HDL-C In Patients Research Articles

Correlation between computed tomography coronary artery and cardiac valve calcium score with HDL-C in patients with aortic valve sclerosis

Correlation between computed tomography coronary artery and cardiac valve calcium score with HDL-C in patients with aortic valve sclerosis

Dietary iron intake aggravates dyslipidaemia by elevating ferritin levels in patients with insulin resistance and cardiovascular diseases: A cross-sectional study

AbstractDietary iron intake causes the elevation of ferritin levels, and higher iron intake might improve insulin resistance and cardiovascular diseases. The aim of this study was to determine the relationship between dietary iron intake and serum ferritin levels, insulin resistance, and nutritional status in patients with cardiovascular disease. Health information of individuals were obtained with a questionnaire form. There were a total of 103 patients, 59 male (57.3%) and 44 female (42.7%). Patients also filled a questionnaire on dietary habits, a 3-day food record. There was a statistically significant difference between ferritin quartiles and total cholesterol, HDL-C, non-HDL-C, LDL-C/HDL-C ratio, and TG/HDL-C ratio (P < 0.05). Study data show that dietary iron intake was associated with the elevation of serum ferritin levels (P < 0.05) and this difference was significant in Q1 and Q4 groups in post-hoc analysis. There was a negative correlation between serum ferritin levels and total cholesterol and HDL-C in patients with insulin resistance (r = −0.384, P < 0.05; r = −0.520, P < 0.05). In conclusion we found a strong association between serum ferritin levels and inflammation, causing an oxidative stress, atherosclerosis, and bringing along cardiometabolic diseases such as cardiovascular diseases and type 2 DM.

A first-in-human single ascending dose study of a monoclonal antibody against the ANGPTL3/8 complex in subjects with mixed hyperlipidemia

Background and Aims : Angiopoietin-like protein 3 (ANGPTL3) inhibition reduces LDL-cholesterol (LDL-C), triglycerides (TG) and HDL-C in patients with hyperlipidemia. Post-prandially, ANGPTL8 forms a complex with ANGPTL3; the ANGPTL3/8 complex inhibits lipoprotein lipase 100-fold more potently and circulates at much lower levels than ANGPTL3 alone. This phase 1 study assessed the safety and pharmacology of single ascending doses of LY3475766 (LY), a monoclonal antibody against the ANGPTL3/8 complex.

Clinical Value of Vitamin D, Trace Elements, Glucose, and Lipid Metabolism in Diagnosis and Severity Evaluation of Psoriasis.

Objective The levels of vitamin D, trace elements, and glucose and lipid metabolism in psoriasis were evaluated, and their value in disease diagnosis and severity evaluation was explored. Methods In this study, the serum trace elements, blood glucose, and blood lipid indexes of 360 patients with psoriasis and 500 healthy subjects were compared and analyzed. Results The results of 25-(OH) D3, Cu/Zn, and HDL-C in patients with psoriasis were significantly different from those in the control group. With the aggravation of the disease, Psoriasis Area and Severity Index (PASI) was positively correlated with 25-(OH) D3 and HDL-C and negatively correlated with Cu/Zn. The AUC of the three indexes for the diagnosis of psoriasis was 0.899, 0.675, and 0.848, respectively. Conclusion There are metabolic abnormalities of 25-(OH) D3, Cu/Zn, and HDL-C in patients with psoriasis, and paying attention to these indicators is conducive to the diagnosis of disease.

