Blood Levels Of LDL-cholesterol Research Articles

An Analysis of the Gut Microbiota and Related Metabolites following PCSK9 Inhibition in Statin-Treated Patients with Elevated Levels of Lipoprotein(a).

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of global mortality, often associated with high blood levels of LDL cholesterol (LDL-c). Medications like statins and PCSK9 inhibitors, are used to manage LDL-c levels and reduce ASCVD risk. Recent findings connect the gut microbiota and its metabolites to ASCVD development. We showed that statins modulate the gut microbiota including the production of microbial metabolites involved in the regulation of cholesterol metabolism such as short chain fatty acids (SCFAs) and bile acids (BAs). Whether this pleiotropic effect of statins is associated with their antimicrobial properties or it is secondary to the modulation of cholesterol metabolism in the host is unknown. In this observational study, we evaluated whether alirocumab, a PCSK9 inhibitor administered subcutaneously, alters the stool-associated microbiota and the profiles of SCFAs and BAs. We used stool and plasma collected from patients enrolled in a single-sequence study using alirocumab. Microbial DNA was extracted from stool, and the bacterial component of the gut microbiota profiled following an amplicon sequencing strategy targeting the V3-V4 region of the 16S rRNA gene. Bile acids and SCFAs were profiled and quantified in stool and plasma using mass spectrometry. Treatment with alirocumab did not alter bacterial alpha (Shannon index, p = 0.74) or beta diversity (PERMANOVA, p = 0.89) in feces. Similarly, circulating levels of SCFAs (mean difference (95% confidence interval (CI)), 8.12 [-7.15-23.36] µM, p = 0.25) and BAs (mean difference (95% CI), 0.04 [-0.11-0.19] log10(nmol mg-1 feces), p = 0.56) were equivalent regardless of PCSK9 inhibition. Alirocumab therapy was associated with increased concentration of BAs in feces (mean difference (95% CI), 0.20 [0.05-0.34] log10(nmol mg-1 feces), p = 0.01). In statin-treated patients, the use of alirocumab to inhibit PCSK9 leads to elevated levels of fecal BAs without altering the bacterial population of the gut microbiota. The association of alirocumab with increased fecal BA concentration suggests an additional mechanism for the cholesterol-lowering effect of PCSK9 inhibition.

Risk factors related to diabetic retinopathy in Vietnamese patients with type 2 diabetes mellitus

Along with the rising incidence of diabetes, the prevalence of diabetic retinopathy (DR) is quickly growing across the world. The incidence of DR complications is high, and many people are not detected until they have complications and visual impairment, causing many difficulties for the treatment process. Aims: The goal of this cross-sectional was to investigate the clinical and subclinical features of Vietnamese diabetic retinopathy patients. Methods: DR was diagnosed using International Clinical Diabetic Retinopathy scale. Complete clinical information (Age, sex, weight, height, history of hypertension and diabetes mellitus, smoking, alcohol), subclinical information (Glucose, urea, creatinine, HbA1c, uric acid, cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol blood levels, Complete blood count) were collected. Results: The research enrolled 140 type 2 diabetic patients (70 in each group: DR and no DR). DR patients had significantly higher age, RBC, Hb, eGFR, uric acid, and creatinine blood levels than patients without DR. A duration of diabetes mellitus of over 15 years was associated with an 8.319-fold increased risk of DR. In conclusion, age, RBC, Hb, eGFR, uric acid, creatinine blood levels and duration of diabetes mellitus over 15 years are risk factors for DR.

Characterization of Adenosine A2A receptors expression in hypercholesterolemia to understand the cardiovascular risk

