Journal ArticleDOI
Two Different Views of the Relationship of Hypertriglyceridemia to Coronary Heart Disease: Implications for Treatment
Scott M. Grundy,Gloria Lena Vega +1 more
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The discovery of the mechanism of the connection between triglycerides and coronary heart disease is crucial for developing a rational therapy.Abstract:
Hypertriglyceridemia is commonly found in patients with coronary heart disease. The reason for this connection, however, is not well understood, and two different views have been put forth to explain the link. First, triglyceriderich lipoproteins, particularly very-low-density lipoproteins, may be directly atherogenic. Or second, the metabolic consequences of hypertriglyceridemia may account for the triglyceride-coronary heart disease relationship. These consequences include an increase in postprandial lipoproteins, large very-low-density lipoprotein particles, small, dense low-density lipoprotein particles, low levels of high-density lipoprotein cholesterol, and possibly a procoagulant state. The appropriate treatment of hypertriglyceridemia depends on which of these views is nearer the truth. If triglyceride-rich lipoproteins are directly atherogenic, then the preferred therapy would be hepatic hydroxymethylglutaryl coenzyme A reductase inhibitors, which lower both very-low-density lipoprotein and low-density lipoprotein levels. On the other hand, if the link to atherogenesis is through the metabolic consequences of hypertriglyceridemia, the appropriate therapy would be to directly lower serum triglyceride levels, as with niacin or a fibric acid. Thus, discovery of the mechanism of the connection between triglycerides and coronary heart disease is crucial for developing a rational therapy. ( Arch Intern Med. 1992;152:28-34)read more
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ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina)
Raymond J. Gibbons,Jonathan Abrams,Kanu Chatterjee,Jennifer Daley,Prakash Deedwania,John S. Douglas,T. Bruce Ferguson,Stephan D. Fihn,Theodore D. Fraker,Julius M. Gardin,Robert A. O'Rourke,Richard C. Pasternak,Sankey V. Williams,Joseph S. Alpert,Elliott M. Antman,Loren F. Hiratzka,Valentin Fuster,David P. Faxon,Gabriel Gregoratos,Alice K. Jacobs,Sidney C. Smith +20 more
TL;DR: The Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine acknowledges the scientific validity of this product as a background paper and as a review that captures the levels of evidence in the management of patients with chronic stable angina as of November 17, 2002.
Journal ArticleDOI
ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina).
Raymond J. Gibbons,Kanu Chatterjee,Jennifer Daley,John S. Douglas,Stephan D. Fihn,Julius M. Gardin,Mark A. Grunwald,Daniel Levy,Bruce W. Lytle,Robert A. O'Rourke,William P. Schafer,Sankey V. Williams,James L. Ritchie,Melvin D. Cheitlin,Kim A. Eagle,Timothy J. Gardner,Arthur Garson,R. O. Russell,Thomas J. Ryan,Sidney C. Smith +19 more
TL;DR: It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies in the management or prevention of disease states.
Journal ArticleDOI
Effects of Insulin Resistance and Type 2 Diabetes on Lipoprotein Subclass Particle Size and Concentration Determined by Nuclear Magnetic Resonance
W. Timothy Garvey,Soonho Kwon,Deyi Zheng,Sara Shaughnessy,Penny Wallace,Amy Hutto,Kimberly Pugh,Alicia J. Jenkins,Richard L. Klein,Youlian Liao +9 more
TL;DR: It is concluded that insulin resistance had profound effects on lipoprotein size and subclass particle concentrations for VLDL, LDL, and HDL when measured by NMR; in type 2 diabetes, the lipop protein subclass alterations are moderately exacerbated but can be attributed primarily to the underlying insulin resistance.
Journal ArticleDOI
Hypertriglyceridemia, Atherogenic Dyslipidemia, and the Metabolic Syndrome
TL;DR: The importance of high serum cholesterol, especially a high level of low-density lipoprotein (LDL) cholesterol, as a risk factor for coronary artery disease is well established as discussed by the authors.
Journal ArticleDOI
Dietary Fructose: Implications for Dysregulation of Energy Homeostasis and Lipid/Carbohydrate Metabolism
TL;DR: This review examines the available data on the effects of dietary fructose on energy homeostasis and lipid/carbohydrate metabolism and suggests an endocrine mechanism by which it induces a positive energy balance.
References
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Journal ArticleDOI
High density lipoprotein as a protective factor against coronary heart disease: The Framingham study
TL;DR: The major potent lipid risk factor was HDL cholesterol, which had an inverse association with the incidence of coronary heart disease in either men or women and these associations were equally significant even when other lipids and other standard risk factors for coronaryHeart disease were taken into consideration.
Journal ArticleDOI
Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease
Frick Mh,O. Elo,Haapa K,Olli P. Heinonen,P. Heinsalmi,P. Helo,Jussi K. Huttunen,Kaitaniemi P,Koskinen P,Manninen +9 more
TL;DR: Results are in accord with two previous trials with different pharmacologic agents and indicate that modification of lipoprotein levels with gemfibrozil reduces the incidence of coronary heart disease in men with dyslipidemia.
Journal ArticleDOI
Plasma-high-density-lipoprotein concentration and development of ischæmic heart-disease
G.J Miller,N.E Miller +1 more
TL;DR: The body cholesterol pool increases with decreasing plasma-high-density-lipoprotein (H.D.L.) but is unrelated to the plasma concentrations of total cholesterol and other lipoproteins, and it is proposed that a reduction of plasma-H.H.L.D., is reduced in several conditions associated with an increased risk of future ischaemic heart-disease, by impairing the clearance of cholesterol from the arterial wall.
Journal ArticleDOI
Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
DeWitt S. Goodman,Stephen B. Hulley,Luther T. Clark,Clay Davis,Valentin Fuster,John C. LaRosa,Albert Oberman,Ernst J. Schaefer,Daniel Steinberg,W. Virgil Brown,Scott M. Grundy,Diane M. Becker,Edwin L. Bierman,Jacqueline Sooter-Bochenek,Rebecca M. Mullis,Neil J. Stone,Donald B. Hunninghake,Jacqueline M. Dunbar,Henry N. Ginsberg,D. Roger Illingworth,Harold C. Sadin,Gustav Schonfeld,James I. Cleeman,H. Bryan Brewer,Nancy D. Ernst,William T. Friedewald,Jeffrey M. Hoeg,Basil M. Rifkind,David L. Gordon +28 more
TL;DR: New guidelines for the treatment of high blood cholesterol in adults 20 years of age and over are provided and which patients should go on to have lipoprotein analysis, and which should receive cholesterol-lowering treatment on the basis of their low density lipop protein levels and status with respect to other coronary heart disease risk factors are detailed.
Journal ArticleDOI
Atherogenesis: a postprandial phenomenon.
TL;DR: Evidence is presented that in humans, and experimental animals, chylomicron remnants as well as low-density lipoproteins are taken up by arterial cells, indicating atherogenesis may occur during the postprandial period.
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