High Cholesterol - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

HIGH CHOLESTEROL A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J ...

Author: Health Publica Icon Health Publications

39 downloads 790 Views 1MB Size Report

This content was uploaded by our users and we assume good faith they have the permission to share this book. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from our site. Start by pressing the button below!

Report copyright / DMCA form

DOWNLOAD PDF

HIGH

CHOLESTEROL A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

ii

ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2003 by ICON Group International, Inc. Copyright ©2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960High Cholesterol: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83925-5 1. High Cholesterol-Popular works. I. Title.

iii

Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

iv

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on high cholesterol. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

v

About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

vi

About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

vii

Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HIGH CHOLESTEROL ................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on High Cholesterol ......................................................................... 13 The National Library of Medicine: PubMed ................................................................................ 25 CHAPTER 2. NUTRITION AND HIGH CHOLESTEROL ...................................................................... 39 Overview...................................................................................................................................... 39 Finding Nutrition Studies on High Cholesterol .......................................................................... 39 Federal Resources on Nutrition ................................................................................................... 40 Additional Web Resources ........................................................................................................... 41 CHAPTER 3. ALTERNATIVE MEDICINE AND HIGH CHOLESTEROL ................................................ 47 Overview...................................................................................................................................... 47 National Center for Complementary and Alternative Medicine.................................................. 47 Additional Web Resources ........................................................................................................... 48 General References ....................................................................................................................... 54 CHAPTER 4. DISSERTATIONS ON HIGH CHOLESTEROL .................................................................. 55 Overview...................................................................................................................................... 55 Dissertations on High Cholesterol ............................................................................................... 55 Keeping Current .......................................................................................................................... 55 CHAPTER 5. CLINICAL TRIALS AND HIGH CHOLESTEROL ............................................................. 57 Overview...................................................................................................................................... 57 Recent Trials on High Cholesterol ............................................................................................... 57 Keeping Current on Clinical Trials ............................................................................................. 58 CHAPTER 6. PATENTS ON HIGH CHOLESTEROL ............................................................................. 61 Overview...................................................................................................................................... 61 Patents on High Cholesterol ........................................................................................................ 61 Patent Applications on High Cholesterol..................................................................................... 66 Keeping Current .......................................................................................................................... 70 CHAPTER 7. BOOKS ON HIGH CHOLESTEROL................................................................................. 71 Overview...................................................................................................................................... 71 Book Summaries: Federal Agencies.............................................................................................. 71 Book Summaries: Online Booksellers........................................................................................... 72 The National Library of Medicine Book Index ............................................................................. 73 Chapters on High Cholesterol ...................................................................................................... 74 CHAPTER 8. MULTIMEDIA ON HIGH CHOLESTEROL ...................................................................... 79 Overview...................................................................................................................................... 79 Video Recordings ......................................................................................................................... 79 Bibliography: Multimedia on High Cholesterol ........................................................................... 80 CHAPTER 9. PERIODICALS AND NEWS ON HIGH CHOLESTEROL ................................................... 81 Overview...................................................................................................................................... 81 News Services and Press Releases................................................................................................ 81 Newsletter Articles ...................................................................................................................... 83 Academic Periodicals covering High Cholesterol......................................................................... 85 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................... 87 Overview...................................................................................................................................... 87 U.S. Pharmacopeia....................................................................................................................... 87 Commercial Databases ................................................................................................................. 88 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 93 Overview...................................................................................................................................... 93 NIH Guidelines............................................................................................................................ 93

viii Contents

NIH Databases............................................................................................................................. 95 Other Commercial Databases....................................................................................................... 97 APPENDIX B. PATIENT RESOURCES ................................................................................................. 99 Overview...................................................................................................................................... 99 Patient Guideline Sources............................................................................................................ 99 Associations and High Cholesterol ............................................................................................ 101 Finding Associations.................................................................................................................. 101 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 103 Overview.................................................................................................................................... 103 Preparation................................................................................................................................. 103 Finding a Local Medical Library................................................................................................ 103 Medical Libraries in the U.S. and Canada ................................................................................. 103 ONLINE GLOSSARIES................................................................................................................ 109 Online Dictionary Directories ................................................................................................... 109 HIGH CHOLESTEROL DICTIONARY .................................................................................... 111 INDEX .............................................................................................................................................. 161

1

FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with high cholesterol is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about high cholesterol, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to high cholesterol, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on high cholesterol. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to high cholesterol, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on high cholesterol. The Editors

1

From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

3

CHAPTER 1. STUDIES ON HIGH CHOLESTEROL Overview In this chapter, we will show you how to locate peer-reviewed references and studies on high cholesterol.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and high cholesterol, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “high cholesterol” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Overweight Associated With Chronic Health Conditions Source: Healthy Weight Journal. 16(1):3. January/February 2002. Summary: A study initially published in the Archives of Internal Medicine examined the risk for the development of chronic disease in obese and overweight men and women. Researchers analyzed the 10-year associated risks of developing high cholesterol, hypertension, gallstones, heart disease, type 2 diabetes, stroke, and colon cancer among 46,060 men in the Health Professionals Follow-up Study and 77,690 women from the Nurses Health Study. The risk of developing diabetes, hypertension, gallstones, and heart disease increased with the severity of overweight in both men and women. As weight increased, the risk of developing more than one chronic disease also increased. The authors concluded that men and women who have a Body Mass Index (BMI) between 25 and 29.9 are at an increased risk for the development of certain health

4

High Cholesterol

conditions. Their findings provide support for the lowering of some health organizations' measure of overweight from a BMI of 27 to 25. The researchers stressed the importance of maintaining a healthy weight. •

Part 2: Rationale for a Wellness Approach to Obesity Source: Healthy Weight Journal. 14(2):20-24. March-April 2000. Summary: Based on a review of studies comparing body mass index (BMI) and mortality, the authors conclude that extremes of weight, both overweight and underweight, result in excess mortality. The excess mortality among the underweight cannot be attributed to smoking, as is sometimes done, because the smokers who are at the highest risk for disease are not especially lean. In the elderly, leanness is an indicator for increased mortality; obesity is not a risk factor until it reaches the extremes of a BMI greater than 35. Obesity can actually be beneficial in terms of risk for some diseases. This is true for cancer, infectious diseases, chronic obstructive pulmonary disease, osteoporosis, eclampsia, peptic ulcer, and suicide, among others. In other diseases, patients were are classified as obese have a better survival rate than leaner patients. Examples are hypertension, high cholesterol, and diabetes type II. The authors caution that this does not mean that patients with these conditions should try to gain weight, but that patients who are overweight do not have as dire a prognosis as leaner patients. More dangerous in the view of the authors are the ineffective methods of weight loss attempted by many overweight patients. None have proved effective and weight cycling (repeated loss and gain of weight) has been shown to be hazardous. The authors call for a change of focus, to healthy lifestyles, rather than a focus on weight loss.

•

Cholesterol-Lowering Medications Source: Access. 15(1): 36-38. January 2001. Contact: Available from American Dental Hygienists' Association. 444 North Michigan Avenue, Chicago, IL 60611. Summary: Hyperlipidemia is an increased plasma (blood) lipid concentration of cholesterol, triglycerides, or both. As lipoproteins play a key role in the formation of atherosclerosis, it is important to monitor the level of dietary cholesterol to reduce the risk of heart disease. However, some people will develop high cholesterol levels simply because they are genetically predisposed to synthesize cholesterol, regardless of their good dietary practices. Treatment for high cholesterol is generally a combination of cholesterol lowering medications and nonpharmacologic methods, including eating a low fat diet, smoking cessation, and exercise. This article familiarizes dental hygienists with the medications commonly prescribed to reduce cholesterol, as well as the relevant oral care considerations. When selecting medications to reduce cholesterol, physicians must consider the drug's benefits, side effects, cost, and convenience. The author first reviews three over the counter medications available to lower cholesterol: vitamin E, psyllium, and niacin. The author then reviews drugs in categories, including the fibrates, bile acid sequestrants, probucol (Lorelco), and HMG CoA reductase inhibitors. 2 tables. 9 references.

•

Why is Cholesterol So Important? Source: Diabetes Self-Management. 11(3): 48, 50-53. May-June 1994. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923.

Studies

5

Summary: In this article, the author provides basic information about cholesterol for people with diabetes. Topics include the differences between saturated and unsaturated fat, the causes of elevated fat and cholesterol levels in the blood, the metabolism of cholesterol, how atherosclerosis develops, where dietary fats and cholesterol come from, and how to lower high cholesterol levels. The author concludes with a review of the cholesterol-lowering medications that are currently available, including colestipol, probucol, lovastatin, pravastatin, and simvastatin, nicotinic acid, and gemfibrozil. •

Prevalence of Obesity, Diabetes, and Obesity-related Health Risk Factors, 2001 Source: Journal of the American Medical Association. 289(1):76-79. January 1, 2003. Summary: In this study, researchers estimated the prevalence of obesity and diabetes among U.S. adults in 2001 by a random-digit telephone survey of a nationally representative sample of 195,005 adults participating in the Behavioral Risk Factor Surveillance System (BRFSS). The nation's obesity rate climbed from 19.8 percent in 2000 to 20.9 percent in 2001 and the rate of diagnosed diabetes rose from 7.3 percent to 7.9 percent. The study used self- reported height and weight to calculate body mass index (BMI), with obesity defined as a BMI of 30 or higher. Overweight and obesity were significantly associated with diabetes, high cholesterol, high blood pressure, arthritis, asthma, and poor health status. The researchers conclude that increases in obesity and diabetes among U.S. adults continues to rise in both genders and all ages, races, and educational levels.

•

Am I Exercising Too Hard? Source: Prevention. p.74. February 2000. Summary: Individuals with cardiovascular problems should be cautious about overexertion, according to Barry Franklin, president of the American College of Sports Medicine. These problems are defined as heart disease, angina, diabetes, or risk factors for heart disease, such as smoking, obesity, high blood pressure or high cholesterol. Even those who have healthy hearts may want to check their exercise level. A method is described for finding heart rate, and a chart is included. The perceived exertion method is also described.

•

Fetal Nutrition and Adult Disease Source: American Journal of Clinical Nutrition. 71(5 Supplement): 1344S-1352S. May 2000. Contact: Available from American Journal of Clinical Nutrition. Production Office, 9650 Rockville Pike, Bethesda, MD 20814. (301) 530-7038. Fax (301) 571-8303. Website: www.ajcn.org. Summary: Recent research suggests that several of the major diseases of later life, including coronary heart disease, hypertension (high blood pressure), and type 2 diabetes, originate in impaired intrauterine growth and development. These diseases may be consequences of 'programming,' whereby a stimulus or insult at a critical sensitive period of early life has permanent effects on structure, physiology, and metabolism. Evidence that coronary heart disease, hypertension and diabetes are programmed came from longitudinal studies of 25,000 men and women from the United Kingdom; these studies show that size at birth was related to the occurrence of the disease in middle age. People who were small or disproportionate (thin or short) at birth had high rates of coronary heart disease, high blood pressure, high cholesterol

6

High Cholesterol

concentrations, and abnormal glucose-insulin metabolism. These relations were independent of the length of gestation, suggesting that cardiovascular disease is linked to fetal growth restriction rather than to premature birth. Although the influences that impair fetal development and program adult cardiovascular disease remain to be defined, there are strong pointers to the importance of the fetal adaptations invoked when the maternoplacental nutrient supply fails to match the fetal nutrient demand. 3 figures. 3 tables. 85 references. •

Part 1: Rationale for a Wellness Approach to Obesity Source: Healthy Weight Journal. 14(1):7-9,14. January-February 2000. Summary: The authors review the evidence for the view of obesity as a disease and call for a wellness approach to obesity based on a healthy lifestyle and treating disease in the obese instead of obesity as a disease. They first examine the link between obesity and type 2 diabetes, and conclude that while excess weight may indicate a risk for diabetes, the excess weight is probably not a direct cause of diabetes. This is reinforced by studies showing that six to eighteen months after treatment, patients who lost weight were at their original blood sugar levels, even when they maintained weight loss. Earnsberger and Koletsky next turn to the link between hypertension and obesity, noting that while hypertension is strongly correlated to obesity, high cholesterol is not. They cite studies which found that obese lab rats subjected to periodic fasting were more hypertensive than obese rats who did not fast. Therefore, they believe that the weight cycling may be the cause of the heart disease.

•

Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes Source: Annals of Internal Medicine. 132(8): 605-611. April 18, 2000. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: This article describes a prospective cohort study that evaluated the prospective association of cardiorespiratory fitness and physical inactivity with mortality in men who have type 2 diabetes. The study population consisted of 1,263 men with type 2 diabetes who received a thorough medical examination between 1970 and 1993 and were followed for mortality up to December 31, 1994. Measurements included cardiorespiratory fitness as determined by a maximal exercise test, self reported physical inactivity at baseline, and subsequent death determined by using the National Death index. During an average followup of 12 years, 180 patients died. The prevalence of self reported physical inactivity was 50 percent in men with diabetes and 33 percent in men without diabetes. The association between low fitness and mortality was present in men with known or unknown diabetes, men who were normal weight or overweight, and men with or without a parental history of cardiovascular disease. After adjustment for age, baseline cardiovascular disease, fasting plasma glucose level, high cholesterol level, overweight, current smoking, high blood pressure, and parental history of cardiovascular disease, men in the low fitness group had an adjusted risk for all cause mortality compared with fit men. Men who reported being physically inactive had an adjusted risk for mortality that was 1.7 fold higher than that in men who reported being physically active. There was an excess number of deaths in unfit men with diabetes from the underlying causes of cardiovascular disease, cancer, diabetes, gastric disease, and injury. The article concludes that low cardiorespiratory fitness and physical inactivity

Studies

7

are independent predictors of all cause mortality in men with type 2 diabetes. Physicians should encourage patients who have type 2 diabetes to participate in regular physical activity and improve cardiorespiratory fitness. 1 figure. 4 tables. 43 references. (AA-M). •

Walking Compared with Vigorous Physical Activity and Risk of Type 2 Diabetes in Women: A Prospective Study Source: JAMA. Journal of American Medical Association. 282(15): 1433-1439. October 20, 1999. Summary: This article describes a study that examined the relationship of total physical activity and incidence of type 2 diabetes in women and compared the benefits of walking versus vigorous activity as predictors of subsequent risk of type 2 diabetes. Subjects for the study were 70,102 women from the Nurses' Health Study cohort who, in 1986, were free from diagnosed diabetes, cardiovascular disease, and cancer and who completed questions on physical activity in 1986. The main outcome measure was risk of type 2 diabetes by quintile of metabolic equivalent task (MET) score, based on time spent per week on each of eight common physical activities, including walking. During 8 years of follow-up, researchers documented 1,419 incident cases of type 2 diabetes. After adjusting for age, smoking, alcohol use, history of hypertension, history of high cholesterol level, and other covariates, the relative risks (RRs) of developing type 2 diabetes across quintiles of physical activity were 1.0, 0.77, 0.75, 0.62, and 0.54. After adjusting for body mass index (BMI), RRs were 1.0, 0.84, 0.87, 0.77, and 0.74. Among women who did not perform vigorous activity, multivariate RRs of type 2 diabetes across quintiles of MET score for walking were 1.0, 0.91, 0.73, 0.69, and 0.58. After adjusting for BMI, the trend remained statistically significant. Faster usual walking pace was independently associated with decreased risk. Equivalent energy expenditures from walking and vigorous activity resulted in comparable magnitudes of risk reduction. The article concludes that the data suggest that greater physical activity level is associated with substantial reduction in risk of type 2 diabetes, including physical activity of moderate intensity and duration. 1 figure. 4 tables. 44 references. (AA-M).

•

Facts on Fats Source: Diabetes Self-Management. 16(6): 89-96. November-December 1999. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article examines the different types of fat found in foods, the role they have in the body, and their impact on health. Fat is an important nutrient in the body because it provides energy and fatty acids necessary for good health. However, too much fat can lead to many health problems, including heart disease, some types of cancer, diabetes, and obesity. National dietary recommendations suggest that fat intake be restricted to 30 percent or less of total daily calories. Fats are a mixture of saturated, monounsaturated, and polyunsaturated fatty acids. The amounts and proportions of these types of fats in the diet affect levels of blood cholesterol in the body. Other fatty acids in food include omega-3 fatty acids and trans fatty acids. Two new products, known as Benecol and Take Control, have appeared in the margarine and butter section of the grocery store that address the issue of trans fats and blood cholesterol levels. Both can be used as other spreads would be used, but they are not recommended for use in baking. These products are intended for people who have moderate to high cholesterol levels, and they are not intended to be a substitute for cholesterol lowering drugs. The

8

High Cholesterol

article includes a guide to help readers select fats, including butter, margarine, buttermargarine blends, shortening, and oils. In addition, the article provides a table of some fat products available in grocery stores and their nutrition facts. 1 table. •

Stroke! Source: Diabetes Forecast. 53(9): 58-62. September 2000. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article presents steps that people who have diabetes can take to significantly reduce their risk of stroke. Most strokes result from a blockage or rupture of a blood vessel in the brain. The blockages that cause stroke usually occur because blood clots have formed or fatty deposits have built up inside blood vessels. Strokes that occur when blood vessels burst open and bleed inside the head are less common than those caused by a blockage. Symptoms of stroke usually occur suddenly and may include weakness or numbness on one side of the body, loss of vision or dimness in one or both eyes, and difficulty talking or understanding speech. Some people experience mini strokes known as transient ischemic attacks. The symptoms for this type of stroke are the same as the symptoms of major stroke, but they last only a few minutes or hours. Although diabetes is considered a nonmodifiable risk factor for stroke, scientists are not sure why people who have diabetes are more likely to suffer a stroke. Prevention involves knowing one's individual risk factors and controlling or eliminating the modifiable ones. Modifiable risk factors include high blood pressure, high cholesterol, atrial fibrillation, cigarette smoking, heavy alcohol consumption, lack of physical activity, and obesity. The article presents suggestions for modifying these risk factors and provides a list of organizations that offer information about stroke.

•

What's in a Name?: Redefining Diabetes Source: Diabetes Self-Management. 15(1): 59-62. January-February 1998. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article provides readers with information about current American Diabetes Association (ADA) recommendations on the classification, diagnosis, and screening of diabetes. The article explains why the ADA, based on reviews by an expert committee, recommends that type 1 and type 2 diabetes no longer called 'insulindependent diabetes mellitus' (IDDM or type I) and 'non-insulin-dependent diabetes mellitus'(NIDDM or type II). The new names, type 1 and type 2, are based on cause rather than treatment, and replace Roman numerals with Arabic numerals to prevent confusion. The article explains that the term 'impaired glucose tolerance' remains unchanged, and is defined as a 2-hour oral glucose tolerance test value of 140 mg/dl or above, but less then 200 mg/dl. The term 'impaired fasting glucose' was added, and is defined by a fasting glucose level of 110 mg/dl or above, but less than 126 mg/dl. The committee recommends that gestational diabetes continue to be defined as diabetes with its first diagnosis or recognition in pregnancy. The article also explains the three ways in which diabetes is diagnosed; the committee clearly states that the fasting plasma glucose test is preferred. The committee also looked at ways to diagnose as many cases of diabetes as early as possible. Mass screening for the antibody markers of type 1 diabetes is not currently recommended. The committee recommends screening for type 2 diabetes in higher risk populations, which include anyone over age 45, and people who are obese; have a close relative with diabetes; are African American, Latino, Native

Studies

9

American, or Asian; have been diagnosed with gestational diabetes or delivered a baby weighing more than nine pounds; have high blood pressure; have high cholesterol; or have previously had impaired glucose tolerance or impaired fasting glucose on testing. The ADA projects that the simple fasting glucose test and increased testing of individuals at risk for developing type 2 diabetes will result in earlier detection of diabetes in many of the 5.4 million Americans currently undiagnosed. A sidebar provides information about three types of tests that can be used to determine whether a person has diabetes. (AA-M). •

Perceived Difficulty of Diabetes Treatment in Primary Care: Does It Differ by Patient Ethnicity? Source: Diabetes Educator. 27(5): 678-684. September-October, 2001. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article reports on a cross sectional study that was undertaken to determine the attitudes of internal medicine physicians toward treating diabetes in different patient ethnic groups and compared those attitudes with those toward treating common chronic medical conditions in primary care. The survey instrument was administered to 55 internal medicine physicians. An email message was sent to each physician with a hyperlink to a site where the survey could be completed. The instrument was a modified, quantitative 10 point scale designed to measure attitudes regarding the difficulty of treating diabetes. Results showed that diabetes was perceived to be more difficult to treat than hyperlipidemia (high cholesterol or other fats) and angina (chest pain). African Americans with diabetes were perceived to be more difficult to treat than Caucasian patients. Difficulty in treating diabetes was comparable to that for hypertension (high blood pressure), arthritis, and congestive heart failure. Physicians were confident about treatment efficacy for diabetes and changing diabetes outcomes, but not about the adequacy of time and resources for diabetes treatment. The authors conclude that to improve diabetes care, there is a need to address these attitudes and concerns of internal medicine physicians. 5 tables. 30 references.

•

Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes Source: Diabetes Care. 25(7): 1129-1134. July 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on a study undertaken to examine whether risk of cardiovascular disease (CVD) is elevated before clinical diagnosis of type 2 diabetes in women. A total of 117,629 female nurses aged 30 to 55 years who were free of diagnosed CVD at baseline were recruited in 1976 and followed for 20 years. A total of 1,508 women had diagnosed type 2 diabetes at baseline in 1976. During 20 years of follow up, 110,227 women remained free of diabetes diagnosis and 5,894 women developed type 2 diabetes. During 2.2 million person-years of follow up, the authors documented 1,556 new cases of myocardial infarction (heart attack, MI), 1,405 strokes, 815 fatal coronary heart disease (CHD), and 300 fatal strokes. Among women who developed type 2 diabetes during follow up, the age-adjusted risk ratios of MI were 3.75 for the period before the diagnosis and 4.57 for the period after the diagnosis, compared with women who remained free of diabetes diagnosis. The risk of stroke was also significantly elevated before diagnosis of diabetes. Further adjustment for history of hypertension

10

High Cholesterol

(high blood pressure) or hypercholesterolemia (high cholesterol levels) did not appreciably alter the results. The authors conclude that these data indicate a substantially elevated risk of CVD before clinical diagnosis of type 2 diabetes in women. These findings suggest that aggressive management of cardiovascular risk factors is warranted in individuals at increased risk for diabetes. 2 figures. 3 tables. 15 references. •

Minimize Your Heart Risk Source: Diabetes Forecast. 54(5): 29-31. May 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reviews ways people who have diabetes can minimize their risk of cardiovascular disease (CVD). Modifiable risk factors for CVD include poorly controlled diabetes, hypertension, high cholesterol, obesity, physical inactivity, and smoking. Nonmodifiable risk factors include age and genetics. The first step people should take to reduce their risk of CVD is to identify whether they or members of their family have one of the major modifiable CVD risk factors. Other steps are controlling blood glucose levels, knowing body mass index and waist circumference, having blood cholesterol levels checked annually, having blood pressure checked at each doctor visit, taking one aspirin per day, and avoiding smoking. The article includes a checklist of precautions people should take before beginning an exercise program.

•

Suspected Kidney Disease: Putting Urinalysis Clues Into Context, Part 1 Source: Consultant. 41(13): 1749-1750, 1752-1753, 1756-1757. November, 2001. Contact: Available from Cliggott Publishing Company. 330 Boston Post Road, Darien, CT 06820-4027. (203) 661-0600. Summary: This first article in a two part series uses a case based approach to illustrate typical urinalysis results found in common renal diseases. The authors show how these results can be integrated with findings from the history, physical examination, and other laboratory studies to arrive at a reliable diagnosis and to guide treatment. Typical urinalysis (urine testing) results in patients with nephritic disease are proteinuria greater than 2 to 3 grams per 24 hours, blood detected by dipstick and microscopic examination, and red blood cell (RBC) casts in the urine. Other findings may include cryoglobulinemia (both polyclonal and monoclonal), low complement levels, and gross hematuria. Characteristic urine findings in patients with nephrotic disease are proteinuria greater than 4 grams per 24 hours, no blood or less than is seen in nephritic disease, and casts without RBCs. Nephrotic disease is also associated with edema, a low albumin level, and a high cholesterol level. An antineutrophilic cystoplasmic antibody (ANCA) assay is useful in determining the underlying cause of rapidly progressive glomerulonephritis. For example, in a patient with azotemia and cavitary lung disease, the presence of cytoplasmic ANCA suggests Wegener granulomatosis. 3 figures. 4 tables. 10 references.

•

Transplantation and Hyperlipidemia: What Is It and Why Should I Be Concerned? Source: Stadtlanders Lifetimes. Issue 3: 18-19. 2000. Contact: Available from Stadtlanders Lifetimes. Stadtlanders Pharmacy, 600 Penn Center Boulevard, Pittsburgh, PA 15235-5810. E-mail: [email protected].

Studies

11

Summary: This health newsletter article reviews hyperlipidemia (increased cholesterol or triglycerides in the blood) and its occurrence in transplant recipients. The author notes that organ preservation, surgical technique, postoperative care, and effective immunosuppressants are improving the life of the transplanted organ, but recipients are still succumbing to cardiovascular illness. Hyperlipidemia can occur early after the transplant procedure. Coronary artery disease (CAD), when the arteries supplying the heart become blocked with fatty substances, is the most worrisome effect of hyperlipidemia. In addition to some immunosuppressants, other medications that transplant recipients are often prescribed have been known to cause or worsen hyperlipidemia. The author stresses the importance of exercise as a way to combat high cholesterol levels in the blood. Exercise not only is beneficial on the lipid profile, but also reduces total body weight, strengthens muscle tone, and improves cardiovascular performance. Reducing saturated fat in the diet appears to have the most effect in the overall reduction of cholesterol. For patients whose hyperlipidemia is not controlled by at least three months of dietary therapy, treatment with medications should be considered. The author reviews the use of specific drugs (the 'statins') for the treatment of hypercholesterolemia and concerns about rhabdomyloysis (a breakdown of the skeletal muscle tissue, with the inability to clear the breakdown products through the kidney). The author concludes by encouraging readers to educate themselves and to work closely with their transplant team on the appropriate management of hyperlipidemia. •

Urban Living Brings Chronic Disease to Pacific Islanders Source: Obesity and Health. 7(3):51; May/June 1993. Contact: Healthy Living Institute, 402 S. 14th St., Hettinger, ND 58639. (701) 567-2645. Summary: This is a brief summary of a study conducted by Australian researchers. The researchers find that rural people, living a mostly traditional way of life, suffer much less from obesity, hypertension, diabetes, and high cholesterol than do city dwellers. Urban-dwelling Pacific Islanders are falling prey to the chronic diseases of urban living. Rural residents are leaner and report much higher levels of physical activity. They eat more total calories, but less of a percentage of fat, and more carbohydrates.

