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

Treatment of hypertension aims at preventing strokes and coronary events although diuretics and beta-blockers lowered blood pressure effectively and allowed prevention of strokes in large-scale trials, they did not reduce the incidence of myocardial infarction or coronary death. The failure of diuretics and beta-blockers to afford cardiac protection may be due in part to the unfavorable effects of these agents on associated risk factors like hyperlipidemia and smoking. Hyperlipidemia is more prevalent in hypertensive patients than in matched normotensive controls, and the combination of hyperlipidemia and smoking is more frequent than can be expected to occur by chance. Diuretics and beta-blockers affect lipid metabolism negatively. Unlike these agents, alpha-blockers do not alter serum lipids and might reduce triglyceride and cholesterol levels. Several trials have shown that the outcome of treatment with beta-blockers was less favorable in smokers than in non-smokers in terms of blood pressure control and prevention of coronary events. A possible explanation is provided by acute experiments in which beta-blockade enhanced the systemic and coronary vasocontriction elicited by smoking, while alpha-blockade had the opposite effect. Although there is reason to believe that alpha-blockers may be preferable to diuretics and beta-blockers for the treatment of high risk hypertensive patients who smoke and/or exhibit high levels of serum lipids, there is a need for larger and longer trials to test their ability to reduce cardiovascular risk.
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PMID:[Effect of alpha inhibitors on risk cofactors in patients with hypertension]. 257 48

The study included 45 consecutive patients in the age group of 27 to 39 years presenting with AMI diagnosed by typical history, ECG changes and enzyme response. Prognostic significance of various risk factors in AMI in young was evaluated. There were 41 M (91.1%) and 4 F (8.9%) with mean age of 34.6 years. ECG showed anterior myocardial infarction (MI) in 18 (40%), inferior MI in 15(33.3%), Subendocardial inf in 10(22.5%) and combined anterior and inferior MI in 2 (4.5%) cases. Various risk factors were: Smoking (60%), hyperlipidemia (44.4%), stress (40%), hypertension (28.9%), family history (28.9%), diabetes mellitus (15.7%) and obesity (8.8%). Attention was given on atherogenic index (AI) (22.2%). Coronary angiogram was done in 20, which revealed significant coronary arterial obstruction in 15 cases; 3-vessel disease (n = 7), 2 vessel disease (n = 4) and single vessel disease (n = 4). Both 3 VD and 2 VD were associated with high AI. Risk factors (RF) were grouped as RFGI when combination of 3 or more RF were present, and RFG II when 2 or less RF were present. RFGI and RFGII were present in 40% and 60% cases respectively. Prognostically, patients were divided in two groups of MI-fatal (6) and nonfatal (39), the latter were subdivided into complicated (14) and uncomplicated (25). It was observed that more fatal cases were found in RFGI, whereas nonfatal uncomplicated MI was more in RFG II (P less than .001).
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PMID:Prognostic significance of risk factors in acute myocardial infarction in young. 259 36

To evaluate the cardiac risk in patients undergoing noncardiac surgery, it has been identified by the multivariated analysis some major and independent correlates of fatal or life-threatening cardiac complications. The most important ones were the history of previous myocardial infarction in the preceding six months, clinical signs of congestive heart failure, third heart sound or jugular venous distention, and for some Authors instable angina class IV CCS. Other predictive factors of complications were premature ventricular and atrial contractions or ectopic rhythms within cardiac diseases, age over 70 years, intraperitoneal, intrathoracic, aortic or emergency operation, severe valvular aortic and mitral stenosis and poor general medical conditions. Stable angina, hypertension, hyperlipidemia and smoking habit were less important. The global evaluation of cardiac risk can be performed by multifactorial index subdividing the patients into four very different risk classes. This is obtained by scores assigned to each statistically significant factor.
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PMID:[Surgical cardiac risk in patients with heart diseases. I. Evaluation of the risk]. 260 75

