Lipids and CVD management: Towards a global consensus

Arteriosclerosis and Lipoprotein Section, Baylor College of Medicine, Houston, TX, USA.
European Heart Journal (Impact Factor: 15.2). 12/2005; 26(21):2224-31. DOI: 10.1093/eurheartj/ehi373
Source: PubMed

ABSTRACT Cardiovascular disease (CVD) is currently the leading cause of morbidity and mortality worldwide and its incidence is likely to increase. Multiple risk factors contribute to CVD. Elevated LDL-cholesterol (LDL-C) and triglyceride levels, low HDL-cholesterol levels, hypertension, type 2 diabetes, and smoking are key modifiable risk factors. Such risk factors are present in 80-90% of coronary heart disease (CHD) patients. For many factors, modification can significantly reduce CVD incidence. For example, statin-induced LDL-C reductions reduce cardiovascular events by 24-37% and smoking cessation reduces CHD mortality by 36%. The need to identify and treat these risk factors has led many national and local groups to develop clinical practice guidelines for management of CVD. Although the aim of such guidelines is to provide practitioners with a framework to identify, prioritize, and manage patients, the plethora of guidelines can cause confusion. In addition, research indicates that guidelines are not being optimally implemented. This review considers these practical issues, highlights the common goals shared by many guidelines, and focuses on how these can be best achieved. It also highlights areas where the guidelines differ and discusses points to consider when selecting the most appropriate recommendation.

Download full-text


Available from: James Shepherd, Jan 20, 2014
15 Reads
  • Source
    • "Cardiovascular disease (CVD) represents the leading cause of mortality and morbidity on a global scale and the costs associated with treatment of the growing number of CVD patients are increasing correspondingly [1] [2]. To date, numerous terol chocolate B; CVD, cardiovascular disease; SRM, selected reaction monitoring metabolic factors have been linked to the development of CVD and atherosclerosis but especially elevated plasma lipids have been extensively postulated as key predictors [3] [4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Dietary intake of cocoa and/or chocolate has been suggested to exhibit protective cardiovascular effects although this is still controversial. The aim of this study was to investigate the effects of chocolate supplementation on metabolic and cardiovascular parameters. Four groups of ApoE*3Leiden mice were exposed to the following diet regimens. Group 1: cholesterol-free control diet (CO). Group 2: high-dose (1.0% w/w) control cholesterol (CC). Group 3: CC supplemented chocolate A (CCA) and Group 4: CC supplemented chocolate B (CCB). Both chocolates differed in polyphenol and fiber content, CCA had a relatively high-polyphenol and low-fiber content compared to CCB. Mice fed a high-cholesterol diet showed increased plasma-cholesterol and developed atherosclerosis. Both chocolate treatments, particularly CCA, further increased plasma-cholesterol and increased atherosclerotic plaque formation. Moreover, compared to mice fed a high-cholesterol diet, both chocolate-treated groups displayed increased liver injury. Mice on high-cholesterol diet had elevated plasma levels of sVCAM-1, sE-selectin and SAA, which was further increased in the CCB group. Similar effects were observed for renal inflammation markers. The two chocolate preparations showed unfavorable, but different effects on cardiometabolic health in E3L mice, which dissimilarities may be related to differences in chocolate composition. We conclude that discrepancies reported on the effects of chocolate on cardiometabolic health may at least partly be due to differences in chocolate composition.
    Molecular Nutrition & Food Research 11/2013; 57(11). DOI:10.1002/mnfr.201200858 · 4.60 Impact Factor
  • Source
    • "Evidence has shown that dietary salt restriction from 10 g to 2 g per day for 5 days in patients with essential hypertension significantly increased total cholesterol and LDL.[31] Furthermore, there is a positive association between increased concentrations of plasma total cholesterol, triglycerides and LDL-C and the development of CVD such as atherosclerosis.[32] In addition, the present study has also shown that canola oil ingestion in the presence of salt increased total cholesterol and LDL-C, whereas the concentration of triglycerides was reduced. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to determine if 50 days of canola oil intake in the absence or presence of salt loading affects: (1) antioxidant and oxidative stress markers, (2) aortic mRNA of NADPH oxidase (NOX) subunits and superoxide dismutase (SOD) isoforms and (3) endothelial function in SHRSP rats. SHRSP rats were fed a diet containing 10 wt/wt% soybean oil or 10 wt/wt% canola oil, and given tap water or water containing 1% NaCl for 50 days. Without salt, canola oil significantly increased RBC SOD, plasma cholesterol and triglycerides, aortic p22phox, NOX2 and CuZn-SOD mRNA, and decreased RBC glutathione peroxidase activity. With salt, canola oil reduced RBC SOD and catalase activity, LDL-C, and p22phox mRNA compared with canola oil alone, whereas plasma malondialdehyde (MDA) was reduced and RBC MDA and LDL-C were higher. With salt, the canola oil group had significantly reduced endothelium-dependent vasodilating responses to ACh and contractile responses to norepinephrine compared with the canola oil group without salt and to the WKY rats. These results indicate that ingestion of canola oil increases O2− generation, and that canola oil ingestion in combination with salt leads to endothelial dysfunction in the SHRSP model.
    PLoS ONE 06/2013; 8(6):e66655. DOI:10.1371/journal.pone.0066655 · 3.23 Impact Factor
  • Source
    • "[1] [2] [3] [4] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hypercholesterolemia is a predominant risk factor for atherosclerosis and associated coronary and cerebrovascular diseases. Control of cholesterol levels through therapeutic drugs, notably statins, have significantly reduced the risk for developing atherosclerosis and associated cardiovascular diseases. However, adverse effects associated with therapeutic drugs warrant to find other alternative approaches for managing hypercholesterolemia, especially for those with borderline cholesterol levels. Food supplements have increasingly become attractive alternatives to prevent or treat hypercholesterolemia and reduce the risk for cardiovascular diseases. This review summarized current patents on food supplements with claims of hypocholesterolemic effects. They can be mainly divided into four categories based on the active ingredients in the supplements: 1) plant sterols or stanols; 2) fiber or polysaccharides; 3) microorganism-derived; and 4) soy protein and phytoestrogens. The efficacy, mechanisms of action and potential side effects are reviewed for each of the four categories. The hypocholesterolemic effects of plant sterols, fiber, Monascus products and soy protein preparations have been consistently demonstrated in clinical trails whereas the efficacy of some probiotic bacteria and phytoestrogens-containing supplements remains to be established. Accumulative clinical data show that plant sterols, fiber, soy protein and phytoestrogen are generally considered safe and cause no obvious side effects. However, additional clinical studies are required to establish the safety profiles of certain probiotic bacteria as food supplements.
    01/2009; 1(1):15-24. DOI:10.2174/2212798410901010015
Show more