Hyperlipidemias: United Kingdom

Ceriello A. · Warwick Medical School, Clinical Sciences Research Institute, University Hospital, Coventry, Warwickshire, UK. · Diabetes Metab Res Rev. · Pubmed #17990280 No free full text.

Abstract: In the last few years, there has been increasing focus on the impact of interventions on cardiovascular outcomes in patients with type 2 diabetes. Insulin resistance and hyperglycaemia often co-exist with a cluster of risk factors for coronary artery disease, but the underlying mechanisms leading to the development of such vascular complications are complex. The over-production of free radicals in patients suffering from diabetes results in a state of oxidative stress, which leads to endothelial dysfunction and a greater risk of atherosclerosis. Moreover, inflammatory factors which play a critical role in atherothrombosis and plaque rupture are often found to be at elevated levels in this patient population.Thiazolidinediones (TZDs) are now routinely used to manage glucose levels, and have been suggested to influence other cardiovascular risk factors and therefore the pathways leading to macrovascular events. Consequently, recent studies have investigated the anti-inflammatory and anti-atherogenic properties of TZDs. The data available up to the present time, in the context of the emerging cardiovascular outcome profiles of rosiglitazone and pioglitazone, will be discussed here.

Pittler MH, Ernst E. · Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, UK. · Mol Nutr Food Res. · Pubmed #17918163 No free full text.

Abstract: The objective of this review is to update and assess the clinical evidence based on rigorous trials of the effectiveness of garlic (A. sativum). Systematic searches were carried out in Medline, Embase, Amed, the Cochrane Database of Systematic Reviews, Natural Standard, and the Natural Medicines Comprehensive Database (search date December 2006). Our own files, the bibliographies of relevant papers and the contents pages of all issues of the review journal FACT were searched for further studies. No language restrictions were imposed. To be included, trials were required to state that they were randomized and double blind. Systematic reviews and meta-analyses of garlic were included if based on the results of randomized, double-blind trials. The literature searches identified six relevant systematic reviews and meta-analysis and double-blind randomized trials (RCT) that were published subsequently. These relate to cancer, common cold, hypercholesterolemia, hypertension, peripheral arterial disease and pre-eclampsia. The evidence based on rigorous clinical trials of garlic is not convincing. For hypercholesterolemia, the reported effects are small and may therefore not be of clinical relevance. For reducing blood pressure, few studies are available and the reported effects are too small to be clinically meaningful. For all other conditions not enough data are available for clinical recommendations.

Lobstein T, Jackson-Leach R. · International Obesity TaskForce, London, UK. · Int J Pediatr Obes. · Pubmed #17902213 No free full text.

Abstract: OBJECTIVES: Obesity in childhood is associated with the presence of risk factors for later disease and with the early development of these diseases. This paper aims to estimate the numbers of children with obesity-related disease risk factors and co-morbidities in the European Union (EU). METHODS: A search of the scientific literature identified prevalence rates relating variously to impaired glucose tolerance, hyperinsulinaemia, type 2 diabetes, several cardiovascular risk factors, non-alcoholic fatty liver disease, and the metabolic disease syndrome among obese children. Using the lowest likely prevalence rates for each disease indicator, estimates were made of the expected numbers of obese children within the EU likely to be showing the specified indicator. RESULTS: On the most conservative estimate, over 20 000 obese children in the EU have type 2 diabetes, while over 400 000 have impaired glucose tolerance. Over a million obese children are likely to show a range of indicators for cardiovascular disease, including hypertension and raised blood cholesterol levels, and have three or more indicators of the metabolic syndrome. Over 1.4 million may have early stages of liver disorder. CONCLUSIONS: Although there will be considerable overlap in the numbers of obese children with the various risk factors described, the estimated burden of disease indicators among obese children is high. Paediatric services need to consider their ability to screen and treat children if we are to avoid a substantial rise in chronic obesity-related disease among young adults over the next decade.

Guthrie B, Inkster M, Fahey T. · Community Health Sciences, University of Dundee, Dundee DD2 4BF. · BMJ. · Pubmed #17855323 No free full text.

This publication has no abstract.

Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. · University of London, Department of Clinical Biochemistry, Royal Free Hospital, Pond Street, London NW3 2QG, UK. · Expert Opin Ther Targets. · Pubmed #17845142 No free full text.