Age is an important factor in predicting risk of myocardial infarction (MI). Age is currently treated as an independent variable in assessing risk, but it is also related to other major risk factors including hyperlipidemia, hypertension and diabetes, all of which increase in prevalence with age. Current evidence indicates that a combination of 2 or more of the major risk factors predisposes a person to a high risk of MI. In the experience of the Prospective Cardiovascular Munster study, patients with diabetes alone have twice the risk of MI, but those with diabetes and hyperlipidemia have about a 15-fold increased risk. Similarly, patients with hypertension alone have twice the risk of MI, but those with hypertension combined with hyperlipidemia have approximately a 15-fold increased risk.
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PMID:Diabetes mellitus and hypertension in the elderly: concomitant hyperlipidemia and coronary heart disease risk. 265 May 22

Approximately 15% of myocardial infarction survivors less than 60 years of age have a plasma lipid abnormality defined as combined hyperlipidaemia. Patients with this condition are at substantial risk for future cardiovascular events. Combined hyperlipidaemia involves elevations in both plasma triglycerides and low-density lipoprotein (LDL) cholesterol and may share similarities with hyperapolipoproteinaemia, LDL-pattern B and the small LDL-pattern. Treatment is directed at reduction of LDL-cholesterol and plasma triglyceride values. Nicotinic acid and the fibric acid derivatives are useful therapeutic agents. Fenofibrate is a fibric acid derivative that lowers both triglycerides and LDL-cholesterol in combined hyperlipidaemia. In combined hyperlipidaemia, fenofibrate has been shown to reduce significantly plasma triglycerides by approximately 40%, LDL-cholesterol by 6%, and to increase high-density lipoprotein cholesterol by 15%. Apoproteins are favourably altered with increases in apoprotein-A, decreases in apoprotein-E and inconsistent decreases in apoprotein-B. Fenofibrate is well tolerated with primarily dermatological side-effects.
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PMID:A review of combined hyperlipidaemia and its treatment with fenofibrate. 265 34

The Program on the Surgical Control of the Hyperlipidemias (POSCH) is a prospective, randomized, controlled, multi-center, secondary, atherosclerosis intervention trial. POSCH addresses the therapeutic arm of the lipid-atherosclerosis theory, i.e. whether lowering of plasma cholesterol is directly related to a reduction in atherosclerosis risk. In this trial, lipid modification is accomplished by the partial ileal bypass operation. Between 1975 and 1983, 838 patients were randomized into this study. All patients were between 30 and 64 years of age, had survived one and only one electrocardiogram and enzyme-documented myocardial infarction, and had a total plasma cholesterol of at least 220 mg/dl or a low density lipoprotein (LDL)-cholesterol of at least 140 mg/dl if the total plasma cholesterol was between 200 and 219 mg/dl after a minimum of 6 weeks of dietary fat and cholesterol restriction. The primary response variable in POSCH is overall mortality. Secondary endpoints include fatal and non-fatal myocardial infarctions, serial electrocardiographic changes, and, most importantly, sequential coronary arteriography changes. The minimum follow-up is currently planned to be 7 years. Study analyses will be made primarily on the "intention to treat" basis. This paper is the first detailed presentation of POSCH design and methodology. Included are descriptions of study design, implementation, and data collection, including data processing, quality assurance/quality surveillance, and patient safety monitoring. POSCH seeks to demonstrate a significant reduction in overall mortality by lipid modification and to validate the use of coronary arteriographic change as a surrogate endpoint for change in coronary heart disease risk.
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PMID:Program on the Surgical Control of the Hyperlipidemias (POSCH): design and methodology. POSCH Group. 268 77

