Incidence Of Atherosclerotic Disease Research Articles

New Trends in the Impact of Periodontal Treatment on Early Cardiovascular Diseases Outcomes: Insights and Future Perspectives.

Cardiovascular diseases represent the primary worldwide cause of mortality, and periodontitis is the main cause of tooth loss. The incidence of atherosclerotic disease has been reported to be higher in individuals affected by periodontitis than in individuals without, regardless of many common risk factors are present. Various pathogenetic models have been presented to clarify the close correlation between these two diseases. First, periodontal bacteria and their toxins can enter the circulation both during dental procedures and normal activities such as eating and teeth brushing. Periodontal bacteria may indirectly contribute to coronary artery disease (e.g., by causing immunological reactions) or directly by damaging coronary arteries. Periodontal treatment significantly reduces periodontal pathogens such as Porphyromonas gingivalis (Pg) or Actinobacillus actinomycetemcomitans (Aa) in deep periodontal pockets. Moreover, periodontal treatment may lower blood inflammatory mediators, enhance the lipid profile, and cause favourable changes in various surrogate markers for cardiovascular disease. The way in which oral bacteremia and periodontal inflammation cause atherosclerosis is still unclear and needs further studies. The real effectiveness of periodontal treatment in preventing cardiovascular events is a topic of current interest. In this regard, this review article explores new insights and provides an indication of future directions on the function of periodontal inflammation and oral bacteria in the incidence and progression of atherosclerosis and cardiovascular diseases, with the main focus on assessing the impact of periodontal treatment on cardiovascular disease outcome biomarkers.

Menopause and lipid profile; a comparative observational study

Introduction: Hormonal changes after menopause such as low plasma estrogen levels and elevated Luteinizing Hormone and Follicle Stimulating Hormone levels had a significant effect on plasma lipid metabolism. The incidence of atherosclerotic diseases is more in postmenopausal women compared to premenopausal women. The objective of this study was to find out the effect of menopause on lipid profile among apparently healthy postmenopausal women. Method: This was an unmatched comparative observational study carried out among apparently healthy pre and postmenopausal women aged between 35-65 years presented at the General Health Check-up OPD of Tribhuvan University Teaching Hospital, Nepal from May 2019 to June 2020.The sample size was 128 in each group and data were analyzed using an independent t-test to compare the mean between the two groups and were considered significant when the p-value is less than 0.05. Result: Among 128 postmenopausal women, mean total cholesterol 191.59±35.78 mg/dl, triglyceride 143.44±72.39 mg/dl, HDL-cholesterol 45.01±9.99 mg/dl, LDL-cholesterol116.43±31.79 mg/dl and VLDL cholesterol was found to 28.69±14.48 mg/dl. Similarly, among 128 premenopausal women, mean TC 164±35.03 mg/dl, TGs 125.52±65.84mg/dl, HDL cholesterol 41.66±7.66 mg/dl, LDL-cholesterol96.95 ±31.78 mg/dl and VLDL-cholesterol was found to 25.10 ± 13.17 mg/dl. Mean TC, TGs, LDL-cholesterol, and VLDL-cholesterol along with cardiac risk ratio (TC/HDL and LDL/HDL) were found to be statistically significantly higher in postmenopausal women compared to premenopausal women. We also observed significantly higher HDL cholesterol in the postmenopausal group. Conclusion: Menopause leads to an increase in mean TC, TGs, LDL-cholesterol, and VLDL-cholesterol along with an increased cardiac risk ratio among postmenopausal women compared to premenopausal women.

