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Query: UMLS:C0020473 (hyperlipidemia)
 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiovascular disease remains the major cause of death in the industrialized world with dyslipidemia, hypertension and cigarette smoking leading a long list of risk factors. Recently, controversy arose from some critical articles expressing concern about the evaluation and interpretation of statistical data of epidemiologic studies. One study using covariance analysis reported an absence of the widely accepted negative association between coronary heart disease (CHD) and high density lipoprotein (HDL) cholesterol. Also criticism was expressed regarding the cost-effectiveness of preventive measures such as the use of lipid lowering drugs on life expectancy. Because of such recent scientific controversy and discussions already taking place in the media, we have summarized in this article recent epidemiologic evidence including a meta-analysis of the major epidemiologic studies on HDL. We have directed particular attention to 3 large epidemiological studies, i.e., the Familial Atherosclerosis Treatment Study (FATS), the Program on the Surgical Control of the Hyperlipidemias (POSCH), and the Cholesterol Lowering Atherosclerosis Study (CLAS), all of which have clearly demonstrated a desirable effect of intensive lipid lowering therapy on coronary lesions.
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PMID:[Risk factors for coronary heart disease]. 194 9

Optimal strategies for identifying children with hypercholesterolemia have not been established. Several groups have advocated that testing of serum cholesterol levels be limited to those children who have family histories of hyperlipidemia or premature coronary heart disease. We studied the ability of comprehensive family histories to identify children with hyperlipidemia in a group of 114 children (mean age, 8 +/- 4 years) who were referred for treatment of hypercholesterolemia. A positive family history was defined according to guidelines of the American Academy of Pediatrics. The mean fasting total cholesterol in the children was 5.74 +/- 1.42 mmol/L (222 mg/dL). Family history was negative for hypercholesterolemia or premature coronary heart disease in 22 (22%) of 100 children with total cholesterol levels greater than the 75th percentile for their ages, in 13 (18.3%) of 71 children with total cholesterol levels greater than the 95th percentile for their ages, and in four (11.8%) of 34 children with presumed heterozygous familial hypercholesterolemia. Of the 78 children who had both hypercholesterolemia and positive family histories, hyperlipidemia was reported in 72 families, whereas premature heart disease was reported in only 27. We conclude that in a population of children referred because of known hypercholesterolemia, a detailed family history not only fails to identify many children with mild hypercholesterolemia, but also fails to identify a significant proportion of children with markedly elevated cholesterol levels. Additionally, in families of children with hypercholesterolemia, a history of hyperlipidemia is more common than a history of premature heart disease.
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PMID:Family history fails to identify many children with severe hypercholesterolemia. 198 31

The atherogenic effects of low-density lipoprotein cholesterol (LDL-C) and the relationship between high levels of LDL-C and coronary heart disease are well established. The article briefly reviews significant research that has provided the rationale for dietary intervention in hyperlipidemia. The focus is the principles of dietary treatment and their clinical application. Methods of counseling and instruction aimed at lowering fat, cholesterol, and calorie consumption and strategies to improve patient compliance are discussed.
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PMID:Dietary management of hyperlipidemia. 198 31

Dietary supplementation with n-3 polyunsaturated fatty acids (n-3 PUFAs) has been shown to inhibit neutrophil and monocyte chemotaxis in healthy subjects and, with respect to neutrophils, also in various patient groups. We studied the effect of dietary supplementation with n-3 PUFAs on monocyte and neutrophil chemotaxis in patients with hyperlipidemia. Chemotaxis was investigated with the under-agarose assay, using autologous serum and N-formyl-methionyl-leucyl-phenylalanine as chemoattractants. The patients were examined before and after 6 weeks of supplementation with 6 g n-3 PUFAs daily. Monocyte chemotaxis was reduced after n-3 PUFA supplementation in type IIa patients but was unaffected in patients with type IV hyperlipidemia. Furthermore, monocyte chemotaxis was increased in untreated type IIa patients compared with normocholesterolemic controls. We also studied the dose-response effects of n-3 PUFAs on monocyte and neutrophil chemotaxis in healthy men given 1.3, 4, and 9 g n-3 PUFAs daily for 6-week periods. Monocyte and neutrophil chemotaxis was reduced after n-3 PUFA supplements in a dose-dependent fashion, with the majority of the effect observed after the low dose. These results lend support to the notion of an antiatherosclerotic effect of n-3 PUFAs and may provide an explanation for the hitherto-unexplained effect of low doses of n-3 PUFAs in coronary heart disease.
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PMID:n-3 fatty acids and leukocyte chemotaxis. Effects in hyperlipidemia and dose-response studies in healthy men. 199 59

