Re: Cholesterol
- From: Susan <nevermind@xxxxxxxxxx>
- Date: Sun, 12 Mar 2006 13:31:23 -0500
x-no-archive: yes
jonaheal@xxxxxxxxx wrote:
Thanks William and Susan. This is exactly what I am looking for -
personal experiences and pointers to studies.
Here are some studies:
Ann Epidemiol. 2005 May;15(5):405-13.
Related Articles, Links
A comparison of lipid variables as predictors of cardiovascular disease in the Asia Pacific region.
Barzi F, Patel A, Woodward M, Lawes CM, Ohkubo T, Gu D, Lam TH, Ueshima H; Asia Pacific Cohort Studies Collaboration.
The George Institute for International Health, University of Sydney, Camperdown, NSW 2050, Australia. fbarzi@xxxxxxxxxxxxxxxxxxxxxx
PURPOSE: Many guidelines advocate measurement of total or low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglycerides (TG) to determine treatment recommendations for preventing coronary heart disease (CHD) and cardiovascular disease (CVD). This analysis is a comparison of lipid variables as predictors of cardiovascular disease. METHODS: Hazard ratios for coronary and cardiovascular deaths by fourths of total cholesterol (TC), LDL, HDL, TG, non-HDL, TC/HDL, and TG/HDL values, and for a one standard deviation change in these variables, were derived in an individual participant data meta-analysis of 32 cohort studies conducted in the Asia-Pacific region. The predictive value of each lipid variable was assessed using the likelihood ratio statistic. RESULTS: Adjusting for confounders and regression dilution, each lipid variable had a positive (negative for HDL) log-linear association with fatal CHD and CVD. Individuals in the highest fourth of each lipid variable had approximately twice the risk of CHD compared with those with lowest levels. TG and HDL were each better predictors of CHD and CVD risk compared with TC alone, with test statistics similar to TC/HDL and TG/HDL ratios. Calculated LDL was a relatively poor predictor. CONCLUSIONS: While LDL reduction remains the main target of intervention for lipid-lowering, these data support the potential use of TG or lipid ratios for CHD risk prediction.
PMID: 15840555 [PubMed - indexed for MEDLINE]
Kopp W.
High-insulinogenic nutrition--an etiologic factor for obesity and the
metabolic
syndrome?
Metabolism. 2003 Jul;52(7):840-4. Review.
PMID: 12870158 [PubMed - indexed for MEDLINE]
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12870158&dopt=Abstract>
the author writes:
"This report postulates a critical role for the quantity and quality
of dietary carbohydrate in the pathogenesis of obesity and the
metabolic syndrome. Significant changes in human nutrition have
occurred during the last 10,000 years, culminating in the current
high-glycemic/high-insulinogenic nutrition. A high insulinogenic
nutrition represents a chronic stimulus to the beta cells that may
induce an adaptive hypertrophy and a progressive dysregulation of
the cells, resulting in postprandial hyperinsulinemia, especially in
genetically predisposed subjects. Significant evidence suggests that
postprandial hyperinsulinemia promotes weight gain and the
development of insulin resistance/metabolic syndrome. The hypothesis
is able to explain the current epidemic of obesity and the metabolic
syndrome in most industrialised countries, as well as some of the
genetics of obesity, including the extreme high incidence of obesity
and the metabolic syndrome in certain ethnic groups."
"A new study suggests that level of triglyceride in the blood may help
predict heart attack risk as well as other more well-known blood fats
such as LDL and HDL cholesterol. High triglycerides alone increased
the risk of heart attack nearly three-fold, according to a report in
the current issue of Circulation. And people with the highest ratio of
triglycerides to HDL -- the "good" cholesterol -- had 16 times the
risk of heart attack as those with the lowest ratio of triglycerides
to HDL in the study of 340 heart attack patients and 340 of their
healthy, same age counterparts. The ratio of triglycerides to HDL was
the strongest predictor of a heart attack, even more accurate than the
LDL/HDL ratio," reported Harvard lead study author.
