Hyperlipidemias: Cokkinos DV

Kolovou GD, Kostakou PM, Anagnostopoulou KK, Cokkinos DV. · 1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Am J Cardiovasc Drugs. · Pubmed #18690758 No free full text.

Abstract: Hypertriglyceridemia is observed in many metabolic diseases such as the metabolic syndrome, diabetes mellitus, or mixed dyslipidemia frequently leading to premature coronary heart disease (CHD). Additionally, several studies have shown that postprandial hypertriglyceridemia is pronounced in patients with CHD, metabolic syndrome, hypertension, and other pathologic conditions. The triglyceride-rich lipoprotein remnants accumulating in the postprandial state seem to be involved in atherogenesis and in events leading to thrombosis. Since abnormal postprandial lipemia is associated with pathologic conditions, its treatment is of clinical importance.Fibrates are of significant help in managing hypertriglyceridemia. This review summarizes the effect of fibric acid derivatives on postprandial lipemia. Fibrates decrease the production of and enhance the catabolism of triglyceride-rich lipoproteins through the activation of peroxisome proliferator-activated receptor-alpha. Results of clinical studies with fibrates have confirmed their action in decreasing postprandial triglyceride levels by increasing lipoprotein lipase activity, decreasing apolipoprotein CIII production, and by increasing fatty acid oxidation in the liver.It is concluded that fibrates are effective agents in lowering the postprandial increase in remnant lipoprotein particles and retinyl palmitate. Furthermore, fibrates can also affect the postprandial lipid profile by increasing hepatic lipase levels and in some cases, by reducing cholesterol ester transfer protein activity. The main target of fibrate therapy is to improve fasting hypertriglyceridemia, which is an essential component associated with improving postprandial lipemia. Fibrates are well tolerated by patients and adverse effects have been reported rarely after their administration.

Kolovou GD, Katerina A, Ioannis V, Cokkinos DV. · 1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Cardiovasc Ther. · Pubmed #18485137 No free full text.

Abstract: Simvastatin is an agent of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor group of drugs. It is administrated orally once a day in doses of 5-80 mg. Although its main action is to reduce total and low-density lipoprotein (LDL) cholesterol, it is able to reduce triglycerides and increase high-density lipoprotein cholesterol levels, though at a lower extent. Beyond this action, studies enrolled with simvastatin have shown beneficial effect on endothelial function, smooth muscle cell function, hemostasis, vascular wall function, LDL oxidation, and inflammation. All these actions mentioned above are known as pleiotropic effects. In this review, we will present all these effects, as well as the beneficial effects on atherogenesis and the reduction in cardiovascular morbidity and mortality related to simvastatin.

Kolovou GD, Anagnostopoulou KK, Daskalopoulou SS, Mikhailidis DP, Cokkinos DV. · Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Curr Med Chem. · Pubmed #16101498 No free full text.

Abstract: Several studies showed that after a fatty meal, plasma triglyceride (TG) levels are higher in patients with coronary heart disease. This abnormality may explain why some individuals develop atherosclerotic disease despite normal fasting lipid values. TG-rich lipoproteins are involved in atherosclerosis and thrombosis. TG, remnant-like particle (RLP) cholesterol (RLP-C) and RLP-TG increase after fat load and could contribute to atherothrombosis. Postprandial lipaemia is not a uniform abnormality. Its pathophysiology is not yet entirely clarified; possibly, the response to dietary fat is a polygenic phenomenon. However, a link with insulin resistance is likely; this link as well as that with obesity is discussed. A substantial part of life is spent in the postprandial state. Therefore, several investigators described fat load tests. However, it is still difficult to establish normal postprandial TG ranges since only small numbers of subjects were studied and there is as yet no standardised method. A more simplified fat load test should be established for 'routine' use. In this review, we consider the metabolic features, prevalence and management of postprandial lipaemia. Treatment may involve lifestyle measures as well as the use of lipid lowering (e.g. fibrates or statins), weight reducing and hypoglycaemic drugs.

