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Query: UMLS:C0020473 (hyperlipidemia)
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Despite of certain successes from preventive measures, myocardial infarction and coronary heart disease are still responsible for a great part of deaths and premature disabilities in western industrialized nations. The rates are even increasing in Eastern Europe. In the Far East, however, incidence of myocardial infarction is low due to nutrition habits low in fat and low serum cholesterol levels. In 1986 and 1988 European Consensus Conferences have agreed on recommendations for the prevention of coronary heart disease. The population strategy seeks to improve the health-oriented behaviour of the whole population. The goal of the individual or high risk strategy is the identification and treatment of persons who are at particular risk. Among the influenceable risk factors hyperlipidemia, hypertension and cigarette smoking are of decisive importance. It is a goal to reduce cholesterol levels to 200 mg/dl by means of lipid lowering diet and, if necessary, drug treatment.
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PMID:[The European cholesterol concensus conferences. Do coronary heart diseases still play a major role in our society?]. 233 67

Double-filtration plasmapheresis is a therapeutic procedure for the extracorporeal depuration of atherogenic lipoproteins, which does not require the administration to the patient of exogenous fluids. We have used it in two patients affected by hyperlipidemia with severe cardiovascular complications. Both patients presented a dramatic improvement of their symptoms (angina pectoris and claudicatio intermittens) shortly after the beginning of treatment. By the brisk reduction of circulating low-density lipoproteins, plasma-filtration may favor the removal of cholesterol from atheromatous plaques of vessel walls. Furthermore, this procedure may modify platelet aggregation and blood viscosity. Our observation suggests that plasma-filtration may be useful not only for delaying coronary heart disease in the rare cases of homozygous familial hypercholesterolemia, but also in the management of patients with other primary hyperlipoproteinemias and clinical manifestations of already established cardiovascular complications.
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PMID:[Double filtration plasmapheresis in the treatment of vascular complications of hyperlipidemia]. 237 5

The relationship between corneal arcus (arcus senilis) and mortality from coronary heart disease (CHD) and cardiovascular disease (CVD) is examined in a prospective study of White men (n = 3,930) and women non-hormone users (n = 2,139), ages 30-69, followed for an average of 8.4 years as part of the Lipid Research Clinics Mortality Follow-up Study. After excluding those with clinically manifest CHD at baseline, corneal arcus was strongly associated with CHD and CVD mortality only in hyperlipidemic men ages 30-49 years, for whom the relative risk for CHD and CVD death was 3.7 and 4.0, respectively, after adjusting for age, total cholesterol, HDL cholesterol, and smoking status using a Cox proportional hazards model. Among 30-49 year old males, corneal arcus appears to be a prognostic factor for CHD, independent of its association with hyperlipidemia in this age-group, of about the same magnitude as other common risk factors, underscoring the usefulness of corneal arcus as a prognostic factor to the practicing clinician.
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PMID:The association of corneal arcus with coronary heart disease and cardiovascular disease mortality in the Lipid Research Clinics Mortality Follow-up Study. 240 23

The principal goal of dietary prevention and treatment of atherosclerotic coronary heart disease is the achievement of physiological levels of the plasma total and LDL cholesterol, triglyceride, and VLDL. These goals have been well delineated by the National Cholesterol Education Program of the National Heart, Lung and Blood Institute and the American Heart Association. Dietary treatment is first accomplished by enhancing LDL receptor activity and at the same time depressing liver synthesis of cholesterol and triglyceride. Both dietary cholesterol and saturated fat decrease LDL receptor activity and inhibit the removal of LDL from the plasma by the liver. Saturated fat decreases LDL receptor activity, especially when cholesterol is concurrently present in the diet. The total amount of dietary fat is of importance also. The greater the flux of chylomicron remnants is into the liver, the greater is the influx of cholesterol ester. In addition, factors that affect VLDL and LDL synthesis could be important. These include excessive calories (obesity), which enhance triglyceride and VLDL and hence LDL synthesis. Weight loss and omega-3 fatty acids from fish oil depress synthesis of both VLDL and triglyceride in the liver. The optimal diet for the treatment of children and adults to prevent coronary disease has the following characteristics: cholesterol (100 mg/day), total fat (20% of calories, 6% saturated with the balance from omega-3 and omega-6 polyunsaturated and monounsaturated fat), carbohydrate (65% of calories, two thirds from starch including 11 to 15 gm of soluble fiber), and protein (15% of calories). This low-fat, high-carbohydrate diet can lower the plasma cholesterol 18% to 21%. This diet is also an antithrombotic diet, thrombosis being another major consideration in preventing coronary heart disease. Dietary therapy is the mainstay of the prevention and treatment of coronary heart disease through the control of plasma lipid and lipoprotein levels. The exact place of the omega-3 fatty acids from fish and fish oil remains to be defined. However, this much seems certain. Fish provides an excellent substitute for meat in the diet. Fish is lower in fat, especially saturated fat, and contains the omega-3 fatty acids. Fish oil may have promise as a therapeutic agent in certain hyperlipidemic states, especially the chylomicronemia of type V hyperlipidemia. Fish oil has logical and well-defined antithrombotic and anti-atherosclerotic activities since it depresses thromboxane A2 production and inhibits cellular proliferation responsible for the progression of atherosclerosis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Diet, atherosclerosis, and fish oil. 240 91