Abstract: The endothelium is a dynamic organ that plays a pivotal role in cardiovascular homeostasis. Alteration in endothelial function precedes the development of atherosclerosis and contributes to its initiation, perpetuation and clinical manifestations. It has been suggested that the assessment of endothelial function could represent a barometer of vascular health that could be used to gauge cardiovascular risk. This review summarises the various methods used to assess endothelium-dependent vasodilatation and their potential prognostic implications. In addition, the techniques used to evaluate arterial stiffness are discussed. The latter is to some extent controlled by the endothelium and has been the subject of considerable research in recent years. This paper also discusses the effects of lipid lowering treatment on both endothelial function and arterial stiffness.

Pottle A. · Harefield Hospital, Harefield, Middlesex. · Nurs Stand. · Pubmed #17711246 No free full text.

Abstract: The measurement and management of cholesterol levels are essential to reduce the risk of developing heart disease. Nursing staff play a key role in the detection and treatment of high cholesterol levels and the promotion of good nutritional health. This article focuses on the process of and rationale for cholesterol testing.

Barnett AH, Mackin P, Chaudhry I, Farooqi A, Gadsby R, Heald A, Hill J, Millar H, Peveler R, Rees A, Singh V, Taylor D, Vora J, Jones PB. · Birmingham Heartlands Hospital, Birmingham, UK. · J Psychopharmacol. · Pubmed #17656425 No free full text.

Abstract: People with schizophrenia are at greater risk of obesity, Type 2 diabetes, dyslipidaemia and hypertension than the general population. This results in an increased incidence of cardiovascular disease (CVD) and reduced life expectancy, over and above that imposed by their mental illness through suicide. Several levels of evidence from data linkage analyses to clinical trials demonstrate that treatment-related metabolic disturbances are commonplace in this patient group, and that the use of certain second-generation antipsychotics may compound the risk of developing the metabolic syndrome and CVD. In addition, smoking, poor diet, reduced physical activity and alcohol or drug abuse are prevalent in people with schizophrenia and contribute to the overall CVD risk. Management and minimization of metabolic risk factors are pertinent when providing optimal care to patients with schizophrenia. This review recommends a framework for the assessment, monitoring and management of patients with schizophrenia in the UK clinical setting.

Schedlbauer A, Schroeder K, Fahey T. · Division of Primary Care, School of Community Health Sciences, 13th Floor, Tower Building, University of Nottingham, Nottingham NG7 2RD. · Fam Pract. · Pubmed #17630270 links to  free full text

Abstract: OBJECTIVE: Poor patient adherence to lipid-lowering medication is a major contributory factor in the lack of success in treating hyperlipidaemia. The objective of this review was to assess the effect of adherence-enhancing interventions for lipid-lowering medication. DESIGN: Systematic review of randomized controlled trials (RCTs). Data sources: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycInfo and CINAHL for all-language publications in November 2005. Direct contact with authors of included RCTs. METHODS: Two reviewers extracted data independently and assessed studies according to criteria outlined by the Cochrane Reviewers' Handbook. RESULTS: Nine RCTs were included in the review. Substantial between-study heterogeneity made pooling of data inappropriate. Four out of nine RCTs reported significantly improved adherence rates. The interventions associated with improved adherence were simplification of drug regimen (absolute increase 11%), patient information and education (13%) and intensified patient care (8.6% and 24%). Duration of follow-up was short, ranging from 2 to 24 months. No clear pattern emerged with regard to different classes of lipid-lowering drugs and adherence levels. CONCLUSIONS: Intensified patient care appears to be the most promising intervention in terms of improved adherence to lipid-lowering drugs. Numbers of trials are low and evidence is sparse. Important aspects to be addressed in future studies are long-term follow-up, effect of improved adherence on serum lipid levels and concurrent, economic evaluation of adherence-enhancing strategies.

Jaumdally JR, Varma C, Lip GY. · Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK. · Expert Opin Pharmacother. · Pubmed #17563259 No free full text.

Abstract: Whether used as primary or secondary prevention, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) can lead to a significant reduction in mortality and morbidity from cardiovascular disease. Given the benefit in halting atherosclerotic disease progression in patients with stable and acute coronary syndrome, the potential for use in South-Asians remains largely unreported. As this ethnic group has a high rate of coronary events at a younger age, with more extensive and diffuse atheroma, the authors review the impact of statins in relation to observed lipid profiles, as well as novel markers of vascular disease.