The current burden of diabetic foot disease

Neuropathy and ischaemia are two great pathologies of the diabetic foot which lead to the characteristic features of foot ulceration (neuropathic and ischaemic) and Charcot neuroarthropathy. These can be complicated by infection and eventually may result in amputation (minor or major) and increased mortality. All of these features contribute to considerable clinical and economic burden.Peripheral nerves in the lower limbs are susceptible to different types of damage in patients with diabetes leading to distinctive syndromes. These include symmetrical sensory neuropathy associated with autonomic neuropathy, which advances gradually, and acutely painful neuropathies and mononeuropathies which have a rather acute presentation but usually recover. Ischaemia in the form of peripheral arterial disease is an important contributor to the burden of the diabetic foot. The incidence of atherosclerotic disease is raised in patients with diabetes and its natural history is accelerated. Diabetes causes severe and diffuse disease below-the knee. The lifetime risk of developing a diabetic foot ulcer is between 19% and 34%. Recurrence is common after initial healing; approximately 40% of patients have a recurrence within 1 year after ulcer healing, almost 60% within 3 years, and 65% within 5 years. Charcot neuroarthropathy is characterised by bone and joint destruction on the background of a neuropathy. Its prevalence in diabetes varies from 0.1% to 8%.Infection develops in 50%–60% of ulcers and is the principal pathology that damages diabetic feet. Approximately 20% of moderate or severe diabetic foot infections result in lower extremity amputations. The incidence of osteomyelitis is about 20% of diabetic foot ulcers.Every 20 s a lower limb is amputated due to complications of diabetes. Of all the lower extremity amputations in persons with diabetes, 85% are preceded by a foot ulcer. The mortality at 5 years for an individual with a diabetic foot ulcer is 2.5 times as high as the risk for an individual with diabetes who does not have a foot ulcer. The economic burden exacted on health care systems is considerable and includes direct and indirect costs, with loss of personal earnings and burden to carers. The diabetic foot is a significant contributor to the global burden of disability and reduces the quality of life. It remains a considerable public health problem.

Dartevelle Approach for Intra-Thoracic Subclavian Artery Aneurysm Repair

Subclavian artery aneurysm is a rare phenomenon in the West, but its prevalence is increasingly proportionate to incidence of atherosclerotic disease in the population. It is generally accepted that gold standard care is surgical resection but with limited experience opportunity remains to optimise this. We report on a 66-year-old female arteriopath with an 8 cm intra-thoracic aneurysm of the right subclavian artery, just distal to the brachiocephalic trunk. Lack of a proximal landing zone prohibited endovascular repair thus we utilised the anterior transcervical approach described by Dartevelle. This approach provided excellent visualisation of the aneurysm, along with right vagus and phrenic nerves, facilitating proximal and distal control and subsequent decompression. Post operative recovery was swift and not marred by substantial pain or inhibition of chest wall mechanics, associated with median sternotomy and thoracotomy incisions usually advocated for such aneurysms. As such we purport this approach to offer excellent operative exposure for this increasing disease burden, with less morbidity associated than the currently accepted approach, representing an advance in the management of this condition.

Investigation of the Aortic Pulse Wave Velocity in Patients with Gilbert’s Syndrome

Arterial stiffness is currently the “gold standard” measure of aortic (carotid-femoral) pulse wave velocity (PWV), which is an important independent predictor of risk of developing a cardiovascular event. Gilbert’s syndrome is a congenital disorder characterized by intermittent and non-hemolytic elevation of indirect bilirubin levels due to the deficiency of the enzyme UDP-glucuronyl transferase in the liver and many prospective studies found an inverse relationship between bilirubin levels and cardiovascular events in these patients. We aimed to investigate serum bilirubin levels and arterial stiffness parameters in patients with Gilbert’s syndrome in this study. A total of 53 cases, consisting of 26 patients with a diagnosis of Gilbert’s syndrome and 27 healthy control subjects, were included in the study. Serum bilirubin levels, other routine blood chemistry, and arterial stiffness measurements were recorded. The mean ages of Gilbert’s syndrome and the control group were 31.5 ± 9.7 and 36.8 ± 11.1 years, respectively. PWV measurements were significantly lower in Gilbert syndrome patients (6.68 and 7.3 m/s in patients and controls; respectively) (P < .05). In correlation analysis in Gilbert’s syndrome patients, PWV had a significant correlation with total and indirect bilirubin levels (r = −0.370, P = .009/r = −0.495, P = .003, respectively). Gilbert’s syndrome patients have lower PWV measurements compared to healthy subjects, and the total and indirect bilirubin levels are also associated with PWV measurements. These findings may indicate the decreased atherosclerotic disease incidence in Gilbert’s syndrome patients.

Repeat right transradial percutaneous coronary intervention in a patient with dextrocardia: The right approach to the right‐sided heart

Dextrocardia (DC) is a rare cardiac condition in which the cardiac location, as well as apex, is rightwardly displaced. As the incidence of atherosclerotic disease is similar to that of the general population, there have been few reports of percutaneous coronary interventions (PCIs) in these patients. Proposed technical strategies for successful angiography and PCI in DC include counter-directional torquing of the catheter, as well as right-left mirror-image inversion angiographic views. All previous reports of DC PCIs have been via transfemoral access.We present a case of successful repeat transradial PCI in a patient with DC. This is first report of transradial coronary angiography, PCI, or repeat PCI in a DC patient. A literature review of technical considerations, including our own recommendations for guide catheter selection, are discussed. We also review the anatomic variations and epidemiology of DC. Although access complications for transradial PCI is known to be lower than that of the transfemoral approach, challenges in technique and concern of repeat access have limited the popularity of the former. Our report demonstrates the safety and feasibility of transradial angiography, PCI, and even repeat PCI, in the rare patient with DC.