The left ventricular contractility was evaluated in patients with hyperlipidemia or uncomplicated Functional Class I-III angina by using echocardiography at rest and during bicycle ergometric tests. A total of 47 males under 60 years were examined, who were divided into 4 groups: 1) 10 healthy subjects; 2) 14 hyperlipidemic subjects without signs of coronary heart disease; 3) 10 patients with Functional Class I-III angina who showed no ischemic response to bicycle ergometry; and 4) 13 patients with angina pectoris who showed an ischemic response to exercise. The patients had no history of myocardial infarction. The patients from Groups 2-4 displayed a lower overall left ventricular contractility as manifested by no decrease in left ventricular end systolic volume after exercise and other parameters. They also exhibited a segment asynergy in myocardial performance.
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PMID:[Myocardial contractility in subjects with hyperlipidemia and patients with angina pectoris according to findings of bicycle ergometry echocardiography]. 204 Dec 83

The Stroke Register was established in 1984 in Heidelberg, as a part of the MONICA Project, covering the same population (approximately 601,000) as the Acute Myocardial Infarction Register. In the present analysis, the data for men and women (aged 25-64) for 1985 and 1986 are presented. During the two years, 303 men and 143 women were registered. The overall age-standardized attack rate was 127.2/100,000 for men and 52.8/100,000 for women, and the age-standardized incidence was 97.4/100,000 in men and 42.9/100,000 in women. The proportion of first stroke was 76.5% in men and 81% in women. The 28-days mortality was 12% for men and 19% for women. Hypertension, diabetes mellitus, smoking and heart disease (coronary heart disease, rhythm disturbances) were identified as risk factors for stroke. Among the registered victims of stroke, 61% of the men and 67% of the women had a history of hypertension. In men, a high prevalence of smokers, 54% was found (33.9% in the total population in the same age range). In women, the prevalence of smokers is nearly the same as in the total population. Diabetes mellitus was present in 23% of men and in 40% of women, and hyperlipidaemia in 30% of men and in 18% of women.
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PMID:First results from the MONICA stroke register in Heidelberg. 208 49

Hepatic, heparin-releaseable lipase is a multifunctional enzyme that may act on all lipoprotein classes present in plasma from fasted subjects. Recent evidence suggests that the enzyme also plays a role in the metabolism of chylomicronremnants. Its activity is impaired in normolipidemic patients with coronary heart disease, which also have a delayed removal of chylomicronremnants from plasma. Therefore hepatic lipase, in addition to lipoprotein lipase, plays an important role in postprandial lipoprotein metabolism. The activity levels of lecithin: cholesterol acyltransferase (LCAT) and cholesterylester transfer protein (CETP) are virtually unchanged after the ingestion of an oral fat load by normolipidemic subjects. However, the net mass transfer of cholesterylesters out of HDL into apo B-containing lipoproteins (chylomicronremnants, VLDL/IDL/LDL) is strongly increased. All triglyceride-rich lipoprotein fractions accumulate postprandially and, as a result of CETP action, become enriched in cholesterylesters. Defects in hepatic remnant removal may result in influx of remnants into the arterial wall. In patients with hyperlipidemia (and increased risk for atherosclerosis) the CETP-mediated formation of cholesterylester-rich remnants may operate, not only during the postprandial phase, but continuously.
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PMID:[Role of hepatic lipases, cholesterol ester transfer proteins and LCAT in the postprandial phase]. 208 75

There is more and more epidemiological evidence elevated plasma triglyceride concentrations increase the risk for atherosclerosis especially for coronary heart disease. Since triglyceride-rich lipoprotein fractions also contain different concentrations of cholesterol and since the metabolism of triglyceride-rich lipoproteins is not independent from the metabolism of HDL, the variables HDL-cholesterol and LDL-cholesterol (respectively total-cholesterol) must be taken into account when evaluating the atherosclerotic risk of triglyceride-rich lipoproteins. This epidemiological evidence is underlined by clinical observations about the high incidence of atherosclerosis and coronary heart disease in relation to abnormalities in the triglyceride-rich lipoprotein metabolism as in patients with diabetes mellitus, familial dysbetalipoproteinemia and familial combined hyperlipidemia. Very low density lipoproteins (VLDL), low density lipoproteins (LDL) and high density lipoproteins (HDL) from patients with hypertriglyceridemia are enriched in free and esterified cholesterol. This changed composition of these lipoprotein fractions leads to an increased elimination from the circulation via atherogenic macrophages and smooth muscles cell pathways. Successful treatment of hypertriglyceridemic states obviously normalizes the changed composition of the lipoprotein fractions and in consequence effects also the atherogenicity.
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PMID:[Triglyceride-rich lipoproteins as risk factors for atherosclerosis]. 208 80

