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- Cooney, M T, et al.
(författare)
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HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk.
- 2009
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 206:2, s. 611-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We aimed to clarify some previous inconsistencies regarding the role of high density lipoprotein cholesterol (HDL-C) as a CVD protective factor. METHODS: The SCORE dataset contained data on HDL-C for 104,961 individuals (45% women) without pre-existing coronary heart disease (CHD). These were from 7 pooled European prospective studies. The effect of HDL-C, both in quintiles and as a continuous variable, on risk of CVD and CHD mortality was examined, using Cox proportional hazards model, adjusted for age, total cholesterol, systolic blood pressure, smoking, diabetes and body mass index and stratified by gender, age group, country and category of SCORE CVD risk. RESULTS: A strong, graded, independent, inverse relationship between HDL-C and both CVD and CHD mortality was demonstrated. Adjusted hazard ratios per 0.5mmol/l increase in HDL-C were 0.60 (0.51, 0.69) and 0.76 (0.70, 0.83) in women and men, respectively for the CVD mortality endpoint. The corresponding hazard ratios were 0.53 (0.42, 0.68) and 0.79 (0.64, 0.98) in elderly women and men, respectively. The relationship was significant in all SCORE CVD risk strata and age groups. CONCLUSIONS: This multivariable analysis, the largest of its kind to date, has confirmed the inverse, independent, strong and graded relationship between HDL-C and both CVD and CHD mortality. We have clarified previous suggestions that the relationship is stronger in women and that it applies in all age groups. This is the first prospective study to demonstrate the independent relationship specifically in healthy elderly women and to show that the relationship holds at all levels of total CVD risk.
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- Kotseva, K, et al.
(författare)
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Treatment potential for cholesterol management in patients with coronary heart disease in 15 European countries: Findings from the EUROASPIRE II survey
- 2008
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 197:2, s. 710-717
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Tidskriftsartikel (refereegranskat)abstract
- Background: During the last decade, the evidence of beneficial effects of cholesterol lowering in patients with coronary heart disease (CHD) has been proven in several clinical trials. This has prompted international guidelines on prevention of CHD to include recommendations on dietary and pharmacological treatment of hyperlipidaernia with set goals on total- and LDL-cholesterol. Methods: The first EUROASPIRE survey performed in 1995/1996 showed poor adherence to the European recommendations on lipid-lowering in patients with CHD. The second survey was carried out in 1999/2000 in 15 European countries and enrolled 8181 patients with CHD. Medical records were assessed and clinical examinations of risk factors including serum lipids were performed. The aim of this survey is to describe the treatment of hyperlipidaemia among CHD patients in Europe. Results: The proportion of patients not reaching the target of 5.0 mmol/l was 58.3% with significant variations between countries. The use of lipid-lowering drugs was relatively high (60.9%). However, the most frequently used doses of lipid-lowering agents were much lower than the doses of proven effect used in clinical trials. Conclusions: Although the treatment of hyperlipidaemia in CHD patients seems to be improving as compared to the first survey, a significant number of patients do not reach treatment goals. If the full potential of lipid-lowering therapy was utilised with all eligible patients treated and doses titrated correctly, more patients would benefit in terms of reduced morbidity and mortality of CHD. (c) 2007 Elsevier Ireland Ltd. All rights reserved.
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- Gylling, H., et al.
(författare)
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Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease
- 2014
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Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150. ; 232:2, s. 346-360
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk. Methods and results: Plant sterols/stanols (when taken at 2g/day) cause significant inhibition of cholesterol absorption and lower LDL-C levels by between 8 and 10%. The relative proportions of cholesterol versus sterol/stanol levels are similar in both plasma and tissue, with levels of sterols/stanols being 500-/10,000-fold lower than those of cholesterol, suggesting they are handled similarly to cholesterol in most cells. Despite possible atherogenicity of marked elevations in circulating levels of plant sterols/stanols, protective effects have been observed in some animal models of atherosclerosis. Higher plasma levels of plant sterols/stanols associated with intakes of 2g/day in man have not been linked to adverse effects on health in long-term human studies. Importantly, at this dose, plant sterol/stanol-mediated LDL-C lowering is additive to that of statins in dyslipidaemic subjects, equivalent to doubling the dose of statin. The reported 6-9% lowering of plasma triglyceride by 2g/day in hypertriglyceridaemic patients warrants further evaluation. Conclusion: Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are no randomised, controlled clinical trial data with hard end-points to establish clinical benefit from the use of plant sterols or plant stanols. © 2013 The Authors.
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