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Query: UMLS:C0020473 (hyperlipidemia)
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Coronary heart disease (CHD) risk factors affect a large proportion of European adult populations; hence most CHD results from the exposure of many people to moderately elevated risk factor levels. The population strategy is directed to improving the health-related behaviour of the entire population, by means of mass education and administrative measures aimed at nutrition, smoking and exercise; these measures are reviewed in some detail. This approach is inadequate for minimising risk in the minority in whom pronounced risk factor levels are present (e.g. major forms of hyperlipidaemia); such persons require individual therapy in a clinical setting, i.e. an individual strategy. The European Atherosclerosis Society (EAS) endorses both strategies and regards them as complementary. It advocates a case-finding approach to identifying those people requiring individual care. Although lipid risk factors, like blood pressure, are continuous variables, the EAS has defined action limits for plasma cholesterol, triglyceride and HDL-cholesterol concentrations; the interpretation of these is influenced by the presence and extent of other risk factors and of cardiovascular disease, and by age and sex. Recently the EAS has produced guidelines on the recognition and treatment of hyperlipidaemia. These provide sufficient step by step detail to permit the effective, safe management of most hyperlipidaemic patients by the non-specialised physician, with advice on dietary and drug therapies, and the investigation and management of all major forms of hyperlipidaemia. The main features of these guidelines are described in this paper.
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PMID:Population and individual strategies for the prevention of coronary heart disease. Policy of the European Atherosclerosis Society. 325 25

Garlic and onion have been used for millenia in the traditional medical practice of many cultures to treat cardiovascular and other disorders. Both Allium species, their extracts, and the chemical constituents of these plants have been investigated for possible effects on cardiovascular disease risk factors--both definite (hyperlipidemia, hypertension and hyperglycemia) and suspected (platelet aggregation and blood fibrinolytic activity). Action of these Allium species on blood coagulability is more clearly defined than their effect on the other risk factors. While many of the studies have serious methodological shortcomings, there is some evidence to suggest that use of certain formulations of garlic and/or onion is accompanied by favorable effects on risk factors in normal subjects and in patients with atherosclerotic disease. The possibility of toxicity resulting from acute and chronic ingestion of large amounts of these plants or their extracts is unresolved. Accordingly, further clinical and epidemiological studies are required before the role of these plants in the prevention and control of cardiovascular disorders is understood and can be realized. Additional research in this area is recommended.
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PMID:Garlic (Allium sativum) and onion (Allium cepa): a review of their relationship to cardiovascular disease. 331 92

To investigate the lipoprotein effect of fenofibrate in hypercholesterolemia or combined hyperlipidemia (types II A and II B hyperlipidemias, respectively), 240 patients were recruited and 227 randomized to a double-blind randomized trial lasting 24 weeks and 192 patients continued to participate in an open-label phase for another 24 weeks. A 100-mg dose of fenofibrate or a matching placebo was given three times daily. Fenofibrate side effects in excess of placebo affected 6 percent of fenofibrate users and were confined almost entirely to skin rashes. In 180 hypercholesterolemic patients randomly assigned to receive fenofibrate versus placebo, triglyceride and very low-density lipoprotein cholesterol levels decreased 38 percent, total cholesterol levels decreased 17.5 percent, and low-density lipoprotein cholesterol levels decreased 20.3 percent with fenofibrate treatment. High-density lipoprotein cholesterol levels increased 11.1 percent with a decrease in the low-density lipoprotein cholesterol: high-density lipoprotein cholesterol ratio of 27 percent. All differences were statistically significant (p less than 0.01). In combined hyperlipidemic (type II B) patients, triglyceride levels decreased by 45 percent, very low-density lipoprotein cholesterol levels decreased 52.7 percent, total cholesterol levels decreased 16 percent, low-density lipoprotein cholesterol levels decreased 6 percent, and high-density lipoprotein levels increased 15.3 percent for a low-density lipoprotein cholesterol: high-density lipoprotein cholesterol ratio decrease of 13 percent. All differences were again statistically significant (p less than 0.01). In both groups of patients, the onset of the drug effect was generally rapid, with maximal total and low-density lipoprotein cholesterol level lowering achieved within four weeks in hypercholesterolemic patients and maximal triglyceride and cholesterol level lowering in hypertriglyceridemic patients achieved in two weeks. Maximum high-density lipoprotein increases occurred after four weeks in type II A patients and 12 to 16 weeks in type II B patients. Fenofibrate is a well-tolerated drug in the fibric acid series and has putatively beneficial effects on triglyceride, very low-density lipoprotein, low-density lipoprotein, and high-density lipoprotein cholesterol concentrations in both type II A and type II B hyperlipidemic patients. If the lipid hypothesis of atherosclerosis applies to the lipoprotein changes induced by fenofibrate, reductions in cardiovascular disease risk in both type II A and II B hyperlipidemic patients should result from fenofibrate treatment.
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PMID:Effects of fenofibrate on plasma lipoproteins in hypercholesterolemia and combined hyperlipidemia. 331 54