Although reduction in total plasma cholesterol has yet to be shown to have a beneficial effect on overall mortality, the weight of experimental and epidemiologic evidence supports efforts to lower total plasma cholesterol levels to reduce the risk of death from coronary heart disease (CHD). This is especially true in patients with heterozygous, type II-A hyperlipoproteinemia, whose total plasma cholesterol levels above the 90th percentile for age and sex place them at markedly increased risk of death from CHD. The lipid results of partial ileal bypass (PIB) were assessed in 110 patients with heterozygous, type II-A hyperlipoproteinemia in the Program on the Surgical Control of the Hyperlipidemias, a randomized, prospective clinical trial assessing the effects of cholesterol reduction on overall mortality and the course of CHD. Compared with dietary control (n = 52), PIB (n = 58) reduced total plasma cholesterol levels 24% +/- 2% (mean +/- SEM), reduced low-density lipoprotein (LDL) cholesterol levels 34% +/- 3%, and increased high-density lipoprotein (HDL) cholesterol levels 5% +/- 5% 5 years after surgery. Very low-density lipoprotein cholesterol levels were 28% +/- 21% higher and plasma triglyceride levels were 24% +/- 11% higher in the surgical group. The HDL cholesterol/total plasma cholesterol and HDL cholesterol/LDL cholesterol ratios were significantly higher after PIB. Apolipoprotein A-I and HDL subfraction 2 levels were significantly higher and apolipoprotein B-100 levels were significantly lower in the surgical group. PIB successfully lowered mean total plasma cholesterol and LDL cholesterol levels below the limits recommended by the National Cholesterol Education Program to minimize the risk of death from CHD. These results confirm the efficacy and support the role of PIB in the management of patients with marked hypercholesterolemia.
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PMID:Lipid results of partial ileal bypass in patients with heterozygous, type II-A hyperlipoproteinemia. Program on the Surgical Control of the Hyperlipidemias. 212 Jul 85

This cost-benefit analysis attempts to translate the clinical findings of the Helsinki Heart Study (HHS) and published results regarding additional cardiovascular conditions into economic terms meaningful to US managed care providers. The study has the following 3 key objectives: to define the cost effectiveness of gemfibrozil in the prevention of coronary heart disease (CHD); to assess the net impact of gemfibrozil on total treatment costs for CHD; and to identify those patient groups for whom gemfibrozil therapy is most cost effective. In order to reach these findings a cost-effectiveness model was constructed based on original clinical data provided by the HHS, published findings for CHD risk and cost of treatment in the US, expert opinion and extension of HHS to other cardiovascular conditions, and documented costs and treatment protocols of US Medicaid and privately managed health care programmes. The model was applied to the California Medicaid (Medi-Cal) programme to estimate costs of hyperlipidaemia therapy using gemfibrozil. In parallel, savings to Medi-Cal from averted coronary events were estimated. From these data, the net expected savings to Medi-Cal were calculated. The probability of experiencing CHD varies with cholesterol level, age, sex and risk factors such as smoking, hypertension and diabetes. Therefore, it is possible to use risk-factor profiles to define groups of individuals with low, moderate or high risk of experiencing acute myocardial infarction (AMI) or sudden cardiac death. The probability of a cardiac event within 5 years ranges from 1.1% in a 45-year-old low risk male to over 36% in a 55-year-old high risk male. The average total cost of CHD care was found to be US$22,271 within 5 years. Using the probability of a CHD event to calculate the expected 5-year cost of CHD care produces a range from US$242 in the 45-year-old low risk male to US$8084 in the 55-year-old high risk male. Treatment with gemfibrozil reduces the probability of AMI and sudden cardiac death events by 34%, as demonstrated in the HHS. Therefore, the corresponding probability ranges are reduced to 0.7% in the 45-year-old low risk male and 27.3% in the 55-year-old high risk male after treatment with gemfibrozil. The expected cost of a coronary event is reduced by US$82 and US$1997, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Gemfibrozil cost-benefit study. Targeting subgroups for effective hyperlipidaemia drug therapy. 212 8


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