Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: UMLS:C0018799 (heart disease)
34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The black patient has a poorer prognosis with arteriosclerotic heart disease than does a white patient and needs a more aggressive approach to reduce cholesterol and other risk factors. The new National Cholesterol Education Panel recommendations are similar to those used in the Multiple Risk Factor Intervention Trial study which lowered cholesterol levels only by 5% to 7% over a seven-year period. We recommend a more aggressive dietary approach introducing the postinfarction patient to a less than 10% fat and 50 mg cholesterol vegetarian diet while recovering in the hospital.
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PMID:Dietary management of the patient with atherosclerosis: are the new National Cholesterol Education Panel recommendations enough? 266 93

Insurers, employers, and individuals create demands for laboratory testing in "wellness programs." Tests chosen to identify cases deserving intervention included routine automated chemical tests plus high-density lipoprotein cholesterol, ferritin, and thyroid tests. Participants' unwarranted concerns were addressed with a personalized reporting schema. We tested 1338 individuals, identified 224 (16.7%) with significant abnormalities, and made phone contact follow-up with 193 (86%) of these six to 14 months later. Cholesterol results suggesting increased risk of heart disease were frequent, and were not studied. Interventions were initiated in 55 of the 193 followup cases (49 by physician and six by participants), including prescription of iron or thyroid hormone, counseling on dietary or alcohol intake, and repeat testing. For 58, there was medical advice without intervention; abnormal results were ignored by 79. Noteworthy participant anxiety was manifested in two of the 193 cases, both of whom were treated with iron. We conclude that 4% of the original 1338 participants potentially benefitted from intervention. Ferritin and thyroid tests initiated 33 (61%) of these 55 specific therapeutic interventions.
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PMID:Chemistry profiles in "wellness programs": test selection and participant outcomes. 339 Sep 15

The National Heart, Lung, and Blood Institute sponsored national telephone surveys of practicing physicians in 1983 (N = 1610) and 1986 (N = 1277) to assess attitudes and practices regarding elevated serum cholesterol levels. The 1983 survey was conducted just before the release of the results of the Lipid Research Clinics Coronary Primary Prevention Trial, which showed that a reduction in the blood cholesterol level reduced coronary heart disease. In 1986, 64% of physicians thought that reducing high blood cholesterol levels would have a large effect on heart disease, up considerably from 39% in 1983. Whereas in 1983, physicians attributed considerably less preventive value to reducing the cholesterol level than to reducing blood pressure or smoking, this disparity was substantially smaller in 1986. The median range of blood cholesterol at which diet therapy was initiated was 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1986, down from 6.72 to 7.21 mmol/L (260 to 279 mg/dL) in 1983; the median for drug therapy was 7.76 to 8.25 mmol/L. (300 to 319 mg/dL) in 1986 and 8.79 to 9.28 mmol/L (340 to 359 mg/dL) in 1983. In 1986, 87% of physicians surveyed felt that medical evidence warranted the recommended treatment levels set forth in the 1984 National Institutes of Health Consensus Conference on Lowering Blood Cholesterol. These changes indicate that by 1986, physicians were more convinced of the benefit of lowering high blood cholesterol levels and were treating patients accordingly. The data also suggest areas for continued educational initiatives.
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PMID:Change in physician perspective on cholesterol and heart disease. Results from two national surveys. 368 55

According to the Adult Treatment Panel of the National Cholesterol Education Program, age is a major risk factor for heart disease. To assess the relation between age and LDL oxidizability, we studied copper-mediated LDL oxidation in 13 healthy elderly subjects (> 59 years) and 13 sex-matched healthy young controls (< 30 years). Total and LDL-cholesterol concentrations were increased in elderly subjects. The time course of copper-mediated LDL oxidation showed no significant differences between the two groups as assessed by formation of conjugated dienes, lipid peroxides, and apolipoprotein B fluorescence. Kinetics of LDL oxidation as quantified by lag time, oxidation rate, and maximal oxidation were not significantly different between the elderly and young groups. Although the concentrations of 16:0, 18:0, 18:1, 18:3, and 20:4 and total polyunsaturated fatty acids were significantly higher in the elderly group, LDL fatty acid concentrations were similar in both groups. Lipid-standardized alpha-tocopherol, beta-carotene, and ascorbate concentrations were not significantly different between the two groups. The findings of the present study suggest that in the healthy elderly, LDL oxidation may not be a crucial mediator for atherogenesis.
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PMID:Effect of aging on susceptibility of low-density lipoproteins to oxidation. 758 53