Cardiovascular diseases (CVD) are the leading cause of mortality and morbidity worldwide. Hypercholesterolemia [elevated blood levels of total- and low-density lipoprotein-cholesterol (T-C and LDL-C)] is one of the main CVD risk factors and hypocholesterolemic treatments (statins, PCSK9 inhibitors, LDL-apheresis) are part of the daily patient care. During ischemia, hypoxia and inflammation, adenosine blood concentration increases and activates A2A adenosine receptors (A2AR, expressed by endothelial cells and lymphocytes), thus producing a protective effect via its vasodilatory and immunosuppressive functions. Alterations of A2A receptors expression and properties have been found in CVD patients. In a previous pilot study, we described a lower A2AR expression in peripheral blood mononuclear cells (PBMCs) of a small cohort of patients with heterozygous Familial hypercholesterolemia (HeFH), a severe genetic hyperlipidemia (Vairo et al., 2021). In this project, we would like to extend the characterization of A2AR expression in a larger cohort of patients with hypercholesterolemia (including heterozygous and homozygous FH and polygenic hypercholesterolemia) before and after hypocholesterolemic treatments and to understand whether 1) alterations of A2AR expression are broadly associated with hypercholesterolemia; 2) there is a correlation among A2AR expression, blood T-C and LDL-C levels and patient's clinical status; 3) all A2AR alterations may be rescued by hypocholesterolemic treatments. Hypercholesterolemic patients and healthy subjects are selected by age, gender and clinical status, including blood cholesterol levels (T-C > 240 mg/dL and/or LDL-C > 190 mg/dL). A2AR expression was explored in PBMCs by western blot and cytometry. We show on a small number of patients a decrease in A2A receptors expression compared with healthy subjects and an inverse correlation between A2AR expression and total- and LDL-cholesterol blood levels. Our results suggest that alterations of A2A receptors expression are associated with hypercholesterolemia and might help to better understand the high cardiovascular risk in hypercholesterolemia patients.

Phoenixin plasma concentration in heart failure with reduced ejection fraction patients

IntroductionHeart failure (HF) nowadays in western countries is an immense problem largely due to its social impact as well as an economic burden. A widely accepted biomarker-based strategy to establish prognosis and predict re-hospitalization events in HF is lacking. Currently, besides natriuretic peptides and cardiac troponins, a variety of molecules are being studied. Phoenixin (PNX) is a neuropeptide mainly involved in the regulation of gonadotropin secretion. Recently, a significant cardioprotective effect of PNX was reported.AimThe aim of this study was to measure PNX plasma concentration in a group of HF with reduced ejection fraction (HFrEF) patients and to compare it to levels found in HF-negative participants.Material and methodsA group of 74 HFrEF patients and a control group consisting of 40 participants without systolic or diastolic myocardial dysfunction were studied. Each individual underwent anthropometric measurements, laboratory testing, clinical and echocardiographic examination. To evaluate PNX plasma concentration, an immunoenzymatic assay (ELISA) was performed.Results and discussionPNX plasma concentration in the HFrEF group was not statistically different than in the control group. No significant correlation between PNX level and age, sex, BMI, HF etiology, diabetes or atrial fibrillation presence was found. PNX concentration correlated positively with total and LDL cholesterol blood levels in HFrEF patients. A negative correlation was found with creatinine in HFrEF, uric acid and triglycerides levels as well as AlAT activity in the control group.ConclusionsThere is no significant difference in PNX plasma concentration between HF and non-HF individuals. PNX role in cardiovascular disease requires further investigation.

Cardiovascular risk among 6-8-year-old children living in urban and rural communities in Ecuador: A cross-sectional analysis.

Cardiovascular diseases have their origins in childhood. At least 20% of children and adolescents in Latin America are overweight or obese. However, little is known regarding the cardiovascular risk of young children living in the region. This paper aims to identify associations between socio-demographics, adiposity, and dietary intake with cardiometabolic risk among children between 6- and 8-years old living in urban and rural Andean regions of Ecuador. A cross-sectional study was conducted among 267 children attending elementary schools between February and August 2018. Sociodemographic data were collected using a structured interview. Bodyweight, height, and waist circumference were measured in duplicate; blood samples were taken after overnight fasting to determine blood lipids, hepatic enzymes, and adipokines; food intake data was assessed by two 24-h recalls administered to the guardians. Associations between cardiometabolic risk (i.e., blood lipids, hepatic enzymes, and adipokines) with sociodemographic characteristics, dietary intake, and waist circumference were tested using multiple hierarchical regression models. Twenty-nine percent of the children were overweight or obese, 12% had low HDL levels, and over 18% had high levels of LDL and triglycerides. Children living in the urban region had lower levels of HDL (β−4.07 mg/dL; 95% CI: −7.00; −1.15; P = 0.007) but higher levels of LDL cholesterol (β 8.52 mg/dL; 95% CI: 1.38; 15.66; P = 0.019). Hepatic enzymes were also higher among urban children (SGOT: β% 22.13; 95% CI: 17.33; 26.93; P < 0.001; SGPT: β 0.84 U/L; 95% CI: 0.09; 1.59; P = 0.028). Leptin blood levels were higher (β% 29.27; 95% CI: 3.57; 54.97; P = 0.026), meanwhile adiponectin plasma concentrations were lower among urban children (β%−103.24; 95% CI: −58.9; −147.58; P = < 0.001). Fiber intake was inversely associated with total cholesterol (β−9.27 mg/dL; 95% CI –18.09; −0.45; P = 0.040) and LDL cholesterol blood levels (β−9.99 mg/dL; 95% CI: −18.22; −1.75; P = 0.018). Our findings demonstrate that young children are at high cardiovascular risk; if no actions are taken, the burden of non-communicable diseases will be substantial. The differences in risk between rural and urban areas are evident; urbanization might predispose children to a different reality and, in most cases, result in poor habits.

