Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020473 (hyperlipidemia)
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The significance of antibodies against ethinyl estradiol (anti-EE-Ab) and other risk factors was discussed for a series of 1318 cases of venous and arterial thrombosis in oral contraceptive users, in comparison to 61 non-users and 124 health current pill users. The cases included 264 deep vein thromboses, 159 pulmonary embolism, 37 coronary artery, 33 systemic artery, 763 cerebrovascular artery thromboses, and 10 hepatic vein thromboses collected from 88 French hospitals from 1976-1988. There were 98 cases with successive or multiple sites involved. The mean age of contraceptive users with thrombosis was 32.1, compared to 28.8 in healthy users. Duration of use was slightly longer in affected users than healthy users, but some cases were affected as early as their 1st cycle. 87.2% had no related history. The anti-EE-Ab were absent in never users, averaged 318 c./min in pill users with thrombosis, but 60 in healthy pill users. There was no correlation between anti-EE-Ab level and dose or duration of pill use. Similar anti-EE-Ab levels were found in those with venous or arterial thrombosis, but women with arterial thrombosis were older, had used pills longer, had fewer predisposing factors of surgery or labor and delivery, but more frequent incidence of hyperlipidemia, smoking, and hypertension. The most frequent associated factors with thrombosis were presence of anti-ee-Ab and smoking: 15.6% smoked, 31.1% had anti-EE-Ab, and 47.6% had both, but only 9.5% had neither factor. It is interesting that lowering the estrogen dose of oral contraceptives has decreased the frequency of venous thrombosis, but not that of arterial thrombosis or mortality, nor anti-EE-Ab levels. The vascular lesions in arterial thrombosis seen in pill users are thought to resemble those in many autoimmune diseases.
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PMID:Oral contraceptives, sex steroid-induced antibodies and vascular thrombosis: results from 1318 cases. 178 53

Factors contributing to deep vein thrombosis (DVT) were studied in 51 patients (62 knees) who had a cementless total knee arthroplasty (TKA) and in 51 patients (69 knees) who had a cemented TKA. All patients were treated with a primary TKA using a porous-coated anatomic prosthesis with a porous-coated central tibial stem. Deep vein thrombosis was diagnosed by roentgenographic venography, and pulmonary embolism was diagnosed by perfusion lung scanning. Incidence of DVT was 32%, and there was no pulmonary embolism. The factors that do not seem to have much relevancy to DVT were advanced age, orthopedic disease, one- or two-staged bilateral TKA, venous anatomic variations, number of venous valves, coagulation assay data, hypertension, tourniquet time, choice of cementless or cemented TKA, severity or duration of operation, amount of blood loss, and amount of blood transfused. Conversely, more immediate relevant factors were obesity, postoperative prolonged immobilization, earlier venous disease, and hyperlipidemia.
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PMID:Factors leading to low incidence of deep vein thrombosis after cementless and cemented total knee arthroplasty. 195 58

The incidence of deep vein thrombosis in 244 patients who had total knee replacement has been studied. In 120 the prosthesis was cemented and in 124 it was cementless. In all cases the replacement was primary and a porous-coated prosthesis with a porous-coated central tibial stem was used. Deep vein thrombosis was diagnosed by venography, and pulmonary embolism by perfusion scanning. The incidence of deep vein thrombosis in the cementless knees (23.8%) and in the cemented (25%) was approximately the same. The only significant predisposing factors for deep vein thrombosis in both groups were obesity, prolonged postoperative immobilisation, previous venous disease and hyperlipidaemia.
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PMID:The incidence of deep vein thrombosis after cementless and cemented knee replacement. 221 55

