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

CHOLESTEROL A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES J AMES N...

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

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

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2003 by ICON Group International, Inc. Copyright Ó2003 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., 1960Cholesterol: 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: 0-597-83615-9 1. Cholesterol-Popular works. I. Title.

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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.

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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 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.

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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.

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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

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CHOLESTEROL........................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Cholesterol..................................................................................... 9 E-Journals: PubMed Central ....................................................................................................... 65 The National Library of Medicine: PubMed ................................................................................ 80 CHAPTER 2. NUTRITION AND CHOLESTEROL ............................................................................... 171 Overview.................................................................................................................................... 171 Finding Nutrition Studies on Cholesterol ................................................................................. 171 Federal Resources on Nutrition ................................................................................................. 179 Additional Web Resources ......................................................................................................... 179 CHAPTER 3. ALTERNATIVE MEDICINE AND CHOLESTEROL ........................................................ 193 Overview.................................................................................................................................... 193 National Center for Complementary and Alternative Medicine................................................ 193 Additional Web Resources ......................................................................................................... 211 General References ..................................................................................................................... 233 CHAPTER 4. DISSERTATIONS ON CHOLESTEROL .......................................................................... 235 Overview.................................................................................................................................... 235 Dissertations on Cholesterol ...................................................................................................... 235 Keeping Current ........................................................................................................................ 243 CHAPTER 5. CLINICAL TRIALS AND CHOLESTEROL ..................................................................... 245 Overview.................................................................................................................................... 245 Recent Trials on Cholesterol ...................................................................................................... 245 Keeping Current on Clinical Trials ........................................................................................... 271 CHAPTER 6. PATENTS ON CHOLESTEROL ..................................................................................... 273 Overview.................................................................................................................................... 273 Patents on Cholesterol................................................................................................................ 273 Patent Applications on Cholesterol............................................................................................ 385 Keeping Current ........................................................................................................................ 440 CHAPTER 7. BOOKS ON CHOLESTEROL ......................................................................................... 441 Overview.................................................................................................................................... 441 Book Summaries: Federal Agencies............................................................................................ 441 Book Summaries: Online Booksellers......................................................................................... 444 The National Library of Medicine Book Index ........................................................................... 469 Chapters on Cholesterol ............................................................................................................. 470 Directories.................................................................................................................................. 474 CHAPTER 8. MULTIMEDIA ON CHOLESTEROL .............................................................................. 477 Overview.................................................................................................................................... 477 Video Recordings ....................................................................................................................... 477 Bibliography: Multimedia on Cholesterol .................................................................................. 478 CHAPTER 9. PERIODICALS AND NEWS ON CHOLESTEROL ........................................................... 481 Overview.................................................................................................................................... 481 News Services and Press Releases.............................................................................................. 481 Newsletters on Cholesterol......................................................................................................... 484 Newsletter Articles .................................................................................................................... 486 Academic Periodicals covering Cholesterol................................................................................ 500 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 501 Overview.................................................................................................................................... 501 U.S. Pharmacopeia..................................................................................................................... 501 Commercial Databases ............................................................................................................... 503

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Researching Orphan Drugs ....................................................................................................... 503 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 507 Overview.................................................................................................................................... 507 NIH Guidelines.......................................................................................................................... 507 NIH Databases........................................................................................................................... 509 Other Commercial Databases..................................................................................................... 520 The Genome Project and Cholesterol ......................................................................................... 520 APPENDIX B. PATIENT RESOURCES ............................................................................................... 527 Overview.................................................................................................................................... 527 Patient Guideline Sources.......................................................................................................... 527 Associations and Cholesterol...................................................................................................... 544 Finding Associations.................................................................................................................. 546 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 549 Overview.................................................................................................................................... 549 Preparation................................................................................................................................. 549 Finding a Local Medical Library................................................................................................ 549 Medical Libraries in the U.S. and Canada ................................................................................. 549 ONLINE GLOSSARIES ................................................................................................................ 555 Online Dictionary Directories ................................................................................................... 557 CHOLESTEROL DICTIONARY ................................................................................................. 559 INDEX .............................................................................................................................................. 665

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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 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 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 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 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 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 cholesterol. The Editors

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

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

Serum Cholesterol, APOE Genotype and the Risk of Alzheimer's Disease: A Population-Based Study of African Americans Source: Neurology. 54(1): 240-242. January 11, 2000. Summary: This journal article examines the interactions among total serum cholesterol (TC), apolipoprotein E (apoE) genotype, and risk of Alzheimer's disease (AD) in a population-based cohort of elderly African Americans. The cohort consisted of 2,212 African Americans over age 65 years from Indiana. The Community Screening Interview for Dementia was used to screen individuals and classify them into performance groups. Random sampling of the performance groups, with oversampling of the poor performers, was used to select individuals for in-depth clinical assessment. Participants also underwent TC determination and apoE genotyping. Results revealed a significant interaction among TC, apoE genotype, and AD risk. Increasing TC was

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significantly associated with increasing risk of AD in participants with no apoE4 allele, whereas it was not associated with increasing AD risk in those with one or more apoE4 alleles. The findings suggest that cholesterol level may be a potentially modifiable risk factor for AD. 1 figure, 2 tables, 10 references. ·

Low-Density Lipoprotein Cholesterol and the Risk of Dementia With Stroke Source: JAMA. 282(3): 254-260. July 21, 1999. Summary: This journal article presents a study of the relationship of plasma lipids and lipoproteins to dementia with stroke. The participants were 1,111 participants without dementia (mean age 75 years) who were followed for an average of 2.1 years. Plasma lipid and lipoprotein fraction levels and apolipoprotein E (apoE) genotype were determined at baseline. A total of 286 participants (25.7%) developed dementia during follow-up; of those, 61 (21.3%) were classified as having dementia with stroke and 225 (78.7%) as having Alzheimer's disease (AD). Elevated levels of low density lipoprotein (LDL) cholesterol were significantly associated with an increased risk of dementia with stroke. After adjusting for vascular risk factors and demographic variables, the relative risk (RR) for dementia with stroke was 3.1 in the highest quartile of LDL cholesterol compared with the lowest quartile. The RR increased to 4.1 in the adjusted analysis with LDL levels corrected for lipoprotein(a). Neither lipid nor lipoprotein levels were associated with risk of AD. 1 figure, 5 tables, 40 references.

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ApoE Genotype in Relation to AD and Cholesterol: A Study of 2,326 Chinese Adults Source: Neurology. 53: 962-966. September 1999. Summary: This journal article presents the frequencies of apolipoprotein E (apoE) alleles and compares the serum cholesterol levels of E2, E3, and E4 carriers in a large community sample of ethnic Chinese adults in Taiwan. As part of an epidemiologic survey of selected neurological disorders, blood samples were collected from 2,326 participants to determine apoE genotypes and measure cholesterol levels. The allelic frequencies of E2, E3, and E4 were 11.8 percent, 76.4 percent, and 11.8 percent, respectively, among 17 Alzheimer's disease patients and 7.8 percent, 84.1 percent, and 8.1 percent, respectively, for the entire sample. The mean cholesterol level of the E2 carriers was significantly lower, and that of the E4 carriers significantly higher, than that of the E3 homozygotes. The authors conclude that the lower rate of the apoE4 allele may account in part for the lower prevalence of AD found among the Chinese. The authors conclude that associations between apoE genotype and serum cholesterol level are similar in Chinese and White populations. 4 tables, 28 references.

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Interactions of Apolipoprotein E Genotype, Total Cholesterol Level, Age, and Sex in Prediction of Alzheimer's Disease: A Case-Control Study Source: Neurology. 45(6): 1092-1096. June 1995. Summary: This study evaluated the joint effects of total cholesterol (TC) levels and the apolipoprotein (apoE) genotype in Alzheimer's disease (AD). Researchers used logistic regression analysis to determine the effects of the apoE genotype, TC, age, and sex on prediction of AD in a community-based study of 206 cases and 276 controls. Results suggest that the relationship of the apoE genotype and AD was dependent on TC, age, and sex. However, current TC level did not fully explain the apoE4-AD association. Affected men with higher TC and age under 80 years had the highest apoE4 allele frequencies. The apoE4 frequency declined significantly with age. According to the authors, a pathologic role of higher TC or cholesterol-based differential survival of

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apoE4-carrying individuals may be involved in the relationship of the apoE4 allele with AD. 2 figures, 3 tables, 44 references. (AA-M). ·

Shock-Wave Lithotripsy in Gallstones and Bile Duct Stones: Long-Term Evaluation of Extracorporeal Shock-Wave Lithotripsy for Cholesterol Gallstones Source: Journal of Gastroenterology and Hepatology. 16(1): 93-99. January 2001. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail: [email protected]. Website: www.blackwell-science.com. Summary: Extracorporeal (outside the body) shock wave lithotripsy (ESWL) is a treatment for gallstones that preserves the gallbladder. Problems after ESWL treatment can include stone recurrence and the development of biliary symptoms. This article reports on a study of 262 patients with cholesterol type gallstones (the best indication for ESWL treatment) who underwent ESWL and 42 control patients with cholesterol type gallstones who received no treatment. The authors evaluated the factors associated with recurrence of gallstones after stone clearance and the development of biliary symptoms after ESWL treatment. The 3, 5, and 7 year cumulative probabilities of gallstone recurrent were 20.6, 27.1, and 33.1 percent, respectively, with the recurrence probability significantly lower in patients with good gallbladder contractility. In patients with recurrence, treatment with ursodeoxycholic acid (UDCA, given orally) was effective. In 69 patients with residual gallstones, the 3, 5, and 7 year cumulative risks of biliary symptoms were 17.3, 24.9, and 30.5 percent, respectively. With residual gallstones, the risk of biliary symptoms developing was significantly lower in patients with a smaller than 3 mm fragment size at the end of ESWL treatment and in those treated consistently with UDCA for 6 months or more after treatment with ESWL. The risk of biliary symptoms was significantly lower in ESWL treated patients with residual stones who had a less than 3 mm fragment size after treatment, compared with control patients. The authors conclude that UDCA was effective in clearing stones in patients with gallstone recurrence. In patients with residual stones, the fragmentation of stones to less than 3 mm and UDCA administration effectively reduced the risk of subsequent biliary symptoms. 3 figures. 4 tables. 18 references.

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Genetic Epidemiology of Cholesterol Cholelithiasis Among Chilean Hispanics, Amerindians, and Maoris Source: Gastroenterology. 115(4): 937-946. October 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: The etiology of cholesterol gallstones is multifactorial, with genetic and environmental interactions. This article reports on a study testing the hypothesis that aborigine cholesterol lithogenic (gallstone creating) genes are widely spread among Chileans, a population with a high prevalence of gallstones. Medical history and anthropometric measurements were obtained, and abdominal ultrasonography was performed in 182 Mapuche Indians, 225 Maoris from Easter Island, and 1,584 Hispanics. Blood groups, DNA, lipids, and glucose were analyzed. The Amerindian Admixture Index and mitochondrial DNA (mtDNA) assessed the ethnicity and degree of racial admixture. The Amerindian Admixture Index was 0.8 in Mapuches and 0.4 in Hispanics. All Mapuches, 88 percent of Hispanics, and none of Maoris had Amerindian mtDNA haplotypes. Age-and sex-adjusted global prevalence of gallstone disease was higher in Mapuches (35 percent) than in Hispanics (27 percent) and Maoris (21 percent).

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Compared with Hispanics, the youngest group of Mapuches had the greatest corrected risk of gallstones: odds ratios of 6.0 in women and 2.3 in men. By contrast, the gallstone risk in Maoris was lower compared with Hispanics: odds ratios of 0.6 for women and 0.5 for men. The article concludes that cholesterol lithogenic genes appear widely spread among Chilean Indians and Hispanics. These genes could determine the early formation of gallstones and explain the high prevalence of gallbladder diseases among some South American populations. 3 figures. 6 tables. 77 references. (AA). ·

Rapid Formation of Cholesterol Crystals in Gallbladder Bile Is Associated with Stone Recurrence After Laparoscopic Cholecystotomy Source: Hepatology. 25(3): 509-513. March 1997. Summary: Laparoscopic cholecystectomy (LCT) with subsequent extraction of gallstones and primary closure of the gallbladder has been introduced as an alternative therapy for patients with cholecystolithiasis and preserved gallbladder function. However, stone recurrence has to be considered as a major drawback that might be related to lithogenic factors of gallbladder bile or the composition of gallbladder stones. This article reports on a study in which these factors were studied in relation to stone recurrence within an observation period of 1 to 5 years in 50 patients after LCT. The concentrations of total and individual bile acids, phospholipids, cholesterol, total lipids, mucin, protein, and the cholesterol saturation indices in gallbladder bile were not significantly different between 10 patients with and 40 patients without stone recurrence. However, the crystal observation time was significantly shorter in the bile of patients with stone recurrence compared to those without. Moreover, all 10 stone recurrences were observed in the 28 patients with a crystal observation time greater than 2 days or in patients with pigment stones. The authors conclude that the rapid formation of cholesterol monohydrate crystals in bile seems to be the major risk factor for recurrent stones after LCT. These are most likely cholesterol stones and, therefore, are amenable to oral bile-acid prevention or treatment. 2 figures. 3 tables. 46 references. (AA-M).

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Cholesterolosis Is Not Associated with High Cholesterol Levels in Patients With and Without Gallstone Disease Source: Journal of Clinical Gastroenterology. 25(3): 518-521. October 1997. Contact: Available from Lippincott-Raven Publishers. P.O. Box 1550, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Summary: High levels of cholesterol have been associated with certain gallbladder disorders such as cholesterolosis and gallstone disease. Furthermore, obesity is considered the main risk factor for cholesterol gallstone disease. This article reports on a study that investigated the incidence of cholesterolosis in patients with and patients without gallbladder stones (GS, or cholelithiasis). The authors reviewed the clinical records of patients with gallstone disease and other gallbladder disorders who had consecutive cholecystectomy during a 5 year period. The authors recorded demographic data, sex, age, serum cholesterol levels, and body mass index (BMI). The diagnosis of cholesterolosis was made macroscopically and microscopically. A total of 636 patients were included in the study; 446 with and 190 without GS. Hypercholesterolemia occurred more frequently in patients with GS. Obese patients with GS had higher percentages of cholesterolosis and hypercholesterolemia than did eutrophic patients. Similar percentages of patients with obesity and hypercholesterolemia were found among those with and without GS. The authors conclude that cholesterolosis in the

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human gallbladder is not necessarily associated with gallstone disease and high plasma cholesterol levels. 4 tables. 30 references. (AA-M). ·

Non-HDL Cholesterol as a Predictor of Cardiovascular Disease in Type 2 Diabetes Source: Diabetes Care. 26(1): 16-23. January 2003. 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 determine whether non-HDL cholesterol, a measure of total cholesterol minus HDL cholesterol is a predictor of cardiovascular disease (CVD) in patients with diabetes. The data was taken from the Strong Heart Study, a population-based study of CVD and its risk factors in 13 American Indian communities in three geographic areas in the United States. Of the 4,549 women and men aged 45 to 74 years participating in the study, 2,108 had diabetes but no CVD at baseline. Data on fatal and nonfatal CVD were collected during the follow up period (average 9 years). Multivariable analyses indicated that non-HDL cholesterol is a strong predictor of CVD in men and women with diabetes and is particularly indicative of coronary events. The utility of non-HDL cholesterol in predicting CVD extended over a wide range of triglyceride concentrations. The authors conclude that non-HDL cholesterol index may be particularly useful in predicting CVD risk in patients with diabetes. 2 figures. 4 tables. 47 references.

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Cost-Effectiveness of Intensive Glycemic Control, Intensified Hypertension Control, and Serum Cholesterol Level Reduction for Type 2 Diabetes Source: JAMA. Journal of the American Medical Association. 287(19): 2542-2551. May 15, 2002. Summary: Several treatment interventions can reduce the complications associated with type 2 diabetes, but their relative cost-effectiveness is not known. This article reports on a study undertaken to estimate the incremental cost-effectiveness of intensive glycemic control (relative to conventional control), intensified hypertension (high blood pressure) control, and reduction in serum cholesterol level for patients with type 2 diabetes. Results show that the incremental cost-effectiveness ratio for intensive glycemic control is $41,384 per quality adjusted life year (QALY); this ratio increased with age at diagnosis from $9614 per QALY for patients aged 25 to 34 years to $2.1 million for patients aged 85 to 94 years. For intensified hypertension control, the cost-effectiveness ratio is minus $1959 per QALY. The cost-effectiveness ratio for reduction in serum cholesterol level is $51,889 per QALY; this ratio varied by age at diagnosis and is lowest for patients diagnosed between the ages of 45 and 84 years. The authors conclude that intensified hypertension control reduces costs and improves health outcomes relative to moderate hypertension control. Intensive glycemic control and reduction in serum cholesterol level increase costs and improve health outcomes. The cost-effectiveness ratios for these latter 2 interventions are comparable with those of several other frequently adopted health care interventions. 3 figures. 5 tables. 46 references.

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NCEP ATP III Guidelines: Cholesterol Management in the Patient with Diabetes Source: Practical Diabetology. 21(1): 21-28. March 2002. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923.

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Summary: Coronary heart disease (CHD) is the number one cause of death in the United States. Unfortunately, people with type 2 diabetes have a twofold to fourfold excess risk of CHD. Approximately two-thirds of the people with diabetes will die of cardiovascular disease, including CHD, stroke, and peripheral vascular disease. In addition, a patient with diabetes is twice as likely to die of a myocardial infarction (heart attack) than is a person without diabetes. For these reasons, cholesterol management is one of the critical treatment goals for individuals with type 2 diabetes. This article outlines the new guidelines of the national Cholesterol Education Program (NCEP) that address the role of diabetes in assessing the risk of CHD. These guidelines also have incorporated existing guidelines from the American Diabetes Association, and have made new recommendations for lipid (fats) management in patients with diabetes. The NCEP Adult Treatment Panel (ATP) III report provides physicians with updated guidelines for the assessment and management of cholesterol in all patients, with special concentration on those with diabetes. The report provides guidance in terms of risk assessment, nutritional therapy, drug therapy, treatment of dyslipidemia, and treatment of special populations. One appendix summarizes the ATP III guidelines for people with diabetes. 3 tables. 8 references. ·

Diabetes Contributes to Cholesterol Metabolism Regardless of Obesity Source: Diabetes Care. 25(9): 1511-1513. September 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 investigate cholesterol metabolism in obesity with and without diabetes. The authors performed cross-sectional metabolic studies in individuals with and without type 2 diabetes. The study included 16 obese subjects with diabetes (mean age 52 years, plus or minus 2 years) and 16 nondiabetic control subjects of similar age and weight. Serum total cholesterol did not differ between the groups, but LDL and HDL cholesterol were significantly lower and VLDL cholesterol and serum total and CLDL triglycerides were higher in the diabetes group compared to the control group. Cholesterol synthesis was higher and neutral sterol and bile acid excretion and cholesterol turnover tended to be higher in the diabetes group than in the control group. In addition, blood glucose was significantly positively related to fecal neutral sterol excretion in both groups. Cholesterol absorption efficiency was lower and cholesterol synthesis was higher in obese subjects with diabetes than in those without diabetes, suggesting that diabetes modulates cholesterol metabolism more than obesity alone. 1 figure. 3 tables. 32 references.

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Counting Down Cholesterol Source: Diabetes Forecast. 54(9): 72-76. September 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the new blood cholesterol guidelines issued by the National Institutes of Health in the Third Report of the National Cholesterol Education Program (NCEP). For the general population, the NCEP recommends a full cholesterol profile every 5 years. The American Diabetes Association (ADA) recommends that people who have diabetes and cholesterol levels in an unhealthy range have a lipid profile every year, whereas people who have cholesterol in the healthy range can have it checked every 2 years. The ADA recommends higher high density lipoprotein (HDL) levels than NCEP in people who have diabetes. The ADA guidelines recommend that

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HDL be above 45 milligrams (mg) per deciliter (dl) for males and above 55 mg per dl for females. The NCEP stresses that the first step to heart health involves determining the risk for coronary heart disease. People who have diabetes are considered to be high risk for coronary heart disease because they tend to have higher rates of clogged arteries and are more susceptible to high low density lipoprotein (LDL) levels than people who do not have diabetes. A section of the new NCEP guidelines specifically outlines cholesterol care for people who have diabetes, and it matches current recommendations of the ADA. Therapy begins with dietary changes that reduce the amount of saturated fat and cholesterol in the diet, losing weight, and exercising more often. In addition to lifestyle changes, various drugs can be used to help lower LDL cholesterol, including statins, bile acid sequestrants, fibric acids, and nicotinic acid. 1 table. ·

What Your Doctor is Reading: Updated Cholesterol Guidelines Source: Diabetes Self-Management. 18(5): 59-61. September-October 2001. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: This article summarizes the findings of the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III or ATP III), the National Cholesterol Education Program's (NCEP) updated guidelines for cholesterol testing and management. The report, released in May 2001, is the first comprehensive revision of NCEP recommendations in eight years. ATP III recommends a lifestyle approach as the first step in reducing the risk of coronary heart disease; this is called Therapeutic Lifestyle Changes (TLC). The essential features of TLC are: less than 7 percent of calories from saturated fat and less than 200 milligrams of cholesterol per day; the use of plant stanols and sterols found in certain margarines and salad dressings; lots (10 to 15 grams) of cholesterol lowering soluble fiber every day (including foods such as grains, peas, beans, fruits and vegetables); weight loss if necessary; and increased physical activity. The article also reviews the risk factors for coronary heart disease and how readers can address at least some of those risk factors, such as smoking and high blood pressure (hypertension). The author notes that most people do not give lifestyle changes a real chance to work and most doctors do not give their patients enough help in their efforts to implement lifestyle changes; drug therapy is often utilized in place of lifestyle changes, instead of as an adjunct to TLC. 1 table. 4 references.

Federally Funded Research on Cholesterol The U.S. Government supports a variety of research studies relating to 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.

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).

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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 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 cholesterol. The following is typical of the type of information found when searching the CRISP database for cholesterol: ·

Project Title: TOXICITY"

"MECHANISM

OF

PHTHALATE

INDUCED

TESTICULAR

Principal Investigator & Institution: Gaido, Kevin W.; Senior Scientist; Ciit Centers for Health Research Po Box 12137 Research Triangle Park, NC 277092137 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): The overall objective of this proposal is to determine the mechanisms by which phthalate esters downregulate testosterone production in the developing fetal rat testes, resulting in antiandrogenic effects on the developing male reproductive tract. Phthalate esters are a class of environmental chemicals to which humans are ubiquitously exposed and which cause antiandrogenic effects on the developing male reproductive tract in rats. The mechanisms by which phthalate esters cause their effects remain to be determined. In preliminary studies, global changes in gene expression in the developing rat testis following in utero exposure to di(n-butyl) phthalate (DBP) were examined. A significant finding was that DBP produced a reduction in key genes in pathways associated with either steroid production or the provision of substrates for this activity. It is therefore hypothesized that phthalates decrease testosterone in the developing testes because of a coordinate disruption in cholesterol transport and steroid biosynthesis. This hypothesis will be tested by investigating the following specific aims: 1) Identify the key steps involved in cholesterol transport and testosterone biosynthesis that are targets for disruption by in utero exposure to DBP in the developing fetal rat testes, 2) Determine the consequences of DBP-induced changes in target gene and protein expression identified in Specific Aim 1 on fetal testicular cell signaling pathways, cholesterol transport, and steroidogenesis, and 3) Establish the molecular mechanism by which DBP downregulates expression of genes involved in cholesterol transport and steroid biosynthesis. Quantitative RT-PCR and protein analysis will be used to identify gene targets in the developing fetal testis following in utero exposure to DBP. The promoter regions of selected gene target will be further examined in vitro to determine the mechanism by which phthalate esters act on cholesterol transport and steroidogenesis. The proposed studies will identify critical genes and pathways associated with cholesterol transport that are targets for DBP in the male rat in utero and will aid in determining potential human risks from exposure to this class of environmental chemicals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ACUTE RENAL FAILURE: MECHANISMS AND ADAPTIVE RESPONSES Principal Investigator & Institution: Zager, Richard A.; Professor; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, WA 98109 Timing: Fiscal Year 2002; Project Start 01-MAR-1988; Project End 28-FEB-2007

Studies 11

Summary: (provided by applicant): Following heterogeneous forms of experimental renal injury (e.g., nephrotoxins, ischemia, urinary tract obstruction), proximal tubules undergo adaptive changes which protect them from further attack. This can either prevent a worsening of established acute renal failure (ARF), or block recurrent episodes. Characteristics of this "acquired cytoresistance" (AC) are that: 1) it requires about 18 hrs to develop; 2) it is expressed against diverse forms of secondary insults; 3) it can protect for at least 30 days; 4) it does not require de novo protein synthesis; and 5) it is mediated by a fundamental change within the proximal tubular plasma (and possibly mitochondrial) membrane(s), conferring cellular protection against further attack. Recent work from this laboratory has identified increased tubular membrane cholesterol expression following renal injury, and this is critical to the AC state. Given the broad based biologic relevance of AC (e.g., it can also contribute to cancer cell resistance to chemotherapy), this proposal has the following 3 Specific Aims: 1. Determine the mechanisms for, and nature of. the cholesterol elevations in the AC state: a) do the cholesterol elevations arise from increased synthesis, increased uptake, or decreased efflux? b) do the cholesterol increments reflect elevations of free vs. esterifled cholesterol pool(s)? and c) what subcellular cholesterol distribution patterns result? 2. Determine mechanisms by which cholesterol mediates AC: a) which cholesterol moieties (e.g. free vs. esterifled) confer AC? b) do they, how do they, increase membrane resistance to attack?; and c) is there a mechanistic link between increased cell cholesterol and improved mitochondrial performance in the AC state? 3. Define whether AC is impacted by two cholesterol- associated signaling pathways: Specifically, do the "upstream" mevalonate pathway and/or the "downstream" cholesterol/sphingomyelin microdomain (raft/caveolae) pathway impact the emergence, or expression, of the AC state? The ultimate goal of these experiments is to better define cellular adaptations to injury in an attempt to devise prophylactic strategies to either increase (or, in the case of cancer chemotherapy, decrease) cellular resistance to superimposed attack. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ALIMENTARY TRACT LIPIDS IN HEALTH AND DISEASE Principal Investigator & Institution: Carey, Martin C.; Brigham and Women's Hospital 75 Francis Street Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 01-JUL-1985; Project End 31-MAR-2004 Summary: Bile formation and secretion control homeostatic mechanisms for eliminating cholesterol and tetrapyrrole molecules form the organism as well as absorption of dietary fat. Bile dysfunction causes several common diseases, including gallstones and cholestasis. This proposal employs biophysical rationale and physical-chemical methodology to further molecular understanding of the physical biochemistry of bile, its formation, secretion and functions. The PI and colleagues will design and study appropriate model systems and correlate the results with pathophysiological phenomena pertaining to the function and dysfunction of native systems. They will use I)novel flurocholesterol methodology, cryoelectron microscopy and electron energy-loss spectroscopy to elucidate physical-chemical pathways whereby cholesterol molecules are transferred from blood to liver cell and bile, ii) characterize interactions of bile salt molecules with sphingomyelin in micellar solutions and at interfaces related to cholesterol secretion, absorption and apoptosis, iii) determine the physical-chemical origin and pathophysiology of lipoprotein X in bile secretory failure, iv) define how phosphatidylcholine, cholesterol and calcium influence the physical- chemical state of natural conjugated bilrubins in model (bilrubin ditaurate) and native biles employing analytical ultracentrifugation and spectrophotometric techniques, v) measure the

12 Cholesterol

metastable and equilibrium solubilities of unconjugated bilirubin in modelbiles utilizing potentiometric titration and dissolution and correlate the information pathophysiologically with pigment-stone biles, vi) discover whether humans with ~black~ pigment gallstones have dysfunctional mutations of the ileal bile acid transporter gene. These objectives are designed to advance our understanding of physical chemistry of bile as ell as normal and abnormal movements of cholesterol and billirubin to and from the liver and alimentary tract. The systematic project should lead to new targets and strategies for prevention of pigment and cholesterol gallstone diseases as well as lipid transport abnormalities sin cholestasis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: AMYLOID BETA-PEPTIDES AND CHOLESTEROL DYNAMICS Principal Investigator & Institution: Wood, W Gibson.; Professor; University of Missouri Columbia 310 Jesse Hall Columbia, MO 65211 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 31-MAR-2006 Summary: Several different lines of evidence point to a potentially important but not well-understood interaction between Alzheimer's disease (AD) and cholesterol dynamics. Apolipoprotein E4, a protein that binds and transports cholesterol and other lipids, has been identified as a risk factor for familial and sporadic AD. Brain cholesterol content was altered in autopsy samples of AD. Amyloid beta-peptide (Abeta), the main component of neuritic plaques seen in brains of AD patients has a multifaceted interaction with cholesterol. Our overall hypothesis is that brain cholesterol dynamics are disrupted by AB. We propose that cholesterol transport into and out of cells and cellular distribution of cholesterol are altered by AB. Experiments of this application will examine potential mechanisms of effects of AB on aspects of those cholesterol dynamics. The disruption in cholesterol dynamics primarily involves the physicochemical interaction of AB with lipids and proteins and AB-induced oxidation. Data in support of this application from our laboratory show that: 1) both soluble and aggregated AB increase fluidity of synaptic plasma membrane and this effect was inhibit by the anti-oxidant, Troxlox; 2) soluble AB partitions into the hydrophobic environment of SPM and aggregated AB is positioned near the membrane surface where it could interact with lipoproteins and their receptors; 3) aggregated AB binds cholesterol with a markedly higher affinity than saturated fatty acids, and phosphatidylcholine (PC); 4) AB increases the influx of cholesterol complexed with apoE4 and PC into cells; 5) AB inhibited HDL-mediated reverse cholesterol transport but facilitated removal of cholesterol in the absence of HDL; and 6) soluble AB increased cholesterol and aggregated AB reduced cholesterol in Golgi of neurons and astrocytes. Mechanisms that explain effects of AB on cholesterol transport and cellular distribution are not wellunderstood. Our hypothesis is that AB modifies cholesterol transport and distribution are not well-understood. Our hypothesis is that AB modifies cholesterol transport and distribution by the following proposed mechanisms: 1) AB increases the transport by altering the structure of apolipoprotein domains and lipid domains of lipoproteins, and inducing oxidation; 2) Soluble and aggregated AB differentially affect lipoproteinmediated cholesterol influx by their actions on lipoprotein structure; 3) Differential action of AB on cholesterol influx mediated by the low density lipoprotein receptorrelated protein (LRP) and the low density lipoprotein receptor (LDLR); 4) AB alters reverse cholesterol transport by modification of cellular distribution of cholesterol, disruption of the Golgi apparatus, cholesterol esterification, oxidation, and direct interaction with apolipoproteins and lipid domains. Cholesterol is essential for optimal

Studies 13

cell function and instability in cholesterol dynamics could certainly contribute to the pathophysiology associated with AD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ANTIATHEROGENIC STRUCTURE/FUNCTION

AMPHIPATHIC

PEPTIDES:

Principal Investigator & Institution: Anantharamaiah, G M.; University of Alabama at Birmingham Uab Station Birmingham, AL 35294 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Apolipoprotein (apo) A-I, the major protein component of HDL, and apo E, a protein component of VLDL, are antiatherogenic. While apo A-I inhibits atherosclerosis without changing plasma cholesterol levels, apo E can reduce the plasma levels of atherogenic lipoproteins. Analogous to the observation that the lipid cross-sectional shapes can regulate membrane properties, we predicted and have shown that the cross-sectional shapes of class A and class L peptides are partially responsible for properties of a lipid surface with which they interact. We showed that class A amphipathic-helical peptides inhibit atherosclerosis without changing plasma cholesterol levels and that Arg-containing class L peptides enhance the uptake of atherogenic lipoproteins in cell culture and in dyslipidemic mouse models. We propose to test the hypothesis that specific alterations of the surface of atherogenic lipoproteins inhibit(s) atherosclerosis by 1) accelerating reverse cholesterol transport (RCT) or 2) inhibiting the formation of oxidized LDL or 3) enhancing the hepatic uptake of atherogenic lipoproteins. Two specific aims to test this are: 1.To identify the determinants and mechanisms by which class A peptides inhibit atherosclerosis. a) Physical chemical properties which correlate to their lipoprotein association. b) Role in RCT: cholesterol efflux rates and the contribution of SR-BI and ABC A1 in peptidemediated cholesterol transfer. c) Role in inhibition of formation of atherogenic lipoproteins. d) Effect of peptide analogs to inhibit the generation of inflammatory molecules; 2. Studies of peptide analogs based on the reciprocal wedge hypothesis: design of Arg-rich class L amphipathic helical peptides for enhanced hepatic uptake of atherogenic lipoproteins. a) Correlate physical-chemical properties with atherogenic lipoprotein association. b) Determine the mechanisms of enhanced lipoprotein uptake. c) Identify the specific receptors for the peptide-lipoprotein uptake d) Peptide-mediated changes in expression of apolipoproteins in HepG2 cells. Studies described in this project will increase our current limited knowledge on how surface alterations of lipoproteins influence the metabolism of cholesterol and will generate a new database, which will facilitate designing small molecules that can be used therapeutically to ameliorate atherosclerosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ANTIBODIES TO LIPOPROTEIN LIPASE AND ATHEROSCLEROSIS Principal Investigator & Institution: Reichlin, Morris; Vice President of Research; Oklahoma Medical Research Foundation Oklahoma City, OK 73104 Timing: Fiscal Year 2002; Project Start 05-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Premature atherosclerosis in patients with Systemic Lupus Erythematosus (SLE) has been recognized for the past 25 years. As much as a 50fold increase in risk for coronary artery disease has been found in SLE patients compared to controls and an increased risk for thrombotic cerebrovascular disease has also been recognized. In the past decade lipid abnormalities have been recognized in

14 Cholesterol

SLE patients that are "proatherogenic". These include elevated LDL cholesterol, low HDL cholesterol and elevated triglyceride levels that are not due to nephrotic syndrome. Careful clinical studies suggest that conventional risk factors such as age, sex, smoking, hypertension, etc., do not completely account for the prevalence of premature atherosclerosis. Indeed, there appears to be an element of risk conferred by the lupus process itself We postulate that this mechanism of the SLE associated risk lies in autoimmune events that perturb lipid homeostasis in the direction of elevated triglycerides and cholesterol. We further suggest that part of this effect is due to an immune response to lipoprotein lipase which occurs in 50% of SLE patients and promotes hypertriglyceridemia. In addition, autoantibodies to apolipoprotein A-1, Apo B and Apo E may perturb lipid transport and promote decreased HDL cholesterol and increased LDL cholesterol. Our plan is to combine our expertise in autoantibody research with epidemiologic methods. We will conduct a prospective study of SLE patients and their matched controls to evaluate these immune responses on lipid levels, in the presence of conventional risk factors and confounders, and their association with premature atherosclerosis. Recognition of autoimmune mechanisms that promote elevated triglycerides could lead to specific interventions as therapy or even possibly prevention of premature atherosclerosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: APO A-1 AND REVERSE CHOLESTEROL TRANSPORT IN VIVO Principal Investigator & Institution: Rader, Daniel J.; Director, Preventive Cardiology; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, PA 19104 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008 Summary: Despite overwhelming evidence that overexpression of apoA-I inhibits progression and even induces regression of atherosclerosis in animals, there remain substantial questions about the mechanisms by which apoA-I reduces atherosclerosis as well as specific questions about the structure-function properties of apoA-I with regard to its ability to promote reverse cholesterol transport (RCT) and reduce atherosclerosis. Project 3 will focus on the use of in vivo studies in mice to address some of these questions in a manner that is highly interactive with Projects 1 and 2. One of the major questions to be addressed is whether intervention to increase plasma apoA-I does in fact promote RCT, a topic of continued debate and uncertainty. We will use different approaches for quantitating RCT in mice. Quantitation of fecal sterol excretion will be used as a measure of total peripheral RCT. In order to determine the rate of RCT specifically from the macrophage, a novel tracer method in which macrophage foam cells labeled with 3H-cholesterol are injected and labeled cholesterol and bile acids are traced in the feces. We will also use a variety of other measures including serum efflux capacity (in collaboration with Project 1), HDL subclass distribution, LCAT activation, and assessment of atherosclerosis. In Specific Aim 1, we will ask whether overexpression of human apoA-I promotes macrophage RCT and whether this correlates with reduction in atherosclerosis. In Specific Aim 2, the importance of the apoA-I interaction with other key gene products in the RCT pathway, such as ABCA1, LCAT, and SR-BI, will be tested using in vivo mouse models. In Specific Aim 3, similar methods will be used to express mutants of apoA-I (in collaboration with Project 2) to probe the structure-function relationships of apoA-I in vivo with regard to effects on RCT and atherosclerosis. Several of the mutant and chimeric forms of apoA-I that will be studied intensively in vitro for lipid binding properties in Project 2 will be assessed in vivo in Project 3. In summary, Project 3 represents in vivo studies that directly address the role of apoA-I in promoting RCT and the importance of interaction with other genes

Studies 15

and of the structure of apoA-I in determining its effects. This project complements the work being performed in Projects 1 and 2 and will result in a highly collaborative effort among the 3 projects in this Program Project. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: APOE AND ATHEROGENESIS Principal Investigator & Institution: Pitas, Robert E.; Senior Investigator; J. David Gladstone Institutes 365 Vermont St San Francisco, CA 94103 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2003 Summary: (Adapted from Investigator's Abstract): This proposal stems from the observation made by the principal investigator that macrophage- specific expression of human apolipoprotein E in apoE-null (Apoe-/-) mice reduces the development of atherosclerosis. However it is not known if the level of apoE normally produced by macrophages in ApoE +/+ mice gives maximal protection. Therefore the investigators have designed their experiments to answer four key questions: a) Will increased levels of expression of apoE by macrophages in wild-type mice decrease the formation of atherosclerotic lesions? b) Will expression of apoE in macrophages after the development of atheroslerotic lesions cause lesions to regress or halt their progression? c) Does expression of apoE in atherosclerotic lesions enhance cholesterol efflux? d) Are there apoE isoform-specific differences on atherosclerotic lesion formation and regression? The proposed specific aims are therefore as follows:. Here they will generate C57BL/6 mice with macrophage-1) To determine the effect of macrophage-specific overexpression of apoE3 on the formation of atherosclerotic lesions expression of apoE3, and then they will examine the effect this expression on diet-induced atherosclerosis. 2) To determine the effect of macrophage-specific expression of human apoE3 on existing atherosclerotic lesions in wild-type and in ApoE-/- mice. Here they will produce wildtype and ApoE-/- mice with tetracycline- regulated, macrophage-specific expression of apoE. They will then determine the effect of ApoE3 expression on atherosclerotic lesion progression or regression in these mice. Finally they will determine the effect of macrophage-specific expression of ApoE3 on the release of cholesterol from atherosclerotic lesions. 3) To determine if ApoE2, ApoE3, and ApoE4 differ in their abilities to facilitate cholesterol efflux from cells and if ApoE3 and ApoE4 differ in their effects on atherosclerotic lesion formation and regression. Here they will examine the ability of plasma from ApoE-/- mice with macrophage-specific expression of ApoE2, ApoE3, or ApoE4 to induce cholesterol efflux from cholesterol-loaded cells. They will compare the ability of peritoneal macrophages and of stably transfected cells expressing ApoE2, ApoE3, or ApoE4 to release cholesterol. They will determine the mechanism of the differential abilities of ApoE3 and ApoE4 to promote cholesterol efflux and to form gammaLPE (a lipid-poor lipoprotein particle with gamma- electrophoretic motility that contains apoE as its only apolipoprotein constituent). Finally they will examine the effect of macrophage- specific expression of ApoE4 on atherosclerosis development and regression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

·

Project Title: APOE IN CHOLESTEROL AND TRIGLYCERIDE HOMEOSTASIS Principal Investigator & Institution: Zannis, Vassilis I.; Medicine; Boston University Medical Campus 715 Albany St, 560 Boston, MA 02118 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2005

16 Cholesterol

Summary: (provided by applicant): Apolipoprotein E (apoE) is an important protein of the cholesterol transport system. ApoE is responsible for the clearance of lipoprotein remnants from the circulation via lipoprotein receptors, contributes to cholesterol homeostasis, and protects from atherosclerosis. ApoE has also been shown to have other functions which contribute to cholesterol and triglyceride homeostasis, including VLDL triglyceride secretion and VLDL lipolysis, two processes which may affect plasma triglyceride levels. It is our hypothesis, which is supported by preliminary data, that the carboxy terminal domain of apoE is responsible for the hypertriglyceridemia which is induced by overexpression of apoE. We also hypothesize that overexpression of carboxy terminal apoE variants may protect from atherosclerosis. Our specific aims are: 1) To use adenovirus-mediated gene transfer as well as transgenic mice to elucidate the role of apoE in triglyceride homeostasis and establish the mechanism of apoE-induced hypertriglyceridemia in vivo. 2) To use adenovirus-mediated gene transfer of different apoE forms (in appropriate receptor-deficient mouse models) to elucidate the role of apoE receptors in cholesterol clearance in vivo and in vitro. The mouse models that will be utilized for gene transfer are apoE-/-, LDLR-/-, liver-specific LRP-/- mice as well as crosses among these The gene transfer and receptor binding studies will define the ligand speciflcities for different receptors. 3) To express long-term apoE forms that do not induce hypertriglyceridemia using adenoassociated viral vectors (AAV-apoE) and transgenic mice in order to correct the hypercholesterolemic and atherogenic profile of apoE-deficient mice. This specific aim will explore the ability of selected truncated and mutant forms of apoE that do not induce hypertriglyceridemia to protect from atherosclerosis. We expect that apoE forms that can clear cholesterol and triglycerides and protect from atherosclerosis may provide new therapeutic tools in the near future for the correction of remnant removal disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: APOLIPOPROTEIN-MEDIATED CHOLESTEROL EFFLUX Principal Investigator & Institution: Davidson, William S.; Associate Professor; Pathology and Lab Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, OH 45221 Timing: Fiscal Year 2001; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: It is well known that plasma levels of apolipoprotein (apo)AI and high density lipoprotein (HDL) are inversely correlated with the risk of cardiovascular disease (CVD). CVDs, which include heart attacks, stroke and high blood pressure, are estimated to shorten the average American life expectancy by about 10 years. Unfortunately, the mechanisms that protect the body from the pathological accumulation of lipid and cholesterol that cause CVD are not well understood. However, recent studies have shown that lipid-poor forms of apoAI may be particularly effective at promoting cholesterol removal from the periphery by a mechanism that is distinct from that used by the bulk of plasma HDL. The long-term goal of this research is to determine how the structure of lipid-poor modulates its ability to remove cholesterol from peripheral cells such as those that comprise the vessel wall. A secondary goal is to develop variant forms of apoAI that vary in their ability to interact with cell surfaces and to promote cholesterol efflux. These mutants will not only provide valuable information on the mechanism of cholesterol removal by lipid-poor apoAI, but will also be useful for future transgenic mouse and gene therapy studies designed to improve the effectiveness of HDL in the prevention of CVD. The approaches will include the use of sophisticated fluorescence studies combined with mutants of apoAI that contain single tryptophan residues to study the structure of

Studies 17

apoAI in the lipid- free form and in various states of HDL particle maturation. This will provide information on apoAI dynamics that is not yet been possible by X-ray crystallography or NMR. Mutagenesis techniques will also be used to modulate the ability of apoAI to interact with lipids and to cell surface proteins. These mutants will be examined using detailed lipid binding and cell surface association assays. Finally, the effect of those modifications on the ability of apoAI to promote cholesterol removal from cells will be determined in cell culture-based studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ASSISTED DETAILING TO IMPROVE GUIDELINE ADHERENCE Principal Investigator & Institution: Bailey, Thomas C.; Medicine; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2003; Project Start 20-SEP-2003; Project End 30-JUN-2007 Summary: (provided by applicant): The proposed research seeks to determine whether physician-targeted, technology-assisted academic detailing can improve adherence to American College of Cardiology/American Heart Association (ACC/AHA) Coronary Heart Disease (CHD) secondary prevention guidelines and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) cholesterol-lowering guidelines. The long-term objective is to develop a generalizable model for implementing national health care guidelines, taking advantage of teachable moments for physicians caring for hospitalized patients. The specific aim of this research is to assess whether the proposed intervention will improve adherence to ACC/AHA CHD and NCEP ATP III cholesterol lowering guidelines for hospitalized patients with CHD and CHD risk equivalents. The study employs a randomized, controlled, two-period parallel design comparing technology-assisted academic detailing to existing practice at the study institutions. All patients admitted over a four-year period to the medical, vascular surgery, and cardiothoracic surgery services of a large Midwestern teaching facility and a community hospital will be studied. This represents a diverse physician and patient population. The physicians include those in private practice, full and parttime academic physicians, and physicians-in-training in various medical and surgical specialties and at varying stages post-training. There is a diverse payor mix, with the largest group being Medicare. The primary outcome measures are physician adherence to ACC/AHA CHD secondary prevention and NCEP ATP III cholesterol lowering guidelines at hospital discharge. We expect to determine the feasibility and effectiveness of this approach for a large, busy, academic medical center and a community hospital that currently do not have computerized physician order entry (CPOE). This is applicable to the majority of medical centers in the US. The alerting rules we develop will also be valuable to those centers implementing CPOE. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEMBRANES

ASYMMETRIC

DISTRIBUTION

OF

CHOLESTEROL

IN

Principal Investigator & Institution: Schroeder, Friedhelm; Veterinary Physiology & Pharmacology; Texas A&M University System College Station, TX 778433578 Timing: Fiscal Year 2001; Project Start 01-MAR-1987; Project End 30-NOV-2003 Summary: Molecular details of how cholesterol moves into, across, and out of membranes involved in cholesterol influx (lysosomal membrane), intracellular movement, and efflux (plasma membrane) are unresolved. While both vesicular and protein mediated pathways contribute, interrelationships are obscure. The specific aims

18 Cholesterol

of the present application are to investigate the role of sterol carrier protein-2 (SCP-2) in intracellular cholesterol trafficking: 1. Examine the ligand binding site(s) of two SCP-2 gene products, recombinant pro-SCP-2 and SCP-x. Circular dichroism and time resolved fluorescence will be used to determine the structure of these proteins, characterize their cholesterol binding site(s), and examine conformational alterations during binding. 2. Investigate lysosomal membrane cholesterol domains and dynamics. The effect of SCP2 on sterol individual leaflet and lateral distribution as well as rate of movement between leaflets will be determined to examine interrelationships between SCP-2 and Niemann-Pick C lysosomal membrane protein in mediating cholesterol efflux. 3. Examine the role of SCP-2 gene products in cholesterol movement from the lysosome and trafficking in intact cells. Transfected L-cell fibroblasts overexpressing specific SCP2 gene products will be used to examine whether SCP-2 mediates sterol transfer out of the lysosome. Cholesterol movement will be followed over time with [3H]-cholesterol and also fluorescent sterols and sterol esters with colocalized organellar immunomarkers, using laser scanning confocal and multiphoton microscopy in overexpressed and mock transfected control cells. 4. Determine the relationship between SCP-2 gene products and caveolin in HDL-mediated cholesterol efflux in intact cells. Both lysosomally derived [3H]- cholesterol and its ester as well as fluorescent sterol and its ester will be examined as in (3) above and in transfected cells overexpressing caveolin. 5. Explore the mechanism whereby SCP-2 interacts with model membranes using SCP-2 and N-terminal peptides, circular dichroism, time resolved fluorescence, and differential polarized phase fluorometry. These experiments should yield novel insight into the function of sterol carrier protein, provide new data on regulation of cholesterol domain structure, and contribute to our understanding of diseases involving abnormal cholesterol absorption, intracellular cholesterol movement, and/or cholesterol accumulation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: BEHAVIORAL FACTORS AND DIETARY CHANGE IN WHTFSMP Principal Investigator & Institution: Bhargava, Alok; Professor; Economics; University of Houston 4800 Calhoun Rd Houston, TX 77004 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): The primary purpose of the research in this project is to specify and estimate models for dietary intakes of the subjects in the Women's Health Trial: Feasibility Study in Minority Populations (WHTFSMP) taking into account the behavioral factors emphasized in the Social Learning Theory and the Health Belief Model. The comprehensive analysis will incorporate the socioeconomic factors such as education and income, and the physiological aspects such as anthropometric indicators and the current energy intakes that reflect the subjects' energy requirements. In addition, the theories of "habit persistence" in diets from the economics literature will be incorporated in the modeling framework. The subjects in the Intervention group of the WHTFSMP received counseling for adopting diets that were low in fat and high in fruits and vegetables. The research will analyze the proximate determinants of the intakes of carbohydrate, saturated, monounsaturated, and polyunsaturated fats, fiber, calcium, acarotene and ascorbic acid using the data at baseline, six and 12 months from the Control and Intervention groups of the WHTFSMP. The second objective of the research is to estimate dynamic random effects models for the subjects' risk factors for coronary disease and cancer such as plasma LDL and HDL cholesterol, triglycerides, and glucose levels. Behavioral factors, anthropometric indicators, energy derived from saturated and polyunsaturated fats, and dietary cholesterol will be explanatory variables in models for

Studies 19

plasma LDL cholesterol. The dynamic model is suitable for plasma cholesterol since 50% of cholesterol is endogenously produced. The comprehensive analysis of the data from the WHTFSMP will be useful for refining educational programs that seek to promote healthful eating. In particular, the incorporation of the various behavioral factors in the analyses of dietary intakes will identify strategies of targeting women who are at greater risk of chronic disease but are less likely to change their behavior and would benefit from enrollment in nutrition education programs. The results from the empirical models for plasma LDL, HDL, triglycerides and glucose will be useful for identifying strategies for lowering the subjects' risks for cardiovascular disease and cancers. Overall, the results will facilitate the design of policies for improving health of especially minority women in the United States and will be useful for analyses of the Women's Health Initiative data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: BENZODIAZEPINE RECEPTOR AND ADRENAL DEVELOPMENT Principal Investigator & Institution: Widmaier, Eric P.; Professor; Biology; Boston University Charles River Campus 881 Commonwealth Avenue Boston, MA 02215 Timing: Fiscal Year 2001; Project Start 01-MAY-1999; Project End 30-APR-2003 Summary: The objectives of this application are to elucidate the role of the peripheraltype benzodiazepine receptor (PBR) in maturation of the adrenal glands, and to determine mechanisms of regulation of this receptor. PBR is expressed in all steroidogenic cells, including gonads, adrenals, placenta, and brain (glia), where it is believed to mediate transport of cholesterol to the inner mitochondrial membrane, the site of enzymes needed to convert cholesterol to pregnenolone. Inability to transfer cholesterol to the inner membrane is associated with decreased steroidogenesis. Since this is the rate-limiting step in steroidogenesis, it is critical that this process be fully understood if new and better therapeutic approaches to disorders of adrenal pathology (e.g., adrenal insufficiency or hypertrophy) are to be developed. Studies on regulation of this important receptor in have been hindered by the lack of a normal cell or animal model in which the receptor is expressed at low levels. The neonatal rat is a model of ACTH-insensitivity, since during this period adrenocortical cells respond weakly to ACTH (10 percent of adult levels). Insensitivity to ACTH is also observed in fetuses of larger mammals, and prevents neurotoxic effects of high levels of glucocorticoids on developing brain cells. Because adrenal insufficiency is the primary cause of morbidity and mortality in premature infants (glucocorticoids are required for induction of surfactant expression in fetal lungs), the process by which the developing adrenal gland matures is of great significance. Recent findings demonstrate that neonatal rat adrenals express PBR at 10 percent the level in adult adrenals. Thus, it is proposed to characterize the complete developmental profile of PBR and other factors suggested to be important in cholesterol transport, and correlate this with changes in adrenocortical sensitivity to ACTH in vivo and in vitro. PBR expression will be determined by immunoblot, Northern blot, in situ hybridization, and ligand binding assays from fetal life through weaning. The effects of chronic treatment with ACTH or cAMP on cholesterol transport, PBR expression, and steroidogenesis in vivo and in cultured neonatal adrenal cells will be examined. The ability of transfected PBR to restore ACTH sensitivity in cultured neonatal cells will also be examined. The ontogenic appearance of PBR ligands will be determined by radioimmunoassay. These studies, therefore, will simultaneously address two important questions: What are the factors that limit steroidogenesis in immature adrenal glands, and which factors regulate expression of PBR? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

20 Cholesterol

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Project Title: BILE ACID AND OXYSTEROL METABOLISM IN LIVER AND BRAIN Principal Investigator & Institution: Russell, David W.; Mcdermott Distinguished Professor; University of Texas Sw Med Ctr/Dallas Dallas, TX 753909105 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant) The objectives of this Project in this application are two-fold: first, to define the biosynthetic pathways by which cholesterol is converted into bile acids, and second to understand the roles of oxysterols in lipid metabolism. These studies will build on our findings in the previous grant period, which demonstrated the existence of three distinct pathways by which sterols are converted into bile acids. Each pathway differs in its substrate (cholesterol vs. various oxysterols) and in the involvement of distinct sterol 7ahydroxylase enzymes that add an essential hydroxyl group to carbon-7 of the starting sterol. We have isolated cDNAs and genes encoding three different sterol 7a-hydroxylases, and a gene encoding 3B-hydroxysteroid oxidoreductase, which catalyzes the step in bile acid synthesis immediately downstream of 7ahydroxylation. Mice lacking two of the sterol 7a-hydroxylases have been characterized in the previous grant period. Using the techniques of homologous recombination and targeted gene disruption, we now will generate lines of mice that lack the remaining sterol 7a-hydroxylase, termed the CYP39A1 oxysterol 7ahydroxylase, and mice that lack the 3B-hydroxy steroid oxidoreductase. We will study gene expression, cholesterol metabolism, and bile acid synthesis in these knockout animals and search for new bile acid synthesis enzymes whose activities are revealed in the mutant mice. Our studies in the mouse have shown that a majority of bile acids (80%) are synthesized by the cholesterol 7a-hydroxylase pathway in which cholesterol serves as the starting substrate. The expression of the cholesterol 7ahydroxylase gene (Cyp7al) is subject to negative feedback repression by bile acids and to positive feedforward induction by oxysterols. Research by others over the last three years has shown that nuclear orphan receptors mediate regulation of the Cyp7al gene. In particular, the liver X receptor (LXR) working in concert with oxysterols and the Cyp7al promoter binding factor (CPF) activate the gene, and the farnesoid X receptor (FXR) working in concert with bile acids and the short interaction heterodimeric partner (SHP) receptor mediate down regulation of the gene. We have obtained knockout mice that lack CPF and SHP and will characterize these animals with respect to the regulation of the cholesterol 7a-hydroxylase pathway and lipid metabolism. Oxysterols perform three important physiological functions. First, they regulate the expression of genes that participate in both sterol and fat metabolism through their inhibitory effect on SREBP processing. Second, they are intermediates in the transfer of sterols from the periphery to the liver. Third, as noted above, they are substrates for bile acid synthesis. We have isolated cDNAs and genes encoding the cholesterol hydroxylases that synthesize three naturally occurring oxysterols (24-hydroxycholesterol, 25- hydroxycholesterol, and 27hydroxycholesterol) and will now use these tools to explore the roles of individual oxysterols in lipid metabolism. Knock out mice will be produced lacking each enzyme and will be studied as described above. Embryonic fibroblast cell lines will be established from the mutant mice and parameters of SREBP cleavage, transport and turnover will be defined. Finally, we will determine the consequences for cholesterol homeostasis of overexpression of one or more of the cholesterol hydroxylases in cultured Chinese hamster ovary (CHO) cell lines. These studies will complement those of Research projects 1-4, which focus on the SREBP pathway and the identification of mutant genes in humans with disorders of cholesterol homeostasis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 21

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Project Title: BILE METABOLISM

ACID

SIGNALING

AND

HEPATIC

CHOLESTOROL

Principal Investigator & Institution: Dent, Paul; Associate Professor; Virginia Commonwealth University Richmond, VA 232980568 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Bile acids may help to coordinately regulate cholesterol and phospholipid metabolism in the hepatocyte by modulating the expression of genes encoding bile acid biosynthetic enzymes and phospholipid transport proteins. The mechanisms by which bile acids coordinate the expression of these genes in order to maintain cholesterol homeostasis and the secretion of a specific ratio of cholesterol: bile acids: phospholipids into bile is unclear, but may have important implications in the pathogenesis of cholesterol gallstone formation, hypercholesterolemia and cholestatic liver diseases. The objectives of this application are (1) To identify bile acid activated signal transduction pathways within hepatocytes and to determine the mechanisms by which bile acids utilize receptor tyrosine kinases / other receptors in the pathway activation processes; (2) To determine which bile acid activated downstream signaling cascade(s) regulate genes involved in maintaining cholesterol and phospholipid homeostasis in the hepatocyte, including CYP7a1: CYP8b1, LDL receptor, neutral cholesterol ester hydrolase (CEH) and mdr2 phospholipid transporter; (3) To determine whether the mechanisms of in vitro regulation of cholesterol and phospholipid homeostasis, specifically the enzyme CYP7a1, also apply in vivo, using JNK1 and JNK2 null mice as well as in the livers of wild type mice infected with recombinant adenoviruses to express dominant negative cJun and dominant negative JNK1. In addition, in Aims 2 and 3, efforts will be made to determine if bile acid activated signaling pathways "cross-talk" with nuclear receptors e.g., farnesoid X receptor, that are also activated by bile acids. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

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 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

22 Cholesterol

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: BIOLOGICAL FUNCTION OF THE NIEMANN PICK C PROTEIN Principal Investigator & Institution: Liscum, Laura; Professor; Physiology; Tufts University Boston Boston, MA 02111 Timing: Fiscal Year 2001; Project Start 01-MAY-1995; Project End 30-APR-2004 Summary: Niemann-Pick type C (NPC) is an autosomal recessive lysosomal storage disease that causes progressive neurological degeneration in young children. Cultured NPC cells express defective transport of lipoprotein-derived cholesterol, resulting in lysosomal accumulation of cholesterol and aberrant regulation of cellular cholesterol homeostasis. The NPC1 gene was recently cloned. It encodes a 1245 aa membrane protein, with sequence homology to two proteins involved in cholesterol homeostasis. What is the biological function of NPC1? Our hypothesis is that NPC1 governs the targeting of cholesterol- carrying vesicles derived from lysosomes. We will test this hypothesis using wild-type and cholesterol transport defective Chinese hamster ovary cells. Specific im 1: To investigate the role of NPC1 in each cholesterol transport pathway. NPC1 will be expressed under the control of a regulated promoter; kinetics of cholesterol transport will be measured. Specific Aim 2: To determine if cellular cholesterol levels regulate NPC1. Transcriptional, translational and posttranslational control of NPC1 expression by cellular cholesterol levels will be investigated. Specific Aim 3: To determine if the ced-1 gene is NPC1. Specific Aim 4: To analyze the intracellular location of NPC1. NPC1 distribution will be analyzed by density gradients and immunofluorescence microscopy. Specific Aim 5: To investigate the membrane orientation of NPC1. The domain organization of NPC1 will become important for structure/function analysis as disease-causing mutations are mapped. Knowledge of the biological function of NPC1 is critical for guiding the investigation into possible therapies for afflicted children. It also has relevance to the control of whole body cholesterol levels as well will gain information on the control of cholesterol availability for reverse cholesterol transport and bile acid metabolism. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BLOOD DRAWING FOR COMPONENT PREPARATION Principal Investigator & Institution: De Oliviera, Elizabeth R.; Rockefeller University New York, NY 100216399

Studies 23

Timing: Fiscal Year 2001 Summary: The purpose of the Blood Drawing for Component Preparation is to obtain cells, proteins, DNA and lipids from healthy volunteers and dyslipidemic subjects for use in research. Our laboratory is focused in trying to identify common mutations in the population that contribute to the variation in lipoprotein levels and atherosclerosis susceptibility between people. In this work, we use the lipoprotein transport genes as candidate genes, although we are also trying to identify other genes that might be important such as those which regulate cholesterol absorption or the blood vessel wall response to hypercholesterolemia. Recent work suggests that mutations which affect the level of expression of the apo CIII gene may cause hypertriglyceridemia and our lab is trying to determine how this occurs. Another area of research relates to studies of apolipoprotein gene expression and how this might influence plasma lipoprotein levels. Lipoproteins (VLDL, LDL, and HDL) are prepared from human subjects and used in experimentation involving the response of cultured cells to lipoproteins and studying lipoprotein modification and oxidation. These studies are relevant to atherosclerosis research, as we are studying cholesterol loading of cells and cholesterol efflux from cells, as well as leukocyte-endothelial cell interactions. In additional studies, DNA is prepared from human blood samples and used to look at human genetic variation and association with lipoprotein metabolism. One human genetic variation that we have studied is at the apoE locus, where there are three common alleles coding for three allelic isoforms, called E2, E3, and E4. The E4 allele is associated with increased LDL cholesterol, increased risk of coronary vascular disease, and most strikingly with Alzheimer's disease. We have begun to study the properties of E4 which may account for their association with human disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CATABOLISM AND EXCRETION OF CHOLESTEROL AND BILE ACIDS Principal Investigator & Institution: Loose-Mitchell, David S.; Integrative Biology and Pharmacology; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, TX 77225 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 31-AUG-2003 Summary: The goal of this proposal is to determine how two key pathways of bile acid biosynthesis are regulated by dietary cholesterol and to determine the mechanisms regulating the apical Na+ -dependent bile-acid transport protein (ASBP) in the ileum. This proposal combines approaches and animal models that have not been combined before to test some basic hypotheses regarding the metabolism and excretion of cholesterol. The proposal has the following goals: 1). To test the hypothesis that the two pathways of bile acid synthesis, the cholesterol 7alpha-hydroxylase pathway and the sterol 27-hydroxylase pathway, are regulated independently, and patterns of regulation depend on cholesterol responsiveness. This will be tested by three different approaches and will take advantage of a unique hypercholesterolemia-resistant rabbit developed at the University of Texas. The applicant proposes a longitudinal study using deuterated 7alpha hydroxycholesterol and 27-hydroxylated cholesterol as bile acid precursors. These studies will precisely measure rates of bile acid synthesis in vivo as animals are fed a hypercholesterolemic and then a hypocholesterolemic diet. The second component of this specific aim will assess rates of bile acid synthesis by the two pathways in an animal with a total bile acid diversion. The third component of this specific aim is directed a elucidating the mechanism through which these two pathways are regulated. The applicant will examine both steady-state rates of mRNA and use a novel transcription assay to assess how altered rates of enzyme biosynthesis is achieved in vivo. 2). To test

24 Cholesterol

the hypothesis that expression of ASBP is regulated by both transcriptional and posttranscriptional mechanisms. This will be tested both in normal and in the hypercholesterolemia-resistant rabbits and the applicant will examine levels in the activity, mRNA, and transcription of the transporter and determine if changes in mRNA are reflected in levels of ASBP protein and localization. In addition, the applicant will determine the functional consequences of ASBP allele found in the hypercholesterolemic rabbit. These studies will make a significant contribution to the understanding of the only routes by which significant cholesterol is removed from the body. In this respect the applicant anticipates that the results will impact upon the treatment of cardiovascular diseases well as having significance for fundamental biological questions of the control of cholesterol homeostasis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CAVEOLAR FUNCTION IN NIEMANN-PICK DISEASE TYPE C Principal Investigator & Institution: Heidenreich, Randall A.; Pediatrics; University of Arizona P O Box 3308 Tucson, AZ 857223308 Timing: Fiscal Year 2001; Project Start 15-MAR-1999; Project End 29-FEB-2004 Summary: Plasma membrane caveolae are specialized domains that have a central role in modulating intracellular cholesterol homeostasis. Alterations in the expression of caveolin-1, a cholesterol-binding proteins of caveolae, and accumulation of unesterified cholesterol within a caveolin-1 containing subcellular compartment, has been shown to occur within tissues and/or cultured cells derived from mice and humans with Niemann Pick type C (NPC). Our preliminary studies indicate that the NPC gene product (NPC1) is found in the detergent insoluble cellular fraction the same cellular fraction enriched in caveolae, implicating a direct relationship between NPC1 and caveolar function. Based on these observations, we believe that NPC is a unique and important model in which to define further the relationship between caveolae and intracellular cholesterol trafficking. The goals of this research project are to: 1) Determine if NPC1 is localized to caveolae. 2) Determine if cholesterol is enriched within caveolae isolated from NPC fibroblasts. 3) Determine the contribution of LDLderived cholesterol and endogenously synthesized cholesterol to caveolae in NPC. 4) Determine if cholesterol efflux from caveolae from LDL-derived cholesterol and endogenously synthesized cholesterol to HDL is disrupted in NPC. 5) Determine the effects of disrupting caveolin-1 expression in heterozygous NPC cells on the trafficking of LDL-derived cholesterol and endogenously synthesized cholesterol to caveolae. These experiments will directly address the role of caveolae in cholesterol homeostasis as well as define the intracellular trafficking pathways utilized to regulate the removal of excess cholesterol mediated by HDL, an important process responsible for the preventing of atherosclerosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CELL BIOLOGY OF ABCA1 Principal Investigator & Institution: Freeman, Mason W.; Chief; Massachusetts General Hospital 55 Fruit St Boston, MA 02114 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: The control of intra-cellular cholesterol levels is an intricately regulated process that depends not only on the regulation of lipid uptake and cellular sterol synthesis but also on a mechanism that permits cells to efflux cholesterol to apolipoprotein and lipoprotein acceptor molecules. The best evidence for the

Studies 25

importance of this efflux pathway in human physiology comes from studies of patient's with Tangier disease. Recent work has shown that the genetic defect in Tangier disease maps to a locus encoding a member of the ABCA family of ATP- binding cassette transporters (ABCA1) and that this transporter is required for normal, apolipoproteinstimulated cholesterol efflux. In vivo, the reverse cholesterol transport pathway is thought to be initiated when a lipid-poor HDL binds to a cell and stimulates the removal of cellular lipids, at least in part, via this ABCA1-mediated process. As the pharmacologic tools for manipulating the reverse cholesterol transport pathway are far less sophisticated and effective than those available for reducing the levels of proatherogenic lipoproteins, insights gained from investigating ABCA1's function have the potential to lead to new clinical therapeutics. In this proposal, the investigators will explore the structural requirements that underlie ABCA1 function, focusing on its membrane topology, binding interaction with ligands, and regulation by kinases. These studies of the cell biology of the ABCA1 transporter will importantly contribute not only to a molecular description of the cellular cholesterol efflux pathway but also to our growing understanding of the mechanisms by which human cholesterol homeostasis is maintained or goes awry. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CELL CHOLESTEROL EFFLUX AND HDL FORMATION Principal Investigator & Institution: Fielding, Christopher J.; Neider Prof of Cardio Physiology; Cardiovascular Research Institute; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: PROPOSED PROGRAM (Applicant?s abstract) This Program Project combines techniques from lipid photochemistry, biochemistry and molecular and cell biology to characterize the structure and properties of the complexes formed between free cholesterol (FC) and phospholipid (PL) with two lipid binding proteins. Caveolin is a major structural protein of cell surface caveolae. Apolipoprotein A-1 (apo A-1) is the major component of high density lipoprotein (HDL), the major atheroprotective lipoprotein of human plasma. Photoactivable FC and PL analogs modified with benzophenone groups at different points in their structure will be synthesized and incorporated into living cells and crosslinks to caveolin and apo A-1 identified. The identity of lipid binding sites will be confirmed using site-directed mutagenesis. In further studies on caveolae, the mechanism by which vanadate, an inhibitor of protein phosphotyrosine phosphatases, reduces FC efflux will be identified. The hypothesis will be explored that phosphorylation of caveolin displaces FC from its binding site, with effects on signal transduction from the cell surface that lead to suppression of caveolin transcription. How oxysterols inhibit FC efflux will also be determined, and in particular, whether these lipids displace FC from caveolin. In studies of apo A-1-PL complex formation, the mechanism by which the ABC1 transporter protein transfers phosphatidyl choline to lipid-free apo A-1 will be analyzed in detail. The origin and mechanism of incorporation of FC into these complexes will be determined, and in particular, whether FC binds directly to apo A-1 or only via PL. Finally, they will investigate whether FC within lipid-poor apo A- 1 /PL/FC complexes formed at the cell surface can be directly esterified by lecithin: cholesterol acyltransferase, and the esters transferred to other HDL particles. In spite of its significance in defining the properties of the cell membrane, there has been little investigation of protein-FC binding. As a result, the information to be obtained in this program will be both novel and highly

