Multiple Lipomatosis Pictures

Pharyngeal accumulation of fat tissue. In some 20 of MSL patients, fat infiltration of the pharyngeal and tracheal wall was found to be responsible for an obstructive apnoea syndrome during sleep. Metabolic abnormalities include hyper-triglyceridaemia and high levels of circulating HDL cholesterol. Hyperuricaemia and reduced glucose tolerance or overt diabetes occur at a frequency slightly higher than casually expected. A defect in adrenergic-stimulated lipolysis 50 and an increase in lipoprotein lipase activity of adipose tissue 51 have been demonstrated in samples of lipomatous tissue. No information is available on the metabolic activity in uninvolved subcutaneous adipose tissue, due to the fat atrophy which makes fat sampling extremely difficult.

Mri Of Atherosclerosis Multi Contrast MRI of Atherosclerosis

Mri Atherosclerosis

Plaque components may be broadly grouped as lipids, fibrous tissue or thrombus intraplaque-hemorrhage. Plaque lipids are largely comprised of unesterified cholesterol, cholesteryl esters, and some lipoproteins (44). This makes them produce a short T2 resulting in low signal intensity on T2-weighted images (Fig. 1). The short T2 of the lipid portion of atheromatous plaque is believed to be the result of (i) the micelle-like structure of lipoproteins (ii) exchanges between cholesteryl esters and water molecules (iii) the results of oxidation and exchanges between free and bound water molecules (44,47,48). In contrast to plaque lipids, stored fat or adipose fat, such as may be found perivascularly, is mostly composed of triglycerides (49). Because of this, adipose fat found perivasculary has a different appearance on MRI compared to lipids found in atherosclerotic plaque.

Lipodystrophic Syndrome

In patients with various types of lipodystrophy and in several animal models. Since the extent of fat loss determines the severity of the complications, a common mechanism seems likely. Only limited quantities of triglycerides can be stored in unaffected fat depots in patients with marked fat loss. Excess triglycerides may then accumulate in the liver and skeletal muscles, contributing to insulin resistance. Although hyperinsulinaemia may initially compensate for insulin resistance and maintain euglycaemia, gradual progression of beta-cell dysfunction can lead to overt hypergly-caemia 35 .

Gender Differences in Coronary Heart Disease

Although women and men share several conventional risk factors for CHD, both non-modifiable (age and genetic predisposition) and modifiable (cigarette smoking, hypertension, obesity, dyslipi-demia, diabetes mellitus, sedentary life style, and psychological stress),their impact may be different in women.4 Recently nine major risk factors were found to be responsible for 90 of the myocardial infarctions.5 Diabetes mellitus,lipid abnormalities, cigarette smoking, and possibly also psychosocial factors, seem to be of special importance in women.6 Diabetes mellitus seems to abolish the gender protection in women and is associated with a less favorable in-hospital and long-term prognosis in subjects with MI, with a greater adverse impact for women than for men. Low HDL cholesterol and elevated triglyceride levels may be particularly important in younger women and may better predict CHD in women than total and LDL cholesterol levels. Also the ApoB ApoA1 ratio has been claimed to be of...

Cardiovascular Risk Factors

- Lower triglycerides - Higher HDL cholesterol The cardiovascular risk profile in elderly patients differs considerably from that in younger patients (Table 47-3). There are fewer smokers but more patients with diabetes and arterial hypertension. The body mass generally decreases with age. The lipid profile shows generally lower triglycerides and a higher HDL cholesterol. Psychosocial risk factors such as hostility, anxiety, and stress are encountered with lower frequency compared to younger patients.1517

Heterogeneity Of Atherogenic Lipoproteins

The pathogenesis of dyslipidemia revolves around the metabolism of lipoproteins. Comprising proteins and lipids (cholesterol, triglycerides TGs , and phospholipids), lipoproteins are the vehicles for lipid transport. The proteins associated with a lipoprotein are known as apolipoproteins, and each atherogenic lipoprotein contains a single protein designated apolipoprotein B (apoB). Lipoprotein metabolism is largely governed by apolipoproteins, which operate as cofactors for enzymes, interact with cell-membrane receptors, and provide a structural framework for lipoproteins. Several lipoproteins are associated with atherosclerosis to varying degrees. The best established is low-density lipoprotein (LDL), which is also typically the most abundant atherogenic lipoprotein. Several other lipoproteins promote atherosclerosis, including very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and lipoprotein(a) (Lp a ). By contrast, high-density lipoprotein (HDL) appears...

