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January 24, 1986, Vol 255, No. 4 >
ARTICLE | January 24, 1986

An Approach to the Management of Hyperlipoproteinemia FREE

Jeffrey M. Hoeg, MD; Richard E. Gregg, MD; H. Bryan Brewer, Jr, MD
[+] Author Affiliations

Reprint requests to National Institutes of Health, Bldg 10, Room 7N114, 9000 Rockville Pike, Bethesda, MD 20205 (Dr Hoeg).


JAMA. 1986;255(4):512-521. doi:10.1001/jama.1986.03370040086030
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References

Recent clinical trials indicate that reduction of plasma cholesterol concentrations in individuals with increased levels of low-density lipoproteins reduces their risk of myocardial infarction and death. Therefore, the question of "whether to treat" should be shifted to "whom to treat" and "how best to treat." The understanding of normal lipid transport via the plasma lipoproteins has grown to a sophisticated level over the past 20 years. Plasma cholesterol, required for cellular membrane integrity, and plasma triglycerides, the primary mammalian energy source, are carried in lipoprotein particles that vary in size, density, lipid composition, and apolipoprotein content. Some lipoprotein particles (low-density lipoproteins) play a causal role in the atherosclerotic process, while other particles (high-density lipoproteins) appear to prevent this process. Utilizing this understanding of the plasma lipoproteins, a systematic approach to the management of the patient with hyperlipoproteinemia has been developed which may lead to the normalization of plasma lipoprotein concentrations in the majority of hyperlipoproteinemic patients.

(JAMA 1986;255:512-521)