Triglycerides, a mixture of fatty acids and glycerol that make up the
principle fats in the blood, bind to carrier proteins, forming
compounds known as lipoproteins. Other types of lipoproteins that
carry cholesterol, such as LDL and HDL, are known to be related to the
risk of heart disease because of their propensity to deposit -- or not
deposit -- fat in coronary arteries. However, it has not been clear if
triglyceride level could predict heart attack risk, despite years of
research." Circulation (1997;96:2520-2525)
Ann Intern Med 1998 Apr 1;128(7):524-33
Metabolic risk factors worsen continuously across the spectrum of nondiabetic glucose tolerance. The Framingham Offspring Study.
Meigs JB, Nathan DM, Wilson PW, Cupples LA, Singer DE
Massachusetts General Hospital, Harvard Medical School, Boston University School of Public Health, 02114, USA. jmeigs@xxxxxxxxxxxxxxxxxxx
BACKGROUND: Categorical definitions for glucose intolerance imply that risk thresholds exist, but metabolic risk for type 2 diabetes mellitus or cardiovascular disease may increase continuously as glucose intolerance increases. OBJECTIVE: To examine the distributions of the following metabolic risk factors across the spectrum of glucose tolerance: overall and central obesity, hypertension, low levels of high-density lipoprotein cholesterol, and increased triglyceride and insulin levels. DESIGN: Cross-sectional analysis. SETTING: The community-based Framingham Offspring Study. PARTICIPANTS: 2583 adults without previously diagnosed diabetes. MEASUREMENTS: Clinical data; fasting glucose, insulin, and lipid levels; and glucose and insulin levels taken 2 hours after oral challenge were collected from 1991 to 1993. Glucose tolerance was determined by 1980 World Health Organization criteria. Patients with normal glucose tolerance were categorized into quintiles of fasting glucose. The distributions of each metabolic risk factor and the metabolic sum of the six risk factors were assessed across seven categories from the lowest quintile of normal fasting glucose level through impaired glucose tolerance and previously undiagnosed diabetes. RESULTS: The mean age of patients was 54 years (range, 26 to 82 years); 52.7% of patients were women. Glucose tolerance testing found that 12.7% of patients had impaired glucose tolerance and 4.8% had previously undiagnosed diabetes. Multivariable-adjusted mean measures of risk factors and odds ratios for obesity, elevated waist-to-hip ratio, hypertension, low levels of high-density lipoprotein cholesterol, elevated triglyceride levels, and hyperinsulinemia showed continuous increases across the spectrum of nondiabetic glucose tolerance. Although a threshold effect near the upper range of nondiabetic glucose tolerance could not be ruled out for triglyceride levels in men and for insulin levels 2 hours after oral challenge in men and women, no other metabolic risk factors showed clear evidence of thresholds for increased risk. CONCLUSIONS: Metabolic risk factors for type 2 diabetes mellitus and for cardiovascular disease worsen continuously across the spectrum of glucose tolerance categories, beginning in the lowest quintiles of normal fasting glucose level.
PMID: 9518396, UI: 98175274
I suspect picture is not that simple, as Susan pointed out.
This is for my parents, esp. mother ( age 67 ) , who has calcified
aortic valve ( mostly cholesterol deposits)
and has elevated cholesterol ( LDL/HDL ratio is not known; I'll find
out about triglycerides ).
She is scared of statins ( not taking them now, and won't do it ).
Nor would I. But pantethine gel caps, 450mg twice per day does the same things as statins (inhibits HMG-COA and thromboxane A2) with no adverse reactions reported. Lowered my LDL 70 pts, and my HDL rose further, to an all time high of 70.
The thing is, when doctors find out she has high cholesterol they'll go
for statins. She ( probably correctly ) doesn't want to take
statins, but then looses doctor's support for whatever it's worth.
(She also discovered flax oil as potentially good thing )
JH.
Here are the statin abstracts, to share with her doctors.
[Evaluation of the cholesterol-lowering effectiveness of pantethine in women in perimenopausal age]
[Article in Italian]
Binaghi P, Cellina G, Lo Cicero G, Bruschi F, Porcaro E, Penotti M.
Servizio di Cardiologia, Istitut Clinici di Perfezionamento, Milano.