26 Cholesterol

relevant to understanding the structure and functions of caveolae, the molecular basis of both FC and PL efflux, and the structure of HDL. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CELL PROCESSING HIGH DENSITY LIPOPROTEINS Principal Investigator & Institution: Reaven, Eve P.; Head, Em Facilities; Palo Alto Institute for Res & Edu Palo Alto, CA 943040038 Timing: Fiscal Year 2001; Project Start 01-APR-1985; Project End 30-NOV-2004 Summary: This proposal represents an effort to identify proteins or factors, which may be linked with the HDL receptor (scavenger receptor subtype BI, SR-BI) to facilitate the uptake of lipoprotein-donated cholesteryl esters through the unique selective cholesterol uptake pathway. This is a pathway in which circulating (i.e., exogenous) lipoproteins are able to contribute bulk cholesterol to many types of cells for synthetic purposes. Recent studies indicate that cystolic extracts from selective pathwaycompetent rodent steriodogenic tissues (such as luteinized ovary) enhance selective uptake in purified SR-BI-containing proteoliposomes by 8-10 fold. The proposed studies will capitalize on this finding and attempt to identify and purify the active agents in luteal tissue using a sensitive cell-free membrane reconstitution system. Potentially important known factors associated with molecular transport machinery (SNARES, sphingomyelin, caveolin etc.), will also be tested by the membrane reconstitution system using selective cholesteryl ester transport as an assay, or may be tested in cell systems containing sufficient quantities of SR-BI, but overexpressing (or lacking) certain other proteins. The idea that caveolin may be a negative regulator for SR-BI function in the selected cholesteryl ester uptake process will be thoroughly investigated, as will the idea that specialized domains of microvillar channel membranes (membrane rafts) in stereridogenic tissues represent distinct regions of the microvillar compartment specialized for efficient uptake of neutral lipids. All tissue/cell models described are available in this laboratory. Currently used technologies permit us to faithfully track proteins both biochemically and morphologically, and the integrated system we propose to study should yield detailed information on potential protein links between the SR-BI receptor and the selective uptake of lipoprotein-donated cholesterol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CELL SIGNALING, LIPOPROTEIN RECEPTORS

MEMBRANE

CHOLESTEROL,

AND

Principal Investigator & Institution: Anderson, Richard G.; Professor and Chairman; University of Texas Sw Med Ctr/Dallas Dallas, TX 753909105 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant) In this new project, our major focus is to understand how cholesterol and cell surface receptors involved in lipoprotein metabolism function together to transmit signals from the cell surface to the cell interior. The receptors of interest belong to the LDL receptor (LDLR) gene family. We plan to use knockout, knockin, and transgenic methods to investigate how these receptors transmit signals from the cell surface to the cell interior, particularly in neuronal tissues. The site for activation of these receptors is likely to involve caveolae, a cholesterol-rich compartment of the plasma membrane that houses many of the putative downstream intermediates in LDLR family signaling. A major objective will be to determine if LDLR gene family members become activated in caveolae and to explore the possibility that caveolae cholesterol regulates their function. Inasmuch as tyrosine kinases are involved in LDLR

Studies 27

family signal transduction and inasmuch as the structure and function of caveolae depend crucially on cholesterol, we will also investigate the role that cholesterol plays in compartmentalizing receptor tyrosine kinases in caveolae and how this sterol links kinase activity to multiple signaling pathways. Finally, we will study the function of caveolin-1, the major cholesterol binding protein in caveolae, and determine its role in maintaining the proper cholesterol level of caveolae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CELLULAR AND MOLECULAR BIOLOGY OF LIPOPROTEIN METABOLISM Principal Investigator & Institution: Phillips, Michael C.; Professor; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 01-JUL-1978; Project End 30-JUN-2003 Summary: This application represents a continuation of a Program Project whose overall theme is the metabolism of lipids, cholesterol and lipoproteins as related to the development of atherosclerosis. The interactions of lipoproteins with cells and the subsequent metabolism of lipids within cells will be investigated. The basic information that will be gained is particularly relevant to understanding the protective action of high density lipoprotein (HDL) against premature coronary artery disease and the progression and regression of atherosclerotic plaque. This Program Project consists of three closely related projects: The first proposes to study the intracellular and extracellular mechanism by which cellular cholesterol homeostasis is maintained. Emphasis is placed on defining intracellular pools of cholesterol and the roles of plasma constituents in mediating cell cholesterol efflux. The second project involves a study of the functions of apolipoprotein A-I in mediating cholesterol transport at cell surfaces. The molecular mechanisms by which apo A-I removes and delivers cholesterol, cholesteryl ester and phospholipid from and to cell plasma membranes will be investigated. The last project focuses on the metabolism of cholesterol in model foam cells. Emphasis is placed on the structure of cholesteryl ester cytoplasmic droplets, characterization of the enzymes involved in their metabolism, and the consequences for macrophages of over-accumulation of unesterified cholesterol. The group of investigators comprising this Program Project share similar interests and goals in lipid and lipoprotein metabolism while providing broad scientific expertise. The scientific disciplines encompassed by these investigators include biochemistry, cell biology, molecular biology and physical biochemistry. The three scientific projects are supported by core laboratories: 1) Administrative/Central Service Core, 2) Tissue Culture Core and 3) Lipoprotein Core. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CELLULAR CHOLESTEROL FLUX AND METABOLISM Principal Investigator & Institution: Rothblat, George H.; Mcp Hahnemann University Broad & Vine Sts Philadelphia, PA 19102 Timing: Fiscal Year 2001 Summary: The studies proposed in this project will enhance understanding of the cellular and extracellular factors that modulate the flux of cholesterol between cells and serum. This bi-directional movement of cholesterol is one of the major mechanisms by which cellular cholesterol homeostasis is maintained and the efflux of cholesterol from cells is the first step in the process by which excess peripheral cholesterol is returned to the liver for excretion. Specific Aim 1 will use cyclodextrins to: 1) examine the kinetics

28 Cholesterol

and mechanism of transport of plasma membrane cholesterol to the endoplasmic reticulum, 2) probe the distribution of cholesterol in fast and slow kinetic pools within the plasma membrane, 3) examine the factors regulating the efflux of synthesized sterols and cholesterol derived from lysosomes and 4) relate the kinetic pools of plasma membrane cholesterol to physical lipid domains through the use of x-ray diffraction and NMR techniques. Specific Aim 2 will focus on the lipoprotein-related factors that modulate bi-directional flux by: 1) expanding our studies showing that cyclodextrins can shuttle cholesterol between cells and lipoproteins and that phospholipid vesicle can function as cholesterol sinks to determine if there are natural shuttles and sinks in serum, 2) study how phospholipid enrichment changes bi-directional cholesterol flux and the sink/shuttle capacity of serum, 3) establish the roles of LCAT and CETP in the modulation of cholesterol efflux from fast and slow pools, and 4) investigate differences among sera in their sink/shuttle capacity and correlate these differences to serum parameters and the regulation of cell cholesterol flux. The information gained from these studies will enhance our understanding of the processes involved in cholesterol accumulation in the vessel wall and will provide insights on interventions to modulate the progression and regression of atherosclerotic plaque. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CELLULAR CHOLESTEROL MOVEMENT AND HOMEOSTATSIS Principal Investigator & Institution: Lange, Yvonne; Professor; Rush-Presbyterian-St Lukes Medical Ctr Chicago, IL 60612 Timing: Fiscal Year 2001; Project Start 01-JUN-1981; Project End 31-MAR-2003 Summary: (Adapted from applicant's abstract): Cell cholesterol is of universal concern because of the enormous burden on health imposed by atherosclerotic cardiovascular disease. We now propose to continue our study o cellular cholesterol homeostasis. The hypothesis that the pool of cholesterol in the plasma membrane regulates its own abundance by signaling the endoplasmi reticulum (ER) through the regulated circulation of a stream of cholesterol will be tested. The set point of a putative cholesterol sensor in the plasma membrane will be characterized. The investigators will also test whether the cholesterol pool in the Golgi apparatus is regulated by the plasma membrane sensor; perhaps the Golgi serves as an intermediate in cholesterol transport. The flux of plasma membrane cholesterol through the lysosomes will be analyzed using cells from Niemann-Pick type C1 (NPC1) disease and cells treated with various amphiphiles which perturb cholesterol metabolism. The question of whether this movement represents specific transport or the flow of bulk plasma membrane bilayer will be addressed. The NPC1 gene product appears to be involved in cholesterol homeostasis. The investigators will analyze how its expression varies with cel cholesterol. Finally, the cell physiology of several sequenced mutants in NPC1 will be analyzed with respect to the gene defect to examine how NPC1 might function in cholesterol homeostasis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHOLESTEROL & PROTEIN-LIPID EFFECTS ON ACH RECEPTOR Principal Investigator & Institution: Lasalde-Dominicci, Jose A.; Biology; University of Puerto Rico Rio Piedras Rio Piedras Sta San Juan, PR 00931 Timing: Fiscal Year 2002; Project Start 01-SEP-1997; Project End 30-APR-2006 Summary: (provided by applicant): Changes in the structure and function of the Nicotinic Acetyicholine Receptor (AChR) are linked to pathogenic responses on human

Studies 29

muscle and brain. The long-term goal of this research proposal is to define the functional role of lipid-protein interactions in the conformational transitions of the ACbR. The objective of this project is to define the modes by which hydrophobic allosteric interactions are linked to the gating machinery of the AChR and bow cholesterol modulates ACbR function. The central hypothesis of this research is that AChR channel kinetics is modulated allosterically by specific sites on the receptor that are in direct contact with the lipid-interface. This hypothesis has been formulated on the basis of strong preliminary data, which suggest that: (1) single amino acid replacements at hydrophobic allosteric sites of the M3 and M4 iransmembrane segments of the AChR greatly enhance the macroscopic response to acetyicholine and produce a remarkable alteration of the modulatory role of cholesterol on the AChR function, and (2) cholesterol plays a novel role in the transition of AChRs from silent to functional membrane pools. The rationale for the proposed research is that changes in membrane lipid composition (and lipid-protein interactions) represent a very important mechanism for the regulation of AChR channel function in cholinergic synapses of muscle and brain, thus understanding the molecular basis of these mechanisms will help to identify conditions in which the membrane lipid composition enhance or inhibit AChR function. The central hypothesis will be tested by pursuing four specific aims: (1) To study the structure-function relationship of five hydrophobic allosteric positions using additional side chain replacements, (2) Introduce periodic tryptophan substitutions to complete all positions along the M3 transmembrane domains in order to define helix-helix contacts, structural constraint positions and additional allosteric sites, (3) Examine the effects of membrane cholesterol levels on AChR channel kinetics and five new hydrophobic ailosteric M3 mutations and (4) Introduce unnatural amino acids at hydrophobic allosteric positions in the M3 domain to determine; (a) the effect of electronic density on channel gating properties and (b) membrane penetration depth of the allosteric positions. The proposed work is innovative because it capitalizes on new approaches, developed by the applicants, to; 1) perform cholesterol enrichment and depletions in the plasmatic membrane of oocytes, and 2) introduce fluorescent unnatural amino acid to assess membrane depth penetration and annular lipid composition using multiphoton confocal imaging. We anticipate that these approaches will allow us to identify new mechanisms by which lipid-protein interactions modulate the allosteric transitions of AChR. The knowledge gained from these studies is of paramount significance as it will: 1) describe new mechanisms for AChR regulation in the intact synapse, 2) provide information on the secondary structure and spatial organization of the M3 and M4 domains, and 3) describe new structure-function relationships for the AChR. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CHOLESTEROL ABSORPTION RATES IN NORMAL SUBJECTS AGED 17-80 Principal Investigator & Institution: Bosner, Matthew S.; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2001 Summary: Cholesterol absorption was measured in 94 normal subjects aged 17-80 while consuming diets low in cholesterol (mean intake=226(126 mg/day). A new dual stable isotope method was used in which 15 mg cholesterol tracer with 6 additional mass units ([26,26,26,27,27,27--2H6]cholesterol) was given intravenously and 30 mg of another tracer with 5 additional mass units ([2,2,4,4,6-2H5]cholesterol or [23,24,25,26,2713C5]cholesterol) was given orally during a test meal. The ratio of tracers in plasma was determined by negative ion mass spectrometry of pentafluorobenzoyl sterol esters.

30 Cholesterol

Absorption values ranged from 29.0% to 80.1% (mean 56.2(12.1). Cholesterol absorption was increased in African-Americans (63.4(11.8% vs. 55.1(11.9%, p=0.027) but was similar for women (53.3(11.9%) and men (57.6(12.1%). It was not related to plasma lipoproteins, age, apo-E genotype, or chronic dietary intake of energy, fat, or cholesterol quantitated from food records. The amount of dietar y choleste rol absorbed was positively correlated with fasting plasma insulin (r=0.525, p200 mg/dL) have been indicated as a major risk factor for heart disease, the leading cause of death among Americans. As a result, experts have recommended that those individuals at high risk decrease serum cholesterol levels through dietary changes, a program of physical exercise, and lifestyle changes. It is recommended that the intake of saturated fat and dietary cholesterol be strictly limited and that soluble fiber consumption be increased. Strictly limiting the intake of saturated fat and cholesterol does not, itself, present a risk to proper health and nutrition. Even where saturated fat and cholesterol are severely restricted from the diet, the liver remains able to synthesize sufficient quantities of cholesterol to perform necessary bodily functions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 401

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Composition for and method of reducing low density lipoprotein cholesterol concentration Inventor(s): Potter, Susan M. (Ellisville, MO), Waggle, Doyle H. (Creve Coeur, MO), Henley, Edna C. (Athens, GA) Correspondence: Richard B. Taylor; Protein Technologies International, Inc. P. O. Box 88940; St. Louis; MO; 63188; US Patent Application Number: 20010026814 Date filed: March 22, 2001 Abstract: The present invention is a composition comprising a plant sterol and a soy protein material and/or and isoflavone selected from genistein, daidzein, glycitein, biochanin A, formononetin, and their naturally occurring glycosides, where the plant sterol comprises at least 0.49% of the composition, by weight. The present invention is also a method for decreasing the blood concentration of total and LDL cholesterol in a human in which a plant sterol and a soy protein material and/or an isoflavone are coadministered to the human, where the plant sterol comprises at least 0.49%, by weight, of the combined weight of the plant sterol and the soy protein material and/or the isoflavone. The present invention is also a method for preventing or minimizing the development of atherosclerosis in a human in which a plant sterol and a soy protein material and/or an isoflavone are co-administered to the human, where the plant sterol comprises at least 0.49%, by weight, of the combined weight of the plant sterol and the soy protein material and/or the isoflavone. Excerpt(s): The present invention relates to compositions for and methods of reducing low density lipoprotein cholesterol and total cholesterol concentrations in the blood. In particular, the present invention relates to compositions containing plant sterols, soy protein, and isoflavones, and combinations thereof, which are useful for lowering LDLcholesterol and total cholesterol blood concentrations and for preventing or minimizing development of atherosclerosis.... Cardiovascular disease is a leading cause of morbidity and mortality, particularly in the United States and in Western European countries. Several causative factors are implicated in the development of cardiovascular disease including hereditary predisposition to the disease, gender, lifestyle factors such as smoking and diet, age, hypertension, and hyperlipidemia, including hypercholesteremia. Several of these factors, particularly hyperlipidemia and hypercholesteremia, contribute to the development of atherosclerosis, a primary cause of vascular and heart disease.... High blood cholesterol concentration is one of the major risk factors for vascular disease and coronary heart disease in humans. Elevated low density lipoprotein cholesterol (hereafter "LDL-cholesterol") and elevated total cholesterol are directly related to an increased risk of coronary heart disease. Cholesterol and Mortality: 30 Years of Follow-Up from the Framingham Study, Anderson, Castelli, & Levy, JAMA, Vol 257, pp. 2176-80 (1987). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Composition for and method of reducing low density lipoprotein cholesterol concentration Inventor(s): Potter, Susan M. (Ellisville, MO), Waggle, Doyle H. (Creve Coeur, MO), Henley, E. C. (Athens, GA) Correspondence: Richard B. Taylor; Protein Technologies Int'1, Inc. P.O. Box 88940; St. Louis; MO; 63188; US Patent Application Number: 20010029248 Date filed: March 30, 2001 Abstract: The present invention is a composition comprising a plant sterol and a soy protein material and/or and isoflavone selected from genistein, daidzein, glycitein, biochanin A, formononetin, and their naturally occurring glycosides, where the plant sterol comprises at least 0.49% of the composition, by weight. The present invention is also a method for decreasing the blood concentration of total and LDL cholesterol in a human in which a plant sterol and a soy protein material and/or an isoflavone are coadministered to the human, where the plant sterol comprises at least 0.49%, by weight, of the combined weight of the plant sterol and the soy protein material and/or the isoflavone. The present invention is also a method for preventing or minimizing the development of atherosclerosis in a human in which a plant sterol and a soy protein material and/or an isoflavone are co-administered to the human, where the plant sterol comprises at least 0.49%, by weight, of the combined weight of the plant sterol and the soy protein material and/or the isoflavone. Excerpt(s): The present invention relates to compositions for and methods of reducing low density lipoprotein cholesterol and total cholesterol concentrations in the blood. In particular, the present invention relates to compositions containing plant sterols, soy protein, and isoflavones, and combinations thereof, which are useful for lowering LDLcholesterol and total cholesterol blood concentrations and for preventing or minimizing development of atherosclerosis.... Cardiovascular disease is a leading cause of morbidity and mortality, particularly in the United States and in Western European countries. Several causative factors are implicated in the development of cardiovascular disease including hereditary predisposition to the disease, gender, lifestyle factors such as smoking and diet, age, hypertension, and hyperlipidemia, including hypercholesteremia. Several of these factors, particularly hyperlipidemia and hypercholesteremia, contribute to the development of atherosclerosis, a primary cause of vascular and heart disease.... High blood cholesterol concentration is one of the major risk factors for vascular disease and coronary heart disease in humans. Elevated low density lipoprotein cholesterol (hereafter "LDL-cholesterol") and elevated total cholesterol are directly related to an increased risk of coronary heart disease. Cholesterol and Mortality: 30 Years of Follow-Up from the Framingham Study, Anderson, Castelli, & Levy, JAMA, Vol 257, pp. 2176-80 (1987). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 403

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Composition for lowering blood cholesterol Inventor(s): Meijer, Geert Willem; (Mahwah, NJ), Reddy, Podutoori Ravinder; (Bethesda, MD), Franke, William Conrad; (Cranbury, NJ) Correspondence: UNILEVER; PATENT DEPARTMENT; 45 RIVER ROAD; EDGEWATER; NJ; 07020; US Patent Application Number: 20030108591 Date filed: August 10, 2001 Abstract: Ingestable products for lowering blood total cholesterol, including isoflavone, vegetable protein such as soy protein and phytosterol. The combination of phytosterol with soy protein (which includes isoflavone) is superior to the individual components alone in improving plasma lipid profiles. Preferably the products are food products. The invention is also a method for lowering plasma cholesterol in animals, preferably humans, by feeding compositions having plasma cholesterol-lowering, synergistically effective amounts of isoflavone, soy protein and phytosterol. Excerpt(s): Despite considerable research efforts over the years, coronary heart disease (CHD) remains a formidable threat to the health of people in many countries throughout the world. Among factors considered to be of predictive value concerning the risk of CHD, an important traditional one has been blood total cholesterol (TC) levels, while in recent years the relative amounts of HDL cholesterol and LDL cholesterol have been linked to risk of CHD. High ratios of HDL to LDL are now generally considered as an indicator of salutary cardiac status.... Phytosterols, i.e., plant sterols, are well documented to have a hypocholesterolemic effect. Phytosterols inhibit intestinal cholesterol absorption, thereby lowering blood total and low-density lipoprotein (LDL) cholesterol concentrations. In human studies, phytosterols have been shown to reduce blood cholesterol concentration by an average of 10%. Moghadasian M H, Frohlich J J, "Effects of dietary phytosterols on cholesterol metabolism and atherosclerosis: clinical and experimental evidence." Am J Med 1999;107:588-594.... Soy protein is among a number of other food ingredients which have been well documented to have a hypocholesterolemic effect. Dietary intake of soy protein has been associated with reduced blood cholesterol concentrations and a lower incidence of coronary heart disease based on a number of the reports obtained from animal, (Potter S M. "Overview of proposed mechanisms for the hypocholesterolemic effect of soy." J Nutr 1995;125:606S-611S), human (Cassidy A, Bingham S, Setchell K D. "Biological effects of a diet of soy protein rich in isoflavones on the menstrual cycle of premenopausal women," Am J Clin Nutr 1994;60:333-340; Teixeira S R, Potter S M, Weigel R, Hannum S, Erdman J W J, Hasler C M. "Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood lipids and apolipoproteins in moderately hypercholesterolemic men," Am J Clin Nutr 2000;71:1077-1084,) and epidemiological (Hollman P C, Katan M B. "Dietary flavonoids: intake, health effects and bioavailability," Food Chem Toxicol 1999;37:937-942) studies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Compositions and methods for treating osteoporosis and lowering cholesterol Inventor(s): Thompson, David D. (Gales Ferry, CT), Lee, Andrew G. (Old Lyme, CT), Day, Wesley W. (Old Lyme, CT) Correspondence: Gregg C. Benson; Pfizer Inc. Patent Department, MS 4159; Eastern Point Road; Groton; CT; 06340; US Patent Application Number: 20030162807 Date filed: January 23, 2001 Abstract: This invention relates to methods, pharmaceutical compositions and kits useful in promoting bone formation and/or preventing bone loss and lowering blood cholesterol. The compositions are comprised of an estrogen agonist/antagonist as a first active component and a statin as a second active component and a pharmaceutically acceptable vehicle, carrier or diluent. The compositions and methods of treatment are effective while substantially reducing the concomitant liability of adverse effects associated with estrogen administration. Excerpt(s): This application claims priority from U.S. provisional application No. 60/188,293, filed Jan. 26, 2000 and 60/205,327, filed Apr. 21, 2000.... This invention relates to pharmaceutical compositions containing combinations of estrogen agonists/antagonists and statins, and pharmaceutically acceptable salts thereof, kits containing such combinations and methods of using such combinations to prevent bone loss and/or promote bone formation and to lower blood lipid levels. The compositions and methods are useful for treating subjects suffering from osteoporosis, bone fracture or deficiency, primary or secondary hyparathyroidism, periodontal disease, metastatic bone disease, osteolytic bone disease, or undergoing orthopedic or oral surgery and treating cardiovascular disease, atherosclerosis and hyperlipidemia, or presenting with symptoms of cardiac risk.... Estrogen alters serum lipid concentrations, coagulation and fibrinolytic systems, antioxidant systems, and the production of other vasoactive molecules, such as nitric oxide and prostaglandins, all of which can influence the development of vascular disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Compositions containing phytosterol and policosanol esters of fatty acids for reducing blood cholesterol and triglycerides Inventor(s): Schersl, Endre Markovits; (Quilpue, CL) Correspondence: David I. ROCHE; BAKER & McKENZIE; 130 E. Randolph Drive; Chicago; IL; 60601; US Patent Application Number: 20020016314 Date filed: January 30, 2001 Abstract: A composition for lowering LDL-cholesterol levels or for elevating HDLcholesterol levels in blood of a mammal or both, comprised of an ester of a policosanol or a mixture or esters of policosanols and a method for lowering LDL-cholesterol levels or for elevating HDL-cholesterol levels in blood of a mammal or both, comprised of orally administering to said mammal a composition comprising an effective amount of an ester of a policosanol or a mixture of esters of policosanols.A composition for lowering LDL-cholesterol and triglycerides or for elevating HDL-cholesterol in blood of a mammal or both, comprised of an ester of a phytosterol or a mixture of esters of

Patents 405

phytosterols wherein the acid moiety of the ester or the mixture of esters is fatty acid selected from the group consisting of eicosapentaenoic acid, docosapentaenoic acid, linoleic acid, linolenic acid and arachidonic acid or a mixture of said esters, and a method for lowering LDL-cholesterol and triglycerides or for elevating HDL-cholesterol in blood of a mammal or both, comprised of orally administering to said mammal a composition comprising an effective amount of an ester of a phytosterol or a mixture of esters of a phytosterols wherein the acid moiety of the ester or the mixture esters is a fatty acid selected from the group consisting of eicosapentaenoic acid, docosapentaenoic acid, linoleic acid, linolenic acid and arachidonic acid.A second composition for lowering LDL-cholesterol and triglycerides or for elevating HDL-cholesterol in blood of a mammal or both, comprised of an ester of a policosanol or a mixture of esters of policosanol and an ester of a phytosterol or a mixture of esters of phytosterols wherein the acid moiety of the ester of the phytosterol or the mixture of esters of the phytosterols is a fatty acid and a second method for lowering LDL-cholesterol and triglycerides or for elevating HDL-cholesterol in blood of a mammal or both, comprised of orally administrating to said mammal a composition containing an effective amount of an ester of a policosanol or a mixture of esters of policosanols, and an ester of a phytosterol or a mixture of esters of phytosterols wherein the acid moiety of the ester of the phytosterol and the mixture of esters of the phytosterols is a fatty acid. Excerpt(s): The present invention is related to food and pharmaceutical compositions and methods suitable for lowering cholesterol and triglyceride levels or for elevating HDL-cholesterol levels in the blood of a mammal, particularly compositions containing phytosterol esters of omega-3 and omega-6 polyunsaturated fatty acids and policosanols esters.... Disorders of lipid metabolism, especially the harmful effects caused by high cholesterol and triglyceride levels in the blood, have been intensively studied for many decades.... Cholesterol levels in the blood over 200 mg/dl constitute the main risk factor of coronary diseases, the most frequent cause of death, principally in developed countries. However, the risk factor is not only related to a high cholesterol level in blood, but also to the different forms of total cholesterol. A high level of low-density lipoprotein, or LDL-cholesterol, and very low-density lipoprotein, or VLDL-cholesterol, in blood constitutes a problem because these lipoproteins are very likely to remain in the cardiovascular system causing the formation of plaques in the coronary arteries. Likewise, low levels of high-density lipoproteins, or HDL-cholesterol, constitute an additional risk factor because they are useful in removing the form of cholesterol that blocks arteries. Therefore total cholesterol levels and total cholesterol/HDL-cholesterol ratios must be considered for evaluating the risk of coronary diseases. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Compositions, screening systems and methods for modulating HDL cholesterol and triglyceride levels Inventor(s): Singaraja, Roshni R. (Vancouver, CA), Hayden, Michael R. (Vancouver, CA) Correspondence: Alan J. Grant, Esq. c/o Carella, Byrne, Bain, Gilfillan Cecchi,; Stewart & Olstein; 6 Becker Farm Road; Roseland; NJ; 07068; US Patent Application Number: 20030092157 Date filed: March 15, 2002 Abstract: The invention features novel ABC1 splice variants and transgenic mice expressing human ABC1 which are useful for studying ABC1 expression, localization,

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and activity in vivo. Additionally, these ABC1 splice variants and transgenic mice are useful in screening for compounds that modulate cholesterol and triglyceride levels. Excerpt(s): This application claims priority of U.S. Provisional Application Serial No. 60/276,387, filed Mar. 16, 2001, the disclosure of which is hereby incorporated by reference in its entirety.... The present invention relates to the field of transgenic animals incorporating selected sequences, such as mutated exons of human genes, and the use of such animals in assays for chemical agents that elevate plasma HDL levels.... Low HDL cholesterol (HDL-C), or hypoalphalipoproteinemia, is a blood lipid abnormality which correlates with a high risk of cardiovascular disease (CVD), in particular coronary artery disease (CAD), but also cerebrovascular disease, coronary restenosis, and peripheral vascular disease. HDL-C levels are influenced by both environmental and genetic factors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Compounds and methods for lowering cholesterol levels without inducing hypertrigylceridemia Inventor(s): Kypreos, Kyriakos E. (Rhodes, GR), Zannis, Vassilis I. (Newton, MA) Correspondence: CLARK & ELBING LLP; 176 FEDERAL STREET; BOSTON; MA; 02110-2214; US Patent Application Number: 20020123093 Date filed: April 5, 2001 Abstract: This invention provides methods of lowering cholesterol, delaying the onset of atherosclerosis, or treating atherosclerosis in a mammal without inducing hypertriglyceridemia. These methods involve administrating to or expressing in a mammal, an apoE polypeptide or nucleic acid that, when administered to or expressed in a mammal, lowers the total serum cholesterol level without inducing hypertriglyceridemia. Excerpt(s): This application is a continuation-in-part of U.S. Ser. No. 09/679,088, filed Oct. 4, 2000, which is a continuation-in-part of U.S. Ser. No. 09/544,386, filed Apr. 6, 2000.... As a ligand that promotes the recognition and catabolism of apolipoprotein E (apoE)-containing lipoproteins by cell receptors, apoE is an important component of the cholesterol transport system (Innerarity and Mahley, Biochemistry 17:1440-1447, 1978; Herz and Willnow, Curr. Opin. Lipidol. 6:97-103, 1995; Wolf et al, Am. J. Pathol. 141:3742, 1992; Kim et al., J. Biol. Chem. 271:8373-8380, 1996; Takahashi et al., Proc. Natl. Acad. Sci. USA 89:9252-9256, 1992, Mahley et al., Curr. Opin. Lipidol. 10:207-217, 1999; Wardell et al., J. Clin. Invest. 80:483-490, 1987; Cohn et al., Vas. Biol. 16:149-159, 1996; Chait et al., Metabolism 27:1055-1066, 1978; Huang et al., Proc. Natl. Acad. Sci. USA 91:1834-1838, 1994; Huang et al., Arterioscler. Thromb. Vasc. Biol. 17:2010-2019, 1997). Heparin sulfate proteoglycans may also be involved in this process (Cullen et al., J. Clin. Invest. 101:1670-1677, 1998; Linton et al., Science 267:1034-1037, 1995; Fazio et al., Proc. Natl. Acad. Sci. USA 95:4647-4652, 1997; Huang et al., J. Biol. Chem. 273:26388-26393, 1998; van Dijk et al., J. Lipid Res., 40:336-344, 1999; Huang et al., Arterioscler. Thromb. Vasc. Biol, 19:2952-2959, 1999; Salah et al., J. Lipid Res. 38:904-912, 1997; Ji et al., J. Biol. Chem. 268:10180-10187. 1993; Ji et al., J. Biol. Chem. 269:13421-13428, 1994; Ji et al., J. Lipid Res. 36:583-592, 1995; Ji et al., J. Biol. Chem. 269:2764-2772, 1994). Mutations in apoE that prevent its binding to the LDL receptor and possibly other receptors and heparin sulfate proteoglycans are associated with type III hyperlipoproteinemia and premature

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atherosclerosis (Mahley et al., Curr. Opin. Lipidol. 10:207-217, 1999; Dong et al., Nature Struc. Biol. 3:718-722, 1996; Wardell et al., J. Clin. Invest. 80:483-490, 1987; Rall et al., J. Clin. Invest. 83:1095-1101, 1989; Mann et al., Biochim. Biophys. Acta 1005:239-244, 1989; Wardell et al., J. Biol. Chem. 264:21205-21210, 1989; van den Maagdenberg et al., Biochem. Biophys. Res. Commun. 165:851-857, 1989; Smit et al.,. J. Lipid Res. 31:45-53, 1990; Ghiselli et al., Science 214:1239-124, 198; Lalazar et al., J. Biol. Chem. 263:3542-3545, 1988; Weisgraber et al., J. Biol. Chem, 258, 12348-12354, 1983; Innerarity et al., J. Biol. Chem. 258:12341-12347, 1983).... ApoE is a 34.2 kDA protein synthesized by the liver and various peripheral tissues, including kidney, adrenal gland, astrocytes, and reticuloendothelial cells. ApoE is synthesized as a precursor with a 18-amino acid signal peptide. After the intracellular cleavage of the signal peptide, apoE is glycosylated with carbohydrate chains containing sialic acid and secreted as sialo apoE. It is subsequently desialated in plasma (see Zannis et al., Adv. Hum. Genet. 21:145-319. 1993; Zannis et al., J. Biol. Chem. 259:5495-5499, 1984; and Zannis et al., J. Biol. Chem. 261:13415-13421, 1986). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Compounds and methods to increase plasma HDL cholesterol levels and improve HDL functionality Inventor(s): Meng, Charles Q. (Alpharetta, GA), Luchoomun, Jayraz; (Lilburn, GA), Saxena, Uday; (Atlanta, GA) Correspondence: KING & SPALDING; 191 PEACHTREE STREET, N.E. ATLANTA; GA; 30303-1763; US Patent Application Number: 20020016364 Date filed: April 11, 2001 Abstract: It has been discovered that certain selected ethers of probucol, and their pharmaceutically acceptable salts or prodrugs, are useful for increasing circulating HDL cholesterol. These compounds may also improve HDL functionality by (a) increasing clearance of cholesteryl esters, (b) increasing HDL-particle affinity for hepatic cell surface receptors or (c) increasing the half life of apoAI-HDL. Excerpt(s): This application claims priority to U.S. Ser. No. 60/196,201, filed on Apr. 11, 2000.... This invention is in the area of compounds, compositions, and methods to increase plasma high density lipoprotein cholesterol levels, and to improve the functionality of circulating high density lipoprotein.... Coronary heart disease (CHD) remains the leading cause of death in the industrialized countries. The primary cause of CHD is atherosclerosis, a disease characterized by the deposition of lipids, including cholesterol, in the arterial vessel wall, resulting in a narrowing of the vessel passages and ultimately hardening of the vascular system. Epidemiological studies have demonstrated an inverse relationship between serum high density lipoprotein cholesterol (HDLc) levels and the incidence of CHD (Castelli, W. P. et al., J. Am. Med. Assoc., 256, 2835 (1986); Miller and Miller Lancet, 1, 16 (1975); Gordon et al., Circulation 79, 8 (1989)). Low levels of HDLc represent a significant independent CHD risk factor whether or not these patients have elevated low density lipoprotein cholesterol (LDLc) levels (Kannel, W. B., Am. J. Cardiol. 76, 69c (1995)). Indeed, high density lipoprotein (HDL) is recognized as the anti-atherogenic lipoprotein (Stein, O. and Stein, Y., Atherosclerosis 144, 28 (1999)). Several clinical studies have demonstrated reduced CHD events with treatments that raised HDLc. For example, the recent VA-HIT trial showed for the first time that by raising HDL cholesterol without affecting LDL cholesterol,

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cardiac events in patients with CHD were substantially reduced (Rubins, H. B. and Robins, S., Am. J. Cardiol. 86, 543 (2000)). Every 1% rise in HDLc, produced a corresponding 2-3% decrease in CHD. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Direct cholesterol esterase assay Inventor(s): Phelps, David J. (Stamford, CT), Wright, Dennis; (Talahassee, FL) Correspondence: Kalow & Springut LLP; 488 Madison Avenue, 19th Floor; New York; NY; 10022; US Patent Application Number: 20010014462 Date filed: December 21, 2000 Abstract: A direct assay for cholesterol esterase is provided wherein the assay reagent comprises a tetrazolium salt, a cholesterol ester an exogenous electron carrier to create an assay sample. In one embodiment the reagent is mixed with a test sample and the presence of cholesterol esterase is detected by an optical response. In a second embodiment, the reagent is mixed with a test sample and the optical response is quantitated by comparison with standards to determine the cholesterol esterase activity in the test sample. Kits are also provided which comprise the reagent components. Excerpt(s): The present invention relates to a method of detection of enzymatic chemical reactions that result in the cleavage or formation of a chemical usually covalent bond. More particularly, the invention is a method for the chromogenic or fluorogenic detection of such enzyme reactions, in particular as an assay screen for new chemical combinations that are produced by biotechnology methodologies, that may have activity in enzyme-substrate interactions.... Enzymes are catalytic proteins that are pervasive in biological systems. Many enzymes catalyze specific reactions which entail the cleavage or formation of a chemical bonds In particular such an Enzyme (E) will increase the rate of reaction of a specific Substrate (S) that involves the formation or cleavage of a covalent bond resulting in a Product (P). Enzymes are necessary in almost every biological reaction, and helpful in many chemical, pharmaceutical and manufacturing processes. Detecting enzyme activity and defining and measuring enzyme-substrate interactions is desirable in many clinical and laboratory situations, particularly in screening enzyme activity and screening molecules as inhibitors, enhancers or modifiers of pharmacologically interesting enzymes.... Known enzymes are classified by the International Union of Biochemistry Commission on Enzymes into six distinct categories: oxdoreductases, transferases, hydrolases, lyases, isomerases and ligases. Recent advances in enzymology have identified previously unknown and/or nonnatural catalytic molecules that have enzymatic-like speed and specificity, such as extremozymes, abzymes, recombinant enzymes, semi-synthetic enzymes, and catalytic ribozymes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 409

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Egg yolk-containing, reduced-cholesterol, oil-in-water emulsified food and the preparation thereof Inventor(s): Ogino, Yuji; (Tokyo-To, JP), Teraoka, Satoshi; (Tokyo-To, JP), Goto, Masahiro; (Tokyo-To, JP), Hayashi, Kunihiko; (Tokyo-To, JP), Tobita, Masao; (Tokyo-To, JP), Yamada, Mari; (Tokyo-To, JP) Correspondence: Richard L. Byrne; WEBB ZIESENHEIM LOGSDON ORKIN & HANSON, P.C. 700 Koppers Building; 436 Seventh Avenue; Pittsburgh; PA; 15219-1818; US Patent Application Number: 20030044507 Date filed: April 19, 2002 Abstract: Disclosed herein is a method for producing an oil-in-water emulsified food having an egg yolk content as calculated in terms of raw egg yolk of 2.8% or more, a content of cholesterol derived from egg yolk of 7.times.10.sup.-4% or more, and a total cholesterol content of less than 6.times.10.sup.-3%. This method comprises the steps of subjecting an egg yolk fluid to enzymatic processing, thereby converting phospholipids contained in the egg yolk into lysophospholipids; subjecting the enzymatically processed egg yolk to processing for reducing cholesterol, thereby obtaining processed dry egg yolk retaining at least 0.1% of cholesterol; and mixing the processed dry egg yolk with other ingredients in an amount of at least 0.7% of all the ingredients used. The product obtained by this method has a significantly reduced cholesterol content although its egg yolk content is high. Further, this product is excellent in emulsion stability and thus scarcely undergoes separation during storage. Furthermore, the product has the characteristic flavor and rich taste of egg yolk. By the addition of egg white in an amount of 6% or more as calculated in terms of raw egg white, or xanthane gum in an amount of 0.03% or more, there can be obtained the oil-in-water emulsified food more excellent in emulsion stability. Excerpt(s): The present invention relates to egg yolk-containing, oil-in-water emulsified foods such as mayonnaise, tartar sauce and dressings, having reduced cholesterol contents.... A demand for reduced-cholesterol foods has been increasing in recent years. However, oil-in-water emulsified foods such as mayonnaise, tartar sauce and dressings, whose main ingredient is egg yolk, inevitably contain at least a certain level of cholesterol. This is because egg yolk itself contains approximately 1.2% of cholesterol and also because some vegetable oils, which may be added as another essential ingredient, contain low levels of cholesterol.... Heretofore, there have been proposed mayonnaise-like foods which are produced without using egg yolk to attain the reduction of cholesterol level (Japanese Patent Laid-Open Publication No. 39341/1995, etc.). In the production of foods of this type, one cannot make use of the excellent emulsifying effect egg yolk has, and thus one should instead add emulsifiers or emulsion stabilizers such as starch, when required. Besides, these foods are lacking in the characteristic flavor and rich taste (superior taste) of egg yolk. Thus, yolk-free, mayonnaise-like foods that are satisfactory from the viewpoint of taste have not been obtained to date. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Food product suitable for reducing low density lipoprotein cholesterol levels Inventor(s): Bodor, Janos; (Vlaardingen, NL), Trautwein, Elke A. (Vlaardingen, NL), Ter Schure, Eelko Gerben; (Vlaardingen, NL), Van Oorschot, Gijsbertus Johannes; (Vlaardingen, NL), Santos Da Silvo, Mario Jorge; (Vlaardingen, NL) Correspondence: UNILEVER; PATENT DEPARTMENT; 45 RIVER ROAD; EDGEWATER; NJ; 07020; US Patent Application Number: 20030104004 Date filed: February 8, 2002 Abstract: A food product suitable for reducing low density lipoprotein cholesterol levels comprising an amount of soy protein of at least 5 grams per average serving and at least 5 mg/kg statins is described. Preferably the food product comprises a fermented soy ingredient. Excerpt(s): The present invention relates to food products suitable for reducing low density lipoprotein cholesterol levels in the human blood.... Cardiovascular disease is a leading cause of morbidity and mortality, particularly in the United States and in Western European countries and is emerging in developing countries. Several factors are mentioned relation to the development of cardiovascular disease including hereditary predisposition to the disease, gender, lifestyle factors such as smoking and diet, age, hypertension, and hyperlipidemia, including hypercholesteremia. Several of these factors, particularly hyperlipidemia and hypercholesteremia, contribute to the development of atherosclerosis, a primary cause of vascular and heart disease.... Elevated low-density lipoprotein cholesterol (hereafter "LDL-cholesterol") is directly related to an increased risk of coronary heart disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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FOOD PRODUCTS CONTAINING BACTERIA WITH CHOLESTEROL LOWERING ACTIVITY Inventor(s): FLETCHER, JOHN M. E. (SHARNBROOK, GB), LIEVENSE, LOURUS CORNELIS; (VLAARDINGEN, NL), DE SMET, INGRID; (GENT, BE) Correspondence: UNILEVER; PATENT DEPARTMENT; 45 RIVER ROAD; EDGEWATER; NJ; 07020; US Patent Application Number: 20010048918 Date filed: February 24, 1997 Abstract: The invention concerns bacteria having byle salt hydrolysis activity and optionally and preferably also bile salt polymerisation activity. Food products comprising such bacteria have been found to be capable to reduce the blood cholesterol level in the human blood. The effect is obtained by interference with the cholesterol and/or bile salt metabolism and is based on BSH activity of the bacteria. Food products which, on the basis of their normal daily intake provide a daily-BSH-intake of 0.3 micromol/min/kg bodyweight, are preferred, and even more preferred are food products providing at least a daily-BSH-intake of 0.6 micro-mol/min/kg bodyweight. In a further preferred embodiment a BSH activity of at least 0.8 micro-mol/min/1e10 cfu is obtained by the common, daily intake of food products comprising the bacteria. Further preferred are food products comprising fat, wherein at least 40% of the fat are poly unsaturated fatty acids.

Patents 411

Excerpt(s): One of the leading causes of death in the Western world today is heart disease. Numerous reports have provided evidence to link high blood cholesterol levels to coronary heart disease. For example, in one study (Lipids Research Clinics Program (1984) The lipid research clinics coronary primary prevention trial results. I Reduction in incidence of coronary heart diseases. J. Am. Med. Soc. 251: 351-363.), in which the influence of reducing serum cholesterol levels in reducing the risk of coronary heart disease was evaluated, the conclusion was drawn that reduction of high blood cholesterol levels significantly reduces the risk of heart attacks. Cholesterol metabolism is closely linked with bile salt metabolism. Bile acids are synthesized in the liver from cholesterol and conjugated with glycine or taurine. Conjugated bile acids are transported to and stored in the gallbladder and are secreted when needed in the upper part of the small intestine (duodenum). Conjugated bile acids are essential in the emulsification and absorption of fats and lipids from the small intestine. They are reabsorbed in the lower part of the small intestine, to be transported by blood circulation to the liver. This constitutes the Entero-Hepatic Cycle (EHC) of bile salts.... During EHC, the bile salt pool (in total 5 to 10 mmol) is secreted several times a day (six on average) in the duodenum, and passes through the jejunum into the ileum (middle and lower part of the small intestine). During intestinal transit, the majority of the bile salts is reabsorbed to return to the liver via the portal vein. The daily faecal loss of bile salts that escape reabsorption is about 1 mmol. Since the body bile salt pool is approximately constant, this loss is to be newly synthesised from cholesterol.... Upon surgical, pharmacological or pathological interruption of the EHC of bile salts, bile salt synthesis is increased, leading to an increased demand for cholesterol in the liver. Apart from the therapeutical or surgical attempts to lower serum cholesterol levels through interruption of the EHC, it has been suggested that the ingestion of certain bacterial cells might also influence cholesterol levels through interference with bile salt metabolism. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

FXR receptor-mediated modulation of cholesterol metabolism Inventor(s): Okamoto, Arthur Y. (San Mateo, CA), Shan, Bei; (Redwood City, CA) Correspondence: TOWNSEND AND TOWNSEND AND CREW, LLP; TWO EMBARCADERO CENTER; EIGHTH FLOOR; SAN FRANCISCO; CA; 94111-3834; US Patent Application Number: 20030003520 Date filed: August 12, 2002 Abstract: This invention provides methods and compositions that are useful for modulating cholesterol levels in a cell, and for identifying compounds that can tested for ability to modulate cholesterol levels in mammals. In vitro assays for prescreening to identify candidate therapeutic agents for modulation of cholesterol metabolism are provided. These methods involve analyzing the effect of a test compound on the binding of FXR to a ligand for FXR. Such ligands include, for example, bile acids, coactivators, and corepressors. The methods and compositions involve modulating FXRmediated expression of genes involved in cholesterol metabolism. Excerpt(s): This application claims benefit of U.S. Provisional Patent Application No. 60/115,249, which was filed on Jan. 7, 1999, which application is incorporated herein by reference for all purposes.... This invention relates to methods and compounds for the modulation of cholesterol metabolism in a mammal and methods for screening to identify candidate therapeutic agents for modulation of cholesterol levels.... Atherosclerosis is a leading cause of death, myocardial infarctions, stroke, peripheral

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vascular disease and cardiovascular disease (Libby, in Chapter 242 of Harrison 's Principles of Internal Medicine, 14th edition (1998) (Fauci et al., eds.); Witztum, in Chapter 36 of Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th edition (1996) (Hardman et al., eds.)). One of the major contributing factors to atherosclerosis is hypercholesterolemia. Hypercholesterolemia is currently treated with a combination of dietary and pharmaceutical therapies. Often more than a single pharmaceutical agent and a dietary regimen are necessary to decrease total cholesterol and LDL cholesterol levels to the desired level. Drugs such as bile acid sequestrants, niacin and the statins are commonly used to treat hypercholesterolemia and atherosclerosis. The use of niacin, however, is limited by the high incidence (>50%) of numerous side effects that are experienced in patients. Thus, a need for therapeutic agents that would decrease cholesterol levels still exists. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

High throughput genetic screening of lipid and cholesterol processing using fluorescent compounds Inventor(s): Pack, Michael; (Philadelphia, PA), Farber, Steven; (Cherry Hill, NJ) Correspondence: THOMAS JEFFERSON UNIVERSITY; INTELLECTUAL PROPERTY DIVISION; 1020 WALNUT STREET; SUITE 620; PHILADELPHIA; PA; 19107; US Patent Application Number: 20020162124 Date filed: January 30, 2002 Abstract: The present invention utilizes fluorescent lipids, particularly quenched phospholipid or cholesterol analogues, to facilitate screening for phenotypes representing perturbations of lipid processing; screening for genetic mutations that lead to disorders of phospholipid and/or cholesterol metabolism; and screening of compounds designed to treat disorders of phospholipid and/or cholesterol metabolism. The present invention is a mutant fish containing a metabolic defect affecting phospholipid and cholesterol processing. The mutant fish is useful for studying phospholipid and cholesterol metabolism and for screening compounds designed to treat disorders of phospholipid and/or cholesterol metabolism. Excerpt(s): This application claims priority under 35 U.S.C..sctn.120 based upon U.S.... Non Provisional Application No. 09/974,550 filed Oct. 10, 2001 and upon U.S. Provisional Application No. 60/264,977 filed Jan. 30, 2001.... The present invention generally relates to the fields of biochemistry and pharmacology and to a mutant fish having a metabolic defect affecting phospholipid and cholesterol processing, and more particularly to the use of a mutant fish labeled with fluorescent lipids to screen for drugs and genetic alterations related to phospholipid and/or cholesterol metabolism and, more particularly, to the use of a mutant zebrafish in conjunction with tagged or quenched lipids for studying lipid metabolism in vivo,. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 413

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High throughput genetic screening of lipid and cholesterol processing using fluorescent compounds Inventor(s): Halpern, Marnie; (US), Pack, Michael; (US), Farber, Steven; (US) Correspondence: David S. Resnick; NIXON PEABODY LLP; 101 Federal Street; Boston; MA; 02110; US Patent Application Number: 20030135869 Date filed: January 13, 2003 Abstract: The present invention utilizes fluorescent lipids, particularly quenched phospholipid or cholesterol analogues, to facilitate screening for phenotypes representing perturbations of lipid processing; screening for genetic mutations that lead to disorders of phospholipid and/or cholesterol metabolism; and screening of compounds designed to treat disorders of phospholipid and/or cholesterol metabolism. Excerpt(s): This application claims priority under 35 U.S.C..sctn. 119 based upon U.S. Provisional Application No. 60/238,928 filed Oct. 10, 2000 and in-part based upon U.S. Provisional Application No. 60/264,977 filed Jan. 30, 2001.... The present invention generally relates to the fields of biochemistry and pharmacology and to the use of a genetic model organism labeled with fluorescent lipids to screen for drugs and genetic alterations related to phospholipid and/or cholesterol metabolism and, more particularly, to the use of optically clear zebrafish in conjunction with tagged or quenched lipids for studying lipid metabolism in vivo.... Genetic analysis in zebrafish is a powerful approach for identifying genes that direct vertebrate development (1-3). Since the completion of the large-scale chemical mutagenesis screens in 1997, the phenotypic and molecular characterizations of many mutations have been reported (416). Analyses of mutations that affect early developmental processes, such as the specification of the embryonic axes and germ layers, have been particularly rewarding (7, 10, 17-27). Recently, related work with mutations that affect organogenesis has led to the recognition that the zebrafish is an important model system for biomedical research (28-31). Given the many aspects of organ physiology that have been conserved during vertebrate evolution, genetic screening to assay organ function in the optically transparent zebrafish is a valuable approach to understanding a variety of metabolic processes and disorders in vertebrates. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Koji molds for preparing cholesterol lowering products Inventor(s): Neeser, Jean-Richard; (Savigny, CH), Mace, Catherine; (Lutry, CH), Fay, Laurent-Bernard; (Evian, FR), Niederberger, Peter; (Epalinges, CH), Van Den Broek, Peter; (Wjmaarn, NL), Hajjaj, Hassan; (Fontaines St. Martin, FR) Correspondence: WINSTON & STRAWN; PATENT DEPARTMENT; 1400 L STREET, N.W. WASHINGTON; DC; 20005-3502; US Patent Application Number: 20030133920 Date filed: January 24, 2003 Abstract: An isolated, naturally occurring microorganism which is incapable of producing a toxin and which produces at least one compound which can be ingested by a human to lower serum cholesterol concentrations. The microorganism can be used to prepare an edible product such as a fermented food product or a medicament that

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includes the at least one compound and that can be safely ingested by the human to reduce serum cholesterol concentrations. Excerpt(s): This application is a continuation of the US national phase designation of International application PCT/EP01/07908 filed Jul. 10, 2001, the content of which is expressly incorporated herein by reference thereto.... The present invention relates to microorganisms which produce cholesterol lowering compounds and the use of these microorganisms in the production of fermented food products such as bio-hydrolysates, soya sauces or seasonings, for example with cholesterol lowering properties.... Biohydrolysates like soya sauces are traditionally produced through a two or three steps process that include a first step of koji production. In this first step, cooked soya beans or defatted soya flour are mixed with roasted wheat, the mixture is inoculated with a culture of koji mold, cultured under aerobiosis and stirred intermittently for one to four days to give a koji. A second step includes the preparation of a moromi by addition of water and salt to initiate hydrolysis. This moromi is left to ferment with moromi yeasts for about 6 to 8 months. A final step relates to the isolation of the liquid sauce from the solids. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Materials and methods relating to cholesterol biosynthesis enzymes Inventor(s): Kelley, Richard I. (Strafford, PA), Grange, Dorothy K. (St. Louis, MO), Herman, Gail E. (Columbus, OH) Correspondence: MARSHALL, O'TOOLE, GERSTEIN, MURRAY & BORUN; 6300 SEARS TOWER; 233 SOUTH WACKER DRIVE; CHICAGO; IL; 60606-6402; US Patent Application Number: 20020172956 Date filed: September 5, 2001 Abstract: The present invention relates to the identification of the NSDHL gene product as a 3.beta.-HSD participating in the conversion of 4,4-dimethylcholest-8(9)-en-3.beta.-ol to cholest-8(9)-en-3.beta.-ol in the cholesterol and vitamin D biosynthetic pathway. Based upon this function the present invention contemplates methods for manipulating the biosynthetic pathway at the step of involvement of NSDHL to increase or decrease the levels of cholesterol and/or vitamin D (or downstream products such as steroids) produced by a cell. Also contemplated are methods for manipulating the accumulation of intermediate compounds upstream of the step of NSDHL in the pathway. Diagnostic methods involving identification of mutations in the genes encoding enzymes involved in the conversion of 4,4-dimethylcholest-8(9)-en-3.beta.-ol to cholest-8(9)-en-3.beta.-ol are also provided, as well as diagnostic methods involving detection of abnormal accumulation of sterol intermediates prior to generation of choles-8(9)-en-3.beta.-ol in the pathway. Excerpt(s): This is a continuation-in-part of U.S. Patent Application Ser. No. 60/137,020 filed Jun. 1, 1999.... The present invention generally relates to 3.beta.-hydroxysteroid dehydrogenase (3.beta.-HSD) enzymes that participate in cholesterol and vitamin D biosynthesis. More particularly, the invention relates to the 3.beta.-HSD enzyme termed NSDHL and to manipulation of the chemical reaction(s) in which it participates.... Various disease states have been linked to abnormalities in cholesterol biosynthesis. For example, mevalonic aciduria was the first disorder of cholesterol synthesis to be recognized and is caused by a defect in mevalonate kinase, an enzyme participating in early steps of the pathway. Patients experience developmental delay, failure to thrive,

Patents 415

hypotonia, ataxia, hepatosplenomegaly, cataracts, myopathy, and enteropathy with fat malabsorption.

lymphadenopathy,

anaemia,

Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Method and reagent for determination of cholesterol in remant-like particles Inventor(s): Miyauchi, Kazuhito; (Tagata-gun, JP) Correspondence: FITZPATRICK CELLA HARPER & SCINTO; 30 ROCKEFELLER PLAZA; NEW YORK; NY; 10112; US Patent Application Number: 20010031479 Date filed: February 21, 2001 Abstract: The present invention provides a method and a reagent for the simple and sensitive determination of cholesterol in remnant-like particles in a biological sample without the separation of components of the sample. The method comprises contacting the sample with (i) cholesterol esterase, (ii) cholesterol oxidase or cholesterol dehydrogenase, and (iii) phospholipase in the presence of oxygen or an oxidized coenzyme, and measuring the formed hydrogen peroxide or reduced coenzyme. The reagent comprises (i) cholesterol esterase, (ii) cholesterol oxidase or cholesterol dehydrogenase, and (iii) phospholipase. Excerpt(s): The present invention relates to a method and a reagent for the quantitative determination of cholesterol in remnant-like particles which is considered as a risk factor for arteriosclerosis and other diseases in clinical tests.... In clinical tests, cholesterol in high density lipoprotein (HDL) is considered as a negative risk factor for arteriosclerosis and cholesterol in low density lipoprotein (LDL) is considered as a positive risk factor for arteriosclerosis. Thus, the determination of cholesterol of such classes is frequently performed in the field of clinical testing. In recent years, it has been demonstrated that cholesterol in lipoproteins formed by lipid metabolism and the like is a more closely linked risk factor for arteriosclerosis than LDL cholesterol. Such lipoproteins include remnant-like particles, and the determination of cholesterol in remnant-like particles is given health insurance scores by the Ministry of Health, Labour and Welfare in Japan.... For the determination of cholesterol in remnant-like particles, a method is known which comprises separating remnant-like particles from a sample using anti apolipoprotein B100 antibody and anti apolipoprotein A1 antibody, and measuring cholesterol in the separated remnant-like particles [Arteriosclerosis (Domyakukoka), 25 (9, 10), 371 (1998)]. However, this method employs affinity chromatography using antibodies and requires separation of components of a sample, which makes it a cumbersome and time-consuming method. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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METHOD FOR PREVENTING, STABILIZING OR CAUSING REGRESSION OF ATHEROSCLEROSIS EMPLOYING A COMBINATION OF A CHOLESTEROL LOWERING DRUG AND AN ACE INHIBITOR Inventor(s): KAWANO, JAMES C. (NARBERTH, PA), BERGEY, JAMES L. (LANSDALE, PA), TSCHOLLAR, WERNER; (LAWRENCEVILLE, NJ), YONCE, CARY S. (NEWTOWN, PA) Correspondence: BURTON RODNEY; BRISTOL-MYERS SQUIBB COMPANY; P.O. BOX 4000; PRINCETON; NJ; 085434000 Patent Application Number: 20030149101 Date filed: December 2, 1991 Abstract: A method is provided for slowing the progression of atherosclerosis in hypertensive or normotensive patients and reducing or eliminating atherosclerotic lesions in such patients by administering a combination of a cholesterol lowering drug such as pravastatin, and an ACE inhibitor, especially one containing a mercapto moiety, such as captopril or zofenopril. Excerpt(s): This application is a continuation-in-part of application Serial No. 524,266, filed May 15, 1990.... The present invention relates to a method for preventing, stabilizing or causing regression of atherosclerosis in mammalian species by administering a combination of a cholesterol lowering drug, such as an HMG CoA reductase inhibitor, for example, pravastatin, and an ACE inhibitor, preferably an ACE inhibitor containing a mercapto moiety, such as captopril or zofenopril, and to a pharmaceutical combination for use in such method.... The proatherosclerotic effect of elevated serum cholesterol on vascular tissue is well documented (Weinstein and Heider, "Protective action of calcium channel antagonists in atherogenesis and vascular injury," Am. J. Hypertens. 2: 205-12,1989). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for quantifying cholesterol in high density lipoprotein Inventor(s): Fujiwara, Akira; (Gosen-shi, JP), Ito, Yasuki; (Gosen-shi, JP), Ohara, Shuichi; (Gosen-shi, JP), Matsui, Hiroshi; (Gosen-shi, JP) Correspondence: BIRCH STEWART KOLASCH & BIRCH; PO BOX 747; FALLS CHURCH; VA; 22040-0747; US Patent Application Number: 20020192732 Date filed: July 9, 2002 Abstract: Disclosed is a method for quantifying cholesterol in HDL, which does not require complex fragmentation and separation operations, and by which the HDL cholesterol in test samples containing HDL and other lipoproteins such as low density lipoprotein (LDL), very low density lipoprotein (VLDL) and chylomicron (CM) may be quantified selectively, simply and accurately. The method for quantifying cholesterol in high density lipoprotein comprises a first step of erasing cholesterol in lipoproteins other than high density lipoprotein in a test sample, and a second step of adding a surfactant which specifically acts on high density lipoprotein to the product of the first step and enzymatically quantifying cholesterol in high density lipoprotein. Excerpt(s): It is known that HDL relates to removal of cholesterol accumulated in cells because it receives cholesterol from various tissues including walls of blood vessels with

Patents 417

arterial sclerosis, so that HDL is useful for estimating the risk for various arterial sclerosises including coronary artery sclerosis, and that its blood level is an indicator for the risk of onset of arterial sclerosis.... Methods for measuring cholesterol in HDL include a method in which HDL is separated from other lipoproteins by ultracentrifugation and then the HDL is measured; and a method in which the cholesterol in HDL is separated by electrophoresis, then the lipid is stained, and the intensity of the generated color is measured. However, these methods are complex or a number of samples cannot be assayed, so that they are not commonly used.... The method for measuring the cholesterol in HDL, which is generally used in the field of clinical test is the method in which a precipitating agent is added to the sample so as to coagulate the lipoproteins other than HDL, removing the coagulated lipoproteins by centrifugation, and the cholesterol in the resulting supernatant containing HDL alone is measured. Although this method is simpler than the ultracentrifugation method and the electrophoresis method, it is not satisfactorily simple because it comprises addition of the precipitating agent and subsequent separation, and a comparative large amount of sample is needed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Method of determining cholesterol and sensor applicable to the same Inventor(s): Yoshioka, Toshihiko; (Hirakata-shi, JP), Nankai, Shiro; (Hirakata-shi, JP), Watanabe, Motokazu; (Katano-shi, JP) Correspondence: AKIN, GUMP, STRAUSS, HAUER & FELD, L.L.P. ONE COMMERCE SQUARE; 2005 MARKET STREET, SUITE 2200; PHILADELPHIA; PA; 19103; US Patent Application Number: 20020025584 Date filed: September 24, 2001 Abstract: The present disclosure relates to a method for determining cholesterol in low density lipoprotein comprising the steps of (a) measuring total cholesterol level in a sample containing at least high density lipoprotein, low density lipoprotein, very low density lipoprotein and chylomicron, and (b) measuring cholesterol levels in the high density lipoprotein, very low density lipoprotein and chylomicron in the sample, wherein the cholesterol level in the low density lipoprotein is determined by subtracting a value obtained in the step (b) from a value obtained in the step (a). The present invention enables concurrent determination of cholesterol level in low density lipoprotein and total cholesterol level, facilitating acquisition of two types of biological information at a time. Excerpt(s): The present invention relates to a method for determining cholesterol in low density lipoprotein in a sample such as blood, serum and plasma.... A conventional method for determining cholesterol in low density lipoprotein has been based on fractionation using ultracentrifugation. This method, however, has drawbacks of requiring a particular device and taking much time for measurement.... A general method for determining cholesterol without ultracentrifugation is a method which measures total cholesterol level in a sample, cholesterol levels in high density lipoprotein, and triglyceride level individually to calculate cholesterol level in low density lipoprotein using known Friedewald equation. However, this method also has a problem of poor reliability in terms of reproducibility and accuracy if the sample contains much triglyceride. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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METHOD OF DETERMINING CHOLESTEROL CONTENT OF HIGH-DENSITY LIPOPROTEINS Inventor(s): OHARA, SHUICHI; (NIIGATA, JP), FUJIWARA, AKIRA; (NIIGATA, JP), MATSUI, HIROSHI; (NIIGATA, JP), ITO, YASUKI; (NIIGATA, JP) Correspondence: BIRCH STEWART KOLASCH & BIRCH; PO BOX 747; FALLS CHURCH; VA; 22040-0747; US Patent Application Number: 20020001819 Date filed: August 6, 1998 Abstract: Disclosed is a method for quantifying cholesterol in HDL, which does not require complex fragmentation and separation operations, and by which the HDL cholesterol in test samples containing HDL and other lipoproteins such as low density lipoprotein (LDL), very low density lipoprotein (VLDL) and chylomicron (CM) may be quantified selectively, simply and accurately. The method for quantifying cholesterol in high density lipoprotein comprises a first step of erasing cholesterol in lipoproteins other than high density lipoprotein in a test sample, and a second step of adding a surfactant which specifically acts on high density lipoprotein to the product of the first step and enzymatically quantifying cholesterol in high density lipoprotein. Excerpt(s): It is known that HDL relates to removal of cholesterol accumulated in cells because it receives cholesterol from various tissues including walls of blood vessels with arterial sclerosis, so that HDL is useful for estimating the risk for various arterial sclerosises including coronary artery sclerosis, and that its blood level is an indicator for the risk of onset of arterial sclerosis.... Methods for measuring cholesterol in HDL include a method in which HDL is separated from other lipoproteins by ultracentrifugation and then the HDL is measured; and a method in which the cholesterol in HDL is separated by electrophoresis, then the lipid is stained, and the intensity of the generated color is measured. However, these methods are complex or a number of samples cannot be assayed, so that they are not commonly used.... The method for measuring the cholesterol in HDL, which is generally used in the field of clinical test is the method in which a precipitating agent is added to the sample so as to coagulate the lipoproteins other than HDL, removing the coagulated lipoproteins by centrifugation, and the cholesterol in the resulting supernatant containing HDL alone is measured. Although this method is simpler than the ultracentrifugation method and the electrophoresis method, it is not satisfactorily simple because it comprises addition of the precipitating agent and subsequent separation, and a comparative large amount of sample is needed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of forcing the reverse transport of cholesterol from a body part to the liver while avoiding harmful disruptions of hepatic cholesterol homeostasis, and pharmaceutical compositions, and kit related thereto Inventor(s): Williams, Kevin Jon; (Wynnewood, PA) Correspondence: PATREA L. PABST; HOLLAND & KNIGHT LLP; SUITE 2000, ONE ATLANTIC CENTER; 1201 WEST PEACHTREE STREET, N.E. ATLANTA; GA; 303093400; US Patent Application Number: 20020071862 Date filed: January 31, 2002

Patents 419

Abstract: The present invention provides a pharmaceutical composition, kit, and method of forcing the reverse transport of cholesterol from peripheral tissues to the liver in vivo while controlling plasma LDL concentrations. The method includes the step of administering a therapeutically effective amount of a multiplicity of large liposomes comprised of phospholipids substantially free of sterol for a treatment period. The method optionally includes the step of periodically assaying plasma LDL concentrations with an assay during the treatment period to assess plasma atherogenic lipoprotein concentrations and obtain an atherogenic lipoprotein profile, and adjusting the administration in response to said profile. The large liposomes are dimensioned larger than fenestrations of an endothelial layer lining hepatic sinusoids in the liver so that the liposomes are too large to readily penetrate the fenestrations. The therapeutically effective amounts are in the range of about 10 mg to about 1600 mg phospholipid per kg body weight per dose. A pharmaceutical composition and related kit for mobilizing peripheral cholesterol and sphingomyelin that enters the liver of a subject consisting essentially of liposomes of a size and shape larger than fenestrations of an endothelial layer lining hepatic sinusoids in the liver is also provided. Excerpt(s): This application is a continuation in part regular patent application of pending U.S. provisional patent application serial No. 60/005,090 filed by Kevin Jon Williams, a citizen of the United States, residing at 425 Wister Road, Wynnewood, Pa. 19096 on Oct. 11, 1995 entitled "METHOD OF FORCING THE REVERSE TRANSPORT OF CHOLESTEROL FROM PERIPHERAL TISSUES TO THE LIVER IN VIVO WHILE CONTROLLING PLASMA LDL AND COMPOSITIONS THEREFOR." Pending U.S. provisional patent application serial No. 60/005,090 filed Oct. 11, 1995 is attached to the instant regular patent application as attachment A. Applicant expressly incorporates attachment A hereto into the instant regular patent application by reference thereto as if fully set forth.... Several human conditions are characterized by distinctive lipid compositions of tissues, cells, membranes, and extracellular regions or structures. For example, in atherosclerosis, cholesterol (unesterified, esterified, and oxidized forms) and other lipids accumulate in cells and in extracellular areas of the arterial wall and elsewhere. These lipids have potentially harmful biologic effects, for example, by changing cellular functions, including gene expression, and by narrowing the vessel lumen, obstructing the flow of blood. Removal of these lipids would provide numerous substantial benefits. Moreover, cells, membranes, tissues, and extracellular structures will benefit in general from compositional alterations that include increasing resistance to oxidation and oxidative damage, such as by increasing the content and types of antioxidants, removing oxidized material, and increasing the content of material that is resistant to oxidation. In aging, cells have been shown to accumulate sphingomyelin and cholesterol, which alter cellular functions. These functions can be restored in vitro by removal of these lipids and replacement with phospholipid from liposomes. A major obstacle to performing similar lipid alterations in vivo has been disposition of the lipids mobilized from tissues, cells, extracellular areas, and membranes. Natural (e.g., highdensity lipoproteins) and synthetic (e.g., small liposomes) particles that could mobilize peripheral tissue lipids have a substantial disadvantage: they deliver their lipids to the liver in a manner that disturbs hepatic cholesterol homeostasis, resulting in elevations in plasma concentrations of harmful lipoproteins, such as low-density lipoprotein (LDL), a major atherogenic lipoprotein. There exist a need for better methods to manipulate the lipid content and composition of peripheral tissues, cells, membranes, and extracellular regions in vivo.... The intravenous administration of cholesterol-poor phospholipid vesicles (liposomes) or other particles that transport cholesterol and other exchangeable material from lipoproteins and peripheral tissues, including atherosclerotic arterial lesions, to the liver produces substantial derangements of hepatic cholesterol

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homeostasis, such as enhanced hepatic secretion of apolipoprotein-B, and suppression of hepatic LDL receptors. The hepatic derangements lead to increase plasma concentrations of LDL and other atherogenic lipoproteins. Increased concentrations of LDL or other atherogenic lipoproteins will accelerate, not retard, the development of vascular complications. Deranged hepatic cholesterol homeostasis can also be manifested by abnormal regulation of genes, such as a gene for the LDL receptor, a gene for HMG-CoA reductase, a gene for cholesterol 7-alpha hydroxylase, and a gene regulating a function involved in cholesterol homeostasis. There exists a need for methods or compounds that can produce a removal of cholesterol and other exchangeable material, from peripheral cells, tissues, organs, and extracellular regions, and that can produce a delivery of material, such as phospholipids, to cells, tissues, or organs, extracellular regions, but without harmfully disrupting hepatic cholesterol homeostasis and plasma concentrations of atherogenic lipoproteins. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Method of reducing cholesterol in chicken eggs Inventor(s): Slaugh, Bartel T. (West Chester, PA) Correspondence: DRINKER BIDDLE & REATH; ONE LOGAN SQUARE; 18TH AND CHERRY STREETS; PHILADELPHIA; PA; 19103-6996; US Patent Application Number: 20020197349 Date filed: July 9, 2002 Abstract: A feed for producing reduced-cholesterol brown eggs from brown-egg-laying fowl is provided. The feed contains organic chromium, bacterial culture for improving digestion, at least one enzyme for improving digestion, and at least about 2 wt. % fiber. Excerpt(s): This application is a divisional of pending U.S. patent application Ser. No. 09/535,125, filed Mar. 24, 2000 which claims benefit of the filing date of U.S. provisional patent application Ser. No. 60/126,352, filed Mar. 26, 1999. The entire disclosures of the aforesaid applications are incorporated herein by reference.... The invention relates generally to a feed for egg-laying fowl, and particularly to a feed that enables reduced cholesterol eggs to be produced.... People are mindful of their dietary cholesterol intake because elevated cholesterol levels have been linked to heart disease in humans. Since chicken eggs are a comparatively prominent source of cholesterol, eggs are resultingly avoided in diets. This is unfortunate since eggs are an excellent source of protein and other nutrients. There is also a growing trend to develop food products that are "cholesterol-free", or of "low cholesterol" or "reduced cholesterol". Because of the egg's prominence as a source of cholesterol, efforts have been undertaken to develop methods of producing or identifying eggs having lower naturally occurring levels of cholesterol. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 421

