胆固醇吸收合成标志物与冠心病

冠心病是由多种危险因素引发的重大疾病,血脂异常是其重要的危险因素之一.目前,我国面临着严峻的血脂异常防治形势和严重的疾病防控挑战.2007年中国成人血脂异常防治指南的发表[1],标志着我国血脂异常防治工作进入一个新的历史阶段.胡大一教授最近指出,丰富的循证医学依据一再证实胆固醇的升高是引发冠心病的罪魁祸首,在当前繁重的血脂异常防治工作中,胆固醇是血脂干预的首要目标[2].20世纪90年代,北欧辛伐他汀生存研究(scandinavian simvastatin survival study,4S)等一系列采用他汀类药物调脂治疗的大规模临床试验已充分表明,通过大幅降低血清总胆固醇(TC)、特别是低密度脂蛋白胆固醇(LDL-C),可显著降低冠心病事件发生.     

胆固醇吸收合成标志物研究进展

国外大量研究已证明胆固醇吸收标志物(菜油甾醇、谷固醇、胆甾烷醇等)代表胆固醇吸收,胆固醇合成标志物(7-烯胆烷醇、角鲨烯、琏甾醇等)代表胆固醇合成,并将这些标志物用于血脂代谢异常的流行病学研究、临床降脂药物疗效评价及胆固醇代谢的实验研究,取得良好效果。现将胆固醇吸收合成标志物的研究进展做一综述。     

64例血脂正常人胆固醇吸收与合成标志物检测

目的 了解健康成人胆固醇吸收与合成标志物的均值及分布情况.方法 入选北京安贞医院体检中心64例健康成人,常规测定肝肾功能、血清总胆固醇、高密度脂蛋白胆固醇、甘油三酯、空腹血糖等指标;采用气相色谱法测定胆固醇吸收与合成标志物.结果 5种非胆固醇类固醇总和平均值为1.02 mg/dL,约为胆固醇总量的0.72％,且存在个体差异;与女性比较,男性血清中7-烯胆甾烷醇水平升高(P＜0.05),而豆固醇水平较女性低(P＜0.01);合成标志物角鲨烯随着年龄的增长而降低,吸收标志物豆固醇随着年龄的增长而升高.结论 通过检测胆固醇吸收与合成标志物,了解健康个体间胆固醇吸收、合成标志物分布情况.     

血浆胆固醇与冠心病

流行病学、临床和实验资料证明,发生或死于冠心病的危险,与血浆胆固醇水平有直接关系。血浆胆固醇水平为3.88～5.17mmol/L者中,死于冠心病的危险缓慢增加;>5.17mmol/L者中,较快增加;6.21～7.76mmol/L者中,冠心病危险比血浆胆固醇<5.17mmol/L者增加4倍。因而,血浆胆固醇<5.17mmol/L被列为要求的水平;5.17～6.18mmol/L被列为临界性高危险水平;≥6.21mmol/L则被列为高危险水平。血浆LDL胆固醇<3.36mmol/L被列为要求的水     

炎症标志物与冠心病

近来证据表明 :炎症大量卷入动脉血栓性疾病的激发和进展。健康人群和冠心病 (CHD)患者的炎症标志物浓度 ,与未来发生冠心病危险有相关性。C 反应蛋白 (CRP)是最广泛应用的炎症标志物 ,研究表明CRP在体外可激活补体、诱导内皮产生单核细胞趋化蛋白 1(MCP 1)、上调ICAM 1、VCAM 1和E选择素、介导巨噬细胞摄入天然低密度脂蛋白(LDL)、使单核细胞产生组织因子增加。另外 ,CRP存在于梗死心肌及动脉粥样硬化血管和斑块中 ,并与补体终端复合物共同定位。本文说明CRP在外观健康人群与急性冠脉综合征患者中的临床应用。1　CRP与急性冠…     

低胆固醇人群中血清胆固醇与冠心病

对血清平均胆固醇值偏高的人群进行前瞻性研究提示血清胆固醇与冠心病有明显直接关系。而血胆固醇值低与冠心病的关系未明。为此,作者对上海9000多名中年工人进行了前瞻性研究,其平均血胆固醇值较西方人群低得多,并且观察了低胆固醇值与各种非冠脉性死亡的关系。资料和方法调查对象9351名,男6494名,女2857名,年龄35～64岁,在筛选同时记录收缩压、舒张压、吸烟、饮酒和血清胆固醇值测定。其中330名除外,因其未测血胆固醇值或心电图显示陈旧性心肌梗死。     

