Health Care

Cardiovascular disease is a class of illnesses that affect heart and blood vessels. Cardiovascular diseases include heart attack, coronary heart disease, stroke, and a congenital heart condition. These heart and blood vessel conditions are mainly caused by atherosclerosis. Atherosclerosis occurs when the arteries become narrow due to a slow buildup of fat within the walls of the arteries. With time, the arteries become too narrow, which is why they have difficulty delivering enough oxygenated blood to the heart. Some of the risk factors that can lead to cardiovascular diseases include obesity, smoking, high blood pressure, ethnic background, sex, age, and family history. According to Félix-Redondo et al., high cholesterol level or hypercholesterolemia is another major risk factor for cardiovascular diseases (154). High cholesterol increases the prevalence of the atherosclerotic condition among the adults and the elderly. Cholesterol is an important biological molecule that forms the cell membrane and maintains its structural integrity. The fatty substance creates bile acids to improve digestion and hormonal state. The liver produces cholesterol, but a large portion of the fatty substance is obtained from food. However, other studies disagree that cholesterol increases the risk of developing a cardiovascular disease. According to Ali et al., dyslipidemia is characterized by the abnormal amount of low-density lipoprotein cholesterol (LCL-C) in blood and low amount of high-density lipoprotein cholesterol (HDL-C) (1174). The Framingham research was the first large-scale research to conclude that low level of HDL-C increased the risk of developing cardiovascular diseases. In 1989, Gordon et al. showed that an increase in HDL-C reduced the risk of developing a cardiovascular disease by 2-3% (1174). 

Summary Article 1

The relationship between atherosclerosis and cholesterol is characterized by an increase in plasma concentration. In essence, the process starts at a young age as the accumulation of cholesterol in the arteries increases. With increased lesions also known as the atherosclerotic plaque, the lumen of the blood vessel ruptures, leading to thrombosis. Thrombosis causes the ischemic condition, which could cause coronary heart disease, peripheral artery illness, or ischemic stroke. Félix-Redondo et al. argue that of statins play a major role in the decrease of myocardial infarction cases or death in people with the history of cardiovascular conditions regardless of the age of the individual (155). Most of the treatments provided to prevent the occurrence of cardiovascular condition and decrease of cholesterol levels in the elderly are mainly based on studies conducted among the youth. In the narrative review, Félix-Redondo et al. summarize the main observations and randomized clinical tests that have established the relationship between cardiovascular diseases and cholesterol. The authors also mention the potential drawbacks and benefits of using statins among the elderly. 

Plasma cholesterol originates from the cellular synthesis, from bile salts formed by the liver, and from intestinal absorption of food. Lipoproteins transport cholesterol in the plasma. The total plasma cholesterol is based on the provision of cholesterol from very low-density lipoproteins, intermediate density lipoproteins, low-density lipoproteins, and high-density lipoproteins (157). Low-density lipoproteins, LDL, transport around 60% of the plasma cholesterol. LDL is responsible for transporting the cholesterol from the liver to the peripheral tissues. The cholesterol is then deposited in the intimal arteries layer, starting the atherosclerotic process. However, the high-density lipoproteins, HDL could eliminate the excess cholesterol from the cells including macrophages with cholesterol in the lesions of atherosclerosis. It also transports the surplus to the liver with HDL, transporting 30% of the plasma cholesterol. The concentration of cholesterol in plasma increases with age among men. In women, the accumulation of cholesterol increases ten years after the age of 55 but also decreases later. The reduction is caused by a decrease in the synthesis of LDC because of reduced liver function. However, in comparison to the LDL cholesterol, the HDL fluctuate less in men. The studies in the post-menopausal females show variable fluctuations. 

