Hypercholesterolemia

Hypercholesterolemia
Other names: High LDL cholesterol, hypercholesterolaemia, high cholesterol
Xanthelasma palpebrarum, yellowish patches consisting of cholesterol deposits above the eyelids.
SpecialtyCardiology
SymptomsNone, xanthomas[1][2]
ComplicationsHeart disease, stroke, peripheral vascular disease[3]
CausesFamilial hypercholesterolemia, low thyroid, nephrotic syndrome, cholestasis, alcoholism, diabetes, certain medications like HCTZ[3][1]
Risk factorsFamily history, diet, inactivity, obesity smoking[3][2]
Diagnostic methodBlood tests[1]
TreatmentLifestyle changes, statin[2]
Frequency39% of adults[4]

Hypercholesterolemia, also called high cholesterol, is the presence of high levels of cholesterol in the blood.[1] It is type of abnormal blood lipids, along with high triglycerides and low HDL cholesterol.[5][6] There are generally no symptoms.[2] In severe cases xanthomas may occur.[1] Complications may include heart disease, stroke, and peripheral vascular disease.[3]

Causes may include genetic diseases such as familial hypercholesterolemia.[3] Most cases; however, are due to a combination of genetic factors together with diet, inactivity, obesity and smoking.[3][2] Other risk factors include low thyroid, nephrotic syndrome, cholestasis, alcoholism, diabetes, and certain medications like HCTZ.[3][1] Diagnosis is based on blood tests finding a high total cholesterol or LDL cholesterol.[6][1]

Treatment often involves lifestyle changes and medications.[2] Life style changes include exercise and a healthy diet.[1] If lifestyle changes are not sufficient, statin medications are often recommended.[2] Other medications that may be used include ezetimibe, niacin, and PCSK9 inhibitors.[3] Rarely LDL apheresis or liver transplant is performed.[7]

High cholesterol is estimated to affected about 39% of people globally.[4] About 74 million (32%) adults in the United States have high cholesterol.[3] Familial hypercholesterolemia affects about 1 in 250 people.[3] Older people are more commonly affected.[2] Globally it is estimated to cause about 2.6 million deaths per year.[4] Familial hypercholesterolemia was first described in 1938.[8]

Signs and symptoms

Xanthomas of Achilles tendon

Although hypercholesterolemia itself is asymptomatic, longstanding elevation of serum cholesterol can lead to atherosclerosis (hardening of arteries).[9] Over a period of decades, elevated serum cholesterol contributes to formation of atheromatous plaques in the arteries. This can lead to progressive narrowing of the involved arteries. Alternatively smaller plaques may rupture and cause a clot to form and obstruct blood flow.[10] A sudden blockage of a coronary artery may result in a heart attack. A blockage of an artery supplying the brain can cause a stroke. If the development of the stenosis or occlusion is gradual, blood supply to the tissues and organs slowly diminishes until organ function becomes impaired. At this point tissue ischemia (restriction in blood supply) may manifest as specific symptoms. For example, temporary ischemia of the brain (commonly referred to as a transient ischemic attack) may manifest as temporary loss of vision, dizziness and impairment of balance, difficulty speaking, weakness or numbness or tingling, usually on one side of the body. Insufficient blood supply to the heart may cause chest pain, and ischemia of the eye may manifest as transient visual loss in one eye. Insufficient blood supply to the legs may manifest as calf pain when walking, while in the intestines it may present as abdominal pain after eating a meal.[11][12]

Some types of hypercholesterolemia lead to specific physical findings. For example, familial hypercholesterolemia (Type IIa hyperlipoproteinemia) may be associated with xanthelasma palpebrarum (yellowish patches underneath the skin around the eyelids),[13] arcus senilis (white or gray discoloration of the peripheral cornea),[14] and xanthomata (deposition of yellowish cholesterol-rich material) of the tendons, especially of the fingers.[15][16] Type III hyperlipidemia may be associated with xanthomata of the palms, knees and elbows.[15]

Causes

Formula structure of cholesterol

Hypercholesterolemia is typically due to a combination of environmental and genetic factors.[9] Environmental factors include weight, diet, and stress.[9][17] Loneliness is also a risk factor.[18]

Medical conditions

A number of other conditions can also increase cholesterol levels including diabetes mellitus type 2, obesity, alcohol use, monoclonal gammopathy, dialysis therapy, nephrotic syndrome, hypothyroidism, Cushing’s syndrome and anorexia nervosa.[9] Several medications and classes of medications may interfere with lipid metabolism: thiazide diuretics, ciclosporin, glucocorticoids, beta blockers, retinoic acid, antipsychotics),[9] certain anticonvulsants and medications for HIV as well as interferons.[19]

Genetics

Genetic contributions are usually due to the additive effects of multiple genes ("polygenic"), though occasionally may be due to a single gene defect such as in the case of familial hypercholesterolaemia.[9] In familial hypercholesterolemia, mutations may be present in the APOB gene (autosomal dominant), the autosomal recessive LDLRAP1 gene, autosomal dominant familial hypercholesterolemia (HCHOLA3) variant of the PCSK9 gene, or the LDL receptor gene.[20] Familial hypercholesterolemia affects about one in 250 individuals.[21]

Diet

Diet has an effect on blood cholesterol, but the size of this effect varies between individuals.[22][23] Moreover, when dietary cholesterol intake goes down, production (principally by the liver)[24] typically increases, so that blood cholesterol changes can be modest[25] or even elevated. This compensatory response may explain hypercholesterolemia in anorexia nervosa. A 2016 review found tentative evidence that dietary cholesterol is associated with higher blood cholesterol.[26] Trans fats have been shown to reduce levels of HDL while increasing levels of LDL.[27] LDL and total cholesterol also increases by very high fructose intake.[28]