Kolovou GD, Anagnostopoulou KK, Cokkinos DV. · 1st Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece. <> · Postgrad Med J. · Pubmed #15937200 links to  free full text

Abstract: The insulin resistance/metabolic syndrome is characterised by the variable coexistence of hyperinsulinaemia, obesity, dyslipidaemia, and hypertension. The pathogenesis of the syndrome has multiple origins, but obesity and sedentary lifestyle coupled with diet and still largely unknown genetic factors clearly interact to produce the syndrome. Dyslipidaemia, the hallmark of the metabolic syndrome, includes increased flux of free fatty acids, raised triglycerides, apolipoprotein B, and small dense low density lipoprotein, and decreased high density lipoprotein cholesterol. The widely prevalent nature of the metabolic syndrome emphasises the importance of its diagnosis and treatment. This review analyses the clinical and dynamic features of this syndrome in the aspect of dyslipidaemia and its management.

Kolovou GD, Cokkinos DV. · First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Curr Med Res Opin. · Pubmed #12240788 No free full text.

Abstract: Low serum levels of high-density lipoprotein (HDL) cholesterol is an independent risk factor for coronary artery disease. Raising HDL cholesterol should be an important therapeutic goal in patients with coronary artery disease. Fibrates can reduce the risk of cardiac events and death from coronary artery disease.

Kolovou GD, Anagnostopoulou KK, Pilatis ND, Giannopoulou M, Hoursalas IS, Pavlidis AN, Adamopoulou E, Valaora AI, Mikhailidis DP, Cokkinos DV. · 1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · J Womens Health (Larchmt). · Pubmed #15650345 No free full text.

Abstract: BACKGROUND: Heterozygous familial hypercholesterolemia (hFH) is a genetic disease that leads to premature atherosclerosis. Natural menopause leads to an adverse lipid profile and an enhanced risk of coronary heart disease (CHD). Raised plasma triglyceride (TG) levels also contribute to the risk of vascular events. The aim of this study was to evaluate the postprandial TG levels (after a standardized fatty meal) in premenopausal and postmenopausal women with hFH. METHODS: Thirty-three Greek women with hFH were divided into the premenopausal group--n = 16, mean age 34(SD = 7), mean total cholesterol = 330(30) mg/dl--and the postmenopausal group--n = 17, mean age 62(5), mean total cholesterol = 346(63) mg/dl. Plasma TG concentrations were measured before and 2, 4, 6, and 8 hours after a standardized fat load. A value of >219 mg/dl (2.5 mmol/L) was taken as an abnormal response to the fat load, according to our previous studies. RESULTS: Postmenopausal women had higher TG levels at 2 (p = 0.001), 4 (p = 0.003), 6 (p = 0.003), and 8 hours (p = 0.005) after the fatty meal compared to premenopausal women. Forty-one percent of postmenopausal hFH women had abnormal TG response (hFH-A) after a fatty meal, and such women had higher fasting TG levels than postmenopausal hFH women with a normal response to the fatty meal (hFH-N) (p = 0.0014). CONCLUSIONS: Women with hFH tend to have an abnormal TG response to a fatty meal after the menopause. Fasting TG levels may be able to predict the abnormal response to a fatty meal.

Kolovou GD, Salpea KD, Mihas C, Malakos I, Kafaltis N, Bilianou HG, Adamopoulou EN, Mykoniatis M, Cokkinos DV. · 1st Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece. · Hellenic J Cardiol. · Pubmed #18459464 links to  free full text

Abstract: INTRODUCTION: Previous studies of ours have shown that simvastatin (S) and nicotinic acid (NA) lower the alcohol (Alc)-induced increase of triglycerides. The aim of this study was to evaluate which drug is more effective and safe in decreasing Alc-induced hypertriglyceridaemia in Wistar rats. METHODS: Male Wistar rats were randomised into 6 groups, which were fed with: (1) olive oil (Oil group, n=10); (2) Oil + Alc, (Alc group, n=10); (3) S solution in Oil (65 microg/100g body weight), (S group, n=10); (4) NA solution in Oil (8.5 mg/100g body weight), (NA group, n=8); (5) S solution in Oil + AIc (S+Alc group, n=10); and (6) NA solution in Oil + Alc (NA+Alc group, n=9). Another 13 male Wistar rats were fed only a standard laboratory diet (control group). After 8 weeks, blood samples were drawn and the livers were removed. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), total cholesterol (TC) and triglycerides (TG) were measured. Liver histopathology was also assessed. RESULTS: Liver histopathology was similar in all groups and within the normal range. The TG plasma concentration in the Alc group was higher than in the control rats (p < 0.001) or any other groups (Oil, p < 0.001, or S, p < 0.001, or NA, p = 0.003). The Oil, S+Alc, NA+Alc and control groups had similar TG levels, but these were significantly lower compared to the Alc group (p < 0.001). AST plasma concentration was higher in the Alc group compared to controls (p < 0.001), Oil (p < 0.001), S (p < 0.001) and NA (p < 0.001) groups, while the AST concentration in the S+Alc and Na+Alc groups was lower than in the Alc group (p = 0.042, p < 0.001, respectively). CONCLUSIONS: NA and S, two drugs of different classes, seem to decrease Alc-induced secondary hypertriglyceridaemia to the same extent. Moreover, NA displays a better alleviation of Alc-induced AST raises compared to S, although it enhances small increases in AP and ALT levels.

