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Atherosclerotic cardiovascular disease still represents the leading cause of death in western countries. A wealth of scientific evidence demonstrates that increased blood cholesterol levels have a major impact on the outbreak and progression of atherosclerotic plaques. Moreover, several cholesterol-lowering pharmacological agents, including statins and ezetimibe, have proven effective in improving clinical outcomes. This document is focused on the clinical management of hypercholesterolemia and has been conceived by 16 Italian medical associations with the support of the Italian National Institute of Health. The authors have considered with particular attention the role of hypercholesterolemia in the genesis of atherosclerotic cardiovascular disease. Besides, the implications of high cholesterol levels in the definition of the individual cardiovascular risk profile have been carefully analyzed, while all available therapeutic options for blood cholesterol reduction and cardiovascular risk mitigation have been considered. Finally, this document outlines the diagnostic and therapeutic pathways for the clinical management of patients with hypercholesterolemia.

The aim of this study was to verify the possible effects that several of the most common endogenous and exogenous risk factors may have on the development of essential hypertension, hypercholesterolemia and type I diabetes. The study was performed on a national sample of the population aged 16-65 years. The study population was classified on the basis of health status, main life habits and family history. The relative risk of various exposures in healthy and ill subjects was evaluated as well as the population inference for the probability of developing disease. Though the proportion of ill subjects, especially diabetics, was low, the evaluated risk factors play an important role in most cases of chronic morbidity in patients over 40 years of age.

An example of good integration of territorial sanitary services with hospital services. An observational study that pointed out cholesterol disorders in a pre-adolescent population of a little city next to Milan.

In this paper the presence of a correlation between plasma Lp(a) levels and peripheral vascular disease (PVD) and/or coronary heart disease (CHD) was investigated in 20 dyslipidaemic patients (10 males and 10 females, well matched for age, type of hyperlydaemia and other CVD risk factors). Lp(a) plasma levels, ECG and carotid and femoral arteries duplex ultrasonography were performed in all the patients. No difference in plasma Lp(a) levels between patients without and with carotid and femoral arteries stenotic lesions was observed. On the contrary Lp(a) was significantly higher in patients with ECG signs of coronary ischaemic heart diseases than in patients with normal ECG. These observations confirm the importance of Lp(a) as a risk factor for coronary heart disease in dyslipidaemic patients.

The finding of normocholesterolaemia, characterized by plasmatic values of total cholesterol < 2 g/l, which may hide silent lipidic alterations, is not by itself sufficient to rule out the existence of cardiovascular risk. First level screening of patients exposed to atherogenic risk must begin from dosage of three basic lipidic indicators, represented by total cholesterol, triglycerides, and HDL cholesterol. By using the values of the three above-mentioned indicators and by applying Friedewald's formula, it is possible to calculate LDL cholesterol indirectly. Atherogenic risk is present when HDL cholesterol and LDL cholesterol show plasmatic concentration inferior to 0.35 g/l and superior to 1,3 g/l respectively. The European Atherosclerosis Society lists five hyperlipidaemic classes, from A to E, determined on the basis of plasmatic levels of cholesterol and triglycerides. Mild hypercolesterolaemia associated with modest atherogenic risk and which largely occurs in people and is frequently underestimated form a diagnostic point of view, contributes to cardiovascular mortality more considerably than more serious forms of hypercholesterolaemia. On the basis of this observation, there originated the programmatic proposal for the prevention of hyperlipidaemic complications, presented by the Authors.

Cholesterol (TC) and triglyceride (TG) plasma levels physiologically increase during pregnancy. The lipid increment is respectively 23%-53% above pregravidic level for TC and two-three fold the pre-pregnancy level for TG. If the TC and TG are higher than normal values in pregnancy the patient must be carefully monitored. Acute pancreatitis is the main consequence of hyperlipidemia and it can occur either during pregnancy, in the third trimester, or in the puerperium. Mortality is high both for the mother (21%) and the fetus (20%). The authors report a case of 37-year-old pregnant woman at 35 week gestation with hypercholesterolemia (TC = 425 mg/dl) and severe hypertriglyceridemia (TG = 3315 mg/dl). The patient was admitted to the hospital for treatment with an appropriate diet and drug lowering lipid levels (gemfibrozil). The baby was delivered by cesarean section at week 36. The neonatal weight at birth was 2670 g and the Apgar score was 9 at the first minute. After delivery the maternal triglyceride levels showed a remarkable reduction. According to a review of the literature, severe hypertriglyceridemia in pregnancy should be treated with a careful restriction of calories and fat; for preventing acute pancreatitis hospitalization for intravenous fluid therapy and plasma exchange must be required.

The research in particular the incidence of obesity, hypertension and hyperlipemia was evaluated involved 201 primary school children. The results show an obesity percentage equal to 28%; 23% of the young were hypercholesterolic and 21% had hypertriglyceridemia. Nobody was hypertensioned. The high percentage of obese and hjperlipemic subjects suggest the immediate needs of Courses of alimentary education in schools, as well as to resort to sound daily sporting activity.

A direct method is proposed for total serum cholesterol determination by two specific enzymes and a coupled colorimetric reaction according to Trinder. The red colored compound is antipyridilquinonimine. The method is simple (serum plus reagent), rapid (30 min of incubation) and relatively inexpensive. It is perfectly correlated with Röschlau's method and easy to apply to discrete automatic methods.

The TAS of 211 normo lipemic patients and of 84 hyperlipemic patients has been determined by the tube dilution hemolysis method of Rantz and Randall, the Aso Quantum hemolytic method (I.S.V.T. "Sclavo" S.p.A., Siena) and methods with streptolysin O antigen coated on the surface of biologically inert latex particles. A good correlation has been shown between all the analytical techniques considered and, moreover, the incidence of wrong positives and negatives has been showed in comparison with the hemolytic method by Rantz and Randall, considered test of reference. Finally, the greater influence of cholesterol on the classic hemolytic system, compared with the latex technique in causing an unspecific increase of TAS is proposed; this is evaluated before and after treatment of the hyperlipemic samples with ether.

On 814 subjects the cholesterolemia, the triglyceridemia and serum lipoproteins were determined; also the nephelometric analysis of the serum was conducted. The statistical analysis of the results allowed the following conclusions. 1) Approximately 98% of the pathological results are found in 3 types: type IV (about 49%), IIa (about 40%), IIb (about 11%). 2) The nephelometric determination of the M particles is particularly useful in the distinction between types IIa and IIb, because in type IIb there are pathologically increased values also when the triglycerides are normal or almost normal. There exists a significant correlation between the M particles determined by nephelometric analysis and the triglycerides determined by chemical methods.