Acute coronary syndrome (ACS)
Adverse coronary events, such as unstable angina and acute myocardial infarction, in which the primary culprit is atherosclerosis.
Albumin
A major plasma protein synthesized in the liver that serves as a transport for fatty acids, bilirubin, and some pharmacologic agents. Decreased serum albumin occurs in renal disease.
Albuminuria
A condition in which the urine has more-than-normal amounts of albumin. It may be a sign of nephropathy (kidney disease), which is often a complication of diabetes.
Aldosterone
A steroid hormone produced by the adrenal gland. It acts on the kidney to retain salt and water and excretes potassium and hydrogen ions. Aldosterone secretion is increased by angiotensin II.
Angina
Commonly experienced as deep or poorly localized chest or arm pain that occurs when the heart is not receiving sufficient oxygen. Severe angina, or angina with little stress or exertion, is referred to as "unstable" and may signify an impending heart attack.
Angiotensin-converting enzyme (ACE) inhibitor
Commonly used to treat high blood pressure, this drug class blocks the action of angiotensin-converting enzymes. It reduces the constriction of the blood vessels, veins, and arteries, resulting in the lowering of blood pressure.
Ankle-brachial index (ABI)
A measurement designed to diagnose intermittent claudication in the legs caused by peripheral artery disease (PAD). The lower the index, the greater the risk for heart attack, stroke, or other serious circulatory or heart events. An index of .41 to .90 suggests PAD. Measurements less than .40 indicate severe blockage in the leg arteries.
Apolipoprotein A1 (Apo A1)
A major protein associated with HDL-C levels. It is an independent predictor of coronary heart disease (CHD) risk; increased levels are associated with reduced risk of CHD risk. Apo A1 levels are measured for the evaluation of CHD risk and for monitoring treatment when low levels and/or presence of CHD have been determined.
Apolipoprotein B (Apo B)
A major protein associated with LDL-C. It is useful in evaluating CHD risk and in monitoring treatment when CHD and/or high levels of apo B have been established.
Arteriosclerosis
A group of vascular diseases characterized by thickening and loss of elasticity of artery walls. The three main types are atherosclerosis, Monckeberg's arteriosclerosis (deposits of calcium in the medial coat with little obstruction of the lumen; affects the peripheral arteries), and arteriolosclerosis (calcification of the arterioles, or smaller arteries).
Atherogenic
Substances that have the capacity to start or accelerate the process of atherogenesis or the formation of lipid deposits in the arteries.
Atheroma
A fatty deposit in the intima (inner lining) of an artery, resulting from atherosclerosis. Also called plaque, atherosclerotic plaque, or arterial plaque.
Atherosclerosis
A narrowing of a blood vessel due to the accumulation of plaque, resulting in a restriction of blood flow. Plaque comprises irregular deposits of cholesterol and other debris deposited within the intima and media of large and medium-sized arteries.
ATP III (see NCEP)
The ATP III (Third Adult Treatment Panel) evidence-based guidelines include nearly 1,000 references and represent a synthesis of all the data from major clinical trials. By elaborating further on previous reports, ATP III provides for more intensive lipid-lowering treatment in a larger population of patients, with special emphasis on those with multiple risk factors.
Bile-acid sequestrants
These lipid-regulating agents bind with cholesterol-containing bile acids in the intestines and prevent them from being absorbed into the bloodstream. They bind bile acids in the small intestine and carry them out of the body, causing the body to use more cholesterol to make more bile acids. This results in lower cholesterol levels. Bile-acid sequestrants also prevent absorption of some dietary cholesterol.
Body mass index (BMI)
A frequently employed index of obesity, expressed as weight in kilograms (kg) divided by the square of height in meters (m2); BMI = kg/m2.
Calcium channel blocker (CCB)
A drug that reduces spasm of the blood vessels, lowers blood pressure, and controls angina; acts by selectively blocking the uptake of calcium by the cells.
Cardiovascular disease (CVD)
Any disease of the heart and/or blood vessels, including peripheral, coronary and cerebrovascular diseases.
Carotid artery disease (CAD)
A progressive disease involving the buildup of fatty material and plaque in the carotid arteries; can lead to a stroke.
