Clinical practice: Low HDL cholesterol levels
Johns Hopkins University, Baltimore, Maryland, United States New England Journal of Medicine
(Impact Factor: 55.87).
10/2005; 353(12):1252-60. DOI: 10.1056/NEJMcp044370
Available from: Guang Wang
- "LDL-C may directly impair endothelial nitric oxide (NO) synthase activity and NO bioavailability. Some studies have shown a beneficial effect of lowering the LDL level on endothelial function in Type 2 DM. Reduced levels of HDL-C are associated with increased risk of coronary disease and cardiovascular events, even in patients with low LDL-C levels., The deleterious effects of oxidized LDL-C on the endothelium may be counteracted by increased HDL-C levels because of HDL-mediated vasoprotective effects. "
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ABSTRACT: To evaluate the association of coronary artery endothelial function and plasma levels of low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in patients with Type 2 Diabetes Mellitus (DM).
We investigated 90 participants from our institution between October 2007 to March 2010: non-DM (n = 60) and DM (n = 30). As an indicator of coronary endothelial dysfunction, we used non-invasive Doppler echocardiography to quantify coronary flow velocity reserve (CFVR) in the distal part of the left descending artery after rest and after intravenous adenosine administration.
Plasma level of LDL-C was significantly higher in patients with DM than in non-DM (3.21 ± 0.64 vs. 2.86 ± 0.72 mmo/L, P < 0.05), but HDL-C level did not differ between the groups (1.01 ± 0.17 vs. 1.05 ± 0.19 mmo/L). Furthermore, the CFVR value was lower in DM patients than non-diabetics (2.45 ± 0.62 vs. 2.98 ± 0.68, P < 0.001). Plasma levels of LDL-C were negatively correlated with CFVR in all subjects (r = -0.35, P < 0.001; 95% confidence interval (CI): -0.52 - -0.15) and in the non-DM (r = -0.29, P < 0.05; 95% CI: -0.51- -0.05), with an even stronger negative correlation in the DM group (r = -0.42, P < 0.05; 95% CI: -0.68 - -0.06). Age (β = -0.019, s = 0.007, sβ = -0.435, 95% CI: -0.033 - -0.005, P = 0.008), LDL-C (β = -0.217, s = 0.105, sβ = -0.282, 95% CI: -0.428 - -0.005, P = 0.045) remained independently correlated with CFVR in the DM group. However, we found no correlation between HDL-C level and CFVR in any group.
Diabetes may contribute to coronary artery disease (CAD) by inducing dysfunction of the coronary artery endothelium. Increased LDL-C level may adversely impair coronary endothelial function in DM. HDL-C may lose its endothelial-protective effects, in part as a result of pathological conditions, especially under abnormal glucose metabolism.
Available from: Donald G Mclaren
- "Oxidative stress, including lipid peroxidation, has been shown to be the mediator of the pathologic effects of numerous risk factors of Alzheimer's disease (AD; Guglielmotto et al., 2010). Lastly, lifestyle interventions proven to increase HDL cholesterol levels (Ashen and Blumenthal, 2005) including “healthy” diet, regular exercise, weight control, and smoking cessation have also been shown to provide neuroprotective effects (Panza et al., 2004; Ward et al., 2005; Kramer et al., 2006; Swan and Lessov-Schlaggar, 2007). Together these findings suggest that individuals with low HDL cholesterol levels may be more susceptible to neuropathological changes and future development of neurodegenerative and neurovascular diseases. "
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ABSTRACT: Dyslipidemia is common in adults and contributes to high rates of cardiovascular disease and may be linked to subsequent neurodegenerative and neurovascular diseases. This study examined whether lower brain volumes and cognition associated with dyslipidemia could be observed in cognitively healthy adults, and whether apolipoprotein E (APOE) genotype or family history of Alzheimer's disease (FHAD) alters this effect. T1-weighted magnetic resonance imaging was used to examine regional brain gray matter (GM) and white matter (WM) in 183 individuals (58.4 +/- 8.0 years) using voxel-based morphometry. A non-parametric multiple linear regression model was used to assess the effect of high-density lipoprotein (HDL) and non-HDL cholesterol, APOE, and FHAD on regional GM and WM volume. A post hoc analysis was used to assess whether any significant correlations found within the volumetric analysis had an effect on cognition. HDL was positively correlated with GM volume in the bilateral temporal poles, middle temporal gyri, temporo-occipital gyri, and left superior temporal gyrus and parahippocampal region. This effect was independent of APOE and FHAD. A significant association between HDL and the Brief Visuospatial Memory Test was found. Additionally, GM volume within the right middle temporal gyrus, the region most affected by HDL, was significantly associated with the Controlled Oral Word Association Test and the Center for Epidemiological Studies Depression Scale. These findings suggest that adults with decreased levels of HDL cholesterol may be experiencing cognitive changes and GM reductions in regions associated with neurodegenerative disease and therefore, may be at greater risk for future cognitive decline.
Available from: Michael Garnet Irwin
- "Atherosclerosis is a multi-factorial systemic disease, with hyperlipidemia as an important risk factor. For more than a decade, statins have been used clinically in lowering elevated levels of cholesterol and thus decreasing the risk for atherosclerosis (Grundy 1988; Eisenberg 1998; Ashen and Blumenthal 2005). Not only are statins highly effective in reducing low-density lipoproteins and cholesterol, they also increase high-density lipoproteins and have additional benefi cial effects on systemic atherosclerosis. "
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ABSTRACT: Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) can significantly decrease cardiovascular mortality and morbidity, irrespective of the patients' cholesterol status. This paper reviews the effects of perioperative statin therapy in patients undergoing noncardiac surgery.
A systematic literature review was undertaken of all published literature on this subject using Medline and cross-referenced. All published relevant papers on the perioperative use of statins were used.
Perioperative statin therapy is associated with a lower perioperative morbidity and mortality in patients undergoing elective or emergency surgery. The effects are due to a combination of lipid-lowering and pleiotropic properties of statins.
Ideally a large scale multi-centre randomized controlled trial of perioperative statin therapy should be performed but this may be difficult to conduct since there is already overwhelming evidence in the literature to suggest perioperative cardiovascular protective properties. Statins may still be under-prescribed in surgical patients.
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