The role of cholesterol in the regulation of adenosine A2A receptor: A basic and clinical approach

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide and hypercholesterolemia is one of the main CVD risk factors. During inflammation, adenosine blood concentration increases and activates A2A adenosine receptors (expressed by endothelial cells and lymphocytes), thus producing a protective effect via its vasodilatory and immunosuppressive functions. Conversely, alterations of A2A receptor expression and properties have been found in CVD patients. Cholesterol seems to directly regulate the functional characteristics of this receptor and studies suggest that A2A receptor alterations are also associated with dyslipidemia. In order to study the role of cholesterol in A2A receptor regulation, two approaches are used: 1) basic, via the analysis in cellular models of the effect of cholesterol modulation on A2AR localization and signaling, and 2) clinical, by characterizing A2AR expression and functions in patients with familial hypercholesterolemia (FH) and by studying a possible correlation between A2AR, blood cholesterol levels and patient's clinical status. T cells (CEM) and endothelial cells (HMEC-1) are depleted (Methyl-β-Cyclodextrin) or supplemented with cholesterol (Water Soluble Cholesterol) and stimulated with a selective A2A receptor agonist, Adonis. Ligand interaction and A2A receptor activation are analyzed by western blot, flow cytometry and ELISA, A2AR localization by immunofluorescence and microscopy. 2) FH patients and healthy subjects are selected by age, gender and clinical status. After isolation of peripheral blood mononuclear cells (PBMCs), A2AR expression is analyzed by western blot. 1) Cholesterol depletion in CEM does not affect receptor affinity (KD) for its agonist, but increases its binding capacity (Bmax). 2) Our pilot study on a small cohort of patients shows a decrease in A2A receptor expression compared with healthy subjects and an inverse correlation between A2AR expression and total and LDL cholesterol blood levels. Our results demonstrate that cholesterol modulates A2A receptor and that alterations of A2A properties are associated with hypercholesterolemia, which might help to better understand the high cardiovascular risk in hypercholesterolemia patients.

The correction of the metabolic parameters of msg-induced obesity in rats by 2-[4-(benzyloxy) phenoxy] acetic acid

Epidemiological data showed that the number of obese people increases swiftly in all countries. Obesity can evoke metabolic syndrome or second type diabetes (T2D). So, the aim of our study was to investigate the influence of 2-[4-(benzyloxy) phenoxy] acetic acid on metabolic parameters of monosodium glutamate (MSG)-induced obesity in rats. We divided the rats as follows: 1- control group, 2 - MSG-group, 3 - MSG + 2-[4-(benzyloxy) phenoxy] acetic acid group. We investigated anthropometric parameters and blood biochemistry. It was established that MSG induced the development of visceral obesity in rats, in particular, it increased the Lee index, body mass index, deposits of subcutaneous, gonadal and visceral adipose tissue. The administration of 2-[4-(benzyloxy) phenoxy] acetic acid decreased metabolic parameters evoked by MSG. After obesity induction, there was recorded significant growth of cholesterol, triglycerides, and LDL cholesterol blood levels and significant decline in HDL cholesterol blood levels. There was a significant reduction in triglycerides, LDL cholesterol and VLDL, in 2-[4-(benzyloxy) phenoxy] acetic acid - treated group. Our results represent the basis for development of new treatment of obesity and associated conditions.