高密度脂蛋白胆固醇与妇女冠心病

[英 ]/ＢｉｔｔｎｅｒＶ…∥ＡｍＨａｅｒｔＪ 2 0 0 0 ,1 3 9( 2 ) 2 88～ 2 96 以往研究证实 ,高密度脂蛋白胆固醇(ＨＤＬ Ｃ)水平与冠心病 (ＣＨＤ)的发生发展及预后呈负相关。但近期研究发现 ,绝经后妇女中 ,许多高水平ＨＤＬ Ｃ者亦患有ＣＨＤ。为探讨ＨＤＬ Ｃ与妇女ＣＨＤ的关系 ,作者对影响ＨＤＬ Ｃ心脏保护作用的因素进行了研究。病人和方法　自 1 993年 2月至 1 994年 9月 ,采用随机双盲方法选择接受雌 /孕激素替代治疗的 2 763名绝经后妇女作为研究对象。入选条件为 :年龄 <80 ( 44～ 79)岁 ;子宫完整 ;有临床确诊的ＣＨＤ病…     

冠心病与高胆固醇血症

什么是胆固醇？胆固醇是一种对人体正常功能具有重要作用的脂肪样物质。除部分从食物中摄取外，部分的胆固醇是由身体自行制造。     

总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇与苏格兰男子冠心病

中年男性因冠心病所致的死亡率有地区性差异。而这种差异不能用平均胆固醇或高密度脂蛋白胆固醇(HDL-C)浓度的差异来解释。作者观察了总胆固醇、HDL-C 和低密度脂蛋白胆固醇(LDL-C)浓度以及其他致冠心病危险因子的长程变化,并评价这些变化对苏格兰男子冠心病发病的重要性。病人和方法 1976年对年龄为40岁的无心肺疾患和心理障碍的苏格兰男子107名作受试对象。在检测所需指标之后,告之预防冠心病的普通常识,但并不告之关于随访研究的任何     

Cholesterol and coronary heart disease

Background: Until recent years considerable controversy has surrounded the importance of cholesterol reduction. Aims: This article reviews recent new findings relating to the epidemiology of cholesterol and coronary heart disease (CHD) and the effects of cholesterol lowering. Methods: A review of recent literature. Results: Compelling epidemiological data relate serum cholesterol levels to the prevalence of CHD. Recent large-scale clinical trials have shown the benefits of cholesterol lowering for primary prevention of CHD in those with elevated cholesterol and for secondary prevention in those with “average” as well as elevated cholesterol levels. Safety data have largely allayed concerns about any impact of cholesterol reduction on non-CHD death. Conclusions: A very aggressive approach to lipid modification is necessary to minimise its impact on CHD. In primary prevention this must be appropriately underpinned by community education programs, with drug therapy of selected patients. For secondary prevention lipid-lowering drug therapy with agents such as HMG CoA reductase inhibitors is often justified. Future investigation should centre upon definition of absolute risk and cost-benefit considerations in particular subgroups.     

Cholesterol and coronary heart disease mortality

The epidemiological relation between increased levels of blood cholesterol and increased risk of future heart disease is clear, both within and between countries. These strong relationships have led to the adoption of consensus statements in most countries which recommend measures such as the reduction of dietary saturated fat/an increase in the polyunsaturated/saturated ratio and other dietary and sometimes drug methods to reduce serum cholesterol. There is controversy as to whether these measures should be targeted at individuals with high levels of cholesterol or whether there should be a public health approach to the whole population. The public and medical debate has become more heated since the data from intervention trials are conflicting. Taken overall the trials do appear to show reduction in risk of coronary which is stronger for non fatal, compared with fatal coronary events. Meta analysis suggests that increasing benefit accrues from larger reductions and also longer reductions in cholesterol by intervention. However, individual trials frequently show variable results and some, especially the recent 15 year follow up of a Finnish five year intervention (by diet, cholesterol lowering and blood pressure lowering drugs) was strikingly adverse—although the total number of events was not large. Total mortality is much harder to influence and the sum of the available trials is hopelessly inadequate in size to address these questions. As a result confusion abounds and is unlikely to be clarified by the present on going trials. The need for more data is clear. The pilot study for the Oxford Cholesterol Study will be presented as a prelude for a proposed main study in about 20 000 high risk individuals.     

