Pharmacologic therapy for high blood cholesterol levels and clinical aspects of lipid-lowering drugs

AbstractHigh blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

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III. The Individualized Approach: Detection/Diagnosis/Evaluation

PEDIATRICS ◽

10.1542/peds.89.3.545 ◽

1992 ◽

Vol 89 (3) ◽

pp. 545-554

Keyword(s):

Children And Adolescents ◽

Familial Aggregation ◽

Significant Risk ◽

Blood Cholesterol ◽

Selective Screening ◽

High Blood Cholesterol ◽

Cooperative Effort ◽

Cholesterol Levels ◽

Increased Risk ◽

Individualized Approach

The individualized approach to cholesterol lowering among children and adolescents focuses on those who appear to be destined to become adults with high blood cholesterol and an increased risk of coronary heart disease (CHD). This approach calls for the cooperative effort of the entire health professional team to identify, treat, and monitor individual children and adolescents who have high serum cholesterol levels, with the ultimate objective of preventing formation of atherosclerotic lesions in the coronary arteries. Because tracking of cholesterol levels from childhood to adulthood occurs but is imperfect, the panel sought ways to identify those children and adolescents whose elevated cholesterol levels are likely to indicate significant risk. The panel reached consensus that a low density lipoprotein (LDL)-cholesterol value of 130 mg/dL or higher (95th percentile), when associated with family history of cardiovascular disease (CVD) or parental hypercholesterolemia, is sufficiently elevated to warrant further evaluation and probable treatment and followup. The panel deliberately targeted the family unit and the familial aggregation of CVD and/or inherited lipid problems because hypercholesterolemia in a child from such a family is of clinical significance. Children with parents and grandparents who have premature CVD often have high cholesterol levels. Thus cholesterol levels in a child are linked to familial CVD.65,67,69,158 CHOLESTEROL MEASUREMENT: RECOMMENDATIONS FOR SELECTIVE SCREENING Who Should Have Cholesterol Measurements? The panel makes the following recommendations for the detection (selective screening), in the context of continuing health care, of children and adolescents likely to become adults with high blood cholesterol levels and increased risk for CVD.

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LDL-Apheresis: Technical and Clinical Aspects

The Scientific World JOURNAL ◽

10.1100/2012/314283 ◽

2012 ◽

Vol 2012 ◽

pp. 1-19 ◽

Cited By ~ 32

Author(s):

Rolf Bambauer ◽

Carolin Bambauer ◽

Boris Lehmann ◽

Reinhard Latza ◽

Ralf Schiel

Keyword(s):

Therapeutic Option ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipid Lowering ◽

Clinical Aspects ◽

Published Data ◽

Ldl Apheresis ◽

Lipoprotein A ◽

Regular Treatment ◽

Lipid Lowering Drugs

The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are five different LDL-apheresis systems available: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. There is a strong correlation between hyperlipidemia and atherosclerosis. Besides the elimination of other risk factors, in severe hyperlipidemia therapeutic strategies should focus on a drastic reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. Hence, in such patients, treatment with LDL-apheresis is indicated. Technical and clinical aspects of these five different LDL-apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or triglycerides observed. With respect to elevated lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term application.

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