•

Stroke: What It Is and What to Do Source: Diabetes Self-Management. 13(5): 60-63. September-October 1996. Contact: Available from R.A. Rapaport Publishing,Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This patient education article describes strokes, what they are, how they can be prevented, and how to minimize the damage a stroke can inflict. The author explains the two basic types of stroke, ischemic and hemorrhagic; the risk factors for stroke, including diabetes, high blood pressure, atrial fibrillation, high cholesterol, smoking, and alcohol use; the warning signs of stroke and the occurrence of transient ischemic attacks (TIAs), which can serve as a precursor of a true stroke; evaluation considerations, including the use of CT scans and MRI to check for signs of brain injury, poststroke; and treatment options, including surgery, drug therapy with anticoagulants, balloon angioplasty, neuroprotective drugs, and rehabilitation. By carefully attending to the risk factors, especially in people with diabetes, the chance of ever developing a stroke can be minimized. One sidebar describes surgical options used to treat carotid artery stenosis and perhaps prevent stroke. A list of additional resource organizations is also included.

12

High Cholesterol

•

Epidemiology of Macrovascular Disease in Diabetes Source: Diabetes Reviews. 5(4): 294-315. 1997. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This review article provides information on the epidemiology of macrovascular disease in type 2 diabetes. According to the authors, evidence has accumulated from autopsy studies, clinical studies, and population-based studies to indicate that type 2 diabetes significantly increases the risk for all macrovascular complications. For example, type 2 diabetes is known to be associated with several cardiovascular risk factors such as hypertension, obesity, central obesity, hyperinsulinemia, and serum lipid and lipoprotein abnormalities. Topics include why the risk for atherosclerotic vascular disease (ASVD) is increased in type 2 diabetes; coronary heart disease; cerebrovascular disease; peripheral vascular disease; risk factors for ASVD in people with type 2; and a summary of the role of different cardiovascular risk factors as predictors for ASVD in type 2. Because the role of classic risk factors, which include high cholesterol, smoking, and elevated blood pressure, to predict ASVD is similar in people with and without type 2 diabetes, other risk factors must play a role in diabetes atherogenesis. The article points out that low HDL cholesterol and high total triglyceride levels are likely to contribute to the risk of atherosclerotic complications more in type 2 patients than in normoglycemic subjects. The authors conclude that there is considerable potential to reduce the risk for macrovascular complications in type 2 diabetes. 8 figures. 1 table. 229 references. (AA-M).

•

Effects of Psyllium on Glucose and Serum Lipid Responses in Men with Type 2 Diabetes and Hypercholesterolemia Source: American Journal of Clinical Nutrition. 70(4): 466-473. October 1999. Contact: Available from American Journal of Clinical Nutrition. Production Office, 9650 Rockville Pike, Bethesda, MD 20814. (301) 530-7038. Fax (301) 571-8303. Website: www.ajcn.org. Summary: Water soluble dietary fibers decrease postprandial (after a meal) glucose (sugar) concentrations and decrease serum cholesterol concentrations. This article reports on a study examining the effects of administering psyllium to men with type 2 diabetes. Psyllium is a viscous, mostly water soluble fiber. The objective of the study was to evaluate the safety and effectiveness of psyllium husk fiber used adjunctively to a traditional diet for diabetes. After a 2 week dietary stabilization phase, 34 men with type 2 diabetes and mild to moderate hypercholesterolemia (high cholesterol) were randomly assigned to receive 5.1 grams of psyllium or cellulose placebo twice daily for 8 weeks. Serum lipid and glycemic indexes were evaluated biweekly on an outpatient basis and at weeks 0 and 8 in a metabolic ward. The psyllium group showed significant improvement in glucose and lipid values compared with the placebo group. Serum total concentrations were 8.9 percent lower and LDL (low density lipoprotein) cholesterol concentrations were 13.0 percent lower in the psyllium than in the placebo group. All day and postlunch postprandial glucose concentrations were 11 percent and 19.2 percent lower in the psyllium than in the placebo group. Both products were well tolerated, with no serious adverse events related to treatment reported in either group. The authors conclude that the addition of psyllium to a traditional diet for persons with diabetes is safe, is well tolerated, and improves glycemic and lipid control in men with type 2 diabetes and hypercholesterolemia. 1 figure. 3 tables. 45 references.

Studies

•

13

Fat-Blocking Drug Can Help Fight Obesity Source: FDA Consumer. July-August 1999. Contact: Food and Drug Administration (HDI-40), 5600 Fishers Lane, Rockville, MD 20857. Summary: Xenical (orlistat) was approved by the FDA in April. It works by blocking the body's absorption of fat, not by suppressing appetite like other diet drugs. Xenical is for obese patients with a body mass index (BMI) of 30 or more or for patients with a BMI of at least 27 who also have high blood pressure, high cholesterol, or diabetes.

Federally Funded Research on High Cholesterol The U.S. Government supports a variety of research studies relating to high cholesterol. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to high cholesterol. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore high cholesterol. The following is typical of the type of information found when searching the CRISP database for high cholesterol: •

Project Title: BILE SALTS, MEMBRANES, AND CYTOTOXICITY Principal Investigator & Institution: Heuman, Douglas; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2001 Summary: Bile salts adsorb to membranes, at high concentrations causing membrane disruption. Adsorption of bile salts to intracellular membranes may determine many of their physiological effects, and bile salt induced membrane injury may be important in pathogenesis of cholestatic liver disease and gallstones. We have studied the adsorption of bile salts to lecithin-cholesterol vesicles and have developed and validated a quantitative model which predicts the distribution of bile salt taurine conjugates in mixed bile salt solutions between lecithin-cholesterol bilayers and the aqueous phase. In the studies proposed, this model will be generalized to a broad array of bile acids and other organic anions, membrane lipids, and solution conditions. Using large unilamellar vesicles of varying lipid composition, we will examine the relationship between membrane binding of bile salts, mixed micellar dissolution of membrane lipids (observed with quasielastic light scattering) and altered membrane permeability (release of trapped soluble markers assessed by ultrafiltration) to determine if the mixed micellar threshold concentration and the permeation threshold at which membrane leakage

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

14

High Cholesterol

begins are predictable consequences of the membrane-bound ionized bile salt/lecithin ratio. Pure protein kinase C isoenzymes (alpha, betaII, delta, epsilon) prepared in a baculovirus system will be employed to test the hypothesis that bile salts activate protein kinase C isoenzymes by binding to membranes and serving as a "bridge" between the enzymes and membrane lipids. The model of bile salt-lecithin interactions will be extended beyond the limits of the two phase (monomer-membrane) region into micellar regions of the phase diagram by combining techniques of gel filtration and ultrafiltration, in order to permit modelling of detergent effects of mixed bile salt solutions. Using synthetic vesicles, isolated canalicular plasma membranes, and living cells (erythrocytes, cultured neoplastic gallbladder epithelia) we will test the hypothesis that lecithin in bile normally protects high cholesterol plasma membranes from bile salt injury by depressing the non-lecithin- associated bile salt concentration to non-toxic levels, and that this protective effect declines predictably as the cholesterol content of biliary vesicles increases. Finally the hepatoprotective role of biliary lipids and biliary bile salt-lipid interactions will be studied in two in vivo models of bile salt-induced liver injury: acute infusion of bile salts in the choline deficient bile fistula rat and chronic feeding of bile salts in hamsters fed lithogenic diets. The ultimate goal of these studies is to provide a conceptual framework for understanding the toxic and protective properties of bile salts and the role of bile salt toxicity in human disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CELLULAR MECHANISM FOR LDL RETENTION BY THE ARTERY WALL Principal Investigator & Institution: Innerarity, Thomas L.; Senior Investigator; J. David Gladstone Institutes 365 Vermont St San Francisco, Ca 94103 Timing: Fiscal Year 2001 Summary: Although it is well-documented that animals with high plasma levels of lipoproteins containing apo-B develop premature atherosclerosis, the exact mechanism is still unknown. The response-to-retention hypothesis holds that low density lipoproteins (LDL) and other atherogenic apo-B containing lipoproteins are retained or trapped in the subendothelium by interacting with intimal proteoglycans initiating early atherosclerosis. Our preliminary evidence shows that we can design and genetically alter atherogenic lipoproteins in such a way that they will not bind to artery wall proteoglycans. If the interaction with proteoglycans is a significant component in the subendothelial retention of lipoproteins, these altered lipoproteins therefore should not be retained in the subendothelium. Further, if binding to proteoglycans is the initial or a significant step in atherogenesis, then high levels of genetically altered of genetically altered defective-proteoglycan-binding LDL will be much less atherogenic than equivalent levels of normal LDL. Using transgenic mouse models we will first determine if proteoglycan-defective-binding LDL causes less atherosclerosis than normal LDL animals fed a high cholesterol diet. If mouse atherosclerosis studies indicate defective-proteoglycan-binding LDL are less atherogenic, we will investigate the mechanism with presumption that proteoglycan-binding LDL are less atherogenic, we will investigate the mechanism with the presumption that proteoglycan-defectivebinding LDL are poorly retained in the subendothelium. Using gene-targeted technology, we will generate proteoglycan-defective-binding apo-B48 to determine if the atherogenesis causes by B48-containing lipoproteins is due to their binding to proteoglycans. Finally, we will determine if lipoprotein lipase contributes to atherosclerosis in a direct bridging role by enhancing the binding of LDL with proteoglycans. These studies should help clarify how LDL and other apo-B-containing

Studies

15

lipoproteins cause atherosclerosis. Moreover, if the inhibition of LDL binding to proteoglycans is anti- atherogenic, then the use of small molecules to inhibit LDL binding to proteoglycans may have therapeutic potential to reduce or prevent atherosclerosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: APOPTOSIS

CHARACTERIZATION

OF

OST-BASED

ACTIVATION

OF

Principal Investigator & Institution: Brewster, Jay L.; Natural Sciences; Pepperdine University 24255 Pacific Coast Hwy Malibu, Ca 90265 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant) The proper synthesis and processing of proteins is critical to normal cellular function. The endoplasmic reticulum (ER) is an organelle found in all higher organisms, whose central role in cell function is to mediate protein synthesis. Humans afflicted with abnormal protein processing in the ER and a related organelle, the Golgi body, suffer from devastating developmental abnormalities and comprise a broad category of disease known as Congenital Disorders of Glycosylation (CDGs). The key aspect of protein processing in the ER and Golgi is the addition of sugars to newly synthesized proteins, called glycosylation. This proposal seeks to characterize fundamental aspects of protein glycosylation, specifically how abnormal glycosylation influences the generation of signals within a cell. These signals are generated as a result of abnormal protein synthesis, which results in ER stress. The activation of ER stress can result in cell suicide (apoptosis), adaptation to the stress, growth arrest, or stimulation of localized inflammation. Our long-term goals focus upon how cells activate apoptosis following ER stress. This proposed project will allow characterization of the molecules that carry this stress signal, and examine how this cell suicide is executed. The improper processing of proteins in the ER and Golgi causes mutations in a variety of genes, and the type of disease that results from such mutations depends upon the identity of the mutated protein. Cystic fibrosis patients suffer lung degeneration that is the result of ER stress-activated signals as a membrane protein is improperly glycosylated, and one type of inherited hypercholesterolemia (high cholesterol) is the result of ER-associated processing deficiencies of a signal receptor. The characterization of ER stress and its signaling mechanisms will offer vital insight into the cell biology of stressed cells, and will be valuable to our understanding of diseases that result from abnormal ER function/processing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHOLESTEROL INTERACTIONS

EFFECTS

ON

HUMAN

APOE

AND

APP

Principal Investigator & Institution: Sullivan, Patrick; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001 Summary: This project proposes to test the hypothesis that apoE and cholesterol modify Abeta deposition in an isoform-dependent fashion with the apoE4 allele acting in a dominant mode. Rare mutations in amyloid precursor protein (APP) are responsible for some cases of early onset autosomal dominant Alzheimer's disease (AD). Isoform differences at the AD susceptibility gene apolipoprotein (apo) E locus affect age of onset for late on-set AD, and may influence from 15-50% of all cases. In humans, there are three major apoE isoforms designated apoE2, E3, and E4 that differ by a single amino

16

High Cholesterol

acid. ApoE functions to maintain cholesterol and fat homeostasis. ApoE isoforms also interact either directly or indirectly with APP to modulate the extent of Abeta deposition associated with one dimension of AD pathology. Current human studies suggest that high cholesterol increases the risk of AD. Animal studies reveal significant effects of cholesterol on APP and apoE metabolism in the brain, and on Abeta deposition, and suggest a major environmental (i.e. dietary fat and cholesterol) may modify AD pathology. We have transgenic animal models to test this hypothesis, human apoE targeted replacement mice, human apoE transgenic mice and the human APPV717F transgenic mouse. ApoE isoform-specific promoter effects on brain apoE levels will be measured under basal and high cholesterol conditions. AD-related pathology will be examined by crossing the apoE targeted replacement animals to mice bearing a human APP mutation using Abeta deposition and APP metabolism as endpoints. Finally, the ability to create animal models of the common human heterozygote, APOE3/4, will allow testing for dominant-positive or dominant-negative effects of human apoE isoforms. Modeling dietary factors that may modulate APP and apoE will advance the understanding of environmental and genetic interactions that influence the onset and progression of AD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHOLESTEROL HOMEOSTASIS IN THE INBRED MOUSE Principal Investigator & Institution: Wang, David Q.; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: The intestine is an unique organ providing dietary and re-absorbed biliary cholesterol to the body. Excess cholesterol can result in cholesterol gallstone disease. Cholelithiasis is prevalent in cultures consuming a Western diet with high cholesterol, and can be induced in mouse models by a high cholesterol and cholic acid diet. Therefore, understanding cholesterol absorption is of great importance to both prevention and treatment of cholesterol gallstones. It has been known that genetic factors apparently play a critical role in the development of cholesterol gallstones in inbred mice. It has been found that differences in gallstone susceptibility between C57L and AKR strains are determined by at least two Lith (gallstone) genes, as well as that the sister of P-glycoprotein (Spgp), a canalicular bile salt transporter is a candidate gene for the Lith1. A recent observation that there is a remarkable positive correlation in eleven strains of inbred mice between percent cholesterol absorption and prevalence of cholesterol gallstones at 8 weeks of feeding the lithogenic diet strongly suggests that the extent of cholesterol absorption from the intestine may be a genetically determined step for cholesterol gallstone formation. Furthermore, it has been observed that there are gender differences in susceptibility to cholesterol gallstones, favoring males to females by 2:1. The applicant proposes five specific aims to explore genetic and physiological mechanisms of cholesterol homeostasis as well as molecular mechanisms of cholesterol absorption, and pathophysiological mechanisms of the formation of lithogenic bile and cholesterol cholelithiasis. Aim 1: To investigate genetic variations in cholesterol absorption efficiency and their role in cholesterol gallstone formation among 12 strains of inbred mice. Aim 2: To define differences in molecular mechanisms for cholesterol absorption and chylomicron formation between mice with high and low cholesterol absorption. Aim 3: To study postprandial chylomicron metabolism and its role in the lithogenesis of bile. Aim 4: Using genetically gallstone-susceptible and the SR-B1 att (knockout) mice, to elucidate the role of SR-B 1 (HDL) receptor in biliary cholesterol secretion and cholesterol gallstone formation. Aim 5: To characterize hormonal basis for

Studies

17

gender differences in the gallstone phenotypes. These studies should provide important contributions to our basic understanding of cholesterol homeostasis as well as pathogenesis of cholesterol gallstone formation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENE DIET EFFECTS ON ATHEROSCLEROSIS Principal Investigator & Institution: Breslow, Jan L.; Professor; Lab/Biomed Genetic/Metabolism; Rockefeller University New York, Ny 100216399 Timing: Fiscal Year 2001; Project Start 01-JUN-1984; Project End 30-JUN-2002 Summary: Atherosclerotic coronary heart disease (CHD) is the number one public health problem in the United States. CHD has been increasing in prevalence and with the aging of the baby boomers and the increase in major cardiovascular risk factors in the population (smoking, obesity and physical inactivity) over the last 10 years the problem will be even worse in the 21st century. This is not just a U.S. problem, but is occurring world wide. The WHO has recently predicted that by 2020 heart disease will replace infectious disease worldwide as the number one cause of disability expressed as years of healthy life lost to death or disease. CHD is considered a complex genetic disease with many genes involved and important gene-environment interactions. Cross cultural studies and human and animal feeding studies have clearly established a role for diet, particularly a high saturated fat, high cholesterol diet in atherosclerosis susceptibility. However, clinical studies have also established that there is great variation between people in diet responsiveness of their plasma lipoprotein pattern and presumably, although it has not been studied directly in humans, dietary effects on atherosclerosis susceptibility. Thus a better understanding of gene diet interactions as they effect lipoprotein levels and atherosclerosis susceptibility should lead to better ways to identify and treat individuals susceptible to CHD in the population. In the current competing renewal, I propose to use induced mutant mouse models to better understand the regulation of dietary cholesterol absorption and how dietary fats influence atherosclerosis susceptibility. The following specific aims are proposed: Determine the mechanism of regulation of dietary cholesterol absorption through the study of mutant mice; positional cloning of genes that regulate dietary cholesterol absorption by interbreeding mouse strains that differ in dietary cholesterol absorption; determine the effects of diets enriched in carbohydrate, saturated fat, monounsaturated fat, or polyunsaturated fat on atherosclerosis susceptibility and the mechanisms of the dietary effects observed using induced mutant mouse models of atherosclerosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: IMPACT OF CHD RISK PERCEPTION ON HEALTH BEHAVIORS AND O* Principal Investigator & Institution: Barnhart, Janice M.; Epidemiology & Population Health; Yeshiva University 500 W 185Th St New York, Ny 10033 Timing: Fiscal Year 2002; Project Start 15-MAY-2002; Project End 30-APR-2006 Summary: (Applicant's abstract) The overall goal of the proposed study is determine if perceived risk of heart disease among postmenopausal women enrolled in the Observational Study (OS) of the Women's Health Initiative (WHI) in the New York Clinical Center, differs by race, and if risk perception is related to health behaviors. The applicant's long-term career goals are to become an independent investigator with special scientific interest in determining the key psychosocial contributors to racial and gender disparity in heart disease morbidity and mortality. In the proposed study, the

18

High Cholesterol

first phase will be to develop and pilot test a methodologically sound instrument that measures perceived risk of heart disease. The second phase will be to administer this instrument to 300 White, African-American and Hispanic women at higher risk of heart disease because of smoking status, hypertension, diabetes or high cholesterol (requiring pills) and to determine the relationship of risk perception to risk reduction and other specific health behaviors. There will be 2 annual follow-ups to determine if changes in risk perception or health behavior occur. Data collected will be used as the basis of an independent grant application to expand this study to additional WHI centers and to provide information for future cardiac interventions using culturally- sensitive risk communication strategies to lessen the disease burden in African Americans and other population at high-risk for heart disease. The applicant's immediate career goals are to devote no less than 75 percent of her time to a highly structured and intensely focused research experience, over the next 4 years, to nurture development of her theoretical and practical skills in research design, implementation and analysis and in survey instrument development and test construction. This research and career development plan includes: 1) formal graduate course work in biostatistics, test construction, and decision analysis; 2) mentoring from the WHI Principal Investigator (PI) at the study site and investigators who have done pioneering work in the emerging field of risk perception in diabetes; 3) becoming thoroughly versed in the WHI operations; 4) having a formal evaluation by a Trainee Advisory Committee (TAC). The applicant will work closely under the guidance of the primary mentor (WHI PI). She will learn the rigorous methods employed in the conduct of a major, multi-center study, the WHI, will learn about the rigorous process of identifying and adjudicating coronary outcomes, and about procedures to assure research integrity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTRACOCHLEAR ELECTROCHEMICAL GRADIENTS Principal Investigator & Institution: Brownell, William; Professor; Otorhinolaryn & Communica Scis; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001; Project Start 01-APR-1990; Project End 30-JUN-2003 Summary: The long-term goal of these studies is to identify the physical basis of outer hair cell electromotility. The outer hair cell enhances the sensitivity and frequency selectivity of mammalian hearing by converting the energy of hair energy. The motor is known to reside in the outer hair cell's lateral wall, a 100 nanometer thick, three-layer structure composed of two membranes with a cytoskeletal network sandwiched between them. The specific objective of this project period is to identify the contributions of the lateral wall to the modulation and maintenance of the electrochemical gradient necessary for cell function, specifically electromotility. Coordinated theoretical and experimental approaches identify how the unique molecular organization of the lateral wall influences the transport of ions, water and other molecules through the narrow space between the membranes. The contribution of cholesterol and other lipids to the lateral wall membranes wil be examined to determine how they affect electromotility and membrane permeability. The relative electromotile movement of the membranes will be measured with the goal of determining the motor location. The effect of genetically removing specific cytoskeletal proteins on electromotility will be measured. Methods include outer hair cell isolation from normal and geneticall altered animals; voltage-clamp with voltage-sensitive dyes and twopipette recording; measuring the flow of fluorescent markers with confocal microscopy; video microscopy and photometric measures of displacement; and computational modeling. Changes in outer hair cell electromotility will be ascertained in animal

Studies

19

models by measuring otoacoustic emissions. New medical treatments for hearing disorders associated with high cholesterol may be suggested if it is found they result from a direct action on the lateral wall. The deafness found in mice with genetically induced deficits of specific cytoskeletal proteins ha implications for the molecular basis of other forms of hereditary sensory-neural hearing loss. Clarification of the physical principles underlying electromotility will also contribute to the emerging field of biological nanotechnology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: M-CSF ISOFORMS IN ATHEROSCLEROSIS Principal Investigator & Institution: Rajavashisth, Tripathi B.; Cedars-Sinai Medical Center Box 48750, 8700 Beverly Blvd Los Angeles, Ca 90048 Timing: Fiscal Year 2001; Project Start 10-JUL-1998; Project End 30-JUN-2004 Summary: (Adapted from Investigator's Abstract): The overall goal of this research is to understand the etiologic role of macrophage colony-stimulating factor (M-CSF) in atherosclerosis. Accumulating evidence suggests that M-CSF by influencing the recruitment, growth, survival and function of monocyte-macrophages, may contribute importantly to the promotion of atherosclerosis. Supporting this conclusion are this laboratory's recent findings showing that absence of M-CSF in apolipoprotein (apo) E or low density lipoprotein receptor-deficient mice significantly reduces atherosclerosis despite augmented hypercholesterolemia. The mechanism(s) underlying the causal role of M-CSF in atherosclerosis is not known, but may involve specific isoforms of M-CSF whose biological effects are mediated by a single receptor. The overall hypothesis is that augmented expression of tissue associated M-CSF isoforms in response to atherogenic stimuli in the vessel wall and bone marrow plays a critical role in the development of atheromatous lesions. To test aspects of this hypothesis, studies are proposed with the following specific aims: 1) to study the effects of M-CSF deficiency in the vessel wall on the development of arterial lesions by transplanting wild type. bone marrow cells into mice lacking both M-CSF and apoE and to determine by immunological assays which isoforms of M-CSF are expressed by vascular cells in the normal vessel and during atherogenesis in apo-E null mice; 2) to perform in vitro studies using cultured vascular cells from humans and osteopetrotic (op/op) mice to examine the mechanism(s) underlying the M-CSF mediated growth and activation of monocytes and intimal smooth muscle cells; 3) to produce transgenic mice expressing only the mM-CSF isoform on an op/op genetic background and to examine the effects of the mM-CSF on atherogenesis either by feeding the transgenic mice a high fat, high cholesterol diet or by crossing them with apo E-null mice to generate compound mutants expressing mMCSF on an atherogenic background. These studies may provide new and exciting information that might prove valuable in the rational design of novel therapeutic interventions for atherosclerosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: MORTALITY

NEIGHBORHOOD-LEVEL

INFLUENCES

ON

ALL-CAUSE

Principal Investigator & Institution: Winkleby, Marilyn A.; Associate Professor; Medicine; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2001; Project Start 01-JAN-2001; Project End 31-DEC-2005 Summary: (Taken from the Investigator's Abstract) Few studies have examined how social and physical features of neighborhoods interact with individual factors, e.g.,

20

High Cholesterol

health behaviors and socioeconomic status (SES), to influence disparities in health. Primary Aims: The investigators propose to test the independent and interrelated effects of the neighborhood social environment (e.g., neighborhood SES, social disorganization, Hispanic concentration, crime rates), neighborhood physical environment (e.g., housing conditions, availability of goods and services such as licensed alcohol distributors, fast food restaurants, grocery stores, gun shops, educational resources, recreational facilities, banking/lending institutions), and individual risk factors in predicting all-cause and cardiovascular disease (CVD) mortality in women and men. Design/methods: The investigators will conduct a prospective mortality follow-up study of 8,847 white (nonHispanic) and Hispanic women and men who participated in the Stanford Heart Disease Prevention Program (SHDPP), also referred to as the Stanford Five-City Project. This population-based CVD study included a random sample of women and men aged 25-74 who participated in one of five cross-sectional surveys (1979-1990) and were from four socioeconomically diverse California cities. The SHDPP is recognized for its comprehensive and well-standardized survey and physiologic measures that include SES (education, income, occupation), CVD risk factors (e.g., smoking, high cholesterol and saturated fat), psychosocial factors, and other health-related measures. The investigators propose to match survey data to death records for all-cause and CVD mortality endpoints, and link geocoded addresses to census data and archival data for measures of the neighborhood social and physical environment. They anticipate 824 deaths by 2000 and 1690 deaths by 2005. This work would create a new database where individuals' SES and health indicators are linked with characteristics of their specific neighborhoods. Based on their empirical findings, they will identity neighborhoods currently at high and low risk for mortality, then conduct focus groups and map neighborhood environments (e.g., social, physical, and service features) to create a geographic information system (GIS). These two activities will hopefully extend their empirical findings, generate new hypotheses, and guide the development of their Community Outreach and Education Program (COEP). Dissemination: The COEP will build on their collaborative partnerships with members of the study cities, health advocates, and health agencies that serve low SES and medically under served populations. With the involvement of these partners, they will integrate their empirical findings with knowledge from existing studies and disseminate results via the Internet, media, targeted mailings, and programs offered by the California State and local county health departments in the four study cities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OPOSSUM MODEL FOR THE HIGH & LOW RESPONSES TO DIET Principal Investigator & Institution: Kushwaha, Rampratap S.; Southwest Foundation for Biomedical Res San Antonio, Tx 782450549 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2005 Summary: (provided by applicant): The goal of these proposed studies is to develop the laboratory opossum (Monodelphis domestica) as an animal model for investigating metabolic and molecular mechanisms of high and low responses to dietary lipids. Partially inbred strains of opossums exhibit individual differences in very low (VLDL) and low (LDL) density lipoprotein cholesterol concentrations in response to a high cholesterol and high fat (HCHF) diet. These differences are under strong genetic control and a major gene explains 80% of the variability. Thus, the laboratory opossum may be a unique model for investigating the metabolic and genetic basis of lipemic response to diet. An important question that is proposed to answer is whether the major gene is responsive to dietary cholesterol or dietary fat or a combination of both. Based on

