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Gail Wiley D.O. Candidate GA-PCOM July 2012

Association of High-Density Lipoprotein Cholesterol with Incident Cardiovascular Events in Women, by Low-Density Lipoprotein Cholesterol and Apolipoprotein B100 Levels Annals of Internal Medicine December 2011. Gail Wiley D.O. Candidate GA-PCOM July 2012. Funding.

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Gail Wiley D.O. Candidate GA-PCOM July 2012

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  1. Association of High-Density Lipoprotein Cholesterol with Incident Cardiovascular Events in Women, by Low-Density Lipoprotein Cholesterol and Apolipoprotein B100 LevelsAnnals of Internal MedicineDecember 2011 Gail Wiley D.O. Candidate GA-PCOM July 2012

  2. Funding • Merck and Co., National Heart, Lung and Blood Institute, National Cancer Institute, National Institutes of Health

  3. Background/ Objective: • studies have shown that high levels of HDL have a anti-atherogenic effect and LDL and has an atherogenic effect • HDL particles are able to remove cholesterol from within atheromas and transport it back to the liver for excretion or re-utilization • Does HDL still have this cardioprotective effect in women at all levels of LDL and apolipoprotein B100? • apo B100 is value measuring all LDL’s (inlcluding VLDLS and intermediate density LDL’s), which are also atherogenic • study focuses particulary on women • -answers questions not answered by the Framingham study

  4. Why is this important? • CAD remains the number one cause of death in american women • LDL has been a target of therapy for prevention of CAD (statins), HDL receiving more attention and it is still unclear wether it should be a clinical focus for treatment •  "Although clinical trial results suggest that raising HDL will reduce risk, the evidence is insufficient to specify a goal of therapy. Furthermore, currently available drugs do not robustly raise HDL cholesterol.“ -quote from Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults • HDL currently used to determine CAD risk (ie Framingham tables) but low values are not routinely treated

  5. Study Design and Setting: • prospective cohort study • participants were apparently healthy female health care professionals, age 45 or older • 27,000 women were followed for a mean of 11 years • baseline lipid measurements were done at the start of study

  6. Endpoints included in analysis: • myocardial infarction • stroke • percutaneous coronary intervention • coronary artery bypass grafting • death from cardiovascular causes

  7. Exclusions: • women with self-reported CAD or cancer • women on lipid lowering medications

  8. Results:

  9. cont.

  10. Conclusion: This study confirms the inverse relationship between HDL cholesterol and adverse cardiovascular events in women. • HDL is cardioprotective in women with all levels of LDL- high or low • HDL is cardioprotective in women with moderate to increased apo-B (measure of all “bad fats”) • study could not determine wether HDL was cardioprotective in women with very low levels apoB- very few events occured • protective effect of HDL plateaus at a level of 67 mg/dL • HDL levels have little value in predicting stroke

  11. Limitations: • study population was healthy women- unable to predict wether HDL is protective in women with pre-existing CAD • only one baseline lipid measurement was obtained

  12. Comments: This study did a good job of highlighting the interaction between “good” and “bad” fats, demonstrating why the LDL to HDL ratio of better predictive value than LDL alone. Study also highlighted a need for there to be more research done on the relationship between cholesterol and stroke- only a weak correlation has been shown.

  13. Sources: • Mora S et al. Association of high-density lipoprotein cholesterol with incident cardiovascular events in women, by low-density lipoprotein cholesterol and apolipoprotein B100 levels: A cohort study. Ann Intern Med 2011 Dec 6; 155:742.  • Rafael Carmena, MD; Patrick Duriez, PhD;  Jean-Charles Fruchart, PhD (2003, February 3 Atherosclerosis: Evolving Vascular Biology and Clinical Implications. Retrieved July 15, 2012, from http://circ.ahajournals.org/content/109/23_suppl_1/III-2.full#abstract-1 • Vibhuti N Singh, MD, MPH, FACC, FSCAI. Low HDL Cholesterol (Hypoalphalipoproteinemia) Treatment & Management (2002). Retrieved July 15 2012, from http://emedicine.medscape.com/article/127943-treatment • Jamaluddin Moloo, MD, MPH (Jan 19,2012) Association of Lipid Subfractions and Cardiovascular Events in Women. Retrieved July 15,2012 from http://general-medicine.jwatch.org/cgi/content/full/2012/119/2

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