The National High Blood Pressure Education Program has released three Joint National Committee reports and a task force report on the detection, evaluation, and treatment of high blood pressure. Like its predecessors, the 1988 Joint National Committee report was developed using the consensus process; it is based on the latest scientific research and reflects the state of the art regarding hypertension management. This report updates findings of previous reports in several respects: it broadens the step-care approach to provide more flexibility for clinicians; encourages greater patient involvement in the treatment program; emphasizes a consideration of the quality of life in the management of patients; and addresses the cost of care. It also provides more emphasis on control of other risk factors for cardiovascular disease; includes a discussion of the new cholesterol guidelines; recommends a reduction in alcohol consumption; and discusses the use of calcium and fish oil supplementation. This document expands earlier reports on special populations, including blacks and other racial and ethnic minority groups, young and elderly patients, pregnant patients, surgical candidates, and hypertensive patients with cerebrovascular disease, coronary artery disease, left ventricular hypertrophy, congestive heart failure, peripheral vascular disease, renal disease, chronic obstructive pulmonary disease or bronchial asthma, gout, diabetes mellitus, and hyperlipidemia. The report also updates previous drug tables to include new drugs, revised recommended doses of some drugs, and drug interactions. Consideration of step-down therapy after blood pressure has been controlled is suggested. This report is intended as a guide for practicing physicians and other health professionals in their care of hypertensive patients and as a reference for those participating in the many community high blood pressure control programs throughout the country.
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PMID:The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. 256

Possible risk factors for cardiovascular disease were studied in 52 type II diabetic subjects, 19 with and 33 without a history of coronary heart disease (CHD). None of the recognized risk factors, such as hypertension, hyperlipidaemia, smoking and blood glucose imbalance, could be related to CHD. However, all female patients with CHD were lacking a family history of diabetes, while seven of nine female diabetic subjects without a history of CHD had diabetes in the family (p less than 0.02). This was confirmed in a second study of 150 type II diabetic subjects; CHD was more common among female patients without compared to those with diabetes in the family; 9/38 and 1/28, respectively (p less than 0.03). Diabetes increases the risk of CHD, and it does so for women more than it does for men. The finding of a possible low CHD risk in female diabetic subjects with diabetes in the family supports the hypothesis of genetic factors being important for the pathogenesis of cardiovascular disease in diabetes mellitus.
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PMID:Low risk of coronary heart disease in female type II diabetic subjects with diabetic relatives. 342 84

Many human atherosclerotic lesions, showing no evidence of fissure or ulceration, contain a large amount of fibrin which may be in the form of mural thrombus on the intact surface of the plaque, in layers within the fibrous cap, in the lipid-rich centre, or diffusely distributed throughout the plaque. Small mural thrombi are invaded by SMCs and collagen is deposited in patterns closely resembling the early proliferative gelatinous lesions. In experimental animals, thrombi are converted into lesions with all the characteristics of fibrous plaques, and in saphenous-vein bypass grafts, fibrin deposition is the main cause of wall thickening and occlusion. There seems little doubt that fibrin deposition can both initiate atherogenesis and contribute to the growth of plaques. Epidemiological studies indicate that increased levels of fibrinogen and clotting activity are associated with accelerated atherosclerosis, and although blood fibrinolytic activity has given inconsistent results, in arterial intima both fibrinolytic activity and plasminogen concentration are decreased in cardiovascular disease. Fibrin may stimulate cell proliferation by providing a scaffold along which cells migrate, and by binding fibronectin, which stimulates cell migration and adhesion. Fibrin degradation products, which are present in the intima, may stimulate mitogenesis and collagen synthesis, attract leukocytes, and alter endothelial permeability and vascular tone. In the advanced plaque fibrin may be involved in the tight binding of LDL and accumulation of lipid. Thus there is extensive evidence that enhanced blood coagulation is a risk factor not only for thrombotic occlusion, but also for atherogenesis. Enhanced blood coagulation frequently coexists with hyperlipidaemia and, together, these may have a synergistic effect on atherogenesis.
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PMID:Fibrinogen, fibrin and fibrin degradation products in relation to atherosclerosis. 352 31