As of 2018 there appears to be a modest positive, dose-related relationship between cholesterol intake and LDL cholesterol.[29]

Mechanism

Cholesterol is one of three major classes of lipids which all animal cells make and use to construct their membranes. It is also the precursor of steroid hormones and bile acids. Since cholesterol is insoluble in water, it is transported in the blood plasma within protein particles (lipoproteins). Lipoproteins are classified by their density: very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), low density lipoprotein (LDL), and high density lipoprotein (HDL).[30] All the lipoproteins carry cholesterol, but elevated levels of the lipoproteins other than HDL (termed non-HDL cholesterol), particularly LDL-cholesterol, are associated with an increased risk of atherosclerosis and coronary heart disease.[31] In contrast, higher levels of HDL cholesterol are protective.[32]

Diagnosis

See also: High-density lipoprotein § Recommended ranges, and Low-density lipoprotein § Normal ranges
Interpretation of cholesterol levels
Cholesterol type mmol/L mg/dL Interpretation
Total cholesterol <5.2 <200 desirable[33]
5.2–6.2 200–239 borderline[33]
>6.2 >240 high[33]
LDL cholesterol <2.6 <100 most desirable[33]
2.6–3.3 100–129 good[33]
3.4–4.1 130–159 borderline high[33]
4.1–4.9 160–189 high and undesirable[33]
>4.9 >190 very high[33]
HDL cholesterol <1.0 <40 undesirable; risk increased[33]
1.0–1.5 41–59 okay, but not optimal[33]
>1.55 >60 good; risk lowered[33]

Cholesterol is measured in milligrams per deciliter (mg/dL) of blood in the United States. In the United Kingdom, most European countries and Canada, millimoles per liter of blood (mmol/Ll) is the measure.[34]

For healthy adults, the UK National Health Service recommends upper limits of total cholesterol of 5 mmol/L, and low-density lipoprotein cholesterol (LDL) of 3 mmol/L. For people at high risk of cardiovascular disease, the recommended limit for total cholesterol is 4 mmol/L, and 2 mmol/L for LDL.[35]

In the United States, the National Heart, Lung, and Blood Institute within the National Institutes of Health classifies total cholesterol of less than 200 mg/dL as “desirable,” 200 to 239 mg/dL as “borderline high,” and 240 mg/dL or more as “high”.[36]

There is no absolute cutoff between normal and abnormal cholesterol levels, and interpretation is made in relation to other health conditions and risk factors.

Higher levels of total cholesterol increase the risk of cardiovascular disease, particularly coronary heart disease.[37] Levels of LDL or non-HDL cholesterol both predict future coronary heart disease; which is the better predictor is disputed.[38] High levels of small dense LDL may be particularly adverse, although measurement of small dense LDL is not advocated for risk prediction.[38]

In the past, LDL and VLDL levels were rarely measured directly due to cost. Levels of fasting triglycerides were taken as an indicator of VLDL levels (generally about 45% of fasting triglycerides is composed of VLDL), while LDL was usually estimated by the Friedewald formula: LDL total cholesterol - HDL - (0.2 x fasting triglycerides).

However, this equation is not valid on nonfasting blood samples or if fasting triglycerides are elevated >4.5 mmol/L (> ∼400 mg/dL). 2011 guidelines, therefore, advocated the use of direct methods for measurement of LDL.[38] With modern testing there is little differences between fasting and non-fasting HDL, LDL, and total cholesterol (TC).[39]


It may be useful to measure all lipoprotein subfractions ( VLDL, IDL, LDL, and HDL) when assessing hypercholesterolemia and measurement of apolipoproteins and lipoprotein (a) can also be of value.[38] Genetic screening is now advised if a form of familial hypercholesterolemia is suspected.[38]

Classification

Main article: Hyperlipidemia

Classically, hypercholesterolemia was categorized by lipoprotein electrophoresis and the Fredrickson classification. Newer methods, such as "lipoprotein subclass analysis", have offered significant improvements in understanding the connection with atherosclerosis progression and clinical consequences. If the hypercholesterolemia is hereditary (familial hypercholesterolemia), more often a family history of premature, earlier onset atherosclerosis is found.[40]

Screening

A color photograph of two bags of thawed fresh frozen plasma: The bag on the left was obtained from a donor with hypercholesterolemia, and contains cloudy yellow fluid, while the bag obtained from a normal donor contains clear yellow fluid.
Two bags of fresh frozen plasma: The bag on the left was obtained from a donor with hyperlipidemia, while the other bag was obtained from a donor with normal serum lipid levels.

The U.S. Preventive Services Task Force in 2008 strongly recommends routine screening for men 35 years and older and women 45 years and older for lipid disorders and the treatment of abnormal lipids in people who are at increased risk of coronary heart disease. They also recommend routinely screening men aged 20 to 35 years and women aged 20 to 45 years if they have other risk factors for coronary heart disease.[41] In 2016 they concluded that testing the general population under the age of 40 without symptoms is of unclear benefit.[42][43]

In Canada, screening is recommended for men 40 and older and women 50 and older.[44] In those with normal cholesterol levels, screening is recommended once every five years.[45] Once people are on a statin further testing provides little benefit except to possibly determine compliance with treatment.[46]

Treatment

Treatment recommendations have been based on four risk levels for heart disease.[47] For each risk level, LDL cholesterol levels representing goals and thresholds for treatment and other action are made.[47] The higher the risk category, the lower the cholesterol thresholds.[47]

LDL cholesterol level thresholds[47]
Risk category Criteria for risk category Consider lifestyle modifications Consideration medication
No. of risk factors† 10-year risk of
myocardial ischemia		 mmol/litre mg/dL mmol/litre mg/dL
High Prior heart diseaseOR >20%>2.6[48] >100>2.6 >100
Moderately high 2 or moreAND 10–20%>3.4 >130>3.4 >130
Moderate 2 or moreAND <10%>3.4 >130>4.1 >160
Low 0 or 1>4.1 >160>4.9 >190
†Risk factors include cigarette smoking, hypertension (BP ≥140/90 mm Hg or on antihypertensive medication),
low HDL cholesterol (<40 mg/dL), family history of premature heart disease, and age (men ≥45 years; women ≥55 years).