Armitage J. · Clinical Trial Service Unit and Epidemiological Studies Unit, Oxford, UK. · Lancet. · Pubmed #17559928 No free full text.

Abstract: Statins are effective cholesterol-lowering drugs that reduce the risk of cardiovascular disease events (heart attacks, strokes, and the need for arterial revascularisation). Adverse effects from some statins on muscle, such as myopathy and rhabdomyolysis, are rare at standard doses, and on the liver, in increasing levels of transaminases, are unusual. Myopathy--muscle pain or weakness with blood creatine kinase levels more than ten times the upper limit of the normal range--typically occurs in fewer than one in 10,000 patients on standard statin doses. However, this risk varies between statins, and increases with use of higher doses and interacting drugs. Rhabdomyolysis is a rarer and more severe form of myopathy, with myoglobin release into the circulation and risk of renal failure. Stopping statin use reverses these side-effects, usually leading to a full recovery. Asymptomatic increases in concentrations of liver transaminases are recorded with all statins, but are not clearly associated with an increased risk of liver disease. For most people, statins are safe and well-tolerated, and their widespread use has the potential to have a major effect on the global burden of cardiovascular disease.

Milionis HJ, Liberopoulos EN, Elisaf MS, Mikhailidis DP. · Department of Clinical Biochemistry, Vascular Disease Prevention Clinics, Royal Free Hospital, Pond Street, London NW3 2QG, UK. · Curr Hypertens Rep. · Pubmed #17519121 No free full text.

Abstract: Hypertension and hyperlipidemia, two powerful risk factors of cardiovascular disease (CVD), often coexist. Therefore, treatment should consider the beneficial properties of drugs used to treat either condition. Statins, the mainstay of lipid-lowering therapy, result in a significant clinical benefit both in primary and secondary CVD prevention. In addition to their hypolipidemic capacity, other properties may contribute to statin-induced benefits. Clinical and experimental evidence indicates that statins may modulate blood pressure (BP). The mechanisms by which statins reduce BP seem to be largely independent of their lipid effects. Although small, reductions in BP are possibly clinically relevant. Large landmark studies confirm that statins can reduce CVD risk in hypertensive patients. These findings suggest that statins could be prescribed as an adjunct in treating hypertension with dyslipidemia or even in patients with "normal" cholesterol levels. Whether the effect of statins on BP is accompanied by an additional decrease in clinical outcomes needs to be investigated in long-term, large-scale trials.

Jackson KG, Armah CK, Minihane AM. · Hugh Sinclair Unit of Human Nutrition, Department of Food Biosciences, University of Reading, Reading RG6 6AP, UK. · Biochem Soc Trans. · Pubmed #17511625 No free full text.

Abstract: With increasing recognition of the pivotal role of vascular dysfunction in the progression of atherosclerosis, the vasculature has emerged as an important target for dietary therapies. Recent studies have indicated that chronic fatty acid manipulation alters vascular reactivity, when measured after an overnight fast. However, individuals spend a large proportion of the day in the postprandial (non-fasted) state. Several studies have shown that high fat meals can impair endothelial function within 3-4 h, a time period often associated with peak postprandial lipaemia. Although the impact of meal fatty acids on the magnitude and duration of the postprandial lipaemic response has been extensively studied, very little is known about their impact on vascular reactivity after a meal.

Minihane AM, Harland JI. · HarlandHall. The Stables, Ranbury Ring, London Road, Poulton, GLOS, GL7 5HN, UK. · Crit Rev Food Sci Nutr. · Pubmed #17453925 No free full text.

Abstract: Chronic multifactorial diet related diseases are the major causes of death and illness worldwide. The amount and composition of fat in the diet is an important determinant of the pathobiology of many of these conditions. In the current review the associations between dietary fat and disease risk will be considered. Mean population fat intakes will be compared with dietary recommendations aimed at reducing the population burden of disease and the main sources of fat in the adult and childhood diet will be given. An assessment will be made of the principal vegetable oil sources used in the manufacture of processed foods, in particular fried foods, with particular reference to the rheological and nutritional justification for their use. The impact of the more widespread use of alternative oil sources with improved fatty acid profiles, on the fat composition of fried foods and the overall diet will be presented, demonstrating that such apparently focussed approaches could potentially result in a significant impact on population fat intake and potentially overall chronic disease burden.

