Hypercholesterolemia, related

Erotein whether or not cholesterol was added to the diets C3) ince the publication of this experiment over 45 years ago, there has been a recent resurgence of interest in the area of protein effects on plasma lipids and atherosclerosis. This paper summarizes some of the data generated in our laboratory over the last several years and discusses their significance in relation to hypercholesterolemia and atherosclerosis in other species including humans. 

Seed, M., Hopplicher, F., Reaveley, D., McCarthy, S., Thompson, G. R., Boerwinkle, E., and Utermann, G, Relation of serum lipoprotein(a) concentration and apolipoprotein(a) phenotype to coronary heart disease in patients with familial hypercholesterolemia. N. Engl. 

Sorensen, K. E., Celermajer, D. S., Georgakopoulos, D., Hatcher, G., Betteridge, D. J., and Deanfield, J. E., Impairment of endothelium-dependent dilation is an early event in children with familial hypercholesterolemia and is related to the lipoprotein(a) level. J. Clin. Invest. 93, 50-55 (1994). 

T4. Tato, F., Keller, C., Schuster, H., Spengel, F., Wolfram, G., and Zollner, N., Relation of lipoprotein(a) to coronary heart disease and duplex sonographic findings of the carotid arteries in heterozygous and familial hypercholesterolemia. Atherosclerosis (Shannon. Irel.) 101, 69-77 (1993). 

In addition, Nakao et al. have examined the effects of mood states on persistent versus temporary hypercholesterolemia in students entering a university [29]. They found that depressive mood appeared to relate to hypercholesterolemia when the university students were screened with tension-anxiety, depression, anger-hostility, vigor, fatigue, and confusion scales [29]. In children, after covariance adjustment for age, race, and sex, Glueck et al. pointed out that children having adjustment disorders with depression had much lower covariance-adjusted TC values than control... 

Body iron level and iron depletion play an important role in the gender differences seen in death from cardiac disease. There is a better correlation with heart disease mortality in iron levels compared with levels of cholesterol (5). It was found that risk of coronary heart disease (6) and carotid atherosclerosis (7) is associated with increased iron stores. However, impaired endothelium-derived nitric oxide activity may be without overt atherosclerosis in patients with risk factors and may be associated with the presence of atherosclerosis (4). Thus, endothelial dysfunction related to iron activity not only may be an early marker for cardiovascular risk but also may contribute to the pathogenesis of atherosclerosis (2) by the stimulation of low-density lipoproteins (LDL) and membrane lipid peroxidation (I) and may be a key to the understanding of early mechanism in the development of atheroma (7,8). Nakayama et al. (9) showed the role of heme oxygenase induction in the modulation of macrophage activation in atherosclerosis. However, Howes et al. (10) concludes that at the moment, the available evidence on iron hypothesis remains circumstantial. Moreover, Kiechl et al. (7) showed that the adverse effect of iron is hypercholesterolemia, In patients... 

There is a substantial interindividual variation in LDL cholesterol levels among patients with FH. Generally, LDL cholesterol levels are inversely related to the residual LDL receptor activity, as measured in the in vitro assay that uses skin fibroblasts. Patients with homozygous FH are classically divided into two groups based on the fibroblast LDL receptor activity. Patients with less than 2% activity, as the patient described in the case report, are classified as receptornegative. Patients with 2%-20% LDL receptor activity are classified as receptor-defective. The natural history of the disease is much more severe in receptor-negative patients, who, if left untreated, rarely survive beyond the second decade of fife. Receptor-defective patients, in contrast, have less-severe hypercholesterolemia and a more delayed onset of coronary artery disease and mortality. 

The hypocholesterolemic effect of sesamin could be enhanced by a-tocopherol (107). Data shown in Table 14 clearly indicated that rats fed sesamin together with tocopherol (1%), the serum cholesterol-lowering effect of sesamin, could be demonstrated at a much lower level (0.05%). This synergistic effect was found to be related to both the levels of sesamin and cholesterol in the diet. The combination of a-tocopherol with sesamin has a practical value for the treatment of hypercholesterolemia. The cholesterol-lowering effect of sesamin has also been demonstrated in humans with dietary supplementation of sesamin at 64.8-mg/day level (108). 

Women of blood group O have less of a risk of thromboembolism (15). The risk of thromboembolic complications may be greater where there is a history of diabetes, hypertension, and pre-eclamptic toxemia. In some studies there has been an association with type II hyperlipoproteinemia, hypercholesterolemia, and atheroma (62-66). Hypertension may be an additional risk factor when considered in relation to oral contraceptive use. 

To address the issues discussed previously in this chapter, the NCEP convened expert panels to consider various aspects of diagnosis and treatment of hypercholesterolemia and develop guidelines for reliable lipid and lipoprotein mea-surements Two separate laboratory panels considered issues related to blood lipid and lipoprotein measurement. The first, the NCEP Laboratory Standardization Panel, was concerned with the measurement of total cholesterol, gnd the second, the NCEP Working Group on Lipoprotein Measurement, addressed the measurement of triglycerides, HDL cholesterol, and LDL cholesterol. The recommendations of both panels include extensive reviews of lipid and lipoprotein methodology, and the interested reader is referred to the original reports for details. Here we summarize the principal considerations and recommendations for clinical lipid and lipoprotein measurements. 

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