Cumulative LDL Cholesterol level and other risk factors influence on coronary heart disease in patients with familial hypercholesterolemia

Background. Each year more than 4.3 million people in Europe will die of cardiovascular disease. Therefore, the implementation of simple interventions such as smoking cessation, weight loss, improved diets, and increased exercise is the top priority in prevention and rehabilitation programs. The aim of this study was to evaluate the impact of complex rehabilitation on the manifestation of risk factors and cardiac events in patients with coronary heart disease. Material and Methods. A total of 140 patients with coronary heart disease and NYHA functional class II–IV ischemic heart failure were recruited to the study. The patients were divided into 2 groups: 70 patients who underwent a 6-month complex rehabilitation course (rehabilitation group) and 70 patients who received drug treatment only (control group). Smoking, dietary, and physical activity habits were documented using the questionnaires. Blood pressure (BP), body weight and height, and total serum cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (Tg), and blood glucose levels were measured. Measurements were repeated after 3 and 6 months. Results. After 6 months, significantly reduced systolic BP was observed in both the groups as compared with the baseline values (P<0.05). A significant decrease in the diastolic BP; total cholesterol, LDL-cholesterol, triglyceride and blood glucose levels; body mass index, and percentage of patients with the metabolic syndrome as compared with the baseline data was documented only in the rehabilitation group (P<0.05). All the patients quitted smoking as well as all the patients in the rehabilitation group changed their dietary habits (P<0.05). Fewer patients were excluded from the rehabilitation group because of cardiac events as compared with the control group (7.1% vs. 11.4%, P<0.05). Conclusions. Complex long-term rehabilitation of cardiovascular patients significantly reduced the manifestation of major cardiovascular risk factors and the rate of cardiac events. Aerobic exercise must be the most important part of training but well-done resistance training must also be encouraged.

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Coronary Heart Disease Risk Factors and LDL Cholesterol-Lowering Efficacy of Fibrates and Simvastatin

Clinical Drug Investigation ◽

10.2165/00044011-199714020-00003 ◽

1997 ◽

Vol 14 (2) ◽

pp. 98-108 ◽

Cited By ~ 2

Author(s):

Erik Muls ◽

Philippe Autier ◽

William Malbecq ◽

Greet Vansant

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Heart Disease Risk ◽

Ldl Cholesterol ◽

Disease Risk ◽

Cholesterol Lowering ◽

Heart Disease Risk Factors ◽

Heart Disease Risk

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The treatment of hyperlipidaemia in postmenopausal women

Menopause International ◽

10.1258/136218001100321092 ◽

2001 ◽

Vol 7 (1) ◽

pp. 28-32

Author(s):

Mary Seed ◽

R Mandeno ◽

C Le Roux

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

Primary Prevention ◽

Secondary Prevention ◽

Cardiovascular Risk Factors ◽

Ldl Cholesterol ◽

Factor Vii ◽

Current Evidence

This review summarises current evidence for therapeutic options for hyperlipidaemia in post menopausal women. The two situations in which treatment is recommended are: 1. Primary prevention, which requires assessment of total risk factors for coronary heart disease. a) Statins. AFCAPS/TEXCAPS is the only randomised controlled trial (RCT) to include women. Fewer coronary heart disease (CHD) events, but no difference in mortality was found. b) Hormone replacement therapy (HRT). While there are numerous reports of positive observational epidemiological studies for HRT, there are no completed RCTs. There is little evidence for statin use in women except for familial hypercholesterolaemia. HRT is therefore not only appropriate for its multiple effects on lipoproteins, vascular function and insulin sensitivity but also for prevention of osteoporosis. 2. Secondary prevention, to achieve target total and low density lipoprotein (LDL) cholesterol. a) Statins. The major measurable effect of these drugs is to reduce total and LDL cholesterol. In the RCTs 4S, CARE and LIPID, where 20% of subjects were female, CHD events, but neither CHD mortality nor total mortality were significantly reduced in women. b) HRT. Data available from two RCTs using conjugated equine oestrogens and medroxyprogesterone acetate show no benefit. Other studies of HRT have been observational and positive. The effects of treatment on lipoproteins with statins, HRT and the combination have been investigated. In secondary prevention for hyperlipidaemic women to achieve cholesterol <5 and LDL<3 mmol/L statins will be first choice, with HRT a possible addition for its other benefits on cardiovascular risk factors. Choice of HRT medication. The route of administration will affect specific risk factors, eg, oral oestrogen reduces Lp(a) and LDL, increases HDL, while the transdermal route is less effective at reducing Lp(a) and LDL but does not increase triglyceride. Both routes reduce fibrinogen, factor VII and adhesion molecules and improve blood flow. The choice of progestogen will also affect cardiovascular risk factors. The most important lipid risk factors in women are HDL, triglyceride and Lp(a). The risk associated with raised triglyceride and LDL is offset by high HDL. Thus, in women with risk factors in primary prevention, theoretically oral HRT with a non-androgenic progestogen is likely to be of most benefit. However, since long-term adherence to therapy is important in reducing cardiovascular risk, the individual's choice of route and type of HRT is paramount.