Kolovou GD, Anagnostopoulou KK, Damaskos DS, Mihas C, Mavrogeni S, Hatzigeorgiou G, Theodoridis T, Mikhailidis DP, Cokkinos DV. · First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Ann Clin Lab Sci. · Pubmed #18000290 No free full text.

Abstract: The aim of this study was to evaluate the influence of gender differences on triglyceride (TG) response after a fatty meal in clinically defined heterozygous (h) patients with familial hypercholesterolemia (FH). Nineteen hFH men were age-matched with an equal number of premenopausal women. Plasma TG was measured before and 2, 4, 6, and 8 hr after a standardized fat load. The men with hFH had a greater body mass index (BMI) than hFH women. An abnormal postprandial response was observed in 63% and 16% of hFH men and women, respectively. The mean TG-area under the curve value was higher in hFH men compared to hFH women. Both gender (p = 0.032) and BMI (p = 0.006) equally affected postprandial TG response, but fasting TG levels (p <0.001) were the main determinant. In summary, hFH men have higher BMI, fasting TG level, and postprandial TG level, compared to age-matched premenopausal hFH women, which may partially explain the earlier onset of coronary heart disease in hFH men.

Anagnostopoulou K, Kolovou G, Kostakou P, Mihas C, Mikhailidis D, Cokkinos DV. · Onassis Cardiac Surgery Center, 1st Cardiology Department, 356 Sygrou Avenue, 176 74 Athens, Greece. · Expert Opin Pharmacother. · Pubmed #17931083 No free full text.

Abstract: OBJECTIVE: To examine the effect of the I405V and TaqIB polymorphisms of cholesteryl ester transfer protein (CETP) on the lipid response after simvastatin treatment in 180 hypercholesterolaemic patients. METHODS: Hypercholesterolaemic patients (n = 180) attending the lipid clinic at the Onassis Cardiac Surgery Center were genotyped and their response to simvastatin was evaluated. RESULTS: Sequence variations in the CETP gene influenced the effect of lipid-lowering treatment. Specifically, the I allele of the I405V polymorphism was associated with a greater reduction in triglyceride (TG; p = 0.04) and a significant increase in high-density lipoprotein cholesterol (HDL-C) levels (p = 0.05) after treatment compared with the V allele. CONCLUSIONS: The authors' findings suggest that CETP I405V polymorphism modifies the effect of simvastatin on TG reduction and HDL-C elevation; the carriers of the I allele responded better to treatment. These findings need to be confirmed in larger studies.

Kolovou G, Anagnostopoulou K, Kostakou P, Marvaki C, Mihas C, Mikhailidis DP, Cokkinos DV. · 1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Clin Chem Lab Med. · Pubmed #17848121 No free full text.

Abstract: BACKGROUND: We examined the influence of cholesteryl ester transfer protein TaqIB polymorphism on triglyceride (TG) response to an oral fat tolerance test (OFTT) in patients heterozygous for familial hypercholesterolemia (hFH). METHODS: We genotyped 67 hFH patients (32 men and 35 postmenopausal women) who were subjected to an OFTT. RESULTS: All B1 allele carriers had lower high-density lipoprotein cholesterol (HDL-C) levels (p=0.013) and higher postprandial TG response at 6 and 8 h (p=0.05 and p=0.04, respectively) compared to B2 allele carriers. Multiple regression analysis showed that in the hFH group with a positive response, the presence of the B2 allele was significantly related to lower levels of TG-area under the curve (AUC) (p<0.01) compared to B1, adjusting for age, gender and body mass index. In the hFH group with a negative response, although age and female gender had a significant effect on TG-AUC levels (p<0.01 for both), the allele type was not significantly related to the TG-AUC levels (p=0.99). CONCLUSIONS: B2 carriers had a lower postprandial TG response compared to B1 carriers. There were no differences in TG levels between B1 and B2 carriers in patients with a negative OFTT response. Therefore, at higher TG concentration, the B2 allele may protect against an exaggerated postprandial TG increase and subsequent lowering of HDL-C.

