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Elevated high-density lipoprotein cholesterol, not protective in the presence of homocysteinemia

  • Author Footnotes
    1 Dr. Superko's address is: Cholesterol, Genetics, and Heart Disease Institute, 1875 South Grand Street, Suite 700, San Mateo, California 94402.
    H. Robert Superko
    Footnotes
    1 Dr. Superko's address is: Cholesterol, Genetics, and Heart Disease Institute, 1875 South Grand Street, Suite 700, San Mateo, California 94402.
    Affiliations
    From the Cholesterol, Genetics, and Heart Disease Institute, 1875 South Grand Street, Suite 700, San Mateo, California 94402 USA

    From the Lawrence Berkeley National Laboratory, University of California, Berkeley, California, USA
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  • Author Footnotes
    1 Dr. Superko's address is: Cholesterol, Genetics, and Heart Disease Institute, 1875 South Grand Street, Suite 700, San Mateo, California 94402.
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      Abstract

      Homocysteinemia may increase atherosclerosis risk by a variety of mechanisms.6–9 The disorder can be diagnosed by fasting, or postmethionine load homocyst(e)ine values. An abnormal postload range (>95th percentile) has been suggested to be 20 to 40 nmol/ml.10,11 Twenty-eight percent of patients with peripheral vascular and cardiovascular disease have an abnormal response to the methionine load tests compared with 1% of the healthy population. Therapy is relatively low risk and involves folate or pyridoxine supplementation. Despite the protective effects of very high HDL cholesterol, atherosclerosis can still occur in the setting of hyperhomocysteinemia.
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