Estimating an individual's true cholesterol level and response to intervention

Article Abstract:

Elevated blood cholesterol places an individual at increased risk for developing atherosclerosis and coronary heart disease; fatty plaques accumulate within the coronary arteries, narrowing the internal diameters of the vessels, reducing the flow of blood to the heart muscle, and compromising heart function. When a physician interprets measurements of blood cholesterol, he or she must decide what the patient's true blood cholesterol level is, or how the level has changed in response to some type of cholesterol-lowering intervention. Factors such as biological and technical variability may cause the measurement of a person's cholesterol to differ from its true level. There is particular concern regarding people with cholesterol screening measurements below 5.2 mmol/L (millimoles per liter) who are told that their cholesterol levels are 'normal' when, in fact, their true levels are high and require dietary intervention and/or drug treatment. The purpose of cholesterol screening is to correctly identify people who have values higher than a recommended threshold so that some type of intervention, such as dietary changes, can be initiated. An analysis was undertaken to identify the confidence interval of true cholesterol levels around the observed measurements; that is, the chance or probability that the true value lies within the range of the observed measurements. It was determined that following a low-cholesterol diet, if there is no change in a person's cholesterol (based on three measurements obtained before and after the dietary change), there is an 80 percent chance that the true cholesterol level lies within a range that is 4 percent higher and 9 percent lower than the measured value. In addition to blood cholesterol levels, individual risk factors must be considered when counselling patients and planning care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Hypercholesterolemia

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Synchrotron transvenous angiography holds promise in coronary studies

Article Abstract:

A new imaging technique, synchrotron transvenous angiography, allows physicians to view the arterial supply of the heart without a catheter, a thin flexible tube inserted deep into the vessels of the heart through a peripheral vessel. The synchrotron allows visualization of the coronary arteries (the arteries of the heart muscle) with only the injection of an iodized contrast material through a vein. In addition, the technique uses much less radiation than standard angiographic X-ray techniques. The new procedure relies on the generation of a photon beam produced by radiation from a synchrotron, a high-energy particle accelerator. The beam is highly focused, and about the size of a pencil in circumference. When the beam is directed at the body, the beam interacts with the body's electrons, to a degree that depends on the amount of force created when the photons and electrons collide. The image itself is a composite reconstruction of 0.5 mm 'slices' taken at four miilisecond intervals as the patient sits in a computer-operated chair that is moved through the beam of photons. The entire procedure takes about half an hour, although the actual photographic recording takes only a few minutes. The first experiments with humans have produced pictures which appear underexposed, but this is expected to be solved once human clinical trials begin. Currently, the major impediment is that state-of-the-art devices must 'borrow' electrons from large synchrotron accelerators; however, it is estimated that smaller accelerators with a diameter of 30 feet that can service four patients at once will be available shortly at an estimated cost of $10 to $15 million.

Methods, Usage, Innovations, Angiography, Synchrotron radiation, Coronary arteries, Diagnostic imaging

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New studies fuel controversy over universal cholesterol screening during childhood

Article Abstract:

The American Academy of Pediatrics (AAP) has recommended that selective screening for serum cholesterol should begin in childhood. The recommendation was backed by research by two different groups of clinical investigators. The recommendation has been made for children with a hereditary predisposition for either coronary heart disease or elevated levels of cholesterol in family members. One investigator, Dr. Gerald R. Berenson, claims the need for early childhood cholesterol screening because of evidence that elevation of blood cholesterol leads to the formation of atherosclerotic plaque on the vessels of the heart (coronary atherosclerosis). In opposition to the more restrictive screening called for by the AAP, other prominent medical researchers say that only mass screening of children through their schools will be adequate to identify children at risk. Some have gone so far as to suggest tying school attendance to screening; cholesterol screening should be made a mandatory part of enrollment physical examination. Screening is only the first step in prevention of coronary heart disease, and for any screening program to be effective, it must be linked to a good system of follow-up to insure that the children who are at high risk are treated and counseled.

Coronary heart disease, column, Atherosclerosis in children

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