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Biomedical subjects

R I Levy

Publications and source records attributed to R I Levy.

At least 19 recordsLinked to original sources
PubMed1987

Intermediate-density lipoproteins and progression of coronary artery disease in hypercholesterolaemic men.

Lipoprotein mass concentrations were measured by analytical ultracentrifugation in a subset of 57 hypercholesterolaemic male participants in the National Heart, Lung, and Blood Institute Type II Coronary Intervention Study. 2-year changes in levels of intermediate-density lipoproteins (IDL) of flotation rate 12-20 were strongly predictive of progression of coronary artery disease at 5 years. Changes in serum mass concentrations of low-density lipoproteins (LDL; flotation rate 0-12), very-low-density lipoproteins (VLDL; flotation rate 20-400), high-density lipoproteins (HDL), and the HDL2 and HDL3 subfractions did not differ significantly between men with and without definite progression of coronary artery disease. The relation of IDL mass to disease progression remained significant (p less than 0.05) after adjustment for group assignment to cholestyramine treatment or placebo and was only slightly reduced (p less than or equal to 0.06) by adjustment for changes in LDL mass concentrations. Changes in IDL mass and ratios of HDL-cholesterol to total-cholesterol or LDL-cholesterol were inversely correlated and had a similar ability to predict progression. The findings are consistent with earlier evidence that IDL are directly involved in the development of coronary artery disease and suggest that ratios of HDL-cholesterol to total-cholesterol or LDL-cholesterol may be indicators of coronary disease risk partly owing to relations with IDL metabolism.

Adult↗
PubMed1987

Report on the Lipid Research Clinic trials.

The Lipid Research Clinic Coronary Primary Prevention Trial was a randomized, double-blind, placebo-controlled intervention trial performed in 3806 hypercholesterolaemic (greater than 265 mg dl-1) but asymptomatic men aged 35-59 at entry. The bile acid sequestrant cholestyramine was used to achieve the cholesterol differential in the treatment group. Both groups received a modest low cholesterol-low fat diet. All subjects were followed for at least seven years (mean duration 7.4 years) during which time a mean fall of 8% and 12% in plasma total cholesterol and LDL cholesterol levels respectively relative to levels in placebo controls were achieved and maintained. The cholestyramine group experienced a 19% reduction in risk (P greater than 0.05) of the primary end point-definite coronary heart disease death and/or definite non-fatal myocardial infarction. In addition, the incidence rates for new positive exercise tests, angina, and coronary bypass surgery were all significantly reduced by 25%, 20% and 21%, respectively, in the cholestyramine group. In the treated group, risk reduction was related directly to reduction in total and LDL cholesterol. In a similar but considerably smaller double blind, placebo-controlled, secondary prevention trial where coronary artery lesion change as determined by serial coronary angiography was the end point (The NHLBI Type II Intervention Trial), cholestyramine treatment significantly delayed the progression of atherosclerotic lesions. Plaque progression related directly to both a fall in low density lipoprotein and a rise in high density lipoprotein.

Adult↗
PubMed1987

Role of dietary intervention in the primary prevention of coronary heart disease. Individuals with high-normal or elevated serum cholesterol levels should be placed on cholesterol-lowering diets.

A large and convincing body of evidence links increased coronary risk with elevated plasma levels of low-density lipoprotein (LDL) cholesterol. Cholesterol in atherosclerotic lesions originates from that circulating in the blood bound to LDL. Even mild degrees of hypercholesterolemia (cholesterol greater than 180 mg/dl) when due to increased levels of LDL are associated with increased risk. Lowering plasma levels of LDL has been clearly shown to reduce coronary risk. We are able to modify plasma levels of LDL by restricting the dietary content of cholesterol and saturated fats. Such diets are safe and can be adhered to by large populations. Available information, reviewed here in detail, supports vigorous efforts to lower cholesterol levels by dietary means, even in the patient with so-called mild hypercholesterolemia. The evidence is overwhelming, the risk is nil, and the potential benefits are substantial.

Cholesterol, Dietary↗
PubMed1986

Changing perspectives in the prevention of coronary artery disease.