Soutar AK, Naoumova RP. · Lipoprotein Group, MRC Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK. · Nat Clin Pract Cardiovasc Med. · Pubmed #17380167 No free full text.

Abstract: Familial hypercholesterolemia (FH) is characterized by raised serum LDL cholesterol levels, which result in excess deposition of cholesterol in tissues, leading to accelerated atherosclerosis and increased risk of premature coronary heart disease. FH results from defects in the hepatic uptake and degradation of LDL via the LDL-receptor pathway, commonly caused by a loss-of-function mutation in the LDL-receptor gene (LDLR) or by a mutation in the gene encoding apolipoprotein B (APOB). FH is primarily an autosomal dominant disorder with a gene-dosage effect. An autosomal recessive form of FH caused by loss-of-function mutations in LDLRAP1, which encodes a protein required for clathrin-mediated internalization of the LDL receptor by liver cells, has also been documented. The most recent addition to the database of genes in which defects cause FH is one encoding a member of the proprotein convertase family, PCSK9. Rare dominant gain-of-function mutations in PCSK9 cosegregate with hypercholesterolemia, and one mutation is associated with a particularly severe FH phenotype. Expression of PCSK9 normally downregulates the LDL-receptor pathway by indirectly causing degradation of LDL-receptor protein, and loss-of-function mutations in PCSK9 result in low plasma LDL levels. Thus, PCSK9 is an attractive target for new drugs aimed at lowering serum LDL cholesterol, which should have additive lipid-lowering effects to the statins currently used.

Sethi JK. · Department of Clinical Biochemistry, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QR, UK. · Curr Hypertens Rep. · Pubmed #17362669 No free full text.

Abstract: Adipokines are peptides secreted by adipose tissue that affect whole-body energy metabolism. Their dysregulated production in obesity has implicated them as important mediators in the pathogenesis of obesity-related risk factors for diabetes and cardiovascular disease. PBEF/visfatin/Nampt has recently been described as a novel adipokine with insulin mimetic properties. However, whether it is an authentic adipokine relevant to the metabolic syndrome remains a matter of some debate.

Clements L, Ashurst I. · Dept of Nutrition and Dietetics, Barts and The London NHS Trust, London. · J Ren Care. · Pubmed #17345977 No free full text.

Abstract: Chronic kidney disease is fast becoming a worldwide epidemic. There is an estimated annual increase of 8% with an associated economical and clinical burden. Recent research into lifestyle factors has confirmed different dietary attributes play a part in slowing the progression of chronic nephropathies. This has important implications and a potentially cost-saving way, to help reduce the progression of the disease. The roles of obesity, lipids, protein, diabetes and blood pressure are discussed to show how the current literature reflects how to modify the dietary aspects of these. The mechanisms behind these are not fully understood, but the message remains the same that there is an increased need for dietary advice in the pre-dialysis population.

Chong MF, Fielding BA, Frayn KN. · Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, UK. · Proc Nutr Soc. · Pubmed #17343772 No free full text.

Abstract: The elevation of blood lipid concentrations in response to the consumption of low-fat high-carbohydrate diets is known as carbohydrate-induced hypertriacylglycerolaemia (HPTG). An understanding of the mechanisms involved in the interaction between carbohydrates and plasma lipids may help determine whether carbohydrate-induced HPTG would increase cardiovascular risk. There is growing evidence to suggest that the sugar component of the diet may be largely responsible, rather than the total carbohydrate. In most studies designed to investigate the mechanisms of carbohydrate-induced HPTG, the amounts and types of sugars and starches used in the diets are not specified. Findings have been mixed and inconsistent. It is proposed that the elucidation of mechanisms from current studies could have been confounded by the different ways in which sugars are metabolized in the body. At present, there are few studies that have evaluated the independent effects of dietary sugars. Interest has been focused on de novo lipogenesis (DNL), as it has recently been found to be positively correlated with increases in fasting TAG levels produced on high-carbohydrate diets, indicating that DNL may contribute to carbohydrate-induced HPTG. DNL has been found to be determined by starch:sugar in a high-carbohydrate diet and affected by different types of sugars. The presence of DNL in adipose tissue is supported by emerging gene-expression studies in human subjects. In the wake of rising intakes of sugars, further research is needed to investigate the mechanisms associated with different sugars, so that appropriate therapeutic strategies can be adopted.