REFERENCES

1 +
Antischkow N:  Experimental arteriosclerosis in animals , in Cowdry EV (ed): Arteriosclerosis . New York, Macmillan Publishing Co Inc, 1933;.
2 +
Keys AB: Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease . Cambridge, Mass, Harvard University Press, 1980;.
3 +
Kato H, Tillotson J, Nichaman MZ, et al:  Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: Serum lipids and diet . Am J Epidemiol 1973;;97:372-385.
4 +
Kannel WB, Castelli WP, Gordon T, et al:  Serum cholesterol, lipoproteins, and the risk of coronary heart disease: The Framingham study . Ann Intern Med 1971;;74:1-11.
5 +
Pooling Project Research Group:  Relationship of blood pressure, serum cholesterol, smoking habit, relative weight, and ECG abnormalities to incidence of major coronary events: Final report of the pooling project . J Chronic Dis 1978;;31:201-306.
6 +
Brewer HB Jr, Zech LA, Gregg RE, et al:  Type III hyperlipoproteinemia: Diagnosis, molecular defects, pathology, and treatment . Ann Intern Med 1983;;98:623-640.
7 +
Schaefer EJ, Eisenberg S, Levy RI:  Lipoprotein apolipoprotein metabolism . J Lipid Res 1978;;19:667-687.
8 +
Mahley RW, Innerarity TI, Rall SC Jr, et al:  Plasma lipoproteins: Apolipoprotein structure and function . J Lipid Res 1984;;25:1277-1294.
9 +
Fredrickson DS, Levy RI, Lees RI:  Fat transport in lipoproteins: An integrated approach to mechanisms and disorders . N Engl J Med 1967;;276:32-44, 74-103, 148-156, 215-226, 273-281.
10 +
 The Lipid Research Clinics Coronary Primary Prevention Trial results: I. Reduction in incidence of coronary heart disease . JAMA 1984;; 251:351-364.
11 +
 The Lipid Research Clinics Coronary Primary Prevention Trial results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA 1984;; 251:365-374.
12 +
Hjermann I, Velve Byre K, Holme I, et al:  Effect of diet and smoking interventions on the incidence of coronary heart disease . Lancet 1981;;2:1303-1310.
13 +
Kornitzer M, DeBacker G, Dramaix M, et al:  Belgian heart disease prevention project: Incidence and mortality results . Lancet 1983;; 1:1066-1069.
14 +
Duffield RGM, Lewis B, Miller NE, et al:  Treatment of hyperlipidemia retards progression of symptomatic femoral atherosclerosis . Lancet 1983;;2:639-642.
15 +
Brensike JF, Levy RI, Kelsey SF, et al:  Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: Results of the NHLBI type II coronary intervention study . Circulation 1984;;69:313-324.
16 +
Levy RI, Brensike JF, Epstein SE, et al:  The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: Results of the NHLBI type II coronary intervention study . Circulation 1984;;69:325-337.
17 +
Gotto AM, Bierman EL, Connor WE, et al:  Recommendations for treatment of hyperlipidemia in adults: The Nutrition Committee and Council on Atherosclerosis of the American Heart Association . Circulation 1984;;69:1067A-1090A.
18 +
 National Institutes of Health Consensus Development Conference statement: Lowering blood cholesterol to prevent heart disease . JAMA 1985;;253:2080-2086.
19 +
 National Institutes of Health Consensus Conference on the treatment of hypertriglyceridemia . JAMA 1984;;251:1196-1200.
20 +
The Lipid Research Clinics Population Studies Data Book: I. The Prevalence Study, publication 80-1527 . Bethesda, Md, National Institutes of Health, 1980;.
21 +
Oliver MF:  Serum cholesterol: The knave of hearts and the joker . Lancet 1981;;2:1090-1095.
22 +
Wallace RB, Pomrehn P, Heiss G, et al:  Alterations in clinical chemistry to levels associated with the dyslipoproteinemia . Circulation , in press.
23 +
Gordon T, Castelli WP, Hjortland MC, et al:  High density lipoprotein as a protective factor against coronary heart disease: The Framingham study . Am J Med 1977;;62:707-714.
24 +
Friedwald WT, Levy RI, Fredrickson DS:  Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge . Clin Chem 1972;; 18:499-502.
25 +
Wilson PWF, Zech LA, Gregg RE, et al:  Estimation of VLDL cholesterol in hyperlipidemia . Clin Chem Acta , in press.
26 +
Johansson BG, Medus A:  Increase in plasma α-lipoproteins in chronic alcoholics after acute abuse . Acta Med Scand 1974;;195:273-277.
27 +
Belfrage P, Berg B, Hagerstrand I, et al:  Alterations of lipid metabolism in healthy volunteers during long-term ethanol intake . Eur J Clin Invest 1977;;7:127-131.
28 +
Coronary Drug Project Research Group:  Clofibrate and niacin in coronary heart disease . JAMA 1975;;231:360-381.
29 +
Canner PL:  Mortality in coronary drug project patients during a nine year posttreatment period . J Am Coll Cardiol 1985;;5:442.
30 +
