Blood Total Cholesterol Concentrations Research Articles

School teachers can effectively manage primary prevention of adult cardiovascular disease. The Stradella Project

Objective To determine whether school teachers educated about Primary Prevention of Adult Cardiovascular Disease (PPCVD) could help their students improve their blood lipid profile. Method Five teachers voluntarily received training about PP-CVD. Thirteen classes of a single high school in Stradella (north Italy) were randomized to receive a 2-month course on PP-CVD (PP-classes; 150 pupils) by their teachers or to a control group (control classes; 130 pupils) during 2004. In all students body weight and fasting venous blood concentrations of total cholesterol (TC), HDL-CHOL, LDL-CHOL, and triglycerides were determined before and 6 months after the completion of the PP-CVD course. Results Six months after the PP-CVD course, males had significant improvements of all baseline lipid parameters whereas females had improved HDL-CHOL and TC/HDL ratio. No improvements were observed in the control class students. Body weight was unchanged in both groups of students 6 months after the PP-CVD course or the control course. Conclusion This investigation shows that well-trained school teachers are able to manage PP-CVD education so that students can really improve their lipid profile as a consequence of autonomous changes in dietary habits.

The effects of cholesterol lowering with simvastatin on cause-specific mortality and on cancer incidence in 20,536 high-risk people: a randomised placebo-controlled trial [ISRCTN48489393

BackgroundThere have been concerns that low blood cholesterol concentrations may cause non-vascular mortality and morbidity. Randomisation of large numbers of people to receive a large, and prolonged, reduction in cholesterol concentrations provides an opportunity to address such concerns reliably.Methods20,536 UK adults (aged 40–80 years) with vascular disease or diabetes were randomly allocated to receive 40 mg simvastatin daily or matching placebo. Prespecified safety analyses were of cause-specific mortality, and of total and site-specific cancer incidence. Comparisons between all simvastatin-allocated versus all placebo-allocated participants (ie, "intention-to-treat") involved an average difference in blood total cholesterol concentration of 1.2 mmol/L (46 mg/dL) during the scheduled 5-year treatment period.ResultsThere was a highly significant 17% (95% CI 9–25) proportional reduction in vascular deaths, along with a non-significant reduction in all non-vascular deaths, which translated into a significant reduction in all-cause mortality (p = 0.0003). The proportional reduction in the vascular mortality rate was about one-sixth in each subcategory of participant studied, including: men and women; under and over 70 years at entry; and total cholesterol below 5.0 mmol/L or LDL cholesterol below 3.0 mmol/L. No significant excess of non-vascular mortality was observed in any subcategory of participant (including the elderly and those with pretreatment total cholesterol below 5.0 mmol/L), and there was no significant excess in any particular cause of non-vascular mortality.Cancer incidence rates were similar in the two groups, both overall and in particular subcategories of participant, as well as at particular primary sites. There was no suggestion that any adverse trends in non-vascular mortality or morbidity were beginning to emerge with more prolonged treatment.ConclusionThese findings, which are based on large numbers of deaths and non-fatal cancers, provide considerable reassurance that lowering total cholesterol concentrations by more than 1 mmol/L for an average of 5 years does not produce adverse effects on non-vascular mortality or cancer incidence. Moreover, among the many different types of high-risk individual studied, simvastatin 40 mg daily consistently produced substantial reductions in vascular (and, hence, all-cause) mortality, as well as in the rates of non-fatal heart attacks, strokes and revascularisation procedures.

