Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis

Background and Methods. The effect of intensive lipid-lowering therapy on coronary atherosclerosis among men at high risk for cardiovascular events was assessed by quantitative arteriography. Of 146 men no more than 62 years of age who had apolipoprotein B levels ≥125 mg per deciliter, documented coronary artery disease, and a family history of vascular disease, 120 completed the 2 1/2-year double-blind study, which included arteriography at base line and after treatment. Patients were given dietary counseling and were randomly assigned to one of three treatments: lovastatin (20 mg twice a day) and colestipol (10 g three times a day); niacin (1 g four times a day) and colestipol (10 g three times a day); or conventional therapy with placebo (or colestipol if the low-density lipoprotein [LDL] cholesterol level was elevated). Results. The levels of LDL and high-density lipoprotein (HDL) cholesterol changed only slightly in the conventional-therapy group (mean changes, −7 and +5 percent, respectivel...

https://www.nejm.org/doi/pdf/10.1056/NEJM199011083231901

Regression of Coronary Artery Disease as a Result of Intensive Lipid-Lowering Therapy in Men with High Levels of Apolipoprotein B

Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

/pdf/is-caregiving-hazardous-to-one-s-physical-health-a-meta-9lei6w7pdo.pdf

Is caregiving hazardous to one's physical health? A meta-analysis.

The Cholesterol-Lowering Atherosclerosis Study (CLAS) was a randomized, placebo-controlled, angiographic trial testing combined colestipol hydrochloride and niacin therapy in 162 nonsmoking men aged 40 to 59 years with previous coronary bypass surgery. During two years of treatment there was a 26% reduction in total plasma cholesterol, a 43% reduction in low-density lipoprotein cholesterol, plus a simultaneous 37% elevation of high-density lipoprotein cholesterol. This resulted in a significant reduction in the average number of lesions per subject that progressed ( P P P P P P =.002). ( JAMA 1987;257:3233-3240)

Beneficial Effects of Combined Colestipol-Niacin Therapy on Coronary Atherosclerosis and Coronary Venous Bypass Grafts

DESPITE early observations suggesting an inverse relation between serum levels of high-density lipoprotein (HDL) cholesterol and coronary disease,1 2 3 the possible protective role of HDL in athero...

High-Density Lipoprotein — The Clinical Implications of Recent Studies

We studied the relation between diet, serum lipoproteins, and the progression of coronary lesions in 39 patients with stable angina pectoris in whom coronary arteriography had shown at least one vessel with 50 per cent obstruction before intervention. Intervention consisted of a two-year vegetarian diet that had a ratio of polyunsaturated to saturated fatty acids of at least 2 and that contained less than 100 mg of cholesterol per day. Dietary changes were associated with a significant increase in linoleic acid content of cholesteryl esters and a significant lowering of body weight, systolic blood pressure, serum total cholesterol, and the ratio of total to high-density lipoprotein (total/HDL) cholesterol. Angiographic examination was performed after 24 months; angiograms were assessed visually (with blinding) and by computer-assisted image analysis. Both types of assessment indicated progression of disease in 21 of 39 patients but no lesion growth in 18. Coronary lesion growth correlated with total/HDL cholesterol (r = 0.50, P = 0.001) but not with blood pressure, smoking status, alcohol intake, weight, or drug treatment. Disease progression was significant in patients who had values for total/HDL cholesterol that were higher than the median (greater than 6.9) throughout the trial period. No coronary-lesion growth was observed in patients who had lower values for total/HDL cholesterol (less than 6.9) throughout the trial or who initially had higher values (greater than 6.9) that were significantly lowered by dietary intervention.

Diet, lipoproteins, and the progression of coronary atherosclerosis. The Leiden Intervention Trial.

Association of cholesterol concentrations in low-density lipoprotein, high-density lipoprotein, and high-density lipoprotein subfractions, and of apolipoproteins AI and AII, with coronary stenosis and left ventricular function.

It is of importance to examine if certain interventional procedures can possibly influence the rate of progress of coronary sclerosis in man. In femoral atherosclerosis, Blankenhorn has already shown that computer estimate of atherosclerosis percent change was significantly correlated with triglyceride and cholesterol level (1). Recently Blankenhorn has also shown that coronary atherosclerosis regression studies can be done with computer processed angiograms and, that comparison between human and computer measures on diameter stenosis can be satisfactory (2). The importance of the influence of the diet on coronary atherosclerosis has recently once more been underscored in an impressive way by the study of Hjermann et al, where it was shown in middle-aged men at high risk of CHD that advice to change eating habits and to stop smoking significantly reduced the incidence of the first event of myocardial infarction and sudden death (3).

Preliminary Report on Coronary Lesions and Serum Lipids Before and After 2 Years Dietary Intervention in 22 Patients

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Diet, lipoproteins, and the progression of coronary atherosclerosis. The Leiden Intervention Trial.

Association of cholesterol concentrations in low-density lipoprotein, high-density lipoprotein, and high-density lipoprotein subfractions, and of apolipoproteins AI and AII, with coronary stenosis and left ventricular function.

Preliminary Report on Coronary Lesions and Serum Lipids Before and After 2 Years Dietary Intervention in 22 Patients