High-density lipoprotein - the clinical implications of recent studies

Article Abstract:

Cholesterol is a substance found in the membranes of cells which is essential for the production of certain hormones and other products. The body can either make cholesterol itself or obtain it by eating foods containing cholesterol. Lipoproteins help carry cholesterol through the blood to cells that need it and then return it to the liver for removal. There are five differently sized lipoproteins: chylomicrons, very-low- density lipoproteins (VLDL), intermediate-density lipoproteins (IDP), high density lipoproteins (HDL) and low density lipoproteins (LDL). It is thought that LDLs help carry cholesterol to tissues and HDL helps carry it from the tissues to the liver for removal. The role of cholesterol and lipoproteins in the development of atherosclerosis, the build-up of plaque which narrows the inside of blood vessels, is complicated. Some studies have stated that simultaneous increases in HDL and decreases in LDL reduce the chances for heart attack. Since the interactions of lipoproteins and cholesterol are complex, no one aspect of the pathway has been implicated in causing atherosclerosis. The role of HDL, labeled as the "good cholesterol", in preventing atherosclerosis is deceptive. It is proposed that the direction of cholesterol movement is more important than the carrier itself. How this transport removal relates to the development of atherosclerotic plaques is unclear. It is known that HDL can be raised by exercise and alcohol consumption, while smoking and obesity lower HDL. Most studies have found that low HDL increases the risk of developing coronary heart disease. Some drugs act to raise lowered HDL, but no studies have tested the benefit of this drug therapy. Before it is assumed that raising HDL in patients without high LDL is effective, the role of HDL in coronary heart disease must be made clearer.

Research, Causes of, High density lipoproteins, Lipoproteins, Blood lipoproteins

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Declining serum total cholesterol levels among US adults: the National Health and Nutrition Examination Surveys

Article Abstract:

Blood cholesterol levels appear to have substantially declined among US adults since 1960. The goal of the Department of Health and Human Services is to lower the average adult blood cholesterol level to no more than 200 milligrams per deciliter (mg/dL). Estimates of total blood cholesterol are based on data from four national studies conducted between 1960 and 1991. Between 6,000 and 13,200 people aged 20 to 74 participated in each study, which consisted of a home interview and a medical examination. Between 1988 and 1991, the average cholesterol level among all adults was 206 mg/dL. Between 1960 and 1962, the national average was 220 mg/dL. Most of the decline in total blood cholesterol levels appears to be due to a reduction in the levels of low-density lipoproteins, which dropped an average of 8 mg/dL between 1976 and 1991. More than half the observed decline in blood cholesterol levels occurred between 1976 and 1991, suggesting that public health efforts to lower cholesterol have influenced the population.

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Prevalence of high blood cholesterol among US adults: an update based on guidelines from the second report of the National Cholesterol Education Program Adult Treatment Panel

Article Abstract:

Blood cholesterol levels among adults appear to have declined substantially since 1976. Yet almost 1/3 of adults still could be considered candidates for dietary therapy to lower cholesterol. Data from two national surveys conducted between 1976 and 1991 were used to estimate the incidence of high blood cholesterol. Blood cholesterol levels lower than 200 milligrams per deciliter (mg/dL) are considered desirable. Between 1976 and 1991, the proportion of adults aged 20 to 74 with blood cholesterol levels of 240 mg/dL and higher dropped from 26% to 20%. In the same period, the proportion of of adults with levels below 200 mg/dL rose from 44% to 49%. About 29% of adults over age 20 were potential candidates for dietary therapy and about 7% may be candidates for drug therapy. Six of seven adults with preexisting cases of heart disease were considered candidates for dietary therapy.

Risk factors

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