Heart disease is the number-one cause of death in the United States, and more money is spent on its treatment each year than for any other condition. Both epidemiologic and experimental data clearly show that elevated plasma cholesterol levels increase the risk of death from coronary heart disease. Genetic insufficiencies can cause high blood cholesterol, but most people with high cholesterol do not have genetic abnormalities; rather, they have lifestyles that include high-fat diets and little exercise. Cholesterol can be managed aggressively with coronary artery bypass surgery, percutaneous transluminal coronary angioplasty, partial ileal bypass, and even liver transplant. Antihyperlipidemic drugs include bile-acid-binding resins, nicotinic acid, fibric acid derivatives, hydroxymethyglutaryl coenzyme A-reductase inhibitors, and the antioxidant probucol. Strict programs of low-fat diets and exercise are also effective for reducing cholesterol, lowering blood pressure, and preventing heart disease without the side effects associated with surgery and drug therapy. Such lifestyle changes are critical to reducing the incidence of heart disease in this country.
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PMID:Surgery, drugs, lifestyle, and hyperlipidemia. 769 74

An Expert Panel convened by the National Cholesterol Education Program has recommended selective screening and treatment of children for high blood cholesterol levels, based on family history of cardiovascular disease or high blood cholesterol. This recommendation is problematic for several reasons. First, the recommended diets are likely to cause only a slight decrease in low-density lipoprotein cholesterol levels, the projected benefits of which will be offset by a similar decrease in high-density lipoprotein cholesterol levels. Lack of efficacy of the recommended diets could lead to use of more restrictive diets or to cholesterol lowering drugs. Second, even under optimistic assumptions, beneficial effects of cholesterol intervention will be small and delayed for many decades. As a result, childhood cholesterol-lowering efforts will not be cost-effective. Third, the Expert Panel's recommendations do not address important gender differences. Girls have higher average cholesterol levels than boys. They will therefore qualify for more dietary and drug treatment despite their lower age-adjusted risk of heart disease and the lack of association between cholesterol levels and cardiovascular mortality in women. Finally, recent evidence from randomized trials, cohort studies, and animal experiments suggests that cholesterol lowering may have serious adverse effects. This evidence was not discussed in the Expert Panel's report. Given current evidence, any screening and treatment of children for high blood cholesterol levels is, at best, premature.
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PMID:Problems with the report of the Expert Panel on blood cholesterol levels in children and adolescents. 785 82

The National Cholesterol Education Program (NCEP) has recommended that dietary total fat, saturated fat, and cholesterol intake be reduced to < or = 30% of calories, < 10% of calories, and < 300 mg/day, respectively (Step 1 diet) in the general population to reduce plasma low density lipoprotein (LDL) cholesterol levels and heart disease risk. We examined the LDL cholesterol-lowering response to such a diet (26% fat, 8% saturated fat, and 201 mg/day of cholesterol) as compared to an average American diet (39% fat, 15% saturated fat, and 435 mg/day of cholesterol) in 128 subjects using diet periods of 4-24 weeks for each diet phase. The mean LDL cholesterol reduction was 15% in males (n = 83) and 8% in post-menopausal females (n = 45). The effect of apolipoprotein (apo) E phenotype on responsiveness was examined. LDL cholesterol lowering in males was 14% for 60 apoE3/3 subjects, 23% for 10 apoE3/4 subjects, and 16% for 13 apoE3/2 subjects. Male apoE3/4 subjects had a significantly greater LDL cholesterol reduction (P = 0.006) and a greater decrease in the LDL/HDL ratio (P = 0.047) than apoE3/3 subjects. In females, 7% lowering in LDL cholesterol was observed in 34 apoE3/3 subjects and 11% lowering was observed in 7 apoE3/4 subjects (P = 0.12). A meta-analysis of data from published studies supports this conclusion. These data indicate that apoE phenotype modulates the LDL cholesterol-lowering response to a diet meeting NCEP Step 1 criteria, and that male subjects carrying the apoE4 allele are more responsive than other subjects.
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PMID:Effect of apolipoprotein E phenotype on diet-induced lowering of plasma low density lipoprotein cholesterol. 786 75