For those at high risk, a combination of lifestyle modification and statins has been shown to decrease mortality.[9]

Lifestyle

Lifestyle changes recommended for those with high cholesterol include: smoking cessation, limiting alcohol consumption, increasing physical activity, and maintaining a healthy weight.[22]

Overweight or obese individuals can lower blood cholesterol by losing weight – on average a kilogram of weight loss can reduce LDL cholesterol by 0.8 mg/dl.[7]

Diet

Eating a diet with a high proportion of vegetables, fruit, dietary fibre, and low in fats results in a modest decrease in total cholesterol.[49][50][7]

Eating dietary cholesterol causes a small but significant rise in serum cholesterol, [51][52] the magnitude of which can be predicted using the Keys[53] and Hegsted[54] equations. Dietary limits for cholesterol were proposed in United States, but not in Canada, United Kingdom, and Australia.[51] Consequently, in 2015 the Dietary Guidelines Advisory Committee in the United States removed its recommendation of limiting cholesterol intake.[55]

A 2020 Cochrane review found replacing saturated fat with polyunsaturated fat resulted in a small decrease in cardiovascular disease by decreasing blood cholesterol.[56] Other reviews have not found an effect from saturated fats on cardiovascular disease.[57][58] Trans fats are recognized as a potential risk factor for cholesterol-related cardiovascular disease, and avoiding them in an adult diet is recommended.[58]

The National Lipid Association recommends that people with familial hypercholesterolemia restrict intakes of total fat to 25–35% of energy intake, saturated fat to less than 7% of energy intake, and cholesterol to less than 200 mg per day.[7] Changes in total fat intake in low calorie diets do not appear to affect blood cholesterol.[59]

Increasing soluble fiber consumption has been shown to reduce levels of LDL cholesterol, with each additional gram of soluble fiber reducing LDL by an average of 2.2 mg/dL (0.057 mmol/L).[60] Increasing consumption of whole grains also reduces LDL cholesterol, with whole grain oats being particularly effective.[61] Inclusion of 2 g per day of phytosterols and phytostanols and 10 to 20 g per day of soluble fiber decreases dietary cholesterol absorption.[7] A diet high in fructose can raise LDL cholesterol levels in the blood.[62]

Medication

Statins are the typically used medications, in addition to lifestyle interventions.[63] Statins can reduce total cholesterol by about 50% in the majority of people,[38] and are effective in reducing the risk of cardiovascular disease in both people with[64] and without pre-existing cardiovascular disease.[65][66][67][68][69] In people without cardiovascular disease, statins have been shown to reduce all-cause mortality, fatal and non-fatal coronary heart disease, and strokes.[70] Greater benefit is observed with the use of high-intensity statin therapy.[71] Statins may improve quality of life when used in people without existing cardiovascular disease (i.e. for primary prevention).[70] Statins decrease cholesterol in children with hypercholesterolemia, but no studies as of 2010 show improved outcomes[72] and diet is the mainstay of therapy in childhood.[38]

Other agents that may be used include fibrates, nicotinic acid, and cholestyramine.[73] These, however, are only recommended if statins are not tolerated or in pregnant women.[73] Injectable antibodies against the protein PCSK9 (evolocumab, bococizumab, alirocumab) can reduce LDL cholesterol and have been shown to reduce mortality.[74]

Guidelines

In the USA, guidelines exist from the National Cholesterol Education Program (2004)[75] and a joint body of professional societies led by the American Heart Association.[76]

In the UK, the National Institute for Health and Clinical Excellence has made recommendations for the treatment of elevated cholesterol levels, published in 2008,[73] and a new guideline appeared in 2014 that covers the prevention of cardiovascular disease in general.[77]

The Task Force for the management of dyslipidaemias of the European Society of Cardiology and the European Atherosclerosis Society published guidelines for the management of dyslipidaemias in 2011.[38]

Specific populations

Among people whose life expectancy is relatively short, hypercholesterolemia is not a risk factor for death by any cause including coronary heart disease.[78] Among people older than 70, hypercholesterolemia is not a risk factor for being hospitalized with myocardial infarction or angina.[78] There are also increased risks in people older than 85 in the use of statin drugs.[78] Because of this, medications which lower lipid levels should not be routinely used among people with limited life expectancy.[78]

The American College of Physicians recommends for hypercholesterolemia in people with diabetes:[79]

  1. Lipid-lowering therapy should be used for secondary prevention of cardiovascular mortality and morbidity for all adults with known coronary artery disease and type 2 diabetes.
  2. Statins should be used for primary prevention against macrovascular complications in adults with type 2 diabetes and other cardiovascular risk factors.
  3. Once lipid-lowering therapy is initiated, people with type 2 diabetes mellitus should be taking at least moderate doses of a statin.[80]
  4. For those people with type 2 diabetes who are taking statins, routine monitoring of liver function tests or muscle enzymes is not recommended except in specific circumstances.