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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 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

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Method of treating high plasma cholesterol levels Inventor(s): Steffen, Hans; (Liestal, CH), Lengsfeld, Hans; (Basle, CH), Hadvary, Paul; (Biel-Benken, CH) Correspondence: HOFFMANN-LA ROCHE INC. PATENT LAW DEPARTMENT; 340 KINGSLAND STREET; NUTLEY; NJ; 07110 Patent Application Number: 20030138396 Date filed: December 6, 2002 Abstract: A method prevents or treats diseases associated with high plasma cholesterol levels. In addition, this method reduces plasma cholesterol levels. The method comprises administering a lipase inhibitor, e.g. orlistat, and a pharmaceutically acceptable bile acid sequestrant. Excerpt(s): This application is a divisional of U.S. patent application Ser. No. 09/912,956, filed Jul. 25, 2001, currently pending.... The present invention relates to a new method for the prevention and treatment of diseases associated with high plasma cholesterol levels (hypercholesterolemia).... Bile acid sequestrants have been proposed for use in lowering circulating blood cholesterol levels. Biologically, cholesterol is eliminated from

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the body by conversion to bile acids and excretion as neutral steroids. Bile acids are synthesized from cholesterol in the liver and enter the bile as glycine and taurine conjugates. They are released in salt form in bile during digestion and act as detergents to solubilize and consequently aid in digestion of dietary fats. Following digestion, bile acid salts are mostly reabsorbed in the ileum, complexed with proteins, and returned to the liver through hepatic portal veins. The small amount of bile acid salts which are not reabsorbed by active transport are excreted via the distal ileum and large intestine as a portion of fecal material. Bile acids are synthesized from cholesterol transported in lipoproteins in the liver. Therefore, reabsorption of bile acids, which can be present as the corresponding salts or conjugates, from the intestine conserves lipoprotein cholesterol in the bloodstream. As such, reducing reabsorption of bile acids within the intestinal tract can lower levels of bile acid circulating in the enterohepatic system thereby promoting replacement of bile acids through synthesis from cholesterol, in the liver. The result is a lowering of circulating blood cholesterol levels. One method of reducing the amount of bile acids that are reabsorbed, is oral administration of compounds that sequester the bile acids within the intestinal tract and cannot themselves be absorbed. The sequestered bile acids consequently are excreted. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Method to counter oxidation of LDL, decrease triglyceride or cholesterol and inhibit atherosclerosis using hibiscus sabdariffa extract Inventor(s): Wang, Chau-Jong; (Taichung, TW) Correspondence: BIRCH STEWART KOLASCH & BIRCH; PO BOX 747; FALLS CHURCH; VA; 22040-0747; US Patent Application Number: 20030096021 Date filed: November 21, 2001 Abstract: A method for countering oxidization of low density lipoproteins, reducing cholesterol or triglyceride in plasma or inhibiting atherosclerosis comprising administering an effective amount of a Hibiscus sabdariffa extract. Excerpt(s): The present invention relates to the novel applications of the Hibiscus sabdariffa extract in countering oxidization of low density lipoproteins, reducing cholesterol or triglyceride in plasma or inhibiting atherosclerosis.... Conventionally, Hibiscus sabdariffa is a local soft drink material and medical herb demonstrating analgesic and antipyretic effects and can be used to cure liver-complaint. The past studies showed that Hibiscus sabdariffa possesses analgesic activity as well as antipyretic and anti-inflammatory action American Journal of Chinese Medicine, Vol. XXIV, Nos. 3-4, pp. 263-269, antispasmodic potential Journal of Ethnopharmacology, 31 (1991) 249-257 Elsevier Scientific Publishers Ireland Ltd., antimutagenic and chemopreventive activity Food and Chemical Toxicology 37 (1999) 591-601, antioxidant activity Food and Chemical Toxicology 35 (1997) 1159-1164 and is able to quench the free radicals of 1,1-diphenyl-2-picrylhydrazyl Food and Chemical Toxicology 38 (2000) 411-416 and lower high blood pressure Journal of Ethnopharmacology v.65(3) JUNE 1999 P. 231-236.... The vessel-related diseases such as apoplexy and heart attack have been the major causes of death in many countries. Though vessel-related diseases are caused by interactions of many factors, atherosclerosis has been the major factor contributing to vessel-related diseases according to the previously published literature. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method to treat chronic heart failure and/or elevated cholesterol levels Inventor(s): Morkin, Eugene; (Tucson, AZ) Correspondence: Norman P. Soloway; HAYES SOLOWAY P.C. 130 W. Cushing Street; Tucson; AZ; 85701; US Patent Application Number: 20030147815 Date filed: February 18, 2003 Abstract: A method for treating a patient having congestive heart failure by administering a therapeutically effective amount of 3',3,5-triiodothyropropionic acid (TRIPROP) or 3,5,3',5'-tetraiodothyropr- opionic acid (TETRAPROP). Also described is a method to lower cholesterol blood levels of a patient by administering a therapeutically effective amounts of TRIPROP or TETRAPROP. Excerpt(s): This application is a Continuation-in-Part of co-pending U.S. application Ser. No. 09/774,994, filed Jan. 31, 2001.... The present invention relates to a treatment for patients having congestive heart failure and/or elevated cholesterol blood levels.... Congestive heart failure continues to be a major health problem, affecting about 4.6 million people in the United States, and its prevalence is predicted to increase over the next several decades. The magnitude of heart failure as a clinical problem has placed emphasis on the need to develop new treatment strategies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method to treat chronic heart failure and/or elevated cholesterol levels using 3,5diiodothyropropionic acid and method to prepare same Inventor(s): Goldman, Steven; (Tucson, AZ), Bahl, Joseph J. (Tucson, AZ), Pennock, Gregory D. (Tucson, AZ), Morkin, Eugene; (Tucson, AZ) Correspondence: Dale F. Regelman; HAYES, SOLOWAY, HENNESSEY,; GROSSMAN & HAGE, P.C. 130 W. Cushing Street; Tucson; AZ; 85701; US Patent Application Number: 20020151594 Date filed: January 31, 2001 Abstract: Applicants' invention includes a method to treat a patient having congestive heart failure by administering a therapeutically effective amount of 3,5diidothyropropionic acid. Applicants' invention further includes a method to lower cholesterol blood levels of a patient by administering a therapeutically effective amount of 3,5-diidothyropropionic acid. Applicants' invention further includes a synthetic method to prepare 3,5-diidothyropropionic acid. Excerpt(s): The present invention relates to a treatment for patients having congestive heart failure and/or elevated cholesterol blood levels by administering a therapeutically effective amount of 3,5-Diiodothyropropionic acid. The present invention further relates to a synthetic method to prepare 3,5-Diiodothyropropionic acid.... Congestive heart failure continues to be a major health problem, affecting about 4.6 million people in the United States, and its prevalence is predicted to increase over the next several decades. The magnitude of heart failure as a clinical problem has placed emphasis on the need to develop new treatment strategies.... One approach that has emerged is the use of thyroid hormone, which has unique physiologic and biochemical actions that make it a novel

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and potentially useful agent for treatment of heart failure. Thyroid hormone has been shown to act at the transcriptional level on the content of myocardial calcium cycling proteins to stimulate calcium uptake by sarcoplasmic reticulum. In addition, thyroid hormone causes a reciprocal shift in cardiac myosin heavy chain (MHC) isoform expression, increasing the expression of the high activity V.sub.1 isoform and decreasing the low activity V.sub.3 form. These biochemical alterations may underlie the ability of thyroid hormone to increase the rates of ventricular pressure development and relaxation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Methods for modulation of cholesterol transport Inventor(s): Krieger, Monty; (Needham, MA), Kozarsky, Karen; (Philadelphia, PA), Rigotti, Attilio; (Malden, MA) Correspondence: PATREA L. PABST; HOLLAND & KNIGHT LLP; SUITE 2000, ONE ATLANTIC CENTER; 1201 WEST PEACHTREE STREET, N.E. ATLANTA; GA; 303093400; US Patent Application Number: 20030167475 Date filed: June 24, 2002 Abstract: Methods for regulation of lipid and cholesterol uptake are described which are based on regulation of the expression or function of the SR-BI HDL receptor. The examples demonstrate that estrogen dramatically downregulates SR-BI under conditions of tremendous upregulation of the LDL-receptor. The examples also demonstrate the upregulation of SR-BI in rat adrenal membranes and other nonplacental steroidogenic tissues from animals treated with estrogen, but not in other nonplacental non-steroidogenic tissues, including lung, liver, and skin. Examples further demonstrate the uptake of fluorescently labeled HDL into the liver cells of animal, which does not occur when the animals are treated with estrogen. Examples also demonstrate the in vivo effects of SR-BI expression on HDL metabolism, in mice transiently overexpressing hepatic SR-BI following recombinant adenovirus infection. overexpression of the SR-BI in the hepatic tissue caused a dramatic decrease in cholesterol blood levels. These results demonstrate that modulation of SR-BI levels, either directly or indirectly, can be used to modulate levels of cholesterol in the blood. Excerpt(s): The present invention is generally in the area of modulation of cholesterol transport via the SR-BI scavenger receptor.... All members of the LDL receptor gene family consist of the same basic structural motifs. Ligand-binding (complement-type) cysteine-rich repeats of approximately 40 amino acids are arranged in clusters (ligandbinding domains) that contain between two and eleven repeats. Ligand-binding domains are always followed by EGF-precursor homologous domains. In these domains, two EGF-like repeats are separated from a third EGF-repeat by a spacer region containing the YWTD motif. In LRP and gp330, EGF-precursor homologous domains are either followed by another ligand-binding domain or by a spacer region. The EGFprecursor homology domain, which precedes the plasma membrane, is separated from the single membrane-spanning segment either by an O-linked sugar domain (in the LDL receptor and VLDL receptor) or by one (in C. elegans and gp330) or six EGF-repeats (in LRP). The cytoplasmic tails contain between one and three "NPXY" internalization signals required for clustering of the receptors in coated pits. In a later compartment of the secretory pathway, LRP is cleaved within the eighth EGF-precursor homology domain. The two subunits LRP-515 and LRP-85 (indicated by the brackets) remain

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tightly and non-covalently associated. Only partial amino acid sequence of the vitellogenin receptor and of gp330 are available.... LDL receptors and most other mammalian cell-surface receptors that mediate binding and, in some cases, the endocytosis, adhesion, or signaling exhibit two common ligand-binding characteristics: high affinity and narrow specificity. However, two additional lipoprotein receptors have been identified which are characterized by high affinity and broad specificity: the macrophage scavenger receptors type I and type II. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Methods to increase plasma HDL cholesterol levels and improve HDL functionality with probucol monoesters Inventor(s): Sikorski, James A. (Alpharetta, GA), Saxena, Uday; (Atlanta, GA), Luchoomun, JayRaz; (Lilburn, GA), Sundell, Cynthia L. (Atlanta, GA) Correspondence: KING & SPALDING; 191 PEACHTREE STREET, N.E. ATLANTA; GA; 30303-1763; US Patent Application Number: 20030064967 Date filed: April 11, 2002 Abstract: It has been discovered that certain selected probucol monoesters, and their pharmaceutically acceptable salts or prodrugs, are useful for increasing circulating HDL cholesterol. These compounds may also improve HDL functionality by (a) increasing clearance of cholesteryl esters, (b) increasing HDL-particle affinity for hepatic cell surface receptors or (c) increasing the half life of apoAI-HDL. Excerpt(s): This application claim priority to U.S. Ser. No. 60/283,376 filed on Apr. 11, 2001, and U.S. Ser. No. 60/345,025 filed on Nov. 9, 2001.... This invention is in the area of compositions and methods to increase plasma high density lipoprotein cholesterol levels, and to improve the functionality of circulating high density lipoprotein using probucol monoesters.... Coronary heart disease (CHD) remains the leading cause of death in the industrialized countries. The primary cause of CHD is atherosclerosis, a disease characterized by the deposition of lipids, including cholesterol, in the arterial vessel wall, resulting in a narrowing of the vessel passages and ultimately hardening of the vascular system. Epidemiological studies have demonstrated an inverse relationship between serum high density lipoprotein cholesterol (HDLC) levels and the incidence of CHD (Castelli, W. P. et al., J. Am. Med. Assoc., 256, 2835 (1986); Miller and Miller Lancet, 1, 16 (1975); Gordon et al., Circulation 79, 8 (1989)). Low levels of HDLc represent a significant independent CHD risk factor whether or not these patients have elevated low density lipoprotein cholesterol (LDLc) levels (Kannel, W. B., Am. J. Cardiol. 76, 69c (1995)). Indeed, high-density lipoprotein (HDL) is recognized as the anti-atherogenic lipoprotein (Stein, O. and Stein, Y., Atherosclerosis 144, 28 (1999)). Several clinical studies have demonstrated reduced CHD events with treatments that raised HDLc. For example, the recent VA-HIT trial showed for the first time that by raising HDLc without affecting LDLc, cardiac events in patients with CHD were substantially reduced (Rubins, H. B. and Robins, S., Am. J. Cardiol. 86, 543 (2000)). Every 1% rise in HDLc, produced a corresponding 2-3% decrease in CHD. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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MODIFICATION OF PHYTOCHEMICALS

CHOLESTEROL

CONCENTRATIONS

WITH

CITUS

Inventor(s): MCGILL, CARLA R. (SARASOTA, FL), GREEN, NANCY R. (BRADENTON, FL) Correspondence: COOK ALEX MCFARRON MANZO; CUMMINGS & MEHLER LTD; 200 WEST ADAMS STREET; SUITE 2850; CHICAGO; IL; 60606 Patent Application Number: 20020006953 Date filed: November 5, 1999 Abstract: Methods, products and compositions are provided which, when administered to a mammal, including humans, raises HDL serum cholesterol levels, while typically also lowering the ratio of LDL to HDL serum cholesterol levels. An effective amount of one or more of a monoterpene, a terpene and a flavonoid are included in the treatment composition. Excerpt(s): This invention generally relates to therapeutic compositions and procedures for modifying cholesterol levels in mammals. More particularly, the invention relates to modifying cholesterol levels in a manner which is believed to result in health benefits, especially cardiovascular health benefits. The effects achieved in accordance with the present invention are consistent with reduced risks of cardiovascular disease.... It is generally accepted that an important component in maintaining a profile for good cardiovascular health is the maintenance of desirable cholesterol levels. Currently it is generally accepted that an individual should avoid certain elevated plasma total cholesterol levels. Two major components of plasma cholesterol are low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. More particularly, LDL cholesterol levels should be maintained below an acceptable level, while high HDL cholesterol levels are considered to contribute cardiovascular health. It is generally accepted that a decreased LDL to HDL cholesterol ratio is an advantageous goal for those whose cholesterol ratio is higher than desirable levels.... A typically accepted dietary intervention regimen for altering blood cholesterol concentrations is to take measures in order to reduce LDL cholesterol levels. Generally, such dietary intervention does not enjoy the ability of increasing HDL cholesterol. It will be appreciated that, if a viable dietary intervention program were available for increasing HDL cholesterol and for decreasing LDL to HDL cholesterol levels, considerable potential benefits would obtain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

NEW URETHANES, THIO AND DITHIO ANALOGUES AND THEIR USE AS INHIBITORS OF CHOLESTEROL BIOSYNTHESIS Inventor(s): EISELE, BERNHARD; (BIBERACH, DE), SCHILCHER, GEBHARD; (MITTELBIBERACH, DE), MUELLER, PETER; (STAMFORD, CT), MARK, MICHAEL; (BIBERACH, DE), HURNAUS, RUDOLF; (BIBERACH, DE), MAIER, ROLAND; (BIBERACH, DE), ADELGOSS, GEBHARD; (BIBERACH, DE) Correspondence: BOEHRINGER INGELHEIM CORPORATION; 900 RIDGEBURY ROAD; P O BOX 368; RIDGEFIELD; CT; 06877; US Patent Application Number: 20020019536 Date filed: March 24, 1999

Patents 427

Abstract: The present invention relates to urethanes and the thio and dithio analogues thereof of general formula 1whereinm, n, A, X, Y and R.sup.1 to R.sup.8 are defined as in claim 1, the enantiomers, diastereomers and the salts thereof, particularly the physiologically acceptable acid addition salts thereof which have valuable properties, particularly an inhibitory effect on cholesterol biosynthesis, pharmaceutical compositions containing these compounds, their use and processes for preparing them. Excerpt(s): The present invention relates to new urethanes, the thio and dithio analogues thereof, the salts thereof with physiologically acceptable organic and inorganic acids, processes for preparing these compounds and pharmaceutical compositions containing them.... The compounds according to the invention are inhibitors of cholesterol biosynthesis, particularly inhibitors of the enzyme 2,3-epoxysqualene-lanosterol-cyclase, a key enzyme in cholesterol biosynthesis. The compounds according to the invention are suitable for the treatment and prophylaxis of hyperlipidaemias, hypercholesterolaemias and atherosclerosis. Other possible applications are in the treatment of hyperproliferative skin and vascular diseases, tumours, gallstone problems and mycoses.... Compounds which affect cholesterol biosynthesis are important for the treatment of a number of diseases. These include in particular hypercholesterolaemias and hyperlipidaemias which are risk factors for the occurrence of atherosclerotic vascular changes and their sequelae such as coronary heart disease, cerebral ischaemia, Claudicatio intermittens and gangrene. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

No fat, no cholesterol cake and process of making the same Inventor(s): Donovan, Margaret E. (Aurora, CO) Correspondence: RAMON L. PIZARRO; Suite 200; 3515 SOUTH TAMARAC DRIVE; DENVER; CO; 80237; US Patent Application Number: 20020041924 Date filed: April 3, 2001 Abstract: A no fat, no cholesterol cake possesses a dry premix component, consisting, on a volumetric percentage basis, of about 52.4% flour, 46.6% sugar, and 1% baking soda. Egg. whites and various wet mix ingredients are added to the dry premix to produce a variety of different cakes. In each instance, the wet mix includes an acidic component consisting of fruit and/or fruit juice which reacts with the baking soda to leaven the cake. The fruits and/or fruit juices which may be used include pineapple, orange, cranberry, apple, lemon, and cherry. Natural flavoring ingredients including raisins, dates, bananas, carrots, zucchini, apricots, non-fat yogurt, cinnamon, nutmeg, ginger, cloves, and vanilla may also be employed. No shortening, fillers, or unnatural ingredients are utilized. Excerpt(s): The present invention relates to cakes, and more particularly pertains to an improved no fat, no cholesterol cake. For health reasons, there is an increasing interest in no fat and no cholesterol bakery products. In order to produce such products, particularly cakes, the prior art has proposed various cake mixes in which the conventional shortening components are replaced with alginate and other fillers and chemicals. Many individuals have found such chemical and filler laden cakes to be unacceptable, both for reasons of their unnatural ingredients, as wells as for their poor taste and mouth feel. Accordingly, there is an interest in and need for an improved no fat, no cholesterol cake consisting entirely of natural ingredients, and possessing good

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flavor and mouth feel characteristics.... In order to achieve these and other objects of the invention, the present invention provides an improved no fat, no cholesterol cake which includes a dry premix component, consisting, on a volumetric percentage basis, of about 52.4% flour, 46.6% sugar, and 1% baking soda. Egg whites and various wet mix ingredients are added to the dry premix to produce a variety of different cakes. In each instance, the wet mix includes an acidic component consisting of fruit and/or fruit juice which reacts with the baking soda to leaven the cake. The fruits and/or fruit juices which may be used include pineapple, orange, cranberry, apple, lemon, and cherry. Natural flavoring ingredients including raisins, dates, bananas, carrots, zucchini, apricots, non-fat yogurt, cinnamon, nutmeg, ginger, cloves, and vanilla may also be employed. No shortening, fillers, or unnatural ingredients are utilized.... There has thus been outlined, rather broadly, the more important features of the invention in order that the detailed description thereof that follows may be better understood, and in order that the present contribution to the art may be better appreciated. There are, of course, additional features of the invention that will be described hereinafter and which will form the subject matter of the claims appended hereto. In this respect, before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details set forth in the following description. The invention is capable of other embodiments and of being practiced and carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein are for the purpose of description and should not be regarded as limiting. As such, those skilled in the art will appreciate that the conception, upon which this disclosure is based, may readily be utilized as a basis for the designing of other structures, methods and systems for carrying out the several purposes of the present invention. It is important, therefore, that the claims be regarded as including such equivalent constructions insofar as they do not depart from the spirit and scope of the present invention. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Pharmaceutical and food compositions containing" wood alcohols" or" wood sterols" useful for lowering serum cholesterol Inventor(s): Rojas, Alejandro Markovits; (Quilicura, CL), Schersl, Endre Markovits; (Quilicura, CL), Diaz, Miguel Fuenzalida; (Quilicura, CL) Correspondence: BAKER & McKENZIE; 12th Floor; 101 West Broadway; San Diego; CA; 92101; US Patent Application Number: 20020183298 Date filed: August 3, 2001 Abstract: Dietary utilization of mixtures containing fatty alcohols of less than 26 carbon atoms per molecule and/or wood sterols derived from non-saponifiable compounds contained in black liquor soaps or tall oil pitch useful for lowering serum cholesterol. Food and pharmaceutical compositions containing these fatty alcohols or sterols or sterol esters are provided. Excerpt(s): The present invention is related to food and pharmaceutical compositions containing fatty alcohols of 26 or less carbon atoms per molecule such as octadecanol, eicosanol, docosanol, tetracosanol or hexacosanol and/or wood sterols useful for treating hypercholesteromia in human beings.... Disorders of lipid metabolism especially harmful effects caused by high levels of serum cholesterol have been intensively investigated.... Cholesterol levels in blood over 200 mg/dl constitute the

Patents 429

main risk factor of coronary diseases, the most frequent cause of death, principally in developed countries. However, the risk factor is not only related to high cholesterol level in blood, but also to different forms of total cholesterol. A high level of low-density lipoprotein or LDL cholesterol and very low-density lipoprotein or VLDL cholesterol in blood constitutes a problem because these lipoproteins are very likely to remain in the cardiovascular system causing the formation of plaques in the coronary arteries. Likewise, low levels of high-density lipoproteins or HDL cholesterol constitute an additional risk factor because they are useful in removing the form of cholesterol that blocks arteries. Therefore total cholesterol level and total cholesterol: HDL cholesterol ratio must be considered for evaluating the risk of coronary diseases. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Phospholipid transfer protein (PLTP) and cholesterol metabolism Inventor(s): Chin, Khew-Voon; (Highland Park, NJ) Correspondence: KLAUBER & JACKSON; 411 HACKENSACK AVENUE; HACKENSACK; NJ; 07601 Patent Application Number: 20020187997 Date filed: May 15, 2002 Abstract: A method for controlling cholesterol metabolism in a host, a screening assay for agents that can control cholesterol metabolism, and the agents that may be identified are practiced and determined in relation to the expression of PLTP in HepG2 cells and a clone from these cells, designated HepG2/PLTPpLuc. Particular agents that are covered comprise camptothecin, topotecan, derivatives thereof, metabolic byproducts thereof and small molecule mimics thereof. Excerpt(s): This application claims benefit of priority to provisional application Serial No. 60/291,383, filed May 16, 2001, which is incorporated herein by reference in its entirety.... The present invention relates generally to cholesterol metabolism, and more particularly, to the reduction of serum cholesterol, and particularly, the discovery of new drugs and agents that can achieve this objective. Moreover, new genetic constructs have been developed useful for screening for new drugs and agents that can be used to treat diseases associated with high levels of cholesterol.... The presence of abnormally high serum cholesterol in humans is clearly associated with a variety of pathologies including coronary heart disease, atherosclerosis, hypercholesterolemia and particularly rare forms of these conditions that have defied effective treatment in the past, namely Tangier disease and familial high density lipoprotein (HDL) deficiency. The last mentioned conditions are both characterized by a low concentration of circulating HDL, which are generally thought of as effecting transport and transition of cholesterol for metabolic conversion in the liver to bile acids and, thereafter, for removal from the body. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Procedure for quantitative determination of viral particles having a cholesterolcontaining envelope Inventor(s): Beer, Christiane; (Braunschweig, DE), Wirth, Manfred; (Braunschweig, DE) Correspondence: FROMMER LAWRENCE & HAUG; 745 FIFTH AVENUE- 10TH FL. NEW YORK; NY; 10151; US Patent Application Number: 20030082520 Date filed: December 27, 2001 Abstract: The invention relates to a procedure for quantitatively determining viral particles having a cholesterol-containing envelope, wherein the viral particles are stained with the fluorescent dye filipin and the number of viral particles is determined by counting the fluorescent particles under a fluorescence microscope. Excerpt(s): The invention relates to a procedure for quantitative determination of viral particles having a cholesterol-containing envelope, using the fluorescent dye filipin.... Quantifying total viral particles is a relatively involved procedure compared to determining the number of infectious viral particles. Detection of retroviral particles in cell culture supernatants is used, on the one hand, to exclude the possibility of contamination with retroviruses and, on the other hand, to check the quantity and quality of virus production by packaging cells. Contamination with retroviruses is usually detected by means of the activity of viral reverse transcriptase in the supernatant [85, 106] (a literature list, including bibliographic details, will be found at the end of the description). There are various methods available for quantifying the production of total viral particles. Besides the afore-mentioned activity of reverse transcriptase, determination of viral "strong-stop" cDNA, electron microscope investigations and immunohistochemical staining of proteins on the virus surface are used for quantifying total particles [7, 84, 85, 103].... Those methods can be categorised, according to their principle, into two types. On the one hand, they consist of indirect quantification methods wherein the number of viral particles is inferred from viral enzyme activities or from the nucleic acid content. On the other hand, there are direct methods, serving to make the viral particles visible. The first category includes detection of viral RNA, of viral "strong-stop" cDNA and of the activity of viral reverse transcriptase [84, 85, 143, 144]. Electron microscope investigations and immunohistochemical staining of viral envelope proteins on the surface of the virus are included in the second category of methods used [103, 7]. The advantages of the indirect methods lie in the fact that they are relatively simple to perform and a large number of samples can be quantified rapidly. The disadvantage of that kind of particle number determination lies in the fact that it provides only an approximate idea of the number of viruses released and, as has been shown in the context of investigations relating to the invention, factors specific to the cell type are in some cases required to calculate the total particle numbers. It is, for example, usually assumed that 1% of infectious retroviruses contains "strong-stop" cDNA, irrespective of the cell line and production conditions. However, the data presented together with the invention show that the number of infectious viruses as a proportion of the cDNA-containing particles varies in dependence upon the type of production cell line. For the murine fibroblast cell line NIH3T3, it has been possible to demonstrate, in a number of experiments, that approximately half the infectious particles contain "strong-stop" cDNA. That contradicts the data of other study groups, which have shown that about 1% of total particles are infectious [84, 149]. In order to quantify total viral particles exactly using this method, therefore, it is necessary to take into account a factor specific to the cell type. That factor can, however, be determined only using methods that, like the direct methods, are

Patents 431

capable of detecting all viral particles. However, electron microscope investigations, for example, require a not inconsiderable outlay on apparatus and materials. The immunohistochemical staining procedures developed by Pizzato et al. [7] can, in contrast, be performed relatively rapidly and simply, but they do, in some cases, require a considerable outlay in optimising the staining procedures and they are dependent upon the existence of a corresponding antibody to viral surface proteins. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Process for producing a cholesterol-reduced substance Inventor(s): Mizukami, Toru; (Tokyo, JP), Ouchi, Kozo; (Hasuda-shi, JP), Katsumata, Ryoichi; (Miyagi-ken, JP), Aisaka, Kazuo; (Tokyo, JP), Kumazawa, Hideyo; (Tokyo, JP), Saitoh, Chiaki; (Ibaraki-ken, JP), Ochiai, Keiko; (Ebina-shi, JP), Ando, Katsuhiko; (Tokyo, JP) Correspondence: ANTONELLI TERRY STOUT AND KRAUS; SUITE 1800; 1300 NORTH SEVENTEENTH STREET; ARLINGTON; VA; 22209 Patent Application Number: 20010034041 Date filed: June 4, 2001 Abstract: According to the present invention, a process for producing a practical cholesterol-reduced substance by converting cholesterol contained in foods and feeds to coprostanol having very low intestinal tract absorbability by utilizing enzymatic action is provided. Cholesterol in a cholesterol-containing substance such as meat, egg, milk, seafood and cooked processed foods containing the same, or feeds for animals, poultry and pisciculture, and the like, can be treated with three kinds of enzymes which are a cholesterol dehydrogenase having an optimum pH in a neutral pH range and 4cholesten-3-one dehydrogenase and coprostan-3-one dehydrogenase each having an optimum pH in a weak acidic range, or microbial cells containing the enzymes, for converting the cholesterol to coprostanol to reduce the amount of the cholesterol. Excerpt(s): The present invention relates to a method for producing a cholesterolreduced substance, a cholesterol-reducing composition and a novel cholesterol dehydrogenase, 4-cholesten-3-one dehydrogenase and coprostane-3-one dehydrogenase for using the above-mentioned purpose.... It is widely known that excess intake of food having high cholesterol content increases the amount of cholesterol in serum and that high cholesterol content in serum is a significant factor in heart diseases. Therefore, processing techniques are required for selectively reducing the amount of cholesterol in food without deteriorating the quality of the food.... Among techniques for reducing the amount of cholesterol in food, a method is known that decomposes cholesterol with microorganisms (Japanese Laid-Open Patent Publication No. 267231/88) as a biochemical technique; however, this method produces by-products, therefore, it is not a safe method. Further, a method in which cholesterol is converted to epicholesterol by using an enzyme is known (WO93/25702). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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PROCESS FOR PRODUCING, METHODS AND COMPOSITIONS OF CHOLESTEROL LOWERING AGENTS FROM HIGHER BASIDIOMYCETES MUSHROOMS Inventor(s): RESHETNIKOV, SERGEY V. (KIEV, UA), WASSER, SOLOMON P. (HAIFA, IL) Correspondence: RASHIDA A. KARMALI, ESQ. 230 PARK AVENUE; SUITE 2525; NEW YORK; NY; 10169; US Patent Application Number: 20010016197 Date filed: October 15, 1999 Abstract: The present invention describes new and distinct strains of higher Basidiomycetes mushrooms, and a process for growing them in submerged culture. Specifically, the new strains of species of the genus Pleurotus offer superior yields of mushroom biomass and concentrations of biologically active compounds, for example, cholesterol-lowering compounds, lectins, proteins, essential amino acids, vitamins or polysaccharides. The process includes use of defined media and a simple one-step procedure of separating the lovastatin-containing nutriceuticals from culture broth. Excerpt(s): The present invention is directed to a process for culturing a variety of higher Basidiomycetes mushrooms to produce superior yields of biologically active nutriceuticals. The nutriceutical agents are isolated by a simple one-step process, and are formulated for use as dietary supplements to achieve normal human bodily functions in general, and to control particular abnormal factors, for example, hypercholesterolemia, in particular.... Mushrooms or macrofungi with distinctive fruiting bodies of sufficient size to be seen with the naked eye, include about 10,000 species of varying degrees of edibility. Approximately 100 species have been tested for cultivation and only seven to eight have been cultivated on an industrial scale. The world production of cultivated edible mushrooms in 1994 was estimated to be about five million tons and was valued at about ten billion US dollars. The most popular species of cultivated edible mushrooms include Agaricus bisporus (J. Lge) Imbach, A. bitorquis (Qul.) Sacc., Lentinus edodes (Berk.) Sing, Pleurotus spp., Auricularia spp., Volvariella volvacea (Fr.) Sing., Flammulina velutipes (Fr.) Sing, Tremella fuciformis Berk., Hypsizygus marmoreus (Peck) Bigel., Pholita nameko (T. Ito) S. Ito et Imai, Grifola frondosa (Dicks.: Fr.) S. F. Gray, Hericium erinaceus (Bull.: Fr.) Pers., Dictyophora indusiata (Vent.: Pers.) Fischer, Stropharia rugosoannulata Farl. apud Murr., Lepista nuda (Bull.: Fr.) Cooke, Agrocybe aegerita (Brig.) Sing.... The cultivation of fruiting bodies of mushrooms deals with living organisms, for example, the mushroom itself and other microorganisms which may either be harmful or beneficial. Therefore, the methods employed in mushroom cultivation require modifications depending upon the region being cultivated, substrates available, environmental conditions and species of microorganisms encountered. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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RECOMBINANT VIRUSES EXPRESSING LECITHIN-CHOLESTEROL ACYLTRANSFERASE, AND USES THEREOF IN GENE THERAPY Inventor(s): SEGURET, SANDRINE; (MONTIGINY LE BRETONNEUX, DE), LATTAMAHIEU, MARTINE; (CHARENTON LE PONT, FR), DENEFLE, PATRICE; (SAINT MAUR, FR), DUVERGER, NICOLAS; (PARIS, FR) Correspondence: FINNEGAN HENDERSON FARABOW GARRETT &; DUNNER, LLP; 1300 I STREET, NW; WASHINGTON,; DC; 200053315 Patent Application Number: 20010014319 Date filed: November 5, 1997 Abstract: Defective recombinant viruses containing an inserted gene coding for all or part of lecithin-cholesterol acyltransferase (LCAT) or a variant thereof, pharmaceutical compositions containing said viruses, and the use thereof for treating or preventing dyslipoproteinaemia-related diseases, are disclosed. Excerpt(s): The present invention relates to new recombinant viruses, to their preparation and their use in gene therapy, for the transfer and expression in vivo of desired genes. More precisely, it relates to new recombinant viruses comprising an inserted gene encoding all or part of lecithin-cholesterol acyltransferase (LCAT) or a variant thereof. The present invention also relates to pharmaceutical compositions comprising the said recombinant viruses. More particularly, the present invention relates to defective recombinant viruses and their use for the prevention or the treatment of pathologies linked to dyslipoproteinaemias, which are known for their serious consequences at the cardiovascular and neurological level.... Dyslipoproteinaemias are disorders of the metabolism of the lipoproteins responsible for the transport, in the blood and peripheral fluids, of lipids such as cholesterol and triglycerides. They result in major pathologies, linked respectively to hypercholesterolemia or hypertriglyceridemia, such as especially atherosclerosis. Atherosclerosis is a polygenic complex disease which is defined from the histological point of view by deposits (lipid or fibrolipid plaques) of lipids and of other blood derivatives in the wall of the large arteries (aorta, coronary arteries, carotid). These plaques, which are calcified to a greater or lesser extent according to the progression of the process, can be associated with lesions and are linked to the accumulation, in the arteries, of fatty deposits consisting essentially of cholesterol esters. These plaques are accompanied by a thickening of the arterial wall, with hypertrophy of the smooth muscle, the appearance of spumous cells and the accumulation of fibrous tissue. The atheromatous plaque is very clearly in relief on the wall, which confers on it a stenosing character responsible for vascular occlusions by atheroma, thrombosis or embolism which occur in the patients most affected. Hypercholesterolemias can therefore result in very serious cardiovascular pathologies such as infarction, sudden death, cardiac decompensation, cerebral vascular accidents and the like.... It is therefore particularly important to be able to have available treatments which make it possible to reduce, in certain pathological situations, the plasma cholesterol levels or even to stimulate the efflux of cholesterol (reverse transport of the cholesterol) in the peripheral tissues in order to discharge the cells having accumulated cholesterol within the context of the formation of an atheroma plaque. The cholesterol is carried in the blood by various lipoproteins including the low-density lipoproteins (LDL) and the high-density lipoproteins (HDL). The LDLs are synthesized in the liver and make it possible to supply the peripheral tissues with cholesterol. In contrast, the HDLs capture cholesterol in the peripheral tissues and transport it to the liver where it is stored and/or degraded.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Secreted and cell surface polypeptides affected by cholesterol and uses thereof Inventor(s): Bowen, Benjamin A. (Berkeley, CA), Shang, Jin; (Fremont, CA) Correspondence: QUINE INTELLECTUAL PROPERTY LAW GROUP, P.C. P O BOX 458; ALAMEDA; CA; 94501; US Patent Application Number: 20030170700 Date filed: January 8, 2003 Abstract: Polynucleotides, proteins, antibodies, labeled probes, marker sets, and arrays related to secreted and cell surface proteins that are altered in response to cholesterol are provided. Methods of detecting alterations in secreted and cell surface proteins in response to alterations in cholesterol levels (exposure), modulating cholesterol phenotype in cells and for treating a subject with adverse effects of altered levels of cholesterol, e.g., elevated or high levels of cholesterol, are also provided. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/347,396 filed Jan. 9, 2002, entitled "SECRETED AND CELL SURFACE POLYPEPTIDES AFFECTED BY CHOLESTEROL AND USES THEREOF" and naming Jin Shang et al. as the inventors. This prior application is hereby incorporated by reference in its entirety.... Not Applicable.... This invention is in the field of genes which are relevant for human diseases related to alterations of cholesterol levels, such as elevated levels of cholesterol, e.g., as in atherosclerosis. The present invention relates to the identification of candidate genes and polypeptides encoded by these genes that encode secreted and/or cell surface polypeptides that exhibit significant changes in expression regulated by cholesterol. Related probes, marker sets, polypeptides and/or peptides and antibodies are included in the present invention, along with methods for evaluating and monitoring subjects for responses to alterations of cholesterol levels, e.g., elevated levels of cholesterol, such as, those at risk for atherosclerosis, and controlling the adverse effects of the responses to alterations of cholesterol levels (cholesterol homeostasis), along with cellular and transgenic models relevant to those conditions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Sublingual use of inhibitors in the biosynthesis of cholesterol Inventor(s): Weiss, Sol; (Reseda, CA) Correspondence: MITCHELL, SILBERBERG & KNUPP, LLP; Trident Center; 11377 West Olympic Boulevard; Los Angeles; CA; 90064; US Patent Application Number: 20030100493 Date filed: June 4, 2002 Abstract: The present invention is a method introducing the sublingual placement of statin drugs whose names include: Fluvastatin, Atorvastatin, Lovastatin, Pravastatin and Simvastatin for heart related and other vascular emergencies. Current research challenges are developing many new derivatives and new classes of these HMG-CoA reductase inhibitors, which alter the biosynthesis of cholesterol. This method applies these medications (statin drugs) in a form such as sublingual (under the tongue) for rapid absorption and immediate high blood levels similar to that of nitroglycerin. The

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advantage of this method is that it will benefit those who are stricken with strokes and heart attacks by therefore saving lives and costs of medical care. Excerpt(s): This application contains subject matter of my provisional application Serial No. 60/306,977, filed Jul. 19, 2001, entitled Sublingual Use of Inhibitors in the Biosynthesis of Cholesterol, and in my provisional application Serial No. 60/314,532, filed Aug. 23, 2001, entitled Amendments to Serial No. 60/306,977.... There is disclosed a method and combination of components to administer statin drugs in a beneficial method and manner. This method includes the sublingual administration of drugs selected from the class of drugs known as statin drugs. In addition to the method, there is disclosed a method and attendant components for administering sublingual medication or medications for emergency stabilization of ruptured plaques; suppression of thrombus or aggregation of platelets; alteration of inflammatory responses; improvement of endothelial function; reduction in cell death and augmentation of vasodilation. Disclosed is the combination of medications, such as a statin drug and nitroglycerin, and others, in sublingual administration. In addition, it has been found that combinations of other statin class drugs with other cholesterol lowering drugs such as niacin and other complications rupture, thrombus and platelet aggregation, inflammation, compromised endothelial function, vasoconstriction and cell death. These statin medications both by their own merits and in combinations with other drugs will lend to more beneficial and/or synergistic effects. Statins are like the new aspirins for use in the field of emergency medicine. The new Heart Protection Study (HPS) done in England reflects this latest and major breakthrough study of the statin class of drugs showing a reduction of adverse major vascular events over 5.5 years of treatment in high-risk patients. Most everyone is aware of the beneficial role of aspirin in emergency medicine.... Furthering this theory of use ill medical emergencies are new reports of statins reducing infarct size in stroke patients. Statins favor endothelial nitric oxide synthase (eNOS) and block inducible nitric oxide synthase (iNOS) effects. These effects are neuroprotective by preserving blood flow and limiting neurological insult. Another ongoing study shows that a neurotoxin, Beta-Amyloid, derived from the Amyloid Precursor Protein (APP), was found embedded in the membranes of cells as disclosed in Alzheimer's disease, multiple sclerosis, vascular inflammations and other degenerative changes. Similar changes are recognized in patients with coronary artery and vascular diseases therefore implicating the plaque deposits occur elsewhere in the body as a result of the high cholesterol contents in tissues. High cholesterol induces these toxic changes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Substance and method for reduction of lipids and cholesterol Inventor(s): Hakli, Harri; (Vantaa, FI), Kivekas, Olli; (Tampere, FI), Struszczyk, Henryk; (Zgierz, PL), Saynatjoki, Elina; (Kuhmoinen, FI) Correspondence: Connoly Bove Lodge & Hutz LLP; Suite 800; 1990 M Street, N.W. Washington; DC; 20036-3425; US Patent Application Number: 20030092673 Date filed: August 6, 2001 Abstract: A substance for reduction of absorption of lipids and for reduction of serum cholesterol content in mammals comprising microcrystalline chitosan. The microcrystalline chitosan can be administered orally in food products or in dose units

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containing a predetermined amount of microcrystalline chitosan. The microcrystalline chitosan has an average particle size not higher than 100.mu.m. Excerpt(s): The invention relates to a substance and method for reduction of lipids by reducing their absorption in a living body. The invention also includes a substance and method for reduction of serum cholesterol content.... Lipids play an important role in many biological processes, and quite often such components as triglycerides, fatty and bile acids as well as cholesterol and other sterols act negatively for certain mammals, especially humans. The negative effects of lipids in many biological processes are described inter alia in: Laboratory Investigation; vol 39, pages 574-583, 1978, Biochimica Biophysica Acta, vol, 515, pages 163205, 1978 and International Journal of Pharmacy, vol. 74, pages 137-146, 1991. The subsequent digestion and absorption of lipids affects negatively the weight control as well as causes health problems.... Cholesterol, classified in lipid classification among precursor and derived lipids, an essential component of cell membranes and a precursor for steroid hormone synthesis and triglycerides, an important energy source, are transported as lipoproteins in the blood, Hyperlipoproteinemias are disturbances of lipid transport that result from accelerated synthesis or retarded degradation of lipoproteins. This abnormal phenomenon known as hyperlipidemia is detected by finding an elevated concentration of cholesterol and triglycerides in serum. High contents of serum lipoproteins are clinically very important, because they may cause two life-threatening problems: atherosclerosis and pancreatitis. Suitable reduction of the cholesterol-carrying lipoproteins, through diet and drugs, decreases a risk of myocardial infarction in subjects of hyperlipoproteinemia and hyperlipidemia. 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): Vanhanen, Hannu; (Helsinki, FI), Wester, Ingmar; (Raisio, FI), Miettenen, Tatu; (Espoo, 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.-

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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, 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 ·

Synergistic effect of amlodipine and atorvastatin on cholesterol crystal formation inhibition and aortic endothelial cell nitric oxide release Inventor(s): Mason, R. Preston; (Manchester, MA) Correspondence: PERKINS, SMITH & COHEN LLP; ONE BEACON STREET; 30TH FLOOR; BOSTON; MA; 02108; US Patent Application Number: 20020052394 Date filed: August 3, 2001 Abstract: The combination of the antihypertensive calcium channel blocker amlodipine and lipid-lowering agent atorvastatin inhibits free cholesterol crystallization in atherosclerotic-like membranes. In addition, treatment with a combination of amlodipine and atorvastatin results in a synergistic effect on the release of NO from rabbit aorta endothelial cells. Excerpt(s): This application claims priority from U.S. Provisional Patent Application No. 60/223,214 entitled "Synergistic Effect of Amlodipine and Atorvastatin on the Stimulation of Nitric Oxide Release from Rabbit Aorta Endothelial Cells" that was filed on Aug. 4, 2000.... This invention relates to the effect of amlodipine and atorvastatin, alone and in combination, on cholesterol crystal formation and the release of nitric oxide (NO) from endothelial cells.... Coronary artery disease (CAD) is the leading cause of mortality in the developed world, and is associated with substantial morbidity as well. Typically, the patient with CAD has several concomitant conditions, including hypertension, diabetes, and dyslipidemia, increasing overall risk for poor outcomes and complicating treatment. A therapeutic goal for the treatment of CAD is the development of drugs that can simultaneously target multiple underlying disease processes that contribute to atherosclerosis, thereby altering the course of the disease. Therefore, CAD therapy may have increased positive outcomes if the use of an antihypertensive agent and HMG-CoA reductase inhibitor was combined in a single delivery system. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Synthetic peptides that enhance atherogenic lipoprotein uptake and lower plasma cholesterol Inventor(s): Anantharamaiah, Gattadahalli M. (Birmingham, AL) Correspondence: Gretchen A Rice; Hale and Dorr LLP; 60 State Street; Boston; MA; 02109; US Patent Application Number: 20020128175 Date filed: March 7, 2000 Abstract: The present invention provides novel synthetic apolipoprotein E (ApoE)mimicking peptides wherein the receptor binding domain of apolipoprotein E is covalently linked to 18A, the well characterized lipid-associating model class A amphipathic helical peptide. Such peptides enhance low density lipoprotein (LDL) and very low density lipoprotein (VLDL) binding to and degradation by fibroblast or HepG2 cells. Also provided are possible applications of the synthetic peptides in lowering human plasma LDL/VLDL cholesterol levels, thus inhibiting atherosclerosis. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/271,066 filed Mar. 17, 1999, which claims benefit of provisional patent application U.S. Ser. No. 60/078,229 filed Mar. 17, 1998, now abandoned.... The present invention relates generally to the field of cardiovascular medicine. More specifically, the present invention relates to synthetic peptides that can rapidly lower plasma cholesterol through enhanced LDL and VLDL uptake and degradation by cells.... Apolipoprotein E (apo E) plays an important role in the metabolism of triglyceride-rich lipoproteins, such as very low density lipoprotein (VLDL) and chylomicrons. Apolipoprotein E mediates the high affinity binding of apo E-containing lipoproteins to the low density lipoprotein (LDL) receptor (apo B, E receptor) and the members of its gene family, including LDL receptor related protein (LRP), very low density lipoprotein receptor (VLDLR) and the apoE2 receptor (apoE2R) (1). The putative and complex role of apo E in atherosclerosis has been emphasized by several observations: (i) mice that overexpress human apo E have lower levels of total plasma cholesterol levels (2), (ii) intravenous injection of human apo E into cholesterol-fed rabbits protects these animals from atherosclerosis (3), and (iii) loss of the apo E gene in mice produces spontaneous atherosclerosis (4) which is ameliorated when macrophage-specific apo E expression is reconstituted in apo Edeficient mice (5). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Use of mesophase-stabilized compositions for delivery of cholesterol-reducing sterols and stanols in food products Inventor(s): Akashe, Ahmad; (Mundelein, IL), Miller, Miranda; (Arlington Heights, IL) Correspondence: FITCH EVEN TABIN AND FLANNERY; 120 SOUTH LA SALLE STREET; SUITE 1600; CHICAGO; IL; 606033406 Patent Application Number: 20010027190 Date filed: May 16, 2001 Abstract: Plant sterols and plant sterol esters have been shown to be cholesterolreducing agents in human serum. In the present invention, plant sterols, plant stanols, plant sterol esters, and plant stanol esters are incorporated into mouthfeel-enhancing, texture-building and composition-stabilizing compositions which are mesophase-

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stabilized compositions for use in low-fat, fat-free and triglyceride-free food products. Such compositions may be incorporated into food products resulting in low-fat, fat-free and triglyceride-free food products which may be used to deliver a recommended daily dosage of the cholesterol-reducing compounds to segments of the population which must limit it's cholesterol intake. Excerpt(s): The present invention relates to low-fat, fat-free and triglyceride-free food products which incorporate plant sterols, plant stanols, plant sterol esters, and plant stanol esters as cholesterol-reducing agents in low-fat, fat-free and triglyceride-free foods. These cholesterol-reducing agents are incorporated into mouthfeel-enhancing, texture-building, emulsion-stabilizing and dispersion-stabilizing compositions which are mesophase-stabilized compositions for use in low-fat, fat-free and triglyceride-free food products.... Cholesterol has been known for many years to be a component of atherosclerotic plaques. Mounting evidence indicates diets high in cholesterol may increase the levels of cholesterol in the blood which, in turn, increase the risk of atherosclerotic disease and its attendant manifestations of heart attack, stroke and other tissue injuries resulting from atherosclerosis. Cholesterol absorbed from dietary sources is thought to increase the risk of atherosclerotic disease.... Other than avoidance or reduced consumption of high cholesterol foods, measures available without prescription to the general public to reduce the absorption of cholesterol from the diet have met with little success. However, high cholesterol levels in serum can be lowered effectively by altering the intestinal metabolism of lipids. In recent years, it has become known that certain plant sterols and plant stanols such as.beta.-sitosterol (24-ethyl-5-cholestene3.beta.-ol) and its hydrogenated form.beta.-sitostanol (24-ethyl-5.alpha.-cholestane3.beta.- -ol) can help lower serum cholesterol by inhibiting cholesterol absorption. Plant stanols are the hydrogenated form of plant sterols. See, e.g., "Reduction of Serum Cholesterol With Sitostanol-ester Margarine in a Mildly Hypercholesterolemic Population", New England Journal of Medicine, Nov. 16, 1995 pp. 1308-1312. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Vertebrate intestinal protein which absorbs cholesterol, its inhibitors and mehtod of identifying the same Inventor(s): Kramer, Werner; (Mainz-Laubenheim, DE), Glombik, Heiner; (Hofheim, DE) Correspondence: HELLER EHRMAN WHITE & MCAULIFFE LLP; 1666 K STREET,NW; SUITE 300; WASHINGTON; DC; 20006; US Patent Application Number: 20020039774 Date filed: August 28, 2001 Abstract: The invention relates to a vertebrate intestinal protein which absorbs cholesterol. It was possible to identify the protein by means of high-affinity crosslinking compounds. The invention further relates to this use of the protein for carrying out a method for identifying a compound which inhibits cholesterol absorption in the intestine. Excerpt(s): The invention relates to a vertebrate intestinal protein which absorbs cholesterol. The protein is identified by means of high-affinity crosslinking compounds. The invention further relates to the use of the protein for carrying out a method for identifying a compound which inhibits cholesterol transport in the intestine.... In humans, on average about 50% of the cholesterol is present in the lumen of the intestine.

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The intraluminal cholesterol originates mainly from the diet and from the bile. About 2 g of cholesterol a day is discharged from the bile. The intestinal cholesterol absorption depends greatly on the presence of bile salts. Thus the effect of administration of inhibitors of the reuptake of bile salts or of bile salt sequestrants is to inhibit intestinal cholesterol absorption.... Inhibition of intestinal cholesterol absorption is an important aim of the treatment of lipid disorders, atherosclerosis and cardiovascular disorders. The prevailing opinion amongst experts is that intestinal cholesterol absorption takes place by physicochemical diffusion. 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 cholesterol, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “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 cholesterol. You can also use this procedure to view pending patent applications concerning cholesterol. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON CHOLESTEROL Overview This chapter provides bibliographic book references relating to cholesterol. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on 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 “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 cholesterol: ·

NutriBase Guide to Fat and Cholesterol in Your Food Source: Garden City Park, NY: Avery Publishing Group. 1995. 720 p. Contact: Available from Avery Publishing Group. 120 Old Broadway, Garden City Park, NY 11040. (800) 548-5757, ext. 123. Fax (516) 742-1892. PRICE: $5.95. ISBN: 0895296330. Summary: This reference book lists over 30,000 food items by name and brand. Provided for each item are the total calories and the percentage of calories derived from fat, as well as the amount of fat grams, saturated fat, and cholesterol in each item. An introductory section provides a brief overview of nutrition and healthy eating. The information provided in the book was gleaned from a number of government agencies, from hundreds of manufacturers, and from food trade associations. All of the foods are listed alphabetically. For convenience, similar foods have been grouped together in categories such as Baby Foods, Breads, Candies, Cereals, Cheese, Cookies, Pasta, and

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Sauces. The book includes cross references. A list of codes and abbreviations is also provided. ·

Cholesterol in Children and Adolescents: A Physician's Handbook Source: Bethesda, MD, Citizens for Public Action on Blood Pressure and Cholesterol, Inc., 30 p., 1992. Contact: Citizens for Public Action on Blood Pressure and Cholesterol, Inc., 7200 Wisconsin Avenue, Suite 1002, Bethesda, MD 20814. Summary: Cholesterol in Children and Adolescents: A Physician's Handbook provides physicians with a guide to the National Cholesterol Education Program (NCEP) Expert Panel's recommendations concerning children and blood cholesterol. It draws from a report issued in April 1991, a comprehensive review of the scientific evidence linking blood cholesterol to the development of atherosclerosis or its precursors in children and adolescents. The recommendations set out two fundamental principles for the physician's practice: (1) To encourage and assist all parents and children to adopt heart healthy eating patterns, and (2) to screen selectively children from families with a history of premature cardiovascular disease and/or where one parent has a total blood cholesterol level equal to or greater than 240 mg/dL. Chapters examine (1) what is known about cholesterol, (2) strategies for lowering cholesterol, (3) assessing risk, (4) strategies for measuring cholesterol levels in children, (5) conducting clinical evaluations (including a clinical evaluation decision tree), and (6) ways of treating high cholesterol in children. Pages to duplicate and use as parent handouts include a (1) family history checklist, (2) dietary assessment worksheet, (3) food frequency checklist, (4) foods to choose and to decrease, (5) diet strategies for parents, (6) tips on reducing saturated fat in school lunches, and (7) how to talk to kids about medicine. Other items include a self-assessment test (to evaluate the reader's general knowledge regarding the clinical evaluation of children and adolescents at risk because of abnormal lipid values), a list of addresses and phone numbers of lipid research clinics and specialists, and a comprehensive bibliography.

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Understanding and Managing Cholesterol: A Guide for Wellness Professionals Source: Champaign, IL, Human Kinetics Books, 334 p., 1991. Contact: Human Kinetics Books, P.O. Box 5076, Champaign, IL 61825-5076. Summary: Understanding and Managing Cholesterol: A Guide for Wellness Professionals assists health professionals promote responsible cardiovascular health to their clients and patients by the means of a population-base approach to cholesterol control. The book contains four parts: (1) Information about blood cholesterol, how blood cholesterol contributes to arterial plaque, and how to control blood cholesterol; (2) information and tools for controlling other contributors to atherosclerosis such as stress, high blood pressure, smoking, heredity, and diabetes; (3) theoretical background and rationale behind dietary changes, the mainstay of cholesterol control; and (4) help for health professionals in designing and implementing a cholesterol-lowering program, including conducting screenings and teaching classes about cholesterol reduction. The book contains two appendixes. Appendix A includes: (1) Guidelines for Maximal Exercise Testing; (2) Target Rate for Exercise; and (3) Exclusion for Entry into Exercise Programs. Appendix B addresses four topics: (1) Treatment guidelines; (2) treating borderline high risk individuals; (3) treating high risk individuals; and (4) triglyceride management. 48 figures, 23 tables.

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Costs and Effectiveness of Cholesterol Screening in the Elderly Source: Washington, DC, Office of Technology Assessment, Preventive Health Services Under Medicare series, 57 p., 1989. Contact: Superintendent of Documents, US Government Printing Office, Washington, DC 20402. GPO no. 89-144 (64) (Available for purchase). Summary: Costs and Effectiveness of Cholesterol Screening in the Elderly is the third paper in a series prepared in response to the House Committee on Ways and Means request that the Office of Technology Assessment analyze the effectiveness and costs of providing selected preventive health services to the elderly under the Medicare program. The paper examines (1) the relationship among cholesterol levels, coronary heart disease, and mortality for elderly people; (2) the technologies available to measure cholesterol levels; (3) the potential benefits and costs of treating elevated cholesterol levels in the elderly; and (4) the likely magnitude of the cost if Medicare offered cholesterol screening as a reimbursable service. Arguments that support the value of cholesterol screening include (1) the risk factor that screening detects is important because it is common; (2) the test identifies a group of individuals at excess risk of a serious disease; and (3) treatment of hypercholesterolemia is more effective in reducing overall mortality and morbidity if initiated before it causes symptoms. Cholesterol is not so powerful a risk factor for cardiovascular disease in the elderly as it is in the middleaged. Epidemiologic studies have found that the cholesterol level is either not associated with overall mortality rates or is inversely associated with all-cause mortality. It would be difficult to infer from available evidence that elderly individuals with an elevated blood cholesterol level would benefit from cholesterol reduction. The book includes chapters on epidemiology of hypercholesterolemia in the elderly, measuring cholesterol, treatment of hypercholesterolemia, and implications for Medicare. Appendixes include an expenditure model for diagnosis and treatment of hypercholesterolemia in the elderly.

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Cholesterol and Kids Source: Woodmere, NY, Wellness International Limited, 36 p., 1988. Contact: Wellness International Limited, Box 370, Woodmere, NY 11598. (Available for purchase). Summary: Cholesterol and Kids was published in response to recent studies showing that as many as two-thirds of all children in the United States have elevated cholesterol levels. The monograph presents information on cholesterol in the diet and offers nutritional guidelines based on the American Heart Association recommendations for children. Risk factors discussed include family history of heart disease, overweight, high blood pressure, diabetes, lack of exercise, smoking, and use of birth control pills. Nutritional guidance covers a variety of foods as well as calories and weight control, saturated and unsaturated fats, cholesterol foods, protein foods, carbohydrates, and salt. Height/weight tables for girls and boys are included for ages 2 to 18. General nutritional information is interspersed with specific recommendations. A questionnaire on a child's risk of elevated cholesterol is included.

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Cholesterol Countdown: Lower Your Cholesterol Quickly Source: Woodmere, NY, Wellness International Limited, 38 p., 1987. Contact: Wellness International Limited, Box 370, Woodmere, NY 11598. (Available for purchase).

444 Cholesterol

Summary: Cholesterol Countdown presents information on cholesterol in the diet and offers nutritional guidelines for adults. Nutritional guidance covers sources of cholesterol, heart attack and stroke, good (high density lipoprotein) and bad (low density lipoprotein) cholesterol, cholesterol levels, and testing. A diet questionnaire is followed by detailed information on eight suggested steps for lower cholesterol levels: Eat less fat; use mono-unsaturated fats; eat more high fiber foods; do not drink more than two cups of coffee per day; do not drink more than two alcoholic drinks per day; eat fish two or three times per week; increase physical activity; and lose weight if you are overweight.

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 PrintÒ). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “cholesterol” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “cholesterol” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “cholesterol” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

101 Low Cholesterol Recipes (The Corinne T. Netzer Good Eating) by Corinne T. Netzer, Alice Sorensen (Illustrator) (1998); ISBN: 0440504171; http://www.amazon.com/exec/obidos/ASIN/0440504171/icongroupinterna

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18 Natural Ways to Lower Your Cholesterol in 30 Days by Norman D. Ford (1992); ISBN: 0879835850; http://www.amazon.com/exec/obidos/ASIN/0879835850/icongroupinterna

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2003 Cholesterol Weekly Calendar by Michael Miller, Thomas Masterson; ISBN: 1588082105; http://www.amazon.com/exec/obidos/ASIN/1588082105/icongroupinterna

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21st Century Complete Medical Guide to Heart Disease, Heart Attack, Cholesterol, Coronary Artery Disease, Bypass Surgery, Angioplasty ¿ Authoritative Federal Government Documents and Clinical References for Patients and Physicians with Practical Information on Diagnosis and Treatment Options by PM Medical Health News; ISBN: 1931828342; http://www.amazon.com/exec/obidos/ASIN/1931828342/icongroupinterna

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2-In-1: The Instant Cholesterol and Fat Control System by Herbert Pardell (Contributor), F. M. Oppenheimer; ISBN: 0139320881; http://www.amazon.com/exec/obidos/ASIN/0139320881/icongroupinterna

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30 Days: A Program to Lower Cholesterol, Achieve Optimal Weight and Prevent Serious Disease by Aveline Kushi, Tom Monte (Contributor); ISBN: 0870407902; http://www.amazon.com/exec/obidos/ASIN/0870407902/icongroupinterna

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50 Ways to Lower Cholesterol by Mary P. McGowan, et al; ISBN: 0737305568; http://www.amazon.com/exec/obidos/ASIN/0737305568/icongroupinterna

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7 Day Low Cholesterol Diet Plan: To Change Your Eating Habits for Life by Carolyn Humphries (2000); ISBN: 0572025092; http://www.amazon.com/exec/obidos/ASIN/0572025092/icongroupinterna

Books 445

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A Boomer's Angst: A Collection of Columns About Life, Liberty and the Pursuit of Lower Cholesterol by Paul L. Briand (2001); ISBN: 0595209734; http://www.amazon.com/exec/obidos/ASIN/0595209734/icongroupinterna

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A Celebration of Wellness: A Cookbook for Vibrant Living: Over 300 Heart Healthy, No Dairy, No Cholesterol, Nonfat & Lowfat Inspired Recipes by James, M.D. Levin, Natalie Cederquist (1998); ISBN: 0895296845; http://www.amazon.com/exec/obidos/ASIN/0895296845/icongroupinterna

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A Feast for the Heart: Entertaining With Elegant and Easy Low-Cholesterol Menus by Willa Gelber, Greg Case; ISBN: 0316307440; http://www.amazon.com/exec/obidos/ASIN/0316307440/icongroupinterna

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A Little of What You Fancy: Peter Doyle's Answer to Cholesterol (Milner Healthy Living Guide) by Peter Doyle, Max Foley (Illustrator); ISBN: 1863510044; http://www.amazon.com/exec/obidos/ASIN/1863510044/icongroupinterna

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A Patient's Handbook on Cholesterol Disorders: Practical Guidelines for Managing Your Blood Cholesterol Levels by Antonio M., Jr. Gotto, Antonio M. Gotto; ISBN: 1884065783; http://www.amazon.com/exec/obidos/ASIN/1884065783/icongroupinterna

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Advances in Cholesterol Research by Mojtaba Esfahani, John Swaney; ISBN: 0936923350; http://www.amazon.com/exec/obidos/ASIN/0936923350/icongroupinterna

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All New Diet Cookbook: Low Calorie Low Fat Low Cholesterol; ISBN: 1561735493; http://www.amazon.com/exec/obidos/ASIN/1561735493/icongroupinterna

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Alphabetical Diet Guide Cholesterol Ratings; ISBN: 0895962012; http://www.amazon.com/exec/obidos/ASIN/0895962012/icongroupinterna

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American Heart Association Brand Name Fat and Cholesterol by Heart Association American (1994); ISBN: 0812925637; http://www.amazon.com/exec/obidos/ASIN/0812925637/icongroupinterna

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American Heart Association Low-Fat, Low Cholesterol Cookbook: Heart-Healthy, Easy-To-Make Recipes That Taste Great by American Heart Association (1997); ISBN: 0812926846; http://www.amazon.com/exec/obidos/ASIN/0812926846/icongroupinterna

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American Heart Association Low-Fat, Low-Cholesterol Cookbook: An Essential Guide for Those Concerned About Their Cholesterol Levels [LARGE PRINT] by Scott M. Grundy (Editor), American Heart Association; ISBN: 156054032X; http://www.amazon.com/exec/obidos/ASIN/156054032X/icongroupinterna

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American Heart Association Low-Fat, Low-Cholesterol Cookbook: More Than 200 Delicious, Heart-Healthful Recipes for the Whole Family by Scott M. Grundy (Editor), et al; ISBN: 0812924754; http://www.amazon.com/exec/obidos/ASIN/0812924754/icongroupinterna

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An Illustrated Handbook to Surviving Deli Counters: Selection Guides for Counting and Controlling Fats, Cholesterol, Calories, and Sodium Content in by Edward G. Dorn (1992); ISBN: 0963180622; http://www.amazon.com/exec/obidos/ASIN/0963180622/icongroupinterna

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Arlyn Hackett's Menu Magic: Health-Wise Cuisine:Low-Fat, Low-Cholesterol, LowSalt, Low-Sugar by Arlyn Hackett; ISBN: 0803893558; http://www.amazon.com/exec/obidos/ASIN/0803893558/icongroupinterna

446 Cholesterol

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Atherosclerosis Prevention: Identification and Treatment of the Child With High Cholesterol (Monographs in Clinical Pediatrics, Vol 4) by Marc S. Jacobson (Editor) (1991); ISBN: 3718651211; http://www.amazon.com/exec/obidos/ASIN/3718651211/icongroupinterna

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Atherosclerosis: Its Pathogenesis and the Role of Cholesterol (Atherosclerosis Reviews, Vol. 23) by Peter C. Weber, Alexander Leaf (Editor); ISBN: 0881678686; http://www.amazon.com/exec/obidos/ASIN/0881678686/icongroupinterna

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Attack Cholesterol: Reduce Your Risk Up to Six-fold by Elizabeth Somer; ISBN: 0572017979; http://www.amazon.com/exec/obidos/ASIN/0572017979/icongroupinterna

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Barbara Kraus 30 Day Cholesterol Program: A Diet and Exercise Plan for Lowering Your Cholesterol by Barbara Kraus; ISBN: 0399515089; http://www.amazon.com/exec/obidos/ASIN/0399515089/icongroupinterna

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Barbara Kraus Cholesterol Counter by Barbara Kraus; ISBN: 0399511342; http://www.amazon.com/exec/obidos/ASIN/0399511342/icongroupinterna

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Betty Crocker's Low Fat Cholesterol Cookbook by Betty Crocker (1991); ISBN: 0130841382; http://www.amazon.com/exec/obidos/ASIN/0130841382/icongroupinterna

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Betty Crocker's Low-Fat, Low-Cholesterol Cookbook by Betty Crocker, Betty Crocker; ISBN: 0130844845; http://www.amazon.com/exec/obidos/ASIN/0130844845/icongroupinterna

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Betty Crocker's Low-Fat, Low-Cholesterol Cooking Today by Betty Crocker Editors (Author) (2000); ISBN: 0028637623; http://www.amazon.com/exec/obidos/ASIN/0028637623/icongroupinterna

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Beyond Cholesterol by Gruberg and Raymond, et al; ISBN: 0312077777; http://www.amazon.com/exec/obidos/ASIN/0312077777/icongroupinterna

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Beyond Cholesterol: The Johns Hopkins Complete Guide for Avoiding Heart Disease by Peter O., Jr. Kwiterovich (1989); ISBN: 0801838282; http://www.amazon.com/exec/obidos/ASIN/0801838282/icongroupinterna

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Bile Acids and Cholesterol in Health and Disease by G. Paumgartner (Editor) (1983); ISBN: 0852007299; http://www.amazon.com/exec/obidos/ASIN/0852007299/icongroupinterna

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Bile Acids in Health and Disease: Update on Cholesterol, Gallstones and Bile Acid Diarrhea by Riadh Jazrawi, et al (1988); ISBN: 0746200765; http://www.amazon.com/exec/obidos/ASIN/0746200765/icongroupinterna

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Biological Effects of Cholesterol Oxides by Shi-Kaung Peng, Robert J. Morin; ISBN: 084936776X; http://www.amazon.com/exec/obidos/ASIN/084936776X/icongroupinterna

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Bless Your Heart Low Cholesterol Cookbook by Mary Ellen King, Carol Van Meter; ISBN: 0932047009; http://www.amazon.com/exec/obidos/ASIN/0932047009/icongroupinterna

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Book of Tempeh/the Delicious, Cholesterol-Free Protein, 130 Recipes; ISBN: 0060140097; http://www.amazon.com/exec/obidos/ASIN/0060140097/icongroupinterna

Books 447

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Book of Tempeh/the Delicious, Cholesterol-Free Protein, 130 Recipes (Harper Colophon Books) by William Shurtleff, Akiko Aoyagi (Contributor); ISBN: 0060912650; http://www.amazon.com/exec/obidos/ASIN/0060912650/icongroupinterna

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Brand Name Fat and Cholesterol Counter by American Heart Association (1995); ISBN: 0812923677; http://www.amazon.com/exec/obidos/ASIN/0812923677/icongroupinterna

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Bum Steers: How and Why to Make Your Own Delicious High Protein Mock Meats, Fake Fish and Dairyless Desserts, and Avoid Useless Calories, Cholesterol, Sodium nitr by Frances Sheridan Goulart (1975); ISBN: 9996818543; http://www.amazon.com/exec/obidos/ASIN/9996818543/icongroupinterna

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Carlson Wade's Fact/Book on Fats, Oils, and Cholesterol by Carlson Wade (1976); ISBN: 0879830514; http://www.amazon.com/exec/obidos/ASIN/0879830514/icongroupinterna

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Cell Growth and Cholesterol Esters (Molecular Biology Intelligence Unit (Unnumbered).) by Alessandra Pani (Editor), Sandra Dessi (Editor) (2003); ISBN: 1587061937; http://www.amazon.com/exec/obidos/ASIN/1587061937/icongroupinterna

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Cholesterol by Patricia Krimmel, et al; ISBN: 0916503038; http://www.amazon.com/exec/obidos/ASIN/0916503038/icongroupinterna

