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Bruce Wilson
The latest in lipids - extract
LONDON, UK — In anticipation of the European Society of Cardiology (ESC) 2014 Congress, clinical experts have turned their attention to LDL cholesterol, HDL cholesterol, and triglycerides in an attempt to address the relationship between these lipids and cardiovascular disease. Three papers, which are published in the August 16, 2014 issue of the Lancet, cast an eye on what is known about the relationship between the lipids and coronary heart disease risk, but equally important, on what remains controversial or unknown.
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Despite consistent biological, genetic, and epidemiologic studies showing the benefit of lowering LDL-cholesterol levels, the field is far from settled, according to Ridker.
"The evolving LDL story provides clear evidence that novel concepts from genetics and genomics can be rapidly translated into clinical practice,"
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In their review of the HDL hypothesis—the concept that raising HDL-cholesterol levels would lower the risk of coronary heart disease—Rader and Hovingh note that while the cholesterol within HDL has been shown to be inversely associated with coronary heart disease risk and is a predictor of cardiovascular risk, genetic studies of Mendelian disorders challenge the concept. In people with genetic mutations resulting in low–HDL-cholesterol concentrations, there does not appear to be an increased risk of coronary disease.
"Although each of these trials have their caveats, taken together they contribute to the perception that raising HDL-cholesterol concentrations per se does not necessarily confer a cardiovascular benefit or result in a beneficial effect on coronary heart disease outcome measures."
The reviewers turn their attention to the HDL "function" hypothesis, the idea that HDL cholesterol itself does not protect from atherosclerosis, but rather it is the function, such as the ability to promote cholesterol efflux and reverse cholesterol transport, that is most critical.
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For example, the precise role of inflammation in atherosclerosis is still not fully understood, and several anti-inflammatory drugs have failed in phase 3 studies despite promising results in earlier studies.
Also, it remains to be seen just how safely LDL cholesterol can be lowered with the novel agents and whether this translates into improved clinical outcomes. Kastelein suspects that lowering LDL cholesterol to as low as 25 mg/dL—"the true physiological LDL-cholesterol concentration"—might result in a reduction in clinical events.
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Have any of you been up to Hilltop lately? It has a new look. Here are some pictures Bev and I took at the school last week. The front of the school has new classrooms in a two story building. There are two new buildings in the back of the school where the shop buildings used to be. The senior lawn is certainly showing the adverse effects of the water drought here in Southern California. Our general impression was that the original school buildings looked pretty run down. When we were there 50 years ago, everything was still pretty new. I guess the years have taken their toll on all of us!
