Many infections favor or are directly implicated with lipid metabolism perturbations and/or increased risk of coronary heart disease (CHD). HIV itself has been shown to increase lipogenesis in the liver and to alter the lipid profile, while the presence of unsafe habits, addiction, comorbidities, and AIDS-related diseases increases substantially the risk of cardiovascular disease (CVD) in the HIV-infected population. Antiretroviral therapy reduces such stimuli but many drugs have intrinsic toxicity profiles impacting on metabolism or potential direct cardiotoxicity. In a moment when the main guidelines of HIV therapy are predating the point when to start treating, we mean to highlight the contribution of HIV-1 to lipid alteration and inflammation, the impact of antiretroviral therapy, the decisions on what drugs to use to reduce the probability of having a cardiovascular event, the increasing
use of statins and fibrates in HIV-1 infected subjects, and finally the switch strategies, that balance effectiveness and toxicity to move the decision to change HIV drugs. Early treatment might reduce the negative effect of HIV on overall cardiovascular risk but may also evidence the impact of drugs, and the final balance (reduction or increase in CHD and lipid abnormalities) is not known up to date.

Sara Melzi

Laura Carenzi

Maria Vittoria Cossu

Simone Passerini

Amedeo Capetti

Giuliano Rizzardini

Lipid Metabolism and Cardiovascular Risk in HIV-1 Infection and HAART: Present and Future Problems

A randomized trial of a pharmacist-delivered intervention (PI) versus usual care (UC) was conducted; 689 subjects with known coronary heart disease were recruited from cardiac catheterization laboratories. Participants in the PI condition received 5 pharmacist-delivered telephone counseling calls post-hospital discharge. At one year, 65&#x25; in the PI condition and 60&#x25; in the UC condition achieved an LDL-C level <svg     style="vertical-align:-0.1638pt;width:39.299999px;" id="M1" height="11.125" version="1.1" viewBox="0 0 39.299999 11.125" width="39.299999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z" /></g><g transform="matrix(.017,-0,0,-.017,14.749,10.862)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g><g transform="matrix(.017,-0,0,-.017,22.909,10.862)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,31.068,10.862)"><use xlink:href="#x30"/></g>

		
	
</svg>&#x2009;mg/dL (<svg     style="vertical-align:-0.20474pt;width:50.549999px;" id="M2" height="11.425" version="1.1" viewBox="0 0 50.549999 11.425" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><path id="x32" d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><path id="x39" d="M244 635q90 0 143 -72t53 -177q0 -133 -65 -229.5t-171 -139.5q-79 -32 -140 -32l-5 30q109 18 185 91t101 186l-68 -36q-29 -16 -60 -16q-79 0 -129 51.5t-50 130.5q0 80 57 146.5t149 66.5zM228 602q-52 0 -78 -45.5t-26 -98.5q0 -69 36.5 -115.5t97.5 -46.5&#xA;q53 0 90 28q4 31 4 66q0 51 -9.5 95.5t-39 80.5t-75.5 36z" /></g>

		
	
</svg>); mean statin adherence was 0.88 in the PI, and 0.90 in the UC (<svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M3" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x31"/></g>

		
	
</svg>). The highest percentage of those who reached the LDL-C goal were participants who used statins as opposed to those who did not use statins (67&#x25; versus 58&#x25;, <svg     style="vertical-align:-0.1638pt;width:50.549999px;" id="M4" height="11.375" version="1.1" viewBox="0 0 50.549999 11.375" width="50.549999"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,34.162,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x35"/></g>

		
	
</svg>). However, only 53&#x25; and 56&#x25; of the patients in the UC and PI conditions, respectively, were using statins. We conclude that a pharmacist-delivered intervention aimed only at improving patient adherence is unlikely to positively affect outcomes. Efforts must be oriented towards influencing physicians to increase statin prescription rates.