Plasma Leptin Levels of Elite Endurance Runners after Heavy Endurance Training

A decrease in testosterone levels and an increase in cortisol levels are observed in male athletes with the overtraining syndrome (OTS). Cortisol causes blood leptin levels to rise and testosterone has an inverse relationship with blood leptin levels. Therefore, we hypothesized that the hormonal changes as a result of OTS induce an increase in leptin. To test this hypothesis, we examined the relationship among changes in leptin, testosterone and cortisol in thirteen male collegiate distance runners (aged 20.3+/-1.1 years) before and after an 8-day strenuous training camp. Runners ran 284.1+/-48.2 km during the training camp. Body fat percentages and plasma glucose concentrations decreased significantly after the training. Non-ester fatty acids and total cholesterol concentrations in blood were unchanged. Serum cortisol concentrations showed a significant increase after the training camp (from 11.82+/-2.00 microg/dl to 16.78+/-3.99 microg/dl), and serum testosterone decreased significantly (from 408.0+/-127.6 ng/dl to 265.2+/-97.6 ng/dl). The ratio of testosterone to cortisol (TCR) dropped by 50% after training (from 35.62+/-13.69 to 16.94+/-8.47). These results suggest that the subjects reached a state of the OTS. Contrary to our hypothesis, plasma leptin was not significantly changed (from 1.34+/-0.29 ng/ml to 1.49+/-0.18 ng/ml). Delta Plasma leptin was not significantly correlated with delta serum cortisol, delta TCR or delta fat percentage. However, delta serum testosterone was positively correlated with delta plasma leptin (r=596, p<0.05). Plasma leptin concentrations might modulate the secretion of testosterone in overtraining conditions. In conclusion, the change in blood leptin level is independent of the changes in cortisol, TCR and fat percentage in highly trained male athletes in the state of the OTS.

Effects of an Ethylacetate Fraction of Chrysanthemi Flos on the Antioxidative System and Lipid Profile in Rats with Ethanol-Induced Liver Damage

To investigate the antioxidative effects of an ethylacetate fraction extracted from the flowers of Chrysanthemum indicum L. (Chrysanthemi Flos) on the antioxidative system and lipid profiles of rats with ethanol induced hepatotoxicity. Sprague-Dawley rats weighing 100～150 g were divided into 5 groups: normal group (NOR), Chrysanthemi Flos EtOAC fraction (200 mg/kg) treated group (S1), 35% ethanol (10 mL/kg) treated group (S2), Chrysanthemi Flos EtOAC fraction (200 mg/kg) and ethanol concomitantly treated group (S3) and Chrysanthemi Flos EtOAC fraction (400 mg/kg) and ethanol concomitantly treated group (S4), respectively. The antioxidative activity of each fraction was decreased in order of EtOAC, n-hexane, n-BuOH, water and chloroform. The growth rates and feed efficiency ratios were decreased by ethanol treatment, but were gradually restored to similar levels as in the NOR group by administering Chrysanthemi Flos EtOAC fraction. The whole blood concentrations of total cholesterol and LDL-cholesterol, and the activities of ALT and AST that were elevated by ethanol were significantly decreased in the Chrysanthemi Flos EtOAC fraction treated groups. It was also observed that the activities of SOD, catalase, xanthine oxidase and GSH-Px elevated by ethanol in rat liver were markedly decreased in the Chrysanthemi Flos EtOAC fraction treated group as compared to S2. These results suggest that Chrysanthemi Flos EtOAC fraction has possible protective effects against ethanol induced hepatotoxicity in rat liver.

From cholesterol levels to risk analysis: the revolution of the Heart Protection Study

Prospective epidemiological studies in the general population show that a roughly linear positive association exists between CHD risk and blood total cholesterol concentration, without any evidence of a “threshold” level below which lower cholesterol is not associated with lower risk. Recently, the National Cholesterol Education Program (NCEP), Adult Treatment Panel III (ATP III) published updated guidelines for the treatment of lipid disorders, broadly expanding the number of patients eligible for therapy. The MRC/BHF Heart Protection Study (HPS) including over 20,500 subjects is the largest trial of statin therapy ever conducted; its results have clearly confirmed the results of the previous trials and support the use of statin therapy in secondary prevention. Practically, all patients with vascular disease would benefit to different extents from statins, but maybe clinicians will choose to initiate and continue treatment with statins in high-risk individuals without routine lipid measurements. In primary prevention, the data are not as convincing and generalizations cannot be made as to whether, and in which subgroup, drug therapy to lower LDL cholesterol should be initiated. There are important cost implications to consider and the use of statin therapy has to be decided on an individual basis, particularly in those with high or very high LDL cholesterol levels and/or with multiple risk factors rendering them at high short-and long-term risk of coronary heart disease (CHD). There is evidence of a ‘care gap’ in translating trial data into practice, even in secondary prevention, and this needs closing in order to improve patient outcomes.

Task Force on Strategic Research Direction: Population/Outcomes/Epidemiology/Social Science Subgroup key science topics report.