Lipid disorders are the most important factors in the development of coronary heart disease (CHD). They need to be treated in primary as well as in secondary prevention. U.S. and European Consensus Conferences agreed that desirable serum cholesterol levels should not exceed 200 mg/dL. When baseline cholesterol averages above 250 mg/dL, the minimum requirement for characterizing the lipoprotein disorder is measurement of cholesterol, triglycerides, and high-density lipoprotein (HDL) in the fasting state. In selecting targets for serum lipid values, it may be taken into account that CHD incidence is lowest in persons with serum cholesterol below 180 mg/dL. Any kind of lipid-lowering therapy should be commenced with dietary treatment. If this is ineffective, drugs may be applied additionally. Possible causes of secondary hyperlipidemia should be excluded. There is no strict age limit for treatment but the subject's cardiovascular status should be examined carefully, especially in secondary prevention. The patient in whom extensive myocardial damage is the main arbiter of prognosis is unlikely to gain from strenuous efforts aimed at retarding progression of atheromata, the major causes of CHD. A simple classification distinguishes drugs with a predominant effect on hypercholesterolemia from those effective in endogenous hypertriglyceridemia but with a somewhat weaker cholesterol-lowering action. Using lipid-lowering drugs, their indications and side effects should be considered.
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PMID:The role of diet and drugs in lowering serum cholesterol in the postmyocardial infarction patient. 248 94

Coronary heart disease (CHD) is rare in Papua New Guinea (PNG) highlanders. Fifty-two men and 69 women randomly selected from three rural communities and a low socioeconomic urban community in the Eastern Highlands Province were assessed for hyperlipidemia, diabetes mellitus, diastolic hypertension and cigarette smoking. There was no significant difference between the findings in the rural and urban groups. The mean fasting levels of serum cholesterol, HDL cholesterol and apoproteins A-I and B were significantly lower (p less than 0.001) than those of rural Australians in a comparative study but the serum triglyceride levels were significantly higher in men less than 30 yr and women less than 40 yr of age. There was no significant difference in the serum cholesterol levels in men and women, and the levels of serum cholesterol and triglyceride did not rise with age. The mean fasting levels of plasma glucose were generally lower in PNG subjects and only two (1.7%) had diabetes mellitus. The proportions of highlanders who had diastolic hypertension or who smoked cigarettes were similar to those of Australian populations generally. The low incidence of CHD in PNG highlanders is probably related to the low serum cholesterol and apoprotein B levels, in turn probably related to their basically vegetarian diet and physically active life-style.
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PMID:Levels of serum cholesterol, triglyceride, HDL-cholesterol, apoproteins A-I and B, and plasma glucose, and prevalence of diastolic hypertension and cigarette smoking in Papua New Guinea highlanders. 250 8

The paper presents results obtained from a standardized two-stepped survey of 479 males divided into 4 groups: 2 randomized groups of patients aged under 55 years or more, respectively, at the final step of the survey, and 2 hyperlipidemic groups of those of the same age. At the initial and final steps of the survey, the incidence of coronary heart disease (CHD) was analyzed, which varied from 13.5% to 45.6%. It was shown that CHD remission might occur as judged from the epidemiological criteria. The most favorable course of CHD was observed in males with hyperlipidemia at the age of 50-55 years.
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PMID:[Study of the incidence and dynamics of non-fatal forms of ischemic heart disease in the male population based on repeated examinations]. 252 50

