Risks for Hyperlipidemia

doi:10.1016/S0733-8651(18)30634-9

Cardiology Clinics

Volume 4, Issue 1, February 1986, Pages 45-56

https://doi.org/10.1016/S0733-8651(18)30634-9 Get rights and content

The predisposition for the development of hyperlipidemia rests almost equally on genetic and environmental factors and their interplay. Because one of the least understood factors is the duration of exposure to risk, the authors have chosen to review here some of the genetic factors and some of the relatively long-term environmental factors, such as diet and drug therapies, that are known to increase the risk of hyperlipidemia and likely the predisposition to cardiovascular disease.

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Cited by (8)

Toward an international consensus—Integrating lipoprotein apheresis and new lipid-lowering drugs
2017, Journal of Clinical Lipidology
Citation Excerpt :
Documenting the molecular diagnosis and effects of treatment in an international registry will facilitate learning from colleagues' experience, in these rare patients. This registry might follow the example of the German Lipoprotein Apheresis Registry,82 which documents LA treatment procedures, including treatment efficiency, biocompatibility, and clinical safety. After German Lipoprotein Apheresis Registry had been running for 2 years, 96 German centers had access to the registry, 49 centers were active members, and data of more than 700 patients had been entered.83
Despite advances in pharmacotherapy of lipid disorders, many dyslipidemic patients do not attain sufficient lipid lowering to mitigate risk of atherosclerotic cardiovascular disease. Several classes of novel lipid-lowering agents are being evaluated to reduce atherosclerotic cardiovascular disease risk. Lipoprotein apheresis (LA) is effective in acutely lowering the plasma concentrations of atherogenic lipoproteins including low-density lipoprotein cholesterol and lipoprotein(a), and novel lipid-lowering drugs may dampen the lipid rebound effect of LA, with the possibility that LA frequency may be decreased, in some cases even be discontinued.
This document builds on current American Society for Apheresis guidelines and, for the first time, makes recommendations from summarized data of the emerging lipid-lowering drug classes (inhibitors of proprotein convertase subtilisin/kexin type 9 or microsomal triglyceride transfer protein, high-density lipoprotein mimetic), including the available evidence on combination therapy with LA with respect to the management of patients with dyslipidemia.
Recommendations for different indications are given based on the latest evidence. However, except for lomitapide in homozygous familial hypercholesterolemia and alirocumab/evolocumab in heterozygous familial hypercholesterolemia subjects, limited data are available on the effectiveness and safety of combination therapy. More studies on combining LA with novel lipid-lowering drugs are needed.
Novel lipid-lowering agents have potential to improve the performance of LA, but more evidence is needed. The Multidisciplinary International Group for Hemapheresis TherapY and Metabolic DIsturbances Contrast scientific society aims to establish an international registry of clinical experience on LA combination therapy to expand the evidence on this treatment in individuals at high cardiovascular disease risk.
Incidence of cholesterol in periapical biopsies among adolescent and elderly patients
2013, Journal of Endodontics
Citation Excerpt :
Cholesterol crystals, which are frequently seen in atherosclerotic plaques and foamy macrophages, were suggested to have an important role in the generation of cholesterol crystals in atherosclerosis (14). The Lipid Research Clinics Program reported plasma lipid and lipoprotein cholesterol distributions upon large-scale screening of 20- to 59-year-old men and women; they found age-related trends for increasing levels of triglycerides and cholesterol (15). Serum triglycerides were suggested to be the source of cholesterol in radicular cysts (7).
Cholesterol clefts are common histologic findings in periapical biopsies; they have a reported incidence in periapical periodontitis of up to 44%. Cholesterol crystals are also recognized in advanced atherosclerotic plaques in humans. Male sex, genetic abnormalities, and age have been associated with advanced atherosclerotic lesions. Among these nonmodifiable risk factors, age is the most dominant. The aim of the study was to evaluate if age is also linked to cholesterol deposition in periapical periodontitis.
The database of biopsy reports obtained between 2006 and 2009 was searched for specimens diagnosed as radicular cysts or periapical granulomas. Only data relating to biopsies obtained from adolescent (13–21 years old) and elderly (over 60 years old) patients were selected. The biopsies were examined by a pathologist under a light microscope (Zeiss, Jena, Germany) at magnifications of 40×–200×. The available material was scanned for the presence of cholesterol clefts and foamy cells in radicular cysts and granulomas.
A total of 41 specimens were collected in the adolescent group and 48 specimens in the elderly group over a 4-year period. A higher incidence of cholesterol was found in the elderly group compared with that in the adolescent group (odds ratio = 6.857).
The highly significant incidence of cholesterol deposits in periapical biopsies among elderly patients may be a possible cause for the lack of repair. The mechanism for cholesterol accumulation is probably similar to the process leading to atherosclerosis and coronary artery disease. Statin administration may be advantageous for the treatment of persistent lesions. A clinician should be aware of the risk for persistent lesions after endodontic treatment in elderly patients.
Cholesterol and suicide attempts: A prospective study of depressed inpatients
2007, Psychiatry Research
Citation Excerpt :
Age presented a significant confound for comparison between high and low cholesterol groups. The positive correlation between cholesterol levels and age is consistent with other studies (Fritze et al., 1992; Garland et al., 2000; Bocchetta et al., 2001) and the natural history of hyperlipidemia with age as a non-modifiable risk factor (Nestruck and Davignon, 1986). Analyses were subsequently controlled for age.
Low cholesterol levels have commonly been associated with various suicide measures. We sought to examine suicide attempts in a prospective sample of depressed patients that on prior analysis demonstrated an association between low cholesterol and subsequent suicide completions. Seventy-four inpatients with Research Diagnostic Criteria unipolar major depression, bipolar depression or schizoaffective depression entered a prospective follow-up study from 1978 to 1981. Kaplan–Meier survival analysis and Cox regression were utilized to elucidate the relationship between cholesterol levels and subsequent severe suicide attempts as well as all suicide attempts regardless of severity. Attempts preceding index hospitalization and other lifetime attempts were evaluated cross-sectionally. Low serum cholesterol levels did not predict subsequent suicide attempts. Contrary to our hypothesis, the high cholesterol group was associated with increased risk of suicide attempts on survival analysis in those less than median age. Nonetheless, in cross-sectional analysis, the low cholesterol group had more suicide attempts preceding index hospitalization and more remote lifetime attempts. The results from this prospective dataset do not support an association between low cholesterol and subsequent suicide attempts despite replicating the retrospective findings of previous case–control and cross-sectional studies.
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