Strategic research related to the prevention of cardiovascular disease (CVD) and improvement in quality of life encompasses a wide range of scientific disciplines. Experts from the fields of epidemiology, social sciences, health services and outcomes research, and preventive cardiology reached consensus with regard to five priority substantive areas of research to achieve the Healthy People 2010 objectives and to support the long-term goals and mission of the American Heart Association (AHA). The 2010 goals and objectives for heart disease and stroke are to guide the nation in achieving both increased quality and years of life and the elimination of health disparities among different segments of the population. Broadly, the Healthy People 2010 goals are prevention of the risk factors, detection and treatment of the risk factors, early identification and treatment of heart attacks and strokes, and prevention of recurrent cardiovascular events. Specific objectives include (but are not limited to) reduction in coronary heart disease mortality by 20%, reduction in stroke mortality by 20%, reduction in hospitalization rates for congestive heart failure by 50%, reduction in prevalence of high blood pressure to 16%, and reduction in prevalence of high total blood cholesterol concentration to 17%. Attainment of these goals and objectives will require increased investment of resources at the population level, through such strategies as are outlined below. Within each content area, the committee systematically identified specific research priorities using complementary scientific approaches: ### Prevention Research Priority Content Areas ### Subcategories of Priority Prevention Research Within each of the following categories, highest priority should be given to aspects closest to delivery of science to the population.

An anti-atherogenic effect of Schistosoma mansoni infections in mice associated with a parasite-induced lowering of blood total cholesterol.

In affluent societies the prevalences of so-called 'Western' diseases such as atherosclerosis, allergies and autoimmune disorders appear to have increased, while many diseases caused by communicable infections are now relatively less common. To test whether there may be a causal relationship we examined the effects of Schistosoma mansoni infections in mice that develop cardiovascular pathology as a result of a genetic deficiency in apolipoprotein E (apoE-/-). The development of atherosclerotic lesions in the aortic arch and brachiocephalic artery of the apoE-/- mice was reduced by approximately 50% in mice with the parasitic infection, when comparison was made with uninfected control mice fed the same diet. Observations on S. mansoni-infected conventional laboratory mice indicate that patent schistosome infections could be counteracting the effects of an atherogenic diet by modulating host lipid metabolism and inducing a reduction in blood total cholesterol concentrations.

Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey

Objective: To evaluate the prevalence of the use of lipid lowering agents and its relation to blood lipid concentrations in English adults.Design: Cross sectional survey.Setting: England, 1998.Participants: Nationally representative sample...

Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study.

To examine whether a high dietary glycemic index is associated with hyperinsulinemia, hyperglycemia, dyslipidemia and coronary heart disease (CHD) risk in elderly men. Prospective study of incidence of major CHD (non-fatal myocardial infarction or death due to CHD) between 1985 and 1995 in 646 men, and a cross-sectional analysis of metabolic risk factors in 1990 in 394 men. Population based study in the Dutch town Zutphen. Men aged 64-84 y in 1985 without a history of CHD or diabetes, whose diet was assessed with the cross-check dietary history method. The dietary glycemic index was positively correlated with consumption (g carbohydrate) of wheat bread (r=0.47) and sugar products (r=0.41) and inversely with fruit (r=-0.37) and milk (r=-0.40) consumption. During 4527 person-years of follow-up, 94 cases of CHD were documented. The risk ratio for CHD was 1.11 (95% CI, 0.66-1.87) for the highest as compared to the lowest tertile of glycemic index after correction for age, body mass index, physical activity, cigarette smoking, and dietary factors (P (trend)=0.70). Furthermore, the glycemic index was not appreciably associated with blood concentrations of total cholesterol, HDL-cholesterol, triacylglycerols or (fasting or postload) insulin or glucose. Our findings do not support the hypothesis that a high-glycemic-index diet unfavorably affects metabolic risk factors or increases risk for CHD in elderly men without a history of diabetes or CHD.

Seasonal and Biological Variation of Blood Concentrations of Total Cholesterol, Dehydroepiandrosterone Sulfate, Hemoglobin A1c, IgA, Prolactin, and Free Testosterone in Healthy Women

Concentrations of physiological response variables fluctuate over time. The present study describes within-day and seasonal fluctuations for total cholesterol, dehydroepiandrosterone sulfate (DHEA-S), hemoglobin A(1c) (HbA(1c)), IgA, prolactin, and free testosterone in blood, and estimates within- (CV(i)) and between-subject (CV(g)) CVs for healthy women. In addition, the index of individuality, prediction intervals, and power calculations were derived. A total of 21 healthy female subjects participated in the study. Using a random effects analysis of variance, we estimated CV(g) and total within-subject variation (CV(ti)), i.e., the combined within-subject and analytical variation, from logarithmically transformed data. Analytical variation was subtracted from CV(ti) to give CV(i). CV(i) was estimated from samples taken monthly during 1 year (CV(iy)), weekly during 1 month (CV(im)), and six times within 1 day (CV(id)). A cyclic seasonal variation was demonstrated for total cholesterol, DHEA-S, HbA(1c), prolactin, and free testosterone. Within-day variation was shown for prolactin and free testosterone. The overall mean values for the group and the variability (CV(iy) and CV(g)) were: 5.1 mmol/L, 13% [corrected], and 12% [corrected] for total cholesterol; 6.6 micromol/L, 20% [corrected], and 49% [corrected] for DHEA-S; 30% [corrected], 7.0% [corrected], and 7.5% [corrected] for HbA(1c)/hemoglobin(total); 2.1 g/L, 5.9%, and 13% for IgA; 136 mIU/L, 58% [corrected], and 63% [corrected] for prolactin; and 5.4 pmol/L, 55% [corrected], and 68% [corrected] for free testosterone. Collecting samples at specific hours of the day or times of the year may reduce high biological variation. Alternatively, the number of individuals may be increased and a paired study design chosen to obtain adequate statistical power.

Sex and race differences in cardiovascular disease risk factor changes in schoolchildren, 1975-1990: the Princeton School Study.

This study was done to assess changes in obesity and risk factors for cardiovascular disease (CVD) in Black and White children from 1975 through 1990. A cross-sectional study of body composition and CVD risk factors conducted in a school district as part of the Lipid Research Clinics (LRC) Program Prevalence Study (1973-1975) was compared with a later study (1989-1990) conducted in the same school district, which remained demographically stable. The studies included 1456 third- and fifth-grade students and 300 LRC subjects within the same age ranges. Students in the 1989-1990 study had a significantly higher mean body mass index (BMI), total blood cholesterol concentration, and systolic and diastolic blood pressures and marginally higher resting heart rates than those in the earlier study. The prevalence of obesity increased from 12.5% to 25.3%, and of hypercholesterolemia from 8.0% to 14.8%. Black females had the largest increase in BMI and resting heart rate and the highest prevalence of elevated total cholesterol in the 1989-1990 study. The results of this study suggest a secular trend toward increased obesity in children and portend the potential development of a public health problem that could reverse the recent decline in morbidity from CVD.

Review: dietary advice leads to a modest reduction in blood cholesterol concentration

Tang JL, Armitage JM, Lancaster T , et al. Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects. BMJ1998 Apr 18; 316 : 1213 –20...

Cholesterol-lowering effect of soy protein in normocholesterolemic and hypercholesterolemic men

Cardiovascular heart disease is a major health problem in the United States. Elevated blood cholesterol has been shown to significantly increase the risk of cardiovascular heart disease. The National Cholesterol Educational Program (NCEP) Step I diet, which restricts fat and cholesterol intakes, is usually recommended as the initial treatment to lower blood cholesterol. Soy protein has been shown to be hypo­cholesterolemic, particularly in hypercholesterolemic subjects. However, the hypocholesterolemic effect of soy protein in subjects with a blood total cholesterol concentration <5.17 mmol/L is not clear. To determine whether soy protein could enhance the hypocholesterolemic effect of the NCEP Step I diet, 13 normocholesterolemic and 13 hypercholesterolemic men aged 20–50 y were enrolled in a randomized, 2-part, crossover study. Subjects were fed either an NCEP Step I soy-protein diet or an NCEP Step I animal protein diet for 5 wk. After a washout period of 10–15 wk, the subjects were fed the alternate diet for 5 wk. The hypocholesterolemic effect of soy protein was found to be independent of age, body weight, pretreatment plasma lipid concentrations, and sequence of dietary treatment. Regardless of plasma lipid status, the soy-protein diet was associated with a statistically significant decrease in the plasma concentrations of LDL cholesterol (P = 0.029) as well as the in the ratio of plasma LDL cholesterol to HDL cholesterol (P = 0.005). Our results indicate that soy protein enhances the hypocholesterolemic effect of the NCEP Step I diet in both normocholesterolemic and hypercholesterolemic men. Am J Clin Nutr 1998; 68(suppl):1385S–9S.

