Plasma Levels o f Cholesterol and Risk o f Atherosclerosis in Adults
< 2 0 0
< 1 0 0
Cardioprotective: >60 mg/dl
*LDL level 100-129 mg/dl considered near optimal/above optimal.
The Total Plasma and LDL-Cholesterol Levels in Children and Adolescents from Families with Hypercholes-
terolemia or Premature Cardiovascular Disease
< 1 0 0
> 2 0 0
Examples o f Secondary Causes That Can Alter Plasma
Acute inflammatory disorders
Commonly Prescribed Drugs
/3-Adrenergic blocking agents
important to initiate lifestyle changes that include weight
loss in obese individuals, dietary modifications (e.g., re-
duced saturated fat intake including
exercise, avoidance of tobacco, and moderate alcohol
consumption. Individuals who are homozygous for a
slow oxidizing alcohol dehydrogenase gene (ADH3)
have higher HDL-cholesterol levels and a lower risk
of myocardial infarction. In the absence of positive re-
sults with lifestyle therapy, the pharmacological agents
for increasing HDL cholesterol levels includes niacin
and estrogen in postmenopausal women. Modest in-
creases in HDL cholesterol levels are also observed
with HMG-CoA reductase inhibitors and fibric acids.
Another factor that regulates HDL cholesterol lev-
els is the plasma level of cholesteryl ester transfer pro-
tein (CETP). CETP, a hydrophobic glycoprotein (M.W.
741,000), facilitates the transfer of cholesteryl esters in
HDL and triacylglycerols in LDL and VLDL (see above).
In CETP deficiency due to a point mutation (G ->• A)
in a splice donor site that prevents normal processing of
mRNA, the plasma HDL cholesterol levels of affected in-
dividuals are markedly high, with decreased LDL choles-
terol. In the affected families, there was no evidence
of premature atherosclerosis and, in fact, there was a
trend toward longevity. These observations support the
role of CETP and the antiatherogenic property of HDL.
However, not all factors that elevate HDL levels may be