Yunsheng Ma

Ira S. Ockene

Milagros C. Rosal

Philip A. Merriam

Judith K. Ockene

Pritesh J. Gandhi

Randomized Trial of a Pharmacist-Delivered Intervention for Improving Lipid-Lowering Medication Adherence among Patients with Coronary Heart Disease

Treatment of cardiovascular disease, albeit under the auspices of other clinical descriptors to those described in western biomedicine, has a long history in China. Chinese Medicine (CM) is guided by unique philosophical underpinnings and theories. There are differences in how the heart is conceptualised traditionally in CM compared to biomedicine. This paper focusses on how hypercholesterolemia is understood from within the Chinese medical paradigm, including its aetiology, pathogenesis, and treatment. A brief overview of the key characteristics and theories of CM is given to provide context. Modern science has demonstrated that many Chinese herbs have cholesterol-lowering properties. Examples of research into individual herbs and medicinal formulae, combinations of herbs are presented. At a more sophisticated level, some researchers are challenging some of the very assumptions upon which CM is based, including applicability of CM theory to modern clinical entities such as hypercholesterolemia, and are seeking intersections of knowledge between CM and biomedicine that may extend CM theory.

Kylie A. O&#39;Brien

Alternative Perspectives: How Chinese Medicine Understands Hypercholesterolemia

This study was conducted to elucidate the mechanism underlying the hypolipidemic action of karaya saponin or <i  >Rhodobacter (R.) capsulatus</i>. A total of 40 laying hens (20-week-old) were assigned into four dietary treatment groups and fed a basal diet (as a control) or basal diets supplemented with either karaya saponin, <i  >R. capsulatus</i>, or both for 60 days. The level of serum low-density-lipoprotein cholesterol and the levels of cholesterol and triglycerides in the serum, liver, and egg yolk were reduced by all the supplementations (<svg style="vertical-align:-0.30096pt;width:48.337502px;" id="M1" height="11.25" version="1.1" viewBox="0 0 48.337502 11.25" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.25)">
		<g transform="translate(72,-63)">
			<text transform="matrix(1,0,0,-1,-71.95,63.35)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
				<tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">5</tspan>
			</text>

		</g>
	</g>
</svg>). Liver bile acid concentration and fecal concentrations of cholesterol, triacylglycerol, and bile acid were simultaneously increased by the supplementation of karaya saponin, <i  >R. capsulatus</i>, and the combination of karaya saponin and <i  >R. capsulatus</i> (<svg style="vertical-align:-0.30096pt;width:48.337502px;" id="M2" height="11.25" version="1.1" viewBox="0 0 48.337502 11.25" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.25)">
		<g transform="translate(72,-63)">
			<text transform="matrix(1,0,0,-1,-71.95,63.35)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
				<tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">5</tspan>
			</text>

		</g>
	</g>
</svg>). The supplementation of karaya saponin, <i  >R. capsulatus</i>, and the combination of karaya saponin and <i  >R. capsulatus</i> suppressed the incorporation of <svg style="vertical-align:-0.17554pt;width:22.112499px;" id="M3" height="13.9875" version="1.1" viewBox="0 0 22.112499 13.9875" width="22.112499"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,13.9875)">
		<g transform="translate(72,-60.81)">
			<text transform="matrix(1,0,0,-1,-71.95,66.03)">
				<tspan style="font-size: 8.75px; " x="0" y="0">1</tspan>
				<tspan style="font-size: 8.75px; " x="4.3759999" y="0">4</tspan>
			</text>

			<text transform="matrix(1,0,0,-1,-62.7,61.03)">
				<tspan style="font-size: 12.50px; " x="0" y="0">C</tspan>
			</text>

		</g>
	</g>
</svg> from <svg style="vertical-align:-0.17554pt;width:35.125px;" id="M4" height="13.9875" version="1.1" viewBox="0 0 35.125 13.9875" width="35.125"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,13.9875)">
		<g transform="translate(72,-60.81)">
			<text transform="matrix(1,0,0,-1,-71.95,61.03)">
				<tspan style="font-size: 12.50px; " x="0" y="0">1</tspan>
				<tspan style="font-size: 12.50px; " x="6.2515001" y="0">-</tspan>
			</text>

