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Australia has a government-subsidized, private medical system in which general practitioners (GPs) form the core component of primary care. There are approximately 20,000 active GPs and 80% of the population consults a GP each year. A new vocational register of GPs has been set up that requires training in general practice, followed by formal continuing education. I briefly review sources of information about Australian GPs' practices and knowledge of and attitudes toward nutrition. About 15-17% of GPs say they have a special interest in nutrition (20% of female GPs and 13% of male GPs). The main conditions for which advice is given are heart disease, hyperlipidemia, obesity, and diabetes. The extent of nutrition counseling by GPs is considerably less than might be expected from the strength of their statements about the importance of nutrition and long-term health. Obstacles to nutrition counseling are lack of time, lack of confidence, and inadequate nutrition knowledge, the last documented by objective testing. GPs express interest in learning more about nutrition (which may be partly driven by consumer pressure) but there is still little coherent teaching on the subject, specifically tailored for GPs. When asked their preferences for nutrition education, GPs tend to prefer educational material (such as diet charts) to give to patients.
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PMID:Nutrition and general practice: an Australian perspective. 917 98

Fibrinogen is an important risk factor for atherosclerosis, stroke and cardiovascular heart disease (CHD). This risk is increased when associated with a high serum cholesterol. Furthermore, it is also believed that not only fibrinogen concentration, but also the quality of fibrin networks may be an important risk factor for the development of CHD. CHD and stroke as a result of atherosclerosis, plus the related problems of hyperinsulinaemia, hyperlipidaemia and hypertension are strongly related to diet. The "western" diet, defined by low fibre and high fat, sucrose and animal protein intakes, appears to be a major factor leading to death. It has been established that the water-soluble dietary fibre, pectin, significantly decrease the concentration of serum cholesterol levels. Evidence is also accumulating that a diet rich in fibre may protect against diseases associated with raised clotting factors. This investigation studied the possible effects of pectin on fibrinogen levels and fibrin network architecture. Two groups of 10 male hyperlipidaemic volunteers each, received a pectin supplement (15 g/day) or placebo (15 g/day) for 4 weeks. Lipid and fibrin network structure variables were measured at baseline and the end of supplementation. Pectin supplementation caused significant decreases in total cholesterol, low-density lipoprotein cholesterol, apolipoprotein A & B and lipoprotein (a). Significant changes in the characteristics of fibrin networks developed in the plasma of the pectin supplemented group indicated that networks were more permeable and had lower tensile strength. These network structures are believed to be less atherogenic. It is suspected that pectin modified network characteristics by a combination of its effects on metabolism and altered fibrin conversion. This confirms the therapeutic possibilities of dietary intervention. Furthermore, this study also showed that changes in plasma fibrinogen need not be present to induce alterations in fibrin network architecture.
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PMID:Dietary pectin influences fibrin network structure in hypercholesterolaemic subjects. 917 40

Medical nutrition therapy, consisting of a diet low in saturated fat, has an important role in reducing risks for cardiovascular disease and hyperlipidemia. Dietary factors that have a negative effect on blood lipid levels include dietary cholesterol, saturated fat, and trans fatty acids, whereas unsaturated fats, omega-3 fatty acids, and soluble fiber may help lower blood lipid levels. A two-step approach to medical nutrition therapy can help health professionals counsel people with high lipid levels to change their food choices and eating behaviors to lower their risk of heart disease. This approach involves teaching the patient how to substitute lower-fat foods, read labels, control portions, and use healthier cooking techniques. Medical nutrition therapy needs to be individualized to help lower the risk of heart disease.
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PMID:Optimizing lipid levels through diet. 923 50

