penetrate the endothelium lining of blood vessel cause damage where eventually

Penetrate the endothelium lining of blood vessel

This preview shows page 139 - 141 out of 178 pages.

penetrate the endothelium (lining of blood vessel) & cause damage where eventually plaque builds up o Instrumentation helps identify LDL sizes Nuclear magnetic resonance spectrometers View is that the atherosclerotic culprit is not amount of LDL but the size of it (not the total amount of cholesterol carried by the LDL that matters either) Not cheap yet Lipoprofiles which shows LDL particle size May be the best predictor for heart disease ° HDL: High-Density Lipoprotein Much smaller in structure with embedded cholesterol GOOD Will clean up the dumped cholesterol by LDL by transporting it back to the liver to eliminate it ° ° Lesson 3 (Diet & the Heart II) : ° Does high blood cholesterol cause coronary heart disease or is it just a bystander? ° Will reducing blood cholesterol reduce the risk? ° If it does, at what cholesterol level should you start thinking about dietary intervention? ° Can diet do anything to help or do we need drug intervention? ° ° MR.FIT (Multiple Risk Factor Interventional Trial) Studied association of heart disease & smoking, diet, exercise etc After 7 years, the intervention group (who were advised by dieticians to cut down saturated fat intake) showed 30% in S.F intake o Advised to do so b/c of Keys’ study & others o S.F replaced by PUFAs Difference in blood cholesterol b/w control & intervention was only ~2% Downloaded by Riviera Dresden ([email protected]) lOMoARcPSD|3695286
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Control group also managed to reduce their cholesterol level by ~5% o Probably due to knowing that they are part of a heart disease study Mortality rate in intervention group somewhat smaller (in terms of heart disease) but not tremendously significant o Argument is that if the cholesterol level difference was larger, the difference mortality rate may have been more significant **This study had a lot of authors & virtually all of them had some connection to pharmaceutical companies ** o Does not mean that the data is unreliable but it should be noted MRFIT showed that intervention of many kinds can reduce risk of heart disease, but not significantly ° ° CPPT (Lipid Research Clinics Coronary Primary Prevention Trial ) - 1984 Involved > 3800 high-risk men 35-59 years of age ½ of them treated with diet: counseled to eat saturated fats, PUFAs (which at that era was dogma) ½ of them treated with a diet plus a drug, cholestyramine (intervention) Reason why everyone was given a diet was because it was deemed unethical to not teach high-risk participants to eat a healthy diet Results: Blood cholesterol 9% & heart attack by 19% in the intervention group o Lead to a statement often repeated in many publications: “For every 1% in cholesterol, the risk of heart attack is by 2%” o Interesting that it could also mean for every 67 men treated quite aggressively with diet & drugs, 1 cardiac event is saved ° ° Justification for the Use of Statins in Prevention, an Intervention Trial Evaluating Rosuvastitin (JUPITER) Published in the New England Journal of Medicine Looked at cholesterol levels using statin o
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