Cerebrovascular disease
Any disease affecting the blood vessels of the brain.
Cholesterol
A sterol, or fat-like substance, contained in foods of animal origin, and a precursor of bile acids and steroid hormones. Cholesterol is produced by the liver and is essential for making cell membranes. It plays a significant role in the pathogenesis of atherosclerosis. There are several types, including HDL-C, LDL-C, VLDL-C. Each kind of cholesterol is transported in plasma by specific lipoproteins.
Cholesterol-absorption inhibitors
These lipid-regulating agents localize and appear to act at the brush border of the small intestine. They inhibit the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. This reduces hepatic cholesterol stores and increases clearance of cholesterol from the blood.
Chronic Kidney Disease
Level of renal insufficiency determined by overall kidney damage (pathological abnormalities or markers of damage in blood and urine tests or imaging) and glomerular filtration rate of <60 mL/min/1.73m2 for >3 months.
Coagulation
The sequential process by which multiple coagulation factors of the blood interact, resulting in the formation of an insoluble fibrin clot.
Comorbidity
The presence of one or more diseases in addition to a primary disease.
Congestive Heart Failure
Congestive heart failure, or heart failure, is a condition in which the heart cannot pump enough blood to the body's other organs.
Coronary artery bypass graft (CABG)
A surgery to bypass atherosclerosis in the coronary arteries. The process detours blood around the blockage and restores the supply to the heart muscle.
Coronary artery disease (CAD)
A disease characterized by a narrowing or blockage of the arteries that supply blood to the heart, which may result in angina pectoris, myocardial infarction, or sudden cardiac death.
Coronary heart disease (CHD)
An acute or chronic disease affecting the blood vessels of the heart, and involving an insufficient supply of oxygenated blood to the myocardium. This condition is most often a consequence of arterial narrowing, but can also be due to increased oxygen demand or diminished blood oxygen transport. Also referred to as ischemic heart disease (IHD).
C-reactive protein (CRP)
C-reactive protein (CRP)
A protein produced by the liver that is only present during episodes of acute inflammation. High-sensitivity CRP (hs-CRP) is recommended as an adjunct to major risk factors to assess coronary disease and risk in primary prevention. This measurement is recommended in patients at intermediate risk (10%–20% risk of CHD over 10 years).
Creatinine
A breakdown product of creatine phosphate in muscle. It is usually produced at a fairly constant rate by the body. It is also used as a marker for measuring kidney function.
Cytokines
Small, hormone-like proteins released by leukocytes, endothelial cells, and other cells to promote an inflammatory immune response to an injury.
Diabetes (type 1 and type 2)
A condition characterized by hyperglycemia resulting from the body's inability to use blood glucose for energy.
- Type 1 diabetes: also called insulin-dependent diabetes mellitus (IDDM). In type 1 diabetes, the pancreas makes little or no insulin because the insulin-producing ß-cells have been destroyed. This type of diabetes usually appears suddenly and most commonly in people younger than 30 years of age. Treatment consists of insulin administrated by injection or pump, a planned diet, regular exercise, and daily self-monitoring of blood glucose.
- Type 2 diabetes: also called non–insulin-dependent diabetes mellitus (NIDDM). Type 2 diabetes is associated with insulin resistance and impaired ß-cell function. Its management includes diet, exercise, and monitoring of glucose levels. Sometimes oral antihyperglycemic agents or insulin injections are needed. Type 2 diabetes accounts for 90%–95% of diabetes cases.
Kidney disease that accompanies later stages of diabetes, usually characterized initially by hyperfiltration and sometimes progressing to end-stage renal disease.
Diabetic Neuropathy
A common complication of diabetes in which nerves are damaged as a result of hyperglycemia.
Diuretic
Also known as a water pill, this therapy helps rid the body of excess fluids and salt. Usually used in the treatment of high blood pressure and heart failure.
Dyslipidemia
An abnormal concentration in the blood of one or more lipids, such as an elevated LDL-C level or a depressed HDL-C level.
Endothelium
The layer of cells that lines the cavity of the heart as well as the interior of blood and lymph vessels.