Alternative medicine

According to a survey in 2002, alternative medicine was used in an attempt to treat cholesterol by 1.1% of U.S. adults. Most individuals (55%) used it in conjunction with conventional medicine.[81] A review of trials of phytosterols and/or phytostanols, average dose 2.15 g/day, reported an average of 9% lowering of LDL-cholesterol.[82] In 2000, the Food and Drug Administration approved the labeling of foods containing specified amounts of phytosterol esters or phytostanol esters as cholesterol-lowering; in 2003, an FDA Interim Health Claim Rule extended that label claim to foods or dietary supplements delivering more than 0.8 g/day of phytosterols or phytostanols. Some researchers, however, are concerned about diet supplementation with plant sterol esters and draw attention to lack of long-term safety data.[83]

Epidemiology

Rates of high total cholesterol in the United States in 2010 are just over 13%, down from 17% in 2000.[84]

Average total cholesterol in the United Kingdom is 5.9 mmol/L, while in rural China and Japan, average total cholesterol is 4 mmol/L.[9] Rates of coronary artery disease are high in Great Britain, but low in rural China and Japan.[9]

Research directions

Gene therapy is being studied as a potential treatment.[85][86]

References

  1. 1 2 3 4 5 6 7 8 "Quick Facts: High Cholesterol". Merck Manuals Consumer Version. Archived from the original on 26 February 2021. Retrieved 8 March 2021.
  2. 1 2 3 4 5 6 7 8 "Cholesterol". medlineplus.gov. Archived from the original on 14 March 2021. Retrieved 8 March 2021.
  3. 1 2 3 4 5 6 7 8 9 10 Ibrahim, MA; Asuka, E; Jialal, I (January 2021). "Hypercholesterolemia". PMID 29083750. {{cite journal}}: Cite journal requires |journal= (help)
  4. 1 2 3 Noubiap, JJ; Nansseu, JR; Bigna, JJ; Jingi, AM; Kengne, AP (17 March 2015). "Prevalence and incidence of dyslipidaemia among adults in Africa: a systematic review and meta-analysis protocol". BMJ open. 5 (3): e007404. doi:10.1136/bmjopen-2014-007404. PMID 25783427.
  5. ↑ Pappan, N; Rehman, A (January 2021). "Dyslipidemia". PMID 32809726. {{cite journal}}: Cite journal requires |journal= (help)
  6. 1 2 "Hypercholesterolemia - Symptoms, diagnosis and treatment | BMJ Best Practice US". bestpractice.bmj.com. Archived from the original on 2 March 2021. Retrieved 8 March 2021.
  7. 1 2 3 4 5 Ito MK, McGowan MP, Moriarty PM (June 2011). "Management of familial hypercholesterolemias in adult patients: recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia". J Clin Lipidol. 5 (3 Suppl): S38–45. doi:10.1016/j.jacl.2011.04.001. PMID 21600528.
  8. ↑ Januzzi, James L. (2011). Cardiac Biomarkers in Clinical Practice. Jones & Bartlett Learning. p. 786. ISBN 978-0-7637-6161-5. Archived from the original on 2021-06-10. Retrieved 2021-03-08.
  9. 1 2 3 4 5 6 7 8 9 Bhatnagar D, Soran H, Durrington PN (2008). "Hypercholesterolaemia and its management". BMJ. 337: a993. doi:10.1136/bmj.a993. PMID 18719012. S2CID 5339837.
  10. ↑ Finn AV, Nakano M, Narula J, Kolodgie FD, Virmani R (July 2010). "Concept of vulnerable/unstable plaque". Arterioscler. Thromb. Vasc. Biol. 30 (7): 1282–92. doi:10.1161/ATVBAHA.108.179739. PMID 20554950.
  11. ↑ Durrington, P (August 2003). "Dyslipidaemia". The Lancet. 362 (9385): 717–31. doi:10.1016/S0140-6736(03)14234-1. PMID 12957096. S2CID 208792416.
  12. ↑ Grundy, SM; Balady, GJ; Criqui, MH; Fletcher, G; Greenland, P; Hiratzka, LF; Houston-Miller, N; Kris-Etherton, P; Krumholz, HM; Larosa, J.; Ockene, I. S.; Pearson, T. A.; Reed, J.; Washington, R.; Smith, S. C. (1998). "Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association". Circulation. 97 (18): 1876–87. doi:10.1161/01.CIR.97.18.1876. PMID 9603549.
  13. ↑ Shields, C; Shields, J (2008). Eyelid, conjunctival, and orbital tumors: atlas and textbook. Hagerstown, Maryland: Lippincott Williams & Wilkins. ISBN 978-0-7817-7578-6.
  14. ↑ Zech LA Jr; Hoeg JM (2008-03-10). "Correlating corneal arcus with atherosclerosis in familial hypercholesterolemia". Lipids Health Dis. 7 (1): 7. doi:10.1186/1476-511X-7-7. PMC 2279133. PMID 18331643.
  15. 1 2 James, WD; Berger, TG (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. pp. 530–32. ISBN 978-0-7216-2921-6.
  16. ↑ Rapini, RP; Bolognia, JL; Jorizzo, JL (2007). Dermatology: 2-Volume Set. St. Louis, Missouri: Mosby. pp. 1415–16. ISBN 978-1-4160-2999-1.
  17. ↑ Calderon, R.; Schneider, R. H.; Alexander, C. N.; Myers, H. F.; Nidich, S. I.; Haney, C. (1999). "Stress, stress reduction and hypercholesterolemia in African Americans: a review". Ethnicity & Disease. 9: 451–462. ISSN 1049-510X.
  18. ↑ Cacioppo, J.; Hawkley, L. (2010). "Loneliness Matters: A Theorectical and Empirical Review of Consequences and Mechanisms". Annals of Behavioral Medicine. 40 (2): 218–227. doi:10.1007/s12160-010-9210-8. PMC 3874845. PMID 20652462.