Hoeg JM, Maher MM, Zech LA, et al:  Normalization of plasma lipoproteins with neomycin and niacin in type II hyperlipoproteinemia . Circulation 1984;;70:1004-1011.
31 +
Kane JP, Malloy MS, Tan P, et al:  Normalization of low density lipoprotein levels in heterozygous familial hypercholesterolemia with a combined drug regimen . N Engl J Med 1981;;304:251-258.
32 +
Committee of Principal Investigators:  Report of a WHO cooperative trial on primary prevention of ischaemic heart disease using clofibrate to lower serum cholesterol-mortality follow-up . Lancet 1980;;2:379-384.
33 +
Hoeg JM, Schaefer EJ, Romano CA, et al:  Neomycin affects lipoproteins in type II hyperlipoproteinemia . Clin Pharmacol Ther 1984;; 10:555-559.
34 +
Samuel P:  Treatment of hypercholesterolemia with neomycin: A time for reappraisal . N Engl J Med 1979;;301:595-597.
35 +
Mabuchi H, Sakai T, Sakai Y, et al:  Effect of an inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase on serum lipoproteins and ubiquinone-10 levels in patients with familial hypercholesterolemia . N Engl J Med 1981;; 305:478-482.
36 +
Illingworth DR:  Mevinolin plus echolestyrol in therapy for severe heterozygous familial hypercholesterolemia . Ann Intern Med 1984;; 101:598-604.
37 +
Moore RB, Buchwald H, Varco RL, et al:  The effect of partial ileal bypass on plasma lipoproteins . Circulation 1980;;62:469-476.
38 +
Starzl TE, Chase HP, Ahrens EH, et al:  Portacaval shunt in patients with familial hypercholesterolemia . Ann Surg 1983;;198:273-283.
39 +
Starzl TE, Bilheimer DW, Bahnson HT, et al:  Heart-liver transplantation in a patient with familial hypercholesterolemia . Lancet 1984;; 1:1382-1383.
40 +
Maciejko JJ, Holmes DR, Kottke BA, et al:  Apolipoprotein A-I as a marker of angiographically assessed coronary artery disease . N Engl J Med 1983;;309:385-389.
41 +
Avogaro P, Bittolo BG, Cazzolato G, et al:  Relationship between apolipoproteins and chemical components of lipoproteins in survivors of myocardial infarction . Atherosclerosis 1980;; 37:69-76.
42 +
Sniderman A, Shapiro S, Marpole D, et al:  Association of coronary atherosclerosis with hyperapobetalipoproteinemia (increased protein but normal cholesterol levels in human low density (0) lipoproteins) . Proc Natl Acad Sci USA 1980;;77:604-608.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Antischkow N:  Experimental arteriosclerosis in animals , in Cowdry EV (ed): Arteriosclerosis . New York, Macmillan Publishing Co Inc, 1933;.
2 +
Keys AB: Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease . Cambridge, Mass, Harvard University Press, 1980;.
3 +
Kato H, Tillotson J, Nichaman MZ, et al:  Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: Serum lipids and diet . Am J Epidemiol 1973;;97:372-385.
4 +
Kannel WB, Castelli WP, Gordon T, et al:  Serum cholesterol, lipoproteins, and the risk of coronary heart disease: The Framingham study . Ann Intern Med 1971;;74:1-11.
5 +
Pooling Project Research Group:  Relationship of blood pressure, serum cholesterol, smoking habit, relative weight, and ECG abnormalities to incidence of major coronary events: Final report of the pooling project . J Chronic Dis 1978;;31:201-306.
6 +
Brewer HB Jr, Zech LA, Gregg RE, et al:  Type III hyperlipoproteinemia: Diagnosis, molecular defects, pathology, and treatment . Ann Intern Med 1983;;98:623-640.
7 +
Schaefer EJ, Eisenberg S, Levy RI:  Lipoprotein apolipoprotein metabolism . J Lipid Res 1978;;19:667-687.
8 +
Mahley RW, Innerarity TI, Rall SC Jr, et al:  Plasma lipoproteins: Apolipoprotein structure and function . J Lipid Res 1984;;25:1277-1294.
9 +
Fredrickson DS, Levy RI, Lees RI:  Fat transport in lipoproteins: An integrated approach to mechanisms and disorders . N Engl J Med 1967;;276:32-44, 74-103, 148-156, 215-226, 273-281.
10 +
 The Lipid Research Clinics Coronary Primary Prevention Trial results: I. Reduction in incidence of coronary heart disease . JAMA 1984;; 251:351-364.
11 +
 The Lipid Research Clinics Coronary Primary Prevention Trial results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA 1984;; 251:365-374.
12 +
Hjermann I, Velve Byre K, Holme I, et al:  Effect of diet and smoking interventions on the incidence of coronary heart disease . Lancet 1981;;2:1303-1310.
13 +
Kornitzer M, DeBacker G, Dramaix M, et al:  Belgian heart disease prevention project: Incidence and mortality results . Lancet 1983;; 1:1066-1069.
14 +
Duffield RGM, Lewis B, Miller NE, et al:  Treatment of hyperlipidemia retards progression of symptomatic femoral atherosclerosis . Lancet 1983;;2:639-642.
15 +