Studies

21

pervious work, it is hypothesized that the difference in LDL cholesterol concentrations is due to strain differences in LDL apoB production. To test this hypothesis, LDL apoB synthesis will be conducted, cholesterol absorption and bile acid composition in high and low responding opossums on the chow and HCHF diets will be measured. Dietary cholesterol changes the expression and activity of a number of hepatic genes, and a mutation in any of these genes may affect the handling of excess dietary cholesterol by the liver. Therefore, the expression of a major hepatic and extrahepatic cholesterol responsive genes between high and low responding opossums will be measured and compared. If the activity or the expression of a major cholesterol responsive gene is associated with the lipemic responsiveness, a search for a polymorphism by singlestrand conformation polymorphism analysis will be done. If a polymorphism in the gene is also associated with the response, selectively bred animals will be genotyped and these data used for linkage analysis to determine if this is the major gene detected by genetic analysis. It is possible that this gene may also be a major determinant of dieinduced hyperlipidemia in humans. However, even if this is not the case, these studies are likely to lead to new strategies in the management of diet-induced hyperlipidemia and atherosclerosis in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PLEIOTROPIC EFFECTS ON OBESITY AND LIPOPROTEINS Principal Investigator & Institution: Blangero, John; Southwest Foundation for Biomedical Res San Antonio, Tx 782450549 Timing: Fiscal Year 2001 Summary: Obesity is an important risk factor for atherosclerosis. However, the reasons for the relationship between these disorder are still poorly understood. Evidence from body composition studies suggest that adiposity is highly correlated with several important endocrine measures including phenotypes related to glucoregulatory hormones, growth hormones, and thyroid hormones. These endocrine traits may also directly influence lipoprotein metabolism. Little is known regarding the genes that influence adiposity and their pleiotropic effects on these endocrine parameters and on correlated risk factors for atherosclerosis such as lipoprotein phenotypes. In Project 3, we will measure several adiposity-related phenotypes including total body fat (estimated using bioimpedance), serum concentrations of leptin, insulin-like growth factor I, insulin, triiodothyronine, and thyroxine in pedigreed baboons on three different dietary regimens (chow, a low cholesterol/high fat diet, and a high cholesterol/high fat diet). To better examine the underlying genetic determinants of variable gene expression, we will also measure quantitative mRNA levels of three candidate genes (the leptin structural gene, the lipoprotein lipase gene, and the glucose transporter 4 gene) in biopsied omental fat tissue. We will detect and localize loci influencing these adiposity-related phenotypes and test hypothesis regarding their pleiotropic effects on lipoprotein traits and genotype x diet interaction. Localization of quantitative trait loci will be accomplished via a genomic screen using candidate gene and STR polymorphisms in a single pedigree of 750 non-inbred baboons and in a second sample of 541 purposely inbred pedigreed baboons and their parents. Statistical linkage analyses will be performed using the multipoint variance component method which makes efficient use of all available information and which we have extended to accommodate the complications of inbred pedigrees. The resulting incorporation of inbred animals into our study design will significantly improve our power to detect quantitative trait loci influencing adiposity related phenotypes. Once a quantitative trait

22

High Cholesterol

locus is found, we will utilize multivariate linkage analysis to determine if adiposityrelated genes have pleiotropic effects on lipoprotein phenotypes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF AMYLOID BETA PROTEIN BY APOE & CHOLESTEROL Principal Investigator & Institution: Yankner, Bruce A.; Professor; Children's Hospital (Boston) Boston, Ma 021155737 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: (Verbatim from the Applicant's Abstract) Inheritance of the E4 allele of apolipoprotein E (apoE) is the most prevalent genetic risk factor for Alzheimer's disease (AD) and is associated with increased deposition of amyloid B protein (AB). The goal of this proposal is to elucidate the role of apoE in the metabolism of AB and amyloid precursor protein (APP) and its control by dietary cholesterol. The studies in this proposal are based on the working hypothesis that the absolute level of apoE is a major determinant of AB levels in the brain and can be regulated by dietary cholesterol. Our preliminary studies show that physiological concentrations of apoE significantly elevate the levels of the 40 and 42 amino acid forms of AB in human cortical cultures due to inhibition of AB degradation. Moreover, rats fed a high cholesterol diet show significantly elevated apoE levels in the cerebral cortex and altered processing of APP. These findings suggest that increased cortical apoE, which can be induced by a high cholesterol diet, may predispose to AB deposition and the onset of AD. The effect of apoE on the cortical metabolism of AB and APP will be investigated in apoE-knockout and apoE3 and apoE4-transgenic mice. We will determine whether apoE has the greatest effect on AB metabolism in the aging brain, and whether this effect can be modulated by dietary cholesterol. These studies will be complemented by an investigation of the effects of apoE and dietary cholesterol on plaque formation in APP-transgenic mice, and the examination of potential therapeutic approaches utilizing cholesterol-lowering drugs and neural stem cells that can scavenge apoE. The effect of a high cholesterol diet on AB production in transgenic mice that express disease-causing presenilin-1 mutations will also be examined. To elucidate the mechanism by which apoE inhibits AB degradation; the receptors and soluble factors that mediate AB clearance will be identified in primary human cortical cultures. Known candidate receptors that could mediate AB uptake, including the LDL receptor-related protein, the microglial scavenger receptor and the serpin-enzyme complex receptor, will be examined, as well as novel AB uptake receptors. These studies may help to elucidate the roles of apoE and dietary cholesterol in the pathogenesis of AD, with potentially important implications for early genotyping and therapeutic intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: ROLE ATHEROGENESIS

OF

CHLAMYDIA

PNEUMONIAE

INFECTION

IN

Principal Investigator & Institution: Kuo, Cho-Chou; Professor; Pathobiology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-APR-1997; Project End 31-MAR-2004 Summary: (Adapted from the Applicant's Abstract): Chlamydia pneumoniae (TWAR) is a common human respiratory pathogen. In recent years, there has been mounting evidence showing that this organism might play a role in atherosclerosis. Because coronary heart disease is a leading cause of death in this country, the overall goal is to

Studies

23

investigate the immunopathogenic mechanisms by which C. pneumoniae infection contributes to the development of vascular disease. The proposed studies will exploit our recent findings from mouse model studies linking C. pneumoniae infection and atherosclerosis and in vitro cell culture studies on C. pneumoniae infection of arterial wall cells. The mouse models that will be used are C57BU6 and strains derived from this background strain including, apoE-deficient and TNF-A receptor and apoE double knockout mice. Atherosclerosis in C57BU6 mice can be induced by feeding with a high fat/high cholesterol diet, while apoE mice develop atherosclerosis spontaneously on a regular diet. The specific aims are to 1) further evaluate the synergistic effect of C. pneumoniae infection and hyperlipidemia on atherogenesis by infecting mice with C. pneumoniae followed by feeding animals with a high fat/high cholesterol diet and measuring the atherosclerotic lesion development using computer assisted morphometry; 2) study the effects of C. pneumoniae infection on key components in the inflammatory process of atherosclerosis that promote atherosclerotic lesion development by recruiting lymphocytes/macrophages and eliciting inflammatory responses at lesion sites. In vitro, in vivo, and ex vivo systems will be used to assay the expression of leukocyte adhesion molecules and adherence of macrophages to the endothelial surface. The effect of TNF-A on lesion development will be investigated by infecting TNF-A receptor and apoE double knockout mice and measuring lesion development using computer assisted morphometry; 3) assess the role of macrophages in the establishment of persistent C. pneumoniae infection of atheromatous lesions using cell culture to analyze vascular cell interactions and the effect on infectivity, growth and persistence of C. pneumoniae, and characterize the growth of C. pneumoniae in macrophages loaded with low density lipoproteins (foam cells). The proposed studies should prove invaluable for understanding the disease process and developing better measures for eradication or prevention of C. pneumoniae infection and for reducing atherosclerosis and coronary heart disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF PANCREATIC LIPASE IN DIETARY LIPID ABSORPTION Principal Investigator & Institution: Huggins, Kevin W.; Pathology and Lab Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2001; Project Start 01-JUN-2001 Summary: Pancreatic lipase is a 48 kD protein present in pancreatic secretions. It has been implicated to have a crucial role in the digestion of fat in the intestinal lumen. In vitro data has also suggested that pancreatic lipase activity is important for the efficient absorption of dietary cholesterol. The aims of this research proposal are to determine the relationship between pancreatic lipase gene expression and dietary fat and cholesterol absorption. This will be achieved by generating knockout mice deficient in pancreatic lipase. Initially, mice expressing various levels of pancreatic lipase will be characterized based on their growth and overall health. Fat and cholesterol absorption studies will be performed to assess the role of pancreatic lipase in dietary lipid absorption in vivo. These results will be correlated with mRNA levels to establish the relationship between PL mRNA level and fat and cholesterol absorption efficiency in the various transgenic mice. The mice will also be fed high fat and high fat/high cholesterol diets to assess the role pancreatic lipase plays in regulating serum lipid levels. The impact of recombinant adenoviral-mediated ectopic pancreatic lipase expression in the biliary epitheliurn will be performed to determine if this would be a feasible treatment for fat malabsorption associated with pancreatic insufficiency and cystic fibrosis. These studies will provide nutritionists and clinicians with mechanistic information to design effective dietary

24

High Cholesterol

and/or therapeutic treatment for diseases due to diet-induced hyperlipidemia or to aberrant fat digestion and transport due to pancreatic diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SYNTHESIS OF 7-DEOXYZARAGOZIC ACID A Principal Investigator & Institution: Escobar, Maya; Chemistry and Biochemistry; University of Texas Austin 101 E. 27Th/Po Box 7726 Austin, Tx 78712 Timing: Fiscal Year 2001; Project Start 01-SEP-2001 Summary: The zaragozic acids are a class of highly oxygenated natural products that have been shown to exhibit high activities in the inhibition of squalene synthase, which is an enzyme that acts in the first committed step in the biosynthetic pathway of cholesterol. Since coronary diseases are related directly to elevated serum cholesterol levels, there has been a great effort in the development of an effective treatment of high cholesterol. The zaragozic acids have been shown to have prohibitively high toxicity, however an efficient synthesis to the zaragozic acids allows for further investigation into these types of compounds as cholesterol lowering agents. The high biological activity of the zaragozic acids paired with the synthetically challenging highly oxygenated bicyclic core make 7-deoxyzaragozic acid A a an exciting target molecule. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: THE CHEMOKINE RECEPTOR CXCR-2 IN ATHEROSCLEROSIS Principal Investigator & Institution: Boisvert, William A.; Assistant Member; Scripps Research Institute Tpc7 La Jolla, Ca 92037 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2003 Summary: (Adapted from Investigator's Abstract): Multiple mechanisms operate to promote macrophage accumulation within the atherosclerotic intima. This proposed work stems in part from observations by others, including the finding that in apoE knockout mice which are deficient in the MCP-1 receptor CCR2, atherosclerosis is diminished, but lesion size and complexity still progress from 5-13 weeks. Also monocyte CCR2 expression in vitro is attenuated by several inflammatory mediators which can be in the plaque, or by differentiation to macrophages. They therefore propose that other mechanisms are at play in promoting macrophage retention and expansion within the atherosclerotic lesions. Base on their previous work, they have found that intimal macrophages express the chemokine receptor CXCR2, and the CXCR2 ligands, GROalpha, and IL-8. Initial data also indicate that leukocyte deficiency of the mouse CXCR2 homologue, mIL-8RH, arrested progression of early macrophagerich lesions and decreased retention of lesion macrophages. They therefore hypothesize that specific CXCR2 effects mediate the intra-lesional growth, inflammatory differentiation and activation of recruited macrophages. Their specific aims are as follows: Define the sequence of atherogenic events mediated by CXCR2, using two animal model systems. They will first transplant irradiated LDLR-/- mice with bone marrow from mIL-8/ CXCR2-/- or control mice under gnotobiotic conditions. Mice will be fed a chow or high cholesterol diet to define the role of mIL-8RH in mild vs. severe hypercholesterolemia-induced atherosclerosis. Second, to assess the role of mIL-8RH in cells other than leukocytes, they will study LDLR-/-, mIL-8RH-/- mice derived by crossbreeding. Early monocyte ingress, fatty streak formation, and lesion progression will be studied in both groups at 3 to 30 weeks. They will concurrently detect lesion mIL-8RH and macrophage markers including MOMA2 in each group of mice. They will also compare temporal and spatial macrophage accumulation, expression of mIL-8RH,

Studies

25

KC/GROalpha, JE/MCP-1 and CCR2, the appearance of oxLDL epitopes and lipid deposition. Test the hypothesis that CXCR2 expression acts by promoting macrophage retention in early atherosclerotic lesions, and does so in part by increasing macrophage beta1 integrin-mediated adhesion. First they will determine if retention of lesion monocytes is greater in LDLR-/-, mIL-8RH+/+ than LDLR-/-, mIL-8RH-/- mice. To do so they will isolate, label (using [3H]-glycerol) and infuse bone marrow monocytes into LDLR-/- mice on a high fat diet. Migration and retention of labeled monocytes in vivo will be measured in aortic lesions at 2,4,7, and 14 days post infusion. They will then test the hypothesis that the generalized cell culture adhesion defect of macrophages from mIL-8RH-/- mice is associated with decreased activation of beta1 integrins, which bind fibronectin (VLA-4, VLA-5). They will also study CXCR2-mediated effects on adhesion of human peripheral blood monocytes using specific neutralizing antibodies for integrins and integrin ligands. They will also test the hypothesis that macrophage CXCR2 expression is necessary for macrophage matrix invasion. Test the hypothesis that CXCR2 expression, via effects on macrophage adhesion, mediates macrophage differentiation to a distinct, pro-atherogenic inflammatory phenotype. Here they will further study human peripheral monocyte-derived macrophages and mouse wild type and mIL-8RH-/- bone marrow derived macrophages under conditions where CXCR2 is normally expressed in vitro. They will specifically look at the effects of the CXCR2 ligands, GROalpha, and IL-8 on macrophage proliferation and expression of JE/MCP-1. They will also determine if CXCCR2-mediated adhesion modulates the production of apoE, oxidation of LDL, and accumulation of cholesteryl ester. Finally based on the results of Specific Aim 2, they will test the hypothesis that VLA-5, and VLA-4 activation, via stimulation by CXCR2 ligands, regulate one or more of these activities. They will also correlate these results with the features of the mouse atherosclerotic lesions of Specific Aim 1 (i.e. in vivo correlation studies between CXCR2 expression and PCNA, oxidized LDL antigens, and scavenger receptor expression). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with high cholesterol, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “high cholesterol” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for high cholesterol (hyperlinks lead to article summaries):

3 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

26

High Cholesterol

•

A population at risk. Prevalence of high cholesterol levels in hypertensive patients in the Framingham Study. Author(s): Castelli WP, Anderson K. Source: The American Journal of Medicine. 1986 February 14; 80(2A): 23-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3946458&dopt=Abstract

•

A study of short term lipoprotein changes induced by single high cholesterol diet in healthy and diseases human volunteers. Author(s): Arora RC, Agarwal N, Singh DK. Source: Mater Med Pol. 1991 October-December; 23(4): 299-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1842237&dopt=Abstract

•

Acupuncture: no alternative in treating high cholesterol levels. Author(s): Stehle G, Feng Z, Wang W, Bao H, Schettler G. Source: Artery. 1986; 14(1): 28-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3789921&dopt=Abstract

•

Ask the doctor. I take a statin because of high cholesterol. Now that I'm past menopause, my doctor thinks I need to take a medication to protect my bones. I've read that statins prevent osteoporosis, so do I really need another pill? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2003 June; 13(10): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835155&dopt=Abstract

•

Ask the doctor: I have very high cholesterol that isn't in the target range, even with high doses of statins. I hate to take any more pills. Any advice? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 July; 10(11): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10877881&dopt=Abstract

•

Ask the doctor: I started taking estrogen four years ago because I have a family history of heart disease and I have high cholesterol. Now I read that estrogen may even increase my risk for heart problems. I assume I should stop taking it, right? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 July; 10(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10877862&dopt=Abstract

•

By the way, doctor. I have high cholesterol, and have been taking Mevacor (lovastatin) for two years. Recently, I was switched to Pravachol (pravastatin) because my insurance company would no longer pay for Mevacor. Is it as good? Author(s): Nicholson CR. Source: Harvard Women's Health Watch. 1999 June; 6(10): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10233830&dopt=Abstract

Studies

27

•

By the way, doctor. My doctor recently prescribed Zocor to treat my high cholesterol. She plans to test my liver for possible side effects, which makes me nervous. Is this a dangerous drug? What are its side effects? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 2000 June; 7(10): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10810072&dopt=Abstract

•

By the way, doctor. My hair has been thinning out for the past decade or so, but since my doctor started me on Lipitor (atorvastatin) a few months ago for high cholesterol, I swear it's been falling out much faster. My doctor discounts the possibility, but I looked in the Physicians' desk reference (PDR) and alopecia is listed under “adverse reactions.” What do you think? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2000 July; 25(9): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10877883&dopt=Abstract

•

By the way, doctor.I know that high cholesterol gums up arteries with atherosclerosis. But why don't I ever hear about atherosclerosis in veins? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2002 May; 27(7): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12034558&dopt=Abstract

•

By the way, doctor.I'm a few years past menopause, and I take a statin because of high cholesterol. My doctor has broached the subject of whether I might need to take something else to lower my risk for osteoporosis, but I've read that statins help prevent that problem. Can't I tell the doctor I don't need another pill? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2001 May; 26(7): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11424275&dopt=Abstract

•

Changes in serum lipids and apolipoproteins after exercise in men with high cholesterol: influence of intensity. Author(s): Crouse SF, O'Brien BC, Rohack JJ, Lowe RC, Green JS, Tolson H, Reed JL. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1995 July; 79(1): 279-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7559232&dopt=Abstract

•

Cholesterolosis is not associated with high cholesterol levels in patients with and without gallstone disease. Author(s): Mendez-Sanchez N, Tanimoto MA, Cobos E, Roldan-Valadez E, Uribe M. Source: Journal of Clinical Gastroenterology. 1997 October; 25(3): 518-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9412968&dopt=Abstract

28

High Cholesterol

•

Cumulative effects of high cholesterol levels, high blood pressure, and cigarette smoking on carotid stenosis. Author(s): Wilson PW, Hoeg JM, D'Agostino RB, Silbershatz H, Belanger AM, Poehlmann H, O'Leary D, Wolf PA. Source: The New England Journal of Medicine. 1997 August 21; 337(8): 516-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9262494&dopt=Abstract

•

Drugs for treatment of patients with high cholesterol blood levels and other dyslipidemias. Author(s): Bays HE, Dujovne CA. Source: Prog Drug Res. 1994; 43: 9-41. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7855253&dopt=Abstract

•

Early detection of high cholesterol levels in young adults. Author(s): Grundy SM. Source: Jama : the Journal of the American Medical Association. 2000 July 19; 284(3): 365-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10891970&dopt=Abstract

•

Effect of allicin from garlic powder on serum lipids and blood pressure in rats fed with a high cholesterol diet. Author(s): Ali M, Al-Qattan KK, Al-Enezi F, Khanafer RM, Mustafa T. Source: Prostaglandins, Leukotrienes, and Essential Fatty Acids. 2000 April; 62(4): 253-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10882191&dopt=Abstract

•

Effectiveness and hazards of case finding for a high cholesterol concentration. Author(s): Kinlay S, Heller RF. Source: Bmj (Clinical Research Ed.). 1990 June 16; 300(6739): 1545-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2372619&dopt=Abstract

•

Effects of cholesterol reduction on BP response to mental stress in patients with high cholesterol. Author(s): Sung BH, Izzo JL Jr, Wilson MF. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1997 June; 10(6): 592-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9194504&dopt=Abstract

•

Effects of cigarette smoking, diabetes, high cholesterol, and hypertension on all-cause mortality and cardiovascular disease mortality in Mexican Americans. The San Antonio Heart Study. Author(s): Wei M, Mitchell BD, Haffner SM, Stern MP. Source: American Journal of Epidemiology. 1996 December 1; 144(11): 1058-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8942437&dopt=Abstract

Studies

29

•

Effects of high cholesterol high fat diet on plasma lipoproteins in familial hypercholesterolemia. Author(s): Cole TG, Pfleger B, Hitchins O, Schonfeld G. Source: Metabolism: Clinical and Experimental. 1985 May; 34(5): 486-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3990563&dopt=Abstract

•

Effects of short-term aerobic conditioning and high cholesterol feeding on plasma total and lipoprotein cholesterol levels in sedentary young men. Author(s): Quig DW, Thye FW, Ritchey SJ, Herbert WG, Clevidence BA, Reynolds LK, Smith MC. Source: The American Journal of Clinical Nutrition. 1983 December; 38(6): 825-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6650444&dopt=Abstract

•

Evaluation of the changes in lipid lipoprotein profile induced after ingestion of high cholesterol and fat diet in young healthy females. Author(s): Arora RC, Agarwal N, Garg RK, Arora S, Kumar K, Mangal R. Source: Mater Med Pol. 1988 July-September; 20(3): 163-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3244287&dopt=Abstract

•

Except for high cholesterol, I've always been pretty healthy for my age (72). But I recently started puffing on the stairs, so my doctor sent me for a set of tests. After the echocardiogram, he told me I had congestive heart failure. He gave me Lasix and I feel much better. But now he wants me to take at least three other pills every day. Do I need all of them if I feel well? Author(s): Simon HB. Source: Harvard Men's Health Watch. 2002 October; 7(3): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12393325&dopt=Abstract

•

Expression of human apolipoprotein A-I/C-III/A-IV gene cluster in mice reduces atherogenesis in response to a high fat-high cholesterol diet. Author(s): Baroukh N, Ostos MA, Vergnes L, Recalde D, Staels B, Fruchart J, Ochoa A, Castro G, Zakin MM. Source: Febs Letters. 2001 July 27; 502(1-2): 16-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11478940&dopt=Abstract

•

Fighting high cholesterol levels--lipid lowering drugs. Author(s): Fidge NH. Source: The Medical Journal of Australia. 1993 December 6-20; 159(11-12): 815-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8264477&dopt=Abstract

30

High Cholesterol

•

Good, bad and high cholesterol. Author(s): Solomons HD. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1994 October; 84(10): 698. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7839264&dopt=Abstract

•

Guidelines for diagnosis and treatment of high cholesterol. Author(s): Ring BL. Source: Jama : the Journal of the American Medical Association. 2001 November 21; 286(19): 2401-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11712931&dopt=Abstract

•

Guidelines for diagnosis and treatment of high cholesterol. Author(s): Rosch PJ. Source: Jama : the Journal of the American Medical Association. 2001 November 21; 286(19): 2401; Author Reply 2401-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11712930&dopt=Abstract

•

Guidelines for diagnosis and treatment of high cholesterol. Author(s): Iliff D. Source: Jama : the Journal of the American Medical Association. 2001 November 21; 286(19): 2400-1; Author Reply 2401-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11712929&dopt=Abstract

•

Guidelines for diagnosis and treatment of high cholesterol. Author(s): Caldwell LR. Source: Jama : the Journal of the American Medical Association. 2001 November 21; 286(19): 2400; Author Reply 2401-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11712928&dopt=Abstract

•

Guidelines for diagnosis and treatment of high cholesterol. Author(s): Feeman WE Jr. Source: Jama : the Journal of the American Medical Association. 2001 November 21; 286(19): 2400; Author Reply 2401-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11712927&dopt=Abstract

•

High cholesterol (hyperlipidemia). Author(s): Woods A. Source: Nursing. 2002 June; 32(6): 56-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12189985&dopt=Abstract

Studies

31

•

High cholesterol affects platelet APP processing in controls and in AD patients. Author(s): Borroni B, Colciaghi F, Lenzi GL, Caimi L, Cattabeni F, Di Luca M, Padovani A. Source: Neurobiology of Aging. 2003 September; 24(5): 631-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885570&dopt=Abstract

•

High cholesterol and mortality in older patients. Author(s): Goldstein AO. Source: The Journal of Family Practice. 1995 February; 40(2): 187. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7503833&dopt=Abstract

•

High cholesterol and triglyceride values in Swedish males and females: increased risk of fatal myocardial infarction. First report from the AMORIS (Apolipoprotein related MOrtality RISk) study. Author(s): Walldius G, Jungner I, Kolar W, Holme I, Steiner E. Source: Blood Pressure. Supplement. 1992; 4: 35-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1345333&dopt=Abstract

•

High cholesterol in childhood is a predictor of heart disease in adulthood. Author(s): McCormick EM. Source: J Pract Nurs. 1991 March; 41(1): 26. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2046031&dopt=Abstract

•

High cholesterol levels in healthy seniors: cause for concern? Author(s): Drown DJ. Source: Progress in Cardiovascular Nursing. 1995 Winter; 10(1): 40-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7770441&dopt=Abstract

•

High cholesterol levels in patients with panic disorder. Author(s): Reifman A, Windle M. Source: The American Journal of Psychiatry. 1993 March; 150(3): 527. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8499009&dopt=Abstract

•

High cholesterol levels in patients with panic disorder. Author(s): Feder R. Source: The American Journal of Psychiatry. 1993 March; 150(3): 527. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8434682&dopt=Abstract

•

High cholesterol levels in patients with panic disorder. Author(s): Bajwa WK, Asnis GM, Sanderson WC, Irfan A, van Praag HM. Source: The American Journal of Psychiatry. 1992 March; 149(3): 376-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1536278&dopt=Abstract

32

High Cholesterol

•

High cholesterol levels in patients with sleep panic. Author(s): Agargun MY, Kara H, Algun E, Sekeroglu R, Tarakcioglu M. Source: Biological Psychiatry. 1996 November 15; 40(10): 1064-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8915568&dopt=Abstract

•

High cholesterol levels: is mass screening the best option? Author(s): Kinlay S. Source: The Medical Journal of Australia. 1988 June 20; 148(12): 635-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3132589&dopt=Abstract

•

High density lipoprotein-cholesterol changes in children with high cholesterol levels at birth. Author(s): Bastida S, Sanchez-Muniz FJ, Cuena R, Perea S, Aragones A. Source: European Journal of Pediatrics. 2002 February; 161(2): 94-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11954759&dopt=Abstract

•

Human prostasome membranes exhibit very high cholesterol/phospholipid ratios yielding high molecular ordering. Author(s): Arvidson G, Ronquist G, Wikander G, Ojteg AC. Source: Biochimica Et Biophysica Acta. 1989 September 4; 984(2): 167-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2548623&dopt=Abstract

