Cholesterol

An ultimate cholesterol-lowering plan is urgently needed!

Coronary heart disease (CHD) remains the UK’s number one killer, affecting over 2.8 million people and causing almost 100,000 deaths a year.1 This is despite an overall reduction since the 1970’s through the introduction of statins, improved screening and treatment and an increase in smoking cessation. Although many risk factors have to be taken into consideration, an elevated serum cholesterol level, which affects two out of every three UK adults, remains the single biggest modifiable risk factor for CHD.1,2 Dietary intervention should always be first-line treatment with or without statin therapy. However, there is clearly a need for a diet renaissance – providing patients with a diet that is not only realistic, but one that delivers impactful cholesterol-lowering results.

Managing low HDL cholesterol: need for newer options!

High-density lipoprotein (HDL) particles constitute a heterogeneous family of circulatinglipoproteins composed of amphipathic apoproteins complexed to a monolayer of phospholipidswith a central core of free cholesterol, cholesterol esters (CE) and/or triglycerides. Analyses of theprotein components have identified up to 75 different subpopulations of these particles.However, there are 2 major sub-categories: 1: a dense CE-depleted, protein-rich HDL3 particle (pre-Î² HDL) and 2: a large CE-enriched HDL2 particle (Î±- HDL).Apart from its role in reverse cholesterol transfer (RCT) which involves the transport of cholesterol from lipid-laden foam cells(macrophages) in the arterial endothelium or peripheral cells to the liver for excretion orrecycling, the HDL particle has been shown to have a wide range of properties which includeanti-thrombogenic, anti-inflammatory, anti-oxidative, anti-platelet and vasodilatory functions.HDL may also stimulate insulin synthesis in pancreatic Î² cells.

EDUCATIONAL SERIES ON HDL-C | Targeting low HDL cholesterol: why, who and how

The new coalition government of the United Kingdom (UK) has announced plans to change the NHS radically in England. The Department of Health has published two important documents – Equity and excellence: liberating the NHS and Liberating the NHS: commissioning for patients. The implications for primary and secondary care, and for local authorities, mental health services and community providers, will be enormous. The changes are taking place at a rapid pace and every manager and clinician in the NHS will need to keep abreast of developments as they will affect the way in which we all deliver services in the future.

HDL cholesterol and cardiovascular risk: the case for intervention

Statin therapy, optimally applied, lowers LDL cholesterol and reduces cardiovascular risk by 30-50%. This leaves a residual risk that needs tobe addressed by other interventions. The well-documented strong, inverse relationship between cardiovascular risk and HDL cholesterolconcentration, at all levels of LDL cholesterol, suggests that there may be further benefits from raising HDL cholesterol – the HDL hypothesis.Definitive proof, however, awaits the results of ongoing major outcomes studies.

Solving your cholesterol conundrums: Case studies in lipid management for primary care today

The benefits of lowering low-density lipoprotein (LDL) cholesterol with statin therapy for cardiovascular disease (CVD) prevention are well established. Recent guidelines from the National Institute for Health and Clinical Excellence (NICE) have emphasised the importance of achieving lower lipid levels, by adopting targets of 4 mmol/L for total cholesterol and 2 mmol/L for LDL cholesterol […]

Cholesterol conundrums: juggling patients’ risk factors to optimise lipid lowering therapy

*The British Journal of Primary Care Nursing approached Merck Sharp & Dohme Limited to fund the production of this supplement following a meeting the company supported at the Primary Care Cardiovascular Society (PCCS) Conference 2009. The company was not involved in development, although it was asked to review the supplement for technical accuracy just prior to printing. Editorial control has remained with the British Journal of Primary Care Nursing at all times.

Omega-3 fatty acids: optimising their use in cardiovascular disease and diabetes

*The British Journal of Primary Care Nursing approached Abbott Healthcare Products Limited to fund the production of this supplement. The company was not involved in its development, although it was asked to review it for technical accuracy just prior to printing. Editorial control has remained with the British Journal of Primary Care Nursing at all times.

Making sense of HDL cholesterol

New drug review

Tredaptive: treating raised LDL-cholesterol and beyondGeorge Kassianos

Significant reductions in cardiovascular risk have been achieved over the past 20 years using statins to reduce levels of low-density lipoprotein (LDL) cholesterol and total cholesterol. However, there is growing evidence that managing only this lipid fraction may not optimally reduce patients’ CVD risk, particularly in those with type 2 diabetes or the metabolic syndrome. Low levels of high-density lipoprotein (HDL) cholesterol and raised triglycerides are important, but often overlooked, elements of the dyslipidaemic profile that commonly occur in these patients. Tredaptive offers the potential for reaching optimal nicotinic acid dosage and thereby a convenient option for achieving significant improvements on all three fronts of lipid modification – LDL cholesterol, HDL cholesterol and triglycerides, primarily because of significant reduction in the most troublesome sideeffect of nicotinic acid, facial flushing.

Tredaptive: treating raised LDL-cholesterol and beyond

Making sense of HDL cholesterol in cardiovascular risk

Lowering LDL cholesterol (LDL-C) with statins for the prevention of cardiovascular disease (CVD) has rightly become a core activity for primary care health professionals. However, despite effective lowering of LDL-C, many patients still suffer cardiovascular events. Experts have called this ‘the residual risk’ and have speculated whether further cardiovascular events can be prevented by attention to other lipoprotein fractions, particularly HDL cholesterol (HDL-C).

Triglycerides: Making Sense Of The Sometimes Forgotten Lipid Fraction

The importance of lowering total and LDL cholesterol (LDL-C) in the prevention of cardiovascular disease (CVD) is so firmly established that it has,in only a short time, become part of everyday practice for all primary care health professionals.Lipids,of course,come in multiple forms,which include fatty acids,the different forms of cholesterol and triglycerides.Most practitioners have only a sketchy idea of what triglycerides are,what they do and how important they are.Few understand the intricacies of measurement, diagnosis and interpretation,and when – and how – to manage them.The story is complex and involves difficult biochemical and metabolic concepts,so we should begin at the beginning.

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