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CHD Risk Factors In African-Americans

Circulation ◽

10.1161/circ.103.suppl_1.9999-17 ◽

2001 ◽

Vol 103 (suppl_1) ◽

pp. 1347-1347

Author(s):

Daniel W Jones ◽

Lloyd E Chambless ◽

Aaron R Folsom ◽

Richard G Hutchinson ◽

Richey A Sharrett ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Risk Factor ◽

Heart Disease ◽

Black Women ◽

African Americans ◽

Racial Differences ◽

Ldl Cholesterol ◽

Traditional Risk Factors ◽

Chd Risk Factors

0017 Few studies have reported the incidence of coronary heart disease and its relationship to risk factors in African-Americans. As part of the Atherosclerosis Risk in Communities Study, baseline risk factors were tested as predictors of incident coronary heart disease over 7-10 years of follow-up, 1987-1997, in four U.S. communities (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland). The sample included 14,026 men and women (2,298 black women [BW]; 5,686 white women [WW]; 1,396 black men [BM]; and 4,682 white men [WM] aged 45-64 who were free of clinical coronary heart disease at baseline. Age-adjusted incidence rates for the 7-10 year period (95% confidence interval) for coronary heart disease were BW 5.0(4.1-6.1), WW 4.0(3.5-4.6), BM 10.7(8.9-12.8), and WM 12.6(11.5-13.8). In multivariate analysis, traditional risk factors were generally predictive in blacks as in whites. Hypertension was a particularly strong risk factor in black women, with hazard rate ratios (HR) being: BW 4.12, WW 2.0, BM 1.85, and WM 1.59. Diabetes was predictive, but HRs were somewhat less in blacks than in whites: BW 1.88, WW 3.34, BM 1.70, and WW 2.14. LDL cholesterol was similarly predictive in all race/gender groups, HR 1.19-1.36 per S.D. LDL cholesterol increment. HDL cholesterol appeared somewhat more protective in whites than in blacks. Although black/white differences in risk factor associations exist, there were more similarities than differences in coronary heart disease risk factors and incidence. Findings from this study, along with clinical trial evidence showing efficacy, support aggressive management of traditional risk factors in blacks as in whites. Understanding of the intriguing racial differences in risk factor prediction may be an important part of further understanding the causes of coronary heart disease and may lead to better methods of prevention and treatment.

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Abstract 166: Small Dense LDL Cholesterol Is Associated with Risk for Coronary Heart Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a166 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

John W Gaubatz ◽

Wensheng Sun ◽

Jennifer Jiang ◽

Ashley Buchanan ◽

David Couper ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Proportional Hazards ◽

Ldl Cholesterol ◽

Proportional Hazards Model ◽

Small Dense Ldl ◽

Traditional Risk Factors ◽

Aric Study

Background— Evidence from in vitro studies indicates that small dense LDL (sd-LDL) is more atherogenic than large buoyant LDL. Previously, sd-LDL has been associated with risk for vascular disease. However, the lack of a standardized sd-LDL assay has hampered its clinical application. Objectives— We tested the hypothesis that elevated plasma sd-LDL-cholesterol (sd-LDL-C) level is associated with risk for incident coronary heart disease (CHD) and stroke in the ARIC cohort. Methods— Plasma sd-LDL-C was measured in 11,419 men and women of the biracial ARIC study using a newly developed automated homogeneous assay. A proportional hazards model was used to examine the relationship between sd-LDL-C, vascular risk factors, and risk for CHD events and stroke over a period of ≈10 years. Results— Mean plasma sd-LDL-C was higher in Caucasians than in African Americans (45.2 vs. 37.4 mg/dL, p<0.0001). Plasma sd-LDL-C levels were strongly correlated with an atherogenic lipid profile and were higher in diabetics vs. non-diabetics (49.6 vs. 42.3 mg/dL, p<0.0001, respectively). sd-LDL-C was associated with incident CHD in a basic model as well as a model that included traditional risk factors and hs-CRP with hazard ratios (HRs) of 1.99 (95%CI: 1.68-2.36) and 1.56 (95%CI: 1.26-1.93) for the highest vs. the lowest quartile, respectively (Table). We did not find a significant association of sd-LDL-C with risk for stroke (Table). Conclusions— sd-LDL-C is associated with incident CHD but does not predict risk for stroke in ARIC participants. Further studies will need to determine whether sd-LDL-C will add value beyond traditional risk factors to cardiovascular risk assessment in clinical practice.

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