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September 25, 1991, Vol 266, No. 12 >
ARTICLE | September 25, 1991

Measuring and Knowing: Title and subTitle BreakThe Trouble With Cholesterol and Decision Making FREE

John T. Gwynne, MD
[+] Author Affiliations

Reprint requests to the Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina, CB 7170, MacNider Building, Chapel Hill, NC 27599-7170 (Dr Gwynne).


JAMA. 1991;266(12):1696-1698. doi:10.1001/jama.1991.03470120098042
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References

The evidence that lowering serum low-density lipoprotein (LDL) cholesterol levels prevents both primary and recurrent myocardial infarction now seems overwhelming. Two major primary prospective intervention trials, the Lipid Research Primary Prevention Trial1,2 and the Helsinki Heart Study,3,4 have shown that lowering total and LDL cholesterol levels will decrease the incidence of fatal and nonfatal myocardial infarctions in high-risk middle age men. The outcome of these trials is quantitatively consistent with less-definitive primary prevention trials employing diet alone and is consistent with the degree of benefit predicted by observational epidemiologic studies relating total cholesterol to coronary artery disease risk.2,5 Treatment with nicotinic acid as part of the Coronary Drug Project, a secondary prevention trial in middle-aged men, not only decreased the incidence of nonfatal reinfarction6 but also appeared to have decreased mortality at the 15-year follow-up.7 The results of recent pharmacologic

REFERENCES

1 +
Lipid Research Clinics Program.  The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease. JAMA . 1964;;251:351-364.
2 +
Lipid Research Clinics Program.  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.
3 +
Frick MS, Elo O, Haapa K, et al.  Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia: safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med . 1987;;317:1237-1245.
4 +
Manninen V, Elo MO, Frick MH, et al.  Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA . 1988;;260;641-651.
5 +
Tyroler HA.  Review of lipid-lowering clinical trials in relation to observational epidemiologic studies. Circulation . 1987;;76:515-522.
6 +
The Coronary Drug Project Research Group.  Clofibrate and niacin in coronary heart disease. JAMA . 1975;;231:360-381.
7 +
Canner PL, Berge KG, Wenger NK, et al.  Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol . 1986;;6:1245-1255.
8 +
Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA . 1987;;257:3233-3240.
9 +
Cashin-Hemphill L, Mack WJ, Pogoda JM, Sanmarco ME, Azen SP, Blankenhorn DH.  Beneficial effects of colestipol-niacin on coronary atherosclerosis: a 4-year follow-up. JAMA . 1990;;264:3013-3017.
10 +
Brown G, Albers JJ, Fisher LD, et al.  Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med . 1990;;323:1289-1298.
11 +
Kane JP, Malloy MJ, Ports TA, Phillips NR, Diehl JC, Havel RJ.  Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA . 1990;;264:3007-3012.
12 +
NIH Consensus Conference.  Lowering blood cholesterol to prevent heart disease. JAMA . 1985;;253:2080-2086.
13 +
The Toronto Working Group on Cholesterol Policy, Naylor CD, Basinski A, Frank JW, Rachlis MM. Asymptomatic hypercholesterolemia: a clinical policy review, chap 7: cholesterol-lowering programs: recent policy statements. J Clin Epidemiol . 1990;;43:1103-1112.
14 +
Steinmetz J, Choukaife A, Visvikis S, Henry J, Siest G.  Biological factors affecting concentrations of serum LpAI lipoprotein particles in serum, and determination of reference limits. Clin Chem . 1990;;36:677-680.
15 +
Hegsted DM, Nicolosi RJ.  Individual variation in serum cholesterol levels: risk of coronary heart disease. Proc Natl Acad Sci USA . 1987;;84:6259-6261.
16 +
Gordon DJ, Trost DC, Hyde J, et al.  Seasonal cholesterol cycles: the Lipid Research Clinics Coronary Primary Prevention Trial placebo group. Circulation . 1987;;76:1224-1231.
17 +
Irwig L, Glasziou P, Wilson A, Macaskill P.  Estimating an individual's true cholesterol level and response to intervention. JAMA . 1991;;266:1678-1685.
18 +
Bush TL, Riedel D.  Screening for total cholesterol: do the National Cholesterol Education Program's recommendations detect individuals at high risk of coronary heart disease? Circulation . 1991;;83:1287-1293.
19 +
Scanu AM, Lawn RM, Berg K.  Lipoprotein(a) and atherosclerosis. Ann Intern Med . 1991;;115:209-216.
20 +
Sniderman AD, Silberberg J.  Is it time to measure apolipoprotein B? Arteriosclerosis . 1990;;10:665-667.
21 +
Vega GL, Grundy SM.  Does measurement of apolipoprotein B have a place in cholesterol management? Arteriosclerosis . 1990;;10:668-671.
22 +
Austin MA, Breslow JL, Hennekens CH, Buring JE, Willett WC, Krauss RM.  Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA . 1988;;260:1917-1921.
23 +
Grundy SM, Denke MA.  Dietary influences on serum lipids and lipoproteins. J Lipid Res . 1980;;31:1149-1172.