Hypercholesterolemia as a risk factor for coronary heart disease

Familial Hypercholesterolemia (FH) is a genetic disorder, an expression of a defect in the gene that is responsible for the production of LDL-C receptor. The current study was designed to determine the FH patients in the city of Sulaymaniyah for both sexes. The study included 213 samples, the number of males was 99 and the number of females was 114, both sexes ranged from (30-79) years.The results of cholesterol, triglyceride, high density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) in patients with hypercholesterolemia showed highly significant (P ˂ 0.01) for cholesterol and the concentration level in patients with hypercholesterolemia compared to the level of concentration of healthy.As concerns the effect of hypercholesterolemia on coronary heart disease, the results showed a significant increase (P ˂ 0.01) in cholesterol, triglycerides and LDL-C with a significant decrease in HDL-C concentration in people with heart disease compared with healthy people. triglyceride in patients with compared healthy people. (HDL-C and LDL-C) showed a significant decrease (P ˂ 0.01) in the concentration of HDL-C in patients with hypercholesterolemia compared to their level of concentration in healthy individuals, in relation to low-density lipoprotein (LDL-C) -C is the other (P ˂ 0.01) in.

Varied Relationship of Lipid and Lipoprotein Profiles to Liver Fat Content in Phenotypes of Metabolic Associated Fatty Liver Disease.

BackgroundProgressive overloads of intrahepatic triglycerides are related to metabolic dysregulation of multiple lipid and lipoprotein profiles, but whether similar dose effects are found in each subtype of metabolic associated fatty liver disease (MAFLD) remains unclear. We aimed to characterize the lipid profiles associated with liver fat content (LFC) in MAFLD patients who were overweight, lean/normal weight, or had diabetes.MethodsWe conducted a cross-sectional study enrolling 1,182 consecutive participants (144 non-MAFLD and 1,038 MAFLD) who underwent MRI proton density fat fraction measurement (MRI-PDFF) from 2011 to 2020. Lipid and apolipoprotein profiles, free fatty acid (FFA), liver and metabolism parameters, and anthropometric measurements were also assessed.ResultsMAFLD patients with type 2 diabetes or overweight/obesity had a higher proportion of abnormal lipid and lipoprotein profiles than those who were lean/normal weight. The degree of LFC had a positive correlation with total cholesterol, triglyceride, ApoB, and ApoE in patients with overweight/obesity and type 2 diabetes. In those with overweight/obesity, there were dose–response relationships between moderate-to-severe steatosis and total cholesterol, triglyceride, HDL-c, LDL-c, ApoB, ApoE, and Lp(a). A similar trend was observed for triglyceride in those with type 2 diabetes and for HDL-c in patients who were lean/normal weight (all p for trend <0.05). The combined model of relative lipid-related markers performed well in the prediction of moderate-to-severe steatosis (AUC: 0.762 for overweight/obesity; 0.742 for lean/normal weight).ConclusionLFC was associated with lipid profiles, including triglyceride, LDL-c, ApoB, ApoE, and FFA. These relationships were varied by the phenotype of MAFLD according to its diagnostic flow.

Effectiveness of Coenzyme Q10 Supplementation for Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Objective To evaluate the effectiveness and safety of coenzyme Q10 for patients with type 2 diabetes mellitus (T2DM). Methods Data from randomized controlled trials were obtained to assess the effects of coenzyme Q10 versus placebo or western medicine on patients with T2DM. The study's registration number is CRD42018088474. The primary outcomes included glycosylated hemoglobin, fasting blood glucose, and fasting insulin. Result Thirteen trials involving 765 patients were included. Compared with the control group, coenzyme Q10 may decrease the HbA1c (WMD −0.29; 95% CI −0.54, −0.03; P = 0.03) and the fasting blood glucose (WMD −11.21; 95% CI −18.99, −3.43; P = 0.005). For fasting insulin, there is also not strong evidence that confirms which one is better because there was no statistical difference (WMD −0.48; 95% CI −2.54, 1.57; P = 0.65). Conclusion Based on current evidence, coenzyme Q10 may assist glycemic control, decrease TG, and improve HDL-C in patients with T2DM.

