Coronary artery disease lipid levels

An increase in serum lipids is believed to contribute to or cause atherosclerosis, a disease characterized by deposits of fatty plaques on the inner walls of arteries. These deposits result in a narrowing of the lumen (inside diameter) of the artery and a decrease in blood supply to the area served by the artery. When these fatty deposits occur in the coronary arteries, the patient experiences coronary artery disease. Lowering blood cholesterol levels can arrest or reverse atherosclerosis in the vessels and can significantly decrease the incidence of heart disease. 

Contrary to LDL, high-density lipoproteins (HDL) prevent atherosclerosis, and therefore, their plasma levels inversely correlate with the risk of developing coronary artery disease. HDL antiatherogenic activity is apparently due to the removal of cholesterol from peripheral tissues and its transport to the liver for excretion. In addition, HDL acts as antioxidants, inhibiting copper- or endothelial cell-induced LDL oxidation [180], It was found that HDL lipids are oxidized easier than LDL lipids by peroxyl radicals [181]. HDL also protects LDL by the reduction of cholesteryl ester hydroperoxides to corresponding hydroperoxides. During this process, HDL specific methionine residues in apolipoproteins AI and All are oxidized [182]. 

D4. Dahlen, G. H., Guyton, J. R., Attar, M., Farmer, J. A., Kautz, J. A., and Gotto, A. M., Association of levels of lipoprotein Lp(a), plasmid lipids, and other lipoproteins with coronary artery disease documented by angiography. Circulation 74, 758-765 (1986). 

As discussed above, obesity is associated with dyslipidemia, a condition where high levels of low-density lipoprotein cholesterol (LDL-C) is common. Elevated LDL-C is strongly associated with an elevated risk of coronary artery disease and for this reason a number of lipid-lowering therapies that target LDL-C have been developed. These include bile-acid sequestrants (BAS), statins (HMG-CoA reductase inhibitors), cholesterol absorption inhibitors, and fibrates. ... 

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. 

Recently, ingestion of purple juice for 14 days has been shown to improve endothelial function, as measured by flow-induced vasodilation, in patients with coronary artery disease [78]. The authors attributed this effect to the flavonoidic content of the purple juice. These benefits were observed despite use of antioxidant vitamins, lipid lowering medications and small increases in total cholesterol and triglycerides levels. 

Home BD, et al. Statin therapy, lipid levels, C-reactive protein and the survival of patients with angiographically severe coronary artery disease. J Am Coll Cardiol 2000 36(6) 1774-1780. 

Topical timolol may alter the plasma lipid profile Timolol maleate adversely affects the high-density lipoprotein cholesterol levels in older white, black, and Japanese patients.There is no evidence, however, that chronic use of topical timolol increases the risk of coronary artery disease. 

Cholesterol is a member of the steroid family, a group of lipids having four rings joined together. Because it has just one polar OH group, cholesterol is insoluble in the aqueous medium of the blood. It is synthesized in the liver and transported to other cells bound to water-soluble organic molecules. Elevated cholesterol levels can lead to coronary artery disease. 

Brown G, Albers JJ, Fisher LD, Schaefer SM, Lin JT, Kaplan C, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apoiipoprotein B. N Engl J Med 1990 323 1289-98. 

A comparison of the United States with other countries shows similar relationships between total cholesterol and LDL and an inverse relationship with HDL and coronary artery disease (CAD) mortality. On a positive note, the U.S. mortality rate is midway among the countries studied, and this country has had the greatest decline in CAD mortality (35% to 40%) in men and women over the last 10 years compared with other countries. A decline in the prevalence of hypercholester-olemiain certain segments of the U.S. population parallels these trends in mortality. LDL and the ratio of LDL to HDL also have been used to assess risk, but their use adds little information to total cholesterol alone unless HDL is abnormally high or low. HDL transports cholesterol from lipid-laden foam cells to the liver. HDL has been shown to be protective for the occurrence of CHD, and an inverse relationship exists between CHD and HDL levels. ... 

In addition to diabetes mellitus, Mr. Applebod has a hyperlipidemia (high blood lipid level—elevated cholesterol and triacylglycerols), another risk factor for cardiovascular disease. A genetic basis for Mr. Applebod s disorder is inferred from a positive family history of hypercholesterolemia and premature coronary artery disease in a brother. 

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