Brensike JF, Levy RI, Kelsey SF, et al:  Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: Results of the NHLBI type II coronary intervention study . Circulation 1984;;69:313-324.
16 +
Levy RI, Brensike JF, Epstein SE, et al:  The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: Results of the NHLBI type II coronary intervention study . Circulation 1984;;69:325-337.
17 +
Gotto AM, Bierman EL, Connor WE, et al:  Recommendations for treatment of hyperlipidemia in adults: The Nutrition Committee and Council on Atherosclerosis of the American Heart Association . Circulation 1984;;69:1067A-1090A.
18 +
 National Institutes of Health Consensus Development Conference statement: Lowering blood cholesterol to prevent heart disease . JAMA 1985;;253:2080-2086.
19 +
 National Institutes of Health Consensus Conference on the treatment of hypertriglyceridemia . JAMA 1984;;251:1196-1200.
20 +
The Lipid Research Clinics Population Studies Data Book: I. The Prevalence Study, publication 80-1527 . Bethesda, Md, National Institutes of Health, 1980;.
21 +
Oliver MF:  Serum cholesterol: The knave of hearts and the joker . Lancet 1981;;2:1090-1095.
22 +
Wallace RB, Pomrehn P, Heiss G, et al:  Alterations in clinical chemistry to levels associated with the dyslipoproteinemia . Circulation , in press.
23 +
Gordon T, Castelli WP, Hjortland MC, et al:  High density lipoprotein as a protective factor against coronary heart disease: The Framingham study . Am J Med 1977;;62:707-714.
24 +
Friedwald WT, Levy RI, Fredrickson DS:  Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge . Clin Chem 1972;; 18:499-502.
25 +
Wilson PWF, Zech LA, Gregg RE, et al:  Estimation of VLDL cholesterol in hyperlipidemia . Clin Chem Acta , in press.
26 +
Johansson BG, Medus A:  Increase in plasma α-lipoproteins in chronic alcoholics after acute abuse . Acta Med Scand 1974;;195:273-277.
27 +
Belfrage P, Berg B, Hagerstrand I, et al:  Alterations of lipid metabolism in healthy volunteers during long-term ethanol intake . Eur J Clin Invest 1977;;7:127-131.
28 +
Coronary Drug Project Research Group:  Clofibrate and niacin in coronary heart disease . JAMA 1975;;231:360-381.
29 +
Canner PL:  Mortality in coronary drug project patients during a nine year posttreatment period . J Am Coll Cardiol 1985;;5:442.
30 +
Hoeg JM, Maher MM, Zech LA, et al:  Normalization of plasma lipoproteins with neomycin and niacin in type II hyperlipoproteinemia . Circulation 1984;;70:1004-1011.
31 +
Kane JP, Malloy MS, Tan P, et al:  Normalization of low density lipoprotein levels in heterozygous familial hypercholesterolemia with a combined drug regimen . N Engl J Med 1981;;304:251-258.
32 +
Committee of Principal Investigators:  Report of a WHO cooperative trial on primary prevention of ischaemic heart disease using clofibrate to lower serum cholesterol-mortality follow-up . Lancet 1980;;2:379-384.
33 +
Hoeg JM, Schaefer EJ, Romano CA, et al:  Neomycin affects lipoproteins in type II hyperlipoproteinemia . Clin Pharmacol Ther 1984;; 10:555-559.
34 +
Samuel P:  Treatment of hypercholesterolemia with neomycin: A time for reappraisal . N Engl J Med 1979;;301:595-597.
35 +
Mabuchi H, Sakai T, Sakai Y, et al:  Effect of an inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase on serum lipoproteins and ubiquinone-10 levels in patients with familial hypercholesterolemia . N Engl J Med 1981;; 305:478-482.
36 +
Illingworth DR:  Mevinolin plus echolestyrol in therapy for severe heterozygous familial hypercholesterolemia . Ann Intern Med 1984;; 101:598-604.
37 +
Moore RB, Buchwald H, Varco RL, et al:  The effect of partial ileal bypass on plasma lipoproteins . Circulation 1980;;62:469-476.
38 +
Starzl TE, Chase HP, Ahrens EH, et al:  Portacaval shunt in patients with familial hypercholesterolemia . Ann Surg 1983;;198:273-283.
39 +
Starzl TE, Bilheimer DW, Bahnson HT, et al:  Heart-liver transplantation in a patient with familial hypercholesterolemia . Lancet 1984;; 1:1382-1383.
40 +
Maciejko JJ, Holmes DR, Kottke BA, et al:  Apolipoprotein A-I as a marker of angiographically assessed coronary artery disease . N Engl J Med 1983;;309:385-389.
41 +
Avogaro P, Bittolo BG, Cazzolato G, et al:  Relationship between apolipoproteins and chemical components of lipoproteins in survivors of myocardial infarction . Atherosclerosis 1980;; 37:69-76.
42 +
Sniderman A, Shapiro S, Marpole D, et al:  Association of coronary atherosclerosis with hyperapobetalipoproteinemia (increased protein but normal cholesterol levels in human low density (0) lipoproteins) . Proc Natl Acad Sci USA 1980;;77:604-608.

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