New insights in the treatment of dyslipidemia: A focus on cardiovascular event reduction and the antiatherosclerotic effects of atorvastatin

The identification and treatment of dyslipidemia is a critical component of ongoing efforts to reduce the incidence of atherosclerotic disease in both men and women. Several recent large-scale atorvastatin trials provide a plethora of information that expands the current body of literature describing the pathophysiology of cardiovascular disease and the prevention of acute cardiovascular events. These trials demonstrate the benefit of statin therapy in a broad variety of patient populations, explore the clinical efficacy of more intensive statin regimens, and suggest that the pleiotropic effects of statins may contribute to cardiovascular endpoint reduction. In addition, these studies have challenged whether current guidelines for low-density lipoprotein cholesterol levels provide optimal risk reduction for cardiovascular events. Additional studies with atorvastatin are underway to further explore the extent to which statins can provide cardiovascular benefits.

Prognostic value of lipoproteins and their relation to inflammatory markers among patients with coronary artery disease

Background Lipoproteins and their subfractions are associated with the incidence of atherosclerotic diseases. In patients with coronary artery disease (CAD), low serum concentrations of high density lipoprotein (HDL) and high low-density lipoproteins (LDL) are correlated to myocardial infarction and cardiovascular death. There is growing evidence indicating that those lipoprotein factors are related to the inflammatory process in atherogenesis. Methods We investigated in a median follow up of 3.9 years the association of HDL, apolipoprotein A-I (apoA-I), LDL, apolipoprotein B (apoB), and triglycerides with the incidence of a combined endpoint (myocardial infarction and cardiovascular death) and their relation to markers of inflammation in 1298 patients with angiographically documented CAD. Results In univariate analysis, serum concentrations of apoA-I were significantly and inversely related to the combined endpoint, whereas serum concentrations of LDL, apoB, and triglycerides were not. HDL was not significantly related to the endpoint in univariate analyses ( p=0.057). Multivariate analyses showed that only apoA-I is an independent predictor. ApoA-I (and HDL) was significantly related to markers of inflammation. Conclusion Serum apoA-I levels were an independent predictor for fatal and non-fatal cardiovascular events in patients with CAD. This may be related to its anti-inflammatory effect.

Trends in morbidity, mortality, and risk factor levels of coronary heart disease in Japan—Are Japanese living in Japan still protected against coronary heart disease?

In accordance with the rapid aging of the Japanese population, the number of patients with stroke and heart disease is expected to increase in the 21st century. Continuing rapid westernization of lifestyle, such as dietary habits along with increased hyperlipidemia and diabetes mellitus, presents another concern about a possible future increase in atherosclerotic disease incidence among the male population. A review of mortality from coronary heart disease (CHD) in the mid 1990s revealed that the Japan experienced the lowest mortality among industrialized countries. Japan also belonged to the group of countries with decreased mortality from CHD, with about a 30% reduction observed over the previous 10 years in men. However, recent trends in risk factor levels raise some concerns about the future of CHD in Japan. Compared with the 1990 survey results, the 5th National Survey of Cardiovascular Diseases conducted in 2000 showed an upward trend in the prevalence of hypertension and hyperlipidemia among men in their 30s and 40s. Another report points to an increased DM prevalence in Japan. Therefore, a concern exists about a possible future increase of CHD incidence among young and middle-aged men in Japan. Taking into account the rapid pace of the aging of the population, it is anticipated that, even if the disease's incidence remains unchanged, the number of patients from the ranks of the elderly will rise. Consequently, CHD may become a major issue for Japan's public health care in the 21st Century.