Camici PG, Crea F. · Medical Research Council Clinical Sciences Centre Hammersmith Hospital, and National Heart and Lung Institute, Imperial College, London, United Kingdom. · N Engl J Med. · Pubmed #17314342 No free full text.

This publication has no abstract.

Evered A. · School of Health Science, University of Wales, Swansea. · Nurs Times. · Pubmed #17278732 No free full text.

Abstract: This article looks at cholesterol and its function in the body. It explores cholesterol's role in cardiovascular disease and the factors that contribute to high levels in the blood.

Talmud PJ. · Centre for Cardiovascular Genetics, Department of Medicine, British Heart Foundation Laboratories, Royal Free & University College London Medical School, 5 University Street, London WC1E 6JF, UK. · Atherosclerosis. · Pubmed #17222847 No free full text.

Abstract: In 2001, a gene encoding a novel apolipoprotein (apo), APOA5, was identified by comparative human/mouse sequencing. The encoded protein, apoAV, had been missed in routine apolipoprotein identification because it occurs at very low plasma concentrations and only DNA analysis led to its identification. Knockout and transgenic mouse models of apoAV showed an inverse relationship with plasma triglyceride levels. In human studies, common APOA5 variants have shown near consistent association with elevated plasma TG levels, confirming apoAV as playing a role in human triglyceride metabolism. Based on mouse knockout models it was predicted that individuals with rare mutations in APOA5 would present with severe hypertriglyceridaemia and apoAV deficiency. However, considering the small number of mutation carriers identified to date, the mode of inheritance is variable and in the recessive form TG levels are within the normal range, and apoAV deficiency only occurs in the homozygous state. Furthermore, penetrance of the mutations is low and appears to require co-inheritance of a common APOA5 TG-raising allele as well as environmental factors for expression of the hypertriglyceridaemia. In this review the clinical and metabolic consequences and phenotype of the three APOA5 mutations reported to date, which lead to premature truncations of apoAV are described. The insight these truncated protein give to the structure-function relationship of apoAV is explored and the relative importance of plasma and liver apoAV discussed.

de Lorenzo F, Feher M, Martin J, Collot-Teixeira S, Dotsenko O, McGregor JL. · Thrombosis Research Institute, Genomics & Atherothrombosis, London, UK. · Curr Med Chem. · Pubmed #17168712 No free full text.

Abstract: Primarily statin drugs inhibit hepatic 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase, which is responsible for the reduction in circulating low-density lipoprotein (LDL) cholesterol. Several findings from recent research studies indicate that statins have multiple actions that favorably influence key factors involved in the atherogenic process. These so-called pleiotropic properties affect various aspects of cell function, inflammation, coagulation, and vasomotor activity. These effects are mediated either indirectly through LDL cholesterol reduction or via a direct effect on cellular functions. Such actions may contribute to the early cardiovascular benefit observed in several outcome trials with statin drugs therapy. Although many of the pleiotropic properties of statins may be a class effect, some may be unique to certain agents and account for differences in their pharmacological activity. This review summarise the results of the major outcome trials of statins and non-statins therapy and the possible mechanisms beyond lipid lowering contributing to plaque stability.

Bhatnagar D. · The Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, UK. · Ann Clin Biochem. · Pubmed #17132275 No free full text.

Abstract: Familial hypercholesterolaemia (FH) is a genetic disorder in which the concentration of serum cholesterol is elevated from birth and leads to premature coronary heart disease. FH is commonly caused by a mutation in the LDL receptor, but mutations in other genes can lead to a phenotype similar to FH. FH exhibits marked phenotypic variability due to genetic, metabolic and environmental factors. The presence of tendon xanthomata is the characteristic clinical sign seen in many patients with FH, but they may also have other non-specific signs of lipid disorders such as corneal arcus and xanthelasmata. Premature vascular disease is apparent in many patients. The wide variety of mutations and phenotypic variability have made it difficult to establish definite diagnostic criteria, but three sets of clinical criteria commonly used are the Simon Broome criteria, the Dutch Lipid Clinic criteria and the American criteria. FH screening fits the Wilson and Jungner recommendations for validity of a screening programme. Screening could be carried out on a population basis, in a clinical setting or by application to relatives of probands. This latter approach, termed cascade testing, appears to be the more cost-effective compared with population screening and can be carried out using clinical criteria or genetic testing, or by a combination of both methods. Clinicians need to be made more aware of the clinical features of FH and how to diagnose it in order to increase the index of suspicion and instigate appropriate treatment early, with the aim of preventing premature coronary heart disease.