Design, objectives, and lessons from a pilot 25 year follow up re-survey of survivors in the Whitehall study of London Civil Servants.

DESIGN: To assess the feasibility of conducting a re-survey of men who are resident in the United Kingdom 25 years after enrollment in the Whitehall study of London Civil Servants....

Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects.

Objectives: To estimate the efficacy of dietary advice to lower blood total cholesterol concentration in free-living subjects and to investigate the efficacy of different dietary recommendations.Design: Systematic overview of 19...

Lipoprotein(a) in Korean children and a history of coronary or cerebral vascular events in their older family members.

The purpose of this study was to determine the relationships between serum apolipoprotein concentration and family history of coronary or cerebral events in schoolchildren. In 269 primary schoolchildren aged 6-11 years (145 boys and 124 girls) we measured the blood concentrations of total cholesterol, apolipoproteins B and A-1, and lipoprotein(a), and questioned their parents about coronary or cerebral vascular events. Serum concentrations of apo B, A-1 and Lp(a) significantly increased with age. In children with serum cholesterol concentration > 5.18 mmol/L the concentrations of apo B, A-1, Lp(a) and apo B/apo A-1 ratio were significantly higher. The concentrations of total cholesterol, apo B, Lp(a), and apo B/apo A-1 ratio in the obese group (body weight 20% above the median body weight for age and height) differed significantly from those in the non-obese group. Serum concentrations of Lp(a) in the children who had positive family histories of coronary or cerebral events (geometric mean = 0.174 x/divided by 0.036g/L) and was significantly higher than that in the children with negative history (geometric mean = 0.086 x/divided by 0.36g/L). Family history was an independent and major contributor to high Lp(a). In evaluating children's lipid profiles, measurement of Lp(a) may help to identify children and their families at increased risk and this may facilitate the targeting of preventive measures.

Clinical and angiographic prediction of myocardial infarction and recurrence of severe angina during a five-year follow-up after coronary artery bypass grafting

In a prospective, angiographically controlled study, 339 consecutive patients were examined to evaluate the pre-, peri- and postoperative risk factors for occurrence of myocardial infarction, and recurrence of severe angina during 5 years after coronary artery bypass grafting (CABG). The incidence of myocardial infarction was 6% and the recurrence of severe angina 13%. No pre- or perioperative variable could predict the occurrence of myocardial infarction. Postoperative ejection fraction was significantly lower in patients with than without myocardial infarction (58 ±10% vs 50 ±11%; p < 0.001), and the Cox proportional-hazards method showed a low postoperative ejection fraction to be the only significant risk factor for the occurrence of myocardial infarction (p = 0.02). Patients with a recurrence of severe angina had higher blood total cholesterol concentrations (7.7 ± 1.4 vs 7.0 ± 1.3 mmol/liter; p < 0.05) and triglyceride levels (2.7 mmol/l ± 1.5 vs 2.0 ± 1.0 mmol/liter; p < 0.01) than did those without angina, and also more often had ≥1 occluded bypass graft 3 months after CABG (p < 0.05). No other pre- or postoperative variable could predict the recurrence of angina. Both total blood cholesterol concentration and triglyceride level were significant predictors of the risk of recurrent severe angina by the Cox proportional-hazards method (p = 0.01 and 0.03, respectively). Thus, reduced ejection fraction is a risk factor for subsequent myocardial infarction, whereas blood lipid abnormalities predict the recurrence of severe angina during the 5 years after CABG. The dissimilarities in risk factors between these cardiac events may be explained by differences in their pathophysiologic trigger mechanisms.

