The epidemiologic basis for population-wide cholesterol reduction in the primary prevention of coronary artery disease
ABSTRACT A number of recent epidemiologic observations support the need for new and broader strategies to reduce serum cholesterol levels on a population-wide basis. First, the limited data available suggest a halt in the declining incidence of coronary artery disease (CAD) in the United States since 1990, raising concerns about our current strategies to promote primary prevention of CAD. Data from the 1970s and 1980s support a key role for population-wide cholesterol lowering as a strategy to reduce CAD. Second, large and carefully performed surveys support no further reductions in serum cholesterol levels in the US population since 1990. Is this observation and that of stagnating declines of CAD incidence a coincidence? Interestingly, the lack of cholesterol level reduction occurred in the setting of increased use of prescription cholesterol-lowering drugs, suggesting that drug treatment of the highest-risk persons alone will not shift the population curve. Third, the treatment gap persists, with recent population-wide data suggesting that half of all people with hypercholesterolemia (>/=200 mg/dL) are unaware of their condition, only half of those persons aware are treated, and only half of those treated are controlled. Finally, the moderate-risk population (10% to 20% risk of CAD over 10 years) is sizable in the ages recommended for over-the-counter statin use (>/=45 years in men, >/=55 years in women). Risk reduction in this group, which contributes a significant portion of CAD cases, should be part of any program to reduce the population burden of CAD.
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ABSTRACT: Using data from 3 cross-sectional studies, the authors compared the estimated risk of cardiovascular diseases between migrant Sri Lankans in Oslo, Norway, and Tamils and Sinhalese in Kandy, Sri Lanka. The authors found that Sri Lankans in Oslo had significantly lower Framingham coronary heart disease (CHD) risk. Among men, the prevalence with estimated 10-year risk of a CHD event ≥10% was 20.6% in Oslo, 31.1% in Kandy Tamils, and 44.2% in Kandy Sinhalese. The corresponding figures in women were 10.4% in Oslo, 19.2% in Tamils, and 14.9% in Sinhalese. Risk of fatal cardiovascular disease estimated by the SCORE model showed a similar pattern. The Oslo group had a higher body mass index (BMI), but the differences were observed in all BMI categories. In conclusion, despite a lower BMI, Tamils and Sinhalese in Sri Lanka had higher estimated cardiovascular risk compared with Sri Lankans in Norway, mainly because of poorer lipid profiles.Asia-Pacific Journal of Public Health 11/2013; 25(6):452-62. DOI:10.1177/1010539511423958 · 1.11 Impact Factor
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ABSTRACT: A new lipid lowering nutraceutical in primary cardiovascular prevention in people non responder to previous dietary restriction. Summary Epidemiological studies and clinical trials demonstrated that elevated levels of plasma total cholesterol (TC) and triglycerides (TG) are the major risk factors for coronary heart disease (CHD), whereas high concentrations of plasma high-density lipoprotein cholesterol (HDL-C) and a low ratio of TC/HDL-C are protective against atherosclerosis. The CHD risk progressively increases from borderline to high cholesterol levels as a continu-um. In recent years nutraceuticals have attracted much interest as a possible alternative treatment for amelio-rating dyslipidemia, especially for patients whose blood cholesterol and triglycerides level are marginally high, respectively ranging between 200-240 and 150-180 mg/dL, but not high enough to warrant the prescription of cholesterol-lowering medications. This review summarizes the findings of recent studies in this field and mechanisms of action of lipids modifying nutraceuticals. Furthermore, we report preliminary data coming from a 12 weeks administration of a new proprietary multicomponent supplement, with pleiotropic actions, in borderline dyslipidemic subjects non responder to previous dietary and lifestyle variation. In our case report a significant reduction of TC, TG and other CHD risk factors suggest that the use of a well designed nutraceutical is an effective and safe alternative to statin therapy in people non responsive to lifestyle modifications. Perrone Filardi P, Mammucari M, Fiore M, et al. A new lipid lowering nutraceutical in primary cardiovascular prevention in people non responder to previous dietary restriction. Trends Med 2012; 12(1):1-12. ASL RME 3. Medico di assistenza primaria ASL RME 4. Medico di assistenza primaria ASL VT N onostante il rilevante calo della mortalità intraospe-daliera e la maggiore sopravvi-venza del paziente infartuato, le malattie cardiovascolari conti-nuano a rimanere la prima cau-sa di morte in tutti i Paesi con stili di vita occidentalizzati. Nel 2009 in Italia sono stati registrati circa 130.000 IMA, di cui circa 80.000 primi eventi e 50.000 reinfarti; un numero sostanzial-mente simile a quello registrato nel nostro paese nelle due deca-di precedenti 1 . Ciò significa che a fronte di una prognosi miglio-re del paziente infartuato sia a breve che a lungo termine, gra-zie alla maggiore efficacia e tem-pestività degli interventi in acu-to, il numero di pazienti che va incontro ad un primo evento non è cambiato: questo partico-lare andamento caratterizza tutti i sistemi sanitari dei paesi avan-zati e suggerisce la scarsa efficacia delle misure attualmente adottate per la prevenzione primaria. Per tali ragioni numerosi epidemiologi hanno sollevato il problema del-le disastrose conseguenze econo-miche e sanitarie a lungo termi-ne che un tale trend avrebbe, an-che sui sistemi sanitari più effi-cienti, qualora questa tendenza non dovesse essere invertita 2-4 .Trends in Medicine 07/2012; 12(1):1-12.
Dataset: EBM LDL 2006