			<text transform="matrix(1,0,0,-1,-61.54,66.03)">
				<tspan style="font-size: 8.75px; " x="0" y="0">1</tspan>
				<tspan style="font-size: 8.75px; " x="4.3759999" y="0">4</tspan>
			</text>

			<text transform="matrix(1,0,0,-1,-52.28,61.03)">
				<tspan style="font-size: 12.50px; " x="0" y="0">C</tspan>
			</text>

		</g>
	</g>
</svg>-palmitic acid into the fractions of total lipids, phospholipids, triacylglycerol, and cholesterol in the liver in vitro (<svg style="vertical-align:-0.30096pt;width:48.337502px;" id="M5" height="11.25" version="1.1" viewBox="0 0 48.337502 11.25" width="48.337502"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,11.25)">
		<g transform="translate(72,-63)">
			<text transform="matrix(1,0,0,-1,-71.95,63.35)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="10.890113" y="0">&lt;</tspan>
				<tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">5</tspan>
			</text>

		</g>
	</g>
</svg>). These findings suggest that the hypocholesterolemic effects of karaya saponin and <i  >R. capsulatus</i> are caused by the suppression of the cholesterol synthesis and the promotion of cholesterol catabolism in the liver. 

Sadia Afrose

Md. Sharoare Hossain

Ummay Salma

Abdul Gaffar Miah

Hirotada Tsujii

Dietary Karaya Saponin and <i>Rhodobacter capsulatus</i> Exert Hypocholesterolemic Effects by Suppression of Hepatic Cholesterol Synthesis and Promotion of Bile Acid Synthesis in Laying Hens

<i  >Objective</i>. To assess the effectiveness of niacin/fish oil combination therapy in reducing Lipoprotein (a) [Lp(a)] levels after twelve weeks of therapy. 
<i  >Background</i>. Lipoprotein (a) accumulates in atherosclerotic lesions and promotes smooth muscle cell growth and is both atherogenic and thrombogenic. A clinical trials of combination therapy for the reduction of Lp(a) has not been previously reported. 
<i  >Methods</i>. The study was an observational study following subjects with an elevated Lp(a) (<svg style="vertical-align:-0.30096pt;width:10.825px;" id="M1" height="8.8500004" version="1.1" viewBox="0 0 10.825 8.8500004" width="10.825"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,8.85)">
		<g transform="translate(72,-64.92)">
			<text transform="matrix(1,0,0,-1,-71.95,65.27)">
				<tspan style="font-size: 12.50px; " x="0" y="0">&gt;</tspan>
			</text>

		</g>
	</g>
</svg>70&#x2009;nmol/L) to assess impact of 12 weeks of combination Omega 3FA, niacin, and the Mediterranean diet on Lp(a). 
<i  >Results</i>. Twenty three patients were enrolled with 7 patients lost to follow up and 2 patients stopped due to adverse events. The average Lp(a) reduction in the remaining 14 subjects after 12 weeks of combination therapy was <svg style="vertical-align:-1.09097pt;width:50.287498px;" id="M2" height="12.5125" version="1.1" viewBox="0 0 50.287498 12.5125" width="50.287498"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,12.5125)">
		<g transform="translate(72,-61.99)">
			<text transform="matrix(1,0,0,-1,-71.95,63.12)">
				<tspan style="font-size: 12.50px; " x="0" y="0">2</tspan>
				<tspan style="font-size: 12.50px; " x="6.2515001" y="0">3</tspan>
				<tspan style="font-size: 12.50px; " x="12.503" y="0">%</tspan>
				<tspan style="font-size: 12.50px; " x="28.781906" y="0">±</tspan>
			</text>