Kolovou GD, Dedoussis GV, Anagnostopoulou KK, Hatzigeorgiou GCh, Salpea KD, Choumerianou DM, Rammos S, Mikhailidis DP, Cokkinos DV. · 1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Angiology. · Pubmed #17235114 No free full text.

Abstract: A 13-year-old Greek boy with severe dyslipidemia, large tuberous xanthomas over the knees and elbows, Achilles' tendon xanthomas, and a bilateral corneal arcus was referred to the Lipid Clinic. He had a supravalvular aortic stenosis, 50% to 60% stenosis of both carotid arteries, and normal coronary arteries. Familial hypercholesterolemia was clinically diagnosed. A V408M null low-density lipoprotein receptor (LDLR) mutation was identified in homozygosity. He responded to lipid-lowering drugs by decreasing total cholesterol by 32%, low-density lipoprotein cholesterol by 33%, and triglyceride levels by 30%. Additional treatment with low-density lipoprotein-apheresis further decreased total cholesterol by 52%, low-density lipoprotein cholesterol by 55%, and triglycerides by 43%. Low-density lipoprotein cholesterol levels between apheresis sessions showed a declining pattern. A significant regression of tuberous xanthomas was noted. A suitable combination of lipid-lowering drugs is effective even in this case of homozygosity for a null LDLR mutation. Furthermore, the coadministration of statins, cholestyramine, and ezetimibe during low-density lipoprotein-apheresis tends to counterbalance the postapheresis relapse in low-density lipoprotein cholesterol levels.

Kolovou GD, Anagnostopoulou KK, Pavlidis AN, Salpea KD, Iraklianou SA, Hoursalas IS, Mikhailidis DP, Cokkinos DV. · First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Eur J Cardiovasc Prev Rehabil. · Pubmed #16874161 No free full text.

Abstract: BACKGROUND: Postprandial hyperlipidaemia may be a predictor of vascular risk. DESIGN: We evaluated postprandial lipaemia after an oral fat tolerance test (OFTT) in men (n=41) and women (n=21) with metabolic syndrome (MetS). METHODS: Triglyceride (TG) levels were measured before and 2, 4, 6 and 8 h after the fat load. RESULTS: Men showed a greater plasma TG response 8 h after the fat load (284+/-117 versus 224+/-126 mg/dl, P=0.029). Only fasting TG levels significantly predicted the TG area under the curve (AUC) and incremental AUC. CONCLUSIONS: Men had a more pronounced postprandial hypertriglyceridaemia and seem to have delayed TG clearance.

Kolovou GD, Anagnostopoulou KK, Salpea KD, Hoursalas IS, Petropoulos I, Bilianou HI, Damaskos DS, Giannakopoulou VN, Cokkinos DV. · Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Hellenic J Cardiol. · Pubmed #16752527 links to  free full text

Abstract: INTRODUCTION: The present investigation aimed to evaluate the influence of serum triglycerides (TG) on other plasma lipids in male patients less than 65 years of age intended for hypolipidaemic treatment. METHODS: Lipid profiles of a cohort of 412 dyslipidaemic male patients aged 53.4 +/- 7.7 years (mean +/- standard deviation) were evaluated. Patients were stratified in accordance with their fasting plasma lipid levels. They were divided into multiple groups on the basis of serum TG (> or = 150 or < 150 mg/dl) and high-density lipoprotein cholesterol (HDL-C > or = 40 or < 40 mg/dl). RESULTS: Patients with TG > or = 150 mg/dl had higher total cholesterol and lower HDL-C levels compared with those with TG < 150 mg/dl (p = 0.005 and p < 0.001, respectively). Patients with HDL-C < 40 mg/dl had similar total cholesterol levels and higher TG levels compared to those with HDL-C > or = 40 mg/dl (p < 0.001). In all patients, an inverse correlation between TG and HDL-C was found (r = -0.286, p < 0.001). Additionally, HDL-C levels were inversely correlated with the TG concentration in patients with TG < 150 mg/dl (r = -0.135, p = 0.042) and TG > or = 150 mg/dl (r = -0.188, p = 0.002). CONCLUSIONS: An inverse correlation between TG and HDL-C levels seems to exist in the sampled population, revealing a close link between the metabolic pathways for TG and HDL-C. This inverse correlation appears to persist even in patients with low fasting TG levels.

