Control or Reversal of Atherosclerosis Through Therapy of Lipid Disorders
Until recently, experiments designed to test the hypothesis that human atherosclerotic lesions can be modified by reducing levels of “atherogenic” plasma lipoproteins have relied on indirect endpoints (cardiac death; signs or symptoms of ischemic vascular disease). Large numbers of persons must be enrolled in such trials and the hypolipidemic treatment must therefore be simple in application. Experience has shown that only small reductions of the level of cholesterol-rich lipoproteins (usually evaluated by changes in serum cholesterol) can be obtained in such studies. Furthermore, in order to achieve a requisite sample size, it has not proved feasible to limit enrollment to persons whose risk of experiencing the defined endpoint is very much higher than that of the population at large. The results of such studies have been equivocal, although in the main they provide some encouragement that intervention with diet or drugs may modify the course of atherosclerotic disease. In the next few months, the results of the most extensive such trial will be published—the Lipid Research Clinics Coronary Primary Prevention Trial1.
KeywordsAchilles Tendon Familial Hypercholesterolemia Lipid Research Clinic Cholesteryl Oleate Heterozygous Familial Hypercholesterolemia
Unable to display preview. Download preview PDF.
- 1.Arteriosclerosis: a report by the National Heart and Lung Institute Task Force on Arteriosclerosis. DREW Publication No. (NIH) 71–137, Vol. 1 (June 1971).Google Scholar
- 3.R.J. Havel, Familial dysbetalipoproteinemia: New aspects of pathogenesis and diagnosis, Med. Clin. North Am. 66: 441 (1982).Google Scholar
- 4.R.W. Mahley, Atherogenic hyperlipoproteinemia. The cellular and molecular biology of plasma lipoproteins altered by dietary fat and cholesterol, Med. Clin. North Am. 66: 375 (1982).Google Scholar
- 5.J.L. Goldstein and M.S. Brown, The LDL receptor defect in familial hypercholesterolemia. Implications for pathogenesis and therapy, Med. Clin. North Am. 66: 335 (1982).Google Scholar
- 8.C.J. Fielding and P.E. Fielding, Cholesterol transport between cells and body fluids. Role of plasma lipoproteins and the plasma cholesterol esterification system, Med. Clin. North Am. 66: 363 (1982).Google Scholar
- 9.R.J. Havel, J.L. Goldstein, and M.S. Brown, Lipoproteins and lipid transport, in: “Metabolic Control and Disease, 8th Edition,” P.K. Bondy and L.E. Rosenberg, eds., W.B. Saunders, Philadelphia (1980).Google Scholar
- 12.D.H. Blankenhorn, Reversibility of latent atherosclerosis. Studies by femoral angiography in humans, Mod. Concepts Cardiovasc. Dis. 47: 79 (1978).Google Scholar
- 14.M.J. Malloy, B.H. Brundage, J.P. Kane, N.R. Phillips, and R.J. Havel, Relationship of diameters of xanthomatous tendons and plasma lipoprotein levels to extent of coronary atherosclerosis in familial hypercholesterolemia, Arteriosclerosis 3: 482a (1983).Google Scholar