  19. ↑ Herink, Megan; Ito, Matthew K. (2000-01-01). "Medication Induced Changes in Lipid and Lipoproteins". In De Groot, Leslie J.; Chrousos, George; Dungan, Kathleen; Feingold, Kenneth R.; Grossman, Ashley; Hershman, Jerome M.; Koch, Christian; Korbonits, Márta; McLachlan, Robert (eds.). Endotext. South Dartmouth (MA): MDText.com, Inc. PMID 26561699. Archived from the original on 2020-07-28. Retrieved 2017-08-31.
  20. ↑ "Hypercholesterolemia". Genetics Home Reference. U.S. National Institutes of Health. Archived from the original on 28 January 2014. Retrieved 5 December 2013.
  21. ↑ Akioyamen LE, Genest J, Shan SD, Reel RL, Albaum JM, Chu A; et al. (2017). "Estimating the prevalence of heterozygous familial hypercholesterolaemia: a systematic review and meta-analysis". BMJ Open. 7 (9): e016461. doi:10.1136/bmjopen-2017-016461. PMC 5588988. PMID 28864697. Archived from the original on 2021-08-28. Retrieved 2022-03-14.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  22. 1 2 Mannu, GS; Zaman, MJ; Gupta, A; Rehman, HU; Myint, PK (1 February 2013). "Evidence of lifestyle modification in the management of hypercholesterolemia". Current Cardiology Reviews. 9 (1): 2–14. doi:10.2174/157340313805076313. PMC 3584303. PMID 22998604.
  23. ↑ Howell WH, McNamara DJ, Tosca MA, Smith BT, Gaines JA (June 1997). "Plasma lipid and lipoprotein responses to dietary fat and cholesterol: a meta-analysis". Am. J. Clin. Nutr. 65 (6): 1747–64. doi:10.1093/ajcn/65.6.1747. PMID 9174470.
  24. ↑ Stryer, Lubert; Berg, Jeremy Mark; Tymoczko, John L. (2007). Biochemistry. San Francisco: W.H. Freeman. ISBN 978-0-7167-8724-2.
  25. ↑ Nordestgaard, Børge G.; Langsted, Anne; Mora, Samia; Kolovou, Genovefa; Baum, Hannsjörg; Bruckert, Eric; Watts, Gerald F.; Sypniewska, Grazyna; Wiklund, Olov (2016-07-01). "Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points-a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine". European Heart Journal. 37 (25): 1944–1958. doi:10.1093/eurheartj/ehw152. ISSN 1522-9645. PMC 4929379. PMID 27122601.
  26. ↑ Grundy, SM (November 2016). "Does Dietary Cholesterol Matter?". Current Atherosclerosis Reports. 18 (11): 68. doi:10.1007/s11883-016-0615-0. PMID 27739004. S2CID 30969287.
  27. ↑ Ascherio A, Willett WC (October 1997). "Health effects of trans fatty acids". Am. J. Clin. Nutr. 66 (4 Suppl): 1006S–10S. doi:10.1093/ajcn/66.4.1006S. PMID 9322581.
  28. ↑ Zhang, Yu Hui; An, Tao; Zhang, Rong Cheng; Zhou, Qiong; Huang, Yan; Zhang, Jian (2013-09-01). "Very high fructose intake increases serum LDL-cholesterol and total cholesterol: a meta-analysis of controlled feeding trials". The Journal of Nutrition. 143 (9): 1391–98. doi:10.3945/jn.113.175323. ISSN 1541-6100. PMID 23825185.
  29. ↑ Vincent, Melissa J.; Allen, Bruce; Palacios, Orsolya M.; Haber, Lynne T.; Maki, Kevin C. (2019-01-01). "Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL cholesterol". The American Journal of Clinical Nutrition. 109 (1): 7–16. doi:10.1093/ajcn/nqy273. ISSN 0002-9165. PMID 30596814. Archived from the original on 2020-05-20. Retrieved 2020-05-14.
  30. ↑ Biggerstaff KD, Wooten JS (December 2004). "Understanding lipoproteins as transporters of cholesterol and other lipids". Adv Physiol Educ. 28 (1–4): 105–06. doi:10.1152/advan.00048.2003. PMID 15319192.
  31. ↑ Carmena R, Duriez P, Fruchart JC (June 2004). "Atherogenic lipoprotein particles in atherosclerosis". Circulation. 109 (23 Suppl 1): III2–7. doi:10.1161/01.CIR.0000131511.50734.44. PMID 15198959.
  32. ↑ Kontush A, Chapman MJ (March 2006). "Antiatherogenic small, dense HDL – guardian angel of the arterial wall?". Nat Clin Pract Cardiovasc Med. 3 (3): 144–53. doi:10.1038/ncpcardio0500. PMID 16505860. S2CID 27738163.
  33. 1 2 3 4 5 6 7 8 9 10 11 Consumer Reports; Drug Effectiveness Review Project (March 2013). "Evaluating statin drugs to treat High Cholesterol and Heart Disease: Comparing Effectiveness, Safety, and Price" (PDF). Best Buy Drugs. Consumer Reports: 9. Archived (PDF) from the original on 4 February 2017. Retrieved 27 March 2013. which cites
  34. ↑ High Cholesterol – Tests and Diagnosis Archived 2013-10-08 at the Wayback Machine, Mayo Clinic staff. Retrieved 2013-03-09.
  35. ↑ Diagnosing High Cholesterol Archived 2017-07-28 at the Wayback Machine, NHS Choices. Retrieved 2013-03-09.
  36. ↑ ATP III Guidelines At-A-Glance Quick Desk Reference Archived 2011-11-08 at the Wayback Machine, National Cholesterol Education Program. Retrieved 2013-03-09.
  37. ↑ Peters, Sanne A. E.; Singhateh, Yankuba; Mackay, Diana; Huxley, Rachel R.; Woodward, Mark (2016-05-01). "Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis". Atherosclerosis. 248: 123–131. doi:10.1016/j.atherosclerosis.2016.03.016. ISSN 1879-1484. PMID 27016614.
