Document Detail


Lipoproteins and homocyst(e)ine as risk factors for atherosclerosis: assessment and treatment.
MedLine Citation:
PMID:  7750044     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Two new important independent risk factors for coronary artery disease (CAD) have been identified: lipoprotein (a) [Lp(a)] and homocyst(e)ine. Both are associated with increased frequency of cardiovascular events, both coronary and peripheral. Measurement of these two factors should be considered in patients with symptomatic CAD, stroke, a strong family history (but low other conventional risk factors); in first degree relatives of those with very high Lp(a) or homocyst(e)ine levels; and in other individuals in whom the need for an aggressive treatment of metabolic risk factors is indicated. While treatment of high serum Lp(a) with drugs is difficult it appears from the epidemiological or clinical evidence that the additional risk due to Lp(a) can be drastically lowered by decreasing the patient's low density lipoprotein (LDL) cholesterol levels to below 3 mmol/L. The treatment of increased homocyst(e)ine can be easily accomplished by vitamin B6 or folic acid administration. Various analyses describing the value of positive tests for diagnosis of atherosclerosis indicate that overall risk evaluated by computer models from Framingham data, use of total: high density lipoprotein (HDL) cholesterol ratio and/or the National Cholesterol Education Program (NCEP) II guidelines are the best predictors of future cardiovascular events. The strategic aim for treatment regimens should be threefold: lower serum LDL cholesterol levels; decrease serum triglycerides (and triglyceride-rich lipoproteins); and increase HDL cholesterol. Niacin and statin drugs are the most cost effective means to achieve the former and niacin and fibrates to achieve the latter goal. Where target LDL cholesterol levels can be achieved with less expensive statin preparations their use may be economically advantageous.
Authors:
J J Frohlich
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  11 Suppl C     ISSN:  0828-282X     ISO Abbreviation:  Can J Cardiol     Publication Date:  1995 May 
Date Detail:
Created Date:  1995-06-19     Completed Date:  1995-06-19     Revised Date:  2008-04-09    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  18C-23C     Citation Subset:  IM    
Affiliation:
St Paul's Hospital, Lipid Clinic, Vancouver, British Columbia.
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MeSH Terms
Descriptor/Qualifier:
Antilipemic Agents / therapeutic use*
Cholesterol, HDL / blood
Cholesterol, LDL / blood
Coronary Artery Disease / blood,  etiology*,  therapy
Female
Homocysteine / blood*
Humans
Hyperlipoproteinemias / complications*,  therapy
Lipoprotein(a) / blood*
Male
Recurrence
Risk Factors
Chemical
Reg. No./Substance:
0/Antilipemic Agents; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Lipoprotein(a); 454-28-4/Homocysteine

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