End-Stage Renal Disease
The most severe, fully developed phase of renal disease in which renal function has been compromised anywhere from 80%–95%. It is usually treated by dialysis or kidney transplantation.
Familial hypercholesterolemia (FH)
An inherited condition characterized by abnormally high cholesterol levels in the blood. Affected individuals are unable to process LDL-C properly, and they are at increased risk for coronary heart disease.
Fasting Plasma Glucose
Glucose concentration in plasma obtained after an 8- to 10-hour overnight fast. An FPG level of <100 mg/dL is normal; 101–126 mg/dL is impaired; and >126 mg/dL indicates diabetes if it is reproducible and not found during an acute illness.
Fenofibrate
An oral medication of the fibrate class, it is mainly used with diet changes (lowered cholesterol and fat intake) to reduce the amount of cholesterol and triglycerides in blood.
Fibric acids
Also known as fibrates, these lipid-regulating agents speed up the chemical breakdown of triglyceride-rich lipoproteins that circulate in the body. Fibrates increase lipolysis and eliminate triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing apoprotein C-III production.
Fibrinogen
Produced by the liver, this protein is found in the blood and contributes to clot formation. The sudden formation of a blood clot at the site of an atherosclerotic plaque can contribute to an acute myocardial infarction.
Gestational Diabetes
Carbohydrate intolerance that occurs during pregnancy. It increases the risk of perinatal morbidity in the infant and the later development of diabetes in both infant and mother.
Glucose (blood)
The main sugar that the body makes from the three elements of food—proteins, fats, and carbohydrates—but mostly from carbohydrates. Glucose with insulin is the major source of energy for living cells and is carried to each cell through the bloodstream.
Heart Failure
A condition marked by weakness, edema, and shortness of breath that is caused by the inability of the heart to maintain adequate blood circulation in peripheral tissues and lungs.
Hemoglobin A1c (HbA1c)
Hemoglobin carries oxygen to the red blood cells and sometimes joins with the glucose in the bloodstream. A1c is a test that measures a person's average blood glucose level over 2 to 3 months. The test shows the amount of glucose that adheres to the red blood cell, which is proportional to the amount of glucose in the blood.
High-density lipoprotein (HDL)
A lipoprotein that protects against the development of coronary heart disease through a process known as reverse cholesterol transport. HDL transports cholesterol from the body cells to the liver, where it is excreted in bile. Elevated blood plasma levels of HDL-cholesterol (HDL-C) are negatively correlated with coronary heart disease risk. HDL-C is often called the "good" cholesterol.
HMG-CoA reductase inhibitors (statins)
These lipid-regulating agents (3-hydroxy-3-methylglutarylcoenzyme A reductase inhibitors), commonly referred to as statins, inhibit HMG-CoA reductase in the liver. By inhibiting the formation of mevalonate, the amount of cholesterol produced in the body is reduced. The resulting decrease of cholesterol leads to an increase in the number of hepatic LDL receptors, which results in increased clearance of LDL from the blood.
Homocysteine
A sulfur-containing amino acid and a metabolic intermediate of the methionine cycle. Elevated blood plasma levels of homocysteine are positively correlated with coronary heart disease.
Hormone replacement therapy (HRT)
Postmenopausal HRT is a combination of estrogen and progesterone. Results from the Women’s Health Initiative (WHI) trial show that high health risks outweigh the benefits of HRT for primary prevention of CHD. Also, when HRT was compared to placebo, there were no significant decreases in rates of secondary cardiovascular events in HERS, HERS II, or overall (6.8 years).
Hypercholesterolemia
A condition in which blood plasma cholesterol levels are elevated.
Hyperglycemia
High blood sugar which occurs when the body does not have enough insulin or when the body cannot use insulin properly.
Hyperinsulinemia
This occurs when there is too much insulin in the blood. It is often associated with type 2 diabetes.
Hyperlipidemia
A condition in which any or all lipid levels are elevated, including hypertriglyceridemia and hypercholesterolemia.
Hypertension
The force of blood through and against the walls of arteries causes blood pressure (BP) to rise and fall during the day. If BP remains elevated, it is diagnosed as high blood pressure or hypertension. A consistent blood pressure reading of 140/90 mm Hg or higher is considered hypertension.