Abstract WMP47: Cholesterol Crystals in Embolic Debris Correlate Postoperative Silent Cerebral Embolism in Carotid Artery Stenting

Introduction: Very few studies have investigated the relationship between the histopathology of the embolic debris in embolic protection devises and postoperative cerebral embolism in carotid artery stenting (CAS). The aim of this study was to evaluate embolic debris and its association with clinical, laboratory, and neurointerventional findings in patients treated by CAS due to internal carotid stenosis. Hypothesis: Cholesterol crystals in embolic debris are associated with postoperative cerebral embolism in CAS. Methods: All embolic debris was stained with hematoxylin-eosin. Embolic debris underwent quantitative analysis to quantify three main components: red blood cells, white blood cells and fibrin, by color based segmentation. Histopathological assessment included presence of calcifications, cholesterol crystals, foamy cells, and endothelial cells. Diffusion weighted image (DWI) was evaluated 1 to 3 days after CAS, and patients were classified by presence of new lesions on DWI after CAS. Exclusion criteria were emergency CAS for stroke in evolution or crescendo transient ischemic attack. Results: From November 2015 to April 2017, 40 patients were treated in our hospital by CAS due to internal carotid artery stenosis. Exclusion criteria were fulfilled in 5 patients. 24 patients had new lesions on DWI after CAS and 11 patients did not have those. Single patient had symptomatic cerebral embolism. Patients with new lesions on DWI after CAS had higher rate of cholesterol crystal in embolic debris (80% vs 18%, p&lt;0.01) and higher rate of patients taking strong statin on admission (71% vs 18%, P=0.02) than those without new lesions on DWI after CAS. There is no significant difference with blood levels of LDL-cholesterol [111 mg/dl (79-197) vs 108 mg/dl (62-167); p=0.85]. Main components of embolic debris were not significantly different between two groups. Conclusion: Cholesterol crystals in embolic debris and treatment history of dyslipidemia were significantly associated with post-operative high intensity lesion on DWI in CAS.

Rice bran extract containing acylated steryl glucoside fraction decreases elevated blood LDL cholesterol level in obese Japanese men.

People who frequently consume whole grains show a lower incidence of arteriosclerotic disease than people who consume primarily refined grains. We examined whether or not rice bran extract containing the acylated steryl glucosides (ASG) fraction decreases blood LDL cholesterol levels in obese Japanese men with high blood levels of LDL cholesterol. The study utilized a randomized, double-blind design. A total of 51 subjects were randomly allocated to either a rice bran extract containing ASG fraction (RB-ASG) group or a placebo group. Subjects in the RB-ASG group received 30-50 mg/day of RB-ASG, and the placebo group took 9 capsules/day for 12 weeks. Before and after intake, height, weight, body fat percentage, systolic and diastolic blood pressure were measured, blood was collected, and visceral fat area, subcutaneous fat area, and abdominal circumference were determined based on umbilical computed tomography. Percentage decreases in blood LDL cholesterol, non-HDL cholesterol, LDL/HDL ratio, abdominal circumference and subcutaneous fat area were significantly better in the RB-ASG group than in the placebo group. These findings suggest that RB-ASG fraction may reduce blood LDL cholesterol levels and the risk of arteriosclerosis in obese Japanese men with high LDL cholesterol levels.

Onion peel extracts have hepatoprotective effects and decrease blood levels of LDL cholesterol in liver injuried rats

Onion Peel Extracts (OPE) are known as rich sources of quercetin derivatives. Quercetin has been reported to have antioxidant and anti‐inflammatory properties. The objective of this study was to evaluate hepatoprotective effects of dietary OPE supplementation on liver injuries induced by carbon tetrachloride (CCl4) in rats. OPE were extracted with ethanol, concentrated, and freeze dried to a powder. Thirty two Sprague‐Dawley rats were divided into control group, CCl4 group, 0.15% OPE with CCl4 group, and 3% OPE with CCl4 group. Experimental diets were provided for four weeks. We measured blood lipid levels and enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). Part of the liver was separated and lipid peroxide level(TBARS) was measured. CCl4 cause a marked increase in the activities of serum ALT and ALP levels and the levels of TBARS in the liver. Supplementation of OPE significantly attenuated liver toxic effects of CCl4, and decreased the activities of ALT, and ALP. OPE offered a dose‐dependent hepatoprotective effects and the blood levels of LDL cholesterol were also decreased by supplementation of the OPE. These findings indicate that OPE have hepatoprotective effects in CCl4‐indced liver injuries by reducing lipid peroxidation and enhancing antioxidant properties. Hepatoprotective effects of OPE improve blood cholesterol profiles.

