Hypercholesterolemia: Ansell BJ

Ansell BJ, Waters DD, Anonymous00316. · No affiliation provided · Am J Cardiol. · Pubmed #12208415 No free full text.

This publication has no abstract.

Ansell BJ, Fonarow GC, Fogelman AM. · Atherosclerosis Research Unit, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. · Curr Opin Lipidol. · Pubmed #17620860 No free full text.

Abstract: PURPOSE OF REVIEW: This review addresses how, in atherosclerosis or systemic inflammation, HDL can lose its usual atheroprotective characteristics and even paradoxically assume proinflammatory properties. RECENT FINDINGS: Specific chemical and structural changes within HDL particles can impede reverse cholesterol transport, enhance oxidation of LDL, and increase vascular inflammation. HDL may be viewed as a shuttle that can be either anti-inflammatory or proinflammatory, depending on its cargo of proteins, enzymes, and lipids. Some therapeutic approaches that reduce coronary risk, such as statins and therapeutic lifestyle changes, can favorably moderate the characteristics of proinflammatory HDL. In addition, apolipoprotein A-I mimetic peptides and other compounds that target functional aspects of HDL may offer novel approaches to reduction in cardiovascular risk. SUMMARY: Current data suggest that under some conditions HDL can become dysfunctional and even proinflammatory, but this characterization can change with resolution of systemic inflammation or use of certain treatments.

Ansell BJ. · Center for Primary-Care Based Cardiovascular Disease Prevention, Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles School of Medicine, USA. · Am J Cardiol. · Pubmed #11520484 No free full text.

Abstract: Recent clinical trials have supported the use of cholesterol-lowering therapies to reduce cardiovascular events. Despite these results, a number of unanswered questions remain, including the appropriate intensity of lipid-lowering therapy and the role of high-density lipoprotein cholesterol and/or triglycerides in cardiovascular risk assessment and reduction. In addition, the optimal treatment strategies for women, the elderly, and patients with diabetes are more difficult to determine, as these groups have comprised a minority of subjects in prior trials. Studies in progress will provide guidance toward effective treatment of these populations, the appropriate degree of lipid-lowering therapy, and the role of estrogen replacement therapy in postmenopausal women. In the interim, a clinical strategy incorporating the lessons of recent clinical evidence is suggested.

Ansell BJ. · UCLA School of Medicine, Department of Internal Medicine, Division of General Internal Medicine/Health Services Research, 200 UCLA Medical Plaza, Suite 370-8, Los Angeles, CA 90095, USA. · Curr Atheroscler Rep. · Pubmed #11122730 No free full text.

Abstract: Serum cholesterol traditionally has been considered a poor predictor of total stroke risk; however, it is associated positively with ischemic stroke risk and associated negatively with hemorrhagic stroke risk. Although studies failed to demonstrate stroke reduction using older cholesterol-lowering medications, recent study of the statin class of medications shows both consistent stroke and other cardiovascular benefits. Ischemic stroke and coronary heart disease share similar underlying mechanisms, likely explaining much of the therapeutic benefit from statins. Current research is directed at further determining groups of patients most likely to benefit from lipid reduction in stroke prevention. In the interim, patients with established atherosclerosis should be treated with a statin to achieve a low-density lipoprotein cholesterol level less than 100 mg/dL.

Ansell BJ, Watson KE, Fogelman AM. · Division of General Internal Medicine/Health Services Research, University of California, Los Angeles, School of Medicine, 90095, USA. · JAMA. · Pubmed #10591388 links to  free full text

Abstract: CONTEXT: The Second Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) was issued without the benefit of multiple recently published large clinical trials. OBJECTIVE: To analyze the panel's guidelines for treatment of high cholesterol levels in the context of currently available clinical trial results. DATA SOURCES: MEDLINE was searched for all English-language clinical trial data from 1993 through February 1999 relating to the effects of cholesterol treatment on cardiovascular clinical outcomes. STUDY SELECTION: Studies that were selected for detailed review assessed the effects of cholesterol lowering on either coronary events, coronary mortality, stroke, and/or total mortality, preferably by randomized, double-blind, placebo-controlled design. Selection was by consensus of a general internist, a lipid clinic director, and a researcher in atherosclerotic plaque biology. A core of 37 of the 317 initially screened studies were selected and used as the primary means by which to assess the guidelines. DATA EXTRACTION: By consensus of the group, only prespecified end points of trials were included, unless post hoc analysis addressed issues not studied elsewhere. DATA SYNTHESIS: Recent clinical trial data mostly support the Adult Treatment Panel II guidelines for cholesterol management. While existing trials have validated the target low-density lipoprotein cholesterol (LDL-C) goals in the report, studies are lacking that address mortality benefit from reduction below these levels. Few lipid-lowering trials have treated patients with low high-density lipoprotein cholesterol and/or elevated triglyceride levels with LDL-C levels at or below treatment goals. CONCLUSIONS: Lipid-lowering therapy generally should be more aggressively applied to patients with diabetes and/or at the time of coronary heart disease (CHD) diagnosis. The evidence for statin use in secondary CHD prevention in postmenopausal women outweighs current evidence for use of estrogen replacement in this setting. Further studies are needed to address the effects of lipid modification in primary prevention of CHD in populations other than middle-aged men and to study markers of lipid metabolism other than LDL-C.