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Cholesterol by John R. Sabine; ISBN: 0824765168; http://www.amazon.com/exec/obidos/ASIN/0824765168/icongroupinterna

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Cholesterol & Children: A Parent's Guide to Giving Children a Future Free of Heart Disease by Robert E. Kowalski, et al; ISBN: 0060915897; http://www.amazon.com/exec/obidos/ASIN/0060915897/icongroupinterna

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Cholesterol & Triglycerides: Questions You Have...Answers You Need by Ellen Moyer (1995); ISBN: 1882606515; http://www.amazon.com/exec/obidos/ASIN/1882606515/icongroupinterna

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Cholesterol 1.1: Cholesterol Management System (CD-ROM for Windows 95/98/00/Me, Personal edition for Physicians) by A. Arturo Rodriguez; ISBN: 9685325073; http://www.amazon.com/exec/obidos/ASIN/9685325073/icongroupinterna

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Cholesterol and Children: A Parents Guide to Giving Children a Future Free of Heart Disease by Robert E. Kowalski, et al; ISBN: 5552302338; http://www.amazon.com/exec/obidos/ASIN/5552302338/icongroupinterna

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Cholesterol and Coronary Heart Disease: The Great Debate by Phil, M.D. Gold, et al; ISBN: 1850704147; http://www.amazon.com/exec/obidos/ASIN/1850704147/icongroupinterna

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Cholesterol and Nutrition by Health M, Health Media of America (1987); ISBN: 0937325007; http://www.amazon.com/exec/obidos/ASIN/0937325007/icongroupinterna

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Cholesterol and Phytosterol Oxidation Products: Analysis, Occurrence, and Biological Effects by Francesc Guardiola (Editor), et al (2002); ISBN: 1893997340; http://www.amazon.com/exec/obidos/ASIN/1893997340/icongroupinterna

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Cholesterol and Sodium Book by Andrew Goleszek (1984); ISBN: 0916833011; http://www.amazon.com/exec/obidos/ASIN/0916833011/icongroupinterna

448 Cholesterol

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Cholesterol and Your Health-The Great American Ripoff Part 2 by Ch Mudd; ISBN: 0962451517; http://www.amazon.com/exec/obidos/ASIN/0962451517/icongroupinterna

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Cholesterol Autoxidation by Leland L. Smith (1981); ISBN: 0306407590; http://www.amazon.com/exec/obidos/ASIN/0306407590/icongroupinterna

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Cholesterol Connections; ISBN: 1884153135; http://www.amazon.com/exec/obidos/ASIN/1884153135/icongroupinterna

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Cholesterol Control 3-Week Plan Handbook and Cookbook by Patricia T. Krimmel, Edward A. Krimmel; ISBN: 0916503089; http://www.amazon.com/exec/obidos/ASIN/0916503089/icongroupinterna

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Cholesterol Control Gram Counter: You Can Have a Healthy Heart by William I. Kaufman; ISBN: 0515092487; http://www.amazon.com/exec/obidos/ASIN/0515092487/icongroupinterna

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Cholesterol Control Made Easy: How to Lower Your Cholesterol for a Healthier Heart by Emmanuel Horovitz, David H. Blankenhorn; ISBN: 0961932945; http://www.amazon.com/exec/obidos/ASIN/0961932945/icongroupinterna

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Cholesterol Control Without Diet!: The Niacin Solution by William B. Parsons (1998); ISBN: 0966256867; http://www.amazon.com/exec/obidos/ASIN/0966256867/icongroupinterna

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Cholesterol Count Down: Enjoy Eating While Still Controlling Your Cholesterol by Mary, Hubbard (1989); ISBN: 1877899003; http://www.amazon.com/exec/obidos/ASIN/1877899003/icongroupinterna

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Cholesterol Counter (1980); ISBN: 0515077429; http://www.amazon.com/exec/obidos/ASIN/0515077429/icongroupinterna

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Cholesterol Counter (Health Ser.) by Elizabeth S. Weiss, Rita P. Wolfson (1980); ISBN: 0515056898; http://www.amazon.com/exec/obidos/ASIN/0515056898/icongroupinterna

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Cholesterol Counter Guide by Consumer Guide (Editor); ISBN: 0451160967; http://www.amazon.com/exec/obidos/ASIN/0451160967/icongroupinterna

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Cholesterol Counter News Week by Annette B. Natow (Author); ISBN: 0671682741; http://www.amazon.com/exec/obidos/ASIN/0671682741/icongroupinterna

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Cholesterol Counter, Revised by Annette B. Natow, et al (1993); ISBN: 0671751735; http://www.amazon.com/exec/obidos/ASIN/0671751735/icongroupinterna

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Cholesterol Cure Made Easy by Sylvan R. Lewis; ISBN: 0517089041; http://www.amazon.com/exec/obidos/ASIN/0517089041/icongroupinterna

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Cholesterol Cures: From Almonds and Antioxidants to Garlic, Golf, Wine and Yogurt325 Quick and Easy Ways to Lower Cholesterol and Live Longer by Richard Trubo, et al (1996); ISBN: 0875963994; http://www.amazon.com/exec/obidos/ASIN/0875963994/icongroupinterna

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Cholesterol Cures: More Than 325 Natural Ways to Lower Cholesterol and Live Longer from Almonds and Chocolate to Garlic and Wine by William P. Castelli (Editor), Prevention Health Books (Editor) (2002); ISBN: 1579544819; http://www.amazon.com/exec/obidos/ASIN/1579544819/icongroupinterna

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Cholesterol Diet Cookbook; ISBN: 0685117995; http://www.amazon.com/exec/obidos/ASIN/0685117995/icongroupinterna

Books 449

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Cholesterol Handbook by Consumer Guide Editors, Consumer Guide; ISBN: 0517688549; http://www.amazon.com/exec/obidos/ASIN/0517688549/icongroupinterna

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Cholesterol Handbook (1994); ISBN: 0785309608; http://www.amazon.com/exec/obidos/ASIN/0785309608/icongroupinterna

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Cholesterol in Children: Healthy Eating Is a Family Affair by Diane Publishing Company (1992); ISBN: 0788103296; http://www.amazon.com/exec/obidos/ASIN/0788103296/icongroupinterna

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Cholesterol in Membrane Models by Leonard Finegold (Editor); ISBN: 0849342074; http://www.amazon.com/exec/obidos/ASIN/0849342074/icongroupinterna

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Cholesterol Lowering Trails by Neil Laker; ISBN: 1873240732; http://www.amazon.com/exec/obidos/ASIN/1873240732/icongroupinterna

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Cholesterol Lowering: A Practical Guide to Therapy by Jonathan Abrams, et al (2003); ISBN: 0340761326; http://www.amazon.com/exec/obidos/ASIN/0340761326/icongroupinterna

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Cholesterol measurement : error and variability : hearing before the Subcommittee on Technology of the Committee on Science, U.S. House of Representatives, One Hundred Fourth Congress, first session, February 14, 1995; ISBN: 0160470544; http://www.amazon.com/exec/obidos/ASIN/0160470544/icongroupinterna

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Cholesterol metabolism and lipolytic enzymes; ISBN: 0893520101; http://www.amazon.com/exec/obidos/ASIN/0893520101/icongroupinterna

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Cholesterol Myth by R. Buist; ISBN: 1868259099; http://www.amazon.com/exec/obidos/ASIN/1868259099/icongroupinterna

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Cholesterol Patient Guide : Cholesterol -- Friend or Foe? [DOWNLOAD: PDF]; ISBN: B00009KF1Y; http://www.amazon.com/exec/obidos/ASIN/B00009KF1Y/icongroupinterna

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Cholesterol Planner 2002 by Michael Miller, Thomas Masterson; ISBN: 1588080714; http://www.amazon.com/exec/obidos/ASIN/1588080714/icongroupinterna

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Cholesterol Treatment : User Guide to Lipid Disorder Managemen by David A. Leaf; ISBN: 0917634020; http://www.amazon.com/exec/obidos/ASIN/0917634020/icongroupinterna

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Cholesterol Treatment: A Review of the Clinical Trials Evidence (1996); ISBN: 0788133578; http://www.amazon.com/exec/obidos/ASIN/0788133578/icongroupinterna

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Cholesterol, Children, and Heart Disease: An Analysis of Alternatives by Donald M., Berwick; ISBN: 0195026691; http://www.amazon.com/exec/obidos/ASIN/0195026691/icongroupinterna

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Cholesterol, Keeping It Low: Microwave Pritikin-style Cooking by Suzanne Porter; ISBN: 0867700459; http://www.amazon.com/exec/obidos/ASIN/0867700459/icongroupinterna

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Cholesterol, Magnesium and Coronary Heart Disease: Save Your Heart by John B.,MD Neal; ISBN: 0533081696; http://www.amazon.com/exec/obidos/ASIN/0533081696/icongroupinterna

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Cholesterol: Friend or Foe? by David G. Williams (1988); ISBN: 0944649033; http://www.amazon.com/exec/obidos/ASIN/0944649033/icongroupinterna

450 Cholesterol

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Cholesterol: Lowering and Controlling: 3 Week Plan Handbook and Cookbook by Patricia T. Krimmel, et al; ISBN: 0916503054; http://www.amazon.com/exec/obidos/ASIN/0916503054/icongroupinterna

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Cholesterol: Reducing Your Risk (Positive Health Guides) by David Symes; ISBN: 0356210723; http://www.amazon.com/exec/obidos/ASIN/0356210723/icongroupinterna

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Cholesterol: Your Guide for a Healthy Heart by Consumer Guide Editors (1993); ISBN: 0881765848; http://www.amazon.com/exec/obidos/ASIN/0881765848/icongroupinterna

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Cholesterol-Free Cakes & Cookies: All-Time Favorite Recipes Adapted for a LowCholesterol Diet by Mabel Cavaiani; ISBN: 0805017399; http://www.amazon.com/exec/obidos/ASIN/0805017399/icongroupinterna

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Cholesterol-Lowering Drugs: Everything You and Your Family Need to Know by Richard W., Md. Nesto, et al; ISBN: 0380807793; http://www.amazon.com/exec/obidos/ASIN/0380807793/icongroupinterna

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Cholesterol-Lowering Therapy: Evaluation of Clinical Trial Evidence by Scott M. Grundy (Editor); ISBN: 082478216X; http://www.amazon.com/exec/obidos/ASIN/082478216X/icongroupinterna

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Cholesterols: Causing Cancer and a Whole Lot More by Arthur Isbit, Nancy Buckner; ISBN: 0917591011; http://www.amazon.com/exec/obidos/ASIN/0917591011/icongroupinterna

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Cholesterosis: Membrane Cholesterol Theoretical and Clinical Aspects (Soviet Scientific Reviews Supplement Series, Section C) by Yu M. Lopukhin (Editor) (1984); ISBN: 3718601591; http://www.amazon.com/exec/obidos/ASIN/3718601591/icongroupinterna

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Clinician's Manual on Protective HDL-Cholesterol by L. a. Carlson, S. M. Grundy (2001); ISBN: 1858739292; http://www.amazon.com/exec/obidos/ASIN/1858739292/icongroupinterna

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Colesterol Bueno, Colesterol Malo / Good Cholesterol, Bad Cholesterol by Eli M. Roth (1997); ISBN: 8427021771; http://www.amazon.com/exec/obidos/ASIN/8427021771/icongroupinterna

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Cologne Atherosclerosis Conference No 4 Cholesterol-Homeostasis (Agents and Actions Supplements Vol 26) by M.J. Parnham, R. Niemann (Editor) (1988); ISBN: 0817622470; http://www.amazon.com/exec/obidos/ASIN/0817622470/icongroupinterna

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Combating Your Child's Cholesterol: A Pediatrician Shows You How by Reuben, M.D. Reiman, John Hanc (Contributor); ISBN: 0306444682; http://www.amazon.com/exec/obidos/ASIN/0306444682/icongroupinterna

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Complete "Lite" Foods Calorie, Fat, Cholesterol, and Sodium Counter by Denise Webb; ISBN: 0553284711; http://www.amazon.com/exec/obidos/ASIN/0553284711/icongroupinterna

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Complete 'Lite' Foods Calorie, Fat, Cholesterol, and Sodium Counter (1990); ISBN: 9992717696; http://www.amazon.com/exec/obidos/ASIN/9992717696/icongroupinterna

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Controlling Cholesterol by Kenneth H., Md. Cooper; ISBN: 0553277758; http://www.amazon.com/exec/obidos/ASIN/0553277758/icongroupinterna

Books 451

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Controlling Cholesterol For Dummies® by Carol Ann Rinzler (Author), Martin W. Graf (Author) (2002); ISBN: 0764554409; http://www.amazon.com/exec/obidos/ASIN/0764554409/icongroupinterna

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Controlling Cholesterol the Natural Way: Eat Your Way to Better Health With New Breakthrough Food Discoveries by Kenneth H., Md. Cooper; ISBN: 0553582100; http://www.amazon.com/exec/obidos/ASIN/0553582100/icongroupinterna

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Controlling Cholesterol/Audio Cassette by Ken Dr Cooper; ISBN: 0943371074; http://www.amazon.com/exec/obidos/ASIN/0943371074/icongroupinterna

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Controlling Fat and Cholesterol by Joyce and Murray, Nancy Sorenson; ISBN: 0911638105; http://www.amazon.com/exec/obidos/ASIN/0911638105/icongroupinterna

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Convertible Cooking for Healthy Heart: How to Turn Your Favorite Recipes into Low Fat, Low Cholesterol Delicious Dishes by Joanne D'Agostino (1992); ISBN: 0803893388; http://www.amazon.com/exec/obidos/ASIN/0803893388/icongroupinterna

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Cookin' Up Secrets the Light Way: Low Cholesterol, Low Sodium, and Low Fat Menus and Recipes by Ray Domengeaux, Jane Domengeaux; ISBN: 053308055X; http://www.amazon.com/exec/obidos/ASIN/053308055X/icongroupinterna

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Cooking healthy with BCV's shortcuts : delicious recipes lower in fat/cholesterol/sodium with no refined sugar plus nutrient data by Phyllis A. Milkon; ISBN: 0963002511; http://www.amazon.com/exec/obidos/ASIN/0963002511/icongroupinterna

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Cooking to Your Heart's Content: A Low Cholesterol Cookbook for the Ordinary Kitchen by Barbara Taylor; ISBN: 1557281289; http://www.amazon.com/exec/obidos/ASIN/1557281289/icongroupinterna

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Coping with a Low-cholesterol Lifestyle by McMillan; ISBN: 1868124576; http://www.amazon.com/exec/obidos/ASIN/1868124576/icongroupinterna

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Coronaries/Cholesterol/Chlorine by Joseph M., M.D. Price, Jim Price; ISBN: 0515094617; http://www.amazon.com/exec/obidos/ASIN/0515094617/icongroupinterna

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Coronary Cholesterol by J.M. Price (1984); ISBN: 0515081604; http://www.amazon.com/exec/obidos/ASIN/0515081604/icongroupinterna

·

Count Out Cholesterol Cookbook by Art Dr. Ulene, et al; ISBN: 0394581946; http://www.amazon.com/exec/obidos/ASIN/0394581946/icongroupinterna

·

Count Out Cholesterol: The Official Audio Program of the American Medical Association's Campaign Against Cholesterol by Art Dr. Ulene; ISBN: 0394578694; http://www.amazon.com/exec/obidos/ASIN/0394578694/icongroupinterna

·

C-Reactive Protein : Everthing You Need to Know About It and Why It's More Important Than Cholesterol to Your Health by Scott J. Deron, Scott Deron; ISBN: 0071426426; http://www.amazon.com/exec/obidos/ASIN/0071426426/icongroupinterna

·

Creative Low Cholesterol & Car by Outlet (1980); ISBN: 0517311623; http://www.amazon.com/exec/obidos/ASIN/0517311623/icongroupinterna

·

Cure Indigestion, Heartburn, Cholesterol, Triglyceride & Liver Problems with Artichoke Extract by Gary Ross, et al; ISBN: 1893910016; http://www.amazon.com/exec/obidos/ASIN/1893910016/icongroupinterna

452 Cholesterol

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Cut Your Cholesterol: Featuring the Exclusive Live It Down Plan by David L. Katz, Debra L. Gordon (2003); ISBN: 0762104759; http://www.amazon.com/exec/obidos/ASIN/0762104759/icongroupinterna

·

Day-By-Day Cholesterol by Afsane Haddad, et al; ISBN: 1883205727; http://www.amazon.com/exec/obidos/ASIN/1883205727/icongroupinterna

·

Delicious Food for a Healthy Heart: Over 120 Cholesterol-Free, Low-Fat, Quick & Easy Recipes by Joanne Stepaniak (1999); ISBN: 1570670773; http://www.amazon.com/exec/obidos/ASIN/1570670773/icongroupinterna

·

Delicious Ways to Lower Cholesterol by Leisure Arts, et al; ISBN: 084870777X; http://www.amazon.com/exec/obidos/ASIN/084870777X/icongroupinterna

·

Deliciously Simple: Quick-And-Easy Cholesterol, Low-Sugar Meals by Harriet Roth (1988); ISBN: 0452259843; http://www.amazon.com/exec/obidos/ASIN/0452259843/icongroupinterna

·

Dictionary of Sodium, Fats and Cholesterol by Barbara Kraus; ISBN: 0399509453; http://www.amazon.com/exec/obidos/ASIN/0399509453/icongroupinterna

·

Dietary Cholesterol as a Cardiac Risk Factor - Myth or Reality? by Anthony R. Leeds (Editor), Juliet Gray (Editor) (2001); ISBN: 1854632132; http://www.amazon.com/exec/obidos/ASIN/1854632132/icongroupinterna

·

Dietary Intake & Cardiovascular Risk Factors PT. II: Serum Urate, Serum Cholesterol & Correlates by William R. Harlan, et al (1982); ISBN: 0840602596; http://www.amazon.com/exec/obidos/ASIN/0840602596/icongroupinterna

·

Dietary Proteins, Cholesterol Metabolism and Atherosclerosis (Monographs on Atherosclerosis, Vol 16) by A.C. Beynen (Editor), Michihiro Sugano (1990); ISBN: 3805551932; http://www.amazon.com/exec/obidos/ASIN/3805551932/icongroupinterna

·

Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (MacRonutrients) (Dietary reference by Subcommittees on Upper Reference Levels (2003); ISBN: 030908525X; http://www.amazon.com/exec/obidos/ASIN/030908525X/icongroupinterna

·

Discover the Beta Glucan Secret: For Immune Enhancement, Cancer Prevention & Treatment, Cholesterol Reduction, Glucose Regulation, and Much More! : a by Beth M. Ley; ISBN: 1890766186; http://www.amazon.com/exec/obidos/ASIN/1890766186/icongroupinterna

·

Diseases Explained: Cholesterol by Lexi-Comp; ISBN: 1930598076; http://www.amazon.com/exec/obidos/ASIN/1930598076/icongroupinterna

·

Doctor Solomon's High Health Diet & Exercise Plan: How to Make Cholesterol Work for You by Neil Solomon (1982); ISBN: 0425050866; http://www.amazon.com/exec/obidos/ASIN/0425050866/icongroupinterna

·

Dr. Anderson's Life-Saving Diet: The New High-Fiber, Low-Cholesterol Way to Keep Slim and Stay Healthy by James Anderson; ISBN: 0895864460; http://www.amazon.com/exec/obidos/ASIN/0895864460/icongroupinterna

·

Dr. Richard Furman's Save Your Life Cholesterol Plan by Richard Furman; ISBN: 0425127354; http://www.amazon.com/exec/obidos/ASIN/0425127354/icongroupinterna

Books 453

·

Eat to Your Heart's Content-Gourmet Cookbook the Low Cholesterol Diets by K.B. and Heiss, Cg, Heiss; ISBN: 0451087690; http://www.amazon.com/exec/obidos/ASIN/0451087690/icongroupinterna

·

Eat Your Cholesterol! by William Campbell Douglass (2003); ISBN: 9962636191; http://www.amazon.com/exec/obidos/ASIN/9962636191/icongroupinterna

·

Eater's Choice: A Food Lover's Guide to Lower Cholesterol by Nancy Goor (Author), et al; ISBN: 0395971039; http://www.amazon.com/exec/obidos/ASIN/0395971039/icongroupinterna

·

Eating for Health: Low Cholesterol Cooking by Christine France; ISBN: 1840385995; http://www.amazon.com/exec/obidos/ASIN/1840385995/icongroupinterna

·

Eating to Lower Your High Blood Cholesterol by McKenna (1994); ISBN: 0788115766; http://www.amazon.com/exec/obidos/ASIN/0788115766/icongroupinterna

·

Enjoy Your Low-Cholesterol , Lactose-Free Diet by Catherine Van De Rostyne, Marilyn Schnell; ISBN: 0961217200; http://www.amazon.com/exec/obidos/ASIN/0961217200/icongroupinterna

·

Enjoyment Low Cholesterol by Zelle; ISBN: 0913514020; http://www.amazon.com/exec/obidos/ASIN/0913514020/icongroupinterna

·

Essential Fatty Acids in Health & Disease : Using the Essential Fats w3 and w6 to Improve Your Health, Lower Your Cholesterol, and Prevent Cardiovascular Disease by Edward N. Siguel (1995); ISBN: 0964253402; http://www.amazon.com/exec/obidos/ASIN/0964253402/icongroupinterna

·

Fatigue to Vitality: How to Win the Battle Against Cholesterol, Prevent Degenerative Diseases & Live the Healthiest Lifestyle! by Nick Delgado, Nicholas Delgado (1992); ISBN: 1879084023; http://www.amazon.com/exec/obidos/ASIN/1879084023/icongroupinterna

·

Fats in Your Diet, Live a Longer Life: Guide to Lower Saturated Fat Lower Cholesterol by James R. Moore, Madeline H. Moore (1986); ISBN: 0936833009; http://www.amazon.com/exec/obidos/ASIN/0936833009/icongroupinterna

·

Fats That Heal, Fats That Kill: The Complete Guide to Fats, Oils, Cholesterol and Human Health by Udo Erasmus; ISBN: 0920470386; http://www.amazon.com/exec/obidos/ASIN/0920470386/icongroupinterna

·

Favorite Brand Name: Low Calorie, Fat & Cholesterol Cookbook: Every Recipe 300 Calories or Less! by Random House Value Publishing; ISBN: 0517056690; http://www.amazon.com/exec/obidos/ASIN/0517056690/icongroupinterna

·

Fighting Fat!: How to Beat Heart Disease and Cancer, and Lose Weight: A Practical Guide to Fats, Oils, and Cholesterol by Kathleen, Mayes; ISBN: 0915201283; http://www.amazon.com/exec/obidos/ASIN/0915201283/icongroupinterna

·

Fischer Brown Low Cholesterol Gourmet by Lynn Fisher, Virgil Brown; ISBN: 0318420724; http://www.amazon.com/exec/obidos/ASIN/0318420724/icongroupinterna

·

Flavors of Lebanon : over 130 original recipes with nutritional information including cholesterol and saturated fat by Vera Shammas; ISBN: 0964833409; http://www.amazon.com/exec/obidos/ASIN/0964833409/icongroupinterna

·

Food 3: Eating the Moderate Fat & Cholesterol Way (1982); ISBN: 9996045609; http://www.amazon.com/exec/obidos/ASIN/9996045609/icongroupinterna

454 Cholesterol

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Food Values: Fats and Cholesterol: Lists the Amount of Cholesterol and Fat in More Than 8,000 Foods With Calorie Count for Each Food by Patty Bryan; ISBN: 0062731254; http://www.amazon.com/exec/obidos/ASIN/0062731254/icongroupinterna

·

Getting to the Heart of Cholesterol by Howard Seiden (1989); ISBN: 0919959407; http://www.amazon.com/exec/obidos/ASIN/0919959407/icongroupinterna

·

Good Cholesterol, Bad Cholesterol by Eli M. Roth, Sandra L. Streicher-Lankin (1995); ISBN: 0761500103; http://www.amazon.com/exec/obidos/ASIN/0761500103/icongroupinterna

·

Good Cholesterol, Bad Cholesterol: An Indispensable Guide to the Facts About Cholestrol by Anita Hirsch (2002); ISBN: 1569245282; http://www.amazon.com/exec/obidos/ASIN/1569245282/icongroupinterna

·

Good Fat, Bad Fat: How to Lower Your Cholesterol and Beat the Odds of a Heart Attack by Glen Griffen, et al; ISBN: 1555610137; http://www.amazon.com/exec/obidos/ASIN/1555610137/icongroupinterna

·

Green Tea: Fight Cancer, Lower Cholesterol, Live Longer by Kate Gilbert Udall (1998); ISBN: 1580540244; http://www.amazon.com/exec/obidos/ASIN/1580540244/icongroupinterna

·

Grocery Shopping Guide: A Consumer's Manual for Selecting Food Lower in Dietary Saturated Fat and Cholesterol by Nelda Mercer, Carl E. Orringer (Contributor); ISBN: 0472005006; http://www.amazon.com/exec/obidos/ASIN/0472005006/icongroupinterna

·

Guide to Contented Hearts: Cardiac Risk Management: Cholesterol, High Blood Pressure Exercise, Stress, Weight, Diet by D. Charles Van Fulpen (1995); ISBN: 0963756206; http://www.amazon.com/exec/obidos/ASIN/0963756206/icongroupinterna

·

Harriet Roth's Cholesterol Control Cookbook by Harriet Roth (1991); ISBN: 0452266122; http://www.amazon.com/exec/obidos/ASIN/0452266122/icongroupinterna

·

Harriet Roth's Complete Guide to Fats, Calories, and Cholesterol by Harriet Roth (1996); ISBN: 0451176707; http://www.amazon.com/exec/obidos/ASIN/0451176707/icongroupinterna

·

Harriet Roth's Deliciously Healthy Jewish Cooking: 350 New Low-Fat, LowCholesterol, Low-Sodium Recipes for Holidays and Every Day by Harriet Roth (1996); ISBN: 0525939318; http://www.amazon.com/exec/obidos/ASIN/0525939318/icongroupinterna

·

Harriet Roth's Guide to Low Cholesterol Dining Out by Harriet Roth (1995); ISBN: 0451169018; http://www.amazon.com/exec/obidos/ASIN/0451169018/icongroupinterna

·

Haute Cuisine for Your Heart's Delight: A Low-Cholesterol Cookbook for Gourmets by Carol Cutler; ISBN: 0517500485; http://www.amazon.com/exec/obidos/ASIN/0517500485/icongroupinterna

·

Health Benefits of Probiotics (Latest Research Showing Benefits for Digestion, Cholesterol, Yeast Infection, Immune System, Colon Cancer, Ulcers, etc) by Beth LeyJacobs (2000); ISBN: 1890766100; http://www.amazon.com/exec/obidos/ASIN/1890766100/icongroupinterna

Books 455

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Health Journeys: A Meditation for a Healthy Heart Guided Imagery for Healthy Cholesterol, Open Arteries and a Strong Heart [ABRIDGED] by Belleruth Naparstek; ISBN: 1570426759; http://www.amazon.com/exec/obidos/ASIN/1570426759/icongroupinterna

·

Health Smart Gourmet Cooking: More Than Two Hundred and Fifty Low-Fat, LowCholesterol, Low-.... by Arlyn Hackett (1992); ISBN: 0963407406; http://www.amazon.com/exec/obidos/ASIN/0963407406/icongroupinterna

·

Healthwise : the recipe and reference book for health-conscious individuals and people on special diets : low-fat, low-cholesterol, low sodium, low-sugar, low-calorie by Billie Joan English; ISBN: 0963853309; http://www.amazon.com/exec/obidos/ASIN/0963853309/icongroupinterna

·

Healthy Heart (Nih Low-Cholesterol Cookbook); ISBN: 0453005780; http://www.amazon.com/exec/obidos/ASIN/0453005780/icongroupinterna

·

Healthy Indulgences: Enjoy the Good Life and Good Food With Low Cholesterol Gourmet by Lynn Fischer; ISBN: 0380722496; http://www.amazon.com/exec/obidos/ASIN/0380722496/icongroupinterna

·

Heart Clogs & Other Things Along the Same Vein: Understanding Cholesterol at Last by Thomas J. Sims; ISBN: 094503301X; http://www.amazon.com/exec/obidos/ASIN/094503301X/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

·

Heart Smart: A Doctor's Commonsense Guide to Understanding Cholesterol and Saving Your Heart by Eric Moskow, Tom Biracree (Contributor); ISBN: 0312130856; http://www.amazon.com/exec/obidos/ASIN/0312130856/icongroupinterna

·

Heart Smart: A Plan for Low-Cholesterol Living by Gail L. Becker; ISBN: 067164761X; http://www.amazon.com/exec/obidos/ASIN/067164761X/icongroupinterna

·

Hemodynamic Basis of Atherosclerosis: With Critique of the Cholesterol-Heart Disease Hypothesis by Meyer Texon (1996); ISBN: 1567000290; http://www.amazon.com/exec/obidos/ASIN/1567000290/icongroupinterna

·

Herbs for the Heart: Herbs to Lower Cholesterol and Blood Pressure, Increase Circulation, Prevent Clotting, and Enhance Heart Heath (Keats Good Herb Guide Series) by C. J. Puotinen; ISBN: 0879837969; http://www.amazon.com/exec/obidos/ASIN/0879837969/icongroupinterna

·

High Blood Cholesterol: Description and Bibliography by Edward T. O'Neil (Editor) (2003); ISBN: 1590333403; http://www.amazon.com/exec/obidos/ASIN/1590333403/icongroupinterna

·

High Blood Pressure, Cholesterol, and You by Harold C. Steele; ISBN: 0873971019; http://www.amazon.com/exec/obidos/ASIN/0873971019/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

456 Cholesterol

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High Cholesterol: What You Should Know (Your Health: What You Should Know) by Dean, Dr. Kereiakes, et al; ISBN: 1558705538; http://www.amazon.com/exec/obidos/ASIN/1558705538/icongroupinterna

·

Homocysteine: The New "Cholesterol" by Jack Challem, Victoria Dolby; ISBN: 0879837225; http://www.amazon.com/exec/obidos/ASIN/0879837225/icongroupinterna

·

How to Bypass Your Bypass: What Your Doctor Doesn't Tell You About Cholesterol and Your Diet by MD, Richard M. Fleming; ISBN: 188775055X; http://www.amazon.com/exec/obidos/ASIN/188775055X/icongroupinterna

·

How to Have Your Cake and Eat It Too!: Diet Cooking for the Whole Family, Diabetic, Hypoglycemic, Low-Cholesterol, Low-Fat, Low-Salt and Low-Calorie by Norma M. MacRae; ISBN: 0882400258; http://www.amazon.com/exec/obidos/ASIN/0882400258/icongroupinterna

·

How to Have Your Cake and Eat It Too: Diet Cooking for the Whole Family, Diabetic, Hypoglycemic, Low-Cholesterol, Low Fat, Low Salt, Low Calories by Norma M. MacRae; ISBN: 0882402269; http://www.amazon.com/exec/obidos/ASIN/0882402269/icongroupinterna

·

How to Keep Your Cholesterol in Check by Robert Povey (2000); ISBN: 0859697762; http://www.amazon.com/exec/obidos/ASIN/0859697762/icongroupinterna

·

I Need Help Quick Cookbook: Low-Cholesterol, Low-Fat, Low-Sodium Family Favorite Recipes by Judy McKinney, et al (1989); ISBN: 0962448508; http://www.amazon.com/exec/obidos/ASIN/0962448508/icongroupinterna

·

Indian Recipes for a Healthy Heart: 140 Low-Fat, Low-Cholesterol, Low-Sodium Gourmet Dishes from India by Mrs. Lakhani (1992); ISBN: 0963023500; http://www.amazon.com/exec/obidos/ASIN/0963023500/icongroupinterna

·

Intracellular Cholesterol Trafficking by T. Y. Chang (Editor), Dale A. Freeman (Editor) (1998); ISBN: 0792383656; http://www.amazon.com/exec/obidos/ASIN/0792383656/icongroupinterna

·

Italian Cooking for a Healthy Heart: Low-Fat, Low-Cholesterol Gourmet Dishes by Joanne D'Agostino, Frank J. D'Agostino (Contributor); ISBN: 093193379X; http://www.amazon.com/exec/obidos/ASIN/093193379X/icongroupinterna

·

It's Heartly Fare: A Food Book That Makes Sense of Fat, Cholesterol & Salt by Timothy S. Harlan (1991); ISBN: 093983829X; http://www.amazon.com/exec/obidos/ASIN/093983829X/icongroupinterna

·

Jack Sprat Cookbook: Good Eating on a Low Cholesterol, Low Saturates Fat Diet by Polly Zane; ISBN: 0060908033; http://www.amazon.com/exec/obidos/ASIN/0060908033/icongroupinterna

·

Jack Sprat's Legacy: The Science and Politics of Fat and Cholesterol by Patricia Hausman; ISBN: 0399901116; http://www.amazon.com/exec/obidos/ASIN/0399901116/icongroupinterna

·

Julie Stafford's Low Cholesterol Cookbook: Conquer Cholesterol the "Taste of Life" Way by Julie Stafford; ISBN: 0670875775; http://www.amazon.com/exec/obidos/ASIN/0670875775/icongroupinterna

·

Just What the Doctor Ordered: Gormet Recipes Developed With Boston's Beth Israel Hospital for Low-Calorie, Diabetic, Low-Fat, Low-Cholesterol, Low-So by Harriet W.

Books 457

Goodman, Barbara Morse; ISBN: 0517063433; http://www.amazon.com/exec/obidos/ASIN/0517063433/icongroupinterna ·

Kathy Cooks: Vegetarian, Low Cholesterol (Art of Dieting Without Dieting) by Kathy Hoshijo; ISBN: 0671678051; http://www.amazon.com/exec/obidos/ASIN/0671678051/icongroupinterna

·

Keep Cholesterol Low (Why Should I) by Cindy Devine Dalton (2001); ISBN: 1559163054; http://www.amazon.com/exec/obidos/ASIN/1559163054/icongroupinterna

·

Know Your Fats : The Complete Primer for Understanding the Nutrition of Fats, Oils and Cholesterol by Mary G. Enig; ISBN: 0967812607; http://www.amazon.com/exec/obidos/ASIN/0967812607/icongroupinterna

·

Latin America and Cholesterol Conscious Cooking by Vilma Janke Grace; ISBN: 0874912806; http://www.amazon.com/exec/obidos/ASIN/0874912806/icongroupinterna

·

Lecithin: The Cholesterol Controller by Paul Simons; ISBN: 0722508646; http://www.amazon.com/exec/obidos/ASIN/0722508646/icongroupinterna

·

Legette's Cholesterol Encyclopedia the Largest Quickest to Use Cholesterol Counter Ever by Bernard Legette, Bernard Le Gette (1989); ISBN: 0446350923; http://www.amazon.com/exec/obidos/ASIN/0446350923/icongroupinterna

·

Let Them Eat Cake: And Other Low-Fat and Low-Cholesterol Desserts by Virginia N. White, Rosa A. Mo (Contributor); ISBN: 1565610113; http://www.amazon.com/exec/obidos/ASIN/1565610113/icongroupinterna

·

Light Sauces: Delicious Low-Calorie, Low-Fat, Low-Cholesterol Recipes for Meats and Fish, Pasta, Salads, Vegetables, and Desserts by Barry Bluestein, Kevin Morrissey (Contributor); ISBN: 0809240637; http://www.amazon.com/exec/obidos/ASIN/0809240637/icongroupinterna

·

Light Style: The Low Fat, Low Cholesterol, Low Salt Way to Good Food and Good Health by Deborah Kidushim-Allen (Contributor), Rose Light Style, the New American Cuisine Dosti; ISBN: 0062502417; http://www.amazon.com/exec/obidos/ASIN/0062502417/icongroupinterna

·

Lipoprotein and Cholesterol Metabolism in Steriodogenic Tissues (Nutrition) by Jerome Strauss; ISBN: 039753079X; http://www.amazon.com/exec/obidos/ASIN/039753079X/icongroupinterna

·

Lite Up Your Life: A Delicious Variety of Low-Sodium, Low-Cholesterol, Low-Fat Recipes for Everyday Eating by Waynell. Harris, et al; ISBN: 0937552402; http://www.amazon.com/exec/obidos/ASIN/0937552402/icongroupinterna

·

Living High on Lowering Cholesterol by Marianne Alexander; ISBN: 1930364350; http://www.amazon.com/exec/obidos/ASIN/1930364350/icongroupinterna

·

Louisiana Light: Low-Fat, Low-Calorie, Low-Cholesterol, Low-Salt Cajun and Creole Cookery by Roy F., Jr. Guste (1990); ISBN: 0393027147; http://www.amazon.com/exec/obidos/ASIN/0393027147/icongroupinterna

·

Low Cholesterol by Patricia Payne (1996); ISBN: 1569874492; http://www.amazon.com/exec/obidos/ASIN/1569874492/icongroupinterna

·

Low Cholesterol and Sugarfree Recipes by Marie Lipera; ISBN: 0899626289; http://www.amazon.com/exec/obidos/ASIN/0899626289/icongroupinterna

458 Cholesterol

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Low Cholesterol Cook Book by Sunset Books, Patricia Kearney; ISBN: 037602514X; http://www.amazon.com/exec/obidos/ASIN/037602514X/icongroupinterna

·

Low Cholesterol Cookbook by Oxmoor House (2000); ISBN: 0376025158; http://www.amazon.com/exec/obidos/ASIN/0376025158/icongroupinterna

·

Low Cholesterol Cookbook by Christine France (2002); ISBN: 0754810607; http://www.amazon.com/exec/obidos/ASIN/0754810607/icongroupinterna

·

Low Cholesterol Cookbook by M. Cavaiani; ISBN: 0064634086; http://www.amazon.com/exec/obidos/ASIN/0064634086/icongroupinterna

·

Low Cholesterol Cookbook (Select Classic Cookery) by Philip Gore (Editor); ISBN: 0947199217; http://www.amazon.com/exec/obidos/ASIN/0947199217/icongroupinterna

·

Low Cholesterol Cookbook: Over 50 Recipes, Each One Low in Cholesterol and Saturated Fats (1998); ISBN: 1859675743; http://www.amazon.com/exec/obidos/ASIN/1859675743/icongroupinterna

·

Low Cholesterol Cooking for Health: Over 50 Recipes, Each One Low in Cholesterol and Saturated Fats, but High in Taste (Kitchen Doctor Series) by Christine France (2003); ISBN: 1842159038; http://www.amazon.com/exec/obidos/ASIN/1842159038/icongroupinterna

·

Low Cholesterol Desserts! by Terri J. Siegel (1990); ISBN: 0895944421; http://www.amazon.com/exec/obidos/ASIN/0895944421/icongroupinterna

·

Low Cholesterol Diet Over Healthy Lo by Christine France (Author); ISBN: 1840810661; http://www.amazon.com/exec/obidos/ASIN/1840810661/icongroupinterna

·

Low Cholesterol Favorites Cookbook by Arleen Holst, Sue Willett; ISBN: 096215881X; http://www.amazon.com/exec/obidos/ASIN/096215881X/icongroupinterna

·

Low Cholesterol Kitchen Cookbook by Ellie Schneider (1989); ISBN: 0897163214; http://www.amazon.com/exec/obidos/ASIN/0897163214/icongroupinterna

·

Low Cholesterol Oat Plan by Barbara Earnest, et al; ISBN: 0380708396; http://www.amazon.com/exec/obidos/ASIN/0380708396/icongroupinterna

·

Low Cholesterol Recipes for Life by Better (1991); ISBN: 1561970123; http://www.amazon.com/exec/obidos/ASIN/1561970123/icongroupinterna

·

Low Cholesterol Three Ingredient Cookbook by Ruthie Wornall; ISBN: 0962446734; http://www.amazon.com/exec/obidos/ASIN/0962446734/icongroupinterna

·

Low Cholesterol, Low Fat Cooking: Over 220 Delicious Healthy Recipes for All the Family by Christine France (2002); ISBN: 075480979X; http://www.amazon.com/exec/obidos/ASIN/075480979X/icongroupinterna

·

Low Cholesterol, Low Fat: For a Healthy Heart and Circulation (Powerfoods) by Elizabeth Dopp, et al; ISBN: 185675166X; http://www.amazon.com/exec/obidos/ASIN/185675166X/icongroupinterna

·

Low cholesterol, lower calorie desserts by Stanley Leinwoll; ISBN: 0684133806; http://www.amazon.com/exec/obidos/ASIN/0684133806/icongroupinterna

·

Low cholesterol, lower calorie French cooking by Stanley Leinwoll; ISBN: 0684137453; http://www.amazon.com/exec/obidos/ASIN/0684137453/icongroupinterna

Books 459

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Low Cholesterol: For Your Heart's Sake (Healthy Cooking Series) by Smithmark Publishing; ISBN: 0831780460; http://www.amazon.com/exec/obidos/ASIN/0831780460/icongroupinterna

·

Low Fat Low Cholesterol: Recipes for a Healthy Heart by Christine France (2000); ISBN: 1842150936; http://www.amazon.com/exec/obidos/ASIN/1842150936/icongroupinterna

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Low Salt, Low Cholesterol Cookbook (1991); ISBN: 9994671448; http://www.amazon.com/exec/obidos/ASIN/9994671448/icongroupinterna

·

Low Salt/Low Cholesterol by Myra Waldo; ISBN: 0425057674; http://www.amazon.com/exec/obidos/ASIN/0425057674/icongroupinterna

·

Low-Cholesterol Chinese Cuisine by Teng Chao Chao, et al (1990); ISBN: 0941676226; http://www.amazon.com/exec/obidos/ASIN/0941676226/icongroupinterna

·

Low-Cholesterol Cuisine by Anne Lindsay, Anne Lindsey; ISBN: 0517123290; http://www.amazon.com/exec/obidos/ASIN/0517123290/icongroupinterna

·

Low-Cholesterol Jewish Cookery: [The Unsaturated-Fat Way] by June Spiewak Roth; ISBN: 0668044209; http://www.amazon.com/exec/obidos/ASIN/0668044209/icongroupinterna

·

Lower Cholesterol Without Drugs by Roger Mason; ISBN: 1884820646; http://www.amazon.com/exec/obidos/ASIN/1884820646/icongroupinterna

·

Lower Your Cholesterol in 30 Days by Emanuel Cheraskin, et al; ISBN: 0399515550; http://www.amazon.com/exec/obidos/ASIN/0399515550/icongroupinterna

·

Lower Your Cholesterol/Cassette (Prevention's Mind Body Healing Tapes); ISBN: 0878578781; http://www.amazon.com/exec/obidos/ASIN/0878578781/icongroupinterna

·

Lower Your Cholesterol: A Guide to a Healthier Diet by Gene Brown; ISBN: 0943392535; http://www.amazon.com/exec/obidos/ASIN/0943392535/icongroupinterna

·

Lowering Cholesterol in High-risk Individuals and Populations by Basil M. Rifkind (Editor); ISBN: 0824794125; http://www.amazon.com/exec/obidos/ASIN/0824794125/icongroupinterna

·

Lowering Cholesterol/Audio Cassette by Barrie Konicov (1988); ISBN: 0870829009; http://www.amazon.com/exec/obidos/ASIN/0870829009/icongroupinterna

·

Lowering Cholesterol: A Subliminal Persuasion Self-Hypnosis Tape by Barrie Konicov; ISBN: 0870820885; http://www.amazon.com/exec/obidos/ASIN/0870820885/icongroupinterna

·

Low-Fat Low-Cholesterol Cooking (Practical Handbooks) by Christine France (Editor) (2001); ISBN: 0754807738; http://www.amazon.com/exec/obidos/ASIN/0754807738/icongroupinterna

·

Lynn Fischer's Quick Low Cholesterol Gourmet: Delicious and Healthy Meals You Can Prepare in 20 Minutes or Less by Lynn Fischer; ISBN: 1879326213; http://www.amazon.com/exec/obidos/ASIN/1879326213/icongroupinterna

·

Marlene Pentecost's New Cookbook: No Added Salt, No Added Sugar, No Added Cholesterol by Marlene Pentecost; ISBN: 0731629892; http://www.amazon.com/exec/obidos/ASIN/0731629892/icongroupinterna

460 Cholesterol

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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 (The Natural Pharmacist) by Darin Ingels; ISBN: 0761524673; http://www.amazon.com/exec/obidos/ASIN/0761524673/icongroupinterna

·

Natural Ways to Lower Your Cholesterol: Safe, Drug-Free Ways to Lower Your Cholesterol Up to 30 Points in 30 Days by Norman D. Ford (1997); ISBN: 0883659786; http://www.amazon.com/exec/obidos/ASIN/0883659786/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

·

NCEP Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report (2003); ISBN: 158808003X; http://www.amazon.com/exec/obidos/ASIN/158808003X/icongroupinterna

·

No Brainer Nutrition: High Energy, Flavor Filled Foods With No Cholesterol, Low Fat & No Salt by Marc Seidman (1996); ISBN: 0965201503; http://www.amazon.com/exec/obidos/ASIN/0965201503/icongroupinterna

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No Cholesterol Passover Recipes by Debra Wasserman, Janet Steinberg (Illustrator) (1995); ISBN: 0931411149; http://www.amazon.com/exec/obidos/ASIN/0931411149/icongroupinterna

·

Nutritional Imbalances in Infant and Adult Disease: Mineral, Vitamin D, and Cholesterol: Proceedings of the Sixteenth Annual Meeting of the American C by American College Of Nutrition (1977); ISBN: 0893350079; http://www.amazon.com/exec/obidos/ASIN/0893350079/icongroupinterna

·

Nutri-Tips/a Quick Access Food Guide to Fats, Cholesterol, Calories, Sodium, Vitamins, Minerals, and Important Facts About the Foods We Eat Everyday by Roberta Morgan, Brian L. G. Morgan; ISBN: 0681411848; http://www.amazon.com/exec/obidos/ASIN/0681411848/icongroupinterna

·

Oat Cuisine: Over 200 Delicious Recipes to Help You Lower Your Cholesterol Level by Bobbie Hinman, Vonnie Winslow Crist (Illustrator); ISBN: 1559580038; http://www.amazon.com/exec/obidos/ASIN/1559580038/icongroupinterna

·

One Year of Healthy, Hearty & Simple One-Dish Meals: 365 Low-Fat, LowCholesterol Delicious and Time-Saving Recipes by Pam Spaude, Jan OwanMcMenamin (Contributor); ISBN: 1565610199; http://www.amazon.com/exec/obidos/ASIN/1565610199/icongroupinterna

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Optical Diagnostics and Sensing of Biological Fluids and Glucose and Cholesterol Monitoring by Alexander V. Priezzhev (Editor), Gerard L. Cote (Editor) (2001); ISBN: 081943941X; http://www.amazon.com/exec/obidos/ASIN/081943941X/icongroupinterna

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Optical Diagnostics and Sensing of Biological Fluids and Glucose and Cholesterol Monitoring II (2002); ISBN: 0819443638; http://www.amazon.com/exec/obidos/ASIN/0819443638/icongroupinterna

Books 461

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Outsmart High Cholesterol by Prevention Magazine (Editor); ISBN: 0312988109; http://www.amazon.com/exec/obidos/ASIN/0312988109/icongroupinterna

·

Plus 15 : fifteen days to lower blood pressure & cholesterol by Samuel L. DeShay; ISBN: 0945460163; http://www.amazon.com/exec/obidos/ASIN/0945460163/icongroupinterna

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Plus Fifteen: 15 Days to Lower Cholesterol and Blood Pressure by Samuel L. Deshay, Bernice Deshay (Editor); ISBN: 0898402980; http://www.amazon.com/exec/obidos/ASIN/0898402980/icongroupinterna

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Quick & Easy Low Cholesterol Recipes by Richard Carroll, et al; ISBN: 1582793441; http://www.amazon.com/exec/obidos/ASIN/1582793441/icongroupinterna

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Quick and Easy Low-Fat, Low-Cholesterol Recipes Kids Will Love by Bea Lewis; ISBN: 0380760797; http://www.amazon.com/exec/obidos/ASIN/0380760797/icongroupinterna

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Quick Cholesterol Clean-Out by Peter Cox, Peggy Brusseau; ISBN: 0712630872; http://www.amazon.com/exec/obidos/ASIN/0712630872/icongroupinterna

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Reaction & Responses to High Serum Cholesterol Results (Dinroo) by Alan Pearson, et al (1992); ISBN: 073002010X; http://www.amazon.com/exec/obidos/ASIN/073002010X/icongroupinterna

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Recommendations for Improving Cholesterol Measurement by Barry Leonard (Editor) (1993); ISBN: 0756700698; http://www.amazon.com/exec/obidos/ASIN/0756700698/icongroupinterna

·

Reducing Cholesterol: A Heart-Smart Guide to Low-Fat Eating by Prevention Magazine (Editor), Kenneth Cooper (Editor); ISBN: 0681407182; http://www.amazon.com/exec/obidos/ASIN/0681407182/icongroupinterna

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Report of the National Cholesterol Education Program on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults-Adult Treatment panel by Scott M. Grundy (Editor) (2003); ISBN: 0756731011; http://www.amazon.com/exec/obidos/ASIN/0756731011/icongroupinterna

·

Role of Cyclic Nucleotides in Radiobiology/The Functional Role of Radiationinduced Activation of Cholesterol and Lipogenesis in the Animal Body (Soviet Scientific Reviews Series, Section F) by Sobolev, Kolomiytseva; ISBN: 3718657678; http://www.amazon.com/exec/obidos/ASIN/3718657678/icongroupinterna

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Rutgers Guide to Lowering Your Cholesterol: A Common Sense Approach by Hans Fisher, Eugene Boe; ISBN: 0446326577; http://www.amazon.com/exec/obidos/ASIN/0446326577/icongroupinterna

·

Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: (Adult Treatment Panel Ii) by Scott M. Grundy (1993); ISBN: 0788146807; http://www.amazon.com/exec/obidos/ASIN/0788146807/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

·

Serum Cholesterol Level of Adults 18-74 Years in the United States 1971-1974 (1977); ISBN: 0840601115; http://www.amazon.com/exec/obidos/ASIN/0840601115/icongroupinterna

462 Cholesterol

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Snack to Your Heart's Content!: The Low-Fat, Low-Cholesterol, Low-Calorie Quick & Easy Cookbook by Shelley, Melvin, Marilyn Stone; ISBN: 0937404322; http://www.amazon.com/exec/obidos/ASIN/0937404322/icongroupinterna

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So You Have High Blood Cholesterol by American Heart Association (1993); ISBN: 0160429161; http://www.amazon.com/exec/obidos/ASIN/0160429161/icongroupinterna

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Soluble Fibre and Cholesterol Reduction by P.M. Dodson (1997); ISBN: 1873839219; http://www.amazon.com/exec/obidos/ASIN/1873839219/icongroupinterna

·

Step by Step: Eating to Lower Your High Blood Cholesterol; ISBN: 9999853366; http://www.amazon.com/exec/obidos/ASIN/9999853366/icongroupinterna

·

Subcellular Biochemistry: Cholesterol: Its Functions and Metabolism in Biology and Medicine (Sub-Cellular Biochemistry, 28) by Robert Bittman (Editor) (1997); ISBN: 0306454785; http://www.amazon.com/exec/obidos/ASIN/0306454785/icongroupinterna

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Supercooks Low Cholesterol Cookbook; ISBN: 0890091501; http://www.amazon.com/exec/obidos/ASIN/0890091501/icongroupinterna

·

Taking Charge of Cholesterol by Tessa Cooper, Glenn Cooper; ISBN: 0450532216; http://www.amazon.com/exec/obidos/ASIN/0450532216/icongroupinterna

·

Taste for Health: Delicious Low Fat Low Cholesterol Recipes by Lipid Research Clinic; ISBN: 0941016161; http://www.amazon.com/exec/obidos/ASIN/0941016161/icongroupinterna

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Taste of Life Cookbook: 200 Low Cholesterol Easy to Make Healthy Life Style Recipes by Julie Stafford; ISBN: 0732800099; http://www.amazon.com/exec/obidos/ASIN/0732800099/icongroupinterna

·

The "I ate myself silly, and still lost weight" cookbook : 100 low-cholesterol, low-fat recipes for a healthy heart and body by Millie Haeberle; ISBN: 0963794906; http://www.amazon.com/exec/obidos/ASIN/0963794906/icongroupinterna

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The (Almost No Cholesterol Gourmet Cookbook) by Jeanette M. Seaver, et al (1994); ISBN: 1559702745; http://www.amazon.com/exec/obidos/ASIN/1559702745/icongroupinterna

·

The 8 Week Cholesterol Cure by Robert E. Kowalski; ISBN: 067166638X; http://www.amazon.com/exec/obidos/ASIN/067166638X/icongroupinterna

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The 8-Week Cholesterol Cure : How to Lower Your Cholesterol by Up to 40 Percent Without Drugs or Deprivation by Robert E. Kowalski (Author); ISBN: 006109773X; http://www.amazon.com/exec/obidos/ASIN/006109773X/icongroupinterna

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The 8-Week Cholesterol Cure Cookbook: More Than 200 Delicious Recipes Featuring the Foods Proven to Lower Cholesterol by Robert E. Kowalski; ISBN: 0060160950; http://www.amazon.com/exec/obidos/ASIN/0060160950/icongroupinterna

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The 8-Week Cholesterol Cure Personal Diary by Robert E. Kowalski; ISBN: 0060964715; http://www.amazon.com/exec/obidos/ASIN/0060964715/icongroupinterna

·

The 8-Week Cholesterol Cure: How to Lower Your Blood Cholesterol by 40 Percent or More Without Drugs or Deprivation by Robert E. Kowalski; ISBN: 0671682261; http://www.amazon.com/exec/obidos/ASIN/0671682261/icongroupinterna

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The 8-Week Cholesterol Cure: How to Lower Your Blood Cholesterol by Up to 40 Percent Without Drugs of Deprivation by Robert E. Kowalski, Albert A. Kattus

Books 463

(Introduction); ISBN: 0060156139; http://www.amazon.com/exec/obidos/ASIN/0060156139/icongroupinterna ·

The 8-Week Cholesterol Cure: How to Lower Your Blood Cholesterol by Up Tp 40 Percent Without Drugs or Deprivation by Robert E. Kowalski, Albert A. Kattus (Contributor); ISBN: 0060161833; http://www.amazon.com/exec/obidos/ASIN/0060161833/icongroupinterna

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The All-Natural Cardio Cure: A Drug-Free Cholesterol and Cardiac Inflammation Reduction Program by Allan Magaziner, Batya Swift Yasgur (2004); ISBN: 1583331794; http://www.amazon.com/exec/obidos/ASIN/1583331794/icongroupinterna

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The American Heart Association Low-Fat, Low-Cholesterol Cookbook by American Heart Association, Heart Association American; ISBN: 0345461827; http://www.amazon.com/exec/obidos/ASIN/0345461827/icongroupinterna

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The American Heart Association Low-Fat, Low-Cholesterol Cookbook: More Than 200 Delicious Heart-Healthful Recipes for the Whole Family; ISBN: 0679735348; http://www.amazon.com/exec/obidos/ASIN/0679735348/icongroupinterna

·

The Beef Lover's Guide to Weight Control and Lower Cholesterol by Chriss McNaught, et al (1990); ISBN: 0943255279; http://www.amazon.com/exec/obidos/ASIN/0943255279/icongroupinterna

·

The Biology of Cholesterol by Philip L. Yeagle (Editor) (1988); ISBN: 084934977X; http://www.amazon.com/exec/obidos/ASIN/084934977X/icongroupinterna

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The Cholesterol Conspiracy by Russell Smith (1991); ISBN: 0875274765; http://www.amazon.com/exec/obidos/ASIN/0875274765/icongroupinterna

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The cholesterol content of food by Corinne T. Netzer (Author); ISBN: B00005VLA5; http://www.amazon.com/exec/obidos/ASIN/B00005VLA5/icongroupinterna

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The Cholesterol Counter by Annette, B. Natow, Jo-Ann Heslin; ISBN: 0671004514; http://www.amazon.com/exec/obidos/ASIN/0671004514/icongroupinterna

·

The Cholesterol Counter : 6th Edition by Jo-Ann Heslin (Author), Annette B. Natow (Author) (2004); ISBN: 0743464389; http://www.amazon.com/exec/obidos/ASIN/0743464389/icongroupinterna

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The Cholesterol Hoax: 101+ Lies by Sheldon Zerden (1997); ISBN: 0964010429; http://www.amazon.com/exec/obidos/ASIN/0964010429/icongroupinterna

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The Cholesterol Myths : Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease by Uffe Ravnskov; ISBN: 0967089700; http://www.amazon.com/exec/obidos/ASIN/0967089700/icongroupinterna

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The Cholestin Breakthrough: The Safe, Natural, and Scientifically Proven Way to Lower Your Cholesterol by Richard Harkness, James B. Lavalle; ISBN: 0761518169; http://www.amazon.com/exec/obidos/ASIN/0761518169/icongroupinterna

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The Complete Brand-Name Guide to Choosing the Lowest Fat, Calorie, Cholesterol, and Sodium Foods/Nutritional Values and Fat Ratings for More Than 2,0: Nutritional Values and Fat Ratings for More Than 2,000 of Your Favorite Products by Densie Webb, Denise Ph.D., R.D. Webb; ISBN: 0553291491; http://www.amazon.com/exec/obidos/ASIN/0553291491/icongroupinterna

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The Complete Cholesterol Counter by Penny Mintz; ISBN: 0345363213; http://www.amazon.com/exec/obidos/ASIN/0345363213/icongroupinterna

464 Cholesterol

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The Complete Cholesterol Counter: Count Your Way to a Healthy Heart by Peter Cox, Peggy Brusseau; ISBN: 0747536473; http://www.amazon.com/exec/obidos/ASIN/0747536473/icongroupinterna

·

The Dieter's Complete Guide To-- Calories, Carbohydrates, Sodium, Fats & Cholesterol by Consumer Guide (1981); ISBN: 0449900509; http://www.amazon.com/exec/obidos/ASIN/0449900509/icongroupinterna

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The Dieter's Gourmet Cookbook: Delicious Low-Fat, Low-Cholesterol Cooking and Baking Recipes Using No Sugar or Salt! by Francine Prince; ISBN: 0671961152; http://www.amazon.com/exec/obidos/ASIN/0671961152/icongroupinterna

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The Dieter's Gourmet Cookbook: Delicious Low-Fat, Low-Cholesterol, Cooking and Baking Recipes Using No Suger or Salt! by Francine Prince; ISBN: 0671620215; http://www.amazon.com/exec/obidos/ASIN/0671620215/icongroupinterna

·

The Fat Blocker Diet: The Revolutionary Discovery That Lowers Cholesterol, Reduces Fat, and Controls Weight Naturally by Arnold Fox, et al; ISBN: 0694519014; http://www.amazon.com/exec/obidos/ASIN/0694519014/icongroupinterna

·

The Fischer-Brown Low Cholesterol Gourmet by Lynn Fischer; ISBN: 0874919096; http://www.amazon.com/exec/obidos/ASIN/0874919096/icongroupinterna

·

The Flavor Secret: Using Herbs & Spices to Put Flavor Back into Low-Fat, LowCalorie, Low-Cholesterol Cooking by Judy Gilliard, Joy Kirkpatrick (Contributor); ISBN: 1565610377; http://www.amazon.com/exec/obidos/ASIN/1565610377/icongroupinterna

·

The Gourmet's Low Cholesterol Cookbook by Elizabeth Weiss (1980); ISBN: 0515056901; http://www.amazon.com/exec/obidos/ASIN/0515056901/icongroupinterna

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The Great Eating, Great Dieting Cookbook : American Minceur Cooking for the Whole Family, High in Fiber, Low in Cholesterol : Breakfast, Lunch, and dinner by Arthur. Darack; ISBN: 0690016840; http://www.amazon.com/exec/obidos/ASIN/0690016840/icongroupinterna

·

The Heart Revolution : The Extraordinary Discovery That Finally Laid the Cholesterol Myth to Rest by Kilmer McCully (Author), Martha McCully (Author) (2000); ISBN: 0060929731; http://www.amazon.com/exec/obidos/ASIN/0060929731/icongroupinterna

·

The Jack Sprat cookbook; or, Good eating on a low-cholesterol diet by Polly Zane; ISBN: 0060148012; http://www.amazon.com/exec/obidos/ASIN/0060148012/icongroupinterna

·

The Jewish Low-Cholesterol Cookbook by Roberta Leviton; ISBN: 0839742061; http://www.amazon.com/exec/obidos/ASIN/0839742061/icongroupinterna

·

The Little Cholesterol Book by Douglas Wetherill, Laura Seeley (1999); ISBN: 1892807394; http://www.amazon.com/exec/obidos/ASIN/1892807394/icongroupinterna

·

The Love Your Heart Mediterranean (Low Cholesterol Cookbook) by Carole Kruppa; ISBN: 0940625520; http://www.amazon.com/exec/obidos/ASIN/0940625520/icongroupinterna

·

The Low Cholesterol Cookbook by O London; ISBN: 0706405897; http://www.amazon.com/exec/obidos/ASIN/0706405897/icongroupinterna

Books 465

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The Low Cholesterol Diet by Christine France; ISBN: 1840387157; http://www.amazon.com/exec/obidos/ASIN/1840387157/icongroupinterna

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The Low Fat Low Cholesterol Cookbook: Over 130 Healthy, Low Fat Recipes for All the Family by Christine France; ISBN: 1859671004; http://www.amazon.com/exec/obidos/ASIN/1859671004/icongroupinterna

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The Low Fat, Low Cholesterol Diet by Clara-Beth Young Bond (Editor), et al; ISBN: 038518879X; http://www.amazon.com/exec/obidos/ASIN/038518879X/icongroupinterna

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The Low Fat, Low Cholesterol Diet (1993); ISBN: 9993671053; http://www.amazon.com/exec/obidos/ASIN/9993671053/icongroupinterna

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The Low Fat, Low Cholesterol Diet: What to Eat and How to Prepare It by Clara Beth Young Bond; ISBN: 0385039050; http://www.amazon.com/exec/obidos/ASIN/0385039050/icongroupinterna

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The Low Salt and Cholesterol Diet (Lose Weight) by Gary Null; ISBN: 0871883430; http://www.amazon.com/exec/obidos/ASIN/0871883430/icongroupinterna

·

The low salt, low cholesterol cookbook by Myra Waldo; ISBN: 0399109463; http://www.amazon.com/exec/obidos/ASIN/0399109463/icongroupinterna

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The Low-Cholesterol Cookbook: Over 50 Recipes, Each One Low in Cholesterol and Saturated Fats, but High in Taste and Appeal (The Healthy Eating Library) by Christine France, Lorenz; ISBN: 1859676715; http://www.amazon.com/exec/obidos/ASIN/1859676715/icongroupinterna

·

The Low-Cholesterol Food Processor Cookbook/Sp-162P by Suzanne S. Jones; ISBN: 0385147457; http://www.amazon.com/exec/obidos/ASIN/0385147457/icongroupinterna

·

The Low-Cholesterol Oat Plan; ISBN: 0317673327; http://www.amazon.com/exec/obidos/ASIN/0317673327/icongroupinterna

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The Low-Cholesterol Oat Plan: Over 300 Delicious and Innovative Recipes for the New Miracle Food by Sarah Schlesinger, Barbara Reed Earnest; ISBN: 0688079458; http://www.amazon.com/exec/obidos/ASIN/0688079458/icongroupinterna

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The Low-Fat, Low-Cholesterol Cookbook by Christine France; ISBN: 0831756519; http://www.amazon.com/exec/obidos/ASIN/0831756519/icongroupinterna

·

The Medical Book of Remedies: 50 Ways to Lower Your Fat & Cholesterol by Roberta Larson Duyff, et al (1996); ISBN: 0451183460; http://www.amazon.com/exec/obidos/ASIN/0451183460/icongroupinterna

·

The Miracle Diet Cookbook: Easy Permanent Weight Loss Cookbook: Fat Free, Cholesterol Free, High Fiber by Earl F. Updike, Ethel C. Updike (1996); ISBN: 1887437010; http://www.amazon.com/exec/obidos/ASIN/1887437010/icongroupinterna

·

The Natural Pharmacist: Lowering Cholesterol by Darin Ingels; ISBN: 0761515550; http://www.amazon.com/exec/obidos/ASIN/0761515550/icongroupinterna

·

The New 8-Week Cholesterol Cure by Robert E. Kowalski (Author); ISBN: 0060564601; http://www.amazon.com/exec/obidos/ASIN/0060564601/icongroupinterna

·

The New 8-Week Cholesterol Cure : The Ultimate Program for Preventing Heart Disease by Robert E. Kowalski (Author); ISBN: 0061031763; http://www.amazon.com/exec/obidos/ASIN/0061031763/icongroupinterna

466 Cholesterol

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The New Diabetic Cookbook, Fifth Edition : More Than 200 Delicious Recipes for a Low-Fat, Low-Sugar, Low-Cholesterol, Low-Salt, High-Fiber Diet by Mabel Cavaiani, Joseph T. Crockett; ISBN: 0071391355; http://www.amazon.com/exec/obidos/ASIN/0071391355/icongroupinterna

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The New Good Fat, Bad Fat: Lower Your Cholesterol and Reduce Your Odds of a Heart Attack by William P. Castelli, Glen C. Griffin (1997); ISBN: 1555611176; http://www.amazon.com/exec/obidos/ASIN/1555611176/icongroupinterna

·

The New Low-Cholesterol Gourmet by Lynn Fischer, W. Virgil Brown (1988); ISBN: 0136151396; http://www.amazon.com/exec/obidos/ASIN/0136151396/icongroupinterna

·

The New Pritikin Program: The Easy and Delicious Way to Shed Fat, Lower Your Cholesterol, and Stay Fit by Robert Pritikin, Julie Rubenstein (Editor) (1991); ISBN: 0671731947; http://www.amazon.com/exec/obidos/ASIN/0671731947/icongroupinterna

·

The New Vegan Cookbook: Innovative Vegetarian Recipes Free of Dairy, Eggs, and Cholesterol by Lorna J. Sass, Jonelle Weaver (Photographer) (2001); ISBN: 0811827607; http://www.amazon.com/exec/obidos/ASIN/0811827607/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 NutriBase Guide to Fat & Cholesterol in Your Food by Nutribase (2001); ISBN: 1583331107; http://www.amazon.com/exec/obidos/ASIN/1583331107/icongroupinterna

·

The One-Hundred-Percent Natural, Purely Organic, Cholesterol-Free, Megavitamin, Low-Carbohydrate Nutrition Hoax by Elizabeth M. Whelan, Fredrick J. Stare; ISBN: 0689113358; http://www.amazon.com/exec/obidos/ASIN/0689113358/icongroupinterna

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The Only Cholesterol Guide You'll Ever Need (1994); ISBN: 9993201944; http://www.amazon.com/exec/obidos/ASIN/9993201944/icongroupinterna

·

The Only Cholesterol Guide You'll Ever Need by Joel M. Berns, et al (1994); ISBN: 0345381335; http://www.amazon.com/exec/obidos/ASIN/0345381335/icongroupinterna

·

The PDR Family Guide to Nutrition and Health: With Fat, Cholesterol, and Calorie Counter Guide (The Pdr Family Guide Series) by Medical Economics; ISBN: 1563631350; http://www.amazon.com/exec/obidos/ASIN/1563631350/icongroupinterna

·

The Quick and Easy Cholesterol and Calorie Counter by Lynn Sonberg; ISBN: 0380755734; http://www.amazon.com/exec/obidos/ASIN/0380755734/icongroupinterna

·

The Quick and Easy Cholesterol and Calorie Counter (1988); ISBN: 9993300896; http://www.amazon.com/exec/obidos/ASIN/9993300896/icongroupinterna

·

The Real Cause of Heart Disease Is Not Cholesterol by Paul A. Stitt (2003); ISBN: 0939956101; http://www.amazon.com/exec/obidos/ASIN/0939956101/icongroupinterna

Books 467

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The Red Yeast Rice Cholesterol Solution by Maureen Keane (1999); ISBN: 1580622488; http://www.amazon.com/exec/obidos/ASIN/1580622488/icongroupinterna

·

The Revolutionary Cholesterol Breakthrough: How to Eat Everything You Want and Have Your Heart Thank You for It by Robert E. Kowalski; ISBN: 0836210441; http://www.amazon.com/exec/obidos/ASIN/0836210441/icongroupinterna

·

The Role of Cholesterol in Atherosclerosis: New Therapeutic Opportunities by Scott M. Grundy, Alexander G. Bearn (Editor) (1988); ISBN: 0932883133; http://www.amazon.com/exec/obidos/ASIN/0932883133/icongroupinterna

·

The Type 2 Diabetes Cookbook : Simple & Delicious Low-Sugar, Low-Fat, & LowCholesterol Recipes by Lois M. Soneral, Charles L. Chavez; ISBN: 0737302607; http://www.amazon.com/exec/obidos/ASIN/0737302607/icongroupinterna

·

The Ultimate Healthy Eating Cookbook: Over 400 Delicious No Fat, Low Fat, and Low Cholesterol Recipes for Every Occasion by Anne Sheasby (Editor); ISBN: 075480335X; http://www.amazon.com/exec/obidos/ASIN/075480335X/icongroupinterna

·

The Ultimate Low Cholesterol Low Fat Cookbook (The Ultimate Series) by Christine France; ISBN: 0765108550; http://www.amazon.com/exec/obidos/ASIN/0765108550/icongroupinterna

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The Ultimate Low Cholesterol Low Fat Cookbook: Over 220 Delicious, Healthy Recipes - Stept-By-Step by Christine France (2000); ISBN: 0831772913; http://www.amazon.com/exec/obidos/ASIN/0831772913/icongroupinterna

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The Ultimate Low Cholesterol, Low Fat Cookbook: Over 220 Delicious Healthy Recipes for All the Family in Step-By-Step Colour by Christine France; ISBN: 185967237X; http://www.amazon.com/exec/obidos/ASIN/185967237X/icongroupinterna

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The Vegetarian No-Cholesterol Barbeque Cookbook by Kate Schumann, et al; ISBN: 0312111061; http://www.amazon.com/exec/obidos/ASIN/0312111061/icongroupinterna

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The Vegetarian No-Cholesterol Family-Style Cookbook by Kate Schumann, Virginia Messina (Contributor); ISBN: 0312136129; http://www.amazon.com/exec/obidos/ASIN/0312136129/icongroupinterna

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The Whole Family Low Cholesterol Cookbook by Helen Cassidy. Page; ISBN: 0448121506; http://www.amazon.com/exec/obidos/ASIN/0448121506/icongroupinterna

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The Words Worth Eating Low Cholesterol Cookbook by Jacquelyn Legg; ISBN: 0924713070; http://www.amazon.com/exec/obidos/ASIN/0924713070/icongroupinterna

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The Words Worth Eating Low Cholesterol Cookbook - Book 1 (The Word Worth Eating Low Cholesterol Cookbook Series) by Jacquelyn G. Legg; ISBN: 0924713062; http://www.amazon.com/exec/obidos/ASIN/0924713062/icongroupinterna

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There's More to Heart Health Than Cholesterol by Catherine Saxelby (2002); ISBN: 1569245576; http://www.amazon.com/exec/obidos/ASIN/1569245576/icongroupinterna

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Tofu Magic Zero to Low Cholesterol and Low Sodium Recipes by Julia Weinberg (1988); ISBN: 0922446008; http://www.amazon.com/exec/obidos/ASIN/0922446008/icongroupinterna

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Treatment of Elevated Cholesterol [DOWNLOAD: PDF] by MedPanel Inc. (Author); ISBN: B00005RBN7; http://www.amazon.com/exec/obidos/ASIN/B00005RBN7/icongroupinterna

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Understanding and Managing Cholesterol: A Guide for Wellness Professionals by Kevin P. Byrne (1991); ISBN: 0873223098; http://www.amazon.com/exec/obidos/ASIN/0873223098/icongroupinterna

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Understanding Cholesterol and Heart Disease by Barry Lewis; ISBN: 1898205035; http://www.amazon.com/exec/obidos/ASIN/1898205035/icongroupinterna

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Understanding Your Cholesterol by Philip L. Yeagle; ISBN: 0127690352; http://www.amazon.com/exec/obidos/ASIN/0127690352/icongroupinterna

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User's Guide to Polycosanol & Other Cholesterol-Lowering Nutrients by Mark Stengler; ISBN: 1591200512; http://www.amazon.com/exec/obidos/ASIN/1591200512/icongroupinterna

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Vegetarian Ecstasy: A Healthy Gourmet Celebration of over 250 No Cholesterol, No Dairy, Lowfat Recipes Devoted to Long Life and Good Taste by James Levin, Natalie Cederquist (Contributor); ISBN: 0895296829; http://www.amazon.com/exec/obidos/ASIN/0895296829/icongroupinterna

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Well Bless Your Heart Vol. 2: High Fiber, Low Fat, Low Cholesterol Recipes by Patricia B. Mitchell; ISBN: 0925117560; http://www.amazon.com/exec/obidos/ASIN/0925117560/icongroupinterna

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Well, Bless Your Heart, Vol. 1: High Fiber, Low Fat, Low Cholesterol Recipes for Breakfasts, Brunches, & Lunches by Patricia B. Mitchell; ISBN: 0925117137; http://www.amazon.com/exec/obidos/ASIN/0925117137/icongroupinterna

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Well, Bless Your Heart, Vols. 1 and 2: High Fiber, Low Fat, Low Cholesterol Recipes (Revised Edition) by Patricia B. Mitchell; ISBN: 0925117641; http://www.amazon.com/exec/obidos/ASIN/0925117641/icongroupinterna

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Win the Cholesterol War: 100 Real-Life Secrets to Trimming Points (And Pounds) by Holly McCord (2001); ISBN: 1579544401; http://www.amazon.com/exec/obidos/ASIN/1579544401/icongroupinterna

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Your Child and Cholesterol by Eugene H. Eisman, Diane B. Eisman (Editor); ISBN: 0811900347; http://www.amazon.com/exec/obidos/ASIN/0811900347/icongroupinterna

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Your Control Cholesterol Cookbook by Alkmini Chaitow, Leon Chaitow; ISBN: 0722534760; http://www.amazon.com/exec/obidos/ASIN/0722534760/icongroupinterna

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Your health is what you make it; a guide for diet, vitamin supplementation, cholesterol control, exercise, mental health, and longevity by C. W. Whitmoyer; ISBN: 068247522X; http://www.amazon.com/exec/obidos/ASIN/068247522X/icongroupinterna

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Yvonne Young Tarr's Low-Cholesterol Gourmet by Yvonne Young Tarr, Lauren Jarrett; ISBN: 067152321X; http://www.amazon.com/exec/obidos/ASIN/067152321X/icongroupinterna

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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 “cholesterol” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 ·

A low cholesterol diet manual [by] Joan Hady Bickel [and] Jane Cameron Gray, with the assistance of Sheila Carter Cole. Prepared and compiled under the direction of Daniel B. Stone [and] William E. Connor. Author: Bickel, Joan Hady.; Year: 1968; Iowa City, Univ. of Iowa [c1968]

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Blood pressure as it relates to physique, blood glucose, and serum cholesterol, United States, 1960-1962; a tabular presentation of the data and a multiple regression analysis of blood pressure on five somatic measurements and their derivatives,and on blood glucose and serum cholesterol by age, sex, and race [by Charles du V. Florey and Roy M. Acheson]. Author: Florey, Charles du V.; Year: 1973; Washington, Health Services and Mental Health Administration; [for sale by the Supt. of Docs., U. S. Govt. Print. Off.] 1969

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Cholesterol and the heart. Author: Schwartzman, Aaron S.,; Year: 1965; New York, American Press [c1965]

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Cholesterol control cookery. Author: Revell, Dorothy Tompkins.; Year: 1973; New York, Carlton [c1961]

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Cholesterol control cookery. Author: Revell, Dorothy Tompkins.; Year: 1973; Denver, Nutri-Books [1971]

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Cholesterol, bile acids and atherosclerosis; a biochemical review. Author: Belle, Herman van.; Year: 1963; Amsterdam, North-Holland Pub. Co., 1965

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Cholesterol. Author: Kritchevsky, David,; Year: 1961; New York, Wiley [c1958]

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Free and esterified cholesterol in human organs and tissues. Author: Nieminen, Elna.; Year: 1966; Helsinki, 1965

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High blood pressure: cholesterol and you, by Harold C. Steele [and] Charles B. Crow, Jr. Author: Steele, Harold C.; Year: 1973; [n. p.] Strode [c1969]

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Investigations on the intermediates in the biosynthesis of fatty acids and cholesterol. Author: Waard, Adriaan de.; Year: 1971; Nijmegen, 1958

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Production of hypercholesterolemia and atherosclerosis in rabbits by feeding different fats without supplementary cholesterol. [Tr. by L. James Brown]. Author: Wigand, Gerhard.; Year: 1965; Lund, Berling, 1959

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Serum cholesterol levels of adults, United States, 1960-1962; serum cholesterol levels by age, sex, race, region, and income. Author: National Center for Health Statistics

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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.