  38. 1 2 3 4 5 6 7 8 Reiner Z, Catapano AL, De Backer G, et al. (July 2011). "ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS)". Eur. Heart J. 32 (14): 1769–818. doi:10.1093/eurheartj/ehr158. PMID 21712404.
  39. ↑ Moe, Samantha (15 September 2014). "#121 Can I get my cholesterol checked fast (without fasting)?". CFPCLearn. Archived from the original on 25 March 2023. Retrieved 17 June 2023.
  40. ↑ Youngblom, Emily; Pariani, Mitchel; Knowles, Joshua W. (1993), Adam, Margaret P.; Ardinger, Holly H.; Pagon, Roberta A.; Wallace, Stephanie E. (eds.), "Familial Hypercholesterolemia", GeneReviews®, Seattle (WA): University of Washington, Seattle, PMID 24404629, archived from the original on 2020-09-21, retrieved 2021-01-04
  41. ↑ U.S. Preventive Services Task Force. "Screening for Lipid Disorders: Recommendations and Rationale". Archived from the original on 2015-02-10. Retrieved 2010-11-04.
  42. ↑ Chou Roger (9 August 2016). "Screening for Dyslipidemia in Younger Adults: A Systematic Review for the U.S. Preventive Services Task Force". Annals of Internal Medicine. 165 (8): 560–564. doi:10.7326/M16-0946. PMID 27538032. S2CID 20592431.
  43. ↑ Bibbins-Domingo, Kirsten; Grossman, David C.; Curry, Susan J.; Davidson, Karina W.; Epling, John W.; García, Francisco A. R.; Gillman, Matthew W.; Kemper, Alex R.; Krist, Alex H.; Kurth, Ann E.; Landefeld, C. Seth; Lefevre, Michael; Mangione, Carol M.; Owens, Douglas K.; Phillips, William R.; Phipps, Maureen G.; Pignone, Michael P.; Siu, Albert L. (August 9, 2016). "Screening for Lipid Disorders in Children and Adolescents". JAMA. 316 (6): 625–33. doi:10.1001/jama.2016.9852. PMID 27532917.
  44. ↑ Genest, J; Frohlich, J; Fodor, G; McPherson, R (2003-10-28). "Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: summary of the 2003 update". Canadian Medical Association Journal. 169 (9): 921–4. PMC 219626. PMID 14581310.
  45. ↑ National Cholesterol Education Program (NCEP), III) (2002-12-17). "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report". Circulation. 106 (25): 3143–421. doi:10.1161/circ.106.25.3143. PMID 12485966. Archived from the original on 2016-09-25. Retrieved 2015-01-11.
  46. ↑ Spector, R; Snapinn, SM (2011). "Statins for secondary prevention of cardiovascular disease: the right dose". Pharmacology. 87 (1–2): 63–69. doi:10.1159/000322999. PMID 21228612.
  47. 1 2 3 4 Grundy, SM; Cleeman, JI; Merz, CN; Brewer HB, Jr; Clark, LT; Hunninghake, DB; Pasternak, RC; Smith SC, Jr; Stone, NJ (Jul 13, 2004). "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines". Circulation. 110 (2): 227–39. doi:10.1161/01.cir.0000133317.49796.0e. PMID 15249516.
  48. ↑ Consumer Reports; Drug Effectiveness Review Project (March 2013). "Evaluating statin drugs to treat High Cholesterol and Heart Disease: Comparing Effectiveness, Safety, and Price" (PDF). Best Buy Drugs. Consumer Reports: 9. Archived (PDF) from the original on 4 February 2017. Retrieved 27 March 2013.
  49. ↑ Bhattarai, N; Prevost, AT; Wright, AJ; Charlton, J; Rudisill, C; Gulliford, MC (20 December 2013). "Effectiveness of interventions to promote healthy diet in primary care: systematic review and meta-analysis of randomised controlled trials". BMC Public Health. 13: 1203. doi:10.1186/1471-2458-13-1203. PMC 3890643. PMID 24355095.
  50. ↑ Hartley, L; Igbinedion, E; Holmes, J; Flowers, N; Thorogood, M; Clarke, A; Stranges, S; Hooper, L; Rees, K (4 June 2013). "Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases". The Cochrane Database of Systematic Reviews. 6 (6): CD009874. doi:10.1002/14651858.CD009874.pub2. PMC 4176664. PMID 23736950.
  51. 1 2 Brownawell, Amy M.; Falk, Michael C. (2010-06-01). "Cholesterol: where science and public health policy intersect". Nutrition Reviews. 68 (6): 355–64. doi:10.1111/j.1753-4887.2010.00294.x. ISSN 1753-4887. PMID 20536780.
  52. ↑ Berger, Samantha; Raman, Gowri; Vishwanathan, Rohini; Jacques, Paul F.; Johnson, Elizabeth J. (2015-08-01). "Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis". The American Journal of Clinical Nutrition. 102 (2): 276–94. doi:10.3945/ajcn.114.100305. ISSN 1938-3207. PMID 26109578.
  53. ↑ Keys, Ancel; Anderson, Joseph T; Grande, Francisco (July 1965). "Serum cholesterol response to changes in the diet: IV. Particular saturated fatty acids in the diet". Metabolism. 14 (7): 776–87. doi:10.1016/0026-0495(65)90004-1. ISSN 0026-0495. PMID 25286466. Archived from the original on 2020-12-24. Retrieved 2021-03-08.
  54. ↑ Hegsted, DM; McGandy, RB; Myers, ML; Stare, FJ (November 1965). "Quantitative effects of dietary fat on serum cholesterol in man". The American Journal of Clinical Nutrition. 17 (5): 281–95. doi:10.1093/ajcn/17.5.281. ISSN 0002-9165. PMID 5846902. Archived from the original on 2020-11-12. Retrieved 2021-03-08.