AMELIORATION OF CHOLESTEROL EFFLUX CAPACITY BY CARDIAC REHABILITATION IN PATIENTS WITH ACUTE CORONARY SYNDROME

It has been reported that exercised-based cardiac rehabilitation (CR) can increase HDL-C in patients with coronary artery disease (CAD). However it remains unclear how CR ameliorate HDL function. We measured cholesterol efflux capacity (CEC) in 30 patients with acute coronary syndrome (ACS) and 17

Serum amyloid A is independently related to apolipoprotein A-I but not to HDL-cholesterol in patients with angina pectoris

BackgroundInflammation processes are considered important links between classical lipid risk factors and the progression of atherosclerosis. The interrelationship of high density lipoproteins (HDL) and apolipoprotein apoA-1 with acute phase proteins and cytokines was examined in a clinical setting of patients with angina pectoris. MethodsOn exclusion criteria (myocardial infarction, heart failure, CHD>2years, anticoagulant therapy), 198 patients were recruited and were subdivided according to angiographically documented stenosis, no stenosis vs. =50% stenosis, in accordance with CASS guidelines. Lipids, apoA-1 and apoB, C-reactive protein (hs-CRP), fibrinogen, serum amyloid A (SAA) and cytokines (IL-6, IL-8, IL-10, IL2R, TNFα) were measured. ResultsLow HDL-C (and apoA-I) is associated with advanced coronary stenosis (=50%) and with the number of diseased vessels, independent of age, gender, diabetes, smoking and lipid-lowering therapy. In contrast to hs-CRP and fibrinogen, SAA as well as cytokine levels were not significantly associated with stenosis. SAA (P=0.0003) and diabetes (P=0.0002) were strong predictors of apoA-I concentration independent of age, gender, BMI, smoking, CRP, as well as IL-6 in a multiple regression model. High SAA (P=0.0067) and TG (P=0.0123) were significant predictors of apoA-I/HDL-C ratio. However, SAA was not independently related to HDL-C. ConclusionsSAA is independently and inversely related to apoA-I but not to HDL-C in patients with angina pectoris, reflecting the effect of SAA on the quality of HDL particles. However, HDL-c but not SAA is inversely related to the degree of coronary artery stenosis.

Abstract 447: Treatment of Omega-3 Nutritional Deficiency Improves Cardiovascular Disease Risk Factors: Results of the Randomized, Double-Blind, Placebo-Controlled VASCAZEN-REVEAL Trial

Introduction Treatments with Omega-3 (OM3) formulations have been suggested to have cardio-protective effects. A strong association of high plasma OM3 levels has been correlated with reduced risk of sudden death and “risk quartiles” based upon OM3 levels, have been previously described. However, systematic studies describing the extent of OM3 deficiency, it’s correction by intervention, and improvement in CVD risk factors are lacking. Our study is the first to determine dietary levels of OM3 in plasma and in red blood cells using Omega-Score and Omega-3 Index diagnostics, improvement after treatment with a proprietary “&gt;90%-pure OM3 preparation with a 6:1 EPA (eicosapentaenoic acid): DHA (docosapentaenoic acid) ratio” (6:1-OM3), and the concomitant beneficial effects on CVD risk factors in patients with high triglycerides (TG 200-500mg/dL). Hypothesis CVD patients are nutritionally deficient in OM3 fatty acids, and through treatment with 6:1-OM3, such deficiency can be corrected, improving CVD risk factors. Methods A double blind, placebo-controlled study comprised of 110 subjects randomized and stratified by baseline TG levels (A: 90-199 mg/dL, and B: 200-500mg/dL). This report includes placebo (corn oil, n=54) and 6:1-OM3 treatment (&gt; 3g of EPA + DHA/day; n=56) groups at baseline and after 8 weeks of treatment. The primary endpoints were the change in the Omega-Score (OS) and Omega-3-Index (OI), with secondary endpoints including the change in serum TG, lipoprotein cholesterol (VLDL, LDL, HDL, ApoB, and subfractions), and hsCRP. Results 89% of screened CVD subjects (N=655) were nutritionally deficient in Omega-3. In group B subjects, a significant (p&lt;0.0001) increase in OS (121%) and OI (112%) was observed in treated subjects with a TG reduction of 48% (p=0.0005), VLDL-C reduction of 30% (p=0.0023) and HDL-C increase of 9% (p=0.0069) without significantly affecting LDL-C, ApoB or hsCRP levels. Conclusions This study confirms that omega-3 deficiency is prevalent with CVD, and that such a deficiency can be corrected with 6:1-OM3 resulting in a concomitant and significant placebo-corrected reduction in TG and VLDL, and increase in HDL-C in patients with high TG (200-500mg/dL), without adversely affecting LDL-C.

