High density lipoprotein prevention: Difference between revisions

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==Overview==
==Overview==
[[Statins]] and [[fibrate]] appear to be effective in patients with low [[HDL]] levels compared to those in normal [[HDL]] levels in terms of risk reduction.[[Fibrates]] are more effective when low [[HDL]] levels coincide with low levels of [[LDL]] levels.  Before a combination of [[statins]] and [[fibrates]] are considered, dietary modifications and lifestyle changes can be effective tools to raise [[HDL]] levels. However, a combination therapy of statins with fibrates can result in [[myopathy]] as a potential adverse effect.
Prevention of low HDL may be achieved through lifestyle modifications such as [[physical exercise]], [[smoking cessation]], [[weight loss]],<ref name="Berns-1989">{{Cite journal  | last1 = Berns | first1 = MA. | last2 = de Vries | first2 = JH. | last3 = Katan | first3 = MB. | title = Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period.|journal = Am J Epidemiol | volume = 130 | issue = 6 | pages = 1109-22 | month = Dec | year = 1989 | doi = | PMID = 2589304 }}</ref> [[dieting]],<ref name="Wood-1988">{{Cite journal  | last1 = Wood|first1 = PD. | last2 = Stefanick | first2 = ML. | last3 = Dreon | first3 = DM. | last4 = Frey-Hewitt | first4 = B. | last5 = Garay | first5 = SC. | last6 = Williams | first6 = PT. | last7 = Superko | first7 = HR. | last8 = Fortmann | first8 = SP. | last9 = Albers | first9 = JJ. | title = Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. | journal = N Engl J Med | volume = 319 | issue = 18 | pages = 1173-9 | month = Nov | year = 1988 | doi = 10.1056/NEJM198811033191801 | PMID = 3173455 }}</ref>  and intake of unhydrogenated [[monounsaturated fat]].<ref name="Oh-2005">{{Cite journal  | last1 = Oh | first1 = K. | last2 = Hu | first2 = FB. | last3 = Manson | first3 = JE. | last4 = Stampfer | first4 = MJ. | last5 = Willett | first5 = WC. | title = Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study. | journal = Am J Epidemiol | volume = 161 | issue = 7 | pages = 672-9 | month = Apr | year = 2005 | doi = 10.1093/aje/kwi085 | PMID = 15781956 }}</ref><ref name="Mensink-1990">{{Cite journal  | last1 = Mensink | first1 = RP. | last2 = Katan | first2 = MB. | title = Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects. | journal = N Engl J Med | volume = 323| issue = 7 | pages = 439-45 | month = Aug | year = 1990 | doi = 10.1056/NEJM199008163230703 | PMID = 2374566 }}</ref>
 
===Risk Assessment===
Patients without established [[coronary heart disease]] should be thoroughly assessed with an improved risk prediction tool e.g., [[Framingham risk score|Framingham risk prediction chart]] to determine when to start pharmacotherapy for those at high risk for CHD. Another way to assess the CHD risk is by the use of lipid CHD risk markers (e.g., lipoprotein(a), apolipoprotein B, dense LDL-C) and non-lipid CHD risk markers such as [[homocysteine]],<ref name="Boushey-1995">{{Cite journal  | last1 = Boushey | first1 = CJ. | last2 = Beresford | first2 = SA. | last3 = Omenn | first3 = GS. | last4 = Motulsky | first4 = AG. | title = A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. | journal = JAMA | volume = 274 | issue = 13 | pages = 1049-57 | month = Oct | year = 1995 | doi = | PMID = 7563456 }}</ref> [[fibrinogen]], or [[C-reactive protein]]


==Primary Prevention==
==Primary Prevention==
Shown below is a table summarizing lifestyle modifications and their effect on HDL concentration.