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(U.S.); Year: 1968; Washington [For sale by the Superintendent of Documents, U. S. Govt. Print. Off.] 1967 ·

Serum cholesterol, parental longevity, overweight, and hypertension in the old; a factorial study by Anni Seppänen [et al.]. Author: Seppänen, Anni.; Year: 1968; Helsinki, 1963

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Studies on the conversion of cholesterol into bile acids. Author: Berséus, Olle.; Year: 1967; [Stockholm, 1967]

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Ten-year mortality and morbidity related to serum cholesterol; a follow-up of 3,751 men aged 40-49, by Knut Westlund & Ragnar Nicolaysen. Author: Westlund, Knut.; Year: 1973; [Oslo] Universitetsforlaget [c1972]

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The action of platinum on cholesterol in acetic acid solution, by Herbert Salomon Anker... Author: Anker, Herbert Salomon,; Year: 1961; New York, N. Y., 1944

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The biological synthesis of cholesterol. Author: Bloch, Konrad; Year: 1967; [Stockholm] Nobel Foundation, 1965

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The cholesterol controversy [by] Edward R. Pinckney [and] Cathey Pinckney. Author: Pinckney, Edward R. (Edward Robert),; Year: 1936; Los Angeles, Sherbourne Press [c1973]; ISBN: 0820201553 http://www.amazon.com/exec/obidos/ASIN/0820201553/icongroupinterna

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The dictionary of sodium, fats, and cholesterol. Author: Kraus, Barbara.; Year: 1969; New York, Grosset; Dunlap [c1974]; ISBN: 0448013711 http://www.amazon.com/exec/obidos/ASIN/0448013711/icongroupinterna

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The gourmet's low cholesterol cookbook [by] Elizabeth S. Weiss [and] Rita Parsont Wolfson. Author: Weiss, Elizabeth S.; Year: 1969; Chicago, Regnery [c1973]

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The low cholesterol cookbook. Author: Cavaiani, Mabel.; Year: 1973; Chicago, Regnery [c1972]

Chapters on Cholesterol In order to find chapters that specifically relate to cholesterol, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and 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 “cholesterol” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on cholesterol: ·

Acalculous Cholecystitis, Cholesterolosis, Adenomyomatosis, and Polyps of the Gallbladder Source: in Feldman, M. Friedman, L.S. Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1116-1130. Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736.

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Summary: Although gallstones (cholelithiasis) and their complications account for most cholecystectomies (gallbladder removal), a persistent 15 percent of these operations are performed in patients without gallstones. In general, one of two clinically distinct syndromes occur in these patients: acalculous biliary pain or acute acalculous cholecystitis. This chapter on acalculous cholecystitis, cholesterolosis, adenomyomatosis, and polyps of the gallbladder is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. For each condition, the author considers a definition, epidemiology, pathogenesis, clinical manifestations, diagnostic considerations, and treatment options. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 5 figures. 5 tables. 201 references. ·

Cholesterol Policy and the Primary Prevention of Coronary Disease: Reflections on Clinical and Population Strategies Source: in McCormick, D.B., Bier, D.M., and Goodridge, A.G., eds. Annual Review of Nutrition. Palo Alto, CA: Annual Reviews Inc. 1996. Volume 16: 349-382. Contact: Available from Annual Reviews Inc. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (800) 523-8635. Fax (415) 424-0910. PRICE: $53.00. ISBN: 0824328167. ISSN: 01999885. Individual article reprints available from Annual Reviews Preprints and Reprints. (800) 347-8007 or (415) 259-5017. E-mail: [email protected]. Base price $13.50 per article. Summary: This review article examines evidence about clinical policies and population strategies for the primary prevention of coronary disease, with specific reference to diet and dyslipidemias. The authors note that, despite billions of dollars spent on targeted and population-wide strategies aimed at reducing human consumption of saturated fat and cholesterol, aspects of the diet-heart connection remain a source of debate. At least part of the uncertainty arises from a growing appreciation that the relationship between dietary habits, serum lipids, and atherosclerosis is more complex than was previously thought. The authors summarize some current policies in this area and offer conclusions about broad directions for further policy development. 2 tables. 188 references. (AA-M).

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Cholesterol Emboli: A Common Cause of Renal Failure Source: in Coggins, C.H., Hancock, E.W., and Levitt, L.J., eds. Annual Review of Medicine. Palo Alto, CA: Annual Reviews Inc. 1997. Volume 48: 375-385. Contact: Available from Annual Reviews Inc. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (800) 523-8635. Fax (415) 424-0910. E-mail: [email protected]. PRICE: $60.00 for individuals; $120.00 for institutions. ISBN: 0824303555. ISSN: 00664219. Individual chapter reprints available from Annual Reviews Preprints and Reprints. (800) 347-8007 or (415) 259-5017. Base price $13.50 per article. Summary: This chapter, from the Annual Review of Medicine, describes cholesterol emboli, a common cause of renal failure. Cholesterol embolization (CE), usually occurring in males in their sixth or seventh decade of life, can affect multiple organ systems, including the kidney. The author notes that interventive diagnostic procedures and aortic surgery greatly increase the risk of CE. Rapid or insidious progression of renal failure in association with surgical or diagnostic radiologic procedures should suggest this diagnosis. Progressive renal insufficiency in older patients with generalized arterial disease should suggest ischemic nephropathy secondary to bilateral renal artery stenosis, renal CE, or both. Recent worsening of hypertension is characteristic of either

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diagnosis. A number of clinical conditions can simulate renal CE, and final differentiation may be possible only by renal biopsy. The author stresses that aggressive, supportive management of renal CE is warranted because renal function may stabilize and, in a limited number of cases, may even improve. 2 figures. 2 tables. 44 references. (AA). ·

Development of a Public Health Nurse-delivered Cholesterol Intervention Program Source: in Key Aspects of Preventing and Managing Chronic Illness. Funk, S.G. Tornquist, E.M. Leeman, J. Miles, M.S. Harrell, J.S. eds. New York, NY, Springer Publishing Company, Inc., pp. 128-138, 2001. Contact: Springer Publishing Company, Inc., 536 Broadway, New York, NY 10012-3955. Summary: Development of a Public Health Nurse-delivered Cholesterol Intervention Program, a chapter in Key Aspects of Preventing and Managing Chronic Illness, describes the development of a dietary treatment program, the Food for Heart Program (FFHP), implemented by public health nurses in rural health departments in North Carolina. The intervention was developed to circumvent various obstacles common to diet counseling and behavior change. Seventeen health departments agreed to participate, representing the geographic diversity of the state. Local health departments were asked to recruit nurses to participate in the program. Health department staff screened enough patients considered candidates for coronary heart disease (CHD) risk factor modification in order to identify 30 with high cholesterol during a 3-month enrollment period. The local health departments screened 781 people, 468 of whom met all eligibility criteria and participated in the study. The sample was largely female, older, and white. All were at relatively high risk for CHD. The FFHP was a dietary assessment and counseling program that targeted people with lower literacy and income levels. It was designed to facilitate counseling by health care professionals, taking into consideration their preexisting knowledge and attitudes about diet counseling as well as organizational barriers (e.g., limited time and lack of appropriate educational materials). The program also addressed patient knowledge and attitudes and environmental barriers faced by lower income patients (e.g., costly and culturally insensitive dietary recommendations). The FFHP intervention was initiated and guided by a dietary risk assessment instrument. New materials were developed to teach this population about nutrition with a focus on fat and cholesterol reduction. The FFHP treatment folder served as both a prompt and a flow sheet or monitoring system. Monitoring and followup were also possible using a mail and telephone system. Some of the dietary data resulting from this study included (1) over 80 percent of participants reported minimal to modest intake of hamburger, beef, and pork; (2) people had inadequate consumption of fruits and vegetables; and (3) respondents reported only modest intake of complex carbohydrates and excessive consumption of sweets. Nonwhites had significantly higher scores for meats, side dishes, desserts, and snacks, and spreads, salad dressings, and oils. They also had significantly higher total scores.

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Screening for High Blood Cholesterol Source: in Educated Guesses: Making Policy About Medical Screening Tests. Russell, L. B. Berkeley, CA, University of California Press, pp.45-74, 1994. Contact: University of California Press, 2120 Berkeley Way, Berkeley, CA 94720. (800) 822-6657. Summary: Screening for High Blood Cholesterol, a book chapter in Educated Guesses: Making Policy About Medical Screening Tests, discusses the costs and benefits of

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screening for blood cholesterol. Research in many randomized, controlled clinical trials has shown that, while lowering cholesterol reduces deaths from heart disease, it does not extend life because reducing blood cholesterol is associated with an increase in deaths from causes other than heart disease. Efforts to determine which deaths from causes other than heart disease have increased in treated groups when compared with control groups revealed a consistent and strong tendency toward more deaths from accidents, suicide, and homicide. Cholesterol reduction has been shown to be clearly beneficial for survivors of heart attacks. Population studies show that the link between cholesterol and heart disease is strongest in middle-aged men with very high levels of blood cholesterol and that the incidence of heart disease rises rapidly as cholesterol levels rise. Critics have questioned using these results to make policies for elderly men, young men, women, children, and middle-aged men with less than the highest cholesterol levels. Office of Technology Assessment research has found that, in men over age 65 and elderly women, high blood cholesterol does not shorten lives (and some research indicates that elderly people with high blood cholesterol may live longer than those with lower cholesterol). Recommendations for childhood screening implicitly assume that treatment is more effective the earlier it begins; however, no evidence exists for the effectiveness of treating children for high blood cholesterol. The screening test for blood cholesterol is vulnerable to many inaccuracies (e.g., many people with elevated cholesterol do not develop heart disease, individual's blood cholesterol vary substantially from day to day and month to month, and laboratory errors) increasing the risk of misclassification of condition. At least two tests taken 1-8 weeks apart are needed to reduce the effect of naturally occurring blood cholesterol level variability. Research examining gains in life expectancy as a result of cholesterol reduction show that a 20 percent reduction in people with high blood pressure, smoking, and low high-density lipoprotein cholesterol could be as much as 1 or 2 years; gains in life expectancy for people without those additional risk factors ranged from 3 days to 3 months. ·

Serum Cholesterol and the Older Adult Source: in Physical Activity and the Older Adult: A Knowledge Base for Managing Exercise Programs. Govindasamy, D. Paterson, D.H. Champaign, IL, Stipes Publishing L.L.C., pp. 47-50, 1994. Contact: Stipes Publishing L.L.C., 202-204 West University Avenue, P.O. Box 526, Champaign, IL 61824-0526. Summary: Serum Cholesterol and the Older Adult, a chapter in Physical Activity and the Older Adult: A Knowledge Base for Managing Exercise Programs, discusses the possible effects of exercise on reducing cholesterol levels in older adults. The chapter discusses (1) understanding circulating serum cholesterol levels; (2) identifying hypercholesteremia; and (3) the effects of physical activity, particularly cardiorespiratory training, on circulating serum cholesterol levels. High circulating cholesterol levels increase the risk of cardiovascular disease. Traditionally, when serum cholesterol has been measured, no consideration was given to the fractional contribution of the different forms of cholesterol, high-density lipoprotein (HDLC) and low-density lipoprotein cholesterol (LDLC), and serum cholesterol levels were reported as one single combined measurement, total cholesterol. This measurement is inadequate for those over age 55. A number of research studies have shown that cardiorespiratory training can increase the levels of HDLC, and decrease the levels of LDLC. Weight loss need not occur to increase levels of HDLC through cardiorespiratory training. Weight loss is necessary, however, to achieve decreased levels of fat that will result in lowered LDLC. In order to receive benefits from cardiorespiratory training, the intensity must be at least

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70 to 80 percent of a person's maximum heart rate, for a 40 to 50-minute session, four times a week. The best use of cardiorespiratory training for improving serum cholesterol profile is as an adjunct to dietary modification and possible drug therapy.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to cholesterol have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:12 ·

Directory of Plain Language Health Information Source: Ottawa, Ontario: Canadian Public Health Association. 1999. 104 p. Contact: Available from Canadian Public Health Association. 400-1565 Carling Avenue, Ottawa, Ontario, K1Z 8R1. (613) 725-3769. Fax (613) 725-9826. E-mail: [email protected]. PRICE: $19.95 plus shipping and handling. Also available at www.pls.cpha.ca for free. ISBN: 189432403X. Summary: Patient education materials are often written at a level that is higher than the reading level of the people who need the materials. This directory lists 'plain language' patient education materials. An extensive introductory chapter in the directory describes how patient education materials are evaluated and offers specific information about the best strategies to create plain language materials. Each piece of health information in the directory is rated according to its design assessment, in order to help readers make informed decisions about choosing materials. Part I is a list of health subjects presented in alphabetical order, in the style of a typical index. The page number after a listing notes where to find that piece of health information in Part II. Part II is a list of organizations and their contact information. Below the contact information is a list of the plain language health titles produced by the organization. Each title is grouped under a grade level heading, is numbered, and has a design rating. Part III is an alphabetical list of all the organizations in Part II. Materials related to digestive system diseases include allergies, constipation and soiling in children, cholesterol, hepatitis, constipation, diabetes and diet therapy, exercise for weight control, food choices, nutrition, heart health, immunization, low fat cooking, nausea, vomiting, diarrhea, smoking, and weight loss. Appendices to the directory include a guide to the S.M.O.G. readability formula, clear design tips, and plain language tips. The Directory is also available at www.pls.cpha.ca on the Internet.

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Asians: Sources of Asian Language Health Materials Source: Washington, DC: Office of Minority Health. 199x. 10 p. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. PRICE: Single copy free.

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You will need to limit your search to “Directory” and “cholesterol” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “cholesterol” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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Summary: This directory lists sources identified by the Office of Minority Health Resource Center (OMH RC) that produce or distribute health promotion materials in various Asian languages. The search for materials concentrated on minority health priority areas and associated risk factors: cancer, cardiovascular diseases and stroke, chemical dependency, diabetes, infant mortality, homicide, suicide, and unintentional injury. Sources of AIDS information and educational materials are also included. Topics related to digestive diseases include AIDS, cholesterol, cultural awareness, breastfeeding, hepatitis, immunization, nutrition, and weight control. Sources are arranged alphabetically. Organization entries include organization name, address, telephone number, source title, and annotation. The primary languages in which the organization provides materials are noted. Organizations should be contacted directly to determine the cost and availability of bulk quantities or for permission to photocopy. A subject index is included to assist in identifying materials on specific topics. ·

Directory of Cardiovascular Resources for Minority Populations Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, 122 p., January 1989. Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute Education Programs Information Center, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814. (301) 9513260. Summary: The Directory of Cardiovascular Resources for Minority Populations contains detailed information on printed and audiovisual materials for cardiovascular education specifically designed for the four major minority populations of the U.S.: Blacks, Hispanics, American Indians, and Asians/Pacific Islanders. Materials were selected on the basis of suitability for public education; therefore, scholarly publications have not been included. The directory is designed for use by health professionals who provide services to minority populations but can also be used by health care providers serving the general public. The directory describes leaflets, pamphlets, booklets, books, posters, wallet cards, films, and videotapes that address high blood pressure, high blood cholesterol, and cigarette smoking, as well as other risk factors such as obesity, nutrition, and sedentary lifestyle. Each entry includes information on the language, target audience, grade level, producer, publication date, reproduction restrictions, format, content description, availability, and cost of the materials.

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Finding resources for Healthy Heart programs at work Source: Bethesda, MD: National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services. 1992. 92 pp. Contact: Available from Information Center, National Heart, Lung, and Blood Institute, National Institutes of Health, P.O. Box 30105, Bethesda, MD 20824-0105. Telephone: (301) 951-3260. (NIH Publication No. 92-737). Summary: This resource directory is designed to assist in developing worksite Healthy Heart programs for employees. Healthy Heart programs emphasize cardiovascular health which includes high blood pressure, high cholesterol, smoking, nutrition, weight control, and physical fitness. There are three sections. The first section suggests organizations, associations, and government agencies which can provide information and resources on developing workplace health promotion activities. Included in this section is a list of National Heart, Lung, and Blood Institute Cardiovascular Disease

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Liaisons for each state health department. The second section lists brochures, guides, manuals, booklets, video recordings, programs, services, and other resources available through organizations. The third section is an alphabetical listing of the organizations with their addresses and phone numbers.

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CHAPTER 8. MULTIMEDIA ON CHOLESTEROL Overview In this chapter, we show you how to keep current on multimedia sources of information on 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 cholesterol is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “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 “cholesterol” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on cholesterol: ·

Lowdown on Cholesterol Source: Shingle Springs, CA: NutriVisuals. 1993. (slides). Contact: Available from NutriVisuals. P.O. Box 1367, Shingle Springs, CA 95682. (916) 677-1969. Fax (916) 677-2347. PRICE: $139.95 plus shipping and handling; parts are available separately for $45.00 each. Summary: This set of slides introduces a detailed meal plan covering many aspects of diet designed to reduce serum cholesterol. Four teaching sections, approximately 35 slides each, cover the basics of cholesterol, identifying fat in foods (food labels), the types of fats, and foods to increase in the diet (omega-3 fatty acids and soluble fiber). Specific topics include where cholesterol comes from and its role in the body; healthy target cholesterol levels; the differences between cholesterol and fat; how to establish a 30 percent fat intake; and the differences between saturated, monosaturated, polyunsaturated, and hydrogenated fats. The program comes with recipes for traditional foods. Each recipe notes the calories, fiber, sodium, and fats for a serving;

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diabetes exchanges are not provided. The slides feature full-color photographs to illustrate the concepts presented. (AA-M).

Bibliography: Multimedia on 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 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 cholesterol: ·

American Heart Association cholesterol education program [electronic resource]. Year: 1989; Format: Electronic resource; [Dallas, Tex.]: American Heart Association; [East Hanover, N.J.?]: Sandoz Pharmaceuticals Corp., c1989

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Cholesterol [videorecording]: understanding is the key Source: a presentation of Films for the Humanities & Sciences; Information Television Network; Year: 2000; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c2000

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Cholesterol and coronary disease [videorecording] Source: [presented by] Marshfield Video Network, in cooperation with Marshfield Medical Research Foundation, Marshfield Clinic [and] St. Joseph's Hospital; Year: 1987; Format: Videorecording; Marshfield, WI: The Network, [1987]

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Cholesterol gall stone [i.e. gallstone] disease [videorecording] Source: presented by the Department of Medicine, Emory University, School of Medicine; Year: 1984; Format: I.e. gallstone; Atlanta, Ga.: Emory Medical Television Network, 1984

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Cholesterol gallstone formation [slide] Source: American Gastroenterological Association; Year: 1974; Format: Slide; [Thorofare, N. J.]: The Association, 1974

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Cholesterol management [videorecording]: new concepts and strategies Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of Marshfield Video Network; Year: 1995; Format: Videorecording; Marshfield, WI: The Clinic, [1995]

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Cholesterol, a pediatric perspective [videorecording] Source: produced by Ciné-Med Productions; Year: 1989; Format: Videorecording; Woodbury, CT: Ciné-Med, c1989

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Cholesterol, diet, and heart disease [videorecording] Source: presented by the Clinical Center, National Institutes of Health, Public Health Service, U.S. Department of Health, Education, and Welfare; Year: 1980; Format: Videorecording; [Bethesda, Md.]: The Center, [1980]

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Chronic otitis media [videorecording]: cholesterol granuloma and tympanosclerosis Source: Ear Research Institute; Year: 1978; Format: Videorecording; [Los Angeles]: The Institute, c1978

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Controlling cholesterol [videorecording]: American Heart Association news special Source: presented by American Heart Association; produced by Forney Miller Film Associates; Year: 1989; Format: Videorecording; [S.l.]: Merck & Co., c1989

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Cytotoxic effects of oxidized cholesterol on RPE cells [videorecording]: a potential mechanism for the pathogenesis of age-related macular degeneration Source: Office of Research Services, Medical Arts and Photography Branch; Year: 2003; Format: Videorecording; [Bethesda, Md.: National Institutes of Health, 2003]

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Diet-cholesterol controversies [slide] Source: Henry Blackburn; Year: 1979; Format: Slide; New York: AV/MD, c1979

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Genes that control cholesterol [sound recording] Source: Michael Brown; Year: 1990; Format: Sound recording; [Bethesda, Md.: National Institutes of Health, 1990]

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Hematocrit, cholesterol, and vascular disease [videorecording] Source: Marshfield Medical Foundation, in cooperation with Marshfield Clinic & St. Joseph's Hospital; Year: 1982; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, 1982

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Hypercholesterolemia, current clinical approaches [videorecording] Source: with Robert J. Levy and Conrad B. Blum; Year: 1986; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1986

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Issues in cholesterol screening of children [videorecording] Source: produced by UT/TV-Houston, the University of Texas Health Science Center at Houston; Year: 1990; Format: Videorecording; [Houston, Tex.: UT/TV], c1990

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Michael Brown and Joseph Goldstein [videorecording]: unlocking the secrets of cholesterol. Year: 1990; Format: Videorecording; [United States]: Trans World International, c1990

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Modification of the Schoenheimer-Sperry method for free and total cholesterol [motion picture] Source: Communicable Disease Center; produced by Public Health Service Audiovisual Facility; Year: 1966; Format: Motion picture; [Atlanta]: The Center: [for loan by National Medical Audiovisual Center; Washington: for sale by National Audiovisual Center, 1966]

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Serum cholesterol [motion picture]: Abell-Kendall method (manual Source: Laboratory Branch, Communicable Disease Center; produced by Public Health Service Audiovisual Facility; Year: 1965; Format: Motion picture; [Atlanta]: The Center; [Washington, for sale by National Audiovisual Center], 1965

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CHAPTER 9. PERIODICALS AND NEWS ON CHOLESTEROL Overview In this chapter, we suggest a number of news sources and present various periodicals that cover cholesterol.

News Services and Press Releases One of the simplest ways of tracking press releases on 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 “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 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 “cholesterol” (or synonyms). The following was recently listed in this archive for cholesterol: ·

Cholesterol drugs seem to lower depression risk Source: Reuters Health eLine Date: September 08, 2003 http://www.reutershealth.com/archive/2003/09/08/eline/links/20030908elin021.htm l

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Cholesterol drug relieves leg artery disease Source: Reuters Health eLine Date: September 01, 2003

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Cholesterol drugs may also prevent eye problem Source: Reuters Health eLine Date: August 26, 2003

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Pravachol benefits more than cholesterol Source: Reuters Health eLine Date: August 25, 2003

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Cholesterol drug may also prevent depression Source: Reuters Health eLine Date: August 19, 2003

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U.S. approves new AstraZeneca cholesterol pill Source: Reuters Health eLine Date: August 13, 2003

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Guggulipid not useful for hypercholesterolemia, may raise LDL-C Source: Reuters Medical News Date: August 13, 2003

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Herbal remedy fails cholesterol test: U.S. study Source: Reuters Health eLine Date: August 12, 2003

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

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Low HDL cholesterol levels may impair endothelial function Source: Reuters Medical News Date: July 30, 2003

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Cholesterol drugs improve strange heart problem Source: Reuters Health eLine Date: July 28, 2003

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

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Low fat/plant product diet as good as statins at lowering cholesterol levels Source: Reuters Industry Breifing Date: July 22, 2003

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

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

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Low HDL cholesterol predicts cardiovascular mortality in elderly Source: Reuters Medical News Date: July 18, 2003

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Low "good" cholesterol predicts death in elderly Source: Reuters Health eLine Date: July 18, 2003

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Cholesterol drugs don't prevent broken bones Source: Reuters Health eLine Date: July 14, 2003

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Inflammation can weaken beneficial effects of diet on cholesterol levels Source: Reuters Medical News Date: July 09, 2003

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Consumption of tea products may lower cholesterol levels Source: Reuters Industry Breifing Date: June 25, 2003

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.

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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 “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 you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “cholesterol” (or synonyms). If you know the name of a company that is relevant to 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 “cholesterol” (or synonyms).

Newsletters on Cholesterol Find newsletters on cholesterol using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “cholesterol.” 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.” Type “cholesterol” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: ·

Alagille Syndrome and Nutrition Source: Liver Link. 1(2): 3. Spring 1994. Contact: Available from Alagille Syndrome Alliance. 10630 S.W. Garden Park Place, Tigard, OR 97223. (503) 639-6217. Summary: This newsletter article examines Alagille syndrome and nutrition. The author notes that one of the most serious features of Alagille syndrome is impaired liver function resulting from a scarcity of bile ducts in the liver and, consequently, reduced bile production. Topics include bile flow; blood cholesterol levels; the digestion of dietary fat; and absorption of fat-soluble vitamins. The author focuses primarily on the


effects of Alagille syndrome in children and dietary recommendations to offset potential problems. One sidebar summarizes the functions of the liver. ·

Diabetes: Nutrition Guidelines Emphasize Personal Touch Source: Mayo Clinic Health Letter. 12(8): 4-5. August 1994. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This brief newsletter article reports on the new set of nutrition guidelines for people with diabetes. The guidelines, recently released by the American Diabetes Association (ADA), underscore the important role of diet in keeping blood glucose levels under control. The new recommendations stress the need for individualizing the diet and developing a meal plan based on the individual's food preferences, health concerns such as weight or blood cholesterol level, and insulin therapy. The article concludes by urging readers to work closely with a registered dietitian and other members of the diabetes care team in planning the diet.

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Too Much of the Good Life: Cardiovascular Disease in Oregon Source: CD Summary. 50(18):1-2, August 28, 2001. Contact: Oregon Health Division, 800 Northeast Oregon Street, Portland, OR 97232. (503) 731-4024. FAX: (503) 731-4798. INTERNET/EMAIL: http://www.oshd.org/cdpe/; [email protected]. Summary: This newsletter reviews the epidemiology of cardiovascular disease (CVD) and related risk factors among Oregonians and describes Oregon's cardiovascular health program. Age-adjusted death rates for heart disease in Oregon have declined 29 percent over the past decade. Overall, men have a higher heart disease death rate than women. Age-adjusted death rates due to stroke have been higher than the United States rates for the last 30 years, and the disparity has grown wider since 1990. Much of the CVD burden is preventable. Several risk factors can be modified, including smoking, obesity, hypertension, high cholesterol, unhealthy eating, and physical inactivity. Oregonians with coronary heart disease were as likely to smoke as those without, but those with coronary heart disease were 1.3 times more likely to be former smokers. The purpose of the new Cardiovascular Health Program in Oregon is to improve cardiovascular health statewide through policy and environmental changes addressing obesity, physical inactivity, and nutrition. 2 figures, 1 table, 6 references.

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Physical Activity and Women's Health Source: Physical Activity and Fitness Research Digest. 2(5):1-8, March 1996. Summary: Physical Activity and Women's Health is a feature article from a newsletter on physical activity and fitness. The author presents the growing body of evidence for the beneficial relationships between physical activity (including exercise and physical fitness) and the major chronic diseases in women, with special references to race and ethnicity. The most current data on habitual physical activity are from the Behavioral Risk Factor Surveillance System, a state-based survey to collect self-reported information of adults. Only 27 percent of female respondents in 48 states and the District of Columbia reported participation in leisure-time physical activity in levels recommended by the Centers for Disease Control and the American College of Sports Medicine. Women, especially women of color, are more likely to be sedentary than men. In 1990, 4 of the 10 leading causes of death in American women are chronic diseases

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directly associated with modifiable behavioral factors including physical inactivity or sedentary lifestyle such as heart disease, various cancers, hypertension, stroke, and noninsulin-dependent diabetes mellitus. Controlling body fatness, another factor that relates to the increased risk of chronic diseases, also relates to inactivity. The author discusses major modifiable risk factors for cardiovascular diseases and their relation to physical inactivity including high blood cholesterol and high blood pressure. The author also states that habitual physical activity reduces the risk of hypertension in women, a risk factor for stroke, which is the leading cause of disability in American women. Increasing evidence also indicates that physical activity is associated with decreased overall cancer mortality and decreased incidence of specific types of cancers. Several studies in American women suggest that risk for breast cancer may be lowered in those who are habitually active. The author also cites studies indicating that regular physical activity has an important role in both treatment and prevention of non-insulin-dependent diabetes mellitus among women through its association with reduced body weight, and its independent effects on insulin sensitivity and glucose tolerance. Greater attention to prevention and treatment of obesity in minority populations may help to address critical health issues in American women. The author concludes that research and educational efforts must focus on conceptually-based programs in schools and communities that are culturally-sensitive and ethnic-specific.

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 “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 cholesterol: ·

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.


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Lupus Nephritis: A Practical Guide for the Patient Source: Lupus News. 19(1): 1,3-5. Winter 1998-1999. Contact: Available from Lupus Foundation of America. 1300 Piccard Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 670-9292. Fax (301) 670-9486. Website: www.lupus.org/lupus. Summary: This newsletter article provides people who have systemic lupus erythematous (SLE) with information on lupus kidney disease, also known as lupus nephritis. Estimates indicate that more than half of the patients who have lupus will develop lupus nephritis. Early diagnosis and treatment of lupus nephritis and good followup care are important to ensuring a normal lifespan for patients with SLE. The article explains the normal physiology of the kidney and identifies the mechanisms responsible for lupus nephritis. Lupus kidney disease occurs when immune complexes build up in the kidneys and activate other proteins in the blood called complement. Activation of complement releases chemicals that cause inflammation and result in possible damage to kidney tissue. Symptoms of lupus nephritis include edema and foamy, frothy urine. The diagnosis of is generally made by established criteria. Urine tests that are helpful in diagnosing lupus nephritis are analyzing an early morning specimen and a 24 hour collection. Blood studies that assess blood urea nitrogen and serum creatinine and monitor the levels of anti-DNA antibodies and serum complement are helpful in monitoring lupus nephritis. A kidney biopsy may be needed to determine whether kidney tissue is inflamed or scarred and the severity of the inflammation and scarring. The biopsy will confirm the diagnosis of lupus nephritis, determine the extent of the disease, and classify the type of lupus that is present. Treatment options include using prednisone or immunosuppressive agents such as azathioprine or cyclophosphamide in conjunction with prednisone. In addition to drug therapy, patients who have lupus nephritis should quit smoking, control high cholesterol with diet and exercise, and maintain normal weight. Patients who actively participate in their treatment plan will increase the likelihood of a positive outcome. 3 figures and 3 tables.

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When It's Not a Rheumatic Disease Source: Bulletin on the Rheumatic Diseases. 47(6): 2-4. October 1998. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org. Summary: This newsletter article provides health professionals with information on evaluating patients who present with presumed rheumatic manifestations but do not have rheumatic disease. Rheumatic symptoms may represent the first manifestation of cancer. Arthritis due to metastatic carcinoma is usually monarticular, and the knee is most frequently involved. Polyarthritis may be the presenting manifestation of an occult malignancy. Vasculitis is a well recognized paraneoplastic syndrome that sometimes antedates the discovery of a malignancy. Other conditions that can mimic rheumatic diseases are cholesterol embolism, certain viral infectious diseases, cardiovascular diseases such as primary tumors of the heart, endocrine diseases, and gastrointestinal diseases such as celiac disease and Whipple's disease. In addition, drugs such as retinoids and ergot can cause rheumatic symptoms. Correct and early diagnosis is important so that the appropriate treatment be chosen and the prognosis for the patient improved. 1 table and 13 references.

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Putting One Foot in Front of the Other Source: Harvard Health Letter. 6-7; 1997. Contact: Available from Harvard Health Letter, P.O. Box 380, Boston, MA 02117. Summary: This newsletter article for the general public discusses walking as a form of moderate-level exercise. The Centers for Disease Control and Prevention and the College of Sports Medicine recommend a minimum of 30 minutes of moderate-level exercise at least 5 days a week. Advantages of walking include its accessibility and lack of expense. Walking also burns about 100 calories per mile, reduces the risk of heart attack and stroke, increases bone density, lowers blood pressure and harmful lowdensity lipoprotein cholesterol, and keeps weight down. The article offers guidelines for sedentary individuals who want to begin a walking routine.

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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.

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Liver Tests: Simple Blood Tests Can Reveal a Lot Source: Mayo Clinic Health Letter. 18(5): 1-3. May 2000. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This article, from a health newsletter, reviews the liver function tests that are used to monitor liver health and disease. The author begins by reviewing the healthy functions of the liver, including regulating the composition of the blood, manufacturing vital nutrients (such as cholesterol, vitamin A, certain proteins, bile), and neutralizing toxic substances. Sometimes there is an obvious sign of a problem, such as jaundice, which is a buildup of bilirubin in the blood, resulting in a yellow appearance of the skin and eyes. The various liver tests basically screen for three types of abnormalities: liver cell damage, reduced protein levels in the blood, and failure to eliminate certain substances from the blood. Information from the blood tests, combined with a thorough physical exam and sometimes diagnostic imaging, may be enough to reach a specific diagnosis; sometimes a liver biopsy is added to the list of diagnostic tests. Some of the more common liver disorders that are detected with these tests are viral hepatitis, alcohol or drug related liver disease, liver cancer, nonalcoholic steatohepatitis (a form of fatty liver), and hemochromatosis (high amounts of iron stored in the body). One sidebar reviews the drugs that can lead to liver toxicity. The author concludes that mild


liver test abnormalities are normal; however, significantly abnormal test results should never be ignored. 1 figure. ·

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 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.

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Gallstones: A Common, Sometimes Serious Condition Source: Mayo Clinic Health Letter. 17(3): 7. March 1999. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: Most of the time, gallstones cause no symptoms and require no treatment. However, gallstones can sometimes be serious, even fatal, if left untreated. This brief report from the Mayo Clinic health newsletter offers information about gallstones. Most gallstones form when the patient's bile becomes chemically imbalanced and some of the cholesterol in the bile forms crystals. About 80 percent of gallstones produce no symptoms and require no treatment. Symptoms of gallstones can include episodes of intense, building pain in the upper abdomen; continuous (not intermittent) pain lasting 30 minutes to several hours; pain that may spread to the right shoulder blade or back; and nausea (sometimes with vomiting). Gallstones sometimes escape the gallbladder and enter nearby ducts. These migrating stones can cause serious complications and can be fatal if left untreated. The article outlines the risk factors for gallstones, including being female, being overweight, certain diet and dieting factors, age, and ethnicity. Gallstones that cause symptoms are usually treated by removing the gallbladder, a nonessential organ. Occasionally, conventional open abdominal surgery is the method of choice, but most often laparoscopic techniques are used. 1 figure.

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Drinking Safely When You Have Diabetes Source: Diabetes Advisor. 7(5): 24. September-October 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org.

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Summary: This article provides people who have diabetes with information on consuming alcoholic beverages. Although people who drink moderate amounts of alcohol have higher levels of good cholesterol, there are several drawbacks to alcohol consumption for people who have diabetes. First, alcohol interacts with many types of drugs, alcohol is poisonous to nerves, and alcohol affects blood glucose levels. In addition, alcohol has no vitamins or fiber, and it is low in minerals and high in calories. The American Diabetes Association recommends that women who have diabetes consume no more than one drink per day and that men who have diabetes consume no more than two drinks per day. The article outlines some steps people who have diabetes can take to avoid hypoglycemia when they consume alcoholic beverages. ·

Cool Summer Treats Source: Endless Water. 7(3): 6-7. Summer 2002. Contact: Available from Diabetes Insipidus Foundation, Inc. 4533 Ridge Drive, Baltimore, MD 21229.E-mail: [email protected]. Website: http://diabetesinsipidus.maxinter.net. Summary: This newsletter article offers readers with diabetes insipidus ( a disease characterized by excessive urination and thirst) some ideas for cool summer treats that use the fruits of the summer season. The author includes the recipes for Two-Tone Lemonade Mousse, Berry-Ricotta Pizza, and low-sodium Salsa. Each recipes includes basic nutritional information (calories, fat, cholesterol, sodium, carbohydrate, fiber, and protein).

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Grapefruit Juice Can Interact with Medications Source: Harvard Heart Letter. 9(8): 4. April 1999. Contact: Available from Harvard Medical School Health Publications Group. Harvard Heart Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail: [email protected]. Summary: This brief newsletter alerts readers to the potential interaction of grapefruit juice with some medications. Although grapefruit juice is naturally thought of as healthy, because it is full of vitamin C and low in calories, the juice also contains some naturally occurring substances that can greatly increase the potency of some drugs. Drugs that can be involved include some common heart medications such as blood pressure pills and most of the cholesterol lowering drugs in the statin family. None of the other citrus fruits contain these chemicals, called furanocoumarins, but they are abundant in grapefruit. Experts recommend that people use common sense to avoid any serious interaction between grapefruit juice and medications. The author notes that patients should not make any major changes (either starting to take medications with grapefruit juice, or avoiding grapefruit juice) on their own. The author concludes with a brief note about the research being done in this area, including work exploring whether grapefruit juice may end up being a very handy and inexpensive way to increase the potency of some medications.

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What Blood Tests Tell Us Source: Harvard Women's Health Watch. 7(3): 6. November 1999. Contact: Available from Harvard Women's Health Watch. P.O. Box 420068, Palm Coast, FL 32142-0068. (800) 829-5921 or (904) 445-4662.


Summary: This brief newsletter article describes the standard blood tests that may be done to diagnose disease or monitor risk factors. The author uses the metaphor of the bloodstream as a river that brings oxygen and other vital nutrients to the body's cells and carries waste away from them. This 'river' also transports the cellular and molecular forces that fight disease, and ferries hormones from the glands to the tissues. By sampling this stream, doctors can identify elevated risk in people who are healthy and pick up clues to the sources of symptoms in those who are sick. The few cubic centimeters of blood contain millions of cells and molecules, each of which can vary in number according to the person's state of health. The lab report resulting from a blood test usually consists of two sections: hematology, which provides information about blood cells, and chemistry, which furnishes data about plasma. The bulk of the article consists of a chart that explains the results of a typical blood test. The chart lists the lab values typically studied, the range of results considered normal, and the significance of values outside the normal range. Lab values included are WBC (white blood cells), HCT (hematocrit), PLT (platelets), CHOL (total cholesterol), HDL ('good' cholesterol), LDL ('bad' cholesterol), TRIG (triglycerides), BUN (blood urea nitrogen), CREAT (creatinine), GLU (glucose), and TSH (thyroid stimulating hormone). 1 table. ·

Vegetarian Diets and Implications with Renal Disease Source: Networking News: [Nutrition and Education for the Public]. 19(2): 1, 12. Spring 1997. Contact: Available from Nutrition Education for the Public. 216 West Jackson Boulevard, Chicago, IL 60606-6995. Summary: Nutrition intervention for renal disease varies depending on a number of factors. This article considers vegetarian diets and their implications in patients with renal disease. Evidence indicates that dietary restriction of protein retards the progression of renal disease in both experimentally induced renal disease in animal models, and in some human nephropathies. The author notes that, when vegetable protein is substituted for animal protein in the diet, it seems to induce changes similar to those seen with a reduction in total dietary protein. A vegetarian diet may, however, make it difficult to minimize the metabolic derangements and uremic toxicity associated with renal disease, particularly with respect to phosphorus and potassium. Vegetarian diets are higher in fiber and lower in total fat, saturated fat, and cholesterol than nonvegetarian diets. Therefore, vegetarians tend to have lower rates of coronary artery disease, hypertension, noninsulin-dependent diabetes mellitus, and obesity than do nonvegetarians. These are all risk factors associated with the renal transplant patient. The author concludes by supporting the use of a vegetarian diet for the person with renal disease. The diet can be fairly easy to follow, acceptable, and palatable, with little interference in an individual's lifestyle. Consumption of a vegetarian diet may require an increase in the number of phosphate binders for patients in end-stage renal disease or on dialysis. Monitoring the patient for diet palatability and acceptance, and for signs of malnutrition are still important with the vegetarian diet. 9 references. (AA-M).

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Worksite Programs Target Health and Cost Benefits Source: Prevention Report. Pp. 1-2, 4, August-September 1994. Summary: Recent data show that worksite health promotion and disease prevention programs are growing in popularity. One study revealed that 76 percent of 1,043 employers nationwide used some type of health promotion or early intervention initiative to encourage healthy lifestyles among employees, up 12 percent from a similar

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study done in 1992. The 1992 National Survey of Worksite Health Promotion Activities found that 81 percent of worksites offer at least one health promotion activity, compared with 66 percent in 1985. Of employers with a health promotion initiative, a 1994 benefits survey found that (1) 80 percent offer education or training to encourage healthy lifestyle changes, (2) 30 percent use health risk appraisals to evaluate individual risk factors and motivate employees, (3) 74 percent conduct health risk assessments/screenings to monitor employee health through health fairs or mobile testing, (4) 18 percent use incentives/disincentives in their benefit plan design, and (5) 44 percent offer other interventions, including fitness facilities, sports teams, and health information lines. A 1993 review found that 47 of the 48 published studies done since 1980 indicated positive health benefits associated with worksite health programs. By 1992, the Year 2000 objectives for physical activity programs, alcohol and other drug policies, and occupant protection systems had been exceeded, and increased activity in other key areas (e.g., high blood pressure/cholesterol, smoking policies, nutrition/weight control, stress management, and back care) was encouraging. However, most programs have been found in large worksites (more than 750 employees); smaller worksites should expand their access to health promotion and health care services. 1 figure, 1 table. ·

Establishing Community Health Centers in Rural Appalachia Utilizing Lay Volunteers Source: Human Services in the Rural Environment. 3(1):1-4, January 1978. Summary: Establishing Community Health Centers in Rural Appalachia Utilizing Lay Volunteers describes the establishment of 10 Community Health Centers in the homes of volunteers in communities throughout Harlan County, Kentucky, by the Southeast Community College Appalachian Leadership Community Outreach (ALCOR). ALCOR is a nonprofit, privately funded corporation working through six eastern Kentucky colleges to serve the residents of rural Appalachia. The Community Health Centers were established in response to the need of consumers in rural areas for health care in the community and as a way to provide continuous health care. At each of the 10 sites, a reliable and respected volunteer was trained by ALCOR students in basic first aid and blood pressure measurements. The volunteers were provided with a stethoscope, pressure cuff, and booklets on blood pressure to distribute to community residents. Each center received a set of bathroom scales and a first aid kit containing a snake bite kit and a thermometer. The volunteers' homes became the location of various community health education programs. The programs presented by ALCOR students included the warning signs of cancer, breast self-examination using silicone breast forms with actual lumps, nutrition, dental hygiene, and coronary care. Screening tests for anemia, diabetes, sickle cell anemia, cholesterol, parasites, vision, hearing, and blood group and Rh, were available to community members at no charge. All positive findings were referred for followup care. The Community Health Centers are used throughout the year. Periodic checks are made on blood pressure measurement techniques, first aid supplies, and utilization of the centers. Health education programs will continue to be provided on a limited basis along with more in-depth first aid training.

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Smoking Cessation: High Risk Groups (Part 3) Source: Druginform. 21(5):30-33, September-October 2000. Summary: This literature review considers the use of nicotine replacement and other smoking cessation strategies in groups of persons at increased risk of harmful effects resulting from smoking, including those with cardiovascular disease and pregnant and


breastfeeding women. Compelling evidence exists that smoking causes between 17 to 30 percent of all deaths attributed to cardiovascular disease in the United States. The risk for coronary artery disease among smokers is dose related and smoking in the presence of other coronary risk factors such as hypertension and hypercholesterolemia has a synergistic effect on morbidity and mortality from coronary artery disease. Studies indicate nicotine patches are preferred to other forms of nicotine replacement therapy (NRT) with cardiovascular patients. Nasal sprays should be avoided due to higher blood levels produced. Uneventful NRT use has been documented 2 weeks after acute myocardial infarction, unstable angina, ventricular arrhythmia, and second-degree or higher AV block. Initial doses for the first 1 to 2 days should besmaller than usual. Smoking during pregnancy is associated with (1) intrauterine growth retardation, (2) increased risk o spontaneous abortion, (3) prematurity, (4) perinatal mortality, and (5) poor postnatal development. In addition to nicotine, the fetus may also be exposed to carbon monoxide and tar products. Currently, most NRT products are not licensed in the United Kingdom for use in pregnancy as safety data are lacking. Some suggest that the benefits of NRT outweigh the risk of smoking for pregnant women, but suggest this method be used only for women unable to stop any other way. Women who smoke during pregnancy are less likely to breast-feed and are more likely to wean their infants earlier. This effect appears to be dose related. Studies controlled for socioeconomic status have confirmed that smokers are more likely to fail at breast feeding than nonsmokers. Little information is available on the use of NRT in breast-feeding mothers, but levels of nicotine in breast milk are lower after NRT than after smoking. NRT products are devoid of tars, carbon monoxide, and respiratory irritants found in cigarettes. 28 references. ·

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 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.

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Exercises for Mind and Body Source: American Institute for Cancer Research Newsletter. Issue 75. p. 12. Spring 2002. Contact: American Institute for Cancer Research. 1759 R St. NW, Washington, DC 20009. (202)328-7744. www.aicr.org. Summary: This article focuses on physical activities that emphasize building strength and flexibility. Muscle strength and flexibility become increasingly important as one ages, and helps prevent cramps, stiffness, and injury. Exercises such as t'ai chi, yoga, and Pilates may also help decrease stress levels, blood cholesterol, and blood pressure. With increased strength and muscle mass, the body burns more body fat, maintains bone density, and possibly lowers levels of low-density lipoprotein (LDL or the 'bad'

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cholesterol). The article describes the fundamentals of three popular strength and flexibility workouts-- t'ai chi, yoga, and Pilates. ·

Eating 'Outside the Box' Source: Mayo Clinic Health Letter 20(4):4-5. April 2002. Contact: Mayo Foundation for Medical Education and Research. Rochester, MN 55905. 800/333-9037. Summary: This article provides guidance for making healthy nutrition decisions. Three daily menus are compared: typical American fare, improved fare, and health-boosting fare. The health benefits of the health-boosting menu are discussed. The article also provides a vegetarian chili recipe to encourage one to cook 'outside the box.' The recipe includes information on the calorie, protein, fat, saturated fat, cholesterol, sodium, and fiber content per serving.

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Syndrome X Source: Nutrition Action Healthletter. 29(3):3. April 2002. Contact: Center for Science in the Public Interest. 1875 Connecticut Ave., NW, Suite 300, Washington, DC 20009-5728. www.cspinet.org. Summary: Metabolic syndrome is a group of abnormalities that raise the risk of heart disease. A national survey published in the Journal of the American Medical Association (JAMA) found that one in five Americans have metabolic syndrome, also known as Syndrome X. Two in five adults between the ages of 60 and 70 years have it. It is diagnosed if three or more of the following criteria are present: blood pressure of at least 130 (systolic) or 85 (diastolic), fasting blood sugar of at least 110, triglycerides of at least 150, HDL cholesterol of less than 40 in men or less than 50 in women, and a waist measurement of at least 35 inches in women or at least 40 inches in men. Exercise, even in the absence of weight loss; losing a small amount of weight; and replacing carbohydrates like sweets, bread, and pasta with small amounts of unsaturated fats from oils, nuts, and salad dressing may help reverse metabolic syndrome.

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Making the DASH Source: University of California, Berkeley Wellness Letter. 18(9):1-2. June 2002. Contact: Health Letter Associates, P.O. Box 412, Prince Street Station, New York, New York 10012-0007. www.wellnessletter.com. Summary: The Dietary Approaches to Stop Hypertension (DASH) eating plan helps reduce blood cholesterol and lower blood pressure, especially when combined with a reduced sodium intake. It can also help with weight loss, especially when combined with regular exercise. The DASH plan is rich in low-fat dairy foods, fruits, vegetables, and whole grains. A sample DASH 1-day menu is provided based on a 2,000-calorie intake that can be adjusted for body weight and activity level. Contact information for the DASH plan is included.

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Good for You? Eggsactly! Source: Running and Fitnews. (19)1:2. January 2001. Contact: The American Running Association. 4405 East West Hwy., Number 405, Bethesda, MD 20814, 800/776-2732, www.americanrunning.org.


Summary: A study published in the Journal of the American Medical Association (JAMA) found that eating an egg a day does not increase the risk of heart disease. Researchers looked at two prospective studies to determine whether egg consumption and heart disease and stroke are actually related. After controlling for age, smoking, and other heart disease risk factors, there was a lack of evidence linking egg consumption and risk of heart disease or stroke. The researchers speculated that the cholesterol in the egg is accompanied by unsaturated fat, which may raise levels of high-density lipoprotein (good) cholesterol. Those with normal blood pressure and cholesterol levels, without a family history of heart disease, and who exercise, can safely enjoy an egg a day. ·

Exercise Without Weight Loss Can Reduce Cardiovascular Risk Source: WIN Notes. p.2. Spring 2001. Contact: Weight-control Information Network. 1-877-WIN-4627. Summary: According to a pilot study published in the February 2000 issue of Clinical Exercise Physiology, moderate exercise can significantly lower the risk of heart disease in overweight and mildly obese adults, even if the physical activity does not lead to weight loss. The study, conducted at the Duke University Medical Center in North Carolina, consisted of a 3-month controlled exercise program that monitored participants' weights and diets to prevent weight loss or gain. Three women and four men aged 40 to 55 with body mass indexes (BMI) of 25 to 35 participated in the study. The participants reduced LDL or bad cholesterol, increased HDL or good cholesterol, and decreased body fat. Duke cardiologist William Kraus, M.D, notes that 'this pilot study was a first attempt to isolate the effects of exercise from weight loss in a controlled fashion.' The research team designed the trial so that they could 'attribute all the beneficial effects to exercise alone'.

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How to Cut Your Risk of Diabetes Source: Nutrition Action Healthletter. 28(4): 1, 3-8. May 2001. Contact: Center for Science in the Public Interest. 1875 Connecticut Avenue NW, Suite 300, Washington, DC 20009-5728. Summary: The author explores reducing the risk of developing diabetes. As the incidence of obesity increases in the United States, so too have diabetes rates. The article discusses the risks of high-blood sugar levels and above- optimal blood sugar. According to Frank Vinicor of the Centers for Disease Control and Prevention (CDC), 'as of 1997, the total direct and indirect cost of diabetes was roughly 100 billion dollars a year. The major direct costs are due to hospitalization for coronary heart disease and kidney disease,' although 'blindness and amputations take the greatest toll on quality of life.' To cut diabetes risk, the article advocates losing weight if overweight, walking or being physically active for at least 30 minutes a day, eating whole-grain breads and cereals rather than refined starches and sugars, eating more fruits and vegetables, getting fasting blood sugar tested every 3 years starting at age 45, and using diet and exercise to keep blood pressure and cholesterol at optimal levels if fasting blood glucose consistently exceeds 110 mg/dL. Liebman also discusses a test for a longer term indication of blood sugar called glycated hemoglobin and lists risk factors and warning signs for diabetes, including tips on how to eat wisely to lower diabetes risk. A chart shows how to check Body Mass Index (BMI) to rate weight and diabetes risk.

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Citrus: It Only Begins With C Source: University of California, Berkeley, Wellness Letter. 17(1):1-2. October 2000. Contact: Health Letter Associates. P.O. Box 412, Prince Street Station, New York, NY 10012-0007. Summary: This article focuses on the benefits of eating citrus fruits -- benefits which go beyond their vitamin C content. Citrus fruits also contain phytochemicals (plant chemicals), carotenoids, and fiber, found mainly in the form of pectin, which helps lower cholesterol. Many research studies have shown the benefits of citrus fruits, and these include reducing stroke risk, reducing oxidation of LDL-cholesterol ("bad" cholesterol), and lowering blood levels of homocysteine. Oxidation of LDL-cholesterol increases artery-damaging deposits and promotes atherosclerosis. Homocysteine may increase the risk of heart disease. Although citrus juice may not contain fiber, it still has a host of nutrients, including D-limonene and coumarins, which are found on citrus skin and leach into the juice. D-limonene may help detoxify cancer- causing compounds while reducing the activity of proteins that trigger abnormal cell growth. Coumarins help reduce blood clotting and may also have anticancer capability. The article ends by discussing how best to store juice and cautions that grapefruit juice may increase side effects of certain prescription drugs.

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Why Fat Migrates to Your Middle Source: Tufts University Health and Nutrition Letter. 18(7):6. September 2000. Contact: 10 High St., Suite 706, Boston, MA 02110. [email protected] www.healthletter.tufts.edu. Summary: A book by Dr. Pamela Peeke, Fight Fat After Forty, proposes that middle- age women gain weight around their waists because of emotional stress which causes the steady release of the stress hormone cortisol. According to Dr. Peeke, cortisol not only causes chronic overeating but also causes excess calories to be stored as fat deep in the abdomen. Although it is true that weight gain around the middle is a health problem because it contributes to high blood pressure and increased blood levels of cholesterol, there is still too little research to determine whether a hectic lifestyle has anything to do with abdominal weight gain. Human studies have found a rough link between fat stores in the abdomen and higher cortisol levels, but it is not clear whether the cortisol levels induce the laying down of abdominal fat or whether the greater levels of abdominal fat cause the rise in cortisol levels. Most researchers believe obesity is a complicated problem that involves not only an individual's stress level, but many other factors as well. The article notes that difficulties in coping with life's problems could never be singled out as the defining factor in a woman's eating style and body shape. Other theories on why many women gain weight around the middle as they enter midlife include having a sedentary lifestyle, a loss of muscle tissue due to aging, and a decline in estrogen levels.

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A Vote for Oats Source: University of California, Berkeley, Wellness Letter. 17(2):3. November 2000. Contact: Health Letter Associates. P.O. Box 412, Prince Street Station, New York, NY 10012-0007. www.wellnessletter.com. Summary: Oats are a whole grain rich in soluble fiber. In 1997, the Food and Drug Administration (FDA) allowed the labels on oat products to state that they, along with a


diet low in saturated fat and cholesterol, "may reduce the risk of heart disease." Aside from lowering blood cholesterol, oats may also help control blood sugar, improve insulin sensitivity, and lower blood pressure. Oats also contain phytochemicals and antioxidants that may reduce the risk of heart disease. The article recommends reading labels when buying oat products and suggests looking for those with at least 2 or 3 grams of fiber per serving. ·

Virtuous Vegetarianism Source: Running and Fitnews. (18)11:3. November 2000. Contact: The American Running Association. 4405 East West Hwy., Number 405, Bethesda, MD 20814, 800/776-2732, www.americanrunning.org. Summary: The American Dietetic Association (ADA) supports a well-planned vegetarian diet. Vegetarian diets tend to be lower in fat, are lower in cholesterol, and have been used to reverse severe coronary artery disease. Vegetarian diets are higher in folate, vitamins C and E, carotenoids, and phytochemicals. Vegetarians usually have lower blood cholesterol and lower blood pressure. Vegans, who eat no animal products, including dairy foods and eggs, need to make sure their diets include sufficient vitamin B12 and vitamin D. The article provides guidelines to ensure that a vegetarian diet is nutritionally complete.

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New Dietary Guidelines for Americans Released Source: WIN Notes. p. 5. Fall 2000. Contact: Weight-control Information Network. 1-877-WIN-4627. Summary: The fifth edition of Nutrition and Your Health: Dietary Guidelines for Americans was released in May 2000. Jointly issued by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Service (HHS), the guidelines provide easily understood, science-based information to help Americans choose diets that promote good health. The new guidelines place a stronger emphasis on eating whole grains, fruits, and vegetables. They also stress the importance of physical activity, recommending that both children and adults get at least 30 minutes of physical activity daily. A new recommendation on food safety describes how to prepare, store, and serve food safely. For the first time, the guidelines include the body mass index (BMI) chart to help consumers evaluate whether they are at a healthy weight, or are overweight or obese. Other changes include a focus on reducing saturated fat and cholesterol intake rather than fat intake in general, and the addition of beverages, especially nondiet soft drinks, in the discussion of reducing sugar intake. The article provides information on how to obtain copies of the guidelines.

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Fat Confusion Cleared Up Source: AICR Newsletter. Issue 62, p.5. Winter 1999. Contact: AICR, 1759 R Street NW, Washington, DC. (202) 328-7744. Summary: This article explains the differences between the various kinds of fats. According to the author, it is not healthy to eliminate all fats from the diet. However, individuals should reduce the amount of animal fat they consume. Avocados and almonds eaten in moderation are not unhealthy, and may improve the ratio of `good' cholesterol in the blood, since both contain monounsaturated fats. Olive or canola oils should be used for cooking, says the author, but it is unhealthy to overindulge in any

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kind of fat. Trans-fats are to be avoided, especially those found in hydrogenated vegetable oils and mayonnaise, processed cookies, chips, cakes, and crackers, and in deep-fried foods like doughnuts. ·

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.

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Should You Be Eating More Fat and Fewer Carbohydrates? Source: Tufts University Health and Nutrition Letter. 16(12):1,4,5. February 1999. Contact: Tufts University Health and Nutrition Letter, 53 Park Place, New York, NY 10007. Summary: This article discusses a condition called syndrome X, or hyperinsulinemia, a condition in which the pancreas secretes too much insulin. Therefore, consumption of carbohydrates actually increases the levels of triglycerides, lowers HDL cholesterol, and increases the risk of high blood pressure and blood clots. It is more common in individuals who are overweight, according to the authors. For this reason, the authors stress that individuals should not increase their fat intake. On the contrary, according to experts cited in the article, Americans should reduce their total fat intake, not only saturated fat. The authors list the normal readings for several indicators such as blood pressure, LDL cholesterol, triglycerides, and blood sugar. For those whose readings are not within that normal range, options are suggested. For those with Syndrome X, suggestions are also made for controlling their insulin levels.

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Trans Fat: Another Artery-Clogger? Source: Mayo Clinic Health Letter. May 1998. Contact: Mayo Clinic Health Letter, Mayo Foundation for Medical Education, Rochester MN 55905. Web Site: http://www.mayo.edu. Summary: This article explains what consumers need to know about trans fat. Saturated fat, which is saturated with hydrogen, raises blood cholesterol. Monosaturated and polyunsaturated fats contain less hydrogen and do not increase blood cholesterol. Trans fat is formed from vegetable oil, and recent studies have shown that trans fat may raise blood cholesterol levels as much as saturated fats. The authors recommend reducing consumption of high- fat dairy products and meat, processed baked goods, and fried foods. Instead, they suggest eating more fruits and vegetables, preparing foods without using oil or fats, and using jelly or honey instead of margarine.


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Optimal Workouts Source: University of California at Berkeley Wellness Letter. 13(7):6; April 1997. Contact: University of California at Berkeley Wellness Letter, P.O. Box 420148, Palm Coast, FL 32142. Summary: This article is an update to a report of a study done 2 years ago at the University of California at Berkeley. The earlier study found that, in male runners, increased exercise helps lower some risk factors for heart disease. This update discusses an extension to the original study, which involves female runners. The results were the same for the women, showing that women who exercise also reduce their risk of heart disease. The researchers also found that distance was more of a factor in risk reduction than speed; the runners who ran farther had lower blood cholesterol levels than the runners who ran faster, the faster runners had lower blood pressure. However, scientists still cannot suggest specific aerobic programs for individuals, and according to this article, the best advice is simply to exercise, as any amount of exercise is more beneficial than remaining sedentary.

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50's Restaurant Food: Happy Days or Grease? Source: Nutrition Action Health Letter. 24(4):1,10-13; May 1997. Contact: Center for Science in the Public Interest, 1501 16th St., NW, Washington, DC 20036. (202) 332-9110. Web Address http://www.cspinet.org/. Email: [email protected]. Summary: This article examines the familiar foods of the fifties such as meatloaf, pot roast, and chicken potpie to find out if they are really as unhealthy as they might seem. According to the authors, most entrees have high amounts of fat and cholesterol. The restaurants studied include Denny's, Big Boy's, IHOP, Perkins, and Village Inn. With each review of an entree, suggestions are offered for improving the selections, or making another choice. A chart summarizes the findings.

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Exercise and Women's Health Source: American Health for Women. P.5. Summer 1997. Summary: This article explains why women should exercise. According to the author, exercise has many benefits, including weight loss, an increase in bone density, and lower cholesterol. However, the author cautions, an individual should strive to reach a weight that feels comfortable, rather than attempting to conform to a standardized chart. A sidebar explains how to calculate body mass index.

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Stricter Weight Guidelines in the Offing Source: Tufts University Diet and Nutrition Letter. 13(7):3-6; September 1995. Contact: Tufts Diet and Nutrition Letter, 203 Harris Avenue, Boston, MA 02111. (800) 274-7581. Summary: This article explains that new weight guidelines that will no longer allow for a 10 to 15-pound weight gain for people 35 and older. Evidence supports the premise that regardless of life cycle, as weight increases, so does the incidence of high blood pressure, diabetes, pulmonary problems, and raised cholesterol levels. The new weight guidelines do not apply to men and women over the age of 70. The measurement of body fat is considered.

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Seafood: What a Catch Source: Nutrition Action Health Letter, Center for Science in the Public Interest. 21(9):1, 6-9; November 1994...AV-Center for Science in the Public Interest, Suite 300, 1875 Connecticut Ave., NW, Washington, DC 20009-5728. Summary: This article focuses on seafood, and generally classifies it as a healthy, low-fat food choice. As long as low-fat fish and shell fish are not fried, stuffed, or cooked in cream sauces, the authors declare it a healthful choice. The consumer is warned to avoid high-fat and high-sodium side dishes that often accompany seafood entrees in a restaurant. The authors rank dishes within the appetizer and entree categories from lowest to highest percent of calories from fat. The lowest fat entree was broiled or grilled scallops, the middle range includes blackened catfish, and the highest fat entry was seafood casserole. The article includes a table with calorie, total fat, saturated fat, cholesterol, and sodium content of typical food choices from a seafood restaurant.

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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.

Academic Periodicals covering Cholesterol Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to cholesterol. In addition to these sources, you can search for articles covering 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.”

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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 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 DIÒ Advice for the PatientÒ 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 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.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to cholesterol: Atorvastatin ·

Systemic - U.S. Brands: Lipitor http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203635.html

Cerivastatin ·

Systemic - U.S. Brands: Baycol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203060.html

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

Gemfibrozil ·

Systemic - U.S. Brands: Lopid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202256.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

Monoctanoin ·

Local - U.S. Brands: Moctanin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202380.html

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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

Raloxifene ·

Systemic - U.S. Brands: Evista http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203396.html

Ursodiol ·

Systemic - U.S. Brands: Actigall http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202587.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 ConsultÔ Mosby’s Drug ConsultÔ 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/.