Dietary Fiber Sources Lower Blood Cholesterol In C57BL/6 Mice

Five sources of dietary fiber were compared for their effect on blood and liver cholesterol. The effects of soybean fiber, rice bran (full fat), oat bran, barley bran and mixed bran on total blood cholesterol concentrations and liver cholesterol concentrations were measured in beef-fed C57BL/6 male mice. Each diet contained cooked beef, beef tallow, corn starch and 7% dietary fiber from one of the five fiber sources. A control group consumed a fiber-free diet. Dietary cholesterol was provided by the beef and beef tallow only. The experimental diets were fed for 3 wk; blood and liver were collected when the mice were 18 wk old. The liver cholesterol concentration in the rice bran-fed group was the lowest of the six diet groups and was significantly different than concentrations in the oat bran-fed group and the barley bran-fed group (P less than 0.05). The oat bran, mixed bran, and barley bran did not significantly lower blood cholesterol in the mice. Both the soybean fiber and rice bran diet groups had significantly lower total blood cholesterol than did the fiber-free controls (P less than 0.05). The soybean fiber group also had significantly lower blood cholesterol than the mixed-bran group.

Buoyancy separation of ground forage particles and evaluation of ground white clover particles as feed additive for mice

In order to determine if buoyancy separation of ground forages would yield more nutritious forage particles for monogastrics, the interrelationship between buoyancy, chemical composition, physical dimensions, and nutritive value of various ground forages was studied. Buoyancy trials were performed using samples of ground forages placed on the water surface in a glass cylinder filled with 4 L water. The particles with the greatest buoyancy were relatively shorter, thinner, and contained higher crude protein and lower ADF and lignin contents. Three groups of 12 weanling mice were fed with three different diets during 3 wk. The first diet was a control ration (NRC recommendations), the second and third diets had 5% of either high buoyancy or low buoyancy white clover particles, respectively. The effect of the diet on blood total cholesterol was also measured. Weight gains of the mice were significantly higher (P &lt; 0.01) for the control and lower buoyancy groups than for the higher buoyancy group. The feed consumption was significantly higher (P &lt; 0.05) for the lower buoyancy diet. The blood total cholesterol was significantly (P &lt; 0.05) lower with the diet containing higher buoyancy particles. It appears that the more-nutritious, high buoyancy white clover particles did not yield better feed consumption and weight gain but reduced blood total cholesterol concentration. Key words: Buoyancy, forages, particles, nutritive value, mice

Pharmacologic and Surgical Treatment of Dyslipidemic Children and Adolescents

A wide variety of treatment modalities have been used in children with dyslipidemias to reduce the concentrations of atherogenic lipoprotein particles. Most of the published experience has focused upon children with familial hypercholesterolemia (FH). A variety of pharmacologic regimens have been utilized with variable degrees of success. The bile acid sequestrants colestipol and cholestyramine, lovastatin, pantethine, paraminosalicylic acid, and fenofibrate have all been successful in reducing total blood cholesterol concentrations by 18-24% in hypercholesterolemic children. Of these medications, only the bile acid sequestrants are not absorbed into the circulation. This theoretic advantage is paralled by long-term safety studies which indicate the absence of serious adverse effects with bile acid sequestrant therapy. Therefore, the bile acid sequestrants represent the drugs of choice in treating severely dyslipidemic children. In selected cases of profoundly dyslipidemic children, other therapeutic strategies have been utilized. Most of these efforts have been directed in the treatment of the child homozygous for FH. Despite the lipid lowering effects of partial ileal bypass surgery in hypercholesterolemic adults, homozygous familial hypercholesterolemic children are not adequately treated by this approach. Portacaval shunt has reduced the total cholesterol concentrations by 20-35% in homozygous FH children without having a negative impact on growth and development. These children have, however, gone on to develop atherosclerotic cardiovascular disease despite therapy. Liver transplantation has led to virtual normalization of the plasma lipoprotein concentrations in 3 children homozygous for familial hypercholesterolemia, and there is evidence for regression of vascular lesions in the coronary arteries in one of these children. However, considering the expense, the difficulty in posttransplantation management, and the irreversible nature of the therapy, liver transplantation should be reserved as the therapy of last resort for homozygous FH. The best therapy for FH homozygotes is the frequent removal of the atherogenic lipoproteins by one of the several apheresis procedures currently available. Total plasma exchange, immunoadsorption, membrane filtration, dextran sulfate adsorption, and heparin extracorporeal precipitation have all been used successfully in significantly reducing the concentrations of total and low-density lipoprotein cholesterol. Studies currently under way will more extensively evaluate the long-term safety as well as the efficacy of apheresis procedures.