•

Hypertension & high cholesterol: a dangerous synergy. Author(s): Trottier DJ, Kochar MS. Source: The American Journal of Nursing. 1992 November; 92(11): 40-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1485630&dopt=Abstract

•

I take Zocor for high cholesterol. My doctor checks my lipid levels every six months and they have been pretty good for a few years now. But he also checks my liverfunction tests, because liver damage is one of the side effects of this drug. How worried should I be about this problem, and is checking my liver tests every six months often enough? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1998 September; 9(1): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9734250&dopt=Abstract

•

Improving the prediction of coronary heart disease to aid in the management of high cholesterol levels: what a difference a decade makes. Author(s): Avins AL, Browner WS. Source: Jama : the Journal of the American Medical Association. 1998 February 11; 279(6): 445-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9466637&dopt=Abstract

Studies

33

•

Insulin-mediated venodilation is impaired in patients with high cholesterol. Author(s): Sung BH, Ching M, Izzo J Jr, Dandona P, Wilson MF. Source: Hypertension. 1998 June; 31(6): 1266-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9622140&dopt=Abstract

•

Is atherosclerosis caused by high cholesterol? Author(s): Ravnskov U. Source: Qjm : Monthly Journal of the Association of Physicians. 2002 June; 95(6): 397403. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12037248&dopt=Abstract

•

Isolation of calcifiable vesicles from aortas of rabbits fed with high cholesterol diets. Author(s): Hsu HH, Camacho NP, Sun F, Tawfik O, Aono H. Source: Atherosclerosis. 2000 December; 153(2): 337-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11164422&dopt=Abstract

•

Lercanidipine: short plasma half-life, long duration of action and high cholesterol tolerance. Updated molecular model to rationalize its pharmacokinetic properties. Author(s): Herbette LG, Vecchiarelli M, Sartani A, Leonardi A. Source: Blood Pressure. Supplement. 1998; 2: 10-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9850437&dopt=Abstract

•

Linkage disequilibrium between a marker on the LDL receptor and high cholesterol levels. Author(s): Bissbort S, Wentzel DD, de Villiers LS. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1987 January 24; 71(2): 124. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2880400&dopt=Abstract

•

Linkage disequilibrium between a marker on the low-density lipoprotein receptor and high cholesterol levels. Author(s): Brink PA, Steyn LT, Bester AJ, Steyn K. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1986 July 19; 70(2): 80-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3726706&dopt=Abstract

•

Measuring behaviour in children with high cholesterol levels. Author(s): Joyce DP, Limbos MM. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1997 August 15; 157(4): 372-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9275942&dopt=Abstract

34

High Cholesterol

•

Metabolism of larger high density lipoproteins accumulating in some families of baboons fed a high cholesterol and high saturated fat diet. Author(s): Kushwaha RS, Foster DM, Murthy VN, Carey KD, McGill HC Jr. Source: Journal of Lipid Research. 1989 August; 30(8): 1147-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2504862&dopt=Abstract

•

New guidelines on high cholesterol. Author(s): Sherman FT. Source: Geriatrics. 2001 July; 56(7): 3-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11490984&dopt=Abstract

•

Patients with high cholesterol levels benefit most from early withdrawal of corticosteroids. Author(s): Rigotti P; European Tacrolimus/MMF Transplantation Study Group. Source: Transplantation Proceedings. 2002 August; 34(5): 1797-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12176581&dopt=Abstract

•

Plasma lipid and lipoprotein cholesterol concentrations in adult males consuming normal and high cholesterol diets under controlled conditions. Author(s): Flaim E, Ferreri LF, Thye FW, Hill JE, Ritchey SJ. Source: The American Journal of Clinical Nutrition. 1981 June; 34(6): 1103-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6940435&dopt=Abstract

•

Prevalence of high cholesterol, high blood pressure, and smoking among elementary schoolchildren in North Carolina. Author(s): Bradley CB, Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Webb JP. Source: N C Med J. 1997 September-October; 58(5): 362-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9313361&dopt=Abstract

•

Primary hypertriglyceridemia with borderline high cholesterol and elevated apolipoprotein B concentrations. Comparison of gemfibrozil vs lovastatin therapy. Author(s): Vega GL, Grundy SM. Source: Jama : the Journal of the American Medical Association. 1990 December 5; 264(21): 2759-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2232062&dopt=Abstract

•

Reduced frequency of high cholesterol levels among patients with intracerebral haemorrhage. Author(s): Thrift A, McNeil J, Donnan G; Melbourne Risk Factor Study Group. Source: Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia. 2002 July; 9(4): 376-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217665&dopt=Abstract

Studies

35

•

RSH/SLO (Smith-Lemli-Opitz) syndrome: designing a high cholesterol diet for the SLO syndrome. Author(s): Acosta PB. Source: American Journal of Medical Genetics. 1994 May 1; 50(4): 358-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8209916&dopt=Abstract

•

Screening for high cholesterol. Author(s): Hulley SB, Avins AL. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 1990 January-February; 5(1): 88-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2299430&dopt=Abstract

•

Selective screening for high cholesterol in Australian general practice: the Newcastle Cholesterol Prediction Study. Author(s): Kinlay S, Heller RF. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 1990 January-February; 5(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2299425&dopt=Abstract

•

Selective screening for high cholesterol levels. Author(s): Lyall MM. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1989 September 16; 76(6): 286. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2781430&dopt=Abstract

•

Self-report of high cholesterol: determinants of validity in U.S. adults. Author(s): Natarajan S, Lipsitz SR, Nietert PJ. Source: American Journal of Preventive Medicine. 2002 July; 23(1): 13-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12093418&dopt=Abstract

•

Serum HDL-cholesterol-increasing and fatty liver-improving actions of Panax ginseng in high cholesterol diet-fed rats with clinical effect on hyperlipidemia in man. Author(s): Yamamoto M, Uemura T, Nakama S, Uemiya M, Kumagai A. Source: The American Journal of Chinese Medicine. 1983; 11(1-4): 96-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6660221&dopt=Abstract

•

Should we treat high cholesterol in the aged? Author(s): Godschalk MF. Source: Va Med Q. 1991 Spring; 118(2): 99-101. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2039782&dopt=Abstract

36

High Cholesterol

•

Statin helps heart failure patients without high cholesterol. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2003 August 22; 14(16): 1, 5-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966938&dopt=Abstract

•

The absorption of cholesterol and the sterol balance in the Tarahumara Indians of Mexico fed cholesterol-free and high cholesterol diets. Author(s): McMurry MP, Connor WE, Lin DS, Cerqueira MT, Connor SL. Source: The American Journal of Clinical Nutrition. 1985 June; 41(6): 1289-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4003333&dopt=Abstract

•

The effect of a high cholesterol and saturated fat diet on serum high-density lipoprotein-cholesterol, apoprotein A-I, and apoprotein E levels in normolipidemic humans. Author(s): Tan MH, Dickinson MA, Albers JJ, Havel RJ, Cheung MC, Vigne JL. Source: The American Journal of Clinical Nutrition. 1980 December; 33(12): 2559-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6776798&dopt=Abstract

•

The effect of celiprolol on the blood lipid profile in hypertensive patients with high cholesterol levels. Author(s): Fogari R, Zoppi A, Tettamanti F, Malamani G, Pasotti C. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 1991 January; 4 Suppl 6: 1287-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1826213&dopt=Abstract

•

Training intensity, blood lipids, and apolipoproteins in men with high cholesterol. Author(s): Crouse SF, O'Brien BC, Grandjean PW, Lowe RC, Rohack JJ, Green JS, Tolson H. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1997 January; 82(1): 270-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9029226&dopt=Abstract

•

Treating high cholesterol: everyday applications of the national guidelines. Author(s): Olin JW, Cressman MD. Source: Cleve Clin J Med. 1991 March-April; 58(2): 114-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2025912&dopt=Abstract

•

Treatment with simvastatin and low-dose aspirin depresses thrombin generation in patients with coronary heart disease and borderline-high cholesterol levels. Author(s): Musial J, Undas A, Undas R, Brozek J, Szczeklik A. Source: Thrombosis and Haemostasis. 2001 February; 85(2): 221-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11246536&dopt=Abstract

Studies

•

37

Why mortality from heart disease is low in France. High cholesterol may not have same effect on cardiovascular risk in southern Europe as elsewhere. Author(s): Marrugat J, Senti M. Source: Bmj (Clinical Research Ed.). 2000 January 22; 320(7229): 250. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10712022&dopt=Abstract

39

CHAPTER 2. NUTRITION AND HIGH CHOLESTEROL Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and high cholesterol.

Finding Nutrition Studies on High Cholesterol The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “high cholesterol” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

40

High Cholesterol

The following information is typical of that found when using the “Full IBIDS Database” to search for “high cholesterol” (or a synonym): •

Astrocytosis, microgliosis, metallothionein-I-II and amyloid expression in high cholesterol-fed rabbits. Author(s): CNR Center on Metalloproteins, Department of Biology, University of Padova, Italy. [email protected] Source: Zatta, P Zambenedetti, P Stella, M P Licastro, F J-Alzheimers-Dis. 2002 February; 4(1): 1-9 1387-2877

•

Effects of recombinant human macrophage colony-stimulating factor on atherosclerotic lesions established in the aorta of high cholesterol-fed rabbits. Source: Irie, H. Koshiba, H. Koyama, M. Asakura, E. Shibata, H. Kimura, K. Naito, K. Yamauchi, T. Yada, K. Hanamura, T. J-biochem. Tokyo : Japanese Biochemical Society. May 2001. volume 129 (5) page 717-724. 0021-924X

•

Expression of human apolipoprotein A-I/C-III/A-IV gene cluster in mice reduces atherogenesis in response to a high fat-high cholesterol diet. Author(s): Unite d'Expression des Genes Eucaryotes, Institut Pasteur, 28 rue du Dr. Roux, 75724 Paris Cedex 15, France. Source: Baroukh, N Ostos, M A Vergnes, L Recalde, D Staels, B Fruchart, J Ochoa, A Castro, G Zakin, M M FEBS-Lett. 2001 July 27; 502(1-2): 16-20 0014-5793

•

Supplementation of naringenin and its synthetic derivative alters antioxidant enzyme activities of erythrocyte and liver in high cholesterol-fed rats. Author(s): Department of Food Science and Nutrition, Kyungpook National University, Taegu, South Korea. Source: Lee, M K Bok, S H Jeong, T S Moon, S S Lee, S E Park, Y B Choi, M S BioorgMed-Chem. 2002 July; 10(7): 2239-44 0968-0896

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

•

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

•

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

•

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

•

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

Nutrition

41

•

Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

•

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

•

Google: http://directory.google.com/Top/Health/Nutrition/

•

Healthnotes: http://www.healthnotes.com/

•

Open Directory Project: http://dmoz.org/Health/Nutrition/

•

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

•

WebMD®Health: http://my.webmd.com/nutrition

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to high cholesterol; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Folic Acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,887,00.html Niacin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,892,00.html Pantothenic Acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,882,00.html Pantothenic Acid and Pantethine Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B12 Source: Prima Communications, Inc.www.personalhealthzone.com

42

High Cholesterol

Vitamin B3 Source: Healthnotes, Inc.; www.healthnotes.com Vitamin B3 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904,00.html Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Vitamin E Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,906,00.html Vitamin K Source: Prima Communications, Inc.www.personalhealthzone.com •

Minerals Atorvastatin Source: Healthnotes, Inc.; www.healthnotes.com Calcium Source: Healthnotes, Inc.; www.healthnotes.com Calcium Source: Prima Communications, Inc.www.personalhealthzone.com Carnitine Source: Prima Communications, Inc.www.personalhealthzone.com Chondroitin Source: Prima Communications, Inc.www.personalhealthzone.com Chromium Source: Healthnotes, Inc.; www.healthnotes.com Chromium Source: Prima Communications, Inc.www.personalhealthzone.com Copper Source: Prima Communications, Inc.www.personalhealthzone.com

Nutrition

Creatine Monohydrate Source: Healthnotes, Inc.; www.healthnotes.com Fluvastatin Source: Healthnotes, Inc.; www.healthnotes.com L-carnitine Source: Healthnotes, Inc.; www.healthnotes.com Lecithin/phosphatidylcholine/choline Source: Healthnotes, Inc.; www.healthnotes.com Lovastatin Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Pravastatin Source: Healthnotes, Inc.; www.healthnotes.com Quercetin Source: Prima Communications, Inc.www.personalhealthzone.com Simvastatin Source: Healthnotes, Inc.; www.healthnotes.com Vanadium Alternative names: Vanadate, Vanadyl Source: Integrative Medicine Communications; www.drkoop.com •

Food and Diet Artichoke Alternative names: Cynara scolymus Source: Healthnotes, Inc.; www.healthnotes.com Atkins Diet Source: Healthnotes, Inc.; www.healthnotes.com Barley Source: Healthnotes, Inc.; www.healthnotes.com Chondroitin Sulfate Source: Healthnotes, Inc.; www.healthnotes.com Coffee Source: Healthnotes, Inc.; www.healthnotes.com Crème Fraîche Source: Healthnotes, Inc.; www.healthnotes.com

43

44

High Cholesterol

Fat Alternatives and Fat Replacers Source: Healthnotes, Inc.; www.healthnotes.com Flaxseeds Source: Healthnotes, Inc.; www.healthnotes.com Garlic Alternative names: Allium sativum Source: Healthnotes, Inc.; www.healthnotes.com Garlic Source: Prima Communications, Inc.www.personalhealthzone.com Garlic Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,786,00.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com Kefir Source: Healthnotes, Inc.; www.healthnotes.com Lhassi Source: Healthnotes, Inc.; www.healthnotes.com Lobster & Crayfish Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,175,00.html Low-fat Diet Source: Healthnotes, Inc.; www.healthnotes.com Milk Source: Healthnotes, Inc.; www.healthnotes.com Polyunsaturated Fats Source: Healthnotes, Inc.; www.healthnotes.com Saturated Fats Source: Healthnotes, Inc.; www.healthnotes.com Soy Source: Prima Communications, Inc.www.personalhealthzone.com Soy Products Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,135,00.html

Nutrition

Soybeans Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,105,00.html Special Diets Index Source: Healthnotes, Inc.; www.healthnotes.com Tea Source: Healthnotes, Inc.; www.healthnotes.com Trans-fats Source: Healthnotes, Inc.; www.healthnotes.com Yogurt Source: Healthnotes, Inc.; www.healthnotes.com Yogurt Cheese Source: Healthnotes, Inc.; www.healthnotes.com

45

47

CHAPTER 3. ALTERNATIVE CHOLESTEROL

MEDICINE

AND

HIGH

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to high cholesterol. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to high cholesterol and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “high cholesterol” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to high cholesterol: •

Antioxidative activity of naringin and lovastatin in high cholesterol-fed rabbits. Author(s): Jeon SM, Bok SH, Jang MK, Lee MK, Nam KT, Park YB, Rhee SJ, Choi MS. Source: Life Sciences. 2001 November 2; 69(24): 2855-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11720089&dopt=Abstract

•

Effect of naringin supplementation on cholesterol metabolism and antioxidant status in rats fed high cholesterol with different levels of vitamin E. Author(s): Choi MS, Do KM, Park YS, Jeon SM, Jeong TS, Lee YK, Lee MK, Bok SH. Source: Annals of Nutrition & Metabolism. 2001; 45(5): 193-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11585976&dopt=Abstract

48

High Cholesterol

•

Effects of added dietary taurine on erythrocyte lipids and oxidative stress in rabbits fed a high cholesterol diet. Author(s): Balkan J, Oztezcan S, Aykac-Toker G, Uysal M. Source: Bioscience, Biotechnology, and Biochemistry. 2002 December; 66(12): 2701-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596871&dopt=Abstract

•

Garlic attenuates hypercholesterolemic risk factors in olive oil fed rats and high cholesterol fed rats. Author(s): Chetty KN, Calahan L, Harris KC, Dorsey W, Hill D, Chetty S, Jain SK. Source: Pathophysiology : the Official Journal of the International Society for Pathophysiology / Isp. 2003 May; 9(3): 127-132. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567929&dopt=Abstract

•

Hawthorn fruit is hypolipidemic in rabbits fed a high cholesterol diet. Author(s): Zhang Z, Ho WK, Huang Y, James AE, Lam LW, Chen ZY. Source: The Journal of Nutrition. 2002 January; 132(1): 5-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11773500&dopt=Abstract

•

High density lipoprotein-cholesterol changes in children with high cholesterol levels at birth. Author(s): Bastida S, Sanchez-Muniz FJ, Cuena R, Perea S, Aragones A. Source: European Journal of Pediatrics. 2002 February; 161(2): 94-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11954759&dopt=Abstract

•

Quercetin dihydrate and gallate supplements lower plasma and hepatic lipids and change activities of hepatic antioxidant enzymes in high cholesterol-fed rats. Author(s): Bok SH, Park SY, Park YB, Lee MK, Jeon SM, Jeong TS, Choi MS. Source: Int J Vitam Nutr Res. 2002 May; 72(3): 161-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12098884&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

•

Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

Alternative Medicine 49

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMD®Health: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to high cholesterol; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Angina Source: Healthnotes, Inc.; www.healthnotes.com Angina Source: Integrative Medicine Communications; www.drkoop.com Atherosclerosis Source: Healthnotes, Inc.; www.healthnotes.com Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc.www.personalhealthzone.com Cardiovascular Disease Overview Source: Healthnotes, Inc.; www.healthnotes.com Depression Source: Integrative Medicine Communications; www.drkoop.com Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Gallstones Source: Healthnotes, Inc.; www.healthnotes.com Heart Attack Source: Healthnotes, Inc.; www.healthnotes.com Heart Attack Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com

50

High Cholesterol

High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hypertension Alternative names: High Blood Pressure Source: Prima Communications, Inc.www.personalhealthzone.com Hypothyroidism Source: Healthnotes, Inc.; www.healthnotes.com Insulin Resistance Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Intermittent Claudication Source: Healthnotes, Inc.; www.healthnotes.com Ménière's Disease Source: Healthnotes, Inc.; www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Myocardial Infarction Source: Integrative Medicine Communications; www.drkoop.com Obesity Source: Integrative Medicine Communications; www.drkoop.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com Stroke Source: Healthnotes, Inc.; www.healthnotes.com Transient Ischemic Attacks Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672,00.html Iridology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,709,00.html

Alternative Medicine 51

•

Herbs and Supplements Acidophilus and Other Probiotics Source: Prima Communications, Inc.www.personalhealthzone.com Angkak Source: Integrative Medicine Communications; www.drkoop.com Aortic Glycosaminoglycans Source: Prima Communications, Inc.www.personalhealthzone.com Beni-koji Source: Integrative Medicine Communications; www.drkoop.com Beta-sitosterol Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,972,00.html Bile Acid Sequestrants Source: Healthnotes, Inc.; www.healthnotes.com Brewer’s Yeast Source: Healthnotes, Inc.; www.healthnotes.com Carotenoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,763,00.html Chinese Scullcap Alternative names: Scutellaria baicalensis Source: Healthnotes, Inc.; www.healthnotes.com Coenzyme Q Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,768,00.html Coenzyme Q10 Source: Integrative Medicine Communications; www.drkoop.com Coq10 Source: Integrative Medicine Communications; www.drkoop.com Dehydroepiandrosterone (dhea) Source: Integrative Medicine Communications; www.drkoop.com Dhea Source: Integrative Medicine Communications; www.drkoop.com

52

High Cholesterol

Fenugreek Alternative names: Trigonella foenum-graecum Source: Healthnotes, Inc.; www.healthnotes.com Fiber Source: Healthnotes, Inc.; www.healthnotes.com Fiber Source: Integrative Medicine Communications; www.drkoop.com Fo-ti Alternative names: Polygonum multiflorum Source: Healthnotes, Inc.; www.healthnotes.com Gamma Oryzanol Source: Prima Communications, Inc.www.personalhealthzone.com Gemfibrozil Source: Healthnotes, Inc.; www.healthnotes.com Green Tea Alternative names: Camellia sinensis Source: Healthnotes, Inc.; www.healthnotes.com Guggul Alternative names: Commiphora mukul Source: Healthnotes, Inc.; www.healthnotes.com Guggul Source: Prima Communications, Inc.www.personalhealthzone.com Gugulipid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10033,00.html He Shou Wu Source: Prima Communications, Inc.www.personalhealthzone.com Hong Qu Source: Integrative Medicine Communications; www.drkoop.com Hung-chu Source: Integrative Medicine Communications; www.drkoop.com Isoflavones Source: Prima Communications, Inc.www.personalhealthzone.com Ispaghula Source: Integrative Medicine Communications; www.drkoop.com

Alternative Medicine 53

Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798,00.html Lecithin Source: Prima Communications, Inc.www.personalhealthzone.com Maitake Source: Prima Communications, Inc.www.personalhealthzone.com Milk Thistle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10044,00.html Monascus Source: Integrative Medicine Communications; www.drkoop.com Plantago Isphagula Source: Integrative Medicine Communications; www.drkoop.com Psyllium Alternative names: Plantago ovata, Plantago ispaghula Source: Healthnotes, Inc.; www.healthnotes.com Psyllium Alternative names: Ispaghula,Plantago isphagula Source: Integrative Medicine Communications; www.drkoop.com Psyllium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,814,00.html Red Koji Source: Integrative Medicine Communications; www.drkoop.com Red Leaven Source: Integrative Medicine Communications; www.drkoop.com Red Rice Source: Integrative Medicine Communications; www.drkoop.com Red Yeast Rice Alternative names: Monascus purpureus Source: Healthnotes, Inc.; www.healthnotes.com Red Yeast Rice Alternative names: Angkak, Beni-koju, Hong Qu, Hung-chu, Monascus, Red Leaven, Red Rice, Red Koji, Zhitai, Xue Zhi Kang Source: Integrative Medicine Communications; www.drkoop.com

54

High Cholesterol

Red Yeast Rice Source: Prima Communications, Inc.www.personalhealthzone.com Red Yeast Rice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10054,00.html Royal Jelly Source: Healthnotes, Inc.; www.healthnotes.com St. John's Wort Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824,00.html Terminalia Alternative names: Myrobalans; Terminalia arjuna Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Vanadate Source: Integrative Medicine Communications; www.drkoop.com Vanadyl Source: Integrative Medicine Communications; www.drkoop.com Zhitai Source: Integrative Medicine Communications; www.drkoop.com Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Zue Zhi Kang Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

55

CHAPTER 4. DISSERTATIONS ON HIGH CHOLESTEROL Overview In this chapter, we will give you a bibliography on recent dissertations relating to high cholesterol. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “high cholesterol” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on high cholesterol, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on High Cholesterol ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to high cholesterol. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

The Effects of High Cholesterol Diet on Some Structural and Functional Properties of Rat Myocardium by Moffat, Margaret P; PhD from The University of Manitoba (Canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK54557

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

57

CHAPTER 5. CLINICAL TRIALS AND HIGH CHOLESTEROL Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning high cholesterol.

Recent Trials on High Cholesterol The following is a list of recent trials dedicated to high cholesterol.5 Further information on a trial is available at the Web site indicated. •

Cardiovascular Evaluation of Patients with High Cholesterol and Normal Volunteers Condition(s): Atherosclerosis; Hypercholesterolemia Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: Homozygous familial hypercholesterolemia is a rare inherited disease of metabolism. It occurs in less than 1 in 1 million people within the United States. Patients with the disease are typically children and young adults who develop heart disease early in life. Children less than age 5 years with this disease have suffered heart attacks and death. The normal process that removes cholesterol particles from the blood stream does not work in patients with this disease. It causes cholesterol to buildup in the arteries and leads to hardening of the arteries (atherosclerosis). The goal of this study is to detect and measure atherosclerosis in these patients before it becomes permanent and potentially life threatening. Patients with this disease can participate in this study. Researchers plan to evaluate patients with homozygous familial hypercholesterolemia using new and standard methods for detecting atherosclerosis. Researchers plan to use information gathered during this study to develop new, promising treatments such as liver transplantation and gene therapy. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001204

5

These are listed at www.ClinicalTrials.gov.