There appears to be little doubt that lowering serum cholesterol for reduction of risk for coronary artery disease (CAD) events in patients with established CAD is cost-effective and can decrease the rate of CAD events, stabilize atherosclerotic plaque progression, and reduce CAD mortality and all-cause mortality. Meta-analysis of clinical trials conducted in patients with CAD has shown a 26% reduction in CAD events and a 9% reduction in total mortality. It was generalized from the results of nine major, recent angiographically monitored clinical trials that an improvement in obstruction was seen in 8% of control patients and 25% of treated patients. In the recently released report of the second Adult Treatment Panel (ATP II) of the U.S. National Cholesterol Education Program, atherosclerotic disease status joins low-density lipoprotein cholesterol (LDL-C) level as central to the diagnosis and treatment algorithm. The ATP II evaluation process is divided into two categories according to whether atherosclerotic disease is present, and a lower LDL-C target level--100 mg/dL (2.6 mmol/L)--is set for secondary prevention. Initial therapy when LDL-C is > or = 100 mg/dL in a patient with atherosclerotic disease is the Step Two Diet, weight control, exercise, and control of other risk factors. Drug therapy may be considered after a relatively short trial of hygienic therapy if LDL-C remains > or = 130 mg/dL (3.4 mmol/L). Other, selected aspects of heart disease for general consideration in assessing CAD risk are family history and the presence of left ventricular hypertrophy (LVH). Family history of premature CAD is included in the ATP II algorithm, with different age considerations by gender added. Although LVH is not part of ATP II risk assessment, its presence as defined by echocardiography increases CAD risk six- to eightfold in both men and women.
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PMID:Heart disease in the assessment and treatment of hypercholesterolemia: coronary artery disease and other atherosclerotic disease, family history, and left ventricular hypertrophy. 801 74

Hyperlipidemia is an important risk factor of arteriosclerotic diseases. In Japan, as heart disease and cerebrovascular disorders rank second and third as the causes of death, demand has intensified for measures to prevent these diseases. In the U.S., the National Cholesterol Education Program (NCEP) was initiated as a means to prevent CHD by reducing th prevalence of hypercholesterolemia. Since 1988, this program has demonstrated effectiveness in this regard. In Japan, there are no consistent guidelines for the management of hyperlipidemia such as are espoused by the NCEP. In this study, in an endeavor to resolve this problem, a worksite population (1343 adult males) was classified according to the NCEP guidelines and the role and effectiveness of NCEP in this population were studied. A questionnaire concerning life-style and some biochemical findings were also used to classify the subjects according to the NCEP guidelines. Of the subjects, 22.8% were classified as hypercholesterolemic (> or = 240 mg/dl) and another 34.9% as being borderline high risk (> or = 200 < 240 mg/dl). Twenty-five percent of subjects required diet or drug therapy. The percentage of subjects requiring therapeutic intervention increased with age. The therapy group subjects tended to have a larger number of risk factors compared to the normal group. They also featured a significantly high age-adjusted odds ratios for hypertension, diabetes mellitus, obesity, and elevated serum triglyceride. This study suggests that in the health management of those in the therapy group, educational instruction on coronary risk factors is required.
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PMID:[Classification of hyperlipidemia in a worksite population in Japan using criteria of the U.S. National Cholesterol Education Program]. 804 15

The National Cholesterol Education Program (NCEP) recommends that dietary total fat, saturated fat, and cholesterol intake be reduced to < or = 30% of calories, < 10% of calories, and < 300 mg/d, respectively (step 1 diet), in the general population to reduce plasma low-density lipoprotein cholesterol (LDL-C) levels and heart disease risk. We examined the LDL-C-lowering response to such a diet (26% fat, 8% saturated fat, and 201 mg/d cholesterol) compared with an average American diet (39% fat, 15% saturated fat, and 435 mg cholesterol/d) in 153 subjects using diet periods of 4 through 24 weeks for each diet phase. The mean LDL-C reduction was 13% in men (n = 93) and 7% in postmenopausal women (n = 60). The effect of apolipoprotein (apo) A-IV phenotype on responsiveness was examined. LDL-C lowering in men was significantly (P < .005) less (7%) for 17 apoA-IV (1/2) subjects than for 76 apoA-IV (1/1) subjects (16%). In women, 7% lowering was observed in both 12 apoA-IV (1/2) subjects and 48 apoA-IV (1/1) subjects. ApoA-IV phenotype had a significant effect on plasma high-density lipoprotein cholesterol levels during both dietary periods; women carrying the apoA-IV-2 allele had higher levels than those homozygous for the apoA-IV-1 allele. The opposite was true for triglyceride levels, but only during the period when the subjects consumed the high-fat, high-cholesterol diet.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:ApoA-IV phenotype affects diet-induced plasma LDL cholesterol lowering. 819 78


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