ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Since its introduction more than 10 years agod, LDL‐apheresis has gained much interest and has proven its clinical utility in patients who cannot be adequately treated by diet and drug therapy alone. A number of clinical studies have clearly demonstrated that regular LDL‐apheresis not only favourably influences the progression of coronary artery disease, but also decreases the incidence of cardiovascular events and prolongs survival time of coronary patients at high risk. Both hypercholesterolemia and hyperfibrinogenemia show a high prevalence in heart transplant recipients and seem to cause direct effects on survival time. Heparin‐mediated extracorporeal LDL‐precipitation‐LDL‐apheresis has proven to be very successful in this group of patients, which may be caused by the simultaneous removal of LDL, lipoprotein (a) and fibrinogen, and also because LDL‐apheresis decreases the susceptibility of LDL to oxidation. In addition, there is clear clinical and experimental evidence that LDL‐apheresis rapidly improves the endothelial‐mediated vasomotion. Not unexpectedly, there are differences in specificity and side‐effects between the systems used and these deserve more attention for future routine clinical use. Curr Opin Lipidol 9:521–526. © 1998 Lippincott Williams & Wilkins

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Plant sterols and stanols lower serum cholesterol by inhibiting intestinal absorption of cholesterol. Because of their safety and efficacy, their application for mass intervention is promising. The use of fatty acid esters of stanols is particularly helpful because stanols readily mix with dietary fats in this form and their hypocholesterolemic efficacy is greater than in the free form. Curr Opin Lipidol 9:527–531. © 1998 Lippincott Williams & Wilkins

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

An elevated level of plasma total homocysteine is an independent, graded and strong risk factor for cardiovascular disease, which shows a strong interactive effect with conventional risk factors. It is a predictor of cardiovascular disease events in high‐risk populations, but is weakly associated with risk in healthy individuals. A common polymorphism in the MTHFR gene is a major determinant of the total homocysteine level, but is unrelated to cardiovascular disease risk in most studies. This observation is in accordance with the view that high total homocysteine itself may not be particularly deleterious, but provokes vascular occlusion under conditions predisposing to cardiovascular disease. Curr Opin Lipidol 9:533–539. © 1998 Lippincott Williams & Wilkins

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Data on the protective role of antioxidants in models of atherosclerosis are only partially confirmed in man. Observational and epidemiological data, as well as randomized trials, provide no clear cut indications, because of positive and disappointing results on the use of antioxidants in cardiovascular protection. Despite the lack of a general consensus, recent data reinforce the concept that the regular intake of antioxidants present in food limits the progression of atherosclerosis. When it is possible to monitor the efficacy of any antioxidant therapy with validated markers of oxidation, the potential influence of vitamins and antioxidants on coronary artery disease may eventually be resolved. Curr Opin Lipidol 9:541–549. © 1998 Lippincott Williams & Wilkins

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Recent primary prevention trials demonstrated that cardiovascular morbidity and mortality benefits are not accompanied by adverse effects on overall mortality and morbidity in cohorts representing plasma cholesterol concentrations observed in the bulk of coronary artery disease. During the past year, further analyses of the West of Scotland Coronary Prevention Study have indicated that benefit requires a 25% reduction of LDL cholesterol and that such treatment is not very expensive when focussed on selected high‐risk individuals. The Air Force/Texas Coronary Artery Prevention Study indicated that benefit is seen in individuals with even lower plasma lipid concentration. Although current treatment with lifestyle and lipid modifying drug management is successful in primary prevention, the unpredictable nature of coronary artery disease and the cost of drugs mitigate against direct application of drug management in persons with relatively low risk, but selective treatment should be undertaken in very high‐risk settings. Future studies need to examine more specific at risk cohorts, test better targeted lipoprotein modification, test more risk factors and also examine whether changes in vascular function or markers of inflammation will predict a better outcome. Curr Opin Lipidol 9:551–556. © 1998

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Most probably the decennia of the 1990s will be called the ‘statin decennia’ in the history of coronary heart disease prevention. Statins are effective, both in primary and secondary prevention of coronary heart disease, in middle‐aged and older (<76 years) men and women, in both diabetics and non‐diabetics with coronary heart disease. Statins used in secondary prevention of coronary heart disease significantly reduce the risk of stroke. They also reduce daily attacks of myocardial ischemia. Pathogenetic pathways leading to ‘biological plausibilities’ of the statins favourable effects are multiple, which explains their rapid (less than 1 year) influence on coronary events. Until the results from new event trials become available, fibrates have very few indications as first line drug therapy in dyslipidemia. They should be considered in combined therapy with statins. The scientific evidence with statins is overwhelming and the question is no longer ‘who should we treat?’ but ‘who can society afford to treat?’. Health economics are indeed pivotal in the use of statins and public health authorities have to find answers according to their resources or innovative strategies, including new aspects in dietary advice (the ‘Mediterranean diet’?). Curr Opin Lipidol 9:557–564. © 1998 Lippincott Williams & Wilkins

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

On the basis of a number of new rigorously designed controlled studies, there is increasingly less evidence for lipid lowering properties of garlic preparations. Many other aspects of garlic drugs, such as direct effects on vessel walls (aortic elasticity, effects of antioxidant properties on early steps in atherosclerosis formation) or anti‐platelet aggregation effects, are still awaiting further elucidation in clinical studies. Curr Opin Lipidol 9:565–569. © 1998 Lippincott Williams & Wilkins

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Triglyceride metabolism is complex and still poorly understood. Hypertriglyceridemia seems to enhance the risk for the development of coronary heart disease, but it cannot be regarded as a counterpart of hypercholesterolemia as a risk factor. The relevance of reduction of triglycerides in the prevention of coronary heart disease is still unclear. This is related to a number of problems, such as the lack of adequate clinical trials, heterogeneity in the abnormalities of triglyceride metabolism and unknown atherogenic threshold levels for serum triglycerides. Curr Opin Lipidol 9:571–574. © 1998 Lippincott Williams & Wilkins

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Epidemiological observations, clinical studies, and basic laboratory research suggest that oestrogen replacement therapy is associated with beneficial cardiovascular effects in postmenopausal women. Oestrogen has a multitude of biological effects that may account for this apparent benefit (which remain to be proven in randomized clinical trials), including favourable effects on the lipid profile, a direct effect on the vascular endothelium with increased nitric oxide bioactivity, and improved fibrinolysis. However, long‐term oestrogen therapy increases the risk of breast and endometrial cancers. Raloxifene, a benzothiophene derivative that binds to the oestrogen receptor, is a selective oestrogen receptor modulator, producing oestrogen‐agonistic effects in some tissues (liver, bone), and oestrogen‐antagonistic effects in others (breast, uterus), and may prove to be an option for women with atherosclerosis and its associated risk factors who might benefit from oestrogen therapy. This review updates the current knowledge of the biological effects of oestrogen and selective oestrogen receptor modulators of potential cardiovascular importance in postmenopausal women. Curr Opin Lipidol 9:575–586. © 1998 Lippincott Williams & Wilkins

ISSN:0957-9672    

出版商:OVID    

年代:1998

数据来源: OVID