58

High Cholesterol

•

Safety and Effectiveness of Flaxseed for Reducing High Cholesterol Condition(s): Hypercholesterolemia Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: Flaxseed, a rich source of fiber, may be a significant component of a cholesterol-reducing diet. The purpose of this study is to evaluate the safety and effectiveness of flaxseed in reducing high cholesterol. Phase(s): Phase II; Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00051415

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “high cholesterol” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

•

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

•

For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

•

For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

•

For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

•

For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

•

For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

•

For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

Clinical Trials 59

•

For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

•

For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

•

For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

•

For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

•

For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

•

For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

•

For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

61

CHAPTER 6. PATENTS ON HIGH CHOLESTEROL Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.6 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “high cholesterol” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on high cholesterol, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on High Cholesterol By performing a patent search focusing on high cholesterol, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 6Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

62

High Cholesterol

example of the type of information that you can expect to obtain from a patent search on high cholesterol: •

LPS-containing analgesics and veterinary analgesics Inventor(s): Mizuno; Den'Ichi (Okamoto-18, Kamakura City, Kanagawa, JP), Oshima; Haruyuki (Hachioji, JP), Soma; Gen-Ichiro (1-10-21, Higashi-Tamagawa, Setagaya Ward, Tokyo, JP), Tsukioka; Daisuke (Okamoto-18, Chiba, JP), Yoshimura; Kiyoshi (Okamoto18, Chiba, JP) Assignee(s): Mizuno; Den'Ichi (Kanagawa, JP), Soma; Gen-Ichiro (Tokyo, JP) Patent Number: 5,281,583 Date filed: August 22, 1991 Abstract: An analgesic composition comprising an effective amount of at least one member of LPS whose macrophage activation ED.sub.50 is 0.4-100 ng/ml of culture solution in terms of its limulus test-positive LPS content observed on a sigmoid curve prepared by determining the ability of the LPS to activate the TNF productivity of macrophage cultured in vitro, and plotting the macrophage activation ability (%) along the axis of ordinate wherein the ability is estimated to be 0% in the case where it corresponds to the quantity of TNF produced by macrophage with no LPS added thereto, and 100% is assigned to the macrophage activation ability which provides the maximal and constant quantity of TNF produced by the macrophage and plotting the limulus test-positive LPS content of the LPS along the axis of abscissa on a logarithmic scale, in admixture with a pharmaceutically or veterinarily acceptable carrier, such that when administered to an animal, high cholesterol level of said animal is prevented or cured; and a method of treating pain of an animal comprising administration to said animal an amount of the above composition effective to prevent or cure the pain of said animal. Excerpt(s): The present invention relates to novel analgesics, and novel veterinary analgesics. More particularly, it is concerned with novel analgesics and novel veterinary analgesics containing LPS. Analgesics are classified into two groups; narcotic and nonnarcotic ones. Web site: http://www.delphion.com/details?pn=US05281583__

•

Method for measuring human cholesterol absorption using metabolically stable isotopes Inventor(s): Bosner; Matthew S. (14330 Wainridge, Chesterfield, MO 63110), Lange, III; Louis G. (390 Escobar Rd., Portola Valley, CA 94028), Ostlund; Richard E. (39 Fair Oaks, Ladue, MO 63124) Assignee(s): none reported Patent Number: 5,432,058 Date filed: September 30, 1992 Abstract: This invention is a method for measuring the ability of a human to absorb cholesterol. The method uses two different cholesterol tracers, the first injected into the blood stream and the second ingested by the human subject. After a waiting period a blood sample is taken from the human subject and analyzed to determine percent cholesterol absorption based on the actual amounts of the two naturally occurring,

Patents 63

metabolically stable cholesterol tracers in the blood. The method of this invention is useful in identifying human subjects as high cholesterol absorbers and thereafter administering therapeutic agents to the subject that inhibit the absorption of cholesterol. Excerpt(s): This invention concerns a method for measuring the ability of a human to absorb cholesterol and the use of the method to treat high cholesterol absorbers. The method uses unique injected and ingested naturally occurring, metabolically stable cholesterol tracers and measures the relative amounts of both of the cholesterol tracers in the blood of a human subject after a waiting period. Dietary cholesterol restriction is an important part of therapy for many forms of hyperlipidemia as well as a general recommendation for the public. However, the relation between atherosclerosis and the diet needs further, investigation. Previous studies of dietary cholesterol absorption have focused on middle-aged men, often with hyperlipidemia or atherosclerosis, and have used radioactive methods. These data may not be applicable to other populations. In addition, the use of radioactivity generally precludes the study of women and children making a thorough analysis of the clinical genetics of cholesterol absorption impossible. The method of this invention is ideal for determining cholesterol absorption because it uses only plasma cholesterol measurements and avoids both the inconvenience and increased analytical variability associated with stool collection. Such a method was proposed by Zilversmit, but was based upon cholesterol labeled with tritium (administered intravenously) and carbon-14 (given orally). Isotopic ratio determination in plasma after 3 days of equilibration in the rapidly-miscible pool of body cholesterol provides an estimation of fractional absorption. During this time period, a negligible amount of cholesterol tracer is PG,3 excreted from the body. Such an isotope ratio method has been validated in man by comparison to other methods including those that involve oral administration of radiolabeled cholesterol and stool collection. Web site: http://www.delphion.com/details?pn=US05432058__ •

Oil and fat composition containing phytosterol Inventor(s): Goto; Naohiro (Ibaraki, JP), Nishide; Tsutomu (Ibaraki, JP), Tanaka; Yukitaka (Ibaraki, JP), Yasukawa; Takuji (Ibaraki, JP) Assignee(s): Kao Corporation (Tokyo, JP) Patent Number: 6,025,348 Date filed: April 30, 1998 Abstract: An oil/fat composition is provided which lowers the blood cholesterol level of a person having a high cholesterol level when used in daily life similarly to ordinary fats and is usable without posing any problem concerning appearance, flavor, heat cooking, etc. as compared with generally edible fats, wherein the oil/fat composition contains a phytosterol contained in an oil/fat containing one or more polyhydric alcohol/fatty acid esters each having a degree of esterification of 2 or higher and containing at least one hydroxyl group remaining unesterified. Excerpt(s): The present invention relates to an oil and fat composition which, when used in daily life similarly to ordinary fats, can lower the blood cholesterol level of a person having a high cholesterol level. It further relates to a food and a pharmaceutical preparation each containing the oil and fat composition. There are many drugs and food materials which lower the blood cholesterol level and are highly effective in prophylaxis and therapy. However, since these substances are used in the form of a medicine or auxiliary nutrient food, they should be ingested while paying attention to control of the

64

High Cholesterol

blood cholesterol level of the subject ingesting them. Among the components effective in lowering blood cholesterol are phytosterols. Phytosterols are contained in plant seeds in large amounts and are contained in ordinary edible vegetable oils in amounts of about 0.1 to 1.0% by weight. Many investigations have been made on the blood cholesterol lowering effect of phytosterols. It has been reported that the daily phytosterol ingestion necessary for significantly lowering the blood cholesterol level is 236 mg to 18 g per day (e.g., Ann. Nutr. Metab., 39, 291, 1995). Web site: http://www.delphion.com/details?pn=US06025348__ •

Panax notoginsenoside composition Inventor(s): Pu; De (Industry, CA), Zeng; Lipin (Industry, CA) Assignee(s): Farlong Pharmaceutical, Inc. (City of Industry, CA) Patent Number: 6,500,468 Date filed: January 3, 2002 Abstract: A panax notoginsenoside composition for patients having coronary heart disease, high blood pressure, high blood fat, and high cholesterol, consists of 41% by weight of panax notoginsenoside powder extracted from panax notoginseng (Burk.) F. H. chen ex C. Chow et al, 0.5% by weight of beeswax, 58.48% by weight of peanut oil, and 0.02% by weight of BHT. Excerpt(s): The present invention relates to panax notoginseng, and more particularly to a panax notoginsenoside composition consisting of panax notoginsenoside extracted from panax notoginseng. According to Chinese (herbal) medicine such as Compendium of Materia Medica, panax notoginsenoside extracted from panax notoginseng can help cerebral blood vessel dilatation, increase cerebral blood flow, reduce the oxygen consumption of organism, increase the orgainism's resistance to oxygen shortage, decrease cerebrovascular resistance, enhance immune function of organism, prevent shock caused by bleeding, and provide functions of resisting thrombus, blood coagulation, and atherosclerosis. The main object of the present invention is to provide a panax notoginsenoside compound for patients having coronary heart disease, high blood pressure, high blood fat, and high cholesterol, which consists of 41% by weight of panax notoginsenoside powder extracted from panax notoginseng (Burk.) F. H. chen ex C. Chow et al, 0.5% by weight of beeswax, 58.48% by weight of peanut oil, and 0.02% by weight of BHT (butylated hydroxytoluene). Web site: http://www.delphion.com/details?pn=US06500468__

•

Personalized hand held calorie computer (ECC) Inventor(s): Diaz; H. Benjamin (P. O. Box 294, Brea, CA 92622), Genera; M. Inez (P. O. Box 294, Brea, CA 92622) Assignee(s): none reported Patent Number: 5,890,128 Date filed: March 4, 1996 Abstract: A novel hand held individually customized interactive integrated circuit device for nutrition and exercise management. Featuring built in Random Access Memory (RAM) Storage of extensive food lists with associated caloric and fat contents.

Patents 65

The device also incorporates RAM storage of exercises with associated activity caloric values or rates. The basic unit utilizes the individual's personal characteristics such as sex, age, weight, height, frame size, life style and goals with programmed calculations to derive optimum suggested weight, metabolic rate, daily caloric/fat intake targets, exercise targets and exercise/daily calorie burning rates. The personalized hand held calorie computer tracks daily and historical individual caloric input/output, fat input, and weight which can be viewed in the form of charts and graphs. Alarms are provided in a variety of tones, sounds, and tunes which alert the individual to breach of prescribed optimum daily caloric/fat intake or signal special events such as times for medication, special eating intervals, and appointments. Additionally, it can be used with optional wireless activity sensing and odometer attachments already available in the market to automatically track/deduct burned calories from total daily caloric intake when walking, running, riding a bicycle, or performing other activities. The device is intended for use by individuals interested in increasing, decreasing or maintaining their body weight for personal or medical reasons. Optional medical programs take into consideration special dieting, medication and exercise requirements of patients with diabetes, high cholesterol, heart ailments, hypoglycemia and other diseases. Confidentiality is assured by use of a Personal Identification Number (PIN) which is selected and changed at will by the individual user. The device will be available in various languages. Other functions include a four function calculator and a clock/calendar. Excerpt(s): This invention relates generally to hand held computers and, more specifically, to a totally new way such a device with food and exercise listings in its memory is programmed to utilize personal characteristics and activity sensing devices to individually custom tailor physical and dietary parameters such as optimum weight, daily/exercise calorie burning rates, daily caloric/fat input targets, and caloric inputs/outputs in a comprehensive nutrition and exercise management system. More people everywhere are trying to gain control of their weight for personal and medical reasons. Medical science has made tremendous progress in the area of understanding human weight control and more importantly the health hazards brought on by not maintaining a diet which is more relevant to individual life styles and physical needs. Unfortunately, this wealth of new found knowledge has succeeded only in creating an information overload to the populace in general. Anyone desiring to control his/her weight has to find out his/her metabolic rate at rest, consult long lists of exercise caloric burning rates, calculate his/her caloric burning rates for each exercise using the listed data and his/her metabolic rate, consult cumbersome books listing calories and fat content of foods, document this data daily and manually track this data on an on going basis. Web site: http://www.delphion.com/details?pn=US05890128__ •

Reminder device for blood self-testing Inventor(s): Cota; Joseph A. (Apt #1, No. Andover, MA 01845) Assignee(s): none reported Patent Number: 6,024,723 Date filed: March 4, 1999 Abstract: A device is described for reminding a patient suffering from ailments such as diabetes and high cholesterol levels, who performs daily blood tests, of the site of the last blood extraction, in the case where blood is drawn from one or more sites of each

66

High Cholesterol

finger of the hands. The invention includes two disks, each having an inner face and an outer face, the inner face containing a representation of the opposite hand from the other. On each disk finger holes are punched in the vicinity of the fingers to represent the sites where blood is drawn. On the inner face of each disk is a red marker area which may be displayed under the finger hole on the opposite disk, corresponding to the last site where blood was drawn. When the user progresses from one hand to the other in his testing regime, the device is flipped over, and the outside face of the other disk is used to display the status of the site where blood has been drawn on a representation of the hand currently used. Excerpt(s): The present invention relates to medical reminder devices, and more specifically to reminders used in connection with the drawing of blood for self-testing by patients suffering from ailments such as diabetes and high cholesterol levels. Millions of people suffer from diabetes in the United States alone. Many of these patients are required to draw blood on a daily basis, and do test the blood themselves in order to assure the chemical balance of their systems, which is essential to their wellbeing. Drawing of the blood involves puncturing the skin in the region where blood will flow freely and profusely. The fingers of the hands are generally chosen as appropriate for the sites of blood extraction. Web site: http://www.delphion.com/details?pn=US06024723__

Patent Applications on High Cholesterol As of December 2000, U.S. patent applications are open to public viewing.7 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to high cholesterol: •

Genes and polymorphisms associated with cardiovascular disease and their use Inventor(s): Bansal, Aruna; (Landbeach, GB), Braun, Andreas; (San Diego, CA), Kleyn, Patrick W.; (Concord, MA) Correspondence: Heller Ehrman White & Mcauliffe Llp; 4250 Executive SQ; 7th Floor; LA Jolla; CA; 92037; US Patent Application Number: 20030036057 Date filed: March 9, 2001 Abstract: Genes and polymorphisms associated with cardiovascular disease, methods that use the polymorphism to detect a predisposition to developing high cholesterol, low HDL or cardiovascular disease, to profile the response of subjects to therapeutic drugs and to develop therapeutic drugs are provided. Excerpt(s): The field of the invention involves genes and polymorphisms of these genes that are associated with development of cardiovascular disease. Methods that use polymorphic markers for prognosticating, profiling drug response and drug discovery are provided. Diseases in all organisms have a genetic component, whether inherited or resulting from the body's response to environmental stresses, such as viruses and toxins. The ultimate goal of ongoing genomic research is to use this information to develop new ways to identify, treat and potentially cure these diseases. The first step has been to

7

This has been a common practice outside the United States prior to December 2000.

Patents 67

screen disease tissue and identify genomic changes at the level of individual samples. The identification of these "disease" markers has then fueled the development and commercialization of diagnostic tests that detect these errant genes or polymorphisms. With the increasing numbers of genetic markers, including single nucleotide polymorphisms (SNPs), microsatellites, tandem repeats, newly mapped introns and exons, the challenge to the medical and pharmaceutical communities is to identify genotypes which not only identify the disease but also follow the progression of the disease and are predictive of an organism's response to treatment. Polymorphisms have been known since 1901 with the identification of blood types. In the 1950's they were identified on the level of proteins using large population genetic studies. In the 1980's and 1990's many of the known protein polymorphisms were correlated with genetic loci on genomic DNA. For example, the gene dose of the apolipoprotein E type 4 allele was correlated with the risk of Alzheimer's disease in late onset families (see, e.g., Corder et al. (1993) Science 261: 921-923; mutation in blood coagulation factor V was associated with resistance to activated protein C (see, e.g., Bertina et al. (1994) Nature 369:64-67); resistance to HIV-1 infection has been shown in Caucasian individuals bearing mutant alleles of the CCR-5 chemokine receptor gene (see, e.g., Samson et al. (1996) Nature 382:722-725); and a hypermutable tract in antigen presenting cells (APC, such as macrophages), has been identified in familial colorectal cancer in individuals of Ashkenzi jewish background (see, e.g., Laken et al. (1997) Nature Genet. 17:79-83). There may be more than three million polymorphic sites in the human genome. Many have been identified, but not yet characterized or mapped or associated with a disease. Polymorphisms of the genome can lead to altered gene function, protein function or mRNA instability. To identify those polymorphisms that have clinical relevance is the goal of a world-wide scientific effort. Discovery of such polymorphisms will have a fundamental impact on the identification and development of diagnostics and drug discovery. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method of treating disorder related to high cholesterol concentration Inventor(s): Liao, Shutsung; (Chicago, IL), Song, Ching; (Chicago, IL) Correspondence: Y. Rocky Tsao; Fish & Richardson P.C.; 225 Franklin Street; Boston; MA; 02110-2804; US Patent Application Number: 20030139385 Date filed: November 8, 2002 Abstract: A method of treating a disorder related to a high cholesterol concentration, comprising administering to a subject in need thereof a compound of formula (I): 1Also disclosed are methods, kits, combinations, and compositions for treating a disorder in a subject where an activator of liver X alpha is indicated, such as in, for example, treating a high cholesterol disease. Excerpt(s): The present application claims priority to U.S. Provisional Application Serial No. 60/348,020 filed Nov. 8, 2001; the present application claims priority to U.S. Application Serial No. 10/137,695 filed May 2, 2002 which claims priority to U.S. Provisional Application Serial No. 60/288,643 filed May 3, 2001. The present invention relates to a pharmaceutical compositions comprising a liver X receptor agonist, to methods of treatment comprising administering such a pharmaceutical composition to a subject in need thereof, a method for the manufacture of such a composition, to the use of such a composition in treating disease, to combinations with such a composition with

68

High Cholesterol

other therapeutic agents, and to kits containing such a composition. It has been well known that a high cholesterol concentration is related to vascular disorders such as coronary heart disease or atherosclerosis. See, e.g., Essays of an Information Scientist, 1986, 9, 282-292; and "Cholesterol", Microsoft.RTM. Encarta.RTM. Encyclopedia 2000. It has also been found that some neurodegenerative diseases such as elevated senile cognitive impairment or dementia (e.g., Alzheimer's disease) can be attributed to an elevated concentration of cholesterol. See, e.g., Sparks, D. L. et al., Microsc. Res. Tech., 2000, 50, 287-290. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

METHODS FOR DECREASING BETA AMYLOID PROTEIN Inventor(s): NADEAU, PHILIP; (BOSTON, MA), YANKNER, BRUCE A.; (WEST NEWTON, MA) Correspondence: Patrea L Pabst; Holland & Knight Llp; One Atlantic Center Suite 2000; 1201 W Peachtree Street; Atlanta; GA; 30309-3400; US Patent Application Number: 20020081263 Date filed: January 28, 1999 Abstract: Blood cholesterol levels are correlated with production of amyloid.beta. protein (A.beta.), and are predictors of populations at risk of developing AD. Methods for lowering blood cholesterol levels can be used to decrease production of A.beta., thereby decreasing the risk of developing AD. The same methods and compositions can also be used for treating individuals diagnosed with AD. Methods include administration of compounds which increase uptake of cholesterol by the liver, such as the administration of HMG CoA reductase inhibitors, administration of compounds which block endogenous cholesterol production, such as administration of HMG CoA reductase inhibitors, administration of compositions which prevent uptake of dietary cholesterol, and administration of combinations of any of these which are effective to lower blood cholesterol levels. Methods have also been developed to predict populations at risk, based on the role of cholesterol in production of A.beta. For example, individuals with Apo E4 and high cholesterol, defined as a blood cholesterol level of greater than 200 mg/dl, post menopausal women with high cholesterol levels-especially those who are not taking estrogen, or individuals which high blood cholesterol levels who are not obese are all at risk of developing AD if blood cholesterol levels are not decreased. Excerpt(s): Alzheimer's disease (AD) is the most common cause of dementia in the aged population. The accumulation of large numbers of senile plaques containing the 40-42 amino acid amyloid.beta. protein (A.beta.) is a classic pathological feature of AD. Both genetic and cell biological findings suggest that the accumulation of A.beta. in the brain is the likely cause of AD (Yankner, B. A. (1996) Neuron 16, 921-932.; Selkoe, D. J. Science 275, 630-631 (1997)). Strong genetic evidence in support of the pathogenic role of A.beta. came from the observation that individuals who inherit mutations in the amyloid precursor protein almost invariably develop AD at an early age. These mutations increase the production of a long variant of the A.beta. peptide that forms senile plaques in the brain (Goate et al., (1991) Nature 349, 704-706). Mutations and allelic variations in other genes that cause AD, including the presenilins and apolipoprotein E, also result in increased production or deposition of the A.beta. peptide. Reiman, et al. (1996) N. E. J. Med. 334, 752-758, reported that in middle age, early to mid 50's, individuals who are homozygous for the Apo E4 gene have reduced glucose metabolism in the same regions

Patents 69

of the brain as in patients with Alzheimer's disease. These findings suggest that the pathological changes in the brain associated with this gene start early. Furthermore, individuals with Down's syndrome overexpress the amyloid precursor protein, develop A.beta. deposits in the brain at an early age, and develop Alzheimer's disease at an early age. Finally, the A.beta. protein has been demonstrated to be highly toxic to nerve cells. Thus it is widely believed that drugs which decrease the levels of A.beta. in the brain would prevent Alzheimer's disease. The known genetic causes of AD can account for only a small proportion of the total number of cases of AD. Most cases of AD are sporadic and occur in the aged population. A major goal of research is the identification of environmental factors that predispose to AD that would be amenable to therapeutic measures. It is therefore an object of the present invention to provide methods for predicting populations at risk of developing AD. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Substance for lowering high cholesterol level in serum and methods for preparing and using the same Inventor(s): Miettenen, Tatu; (Espoo, FI), Vanhanen, Hannu; (Helsinki, FI), Wester, Ingmar; (Raisio, FI) Correspondence: Arent Fox Kintner Plotkin & Kahn; 1050 Connecticut Avenue, N.W.; Suite 400; Washington; DC; 20036; US Patent Application Number: 20030134833 Date filed: November 7, 2002 Abstract: The invention relates to a substance which lowers LDL cholesterol levels in serum and which is fat soluble.beta.-sitostanol fatty acid ester, and to a method for preparing and using the same. The substance can be taken orally as a food additive, food substitute or supplement. A daily consumption of the.beta.-sitostanol ester in an amount between about 0.2 and about 20 g/day has been shown to reduce the absorption of biliary and endogenic cholesterol. Excerpt(s): This application is a continuation-in-part of U.S. Ser. No. 08/508,623, filed Jul. 28, 1995, which is a continuation-in-part of U.S. Ser. No. 08/140,085, filed Nov. 22, 1993, now U.S. Pat. No. 5,502,045, which claims priority on WO92/19640, filed Nov. 12, 1992, which claims priority on Finnish Patent application No. PCT/F191/00139 filed May 3, 1991. A high cholesterol level in serum can be lowered effectively by altering the intestinal metabolism of lipids. In this case the aim may be to hamper the absorption of triglycerides, cholesterol or bile acids. It has been observed in a number of investigations that certain plant sterols, such as.beta.-sitosterol (24-ethyl-5.alpha.-cholestane-3.beta.-ol) and its hardened form,.beta.-sitostanol (24-ethyl-5.alpha.-cholestane- -3.beta.-ol), lower serum cholesterol levels by reducing the absorption of dietary cholesterol from the intestines (1-25). The use of plant sterols can be considered safe, since plant sterols are natural components of vegetable fats and oils. Plant sterols themselves are not absorbed from the intestines, or they are absorbed in very low concentrations. A decreased incidence of coronary disease is clearly associated with a decrease in serum cholesterol, in particular LDL cholesterol. A high serum cholesterol value is the most significant single indicator of the risk of coronary disease. The degree of cholesterol absorption depends on a hereditary property, apoprotein E-phenotype. Apoprotein E is a protein which belongs to serum lipoproteins and takes part in the transport of cholesterol in the system (26). Of alleles associated with the synthesis of apoprotein E, i.e. the lipoprotein which affects absorption, there are known three types, e2, e3, and e4,

70

High Cholesterol

which combine in pairs at random. Alleles are capable of forming in total six different combinations. The higher the sum of the subindices, the better absorbable the cholesterol and the higher the level of cholesterol, in particular bad LDL cholesterol, in the serum (27). e4 allele is over represented among the hereditary factors of Finns, so that its proportion is almost double as compared with many European populations (28). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with high cholesterol, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “high cholesterol” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on high cholesterol. You can also use this procedure to view pending patent applications concerning high cholesterol. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

71

CHAPTER 7. BOOKS ON HIGH CHOLESTEROL Overview This chapter provides bibliographic book references relating to high cholesterol. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on high cholesterol include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “high cholesterol” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on high cholesterol: •

Mayo Clinic on High Blood Pressure Source: New York, NY: Kensington Publishing. 1999. 180 p. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. PRICE: $14.95 plus shipping and handling. ISBN: 1893005011. Summary: This book focuses on what people who have high blood pressure can do to better manage their blood pressure and keep it at a safe level. The book begins with a chapter that explains the basics of blood pressure, how high blood pressure develops, and why it can be harmful. This is followed by a chapter that identifies unmodifiable and modifiable risk factors for high blood pressure. Unmodifiable risk factors include race, age, family history, and gender. Modifiable risk factors include obesity, inactivity, tobacco use, sodium sensitivity, low potassium, excessive alcohol consumption, stress,

72

High Cholesterol

chronic illness, high cholesterol, diabetes, sleep apnea, and heart failure. Other topics addressed in this chapter include secondary high blood pressure and ways of preventing high blood pressure. The third chapter focuses on the diagnosis and treatment of high blood pressure. Topics include measuring blood pressure, receiving a diagnosis, getting a medical evaluation, and deciding on treatment with either medication or lifestyle changes. Subsequent chapters discuss determining a healthy weight, losing weight, becoming more physically active, and eating well using the Dietary Approaches to Stop Hypertension (DASH) plan. The following chapters detail the effects of sodium, tobacco, alcohol, caffeine, and stress on blood pressure. Another chapter focuses on the mode of action and side effects of various medications used in controlling high blood pressure, including diuretics, beta blockers, angiotensinconverting enzyme inhibitors, angiotensin II receptor blockers, calcium antagonists, alpha blockers, central acting agents, and direct vasodilators. Remaining chapters examine factors unique to women, management of high blood pressure among specific populations and groups, treatment of difficult-to-control high blood pressure, management of a hypertensive emergency, and home monitoring of blood pressure. The book also includes a week of menus based on the recommendations of the DASH eating plan. 17 figures. 2 tables. •

Women's concise guide to a healthier heart Source: Cambridge, MA: Harvard University Press. 1997. 136 pp. Contact: Available from Harvard University Press, 79 Garden Street, Cambridge, MA 02138. Telephone: (800) 448-2242 or (617) 495-2600 / fax: (800) 962-4983. $12.95. Summary: This book for the general public focuses on recognizing and preventing heart diseases in women. It is divided into three parts. Part one defines the most common heart diseases such as angina pectoris, arrhythmia, coronary artery disease, heart failure, and heart valve disorders. The second part elaborates on other conditions that impact the heart's function. Topics include diabetes, high blood pressure, high cholesterol, obesity, and stroke. Part three discusses various ways of preventing or controlling heart disease, such as alcohol use, diet, estrogen replacement therapy, exercise, quitting smoking, stress reduction, and weight control. The book concludes with a resource listing and an index.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “high cholesterol” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “high cholesterol” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “high cholesterol” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Atherosclerosis Prevention: Identification and Treatment of the Child With High Cholesterol (Monographs in Clinical Pediatrics, Vol 4) by Marc S. Jacobson (Editor)

Books

73

(1991); ISBN: 3718651211; http://www.amazon.com/exec/obidos/ASIN/3718651211/icongroupinterna •

Bible Cure for High Cholesterol by Don Colbert (2004); ISBN: 1591852412; http://www.amazon.com/exec/obidos/ASIN/1591852412/icongroupinterna

•

Heart Disease and High Cholesterol: Beating the Odds (Reducing Your Hereditary Risk) by C. Richard Conti, et al; ISBN: 0201577828; http://www.amazon.com/exec/obidos/ASIN/0201577828/icongroupinterna

•

High Cholesterol (How to Cope Successfully With.) by Tom Smith; ISBN: 1903784093; http://www.amazon.com/exec/obidos/ASIN/1903784093/icongroupinterna

•

High Cholesterol (Pocket Doc Library Patient Guide) by Jack D., Md. McCue, et al; ISBN: 1888886064; http://www.amazon.com/exec/obidos/ASIN/1888886064/icongroupinterna

•

High Cholesterol: What You Should Know by Douglas L. Wetherill, et al; ISBN: 0632045337; http://www.amazon.com/exec/obidos/ASIN/0632045337/icongroupinterna

•

Natural Medicine for Heart Disease: The Best Alternative Methods for Prevention and Treatment: High Cholesterol, High Blood Pressure, Stroke, Chest Pain, Other Circulatory Problems by Glenn S., Md Rothfeld, et al; ISBN: 0875962890; http://www.amazon.com/exec/obidos/ASIN/0875962890/icongroupinterna

•

Natural Treatments for High Cholesterol by Darin Ingels; ISBN: 0761524673; http://www.amazon.com/exec/obidos/ASIN/0761524673/icongroupinterna

•

Nature's Medicines : From Asthma to Weight Gain, from Colds to High Cholesterol -The Most Powerful All-Natural Cures by Gale Maleskey, et al (1999); ISBN: 1579540287; http://www.amazon.com/exec/obidos/ASIN/1579540287/icongroupinterna

•

Outsmart High Cholesterol by The Editors of Prevention Health Books (Author); ISBN: 0312988109; http://www.amazon.com/exec/obidos/ASIN/0312988109/icongroupinterna

•

Secrets to a Healthy Heart and Low Cholesterol: Proven Guidelines and Documented Facts for the Natural Self-Treatment and Prevention of Heart Disease, High Cholesterol, and Other Related Ailments in by William Fischer; ISBN: 0915421135; http://www.amazon.com/exec/obidos/ASIN/0915421135/icongroupinterna

•

The No-Cholesterol No Kidding Cookbook: The Medically Proven Kitchen Cure for High Cholesterol by Mary Harrison Carroll, Hal Straus (Contributor) (1991); ISBN: 0878579761; http://www.amazon.com/exec/obidos/ASIN/0878579761/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “high cholesterol” (or synonyms) into the search box, and select “books

74

High Cholesterol

only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:8 •

Paving the way for the cost-effective reduction of high cholesterol: achieving goals for Australia's health in 2000 and beyond Author: Antioch, Kathryn M.; Year: 1996; Canberra, ACT: National Centre for Epidemiology and Population Health, [1996?]; ISBN: 0731524241

Chapters on High Cholesterol In order to find chapters that specifically relate to high cholesterol, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and high cholesterol using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “high cholesterol” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on high cholesterol: •

Systemic Effects of Periodontal Diseases Source: in Wilson, T.G., Jr.; Kornman, K.S. Fundamentals of Periodontics. 2nd ed. Chicago, IL: Quintessence Publishing Co., Inc. 2003. p. 228-237. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail: [email protected]. Website: www.quintpub.com. PRICE: $82.00 plus shipping and handling. ISBN: 0867154055. Summary: A healthy mouth is part of a healthy lifestyle and recent evidence suggests that poor oral health may be as detrimental to general health as other risk factors, such as smoking or high cholesterol levels. Although the beneficial systemic effects of oral therapy have not been demonstrated, the oral benefits clearly have a positive impact on the quality of life. This chapter on the systemic effects of periodontal diseases is from a periodontics textbook that focuses on diagnosis and clinical management. The authors discuss which systemic diseases are linked with periodontal disease, who is most at risk, how oral infection can affect overall health, the entry of periodontal pathogens into the bloodstream, systemic inflammation caused by periodontal pathogens, the evidence linking periodontal disease to heart disease, periodontal infection during pregnancy, the relationship among periodontitis, pneumonia and osteoporosis, the risks associated with periodontal disease in people with diabetes, animal models, and the potential impact on dentistry. The authors note that the recognition of the medical necessity for periodontal care will increase the perceived importance of dental services, and the demand for dental services will increase. 88 references.