Oxidized low-density lipoprotein autoantibodies in patients with primary gout: effect of urate-lowering therapy

Background: Uric acid is a strong scavenger of reactive oxygen species, which are known to contribute to the development of atherosclerosis, while the incidence of atherosclerotic diseases is rather high in patients with gout. Among the established risk factors for atherosclerosis, oxidized LDL is believed to play a major role in its development and progression. Allopurinol and its active metabolite, oxypurinol, have been suggested to possess an antioxidant ability to scavenge the hydroxyl radical. Therefore, allopurinol may be beneficial in the prevention of LDL oxidation, as well as in the treatment of hyperuricemia. The objective of this work was to determine the degree of LDL oxidation in gout and the effect of allopurinol on LDL oxidation. Methods: Age-matched male patients with primary intercritical gout and healthy male adults were included in the study. The serum concentrations of oxidized LDL autoantibodies and total antioxidant status were measured using an enzyme immunoassay. Results: Serum concentrations of oxidized LDL autoantibodies were significantly higher in patients with gout than the control subjects ( p<0.05) and were significantly decreased after allopurinol treatment ( p<0.05), but not by benzbromarone treatment, in spite of the similar concentrations of uric acid and total antioxidant status in serum following their separate administration. Conclusions: Although the exact mechanism remains unclear, increased serum concentrations of oxidized LDL may play a role in the high incidence of coronary artery disease in gout. In addition, allopurinol may be more preferable to benzbromarone for treatment of gout in light of its inhibitory action toward LDL oxidation.

Carotid stenosis and peripheral artery disease in Japanese patients with coronary artery disease undergoing coronary artery bypass grafting.

The combination of a change in lifestyle toward Western habits and an aging society, has led to a steady increase in the incidence of atherosclerotic diseases in the Japanese population. Coronary artery disease (CAD), carotid stenosis (CS), and peripheral artery disease (PAD) are major manifestations of generalized atherosclerosis and increase the risk of cardiovascular events. However, the incidence of CS and PAD in Japanese patients with CAD is not well known, so the present study investigated this in 380 consecutive patients with CAD undergoing elective coronary aorta bypass grafting (CABG) at Kishiwada Tokushukai Hospital between October 1999 and October 2001. The coexistence of CS and PAD in all patients was preoperatively evaluated by duplex ultrasonography and the ankle - brachial index (ABI). The average age of the study population was 66.09.1 years (range, 42-87). The number of male patients was 293 (77.1%). The incidence of CS was 13.7% and 15.3% for PAD. Multivariate logistic regression analysis demonstrated that no particular traditional atherosclerotic risk factor, such as hypertension, hyperlipidemia, diabetes mellitus, and smoking, was able to predict either CS or PAD, but CS and PAD were independent predictors of each other. The results of the study suggest that CS and PAD were not only highly prevalent but also strongly associated with each other in this cohort of CAD patients. Accordingly, extracoronary atherosclerotic disease should be assessed in Japanese CAD patients.

An association of 5,10-methylenetetrahydrofolate reductase (MTHFR) gene polymorphism and common carotid atherosclerosis.

Plasma homocysteine (Hcy) concentration has been shown to be influenced by a mutation in the gene coding methylenetetrahydrofolate reductase (MTHFR). Although plasma Hcy is related to atherosclerotic disorders, conflicting results have been reported about the association between MTHFR gene polymorphism and sclerotic lesions of the common carotid arteries. The effect of age-gene interaction on carotid arterial remodeling was investigated in elderly subjects with several risk factors for atherosclerosis. We evaluated sclerotic lesions of the common carotid arteries by ultrasonography in 326 patients (mean age +/- standard deviation, 73 +/- 12 years) and studied relations among the known risk factors for atherosclerosis, including MTHFR gene polymorphism and its interactions with age and sex. Of the 326 subjects studied, 136 had MTHFR genotype CC, 136 genotype CT, and 54 genotype TT. The three groups did not differ with respect to background factors such as age, history of cigarette smoking, blood pressure, lipids or uric acid, or in the incidence of atherosclerotic diseases. Spearman's rank correlation revealed a significant relationship between gender, age, Brinkman index, systolic blood pressure, triglycerides, HDL-cholesterol (HDL-C), uric acid, and MTHFR gene polymorphism. Multiple regression analysis using intima-media complex thickness (IMT) as a criterion variable and risk factors, including MTHFR gene polymorphism as explanatory variables showed that MTHFR gene polymorphism (P = 0.039) was a significant independent explanatory variable for IMT, along with gender (male) (P < 0.001), age (P < 0.001), systolic blood pressure (SBP) (P = 0.047), total cholesterol (T-C) (P < 0.001), and HDL-C (P < 0.001). Furthermore, a general linear model analysis revealed that interaction between age and MTHFR gene polymorphism was significantly associated with IMT, independently of age, SBP, T-C, and HDL-C in male subjects. However, age-gene interaction was not observed in female subjects. The findings of the present study confirm an association between MTHFR gene polymorphism and common carotid atherosclerosis in the Japanese population and further support the role of risk factor-gene interaction in common carotid atherosclerosis.

Combined effects of HDL cholesterol, triglyceride, and total cholesterol concentrations on 18-year risk of atherosclerotic disease.

Whether the combination of a low level of HDL cholesterol (HDL-C) and high level of triglyceride (TG) confers increased risk of cardiovascular disease and whether risk varies across levels of total cholesterol (TC) are not well established. Combined effects of HDL-C, TG, and TC on the incidence of atherosclerotic disease were examined prospectively in Japanese-American men from the Honolulu Heart Program. Among 1,646 men aged 51 to 72 years who were free of coronary heart disease (CHD), stroke, and cancer and were not taking lipid-lowering medication, 318 developed atherosclerotic events (angina, coronary insufficiency, aortic aneurysm, definite CHD, or thromboembolic stroke) and 170 developed definite CHD between 1970 and 1988. Subjects were stratified by TC level (desirable, < 200 mg/dL; borderline high, 200 to 239 mg/dL; high, > or = 240 mg/dL), HDL-C level (< 35 and > or = 35 mg/dL), and TG level (< 200 and > or = 200 mg/dL). With Cox regression with high HDL-C and low TG as reference, age-adjusted relative risks (RR) of atherosclerotic events were significantly elevated in men with low HDL-C and high TG at borderline-high (RR, 2.46; 95% CI, 1.48 to 4.09) and high (RR, 2.21; 95% CI, 1.34 to 3.66) TC levels but not in men with desirable TC levels (RR, 0.89; 95% CI, 0.38 to 2.09). Elevated risks were independent of blood pressure, obesity, fat distribution, diabetes, smoking, and alcohol. Results were not materially altered by exclusion of subjects with angina alone and were similar but somewhat weaker for CHD. Risk of atherosclerotic disease appears elevated in subjects with low HDL-C and high TG levels when TC is borderline high or high, independent of other cardiovascular risk factors. These findings support recent cholesterol screening recommendations and suggest that joint effects of HDL-C and TG may be important to consider.

Relation of serum homocysteine and lipoprotein(a) concentrations to atherosclerotic disease in a prospective Finnish population based study

The relation of serum total homocysteine and lipoprotein(a) (Lp(a)) with the incidence of atherosclerotic disease was investigated among 7424 men and women aged 40–64 years free of atherosclerotic disease at baseline in 1977. During the 9-year follow-up, 134 male and 131 female cases with either myocardial infarction or stroke were identified. For each case a control subject was selected belonging to the same sex and 5-year age group. Serum samples collected in 1977 were stored at −20°C and analyzed in 1991. The mean serum homocysteine concentration of male cases and controls was 9,99 μmol/1 and 9.82 μmol/l at baseline and that of female cases and controls 9.58 μmol/l and 9.241μmol/1, respectively. The median serum Lp(a) concentration of male cases and controls was 73 mg/l and 108 mg/l and that of female cases and controls 113 mg/l and 91 mg/l, respectively. The differences between cases and controls were not statistically significant. There was also no significant association between either homocysteine or Lp(a) and atherosclerotic disease, myocardial infarction or stroke in logistic regression analyses. The odds ratios varied from l.00 to l.26 for homocysteine and from 0.81 to 1.06 for Lp(a). The results of this prospective population-based study do not support the hypotheses that serum homocysteine or Lp(a) are risk factors for atherosclerotic disease. The lack of association between serum homocysteine and atherosclerotic disease may be due to the exceptionally low gene frequency predisposing to homocysteinemia in Finland.

The Pattern of Complications in Saudi Arabian Diabetics

The pattern of complications in 533 Saudi Arabian diabetics followed over a 2-year period at King Abdulaziz University Hospital, Jeddah, is reported. The subjects consisted of 137 type 1 (25.7%) an...

Are there atherogenic dietary proteins?

