Lipoproteins and Coronary Heart Disease [antikvár]

PrefaceThe primary prevention of coronary heart disease on the basis of known and detectable risk factors nowadays forms an important part of every modern health service. Secondary prevention is generally easier to achieve since the willingness to undertake measures is greater in patients who have suffered from myocardial infarction. Along with cigarette consumption and hypertension, elevated blood lipids are of special importance for the early and accelerated development of coronary heart disease. Recent investigations have even shown cholesterol to be a causative factor in the primary damage to the vascular endothelium. Our knowledge of the physiological and pathophysiological relationships between extracellular lipoprotein constellations on the one hand, specific cell receptors on the cell membranes on the other, and, furthermore, of intracellular cholesterol biosynthesis has been considerably increased in recent years. This understanding was consequently applied to the development of improved lipid-lowering drugs.Bezafibrate is such a new drug for the treatment of hyperlipemias, and the emphasis of these proceedings of the International Symposium Lipoproteins and Coronary Heart Disease is therefore on research on this drug. The presentation of recent biochemical, clinical, and epidemiological data on lipoprotein metabolism and coronary heart disease also occupies part of the book. The dramatic fall in death rates both for myocardial infarction and stroke experienced since 1968 in the United States and a few other countries is analyzed. Appropriate lessons must be learned by other countries in which such a development has so far not been observed. This particularly applies to the highly industrialized countries of Central Europe, where prevention is hindered more by a lack of organization than by a lack of financial resources. There is often a frightening gap between the extent of the threat of cardiovascular diseases and public efforts to prevent it.The development of drugs requires a climate favoring cooperation between government, science, and industry if success is to be expected at all. Unfortunately this "good climate" is sometimes lacking. The exchange of information is essential for all concerned. Our thanks are therefore directed especially to Boehringer Mannheim whose support made these proceedings possible. Finally, we would Uke to thank Dr. C. Brdiming for her assistance in both the organization of the symposium and the preparation of the proceedings.April, 1980The EditorsIntroductionG. SchettlerMedizinische Universitätsklinik HeidelbergBlood lipids have been recognized as a disease-promoting and disease-inducing factor for many decades. Until the 1950s we had to be content for methodological reasons with determining total lipids, cholesterol, total phosphatides, and triglycerides. In the last 20 years, new procedures have been developed to gain further insight into the fine structure of the lipids. These methodological advances have also enriched clinical diagnostics and, in addition, have made possible new approaches in treating disorders of lipid metabolism. Today both the primary and the much more frequent secondary lipidoses as well account for a large proportion of our patients in hospitals and private practice. Whereas formerly the various methods of lipid analysis remained the domain of a few special laboratories, today any well-equipped laboratory in private practice and, of course, every good hospital laboratory have access to analytical techniques that are both rapid and sufficiently accurate to determine a patient's lipid status. Above all, electrophoretic methods have been responsible for our advances. With their aid it has become possible to isolate and measure not only the lipids themselves but also their simplexes. The determination of the lipoproteins and their separation by means of various tech-niques have thus proved an invaluable tool for clinical practice. In addition, the isolation of the lipid and protein portions of these complex compounds has afforded us extremely important insights into the dynamics of the lipoproteins and, furthermore, has allowed us to gain also knowledge of pathogenic processes. This applies not only to the lipidoses proper as accumulation diseases but in a much more important way to the numerous primary and secondary disorders of lipid metabolism that can be differentiated by an analysis of the plasma lipoproteins. Human genetics has also provided new knowledge in the field of lipoproteins. The genetic disorders of lipid metabolism have assumed a model character for the pathogenesis of arteriosclerosis in particular. Especially the receptor thesis proposed by Goldstein and Brown has yielded valuable insights not only into the pathogenesis of genetically determined lipoproteinemias, but also of their secondary form. The claim of Professor Kaunitz, that the receptor thesis is no longer valid, lacks any scientific basis whatsoever.Today we have a very good knowledge of the pathogenesis of the relevant disorders of lipid metabolism. This is particularly the case for arteriosclerosis, quantitatively the most important disease. Agree-