Today the question is no longer whether cholesterol reduction is beneficial for those at risk for coronary artery disease; the questions now are when, whom and how to treat. Areas of great interest include extrapolation of current trial results to low density lipoprotein reduction by diet and drugs, and assessment of the value of increasing high density lipoprotein levels by pharmacologic means. We will need to decide what measurements (total cholesterol, lipoprotein cholesterol or lipoprotein apoprotein levels) are of most value to the diagnosis, treatment and follow-up of the at-risk patient. Recommendations, including those of the recently published National Institutes of Health Consensus Panel on Cholesterol Lowering, suggest that our index for diagnosis and treatment should be set considerably lower than it is today. To be successful with a more aggressive approach to cholesterol lowering, we will need to better support, educate and motivate the at-risk patient. Physicians need to become more knowledgeable about what plasma cholesterol is and how to change it. Methods that enhance patient adherence to diet and drug therapy must be developed. We will need to alter lifetime habits and will need the help of both the food industry and better informed consumers, knowledgeable on how to read food labels, if we are to succeed. Ultimately, we will need a 2-pronged approach, focusing on both the physician and the public at large.

Animals↗
PubMed1986

Cholesterol and coronary artery disease. What do clinicians do now?

Coronary atherosclerosis and its clinical sequelae are problems of enormous magnitude. Because the first clinical sign of coronary artery disease may be sudden death, investigators have searched for signs or symptoms of coronary atherosclerosis before it becomes symptomatic. Among these signs or risk factors are elevated plasma levels of total cholesterol or low-density lipoprotein cholesterol, or a reduced level of high-density lipoprotein cholesterol. Recent studies complement older epidemiologic, genetic, metabolic, morphologic, and animal data by demonstrating directly in humans the value of cholesterol change. These studies have shown that a reduction in total plasma cholesterol or in low-density lipoprotein cholesterol and/or an elevation in high-density lipoprotein cholesterol results in decreased development of angina, positive exercise test results, and referral for coronary artery bypass surgery, as well as reductions in more severe cardiovascular end points such as heart attack, heart death, and atherosclerotic plaque progression. In the Lipid Research Clinics Coronary Primary Prevention Trial with hypercholesterolemic men, every 1 percent reduction in plasma cholesterol levels was associated with a 2 percent reduction in coronary risk. Today, the issue is no longer whether a reduction in cholesterol levels is beneficial. The questions now are much more practical: whom to treat, when to treat, and how to treat. The potential public health value of reducing cholesterol levels is enormous. Such a reduction should be espoused by all health care professionals, because it promises a better and longer life for persons at risk for coronary artery disease.

Adolescent↗
PubMed1986

IAIMS at Columbia: a strategic plan and model project.

This report describes the Integrated Academic Information Management System (IAIMS) prototype project at the Columbia-Presbyterian Medical Center, the factors that led to the selection of this particular project, and the planning for its implementation. The lessons learned to date and implications for the library are summarized.

Academic Medical Centers↗
PubMed1985

Primary prevention of coronary heart disease by lowering lipids: results and implications.

Evidence to support the hypothesis that lowering total and low-density lipoprotein (LDL) cholesterol may reduce heart attacks and heart deaths has, until recently, not been available. Early primary prevention trials lacked definitive data on these "hard" end points. Since 1980, five primary prevention trials have attempted to demonstrate the benefit of lowering cholesterol. Three of these involved diet: the Oslo Heart Trial and both the European and American Multiple Risk Factor Intervention Trials (MRFITs). Two involved lipid-lowering drugs: the European Clofibrate Primary Prevention Trial and the National Heart, Lung, and Blood Institute's recently concluded Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT). The Olso Heart Trial suggested a benefit from the dietary reduction of cholesterol; results of the other studies of diet were equivocal. Although clofibrate did demonstrate a reduced incidence of heart attacks in the treated group, the cardiac mortality rate was not altered in this group. A significant increase in the all-cause mortality rate (other than ischemic heart disease) observed in this trial in treated subjects makes clofibrate difficult to recommend. The LRC-CPPT study, involving cholestyramine, has provided conclusive evidence concerning the benefits of lowering cholesterol: significant reductions were observed in all cardiovascular end points measured, including the development of angina and positive exercise stress tests, referral for bypass surgery, and the hard primary study end point heart attack and heart attack death.

Cholesterol, LDL↗
PubMed1985

Secondary prevention and lipid lowering: results and implications.

In a secondary prevention trial conducted by the National Heart, Lung, and Blood Institute, the effect of lipid lowering by drug intervention on the progression of existing coronary artery disease (CAD) was evaluated in type II hyperlipidemic patients. This first randomized, secondary prevention trial compared the effect of cholestyramine and diet with that of placebo and diet in 143 patients over a 5-year period. End points evaluated were progression or regression of CAD, as demonstrated by angiographic changes compared with baseline angiograms. The cholestyramine-treated group demonstrated a significant reduction in total cholesterol and in low-density lipoprotein cholesterol (LDL) levels as compared with placebo, and an 8% increase in high-density lipoprotein cholesterol (HDL). A statistically significant result supporting the use of cholestyramine treatment was found in one category of CAD progression.

Angiocardiography↗