Hypertriglyceridemia
A condition in which blood plasma triglyceride levels are elevated.
Impaired Fasting Glucose
A level of fasting plasma glucose (>100 to <126 mg/dL) that is higher than normal but lower than that associated with diabetes.
Impaired Glucose Tolerance
A metabolic state between normoglycemia and diabetes defined by a plasma glucose level (>140 to 200 mg/dL) at the 2-hour point during a 75-g oral glucose tolerance test.
Infarction
Death of cells resulting from decreased blood supply to tissue; usually a result of ischemia.
Inflammation
The body’s response to injury; blood clotting is often part of that response. Blood clots can slow or stop blood flow in the arteries, which can cause heart attacks and strokes.
Insulin resistance
A basic metabolic abnormality underlying type 2 diabetes. Insulin resistance describes reduced insulin sensitivity of cells to the action of insulin.
Intermittent claudication (IC)
A symptom of arterial insufficiency, IC is a form of vascular disease. Lack of blood flow due to atherosclerosis will result in lower leg pain.
Intimal
Pertaining to the inner lining of a blood or lymph vessel.
Ischemia
A decrease of blood flow to tissue due to constriction or obstruction of a blood vessel, which can lead to cell death. Myocardial ischemia (decreased blood supply to the heart) results from a constriction or obstruction of the coronary arteries.
LDL-Apheresis
This is a procedure that removes excess LDL-C from the blood. An IV is inserted into each arm; blood is drawn from the body, filtered through a machine to remove the LDL particles, then returned to the body. For more information, click here.
Leukocyte
A white blood cell found in blood and lymph nodes. During the inflammation process, the body uses leukocytes to fight infections and help repair damaged tissues. However, the body can improperly trigger the inflammatory-response process, causing leukocytes to attack healthy tissue. These situations can result in a range of conditions and diseases, including heart disease.
Lipids
Fats, oils, and waxes that serve as building blocks and energy sources for the body. Compound lipids include the glycolipids (lipid-sulfur combinations), lipoproteins (lipid-protein combinations), and phospholipids (lipid-phosphate combinations).
Lipoprotein
Protein-covered fat particles that facilitate cholesterol and triglyceride transport throughout the body. The four basic classes are high-density, low-density, and very low-density lipoproteins, and chylomicrons.
Lipoprotein(a) (Lp[a])
A lipoprotein particle similar to LDL with an attached protein. Elevated blood plasma levels are positively correlated with coronary heart disease.
Low-density lipoprotein (LDL)
A lipoprotein that is formed in the circulation and transports cholesterol from the liver to other body tissues. Elevated blood plasma levels of LDL-cholesterol (LDL-C) are positively correlated with coronary heart disease risk. LDL-C is often called the "bad" cholesterol.
Lumen
The channel or cavity through which blood flows within blood vessels. Atherosclerotic plaque buildup will often narrow this tubular passage, restricting blood flow.
Metabolic syndrome
According to ATP III guidelines, patients at high-risk for heart disease are diagnosed when three or more of these risk factors are present: Abdominal obesity (waist circumference) men >40 inches, women >35 inches; TG >150 mg/dL; HDL-C, men <40 mg/dL, women <50 mg/dL; blood pressure >130/>85 mm Hg; fasting glucose >110 mg/dL. Weight loss enhances LDL-C lowering and reduces all risk factors. Exercise reduces very–low-density lipoprotein cholesterol levels, increases HDL-C levels, and, in some persons, decreases LDL-C levels. It also can reduce blood pressure and insulin resistance. Treatment of hypertension, elevated TG, and low HDL-C will reduce CHD risk.
Metformin
An oral antidiabetic agent of the biguanide class that is used in the treatment of type 2 diabetes. Metformin acts to reduce elevated blood glucose levels mainly by decreasing gluconeogenesis as well as by improving tissue sensitivity to insulin.
Myalgia
Muscle ache or weakness without creatine kinase elevation.
Myocardial infarction (MI)
Cell death of the myocardium resulting from inadequate blood or oxygen supply. Myocardial infarction is almost always a result of atherosclerosis of the coronary arteries and is associated with thrombosis. Also referred to as a heart attack.