===Lifestyle Modification===
{| cellpadding=3 cellspacing=0 border=1 style="border-collapse:collapse"
{| cellpadding=3 cellspacing=0 border=1 style="border-collapse:collapse"
|bgcolor="#cccccc"| '''LIFESTYLE MEASURE'''
|bgcolor="#cccccc"| '''LIFESTYLE MEASURE'''
Line 32: Line 29:
|-
|-
| Low carbohydrate diet
| Low carbohydrate diet
| 4.5mg/dl increase in HDL<ref name="Nordmann-2006">{{Cite journal  | last1 = Nordmann | first1 = AJ. | last2 = Nordmann | first2 = A. | last3 = Briel | first3 = M. | last4 = Keller | first4 = U. | last5 = Yancy | first5 = WS. | last6 = Brehm | first6 = BJ. | last7 = Bucher | first7 = HC. | title = Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. | journal = Arch Intern Med |volume = 166 | issue = 3 | pages = 285-93 | month = Feb | year = 2006 | doi = 10.1001/archinte.166.3.285 | PMID = 16476868 }}</ref>
| 4.5 mg/dl increase in HDL<ref name="Nordmann-2006">{{Cite journal  | last1 = Nordmann | first1 = AJ. | last2 = Nordmann | first2 = A. | last3 = Briel | first3 = M. | last4 = Keller | first4 = U. | last5 = Yancy | first5 = WS. | last6 = Brehm | first6 = BJ. | last7 = Bucher | first7 = HC. | title = Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. | journal = Arch Intern Med |volume = 166 | issue = 3 | pages = 285-93 | month = Feb | year = 2006 | doi = 10.1001/archinte.166.3.285 | PMID = 16476868 }}</ref>
|-
|-
| Soy protein with isoflavones
| Soy protein with isoflavones
Line 50: Line 47:
| 5-10% increase in HDL<ref name="Rimm-1999">{{Cite journal  | last1 = Rimm | first1 = EB. | last2 = Williams | first2 = P. | last3 = Fosher | first3 = K. | last4 = Criqui | first4 = M. | last5 = Stampfer | first5 = MJ. | title = Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. | journal = BMJ | volume = 319 | issue = 7224 | pages = 1523-8 | month = Dec | year = 1999 | doi =  | PMID = 10591709 }}</ref>
| 5-10% increase in HDL<ref name="Rimm-1999">{{Cite journal  | last1 = Rimm | first1 = EB. | last2 = Williams | first2 = P. | last3 = Fosher | first3 = K. | last4 = Criqui | first4 = M. | last5 = Stampfer | first5 = MJ. | title = Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. | journal = BMJ | volume = 319 | issue = 7224 | pages = 1523-8 | month = Dec | year = 1999 | doi =  | PMID = 10591709 }}</ref>
|}
|}
===Who To Treat===
===Pharmacologic Therapy===
{| cellpadding=3 cellspacing=0 border=1 style="border-collapse:collapse"
|bgcolor="#cccccc"| '''DRUGS'''
|bgcolor="#cccccc"| '''MECHANISM OF ACTION'''
|bgcolor="#cccccc"| '''EFFECT ON HDL'''
|bgcolor="#cccccc"| '''SIDE EFFECTS'''
|-
| [[Nicotinic acid]] (Niacin)
|Decreases VLDL synthesis in the liver through diaglycerol acyl transferase-2 (DGAT-2),<ref name="Wierzbicki-2011">{{Cite journal  | last1 = Wierzbicki |first1 = AS. | title = Niacin: the only vitamin that reduces cardiovascular events. | journal = Int J Clin Pract | volume = 65 | issue = 4 | pages = 379-85 |month = Apr | year = 2011 | doi = 10.1111/j.1742-1241.2011.02630.x | PMID = 21401825 }}</ref> decreases HDL-apo A-I catabolism<ref name="Kamanna-2008">{{Cite journal  | last1 = Kamanna | first1 = VS. | last2 = Kashyap | first2 = ML. | title = Mechanism of action of niacin. | journal = Am J Cardiol | volume = 101 |issue = 8A | pages = 20B-26B | month = Apr | year = 2008 | doi = 10.1016/j.amjcard.2008.02.029 | PMID = 18375237 }}</ref>
|15-35% increase
|Cutaneous [[flushing]], [[hyperglycemia]], [[hyperuricemia]], [[hepatotoxicity]]
|-
| [[Fibrate]]s
|Direct stimulation of apo-A1 and apo-AII synthesis via [[peroxisome proliferator-activated receptor]]s,<ref name="Vu-Dac-1995">{{Cite journal  | last1 = Vu-Dac | first1 = N. | last2 = Schoonjans | first2 = K. | last3 = Kosykh | first3 = V. | last4 = Dallongeville | first4 = J. | last5 = Fruchart | first5 = JC. |last6 = Staels | first6 = B. | last7 = Auwerx | first7 = J. | title = Fibrates increase human apolipoprotein A-II expression through activation of the peroxisome proliferator-activated receptor. | journal = J Clin Invest | volume = 96 | issue = 2 | pages = 741-50 | month = Aug | year = 1995 | doi = 10.1172/JCI118118 | PMID = 7635967 }}</ref>