Cardiovascular diseases are the main cause of death also in women. Their incidence, rapidly growing in the peri-menopausal period, is related to serum levels of total cholesterol and its LDL fraction. It was also shown that the peroxidation of LDL is an additional factor in the genesis of atherosclerotic vascular disease. As long-term treatments with synthetic lipid-lowering drugs may cause undesirable side effects, while pantethine is known to be well tolerated, we treated 24 hypercholesterolemic women (total serum cholesterol greater than or equal to 240 mg/dl), in perimenopausal age (range: 45-55 years, mean +/- SD = 51.6 +/- 2.4) with 900 mg/day of pantethine. This is a precursor of coenzyme A, with an antiperoxidation effect in vivo, and our aim was to confirm its lipid lowering activity in this particular type of patients. After 16 weeks of treatment, significant reductions of total cholesterol, LDL-cholesterol and LDL-C/HDL-C ratio could be observed. No remarkable changes of the main laboratory parameters (fasting blood sugar, B.U.N., creatinine, uric acid) were seen. Efficacy percentages of the treatment were about 80%. None of the patients complained of adverse reactions due to the treatment with pantethine. In conclusion, we suggest that pantethine should be considered in the long-term treatment of lipid derangements occurring in the perimenopausal age.
PMID: 2359503 [PubMed - indexed for MEDLINE]
1: Acta Biomed Ateneo Parmense. 1984;55(1):25-42. Related Articles, Links
[Hyperlipidemia, diabetes and atherosclerosis: efficacy of treatment with pantethine]
[Article in Italian]
Arsenio L, Caronna S, Lateana M, Magnati G, Strata A, Zammarchi G.
The hypolipidemizing effects of Pantethine were investigated by the Authors in 37 hypercholesterolemic and/or hypertriglyceridemic patients. Of these, 21 were also diabetic, in a satisfying glucidic compensation, in order to verify the action of this drug also in this metabolic condition. The study was carried out for three months and during this period the patients were given Pantethine at the dose of 600 mg/die orally. At the 30th, the 60th, the 90th day of treatment the following parameters were controlled: cholesterolemia, HDL cholesterol, apolipoproteins A and B, triglyceridemia, systolic and diastolic arterial pressure, uricemia, body weight. Thirty days after suspending the treatment, the parameters were controlled again to detect a possible "rebound" effect. The results were analyzed on the whole case-record, subdividing the patients in dislipidemic and diabetic-dislipidemic, and on the basis of the Fredrickson's classification. Pantethine induced in all groups a quick and progressive decrease of cholesterolemia, triglyceridemia, LDL cholesterol and Apolipoproteins B with increased HDL cholesterol and Apolipoproteins A. After suspending the treatment, there is a clear inversion of the state of these parameters. The Authors conclude that the present work shows that Pantethine, a natural and atoxic substance, an important component of Coenzyme A, is efficacious in determining a clear tendency towards normalization of the lipidic values.
PMID: 6232801 [PubMed - indexed for MEDLINE]
1: Atherosclerosis. 1984 Jan;50(1):73-83. Related Articles, Links
Controlled evaluation of pantethine, a natural hypolipidemic compound, in patients with different forms of hyperlipoproteinemia.
Gaddi A, Descovich GC, Noseda G, Fragiacomo C, Colombo L, Craveri A, Montanari G, Sirtori CR.
Pantethine (P), the stable disulphate form of pantetheine, major component and precursor of coenzyme A, was evaluated within a double-blind protocol (8 weeks for P or for a corresponding placebo) in 29 patients, 11 with type IIB hyperlipoproteinemia, 15 with type IV, and 3 with an isolated reduction of high density lipoprotein cholesterol (HDL-C) levels. In type IIB patients, P (300 mg t.i.d.) determined a highly significant lowering of plasma total and low density lipoprotein (LDL) associated cholesterol (-13.5% for both parameters). In the same patients, HDL-C levels increased about 10% at the end of treatment. Switching from P to placebo was associated with a rapid return to the baseline cholesterolemia. Both in type IIB and type IV patients, plasma triglyceride levels were reduced around 30%, when P was given as the first treatment; when it was preceded by placebo, reductions were less striking (respectively, -17.8% for type IIB and -13.0% for type IV, at the end of P treatment). HDL-C levels were not increased by P, either in type IV, and in the patients with low HDL cholesterolemia. In type IV, LDL cholesterol levels showed a variable response to P: they tended to increase when below 132 mg/dl, prior to treatment, and to be reduced when above this level. This study provides evidence for a significant hypocholesterolemic effect of P, a natural compound free of overt side effects. It also indicates that P may raise HDL-C levels in type IIB patients, while moderately reducing triglyceridemia.