Statins and Risk of New-Onset Diabetes Mellitus

For any prescription drug, the potential benefits to health must be balanced against potential risks. Understanding these potential risks can help physicians and patients make informed decisions on whether to use a medication. Recently, statins, a class of medications prescribed to treat high cholesterol levels, have been found to modestly increase the risk of developing diabetes mellitus. It is clear that statins can prevent future major cardiovascular events, such as heart attack, stroke, and deaths from cardiovascular causes, in patients who have had a previous heart attack or those with multiple cardiovascular risk factors. However, the associations between diabetes mellitus and statin use have raised concerns over the widespread use of statin medications in patients at lower risk for cardiovascular disease. In this Patient Page, we describe the indications for statin therapy, the most common adverse effects, and recent concerns about new-onset diabetes mellitus to help patients and providers make more informed decisions about the use of this important class of medications in at-risk individuals. Cardiovascular disease is a major cause of illness and death worldwide. Elevated blood cholesterol levels (specifically the low-density lipoprotein [LDL] cholesterol) are associated with a higher risk of heart attack, stroke, and heart failure. It has become clear that elevated LDL cholesterol levels predict future events, and modern risk scores such as the Framingham Risk Score use LDL cholesterol level as an important predictor of future cardiac events.1 In addition, as new large trials shed light on the important role of LDL in cardiac disease, the optimal LDL cholesterol level has been progressively lowered in national guidelines. Statins are a class of medications called 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. These drugs block a critical …

The ACCORD (Action to Control Cardiovascular Risk in Diabetes) Lipid Trial

Atherosclerotic cardiovascular disease is increased severalfold in most patients with type 2 diabetes, particularly patients who are older and have other risk factors (1,2). These associated risk factors include hypertension, obesity, and dyslipidemia. Diabetic dyslipidemia, which has also been called atherogenic dyslipidemia (a term that describes the lipid abnormalities in people with insulin resistance, metabolic syndrome, and type 2 diabetes), is characterized by elevated plasma triglyceride (TG) levels, low levels of HDL cholesterol, and smaller cholesterol ester–depleted LDL (3). Despite the fact that statins, which mainly lower blood levels of LDL cholesterol, have the same relative effectiveness in type 2 diabetic patients as in nondiabetic subjects, absolute rates of atherosclerotic cardiovascular disease events remained higher in patients with diabetes who participated in all of the statin trials (4,5). These findings have raised interest in the use of combination therapy, particularly the combination of a statin plus a drug that would lower plasma TG levels and raise plasma HDL cholesterol levels. ACCORD (Action to Control Cardiovascular Risk in Diabetes) was specifically designed to determine the effects of intensive treatment of blood glucose, and either blood pressure (ACCORD Blood Pressure) or plasma lipids (ACCORD Lipid), on atherosclerotic cardiovascular disease outcomes in patients with type 2 diabetes who were at high risk of such an outcome (6). The ACCORD Lipid trial tested the hypothesis that treatment of patients with type 2 diabetes with fenofibrate to increase plasma HDL cholesterol levels and reduce plasma TG concentrations, on the …

Ezetimibe is effective in the treatment of persistent hyperlipidemia of renal allograft recipients