Plasma Transport Of Carotenoids A Overview of Lipoprotein Metabolism

And small amounts of very-low-density lipoproteins (VLDLA) in the intestines. The intestinal lipoproteins are released into the lymph, and pass from the lymph into the general circulation (but thus are circulated through the entire body instead of passing via the portal circulation, which transfers nutrients from the intestines directly to the liver). Although triglycerides are removed from the intestinal lipoproteins during their circulation through the body (after hydrolysis of triglycerides by lipases), other components of intestinal lipoproteins are taken up by the liver. Endogenous lipids are released from liver as VLDL, which are transformed into intermediate-density lipoproteins (IDLs) and thence into low-density lipoproteins (LDLs) as components are removed during their circulation. High-density lipoproteins (HDLs) are formed by release from extrahepatic tissues and by exchange of components among lipoproteins in circulation. Chylomicrons are cleared rapidly from plasma...

Test Methodology 86 Ldl Cholesterol

Testing for LDL-C involves a calculation that includes total cholesterol, HDL cholesterol (HDL-C), and trigylceride (TG) values using the formula Total cholesterol 350 mg dL triglycerides 150 mg dL HDL-C 30 mg dL Triglycerides are composed of three fatty acids and a glycerol moiety. Analyzing a serum or plasma sample for triglycerides typically involves four reactions. Triglycerides 3 fatty acids + glycerol Glycerol + ATP glycerol-3-phosphate + ADP If a lipid panel (total cholesterol, triglycerides, HDL-C, and LDL-C) is requested, a fasting (10-12 hours) specimen is needed to prevent interferences from dietary fats, including chylomicrons. The total cholesterol portion of this lipid panel can be performed on a nonfasting specimen but provides limited information without the other three lipid and lipoprotein results. High HDL-C levels are seen in premenopausal women, persons who exercise regularly, and those who maintain a low but healthy weight. Insulin, estrogen, and thyroxine (T4)...

Quantification of coronary atherosclerosis for cardiovascular risk assessment the hole in the doughnut

It is remarkable that two investigators, Crawford and Levene, already described the complexity of coronary pathology in 1953 (Paper no. 1). Based on the observations of pressure-distended and undistended aortic wall specimens, the authors stated that ordinary atheromatous plaques do not project into the lumen but lie in a depression in the media, which may bulge outwards. Not surprisingly, these post-mortem observations did not find widespread clinical attention, because in vivo imaging of coronary arteries to confirm clinical significance, was not possible. A few years later, in the late 1950s, selective coronary angiography was the first imaging modality introduced to clinical cardiology. As described in the paper by Proudfit, Shirey, and Sones (Paper no. 2), the diagnosis of coronary disease in the pre-angiographical era relied solely on the elucidation of historical or clinical symptoms of ischaemia. The correlation of these ischaemic syndromes with angiographical findings...

Conclusion Of Gene Therapy

In this review, we have discussed a number of polymorphisms which might interfere with the effectiveness of statin therapy. Most polymorphisms described in this chapter have an indirect effect on statin response. Only a few of them are in genes encoding for proteins that are involved in the disposition of statins, or in genes-encoding proteins that are direct targets of statin therapy. More proteins are involved in efficacy and metabolism of statins therefore, more genes are involved, and probably more polymorphisms will influence the efficacy of statin therapy. The use of other techniques in pharmacogenetic and pharmacogenomic research will enable us to compare gene profiles of patients with differences in reactions to drugs. Instead of looking at one single SNP in a gene, haplotypes might better explain the differences in response to drugs. Furthermore, models need to be developed that enable us to look at combinations of polymorphisms at the same time. Because so many genes are...

Anticytokine and Antiinflammatory Agents

Macrolide antibiotics can reduce inflammation they may also have anti-tumour effects and modulate anti-cancer therapy 151-154 and they stimulate gastric emptying. Whether or not a possible anti-cachexia effect is independent of antibacterial activity is uncertain. This class of drugs has already been used in small clinical trials of advanced cancer and appears worthy of further study 155, 156 . The cholesterol-lowering statins also have anti-inflammatory activity, but did not prevent muscle wasting in a rat model 157 .

Association With Other Risk Indicators

Another substudy from the IRAS study compared LDL-C with apoB as a correlate for a variety ofASCVD risk factors, including dyslipidemia, insulin resistance, hypertension, inflammation, thrombosis, and subclinical atherosclerosis (38). This interesting comparison examined differences between a group who had high LDL-C but normal apoB (i.e., high cholesterol mass distributed among a normal number of particles) and a group who had normal LDL-C but high apoB (i.e., normal cholesterol mass distributed among a larger number of particles). The latter hyper-apoB group had significantly higher TGs, fasting and 2-h insulin, and plasminogen activator inhibitor, and lower HDL-C, LDL particle size, and age than the group with isolated LDL-C elevation. This analysis raises the possibility that the normal LDL-C in the hyper-apoB group is not reassuring. Because apoB is a measure of particle number, this finding points to a discrepancy between the LDL-C and the number of atherogenic particles....

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