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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 +
Lipid Research Clinics Program.  The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease. JAMA . 1964;;251:351-364.
2 +
Lipid Research Clinics Program.  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.
3 +
Frick MS, Elo O, Haapa K, et al.  Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia: safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med . 1987;;317:1237-1245.
4 +
Manninen V, Elo MO, Frick MH, et al.  Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA . 1988;;260;641-651.
5 +
Tyroler HA.  Review of lipid-lowering clinical trials in relation to observational epidemiologic studies. Circulation . 1987;;76:515-522.
6 +
The Coronary Drug Project Research Group.  Clofibrate and niacin in coronary heart disease. JAMA . 1975;;231:360-381.
7 +
Canner PL, Berge KG, Wenger NK, et al.  Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol . 1986;;6:1245-1255.
8 +
Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA . 1987;;257:3233-3240.
9 +
Cashin-Hemphill L, Mack WJ, Pogoda JM, Sanmarco ME, Azen SP, Blankenhorn DH.  Beneficial effects of colestipol-niacin on coronary atherosclerosis: a 4-year follow-up. JAMA . 1990;;264:3013-3017.
10 +
Brown G, Albers JJ, Fisher LD, et al.  Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med . 1990;;323:1289-1298.
11 +
Kane JP, Malloy MJ, Ports TA, Phillips NR, Diehl JC, Havel RJ.  Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA . 1990;;264:3007-3012.
12 +
NIH Consensus Conference.  Lowering blood cholesterol to prevent heart disease. JAMA . 1985;;253:2080-2086.
13 +
The Toronto Working Group on Cholesterol Policy, Naylor CD, Basinski A, Frank JW, Rachlis MM. Asymptomatic hypercholesterolemia: a clinical policy review, chap 7: cholesterol-lowering programs: recent policy statements. J Clin Epidemiol . 1990;;43:1103-1112.
14 +
Steinmetz J, Choukaife A, Visvikis S, Henry J, Siest G.  Biological factors affecting concentrations of serum LpAI lipoprotein particles in serum, and determination of reference limits. Clin Chem . 1990;;36:677-680.
15 +
Hegsted DM, Nicolosi RJ.  Individual variation in serum cholesterol levels: risk of coronary heart disease. Proc Natl Acad Sci USA . 1987;;84:6259-6261.
16 +
Gordon DJ, Trost DC, Hyde J, et al.  Seasonal cholesterol cycles: the Lipid Research Clinics Coronary Primary Prevention Trial placebo group. Circulation . 1987;;76:1224-1231.
17 +
Irwig L, Glasziou P, Wilson A, Macaskill P.  Estimating an individual's true cholesterol level and response to intervention. JAMA . 1991;;266:1678-1685.
18 +
Bush TL, Riedel D.  Screening for total cholesterol: do the National Cholesterol Education Program's recommendations detect individuals at high risk of coronary heart disease? Circulation . 1991;;83:1287-1293.
19 +
Scanu AM, Lawn RM, Berg K.  Lipoprotein(a) and atherosclerosis. Ann Intern Med . 1991;;115:209-216.
20 +
Sniderman AD, Silberberg J.  Is it time to measure apolipoprotein B? Arteriosclerosis . 1990;;10:665-667.
21 +
Vega GL, Grundy SM.  Does measurement of apolipoprotein B have a place in cholesterol management? Arteriosclerosis . 1990;;10:668-671.
22 +
Austin MA, Breslow JL, Hennekens CH, Buring JE, Willett WC, Krauss RM.  Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA . 1988;;260:1917-1921.
23 +
Grundy SM, Denke MA.  Dietary influences on serum lipids and lipoproteins. J Lipid Res . 1980;;31:1149-1172.

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