Cholesterol absorption, synthesis, and fecal output in postmenopausal women with and without coronary artery disease

Hypercholesterolemia is a prominent risk factor for coronary artery disease (CAD), yet cholesterol metabolism has not been evaluated in women with CAD. The objective of this study was to determine the interrelations of CAD, serum squalene and sterols, and cholesterol metabolism with each other in postmenopausal women. For this purpose, we measured serum squalene and sterols and fecal steroids (cholesterol and bile acids) and squalene by gas-liquid chromatography and evaluated cholesterol absorption and synthesis in postmenopausal women with CAD (n=29) and age-matched controls (n=20). On similar dietary lipid intake, the cholesterol absorption efficiency and mean serum cholesterol level were comparable, but the squalene-to-cholesterol ratio was higher in cases than in controls. The presence of CAD was inversely associated with fecal total steroids (logistic regression coefficient beta/SE=-2.11, P=0.04) and cholesterol synthesis (beta/SE=-2.14, P=0.04) and turnover (beta/SE=-2.19, P=0.03) after adjustment for dietary cholesterol, family history of CAD, smoking, low and high density lipoprotein cholesterol, and serum triglyceride levels. A high serum squalene ratio was not related to cholesterol synthesis but was inversely related to fecal squalene excretion, which was lower in cases than in controls. In conclusion, the presence of CAD in postmenopausal women is independently associated with altered cholesterol metabolism, as reflected by low synthesis and inefficient elimination of cholesterol.     

Cholesterol in patients with coronary heart disease

CLINICAL PROBLEM: To examine the evidence supporting the recent National Cholesterol Education Program (NCEP) recommendation that low to moderate levels of cholesterol should be aggressively managed in patients with coronary heart disease (CHD). METHODS: Cohort studies and clinical trials with angiographic or clinical endpoints, that included CHD patients with low to moderate levels of cholesterol, were systematically identified through a MEDLINE search and critically reviewed. SYNOPSIS: None of the cohort studies show that a moderate level of cholesterol confers significantly increased risk of CHD death, although a pooled relative risk of 1.14 (95% CI 1.08 to 1.4) suggests that there may be a slight excess risk. Of five angiographic trials of CHD patients with moderate levels of cholesterol, two demonstrated no improvement in angiographic endpoints with intensive lipid-lowering therapy and the other three are difficult to interpret since they included other interventions in addition to the cholesterol-lowering regimen. No large clinical trial with clinical endpoints has been reported for CHD patients with low to moderate levels of cholesterol. RECOMMENDATIONS: The recommendation to treat CHD patients who have low to moderate levels of cholesterol with diet or drugs is not based on convincing evidence of efficacy. This is in clear contrast to the recommendation for CHD patients with high levels of cholesterol, for whom there is definitive clinical trial evidence of benefit from cholesterol-lowering therapy. While we await clinical trial results for CHD patients with low to moderate levels of cholesterol, clinicians and patients must consider the possible disadvantages of therapy in relation to the uncertain benefit. Received from the Section of General Internal Medicine, Department of Medicine, Veterans Affairs Medical Center, and the University of Minnesota School of Medicine, Minneapolis, Minnesota.     

Cholesterol and coronary heart disease prevention--A transatlantic consensus

Recent research findings have enhanced interest in coronaryheart disease prevention. Three expert panels, one in the UnitedStates and two in Europe, have addressed the subject and recommendedappropriate action. The report of the United States ConsensusConference on Lowering Blood Cholesterol appeared in 1985, andthe reports of the European Atherosclerosis Society and BritishCardiac Society appeared in 1987. We discuss these reports andemphasize the proposals concerning cholesterol. We review thescientific background to the decisions of the expert panels,high-risk and population-based strategies, cholesterol screeningand cholesterol reference levels for the initiation of treatmentand therapeutic goals. Dietary recommendations are highlightedand the attention given to special groups such as women, theelderly and children is appraised. Finally, the recommendationsof the reports regarding the other risk factors are discussed.We note the general consensus among them and outline the strategiesand guidelines which advocate concerted effort to reduce theburden of coronary heart disease.     

Association between very low density lipoprotein cholesterol and cholesterol absorption synthesis markers in patients with moderate and high risk of coronary heart disease

<正>Objective To evaluate the association between very low density lipoprotein cholesterol(VLDL-C)and cholesterol absorption and synthesis markers in patients with moderate and high risk of coronary heart disease.Methods A total of 363 statin-naive patients with moderate and high risk of coronary heart disease were consecutively recruited from two hospitals in Shanxi and Henan provinces