The increasing scarcity of available, and finite, health care resources, and the increased demands for health care, have made consideration of effectiveness and cost-effectiveness of health care services, such as the secondary prevention of heart disease, an imperative. There is considerable evidence that modification of cigarette smoking, hyperlipidemia, hypertension, and lack of physical activity, either singly or in combination, are effective in reducing the number of clinical events in the secondary prevention of heart disease. Economic evaluation is the comparative analysis of alternative courses of action in terms of both costs and consequences. Data generated in economic evaluations of health care services, such as risk factor modification in the secondary prevention of heart disease, are useful in developing clinical practice guidelines and health policies. Smoking cessation is the most cost-effective intervention for patients with documented heart disease while treatment of hyperlipidemia and referral to cardiac rehabilitation are highly cost-effective per quality-adjusted life year and relatively cost-effective per year of life saved. Risk factor management, provided by a team including cardiovascular specialists and other physicians together with appropriately trained allied health professionals, is the cornerstone of optimal care in both the primary and secondary prevention of heart disease.
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PMID:Cardiac rehabilitation and risk factor management after myocardial infarction. Clinical and economic evaluation. 928 70

It is concluded that the most important determinants for cerebral neurodegenerative changes and cognitive decline during aging are neuronal shrinkage and/or loss, which are accelerated by certain risk factors: e.g. TIAs, hypertension, heart disease, hyperlipidemia, smoking, heavy alcohol consumption, male gender, low educational status, family history of cerebrovascular disease and absence of estrogen replacement therapy among women. Some of these risk factors are remediable by therapeutic interventions, including prevention of TIAs and medications that control hypertension, heart disease, hyperlipidemia and estrogen replacement in postmenopausal women, as well as abstention from abuse of tobacco and alcohol. Cerebral neurodegenerative changes measured by neuroimaging appear to be premorbid markers for depleted neuronal and synaptic reserves which predispose to the onset of dementias of both VAD and DAT types. Normal subjects at risk for cognitive decline include those with TIAs, hypertension and heart disease since these risk factors measurably accelerate cerebral atrophy, ventricular enlargement, leukoaraiosis, and decline in cortical perfusion.
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PMID:Risk factors for cerebral degenerative changes and dementia. 951 69

Disorders in lipid metabolism (dyslipidemia) can result to the chronic heart disease. The low density lipoprotein (LDL) is a critical subfraction of total cholesterol present in serum because it is directly linked to coronary heart disease (CHD). The growing awareness of the risks of CHD stipulates the need for more accurate and precise measurement of LDL cholesterol. Current approaches in diagnosing and monitoring CHD is largely dependent on calculated LDL (CLDL) value due to the inherent complexity of ultracentrifugation method. While friedwald's calculated formula may provide comparable values with ultracentrifugation method, it may provide a result which is different. This difference may be of clinical significance. The lipoprotein electrophoresis may be useful in measuring LDL cholesterol, in the diagnosis of type III hyperlipidemia (broad beta band) and when the triglyceride level exceeds 400 mg/dl. The result that compares the CLDL with that obtained by the electrophoresis showed a significant difference (P > or = 0.000) for LDL and insignificant difference (P = 0.068) for high density lipoprotein (HDL) cholesterol.
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PMID:Dyslipidemia: clinical approaches, evaluation of methods and strategies for standardization. 956 2

Hypertension in the elderly features differently from its younger counterpart in terms of diagnosis, associated condition, atypical manifestation, management and complication. Epidemiological study in this increasing age group in the community is, therefore, needed. 334 elderly subjects living in various parts of Bangkok were randomly recruited by appointment at 7 geriatric day centers situated in local health offices of Bangkok Metropolitan Authority. Each subject received blood tests before being interviewed and measured by digital sphygmomanometer. Blood pressure and heart rate changes were recorded during lying, sitting and standing. The prevalence of hypertension was 36.5 per cent, 33.2 per cent were already aware of its existence while 3.3 per cent were newly detected by the survey. Isolated systolic hypertension, a unique subtype found in the elderly, was 4.5 per cent of all or 37.5 per cent among the hypertensive group. The associated medical conditions among the case group were diabetes mellitus 22.9 per cent, hyperlipidemia 13.9 per cent, hyperuricemia 33.3 per cent and heart disease 18.0 per cent. As far as postural hypotension is concerned, 14.8 per cent of case group whereas 11.3 per cent of the control group were affected. On the other hand, the symptom of postural dizziness was found to be 31.1 per cent and 55.2 per cent in the case and control group respectively. Following the statistical logistic regression analysis, the independent associated factors in the hypertension group were: history of hyperlipidemia, increased serum uric acid and poor heart rate response after standing. These findings, as parts of the multiple pathology and potential complications prevalent among this group, should be of concern by any physician looking after the elderly.
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PMID:Hypertension in the elderly: a community study. 962 17