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.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to cholesterol by using the database managed by the

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National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “cholesterol” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for cholesterol: ·

Monooctanoin (trade name: Moctanin) http://www.rarediseases.org/nord/search/nodd_full?code=159

·

Sodium dichloroacetate http://www.rarediseases.org/nord/search/nodd_full?code=56

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.

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APPENDICES

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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 Institute13: ·

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

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

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

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

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

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

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

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

13

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

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·

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

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

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

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

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

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

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

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

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

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

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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

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

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

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

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

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

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

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

Physician Resources 509

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.14 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:15 ·

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

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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/

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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

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

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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/

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

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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

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

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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

14

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). 15 See http://www.nlm.nih.gov/databases/databases.html.

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·

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 Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “cholesterol” using the “Detailed Search” option. Go directly to the following hyperlink: 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 the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “cholesterol” (or synonyms) into the “For these words:” box. The following is a sample result: ·

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Final Report Source: Bethesda, MD, National Heart, Lung, and Blood Institute, 238 p., September 2002. Contact: National Heart, Lung, and Blood Institute, NHLBI Health Information Net, P.O. Box 30105, Bethesda, MD 20824-0105. (301) 592-8573. FAX: (240) 629-3246. Publication no. 02-5215. Summary: Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Final Report presents updated recommendations for cholesterol testing and management. It focuses on the role of the clinical approach in the prevention of coronary heart disease (CHD) and identifies low-density lipoprotein (LDL) as the main target of cholesterol-lowering therapy. The Adult Treatment Panel (ATP) III analyzed the results of recent clinical trials whose findings strongly influenced the development of new guidelines. The ATP III's major goals were to review the literature objectively and to document and display the scientific evidence for ATP III's recommendations. The ATP III's recommendations are based on the panel's best interpretation of the relation between empirical evidence and issues of clinical intervention. ATP III maintains focus on intensive treatment of patients with CHD. Its major new features are (1) a focus on primary prevention in persons with multiple risk factors, (2) modifications of lipid and lipoprotein classification, and (3) support for implementation. Major sections of this report are (1) general approach to treatment: goals and thresholds; (2) adopting healthful lifestyle habits to lower LDL cholesterol and reduce CHD risk; (3) diet appendixes; (4) drug therapy; (5) management of specific dyslipidemias; (6) special consideration for different populations; and (7) adherence.

·

Cholesterol Education Month: September 1989 Source: Austin, TX, Texas Department of Health, Public Health Promotion Division, 1989.


Contact: Texas Department of Health, Public Health Promotion Division, 1100 West 49th Street, Austin, TX 78756. (512) 458-7405. Summary: Cholesterol Education Month was the September 1989 topic for the Texas Pharmaceutical Association and Texas Department of Health Joint Health Promotion Project. The information package contains background information on cholesterol, fact sheets, posters, and descriptions of additional resources. ·

Public Awareness of Cholesterol Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, 4 p., October 1990. Contact: National Heart, Lung, and Blood Institute Education Programs, Information Center, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814-4820. (301) 951-3260. Summary: Public Awareness of Cholesterol presents the results of National Heart, Lung, and Blood Institute and the Food and Drug Administration sponsored surveys of public attitudes, knowledge, and practices regarding blood cholesterol. The surveys involved 4,000 adults over 17 years old between 1983 and 1986, and approximately 3, 200 in 1988. Results of these surveys show that public awareness of the cholesterol issue has grown markedly since 1983, including the increased use of cholesterol level checks, knowledge of cholesterol levels, and attempts to reduce dietary fat intake levels. However, a significant gap exists in the public's knowledge of saturated fats and dietary cholesterol. In 1988, 96 percent stated that eating fewer high fat foods would have a moderate or large effect in preventing heart disease, while only 56 percent of the public knew that saturated fat raises blood cholesterol levels, and only 35 percent knew that a food labeled to contain no cholesterol could still be high in saturated fats. While the public's general awareness about risks of elevated blood cholesterol is high, specific knowledge that would assist the public in making necessary dietary changes to effectively lower blood cholesterol levels remains much lower and presents an important educational challenge.

·

Recommendations Regarding Public Screening for Measuring Blood Cholesterol Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, 14 p., September 1995. Contact: NHLBI Information Center, P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. NIH Publication no. 95-3045. Summary: Recommendations Regarding Public Screening for Measuring Blood Cholesterol updates guidelines for cholesterol screening programs issued by the National Heart, Lung, and Blood Institute and the American Heart Association in 1989. These guidelines incorporate the recommendation to add measurement of high-density lipoprotein (HDL) cholesterol to initial cholesterol testing. Public screening must meet standards for recruitment of participants, reliable measurement of cholesterol levels, the provision of appropriate information, staff training, and referral for additional evaluation. Experts recommend that public screening programs (1) use recruitment approaches to attract all adults in the community and develop outreach approaches for groups that would be underrepresented in usual detection programs, such as men, young adults, low-income or low-education groups, and minorities; (2) comply with requirements established under the Clinical Laboratory Improvement Amendments of

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1988; (3) meet standards for precise and accurate cholesterol measurements as defined by the Laboratory Standardization Panel of the National Cholesterol Education Program (NCEP); (4) provide reliable verbal and written information about cholesterol levels to program participants; (5) ensure that staff members have received appropriate training and have adequate supervision; (6) offer convenient, efficient screening sites; (7) provide screening at a reasonable cost for the participant; (8) establish liaisons with community health care resources; and (9) provide referral and followup such as letters or telephone calls. Participants should be referred to a physician for medical management if they have (1) total cholesterol of 240 mg/dL or higher, (2) HDL cholesterol less than 35 mg/dL, (3) total cholesterol between 200-239 mg/dL, or (4) total cholesterol below 200 mg/dL. The appendix includes a risk factor questionnaire. ·

National Cholesterol Education Program: A Communications Strategy for Public Education Source: Bethesda, MD, National Heart, Lung, and Blood Institute, National Heart, Lung, and Blood Institute Communications Series, 26 p., November 1994. Contact: National Heart, Lung, and Blood Institute Information Center, P.O. Box 30105, Bethesda, MD 20824. (301) 251-1222. NIH Publication No. 94-3292. Summary: National Cholesterol Education Program: A Communications Strategy for Public Education outlines an approach for helping to reduce illness and death from coronary heart disease by using the mass media to educate the public about high blood cholesterol. The National Cholesterol Education Program (NCEP) targets its messages to professionals, patients, and the public. The report is divided into seven sections. Section one describes (1) the program's background and overall objectives, (2) the purpose and scope of the communications strategy, (3) recent NCEP developments influencing the strategy, (4) scientific and public knowledge basis for the strategy, and (5) the role of the mass media campaign. Section two describes the population at risk for high blood cholesterol and presents a two-pronged strategy for lowering blood cholesterol levels in the United States: A population approach that seeks to lower average blood cholesterol levels by encouraging all Americans over age 2 years to consume lower amounts of saturated fatty acids, total fat, and cholesterol and a high-risk approach that seeks to identify and treat individuals with high blood cholesterol levels who have a high risk of coronary heart disease. Section three highlights examples of progress and identifies areas requiring more educational emphasis. Section four describes audiences for the population strategy and high-risk strategy (e.g., those with coronary heart disease and those with high total blood cholesterol). Section five describes program objectives as encouraging public awareness, knowledge, and action toward reducing blood cholesterol and identifying the high-risk population. Sections six and seven include desired actions and conclusions.

·

Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) Source: Bethesda, MD, National Heart, Lung, and Blood Institute, 161 p., September 1993. Contact: National Heart, Lung, and Blood Institute, Information Center, P.O. Box 30105, Bethesda, MD 20824. (301) 251-1222. Summary: The Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) presents the National Cholesterol Education Program's updated recommendations for cholesterol


management. The report includes four sections. Section one, Classification, Prevalence, Detection, and Evaluation, addresses (1) a basic description of lipids and lipoproteins, (2) a rationale for intervention, (3) detection and evaluation, and (4) general approach to treatment. Section two, Dietary Therapy and Physical Activity, discusses (1) recommended diets, (2) practical approaches to dietary therapy, (3) monitoring and followup. Section three, Drug Treatment, discusses (1) when to consider drug therapy and treatment goals, (2) available drug therapies, (3) selection of drugs, (4) monitoring and followup of patients, and (5) achieving long-term cholesterol control. Section four, Special Issues, discusses (1) aging, (2) low high-density lipoprotein (HDL) cholesterol without hypertriglyceridemia, (3) hypertriglyceridemia, (4) secondary dyslipidemias, (5) severe forms of hypercholsterolemia, (6) patients with high blood cholesterol and concomitant hypertension, (7) cost-effectiveness as a criterion for evaluation and therapy, and (8) issues that were unresolved in Adult Treatment Panel II. ·

Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction: Executive Summary Source: U.S. Department of Health and Human Services, National Heart, Lung, and Blood Institute, 41 p., March 1993. Contact: National Heart, Lung, and Blood Institute, P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. FAX: (301) 251-1223. NIH Publication No. 93-3047. Summary: Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction: Executive Summary presents data on the importance and effects of blood cholesterol reduction on coronary health. Coronary heart disease (CHD) is a major public health problem in the United States, killing more than 500,000 people annually and costing the economy over $50 billion annually. CHD results from atherosclerosis, in which deposits of cholesterol and other lipids, as well as cellular reactions, thicken artery walls. The process gradually reduces the caliber of the artery and restricts blood flow, which may cause injury or death of tissues beyond the site of reduced flow (which in the coronary arteries can lead to myocardial infarction or sudden death). Many factors influence whether a person will develop CHD and how rapidly atherosclerosis progresses (including genetics, gender, advancing age, and high blood cholesterol). Research has indicated that high blood cholesterol levels play a causal role in CHD. Two kinds of strategies are needed: (1) Patient-based strategies for those with the highest blood cholesterol levels and (2) population-based strategies to reach all Americans. Two types of research provide reason for optimism that CHD mortality rates can be reduced and trends toward reduced CHD death rates will continue or accelerate: (1) Studies indicate that reducing blood cholesterol can reduce the likelihood of developing or dying from CHD, and (2) many effective strategies exist for helping Americans develop more healthful lifestyles and eating patterns. The Population Panel of the National Cholesterol Education Program offers recommendations to help healthy Americans lower their blood cholesterol levels through changes in eating patterns. Each recommendation is intended to be achieved by an individual as an average of nutrient intake over several days. The recommendations are appropriate for the general population. As healthy children join in the eating patterns of others, they should follow the recommended nutrient intake and eating patterns. The panel recommends eating foods with lower amounts of saturated fatty acids, total fat, and cholesterol; choosing a variety of foods to ensure recommended intakes of protein, carbohydrates, and other nutrients; and eating only enough calories to maintain desirable weight. The group also makes recommendations for (1) special populations, (2) health professionals, (3) the food industry, (4) government agencies, (5) the mass media, (6) educational programs, (7)

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measurement of blood cholesterol, and (8) research and surveillance. Implementation of these recommendations will result in an approximate reduction of 10 percent or more in the average blood cholesterol level of the American population, which will lead to a reduction of 20 percent or more in CHD. ·

National Cholesterol Education Program: Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National Cholesterol Education Program, 119 p., September 1991. Contact: National Heart, Lung, and Blood Institute, Information Center, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814-4820. (301) 951-3260. Summary: National Cholesterol Education Program: Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents examines the problem of preventing or slowing the atherosclerotic process in childhood and adolescence; the report also discusses two strategies to lower blood cholesterol levels: Population and individual. The population approach aims to lower the average levels of blood cholesterol among all American children and adolescents through population-wide changes in nutrient intake and eating patterns. The individual approach aims to identify and treat children and adolescents who are at the greatest risk of having high blood cholesterol as adults and an increased risk of cardiovascular heart disease. The report contains four main sections. The first examines the rationale for attention to cholesterol levels in children and adolescents. The second discusses the population approach strategy and provides nutrition strategies for healthy children and adolescents. The third section discusses the individualized approach through an examination of (1) the detection process of children and adolescents who are at high risk for cardiovascular disease, (2) diagnosing them as high risk, and (3) evaluating the clinical measurements. Finally, the fourth section examines the treatment arm of the individualized strategy in terms of diet and drug therapy. Appendixes contain information about the corresponding levels of lipids in mg/dL and mmol/L; the rationale for screening recommendations; and examples of food tables (i.e., diet examples, nutrient information, and sample menus).

·

Public Cholesterol Screening in Michigan: Final Recommendations Source: Lansing, MI, Michigan Association for Local Public Health, 34 p., August 1991. Contact: Michigan Association for Local Public Health, 215 N. Walnut Street, P.O. Box 14065, Lansing, MI 48901. (517) 485-0660. Summary: Public Cholesterol Screening in Michigan: Final Recommendations, presented by the Michigan Department of Public Health (MDPH), is the concluding report from the MDPH Cardiovascular Disease Cholesterol Subcommittee of the State's Chronic Disease Advisory Committee. The Subcommittee (1) advises on strategies that would provide for safe, accurate, effective cholesterol screening programs; (2) reviews and incorporates National Cholesterol Education Program guidelines into Michigan recommendations; (3) develops recommendations for effective quality control at cholesterol screening sites; and (4) incorporates multifactor risk assessment into screening recommendations. Recommendations for public cholesterol screening in the State include: (1) Using recruitment approaches that attract adult segments of the community and develop special approaches to reach target groups; (2) establishing a relationship with a licensed clinical laboratory; (3) ensuring that staff are well-trained


and carefully supervised, and that they have access to ongoing consultation from appropriate health professionals; (4) providing cholesterol screening at reasonable cost to participants at sites that are convenient, efficient, offer appropriate degrees of privacy and confidentiality, and are designed to assure safety, quality, and infection control; and (5) providing an active referral and followup program. Section headings include administration, recruitment, laboratory measurement, licensure/registration, safety and environment, training, and patient education. An appendix includes specific recommendations for referral, followup, and evaluation. 1 figure, 3 tables, 32 references. ·

Promoting Heart Health in Canada: A Focus on Cholesterol Source: Ottawa, Canada, Health and Welfare Canada, 64 p., November 1991. Summary: Promoting Heart Health in Canada: A Focus on Cholesterol discusses cholesterol within the context of a multifactorial approach to cardiovascular disease (CVD) prevention. The Working Group was charged by the Federal Provincial Advisory Committee on Community Health to develop a public health strategy to deal with blood cholesterol as it pertains to CVD risk. The group was asked to assess the implications of the recommendations from the 1988 Canadian Consensus Conference on Cholesterol, which proposed a two-pronged approach to dealing with the high prevalence of elevated blood cholesterol. The Working Group sought international and national consultation to establish the views of (1) provincial and territorial jurisdictions, (2) voluntary agencies, (3) professional associations, (4) the private sector, and (5) individual experts. It found that many provincial jurisdictions have evaluation and treatment guidelines for hypercholesterolemia. The guidelines differ between provinces, which causes confusion in the professional community and the general public. Increased awareness among physicians and the public is creating increasing demand for evaluation, treatment, and health care resources. Over 8 million Canadians are at increased risk of ischemic heart disease due to elevated levels of blood cholesterol, with 3 million at high risk. This presents a good opportunity for prevention, because a main cause of this prevalence is a diet high in total fat and saturated fat. The cholesterol issue must be managed, but leadership on the part of federal, provincial, and territorial jurisdictions is needed to support and coordinate activities of numerous stakeholders. Implementing the policy described in this report will require a 5 to 10-year phase-in period. Public education programs must provide clear, consistent messages, including specific information on blood cholesterol as a risk factor, and advice on how to comply with the new Nutrition Recommendations recently released by the Department of National Health and Welfare. National guidelines for evaluation and treatment of people at risk are needed to clarify the current confusion. The accuracy and precision of blood lipid analysis must be improved via a coordinated program of standardization and of internal and external quality control.

·

Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National Cholesterol Education Program, 139 p., November 1990. Contact: Information Center, National Heart, Lung, and Blood Institute, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814. (301) 496-4236. (NIH Publication No. 90-3046). Summary: The Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction is the result of an extensive review of the scientific basis for making blood cholesterol lowering recommendations. The report directs the panel's recommendations

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to individuals, special population groups, health professionals, the food industry, government agencies, and to public and private education agencies. The report presents (1) panel conclusions; (2) recommendations involving nutrient intake, eating patterns, and healthy children and adolescents; (3) scientific evidence for recommendations affecting the general public, including diet patterns and health, eating patterns in the United States, eating pattern influences, and dietary behavior interventions; and (4) ethnic, cultural, and minority characteristics that influence diet and health for blacks, Hispanics, Asians/Pacific Islanders, and Native Americans. The panel recommends the following nutrient intakes for healthy Americans: (1) Less than 10 percent of total calories from saturated fatty acids; (2) an average of 30 percent of total calories of less from all fat; (3) dietary energy (carbohydrate) levels needed to reach or maintain a desirable body weight; and (4) less than 300 mg of cholesterol per day. The recommendations also address cholesterol screening, and the need for continued research and evaluation as eating patterns change, blood cholesterol levels decrease, and coronary heart disease continues to decline. 629 references. ·

Public Cholesterol Screening Source: Washington, DC, US Department of Health and Human Services, Office of the Inspector General, Division of Public Affairs, 29 p., May 1990. Contact: US Department of Health and Human Services, Office of the Inspector General, Division of Public Affairs, 300 Independence Avenue, SW., Washington, DC 20201. (202) 619-1142. Summary: The U.S. Department of Health and Human Services conducted a literature review, telephone interviews of 250 participants, and a special field survey in which researchers observed and participated in 71 public cholesterol screenings to examine the prevalence, conduct, and regulation of public cholesterol screening. The inspection concluded that (1) the percentage of adults who had their cholesterol checked increased from 35 percent in 1983 to 66 percent in 1989; (2) providers as varied as hospitals, public health departments, health clubs, and grocery stores conducted public screenings at sites such as shopping malls, pharmacies, and other community settings; (3) qualifications and training of screening staff varied widely, both people with and people without health care experience conducted the screenings; (4) education, counseling, and physician referral of persons screened were often lacking; (5) staff frequently disregarded basic rules of hygiene; (6) researchers questioned whether screeners had adequate operator training, provided sufficient quality control, and paid attention to detail to the extent required to obtain accurate results from the portable analyzers in public screenings; and (7) the type and extent of regulation, in the 16 States that regulate this activity, varied widely. The U.S. Department of Health and Human Services recommends that public cholesterol screening not meeting National Cholesterol Education Program guidelines be discouraged, and that the Health Care Financing Administration should not apply the Clinical Laboratory Improvement Amendments of 1988 waiver provision to public cholesterol screening.

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Public Cholesterol Screening in Michigan: Interim Recommendations Source: East Lansing, MI, Michigan Health Council, 31 p., December 1989. Contact: Michigan Health Council, 1305 Abbott Road, Suite 102, East Lansing, MI 48823. (517) 337-1615. Summary: Public Cholesterol Screening in Michigan: Interim Recommendations outlines strategies for safe, accurate, and effective cholesterol screening programs, reflects


material developed by the National Cholesterol Education Program, describes quality assurance requirements, referral and followup procedures, and incorporates multifactor risk assessment into the screening service. The recommendations contained within the report include (1) using recruitment approaches that attract adult segments of the community and develop special approaches to reach target groups; (2) ensuring precise and accurate cholesterol measurements; (3) including educational materials as part of screening, by providing reliable verbal and printed information about cholesterol levels from knowledgeable staff; (4) including a stated program purpose and objectives with professional clinical leadership identified; and (5) providing cholesterol screening at reasonable cost to participants at sites that are convenient, efficient, offer appropriate degrees of privacy and confidentiality, and are designed to assure safety, quality, and infection control. The report also includes recommendations for training, licensure and regulation procedures, and patient education. ·

Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National Cholesterol Education Program, 87 p., January 1989. Contact: Education Center, National Heart, Lung, and Blood Institute (NHLBI) Education Programs, 4733 Bethesda Avenue, Room 530, Bethesda, MD 20814. (301) 9513260. Summary: An expert panel has prepared a report on detection, evaluation and treatment of high blood cholesterol in adults. The report contains three main parts: (1) Classification of patients based on total and low density lipoprotein cholesterol, (2) treating patients with diet alone, and (3) treating patients with drugs in addition to diet. Part one of the report provides background and introductory information on coronary heart disease and information on detection and evaluation, including who should be tested, classification of patients based on total cholesterol level, methods of detection, and clinical evaluation of patients with a high cholesterol level. The second part of the report addresses dietary considerations for cholesterol treatment including (1) goals for dietary therapy, (2) general approach to dietary therapy, (3) recommended diets, (4) practical approach to dietary therapy, (5) monitoring and followup, (6) dietary therapy for special groups such as high risk patients and pregnant women, and (7) a dietary approach to use with patients in the borderline high blood cholesterol group. Part three of the report provides information on use of drug therapy including when to consider drug therapy and treatment goal for this type of therapy, selection and use of drugs, monitoring and followup of patients, and adherence to drug therapy.

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Highlights of the Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National Cholesterol Education Program, 8 p., 1987. Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National Cholesterol Education Program, C-200, Bethesda, MD 20892. Summary: The 1987 report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults offered

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practical detection, evaluation, and treatment recommendations for physicians. The panel updated and added more specific recommendations to basic policies set forth by previous expert committees. The report deals with three principal interventions: (1) Classification of blood cholesterol and patient evaluation, (2) dietary treatment, and (3) drug treatment. The panel addressed only patients age 20 and above. While the report is intended primarily for physicians, it is important to note that these interventions also require the active involvement of dietitians, nurses, pharmacists, other health professionals, and patients themselves. 4 figures. ·

National Cholesterol Education Program: Strategy Development Workshop for Minorities. Summary Report Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, Office of Prevention, Education, and Control, National Cholesterol Education Program, 80 p., May 7, 1987. Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, Office of Prevention, Education, and Control, National Cholesterol Education Program, Bethesda, MD 20892. Summary: The National Cholesterol Education Program (NCEP) Strategy Development Workshop on Cholesterol and Minority Health held on May 7, 1987, was one in a series of activities designed by the National Heart, Lung, and Blood Institute to identify and meet the unique needs of minority populations in the United States. Minority groups targeted for this initiative included blacks, Hispanics, Asian/Pacific Islanders, and American Indians. The Strategy Development Workshop on Cholesterol and Minority Health had five specific objectives: (1) To evaluate existing epidemiologic and research data concerning cholesterol and minority populations and to develop appropriate programs for obtaining statistically significant data when needed; (2) to identify cholesterol education needs that are unique to these four minority groups and the existing minority-focused cholesterol education initiatives that address these needs; (3) to generate a list of the most appropriate health activities, materials, and organizations that can help NCEP address the problem of high blood cholesterol within these minority groups; (4) to develop effective marketing strategies to adequately disseminate information and products for cholesterol education and management; and (5) to recommend appropriate evaluation criteria for program/product development. Common issues established during the course of the workshop include audience needs, social and cultural issues, economic considerations, and product standards.

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The national cholesterol education program: A communications strategy for public education Source: Washington, DC: National Cholesterol Education Program, National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services. 1994. 26 pp. Contact: Available from Information Center, National Heart, Lung, and Blood Institute, National Institutes of Health, P.O. Box 30105, Bethesda, MD 20824. Telephone: (301) 2511222. (NIH 94-3292). Summary: This report provides an overview of the public education strategy for achieving the objectives of the National Cholesterol Education Program. The report provides background information about the program, highlights the scientific basis for the strategy, and summarizes the role of the mass media campaign. It includes an assessment of the population at risk, identifies two main approaches to help accomplish


the strategy, profiles the target audiences which are high-risk groups and the population at large and suggests communications objectives and strategies for the health promotion effort. ·

Report of the expert panel on blood cholesterol levels in children and adolescents Source: Bethesda, MD: National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services. 1991. 119 pp. Contact: Available from Information Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 208144820. Telephone: (301) 951-3260. Available at no charge. (NIH 91-2732). Summary: This report includes a review of the significance of blood cholesterol levels in childhood and adolescence; nutrient recommendations and recommendations to groups that influence the eating patterns of children and adolescents; and an individualized approach to cholesterol lowering aimed at identifying and treating children and adolescents who are at the greatest risk of having high blood cholesterol as adults and an increased risk of coronary heart disease. Recommendations for screening, diet therapy, and drug therapy are included. A highlights volume is published separately.

The NLM Gateway16 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.17 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “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 132652 824 348 500 35 134359

HSTAT18 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.19 These documents include clinical practice guidelines, quick16 17

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

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). 18 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

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reference 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.20 Simply search by “cholesterol” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists21 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.22 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.23 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/.

The Genome Project and Cholesterol In the following section, we will discuss databases and references which relate to the Genome Project and cholesterol. 19

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

20

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. 21 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 22

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.

23 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.


Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).24 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “cholesterol” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for cholesterol: ·

24-@dehydrocholesterol Reductase Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?606418

·

7-@dehydrocholesterol Reductase Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?602858

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Autosomal Recessive Hypercholesterolemia Gene Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?605747

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Cholesterol 25-hydroxylase Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?604551

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Cholesterol Crystallization Inhibitor Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?118457

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Cholesterol Pneumonia Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?215030

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Cholesterol Repressible Protein 39b Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?118480

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Cholesterol Repressible Protein 39c Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?302920

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Cholesterol-lowering Factor Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?604595

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Desmosterol-to-cholesterol Enzyme Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?125650

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High Density Lipoprotein Cholesterol Level Quantitative Trait Locus Chromosome 8 Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?607053

24

on

Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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·

High Density Lipoprotein Cholesterol Level Quantitative Trait Locus Chromosome 9 Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?606613

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High Density Lipoprotein Cholesterol, Low Serum, 3 Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?607687

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Hypercholesterolemia Suppressor Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?144020

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Hypercholesterolemia, Autosomal Dominant Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?143890

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Hypercholesterolemia, Autosomal Dominant, 3 Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?603776

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Hypercholesterolemia, Autosomal Dominant, Type B Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?144010

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Hypercholesterolemia, Autosomal Recessive Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?603813

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Lecithin:cholesterol Acyltransferase Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?606967

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Lecithin:cholesterol Acyltransferase Deficiency Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?245900

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Low Density Lipoprotein Cholesterol, Mild Elevation of Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?605028

on

Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: ·

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

·

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

·

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity,


paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html ·

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

·

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html

·

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

·

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html

Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

·

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

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·

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

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PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

·

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “cholesterol” (or synonyms) into the search box and click “Go.”

Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database25 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database26 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. 25

Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 26 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.


To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “cholesterol” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

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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 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 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 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 “cholesterol”:

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·

Other Guides Coronary Disease http://www.nlm.nih.gov/medlineplus/coronarydisease.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseasesgeneral.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html Managing Cholesterol http://www.nlm.nih.gov/medlineplus/tutorials/managingcholesterolloader.html

Within the health topic page dedicated to cholesterol, the following was listed: ·

General/Overviews Cholesterol Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4488 High Blood Cholesterol http://www.4woman.gov/faq/easyread/cholesterol-etr.htm Keeping Cholesterol Under Control Source: Food and Drug Administration http://www.fda.gov/fdac/features/1999/199_chol.html Managing Cholesterol http://www.nlm.nih.gov/medlineplus/tutorials/managingcholesterolloader.html

·

Treatment Cholesterol Lowering Medicines Source: National Heart, Lung, and Blood Institute http://rover.nhlbi.nih.gov/chd/meds.htm Facts about ALLHAT: New Findings about Drugs to Lower High Blood Pressure and Cholesterol Source: National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/health/allhat/facts.htm FDA Approves New Drug for Lowering Cholesterol Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01247.html How Cholesterol-Lowering Drugs Work Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00424 Statin Drugs: Potential Side Effects? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00587 Statins: Powerful Drugs for Lowering Cholesterol http://circ.ahajournals.org/cgi/reprint/105/13/1514.pdf

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·

Nutrition Clarification of Association's Recommendations on Egg Consumption Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3001455 DASH Hypertension Diet Also Lowers Cholesterol, Finds New NHLBI-Funded Study Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/jun2001/nhlbi-21.htm Fats & Cholesterol -- The Good, The Bad, and The Healthy Diet Source: Harvard School of Public Health http://www.hsph.harvard.edu/nutritionsource/fats.html Heart-Healthy Home Cooking: African American Style Source: National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/health/public/heart/other/chdblack/cooking.pdf How Can I Lower High Cholesterol? http://www.americanheart.org/downloadable/heart/1030374239974LwrHighChol .pdf Tips for Eating Out Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=531

·

Specific Conditions/Aspects Cholesterol, Triglycerides, and Diabetes http://www.diabetes.org/main/uedocuments/ADACholesterolPatient.pdf Risk Assessment Tool for Estimating Your 10-Year Risk of Having a Heart Attack Source: National Heart, Lung, and Blood Institute http://hin.nhlbi.nih.gov/atpiii/calculator.asp What Every Consumer Should Know about Trans Fatty Acids Source: Food and Drug Administration http://www.fda.gov/oc/initiatives/transfat/q_a.html What's the Difference between LDL and HDL Cholesterol? Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=180

·

Children Cholesterol and Your Child Source: Nemours Foundation http://kidshealth.org/parent/medical/heart/cholesterol.html Cholesterol: Diet Tips for Children with High Cholesterol Source: American Academy of Family Physicians http://familydoctor.org/handouts/495.html NHLBI Study Shows Reduced Fat Intake To Lower Cholesterol Is Safe and Beneficial for Children Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/feb2001/nhlbi-05.htm

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What's Cholesterol? Source: Nemours Foundation http://kidshealth.org/kid/talk/qa/cholesterol.html ·

From the National Institutes of Health Cholesterol Counts for Everyone Source: National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/chd/index.htm Facts about ALLHAT: New Findings about Drugs to Lower High Blood Pressure and Cholesterol Source: National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/health/allhat/facts.htm High Blood Cholesterol: What You Need to Know Source: National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm Live Healthier Live Longer http://www.nhlbi.nih.gov/health/public/heart/chol/liv_chol.pdf

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Latest News Cholesterol Drug Relieves Leg Artery Disease Source: 09/01/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_13854 .html Cholesterol Drugs Seem to Lower Depression Risk Source: 09/08/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_13909 .html FDA Approves New Drug for Lowering Cholesterol Source: 08/12/2003, Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01247.html Heart Risk High in Arthritis Patients Source: 08/26/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_13799 .html Metabolic Syndrome Puts Some Teens At Risk Source: 09/09/2003, American Diabetes Association http://ada.yellowbrix.com/pages/ada/Story.nsp?story_id=41504351&ID=ada More News on Cholesterol http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/alphanews_c.html#C holesterol National Cholesterol Education Month - September 2003 Source: 08/26/2003, National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/cvh/cholesterol_education_month.htm


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Organizations American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=1200000 National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

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Prevention/Screening Cholesterol Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/cholesterol/test.html Cholesterol: What You Can Do to Lower Your Level Source: American Academy of Family Physicians http://familydoctor.org/healthfacts/029/index.html FDA Clears New Palm Test For Skin Cholesterol Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01154.html HDL Cholesterol Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/hdl/test.html LDL Cholesterol Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/ldl/test.html Simple Steps to Help Reduce Your Risk Source: National Heart, Lung, and Blood Institute http://hin.nhlbi.nih.gov/cholmonth/tips.htm Time to Prevent Cardiovascular Disease Is Now Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3007101

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Research Cholesterol-lowering Drugs Safe and Effective in Children Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3005479 Different Cholesterol Predicts Heart Risk Too, New Target for Drugs? Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3005949 Fish-rich Tribal Diet Linked with Low Leptin Levels Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3003556 High Cholesterol Elevates Women's Risk of Stroke Death Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3003620 Metabolic Syndrome Puts Some Teens At Risk Source: American Diabetes Association

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http://ada.yellowbrix.com/pages/ada/Story.nsp?story_id=41504351&ID=ada Muscle Abnormalities in Four Patients Taking Statins To Treat Unfavorable Cholesterol Levels Source: American College of Physicians http://www.annals.org/cgi/content/full/137/7/I-45 New Drug Raises “Good” Cholesterol Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3002129 Statins before Procedures Reduce Cardiovascular Events and Deaths, Primarily for Patients with Inflammation Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3010301 Treating Cholesterol in Patients with Mild Kidney Disease Source: American College of Physicians http://www.annals.org/cgi/content/full/138/2/I-28 Women Urged to Reduce Heart Disease Risk Before Menopause Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3009770 ·

Statistics Cholesterol Fact Sheet Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/cvh/fs-cholesterol.htm FASTATS: Cholesterol Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/cholest.htm High Blood Cholesterol and Other Lipids: Biostatistical Fact Sheets Source: American Heart Association http://www.americanheart.org/downloadable/heart/1045754065601FS13CHO3.p df State-Specific Trends in High Blood Cholesterol Awareness Among Persons Screened - United States, 1991-1999 Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/fs010907a.htm

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Teenagers What Is Cholesterol? Source: Nemours Foundation http://kidshealth.org/teen/question/dieting/cholesterol.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 Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on cholesterol. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Thinking About Lowering Your Cholesterol Source: Midland, MI: Health Enhancement Systems. 1999. 2 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.68 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESHC1. Summary: This brochure guides readers through the process of thinking about lowering their cholesterol. Cholesterol is a fat like substance that the body needs for many functions, and the liver produces all the cholesterol the body requires. Cholesterol and blood do not mix, so cholesterol needs to be carried in the blood, by fat and protein, in packages called lipoproteins. High density lipoprotein takes cholesterol out of the bloodstream and back to the liver, but low density lipoprotein leaves cholesterol deposits in the walls of the arteries. The brochure begins by explaining the importance of reducing high cholesterol levels. High blood cholesterol levels increase the risk of atherosclerosis, a buildup of fatty deposits in the arteries. This can result in chest pain, heart attacks, and strokes. In addition, the brochure asks a series of questions that helps readers think about lowering cholesterol. The brochure includes a list of helpful organizations.

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Benefits of Controlling Cholesterol Source: Midland, MI: Health Enhancement Systems. 1999. 6 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.98 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESHC2. Summary: This brochure provides readers with information on the benefits of controlling their cholesterol. The brochure begins by identifying the risk factors for high cholesterol that people can and cannot control. Controllable risk factors include diet, weight, and physical activity. Risk factors that people cannot control include age, gender, and heredity. This is followed by information on the advantages of controlling cholesterol and the benefits of keeping an eating and physical activity record. In addition, the brochure presents several scenes that readers can reflect upon to help them control their cholesterol, provides sample questions that readers can answer to learn about their cholesterol and how to lower it, and explains the importance of finding supportive people. The brochure includes a list of helpful organizations.

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Preparing to Control Your Cholesterol Source: Midland, MI: Health Enhancement Systems. 1999. 14 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $1.96 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESHC3. Summary: This brochure provides readers with information on preparing to control their cholesterol. The brochure includes activities that readers complete to learn and practice the skills they need to control their cholesterol. The brochure begins by outlining the advantages of lowering blood cholesterol; identifying the risk factors that people can and cannot control; and presenting information on desirable, borderline, and undesirable total, high density lipoprotein, and low density lipoprotein levels. This is followed by a discussion of the effect of diet and physical activity on blood cholesterol. The brochure then presents eating and exercising strategies to control cholesterol. Eating strategies include lowering total dietary fat, eating less saturated fat, using unsaturated fat when cooking, increasing the intake of naturally low fat foods, eating fewer foods that contain cholesterol, reading food labels for fat content, and asking a registered dietitian for help. Physical activity strategies include finding an enjoyable activity, varying activities, working exercise into the day, and finding a workout partner. In addition, the brochure presents nutrition and physical activity tips to lower cholesterol. Other topics include taking cholesterol lowering medication; monitoring cholesterol; identifying specific, measurable, achievable, relevant, and trackable goals; and putting a personal plan into action by setting a start date, telling others about one's commitment to cholesterol control, establishing priorities, and choosing an option for behavior change. The brochure also includes a healthy eating and exercise log and a list of helpful organizations. 2 tables.

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Feeling Good About Managing Your Cholesterol Source: Midland, MI: Health Enhancement Systems. 1999. 6 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.98 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESHC4. Summary: This brochure provides readers with information on feeling good about managing their cholesterol. The brochure begins by presenting ideas to help readers overcome some of the potential barriers to long term success such as being bored with low calorie eating, being too busy to exercise, traveling, having a hard time eating healthy foods in restaurants, and responding negatively to stress. This is followed by information on establishing goals that are specific, measurable, achievable, relevant, and trackable. Other topics include ways to reward oneself for striving to permanently keep blood cholesterol low and ways friends or family members can be supportive. The brochure includes a personal wellness contract and a list of helpful organizations.

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Maintaining Healthy Cholesterol for Good Source: Midland, MI: Health Enhancement Systems. 1999. 6 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.98 each for a pack of 10 to 50


brochures; bulk quantities available; plus shipping and handling. Item number HESHC5. Summary: This brochure provides readers with information on maintaining healthy cholesterol for life. The brochure begins by explaining how readers can determine whether lapses in cholesterol control are just a momentary slip or a more serious cause for concern. This is followed by information on staying focused on cholesterol control, renewing one's commitment to cholesterol control, balancing one's life, and finding new ways to build even more healthy changes into one's life. Readers answer questions or complete written statements to determine how well they are maintaining their cholesterol control efforts. The brochure includes a list of helpful organizations. ·

Cholesterol and Your Heart Source: Dallas, TX: American Heart Association. 1996. 31 p. Contact: Available from Channing L. Bete Company/American Heart Association Fulfillment Center. 200 State Road, South Deerfield, MA 01373-0200. (800) 611-6083. Fax (800) 499-6464. E-mail: [email protected]. PRICE: $9.50 for 50 copies. Summary: This booklet addresses what cholesterol is, what cholesterol and triglyceride measurements mean, and how foods can help or hinder cholesterol control. The brochure points out that too much cholesterol in the blood increases the risk of heart attack. Topics addressed in the brochure include LDL-cholesterol, HDL-cholesterol, triglycerides, and what cholesterol numbers mean. The booklet explains that of the three kinds of fats in foods, only saturated fatty acids and dietary cholesterol raise blood cholesterol. The four major risk factors for heart attack are high blood cholesterol, tobacco smoke, high blood pressure, and physical inactivity. Another factor that increases the risk of heart attack is diabetes. The brochure notes that dietary cholesterol is found only in foods from animals, such as meat, fish, poultry, and dairy products. According to American Heart Association recommendations, cholesterol intake should be limited to an average of no more than 300 milligrams per day. The booklet concludes with resources to contact for further information. (AA-M).

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Cholesterol and Heart Disease Source: New York, NY: Pfizer Pratt Pharmaceuticals. May 1992. 4 p. Contact: Available from Pfizer Pratt Pharmaceuticals. Attn: Marketing, 235 East 42nd Street, New York, NY 10017. (212) 573-2551. PRICE: Single copy free. Order Number RGA025X91H. Summary: This chart-like brochure briefly presents information about cholesterol and heart disease. Topics include the risk factors for heart disease for people with diabetes; the role of cholesterol in heart problems; and lowering the risks for heart disease by controlling cholesterol, exercising, losing weight, and modifying one's diet. Simple line drawings on each page help to reiterate the concepts presented.

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Cholesterol: The kids' book Source: Valhalla, NY: American Health Foundation. 1993. 8 pp. Contact: Available from American Health Foundation, Child Health Center, One Dana Road, Valhalla, NY 10595. Telephone: (914) 592-2600 or (914) 789-7239 / fax: (914) 5926317.

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Summary: This brochure, developed for young children, provides information on heart health. It explains in simple terms and in colorful drawings what cholesterol is, which foods are high in fat or cholesterol and should be avoided, and which foods are good to eat. ·

Growing up healthy: Fat, cholesterol and more Source: Chicago, IL: American Dietetic Association. ca. 1993. 2 pp. Contact: Available from Customer Service, American Dietetic Association, 216 West Jackson Boulevard, Suite 800, Chicago, IL 60606-6995. Telephone: (312) 899-0040 or (800) 877-1600 or (800) 366-1655 or (800) 225-5267 / fax: (312) 899-1758 / Web site: http://www.eatright.org. Sold in packages of 25, $5.00, ADA members; $6.25, nonmembers. Summary: This brochure was developed as part of a healthy eating campaign for children called, Healthy Start. It is designed to educate parents about good nutrition habits for children and how to help children choose the right foods to avoid too much fat, cholesterol, and sodium. It includes tips for the whole family on limiting fat and cholesterol and increasing physical activity. The brochure is available in English and Spanish.

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Cholesterol and kids: A parent's guide Source: Bethesda, MD: Citizens for Public Action on Blood Pressure and Cholesterol. 1991. 1 p. Contact: Available from Citizens for Public Action on Blood Pressure and Cholesterol, 7200 Wisconsin Avenue, Suite 1002, Bethesda, MD 20814. Telephone: (301) 907-7790. $1.00 for poster-brochure; $3.00 for individual poster. Summary: This fold-out brochure/poster highlights information contained in the National Cholesterol Education Program's report on blood cholesterol levels of children and adolescents). Designed for parents, the brochure highlights the importance of a diet low in total fat, saturated fat, and cholesterol. It reminds parents that they are setting an example and provides suggestions for low-fat, low-cholesterol food choices. Preparation tips are included for breakfast, fast-food trips, eating out, lunch, snacks, kid's favorites, and dinner.

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Empower Yourself! Learn Your Cholesterol Number Source: Washington, DC: National Heart, Lung, and Blood Institute. Office of Research on Minority Health. 8p. 1997. Contact: NHLBI Information Center. Attention: Web Site P.O. Box 30105 Bethesda, MD 20824-0105. Phone 301-592-8573. Fax: 301-592- 8563 E-mail: [email protected]. Website: http://www:nhlbi.nih.gov. Summary: This brochure, aimed at African Americans, explains why high cholesterol is unhealthy, and the difference between HDL and LDL. Suggested actions to lower cholesterol include substituting ground turkey breast for pork sausage and ground beef, skim milk for whole milk and cream, vegetable oil for lard or butter, and lower-fat meats (such as turkey thighs) or bean and grain dishes for fatback, bacon, and other high-fat meats. Readers are advised to be physically active by, for example, jogging, gardening, climbing stairs, or playing a sport. Readers are urged to maintain a healthy


weight by following the low-fat recommendations, staying active, and eating fruits and vegetables for snacks. ·

Be Heart Smart! Eat Foods Lower in Saturated Fats and Cholesterol Source: Washington, DC: National Heart, Lung, and Blood Institute. Office of Research on Minority Health. 8p. 1997. Contact: NHLBI Information Center. Attention: Web Site P.O. Box 30105 Bethesda, MD 20824-0105. Phone 301-592-8573. Fax: 301-592- 8563 E-mail: [email protected]. Website: http://www:nhlbi.nih.gov. Summary: This brochure focuses on ways African Americans can blend traditional foods with a low-fat diet. The role of saturated fat and cholesterol in heart disease is explained and common sources of saturated fats and cholesterol are listed. Suggested meats include pork ears and ham hocks, opossum, and beef tripe. A list of suggestions for alternative cooking methods includes using vegetable oil or broth instead of lard, using low-fat cheese, skimming fat from gravies, and using egg whites or egg substitutes rather than whole eggs. Other ideas are to use other cooking methods than frying, to remove poultry skin, to trim visible fat, to use chicken breasts or drumsticks instead of wings and thighs, to drink skim milk, to eat plenty of vegetables, fruits and grains, and to read nutrition labels. The nutrition label is explained in detail.

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Sane Talk About Healthy Eating for the '90's the Dietary Guidelines Way. Choose a Diet Low in Fat, Saturated Fat and Cholesterol Source: Memphis, TN: Kraft Food Ingredients Corporation, 8 p., N.D. Contact: Kraft Food Ingredients Corporation, 6410 Poplar Avenue, Memphis, TN 38119. Summary: This brochure is one of a series of booklets designed to help consumers follow the U.S. Department of Agriculture's Dietary Guidelines. This brochure focuses on the third guideline, choosing a diet low in fat, saturated fat, and cholesterol. It explains the health risks of a diet high in cholesterol, fat, and saturated fats, offering easy-to-understand definitions for the terms associated with dietary fats. The brochure also explains the link between heart disease and a diet high in fat and cholesterol. Some of the myths and misconceptions about dietary fats are sets straight, and there are four low-fat recipe cards included.

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FitForce, Kit 3: Shooting Down Cholesterol Source: Champaign, IL, Human Kinetics, 10-minute VHS videotape, poster, 19-page instructor's manual, 1995. Contact: Human Kinetics, P.O. Box 5076, Champaign, IL 61825-5076. (800) 747-4457; (217) 351-5076. Summary: FitForce, Kit 3: Shooting Down Cholesterol, an information package, is part of a program called FitForce, which is intended to improve the fitness level of law enforcement officers. Program goals include building strength, eating properly, preventing back pain, controlling cholesterol, and coping with stress. A VHS videotape begins with an officer describing the fear he experienced when he learned that he faced heart surgery. Heart disease is the cause of half of the disability retirements among law enforcement officers. In addition, a police officer is 15 to 20 times more likely to die from a heart attack than from being killed in the line of duty. Factors that increase the risk for heart attack include a high-fat diet, lack of exercise, stress, and a family history of heart

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disease. Methods of reducing one's risk for heart attack include lowering blood pressure, losing weight, and not smoking. In the videotape, a health professional at a rehabilitation facility explains that the fewer predisposing factors a person has, the faster the recovery from stroke and the greater the likelihood that a stroke can be prevented. The degree of artery blockage can even be reversed by eating well, exercising, and not smoking. Other materials in the information package include instructions and a timeline for a 2-month program; a sample program announcement; optional program ideas, such as publications and seminars; tips for lowering cholesterol; a low-fat shopping list; a fact sheet on the effects of cholesterol on the body; a fact sheet listing risk factors for high cholesterol; a lesson plan with objectives and content; text for transparencies; a poster to publicize the program; and an evaluation form. ·

Cholesterol Desk Reference: A Guide for Physicians and Health Care Professionals Source: Washington, DC, American Egg Board, Egg Nutrition Center, 1989. Contact: American Egg Board, Egg Nutrition Center, 2501 M Street, NW., Washington, DC 20037. (202) 883-9950. Summary: The Egg Nutrition Center in Washington, D.C., compiled the Cholesterol Desk Reference: A Guide for Physicians and Health Care Professionals to help the health professional make appropriate dietary recommendations to patients who are at risk for coronary heart disease due to elevated serum cholesterol level. The information is consistent with the National Cholesterol Education Program's Adult Treatment Panel Step 1 Diet and the American Heart Association's Prudent Diet. The kit includes the following: (1) Scientific reviews about cholesterol and heart disease; (2) Nutrition Closeup, a quarterly newsletter; (3) information for diagnosis, treatment, counseling, and followup of high risk patients; (4) patient handouts in black and white reproducible format; (5) samples of four color patient brochures which may be ordered in quantity; and (6) a resource list for additional information.

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Physician's Kit on High Blood Cholesterol Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, Office of Prevention, Education, and Control, National Cholesterol Education Program, six brochures, one poster, 1988. Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, Office of Prevention, Education, and Control, National Cholesterol Education Program, Bethesda, MD 20892. Summary: The Physician's Kit on High Blood Cholesterol includes a number of materials designed to assist the physician in detecting, evaluating, and treating patients with high blood cholesterol. The kit includes the following components: (1) Highlights of the Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, capturing the key recommendations; (2) two patient education publications, So You Have High Blood Cholesterol and Eating to Lower High Blood Cholesterol, which also reflect the report's recommendations; (3) a wall poster for the waiting room urging patients to ask their physician about cholesterol levels; (4) a fact sheet on blood cholesterol for waiting room reading; (5) a brochure from the American Heart Association (AHA) describing new AHA physician education programs; and (6) a marketing flyer which advises physicians on how to obtain the full report, additional copies of patient education publications, and other materials.


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Cholesterol Lowering Principles Source: West Hills, CA: Nutrition Prescriptives. 1997. 1 p. Contact: Available from Nutrition Prescriptives. P.O. Box 4417, West Hills, CA 91308. (818) 347-4760. Fax (818) 992-4319. E-mail: [email protected]. PRICE: $10.00. Summary: This copier-ready, interactive counseling tool is designed to help health care professionals educate patients about lowering cholesterol. The fact sheet provides an action plan for eating fewer foods high in saturated fat, limiting intake of foods high in cholesterol, using low fat cooking methods, eating no more than 30 percent of daily calories as fat, eating foods rich in fiber, and exercising regularly. Space is provided for patients to personalize the suggestions given. The fact sheet includes several computergenerated illustrations and is printed on durable stock. Purchase of a master fact sheet includes a non-transferable license to make copies for patients. The fact sheet is available in English or Spanish. (AA-M).

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Wise Food Choices For Lowering Cholesterol Source: Columbus, OH: Central Ohio Diabetes Association 199x. 2 p. Contact: Available From Central Ohio Diabetes Association (CODA). Janet Gorman, 1803 West Fifth Avenue, Columbus, OH 43212. (614) 486-7124; (800) 422-7946. PRICE: Single copy free. Summary: This fact sheet summarizes wise food choices for readers who are interested in lowering their cholesterol levels. Topics include the metabolism of cholesterol; saturated fats; unsaturated fats; and shopping and preparation tips. The fact sheet presents guidelines for food choices in each of five food groups: meat and meat substitutes, fruits and vegetables, fats and oils, milk and milk products, and bread and cereals.

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Facts About Heart Disease and Women: Reducing High Blood Cholesterol Source: Bethesda, MD, National Heart, Lung, and Blood Institute, 8 p., September 1998. Contact: National Heart, Lung, and Blood Institute, P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. INTERNET/EMAIL: http://www.nhlbi.nih.gov. Summary: Facts About Heart Disease and Women: Reducing High Blood Cholesterol is a source for information on high blood cholesterol and women. Approximately one quarter of American women have blood cholesterol levels high enough to pose a serious risk for heart disease. Ways of reducing blood cholesterol include (1) changing eating habits, (2) losing weight, (3) being physically active, and (4) taking cholesterol-lowering medication. To lower blood cholesterol, one must eat so that less than 10 percent of the day's total calories come from saturated fat, less than 30 percent of the day's total calories come from fat, and less than 300 milligrams of dietary cholesterol are consumed per day. Saturated fat is found mainly in foods that come from animals. Women with high blood cholesterol should read product labels carefully and create a balanced diet by meal planning. Increasing regular physical activity can also help lower one's low density lipoproteins and raise the high density lipoprotein levels. For those who are overweight, losing weight also can help to lower high blood cholesterol.

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Prevalence of High Blood Cholesterol Among Adults in the US Source: Bethesda, MD, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, 4 p., September 1989. Contact: National Heart, Lung, and Blood Institute Education Programs, Information Center, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814-4820. (301) 951-3260. Summary: Prevalence of High Blood Cholesterol Among Adults in the U.S. presents the Adult Treatment Panel (ATP) guidelines for the classification and management of high blood cholesterol. The fact sheet examines the application of the ATP guidelines to the National Health and Nutrition Examination Survey of 1976 through 1980. The data reveals that when the guidelines were applied to the NHANES II, about 41 percent of adults (ages 20 to 74 years) should have lipoprotein analysis after an initial measurement of serum total cholesterol. An estimated 88 percent of those who would need lipoprotein analysis would be candidates for medical advice and intervention based on their low-density lipoprotein cholesterol and risk factor profile. This represents 36 percent of all adults aged 20 to 74 years. Overall, based on 1986 population, the researchers estimate that about 60 million Americans aged 20 and over would be candidates for medical advice and intervention for high blood cholesterol. Tables and figures provide information on the coronary heart disease risk factors to consider when interpreting blood cholesterol levels, and the percent of adults needing lipoprotein analysis and intervention by race, sex, and age category. 3 figures, 2 tables.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “cholesterol” (or synonyms). The following was recently posted: ·

Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Source: National Cholesterol Education Program - Federal Government Agency [U.S.]; 1993 September (updated 2001); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=2969&nbr=2195&a mp;string=cholesterol

Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:


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Be Smart About Your Heart: Control the ABCs of Diabetes Summary: This brochure from the National Diabetes Education Program focuses not only on glucose control but on the control of blood pressure and cholesterol as well. Source: National Diabetes Education Program, National Institute of Diabetes & Digestive & Kidney Diseases http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6365

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Cardiovascular Information for Health Care Professionals Summary: Documents on this site include the Expert Panel Report on High Blood Cholesterol in Adults. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=700

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Check Your Cholesterol And Heart Disease I.Q. Summary: Are you cholesterol smart? This quiz allows you to test your knowledge about high blood cholesterol. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=718

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Cholesterol - too much is dangerous. Samoan and Tongan Food. Summary: Also available In: Source: New South Wales Multicultural Health Communication Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7531

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Cholesterol Information for Patients and General Public Summary: If you have CHD, that's the bad news. But the good news is that by lowering your cholesterol you can reduce your risk of having a heart attack. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1411

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Cholesterol Quiz Summary: Take this online health quiz and find out how much you know about cholesterol levels, smart ways to reduce cholesterol intake, and which foods are high in cholesterol. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6165

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Cholesterol: too much is dangerous. Asian foods Summary: Also available In: Source: New South Wales Multicultural Health Communication Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7481

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Clinical Research Studies: National Heart, Lung, and Blood Institute (NHLBI)/NIH Summary: The National Institutes of Health conducts a large number of research studies with patients who have diseases of the heart and blood vessels, lungs, blood cells and bone marrow, or cholesterol. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2016

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Control the ABCs of Diabetes Summary: This page links to the National Diabetes Education Program campaign stressing the management of blood glucose, blood pressure, and cholesterol. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6553

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High Blood Cholesterol--What You Need to Know Summary: Find out what your cholesterol numbers mean and what treatment your doctor may prescribe to help lower your cholesterol level. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6424

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Learn Your Cholesterol Number Summary: Also available In: Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3165

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Live Healthier, Live Longer: Lowering Cholesterol for the Person With Heart Disease (Interactive Web Site) Summary: If you have heart disease or are at risk for heart disease, visit this interactive site and find out how you can lower your cholesterol. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2933


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MedPed and IHCF Summary: A survey research project and a non-profit organization funded to register and help people with inherited cholesterol disorders. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4133

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National Cholesterol Education Program (NCEP) Summary: The National Heart, Lung, and Blood Institute (NHLBI) launched the National Cholesterol Education Program (NCEP) in November 1985. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=727

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Palm OS Applications--National Heart, Lung, and Blood Institute Summary: Palm OS applications from NHLBI for the following: asthma treatment, BMI calculations, obesity treatment, and cholesterol management. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6391

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Protect Your Heart--Lower Your Blood Cholesterol Summary: Also available In: Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3169

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Questions and Answers about Trans Fat Nutrition Labeling Summary: Answers are provided to questions consumers may have about fat, trans fatty acid (trans fat) and cholesterol. Source: Center for Food Safety and Applied Nutrition http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7626

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Take Care of Your Heart. Manage Your Diabetes: Blood Glucose, Blood Pressure, and Cholesterol Summary: Also available In: Source: National Diabetes Education Program, National Institute of Diabetes & Digestive & Kidney Diseases http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7350

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Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Summary: The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) constitutes the National Cholesterol Education Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6422 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 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

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

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

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

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

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

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WebMDÒHealth: http://my.webmd.com/health_topics

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

Ara Parseghian Medical Research Foundation Address: Telephone: (520) 577-5106 Toll-free: Fax: (520) 577-5212 Email: [email protected]


Web Site: http://www.parseghian.org Background: The Ara Parseghian Medical Research Foundation is an international notfor-profit voluntary organization dedicated to funding research projects to expedite a cure for Niemann-Pick Disease Type C (NP-C); promoting collaborative research efforts among the world s leading experts in cholesterol metabolism; and studying parallel pediatric neurodegenerative disorders. NP-C, a rare inherited disorder of childhood, is a degenerative disease that causes progressive deterioration of the nervous system due to an inability to properly break down cholesterol. Excessive amounts of cholesterol accumulate in the brain, liver, and spleen leading to a variety of symptoms and findings. These may include abnormal enlargement of the liver and spleen (hepatosplenomegaly); difficulty walking (ataxia) and positioning the arms and legs; slurred or slow speech; difficulties performing certain eye movements (vertical supranuclear gaze palsy); and additional symptoms. During mid-adolescence, progressive neurological problems usually lead to life-threatening complications. Established in 1994, the Foundation s purpose is to speed the search for a cure by funding research and promoting worldwide interaction among scientists, research institutes, and universities working on NP-C and related diseases involving the metabolism of cholesterol. ·

Inherited High Cholesterol Foundation Address: 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.

·

National Niemann-Pick Disease Foundation, Inc Address: Telephone: (920) 563-0930 Toll-free: (877) 287-3672 Fax: (920) 563-0931 Email: [email protected] Web Site: http://www.nnpdf.org

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Background: The National Niemann-Pick Disease Foundation, Inc. is an international voluntary not-for-profit organization made up of parents, medical professionals, friends, relatives, and others who are committed to finding a cure for Niemann-Pick Disease (NPD). Niemann-Pick is a group of rare inherited diseases in which excessive amounts of a fatty substance called sphingomyelin and/or cholesterol accumulate in many organs of the body. Established in 1984, the National Niemann-Pick Disease Foundation is dedicated to promoting medical research into the cause and cure of Niemann-Pick Disease; providing medical and educational information to assist in the correct diagnosis and referral of children with Niemann-Pick Disease; and providing support to families of affected children. The Foundation is also committed to facilitating genetic counseling for parents who are known carriers of Niemann-Pick Disease; encouraging the sharing of research information among scientists; and supporting legislation that is beneficial to affected individuals and family members. The National Niemann-Pick Disease Foundation conducts a national conference and provides a variety of educational and support materials.

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to cholesterol. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with 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 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. 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 “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 “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 “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 “cholesterol” (or a synonym) into the search box, and click “Submit Query.”

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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.27

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

27

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

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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)28: ·

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/

28

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

Finding Medical Libraries 551

·

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/

552 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 553

·

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/

554 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

555

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). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on cholesterol: ·

Basic Guidelines for Cholesterol Cholesterol Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002472.htm Cholesterol test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003492.htm

·

Signs & Symptoms for Cholesterol Fainting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm

556 Cholesterol

·

Diagnostics and Tests for Cholesterol ACTH Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003695.htm Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm Cholesterol levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003492.htm HDL Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003496.htm LDL Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003495.htm Total cholesterol Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003492.htm Venipuncture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003423.htm

·

Nutrition for Cholesterol Cholesterol Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002472.htm Fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Low-fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Monounsaturated fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Niacin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002409.htm Polyunsaturated fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Saturated fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Vitamin D Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002405.htm Yogurt Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002463.htm

Online Glossaries 557

·

Background Topics for Cholesterol Adolescent test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002054.htm Bile Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002237.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Cardiovascular Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002310.htm Heart disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000147.htm Infant test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002055.htm Preschooler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002057.htm Schoolage test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002058.htm Shellfish Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002851.htm Toddler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002056.htm

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

559

CHOLESTEROL DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] 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] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [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] Acetone: A colorless liquid used as a solvent and an antiseptic. It is one of the ketone bodies produced during ketoacidosis. [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] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH]

Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acute myelogenous leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myeloid leukemia or acute nonlymphocytic leukemia. [NIH] Acute myeloid leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myelogenous leukemia or acute nonlymphocytic leukemia. [NIH]

560 Cholesterol

Acute nonlymphocytic leukemia: A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myeloid leukemia or acute myelogenous leukemia. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Acyl Coenzyme A: S-Acyl coenzyme A. Fatty acid coenzyme A derivatives that are involved in the biosynthesis and oxidation of fatty acids as well as in ceramide formation. [NIH]

Acylation: The addition of an organic acid radical into a molecule. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [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] Adduct: Complex formed when a carcinogen combines with DNA or a protein. [NIH] 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] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal insufficiency: The reduced secretion of adrenal glands. [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] Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic betaantagonists are used for treatment of hypertension, cardiac arrythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. [NIH] Adrenodoxin:

An iron-sulfur protein which serves as an electron carrier in enzymatic

Dictionary 561

steroid hydroxylation reactions in adrenal cortex mitochondria. The electron transport system which catalyzes this reaction consists of adrenodoxin reductase, NADP, adrenodoxin, and cytochrome P-450. [NIH] Adrenoleukodystrophy: A chromosome X-linked disease. [NIH] 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] 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] Aerobiosis: Life or metabolic reactions occurring in an environment containing oxygen. [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] Affinity Chromatography: In affinity chromatography, a ligand attached to a column binds specifically to the molecule to be purified. [NIH] 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] 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] Aldehyde Dehydrogenase: An enzyme that oxidizes an aldehyde in the presence of NAD+

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and water to an acid and NADH. EC 1.2.1.3. Before 1978, it was classified as EC 1.1.1.70. [NIH]

Alfalfa: A deep-rooted European leguminous plant (Medicago sativa) widely grown for hay and forage. [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 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] Allo: A female hormone. [NIH] Allografts: A graft of tissue obtained from the body of another animal of the same species but with genotype differing from that of the recipient; tissue graft from a donor of one genotype to a host of another genotype with host and donor being members of the same species. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-fetoprotein: AFP. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [NIH] Alpha-helix: One of the secondary element of protein. [NIH] Alpha-Linolenic Acid: A fatty acid that is found in plants and involved in the formation of prostaglandins. [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] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]

Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by

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organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] 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] Amlodipine: 2-((2-Aminoethoxy)methyl)-4-(2-chlorophenyl)-1,4-dihydro-6-methyl-3,5pyridinedicarboxylic acid 3-ethyl 5-methyl ester. A long-acting dihydropyridine calcium channel blocker. It is effective in the treatment of angina pectoris and hypertension. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ammonium Chloride: An acidifying agent that is used as an expectorant and a diuretic. [NIH]

Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]

Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [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] Amyloid beta-Protein: A 4 kD protein, 39-43 amino acids long, expressed by a gene located on chromosome 21. It is the major protein subunit of the vascular and plaque amyloid filaments in individuals with Alzheimer's disease and in aged individuals with trisomy 21 (Down syndrome). The protein is found predominantly in the nervous system, but there have been reports of its presence in non-neural tissue. [NIH] Anaemia: A reduction below normal in the number of erythrocytes per cu. mm., in the quantity of haemoglobin, or in the volume of packed red cells per 100 ml. of blood which occurs when the equilibrium between blood loss (through bleeding or destruction) and blood production is disturbed. [EU]

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Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] 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] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

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] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] 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] Anginal: Pertaining to or characteristic of angina. [EU] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [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 the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly

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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] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Anhydrous: Deprived or destitute of water. [EU] 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] Anion Exchange Resins: High-molecular-weight insoluble polymers that contain functional anionic groups capable of undergoing exchange reactions. These resins are used for ion exchange chromatography, as gastric antacids, hypocholesteremics, etc. [NIH] Anionic: Pertaining to or containing an anion. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anthropometric measurements: Measurements of human body height, weight, and size of component parts, including skinfold measurement. Used to study and compare the relative proportions under normal and abnormal conditions. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] 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] Antibody therapy: Treatment with an antibody, a substance that can directly kill specific tumor cells or stimulate the immune system to kill tumor cells. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antidote: A remedy for counteracting a poison. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective

566 Cholesterol

against fungal infections. [EU] Antifungal Agents: Substances that destroy fungi by suppressing their ability to grow or reproduce. They differ from fungicides, industrial because they defend against fungi present in human or animal tissues. [NIH] 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] Antihypertensive: An agent that reduces high blood pressure. [EU] Antihypertensive Agents: Drugs used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Among the antihypertensive agents are diuretics (especially diuretics, thiazide), adrenergic beta-antagonists, adrenergic alpha-antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. [NIH] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [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] Antipruritic: Relieving or preventing itching. [EU] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are

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caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiserum: The blood serum obtained from an animal after it has been immunized with a particular antigen. It will contain antibodies which are specific for that antigen as well as antibodies specific for any other antigen with which the animal has previously been immunized. [NIH] Antispasmodic: An agent that relieves spasm. [EU] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Apheresis: Components being separated out, as leukapheresis, plasmapheresis, plateletpheresis. [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] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Aqueous fluid: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arcus Senilis: A corneal disease in which there is a deposition of phospholipid and cholesterol in the corneal stroma and anterior sclera. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Argon: A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight 39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [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] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH]

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Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] 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] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthralgia: Pain in the joint. [NIH] Articular: Of or pertaining to a joint. [EU] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspiration: The act of inhaling. [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] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] Atrial: Pertaining to an atrium. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a

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variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [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] Autopsy: Postmortem examination of the body. [NIH] Avidity: The strength of the interaction of an antiserum with a multivalent antigen. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Artery: The continuation of the subclavian artery; it distributes over the upper limb, axilla, chest and shoulder. [NIH] Azotemia: An excess of urea or other nitrogenous compounds in the blood. [EU] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] 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] Bactericidal: Substance lethal to bacteria; substance capable of killing 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] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [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

570 Cholesterol

and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Beta carotene: A vitamin A precursor. Beta carotene belongs to the family of fat-soluble vitamins called carotenoids. [NIH] Betablocker: A drug that induces adrenergic blockade at either ß1- or ß2-adrenergic receptors or at both. [EU] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bezafibrate: Antilipemic agent that lowers cholesterol and triglycerides. It decreases low density lipoproteins and increases high density lipoproteins. [NIH] Bilateral: Affecting both the right and left side of body. [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] 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 duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding agent: A substance that makes a loose mixture stick together. For example, binding agents can be used to make solid pills from loose powders. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biochemical reactions: In living cells, chemical reactions that help sustain life and allow cells to grow. [NIH] Biogenesis: The origin of life. It includes studies of the potential basis for life in organic compounds but excludes studies of the development of altered forms of life through mutation and natural selection, which is evolution. [NIH] Biogenic Amines: A group of naturally occurring amines derived by enzymatic decarboxylation of the natural amino acids. Many have powerful physiological effects (e.g., histamine, serotonin, epinephrine, tyramine). Those derived from aromatic amino acids, and

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also their synthetic analogs (e.g., amphetamine), are of use in pharmacology. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomass: Total mass of all the organisms of a given type and/or in a given area. (From Concise Dictionary of Biology, 1990) It includes the yield of vegetative mass produced from any given crop. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] 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] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [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] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [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 Groups: The classification systems (or schemes) of the different antigens located on erythrocytes.The antigens are the phenotypic expression of the genetic differences characteristic of specific blood groups. [NIH] Blood Preservation: The process by which blood or its components are kept viable outside of the organism from which they are derived (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] 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]

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Blood Proteins: Proteins that are present in blood serum, including serum albumin, blood coagulation factors, and many other types of proteins. [NIH] Blood urea: A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases. [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 Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [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] 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] Boron: A trace element with the atomic symbol B, atomic number 5, and atomic weight 10.81. Boron-10, an isotope of boron, is used as a neutron absorber in boron neutron capture therapy. [NIH] Boron Neutron Capture Therapy: A technique for the treatment of neoplasms, especially gliomas and melanomas in which boron-10, an isotope, is introduced into the target cells followed by irradiation with thermal neutrons. [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] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions),

Dictionary 573

or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Brain Stem Infarctions: Infarctions that occur in the brain stem which is comprised of the midbrain, pons, and medulla. There are several named syndromes characterized by their distinctive clinical manifestations and specific sites of ischemic injury. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breast Self-Examination: The inspection of one's breasts, usually for signs of disease, especially neoplastic disease. [NIH] Bromocriptine: A semisynthetic ergot alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion and is used to treat amenorrhea, galactorrhea, and female infertility, and has been proposed for Parkinson disease. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Buccal mucosa: The inner lining of the cheeks and lips. [NIH] Bullous: Pertaining to or characterized by bullae. [EU] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cachexia: General ill health, malnutrition, and weight loss, usually associated with chronic disease. [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] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcineurin: A calcium- and calmodulin-binding protein present in highest concentrations in the central nervous system. Calcineurin is composed of two subunits. A catalytic subunit, calcineurin A, and a regulatory subunit, calcineurin B, with molecular weights of about 60 kD and 19 kD, respectively. Calcineurin has been shown to dephosphorylate a number of

574 Cholesterol

phosphoproteins including histones, myosin light chain, and the regulatory subunit of cAMP-dependent protein kinase. It is involved in the regulation of signal transduction and is the target of an important class of immunophilin-immunosuppressive drug complexes in T-lymphocytes that act by inhibiting T-cell activation. EC 3.1.3.-. [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] Calcium Chloride: A salt used to replenish calcium levels, as an acid-producing diuretic, and as an antidote for magnesium poisoning. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency, or other output. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Camptothecin: An alkaloid isolated from the stem wood of the Chinese tree, Camptotheca acuminata. This compound selectively inhibits the nuclear enzyme DNA topoisomerase. Several semisynthetic analogs of camptothecin have demonstrated antitumor activity. [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] Capillary Permeability: Property of blood capillary walls that allows for the selective exchange of substances. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (tight junctions) which may limit large molecule movement. [NIH] Capsid: The outer protein protective shell of a virus, which protects the viral nucleic acid. [NIH]

Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH]

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Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the 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] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboxy: Cannabinoid. [NIH] Carboxylic Acids: Organic compounds containing the carboxy group (-COOH). This group of compounds includes amino acids and fatty acids. Carboxylic acids can be saturated, unsaturated, or aromatic. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiopathy: Any disorder or disease of the heart. In addition to heart disease of inflammatory origin, there are arteriosclerotic cardiopathy, due to arteriosclerosis; fatty cardiopathy, due to growth of fatty tissue; hypertensive cardiopathy, due to high blood pressure; nephropathic cardiopathy, due to kidney disease, thyrotoxic cardiopathy, due to thyroid intoxication; toxic cardiopathy, due to the effect of some toxin; and valvular cardiopathy, due to faulty valve action. [EU] Cardiorespiratory: Relating to the heart and lungs and their function. [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] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotenoids: Substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. May reduce the risk of developing cancer. [NIH] Carotid Arteries: Either of the two principal arteries on both sides of the neck that supply blood to the head and neck; each divides into two branches, the internal carotid artery and the external carotid artery. [NIH]

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Carotid Stenosis: The constriction or narrowing of an orifice or the lumen of a hollow or tubular organ. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Cataracts: In medicine, an opacity of the crystalline lens of the eye obstructing partially or totally its transmission of light. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catfish: Common name to express the order Siluriformes. This order contains many families and over 2,000 species, including venomous species. Heteropneustes and Plotosus genera have dangerous stings and are aggressive. Most species are passive stingers. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [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] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] 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] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Caveolae: Endocytic/exocytic cell membrane structures rich in glycosphingolipids, cholesterol, and lipid-anchored membrane proteins that function in endocytosis (potocytosis), transcytosis, and signal transduction. Caveolae assume various shapes from open pits to closed vesicles. Caveolar coats are composed of caveolins. [NIH] Caveolins: The main structural proteins of caveolae. Several distinct genes for caveolins have been identified. [NIH] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Celecoxib: A drug that reduces pain. Celecoxib belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is being studied for cancer prevention. [NIH] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [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

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metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [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] Cell Membrane Structures: Structures which are part of the cell membrane or have cell membrane as a major part of their structure. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellular adhesion: The close adherence (bonding) to adjoining cell surfaces. [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] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and

578 Cholesterol

learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [NIH] Cerebral Hemorrhage: Bleeding into a cerebral hemisphere of the brain, including lobar, subcortical white matter, and basal ganglia hemorrhages. Commonly associated conditions include hypertension; intracranial arteriosclerosis; intracranial aneurysm; craniocerebral trauma; intracranial arteriovenous malformations; cerebral amyloid angiopathy; and cerebral infarction. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrotendinous Xanthomatosis: A primary fatty degeneration of the cornea occurring physiologically as an arcus senilis. [NIH] 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] CHD: 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] Chemopreventive: Natural or synthetic compound used to intervene in the early precancerous stages of carcinogenesis. [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] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chenodeoxycholic Acid: A bile acid, usually conjugated with either glycine or taurine. It acts as a detergent to solubilize fats for intestinal absorption and is reabsorbed by the small intestine. It is used as cholagogue, a choleretic laxative, and to prevent or dissolve gallstones. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH]

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Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Chloroform: A commonly used laboratory solvent. It was previously used as an anesthetic, but was banned from use in the U.S. due to its suspected carcinogenecity. [NIH] Chlorpromazine: The prototypical phenothiazine antipsychotic drug. Like the other drugs in this class chlorpromazine's antipsychotic actions are thought to be due to long-term adaptation by the brain to blocking dopamine receptors. Chlorpromazine has several other actions and therapeutic uses, including as an antiemetic and in the treatment of intractable hiccup. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Cholecystostomy: Establishment of an opening into the gallbladder either for drainage or surgical communication with another part of the digestive tract, usually the duodenum or jejunum. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Choleretic: A choleretic agent. [EU] Cholestanol: A cholesterol derivative found in human feces, gallstones, eggs, and other biological matter. [NIH] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [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 Esterase: An enzyme that catalyzes the hydrolysis of cholesterol and some other sterol esters, to liberate cholesterol plus a fatty acid anion. EC 3.1.1.13. [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] Cholesterol Oxidase: An enzyme that catalyzes the oxidation of cholesterol in the presence of molecular oxygen to 4-cholesten-3-one and hydrogen peroxide. The enzyme is not specific for cholesterol, but will also oxidize other 3-hydroxysteroids. EC 1.1.3.6. [NIH] Cholestyramine: Strongly basic anion exchange resin whose main constituent is polystyrene trimethylbenzylammonium as Cl(-) anion. It exchanges chloride ions with bile salts, thus decreasing their concentration and that of cholesterol. It is used as a hypocholesteremic in diarrhea and biliary obstruction and as an antipruritic. [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] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH]

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Chromaffin System: The cells of the body which stain with chromium salts. They occur along the sympathetic nerves, in the adrenal gland, and in various other organs. [NIH] 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] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chromosomal: Pertaining to chromosomes. [EU] 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 renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary Body: A ring of tissue extending from the scleral spur to the ora serrata of the retina. It consists of the uveal portion and the epithelial portion. The ciliary muscle is in the uveal portion and the ciliary processes are in the epithelial portion. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clathrin: The main structural coat protein of coated vesicles which play a key role in the intracellular transport between membranous organelles. Clathrin also interacts with cytoskeletal proteins. [NIH] Claudication: Limping or lameness. [EU] 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]

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Climacteric: Physiologic period, characterized by endocrine, somatic, and psychic changes with the termination of ovarian function in the female. It may also accompany the normal diminution of sexual activity in the male. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [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] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [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] Coal: A natural fuel formed by partial decomposition of vegetable matter under certain environmental conditions. [NIH] Coated Vesicles: Vesicles formed when cell-membrane coated pits invaginate and pinch off. The outer surface of these vesicles are covered with a lattice-like network of coat proteins, such as clathrin, coat protein complex proteins, or caveolins. [NIH] Cod Liver Oil: Oil obtained from fresh livers of the cod family, Gadidae. It is a source of vitamins A and D. [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] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Colchicine: A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (periodic disease). [NIH] Colestipol: Highly crosslinked and insoluble basic anion exchange resin used as anticholesteremic. It may also may reduce triglyceride levels. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is

582 Cholesterol

differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] 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 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] Complementation: The production of a wild-type phenotype when two different mutations are combined in a diploid or a heterokaryon and tested in trans-configuration. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or

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bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [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] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Computerized 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 computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concentric: Having a common center of curvature or symmetry. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] 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] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [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] Connective Tissue Cells:

A group of cells that includes fibroblasts, cartilage cells,

584 Cholesterol

adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constrict: Tighten; narrow. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contact dermatitis: Inflammation of the skin with varying degrees of erythema, edema and vesinculation resulting from cutaneous contact with a foreign substance or other exposure. [NIH]

Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] 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] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: group. [NIH]

An experiment or clinical trial that includes a comparison (control)

Cookery: The art or practice of cooking. It includes the preparation of special foods for diets in various diseases. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Corn Oil: Oil from corn or corn plant. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneum: The superficial layer of the epidermis containing keratinized cells. [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 Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart.