Myocardium
The muscle of the heart's walls.
Myopathy
Any disease of muscles. Symptoms include limb and respiratory weakness. Myopathy can result from endocrine disorders, metabolic disorders, infection, or inflammation of the muscle.
National Cholesterol Education Program (NCEP)
Launched in 1985 by the National Heart, Lung, and Blood Institute, the NCEP educates health professionals and the public on the importance of high blood cholesterol as a risk factor for coronary heart disease. In 1988, the Adult Treatment Panel (ATP) issued recommendations for detecting, evaluating, and treating high blood cholesterol in adults, identifying LDL-C as the primary target for lipid intervention. In 1993, the second Adult Treatment Panel (ATP II) issued revised guidelines stressing that elevated blood cholesterol, high blood pressure, and obesity as well as smoking are important modifiable risk factors for cardiovascular disease. In 2001, ATP III provided for more intensive lipid-lowering treatment in a larger population, with special emphasis on those with multiple risk factors.
Nephron
The functional unit of the kidney, consisting of a variety of tubules and the loop of Henle. The number of nephrons in each kidney varies but is usually in the thousands.
Nicotinic acid
Also known as niacin, this water-soluble derivative of vitamin B works in the liver by reducing production of triglycerides and VLDL. There are three types of nicotinic acid: immediate release, timed release, and extended release.
Non–HDL-C
Total cholesterol minus HDL-C. Non–HDL-C goals are set 30 mg/dL higher than LDL-C goals for each risk category in ATP III. Non–HDL-C goal is recommended for persons with high TG levels (>200 mg/dL).
Omega-3 fatty acids
Unsaturated fatty acids that are present in marine animal fats and some vegetable oils. These fatty acids can increase the ratio of high-density to low-density lipoproteins while lowering overall plasma lipid levels, particularly TG. Research has shown that omega-3 fatty acids decrease risk of arrhythmias, thrombosis, TG levels, the growth rate of atherosclerotic plaque, and the risk for arrhythmias and thrombosis. They also improve the health of arteries and may slightly lower BP.
Percutaneous coronary intervention (PCI)
A medical procedure that reduces the amount of constriction, or narrowing, in a coronary artery due to plaque formation.
Peripheral artery disease (PAD; see PVD)
Damage to or narrowing of the blood vessels that transport blood away from the heart to arms, legs, or organs.
Peripheral vascular disease (PVD; see PAD)
Damage to or blockage in the veins that transport blood from the arms and legs back to the heart.
Pioglitazone
An oral antidiabetic agent that acts primarily by decreasing insulin resistance. It belongs to the thiazolidinedione class of drugs.
Placebo
A dummy treatment administered to the control group in a clinical trial so the specific and nonspecific effects of the experimental treatment can be distinguished. The experimental treatment must produce better results than the placebo in order to be considered effective.
Plaque
Atherosclerotic plaque is composed of a lipid-rich core and a fibrous cap that separates the core from the artery's plasma compartment. Plaque buildup may cause the intimal layer of the vessel's wall to protrude into the lumen, thus narrowing the passageway for blood. Many plaques grow abluminally and may not decrease lumen size.
Platelet
A blood particle involved in coagulation and the maintenance of hemostasis.
Pleiotropic effects
These are effects extending beyond that which is primarily established. In statins, these would be effects other than cholesterol lowering: improving or restoring endothelial function, enhancing the stability of atherosclerotic plaques, decreasing oxidative stress and inflammation, and inhibiting the thrombogenic response in the vascular wall.
PPAR
Abbreviation for peroxisome proliferator-activated receptor. A member of the nuclear hormone receptor subfamily of transcription factors. There are three known subtypes of PPARs—PPAR-alpha, PPAR-gamma, and PPAR-delta.
Primary prevention
Any form of intervention to reduce risk and/or prevent the development of coronary heart disease in individuals with no existing history of the disease.
Proteinuria
A condition in which urine contains an abnormal amount of protein, possibly signifying kidney damage.