From the narrative review, the factors that determine the concentration of plasma cholesterol among the elderly vary based on the circumstances such as exercising, diet, and metabolism. Diets rich in Trans and saturated fats and cholesterol increase the LDL cholesterol concentration. Some intraluminal conditions in the large or small intestine such as the cholesterol bile content or increased transit duration increase LDL cholesterol. These factors are common among the elderly. Regular exercises do not decrease the total level of cholesterol and LDL without weight loss. However, regular physical exercises increase HDL cholesterol and reduce triglycerides. A large number of the elderly have a sedentary lifestyle, which is why they are prone to developing cardiovascular diseases. Errors in the genes could increase the concentration of plasma cholesterol. Some of the genetic errors affect the identification of liver receptors of LDL, causing familial hypercholesterolemia. The issue increases the cholesterol levels and leads to premature CHD (160). 

The relationship between the high level of cholesterol and cardiovascular risk was initially observed in ecological research then evaluated in the animal models and confirmed in interventional and large observational studies. Félix-Redondo et al. state that most of the cardiovascular diseases occur among the elderly (163). The epidemiological research analyzed in various geographical locations indicate a high hypercholesterolemia prevalence in later life. The Prospective Studies meta-analysis that studied 51 Americans and Europeans showed that a lower total concentration of plasma of 1 mmol/L was linked to a low risk of mortality from cardiovascular diseases in men and women from 70 to 80 years. In cohort studies of the elderly, mixed results were obtained on the relationship between cardiovascular diseases and cholesterol levels. In the follow-up, the cohort with an average age of 80 years before the use of statins showed an increase of 10 mg/dL in the accumulative cholesterol levels that had an augmented risk of having the coronary condition by 1.12. The analysis of Framingham and Kaiser Permanente Heart Study indicated a major relationship between the risk of cardiovascular mortality and cholesterol levels among the people with and without the CVD history. However, in the EPESE study that had a sample population consisting of individuals with an average age of 79 years, there was no association between cholesterol levels and cardiovascular disease (166). 

Based on outcomes of the narrative review, it is true that hypercholesterolemia is prevalent among the elderly due to genetic and environmental factors and comorbidity. The relationship between plasma cholesterol and CHD is well-established among the elderly. However, no evidence links plasma cholesterol level to ischemic stroke. Statin therapy is important in the reduction of cardiovascular diseases among the elderly. However, there is no evidence that shows the effect of statin in the prevention of cardiovascular diseases after the age of 80. 

The article also analyses the effectiveness of station therapy. The first experiment to show the efficiency of statins in the cardiovascular disease prevention consisted of 4,444 people. The sample population had members with a cardiovascular disease history and received simvastatin. In this study, 1021 people between 65 and 70 years went through a specific analysis. The results showed a reduction in endpoint death, and reduction in the major cardiovascular events. In another study that was conducted on 4159 people, it was established that pravastatin reduced major coronary events by 35%. The LIPID study conducted in 1998 on 9,041 patients with myocardial infarction received pravastatin showed a significant reeducation in the death from cardiovascular disease. 

Table 1: Summary of the Main Study, Article 1

Authors	Year of Publication	Purpose of the Study	Study Sample	Outcomes
Félix-Redondo, Francisco J., Maria Grau, & Daniel Fernández-Bergés	2013	Summarize the randomized clinical tests and observational studies to show the relationship between cardiovascular illnesses and cholesterol. The study analyzes the advantages and disadvantages of use of statins among the elderly	Elderly patients	Hypercholesterolemia is a prevalent illness among the elderly because of the genetic and environmental elements and comorbidity. Statin therapy is effective in presentation of cardiovascular diseases

Summary Article 2

The Framingham research indicated that HDL-C is a cardiovascular risk and a 10 mg•L−1 increase in HDC-L reduces risk by two to three percent. Although statin therapy and low-density lipoprotein, LCL-C decrease lower coronary heart condition, cardiovascular mortality, and morbidity are still prevalent in people who receive the statin therapy. This means that new therapies and strategies are needed to reduce the risk of cardiovascular diseases. Lowering the cholesterol level among the elderly is ineffective. Statins are the standard therapy in secondary and primary cardiovascular prevention. Based on the Treating to New Targets tests, a high dose treatment long with the treatment purpose of LDL-C below 1000 mg•L−1 achieve the most effective results in the reduction of cardiovascular disease risk. High statin dose is beneficial in individuals with normal LDL-C concentration. 