Publication Types:
• Clinical Trial
• Controlled Clinical Trial
PMID: 6365107 [PubMed - indexed for MEDLINE]
1: Int J Clin Pharmacol Ther Toxicol. 1986 Nov;24(11):630-7. Related Articles, Links
Lipoprotein changes induced by pantethine in hyperlipoproteinemic patients: adults and children.
Bertolini S, Donati C, Elicio N, Daga A, Cuzzolaro S, Marcenaro A, Saturnino M, Balestreri R.
Following a brief outline of current knowledge concerning atherosclerosis and its treatment, the authors describe the results obtained by treating with pantethine (900-1200 mg daily for 3 to 6 months) a series of 7 children and 65 adults suffering from hypercholesterolemia alone or associated with hypertriglyceridemia (types IIa and IIb of Fredrickson's classification). Pantethine treatment produced significant reduction of the better known risk factors (total cholesterol, LDL-cholesterol, triglycerides, and apo-B) and a significant increase of HDL-cholesterol (signally HDL2) and apolipoprotein A-I. The authors conclude with a discussion of these results and of the possible role of pantethine in the treatment of hyperlipoproteinemia, in view of its perfect tolerability and demonstrated therapeutic effectiveness.
PMID: 3098691 [PubMed - indexed for MEDLINE]
: Atherosclerosis. 1984 Dec;53(3):255-64. Related Articles, Links
Pantethine reduces plasma cholesterol and the severity of arterial lesions in experimental hypercholesterolemic rabbits.
Carrara P, Matturri L, Galbussera M, Lovati MR, Franceschini G, Sirtori CR.
Pantethine (P), a coenzyme A precursor, was administered to cholesterol-fed rabbits (0.5% cholesterol diet + 1% pantethine) for 90 days. At the end of treatment, plasma total cholesterol levels were reduced 64.7% and the HDL/total cholesterol ratio increased in P-treated animals; a significant rise of the apo A-I/A-II ratio was detected in HDL. VLDL lipid and protein levels were, on the other hand, reduced by P. The cholesterol-ester content of both liver and aortic tissues was not significantly affected by P. Although the total aortic area with evident plaques was reduced only 18.2%, the microscopical examination of sections from the major vessels of P-treated animals, showed a reduction in the severity of lesions, both in the aorta and in the coronary arteries. These findings suggest that P, in addition to significantly lowering plasma cholesterol levels in rabbits on an experimental diet, may modify lipid deposition in major arteries, possibly by affecting lipoprotein composition and/or exerting an arterial protective effect.
PMID: 6442152 [PubMed - indexed for MEDLINE]
Clin Ther. 1986;8(5):537-45. Related Articles, Links
Effectiveness of long-term treatment with pantethine in patients with dyslipidemia.
Arsenio L, Bodria P, Magnati G, Strata A, Trovato R.
A one-year clinical trial with pantethine was conducted in 24 patients with established dyslipidemia of Fredrickson's types II A, II B, and IV, alone or associated with diabetes mellitus. The treatment was well tolerated by all patients with no subjective complaints or detectable side effects. Blood lipid assays repeated after 1, 3, 6, 9, and 12 months of treatment revealed consistent and statistically significant reductions of all atherogenic lipid fractions (total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B) with parallel increases of high-density lipoprotein cholesterol and apolipoprotein A. The results were equally good in patients with uncomplicated dyslipidemia and in those with associated diabetes mellitus. The authors conclude that pantethine (a drug entity related to the natural compound, pantetheine) represents a valid therapeutic support for patients with dyslipidemia not amenable to satisfactory correction of blood lipids by diet alone.
PMID: 3094958 [PubMed - indexed for MEDLINE]
Acta Biomed Ateneo Parmense. 1987;58(5-6):143-52. Related Articles, Links
[Clinical use of pantethine by parenteral route in the treatment of hyperlipidemia]
[Article in Italian]
Arsenio L, Bodria P, Bossi S, Lateana M, Strata A.
