of the LDL between the large and small particles that matters The smaller LDL particles are more able to penetrate the endothelium that is the lining of blood vessels and cause damage where eventually plaque builds up HDL – much smaller in structure than LDL o Also have embedded cholesterol o “Good cholesterol” o High Density Lipoprotein
o HDL lipoproteins pick up cholesterol that has been dumped overboard by LDL and transports it back to liver NMR lipoprofile test is an advanced cardiovascular diagnostic blood test that uses nuclear magnetic resonance spectroscopy to uniquely provide rapid, simultaneous and direct measurement of LDL particle number and size of LDL particles o The atherosclerotic culprit is not LDL particle numbers, but the size of the particles When plaque around the arteries bursts, the body perceives that as damage, and brings its army of blood cells to try to curb the damage o A blood clot forms in the artery and can block the flow of blood and may cause a heart attack o Whether or not the plaque bursts depends on inflammation – a response of body tissues to injury or irritation; characterized by pain, swelling, redness, and heat Inflammation makes the plaque more susceptible to bursting High sensitivity C-reactive protein – blood test that can be done; when level is less than 2mg/L, the risk of heart disease decreases Lesson 3: Diet & the Heart II Video 1 Intervention studies – intervene in some fashion with one group and not the other MR. FIT o After 7 years intervention group reduced saturated fat intake by 30% and increased polyunsaturated fats by 33% o Diference in blood cholesterol was 2% between intervention and non- intervention groups o Mortality rate in intervention group from coronary heart disease (CHD) was 17.9 per 1000 and in control group 19.3 per 1000 o Virtually all authors had some connection to pharmaceutical companies 1984 lipid research clinics coronary primary prevention trial o 3806 high risk men aged 35-39 o Half treated with diet – cut down on saturated fats, increase in polyunsaturated o Half treated with diet plus cholestyramine to further lower blood cholesterol o Blood cholesterol decreased by 9% in intervention group Heart attacks decreased by 19% o “For every 1% decrease in cholesterol the risk of heart attack is decreased by 2%” Have to treat 67 men aggressively to save one cardiac event JUPITER study looked at reducing cholesterol levels by a statin (classic cholesterol- reducing drugs) o Gave intervention group the drug 100% reduction in cardiovascular events in men who were at risk 83 out of 8901 in the statin group had a major event 157 out of 8901 in the placebo group had a major event
o Have to treat 120 people to prevent 1 event, but cost to treat 120 people is $290,000 How do you reduce cholesterol?
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