Cholesterol lowering in the elderly population. Coordinating Committee of the National Cholesterol Education Program.

The incidence of coronary heart disease (CHD) peaks in the elderly population. In secondary and primary prevention trials, cholesterol-lowering therapy reduces risk for CHD in both older and younger participants. This benefit, therefore, can be extended to the elderly.

Distributions and trends of serum lipid levels among United States children and adolescents ages 4-19 years: data from the Third National Health and Nutrition Examination Survey.

Background: Atherosclerosis begins in childhood and progresses into adulthood. The reduction of cardiovascular risk factors, such as elevated serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels, in childhood may reduce cardiovascular morbidity and mortality in adulthood. Lipid distributions among children and adolescents were examined using the most recent nationally representative data.

Clinical trials of reducing low-density lipoprotein concentrations.

Much diverse evidence suggests that the plasma levels of low-density lipoprotein (LDL) cholesterol play a causal role in the pathogenesis of atherosclerotic coronary heart disease. Until recently, clinical trials of LDL lowering, while showing significant reductions in coronary heart disease (CHD) rates, were not entirely convincing and left some questions of long-term toxicity unresolved. The results of a series of new trials using members of the powerful statin class of drugs are now being reported.

Declining serum total cholesterol levels among US adults. The National Health and Nutrition Examination Surveys.

Objective: To examine the secular trend in serum total cholesterol levels of the US adult population.

Design: Nationally representative cross-sectional surveys with both an in person interview and a medical examination that included the measurement of blood lipid levels.

Setting/participants: Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 through 1962, 1971 through 1974, 1976 through 1980, and 1988 through 1991.

Report of the Conference on Low Blood Cholesterol: Mortality Associations.

Background: A National Heart, Lung, and Blood Institute (NHLBI) Conference was held October 9-10, 1990, to review and discuss existing data on U-shaped relations found between mortality rates and blood total cholesterol levels (TC) in some but not other studies. Presentations were given from 19 cohort studies from the United States, Europe, Israel, and Japan. A representative of each study presented its findings and also submitted tables of proportional hazards regression coefficients for entry TC levels in regard to death, and these were incorporated into a formal statistical overview adjusted for age, diastolic blood pressure, cigarette smoking, body mass index, and alcohol intake, as available.

Cost and health implications of cholesterol lowering.

Background: A broad, scientific consensus supports the role of cholesterol as a risk factor for coronary heart disease and agrees that lowering cholesterol levels will reduce coronary heart disease incidence. Cost-effectiveness analysis is a potentially powerful method for measuring the benefits to be achieved by expenditures of health care dollars.

Methods And Results: The literature related to the effectiveness and cost-effectiveness of cholesterol lowering was reviewed.

Serum total cholesterol: HDL cholesterol ratios in US white and black adults by selected demographic and socioeconomic variables (HANES II).

Background: Framingham Study findings suggest that total cholesterol (TC):High density lipoprotein cholesterol (HDL-C) ratio is a useful summary of the joint contribution of TC and HDL-C to coronary heart disease (CHD) risk. Information on the distribution of TC:HDL-C in the US population is limited to selected populations and the relationship of the ratio distribution and its correlates has received little attention.

Method: TC/HDL-C ratios were examined in a representative sample of the United States adult population ages 20 to 74 years, between February 1976 and February 1980 during NHANES II, using stratification and multivariate regression analyses.

Change in cholesterol awareness and action. Results from national physician and public surveys.

The National Heart, Lung, and Blood Institute, Bethesda, Md, sponsored national telephone surveys of practicing physicians and the adult public in 1983, 1986, and 1990 to assess attitudes and practices regarding high serum cholesterol levels. Each time, approximately 1600 physicians and 4000 adults were interviewed. Trends show continuing change in medical practice and public health behavior relating to serum cholesterol.

The Lipid Research Clinics Coronary Primary Prevention Trial: design, results, and implications.

The Coronary Primary Prevention Trial (CPPT) was the major clinical investigation conducted in the Lipid Research Clinics (LRC) Program. There were 12 North American clinics involved in this joint double-blind protocol. The hypothesis tested was: lowering plasma cholesterol in middle-aged men with primary hypercholesterolemia [plasma total cholesterol greater than or equal to 265 mg/dl (6.

A single cholesterol measurement underestimates the risk of coronary heart disease. An empirical example from the Lipid Research Clinics Mortality Follow-up Study.

In prospective epidemiologic studies of coronary heart disease, a single measurement of cholesterol is made to assess its relationship to the risk of coronary disease. Statistical theory states that if this measurement is subject to within-individual variability, the strength of the relationship will be underestimated. This is empirically shown for the example of plasma cholesterol.

The association of corneal arcus with coronary heart disease and cardiovascular disease mortality in the Lipid Research Clinics Mortality Follow-up Study.

The relationship between corneal arcus (arcus senilis) and mortality from coronary heart disease (CHD) and cardiovascular disease (CVD) is examined in a prospective study of White men (n = 3,930) and women non-hormone users (n = 2,139), ages 30-69, followed for an average of 8.4 years as part of the Lipid Research Clinics Mortality Follow-up Study. After excluding those with clinically manifest CHD at baseline, corneal arcus was strongly associated with CHD and CVD mortality only in hyperlipidemic men ages 30-49 years, for whom the relative risk for CHD and CVD death was 3.

Policies for the prevention of coronary heart disease through cholesterol-lowering.

Policies for coronary heart disease prevention through cholesterol-lowering have been advocated by groups in the UK, the US and Continental Europe. Such policies are based on studies of the atherosclerotic plaque, experimental animals, genetic disorders, and lipoprotein metabolism, and from different epidemiological studies and clinical trials. Surveys of physicians and the public indicate a growing awareness of the importance of cholesterol.

High-density lipoprotein cholesterol and coronary artery disease: survey of the evidence.

The epidemiologic evidence linking high-density lipoprotein (HDL) levels with coronary artery disease (CAD) is persuasive. Case-control studies have shown CAD patients to have lower HDL levels than control subjects. Several large-scale, observational epidemiologic studies in the United States and abroad have shown a strong independent inverse relation between HDL and CAD.

Serum lipids and lipoproteins of Hispanics, 1982-84.

This report presents descriptive data for serum lipids and lipoproteins by age, sex, and selected socioeconomic variables. This information is from the Hispanic Health and Nutrition Examination Survey, a sample survey of selected groups of civilian noninstitutionalized Hispanic persons residing in selected area of the United States, that was conducted during the period 1982-84.

Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease.

To determine the associations of total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol with mortality from coronary heart disease and cardiovascular disease, we studied 2541 white men who were 40 to 69 years old at base line and followed them for an average of 10.1 years. Seventeen percent had some manifestation of cardiovascular disease at base line, whereas the others did not.

Does lowering serum cholesterol levels lower coronary heart disease risk?

Many lines of evidence converge toward the conclusion that low-density lipoprotein cholesterol (LDLC) is indeed a causal factor in the genesis of CHD. These range from animal studies, pathology studies, inborn errors of metabolism, clinical observations, and the existence of plausible biologic mechanisms, to the vast body of epidemiologic evidence. Observations of the association of LDLC with CHD hold between different populations, in the same population at different times, and to studies of individuals within populations.