Servizio di Malattie del Ricambio e Diabetologia, Ospedali Riuniti, Parma.
Recent investigations have confirmed the effectiveness and the excellent tolerability of pantethine, a derivative of pantetheine, an essential part of the acetylation coenzyme CoA, administered P.O., in normalizing the blood lipid concentrations of patients with hyperlipidemias. A group of 18 patients with hyperlipidemias (9 M, 9 F), with an average age of 52.6 years, was submitted to pantethine parenteral treatment. After a 20 days wash-out, pantethine (400 mg/day; BID) was administered intramuscularly, for 20 days. Total cholesterol, triglycerides, HDL-cholesterol, apo A-1 and B lipoprotein, uric acid in serum, glycemia, CBC, B.U.N., creatininemia, E.S.R., SGOT, SGPT, bilirubinemia, cardiac frequency, blood pressure and body weight were controlled before and after treatment. The drug showed to have a therapeutic effectiveness by a rapid and significant improvement in the blood lipid pattern with reduction of total cholesterol, triglycerides and apo-B lipoprotein and increase of HDL-cholesterol and apo A-1 lipoprotein. The tolerability of pantethine at the stated dosage and mode of administration was invariably excellent, with non complaints or visible side effects imputable to the test drug. BUN, creatininemia, glycemia, SGOT, SGPT, bilirubinemia, E.S.R., CBC, cardiac frequency and blood pressure readings showed no noteworthy changes throughout the study.
PMID: 2970754 [PubMed - indexed for MEDLINE]
1: Vopr Pitan. 1987 Mar-Apr;(2):15-7. Related Articles, Links
[Therapeutic efficacy of pantothenic acid preparations in ischemic heart disease patients]
[Article in Russian]
Borets VM, Lis MA, Pyrochkin VM, Kishkovich VP, Butkevich ND.
The therapeutic effectiveness of the pantothenic acid drugs: calciipantothenas and pantethine, was studied in 182 patients with coronary heart disease and stable angina of effort. It is shown that both the drugs produce favourable effects on certain parameters of hemodynamics, on the metabolism of lipids, riboflavin and ascorbic acid. It is recommended that the administration of calciipantothenas in a dose of 300 mg/day, during 3 weeks, be included into the combined treatment of coronary patients with no manifest disorders of lipid metabolism. Patients with manifest hyperlipidemia should be administered pantethine in a dose of 500 mg/day.
PMID: 3590676 [PubMed - indexed for MEDLINE]
1: Clin Nephrol. 1986 Feb;25(2):70-4. Related Articles, Links
Pantethine improves the lipid abnormalities of chronic hemodialysis patients: results of a multicenter clinical trial.
Donati C, Barbi G, Cairo G, Prati GF, Degli Esposti E.
In the course of a post-marketing surveillance program on the effectiveness and tolerability of pantethine in the treatment of hyperlipidemia, the effects of the drug were explored in 31 patients with dyslipidemia undergoing chronic hemodialysis. The mean duration of treatment was 9 months (min. 7 months, max. 24 months), with oral doses of 600 to 1200 mg of pantethine daily (mean daily dosage 970 mg). Improvement was noted in terms of total blood cholesterol in the 7 patients with basal hypercholesterolemia (p less than 0.01) and highly significant reduction of serum triglycerides. No variations of HDL-cholesterol or total Apo-A were detected. None of the patients experienced any adverse effects from the treatment. In the light of extensive experience with the drug, plus the results of this study, the authors conclude by stressing the importance of an effective and readily tolerated product, such as pantethine, for the treatment of dyslipidemia in patients on chronic hemodialysis.
Publication Types:
• Clinical Trial
PMID: 3516477 [PubMed - indexed for MEDLINE]
1: Artery. 1987;15(1):1-12. Related Articles, Links
Lowering effect of pantethine on plasma beta-thromboglobulin and lipids in diabetes mellitus.
Eto M, Watanabe K, Chonan N, Ishii K.
Second Department of Internal Medicine, Asahikawa Medical College, Japan.
