title: Background to discuss guidelines for control of plasma HDL-cholesterol in Japan.
abstract: A decrease in high density lipoprotein-cholesterol (HDL-C) is a strong risk factor for atherosclerotic disorders in Japan, probably more important than an increase in low density lipoprotein-cholesterol (LDL-C). While there are rational grounds for the argument that elevation of HDL-C leads to decreased risk, there has as yet been no direct evidence of such an effect. If elevation of HDL-C decreases the risk, this effect is expected throughout the normal range of HDL-C or perhaps even higher than that. Simulation based on epidemiological data indicated that it may eventually reduce the incidence of ischemic heart disease by 60-70% in Japan. In the risk management guideline, "low" HDL-C is presently defined as 40 mg/dL or below. While there is no evidence that strongly urges a change in this definition, the results of epidemiological studies support "The higher the HDL-C level, the lower the risk,"even in the "normal range". Elevation of the HDL-C level may reduce the risk, probably at least up to 70 mg/dL; however, there are no supportive data for this effect still being obtained over 80 mg/dL. Patients with homozygous CETP deficiency should be followed-up while controlling other risk factors, so as not to dismiss the possibility of a risk increase with an extremely elevated HDL-C level.
authors.affiliation: Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Kasugai, Japan. syokoyam@med.nagoya-cu.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Shizuya
authors.initials: S
authors.lastname: Yamashita
authors.forename: Shun
authors.initials: S
authors.lastname: Ishibashi
authors.forename: Hirohito
authors.initials: H
authors.lastname: Sone
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oikawa
authors.forename: Kohji
authors.initials: K
authors.lastname: Shirai
authors.forename: Takao
authors.initials: T
authors.lastname: Ohta
authors.forename: Hideaki
authors.initials: H
authors.lastname: Bujo
authors.forename: Junji
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Arai
authors.forename: Mariko
authors.initials: M
authors.lastname: Harada-Shiba
authors.forename: Masaaki
authors.initials: M
authors.lastname: Eto
authors.forename: Toshio
authors.initials: T
authors.lastname: Hayashi
authors.forename: Takanari
authors.initials: T
authors.lastname: Gotoda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Yamada
mesh_terms: D053480:Cholesterol Ester Transfer Proteins / Q000172:deficiency*; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007564:Japan; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: C506642:CETP protein, human; D053480:Cholesterol Ester Transfer Proteins; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL