Insights into the pathogenesis and prevention of coronary artery disease

O'Keefe, J. H., Lavie, C. J. and McCallister, B. D. (1995) Insights into the pathogenesis and prevention of coronary artery disease. Mayo Clinic Proceedings, 70 1: 69-79.

Author O'Keefe, J. H.
Lavie, C. J.
McCallister, B. D.
Title Insights into the pathogenesis and prevention of coronary artery disease
Journal name Mayo Clinic Proceedings   Check publisher's open access policy
ISSN 0025-6196
1942-5546
Publication date 1995-01
Sub-type Critical review of research, literature review, critical commentary
Volume 70
Issue 1
Start page 69
End page 79
Total pages 11
Place of publication New York, NY, United States
Publisher Elsevier
Language eng
Formatted abstract
Objective: To present information about risk factor clustering and the oxidation hypothesis of atherosclerosis and attempt to synthesize these facts into a clinically relevant approach to patients with or at risk for coronary artery disease (CAD).

Material and Methods: The total cholesterol level is a relatively weak marker for the risk of CAD. The levels of both high-density lipoprotein (HDL) cholesterol and remnants of triglyceride-rich lipoproteins and the inherent susceptibility of the low-density lipoprotein (LDL) particles to oxidative modification may be as important as the total or LDL cholesterol levels. LDL cholesterol must undergo oxidative modification by means of oxygen free radical processes before it becomes atherogenic. Patients with high levels of oxidative stress include those with risk factor clustering or insulin resistance (or both). Such patients are characterized by hypertension, truncal obesity, hypertriglyceridemia, depressed HDL cholesterol levels, and increased insulin levels. They also have increased levels of triglyceride-rich remnant lipoproteins and LDL particles that are characterized by their small dense nature and pronounced predisposition to oxidative modification.

Results: Biologic antioxidants seem to be promising therapy for the prevention of atherogenesis. Although long-term prospective data are not yet available, vitamin E has been shown to be effective in both animal and human models in preventing LDL oxidation, and it may have a role in the prevention of CAD. A healthy diet of fresh fruits, vegetables, and whole grains is beneficial because it improves the lipid levels and provides high levels of natural antioxidants. The atherogenic potential of hydrogenated polyunsaturated fats is approximately equivalent to that of saturated fats. Monounsaturated fat is inherently resistant to oxidation and may be protective against CAD. Niacin may be effective in patients with clustered risk factors. It has been found to convert the easily oxidized small dense LDL pattern to the large buoyant oxidation-resistant particles. Hydroxymethylglutaryl-coenzyme A reductase inhibitors are well tolerated and highly effective in decreasing LDL cholesterol, but they are expensive. Estrogen has multiple potentially beneficial effects relative to cardiovascular disease.

Conclusion: Persons with or at high risk for CAD should be identified early and aggressively treated with a program that involves lifestyle changes, alterations in dietary intake, and pharmacologic therapy.
Keyword Risk factor clustering
Oxidation hypothesis
Atherosclerosis
Oxidative modification
Myocardial infarction
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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Created: Mon, 14 Mar 2011, 09:37:51 EST