Adverse events of statin–fenofibric acid versus statin monotherapy: a meta-analysis of randomized controlled trials

Background:Patients with mixed dyslipidemia can benefit from the combination of fenofibric acid (FA) with statins, but concerns about adverse events make physicians reluctant to prescribe the combination therapy.Objective:In the present study, we performed a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and adverse events in patients taking statins and FA.Methods:Medline, Embase and the Cochrane Library were searched to identify studies that reported adverse events. Finally, five trials covering 2704 patients were selected in this study.Results:There were significant decreases in TG and increases in HDL-C in patients receiving combination therapy compared with statin monotherapy. The incidence of hepatic toxicity (OR, 3.57; 95% CI, 1.17–10.83; P < 0.05) and increased creatinine (OR, 3.22; 95% CI, 1.28–8.11; P < 0.05) was significantly higher in the FA + low-dose statin group than in the corresponding statin monotherapy. The incidence of CK elevations and muscle-associated AEs was not statistically different between the two groups. The adverse events in the FA + moderate-dose statin group were almost identical to those in the FA + low-dose statin group.Conclusions:In conclusion, combination therapy could improve the blood lipid profile. Addition of FA to statins therapy is more frequently associated with hepatic and renal toxicity than muscle-associated AEs. Therefore patients taking the combination of FA with statins should have liver enzyme and renal function monitored. However, we still need large-scale and long follow-up period RCTs to definitively confirm the adverse events of FA–statin therapy.

Abstract 9649: Lipid-modifying Effects of Anacetrapib in Patients with Lower versus Higher Baseline Levels Of HDL-C, LDL-C, And TG: Pre-Specified Subgroup Analyses of the DEFINE (Determining the Efficacy and Tolerability of CETP INhibition with AnacEtrapib) Trial

Purpose : Low HDL-C is a risk factor for coronary heart disease which partly accounts for residual risk despite statin therapy. After 24 weeks of treatment, the addition of anacetrapib (ANA), a cholesteryl ester transfer protein (CETP) inhibitor to statin therapy increased HDL-C by 138% and reduced LDL-C by 40% in a 1623 patient safety and lipid efficacy Phase III trial (DEFINE). Sub-group analyses were performed to determine the degree to which ANA raises HDL-C and lowers LDL-C in patients with low baseline HDL-C and in patients with diabetes and other subgroups. Methods: Percent placebo-corrected HDL-C increases and LDL-C decreases from baseline after 24 weeks of ANA, 100 mg/day, were compared among patients according to baseline HDL-C, LDL-C, and TG levels above or below the median and in patients with diabetes. Results: Median baseline HDL-C, LDL-C, and TG were 40 mg/dL, 81 mg/dL, and 128 mg/dL, respectively. ANA produced robust increases in HDL-C in patients with baseline HDL-C below (152%) and above (127%) the median. In the lowest baseline quartile of HDL-C (15 to 34 mg/dL) levels also increased to a mean on-treatment HDL-C of 85 mg/dL. The percent increase in HDL-C was similar in patients with lower vs. higher baseline TG levels. ANA increased HDL-C similarly in diabetics compared to non-diabetics (130% vs 150%) with a mean on-treatment HDL-C of 100 vs. 102 respectively. The percent reduction in LDL-C with ANA was generally similar in patients with lower vs higher baseline LDL-C, HDL-C or TG levels and in patients with or without diabetes. Conclusion: ANA robustly increased HDL-C in all patients especially those with low HDL-C. Reductions in LDL-C with ANA were independent of baseline LDL-C, HDL-C, or TG levels. The clinical impact of these lipid-modifying effects of ANA in these sub-groups will be assessed in REVEAL-HPS3/TIMI55, a 30,000 patient clinical outcomes trial.

Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients

BackgroundWe analyzed the effects of insulin therapy, age and gender on the risk of ischemic heart disease (IHD) and cerebrovascular accident (CVA) according to glycemic control.Methods and ResultsWe performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) of type 2 diabetes patients (n = 4014) for 2 years. The primary endpoint was the onset of fatal/non-fatal IHD and/or CVA, which occurred at rates of 7.9 and 7.2 per 1000 person-years, respectively. We divided diabetic patients into four groups based on age (≤ 70 and > 70) and hemoglobin A1C levels (≤ 7.0 and > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure and low HDL-C in patients under 70 years of age with fair glycemic control and was associated with low diastolic blood pressure in the older/fair group. Interestingly, insulin use was associated with IHD in the older/poor group (OR = 2.27, 95% CI = 1.11-5.89; p = 0.026) and was associated with CVA in the older/fair group (OR = 2.09, 95% CI = 1.06-4.25; p = 0.028). CVA was associated with lower HDL-C and longer duration of diabetes in younger/poor glycemic control group. Results by stepwise analysis were similar. Next, patients were divided into four groups based on gender and diabetic control(hemoglobinA1C < or > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure in male/fair glycemic control group, age in male/poor control group, and short duration of diabetic history in females in both glycemic control groups. Interestingly, insulin use was associated with IHD in the male/poor group(OR = 4.11, 95% CI = 1.22-8.12; p = 0.018) and with CVA in the female/poor group(OR = 3.26, 95% CI = 1.12-6.24; p = 0.02). CVA was associated with short duration of diabetes in both female groups.ConclusionsIHD and CVA risks are affected by specific factors in diabetics, such as treatment, gender and age. Specifically, insulin use has a potential role in preventing IHD but may also be a risk factor for CVA among the diabetic elderly, thus revealing a need to develop improved treatment strategies for diabetes in elderly patients. The Japan Cholesterol and Diabetes Mellitus Study was formulated to evaluate them(Umin Clinical Trials Registry, clinical trial reg. no. UMIN00000516; http://www.umin.ac.jp/ctr/index.htm).

GLOMERULOSCLEROSIS

Objective: Objective is to determine the changes in lipids and lipoproteins in patients with glomerulosclerosis and healthy controls.Place and Duration: Department of Biochemistry, Frontier Medical College, Abbottabad with the collaboration of Nephrology Unit, AyoubMedical Complex, Abbottabad. April, 2006 February 2007. Material and Methods: Study includes 50 subjects out of which 25 adult patients(18 males, 7 females; age range 20-50 years) with glomerulosclerosis were selected from Nephrology Unit of Ayoub Medical Complex,Abbottabad. Apparently, 25 clinically healthy volunteers of similar age, sex, body mass index (BMI), and socio-economic status as that ofpatients, were selected from various areas of Abbottabad, as controls. Serum triacylglycerols, serum total cholesterol, and HDL-cholesterollevels were measured by kit method. LDL-cholesterol was calculated according to the Friedewald formula17. Serum VLDL-cholesterol ascalculated according to the formula proposed by Wilson cited by Delongi18 The results were expressed as mean ± standard error of mean.Statistical analysis was done using student's test. Results: Distribution of 25 patients and 25 controls, according to age is made. Male subjectswith glomerulosclerosis were greater in number than female, with male to female ratio of 1.85:1. Comparison of serum TGs, TC, HDL-c, LDL-c,VLDL-c, and HDL-c, LDL-c ratio. The mean values of TAGs, TC, HDL-c, LDL-c, VLDL-c, and ratio of HDL-c, vs. LDL-c of patients were observedsignificantly high (P&lt;0.001), when compared to controls. In addition significant low values (P&lt;0.001) of HDL-c in patients were also observedwhen compared to healthy controls. Conclusion: It is concluded that the results of this study provide evidence for raised lipids and lipoproteinslevels, which is invariable feature of nephritic syndrome with glomerulosclerosis. It is suggested that the patients with nephriticglomerulosclerosis should be assessed and managed to avoid potential of accelerating the development of coronary artery disease andincreasing risk of renal failure. Hopefully earlier intervention might decrease higher morbidity and mortality.