|10-20% increase
|Increased risk of [[myopathy]] when combined with statins, [[gallstones]], [[dyspepsia]]
|-
| [[HMG-CoA reductase inhibitor]]
| Increases synthesis of apo-A1 and HDL in the liver,<ref name="Yamashita-2010">{{Cite journal  | last1 = Yamashita | first1 = S. | last2 = Tsubakio-Yamamoto |first2 = K. | last3 = Ohama | first3 = T. | last4 = Nakagawa-Toyama | first4 = Y. | last5 = Nishida | first5 = M. | title = Molecular mechanisms of HDL-cholesterol elevation by statins and its effects on HDL functions. | journal = J Atheroscler Thromb | volume = 17 | issue = 5 | pages = 436-51 | month = May |year = 2010 | doi =  | PMID = 20513953 }}</ref> increases [[ABCA1]] mRNA in hepG2 cells,<ref name="Maejima-2011">{{Cite journal  | last1 = Maejima | first1 = T. | last2 = Sugano | first2 = T. | last3 = Yamazaki | first3 = H. | last4 = Yoshinaka | first4 = Y. | last5 = Doi | first5 = T. | last6 = Tanabe | first6 = S.| last7 = Nishimaki-Mogami | first7 = T. | title = Pitavastatin increases ABCA1 expression by dual mechanisms: SREBP2-driven transcriptional activation and PPARα-dependent protein stabilization but without activating LXR in rat hepatoma McARH7777 cells. | journal = J Pharmacol Sci | volume = 116 | issue = 1 |pages = 107-15 | month =  | year = 2011 | doi =  | PMID = 21521932 }}</ref> inhibits CETP mass and activities<ref name="van Venrooij-2003">{{Cite journal  |last1 = van Venrooij | first1 = FV. | last2 = Stolk | first2 = RP. | last3 = Banga | first3 = JD. | last4 = Sijmonsma | first4 = TP. | last5 = van Tol | first5 = A. | last6 = Erkelens | first6 = DW. | last7 = Dallinga-Thie | first7 = GM. | title = Common cholesteryl ester transfer protein gene polymorphisms and the effect of atorvastatin therapy in type 2 diabetes. | journal = Diabetes Care | volume = 26 | issue = 4 | pages = 1216-23 | month = Apr | year = 2003 | doi =  |PMID = 12663600 }}</ref>
|5-15% increase
|[[Myopathy]], [[rhabdomyolysis]]
|-
| [[Ezetimibe]]
|Inhibits cholesterol absorption at intestine level
|3% increase in HDL along with statins<ref name="Ballantyne-2003">{{Cite journal  | last1 = Ballantyne | first1 = CM. | last2 = Houri | first2 = J. | last3 = Notarbartolo | first3 = A. | last4 = Melani | first4 = L. | last5 = Lipka | first5 = LJ. | last6 = Suresh | first6 = R. | last7 = Sun | first7 = S. | last8 = LeBeaut | first8 = AP. | last9 = Sager | first9 = PT. | title = Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia: a prospective, randomized, double-blind trial. | journal = Circulation | volume = 107 | issue = 19 | pages = 2409-15 | month = May | year = 2003 | doi = 10.1161/01.CIR.0000068312.21969.C8 | PMID = 12719279 }}</ref>
|[[Headache]], [[diarrhea]], [[hypersensitivity]]
|-
| [[Thiazolidinedione]]s
|Increase in [[adiponectin]] which increases insulin resistance
|14% increase in HDL<ref name="Szapary-2006">{{Cite journal  | last1 = Szapary | first1 = PO. | last2 = Bloedon | first2 = LT. | last3 = Samaha | first3 = FF.| last4 = Duffy | first4 = D. | last5 = Wolfe | first5 = ML. | last6 = Soffer | first6 = D. | last7 = Reilly | first7 = MP. | last8 = Chittams | first8 = J. |last9 = Rader | first9 = DJ. | title = Effects of pioglitazone on lipoproteins, inflammatory markers, and adipokines in nondiabetic patients with metabolic syndrome. | journal = Arterioscler Thromb Vasc Biol | volume = 26 | issue = 1 | pages = 182-8 | month = Jan | year = 2006 | doi = 10.1161/01.ATV.0000195790.24531.4f | PMID = 16284192 }}</ref>
|Fluid retention
|-
| [[Hormone replacement therapy]]
|Increases Apo-A1 and decreases activity of [[hepatic lipase]]
|5 to 20% increase
|Increases risk of [[stroke]] and [[thromboembolic disease]]s
|-
| [[Bile acid sequestrant]]s