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[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] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Corpuscle: A small mass or body; a sensory nerve end bulb; a cell, especially that of the blood or the lymph. [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] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Coumarin: A fluorescent dye. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] 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] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Criterion: A standard by which something may be judged. [EU]

586 Cholesterol

Cross Infection: Any infection which a patient contracts in a healthcare institution. [NIH] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] Culture Media: Any liquid or solid preparation made specifically for the growth, storage, or transport of microorganisms or other types of cells. The variety of media that exist allow for the culturing of specific microorganisms and cell types, such as differential media, selective media, test media, and defined media. Solid media consist of liquid media that have been solidified with an agent such as agar or gelatin. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curcumin: A dye obtained from tumeric, the powdered root of Curcuma longa Linn. It is used in the preparation of curcuma paper and the detection of boron. Curcumin appears to possess a spectrum of pharmacological properties, due primarily to its inhibitory effects on metabolic enzymes. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyanide: An extremely toxic class of compounds that can be lethal on inhaling of ingesting in minute quantities. [NIH] 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] Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, ... New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytochrome b: Cytochromes (electron-transporting proteins) with protoheme or a related heme as the prosthetic group. The prosthetic group is not covalently bound to the protein moiety. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] 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]

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Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Cytotoxic: Cell-killing. [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] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [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] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Materials: Materials used in the production of dental bases, restorations, impressions, prostheses, etc. [NIH] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH] Deoxycholic Acid: A bile acid formed by bacterial action from cholate. It is usually conjugated with glycine or taurine. Deoxycholic acid acts as a detergent to solubilize fats for intestinal absorption, is reabsorbed itself, and is used as a choleretic and detergent. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively

588 Cholesterol

persistent. [NIH] Dermal: Pertaining to or coming from the skin. [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] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [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] Desquamation: The shedding of epithelial elements, chiefly of the skin, in scales or small sheets; exfoliation. [EU] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [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] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH]

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Dichloroacetate: A derivative of acetic acid which increases the activity of pyruvate dehydrogenase and rate of lipogenesis. It is used in organic synthesis, pharmaceuticals, and medicine. [NIH] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] 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] Dietary Proteins: Proteins obtained from foods. They are the main source of the essential amino acids. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Diffusivity: Of a reverberant sound field. The degree to which the directions of propagation of waves are random from point to point. [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] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dihydroxy: AMPA/Kainate antagonist. [NIH] Dihydroxyacetone: A ketotriose compound. Its addition to blood preservation solutions results in better maintenance of 2,3-diphosphoglycerate levels during storage. It is readily phosphorylated to dihydroxyacetone phosphate by triokinase in erythrocytes. In combination with naphthoquinones it acts as a sunscreening agent. [NIH] Dihydroxyacetone Phosphate: glycolysis. [NIH]

An important intermediate in lipid biosynthesis and in

Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Dimerization: The process by which two molecules of the same chemical composition form a condensation product or polymer. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH]

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Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of singlestranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Dolichol: Eicosamethyl octacontanonadecasen-1-o1. Polyprenol found in animal tissues that contains about 20 isoprene residues, the one carrying the alcohol group being saturated. [NIH]

Domesticated: Species in which the evolutionary process has been influenced by humans to meet their needs. [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] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the

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back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Combinations: Single preparations containing two or more active agents, for the purpose of their concurrent administration as a fixed dose mixture. It is differentiated from combination drug therapy in which two or more drugs are administered separately for a combined effect. [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] Drusen: Tiny yellow or white deposits in the retina or optic nerve head. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] 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] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents (Dorland, 27th ed). [NIH] 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]

592 Cholesterol

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] Egg Yolk: Cytoplasm stored in an egg that contains nutritional reserves for the developing embryo. It is rich in polysaccharides, lipids, and proteins. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [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] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrochemistry: The study of chemical changes resulting from electrical action and electrical activity resulting from chemical changes. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electron microscope: A microscope (device used to magnify small objects) that uses electrons (instead of light) to produce an enlarged image. An electron microscopes shows tiny details better than any other type of microscope. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Electroplating: Coating with a metal or alloy by electrolysis. [NIH] Electroretinogram: The electrical effect recorded from the surface of the eyeball and originated by a pulse of light. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH]

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Emergency Medicine: A branch of medicine concerned with an individual's resuscitation, transportation and care from the point of injury or beginning of illness through the hospital or other emergency treatment facility. [NIH] Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH]

Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH] Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [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] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocytosis: Cellular uptake of extracellular materials within membrane-limited vacuoles or microvesicles. Endosomes play a central role in endocytosis. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [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]

594 Cholesterol

Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [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] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enterocytes: Terminally differentiated cells comprising the majority of the external surface of the intestinal epithelium (see intestinal mucosa). Unlike goblet cells, they do not produce or secrete mucins, nor do they secrete cryptdins as do the paneth cells. [NIH] Enterohepatic: Of or involving the intestine and liver. [EU] Enterohepatic Circulation: Recycling through liver by excretion in bile, reabsorption from intestines into portal circulation, passage back into liver, and re-excretion in bile. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [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] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Enzyme-Linked Immunosorbent Assay: An immunoassay utilizing an antibody labeled

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with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. [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] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU]

Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]

Epoprostenol: A prostaglandin that is biosynthesized enzymatically from prostaglandin endoperoxides in human vascular tissue. It is a potent inhibitor of platelet aggregation. The sodium salt has been also used to treat primary pulmonary hypertension. [NIH] Epoxy Resins: Organic compounds containing an epoxide group and characterized by strength and thermosetting properties. Epoxy resins are often used as dental materials. [NIH] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a fungus. [NIH] ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocyte Membrane: The semipermeable outer portion of the red corpuscle. It is known as a 'ghost' after hemolysis. [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.

596 Cholesterol

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]

Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [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] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethanolamine: A viscous, hygroscopic amino alcohol with an ammoniacal odor. It is widely distributed in biological tissue and is a component of lecithin. It is used as a surfactant, fluorimetric reagent, and to remove CO2 and H2S from natural gas and other gases. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [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] Ethylene Glycol: A colorless, odorless, viscous dihydroxy alcohol. It has a sweet taste, but is poisonous if ingested. Ethylene glycol is the most important glycol commercially available and is manufactured on a large scale in the United States. It is used as an antifreeze and coolant, in hydraulic fluids, and in the manufacture of low-freezing dynamites and resins. [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] Excrete: To get rid of waste from the body. [NIH] Exfoliation: A falling off in scales or layers. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exon: The part of the DNA that encodes the information for the actual amino acid sequence of the protein. In many eucaryotic genes, the coding sequences consist of a series of exons alternating with intron sequences. [NIH] Expectorant: 1. Promoting the ejection, by spitting, of mucus or other fluids from the lungs

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and trachea. 2. An agent that promotes the ejection of mucus or exudate from the lungs, bronchi, and trachea; sometimes extended to all remedies that quiet cough (antitussives). [EU]

Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [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] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Facial: Of or pertaining to the face. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Farnesyl: Enzyme which adds 15 carbon atoms to the Ras precursor protein. [NIH] Fast Neutrons: Neutrons, the energy of which exceeds some arbitrary level, usually around one million electron volts. [NIH] Fat: Total lipids including phospholipids. [NIH] Fat Substitutes: Compounds used in food or in food preparation to replace dietary fats. They may be carbohydrate-, protein-, or fat-based. Fat substitutes are usually lower in calories but provide the same texture as fats. [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]

598 Cholesterol

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] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH]

Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fertilizers: Substances or mixtures that are added to the soil to supply nutrients or to make available nutrients already present in the soil, in order to increase plant growth and productivity. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibril: Most bacterial viruses have a hollow tail with specialized fibrils at its tip. The tail fibers attach to the cell wall of the host. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of 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] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filipin: A complex of polyene antibiotics obtained from Streptomyces filipinensis. Filipin III alters membrane function by interfering with membrane sterols, inhibits mitochondrial respiration, and is proposed as an antifungal agent. Filipins I, II, and IV are less important. [NIH]

Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fish Products: Food products manufactured from fish (e.g., fish flour, fish meal). [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral

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cortex which involves the entire thickness of the brain wall. [EU] Flatus: Gas passed through the rectum. [NIH] Flexor: Muscles which flex a joint. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Foam Cells: Lipid-laden macrophages originating from monocytes or from smooth muscle cells. [NIH] Foetal: Of or pertaining to a fetus; pertaining to in utero development after the embryonic period. [EU] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Follicles: Shafts through which hair grows. [NIH] Follicular Fluid: A fluid consisting of sex steroid hormones, plasma proteins, mucopolysaccharides, and electrolytes that is present in the vesicular ovarian follicle (Graafian follicle) surrounding the ovum. [NIH] Food Preferences: The selection of one food over another. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Founder Effect: The principle that when a small subgroup of a larger population establishes itself as a separate and isolated entity, its gene pool carries only a fraction of the genetic diversity of the parental population. This may result in an increased frequency of certain diseases in the subgroup, especially those diseases known to be autosomal recessive. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH]

600 Cholesterol

Frontal Sinus: One of the paired, but seldom symmetrical, air spaces located between the inner and outer compact layers of the frontal bone. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [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] Fungicides, Industrial: Chemicals that kill or inhibit the growth of fungi in agricultural applications, on wood, plastics, or other materials, in swimming pools, etc. [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] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallbladder Emptying: A process whereby bile is delivered from the gallbladder into the duodenum. The emptying is caused by both contraction of the gallbladder and relaxation of the sphincter mechanism at the choledochal terminus. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gamma-interferon: Interferon produced by T-lymphocytes in response to various mitogens and antigens. Gamma interferon appears to have potent antineoplastic, immunoregulatory and antiviral activity. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] Ganglioside: Protein kinase C's inhibitor which reduces ischemia-related brain damage. [NIH]

Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH]

Dictionary 601

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] Gasoline: Volative flammable fuel (liquid hydrocarbons) derived from crude petroleum by processes such as distillation reforming, polymerization, etc. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal Agents: Drugs used for their effects on the gastrointestinal system, as to control gastric acidity, regulate gastrointestinal motility and water flow, and improve digestion. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gavage: Feeding by a tube passed into the stomach; called also tube feeding. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [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] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [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 Screening: Searching a population or individuals for persons possessing certain

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genotypes or karyotypes that: (1) are already associated with disease or predispose to disease; (2) may lead to disease in their descendants; or (3) produce other variations not known to be associated with disease. Genetic screening may be directed toward identifying phenotypic expression of genetic traits. It includes prenatal genetic screening. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetic transcription: The process by which the genetic information encoded in the gene, represented as a linear sequence of deoxyribonucleotides, is copied into an exactly complementary sequence of ribonucleotides known as messenger RNA. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Layers: The three layers of cells comprising the early embryo. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [NIH] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [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] Glomerulosclerosis: Scarring of the glomeruli. It may result from diabetes mellitus (diabetic glomerulosclerosis) or from deposits in parts of the glomerulus (focal segmental glomerulosclerosis). The most common signs of glomerulosclerosis are proteinuria and kidney failure. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH]

Dictionary 603

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 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] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glucuronides: Glycosides of glucuronic acid formed by the reaction of uridine diphosphate glucuronic acid with certain endogenous and exogenous substances. Their formation is important for the detoxification of drugs, steroid excretion and bilirubin metabolism to a more water-soluble compound that can be eliminated in the urine and bile. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH] Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [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]

Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [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] Glycophorin: The major sialoglycoprotein of the human erythrocyte membrane. It consists of at least two sialoglycopeptides and is composed of 60% carbohydrate including sialic acid and 40% protein. It is involved in a number of different biological activities including the binding of MN blood groups, influenza viruses, kidney bean phytohemagglutinin, and wheat germ agglutinin. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH]

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Glycosaminoglycan: A type of long, unbranched polysaccharide molecule. Glycosaminoglycans are major structural components of cartilage and are also found in the cornea of the eye. [NIH] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Goblet Cells: Cells of the epithelial lining that produce and secrete mucins. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] 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] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [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]

Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Graft-versus-host disease: GVHD. A reaction of donated bone marrow or peripheral stem cells against a person's tissue. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Granuloma Inguinale: Anogenital ulcers caused by Calymmatobacterium granulomatis as distinguished from lymphogranuloma inguinale (see lymphogranuloma venereum) caused by Chlamydia trachomatis. Diagnosis is made by demonstration of typical intracellular Donovan bodies in crushed-tissue smears. [NIH] Graphite: An allotropic form of carbon that is used in pencils, as a lubricant, and in matches and explosives. It is obtained by mining and its dust can cause lung irritation. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH]

Dictionary 605

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanine: One of the four DNA bases. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Guinea Pigs: A common name used for the family Caviidae. The most common species is Cavia porcellus which is the domesticated guinea pig used for pets and biomedical research. [NIH]

Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] 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] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] 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] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Hate: An enduring attitude or sentiment toward persons or objects manifested by anger, aversion and desire for the misfortune of others. [NIH] HDL: Lipoproteins (high-density lipoproteins) that contain a small amount of cholesterol and carry cholesterol away from body cells and tissues to the liver for excretion from the body. Low-level HDL increases the risk of heart disease, so the higher the HDL level, the better. The HDL component normally contains 20 to 30 percent of total cholesterol, and HDL levels are inversely correlated with coronary heart disease risk. [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] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH]

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Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Fairs: Community health education events focused on prevention of disease and promotion of health through audiovisual exhibits. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [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] Heartbeat: One complete contraction of the heart. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemicellulose: A general term to describe those polysaccharides other than cellulose which are constituents of vegetable cell walls. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [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] 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

Dictionary 607

lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocyte: A liver cell. [NIH] Herbicides: Pesticides used to destroy unwanted vegetation, especially various types of weeds, grasses, and woody plants. [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] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH] Heterotrophic: Pertaining to organisms that are consumers and dependent on other organisms for their source of energy (food). [NIH] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [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 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

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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] High-density lipoproteins: Lipoproteins that contain a small amount of cholesterol and carry cholesterol away from body cells and tissues to the liver for excretion from the body. Low-level HDL increases the risk of heart disease, so the higher the HDL level, the better. The HDL component normally contains 20 to 30 percent of total cholesterol, and HDL levels are inversely correlated with coronary heart disease risk. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homicide: The killing of one person by another. [NIH] Homogenate: A suspension of animal tissue that is ground in the all-glass "homogenizer" described by Potter and Elvehjem in 1936. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] 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] Horny layer: The superficial layer of the epidermis containing keratinized cells. [NIH] Horseradish Peroxidase: An enzyme isolated from horseradish which is able to act as an antigen. It is frequently used as a histochemical tracer for light and electron microscopy. Its antigenicity has permitted its use as a combined antigen and marker in experimental immunology. [NIH] Hospitals, Public: Hospitals controlled by various types of government, i.e., city, county, district, state or federal. [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] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydration: Combining with water. [NIH]

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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] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolases: Any member of the class of enzymes that catalyze the cleavage of the substrate and the addition of water to the resulting molecules, e.g., esterases, glycosidases (glycoside hydrolases), lipases, nucleotidases, peptidases (peptide hydrolases), and phosphatases (phosphoric monoester hydrolases). EC 3. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxycholesterols: Cholesterol which is substituted by a hydroxy group in any position. [NIH]

Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hydroxysteroids: Steroids in which one or more hydroxy groups have been substituted for hydrogen atoms either within the ring skeleton or on any of the side chains. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] 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] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperkeratosis: 1. Hypertrophy of the corneous layer of the skin. 2a. Any of various conditions marked by hyperkeratosis. 2b. A disease of cattle marked by thickening and wringling of the hide and formation of papillary outgrowths on the buccal mucous membranes, often accompanied by watery discharge from eyes and nose, diarrhoea, loss of condition, and abortion of pregnant animals, and now believed to result from ingestion of the chlorinated naphthalene of various lubricating oils. [EU] Hyperlipidaemia: A general term for elevated concentrations of any or all of the lipids in the plasma, including hyperlipoproteinaemia, hypercholesterolaemia, etc. [EU] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in

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the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [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] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypochlorous Acid: HClO. An oxyacid of chlorine containing monovalent chlorine that acts as an oxidizing or reducing agent. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypolipidemic: A drug that lowers abnormally high plasma concentrations of cholesterol or triglycerides or both. [NIH] Hypophysis: A remnant of the entodermal pouch of Rathke beneath the mucous membrane of the pharynx, which shows pituitary tissue. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] 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] Hypotonia: A condition of diminished tone of the skeletal muscles; diminished resistance of muscles to passive stretching. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Ichthyosis: Any of several generalized skin disorders characterized by dryness, roughness, and scaliness, due to hypertrophy of the stratum corneum epidermis. Most are genetic, but some are acquired, developing in association with other systemic disease or genetic syndrome. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileum: The lower end of the small intestine. [NIH] Iliac Artery: Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs. [NIH] Iloprost: An eicosanoid, derived from the cyclooxygenase pathway of arachidonic acid metabolism. It is a stable and synthetic analog of epoprostenol, but with a longer half-life than the parent compound. Its actions are similar to prostacyclin. Iloprost produces vasodilation and inhibits platelet aggregation. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH]

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Immune response: (antigens). [NIH]

The activity of the immune system against foreign substances

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [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 effects of foreign microorganisms or to the toxic effect of antigenic substances. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] 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] Immunology: The study of the body's immune system. [NIH] Immunophilin: A drug for the treatment of Parkinson's disease. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive Agents: Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of suppressor T-cell populations or by inhibiting the activation of helper cells. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of interleukins and other cytokines are emerging. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] 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] Incision: A cut made in the body during surgery. [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] Incubated: Grown in the laboratory under controlled conditions. (For instance, white blood cells can be grown in special conditions so that they attack specific cancer cells when

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returned to the body.) [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] 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] Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] 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, 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]

Infection Control: Programs of disease surveillance, generally within health care facilities, designed to investigate, prevent, and control the spread of infections and their causative microorganisms. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infestation: Parasitic attack or subsistence on the skin and/or its appendages, as by insects, mites, or ticks; sometimes used to denote parasitic invasion of the organs and tissues, as by helminths. [NIH] 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] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been

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identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insecticides: Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. [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] Instillation: . [EU] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [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] Intercellular Adhesion Molecule-1: A cell-surface ligand with a role in leukocyte adhesion and inflammation. Its production is induced by gamma-interferon and it is required for neutrophil migration into inflamed tissue. [NIH] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intermittent Claudication: A symptom complex characterized by leg pain and weakness brought on by walking, with the disappearance of the symptoms following a brief rest. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [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] Intracranial Aneurysm: A saclike dilatation of the walls of a blood vessel, usually an artery. [NIH]

Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the

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circulatory system, CSF dynamics, and skull rigidity. [NIH] Intrahepatic: Within the liver. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: individuals. [NIH]

Pressure of the fluid inside the eye; normal IOP varies among

Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Exchange: Reversible chemical reaction between a solid, often an ION exchange resin, and a fluid whereby ions may be exchanged from one substance to another. This technique is used in water purification, in research, and in industry. [NIH] Ion Exchange Resins: High molecular weight, insoluble polymers which contain functional groups that are capable of undergoing exchange reactions (ion exchange) with either cations or anions. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [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] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight,

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speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Isoelectric: Separation of amphoteric substances, dissolved in water, based on their isoelectric behavior. The amphoteric substances are a mixture of proteins to be separated and of auxiliary "carrier ampholytes". [NIH] Isoelectric Point: The pH in solutions of proteins and related compounds at which the dipolar ions are at a maximum. [NIH] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Isoflavones: 3-Phenylchromones. Isomeric form of flavones in which the benzene group is attached to the 3 position of the benzopyran ring instead of the 2 position. [NIH] Isoleucine: An essential branched-chain amino acid found in many proteins. It is an isomer of LEUCINE. It is important in hemoglobin synthesis and regulation of blood sugar and energy levels. [NIH] Isomerases: A class of enzymes that catalyze geometric or structural changes within a molecule to form a single product. The reactions do not involve a net change in the concentrations of compounds other than the substrate and the product.(from Dorland, 28th ed) EC 5. [NIH] Isoprenoid: Molecule that might anchor G protein to the cell membrane as it is hydrophobic. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kallidin: A decapeptide bradykinin homolog produced by the action of tissue and glandular kallikreins on low-molecular-weight kininogen. It is a smooth-muscle stimulant and hypotensive agent that functions through vasodilatation. [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] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Keratosis: Any horny growth such as a wart or callus. [NIH]

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Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [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 Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [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] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactation: The period of the secretion of milk. [EU] 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] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

LDL: 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] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Leg Ulcer: Ulceration of the skin and underlying structures of the lower extremity. About 90% of the cases are due to venous insufficiency (varicose ulcer), 5% to arterial disease, and the remaining 5% to other causes. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the

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peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lethal: Deadly, fatal. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH]

Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukaemia: An acute or chronic disease of unknown cause in man and other warmblooded animals that involves the blood-forming organs, is characterized by an abnormal increase in the number of leucocytes in the tissues of the body with or without a corresponding increase of those in the circulating blood, and is classified according of the type leucocyte most prominently involved. [EU] Leukapheresis: The preparation of leukocyte concentrates with the return of red cells and leukocyte-poor plasma to the donor. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: circulation. [NIH]

Services offered to the library user. They include reference and

Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligases: A class of enzymes that catalyze the formation of a bond between two substrate molecules, coupled with the hydrolysis of a pyrophosphate bond in ATP or a similar energy donor. (Dorland, 28th ed) EC 6. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Limb Bud: A swelling on the trunk of the vertebrate embryo that becomes a limb. Limb bud cultures are used in developmental, organogenesis, morphogenesis, and cell differentiation studies. The limb bud of the chick embryo is most commonly used but mouse and rat limb buds are also used. [NIH]

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Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [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] Linolenic Acids: Eighteen-carbon essential fatty acids that contain three double bonds. [NIH]

Lipaemia: The presence of an excess of fats or lipids in the blood. [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 Bilayers: Layers of lipid molecules which are two molecules thick. Bilayer systems are frequently studied as models of biological membranes. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipodystrophy: A collection of rare conditions resulting from defective fat metabolism and characterized by atrophy of the subcutaneous fat. They include total, congenital or acquired, partial, abdominal infantile, and localized lipodystrophy. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] 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] Lipoprotein(a): A family of lipoprotein particles varying in density and size depending on the protein-lipid ratio and the protein composition. These particles consist of apolipoprotein B-100 covalently linked to apolipoprotein-a by one or two disulfide bonds. There is a correlation between high plasma levels of this lipoprotein and increased risk for atherosclerotic cardiovascular disease. [NIH] Liposomal: A drug preparation that contains the active drug in very tiny fat particles. This fat-encapsulated drug is absorbed better, and its distribution to the tumor site is improved. [NIH]

Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between

Dictionary 619

linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is laser lithotripsy. [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 cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [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] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [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 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

620 Cholesterol

fat. [NIH] Lubricants: Oily or slippery substances. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lupus Nephritis: Glomerulonephritis associated with systemic lupus erythematosus. It is classified into four histologic types: mesangial, focal, diffuse, and membranous. [NIH] Lyases: A class of enzymes that catalyze the cleavage of C-C, C-O, and C-N, and other bonds by other means than by hydrolysis or oxidation. (Enzyme Nomenclature, 1992) EC 4. [NIH]

Lye: Generally speaking, it is the alkaline substance obtained from wood ashes by percolation. Preparations of lye can either be solutions of potassium or sodium hydroxide. The term lye, is also used to refer to the household product which is a mixture of sodium hydroxide and sodium carbonate. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphadenopathy: Disease or swelling of the lymph nodes. [NIH] 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] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [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] Lymphogranuloma Venereum: Subacute inflammation of the inguinal lymph glands caused by certain immunotypes of Chlamydia trachomatis. It is a sexually transmitted disease in the U.S. but is more widespread in developing countries. It is distinguished from granuloma venereum (granuloma inguinale), which is caused by Calymmatobacterium granulomatis. [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] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysophospholipase: An enzyme that catalyzes the hydrolysis of a single fatty acid ester bond in lysoglycerophosphatidates with the formation of glyceryl phosphatidates and a

Dictionary 621

fatty acid. EC 3.1.1.5. [NIH] Lysophospholipids: Derivatives of phosphatidic acids that lack one of its fatty acyl chains due to its hydrolytic removal. [NIH] Lysosome: A sac-like compartment inside a cell that has enzymes that can break down cellular components that need to be destroyed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] 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] Macula: A stain, spot, or thickening. Often used alone to refer to the macula retinae. [EU] Macula Lutea: An oval area in the retina, 3 to 5 mm in diameter, usually located temporal to the superior pole of the eye and slightly below the level of the optic disk. [NIH] Macular Degeneration: Degenerative changes in the macula lutea of the retina. [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] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mammogram: An x-ray of the breast. [NIH] Mange: Sarcoptic infestation of human skin, particularly a contagious skin disease caused by invasion of the epidermis with Sarcoptes scabiei. [NIH] Manic: Affected with mania. [EU] Mass Media: Instruments or technological means of communication that reach large numbers of people with a common message: press, radio, television, etc. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Sinus: One of the paired paranasal sinuses, located in the body of the maxilla, communicating with the middle meatus of the nasal cavity. [NIH]

622 Cholesterol

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] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: illnesses. [NIH]

Recording of pertinent information concerning patient's illness or

Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: anaemia. [EU]

A large abnormal red blood cell appearing in the blood in pernicious

Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Fluidity: The motion of phospholipid molecules within the lipid bilayer, dependent on the classes of phospholipids present, their fatty acid composition and degree of unsaturation of the acyl chains, the cholesterol concentration, and temperature. [NIH] Membrane Lipids: Lipids, predominantly phospholipids, cholesterol and small amounts of glycolipids found in membranes including cellular and intracellular membranes. These lipids may be arranged in bilayers in the membranes with integral proteins between the layers and peripheral proteins attached to the outside. Membrane lipids are required for active transport, several enzymatic activities and membrane formation. [NIH] Membrane Microdomains: Detergent-insoluble cell membrane components. They are enriched in sphingolipids and cholesterol and clustered with glycosyl-phosphatidylinositol (GPI)-anchored proteins. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They

Dictionary 623

include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [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] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] 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] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Mesoderm: The middle germ layer of the embryo. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [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] Metaphase: The second phase of cell division, in which the chromosomes line up across the equatorial plane of the spindle prior to separation. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methanol: A colorless, flammable liquid used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, antifreeze, and as a solvent. Ingestion of methanol is toxic and may cause blindness. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methylcellulose: Methylester of cellulose. Methylcellulose is used as an emulsifying and

624 Cholesterol

suspending agent in cosmetics, pharmaceutics and the chemical industry. It is used therapeutically as a bulk laxative. [NIH] Methylene Blue: A compound consisting of dark green crystals or crystalline powder, having a bronze-like luster. Solutions in water or alcohol have a deep blue color. Methylene blue is used as a bacteriologic stain and as an indicator. It inhibits Guanylate cyclase, and has been used to treat cyanide poisoning and to lower levels of methemoglobin. [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] Micelle: A colloid particle formed by an aggregation of small molecules. [EU] 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] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microglia: The third type of glial cell, along with astrocytes and oligodendrocytes (which together form the macroglia). Microglia vary in appearance depending on developmental stage, functional state, and anatomical location; subtype terms include ramified, perivascular, ameboid, resting, and activated. Microglia clearly are capable of phagocytosis and play an important role in a wide spectrum of neuropathologies. They have also been suggested to act in several other roles including in secretion (e.g., of cytokines and neural growth factors), in immunological processing (e.g., antigen presentation), and in central nervous system development and remodeling. [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] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milk Thistle: The plant Silybum marianum in the family Asteraceae containing the bioflavonoid complex silymarin. For centuries this has been used traditionally to treat liver disease. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH]

Dictionary 625

Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] 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] Mitotic: Cell resulting from mitosis. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] 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] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

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] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocyte: A type of white blood cell. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monophosphate: So called second messenger for neurotransmitters and hormones. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Monounsaturated fat: An unsaturated fat that is found primarily in plant foods, including olive and canola oils. [NIH] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism.

626 Cholesterol

[NIH]

Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motilin: A 22-amino acid polypeptide (molecular weight 2700) isolated from the duodenum. At low pH it inhibits gastric motor activity, whereas at high pH it has a stimulating effect. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor Neurons: Neurons which activate muscle cells. [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or glycoprotein, the chief constituent of mucus. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multidrug resistance: Adaptation of tumor cells to anticancer drugs in ways that make the drugs less effective. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Multivalent: Pertaining to a group of 5 or more homologous or partly homologous chromosomes during the zygotene stage of prophase to first metaphasis in meiosis. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Mycophenolate mofetil: A drug that is being studied for its effectiveness in preventing graft-versus-host disease and autoimmune disorders. [NIH]

Dictionary 627

Mycosis: Any disease caused by a fungus. [EU] Mycotic: Pertaining to a mycosis; caused by fungi. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myelin Proteins: Proteins found in the myelin sheath. The major proteins of central nervous system myelin include: myelin proteolipid protein, myelin basic proteins, and myelin-associated glycoprotein. The major proteins of peripheral nervous system myelin include: myelin basic proteins (myelin p1 protein and myelin p2 protein), myelin p0 protein, and myelin-associated glycoprotein. [NIH] Myelin Sheath: The lipid-rich sheath investing many axons in both the central and peripheral nervous systems. The myelin sheath is an electrical insulator and allows faster and more energetically efficient conduction of impulses. The sheath is formed by the cell membranes of glial cells (Schwann cells in the peripheral and oligodendroglia in the central nervous system). Deterioration of the sheath in demyelinating diseases is a serious clinical problem. [NIH] Myelogenous: Produced by, or originating in, the bone marrow. [NIH] 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] Myopathy: Any disease of a muscle. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Myositis: Inflammation of a voluntary muscle. [EU] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Myristate: Pharmacological activator of protein kinase C. [NIH] Naphthoquinones: Naphthalene rings which contain two ketone moieties in any position. They can be substituted in any position except at the ketone groups. [NIH] Natural selection: A part of the evolutionary process resulting in the survival and reproduction of the best adapted individuals. [NIH] 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,

628 Cholesterol

prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [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] Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [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] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neuroblastoma: Cancer that arises in immature nerve cells and affects mostly infants and children. [NIH] 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] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [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]

Dictionary 629

Neurosecretory Systems: A system of neurons that has the specialized function to produce and secrete hormones, and that constitutes, in whole or in part, an endocrine organ or system. [NIH] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] 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] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful antianginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [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] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Nitroprusside: (OC-6-22)-Pentakis(cyano-C)nitrosoferrate(2-). A powerful vasodilator used in emergencies to lower blood pressure or to improve cardiac function. It is also an indicator for free sulfhydryl groups in proteins. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in

630 Cholesterol

the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Notochord: The rod-shaped body, composed of cells derived from the mesoblast and defining the primitive axis of the embryo. In lower vertebrates, it persists throughout life as the main axial support of the body, but in higher vertebrates it is replaced by the vertebral column. [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] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleotidases: A class of enzymes that catalyze the conversion of a nucleotide and water to a nucleoside and orthophosphate. EC 3.1.3.-. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] 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] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Omega-3 fatty acid: A type of fat obtained in the diet and involved in immunity. [NIH]

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Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [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] Optic nerve head: The circular area (disc) where the optic nerve connects to the retina. [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] Organogenesis: Clonal propagation which involves culturing explants from roots, leaves, or stems to form undifferentiated callus tissue; after the cells form shoots, they are separated and rooted. Alternatively, if the callus is put in liquid culture, somatic embryos form. [NIH] Organoleptic: Of, relating to, or involving the employment of the sense organs; used especially of subjective testing (as of flavor, odor, appearance) of food and drug products. [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 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] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteolytic: Causing the breakdown of bone. [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] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment

632 Cholesterol

in a clinic or dispensary connected with the hospital. [NIH] Ovarian Follicle: Spheroidal cell aggregation in the ovary containing an ovum. It consists of an external fibro-vascular coat, an internal coat of nucleated cells, and a transparent, albuminous fluid in which the ovum is suspended. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [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] Ovomucin: A heterogeneous mixture of glycoproteins responsible for the gel structure of egg white. It has trypsin-inhibiting activity. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidants: Oxidizing agents or electron-accepting molecules in chemical reactions in which electrons are transferred from one molecule to another (oxidation-reduction). In vivo, it appears that phagocyte-generated oxidants function as tumor promoters or cocarcinogens rather than as complete carcinogens perhaps because of the high levels of endogenous antioxidant defenses. It is also thought that oxidative damage in joints may trigger the autoimmune response that characterizes the persistence of the rheumatoid disease process. [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]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] 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] Oxides: Binary compounds of oxygen containing the anion O(2-). The anion combines with metals to form alkaline oxides and non-metals to form acidic oxides. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and

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stimulates lactation. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] 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 cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Paneth Cells: Epithelial cells found in the basal part of the intestinal glands (crypts of Lieberkuhn). Paneth cells synthesize and secrete lysozyme and cryptdins. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Paraneoplastic syndrome: A group of symptoms that may develop when substances released by some cancer cells disrupt the normal function of surrounding cells and tissue. [NIH]

Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [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] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [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] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Compliance: regimen. [NIH]

Voluntary cooperation of the patient in following a prescribed

Patient Education: The teaching or training of patients concerning their own health needs.

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[NIH]

Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Hydrolases: A subclass of enzymes from the hydrolase class that catalyze the hydrolysis of peptide bonds. Exopeptidases and endopeptidases make up the sub-subclasses for this group. EC 3.4. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pergolide: A long-acting dopamine agonist which is effective in the treatment of Parkinson's disease and hyperprolactinemia. It has also been observed to have antihypertensive effects. [NIH] Pericarditis: Inflammation of the pericardium. [EU] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal Pocket: An abnormal extension of a gingival sulcus accompanied by the apical migration of the epithelial attachment and bone resorption. [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] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal

Dictionary 635

layer of the bowel wall. [NIH] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Peroxisome Proliferators: A class of nongenotoxic carcinogens that induce the production of hepatic peroxisomes and induce hepatic neoplasms after long-term administration. [NIH] Pesticides: Chemicals used to destroy pests of any sort. The concept includes fungicides (industrial fungicides), insecticides, rodenticides, etc. [NIH] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Petrolatum: A colloidal system of semisolid hydrocarbons obtained from petroleum. It is used as an ointment base, topical protectant, and lubricant. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] 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] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [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] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenolphthalein: An acid-base indicator which is colorless in acid solution, but turns pink to red as the solution becomes alkaline. It is used medicinally as a cathartic. [NIH] 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] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phosphates: Inorganic salts of phosphoric acid. [NIH] Phosphatidic Acids: Fatty acid derivatives of glycerophosphates. They are composed of glycerol bound in ester linkage with 1 mole of phosphoric acid at the terminal 3-hydroxyl group and with 2 moles of fatty acids at the other two hydroxyl groups. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the

636 Cholesterol

cyclic GMP. [NIH] Phosphogluconate Dehydrogenase: An enzyme of the oxidoreductase class that catalyzes the reaction 6-phospho-D-gluconate and NADP+ to yield D-ribulose 5-phosphate, carbon dioxide, and NADPH. The reaction is a step in the pentose phosphate pathway of glucose metabolism. (From Dorland, 27th ed) EC 1.1.1.43. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [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] Phosphoric Monoester Hydrolases: A group of hydrolases which catalyze the hydrolysis of monophosphoric esters with the production of one mole of orthophosphate. EC 3.1.3. [NIH] Phosphorous: Having to do with or containing the element phosphorus. [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] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physicochemical: Pertaining to physics and chemistry. [EU] 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] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Placental tissue: The tissue intervening between fetal blood and maternal blood in the placenta; it acts as a selective membrane regulating the passage of substances from the maternal to the fetal blood. [NIH]

Dictionary 637

Plana: The radiographic term applied to a vertebral body crushed to a thin plate. [NIH] Plant Oils: Oils derived from plants or plant products. [NIH] Plant Proteins: Proteins found in plants (flowers, herbs, shrubs, trees, etc.). The concept does not include proteins found in vegetables for which vegetable proteins is available. [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] Plasmapheresis: Procedure whereby plasma is separated and extracted from anticoagulated whole blood and the red cells retransfused to the donor. Plasmapheresis is also employed for therapeutic use. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Plastic surgeon: A surgeon who specializes in reducing scarring or disfigurement that may occur as a result of accidents, birth defects, or treatment for diseases. [NIH] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness,

638 Cholesterol

aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] 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] Platelet-Derived Growth Factor: Mitogenic peptide growth hormone carried in the alphagranules of platelets. It is released when platelets adhere to traumatized tissues. Connective tissue cells near the traumatized region respond by initiating the process of replication. [NIH] Plateletpheresis: The preparation of platelet concentrates with the return of red cells and platelet-poor plasma to the donor. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Plethysmography: Recording of change in the size of a part as modified by the circulation in it. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Pollen: The male fertilizing element of flowering plants analogous to sperm in animals. It is released from the anthers as yellow dust, to be carried by insect or other vectors, including wind, to the ovary (stigma) of other flowers to produce the embryo enclosed by the seed. The pollens of many plants are allergenic. [NIH] Poly U: A group of uridine ribonucleotides in which the phosphate residues of each uridine ribonucleotide act as bridges in forming diester linkages between the ribose moieties. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polyesters: Polymers of organic acids and alcohols, with ester linkages--usually polyethylene terephthalate; can be cured into hard plastic, films or tapes, or fibers which can be woven into fabrics, meshes or velours. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short

Dictionary 639

oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polyp: A growth that protrudes from a mucous membrane. [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] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] 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] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] 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] Potassium hydroxide: A toxic and highly corrosive chemical used to make soap, in bleaching, and as a paint remover. It is used in small amounts as a food additive and in the preparatrion of some drugs. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [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] Precancerous: A term used to describe a condition that may (or is likely to) become cancer.

640 Cholesterol

Also called premalignant. [NIH] Precipitation: The act or process of precipitating. [EU] 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] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Pregnenolone: Steroid hormone. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [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] Preventive Health Services: Services designed for promotion of health and prevention of disease. [NIH] Prickle: Several layers of the epidermis where the individual cells are connected by cell bridges. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Primary tumor: The original tumor. [NIH] Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progeny: The offspring produced in any generation. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [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]

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Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Proliferative Retinopathy: A disease of the small blood vessels of the retina of the eye. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Promotor: In an operon, a nucleotide sequence located at the operator end which contains all the signals for the correct initiation of genetic transcription by the RNA polymerase holoenzyme and determines the maximal rate of RNA synthesis. [NIH] Pronase: A proteolytic enzyme obtained from Streptomyces griseus. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protease Inhibitors: Compounds which inhibit or antagonize biosynthesis or actions of proteases (endopeptidases). [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 Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein

642 Cholesterol

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] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [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] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [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] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] 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] 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]

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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]

Pupil: The aperture in the iris through which light passes. [NIH] Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [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 end product of purine metabolism. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [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] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [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] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH]

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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] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radionuclide Imaging: Process whereby a radionuclide is injected or measured (through tissue) from an external source, and a display is obtained from any one of several rectilinear scanner or gamma camera systems. The image obtained from a moving detector is called a scan, while the image obtained from a stationary camera device is called a scintiphotograph. [NIH]

Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Radius: The lateral bone of the forearm. [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] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] 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] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH]

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Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Relapse: The return of signs and symptoms of cancer after a period of improvement. [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] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Reminder Systems: Systems used to prompt or aid the memory. The systems can be computerized reminders, color coding, telephone calls, or devices such as letters and postcards. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters. [NIH] Renal cell carcinoma: A type of kidney cancer. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [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, 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 Support: Financial support of research activities. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] 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]

646 Cholesterol

Response Elements: Nucleotide sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents. These elements may be found in both promotor and enhancer regions. [NIH]

Resting metabolic rate: RMR accounts for 65 to 75 percent of daily energy expenditure and represents the minimum energy needed to maintain all physiological cell functions in the resting state. The principal determinant of RMR is lean body mass (LBM). Obese subjects have a higher RMR in absolute terms than lean individuals, an equivalent RMR when corrected for LBM and per unit surface area, and a lower RMR when expressed per kilogram of body weight. Obese persons require more energy for any given activity because of a larger mass, but they tend to be more sedentary than lean subjects. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] 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] Retinae: A congenital notch or cleft of the retina, usually located inferiorly. [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] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] 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] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Reverberant: The sound field prevailing in a large enclosure with moderately reflecting surfaces. [NIH] Rhabdomyolysis: Necrosis or disintegration of skeletal muscle often followed by myoglobinuria. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [NIH] 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] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH]

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Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rodenticides: rodents. [NIH]

Substances used to destroy or inhibit the action of rats, mice, or other

Rosiglitazone: A drug taken to help reduce the amount of sugar in the blood. Rosiglitazone helps make insulin more effective and improves regulation of blood sugar. It belongs to the family of drugs called thiazolidinediones. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Rural Health: The status of health in rural populations. [NIH] Rural Population: The inhabitants of rural areas or of small towns classified as rural. [NIH] Rutin: 3-((6-O-(6-Deoxy-alpha-L-mannopyranosyl)-beta-D-glucopyranosyl)oxy)-2-(3,4dihydroxyphenyl)-5,7-dihydroxy-4H-1-benzopyran-4-one. Found in many plants, including buckwheat, tobacco, forsythia, hydrangea, pansies, etc. It has been used therapeutically to decrease capillary fragility. [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] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponification: The hydrolysis of an ester into an alcohol and acid. [NIH] Saponin: A substance found in soybeans and many other plants. Saponins may help lower cholesterol and may have anticancer effects. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones,

648 Cholesterol

and parotid glands. [NIH] Sarcoplasmic Reticulum: A network of tubules and sacs in the cytoplasm of skeletal muscles that assist with muscle contraction and relaxation by releasing and storing calcium ions. [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 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] Scleroproteins: Simple proteins characterized by their insolubility and fibrous structure. Within the body, they perform a supportive or protective function. [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] Seafood: Marine fish and shellfish used as food or suitable for food. (Webster, 3d ed) shellfish and fish products are more specific types of seafood. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [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] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Secular trends: A relatively long-term trend in a community or country. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Sedimentation: The act of causing the deposit of sediment, especially by the use of a

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centrifugal machine. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Sella: A deep depression in the shape of a Turkish saddle in the upper surface of the body of the sphenoid bone in the deepest part of which is lodged the hypophysis cerebri. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [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] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Sequester: A portion of dead bone which has become detached from the healthy bone tissue, as occurs in necrosis. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serrata: The serrated anterior border of the retina located approximately 8.5 mm from the limbus and adjacent to the pars plana of the ciliary body. [NIH] Serrated: Having notches or teeth on the edge as a saw has. [NIH]

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Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [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] Sex Determination: female or male. [NIH]

The biological characteristics which distinguish human beings as

Sharpness: The apparent blurring of the border between two adjacent areas of a radiograph having different optical densities. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [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]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [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] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicic: A mixture of gelatinous substances obtained by treating silicates with acids. [NIH] Silymarin: A mixture of flavonoids extracted from seeds of the milk thistle, Silybum marianum. It consists primarily of three isomers: silicristin, silidianin, and silybin, its major component. Silymarin displays antioxidant and membrane stabilizing activity. It protects various tissues and organs against chemical injury, and shows potential as an antihepatoxic agent. [NIH] 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

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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] Small cell lung cancer: A type of lung cancer in which the cells appear small and round when viewed under the microscope. Also called oat cell lung cancer. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [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] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [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] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatic cells: All the body cells except the reproductive (germ) cells. [NIH] Somatotropin: A small peptide hormone released by the anterior pituitary under hypothalamic control. Somatotropin, or growth hormone, stimulates mitosis, cell growth,

652 Cholesterol

and, for some cell types, differentiation in many tissues of the body. It has profound effects on many aspects of gene expression and metabolism. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [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] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrophotometry: The art or process of comparing photometrically the relative intensities of the light in different parts of the spectrum. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sperm Capacitation: The process by which a spermatozoon becomes capable of fertilizing an ovum after it reaches the ampullary portion of the uterine tube. [NIH] Spermatozoon: The mature male germ cell. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Sphingomyelin Phosphodiesterase: An enzyme that catalyzes the hydrolysis of sphingomyelin to ceramide (N-acylsphingosine) plus choline phosphate. A defect in this enzyme leads to Niemann-Pick disease. EC 3.1.4.12. [NIH] Spices: The dried seeds, bark, root, stems, buds, leaves, or fruit of aromatic plants used to season food. [NIH] 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] Spinal tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH]

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Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Squalene Synthetase: Catalyzes the rearrangement and reduction of the cyclopropane compound, presqualene pyrophosphate to form squalene, with NADPH as the coenzyme. [NIH]

Stabilization: The creation of a stable state. [EU] Stabilizer: A device for maintaining constant X-ray tube voltage or current. [NIH] 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] Stenosis: Narrowing or stricture of a duct or canal. [EU] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] 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] Stethoscope: An instrument used for the detection and study of sounds within the body that conveyed to the ears of the observer through rubber tubing. [NIH] Stimulants: Any drug or agent which causes stimulation. [NIH] 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] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH]

654 Cholesterol

Stricture: The abnormal narrowing of a body opening. Also called stenosis. [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]

Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [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 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] Sublingual: Located beneath the tongue. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [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]

Substrate: A substance upon which an enzyme acts. [EU] Substrate Specificity: A characteristic feature of enzyme activity in relation to the kind of substrate on which the enzyme or catalytic molecule reacts. [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] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Sulfates: Inorganic salts of sulfuric acid. [NIH] Sulfotransferases: Enzymes which transfer sulfate groups to various acceptor molecules. They are involved in posttranslational sulfation of proteins and sulfate conjugation of exogenous chemicals and bile acids. EC 2.8.2. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sulfuric acid: A strong acid that, when concentrated is extemely corrosive to the skin and mucous membranes. It is used in making fertilizers, dyes, electroplating, and industrial explosives. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH]

Dictionary 655

Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [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] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Tartar: A mass of calcium and magnesium salts deposited around the teeth and upon artificial dentures. [NIH] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during

656 Cholesterol

mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [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] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Tendonitis: Inflammation of tendons attached to the biceps muscle, i. e. the main flexor muscle of the upper arm. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [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 antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thioamides: Organic compounds containing the radical -CSNH2. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [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] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH]

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Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [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] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] 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] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [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] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. EC 3.4.21.68. [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] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make

658 Cholesterol

permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Topical: On the surface of the body. [NIH] Topotecan: An antineoplastic agent used to treat ovarian cancer. It works by inhibiting DNA topoisomerase. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [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] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [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] Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [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] 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

Dictionary 659

protein. It occurs on the ribosome and is unidirectional. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transport Vesicles: Vesicles that are involved in shuttling cargo from the interior of the cell to the cell surface, from the cell surface to the interior, across the cell or around the cell to various locations. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] 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] Trisomy: The possession of a third chromosome of any one type in an otherwise diploid cell. [NIH] Troglitazone: A drug used in diabetes treatment that is being studied for its effect on reducing the risk of cancer cell growth in fat tissue. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] 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] Tyramine: An indirect sympathomimetic. Tyramine does not directly activate adrenergic receptors, but it can serve as a substrate for adrenergic uptake systems and monoamine oxidase so it prolongs the actions of adrenergic transmitters. It also provokes transmitter release from adrenergic terminals. Tyramine may be a neurotransmitter in some invertebrate nervous systems. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ubiquinone: A lipid-soluble benzoquinone which is involved in electron transport in mitochondrial preparations. The compound occurs in the majority of aerobic organisms, from bacteria to higher plants and animals. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ultrasonography:

The visualization of deep structures of the body by recording the

660 Cholesterol

reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Unsaturated Fats: A type of fat. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

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] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [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] Uridine Diphosphate: A uracil nucleotide containing a pyrophosphate group esterified to C5 of the sugar moiety. [NIH] Uridine Diphosphate Glucuronic Acid: A nucleoside diphosphate sugar which serves as a source of glucuronic acid for polysaccharide biosynthesis. It may also be epimerized to UDP iduronic acid, which donates iduronic acid to polysaccharides. In animals, UDP glucuronic acid is used for formation of many glucosiduronides with various aglycones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Plasminogen Activator: A proteolytic enzyme that converts plasminogen to plasmin where the preferential cleavage is between arginine and valine. It was isolated originally from human urine, but is found in most tissues of most vertebrates. EC 3.4.21.73. [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] Ursodeoxycholic Acid: An epimer of chenodeoxycholic acid. It is a mammalian bile acid found first in the bear and is apparently either a precursor or a product of chenodeoxycholate. Its administration changes the composition of bile and may dissolve gallstones. It is used as a cholagogue and choleretic. [NIH] Uterine Contraction: Contraction of the uterine muscle. [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] Vaccine: A substance or group of substances meant to cause the immune system to respond

Dictionary 661

to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose Ulcer: Ulcer due to varicose veins. Chronic venous insufficiency in the deep veins of the legs leads to shunting the venous return into the superficial veins, in which pressure and flow rate, as well as oxygen content, are increased. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilatation: A state of increased calibre of the blood vessels. [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] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vegetable Proteins: Proteins which are present in or isolated from vegetables or vegetable products used as food. The concept is distinguished from plant proteins which refers to nondietary proteins from plants. [NIH] Vegetative: 1. Concerned with growth and with nutrition. 2. Functioning involuntarily or unconsciously, as the vegetative nervous system. 3. Resting; denoting the portion of a cell cycle during which the cell is not involved in replication. 4. Of, pertaining to, or characteristic of plants. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Pressure: The pressure within a cardiac ventricle. Ventricular pressure waveforms can be measured in the beating heart by catheterization or estimated using imaging techniques (e.g., Doppler echocardiography). The information is useful in evaluating the function of the myocardium, cardiac valves, and pericardium, particularly with simultaneous measurement of other (e.g., aortic or atrial) pressures. [NIH]

662 Cholesterol

Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Very low-density lipoprotein: The lipoprotein particles that initially leave the liver, carrying cholesterol and lipid. VLDLs contain 10 to 15 percent of the total serum cholesterol along with most of the triglycerides in the fasting serum; VLDLs are precursors of LDL, and some forms of VLDL, particularly VLDL remnants, appear to be atherogenic. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Video Recording: The storing or preserving of video signals for television to be played back later via a transmitter or receiver. Recordings may be made on magnetic tape or discs (videodisc recording). [NIH] Videodisc Recording: The storing of visual and usually sound signals on discs for later reproduction on a television screen or monitor. [NIH] Villous: Of a surface, covered with villi. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Envelope Proteins: Layers of protein which surround the capsid in animal viruses with tubular nucleocapsids. The envelope consists of an inner layer of lipids and virus specified proteins also called membrane or matrix proteins. The outer layer consists of one or more types of morphological subunits called peplomers which project from the viral envelope; this layer always consists of glycoproteins. [NIH] Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] Virion: The infective system of a virus, composed of the viral genome, a protein core, and a protein coat called a capsid, which may be naked or enclosed in a lipoprotein envelope called the peplos. [NIH] 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] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU]

Dictionary 663

Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitamin E: Vitamin found largely in plant materials, especially wheat germ, corn, sunflower seed, rapeseed, soybean oils, alfalfa, and lettuce. It is used as an antioxidant in vegetable oils and shortenings. [NIH] Vitellogenin: A serum and yolk protein which has been characterized as a calcium-binding glycolipophosphoprotein. It is induced by estrogen or juvenile hormone and is essential for yolk formation in various insect species. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [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] Vulgaris: An affection of the skin, especially of the face, the back and the chest, due to chronic inflammation of the sebaceous glands and the hair follicles. [NIH] War: Hostile conflict between organized groups of people. [NIH] Wart: A raised growth on the surface of the skin or other organ. [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] 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] Xenobiotics: Chemical substances that are foreign to the biological system. They include naturally occurring compounds, drugs, environmental agents, carcinogens, insecticides, etc. [NIH]

Xenograft: The cells of one species transplanted to another species. [NIH]

664 Cholesterol

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] Zebrafish: A species of North American fishes of the family Cyprinidae. They are used in embryological studies and to study the effects of certain chemicals on development. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

665

INDEX A Abdominal, 5, 265, 489, 496, 559, 610, 618, 623, 633, 634, 645, 646 Abdominal fat, 496, 559 Abortion, 559, 609 Acceptor, 319, 387, 389, 559, 618, 632, 654, 658 Acetone, 559, 616 Acetylcholine, 263, 559, 579, 629 Acetylcysteine, 227, 559 Acetylgalactosamine, 394, 559 Acidity, 283, 559, 601, 635 Acne, 559, 646 Acrylonitrile, 559, 647 Actin, 559, 626, 627 Activities of Daily Living, 257, 559 Acute myelogenous leukemia, 559, 560 Acute myeloid leukemia, 559, 560 Acute nonlymphocytic leukemia, 559, 560 Acute renal, 560 Acyl, 70, 204, 238, 239, 276, 277, 281, 282, 291, 329, 332, 333, 350, 351, 386, 387, 397, 560, 596, 621, 622 Acyl Coenzyme A, 386, 560 Acylation, 66, 75, 560 Adaptability, 560, 577 Adaptation, 560, 579, 626 Adduct, 301, 560 Adenine, 289, 321, 560, 643 Adenosine, 560, 568, 573, 636, 656 Adenovirus, 66, 424, 560 Adipose Tissue, 73, 559, 560, 618 Adjuvant, 399, 560, 601 Adolescence, 514, 519, 545, 560 Adrenal Cortex, 73, 361, 362, 560, 561, 585, 596, 640, 645 Adrenal Glands, 176, 560, 645 Adrenal insufficiency, 560 Adrenergic, 560, 566, 570, 590, 595, 655, 659 Adrenergic beta-Antagonists, 560, 566 Adrenodoxin, 304, 560 Adrenoleukodystrophy, 175, 561 Adsorption, 303, 358, 561 Adsorptive, 561 Adverse Effect, 248, 266, 327, 397, 404, 434, 561, 650

Aerobic, 240, 241, 242, 499, 561, 625, 632, 659 Aerobiosis, 414, 561 Affinity Chromatography, 415, 561 Agar, 561, 586, 637 Age of Onset, 561, 659 Agonist, 66, 209, 314, 384, 385, 404, 421, 561, 573, 590, 629, 634 Airway, 72, 561 Albumin, 293, 561, 637 Aldehyde Dehydrogenase, 561 Alfalfa, 216, 311, 322, 355, 562, 663 Algorithms, 562, 571 Alimentary, 295, 562, 589, 633 Alkaline, 307, 328, 356, 562, 563, 574, 620, 632, 635 Alkaloid, 385, 562, 573, 574, 581, 629, 656 Alleles, 4, 437, 562 Allo, 562, 604 Allografts, 562 Allopurinol, 486, 562 Allylamine, 347, 562, 563 Alopecia, 172, 562, 586 Alpha Particles, 562, 643 Alpha-fetoprotein, 562, 598 Alpha-helix, 562, 615 Alpha-Linolenic Acid, 199, 217, 562 Alternative medicine, 484, 562 Ambulatory Care, 562 Ameliorated, 270, 438, 562 Amenorrhea, 562, 573 Amine, 562, 608 Amino Acid Sequence, 277, 303, 314, 315, 316, 318, 353, 382, 425, 563, 565, 596, 601 Amlodipine, 437, 563 Ammonia, 562, 563, 655, 660 Ammonium Chloride, 302, 563 Amnion, 563 Amniotic Fluid, 256, 563 Amphetamine, 563, 571 Amplification, 563 Ampulla, 563, 579 Amyloid, 66, 68, 177, 257, 435, 563, 578, 649 Amyloid beta-Protein, 563 Anaemia, 415, 563, 622 Anaerobic, 241, 336, 564 Anaesthesia, 564, 612

666 Cholesterol

Anal, 346, 564, 631 Analgesic, 422, 564, 589, 610 Analog, 68, 353, 382, 564, 610 Analogous, 564, 638, 658 Analytes, 290, 350, 351, 352, 368, 531, 564 Anaphylatoxins, 564, 582 Anatomical, 564, 578, 584, 589, 593, 611, 619, 624, 648 Androgens, 560, 564, 585 Anemia, 240, 492, 523, 564, 599, 606 Anesthesia, 561, 564, 593 Aneurysm, 564, 600, 661 Angina, 211, 284, 311, 398, 493, 560, 563, 564, 629 Angina Pectoris, 311, 560, 563, 564 Anginal, 564, 629 Angiogenesis, 207, 564 Angiography, 249, 250, 262, 266, 564 Angioplasty, 284, 444, 564 Angiotensin-Converting Enzyme Inhibitors, 564, 566 Angiotensinogen, 565, 645 Anhydrous, 286, 565 Animal model, 209, 491, 565 Anion Exchange Resins, 293, 565 Anionic, 283, 565 Anions, 561, 565, 614, 650, 654 Annealing, 565, 639 Anorexia, 211, 213, 565, 660 Anthropometric measurements, 5, 565 Antibacterial, 565, 652 Antibiotic, 217, 565, 595, 652 Antibody therapy, 565 Anticoagulant, 565, 641 Antidepressant, 565, 599 Antidote, 565, 574 Antiemetic, 565, 566, 579 Antifungal, 333, 347, 565, 566, 598 Antifungal Agents, 333, 566 Antigen, 561, 565, 566, 567, 569, 582, 595, 602, 608, 610, 611, 612, 622, 624 Antigen-Antibody Complex, 566, 582 Antihypertensive, 77, 437, 566, 634 Antihypertensive Agents, 566 Anti-infective, 566, 609, 614, 651 Anti-inflammatory, 175, 257, 333, 422, 566, 568, 576, 585, 589, 602, 610, 640 Anti-Inflammatory Agents, 566, 568, 576, 585 Antimicrobial, 566, 588 Antineoplastic, 566, 585, 586, 600, 602, 658, 662

Antineoplastic Agents, 566, 662 Antioxidant, 197, 207, 248, 287, 313, 341, 342, 404, 422, 566, 568, 632, 650, 663 Antipruritic, 566, 579 Antipsychotic, 566, 579 Antipyretic, 422, 567, 589 Antiserum, 567, 569 Antispasmodic, 422, 567 Antithrombotic, 567 Antiviral, 559, 567, 600 Anus, 564, 567, 572, 582 Anxiety, 560, 567 Aorta, 68, 203, 204, 433, 437, 567, 584, 610, 645, 661 Aperture, 567, 643 Apheresis, 177, 178, 567 Apolipoproteins, 201, 403, 567, 601, 618 Aponeurosis, 567, 600 Approximate, 430, 514, 567 Aqueous fluid, 281, 383, 567 Arachidonic Acid, 405, 567, 610, 617, 641 Arcus Senilis, 567, 578 Arginine, 217, 218, 564, 567, 629, 659, 660 Argon, 248, 249, 266, 567 Aromatic, 567, 570, 575, 635, 652, 654 Arrhythmia, 311, 493, 567 Arteriolar, 567, 568, 572, 645 Arterioles, 567, 568, 572, 574, 627 Arteriolosclerosis, 300, 568 Arteriovenous, 568, 578 Arthralgia, 254, 568 Articular, 568, 631 Ascorbic Acid, 180, 181, 287, 357, 568, 609 Aspiration, 568, 598 Aspirin, 173, 177, 398, 435, 568 Astrocytes, 407, 568, 624 Asymptomatic, 568, 633 Ataxia, 415, 523, 545, 568, 656 Atopic, 338, 568 Atrial, 568, 661 Atrophy, 394, 395, 522, 523, 568, 618, 628 Attenuation, 394, 395, 569 Atypical, 569 Autoantibodies, 569, 588 Autodigestion, 569, 633 Autoimmune disease, 569, 626 Autonomic, 559, 566, 569, 600, 629, 634 Autopsy, 569 Avidity, 569 Axillary, 569, 572 Axillary Artery, 569, 572 Azotemia, 569, 660

Index 667

B Back Pain, 537, 569 Bactericidal, 569, 596 Bacteriophage, 569, 637, 658 Bacteriostatic, 569, 595 Bacterium, 317, 318, 569, 583 Basal Ganglia, 566, 568, 569, 572, 578, 600 Basal Ganglia Diseases, 568, 569 Basophils, 569, 604, 617 Benign, 212, 337, 568, 570, 600, 605, 628, 644 Benzene, 292, 570, 615 Beta carotene, 342, 570 Betablocker, 399, 570 Beta-pleated, 563, 570 Bezafibrate, 570 Bilateral, 471, 570 Bile Acids, 6, 252, 260, 292, 293, 298, 299, 300, 303, 308, 326, 331, 360, 363, 411, 422, 429, 436, 446, 469, 470, 570, 653, 654, 656 Bile Acids and Salts, 570 Bile duct, 484, 570, 600 Bile Pigments, 570, 615 Biliary Tract, 380, 570, 574, 633 Bilirubin, 290, 314, 315, 316, 330, 488, 561, 570, 600, 603, 609 Binding agent, 298, 313, 570 Bioavailability, 370, 371, 403, 570 Biochemical reactions, 174, 570 Biogenesis, 290, 301, 570 Biogenic Amines, 303, 570 Biological therapy, 571, 605 Biomass, 432, 571 Biopsy, 256, 472, 487, 488, 571, 634 Biotechnology, 65, 408, 469, 484, 509, 521, 522, 523, 524, 571 Biotransformation, 571 Bivalent, 291, 571 Bladder, 385, 571, 583, 611, 619, 626, 628, 641, 660 Blastocyst, 571, 583, 636 Blood Cell Count, 571, 606 Blood Coagulation, 571, 572, 574, 657 Blood Coagulation Factors, 571, 572 Blood Glucose, 8, 79, 265, 469, 485, 490, 495, 542, 543, 571, 606, 613 Blood Groups, 571, 603 Blood Preservation, 571, 589 Blood pressure, 7, 9, 172, 175, 248, 250, 253, 254, 258, 263, 264, 265, 266, 270, 340, 366, 422, 442, 443, 461, 469, 473,

475, 486, 488, 490, 492, 493, 494, 495, 496, 497, 498, 499, 500, 535, 538, 541, 542, 556, 566, 571, 575, 600, 610, 625, 629, 630, 634, 651 Blood Proteins, 174, 572 Blood urea, 487, 491, 572 Body Composition, 237, 572 Body Fluids, 290, 334, 366, 371, 392, 572, 573, 591, 651 Body Mass Index, 6, 493, 495, 497, 499, 572, 632 Bone Density, 488, 493, 499, 572 Bone Marrow, 542, 559, 560, 570, 572, 586, 601, 604, 611, 620, 627, 651 Bone scan, 572, 648 Boron, 295, 572, 586 Boron Neutron Capture Therapy, 295, 572 Bowel, 214, 385, 564, 572, 589, 613, 616, 628, 631, 634, 653 Bowel Movement, 572, 589, 653 Brachial, 199, 263, 264, 572 Brachial Artery, 263, 572 Brachytherapy, 572, 613, 643 Bradykinin, 263, 572, 615, 629, 637 Brain Infarction, 572 Brain Stem, 572, 573, 577 Brain Stem Infarctions, 572, 573 Branch, 478, 479, 553, 573, 593, 601, 620, 622, 633, 642, 645, 652, 656 Breakdown, 572, 573, 589, 601, 631, 650 Breast Self-Examination, 492, 573 Bromocriptine, 384, 385, 573 Buccal, 246, 573, 609, 620 Buccal mucosa, 246, 573 Bullous, 573, 588 Burns, 488, 493, 573 Burns, Electric, 573 Bursitis, 385, 573 Bypass, 172, 262, 268, 284, 444, 456, 573 C Cachexia, 573 Caffeine, 241, 573, 643 Calcification, 568, 573 Calcineurin, 573 Calcium, 68, 172, 182, 237, 269, 365, 373, 416, 424, 437, 563, 566, 573, 574, 582, 624, 629, 648, 650, 655, 663 Calcium channel blocker, 269, 437, 563, 566, 574 Calcium Channel Blockers, 566, 574 Calcium Chloride, 365, 574 Calculi, 574, 604