Studies with rabbits have shown that the nature of protein in the diet can influence the concentration of cholesterol in plasma and the severity of arterial lesions. The feeding of animal proteins such as beef protein, casein or fish protein results in a high degree of aortic atherosclerosis. On the other hand, when rabbits are fed on diets containing plant protein preparations such as wheat gluten, corn protein or soy protein, the severity of aortic lesions is minimal. The animal proteins produce higher concentrations of serum cholesterol than the plant proteins. The rise in serum cholesterol induced by the milk protein casein in comparison with soy protein is also found in guinea pigs, pigs, rats, hamsters, but not in domestic fowl, calves and mice. The ultimate aim of such nutrition research with experimental animals is to provide further insight into practical means of decreasing the concentration of plasma cholesterol in man through changes in dietary habits. A decrease in plasma cholesterol will decrease incidence of atherosclerotic disease as manifested, for example, by myocardial infarction. A number of investigators have reported that intake of soy protein in contrast to animal proteins by hypercholesterolaemic patients reduced plasma cholesterol by 0 to 30%. Such studies are often quoted to support the view that the replacement of animal proteins in the diet by vegetable proteins would lower plasma cholesterol in man. However, the intake of soy protein in the studies with hypercholesterolemic patients also involved other changes in the diet, including the elimination of dietary cholesterol and replacement of saturated fatty acids by polyunsaturated fatty acids. In studies in which the type of protein was the only dietary variable, only a small effect or no effect at all of mixed animal proteins or casein over soy protein on plasma cholesterol was seen in healthy subjects while a slightly larger effect was seen in hypercholesterolemic patients. Thus it is questionable whether changes in the nature of protein in man could really contribute to the prevention of atherosclerosis.

Hyperlipidemia Screening and Semmelweis Re-revisited

Dietary modification can lower lipid levels in children, but will such modification, or therapeutic intervention, lower the probability of developing future coronary heart disease? The answer is still not in, as Dr Glueck well knows. "...diet-heart trials have not unequivocally proved or disproved the underlying hypothesis that cholesterol-lowering leads to reduced incidence of atherosclerotic disease." Moreover, "there is no evidence, either observational or experimental, that conclusively demonstrates a causative relationship between dietary fat per se and human and atherosclerotic disease."1 Faced with an unproved hypothesis pediatricians have four choices: (1) make no recommendation regarding diet changes; (2) Advocate a prudent diet to all families; (3) Screen for hypercholesterolemia and recommend diet changes and other measures to those with high levels; (4) Intervene, either by screening or by diet modification without screening, in only those children with a strong family history of coronary heart disease.

糖尿病患者における HDL-コレステロール

An inversed relationship between plasma HDL-cholesterol level and the incidence of atherosclerotic disease has been demonstrated.And patients with diabetes mellitus have a higher incident of atherosclerotic diasease than nondiabetics. The factors that increase the incidence of atherosclerotic diasease in diabetics are not well understood. Therefore, measurement of HDL-C in diabetics is important. And there are some studies about the problem whether HDL-C in diabetics is lower or higher than in healthy subjects. But the results of the studies are not yet established.In this study, we divided diabetics into three groups treated with diet only, oral agent, and insulin group, and compared HDL-C of three diabetic groups with that of healthy group.We determined HDL-C concentrations in plasma of 848 subjects (male 475, female 373) who received a routine medical check up in Meiji Life Insurence Shinjuku health testing center and 308 diabetics (diet only 136, oral agent 86, insulin 82) by the heparin-Mn2+ precipitation method. The healthy subjects, who had no abnormalities in TG, TC, obesity index, skin fold thickness, blood pressure, ECG finding, GOT, GPT, and blood sugar, were obtained from the testing center. The average HDL-C values of 127 healthy males and 160 females were 61.0±16.9mg/dl and 68.5±13.7mg/dl.Plasma HDL-C was strongly affected by TG, TC, and obesity index in both non-diabetics and diabetics. Average plasma HDL-C value of the female diabetics treated with diet only and oral agents was lower than that of healthy females. And average plasma HDL-C value of the male diabetics treated with insulin was higher than that of healthy males.But plasma HDL-C values adjusted with TG, TC, and obesity index were similar in non-diabetics and diabetics-in any three therapeutic groups. Therefore, we concluded that difference before adjustment was due to the influence of TG, TC, and obesity index. High incidence of atherosclerosis in diabetics was not accounted for by plasma HDL-C.

Appraisal of cholesterol as a causative factor in atherogenesis

This document attempts to evaluate the strengths of the associations between dietary cholesterol and incidence of atherosclerotic disease, the kinds of evidence on which these associations are based, and the risks and benefits caused by reduced intakes of cholesterol. Whenever possible, the role of dietary cholesterol will be evaluated independently of other dietary factors such as total caloric intake, proportions of dietary protein, fat, and carbohydrate, and the quality of dietary fat. However, since cholesterol is typically a constituent of fats of animal origin, it is necessary at times to consider saturated fat and cholesterol as conjoint factors in atherogenesis.