We studied the serum lipid profiles of 29 children, 3.9-17.9 years of age who were 0.6-7.6 years after renal transplantation (Tx). Twenty normoglycemic and non-proteinuric children had a well functioning allograft and 5 children had reduced renal function. Both groups were at least 7 months on alternate day corticosteroid (ADCS) therapy. Four additional patients had good renal function but were only 2.3 +/- 0.5 months on an ADCS regimen. Fifteen normal children served as controls. The levels of serum triglycerides (STG) and total cholesterol (CHOL) were elevated and high-density lipoprotein CHOL (HDL-CHOL) were low in all patients compared to control subjects (p less than 0.01). Their cardiovascular risk factor (CHOL/HDL-CHOL) was increased. The lipid abnormalities were most prominent in Tx patients with reduced graft function. These data show that treatment with ADCS does not prevent post-Tx hyperlipidemia. More insight is needed into the mechanisms responsible for the hyperlipidemia after Tx in order to reduce possible future morbidity (and mortality) from premature cardiovascular disease in this group of young, high-risk patients.
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PMID:Hyperlipidemia after renal transplantation in children on alternate day corticosteroid therapy. 353 34

Whether systolic or diastolic, labile or fixed, at any age in either sex, hypertension is dangerous. Adiposity, heart rate, alcohol intake, hematocrit, blood sugar, serum cholesterol, and triglycerides are all related to the occurrence of hypertension in one or both sexes. These factors also contribute to the occurrence of the cardiovascular sequelae of hypertension. The influence of blood pressure on the incidence of cardiovascular disease is independent of other predisposing cofactors but is greatly affected by them. Elevated pressures are often accompanied by hyperlipidemia, hyperglycemia, elevated fibrinogen, and ECG abnormalities, all of which augment the risk. Coronary disease is now the most common sequela of hypertension, and the excess risk is concentrated in those with an increased low-density lipoprotein/high density lipoprotein ratio, impaired glucose tolerance, and ECG abnormalities, and in cigarette smokers. Hypertension is only a component of a multifactorial coronary risk profile which must be considered when implementing optimal therapy. Both the urgency for treatment and judgment of efficacy should be guided by the multivariate risk profile.
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PMID:Hypertension and other risk factors in coronary heart disease. 366 84

Elevated blood pressure is a major contributor to cardiovascular disease in general and to coronary heart disease in particular, now its most common sequela. The risk is proportional to the degree of blood pressure elevation, at all ages and in either sex, whether the increased pressure is labile or fixed, diastolic or systolic in character. The effect of blood pressure on cardiovascular disease incidence is independent of the influence of other predisposing co-factors, but the hazard is greatly influenced by them. Elevated pressures are often accompanied by hyperlipidaemia, hyperuricaemia, overweight, hyperglycaemia, elevated fibrinogen values and ECG abnormalities. The risk associated with any degree of elevation of pressure varies greatly, depending on the number and level of these often associated risk factors, and on whether or not there is the indication of target organ involvement. The excess cardiovascular risk in hypertensive persons tends to be concentrated in those with an increased LDL/HDL cholesterol ratio, impaired glucose tolerance, cigarette smokers and those with accompanying ECG abnormalities. Hypertension is best conceptualised as a component of a multivariate cardiovascular risk profile which provides a sound basis for determining urgency for drug treatment. Optimal preventive management of hypertension requires multifactorial correction of all disordered components of the cardiovascular risk profile before occurrence of target organ involvement.
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PMID:Hypertension. Relationship with other risk factors. 372 May 67

Several parameters of lipoprotein metabolism were examined in 38 men with primary hypertriglyceridemia (phenotype IV). Family investigation showed that 17 men had familial combined hyperlipidemia (FCH), seven had familial hypertriglyceridemia (FHT), and 14 had unclassified hypertriglyceridemia (UNC). In all three groups, plasma high density lipoprotein (HDL) cholesterol and the concentrations of apolipoprotein A-I and A-II were decreased, and apolipoprotein B was increased, each to the same extent. These results are compatible with an increased risk of cardiovascular disease in both FCH and FHT patients. The mean concentration of LDL cholesterol and the ratio of LDL to HDL cholesterol were significantly higher in FCH subjects, which could explain their increased risk. Postheparin lipoprotein lipase and hepatic lipase were the same in both groups. Determination of apolipoprotein C composition, which may modulate lipoprotein lipase activity, did not reveal any abnormalities in the different groups. In both FCH and FHT, the mean turnover rate of plasma triglycerides was almost twice normal, indicating that overproduction of plasma triglyceride plays an important role in both disorders. However, there was an overlap with normal controls, indicating impaired triglyceride removal in some subjects. The underlying mechanism of hypertriglyceridemia in FCH and FHT therefore seems to be heterogeneous.
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PMID:Plasma lipoproteins, apolipoproteins, and triglyceride metabolism in familial hypertriglyceridemia. 372 96


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