668 Cholesterol

Calibration, 281, 574 Callus, 574, 615, 631 Calmodulin, 274, 573, 574 Caloric intake, 297, 348, 574 Camptothecin, 429, 574 Capillary, 212, 572, 574, 618, 647, 662 Capillary Permeability, 572, 574 Capsid, 574, 662 Capsules, 574, 591, 598, 601 Captopril, 416, 575 Carbohydrate, 238, 311, 312, 407, 452, 466, 490, 516, 575, 585, 597, 603, 604, 639 Carbon Dioxide, 354, 574, 575, 587, 636, 645, 661 Carboxy, 236, 368, 575 Carboxylic Acids, 306, 575 Carcinogen, 560, 575, 626 Carcinogenesis, 575, 578 Carcinogenic, 570, 575, 612, 641, 653 Carcinoma, 487, 575 Cardiac arrest, 398, 575, 654 Cardiopathy, 335, 575 Cardiorespiratory, 473, 575 Cardiovascular System, 341, 405, 429, 575 Carotene, 180, 218, 231, 341, 342, 570, 575, 646 Carotenoids, 219, 496, 497, 570, 575 Carotid Arteries, 262, 327, 397, 575 Carotid Stenosis, 576 Carrier Proteins, 576, 637 Case report, 576, 581 Catabolism, 240, 288, 299, 300, 331, 363, 406, 576 Cataracts, 256, 415, 576 Catecholamine, 576, 590 Catfish, 500, 576 Catheter, 251, 255, 263, 265, 380, 576, 593, 619 Catheterization, 564, 576, 661 Cations, 576, 614 Caudal, 576, 610, 639 Causal, 237, 312, 386, 513, 576, 607 Caustic, 366, 576, 651 Caveolae, 75, 576 Caveolins, 576, 581 Cecum, 576, 616 Celecoxib, 249, 576 Celiac Disease, 487, 489, 576 Cell Adhesion, 176, 576 Cell Death, 76, 238, 435, 576, 602 Cell Differentiation, 577, 617, 650

Cell Division, 522, 569, 577, 605, 622, 623, 625, 637, 641, 649 Cell Membrane Structures, 576, 577 Cell proliferation, 174, 296, 337, 568, 577, 613, 650 Cell Respiration, 577, 625, 632, 645 Cell Survival, 577, 605 Cellobiose, 577 Cellular adhesion, 577 Cellulose, 307, 319, 324, 335, 381, 577, 600, 606, 623, 637 Central Nervous System Infections, 577, 605 Centrifugation, 286, 417, 418, 577, 606, 624 Ceramide, 68, 560, 577, 652 Cerebellar, 568, 577, 644 Cerebellum, 573, 577, 644 Cerebral, 255, 262, 283, 317, 366, 427, 433, 568, 569, 572, 573, 577, 578, 595, 598, 607 Cerebral Cortex, 568, 577, 599 Cerebral hemispheres, 569, 572, 573, 577, 578 Cerebral Hemorrhage, 317, 366, 578 Cerebral Infarction, 572, 578 Cerebrospinal, 256, 257, 578, 620, 650, 652 Cerebrospinal fluid, 256, 257, 578, 620, 650, 652 Cerebrotendinous Xanthomatosis, 252, 578 Cerebrum, 577, 578, 659 Character, 372, 433, 564, 578, 587, 603 Chemopreventive, 422, 578 Chemotactic Factors, 578, 582 Chemotherapeutic agent, 578 Chemotherapy, 295, 347, 578 Chenodeoxycholic Acid, 252, 578, 660 Chest Pain, 172, 460, 533, 578 Chin, 175, 429, 578, 623 Chlorine, 451, 579, 610 Chloroform, 380, 579 Chlorpromazine, 274, 295, 579 Cholecystectomy, 6, 579 Cholecystitis, 470, 471, 579 Cholecystostomy, 380, 579 Cholelithiasis, 5, 6, 236, 471, 579 Choleretic, 578, 579, 587, 660 Cholestanol, 252, 579 Cholestasis, 200, 579 Cholestyramine, 292, 293, 303, 326, 327, 332, 396, 502, 579 Cholic Acid, 285, 355, 579 Choline, 184, 579, 652

Index 669

Cholinergic, 566, 579, 629 Choroid, 579, 646 Chromaffin System, 580, 593 Chromatin, 580, 595 Chromium, 182, 342, 343, 344, 345, 420, 580 Chromosomal, 176, 563, 580, 637 Chromosome, 521, 522, 561, 563, 580, 583, 605, 618, 649, 659 Chronic Disease, 264, 349, 485, 514, 530, 532, 573, 580, 617 Chronic renal, 291, 580, 638, 660 Chylomicrons, 332, 348, 383, 438, 580, 618 Ciliary, 567, 580, 649 Ciliary Body, 580, 649 Ciliary processes, 567, 580 Circulatory system, 312, 348, 368, 372, 580, 593, 614 Cirrhosis, 580, 606 CIS, 306, 357, 367, 580, 646 Citrus, 397, 490, 496, 568, 580 Clamp, 251, 580 Clathrin, 66, 72, 580, 581 Claudication, 248, 398, 580 Claviceps, 580, 647 Clear cell carcinoma, 580, 588 Climacteric, 366, 581 Clinical Medicine, 199, 208, 581, 640 Clinical study, 581, 584 Clinical trial, 69, 245, 271, 349, 370, 509, 510, 581, 584, 586, 591, 642, 644 Clone, 429, 581 Cloning, 67, 305, 306, 318, 571, 581 Coagulation, 404, 571, 581, 637, 657 Coal, 570, 581 Coated Vesicles, 580, 581 Cod Liver Oil, 581, 593 Cofactor, 581, 641, 657 Cognitive restructuring, 581, 653 Colchicine, 581 Colestipol, 220, 262, 293, 326, 327, 332, 396, 502, 581 Collagen, 176, 394, 395, 563, 581, 598, 601, 638, 641 Colloidal, 309, 329, 374, 561, 582, 592, 635, 650 Colon, 212, 454, 522, 582, 616 Colorectal, 582 Colorectal Cancer, 582 Combination Therapy, 331, 582 Complement, 174, 424, 487, 564, 582, 601, 621, 637

Complementary and alternative medicine, 193, 233, 582 Complementary medicine, 193, 582 Complementation, 174, 582 Compliance, 246, 582 Compress, 583, 607 Computational Biology, 509, 521, 583 Computed tomography, 572, 583, 648 Computer Simulation, 267, 583 Computerized tomography, 265, 583 Concentric, 568, 583 Conception, 428, 559, 583, 598, 653 Concomitant, 404, 437, 513, 583 Concretion, 574, 583 Conduction, 266, 583, 627 Congestive heart failure, 398, 423, 583, 619 Conjugated, 198, 200, 220, 411, 570, 578, 579, 583, 586, 587 Conjugation, 75, 571, 583, 654 Connective Tissue, 373, 385, 568, 572, 581, 583, 588, 598, 600, 601, 620, 646, 655, 656 Connective Tissue Cells, 583 Consciousness, 564, 584, 587, 590, 642, 646 Constipation, 474, 566, 584 Constrict, 263, 584 Constriction, 263, 291, 576, 584, 614, 661 Constriction, Pathologic, 584, 661 Consultation, 251, 515, 584 Contact dermatitis, 338, 584 Contamination, 430, 584 Contractility, 5, 565, 584 Contraindications, ii, 584 Contrast medium, 564, 584 Control group, 8, 248, 262, 284, 473, 584 Controlled clinical trial, 473, 584 Controlled study, 584 Cookery, 457, 458, 459, 469, 584 Coordination, 577, 584, 626 Corn Oil, 584 Cornea, 567, 578, 584, 604 Corneum, 393, 394, 395, 584, 595, 610 Coronary Arteriosclerosis, 262, 263, 584, 627 Coronary Artery Bypass, 584 Coronary Circulation, 564, 584, 629 Coronary heart disease, 8, 9, 78, 177, 254, 279, 280, 284, 288, 312, 327, 331, 336, 339, 343, 344, 345, 346, 349, 365, 370, 381, 391, 396, 400, 401, 402, 403, 407, 410, 411, 421, 425, 427, 429, 443, 472, 485, 495, 510, 512, 513, 516, 517, 519, 538, 540, 575, 578, 585, 605, 608

670 Cholesterol

Coronary Thrombosis, 585, 624, 627 Coronary Vessels, 584, 585 Corpus, 585, 640, 663 Corpus Luteum, 585, 640 Corpuscle, 585, 595 Cortex, 176, 585, 644 Cortical, 585, 649, 656 Corticosteroid, 585, 640 Cortisol, 496, 561, 585 Cortisone, 585, 640 Coumarin, 585 Cranial, 577, 585, 605, 613, 631, 633, 634 Craniocerebral Trauma, 569, 578, 585, 605, 656, 657 Creatinine, 487, 491, 585, 660 Criterion, 513, 585 Cross Infection, 586 Crystallization, 71, 376, 437, 521, 586 Culture Media, 328, 561, 586 Cultured cells, 298, 586 Curative, 586, 629, 647, 656 Curcumin, 200, 586 Cutaneous, 333, 584, 586, 614, 620 Cyanide, 586, 624 Cyclic, 290, 461, 573, 574, 586, 605, 629, 636, 656 Cyclophosphamide, 253, 487, 586 Cyclosporine, 200, 586 Cytochrome, 79, 257, 293, 303, 561, 586 Cytochrome b, 293, 304, 586 Cytokines, 586, 611, 624 Cytoplasm, 275, 361, 362, 387, 388, 394, 395, 570, 577, 586, 592, 594, 595, 604, 647, 648 Cytosine, 293, 587, 643 Cytotoxic, 197, 478, 587, 611, 643, 644, 650 D Dairy Products, 286, 349, 377, 498, 535, 587, 648 De novo, 303, 310, 361, 362, 386, 587 Deamination, 587, 660 Decarboxylation, 570, 587, 608 Decidua, 587, 636 Decompensation, 433, 562, 587 Degenerative, 435, 453, 545, 587, 607, 621, 631 Dehydroepiandrosterone, 221, 587 Deletion, 318, 587 Delivery of Health Care, 587, 606 Dementia, 3, 4, 373, 421, 566, 587 Denaturation, 587, 639 Dendrites, 587, 628

Dental Materials, 587, 595 Dentures, 587, 655 Deoxycholic Acid, 587 Depolarization, 587, 650 Depressive Disorder, 587, 619 Dermal, 394, 395, 588 Dermatitis, 338, 489, 588, 591 Dermatitis Herpetiformis, 489, 588 Dermis, 394, 395, 588, 655 DES, 174, 564, 588 Desquamation, 395, 588 Detergents, 392, 422, 588 Detoxification, 588, 603 Deuterium, 588, 609 Developed Countries, 296, 353, 405, 429, 588 Developing Countries, 410, 588, 620 Diabetes Insipidus, 490, 588 Diabetes Mellitus, 212, 248, 251, 265, 266, 268, 270, 486, 491, 588, 602, 603, 606 Diagnostic procedure, 273, 471, 484, 588 Dialyzer, 588, 606 Diarrhea, 446, 474, 579, 588 Diarrhoea, 588, 609 Diastole, 588 Diastolic, 366, 494, 588, 610 Diastolic blood pressure, 366, 588 Dichloroacetate, 504, 589 Diclofenac, 178, 589 Diclofenac Sodium, 178, 589 Dietary Fats, 422, 537, 589, 597, 618 Dietary Fiber, 236, 311, 335, 381, 589 Dietary Proteins, 452, 589, 661 Dietitian, 485, 534, 589 Diffusivity, 314, 589 Digestion, 297, 420, 422, 436, 454, 484, 562, 570, 572, 589, 601, 613, 618, 619, 653, 661 Digestive system, 271, 474, 589 Digestive tract, 579, 589, 651 Dihydrotestosterone, 589, 644 Dihydroxy, 589, 596, 647 Dihydroxyacetone, 289, 589 Dihydroxyacetone Phosphate, 589 Dilatation, 559, 564, 589, 613, 640, 661 Dilatation, Pathologic, 589, 661 Dilate, 263, 589 Dilation, 255, 572, 589, 661 Dilator, 589, 629 Dilution, 320, 321, 589 Dimerization, 310, 589 Dimethyl, 177, 589 Diploid, 582, 590, 637, 659

Index 671

Discrete, 368, 590, 619, 656 Disease Progression, 590 Disinfectant, 590, 596 Disparity, 485, 590 Disposition, 419, 590 Dissociation, 561, 590, 614 Distal, 422, 584, 590, 592, 642 Diuretics, Thiazide, 566, 590 DNA Topoisomerase, 590, 602 Dolichol, 310, 590 Domesticated, 337, 590, 605 Dopamine, 384, 385, 563, 566, 573, 579, 590, 629, 634, 635 Dorsal, 590, 639 Dosage Forms, 398, 591 Double-blind, 198, 204, 591 Drug Combinations, 261, 591 Drug Interactions, 503, 591 Drug Tolerance, 591, 657 Drusen, 591 Duct, 5, 563, 576, 591, 596, 647, 653, 655 Duodenum, 411, 570, 579, 591, 600, 615, 626, 653 Dyes, 489, 563, 570, 591, 654 Dyslipidemia, 8, 72, 437, 591 Dysphoric, 587, 591 Dysplasia, 256, 523, 591 Dyspnea, 587, 591 Dystrophy, 239, 523, 591 E Echocardiography, 265, 591, 661 Eczema, 370, 591 Edema, 248, 249, 266, 283, 487, 579, 584, 587, 591, 607, 616, 626, 660 Effector, 365, 384, 559, 582, 591, 635 Egg Yolk, 175, 199, 200, 307, 321, 322, 324, 349, 353, 354, 375, 376, 380, 381, 409, 592 Elastic, 71, 194, 592, 603, 652, 655 Elasticity, 300, 365, 568, 584, 592 Elastin, 394, 395, 582, 592 Elective, 78, 592 Electrocardiogram, 254, 265, 592 Electrochemistry, 204, 592 Electrocoagulation, 581, 592 Electrode, 255, 280, 319, 320, 321, 592 Electrolyte, 585, 592, 624, 639, 651, 660 Electron microscope, 430, 592 Electrophoresis, 65, 417, 418, 592 Electroplating, 592, 654 Electroretinogram, 249, 255, 592 Elementary Particles, 592, 629, 642 Emboli, 73, 292, 471, 592

Embolism, 433, 487, 592 Embolization, 471, 592 Embolus, 592, 612 Embryo, 559, 563, 571, 577, 592, 602, 612, 617, 623, 630, 638, 653 Emergency Medicine, 435, 593 Emergency Treatment, 593 Emollient, 593, 603, 630 Empirical, 510, 593 Emulsion, 76, 308, 376, 409, 439, 593 Enalapril, 593 Enamel, 593, 615 Encapsulated, 311, 593, 618 Encephalopathy, 300, 593 Endarterectomy, 564, 593 Endocarditis, 593 Endocardium, 593 Endocrine Glands, 593 Endocrine System, 256, 593 Endocytosis, 68, 303, 386, 425, 576, 593 Endogenous, 289, 360, 386, 571, 590, 591, 593, 603, 632, 658 Endometrial, 488, 593 Endometrium, 268, 587, 593, 623 Endopeptidases, 594, 634, 641 Endothelial cell, 260, 437, 593, 594, 657 Endothelium, 70, 201, 204, 207, 269, 290, 298, 397, 594, 629, 637 Endothelium, Lymphatic, 594 Endothelium, Vascular, 594 Endothelium-derived, 594, 629 Endotoxic, 594, 618 Endotoxins, 582, 594 End-stage renal, 491, 580, 594, 638 Enhancer, 594, 646 Enterocytes, 332, 594 Enterohepatic, 292, 422, 594 Enterohepatic Circulation, 292, 594 Environmental Exposure, 594, 631 Environmental Health, 508, 510, 594 Enzyme Inhibitors, 594, 637 Enzyme-Linked Immunosorbent Assay, 594 Eosinophils, 595, 604, 617 Epidemiological, 284, 370, 403, 407, 425, 595 Epidermal, 337, 394, 395, 595, 615, 622 Epidermis, 394, 395, 584, 588, 595, 608, 610, 615, 621, 640, 643 Epigastric, 595, 633 Epinephrine, 560, 570, 590, 595, 629, 659

672 Cholesterol

Epithelial, 72, 386, 580, 587, 588, 595, 604, 633, 634 Epithelial Cells, 72, 386, 595 Epithelium, 594, 595, 614 Epitope, 595 Epoprostenol, 241, 595, 610 Epoxy Resins, 283, 595 Ergot, 385, 487, 573, 595, 647 ERV, 595, 597 Erythema, 584, 595 Erythrocyte Membrane, 595, 603 Erythrocytes, 175, 563, 564, 571, 572, 589, 595, 607 Erythromycin, 257, 258, 595 Esophagus, 589, 596, 635, 653 Essential Tremor, 523, 596 Esterification, 66, 70, 387, 397, 596 Estradiol, 246, 596 Estrogen, 246, 268, 404, 424, 496, 596, 641, 663 Estrogen receptor, 596 Ethanol, 298, 321, 365, 596 Ethanolamine, 302, 596 Ether, 275, 330, 335, 337, 357, 367, 380, 381, 596 Ethnic Groups, 596 Ethylene Glycol, 596 Eukaryotic Cells, 72, 596, 631 Evacuation, 584, 596, 616, 643 Excrete, 486, 596, 616 Exfoliation, 588, 596 Exocrine, 596, 633 Exocytosis, 78, 596 Exogenous, 203, 303, 360, 408, 561, 571, 575, 591, 593, 596, 603, 654, 659 Exon, 206, 596 Expectorant, 563, 596 Expiratory, 595, 597 Expiratory Reserve Volume, 595, 597 Extensor, 597, 642 External-beam radiation, 597, 643 Extracellular Matrix, 583, 597, 598 Extracorporeal, 5, 284, 597 Extraction, 6, 72, 321, 330, 354, 374, 597 Extrapyramidal, 566, 590, 597 Extremity, 597, 616 Eye Infections, 560, 597 Eye Movements, 249, 250, 266, 545, 597 F Facial, 256, 597, 622, 633 Faecal, 411, 588, 597 Failure to Thrive, 414, 597

Family Planning, 509, 597 Farnesyl, 310, 358, 597 Fast Neutrons, 597, 629 Fat Substitutes, 297, 597 Fatigue, 453, 597, 606 Fatty Liver, 488, 597 Feces, 326, 579, 584, 597, 598, 653 Femoral, 262, 598 Femoral Artery, 262, 598 Femur, 598 Ferritin, 598 Fertilizers, 598, 654 Fetal Blood, 598, 636 Fetoprotein, 236, 598 Fetus, 493, 559, 562, 598, 599, 636, 640, 653, 660 Fibril, 598 Fibrin, 571, 598, 637, 656, 657 Fibrinogen, 268, 359, 598, 637, 656 Fibrinolysis, 373, 598 Fibrinolytic, 404, 598 Fibroblasts, 66, 76, 256, 583, 598 Fibrosis, 253, 523, 562, 598, 647, 648 Filipin, 430, 598 Filler, 364, 427, 598 Filtration, 284, 286, 359, 598 Fish Products, 598, 648 Fissure, 311, 598 Flatus, 599, 601 Flexor, 597, 599, 656 Fluorescence, 68, 350, 351, 430, 599 Fluoxetine, 599 Flushing, 325, 326, 599 Foam Cells, 72, 76, 290, 369, 373, 387, 397, 599 Foetal, 599 Folate, 181, 183, 207, 398, 497, 599 Fold, 265, 355, 446, 536, 598, 599, 623 Folic Acid, 180, 181, 183, 599 Follicles, 599 Follicular Fluid, 599 Food Preferences, 485, 599 Foot Ulcer, 599 Forearm, 258, 263, 264, 571, 599, 644 Fossa, 577, 599 Founder Effect, 599 Fractionation, 364, 417, 599 Free Radicals, 287, 394, 395, 422, 566, 590, 599 Frontal Sinus, 600 Fructose, 600, 604

Index 673

Fungi, 347, 565, 566, 580, 583, 597, 600, 604, 624, 627, 653, 664 Fungicides, Industrial, 566, 600 Fungus, 595, 600, 627, 647 G Gallbladder, 5, 6, 213, 411, 470, 471, 489, 559, 570, 579, 589, 600, 619 Gallbladder Emptying, 600 Gamma Rays, 600, 643, 644 Gamma-interferon, 600, 613 Ganglia, 559, 569, 600, 628, 634 Ganglion, 600, 631 Ganglionic Blockers, 566, 600 Ganglioside, 77, 600 Gangrene, 300, 427, 600 Gas, 376, 563, 567, 575, 579, 595, 596, 599, 601, 609, 626, 629, 654, 661 Gasoline, 570, 601 Gastric, 283, 374, 565, 569, 591, 601, 608, 626 Gastrin, 601, 608 Gastrointestinal, 174, 203, 256, 470, 471, 487, 572, 595, 596, 601, 617, 649, 654 Gastrointestinal Agents, 174, 601 Gastrointestinal tract, 256, 471, 596, 601, 617, 649 Gavage, 601 Gelatin, 586, 601, 603, 656 Gemfibrozil, 223, 332, 341, 342, 502, 601 Gene Expression, 78, 236, 239, 419, 524, 601, 652 Gene Therapy, 247, 433, 560, 601 General practitioner, 72, 601 Genetic Code, 601, 630 Genetic Counseling, 546, 601 Genetic Engineering, 277, 302, 303, 571, 581, 601 Genetic Screening, 72, 412, 413, 601 Genetic testing, 256, 602, 639 Genetic transcription, 602, 641, 658 Genistein, 205, 278, 338, 339, 401, 402, 602 Genotype, 3, 4, 562, 602, 635 Germ Layers, 413, 602 Gestation, 602, 634, 636, 653 Giant Cells, 602, 647 Ginger, 223, 232, 427, 428, 602 Ginseng, 221, 223, 228, 311, 602 Gland, 407, 560, 580, 585, 602, 620, 633, 636, 641, 648, 653, 655, 657 Glomerular, 200, 602, 645 Glomeruli, 602 Glomerulonephritis, 602, 620

Glomerulosclerosis, 239, 253, 602 Glomerulus, 602, 628 Glucocorticoid, 602, 640 Glucose Intolerance, 265, 588, 603 Glucose tolerance, 265, 486, 603 Glucose Tolerance Test, 603 Glucuronic Acid, 603, 607, 660 Glucuronides, 303, 603 Glutamate, 603 Glutamic Acid, 599, 603, 629, 641 Glutathione Peroxidase, 603, 649 Gluten, 489, 576, 603 Glycerol, 289, 297, 603, 635, 636 Glycerophospholipids, 603, 636 Glycine, 205, 411, 422, 563, 570, 578, 579, 587, 603, 629, 649 Glycophorin, 293, 603 Glycoprotein, 80, 177, 598, 602, 603, 604, 626, 627, 657 Glycosaminoglycan, 373, 604 Glycoside, 278, 311, 338, 604, 609 Glycosidic, 577, 604, 630 Goats, 587, 604 Goblet Cells, 594, 604 Gonad, 604 Gonadal, 303, 604, 653 Gout, 486, 581, 604 Governing Board, 604, 639 Government Agencies, 441, 475, 513, 516, 604, 639 Gp120, 604 Grade, 208, 242, 326, 375, 376, 474, 475, 604 Graft, 262, 562, 604, 608, 626 Grafting, 333, 584, 604, 611 Graft-versus-host disease, 604, 626 Granulocytes, 604, 617, 650, 663 Granuloma, 478, 604, 620 Granuloma Inguinale, 604, 620 Graphite, 281, 604 Grasses, 580, 599, 604, 607 Growth factors, 264, 605, 624 Guanine, 605, 643 Guanylate Cyclase, 605, 629 Guinea Pigs, 239, 605 H Habitual, 485, 578, 605 Haematoma, 605 Haemorrhage, 175, 559, 605 Hair follicles, 588, 605, 663 Half-Life, 605, 610 Haploid, 605, 637

674 Cholesterol

Haplotypes, 5, 605 Haptens, 561, 605 Hate, 605 Headache, 264, 370, 573, 605, 612 Headache Disorders, 605 Health Care Costs, 342, 343, 344, 345, 346, 606 Health Education, 492, 606 Health Expenditures, 606 Health Fairs, 492, 606 Health Policy, 606 Health Promotion, 475, 491, 510, 511, 519, 530, 532, 606 Heart failure, 177, 263, 366, 423, 564, 606 Heartbeat, 606, 654 Hematocrit, 479, 491, 571, 606 Hematology, 491, 606 Hematoma, 606, 607 Heme, 303, 570, 586, 606 Hemicellulose, 335, 606 Hemochromatosis, 488, 606 Hemodialysis, 398, 588, 606, 616 Hemoglobin, 249, 250, 266, 330, 495, 564, 571, 595, 606, 607, 615, 617 Hemoglobin A, 495, 607 Hemoglobinopathies, 601, 607 Hemoglobinuria, 523, 607 Hemolysis, 595, 607 Hemorrhage, 317, 585, 592, 605, 607, 643, 654 Hemorrhagic stroke, 607 Heparin, 225, 359, 364, 406, 607 Hepatitis, 474, 475, 607, 662 Hepatocellular, 282, 334, 607 Hepatocyte, 579, 607 Herbicides, 277, 607 Hereditary, 239, 278, 338, 339, 401, 402, 410, 437, 455, 604, 607, 628, 646 Heredity, 442, 533, 601, 602, 607 Heterogeneity, 561, 607 Heterotrophic, 600, 607 Hiccup, 579, 607 High blood cholesterol, 279, 294, 312, 313, 338, 339, 353, 358, 359, 376, 393, 401, 402, 411, 473, 475, 486, 512, 513, 514, 517, 518, 519, 533, 535, 538, 539, 540, 541, 607 High-density lipoproteins, 341, 359, 405, 419, 429, 433, 605, 608 Histamine, 564, 566, 570, 608 Histidine, 608 Homicide, 473, 475, 608

Homogenate, 391, 608 Homogeneous, 353, 382, 568, 608, 635 Homologous, 424, 562, 571, 601, 608, 626, 649, 655 Hormonal, 314, 569, 585, 608, 663 Hormone Replacement Therapy, 246, 608 Horny layer, 595, 608 Horseradish Peroxidase, 281, 595, 608 Hospitals, Public, 516, 608 Host, 71, 77, 277, 317, 318, 429, 496, 562, 569, 598, 608, 611, 617, 647, 662 Hybrid, 581, 608, 647 Hybridization, 298, 608 Hydration, 304, 305, 608 Hydrolases, 408, 609, 636 Hydrophilic, 275, 276, 298, 319, 320, 321, 358, 359, 360, 374, 394, 588, 609 Hydrophobic, 358, 374, 588, 603, 609, 615, 618 Hydroxycholesterols, 609 Hydroxylation, 260, 298, 364, 561, 609 Hydroxylysine, 582, 609 Hydroxyproline, 563, 582, 609 Hydroxysteroids, 317, 392, 579, 609 Hyperbilirubinemia, 609, 615 Hypercholesterolemia, Familial, 545, 609 Hyperglycemia, 203, 204, 609 Hyperkeratosis, 338, 609 Hyperlipidaemia, 386, 609 Hyperlipidemia, 245, 279, 288, 291, 292, 299, 313, 338, 339, 363, 372, 399, 401, 402, 404, 410, 436, 545, 591, 609 Hyperplasia, 212, 303, 609 Hypersensitivity, 71, 610, 617, 646 Hyperthyroidism, 264, 610 Hypertriglyceridemia, 242, 251, 260, 291, 372, 406, 433, 513, 591, 610 Hypertrophy, 433, 609, 610 Hyperuricemia, 604, 610 Hypochlorous Acid, 610 Hypoglycemia, 490, 610 Hypolipidemic, 294, 331, 610 Hypophysis, 385, 610, 649 Hypothalamic, 610, 651 Hypothalamus, 610, 636 Hypotonia, 256, 415, 610 I Ibuprofen, 257, 610 Ichthyosis, 338, 610 Id, 179, 211, 528, 530, 532, 540, 544, 552, 554, 610 Idiopathic, 610, 647

Index 675

Ileal, 268, 610 Ileum, 364, 411, 422, 576, 610, 615 Iliac Artery, 598, 610 Iloprost, 73, 610 Immune function, 384, 610, 611 Immune response, 560, 566, 569, 585, 605, 611, 621, 654, 662 Immune Sera, 611 Immune system, 565, 571, 611, 617, 620, 621, 626, 635, 660, 663 Immunity, 174, 611, 620, 630, 658 Immunization, 474, 475, 611, 640 Immunoassay, 594, 611 Immunodeficiency, 77, 333, 522, 611 Immunogenic, 611, 618 Immunoglobulin, 565, 611, 625 Immunologic, 578, 611, 621, 644 Immunology, 560, 561, 608, 611 Immunophilin, 574, 611 Immunosuppressive, 333, 487, 574, 586, 602, 611, 655 Immunosuppressive Agents, 487, 611 Impairment, 207, 258, 319, 421, 568, 579, 597, 611, 623 Implant radiation, 611, 613, 643 Implantation, 583, 611 Incision, 611, 614 Incontinence, 611, 631 Incubated, 276, 611 Incubation, 335, 612 Indicative, 7, 444, 612, 633, 661 Induction, 70, 283, 373, 385, 564, 566, 600, 612, 641, 650 Infant Mortality, 475, 612 Infarction, 8, 214, 268, 290, 300, 311, 325, 326, 349, 359, 366, 386, 398, 433, 436, 493, 513, 578, 585, 607, 612, 624, 627 Infection Control, 515, 517, 612 Infertility, 573, 612 Infestation, 612, 621 Infiltration, 602, 612 Influenza, 603, 612 Infusion, 380, 612 Ingestion, 203, 297, 308, 335, 393, 397, 411, 603, 609, 612, 623, 638 Inguinal, 612, 620 Initiation, 289, 612, 641, 658 Inorganic, 357, 367, 427, 612, 635, 654 Inositol, 342, 343, 344, 345, 612 Inotropic, 590, 613 Insecticides, 613, 635, 663 Insight, 613

Instillation, 380, 613 Insulator, 613, 626, 627 Insulin-dependent diabetes mellitus, 269, 486, 613 Intercellular Adhesion Molecule-1, 613 Interleukins, 611, 613 Intermittent, 214, 247, 248, 489, 613 Intermittent Claudication, 214, 247, 248, 613 Internal radiation, 613, 643 Interstitial, 572, 613, 628, 645 Intestinal Mucosa, 294, 576, 594, 613 Intoxication, 575, 613, 663 Intracellular Membranes, 613, 622 Intracranial Aneurysm, 578, 613 Intracranial Pressure, 264, 613 Intrahepatic, 614 Intramuscular, 614, 633 Intraocular, 264, 614 Intraocular pressure, 264, 614 Intravenous, 419, 438, 612, 614, 633 Intrinsic, 561, 614 Invasive, 295, 368, 611, 614, 621 Involuntary, 569, 596, 614, 627, 644, 651, 652 Iodine, 353, 614 Ion Channels, 568, 614, 655 Ion Exchange, 283, 293, 308, 326, 565, 577, 614 Ion Exchange Resins, 283, 293, 326, 614 Ionization, 614 Ionizing, 562, 594, 614, 644 Ions, 364, 559, 569, 574, 579, 590, 592, 609, 614, 615, 625, 648 Iris, 584, 614, 643 Irritants, 493, 614 Ischemia, 569, 600, 607, 614 Ischemic stroke, 614 Isoelectric, 318, 615 Isoelectric Point, 318, 615 Isoenzyme, 361, 362, 615 Isoflavones, 176, 198, 204, 207, 208, 225, 230, 278, 338, 339, 401, 402, 403, 615 Isoleucine, 361, 362, 615 Isomerases, 408, 615 Isoprenoid, 310, 358, 615 J Jaundice, 488, 609, 615 Jejunum, 411, 579, 615 Joint, 4, 486, 511, 568, 599, 615, 631, 655 K Kallidin, 572, 615

676 Cholesterol

Kb, 508, 615 Keratin, 394, 395, 615 Keratinocytes, 615 Keratosis, 338, 615 Ketone Bodies, 361, 362, 559, 616 Kidney Disease, 253, 258, 268, 269, 271, 487, 495, 508, 523, 532, 541, 542, 543, 575, 616 Kidney Failure, 253, 594, 602, 616 Kidney stone, 616, 660 Kinetic, 74, 614, 616 L Labile, 582, 616 Lactation, 616, 633, 641 Large Intestine, 422, 576, 582, 589, 613, 616, 644, 651 Latent, 616, 640 Laxative, 174, 561, 578, 616, 624 Least-Squares Analysis, 616, 645 Lectin, 371, 616, 623 Leg Ulcer, 616 Lens, 249, 250, 255, 266, 567, 576, 616, 663 Leprosy, 599, 616 Lethal, 303, 333, 569, 586, 617, 626 Leucine, 361, 362, 617 Leucocyte, 175, 617 Leukaemia, 333, 617 Leukapheresis, 567, 617 Leukemia, 67, 522, 601, 617 Leukocytes, 175, 569, 571, 572, 578, 586, 595, 604, 613, 617 Leukotrienes, 303, 567, 617 Libido, 564, 617 Library Services, 552, 617 Life cycle, 385, 499, 600, 617 Life Expectancy, 238, 473, 617 Ligament, 617, 641 Ligands, 291, 360, 411, 617 Ligases, 408, 617 Likelihood Functions, 617, 645 Limb Bud, 301, 390, 617 Linear Models, 618, 645 Linkage, 283, 577, 618, 635 Linolenic Acids, 333, 618 Lipaemia, 618 Lipase, 65, 73, 175, 283, 297, 371, 421, 618, 631 Lipid Bilayers, 176, 373, 618 Lipid Peroxidation, 618, 632 Lipodystrophy, 245, 618 Lipophilic, 275, 276, 340, 359, 388, 618 Lipopolysaccharides, 618

Lipoprotein Lipase, 73, 618 Lipoprotein(a), 4, 618 Liposomal, 294, 302, 618 Liposome, 293, 618 Lipoxygenase, 617, 618 Liquor, 428, 619 Lisinopril, 269, 619 Lithium, 566, 619 Lithotripsy, 5, 619 Liver cancer, 488, 562, 619 Liver scan, 619, 648 Liver Transplantation, 247, 619 Lobe, 578, 619 Localization, 75, 405, 619 Localized, 70, 277, 329, 488, 593, 605, 606, 612, 618, 619, 637, 648, 659 Locomotion, 619, 637 Logistic Models, 619, 645 Lower-fat diet, 498, 619 Lubricants, 620, 635 Lumbar, 255, 257, 569, 620, 652 Lumbar puncture, 255, 257, 620, 652 Lumen, 300, 311, 331, 419, 439, 576, 594, 620 Lupus, 215, 261, 487, 620, 655 Lupus Nephritis, 487, 620 Lyases, 408, 620 Lye, 356, 620 Lymph, 256, 415, 569, 580, 585, 594, 620, 647 Lymph node, 569, 620, 647 Lymphadenopathy, 415, 620 Lymphatic, 594, 612, 620, 651, 652, 657 Lymphatic system, 620, 651, 652, 657 Lymphocyte, 174, 384, 385, 566, 620, 621, 622 Lymphogranuloma Venereum, 71, 604, 620 Lymphoid, 565, 617, 620 Lymphokines, 620, 621 Lymphoma, 69, 522, 620 Lysophospholipase, 289, 620 Lysophospholipids, 409, 621 Lysosome, 621 Lytic, 293, 621 M Macrophage Activation, 621 Macula, 248, 249, 266, 621 Macula Lutea, 621 Macular Degeneration, 214, 249, 478, 621 Magnetic Resonance Imaging, 177, 251, 621, 648

Index 677

Major Histocompatibility Complex, 605, 621 Malabsorption, 177, 415, 488, 522, 576, 621 Malignancy, 487, 621 Malignant, 295, 338, 522, 566, 568, 619, 621, 628, 644 Malnutrition, 491, 561, 569, 573, 621, 626 Mammary, 584, 618, 621 Mammogram, 573, 621, 624 Mange, 338, 621 Manic, 566, 619, 621 Mass Media, 512, 513, 518, 621 Maxillary, 621, 633 Maxillary Sinus, 621 Meat Products, 377, 384, 589, 622 Meatus, 621, 622 Medial, 290, 300, 568, 622 Mediate, 66, 80, 389, 425, 590, 622 Mediator, 67, 79, 259, 280, 281, 320, 321, 622, 649 Medical Records, 256, 622 Medicament, 384, 385, 413, 622 MEDLINE, 509, 521, 523, 622 Megaloblastic, 599, 622 Meiosis, 571, 622, 626, 655 Melanin, 614, 622, 635, 659 Melanocytes, 622 Melanoma, 522, 572, 622 Membrane Fluidity, 396, 622 Membrane Lipids, 622, 636 Membrane Microdomains, 78, 622 Membrane Proteins, 69, 576, 622 Memory, 257, 565, 587, 623, 645 Meninges, 577, 585, 623 Menopause, 176, 214, 246, 270, 532, 623, 639, 640 Menstrual Cycle, 403, 623, 640 Menstruation, 213, 562, 587, 623 Mental Disorders, 272, 623, 640, 642 Mental Health, iv, 257, 272, 468, 469, 508, 520, 623, 640, 642 Mental Retardation, 255, 256, 264, 524, 623 Mesenteric, 300, 623, 639 Mesentery, 623, 634, 652 Mesoderm, 301, 390, 623 Meta-Analysis, 69, 77, 201, 207, 623 Metabolic disorder, 588, 604, 623 Metabolite, 571, 589, 619, 623, 639, 640 Metaphase, 571, 623 Metastasis, 623, 628 Metastatic, 404, 487, 623 Methanol, 322, 623

Methionine, 227, 589, 623, 654 Methylcellulose, 381, 623 Methylene Blue, 321, 624 MI, 6, 75, 199, 280, 291, 347, 493, 495, 497, 514, 516, 533, 534, 557, 624 Micelle, 293, 624 Microbe, 624, 658 Microbiology, 328, 560, 569, 624 Microcalcifications, 573, 624 Microglia, 568, 624 Microorganism, 314, 315, 316, 318, 337, 391, 413, 581, 624, 633, 663 Micro-organism, 276, 305, 306, 624, 636 Microscopy, 608, 624 Microsomal, 239, 277, 303, 329, 391, 624 Migration, 395, 613, 621, 624, 634 Milk Thistle, 230, 624, 650 Milliliter, 572, 624 Mineralocorticoids, 560, 585, 624 Minority Groups, 518, 625 Mitochondria, 303, 561, 625, 631 Mitosis, 337, 625, 651 Mitotic, 395, 625 Mobility, 65, 74, 625 Mobilization, 75, 625 Modeling, 260, 267, 625 Modulator, 625 Molecular Structure, 277, 329, 625 Monitor, 255, 349, 487, 488, 491, 492, 585, 625, 630, 662 Monoclonal, 353, 382, 625, 643 Monoclonal antibodies, 625 Monocyte, 71, 80, 625 Mononuclear, 174, 604, 625 Monophosphate, 361, 362, 625 Monotherapy, 331, 625 Monounsaturated fat, 69, 354, 375, 381, 497, 556, 625 Mood Disorders, 625 Morphogenesis, 617, 625 Morphological, 300, 592, 600, 622, 626, 662 Morphology, 606, 621, 626 Motilin, 626 Motility, 601, 626, 649 Motion Sickness, 626, 627 Motor Activity, 626 Motor Neurons, 626 Mucinous, 600, 626 Mucins, 594, 604, 626 Mucolytic, 559, 626 Mucosa, 612, 620, 626, 641 Multidrug resistance, 626

678 Cholesterol

Multiple sclerosis, 435, 626 Multivalent, 569, 626 Muscle Contraction, 626, 648 Muscle Fibers, 626, 627 Muscular Atrophy, 523, 626 Muscular Dystrophies, 591, 626 Mustard Gas, 614, 626 Mycophenolate mofetil, 626 Mycosis, 627 Mycotic, 333, 627 Mydriatic, 589, 627 Myelin, 626, 627 Myelin Proteins, 627 Myelin Sheath, 627 Myelogenous, 627 Myocardial Ischemia, 80, 259, 261, 262, 268, 564, 585, 627 Myocardium, 242, 564, 624, 627, 661 Myopathy, 332, 415, 627 Myosin, 424, 574, 626, 627 Myositis, 385, 627 Myotonic Dystrophy, 523, 627 Myristate, 334, 627 N Naphthoquinones, 589, 627 Natural selection, 570, 627 Nausea, 474, 489, 565, 566, 591, 627, 660 NCI, 1, 271, 507, 580, 627 Needs Assessment, 628 Neonatal, 612, 628 Neoplasia, 385, 522, 628 Neoplasms, 566, 572, 628, 635, 644, 656 Neoplastic, 573, 620, 628 Nephritis, 487, 628 Nephropathy, 269, 471, 616, 628 Nephrosis, 628 Nephrotic, 253, 283, 628 Nervous System, 256, 523, 545, 559, 563, 565, 570, 573, 577, 600, 603, 617, 622, 624, 626, 627, 628, 631, 634, 649, 655, 656, 659, 661 Neural, 563, 598, 600, 624, 628 Neural tube defects, 598, 628 Neuroblastoma, 628 Neurodegenerative Diseases, 421, 569, 628 Neurologic, 628 Neuromuscular, 559, 628, 660 Neuromuscular Junction, 559, 628 Neuronal, 628, 649 Neurons, 68, 587, 600, 626, 628, 629, 655 Neuropathy, 370, 628 Neurosecretory Systems, 593, 629

Neurotoxin, 435, 629 Neurotransmitter, 559, 560, 563, 572, 590, 603, 608, 614, 629, 650, 654, 655, 659 Neutrons, 295, 562, 572, 597, 629, 643 Neutrophil, 613, 629 Nicotine, 492, 629 Nifedipine, 269, 629 Nitric Oxide, 270, 404, 435, 437, 629 Nitrogen, 242, 376, 487, 491, 562, 564, 567, 586, 629, 659 Nitroglycerin, 263, 264, 434, 435, 629 Nitroprusside, 263, 629 Norepinephrine, 560, 590, 629 Normotensive, 416, 630 Notochord, 301, 390, 630 Nuclear, 68, 69, 70, 208, 295, 569, 574, 583, 596, 600, 630 Nuclei, 562, 583, 601, 621, 625, 629, 630, 631, 642 Nucleic Acid Hybridization, 608, 630 Nucleotidases, 609, 630 O Observational study, 630 Occult, 487, 630 Odds Ratio, 6, 630, 645 Odour, 567, 630, 660 Ointments, 591, 630, 651 Oligosaccharides, 187, 630 Omega-3 fatty acid, 190, 477, 630 Oncogene, 522, 631 On-line, 555, 631 Opacity, 576, 587, 631 Operon, 631, 641 Optic Nerve, 591, 631, 646 Optic nerve head, 591, 631 Organelles, 577, 580, 586, 622, 631, 637 Organogenesis, 413, 617, 631 Organoleptic, 378, 379, 631 Orlistat, 421, 631 Osmotic, 561, 631, 650 Osteoarthritis, 67, 631 Osteolytic, 404, 631 Osteoporosis, 205, 268, 404, 631 Otitis, 478, 631 Otitis Media, 478, 631 Outpatient, 631 Ovarian Follicle, 585, 599, 632 Ovariectomy, 203, 632 Ovaries, 361, 362, 632, 650 Ovary, 585, 596, 604, 632, 638 Overexpress, 438, 632 Ovomucin, 632

Index 679

Ovum, 585, 587, 599, 602, 617, 632, 640, 641, 652, 664 Oxidants, 419, 632 Oxidation-Reduction, 334, 571, 632 Oxidative metabolism, 617, 632 Oxidative Stress, 178, 200, 203, 632 Oxides, 197, 446, 632 Oxygen Consumption, 240, 276, 632, 645 Oxygenation, 607, 632 Oxytocin, 632 P Palliative, 633, 656 Palsy, 545, 633 Pancreas, 352, 382, 471, 498, 559, 589, 606, 613, 618, 633, 652, 659 Pancreatic, 283, 294, 352, 382, 522, 633 Pancreatic cancer, 522, 633 Pancreatitis, 291, 436, 633 Paneth Cells, 594, 633 Papilla, 633 Papillary, 609, 633 Paranasal Sinuses, 621, 633 Paraneoplastic syndrome, 487, 633 Parasite, 69, 175, 633 Parenteral, 633 Parotid, 633, 648 Paroxysmal, 523, 564, 605, 633 Pathogen, 73, 612, 633 Pathogenesis, 75, 239, 446, 471, 478, 633 Pathologic, 4, 571, 584, 609, 610, 633, 642, 645 Pathologies, 429, 433, 633 Pathophysiology, 470, 633 Patient Compliance, 365, 633 Patient Education, 474, 515, 517, 533, 538, 550, 552, 557, 633 Pelvic, 634, 641 Pelvis, 559, 610, 616, 620, 632, 634, 660 Peptide Hydrolases, 594, 609, 634 Percutaneous, 380, 619, 634 Perfusion, 196, 311, 634 Pergolide, 385, 634 Pericarditis, 634 Pericardium, 634, 655, 661 Perinatal, 493, 612, 634 Periodontal disease, 404, 634 Periodontal Pocket, 634 Peripheral blood, 174, 384, 634 Peripheral Nervous System, 627, 628, 629, 633, 634, 654 Peripheral Vascular Disease, 8, 214, 247, 264, 360, 398, 406, 412, 634

Peritoneal, 471, 634 Peritoneum, 623, 634, 646 Peroxide, 276, 282, 283, 290, 314, 315, 316, 317, 323, 334, 337, 356, 392, 415, 579, 603, 609, 618, 635, 654 Peroxisome Proliferators, 635 Pesticides, 392, 607, 613, 635 Petechiae, 605, 635 Petrolatum, 593, 635 Petroleum, 335, 357, 367, 601, 635 PH, 65, 67, 73, 76, 198, 201, 203, 572, 635 Phagocyte, 632, 635 Pharmaceutical Preparations, 304, 305, 577, 596, 601, 635 Pharmaceutical Solutions, 591, 635 Pharmacist, 460, 465, 635 Pharmacokinetic, 635 Pharmacologic, 196, 564, 605, 635, 658 Pharynx, 610, 612, 635 Phenolphthalein, 593, 635 Phenotype, 73, 201, 434, 437, 582, 635 Phenyl, 306, 328, 635 Phenylalanine, 635, 659 Phosphates, 201, 368, 635 Phosphatidic Acids, 621, 635 Phosphodiesterase, 289, 635 Phosphogluconate Dehydrogenase, 361, 362, 636 Phospholipases, 636, 650 Phosphoric Monoester Hydrolases, 609, 636 Phosphorous, 350, 636 Phosphorus, 323, 491, 574, 636 Phosphorylated, 581, 589, 636 Phosphorylation, 636, 642 Photocoagulation, 581, 636 Physical Examination, 249, 251, 254, 255, 263, 264, 608, 636 Physical Fitness, 237, 241, 475, 485, 636 Physicochemical, 440, 636 Physiologic, 423, 561, 581, 605, 623, 636, 644, 645 Physiology, 176, 199, 210, 413, 487, 495, 560, 575, 606, 636 Pigments, 322, 374, 570, 575, 636, 637, 646 Pilot study, 261, 495, 636 Pitch, 428, 636 Pituitary Gland, 385, 585, 636 Placenta, 303, 361, 362, 596, 598, 636, 640 Placental tissue, 636 Plana, 637, 649 Plant Oils, 277, 630, 637

680 Cholesterol

Plant Proteins, 637, 661 Plaque, 260, 277, 284, 290, 311, 329, 341, 342, 343, 344, 345, 369, 397, 433, 435, 442, 563, 564, 637 Plasma cells, 565, 637 Plasma protein, 75, 288, 561, 594, 599, 637, 650 Plasmapheresis, 359, 365, 567, 637 Plasmid, 275, 314, 315, 316, 388, 637, 661 Plasmin, 637, 657, 660 Plasminogen, 373, 637, 657, 660 Plasminogen Activators, 637 Plastic surgeon, 265, 637 Plastids, 631, 637 Platelet Activation, 637, 650 Platelet Aggregation, 327, 397, 435, 564, 595, 610, 629, 638, 657 Platelet-Derived Growth Factor, 638 Plateletpheresis, 567, 638 Platelets, 240, 435, 491, 629, 637, 638, 649, 656, 657 Platinum, 470, 638 Pleated, 615, 638 Plethysmography, 263, 638 Pneumonia, 521, 584, 638 Poisoning, 574, 595, 613, 624, 627, 638 Policy Making, 604, 638 Pollen, 638, 643 Poly U, 410, 638 Polycystic, 523, 638 Polyesters, 359, 638 Polyethylene, 638 Polymerase, 278, 329, 638, 641 Polymerase Chain Reaction, 278, 329, 638 Polymers, 340, 565, 614, 638, 639, 642, 654 Polymorphism, 206, 210, 639 Polyp, 639 Polyposis, 582, 639 Polysaccharide, 364, 566, 577, 604, 639, 642, 660 Polyunsaturated fat, 175, 210, 311, 354, 375, 381, 405, 498, 556, 639, 657 Portal Vein, 364, 411, 422, 639 Posterior, 301, 390, 564, 568, 569, 577, 579, 591, 614, 632, 633, 639 Postmenopausal, 201, 242, 246, 262, 268, 270, 631, 639 Postnatal, 493, 639 Postprandial, 639 Postsynaptic, 639, 650, 655 Potassium, 335, 357, 367, 491, 590, 620, 624, 639, 651

Potassium hydroxide, 335, 357, 367, 639 Potentiation, 177, 639, 650 Practice Guidelines, 519, 540, 639 Pravastatin, 184, 258, 327, 332, 392, 397, 398, 416, 434, 639 Precancerous, 578, 639, 640 Precipitation, 288, 323, 330, 351, 364, 640 Predisposition, 278, 338, 339, 401, 402, 410, 640 Prednisolone, 640 Prednisone, 487, 640 Pregnenolone, 228, 303, 346, 640 Premalignant, 338, 640 Premenopausal, 403, 640 Prenatal, 592, 602, 640 Prevalence, 4, 5, 349, 423, 500, 513, 515, 516, 540, 630, 640 Preventive Health Services, 443, 640 Prickle, 615, 640 Primary Prevention, 284, 411, 471, 510, 640 Primary tumor, 487, 640 Private Sector, 515, 640 Probe, 238, 640 Prodrug, 640 Progeny, 583, 640 Progesterone, 228, 314, 640, 641, 653 Progression, 247, 284, 290, 327, 384, 397, 416, 433, 471, 491, 565, 640 Prolactin, 573, 641 Proliferative Retinopathy, 264, 641 Proline, 582, 609, 641 Promoter, 287, 363, 641 Promotor, 641, 646 Pronase, 641 Prone, 373, 545, 641 Prophase, 571, 626, 641, 655 Prophylaxis, 294, 383, 427, 641, 646 Proportional, 263, 321, 595, 641 Prospective Studies, 495, 641 Prospective study, 269, 641 Prostaglandins, 303, 404, 562, 567, 641 Prostate, 212, 214, 522, 641 Protease, 245, 258, 261, 277, 283, 329, 371, 582, 641, 657 Protease Inhibitors, 245, 641 Protein C, 257, 359, 561, 563, 567, 569, 581, 598, 615, 618, 641, 660, 662 Protein Conformation, 563, 615, 641 Protein S, 301, 377, 389, 403, 407, 469, 523, 524, 563, 571, 596, 601, 641, 647 Protein-Tyrosine Kinase, 602, 642

Index 681

Proteinuria, 253, 602, 642 Proteoglycans, 406, 642 Proteolytic, 66, 582, 598, 637, 641, 642, 657, 660 Protocol, 257, 642 Protons, 562, 609, 614, 642, 643 Protozoa, 583, 624, 642, 653 Proximal, 287, 590, 642 Pruritic, 588, 591, 642 Pruritus, 642, 660 Psoriasis, 215, 337, 626, 642, 646 Psychiatric, 258, 623, 642 Psychiatry, 642 Psychic, 581, 617, 623, 642, 649 Psychoactive, 642, 663 Psyllium, 225, 228, 229, 297, 642 Public Policy, 509, 642 Pulmonary, 499, 571, 579, 584, 595, 616, 617, 642, 643, 655, 661 Pulmonary Artery, 571, 643, 661 Pulse, 176, 241, 250, 266, 592, 625, 643 Pupil, 255, 584, 589, 627, 643 Purgative, 616, 643 Purifying, 328, 588, 643 Purines, 486, 643, 649, 663 Purpura, 605, 643 Putrefaction, 600, 643 Pyrimidines, 643, 649 Q Quality of Life, 198, 495, 643 Quaternary, 275, 308, 641, 643 Quercetin, 174, 184, 643 R Race, 469, 485, 540, 624, 643 Radiation, 295, 394, 395, 461, 564, 592, 594, 597, 599, 600, 613, 614, 643, 644, 648, 664 Radiation therapy, 295, 597, 599, 613, 643 Radioactive, 295, 572, 605, 609, 611, 613, 614, 619, 625, 630, 643, 644, 648 Radioimmunotherapy, 643, 644 Radioisotope, 644, 658 Radiolabeled, 643, 644 Radiological, 634, 644 Radionuclide Imaging, 644 Radiotherapy, 295, 572, 643, 644 Radius, 644 Reactive Oxygen Species, 644 Recombinant, 314, 315, 316, 317, 372, 408, 424, 433, 644, 661 Recombination, 583, 601, 644 Rectum, 567, 572, 582, 589, 599, 601, 611, 616, 641, 644

Recurrence, 5, 6, 177, 325, 326, 644 Red Nucleus, 568, 644 Refer, 1, 282, 335, 573, 582, 600, 619, 620, 621, 629, 643, 644, 658 Reflex, 597, 644 Refraction, 644, 652 Regimen, 172, 254, 258, 261, 262, 360, 412, 426, 486, 592, 633, 644 Regression Analysis, 4, 469, 645 Relapse, 645 Relative risk, 4, 645 Reliability, 417, 645 Reminder Systems, 259, 645 Remission, 644, 645 Renal Artery, 471, 645 Renal cell carcinoma, 645 Renal failure, 369, 471, 645 Renin, 398, 565, 575, 645 Renin-Angiotensin System, 398, 565, 575, 645 Research Support, 287, 299, 363, 645 Resorption, 634, 645 Respiration, 575, 598, 625, 632, 645, 646 Response Elements, 646 Resting metabolic rate, 251, 646 Resuscitation, 593, 646 Retina, 248, 249, 255, 266, 579, 580, 591, 616, 621, 631, 641, 646, 647, 649, 663 Retinae, 621, 646 Retinal, 590, 631, 646, 663 Retinoblastoma, 522, 646 Retinoids, 487, 646, 663 Retroperitoneal, 560, 646 Retrospective, 646 Retroviral vector, 601, 646 Reverberant, 589, 646 Rhabdomyolysis, 332, 646 Rheumatic Diseases, 487, 646 Rheumatism, 610, 646 Rheumatoid, 67, 215, 632, 646 Rheumatoid arthritis, 67, 646 Ribose, 560, 638, 647 Ribosome, 647, 659 Rickets, 647, 663 Rigidity, 614, 637, 647 Risk patient, 435, 517, 538, 647 Rod, 569, 580, 630, 647 Rodenticides, 635, 647 Rosiglitazone, 245, 263, 647 Rubber, 263, 559, 647, 653 Rural Health, 472, 647 Rural Population, 242, 647

682 Cholesterol

Rutin, 643, 647 Rye, 489, 580, 595, 647 S Salivary, 589, 633, 647 Salivary glands, 589, 647 Saphenous, 584, 647 Saphenous Vein, 584, 647 Saponification, 321, 330, 337, 356, 647 Saponin, 286, 311, 323, 333, 647 Sarcoidosis, 647 Sarcoplasmic Reticulum, 424, 648 Scans, 648 Schizoid, 648, 663 Schizophrenia, 215, 648, 663 Schizotypal Personality Disorder, 648, 663 Scleroderma, 488, 568, 648 Scleroproteins, 615, 648 Sclerosis, 300, 417, 418, 488, 523, 568, 626, 648 Seafood, 301, 376, 390, 431, 500, 648 Sebaceous, 588, 614, 648, 663 Sebaceous gland, 588, 614, 648, 663 Secretory, 424, 648, 655 Secular trends, 259, 648 Sedative, 274, 648 Sedentary, 297, 398, 475, 485, 488, 496, 499, 646, 648 Sedimentation, 577, 648 Segmental, 253, 602, 649 Segmentation, 649 Segregation, 68, 644, 649 Seizures, 633, 649 Selenium, 184, 342, 343, 344, 345, 649 Self Care, 559, 649 Sella, 636, 649 Semen, 242, 641, 649 Semisynthetic, 573, 574, 649 Senile, 421, 631, 649 Senile Plaques, 649 Sensor, 280, 319, 320, 321, 368, 417, 649 Sequencing, 639, 649 Sequester, 292, 422, 649 Serine, 594, 649, 657, 659 Serotonin, 566, 570, 599, 629, 649, 659 Serous, 594, 649 Serrata, 219, 580, 649 Serrated, 649 Serum Albumin, 572, 650 Sex Characteristics, 560, 564, 650, 656 Sex Determination, 523, 650 Sharpness, 650, 663 Shedding, 394, 588, 650

Shock, 5, 619, 650, 659 Shunt, 361, 362, 650 Signal Transduction, 574, 576, 613, 650 Signs and Symptoms, 645, 650, 660 Silicic, 329, 650 Silymarin, 201, 624, 650 Skeletal, 73, 238, 564, 580, 610, 626, 646, 648, 651, 652 Skeleton, 559, 598, 609, 615, 651 Skull, 585, 614, 628, 651, 656 Small cell lung cancer, 252, 651 Small intestine, 279, 331, 411, 576, 578, 580, 591, 608, 610, 613, 615, 651, 659 Smoking Cessation, 492, 651 Smooth muscle, 290, 296, 433, 562, 564, 573, 574, 584, 599, 608, 629, 645, 651, 652, 654 Sneezing, 650, 651 Soaps, 428, 651 Social Environment, 643, 651 Social Support, 651, 653 Soft tissue, 572, 651 Solid tumor, 564, 651 Solvent, 282, 322, 354, 364, 371, 374, 380, 392, 559, 570, 579, 596, 603, 623, 631, 635, 651 Soma, 651 Somatic, 385, 469, 560, 581, 622, 625, 631, 634, 651 Somatic cells, 622, 625, 651 Somatotropin, 384, 385, 651 Sound wave, 263, 583, 652 Soybean Oil, 354, 639, 652, 663 Spasm, 567, 607, 652 Specialist, 253, 546, 589, 652 Specificity, 78, 208, 306, 408, 425, 561, 594, 652 Spectrophotometry, 350, 351, 652 Spectrum, 368, 586, 624, 652 Sperm, 564, 580, 638, 652 Sperm Capacitation, 652 Spermatozoon, 652 Sphincter, 600, 652 Sphingomyelin Phosphodiesterase, 652 Spices, 376, 464, 652 Spinal cord, 255, 257, 301, 390, 568, 572, 573, 577, 578, 579, 600, 623, 628, 634, 644, 652 Spinal tap, 255, 257, 620, 652 Spinous, 595, 615, 652 Spleen, 78, 545, 620, 647, 652 Splenic Vein, 639, 652

Index 683

Spontaneous Abortion, 493, 653 Sporadic, 628, 646, 653 Spores, 489, 653 Squalene Synthetase, 310, 653 Stabilization, 387, 435, 653 Stabilizer, 281, 304, 305, 653 Staging, 648, 653 Statistically significant, 284, 518, 653 Steatosis, 597, 653 Steel, 580, 653 Stenosis, 471, 653, 654 Sterility, 586, 612, 653 Stethoscope, 492, 653 Stimulants, 602, 653 Stimulus, 584, 592, 614, 644, 653, 656 Stomach, 559, 569, 589, 596, 601, 603, 608, 627, 635, 651, 652, 653 Stool, 255, 582, 611, 616, 653 Strand, 638, 653 Stress management, 492, 653 Stricture, 653, 654 Styrene, 283, 292, 647, 654 Subacute, 612, 620, 654 Subarachnoid, 605, 654 Subclinical, 612, 649, 654 Subcutaneous, 591, 618, 633, 654 Sublingual, 434, 435, 654 Subspecies, 652, 654 Substance P, 595, 623, 648, 654 Substrate Specificity, 305, 318, 654 Suction, 598, 654 Sudden death, 311, 433, 513, 654 Sulfates, 303, 654 Sulfotransferases, 654 Sulfur, 185, 304, 560, 623, 654 Sulfuric acid, 282, 330, 335, 371, 654 Superoxide, 204, 654 Superoxide Dismutase, 654 Supplementation, 195, 198, 203, 206, 207, 209, 255, 468, 654 Suppression, 274, 420, 435, 585, 654 Surfactant, 281, 282, 319, 320, 321, 346, 356, 357, 365, 367, 383, 416, 418, 596, 655 Sweat, 588, 655 Sweat Glands, 588, 655 Sympathomimetic, 563, 590, 595, 630, 655, 659 Symphysis, 578, 641, 655 Symptomatic, 246, 248, 385, 633, 655 Synapse, 560, 628, 655, 659 Synapsis, 655 Synaptic, 629, 650, 655

Synaptic Transmission, 629, 655 Synergistic, 340, 385, 400, 435, 437, 493, 641, 655 Systemic disease, 610, 655 Systemic lupus erythematosus, 198, 398, 620, 655 Systolic, 268, 366, 494, 610, 655 Systolic blood pressure, 268, 366, 655 T Tacrolimus, 655 Tartar, 409, 655 Taurine, 200, 203, 231, 411, 422, 570, 578, 579, 587, 655 Tear Gases, 614, 656 Telangiectasia, 523, 656 Temporal, 605, 621, 622, 656 Tendon, 254, 573, 600, 656 Tendonitis, 385, 656 Testis, 596, 656 Testosterone, 644, 656 Thalamic, 568, 656 Thalamic Diseases, 568, 656 Theophylline, 643, 656 Therapeutics, 207, 360, 382, 412, 503, 656 Thermal, 572, 590, 629, 639, 656 Thigh, 255, 598, 656 Thioamides, 289, 290, 656 Thoracic, 204, 311, 569, 656, 663 Thorax, 559, 620, 656 Threonine, 649, 656 Threshold, 385, 610, 656 Thrombin, 239, 598, 638, 641, 656, 657 Thrombocytes, 638, 656 Thrombolytic, 637, 657 Thrombomodulin, 641, 657 Thromboxanes, 567, 657 Thrombus, 435, 585, 612, 615, 627, 638, 657 Thymus, 384, 611, 620, 657 Thyroid, 70, 177, 282, 334, 369, 423, 491, 575, 610, 614, 657, 659 Thyroid Gland, 610, 657 Thyroxine, 561, 635, 657 Time Management, 653, 657 Tin, 638, 657 Tinnitus, 215, 631, 657 Tissue Plasminogen Activator, 657 Tolerance, 265, 277, 324, 560, 603, 657 Tomography, 583, 648, 657 Tone, 256, 269, 490, 610, 630, 657 Tonus, 657, 658 Topical, 225, 287, 333, 337, 394, 395, 596, 609, 635, 651, 658

684 Cholesterol

Topotecan, 429, 658 Torsion, 612, 658 Toxicity, 252, 283, 323, 334, 387, 488, 491, 591, 658 Toxicokinetics, 658 Toxicology, 422, 510, 658 Toxin, 413, 575, 594, 657, 658 Trace element, 572, 580, 657, 658 Tracer, 373, 608, 658 Trachea, 597, 635, 657, 658 Traction, 580, 658 Transcriptase, 261, 430, 658 Transcription Factors, 298, 299, 646, 658 Transduction, 650, 658 Transfection, 72, 78, 175, 275, 302, 388, 571, 601, 658 Transfer Factor, 611, 658 Transferases, 408, 658 Translation, 358, 563, 596, 658 Translocation, 596, 659 Transmitter, 559, 568, 590, 614, 622, 629, 659, 662 Transplantation, 580, 611, 621, 659 Transport Vesicles, 369, 659 Trauma, 633, 659 Trees, 637, 647, 659 Trisomy, 563, 659 Troglitazone, 659 Trypsin, 632, 659 Tryptophan, 287, 582, 649, 659 Tuberous Sclerosis, 523, 659 Tumour, 600, 659 Type 2 diabetes, 7, 8, 249, 250, 265, 266, 659 Tyramine, 570, 659 Tyrosine, 590, 642, 659 U Ubiquinone, 310, 659 Ulcer, 283, 659, 661 Ultrasonography, 5, 659 Unconscious, 610, 660 Unsaturated Fats, 380, 443, 444, 494, 539, 660 Uraemia, 633, 660 Urea, 280, 569, 572, 655, 660 Uremia, 616, 645, 660 Ureter, 619, 660 Urethra, 641, 660 Uric, 290, 357, 486, 562, 604, 610, 643, 660 Uridine Diphosphate, 603, 660 Uridine Diphosphate Glucuronic Acid, 603, 660

Urinary, 385, 574, 611, 657, 660, 663 Urinary Plasminogen Activator, 657, 660 Ursodeoxycholic Acid, 5, 660 Uterine Contraction, 559, 632, 660 Uterus, 559, 585, 587, 593, 623, 632, 640, 660, 661 V Vaccine, 560, 642, 660 Vacuoles, 593, 631, 661 Vagina, 246, 588, 623, 661 Valves, 661 Varicose, 616, 661 Varicose Ulcer, 616, 661 Vasculitis, 487, 633, 661 Vasoactive, 404, 661 Vasoconstriction, 435, 595, 661 Vasodilatation, 201, 615, 661 Vasodilation, 435, 565, 610, 661 Vasodilator, 566, 572, 590, 608, 629, 661 VE, 172, 173, 259, 661 Vector, 277, 278, 305, 306, 329, 372, 658, 661 Vegetable Proteins, 193, 359, 377, 637, 661 Vegetative, 571, 661 Vein, 249, 250, 251, 255, 265, 267, 455, 564, 568, 614, 630, 633, 639, 647, 652, 661 Venous, 568, 571, 573, 578, 587, 616, 629, 642, 661 Venous blood, 571, 573, 578, 661 Ventricle, 610, 643, 655, 661 Ventricular, 311, 424, 493, 661 Ventricular Pressure, 424, 661 Venules, 572, 574, 594, 662 Vertebrae, 257, 652, 662 Vertebral, 630, 637, 662 Vertigo, 631, 662 Very low-density lipoprotein, 405, 429, 662 Vesicular, 588, 599, 624, 662 Veterinary Medicine, 199, 509, 662 Video Recording, 476, 477, 662 Videodisc Recording, 662 Villous, 576, 662 Vinca Alkaloids, 662 Vincristine, 205, 662 Viral, 77, 430, 487, 488, 559, 574, 602, 612, 658, 662 Viral Envelope Proteins, 430, 662 Viral Hepatitis, 488, 662 Virion, 662 Virulence, 658, 662

Index 685

Virus, 67, 74, 75, 77, 78, 79, 430, 569, 574, 577, 594, 601, 602, 604, 637, 646, 658, 662 Viscera, 385, 623, 651, 662 Viscosity, 319, 380, 381, 559, 662 Visual Acuity, 249, 250, 266, 663 Vitamin A, 180, 184, 185, 612, 663 Vitamin D, 181, 219, 220, 222, 239, 322, 391, 460, 556, 647, 663 Vitamin E, 174, 181, 182, 183, 663 Vitellogenin, 425, 663 Vitreous, 616, 646, 663 Vitreous Body, 646, 663 Vitro, 72, 177, 302, 303, 304, 360, 411, 419, 601, 607, 611, 638, 655, 663 Vivo, 72, 73, 75, 284, 302, 303, 317, 368, 406, 412, 413, 419, 424, 433, 601, 607, 611, 632, 655, 657, 663 Vulgaris, 204, 663 W War, 468, 626, 663

Wart, 615, 663 Weight Gain, 174, 250, 297, 460, 493, 496, 499, 597, 663 White blood cell, 491, 565, 611, 617, 620, 621, 625, 629, 637, 663 Windpipe, 635, 657, 663 Withdrawal, 380, 663 X Xanthine, 562, 663 Xanthine Oxidase, 562, 663 Xenobiotics, 364, 663 Xenograft, 565, 663 X-ray, 251, 254, 256, 266, 572, 583, 584, 599, 600, 621, 630, 643, 644, 648, 653, 664 Y Yeasts, 414, 600, 635, 664 Z Zebrafish, 412, 413, 664 Zygote, 583, 664 Zymogen, 641, 664

686 Cholesterol

Index 687

688 Cholesterol

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