8

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

Books

•

75

Possible Causes Source: in Haybach, P.J. Meniere's Disease: What You Need to Know. Portland, OR: Vestibular Disorders Association. 1998. p. 53-60. Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $24.95 plus shipping and handling. ISBN: 0963261118. Summary: The cause of Meniere's disease is unknown, however many theories have been proposed to explain the symptoms of Meniere's or the factors that may aggravate those symptoms. This chapter is from a book that provides information for people who have or suspect they have Meniere's disease want to know more about its diagnosis and treatment, as well as strategies for coping with its effects. Written in nontechnical language, this chapter discusses the possible causes of Meniere's disease. Listed in alphabetical order, they include: abnormal circulation, adrenal-pituitary insufficiency, allergy, autoimmune disease, autonomic nervous system malfunction, bacterial infection, blockage of endolymph, estrogen insufficiency, head injury, heredity, hormonal imbalance, malformed or small endolymphatic sac, malfunction in the use of foods by the body (high cholesterol, triglycerides, or lipids), meningitis, menstrual or premenstrual problems, noise pollution (noise trauma or acoustic trauma), otosclerosis, stress, and viral infection. The author discusses the most widely accepted theories of the causes of Meniere's disease and then briefly considers specific conditions that are known or thought to sometimes cause symptoms like those of Meniere's disease. 24 references.

•

Medications Used To Treat Complications of Diabetes Source: in Carlisle, B.A.; Kroon, L.A.; Koda-Kimble, M.A. 101 Medication Tips for People with Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 66-75. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400329. Order number 483301. Summary: This chapter answers questions about the meditations used to treat diabetes complications, including nonprescription analgesics, tricyclic antidepressants, capsaicin cream, angiotensin converting enzyme (ACE) inhibitors, laxatives, and calcium channel blockers. Nonprescription analgesics, antidepressants, and narcotic analgesics can be used to treat the pain associated with diabetic neuropathy. Capsaicin cream, a chemical found in hot chili peppers, can be applied to the feet to relieve pain. ACE inhibitors can be used to treat microalbuminuria, an early sign of kidney damage. The symptoms of gastroparesis, a condition that affects the nerves of the stomach, can be treated with metoclopramide, cisapride, and erythromycin. These medications increase the stomach's ability to contract and aid in digestion. Constipation can be treated by increasing the amount of fluid and fiber in a person's diet. Laxatives may also be useful in treating constipation. Men who have diabetes and experience impotence can use the medications alprostadil and sildenafil to maintain an erection. People who have diabetes and high blood pressure can be treated with ACE inhibitors, diuretics, and calcium channel blockers. Angiotensin receptor II antagonists and calcium channel blockers can be used to treat kidney disease. People who have diabetes should take any medications their doctor prescribes for other conditions, such as high blood pressure, heart disease, high cholesterol or triglycerides, obesity, and insulin resistance.

76

High Cholesterol

•

Solving Circulation Problems Source: in Touchette, N. Diabetes Problem Solver. Alexandria, VA: American Diabetes Association. 1999. p. 161-195. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $19.95 for members; plus shipping and handling. ISBN: 1570400091. Summary: This chapter deals with solving circulation problems in people who have diabetes. High levels of sugar in the blood makes the blood thick and sticky, so it cannot flow well. Therefore, chronically high levels of blood glucose can increase the risk of cardiovascular disease and other complications of diabetes. Coronary artery disease can develop in a person whose heart does not get the blood it needs. Angina is a form of coronary artery disease in which a person experiences chest pain. Although the condition is not life-threatening, it does indicate a reduced flow of blood to the heart and should not be ignored. A heart attack occurs when the flow of blood to the heart is interrupted abruptly. The chapter presents information on the symptoms, diagnosis, and pharmacological and surgical treatment of angina and discusses the symptoms, treatment, and prevention of a heart attack. Another cardiovascular problem people who have diabetes may experience is congestive heart failure. This condition results when the heart cannot pump out enough blood to get to the parts of the body that need it. The chapter discusses this condition in terms of recognizing, handling, treating, and preventing it. Cholesterol abnormalities may also increase the risk of developing coronary artery disease. Risk factors that contribute to high cholesterol levels include heredity, age, gender, diet, weight, physical activity level, and alcohol consumption. The chapter explains how a person can determine whether his or her cholesterol level is too high and discusses the use of diet, exercise, weight loss, cholesterol-lowering medication, and hormone replacement therapy to treat high cholesterol. In addition, the chapter provides the reader with information on risk factors, symptoms, treatment, and prevention of stroke, hypertension, and peripheral vascular disease.

•

Tinnitus: For Whom the Bell Tolls-and Tolls, and Tolls Source: in Rosenfeld, I. Live Now, Age Later: Proven Ways to Slow Down the Clock. New York, NY: Warner Books. 1999. p. 311-321. Contact: Available from Warner Books. 1271 Avenue of the Americas, New York, NY 10020. (800) 759-0190. E-mail: [email protected]. Website: www.twbookmark.com. PRICE: $7.99 plus shipping and handling. Summary: This chapter on tinnitus is from a book that offers practical strategies and healthy living advice for people who want to slow down their own aging process. The book is written in casual language with an emphasis on explaining medical and health issues for the general public. The chapter first defines tinnitus (ringing or other sounds in the ears) and describes how it can occur. The author describes two types of tinnitus, objective tinnitus (someone else can hear the sounds) and subjective tinnitus (only the patient can hear the sounds). Causes of tinnitus can include wax in the ear canal, high blood pressure, prolonged bouts of high blood glucose (sugar), arthritis, neurological processes, emotional stress, drug therapy, food allergies, alcohol use, marijuana, caffeine, nicotine, Meniere's disease, otosclerosis (a bone disease), repeated exposure to loud noise, hypothyroidism (underfunction of the thyroid gland), infections, tooth grinder, and high cholesterol. The author also reviews the treatment options for the

Books

77

tinnitus of aging. The chapter concludes with a brief summary of the points covered, focusing on the ways to reduce the negative impact of tinnitus. •

Treating Nutritional and Metabolic Disorders Source: in Daly, S., ed. Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corporation. 1996. p. 193-234. Contact: Available from Springhouse Publishing. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477. (800) 331-3170 or (215) 646-4670 or (215) 646-4671. Fax (215) 6468716. PRICE: $24.95. ISBN: 0874348218. Summary: This chapter on treating nutritional and metabolic disorders is from a consumer reference book on medical treatments. Treatments include drugs for high cholesterol; vitamin and mineral supplementation; diets, including calorie-modified, fiber-modified, protein-modified, low-cholesterol, low-fat, low-salt, gluten-free, lowpurine, low-phenylalanine, and lactose-reduced; and other treatments including tube feedings, nutritional through an intravenous line, replenishing fluids with intravenous solutions, and surgical treatments of obesity. For each treatment, the text answers these questions: Why is this treatment done? When shouldn't this treatment be done? What happens before, during, and after the treatment? What are the side effects or complications of this treatment?

•

What You Need to Know About Diabetic Nephropathy Source: in Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 87-100. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400612. Summary: This chapter provides information on diabetic nephropathy. In this complication of diabetes, the blood vessels that carry blood and toxins to the kidneys become blocked and leaky, causing some toxins to remain in the blood. Factors that contribute to the risk of developing diabetic nephropathy include time since developing diabetes, poor blood glucose control, genetic factors, high blood pressure, smoking, and high cholesterol levels. The chapter explains how diabetic nephropathy develops in people who have type 1 and type 2 diabetes and discusses the prevention and treatment of this complication. Controlling both blood glucose levels and blood pressure levels can help prevent kidney damage. The development of diabetic nephropathy can be slowed with the use of a group of blood pressure medications called angiotensin converting enzyme (ACE) inhibitors, even when blood pressure is normal. ACE inhibitors appear to lower microalbuminuria and keep the kidneys working. Common side effects of ACE inhibitors are a cough and an increase in potassium level in the blood. Other steps people can take to prevent or slow the progression of kidney disease include treating urinary tract infections quickly, avoiding drugs that could harm kidney function such as ibuprofen and naproxen, undergoing diagnostic tests that do not require the use of contrast agents, and treating a neurogenic bladder. Adults with type 2 diabetes and young people past puberty who have had diabetes for 5 years should be screened for nephropathy on a yearly basis. The chapter includes a list of questions a patient may ask a doctor and questions a doctor may ask a patient. 1 figure. 1 table.

78

High Cholesterol

•

Blood Fats Source: in American Diabetes Association. Diabetes A to Z: What You Need to Know About Diabetes, Simply Put. 4th ed. Alexandria, VA: American Diabetes Association. 2000. p. 6-8. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $12.95 for members; $14.95 for nonmembers; plus shipping and handling. ISBN: 1580400353. Summary: This chapter provides people who have diabetes with information on blood fats. People with diabetes often have high blood fat levels. This increases their risk for cardiovascular problems. Fats in the body include cholesterol and triglycerides. They are carried by lipoproteins, including very low density lipoproteins, low density lipoproteins, and high density lipoproteins. The chapter presents the healthiest blood fat levels and suggests ways to improve blood fat levels if they exceed healthy levels. Tips include controlling one's diabetes, losing weight, cutting back on all fats, replacing saturated fats with unsaturated fats, eating fewer high cholesterol foods and more high fiber foods, exercising, and quitting smoking.

79

CHAPTER 8. MULTIMEDIA ON HIGH CHOLESTEROL Overview In this chapter, we show you how to keep current on multimedia sources of information on high cholesterol. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on high cholesterol is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “high cholesterol” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “high cholesterol” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on high cholesterol: •

Living with Diabetes: Making the Diagnosis Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1999. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 071899A. Summary: This videotape, part of a series on living with diabetes, focuses on the diagnosis of diabetes. A moderator discusses the new criteria for the diagnosis and classification of diabetes, the rise in the incidence of diabetes, the symptoms of diabetes, and the prevention of diabetes with an endocrinologist. The videotape begins with a discussion of what diabetes is, how insulin works, the types of diabetes, and risk factors for diabetes. Type 1 diabetes, which was formerly known as insulin dependent diabetes, usually develops quickly, whereas type 2 diabetes, which was formerly known as

80

High Cholesterol

noninsulin dependent diabetes, usually has a gradual onset. The symptoms of diabetes, which are generally the same regardless of the type, are related to high blood sugar. They include excessive urination and thirst, fatigue, hunger, weight loss, and blurred vision. Risk factors for type 1 diabetes include a genetic predisposition for developing the disease. Risk factors for type 2 diabetes include being overweight, sedentary, and over 45 years old; having a history of stillbirth or gestational diabetes; having high blood pressure and high cholesterol; being African American, Hispanic, or Native American; and having previously been identified with impaired glucose tolerance. The acute complications of diabetes include ketoacidosis, nonketotic hyperosmolar syndrome, and hypoglycemia. The chronic complications are divided into microvascular and macrovascular complications. Microvascular complications include retinopathy, neuropathy, and nephropathy. Macrovascular complications include heart attack, stroke, and peripheral vascular disease. Early diagnosis is important in preventing complications. Diagnosis is based on blood sugar levels obtained from a blood glucose test, a fasting plasma glucose test, or an oral glucose tolerance test. The risk of developing type 2 diabetes may be reduced by eating properly, maintaining an ideal weight, and exercising. The videotape includes a self test that viewers can take to assess their risk of developing type 2 diabetes.

Bibliography: Multimedia on High Cholesterol The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in high cholesterol (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on high cholesterol: •

Dietary and drug treatment for high cholesterol [videorecording] Source: [presented by] Marshfield Video Network, in cooperation with Marshfield Clinic, St. Joseph's Hospital, and Marshfield Medical Research Foundation; Year: 1988; Format: Videorecording; Marshfield, WI: The Network, [1988]

•

High cholesterol [videorecording]: an introduction to treatment Source: [presented by] Milner-Fenwick; Year: 2002; Format: Videorecording; Timonium, MD: Milner-Fenwick, c2002

•

Rational[e] for diagnosing and treating high cholesterol [videorecording] Source: [presented by] Marshfield Video Network, in cooperation with Marshfield Clinic, St. Joseph's Hospital and Marshfield Medical Research Foundation; Year: 1988; Format: videorecording; Marshfield, WI: The Network, [1988]

81

CHAPTER 9. PERIODICALS CHOLESTEROL

AND

NEWS

ON

HIGH

Overview In this chapter, we suggest a number of news sources and present various periodicals that cover high cholesterol.

News Services and Press Releases One of the simplest ways of tracking press releases on high cholesterol is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “high cholesterol” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to high cholesterol. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “high cholesterol” (or synonyms). The following was recently listed in this archive for high cholesterol: •

High cholesterol may weaken bones: study Source: Reuters Health eLine Date: November 03, 2003

82

High Cholesterol

•

Vitamins reduce inherited high cholesterol effects Source: Reuters Health eLine Date: August 11, 2003

•

Special diet as good as drugs for high cholesterol Source: Reuters Health eLine Date: July 22, 2003

•

High cholesterol may affect kidneys, too Source: Reuters Health eLine Date: July 21, 2003

•

High cholesterol linked with risk of kidney problems in healthy men Source: Reuters Medical News Date: July 21, 2003

•

Hollis-Eden to commence phase II testing of experimental high cholesterol therapy Source: Reuters Industry Breifing Date: August 05, 2002 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “high cholesterol” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or

Periodicals and News

83

you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “high cholesterol” (or synonyms). If you know the name of a company that is relevant to high cholesterol, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “high cholesterol” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “high cholesterol” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on high cholesterol: •

Exploding the Myth: Weight Loss Makes You Healthier Source: Healthy Weight Journal. 13(1):4-6. January/February, 1999. Contact: Healthy Living Institute, 402 S. 14th St., Hettinger, ND 58639. (701) 567-2645. Summary: Ernsberger says that since weight loss is so difficult and the effects transitory, obese individuals should instead strive for a healthier lifestyle. By reducing the intake of saturated fats, exercising more, and consuming more fruits and vegetables, individuals may not lose as much weight, according to Ernsberger. However, he says, they will have lower cholesterol and blood sugar levels, as well as lower blood pressure. According to Ernsberger, since this is so, physicians should focus on a lower-fat diet, exercise and medication as treatments for high blood pressure, diabetes and high cholesterol. He says improvements in these conditions brought about by weight loss are temporary, and that weight loss attempts can actually be harmful by preventing the patient from pursuing other treatments.

•

Excess Weight Found to Increase Stroke Risk Source: Tufts University Health and Diet Letter. 20(12):2. February 2003. Contact: P.O. Box 420235, Palm Coast, FL 32142-0235. 800/274-7581. www.healthletter.tufts.edu. Summary: Research from Brigham and Women's Hospital indicates that excess weight increases the risk for having a stroke. Researchers tracked 21,414 male doctors participating in the Physicians' Health Study, 747 of whom suffered a stroke over a 12.5 year period. The men's risk for stroke rose with an increased body mass index (BMI) even after accounting for stroke risk factors such as high blood pressure, diabetes, and

84

High Cholesterol

high cholesterol. Risk rose six percent with every one-unit increase in BMI, a weight gain of about 6 or 7 pounds. Men with a BMI of 30 or higher-considered obese-were twice as likely to have a stroke as men with a BMI under 23. •

Beyond the ABCs of Nutrition Source: Prevention Report. p.1-2,11. December 1992/January 1993. Summary: This newsletter article discusses the introduction of a nutrition education curriculum into the elementary school classroom. Early evidence shows that these new approaches are beginning to have an impact, and that the children of the 1990s will have a solid nutrition knowledge base. However, an alarming number of children, ages 3 through 17, are overweight, have high cholesterol, and high blood pressure. The article discusses studies that are examining the incidence and prevalence of obesity in children, including the National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study. Expanding nutrition education in the schools is a Healthy People 2000 objective. Nutrition education received a boost with the release of the Food Guide Pyramid; food industry and commodity groups have adopted the Pyramid to help explain good nutrition to children. The article briefly reviews other measures being implemented to enhance nutrition and nutrition education of young children.

•

Health Information Exchange Source: Beacon. 4-5. Summer 1996. Contact: Available from Scleroderma Foundation. 12 Kent Way, Suite 101, Byfield, MA 01922. (800) 722-4673 or (978) 463-5843. Fax (978) 463-5809. E-mail: [email protected]. Website: www.scleroderma.org. Summary: This newsletter article for individuals with scleroderma answers questions about various aspects of the disease. Topics addressed include the use of cytoxan therapy for treating scleroderma, the dosage and mode of administration of cytoxan, the long-term effects of cytoxan, the exchange of information about patients among physicians, the relationship between high cholesterol and scleroderma, the cause of darkening of the skin, and the prevention of blisters of the tops of feet. Remaining questions concern the relationship between endometrial thickening and systemic sclerosis, treatment for severe malabsorption, the presence of Factor 8 inhibitors in scleroderma, and localized scleroderma becoming systemic sclerosis.

•

Can Celiacs Eat Cheese?: A Resounding Yes! If the Cheese is Real, Maybe Not if It's 'Processed' Source: Gluten-Free Living. 5(6): 1, 13. November-December 2000. Contact: Available from Gluten-Free Living. P.O. Box 105, Hastings-On-Hudson, NY 10706. (914) 969-2018. E-mail: [email protected]. Website: www.celiac.com. Summary: This newsletter article for people following a gluten free diet (to treat celiac disease or dermatitis herpetiformis, for example) explains how to incorporate cheese into one's diet. The author stresses that, with the exception of French Roquefort, 'real' cheese is a top quality food that people with celiac disease can enjoy to the fullest, though perhaps not if they are overweight, severely lactose intolerant, or have high cholesterol. The author briefly reviews the categories of cheese (fresh, soft fermented, and hard fermented), emphasizing the benefits of buying quality cheeses. The author explains why Roquefort may be off limits; it is made from sheep's milk and aged with mold spores that form on specially baked loaves of rye bread. The cheese therefore

Periodicals and News

85

contains gliadins, albeit in tiny amounts and perhaps rendered harmless by the mold spores themselves. The article concludes with a discussion of 'processed' cheese, which is usually made from a combination of natural cheese, vegetable based gums, dyes, emulsifiers, and stabilizers, any of which may contain gluten. One sidebar offers a recipe for goat cheese dip, the availability of a kit to make mozzarella, and summaries of two books about cheese. •

Gout: How To Control an Ancient Disease Source: Mayo Clinic Women's HealthSource. 4(6): 6. June 2000. Contact: Available from Mayo Clinic Women's HealthSource, 200 First Street SW, Rochester, MN 55905. (800) 876-8633 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article provides people who have gout with information on controlling this disease. Gout, or gouty arthritis, has been recognized for more than 2,000 years. It is caused by too much uric acid. People who have gout either produce too much uric acid or excrete too little. Uric acid is typically dissolved in the blood and passed through the kidneys into the urine. When excess uric acid builds up, sharp crystals can form and deposit in a joint and surrounding tissue. This causes pain, inflammation, and swelling. Other factors that contribute to gout include foods high in purines, alcohol consumption, obesity, high cholesterol, diabetes, and medications. Diagnosis involves undergoing a blood uric acid test and having fluid drawn from the affected joint to look for crystals. An acute attack can be treated with nonsteroidal antiinflammatory drugs. Preventive treatment involves a regimen of medications such as allopurinol. Lifestyle changes such as weight loss, dietary changes, and abstinence from alcohol can also help. 1 figure.

Academic Periodicals covering High Cholesterol Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to high cholesterol. In addition to these sources, you can search for articles covering high cholesterol that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

87

CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for high cholesterol. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with high cholesterol. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

88

High Cholesterol

The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to high cholesterol: Cholestyramine •

Oral - U.S. Brands: Questran http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202137.html

Clofibrate •

Systemic - U.S. Brands: Abitrate; Atromid-S http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202150.html

Colesevelam •

Oral-Local - U.S. Brands: Welchol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500157.html

Colestipol •

Oral - U.S. Brands: Colestid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202161.html

Hmg-Coa Reductase Inhibitors •

Systemic - U.S. Brands: Baycol; Lescol; Lipitor; Mevacor; Pravachol; Zocor http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202284.html

Laxatives •

Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202319.html

Niacin for High Cholesterol •

Systemic - U.S. Brands: Endur-Acin; Nia-Bid; Niac; Niacels; Niacor; Nico-400; Nicolar; Slo-Niacin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202404.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

Researching Medications

89

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

91

APPENDICES

93

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

94

High Cholesterol

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

95

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

96

High Cholesterol

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “high cholesterol” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 34959 161 859 124 16 36119

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “high cholesterol” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

13

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources

97

Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

17 Adapted 18

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

99

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on high cholesterol can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to high cholesterol. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to high cholesterol. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “high cholesterol”:

100 High Cholesterol

•

Other guides Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to high cholesterol. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Patient Resources

101

Associations and High Cholesterol The following is a list of associations that provide information on and resources relating to high cholesterol: •

Inherited High Cholesterol Foundation Telephone: (801) 581-8720 Toll-free: (888) 244-2465 TTY: Fax: (801) 581-5402 Background: The Inherited High Cholesterol Foundation (IHCF) is a not-for-profit organization dedicated to promoting the early diagnosis and treatment of inherited cholesterol disorders by assisting in the identification of family members who may be predisposed to such disorders. Established in 1995 and currently consisting of approximately 5,400 members, the Foundation works in association with the MEDPED (Make Early Diagnoses and Prevent Early Deaths in Medical Pedigrees) program, an international collaboration consisting of research centers around the world dedicated to developing and implementing programs to identify affected individuals and their relatives. The Inherited High Cholesterol Foundation educates members of high risk families, health care providers, insurance companies, appropriate medical institutions and agencies, and the general public about inherited cholesterol disorders such as familial hypercholesterolemia, familial defective apoB, polygenic hypercholesterolemia, and familial combined hyperlipidemia. Individuals with such inherited conditions may be prone to highly elevated levels of cholesterol and an associated risk of early heart attack. The Inherited High Cholesterol Foundation also offers local support to affected individuals and family members and provides a variety of educational materials including pamphlets, brochures, leaflets, and newsletters.

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to high cholesterol. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with high cholesterol. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about high cholesterol. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines.

102 High Cholesterol

The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “high cholesterol” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “high cholesterol”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “high cholesterol” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “high cholesterol” (or a synonym) into the search box, and click “Submit Query.”

103

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

20

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

104 High Cholesterol

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)21: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

21

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

105

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

106 High Cholesterol

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

107

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

108 High Cholesterol

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

109

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

111

HIGH CHOLESTEROL DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH]

112 High Cholesterol

Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Age-Adjusted: Summary measures of rates of morbidity or mortality in a population using statistical procedures to remove the effect of age differences in populations that are being compared. Age is probably the most important and the most common variable in determining the risk of morbidity and mortality. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have

Dictionary 113

nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alprostadil: A potent vasodilator agent that increases peripheral blood flow. It inhibits platelet aggregation and has many other biological effects such as bronchodilation, mediation of inflammation, etc. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are

114 High Cholesterol

the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anode: Electrode held at a positive potential with respect to a cathode. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Aorta: The main trunk of the systemic arteries. [NIH]

Dictionary 115

Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apolipoproteins A: Lipoproteins found in human blood serum in the high-density and very-high-density lipoprotein fraction (HDL, VHDL). They consist of several different polypeptides, the most important of which are apolipoprotein A-I and A-II. They maintain the structural integrity of the HDL particles and are activators of lecithin:cholesterol acyltransferase (LCAT). Atherosclerotic patients show low apolipoprotein A levels and these apolipoproteins are either absent or present in extremely low plasma concentration in Tangier disease. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Aromatic: Having a spicy odour. [EU] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atherogenic: Causing the formation of plaque in the lining of the arteries. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition,

116 High Cholesterol

or hormonal changes. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autopsy: Postmortem examination of the body. [NIH] Azotemia: An excess of urea or other nitrogenous compounds in the blood. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Beta blocker: A drug used to slow the heart rate and reduce pressure inside blood vessels. It also can regulate heart rhythm. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH]

Dictionary 117

Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bivalent: Pertaining to a group of 2 homologous or partly homologous chromosomes during the zygotene stage of prophase to the first metaphase in meiosis. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH]

118 High Cholesterol

Bone Marrow Cells: Cells contained in the bone marrow including fat cells, stromal cells, megakaryocytes, and the immediate precursors of most blood cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bullous: Pertaining to or characterized by bullae. [EU] Butylated Hydroxytoluene: Antioxidant used in foods, cosmetics, petroleum products, etc. It may inhibit some neoplasms and facilitate others. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the

Dictionary 119

pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Carotid Stenosis: The constriction or narrowing of an orifice or the lumen of a hollow or tubular organ. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [NIH] Celiprolol: A cardioselective beta-1-adrenergic antagonist that may act as a partial agonist at some adrenergic sites. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH]

120 High Cholesterol

Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Cholic Acid: A major primary bile acid produced in the liver and usually conjugated with glycine or taurine. It facilitates fat absorption and cholesterol excretion. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Claviceps: A genus of ascomycetous fungi, family Clavicipitaceae, order Hypocreales, parasitic on various grasses. The sclerotia contain several toxic alkaloids. Claviceps purpurea on rye causes ergotism. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient.

