Is high-density lipoprotein the cardiovascular the protector system?

被引:10
作者
Barter, P [1 ]
机构
[1] Heart Res Inst, Sydney, NSW 2050, Australia
关键词
coronary heart disease; high-density lipoprotein; low-density lipoprotein; statins; fibrate; niacin;
D O I
10.1016/j.ehjsup.2004.01.005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Low high-density Lipoprotein (HDL-C) cholesterol is a powerful predictor of risk for coronary heart disease (CHD), and raising HDL-C reduces CHD risk, with available data indicating a 1% decrease in risk with each 1% increase in HDL-C. Both epidemiological and intervention studies have shown that HDL is predictive of risk independent of low-density lipoprotein cholesterol. In treatment trials, both fibrates and statins have been shown to reduce risk in patients with tow HDL-C. Statins reduce risk across all HDL-C levels from low to high, whereas fibrates appear to have benefits limited to low HDL-C in the context of the metabolic syndrome. The primary management component of increasing HDL-C is lifestyle intervention focusing on diet, exercise and smoking cessation. Drug options for raising HDL-C include niacin (+10-30%), fibrates (+5-25%) and statins (+3-12%). Niacin is poorly tolerated. Fenofibrate may pose advantages over gemfibrozil among fibrates. Findings in the large-scale Statin Therapies for Elevated Lipid Levels compared Across dose ranges to Rosuvastatin (STELLAR) trial indicate that rosuvastatin has the best HDL-C raising effect among statins. Selection of therapy requires consideration of the individual patient's overall risk profile. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:A19 / A22
页数:4
相关论文
共 17 条
  • [1] HIGH-DENSITY LIPOPROTEIN CHOLESTEROL, TOTAL CHOLESTEROL SCREENING, AND MYOCARDIAL-INFARCTION - THE FRAMINGHAM-STUDY
    ABBOTT, RD
    WILSON, PWF
    KANNEL, WB
    CASTELLI, WP
    [J]. ARTERIOSCLEROSIS, 1988, 8 (03): : 207 - 211
  • [2] RELATION OF HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL AND TRIGLYCERIDES TO INCIDENCE OF ATHEROSCLEROTIC CORONARY-ARTERY DISEASE (THE PROCAM EXPERIENCE)
    ASSMANN, G
    SCHULTE, H
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1992, 70 (07) : 733 - 737
  • [3] REGRESSION OF ATHEROSCLEROTIC LESIONS BY HIGH-DENSITY-LIPOPROTEIN PLASMA FRACTION IN THE CHOLESTEROL-FED RABBIT
    BADIMON, JJ
    BADIMON, L
    FUSTER, V
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1990, 85 (04) : 1234 - 1241
  • [4] Executive summary of the 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)
    Cleeman, JI
    Grundy, SM
    Becker, D
    Clark, LT
    Cooper, RS
    Denke, MA
    Howard, WJ
    Hunninghake, DB
    Illingworth, DR
    Luepker, RV
    McBride, P
    McKenney, JM
    Pasternak, RC
    Stone, NJ
    Van Horn, L
    Brewer, HB
    Ernst, ND
    Gordon, D
    Levy, D
    Rifkind, B
    Rossouw, JE
    Savage, P
    Haffner, SM
    Orloff, DG
    Proschan, MA
    Schwartz, JS
    Sempos, CT
    Shero, ST
    Murray, EZ
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (19): : 2486 - 2497
  • [5] Collins R, 2002, LANCET, V360, P7, DOI 10.1016/S0140-6736(02)09327-3
  • [6] HIGH-DENSITY LIPOPROTEIN CHOLESTEROL AND CARDIOVASCULAR-DISEASE - 4 PROSPECTIVE AMERICAN-STUDIES
    GORDON, DJ
    PROBSTFIELD, JL
    GARRISON, RJ
    NEATON, JD
    CASTELLI, WP
    KNOKE, JD
    JACOBS, DR
    BANGDIWALA, S
    TYROLER, HA
    [J]. CIRCULATION, 1989, 79 (01) : 8 - 15
  • [7] HIGH-DENSITY LIPOPROTEIN AS A PROTECTIVE FACTOR AGAINST CORONARY HEART-DISEASE - FRAMINGHAM STUDY
    GORDON, T
    CASTELLI, WP
    HJORTLAND, MC
    KANNEL, WB
    DAWBER, TR
    [J]. AMERICAN JOURNAL OF MEDICINE, 1977, 62 (05) : 707 - 714
  • [8] Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvalstaltin, and pravastatin across doses (STELLAR* trial)
    Jones, PH
    Davidson, MH
    Stein, EA
    Bays, HE
    McKenney, JM
    Miller, E
    Cain, VA
    Blasetto, JW
    STELLAR Study Grp
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2003, 92 (02) : 152 - 160
  • [9] LIPID ALTERATIONS AND DECLINE IN THE INCIDENCE OF CORONARY HEART-DISEASE IN THE HELSINKI HEART-STUDY
    MANNINEN, V
    ELO, MO
    FRICK, MH
    HAAPA, K
    HEINONEN, OP
    HEINSALMI, P
    HELO, P
    HUTTUNEN, JK
    KAITANIEMI, P
    KOSKINEN, P
    MAENPAA, H
    MALKONEN, M
    MANTTARI, M
    NOROLA, S
    PASTERNACK, A
    PIKKARAINEN, J
    ROMO, M
    SJOBLOM, T
    NIKKILA, EA
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1988, 260 (05): : 641 - 651
  • [10] Niacin as a component of combination therapy for dyslipidemia
    Miller, M
    [J]. MAYO CLINIC PROCEEDINGS, 2003, 78 (06) : 735 - 742