| Increases apo A-1 production<ref name="Shepherd-1989">{{Cite journal  | last1 = Shepherd | first1 = J. | title = Mechanism of action of bile acid sequestrants and other lipid-lowering drugs. | journal = Cardiology | volume = 76 Suppl 1 | issue =  | pages = 65-71; discussion 71-4 | month =  | year = 1989| doi =  | PMID = 2713876 }}</ref>
| 3-5% increase
| GI discomfort, [[constipation]], reduces absorption of other medications
|}
{{familytree/start |summary=Treatment of low HDL}}
{{familytree | | | | | | | | | | | | | | | A01 | | | | | A01='''Low HDL'''}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | | | B02 | | | | | | B02=<u>Rule out secondary causes</u><br>[[Hypothyroidism]]<br>[[Diabetes mellitus]]<br>[[Uremia]]<br>[[Liver disease]]<br>Medications - [[diuretic]]s, [[progestin]], [[androgen]]s, [[beta blocker]]s<br>Acute illness - MI, burns, surgery}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | | | C01 | | | | | | C01=<u>Lifestyle modification</u><br>[[Diet]]<ref name="Wood-1988">{{Cite journal  | last1 = Wood|first1 = PD. | last2 = Stefanick | first2 = ML. | last3 = Dreon | first3 = DM. | last4 = Frey-Hewitt | first4 = B. | last5 = Garay | first5 = SC. | last6 = Williams | first6 = PT. | last7 = Superko | first7 = HR. | last8 = Fortmann | first8 = SP. | last9 = Albers | first9 = JJ. | title = Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. | journal = N Engl J Med | volume = 319 | issue = 18 | pages = 1173-9 | month = Nov | year = 1988 | doi = 10.1056/NEJM198811033191801 | PMID = 3173455 }}</ref><br>[[Physical exercise]]<br>[[Smoking cessation]]<br>[[Weight loss]]<ref name="Berns-1989">{{Cite journal  | last1 = Berns | first1 = MA. | last2 = de Vries | first2 = JH. | last3 = Katan | first3 = MB. | title = Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period.|journal = Am J Epidemiol | volume = 130 | issue = 6 | pages = 1109-22 | month = Dec | year = 1989 | doi =  | PMID = 2589304 }}</ref><br>Intake of unhydrogenated [[monounsaturated fat]]<ref name="Oh-2005">{{Cite journal  | last1 = Oh | first1 = K. | last2 = Hu | first2 = FB. | last3 = Manson | first3 = JE. | last4 = Stampfer | first4 = MJ. | last5 = Willett | first5 = WC. | title = Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study. | journal = Am J Epidemiol | volume = 161 | issue = 7 | pages = 672-9 | month = Apr | year = 2005 | doi = 10.1093/aje/kwi085 | PMID = 15781956 }}</ref><ref name="Mensink-1990">{{Cite journal  | last1 = Mensink | first1 = RP. | last2 = Katan | first2 = MB. | title = Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects. | journal = N Engl J Med | volume = 323| issue = 7 | pages = 439-45 | month = Aug | year = 1990 | doi = 10.1056/NEJM199008163230703 | PMID = 2374566 }}</ref>
e.g., olive oil, canola oil}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | |!| |}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | E02 | |E02=Assess risk}}
{{familytree | | | | | | | | | | | | | |,|-|^|-|-|-|-|.| | | | | |}}
{{familytree | | | | | | | | | | | | | F03 | | | | | F04 | |F03=<u>'''High risk'''</u><br><br> CHD risk>20% per 10 years|F04=<u>'''Low risk'''</u><br><br>CHD≤20% per 10 years}}
{{familytree | | | | | | | | | | | | | |!| | | | | | |!| | | |}}
{{familytree | | | | | | | | | | | | | |!| | | | | | |!| | |}}
{{familytree | | | | | | | | | | | | | |!| | | | | | |!| | }}
{{familytree | | | | | | | | | | | | | H04 | | | | | |!| |H04=[[Statins]] or [[Niacin]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | }}
{{familytree | | | | | | | | | | | | | | | | I05 | | | | | | I06 | |I05=Positive family history of premature CHD|I06=Negative family history of premature CHD}}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | |}}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | | K04 | | | | | | K05 |K04=Considar [[statin]]s or [[niacin]]|K05=Continue non-pharmacological approach}}
{{familytree/end}}