Gazi IF, Mikhailidis DP. · Royal Free Hospital, Department of Clinical Biochemistry, Royal Free and University College of Medicine, University of London, Pond Street, London NW3 2QG, UK. · Expert Opin Ther Targets. · Pubmed #17105372 No free full text.

Abstract: Ezetimibe, an intestinal cholesterol absorption inhibitor, lowers circulating low-density lipoprotein cholesterol (LDL-C) levels both when administered as monotherapy and in combination with other hypolipidaemic drugs, mostly statins. This review focuses on the effects of ezetimibe on non-LDL-C-associated variables. In most studies, ezetimibe effectively reduced triglyceride and increased high density lipoprotein cholesterol levels. The authors also consider the effect of ezetimibe on other variables such as C-reactive protein levels, insulin sensitivity and endothelial function. Ezetimibe is useful in patients with sitosterolaemia (a rare inherited disorder) as it significantly reduces plasma phytosterol concentrations. Ezetimibe fulfils two of the three essential characteristics of any drug (efficacy and safety). However, clinical studies are required to provide evidence of its ability to reduce vascular events.

Arambepola C, Farmer AJ, Perera R, Neil HA. · Division of Public Health and Primary Health Care, University of Oxford, Oxford OX3 7LF, UK. · Atherosclerosis. · Pubmed #17097660 No free full text.

Abstract: AIMS: To assess efficacy and safety of HMG-CoA reductase inhibitor (statin) treatment in children and adolescents with heterozygous familial hypercholesterolaemia. METHODS: MEDLINE, EMBASE, COCHRANE and Current Controlled Trials databases were searched. Study design, efficacy, and safety outcome-measures were extracted. Results of parallel-group randomised placebo controlled trials with low density (LDL) and high density lipoprotein cholesterol (HDL), and triglycerides as outcomes were pooled using standard meta-analytical methods. RESULTS: One hundred and fifty seven of 1060 identified papers studied familial hypercholesterolaemia, and 18 papers reported 7 prospective case series, 1 non-randomised trial, 2 trials with active treatment control groups, and 8 parallel-group randomised placebo controlled trials (RCT). The RCTs randomised 947 children, aged 8-18 years, for periods of 6-96 weeks with an estimated 850 person-years follow-up. There were no differences in clinical or laboratory adverse reactions between placebo and active treatment. Statins lowered LDL 32.5% (95% CI 24.3, 40.7), increased HDL 3.4% (0.8, 6.0), lowered triglycerides 3.0% (-11.6, 17.6), attenuated progression of carotid medial thickness, and improved endothelial function. CONCLUSIONS: Statin monotherapy is efficacious, well tolerated and safe in the short-term, although long-term safety remains unclear. Current evidence supports treatment of children at highest cardiovascular risk, but results of on-going, longer-term studies may extend these indications.

Wilkinson I, Cockcroft JR. · Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. · Adv Cardiol. · Pubmed #17075215 No free full text.

Abstract: Arterial stiffness and pulse pressure are important determinants of cardiovascular risk. Patients with hypercholesterolaemia have a higher central pulse pressure and stiffer blood vessels than matched controls, despite similar peripheral blood pressures. These haemodynamic changes may contribute to the increased risk of cardiovascular disease associated with hypercholesterolaemia and their assessment may improve risk stratification. Lipid-lowering therapy, particularly with statins, generally leads to a reduction in arterial stiffness, re-enforcing the concept that stiffness is a modifiable parameter and risk factor. There are a number of potential mechanisms linking arterial stiffness and plasma lipids, including atherosclerosis, changes in the elastic elements of the arterial wall, endothelial dysfunction and inflammation. This review will focus on the current evidence linking cholesterol to larger artery stiffening, potential therapies and mechanisms.