Dictionary 121

[NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colestipol: Highly crosslinked and insoluble basic anion exchange resin used as anticholesteremic. It may also may reduce triglyceride levels. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative

122 High Cholesterol

pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH]

Dictionary 123

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Cryoglobulinemia: A condition characterized by the presence of abnormal or abnormal quantities of cryoglobulins in the blood. They are precipitated into the microvasculature on exposure to cold and cause restricted blood flow in exposed areas. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeletal Proteins: Major constituent of the cytoskeleton found in the cytoplasm of eukaryotic cells. They form a flexible framework for the cell, provide attachment points for organelles and formed bodies, and make communication between parts of the cell possible. [NIH]

124 High Cholesterol

Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Hygienists: Persons trained in an accredited school or dental college and licensed by the state in which they reside to provide dental prophylaxis under the direction of a licensed dentist. [NIH] Depersonalization: Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in depersonalization disorder, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both. [EU] Derealization: Is characterized by the loss of the sense of reality concerning one's surroundings. [NIH] Dermatitis: Any inflammation of the skin. [NIH] Dermatitis Herpetiformis: Rare, chronic, papulo-vesicular disease characterized by an intensely pruritic eruption consisting of various combinations of symmetrical, erythematous, papular, vesicular, or bullous lesions. The disease is strongly associated with the presence of HLA-B8 and HLA-DR3 antigens. A variety of different autoantibodies has been detected in small numbers in patients with dermatitis herpetiformis. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH]

Dictionary 125

DHEA: Dehydroepiandrosterone. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dimness: A result of alcohol's toxic effect on the optic nerve. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Diuresis: Increased excretion of urine. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH]

126 High Cholesterol

Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]

Ectopic: Pertaining to or characterized by ectopia. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrinologist: A doctor that specializes in diagnosing and treating hormone disorders. [NIH]

Endolymph: The fluid contained in the membranous labyrinth of the ear. [NIH] Endolymphatic Duct: Duct connecting the endolymphatic sac with the membranous labyrinth. [NIH]

Dictionary 127

Endolymphatic Sac: The blind pouch at the end of the endolymphatic duct. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a fungus. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Esterification: The process of converting an acid into an alkyl or aryl derivative. Most frequently the process consists of the reaction of an acid with an alcohol in the presence of a trace of mineral acid as catalyst or the reaction of an acyl chloride with an alcohol. Esterification can also be accomplished by enzymatic processes. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy.

128 High Cholesterol

[NIH]

Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excrete: To get rid of waste from the body. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exons: Coding regions of messenger RNA included in the genetic transcript which survive the processing of RNA in cell nuclei to become part of a spliced messenger of structural RNA in the cytoplasm. They include joining and diversity exons of immunoglobulin genes. [NIH]

Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fatty Liver: The buildup of fat in liver cells. The most common cause is alcoholism. Other causes include obesity, diabetes, and pregnancy. Also called steatosis. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of

Dictionary 129

the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibronectin: An adhesive glycoprotein. One form circulates in plasma, acting as an opsonin; another is a cell-surface protein which mediates cellular adhesive interactions. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Foam Cells: Lipid-laden macrophages originating from monocytes or from smooth muscle cells. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallate: Antioxidant present in tea. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several

130 High Cholesterol

different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomeruli: Plural of glomerulus. [NIH] Glomerulonephritis: Glomerular disease characterized by an inflammatory reaction, with leukocyte infiltration and cellular proliferation of the glomeruli, or that appears to be the result of immune glomerular injury. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is

Dictionary 131

a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Hate: An enduring attitude or sentiment toward persons or objects manifested by anger, aversion and desire for the misfortune of others. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their

132 High Cholesterol

health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Heterozygote: An individual having different alleles at one or more loci in homologous chromosome segments. [NIH] High blood cholesterol: Cholesterol is the most abundant steroid in animal tissues, especially in bile and gallstones. The relationship between the intake of cholesterol and its

Dictionary 133

manufacture by the body to its utilization, sequestration, or excretion from the body is called the cholesterol balance. When cholesterol accumulates, the balance is positive; when it declines, the balance is negative. In 1993, the NHLBI National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults issued an updated set of recommendations for monitoring and treatment of blood cholesterol levels. The NCEP guidelines recommended that total cholesterol levels and subfractions of high-density lipoprotein (HDL) cholesterol be measured beginning at age 20 in all adults, with subsequent periodic screenings as needed. Even in the group of patients at lowest risk for coronary heart disease (total cholesterol 200 mg/dL and HDL 35 mg/dL), the NCEP recommended that rescreening take place at least once every 5 years or upon physical examination. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hypercholesterolemia, Familial: A familial disorder characterized by increased plasma concentration of cholesterol carried in low density lipoproteins (LDL) and by a deficiency in a cell surface receptor which regulates LDL degradation and cholesterol synthesis. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperlipoproteinemia: Metabolic disease characterized by elevated plasma cholesterol and/or triglyceride levels. The inherited form is attributed to a single gene mechanism. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH]

134 High Cholesterol

Hypoglycemia: Abnormally low blood sugar [NIH] Hypolipidemic: A drug that lowers abnormally high plasma concentrations of cholesterol or triglycerides or both. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileum: The lower end of the small intestine. [NIH] Imaging procedures: Methods of producing pictures of areas inside the body. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus,

Dictionary 135

or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH]

136 High Cholesterol

Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intravenous: IV. Into a vein. [NIH] Introns: Non-coding, intervening sequences of DNA that are transcribed, but are removed from within the primary gene transcript and rapidly degraded during maturation of messenger RNA. Most genes in the nuclei of eukaryotes contain introns, as do mitochondrial and chloroplast genes. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Cortex: The outer zone of the kidney, beneath the capsule, consisting of kidney glomerulus; kidney tubules, distal; and kidney tubules, proximal. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities

Dictionary 137

of bones. They are pliant, tough, and inextensile. [NIH] Ligands: A RNA simulation method developed by the MIT. [NIH] Limulus Test: Sensitive method for detection of bacterial endotoxins and endotoxin-like substances that depends on the in vitro gelation of Limulus amebocyte lysate (LAL), prepared from the circulating blood (amebocytes) of the horseshoe crab, by the endotoxin or related compound. Used for detection of endotoxin in body fluids and parenteral pharmaceuticals. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lipoprotein Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. The enzyme hydrolyzes triacylglycerols in chylomicrons, very-low-density lipoproteins, low-density lipoproteins, and diacylglycerols. It occurs on capillary endothelial surfaces, especially in mammary, muscle, and adipose tissue. Genetic deficiency of the enzyme causes familial hyperlipoproteinemia Type I. (Dorland, 27th ed) EC 3.1.1.34. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Lovastatin: A fungal metabolite isolated from cultures of Aspergillus terreus. The compound is a potent anticholesteremic agent. It inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting

138 High Cholesterol

enzyme in cholesterol biosynthesis. It also stimulates the production of low-density lipoprotein receptors in the liver. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lower-fat diet: An eating plan in which 30 percent or less of the day's total calories are from fat. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphokines: Soluble protein factors generated by activated lymphocytes that affect other cells, primarily those involved in cellular immunity. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Macrophage Activation: The process of altering the morphology and functional activity of macrophages so that they become avidly phagocytic. It is initiated by lymphokines, such as the macrophage activation factor (MAF) and the macrophage migration-inhibitory factor (MMIF), immune complexes, C3b, and various peptides, polysaccharides, and immunologic adjuvants. [NIH] Macrophage Colony-Stimulating Factor: A mononuclear phagocyte colony-stimulating factor synthesized by mesenchymal cells. The compound stimulates the survival, proliferation, and differentiation of hematopoietic cells of the monocyte-macrophage series. M-CSF is a disulfide-bonded glycoprotein dimer with a MW of 70 kDa. It binds to a specific high affinity receptor (receptor, macrophage colony-stimulating factor). [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mass Screening: Organized periodic procedures performed on large groups of people for the purpose of detecting disease. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Meat Products: Articles of food which are derived by a process of manufacture from any portion of carcasses of any animal used for food (e.g., head cheese, sausage, scrapple). [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU]

Dictionary 139

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megakaryocytes: Very large bone marrow cells which release mature blood platelets. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metallothionein: A low-molecular-weight (approx. 10 kD) protein occurring in the cytoplasm of kidney cortex and liver. It is rich in cysteinyl residues and contains no aromatic amino acids. Metallothionein shows high affinity for bivalent heavy metals. [NIH] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Midaxillary line: An imaginary vertical line that passes midway between the anterior and posterior axillary (armpit) folds. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH]

140 High Cholesterol

Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Miscible: Susceptible of being mixed. [EU] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocyte: A type of white blood cell. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monounsaturated fat: An unsaturated fat that is found primarily in plant foods, including olive and canola oils. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or

Dictionary 141

stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Natriuresis: The excretion of abnormal amounts of sodium in the urine. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH]

142 High Cholesterol

Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Omega-3 fatty acid: A type of fat obtained in the diet and involved in immunity. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Organ Preservation: The process by which organs are kept viable outside of the organism from which they were removed (i.e., kept from decay by means of a chemical agent, cooling, or a fluid substitute that mimics the natural state within the organism). [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orlistat: A lipase inhibitor used for weight loss. Lipase is an enzyme found in the bowel that assists in lipid absorption by the body. Orlistat blocks this enzyme, reducing the amount of fat the body absorbs by about 30 percent. It is known colloquially as a "fat blocker." Because

Dictionary 143

more oily fat is left in the bowel to be excreted, Orlistat can cause an oily anal leakage and fecal incontinence. Orlistat may not be suitable for people with bowel conditions such as irritable bowel syndrome or Crohn's disease. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Otosclerosis: The formation of spongy bone in the labyrinth capsule. The ossicles can become fixed and unable to transmit sound vibrations, thereby causing deafness. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overexpress: An excess of a particular protein on the surface of a cell. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Insufficiency: Absence of or reduced pancreatic exocrine secretion into the duodenum and resultant poor digestion of lipids, vitamins, nitrogen, and carbohydrates. [NIH]

Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that

144 High Cholesterol

last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide T: N-(N-(N(2)-(N-(N-(N-(N-D-Alanyl L-seryl)-L-threonyl)-L-threonyl) L-threonyl)L-asparaginyl)-L-tyrosyl) L-threonine. Octapeptide sharing sequence homology with HIV envelope protein gp120. It is potentially useful as antiviral agent in AIDS therapy. The core pentapeptide sequence, TTNYT, consisting of amino acids 4-8 in peptide T, is the HIV envelope sequence required for attachment to the CD4 receptor. [NIH] Perceived risk: Estimate or evaluation of risk as observed through personal experience or personal study, and personal evaluation of consequences. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH]

Dictionary 145

Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontics: A dental specialty concerned with the histology, physiology, and pathology of the tissues that support, attach, and surround the teeth, and of the treatment and prevention of disease affecting these tissues. [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH]

146 High Cholesterol

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pipette: Tube designed to measure liquids in drops. [NIH] Plant sterols: Plant-based compounds that can compete with dietary cholesterol to be absorbed by the intestines. This results in lower blood cholesterol levels. They may have some effect in cancer prevention. Also known as phytosterols. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU]

Dictionary 147

Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Pravastatin: An antilipemic fungal metabolite isolated from cultures of Nocardia autotrophica. It acts as a competitive inhibitor of HMG CoA reductase (hydroxymethylglutaryl CoA reductases). [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Pre-eclamptic: A syndrome characterized by hypertension, albuminuria, and generalized oedema, occurring only in pregnancy. [NIH] Premenstrual: Occurring before menstruation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin

148 High Cholesterol

synthesis leading to further increases in cyclic AMP. [EU] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]

Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]

Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Pruritic: Pertaining to or characterized by pruritus. [EU] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic

Dictionary 149

end product of purine metabolism. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radioactivity: The quality of emitting or the emission of corpuscular or electromagnetic radiations consequent to nuclear disintegration, a natural property of all chemical elements of atomic number above 83, and possible of induction in all other known elements. [EU] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Rationalize: To attribute one's actions to rational and creditable motives without adequate analysis of the true and unconscious motives. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme,

150 High Cholesterol

and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rye: A hardy grain crop, Secale cereale, grown in northern climates. It is the most frequent host to ergot (claviceps), the toxic fungus. Its hybrid with wheat is triticale, another grain. [NIH]

Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saturated fat: A type of fat found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils, including coconut, palm kernel, and palm oils. Saturated fat raises blood cholesterol more than anything else eaten. On a Step I Diet, no more than 8 to 10 percent of total calories should come from saturated fat, and in the Step II Diet, less than 7 percent of the day's total calories should come from saturated fat. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or

Dictionary 151

computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Senile Plaques: Spherical masses consisting of amyloid fibrils and neuronal processes. [NIH] Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH]

152 High Cholesterol

Simvastatin: A derivative of lovastatin and potent competitive inhibitor of 3-hydroxy-3methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL-cholesterol (lipoproteins, LDL cholesterol). [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soybean Oil: Oil from soybean or soybean plant. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU]

Dictionary 153

Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by

154 High Cholesterol

clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and

Dictionary 155

antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroid Hormones: Hormones secreted by the thyroid gland. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of

156 High Cholesterol

toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Transient Ischemic Attacks: Focal neurologic abnormalities of sudden onset and brief duration that reflect dysfunction in the distribution of the internal carotid-middle cerebral or the vertebrobasilar arterial system. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Unsaturated Fats: A type of fat. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder.

Dictionary 157

[NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urine Testing: Checking urine to see if it contains glucose (sugar) and ketones. Special strips of paper or tablets (called reagents) are put into a small amount of urine or urine plus water. Changes in the color of the strip show the amount of glucose or ketones in the urine. Urine testing is the only way to check for the presence of ketones, a sign of serious illness. However, urine testing is less desirable then blood testing for monitoring the level of glucose in the body. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular

158 High Cholesterol

nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villous: Of a surface, covered with villi. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Waist circumference: To define the level at which the waist circumference is measured, a bony landmark is first located and marked. The subject stands, and the technician, positioned to the right of the subject, palpates the upper hip bone to locate the right ileum. Just above the uppermost lateral border of the right ileum, a horizontal mark is drawn and then crossed with a vertical mark on the midaxillary line. The measuring tape is then placed around the trunk, at the level of the mark on the right side, making sure that it is on a level horizontal plane on all sides. The tape is then tightened slightly without compressing the skin and underlying subcutaneous tissues. The measure is recorded in centimeters to the nearest millimeter. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]

Dictionary 159

Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xanthine: An urinary calculus. [NIH] Xanthine Oxidase: An iron-molybdenum flavoprotein containing FAD that oxidizes hypoxanthine, some other purines and pterins, and aldehydes. Deficiency of the enzyme, an autosomal recessive trait, causes xanthinuria. EC 1.1.3.22. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

161

INDEX A Abdominal, 111, 136, 143, 144 Aberrant, 24, 111 Acceptor, 111, 137, 143, 156 Acetylcholine, 111, 120 Acoustic, 75, 111, 158 Acyl, 111, 127 Adaptation, 15, 111 Adenine, 111, 148 Adenosine, 111, 118, 145, 155 Adipocytes, 111, 136 Adipose Tissue, 111, 137 Adjustment, 6, 9, 111 Adrenergic, 111, 119, 125 Adsorption, 13, 111 Adsorptive, 111 Adverse Effect, 112, 151 Aerobic, 29, 112, 128 Afferent, 112, 136 Affinity, 112, 138, 139, 152 Agar, 112, 146 Age of Onset, 15, 112, 156 Age-Adjusted, 9, 112 Agonist, 67, 112, 119, 125, 142 Airway, 112, 152 Albumin, 10, 112, 146 Alertness, 112, 118 Algorithms, 112, 117 Alimentary, 112, 125, 144 Alkaline, 112, 118 Alkaloid, 112, 118, 140, 142, 154 Alleles, 67, 69, 113, 132 Allopurinol, 85, 113 Alopecia, 27, 113 Alprostadil, 75, 113 Alternative medicine, 82, 113 Amino Acid Sequence, 113, 114 Amino Acids, 113, 127, 139, 144, 148, 156 Amyloid, 15, 22, 40, 68, 113, 151 Anal, 113, 143 Analgesic, 62, 113, 134, 140 Anaphylatoxins, 113, 122 Anatomical, 113, 115, 134, 151 Angina, 5, 9, 49, 72, 76, 113 Angina Pectoris, 72, 113 Angioplasty, 11, 113 Angiotensin-Converting Enzyme Inhibitors, 72, 113

Animal model, 16, 19, 20, 24, 74, 114 Anions, 13, 112, 114, 136 Anode, 114 Antagonism, 114, 118, 155 Antibiotic, 114, 127 Antibodies, 25, 114, 116, 127, 138, 146 Antibody, 8, 10, 112, 114, 121, 133, 134, 135, 140 Antiemetic, 114, 139 Antigen, 67, 112, 114, 121, 127, 133, 134, 135 Antigen-Antibody Complex, 114, 121 Anti-inflammatory, 114, 115, 134 Anti-Inflammatory Agents, 114, 115 Antioxidant, 40, 47, 48, 114, 118, 129, 143 Antiviral, 114, 144 Anxiety, 114, 143 Anxiety Disorders, 114, 144 Aorta, 40, 114 Apnea, 115 Apolipoproteins, 27, 36, 115, 130, 137 Apolipoproteins A, 27, 115 Apoptosis, 15, 115 Aqueous, 13, 115, 116, 123 Aromatic, 115, 139, 145 Arrhythmia, 72, 115 Arterial, 19, 23, 115, 120, 133, 148, 154, 156 Arteries, 11, 27, 57, 114, 115, 117, 123, 138, 139, 140 Arterioles, 115, 117, 118, 140 Arteriosclerosis, 115, 133, 140 Aspirin, 10, 36, 115 Assay, 10, 23, 115 Atherogenic, 14, 19, 24, 115 Atrial, 8, 11, 115 Atrial Fibrillation, 8, 11, 115 Atrium, 115 Atrophy, 115, 141 Attenuated, 24, 116 Auditory, 116, 132 Autoantibodies, 116, 124 Autoimmune disease, 75, 116 Autonomic, 75, 111, 116, 145, 152, 154 Autonomic Nervous System, 75, 116, 145, 152, 154 Autopsy, 12, 116 Azotemia, 10, 116

162 High Cholesterol

B Bacteria, 111, 114, 116, 117, 127, 128, 129, 139, 157 Bacterial Physiology, 111, 116 Bacteriophage, 116, 146 Bacteriostatic, 116, 127 Bacteriuria, 116, 157 Base, 24, 84, 111, 116, 124, 136, 154 Basophils, 116, 136 Beta blocker, 72, 116 Beta-pleated, 113, 116 Bewilderment, 116, 122 Bile, 4, 13, 16, 21, 51, 69, 116, 117, 120, 129, 132, 137, 153, 154 Bile Acids, 13, 69, 116, 117, 153, 154 Bile Acids and Salts, 116, 117 Bile Ducts, 117, 129 Biliary, 14, 16, 23, 69, 117, 118 Bilirubin, 112, 117, 129 Biochemical, 40, 113, 117, 131 Biosynthesis, 117, 138, 152 Biotechnology, 25, 48, 74, 82, 95, 117 Bivalent, 117, 139 Bladder, 77, 117, 134, 141, 156, 157 Bloating, 117, 130, 136 Blood Coagulation, 64, 67, 117, 118 Blood Coagulation Factors, 117 Blood Glucose, 10, 76, 77, 80, 117, 132, 135 Blood vessel, 8, 64, 77, 116, 117, 118, 119, 120, 131, 137, 139, 145, 152, 153, 154, 155, 157 Body Composition, 21, 117 Body Fluids, 117, 137, 152 Body Mass Index, 3, 4, 5, 7, 10, 13, 83, 117, 143 Bone Marrow, 19, 24, 117, 118, 138, 139, 153 Bone Marrow Cells, 19, 118, 139 Bone scan, 118, 150 Bowel, 113, 118, 125, 135, 142, 153 Bowel Movement, 118, 125, 153 Branch, 107, 118, 144, 148, 152, 155 Breakdown, 11, 118, 125, 129, 152 Bronchitis, 118, 120 Bullous, 118, 124 Butylated Hydroxytoluene, 64, 118 C Caffeine, 72, 76, 118, 148 Calcium, 42, 72, 75, 118, 121, 148 Calcium channel blocker, 75, 118 Calcium Channel Blockers, 75, 118 Calculi, 118, 131

Caloric intake, 65, 118 Capillary, 118, 137, 157 Capsaicin, 75, 118 Carbohydrate, 17, 118, 131, 146 Carcinogenic, 119, 142, 147, 153 Cardiac, 18, 115, 118, 119, 123, 129, 132, 140, 153 Cardiorespiratory, 6, 119 Cardioselective, 119 Cardiovascular, 5, 6, 7, 9, 10, 11, 12, 17, 20, 28, 31, 36, 37, 49, 57, 66, 76, 78, 119, 128, 152 Cardiovascular disease, 6, 7, 9, 10, 20, 28, 66, 76, 119 Carnitine, 42, 43, 119 Carotid Stenosis, 28, 119 Catheterization, 113, 119 Cations, 119, 136 Causal, 19, 119 Cause of Death, 22, 119 Celiac Disease, 84, 119 Celiprolol, 36, 119 Cell, 10, 15, 18, 23, 25, 68, 112, 113, 115, 116, 117, 118, 119, 120, 122, 123, 125, 127, 128, 129, 130, 133, 135, 140, 141, 143, 145, 146, 147, 149, 150, 153, 154, 158 Cell Adhesion, 119, 135 Cell Death, 115, 119, 141 Cell membrane, 118, 119, 145 Cellobiose, 119 Cellulose, 12, 119, 129, 146 Central Nervous System, 111, 116, 118, 120, 131, 140, 142, 154 Cerebral, 22, 64, 120, 123, 128, 156 Cerebrovascular, 12, 64, 118, 119, 120 Cerebrum, 120, 123 Character, 113, 120, 124, 131 Chemotactic Factors, 120, 122 Chest Pain, 9, 73, 76, 120 Cholelithiasis, 16, 120 Cholesterol Esters, 120, 137 Cholic Acid, 16, 120 Choline, 14, 43, 120 Cholinergic, 120, 142 Chromatin, 115, 120, 127, 141 Chromosome, 120, 132, 137 Chronic, 3, 4, 9, 11, 14, 72, 80, 120, 124, 135, 136, 137, 151, 153 Chronic Disease, 3, 11, 120 Chronic Obstructive Pulmonary Disease, 4, 120 Chylomicrons, 120, 137

Index 163

Clamp, 18, 120 Claviceps, 120, 150 Clear cell carcinoma, 120, 124 Clinical Medicine, 120, 147 Clinical trial, 13, 57, 58, 95, 121, 149 Cloning, 17, 117, 121 Coagulation, 117, 121, 132, 146, 155 Cochlear, 121, 155, 157, 158 Cochlear Diseases, 121, 155 Coenzyme, 51, 121, 137, 152 Cofactor, 121, 148 Colestipol, 5, 88, 121 Collapse, 118, 121, 152 Colloidal, 112, 121 Colorectal, 67, 121 Colorectal Cancer, 67, 121 Combination Therapy, 121, 127 Complement, 10, 113, 121, 122, 130, 135, 146 Complementary and alternative medicine, 47, 54, 122 Complementary medicine, 47, 122 Computational Biology, 95, 122 Computed tomography, 122, 150 Computerized axial tomography, 122, 151 Confusion, 8, 122, 125 Congestive heart failure, 9, 29, 76, 122 Conjugated, 117, 120, 122 Connective Tissue, 117, 122, 129, 139, 148, 150, 153 Consciousness, 113, 122, 124 Constipation, 75, 122, 136 Constriction, 119, 122 Consumption, 8, 69, 71, 76, 85, 122, 143 Contractility, 114, 122 Contraindications, ii, 122 Convulsions, 123, 126 Coronary, 5, 9, 11, 12, 17, 18, 22, 24, 32, 36, 64, 68, 69, 72, 76, 113, 119, 123, 133, 139, 140 Coronary Circulation, 113, 123 Coronary Disease, 24, 69, 123 Coronary heart disease, 5, 9, 12, 17, 22, 32, 36, 64, 68, 119, 123, 133 Coronary Thrombosis, 123, 139, 140 Coronary Vessels, 123 Cortex, 22, 123, 128, 150 Cortical, 22, 123 Cortices, 123, 132 Corticosteroids, 34, 123 Cortisol, 112, 123 Craniocerebral Trauma, 123, 131, 155

Cryoglobulinemia, 10, 123 Curative, 123, 142, 155 Cyclic, 118, 123, 147, 154 Cytoplasm, 115, 116, 119, 123, 124, 127, 128, 139, 141 Cytoskeletal Proteins, 18, 123 Cytoskeleton, 123, 124, 135 D Dairy Products, 124, 150 Data Collection, 124, 129 Databases, Bibliographic, 95, 124 Defense Mechanisms, 124, 135 Degenerative, 124, 150 Deletion, 115, 124 Dementia, 68, 124 Density, 12, 14, 19, 20, 23, 32, 34, 36, 48, 78, 115, 117, 124, 133, 137, 142 Dental Hygienists, 4, 124 Depersonalization, 124, 144, 151 Derealization, 124, 144 Dermatitis, 84, 124 Dermatitis Herpetiformis, 84, 124 DES, 40, 113, 124 DHEA, 51, 125 Diabetes Mellitus, 8, 125, 130, 132 Diagnostic procedure, 61, 82, 125 Diastolic, 125, 133 Dietary Fats, 5, 17, 125, 137 Dietary Fiber, 12, 125 Diffusion, 125, 135, 156 Digestion, 23, 75, 112, 116, 117, 118, 125, 130, 135, 137, 143, 144, 153 Digestive system, 59, 125 Dihydrotestosterone, 125, 149 Dilatation, 64, 113, 125, 157 Dimness, 8, 125 Direct, iii, 6, 14, 19, 72, 87, 120, 125, 149 Disorientation, 122, 125 Disparity, 17, 125 Diuresis, 118, 125, 154 Dizziness, 125, 144 Dopamine, 125, 139, 145 Drug Interactions, 88, 89, 125 Drug Tolerance, 125, 155 Duodenum, 116, 126, 129, 143, 153 Dura mater, 126, 139, 143 Dyes, 18, 85, 113, 116, 126, 141 Dyspareunia, 126, 127 Dyspnea, 126, 144 E Eclampsia, 4, 126 Ectopic, 23, 126