Pantethine in a dosage of 600 mg for the first 3 months, and in a dosage of 1200 mg for the second 6 months was given to 16 diabetics in whom plasma beta-thromboglobulin was raised (greater than 50 ng/ml). Plasma beta-TG levels decreased significantly with pantethine treatment for 9 months. Plasma triglyceride, total cholesterol, apo E and apo CII levels decreased significantly after 9 months. Plasma LDL-C and atherogenic index (LDL-C/HDL-C ratio or apo B/apo AI ratio) tended to decrease with treatment. It is concluded that administration of pantethine may be beneficial in the prevention of diabetic angiopathy because of its lowering effect on plasma beta-TG, lipids and apolipoproteins.
PMID: 2963604 [PubMed - indexed for MEDLINE]
1: Ter Arkh. 1991;63(11):58-60. Related Articles, Links
[The use of pantothenic acid preparations in treating patients with viral hepatitis A]
[Article in Russian]
Komar VI.
Calcium pantothemate in the daily dose 300 mg and 600 mg and pantetheine in the dose 90 mg and 180 mg per os were applied for 3-4 weeks in combined therapy of 156 patients with viral hepatitis A. In addition to the positive clinico-biochemical effect, these drugs produced an immunomodulatory action and a beneficial effect on the level of blood serum immunoglobulins and the phagocytic activity of peripheral blood neutrophils. Pantetheine provided the most pronounced therapeutic effect.
PMID: 1810066 [PubMed - indexed for MEDLINE]
1: Clin Ter. 1989 Mar 31;128(6):411-22. Related Articles, Links
[Pantethine, diabetes mellitus and atherosclerosis. Clinical study of 1045 patients]
[Article in Italian]
Donati C, Bertieri RS, Barbi G.
After a review of the clinical studies on the treatment of diabetic patients with pantethine, the authors discuss the results obtained in a postmarketing surveillance (PMS) study on 1045 hyperlipidemic patients receiving pantethine (900 mg/day on average). Of these patients, 57 were insulin-dependent (Type I) and 241 were non insulin-dependent (Type II) diabetics. Beyond the epidemiological considerations made possible by a PMS study, the authors show that pantethine brought about a statistically significant and comparable improvement of lipid metabolism in the three groups of patients, with very good tolerability. Pantethine should therefore be considered for the treatment of lipid abnormalities also in patients at risk such as those with diabetes mellitus.
PMID: 2524328 [PubMed - indexed for MEDLINE]
1: Vopr Pitan. 1983;(1):45-9. Related Articles, Links
[Pantothenic acid metabolic disorder and its relation to the change in energy processes in patients with ischemic heart disease and hypertension]
[Article in Russian]
Borets VM, Ovchinnikov VA, Mironchik VV, Moiseenok AG, Lis MA.
Pantothenic acid metabolism and the status of energy processes in leukocytes were examined in 171 patients with hypertension and coronary heart disease. It was shown that the patients' body supply with the vitamin decreased as the disease progressed and heart failure supervened. The deficiency of pantothenic acid was shown to be interrelated with the impairment of energy processes. Application of pantothenate in a dose of 200 mg a day for two weeks led to the increased content of pantothenic acid and to normalization of energy processes.
PMID: 6837001 [PubMed - indexed for MEDLINE]
1: Angiology. 1987 Mar;38(3):241-7. Related Articles, Links
Effect of oral treatment with pantethine on platelet and plasma phospholipids in IIa hyperlipoproteinemia.
Prisco D, Rogasi PG, Matucci M, Paniccia R, Abbate R, Gensini GF, Neri Serneri GG.
In a single-blind, crossover, completely randomized study, the effects of oral treatment with pantethine or placebo on fatty acid composition of plasma and platelet phospholipids were investigated in 10 IIa hyperlipoproteinemic patients. A significant decrease of total cholesterol and total phospholipids was observed both in plasma and in platelets after a twenty-eight-day treatment. In plasma, pantethine induced a decrease of the ratio sphingomyelin/phosphatidylcholine. Moreover, a relative increase of n3-polyunsaturated fatty acids both in plasma and in platelet phospholipids and a decrease of arachidonic acid in plasma phospholipids were observed. These results indicate that pantethine can affect plasma and platelet lipid composition with possibly favorable influences on the determinants of cell membrane fluidity.
Publication Types:
• Clinical Trial
• Randomized Controlled Trial
PMID: 3551695 [PubMed - indexed for MEDLINE]
Susan
.
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