Ezetimibe is a hypolipidemic agent acting via inhibition of cholesterol absorption from the small intestine. The effectiveness and safety of long-term administration of ezetimibe was evaluated in renal allograft recipients with persistent hyperlipidemia. 67 renal allograft recipients with post-transplantation hyperlipidemia resistant to statins were included in the study; 11 were treated with ezetimibe (10 mg/day) alone and 56 with ezetimibe and statin. The effectiveness of ezetimibe was assessed by determination of total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and triglycerides (TR). Its safety was determined by liver enzymes (ALT, AST), LDH, CPK, serum creatinine and blood levels of immunosuppressive drugs (cyclosporine, tacrolimus, everolimus, sirolimus) over the follow-up period of 18±6 months. A significant reduction of TC and LDL-C blood levels by 25% and 34% respectively, was observed during the first month of treatment with ezetimibe (p<0.001). This reduction was maintained for the whole period of ezetimibe administration. Renal function remained stable over the follow-up period, while no changes of the blood levels of immunosuppressive drugs were observed. Liver enzymes, LDH and CPK remained normal in all patients except for one diabetic patient who developed rhabdomyolysis. Apart from gastrointestinal symptoms in 2 patients, no other side effects were observed. Combination of ezetimibe with statins represents an effective and safe regimen for treatment of persistent hyperlipidemia in renal allograft recipients.

The Usual Intake of Lignans but Not That of Isoflavones May Be Related to Cardiovascular Risk Factors in U.S. Men

Isoflavone supplementation in the form of soy protein–containing isoflavones is associated with beneficial lipid changes. Information on usual isoflavone and lignan intakes in the diet of Western men and their associations with cardiovascular risk factors is not available. From the Health Professionals Follow-up Study, we selected 468 men, aged 47–83 y, who were free of cardiovascular disease, diabetes, and cancer, and who had provided a blood sample in 1994. We measured circulating total, LDL, and HDL cholesterol, triacylglycerol, lipoprotein(a), apolipoprotein (apo) A1, apoB, hemoglobin (Hb)A1c, insulin, C-peptide, and leptin concentrations. Isoflavone and lignan intakes were calculated from a FFQ. We used multivariate linear regression. None of the cardiovascular risk factors was strongly associated with isoflavone intake. Blood levels of LDL cholesterol and apoB tended to increase with increasing lignan intake [for LDL cholesterol, quartile 4 –quartile 1 = 9% (95% CI 1%; 16%), P for trend = 0.01, and for apo B, quartile 4 –quartile 1 = 9% (95% CI 1%; 16%), P for trend = 0.02]. Fasting insulin and C-peptide tended to decrease with increasing lignan intake [for insulin, quartile 4 –quartile 1 = –11% (95% CI –55%; –8%), P for trend = 0.02, and for C-peptide, quartile 4 –quartile 1 = –25% (95% CI –44; −6%), P for trend = 0.01]. Our results suggest that intake of isoflavones within the range of Western diets is not associated with a cardiovascular risk profile among men. Diets high in lignan intake may increase apoB-containing lipoproteins and decrease fasting insulin secretion, but these findings require confirmation.

Atherogenic dyslipidaemia in type 2 diabetes and metabolic syndrome: current and future treatment options

Dyslipidaemia is a major risk factor for atherosclerotic coronary heart disease, which in turn is the commonest cause of mortality in type 2 diabetes. This highlights the importance of appropriate management of diabetic dyslipidaemia. Management is typically multifactorial and includes dietary recommendations, routine physical exercise, aggressive control of other lifestyle risk factors, and for many patients drug intervention. Future drug treatments will increasingly target not only mechanisms that might improve glucose and LDL cholesterol blood levels, but also improve other facets of diabetic dyslipidaemia, atherogenesis and vascular risk.

Economic analysis of secondary prevention of coronary heart disease with simvastatin (Zocor) in Germany

Coronary artery disease (CAD) has enormous financial, medical, as well as economical consequences in Germany. Important risk factors include raised total cholesterol and LDL cholesterol blood levels. The 4S Study has demonstrated the clinical effectiveness in the secondary prevention of CAD. Based on the health economics data of this study, we undertook a cost-effectiveness analysis of the secondary prevention of CAD with simvastatin in Germany. On average, the costs per life year gained were DM 18,500.-(sensitivity analysis: DM 9,340.- to DM 29,374.-). The consequences of this result are discussed. It is necessary from a health economists' point of view to assess the efficiency of a clinically effective measure in a standardised manner. This permits a comparison of efficiency with other, competing forms of health care, which is necessary in areas like CAD where there are different approaches to combat the disease. Simvastatin is highly efficacious in the secondary prevention of CAD in a defined patient population and, in comparison to other interventions in this area, it also proves to be cost-efficient.