Smoking is one of the three major cardiovascular risk factors, the other two being hyperlipidaemia and hypertension. Cardiovascular diseases contribute in Austria, as well as in other industrialized countries, more than 50% to total mortality. Unlike in other industrialized countries ischaemic heart diseases in Austria have an unfavourable mortality trend, with a substantial relative increase. The atherogenicity of smoking is partly caused by interaction with other risk factors, especially hyperlipidaemia, hypertension and a high fibrinogen level. 30% of the Austrian population are smokers. The percentage has increased over the past few years, especially in young women. Other cardiovascular risk factors are very common too and, hence, a large proportion of the Austrian population is at risk due to a combination of risk factors. Smoking and the use of oral contraceptives is associated with significant risk of both myocardial infarction and stroke. The Austrian trend of cigarette smoking among young women points to a substantial increase in the number of women at risk by this combination of risk factors. Strategies to control the smoking epidemic have been internationally tested. An integrated approach is set out in a document provided by the International Union Against Cancer (1983). In a country like Austria with a tobacco monopoly the conditions for implementing smoking control measures should theoretically be better than in other countries.
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PMID:[Smoking and atherosclerosis]. 268 75

The relationships between total serum cholesterol levels greater than 200 mg/dl or LDL-cholesterol levels greater than 155 mg/dl (135 mg/dl) and the incidence of coronary heart disease is well established. In contrast an inverse relationship could be shown between HDL-cholesterol levels and the frequency of cardiac death and non fatal myocardial infarction. It also seems to be possible that elevated triglyceride levels (greater than 200 mg) may represent an additional risk factor. Subsequent studies with a large number of patients and longterm observation proved, that fat-modified diets or drug treatment of hyperlipidemia results in a reduction of morbidity and mortality due to coronary heart disease, whereby the reduction of coronary events correlates directly to the degree of reduction of total cholesterol or LDL-cholesterol, respectively. This knowledge allows the clinician to identify persons at high risk for coronary heart disease and to start effective individual therapy in accordance with the recommendations of the European Atherosclerosis Society.
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PMID:[Hyperlipidemia and coronary heart disease]. 269 30

The European Consensus Conference has classified persons with hyperlipidemia into 5 groups on the basis of cholesterol and triglyceride levels. Plasma cholesterol concentration alone is not sufficient for the assessment of myocardial infarction risk; other risk factors must be considered for a more sensitive prediction. Guidelines for risk assessment of coronary heart disease and treatment regimens for each of the 5 hyperlipidemia groups, as outlined in the Policy Statement on coronary heart disease of the European Atherosclerosis Society, are described. It is emphasized that therapeutic goals for patients with hyperlipidemia depend to some extent on the presence or absence of other risk factors; plasma cholesterol and low-density lipoprotein cholesterol target levels may be lower in those with associated risk factors.
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PMID:European lipid guidelines: therapeutic recommendations. European Atherosclerosis Society. 270 96

We evaluated the relation between smoking and myocardial infarction using data from a hospital-based case-control study conducted in Northern Italy on 262 young and middle-age women with acute myocardial infarction (median age: 49 years) and 519 controls (median age: 47 years), admitted for a series of acute conditions unrelated to any of the established or potential risk factors for ischaemic heart disease. With reference to lifelong non-smokers, the multivariate relative risk was not significantly higher for ex-smokers, but rose progressively with the number of cigarettes smoked. The risk estimates were 2.3, 5.9 and 11.0 for less than 15, 15-24, greater than or equal to 25 cigarettes per day. This trend in risk was statistically significant. Smoking-related risks were similar below and above 50 years of age; they were consistently and substantially higher in various strata of other major determinants of myocardial infarction (hyperlipidaemia, hypertension) or correlated lifestyle habits (alcohol and coffee). In terms of population attributable risk, 48% of all myocardial infarction in this data could be attributed to smoking. Although myocardial infarction is less frequent in Italian women compared to Northern European or American women, our data indicate that cigarette smoking is undoubtedly its most prominent cause. This confirms, once again, the urgent need to intervene and eliminate this risk factor.
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PMID:[Cigarette smoking and the risk of myocardial infarction. A case-controlled study in northern Italy]. 274 20


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