==References==
==References==
Line 131: Line 57:
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Lipoproteins]]
[[Category:Lipoproteins]]
[[Category:HDLpedia]]


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Latest revision as of 16:03, 9 October 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

Prevention of low HDL may be achieved through lifestyle modifications such as physical exercise, smoking cessation, weight loss,[1] dieting,[2] and intake of unhydrogenated monounsaturated fat.[3][4]

Primary Prevention

Shown below is a table summarizing lifestyle modifications and their effect on HDL concentration.

LIFESTYLE MEASURE EFFECT ON HDL
Physical exercise[5] 5-30% increase
Weight reduction 5-20% increase[6]
Smoking cessation 5% increase[7]
Multivitamins 31% increase in HDL
DASH diet 21% increase in HDL[8]
Low carbohydrate diet 4.5 mg/dl increase in HDL[9]
Soy protein with isoflavones 3% increase in HDL[10]
Fish oil (omega-3 fatty acid) Significant increase in HDL2 fraction[11]
Fish oil with exercise 8% increase in HDL[12]
Low fat diet 5-14% increase in HDL when combined with exercise[13]
Moderate alcohol consumption 5-10% increase in HDL[14]

References

  1. ↑ Berns, MA.; de Vries, JH.; Katan, MB. (1989). "Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period". Am J Epidemiol. 130 (6): 1109–22. PMID 2589304. Unknown parameter |month= ignored (help)
  2. ↑ Wood, PD.; Stefanick, ML.; Dreon, DM.; Frey-Hewitt, B.; Garay, SC.; Williams, PT.; Superko, HR.; Fortmann, SP.; Albers, JJ. (1988). "Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise". N Engl J Med. 319 (18): 1173–9. doi:10.1056/NEJM198811033191801. PMID 3173455. Unknown parameter |month= ignored (help)
  3. ↑ Oh, K.; Hu, FB.; Manson, JE.; Stampfer, MJ.; Willett, WC. (2005). "Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study". Am J Epidemiol. 161 (7): 672–9. doi:10.1093/aje/kwi085. PMID 15781956. Unknown parameter |month= ignored (help)
  4. ↑ Mensink, RP.; Katan, MB. (1990). "Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects". N Engl J Med. 323 (7): 439–45. doi:10.1056/NEJM199008163230703. PMID 2374566. Unknown parameter |month= ignored (help)
  5. ↑ Thompson PD (1990). "What do muscles have to do with lipoproteins?". Circulation. 81 (4): 1428–30. PMID 2317921.
  6. ↑ Dattilo AM, Kris-Etherton PM (1992). "Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis". Am J Clin Nutr. 56 (2): 320–8. PMID 1386186.
  7. ↑ Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH (2011). "Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial". Am Heart J. 161 (1): 145–51. doi:10.1016/j.ahj.2010.09.023. PMC 3110741. PMID 21167347.
  8. ↑ Azadbakht, L.; Mirmiran, P.; Esmaillzadeh, A.; Azizi, T.; Azizi, F. (2005). "Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome". Diabetes Care. 28 (12): 2823–31. PMID 16306540. Unknown parameter |month= ignored (help)
  9. ↑ Nordmann, AJ.; Nordmann, A.; Briel, M.; Keller, U.; Yancy, WS.; Brehm, BJ.; Bucher, HC. (2006). "Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials". Arch Intern Med. 166 (3): 285–93. doi:10.1001/archinte.166.3.285. PMID 16476868. Unknown parameter |month= ignored (help)
  10. ↑ Zhan, S.; Ho, SC. (2005). "Meta-analysis of the effects of soy protein containing isoflavones on the lipid profile". Am J Clin Nutr. 81 (2): 397–408. PMID 15699227. Unknown parameter |month= ignored (help)
  11. ↑ Sacks FM, Hebert P, Appel LJ, Borhani NO, Applegate WB, Cohen JD; et al. (1994). "The effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the Trials of Hypertension Prevention. Trials of Hypertension Prevention Collaborative Research Group". J Hypertens Suppl. 12 (7): S23–31. PMID 7769501.
  12. ↑ Herrmann W, Biermann J, Kostner GM (1995). "Comparison of effects of N-3 to N-6 fatty acids on serum level of lipoprotein(a) in patients with coronary artery disease". Am J Cardiol. 76 (7): 459–62. PMID 7653444.
  13. ↑ Varady KA, Jones PJ (2005). "Combination diet and exercise interventions for the treatment of dyslipidemia: an effective preliminary strategy to lower cholesterol levels?". J Nutr. 135 (8): 1829–35. PMID 16046704.
  14. ↑ Rimm, EB.; Williams, P.; Fosher, K.; Criqui, M.; Stampfer, MJ. (1999). "Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors". BMJ. 319 (7224): 1523–8. PMID 10591709. Unknown parameter |month= ignored (help)


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