- Foreword
- Preface
- Acknowledgements
- Contributors
- List of abbreviations
- Part I Coronary heart disease
- Chapter 1 Epidemiology, outcomes, and quality of care
- Chapter 2 Lipids and cardiovascular disease
- Chapter 3 Myocardial ischaemia
- Chapter 4 Thrombosis, haemostasis, and platelet biology
- Chapter 5 Medical versus invasive management of coronary heart disease
- Chapter 6 Percutaneous coronary intervention
- Chapter 7 Percutaneous coronary intervention versus coronary artery bypass graft surgery
- Part II Cardiac electrophysiology and heart rhythm disturbances
- Chapter 8 Epidemiology and molecular foundation
- Chapter 9 Atrial fibrillation
- Chapter 10 Interventional electrophysiology
- Chapter 11 Anti-arrhythmic drug therapy
- Part III Heart failure
- Chapter 12 Epidemiology
- Chapter 13 Medical management
- Chapter 14 Cardiac resynchronization therapy
- Chapter 15 Non-ischaemic cardiomyopathy
- Chapter 16 Cardiac failure and transplantation
- Part IV Hypertension
- Chapter 17 Systemic arterial hypertension
- Chapter 18 Pulmonary arterial hypertension
- Part V Valvular heart disease
- Chapter 19 Epidemiology and intervention
- Chapter 20 Endocarditis
- Part VI Cardiac imaging
- Chapter 21 Echocardiography
- Chapter 22 Cardiovascular magnetic resonance
- Chapter 23 Cardiac computed tomography
- Part VII Congenital heart disease
- Chapter 24 Congenital heart disease
- Part VIII Obstetric cardiology
- Chapter 25 Obstetric cardiology
- Part IX Cardiac rehabilitation
- Chapter 26 Cardiac rehabilitation
- Index
(p. 30) Lipids and cardiovascular disease
- Chapter:
- (p. 30) Lipids and cardiovascular disease
- Author(s):
Dr Adie Viljoen
and Anthony Wierzbicki
- DOI:
- 10.1093/med/9780199594764.003.0002
Atherosclerotic plaques were noted to contain waxy deposits (cholesterol) by Fallopius in 1575 and in 1914 Anitschkow showed that cholesterol feeding led to atherosclerosis in a rabbit. The results of early lipid- lowering trials such as the Coronary Drug Project (clofibrate; niacin; d-thyroxine and oestrogen), World Health Organization Clofibrate Trial, Lipid Research Clinics (cholestyramine), and Programme on Surgical Correction of Hyperlipidaemia (ileal bypass surgery) were unclear, with some therapies showing no benefit (d-thyroxine and oestrogen) and the rest giving reductions in cardiovascular disease (CVD) events but not total mortality within the trial period. In some cases, for instance with clofibrate, mortality increased. Later trials (e.g. Helsinki Heart Study) failed to clarify the situation. A cholesterol controversy arose stating that cholesterol reduction might reduce CVD but increase other causes of mortality. The identity of the LDL-receptor was clarified and a class of drugs designed to block the rate-limiting step in cholesterol synthesis (2-hydroxy-methyl-glutaryl (HMG)-CoA reductase inhibitors) and increase LDL clearance was discovered. It remained to determine what their effects were in clinical practice.
A landmark paper in this field should fundamentally influence medical practice by setting a new paradigm for diagnosis, treatment, or by defining audit standards for the effectiveness of diagnosis or treatment so that improvements in care can be introduced and managed equitably.
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- Foreword
- Preface
- Acknowledgements
- Contributors
- List of abbreviations
- Part I Coronary heart disease
- Chapter 1 Epidemiology, outcomes, and quality of care
- Chapter 2 Lipids and cardiovascular disease
- Chapter 3 Myocardial ischaemia
- Chapter 4 Thrombosis, haemostasis, and platelet biology
- Chapter 5 Medical versus invasive management of coronary heart disease
- Chapter 6 Percutaneous coronary intervention
- Chapter 7 Percutaneous coronary intervention versus coronary artery bypass graft surgery
- Part II Cardiac electrophysiology and heart rhythm disturbances
- Chapter 8 Epidemiology and molecular foundation
- Chapter 9 Atrial fibrillation
- Chapter 10 Interventional electrophysiology
- Chapter 11 Anti-arrhythmic drug therapy
- Part III Heart failure
- Chapter 12 Epidemiology
- Chapter 13 Medical management
- Chapter 14 Cardiac resynchronization therapy
- Chapter 15 Non-ischaemic cardiomyopathy
- Chapter 16 Cardiac failure and transplantation
- Part IV Hypertension
- Chapter 17 Systemic arterial hypertension
- Chapter 18 Pulmonary arterial hypertension
- Part V Valvular heart disease
- Chapter 19 Epidemiology and intervention
- Chapter 20 Endocarditis
- Part VI Cardiac imaging
- Chapter 21 Echocardiography
- Chapter 22 Cardiovascular magnetic resonance
- Chapter 23 Cardiac computed tomography
- Part VII Congenital heart disease
- Chapter 24 Congenital heart disease
- Part VIII Obstetric cardiology
- Chapter 25 Obstetric cardiology
- Part IX Cardiac rehabilitation
- Chapter 26 Cardiac rehabilitation
- Index