Renal Glycosuria
Excretion of glucose associated with increased permeability of the kidneys without increased sugar concentration in the blood (also called renal diabetes).
Renin
An enzyme produced by the kidney that is involved in the regulation of blood pressure. Renin converts angiotensinogen to angiotensin I, the precursor of the vasoconstrictor angiotensin II.
Revascularization
A surgical procedure that restores an adequate supply of blood by means of a blood vessel graft.
Risk factor
Cardiac risk factors comprise modifiable and non-modifiable factors that predispose an individual to the development of heart disease. Although there are different guidelines for assessing risk, commonly accepted risk factors include elevated LDL-C, depressed HDL-C, elevated triglycerides, smoking, diabetes, family history of heart disease, obesity, sedentary lifestyle, high blood pressure, elevated lipoprotein(a), elevated homocysteine level, and being a male over 45 or a postmenopausal female not on hormone replacement.
Rosiglitazone
An oral thiazolidinedione agent that reduces the amount of sugar in the blood. It is used for treating patients with type 2 diabetes.
Secondary prevention
Any form of intervention to reduce risk and/or prevent the reoccurrence of a cardiac event in individuals with an existing history of the disease.
SERM: Selective Estrogen Receptor Modulator
A drug that acts like estrogen on some tissues but blocks the effect of estrogen on other tissues (eg, raloxifene). The MORE (Multiple Outcomes of Raloxifene Evaluation) trial showed no significant affect on CV events in the overall population. The RUTH (Raloxifene Use in The Heart) trial is ongoing.
Statin
A general term for an HMG-CoA reductase inhibitor.
Stenosis (aortic)
Narrowing of the aorta or of the heart’s aortic orifice.
Stent
A wire mesh tube used to open an artery recently cleared by angioplasty. It is collapsed to a small diameter and surrounds a balloon catheter. When the balloon is inflated the stent expands, locks in place, and forms a scaffold holding the artery open. It improves blood flow to the heart muscle and relieves symptoms.
Stroke
Occurs when blood flow to the brain is interrupted, preventing oxygen and nutrients from reaching brain tissue. Without the nourishment, brain cells begin to die, leading to a loss of abilities controlled by the affected area of the brain.
- Embolic stroke: Occurs when a blood clot or small piece of plaque or vegetation travels through the bloodstream to the brain and lodges in one of the smaller cerebral arteries, blocking blood flow.
- Hemorrhagic stroke: Caused by various disorders affecting the cerebral blood vessels, including chronic hypertension and aneurysms. This type accounts for 17% of all strokes.
- Ischemic stroke: Develops when a clot blocks an artery supplying blood to the brain. This artery usually has been narrowed and hardened by plaque. This type accounts for 83% of all strokes.
- Thrombotic stroke: Develops when a blood clot forms in an area of atherosclerosis in a carotid, vertebral, or cerebral artery and blocks blood flow to or within the brain.
- Transient ischemic attack (TIA): also reffered to as a “mini-stroke.” Occurs when the blood supply to part of the brain is briefly interrupted. TIA symptoms are similar to those of a stroke but do not last as long. Most symptoms disappear within an hour, although they may persist for up to 24 hours.
A class of antidiabetic agents that reduce insulin resistance. Thiazolidinediones improve insulin sensitivity by interacting with a nuclear transcription factor called peroxisome proliferator-activated receptor.
Thrombosis
The formation of a blood clot within a blood vessel.
Total cholesterol (TC)
The total amount of cholesterol carried in the blood, whether by HDL, LDL, or another carrier.
Triglycerides (TG)
Fat made by the liver or ingested through the diet. Elevated blood plasma levels of triglycerides are positively correlated with coronary heart disease risk.
Urinary Albumin: Creatinine Ratio
A useful measure of renal function used in diabetic renal disease. It is measured using the first morning urine sample.
Very–low-density lipoprotein (VLDL)
A class of lipoproteins that transports triglycerides from the intestine and liver to the adipose and muscle tissues. They are synthesized by the liver and primarily contain triglycerides in their lipid cores.
Visceral Fat
Visceral fat, which is buried beneath muscle, surrounds vital organs and is metabolized by the liver, which turns it into blood cholesterol.