The impact of the national cholesterol education program adult treatment panel III guidelines on drug development

In the newest guidelines of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III, more intensive low-density lipoprotein cholesterol-lowering therapy, together with more attention to other lipid and lipoprotein parameters, are recommended for a larger group of dyslipidemic patients than was covered under ATP I and ATP II. A discussion to evaluate how future drug development might be affected by these new guidelines took place at the 14th International Symposium on Drugs Affecting Lipid Metabolism (DALM) conference, held in New York in September 2001. These discussions involved how to develop new lipid-lowering drugs in an era in which so much compelling evidence demonstrates the benefits of statins. Also covered were issues related to the development of drugs with triglyceride indications and whether the proportion of patients achieving NCEP guidelines should be included in the label of lipid-lowering drugs. Additional topics discussed included: (1) the possibility of incorporating a non-high-density lipoprotein cholesterol (HDL-C) indication for lipid-lowering drugs, (2) the possibility of obtaining indications for lipid-lowering drugs specifically in patients with diabetes, (3) the place of combination lipid-lowering drug therapy in drug development, and (4) whether drugs could be approved to increase levels of HDL-C in patients with isolated low HDL-C.

Monotherapy with GI262570, a non-thiazolidinedione PPARγ agonist, reduces triglyceride and increases HDL-C in patients with type 2 diabetes

Monotherapy with GI262570, a non-thiazolidinedione PPARγ agonist, reduces triglyceride and increases HDL-C in patients with type 2 diabetes

An abnormal cholesterol profile in young adults with normocholesterolemic cerebral ischemia.

An abnormal cholesterol fraction can still be able to provoke cascades of lipidic atherogenesis even when the serum TC level is within normal range (< 200 mg%). However, there is a shortage of convincing data concerning cerebral atherogenesis in young Asians who have a different diet habit and living style from those in western countries. In this study, we examined the lipoprotein-cholesterol profile in young Taiwanese patients with noncardiac cerebral ischemia (NCCI) whose serum TC level was < 200 mg% and 200-250 mg%. The results showed a decrease of HDLC and an increase of VLDLC in patients with TC < 200 mg%, but only a decrease of HDLC in patients with TC = 200-250 mg%. The cholesterol fraction metabolism is obviously perplexed in NCCI subjects. These findings were not related to their associated risk factors. Accordingly, a derangement of cholesterol fraction with normal serum TC level can also incite lipidic cerebral atherogenesis in young Taiwanese adults. Therefore, a detailed evaluation of cholesterol profile should be born in mind in young eastern NCCI patients despite of a normal serum TC level. Tailored measure of diet and living should be modified to prevent lipidic atherogenesis in our society in future.