164 High Cholesterol

Edema, 10, 126, 136 Effector, 111, 121, 126 Efficacy, 9, 126 Elective, 35, 126 Electrolysis, 114, 119, 126 Electrolyte, 126, 132, 147, 152 Electrons, 114, 116, 126, 136, 143, 149 Embryo, 126, 128, 134 Emollient, 126, 131 Emphysema, 120, 126 Empirical, 20, 126 Endarterectomy, 113, 126 Endemic, 126, 152 Endocrinologist, 79, 126 Endolymph, 75, 126 Endolymphatic Duct, 126, 127 Endolymphatic Sac, 75, 126, 127 Endometrial, 84, 127 Endometrium, 127 Endotoxic, 127, 137 Endotoxin, 127, 137 Energy balance, 127, 136 Environmental Health, 94, 96, 127 Enzymatic, 118, 122, 127, 150 Eosinophils, 127, 136 Epidemic, 127, 152 Epitopes, 25, 127 Erectile, 127 Erection, 75, 127 Ergot, 127, 150 Erythrocytes, 14, 117, 127 Erythromycin, 75, 127 Esophagus, 125, 127, 153 Esterification, 63, 127 Estrogen, 26, 68, 72, 75, 127 Estrogen Replacement Therapy, 72, 127 Ethnic Groups, 9, 128 Eukaryotic Cells, 123, 128, 142 Evacuation, 122, 128, 129 Evoke, 128, 153 Excrete, 85, 128 Exercise Test, 6, 128 Exocrine, 128, 143 Exogenous, 111, 128, 156 Exons, 67, 128 Extracellular, 113, 122, 128, 135, 152 Extracellular Matrix, 122, 128, 135 Extraction, 65, 66, 128 F Family Planning, 95, 128 Fatigue, 80, 128, 132 Fatty acids, 7, 112, 128, 147

Fatty Liver, 35, 128 Feces, 122, 128, 153 Fetal Development, 6, 128 Fetus, 128, 153, 157 Fibrin, 117, 128, 155 Fibrinogen, 128, 129, 146, 155 Fibronectin, 25, 129 Fibrosis, 15, 23, 129, 151 Filtration, 14, 129 Fistula, 14, 129 Foam Cells, 23, 129 Focus Groups, 20, 129 Fold, 6, 129 Forearm, 117, 129 Fungi, 120, 129, 139, 153, 159 Fungus, 127, 129, 150 G Gallate, 48, 129 Gallbladder, 14, 111, 117, 125, 129 Gallstones, 3, 13, 16, 49, 117, 120, 129, 132 Gas, 125, 129, 133, 136, 142, 154, 157 Gastric, 6, 119, 129, 130, 144 Gastric Emptying, 129, 130 Gastric Juices, 129, 144 Gastric Mucosa, 129, 144 Gastrin, 130, 133 Gastroparesis, 75, 130 Gemfibrozil, 5, 34, 52, 130 Gene, 14, 15, 16, 17, 20, 21, 23, 29, 40, 57, 67, 68, 74, 113, 117, 130, 133, 136 Gene Expression, 21, 23, 130 Genetic Engineering, 117, 121, 130 Genetic Markers, 67, 130 Genetics, 10, 35, 63, 130 Genotype, 21, 130, 145 Gestation, 6, 130 Gestational, 8, 80, 130 Ginseng, 35, 130 Gland, 130, 143, 151, 153, 155 Glomerular, 130 Glomeruli, 130 Glomerulonephritis, 10, 130 Glucose, 6, 8, 12, 21, 68, 77, 80, 117, 119, 125, 130, 131, 132, 135, 157 Glucose Intolerance, 125, 130 Glucose tolerance, 8, 80, 130 Glucose Tolerance Test, 8, 80, 130, 131 Gluten, 77, 84, 119, 131 Glycerol, 25, 131, 145 Glycine, 117, 120, 131 Glycoprotein, 16, 129, 131, 138 Glycosaminoglycans, 51, 131, 148

Index 165

Glycosylation, 15, 131 Gout, 85, 131 Governing Board, 131, 147 Gp120, 131, 144 Growth, 5, 15, 19, 21, 23, 24, 84, 114, 115, 116, 119, 128, 131, 135, 141, 146, 155 H Haematoma, 131 Haemorrhage, 34, 131 Half-Life, 33, 131 Hate, 26, 131 Headache, 118, 131 Health Behavior, 17, 20, 131 Health Status, 5, 132 Hearing Disorders, 19, 132 Heart attack, 9, 57, 76, 80, 101, 119, 132 Heart failure, 36, 72, 114, 132 Hematuria, 10, 132 Hemodiafiltration, 132, 156 Hemodialysis, 132, 156 Hemofiltration, 132, 156 Hemoglobin, 127, 132 Hemorrhage, 123, 131, 132, 149, 153 Hemostasis, 132, 135 Hepatic, 21, 48, 112, 131, 132, 152 Hereditary, 19, 69, 73, 131, 132, 141 Heredity, 75, 76, 130, 132 Heterodimers, 132, 135 Heterozygote, 16, 132 High blood cholesterol, 68, 132 Histology, 133, 145 Homeostasis, 16, 133, 152 Homologous, 113, 117, 132, 133, 154 Hormonal, 16, 75, 116, 127, 133 Hormone, 76, 123, 124, 126, 127, 130, 133, 135, 136, 152, 154, 155 Hormone Replacement Therapy, 76, 133 Host, 116, 133, 150, 158 Hybrid, 133, 150 Hydrogen, 111, 116, 119, 133, 137, 140, 143 Hydrophobic, 133, 137 Hypercholesterolemia, 10, 11, 12, 15, 19, 24, 29, 50, 57, 58, 101, 133 Hypercholesterolemia, Familial, 101, 133 Hyperlipidemia, 4, 9, 10, 11, 21, 23, 24, 30, 35, 63, 101, 133 Hyperlipoproteinemia, 133, 137 Hypertension, 3, 4, 5, 6, 7, 9, 10, 11, 12, 18, 28, 32, 33, 50, 72, 76, 114, 118, 119, 133, 136, 147 Hypertriglyceridemia, 34, 133 Hyperuricemia, 131, 133

Hypoglycemia, 65, 80, 134 Hypolipidemic, 48, 134 Hypothalamus, 116, 134 Hypothyroidism, 50, 76, 134 I Ibuprofen, 77, 134 Id, 41, 48, 100, 106, 108, 134 Ileum, 134, 158 Imaging procedures, 134, 156 Immune function, 64, 134 Immune response, 114, 116, 134, 154, 158 Immune system, 134, 138, 145, 158 Immunity, 134, 138, 142 Immunogenic, 134, 137 Immunoglobulin, 114, 128, 134, 140 Immunologic, 120, 134, 138 Impairment, 68, 116, 134, 139 Impotence, 75, 127, 134 In vitro, 19, 23, 24, 62, 134, 137 In vivo, 14, 23, 25, 134 Incontinence, 134, 143 Indicative, 72, 134, 144, 157 Induction, 134, 149, 152 Infarction, 50, 134 Infection, 23, 67, 74, 75, 120, 134, 135, 138, 141, 153, 158 Infiltration, 130, 135 Inflammation, 15, 74, 85, 112, 113, 114, 115, 118, 124, 129, 135, 139, 143, 145, 150 Infuse, 25, 135 Infusion, 14, 25, 135 Ingestion, 29, 64, 131, 135 Insight, 15, 135 Insulin, 6, 8, 21, 33, 50, 75, 79, 131, 135, 156 Insulin-dependent diabetes mellitus, 8, 135 Insulin-like, 21, 135 Integrins, 25, 135 Intermittent, 50, 135, 137 Internal Medicine, 3, 6, 9, 35, 135 Intestinal, 23, 69, 119, 130, 135, 138 Intestine, 16, 117, 118, 121, 135, 136 Intoxication, 135, 158 Intracellular, 13, 118, 135, 147 Intracellular Membranes, 13, 135 Intracranial Hypertension, 131, 136, 155 Intravenous, 77, 135, 136, 144 Introns, 67, 136 Ions, 18, 116, 126, 133, 136, 140, 148 Irritable Bowel Syndrome, 136, 143 J Joint, 85, 136

166 High Cholesterol

K Kb, 94, 136 Kidney Cortex, 136, 139 Kidney Disease, 10, 59, 75, 77, 94, 136 Kidney stone, 136, 157 L Labile, 121, 136 Labyrinth, 126, 136, 143, 157 Large Intestine, 121, 125, 135, 136, 149, 152 Latent, 136, 147 Leptin, 21, 136 Lesion, 23, 24, 136 Lethargy, 134, 136 Leukocytes, 24, 116, 117, 120, 127, 136, 141 Library Services, 106, 136 Ligaments, 123, 136 Ligands, 24, 135, 137 Limulus Test, 62, 137 Linkage, 21, 33, 119, 130, 137 Lipase, 23, 137, 142 Lipid, 4, 11, 12, 13, 23, 25, 29, 32, 34, 36, 115, 120, 129, 130, 131, 135, 137, 142, 143, 156 Lipid A, 12, 23, 34, 137, 142 Lipid Peroxidation, 137, 143 Lipopolysaccharides, 137 Lipoprotein, 12, 14, 17, 19, 20, 21, 26, 29, 32, 34, 36, 48, 69, 115, 133, 137, 138 Lipoprotein Lipase, 14, 21, 137 Liver scan, 137, 150 Liver Transplantation, 57, 137 Localized, 15, 84, 131, 135, 137, 146, 151 Longitudinal Studies, 5, 137 Long-Term Care, 17, 137 Lovastatin, 5, 26, 34, 43, 47, 137, 152 Low-density lipoprotein, 33, 137, 138 Lower-fat diet, 83, 138 Lumen, 23, 119, 138 Lymphatic, 135, 138, 139 Lymphocyte, 114, 138 Lymphoid, 114, 123, 138 Lymphokines, 138 M Macrophage, 19, 24, 40, 62, 138 Macrophage Activation, 62, 138 Macrophage Colony-Stimulating Factor, 19, 40, 138 Magnetic Resonance Imaging, 138, 151 Malabsorption, 23, 84, 119, 138 Malnutrition, 112, 115, 138 Mammary, 137, 138 Mass Screening, 32, 138

Meat, 125, 138, 150 Meat Products, 125, 138 Mediate, 15, 22, 24, 125, 138 MEDLINE, 95, 139 Megakaryocytes, 118, 139 Melanin, 139, 145 Membrane, 13, 15, 18, 119, 122, 128, 131, 139, 140, 142, 143, 145, 146, 150 Memory, 64, 65, 124, 139 Meninges, 120, 123, 126, 139 Meningitis, 75, 139 Menopause, 26, 27, 50, 139, 146 Menstruation, 139, 147 Mental Disorders, 59, 139 Mental Health, iv, 13, 59, 94, 96, 139, 148 Mesenchymal, 138, 139 Metabolic disorder, 77, 131, 139 Metabolite, 137, 139, 147 Metallothionein, 40, 139 Metoclopramide, 75, 139 MI, 3, 4, 5, 7, 9, 13, 109, 139 Microbe, 139, 155 Microbiology, 111, 116, 139 Microorganism, 121, 139, 144, 158 Microscopy, 18, 139 Midaxillary line, 139, 158 Migration, 25, 138, 139 Millimeter, 140, 158 Miscible, 63, 140 Mitosis, 115, 140 Modeling, 16, 18, 140 Modification, 130, 140, 149 Molecular, 16, 18, 20, 32, 33, 95, 97, 117, 122, 129, 132, 139, 140, 156 Molecular Structure, 140, 156 Molecule, 24, 114, 116, 121, 126, 131, 140, 143, 148, 149 Monitor, 4, 140, 142 Monoclonal, 10, 140 Monocyte, 19, 24, 138, 140 Mononuclear, 138, 140 Monounsaturated fat, 17, 140 Morphine, 140, 141 Morphology, 138, 140 Mucosa, 119, 129, 140, 153 Myocardial infarction, 9, 31, 123, 139, 140 Myocardial Ischemia, 113, 123, 140 Myocardium, 55, 113, 139, 140 N Narcosis, 140 Narcotic, 62, 75, 140 Natriuresis, 114, 141

Index 167

Nausea, 114, 130, 141, 144 NCI, 1, 58, 93, 141 Necrosis, 115, 134, 139, 140, 141 Need, 3, 9, 26, 27, 29, 67, 71, 74, 75, 76, 77, 78, 79, 83, 102, 112, 141, 155 Neoplasia, 141 Neoplasm, 141 Neoplastic, 14, 141 Nephropathy, 77, 80, 136, 141 Nephrosis, 141 Nephrotic, 10, 141 Nerve, 69, 111, 130, 141, 142, 151, 153, 157, 158 Nervous System, 112, 116, 120, 141, 145, 154 Neural, 19, 22, 112, 113, 141 Neurodegenerative Diseases, 68, 141 Neurogenic, 77, 141 Neurologic, 141, 156 Neuronal, 140, 141, 151 Neurons, 141, 142, 154, 158 Neuropathy, 75, 80, 141 Neutrophils, 136, 141 Niacin, 4, 41, 88, 142 Nicotine, 76, 142 Nitrogen, 113, 142, 143 Nuclear, 126, 128, 141, 142, 149 Nuclei, 126, 128, 130, 136, 138, 140, 142, 158 Nucleic acid, 142, 148 Nucleus, 115, 116, 120, 123, 127, 128, 140, 141, 142, 152, 153, 158 O Odds Ratio, 142, 149 Omega-3 fatty acid, 7, 142 Oncogenic, 135, 142 Opacity, 124, 142 Optic Nerve, 125, 142, 143, 150 Oral Health, 74, 142 Organ Preservation, 11, 142 Organelles, 123, 142 Orlistat, 13, 142 Osmotic, 112, 143 Ossicles, 143 Osteoporosis, 4, 26, 27, 74, 127, 143 Otosclerosis, 75, 76, 143 Outpatient, 12, 143 Overexpress, 69, 143 Overweight, 3, 4, 5, 6, 40, 80, 84, 143 Ovum, 130, 143 Oxidation, 25, 111, 114, 137, 143 Oxidative Stress, 48, 143

Oxygen Consumption, 64, 128, 143, 150 P Pachymeningitis, 139, 143 Palliative, 143, 155 Pancreas, 111, 125, 135, 137, 143 Pancreatic, 23, 119, 143 Pancreatic Insufficiency, 23, 143 Panic, 31, 32, 143 Panic Disorder, 31, 143 Parenteral, 137, 144 Paresthesias, 144 Paroxysmal, 113, 144 Pathogen, 22, 144 Pathogenesis, 13, 17, 22, 144 Pathologic, 115, 123, 144, 157 Pathologic Processes, 115, 144 Patient Education, 11, 104, 106, 109, 144 Pedigree, 21, 144 Pepsin, 144 Pepsin A, 144 Peptic, 4, 144 Peptic Ulcer, 4, 144 Peptide, 68, 136, 144, 148, 155 Peptide T, 68, 144 Perceived risk, 17, 144 Perception, 17, 124, 132, 144, 151 Periodontal disease, 74, 145 Periodontics, 74, 145 Periodontitis, 74, 145 Peripheral blood, 25, 113, 145 Peripheral Nervous System, 141, 145, 154 Peripheral Vascular Disease, 12, 76, 80, 145 Petechiae, 131, 145 Petroleum, 118, 145 Phagocyte, 138, 145 Pharmaceutical Preparations, 119, 145 Pharmacokinetic, 33, 145 Pharmacologic, 131, 145, 155 Phenotype, 25, 69, 145 Phenylalanine, 77, 144, 145 Phospholipids, 128, 137, 145 Phosphorus, 118, 145 Physical Examination, 10, 133, 145 Physiologic, 20, 112, 117, 128, 131, 139, 146, 147, 149 Physiology, 5, 27, 36, 145, 146 Pipette, 18, 146 Plant sterols, 69, 146 Plants, 112, 120, 130, 140, 146, 153, 156 Plaque, 22, 24, 113, 115, 146 Plasma cells, 114, 146

168 High Cholesterol

Plasma protein, 112, 146, 148 Platelet Aggregation, 113, 146 Platelets, 139, 146, 155 Polymorphic, 66, 146 Polymorphism, 21, 66, 146 Polyposis, 121, 146 Polysaccharide, 114, 119, 146, 148 Polyunsaturated fat, 7, 17, 146 Postmenopausal, 17, 127, 143, 146 Postnatal, 146, 153 Postoperative, 11, 146 Postprandial, 12, 16, 146 Potassium, 71, 77, 147 Practice Guidelines, 96, 147 Pravastatin, 5, 26, 43, 147 Precursor, 11, 15, 22, 68, 120, 125, 126, 127, 145, 147, 148 Predisposition, 66, 80, 147 Pre-eclamptic, 126, 147 Premenstrual, 75, 147 Prevalence, 5, 6, 16, 17, 26, 34, 84, 142, 147 Progression, 16, 24, 67, 77, 114, 147 Progressive, 10, 124, 125, 127, 131, 141, 147 Promoter, 16, 147 Prone, 101, 147 Prophylaxis, 63, 124, 147, 150 Prostaglandin, 114, 147 Protective Agents, 118, 148 Protein C, 112, 113, 115, 116, 137, 148, 156 Protein S, 15, 74, 117, 127, 148 Proteinuria, 10, 148 Proteoglycan, 14, 148 Proteolytic, 121, 129, 148 Prothrombin, 148, 155 Protozoa, 139, 148, 153 Pruritic, 124, 148 Psyllium, 4, 12, 53, 148 Puberty, 77, 148 Public Health, 17, 96, 148 Public Policy, 95, 148 Pulmonary, 117, 122, 128, 132, 148 Pulmonary Artery, 117, 148 Pulse, 140, 148 Purines, 85, 148, 159 Purpura, 131, 149 Q Quality of Life, 74, 149 R Race, 17, 71, 139, 149 Radiation, 113, 149, 151, 159 Radioactive, 63, 118, 131, 133, 137, 142, 149, 151

Radioactivity, 63, 149 Radioisotope, 149, 156 Radiolabeled, 63, 149 Randomized, 126, 149 Rationalize, 33, 149 Receptor, 15, 16, 19, 22, 23, 24, 33, 67, 72, 75, 111, 114, 125, 131, 133, 138, 144, 149 Recombinant, 23, 40, 149 Recombination, 130, 149 Rectum, 118, 121, 125, 129, 134, 136, 149, 151 Reductase, 4, 68, 88, 137, 147, 149, 152 Refer, 1, 121, 125, 129, 149, 157 Regimen, 85, 126, 149 Relative risk, 7, 149 Renin, 114, 149 Renin-Angiotensin System, 114, 149 Research Design, 18, 150 Respiration, 115, 140, 150 Retina, 142, 150 Retinal, 125, 142, 150 Retinoids, 150, 158 Retinopathy, 80, 150 Rheumatism, 134, 150 Risk factor, 4, 5, 8, 10, 11, 12, 17, 20, 21, 22, 48, 71, 74, 76, 79, 83, 149, 150 Rod, 120, 150 Rye, 84, 120, 127, 150 S Salivary, 125, 150 Salivary glands, 125, 150 Saturated fat, 11, 17, 20, 34, 36, 78, 83, 150 Scans, 11, 150 Schizoid, 151, 158 Schizophrenia, 151, 158 Schizotypal Personality Disorder, 124, 151, 158 Scleroderma, 84, 151 Sclerosis, 84, 115, 151 Screening, 8, 35, 121, 151, 157 Secretion, 16, 134, 135, 143, 151 Sedentary, 29, 80, 151 Sediment, 151, 157 Senile, 68, 143, 151 Senile Plaques, 68, 151 Sequence Homology, 144, 151 Serum, 12, 21, 23, 24, 27, 28, 35, 36, 69, 112, 113, 115, 121, 130, 138, 151 Sex Characteristics, 148, 151, 154 Shock, 64, 151, 156 Side effect, 4, 27, 32, 72, 77, 87, 112, 133, 151, 155

Index 169

Sigmoid, 62, 151 Sigmoid Colon, 151 Simvastatin, 5, 36, 43, 152 Skeletal, 11, 120, 152 Skeleton, 136, 147, 152 Skull, 123, 152, 154 Sleep apnea, 72, 152 Small intestine, 117, 120, 126, 133, 134, 135, 152 Smooth muscle, 19, 113, 118, 129, 140, 150, 152, 154 Social Environment, 20, 149, 152 Sodium, 71, 131, 141, 152 Soft tissue, 117, 152 Solitary Nucleus, 116, 152 Solvent, 131, 143, 152 Soybean Oil, 146, 152 Specialist, 101, 152 Species, 118, 133, 139, 140, 149, 151, 152, 156, 158, 159 Spinal cord, 120, 126, 139, 141, 143, 145, 152, 154 Sporadic, 69, 141, 152 Spores, 84, 153 Stabilization, 12, 153 Staging, 150, 153 Statistically significant, 7, 153 Steatosis, 128, 153 Steel, 120, 153 Stem Cells, 22, 153 Steroid, 117, 123, 132, 152, 153 Stillbirth, 80, 153 Stimulant, 118, 153 Stimulus, 5, 122, 144, 153, 155 Stomach, 75, 111, 125, 127, 129, 130, 131, 133, 141, 144, 152, 153 Stool, 63, 134, 136, 153 Strand, 21, 153 Stress, 15, 28, 71, 72, 75, 76, 116, 123, 136, 141, 143, 147, 153 Stroke, 3, 8, 9, 11, 50, 59, 72, 73, 76, 80, 83, 94, 119, 153 Stromal, 118, 153 Stromal Cells, 118, 153 Stupor, 136, 140, 141, 153 Subacute, 135, 153 Subclinical, 135, 153 Subcutaneous, 111, 126, 144, 154, 158 Substance P, 127, 139, 151, 154 Suction, 129, 154 Supplementation, 40, 47, 77, 154 Survival Rate, 4, 154

Sympathetic Nervous System, 114, 116, 154 Synaptic, 142, 154 Synaptic Transmission, 142, 154 Synergistic, 23, 154 Systemic, 74, 84, 88, 114, 117, 135, 136, 151, 154 Systemic disease, 74, 154 Systolic, 133, 154 T Taurine, 13, 48, 117, 120, 154 Temporal, 24, 132, 154 Testosterone, 149, 154 Theophylline, 148, 154 Therapeutics, 89, 155 Threonine, 144, 155 Threshold, 13, 133, 155 Thrombin, 36, 128, 129, 146, 148, 155 Thrombosis, 36, 135, 148, 153, 155 Thrombus, 64, 123, 134, 140, 146, 155 Thyroid, 21, 76, 134, 155 Thyroid Gland, 76, 155 Thyroid Hormones, 21, 155 Thyrotropin, 134, 155 Thyroxine, 21, 112, 145, 155 Tinnitus, 76, 155, 158 Tolerance, 9, 33, 131, 155 Tooth Preparation, 111, 155 Toxic, iv, 14, 69, 120, 125, 134, 141, 142, 150, 155 Toxicity, 14, 24, 125, 155 Toxicology, 96, 155 Toxins, 66, 77, 114, 135, 156 Tracer, 63, 156 Trachea, 155, 156 Traction, 120, 156 Transfection, 117, 156 Transferases, 131, 156 Transient Ischemic Attacks, 8, 11, 50, 156 Translation, 127, 156 Translocation, 127, 156 Trauma, 75, 141, 156 Tricyclic, 75, 156 Triglyceride, 12, 31, 121, 133, 156 Tuberculosis, 122, 156 Type 2 diabetes, 3, 5, 6, 7, 8, 9, 12, 77, 79, 156 U Ultrafiltration, 13, 132, 156 Unconscious, 124, 134, 149, 156 Unsaturated Fats, 78, 156 Urea, 116, 156

170 High Cholesterol

Ureters, 136, 156, 157 Urethra, 156, 157 Uric, 85, 113, 131, 133, 148, 157 Urinalysis, 10, 157 Urinary, 77, 116, 118, 134, 156, 157, 159 Urinary tract, 77, 116, 157 Urinary tract infection, 77, 116, 157 Urine, 10, 85, 116, 117, 125, 132, 134, 136, 141, 148, 156, 157 Urine Testing, 10, 157 Uterus, 127, 139, 157 V Vagina, 124, 139, 157 Vascular, 12, 19, 23, 68, 118, 135, 155, 157 Vasodilation, 114, 157 Vasodilator, 113, 125, 157 Vasomotor, 127, 157 VE, 26, 27, 29, 157 Vein, 136, 142, 157 Venous, 148, 157 Venules, 117, 118, 157 Vesicular, 124, 157 Vestibular, 75, 157, 158 Vestibule, 157 Vestibulocochlear Nerve, 155, 157, 158

Vestibulocochlear Nerve Diseases, 155, 158 Veterinary Medicine, 95, 158 Villous, 119, 158 Viral, 75, 142, 158 Virulence, 116, 155, 158 Virus, 116, 130, 131, 146, 158 Visceral, 116, 158 Visceral Afferents, 116, 158 Vitamin A, 77, 158 Vitro, 23, 25, 158 Vivo, 23, 25, 158 W Waist circumference, 10, 158 Weight Gain, 73, 84, 158 White blood cell, 114, 136, 138, 140, 146, 158 Windpipe, 155, 158 Withdrawal, 34, 158 Wound Healing, 135, 159 X Xanthine, 113, 159 Xanthine Oxidase, 113, 159 Xenograft, 114, 159 X-ray, 122, 142, 151, 159 Y Yeasts, 129, 145, 159

Index 171

172 High Cholesterol

High Cholesterol - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cholesterol Test: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cholesterol-Lowering Drugs - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cholesterol - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High Blood Pressure - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High Blood Pressure - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High Fever: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

High Protein Diet - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High-risk Pregnancy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Influenza A - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hepatitis A Vaccine: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Butternut Squash: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Facial Paralysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Wine - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Breast Augmentation - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Premenstrual Dysphoric Disorder - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anagrelide: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Peanut Allergy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cauda Equina Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Magnesium Citrate: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lipomas - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Barbiturates - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cephalexin - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Body Dysmorphic Disorder: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lymphedema - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Dermabrasion: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Septra: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Vaginitis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Feet - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Glioblastoma Multiforme - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High Cholesterol - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cholesterol Test: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cholesterol-Lowering Drugs - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cholesterol - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High Blood Pressure - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High Blood Pressure - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High Fever: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

High Protein Diet - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

High-risk Pregnancy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Influenza A - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Hepatitis A Vaccine: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Foot and Mouth Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Butternut Squash: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Facial Paralysis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Wine - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Breast Augmentation - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Premenstrual Dysphoric Disorder - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Anagrelide: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Peanut Allergy: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Cauda Equina Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Magnesium Citrate: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lipomas - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Barbiturates - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Cephalexin - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Body Dysmorphic Disorder: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Lymphedema - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Dermabrasion: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Septra: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Vaginitis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Feet - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Glioblastoma Multiforme - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

Recommend Documents