Although statins reduce LDL-C, they are increasing HDL-C by six to 14.7- percent. In a recent meta-analysis of thirty-seven randomized types of research that included 32, 256 patients with dyslipidemia, the effects of statins on HDL-C were investigated. The study showed that all statins increased the HDL-C levels. However, the level of increase depended on the dosage and not each statin dose has an effect. Nevertheless, the changes in HDL-C and LDL-C concentrations were dependent on each other regardless of the station. Ali et al. argue that increasing HDL-C is a promising way to reduce the risk of cardiovascular diseases. However, the current treatment method of using statins does not increase HDL-C, but rather reduces LDL-C (1192). In the study, the authors suggest the use of other strategies to reduce cardiovascular disease rather than lowering cholesterol levels. One such way is the use of Niacin, which has the potential of increasing HDL-C levels by 25%. The most important way of reducing the risk of cardiovascular diseases is through changes in lifestyle and diets. Reducing the level of cholesterol in the body might cause other health issues since the fatty substance is an important part of the cell structure. 

Table 1: Summary of the Main Study, Article 1

Authors	Year of Publication	Purpose of the Study	Study Sample	Outcomes
Ali, K. Mahdy, et al	2013	Reduction of cardiovascular condition risk by increasing HDL cholesterol	Elderly patients	Class of substances includes niacin, fibrates, and satins. These improved anti-inflammation, increased sensitivity of insulin, improved endothelial function, reduced cerebrovascular events, and stabilization of plaque.

Recommendations and Conclusion 

The Framingham research was the first study to suggest a positive relationship between the risk of cardiovascular disease and cholesterol. In the research, the authors suggested that HDL-C levels decreases cardiovascular mortality. Since then many studies have confirmed the research. Several studies have shown that statin reduces the cholesterol level and the risk of cardiovascular disease. Some results have been inconclusive due to the variation in the outcomes of the patient using statin. Statin increases the HDL-C and lowers LDL-C. However, recent studies suggest that the use of statin to decrease cardiovascular disease by lowering LDL-C levels is ineffective. Increasing HDL-C was considered a significant method of reducing the risk of having a cardiovascular disease. Increasing HDL-C is not easy. This means that most physicians prefer lowering the level of cholesterol to prevent and manage cardiovascular diseases using statin. However, the use of statin of reduce cardiovascular diseases has proven ineffective due to the increased mortality. 

The most effective way of treating and managing cardiovascular diseases is though increasing HDL-C. However, statins are ineffective in increasing the level of this type of cholesterol. Using other methods such as Niacin could effectively increase the levels of HDL-C. Preventing cardiovascular diseases through dietary and lifestyle changes is the most effective method compared to lowering the cholesterol level. A large number of people suffering from cardiovascular diseases are elderly. These individuals have a sedentary life and they pay little attention to the food they eat. One major way of reducing the risk of cardiovascular disease includes preventive strategies and exercises. Physical exercise does not reduce the level LDL-C in the body, but it increases the level of HDL-C. Another way to reduce the risk of developing cardiovascular diseases without compromising the cholesterol level in the body is healthy eating. Cholesterol is important to the body, and reducing its level might lead to other diseases. However, eating the right amount of food would help the body absorb the required nutrients without compromising the health.

Works Cited

Ali, K. Mahdy, et al., “Cardiovascular Disease Risk Reduction by Raising HDL Cholesterol–

Current Therapies and Future Opportunities,” British Journal of Pharmacology, vol. 167, no. 6, 2012, pp. 1177-1194. 

Félix-Redondo, Francisco J., Maria Grau, and Daniel Fernández-Bergés, “Cholesterol and 

Cardiovascular Disease in the Elderly. Facts and Gaps.” Aging and Ddisease, vol. 4, no. 3, 2013, 154-169. 

Feedback,

Dear Naomi, 

Thank you for your work. Do not forget that the subject and the verb should agree in a sentence. Avoid passive voice in academic writing. Review the difference between essential and non-essential clauses. Avoid ambiguities.

Keep working on your writing skills.

Best regards, 

Dennis. 

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