  55. ↑ The 2015 Dietary Guidelines Advisory Committee (2015). "Scientific Report of the 2015 Dietary Guidelines Advisory Committee" (PDF). health.gov. p. 17. Archived (PDF) from the original on 3 May 2016. Retrieved 16 May 2016. The 2015 DGAC will not bring forward this recommendation 644 because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol, consistent with the conclusions of the AHA/ACC report.
  56. ↑ Hooper, Lee; Martin, Nicole; Jimoh, Oluseyi F.; Kirk, Christian; Foster, Eve; Abdelhamid, Asmaa S. (21 August 2020). "Reduction in saturated fat intake for cardiovascular disease". The Cochrane Database of Systematic Reviews. 8: CD011737. doi:10.1002/14651858.CD011737.pub3. ISSN 1469-493X. PMID 32827219. Archived from the original on 8 October 2020. Retrieved 10 October 2020.
  57. ↑ Chowdhury, R; Warnakula, S; Kunutsor, S; Crowe, F; Ward, HA; Johnson, L; Franco, OH; Butterworth, AS; Forouhi, NG; Thompson, SG; Khaw, KT; Mozaffarian, D; Danesh, J; Di Angelantonio, E (18 March 2014). "Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis". Annals of Internal Medicine. 160 (6): 398–406. doi:10.7326/M13-1788. PMID 24723079.
  58. 1 2 de Souza, RJ; Mente, A; Maroleanu, A; Cozma, AI; Ha, V; Kishibe, T; Uleryk, E; Budylowski, P; Schünemann, H; Beyene, J; Anand, SS (11 August 2015). "Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies". BMJ (Clinical Research Ed.). 351: h3978. doi:10.1136/bmj.h3978. PMC 4532752. PMID 26268692.
  59. ↑ Schwingshackl, L; Hoffmann, G (December 2013). "Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and meta-analysis". Journal of the Academy of Nutrition and Dietetics. 113 (12): 1640–61. doi:10.1016/j.jand.2013.07.010. PMID 24139973. Including only hypocaloric diets, the effects of low-fat vs high-fat diets on total cholesterol and LDL cholesterol levels were abolished.
  60. ↑ Brown, Lisa; Rosner, Bernard; Willett, Walter W.; Sacks, Frank M. (1999-01-01). "Cholesterol-lowering effects of dietary fiber: a meta-analysis". The American Journal of Clinical Nutrition. 69 (1): 30–42. doi:10.1093/ajcn/69.1.30. ISSN 0002-9165. PMID 9925120.
  61. ↑ Hollænder, Pernille LB; Ross, Alastair B.; Kristensen, Mette (2015-09-01). "Whole-grain and blood lipid changes in apparently healthy adults: a systematic review and meta-analysis of randomized controlled studies". The American Journal of Clinical Nutrition. 102 (3): 556–72. doi:10.3945/ajcn.115.109165. ISSN 0002-9165. PMID 26269373.
  62. ↑ Schaefer, EJ; Gleason, JA; Dansinger, ML (June 2009). "Dietary fructose and glucose differentially affect lipid and glucose homeostasis". The Journal of Nutrition. 139 (6): 1257S–62S. doi:10.3945/jn.108.098186. PMC 2682989. PMID 19403705.
  63. ↑ Grundy, Scott M.; Stone, Neil J.; Bailey, Alison L.; Beam, Craig; Birtcher, Kim K.; Blumenthal, Roger S.; Braun, Lynne T.; de Ferranti, Sarah; Faiella-Tommasino, Joseph (2018-11-10). "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. 139 (25): e1082–e1143. doi:10.1161/CIR.0000000000000625. ISSN 0009-7322. PMC 7403606. PMID 30586774.
  64. ↑ Windecker, Stephan; Mach, François; Räber, Lorenz; Mavridis, Dimitris; Piccolo, Raffaele; Siontis, George C. M.; Koskinas, Konstantinos C. (2018-04-07). "Effect of statins and non-statin LDL-lowering medications on cardiovascular outcomes in secondary prevention: a meta-analysis of randomized trials". European Heart Journal. 39 (14): 1172–1180. doi:10.1093/eurheartj/ehx566. ISSN 0195-668X. PMID 29069377.
  65. ↑ Tonelli, M; Lloyd, A; Clement, F; Conly, J; Husereau, D; Hemmelgarn, B; Klarenbach, S; McAlister, FA; Wiebe, N; Manns, B (2011-11-08). "Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis". CMAJ : Canadian Medical Association Journal. 183 (16): E1189–E1202. doi:10.1503/cmaj.101280. PMC 3216447. PMID 21989464.
  66. ↑ Mills, EJ; Wu, P; Chong, G; Ghement, I; Singh, S; Akl, EA; Eyawo, O; Guyatt, G; Berwanger, O; Briel, M (February 2011). "Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170,255 patients from 76 randomized trials". QJM : Monthly Journal of the Association of Physicians. 104 (2): 109–24. doi:10.1093/qjmed/hcq165. PMID 20934984.
  67. ↑ Cholesterol Treatment Trialists' (CTT) Collaborators (2012). "The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials". Lancet. 380 (9841): 581–90. doi:10.1016/S0140-6736(12)60367-5. PMC 3437972. PMID 22607822.
  68. ↑ Jeanne, Thomas L.; Daeges, Monica; Blazina, Ian; Dana, Tracy; Chou, Roger (2016-11-15). "Statins for Prevention of Cardiovascular Disease in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force". JAMA. 316 (19): 2008–2024. doi:10.1001/jama.2015.15629. ISSN 0098-7484. PMID 27838722.
  69. ↑ Ton, Joey (10 July 2023). "#344 Statins in Older Adults (Free)". CFPCLearn. Archived from the original on 12 July 2023. Retrieved 10 July 2023.
  70. 1 2 Taylor, Fiona; Huffman, Mark D; Macedo, Ana Filipa; Moore, Theresa HM; Burke, Margaret; Davey Smith, George; Ward, Kirsten; Ebrahim, Shah (2013-01-31). "Statins for the primary prevention of cardiovascular disease". Cochrane Database of Systematic Reviews (1): CD004816. doi:10.1002/14651858.cd004816.pub5. ISSN 1465-1858. PMC 6481400. PMID 23440795.
  71. ↑ Expert Opin Pharmacother. 2015 Feb;16(3):347–56. doi: 10.1517/14656566.2014.986094. Epub 2014 Dec 5. Ongoing challenges for pharmacotherapy for dyslipidemia. Pisaniello AD, Scherer DJ, Kataoka Y, Nicholls SJ.
  72. ↑ Lebenthal Y, Horvath A, Dziechciarz P, Szajewska H, Shamir R (2010). "Are treatment targets for hypercholesterolemia evidence based? Systematic review and meta-analysis of randomised controlled trials". Arch Dis Child. 95 (9): 673–80. doi:10.1136/adc.2008.157024. PMID 20515970. S2CID 24263653.
  73. 1 2 3 National Institute for Health and Clinical Excellence. Clinical guideline 67: Lipid modification. London, 2008.
  74. ↑ Navarese EP; Kolodziejczak M; Schulze V; Gurbel PA; Tantry U; Lin Y; Brockmeyer M; Kandzari DE; Kubica JM; D'Agostino RB Sr; Kubica J; Volpe M; Agewall S; Kereiakes DJ; Kelm M. (7 July 2015). "Effects of Proprotein Convertase Subtilisin/Kexin Type 9 Antibodies in Adults With Hypercholesterolemia: A Systematic Review and Meta-analysis". Ann Intern Med. 163 (1): 40–51. doi:10.7326/M14-2957. PMID 25915661.
  75. ↑ Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Stone NJ (2004). "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines". J Am Coll Cardiol. 44 (3): 720–32. doi:10.1016/j.jacc.2004.07.001. PMID 15358046.
  76. ↑ Grundy, SM; Stone, NJ; Bailey, AL; Beam, C; Birtcher, KK; Blumenthal, RS; Braun, LT; de Ferranti, S; Faiella-Tommasino, J; Forman, DE; Goldberg, R; Heidenreich, PA; Hlatky, MA; Jones, DW; Lloyd-Jones, D; Lopez-Pajares, N; Ndumele, CE; Orringer, CE; Peralta, CA; Saseen, JJ; Smith SC, Jr; Sperling, L; Virani, SS; Yeboah, J (10 November 2018). "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary". Circulation. 139 (25): e1046–e1081. doi:10.1161/CIR.0000000000000624. PMID 30565953.
  77. ↑ National Institute for Health and Clinical Excellence. "Cardiovascular disease: risk assessment and reduction, including lipid modification". NICE. Archived from the original on 27 May 2019. Retrieved 27 May 2019.
  78. 1 2 3 4 AMDA – The Society for Post-Acute and Long-Term Care Medicine (February 2014), "Ten Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, AMDA – The Society for Post-Acute and Long-Term Care Medicine, archived from the original on 13 September 2014, retrieved 20 April 2015
  79. ↑ Snow V, Aronson M, Hornbake E, Mottur-Pilson C, Weiss K (2004). "Lipid control in the management of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians". Ann Intern Med. 140 (8): 644–49. doi:10.7326/0003-4819-140-8-200404200-00012. PMID 15096336. S2CID 6744974.
  80. ↑ Vijan, S; Hayward, RA; American College Of, Physicians (2004). "Pharmacologic lipid-lowering therapy in type 2 diabetes mellitus: background paper for the American College of Physicians". Ann Intern Med. 140 (8): 650–58. doi:10.7326/0003-4819-140-8-200404200-00013. PMID 15096337.
  81. ↑ Barnes PM, Powell-Griner E, McFann K, Nahin RL (May 27, 2004). "Complementary and Alternative Medicine Use Among Adults: United States, 2002" (PDF). Advance Data from Vital and Health Statistics. http://nccih.nih.gov/news/2004/052704.htm (343): 6–9. Retrieved 2010-11-04. {{cite journal}}: External link in |version= (help)CS1 maint: url-status (link)
  82. ↑ Demonty I, Ras RT, van der Knaap HC, Duchateau GS, Meijer L, Zock PL, Geleijnse JM, Trautwein EA (February 2009). "Continuous dose-response relationship of the LDL-cholesterol-lowering effect of phytosterol intake". J Nutr. 139 (2): 271–84. doi:10.3945/jn.108.095125. PMID 19091798.
  83. ↑ Weingärtner O.; Bohm, M.; Laufs, U.; et al. (2009). "Controversial role of plant sterol esters in the management of hypercholesterolaemia". European Heart Journal. 30 (4): 404–09. doi:10.1093/eurheartj/ehn580. PMC 2642922. PMID 19158117. Archived from the original on 2009-03-05. Retrieved 2009-12-20.
  84. ↑ Carrol, Margaret (April 2012). "Total and High-density Lipoprotein Cholesterol in Adults: National Health and Nutrition Examination Survey, 2009–2010" (PDF). CDC. Archived (PDF) from the original on 2017-11-13. Retrieved 2017-09-09.
  85. ↑ Van Craeyveld E, Jacobs F, Gordts SC, De Geest B (2011). "Gene therapy for familial hypercholesterolemia". Curr Pharm Des. 17 (24): 2575–91. doi:10.2174/138161211797247550. PMID 21774774.
  86. ↑ Al-Allaf FA, Coutelle C, Waddington SN, David AL, Harbottle R, Themis M (2010). "LDLR-Gene therapy for familial hypercholesterolaemia: problems, progress, and perspectives". Int Arch Med. 3: 36. doi:10.1186/1755-7682-3-36. PMC 3016243. PMID 21144047.
Classification
External resources
This article is issued from Offline. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.