Daskalova DC, Kolovou GD, Panagiotakos DB, Pilatis ND, Cokkinos DV. · Cardiology Department, Onassis Cardiac Surgery Center, Harokopio University, University Medical School, Athens, Greece. · Clin Cardiol. · Pubmed #16405202 No free full text.

Abstract: BACKGROUND: Aortic pulse wave velocity (aPWV), an index of aortic distensibility, and postprandial hypertriglyceridemia are recognized as independent cardiovascular risk factors. HYPOTHESIS: The aim of this study was to evaluate the relationship between postprandial hypertriglyceridemia and changes in aPWV. METHODS: We prospectively studied 45 patients (mean age 48 [14] years, 28.9% men), who were submitted to a standardized fat meal (FM) test. According to their triglyceride (TG) levels 2, 4, 6, and 8 h after the FM, the patients were divided into two groups: Group 1 (31 patients) with postprandial TG levels < or = 219 mg/dl, and Group 2 (14 patients) with TG levels > 219 mg/dl at one of the aforementioned time intervals. Before and 6 h after the FM, aPWV was measured noninvasively. RESULTS: Baseline characteristics in the two groups were similar, except for higher TG, pulse pressure, waist-to-hip ratio, percentage of patients who smoked or had arterial hypertension, and lower high-density lipoprotein cholesterol levels in Group 2. Postprandially, aPWV was higher in Group 2 [11.2(2.7) vs. 9.1(2.1) m/s, p = 0.004]. Changes in aPWV correlated with TG changes from baseline to 6 h after FM (r = 0.539, p < 0.001) and with the areas under the TG curve (r = 0.617, p < 0.001). A postprandial TG increase of 100 mg/dl resulted in a 0.88 m/s rise of aPWV. CONCLUSION: An increase in aPWV 6 h after an FM test correlates positively with abnormal postprandial hypertriglyceridemia. These relationships, reported here for the first time, could be of practical use for better evaluation of patient prognosis.

Kolovou GD, Anagnostopoulou KK, Pilatis ND, Iraklianou S, Hoursalas IS, Liberi S, Pavlidis AN, Dritsas A, Mikhailidis DP, Cokkinos DV. · Cardiology Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece. · Int J Clin Pract. · Pubmed #15857328 No free full text.

Abstract: Familial hypercholesterolaemia (FH) is associated with premature coronary heart disease (CHD). Post-prandial hypertriglyceridaemia has also been associated with cardiovascular disease. Thus, an abnormal post-prandial triglyceride (TG) clearance may contribute to the heterogeneity in the risk of CHD in heterozygous (h) FH. Therefore, we investigated the response of TG levels to a fatty meal in men with hFH. We studied 26 Greek men divided into two groups: the hFH group of 14 men, mean age 39 (SD = 11) years and the control group of 12 healthy men, mean age 43 (50:5) years. An increased TG response to the fatty meal was defined as a post-prandial TG concentration (at 4, 6 or 8 h) greater than the highest TG concentration in any hour in any control individual. All hFH patients had normal baseline fasting TG levels. However, seven hFH men showed an abnormal TG response after the fatty meal; these patients had higher baseline fasting TG levels than others [1.5 (0.2) vs. 1.0 (0.4) mmol/l, p = 0.005]. The hFH men constituted a heterogeneous group regarding their TG response to the fatty meal compared with healthy men because 50% with higher, but nevertheless 'normal' basal TG levels, had an abnormal post-prandial TG response. The reduced activity of low-density lipoprotein receptors in hFH together with other defects in TG handling may explain the abnormal rise of TG levels post-prandially.

Kolovou G, Daskalova D, Mastorakou I, Anagnostopoulou K, Cokkinos DV. · 1st Cardiology Department of the Onassis Cardiac Surgery Center, Athens, Greece. · Angiology. · Pubmed #15156269 No free full text.