The influence of antiatherosclerotic diet with including 15 g preparation "Eikovit" containing fat of freshwater fish on fat acid composition of erythrocytes membrane was studied in 399 patients with ishemic heart disease and hyperlipidemia. Against a background of positive influence on clinical symptoms of diseases, lipids of blood serum, homeostasis expressed influence of PUFA omega-3 in "Eikovit" on biomembrane fat acid composition was noted. It was shown sharp increasing a quota an eicosapentaenic acid by simultaneous reducing PUFA omega-6 level.
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PMID:[Study of metabolic and clinical effects of polyunsaturated fatty acids omega-3 from "Eicovit" in patients with ischemic heart disease and familial hyperlipoproteinemia]. 968 Jun 69

The results of longitudinal studies in geriatric medicine were reviewed by referring to relatively recent publications. "Longidufinal studies" comprised not only cohort studies but also prospective case-control studies in the broad sense. Poor self-rated health, weight loss hypoalbuminemia, inability to perform activities of daily living, low levels of physical activity, and cognitive dysfunction, all of which could be manifestations of chronic diseases, might shorten longevity. Cardiomegaly or left ventricular hypertrophy on ECG were again found to be important risk factors for cardiovascular disease in the aged, because of their relation to atherosclerosis. There is no evidence regarding the contribution of hyperlipidemia to the risk of cardiovascular disease in the aged, although insulin resistance can increase serum triglyceride levels and reduced level of high-density lipoprotein cholesterol even in the aged. Mortality due to stroke and heart disease have been decreasing in most developed countries, and several recent community-based studies have also shown decreases in the incidence of cerebral stroke. Large-scale case-control studies on the pharmacological treatment of hyperlipidemia have resulted in both primary and secondary prevention of coronary heart disease. However, information concerning the effects of treatment for hyperlipidemia on coronary heart disease in the aged is limited. Results of large-scale case-control studies indicate that pharmacological treatment of elderly hypertensive patients can reduce cardiovascular morbidity and mortality, and angiotensin-converting enzyme inhibitors have recently been shown ot be useful.
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PMID:[Longitudinal studies in geriatric medicine]. 971 Oct 88

Cardiovascular disease related to hyperlipidemia is a significant cause of morbidity and mortality in the United States. The benefit of lowering lipid levels in patients with and without cardiovascular disease has been demonstrated in numerous clinical trials. The results of these trials prompted the National Heart, Blood, and Lung Institute to form the Nation Cholesterol Education Panel (NCEP). This panel developed guidelines for identifying and treating lipid disorders. Before starting antilipemic therapy, patients should be evaluated for secondary causes of hyperlipidemia, including disease states and medications. Risk factors for cardiovascular disease should be identified and used to determine the patient's goal low-density lipoprotein level. Regardless of the drug therapy used, the cornerstone treatment for hyperlipidemia is dietary changes. The NCEP recommendation for dietary modification follows a two-step plan to reduce intake of cholesterol and dietary fats. Other nonpharmacologic treatments for hyperlipidemia include exercise, weight reduction for obese patients, reduction of excessive alcohol use, and smoking cessation . Drug therapy should be considered in patients who do not respond to an adequate trial of dietary modifications and lifestyle changes. The principal lipid-lowering agents currently used are the bile acid sequestrants, nicotinic acid, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, and fibric acid derivatives. Estrogen, fish oil, and alcohol also can decrease the risk of developing heart disease. In pharmacoeconomic studies, lipid-lowering drug therapy has been shown to decrease the number of procedures, hospitalizations, and other medical interventions required by patients with cardiovascular disease.
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PMID:Identifying and managing patients with hyperlipidemia. 1017 Mar 3


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