Atherosclerosis epidemiology

Clinical coronary heart disease usually appears at least two or three decades after the onset of pathological lesions of coronary atherosclerosis. Epidemiological studies emphasize that hyperlipidemia, especially hypercholesterolemia, is a primary risk factor which should be construed as a warning sign. Normalization of high blood-lipid levels could start, therefore, long before the acute phases of coronary heart disease are manifest. 

Beckman, J A, Creager, MA and Libby, P (2002) Diabetes and atherosclerosis epidemiology, pathophysiology, and management. JAMA, 287(19), 2570-2581. 

Carotenoids and cardiovascular diseases — Numerous epidemiological studies aimed to study the relationship of carotenoids and cardiovascular diseases (CVDs) including coronary accident risk and stroke. It appeared then that observational studies, namely prospective and case-control studies, pointed to a protective effect of carotenoids on myocardial infarct and stroke, but also on some atherosclerosis markers such as intima media thickness (IMT) of the common carotid artery (CCA) and atheromatous plaque formation. 

Since epidemiological and clinical studies show a strong relationship between the risk of atherosclerosis and plasma Lp(a) concentrations, attempts have been made to elucidate this relationship at a cellular and molecular level (H2, M28, Nl, R5, R6, S9, S10, S12-S14, S16, S24, S25). 

Austin MA. Genetic epidemiology of dyslipidaemia and atherosclerosis. Annals of Medicine 1996 28 45963. 

Physical activity Evidence for the beneficial effects of physical activity on the development of atherosclerosis first arose from a series of epidemiological studies (Box 22.4). This activity is now known to cause several changes, all of which are beneficial in decreasing the risk of development of atherosclerosis. These are ... 

The role of the antioxidant properties of vitamins C, E, and p-carotene in the prevention of cardiovascular disease has been the focus of several recent studies. Antioxidants reduce the oxidation of low-density lipoproteins, which may play a role in the prevention of atherosclerosis. However, an inverse relationship between the intake or plasma levels of these vitamins and the incidence of coronary heart disease has been found in only a few epidemiological studies. One study showed that antioxidants lowered the level of high-density lipoprotein 2 and interfered with the effects of lipid-altering therapies given at the same time. While many groups recommend a varied diet rich in fruits and vegetables for the prevention of coronary artery disease, empirical data do not exist to recommend antioxidant supplementation for the prevention of coronary disease. 

Although atherosclerosis exerts its most important effects on the coronary vessels, other vascular beds are frequently affected, such as the carotid arteries, the aorta, and the vessels of the legs. However, the possibility that effective lipid lowering could have beneficial effects on atherosclerotic diseases other than CHD has received relatively little attention. Although there is some evidence that hypercholesterolemia is a risk factor for stroke, especially in younger patients (Prospective Studies Collaboration, 1995), the epidemiologic data are not nearly as extensive or unequivocal as for CHD. The first evidence that HMG-CoA reductase inhibitors could reduce the risk of cerebrovascular effects was provided by 4S, in which there was a significant 28% reduction in the... 

Pyorala, K., M. Laakso, and M. Uusitupa. 1987. Diabetes and atherosclerosis an epidemiologic view. Diabetes Metab. Rev. 3 463-524. 

Although most epidemiological studies on the relationships between plasma lipids and coronary heart disease have examined total plasma cholesterol (most of which is apoB-associated cholesterol) as a major risk factor, some case-control studies have shown that apoB-100 (i.e., apoB in LDL and VLDL) is higher in subjects with coronary heart disease than controls (A31, A32, F2, M34, 06, RIO, S43, V6, W14). It may be that apoB is itself a risk factor, and that a raised apoB concentration but normal LDL cholesterol will be a marker for a previously unsuspected group of people at risk from coronary heart disease (S43). An increasing body of evidence suggests that hyper-B-apoproteinemia may be an important risk factor for coronary heart disease. This evidence, and the possibility that apolipoprotein assays (in particular apoB and apoA-I assays) may serve as a better marker of risk for atherosclerosis than the standard lipid measurements, have been discussed by Brunzell et al. (B59). 

Epidemiological studies on the incidence of atherosclerosis indicate which of the following ... 

Since results from studies with biomedical models indicate potential, there is of obvious interest in the effects of RA consumption in foods on the risk of atherogenesis in humans. The use of surrogate biomarkers for disease risk is more readily achievable for atherosclerosis than for cancer in humans and a number of genetic and environmental risk factors have been identified, with the relative abundance of the different lipoproteins being of primary importance (Lusis, 2000). To date, there have been no epidemiological studies that have examined the intake of CLA derived from foods with the risk of atherosclerosis. However, as discussed in Section 3.6.2.1, the challenge of adequately evaluating the effect of dietary intake of CLA from different food sources presents some special limitations. 

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