Disturbances in dietary fat metabolism and their role in the development of atherosclerosis

It was suggested that postprandial lipoproteins (PPLp) may play an important role in atherogenesis. To examine this hypothesis, we studied PPLp metabolism in normolipidemic individuals and hyperlipoproteinemic (HLP) patients on various diets, physical activity programs and hypolipidemic drugs as well as in patients with coronary artery disease (CAD). We used the vitamin A-fat loading test, which labels intestinally derived lipoproteins with retinyl palmitate. Type IV HLP patients demonstrated a severe defect in chylomicron clearance. Type III HLP patients showed severely disordered clearance of chylomicron remnants. Compared to the saturated fatty acid enriched diet, the omega 6 polyunsaturated acid enriched diet reduced chylomicrons and their remnant levels by 56% and 38%, respectively. The diet enriched in omega 3 polyunsaturated acid decreased chylomicrons and their remnant levels by 67% and 53%, respectively. Physical conditioning reduced chylomicron levels by 37%. Gemfibrozil decreased chylomicron levels in type IV HLP patients. Cholestyramine increased chylomicron levels by 88%. Bezafibrate reduced chylomicrons and their remnants levels and increased fasting HDL-C in patients with isolated low HDL-C levels. Continuous prolonged intravenous heparin administration inhibited chylomicron clearance. Normolipidemic patients with CAD had significantly higher plasma levels of chylomicron remnants than matched controls with normal coronary arteries. The studies reported here demonstrate that both chylomicrons and their remnants are present in the plasma of normolipidemic people and more so for hyper- or dyslipidemic patients for a prolonged period of time after fat ingestion. The duration and magnitude of this postprandial lipemia can be regulated or altered by such interventions as diet, physical activity, and drugs. Our case control studies strongly support the hypothesis that PPLp may play a crucial part in atherogenesis, and therefore justify measuring their levels in high risk patients. We believe that in selected patient groups the use of one or more of the interventions mentioned here is warranted.

Effect of simvastatin treatment on high-density lipoprotein cholesterol

Lowering of serum low-density lipoprotein cholesterol (LDL-C) is the main objective in the prevention of atherosclerotic cardiovascular disease. However, recent epidemiologic and clinical studies have suggested that low high-density lipoprotein (HDL-C) serum levels could also be an important risk factor for coronary heart disease. Clinical investigations have shown that the competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCoA) are effective in significantly reducing total cholesterol and LDL-C serum concentrations in hypercholesterolemic patients. However, their efficacy in increasing HDL-C serum levels appears to be less and more variable. The effect of 24 months of treatment with simvastatin (10–30 mg/day), an inhibitor of HMGCoA reductase, on HDL-C was studied in 76 patients with primary hypercholesterolemia who had high serum cholesterol levels after 4 weeks of standard dietary therapy. Patients were divided into two groups according to their baseline HDL-C serum levels: group A included 21 patients (18 men and 3 women, aged 37 to 63 years) with HDL-C ⩽40 mg/dl; group B included 55 patients (18 men and 37 women, aged 27 to 69 years) with HDL-C > 40 mg/dl. The two groups showed a similar significant decrease in total and LDL-C serum levels after 24 months. The increases in HDL-C and in the HDL-C/total cholesterol ratio were significant in both groups, but were more evident in group A (+23% and +81%, respectively) than in group B (+11% and +58%, respectively) at the end of treatment period. These preliminary data appear to suggest the greater efficacy of long-term therapy with simvastatin in increasing HDL-C in patients with low baseline HDL-C serum levels. Further studies are needed to verify these results.

Nicotinic Acid for the Treatment of Hyperlipoproteinemia

Nicotinic acid is a water-soluble B-complex vitamin that has been shown, in high doses, to lower total plasma cholesterol (C), LDL-C, and VLDL-triglycerides (Tg), while raising HDL-C in patients with type II, III, IV, and V hyperlipoproteinemia. Its exact mechanism of action is not known, but it appears to lower the production of VLDL in the liver while activating lipoprotein lipase. The drug may also influence the metabolism of HDL-C. The drug is a second or third choice for isolated hypercholesterolemia because of a high incidence of side effects. However, it has a therapeutic advantage as a monotherapy when reduction of both LDL-C and triglycerides are needed in patients with severe combined hyperlipidemia. The drug can be used in combination with other cholesterol-lowering agents to maximize lipid-lowering activity. Nicotinic acid has been associated with a reduced risk of cardiovascular morbidity in clinical trials.