		</g>
	</g>
</svg> 17&#x25; <svg style="vertical-align:-1.95624pt;width:66.550003px;" id="M3" height="13.125" version="1.1" viewBox="0 0 66.550003 13.125" width="66.550003"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,13.125)">
		<g transform="translate(72,-61.5)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">[</tspan>
				<tspan style="font-size: 12.50px; " x="4.1634989" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="15.053612" y="0">=</tspan>
				<tspan style="font-size: 12.50px; " x="27.094002" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="30.219751" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="36.471252" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="42.722752" y="0">3</tspan>
				<tspan style="font-size: 12.50px; " x="48.974251" y="0">]</tspan>
			</text>

		</g>
	</g>
</svg> with a significant association of the reduction of Lp(a) with increasing baseline levels of Lp(a) [<svg style="vertical-align:-0.17555pt;width:71.199997px;" id="M4" height="13.9875" version="1.1" viewBox="0 0 71.199997 13.9875" width="71.199997"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,13.9875)">
		<g transform="translate(72,-60.81)">
			<text transform="matrix(1,0,0,-1,-71.95,61.03)">
				<tspan style="font-size: 12.50px; " x="0" y="0">R</tspan>
			</text>

			<text transform="matrix(1,0,0,-1,-63.61,66.03)">
				<tspan style="font-size: 8.75px; " x="0" y="0">2</tspan>
			</text>

			<text transform="matrix(1,0,0,-1,-55.26,61.03)">
				<tspan style="font-size: 12.50px; " x="0" y="0">=</tspan>
				<tspan style="font-size: 12.50px; " x="12.027886" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="18.279387" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="21.405136" y="0">6</tspan>
				<tspan style="font-size: 12.50px; " x="27.656635" y="0">3</tspan>
				<tspan style="font-size: 12.50px; " x="33.908134" y="0">3</tspan>
			</text>

		</g>
	</g>
</svg>, <svg style="vertical-align:-0.17555pt;width:56.150002px;" id="M5" height="10.9125" version="1.1" viewBox="0 0 56.150002 10.9125" width="56.150002"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,10.9125)">
		<g transform="translate(72,-63.27)">
			<text transform="matrix(1,0,0,-1,-71.95,63.5)">
				<tspan style="font-size: 12.50px; " x="0" y="0">𝑃</tspan>
				<tspan style="font-size: 12.50px; " x="10.890113" y="0">=</tspan>
				<tspan style="font-size: 12.50px; " x="22.930502" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="26.056252" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="38.559254" y="0">1</tspan>
			</text>

		</g>
	</g>
</svg>]. 
<i  >Conclusions</i>. There was a significant reduction in Lp(a) levels with combination therapy. A more pronounced effect was noted in patients with higher baseline levels of Lp(a).

Alan F. Helmbold

Jennifer N. Slim

Jennifer Morgan

Laudino M. Castillo-Rojas

Eric A. Shry

Ahmad M. Slim

The Effects of Extended Release Niacin in Combination with Omega 3 Fatty Acid Supplements in the Treatment of Elevated Lipoprotein (a)

Recent studies suggest that lecithin-rich diet can modify cholesterol homeostasis and hepatic lipoprotein metabolism. Considering the phytotherapeutic impact of lecithin, this work hypothesizes that lecithin administration in hypercholesterolemic patients may reduce cholesterol concentrations by increasing biliary secretion. Total cholesterol and LDL were evaluated after soy lecithin administration in hypercholesterolemic patients. One soy lecithin capsule (500&#x2009;mg/RP-Sherer) was administrated daily. One-two months before the treatment beginning, blood samples were collected for total lipids and cholesterol fractions analysis. The results showed a reduction of 40.66&#x25; and 42.00&#x25; in total cholesterol and of 42.05&#x25; and 56.15&#x25; in LDL cholesterol after treatment for one and two months, respectively. A significant reduction in total cholesterol and LDL-cholesterol concentrations was observed during the first month of treatment, suggesting that the administration of soy lecithin daily may be used as a supplemental treatment in hypercholesterolemia.

Amouni Mohamed Mourad

Eder de Carvalho Pincinato

Priscila Gava Mazzola

Maricene Sabha

Patricia Moriel

Influence of Soy Lecithin Administration on Hypercholesterolemia

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