Prevention of vascular disease and acute pancreatitis is the goal of hyperlipidemia treatment. The risk of coronary heart disease (CHD) increases with increasing plasma cholesterol levels because low-density lipoprotein (LDL), the major carrier of cholesterol in the plasma, is atherogenic. High-density lipoprotein (HDL), especially the HDL2 subfraction, protects against CHD. Hypertriglyceridemia, although not an independent risk factor for CHD, is generally accompanied by low HDL cholesterol (HDLch), which may predispose to CHD. Reducing plasma LDL and raising HDL levels are thus goals in preventing CHD. Serum LDL levels may be lowered by reducing saturated fat and cholesterol intake; weight loss may decrease LDL but is more effective in lowering plasma triglycerides and raising HDLch. The percent of total calories from polyunsaturated, monounsaturated, and saturated fats should be less than 10%, up to 10-15%, and less than 10%, respectively. High cholesterol intake increases the flux of cholesterol, which may be harmful to arterial walls, but beyond a certain point does not increase plasma cholesterol levels. Some diets change the composition rather than the level of LDL and apoproteins. Weight reduction and maintenance are the most effective dietary measures to lower plasma triglycerides; omega-3 fatty acids (fish oils) have shown promise in reducing triglyceride but not cholesterol levels. Substitution of starch for sugar lowered triglyceride levels toward normal in hypertriglyceridemia patients. Fasting triglyceride levels rise in all individuals fed high-carbohydrate diets, but the high levels persist in hypertriglyceridemia patients. Weight loss, cessation of cigarette smoking, increased physical activity, good control of diabetes, and moderate alcohol use all raise HDLch levels. Vitamin E deficiency causes neurological sequelae in children with severe malabsorption problems due to abetalipoproteinemia or cholestatic liver disease.
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PMID:Nutritional management of plasma lipid disorders. 255 90

The importance of hypertension and hyperlipidemia as independent and interactive risk factors for the development of premature cardiovascular disease, and particularly for the development of atherosclerotic coronary heart disease, is becoming increasingly apparent both from epidemiologic data and from therapeutic trials. Nevertheless, therapeutic trials of patients with mild hypertension have not demonstrated benefits from lowering arterial pressure, in terms of reduced mortality rates from coronary events. This may, in part, be due to the fact that many of the antihypertensive agents used in these trials adversely influence lipid and lipoprotein levels. Thus, agents that are lipid-neutral or that favorably influence the lipid profile, such as selective alpha 1-inhibitors, are receiving increasing attention for the treatment of mild hypertension. Recent insights into these issues are considered.
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PMID:Selective alpha 1-adrenergic blockade, lipids, and coronary heart disease risk. Considerations in the treatment of mild hypertension. 256 24

High correlation of plasma lipid levels, especially low density lipoprotein (LDL) cholesterol levels, with the risk of coronary heart disease has been clearly indicated by epidemiologic studies. This study was undertaken to use an animal model of nondiet-induced hyperlipidemia in the homozygous Watanabe heritable hyperlipidemic rabbit (WHHL) to evaluate the effect of plasma cholesterol lowering on the progression of atherosclerosis, and to correlate plasma cholesterol levels with the amount of atherosclerotic plaque. Studies were carried out on ten homozygous WHHL rabbits divided into two groups: lipid lowering (treated) and control (nontreated). Lipid lowering was accomplished by thermofiltration (on-line plasma membrane filtration at 39 degrees C for removal of VLDL and LDL). The treated group had a significantly lower mean plasma level of total cholesterol over the course of the study than the nontreated group (293 vs. 655 mg/dl, p = 0.004). The amount of aortic atherosclerotic plaque in the treated group was also significantly lower than that in the control group (16.9 vs. 44.2%, p = 0.003). Microscopically, thickness measurements of the atherosclerotic lesions revealed that the control group had a thicker intima than the treated group. This study convincingly demonstrated the slowing or interdiction of progression of atherosclerotic lesions with lowering of the plasma total cholesterol level by thermofiltration.
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PMID:The effect of extracorporeal cholesterol removal on the progression of atherosclerosis. 259 78


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