Abstract: Familial hypercholesterolemia (FH) is a relatively common autosomal monogenic disease with dominant inheritance and threefold to fourfold increase in relative risk of cardiovascular death in untreated patients. For a "definitive" clinical diagnosis of FH the Simon Broome Register proposes the presence of tendon xanthomas as a key feature. However, detection of tendon xanthomas by physical examination is subjective and difficult to use for follow-up purposes. Several instrumental methods have been reported to be more sensitive than physical examination for the evaluation of xanthomas. The present case illustrates the usefulness of computed tomography (CT) to detect xanthomas in the Achilles tendons (XAT) and their regression in response to hypolipidemic drug treatment in a heterozygous FH patient. As XAT are atherosclerotic plaque-like depositions of lipids it is likely that their progression or regression follows the behavior of vascular atherosclerotic lesions.

Kolovou G, Daskalova D, Anagnostopoulou K, Hoursalas I, Voudris V, Mikhailidis DP, Cokkinos DV. · Cardiology Department, Onassis Cardiac Surgery Centre, 17674 Athens, Greece. · J Clin Pathol. · Pubmed #14645354 links to  free full text

Abstract: BACKGROUND: Tangier disease (TD) is the phenotypic expression of rare familial syndromes with mutations in the ABCA1 transporter. TD results in extremely low high density lipoprotein (HDL) cholesterol and reduced low density lipoprotein cholesterol, with normal or mildly increased fasting triglyceride (TG) concentrations. Although there is a close relation between HDL cholesterol values and atherogenesis, the risk of coronary artery disease is variable in TD. Raised fasting or postprandial TG values frequently accompany low HDL cholesterol and can add to the risk of a vascular event. AIMS: To investigate the postprandial TG response in TD. PATIENTS AND METHODS: Five patients (three homozygotes (HTD) and two heterozygotes (hTD)) from one family were studied. One was defined by DNA analysis as homozygous for a new mutation (C2033A) resulting in truncation of the ABCA1 protein. Their TG concentrations were measured before and four, six, and eight hours after a standardised fat load and compared with a control group. RESULTS: Two patients with HTD had high fasting TG concentrations. The third patient with HTD, the two with hTD, and the control group had TG concentrations within the reference range. The patients with HTD had increased postprandial peak TG values when compared with those with hTD and controls. CONCLUSION: Patients with HTD, with or without fasting hypertriglyceridaemia, may have an increased TG response to a fatty meal. The small number of patients does not allow definitive conclusions to be made. However, postprandial hypertriglyceridaemia could be a reason why some patients with TD develop premature atherosclerosis.

Kolovou GD, Daskalova DC, Petropoulos II, Anagnostopoulou KK, Bilianou HI, Pilatis ND, Pavlidis AN, Cokkinos DV. · First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. · Am J Cardiol. · Pubmed #14636917 No free full text.

Abstract: The response of high-density lipoprotein cholesterol to hypolipidemic monotherapy with diet, statins, fibrates, or nicotinic acid was investigated prospectively in 801 patients with dyslipidemia. We hypothesized that the behavior of high-density lipoprotein cholesterol after treatment would depend on its baseline levels and the therapy used.

Kolovou GD, Damaskos DS, Anagnostopoulou KK, Salpea KD, Dritsas A, Giannakopoulou V, Vasiliadis IK, Cokkinos DV. · No affiliation provided · Int J Cardiol. · Pubmed #17239976 No free full text.

Abstract: We evaluated 62 exercise treadmill tests (ETTs) in equal numbers of heterozygous for familial hypercholesterolemia (hFH) and healthy (HLY) women, matched for age, baseline systolic and diastolic blood pressure (BP) and baseline heart rate (HR), using the Bruce protocol. Both groups had similar rate pressure product (RPP) and workload in metabolic equivalents (METs) (27,563+/-3124 vs. 29,090+/-4077, p=0.103 and 11.2+/-1.7 vs. 11.5+/-1.8, p=0.473, respectively). Women with hFH had lower delta (difference of peak to baseline) and peak exercise systolic and diastolic BP (systolic: 48+/-12 vs. 58+/-17 mmHg, p=0.010 and 167+/-19 vs. 177+/-17 mmHg, p=0.042, respectively; diastolic: 11+/-7 vs. 15+/-7 mmHg, p=0.028 and 85+/-7 vs. 91+/-7 mmHg, p<0.001, respectively). Furthermore, women with hFH had higher delta percentage (%) of HR, compared to HLY; (106+/-25 vs. 95+/-20, p=0.047). In conclusion, hFH women possibly have an inadequate rise in systolic BP during ETT. Diastolic BP increased more in the HLY than in the hFH group, but still remained within normal limits. These findings may reflect preclinical changes of atherosclerosis in hFH women, however further research should be undertaken.