Decisions to resect small aortic aneurysms or employ non-operative treatment for aorto-iliac occlusive disease must depend on current rather than historical surgical results. To assess current morbidity and mortality, we reviewed 200 consecutive aortic resections in two groups of patients treated from 1981 to 1989: those undergoing elective aortofemoral bypass for occlusive disease (AFB, no. 100) or resection of infrarenal abdominal aortic aneurysms (AAA, no. 100). Indications for AFB included claudication (54%), rest pain (32%), and gangrene (13%). AAA size ranged from 3 to 14 cm (mean 6.5 +/- 2.4 cm); 45% presented with abdominal or back pain. Patients undergoing AFB were younger (AFB 61.5 +/- 10 years vs AAA 68.7 +/- 8.9 years) with a higher incidence of some atherosclerotic risk factors, diabetes mellitus 30% vs 10%, tobacco use 77% vs 49%, hyperlipidemia 21% vs 7%; p less than 0.001). Coronary artery disease (CAD) was more prevalent in AAA patients (49% vs 34%; p less than 0.001). Postoperative mortality was not different in occlusive or aneurysmal disease (3% AFB vs 2% AAA), nor was the occurrence of serious complications such as myocardial infarction (2% vs 1%) or pulmonary embolism (2% vs 3%). Improvements in patient selection, perioperative care and surgical technique have lowered the mortality of elective aortic surgery. Given the current standard of care, an aggressive approach to AAA even in high risk patients is appropriate. The low morbidity of AFB for occlusive disease mandates a critical appraisal of less effective nonoperative therapies.
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PMID:Current results of elective aortic reconstruction for aneurysmal and occlusive disease. 221 95

Acute fatal pulmonary embolism is one cause of sudden death which should be guarded against. It is the most often missed diagnosis in sudden death cases within the hospital. Clinical pictures of 10 patients with acute fatal pulmonary embolism proved by autopsy were examined to elucidate the problems of diagnosis, and to look for an effective treatment, and a method of prevention. Common risk factors were old age and immobility due to stroke or postoperative state. Common past histories were hypertension, diabetes mellitus, obesity, atrial fibrillation and hyperlipidemia. Electrocardiogram and echocardiogram showed that in these patients there was definite evidence of acute right ventricular overload. High doses of intravenous urokinase should be given whenever acute cardiovascular collapse develops in such high risk patients. Emergent pulmonary angiogram and pulmonary embolectomy could be life-saving in patients with acute massive pulmonary embolism. Prevention is, however, the best treatment. In addition to anticoagulation medication, frequent change of body position and early mobilization are important precautions to prevent fatal pulmonary embolism developing in such patients.
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PMID:[Acute fatal pulmonary embolism: its prevention, diagnosis and treatment]. 236 72

Vascular risk, mainly thromboembolitic risk, attributed to oral contraceptives (OCs) since 1962, has been primarily linked to ethinyl estradiol (EE). OCs which combine estrogen and have been associated with cerebral vascular accidents. A 1977 study showed a 40% increase of mortality due to cardiovascular complications in women taking OCs. There were of both an arterial and a venous character. The risk of myocardial infarction was 3 times more frequent among OC users. Deep venous thrombosis and pulmonary embolism were more numerous. Some other risk factors include smoking, hypertension, diabetes, and age 35. The risk of heart attack vanishes a few years after stopping OC use. The reduction of EE (and similarly progesterone) dosage from 100-50 mcg also lower the risk of hypertension, cerebral vascular accidents, and venous thrombosis. Prolonged use of OCs causes disorders of hemostasis affecting the walls of blood vessels, modifying the viscosity of blood flow (increase of hematocrits, reduction of venous tonus), modifying plasmatic coagulation (increase of platelets, increase of factors VII and X and plasma fibrinogen, and decrease of antithrombin III activity), and increased fibrinolysis. These anomalies are exclusively associated with high doses of estrogens. 5% of women using OCs develop moderate hypertension of 5-10 mm Hg of systolic pressure 5 years later, but after cessation it is reversed. OCs stimulate the renin-angiotensin-aldosterone system causing accelerated production of angiotensin II with the resultant forceful vasotension. 3 months after quitting OC use, high blood pressure returns to normal. EE can provoke diabetes; it increases very low density lipoprotein (VLDL) and high density lipoprotein (HDL) production, but total cholesterol is hardly affected. The androgenic property of progestogens reduces HDL. Combined OCs are contraindicated for women with hypertension, hyperlipidemia, diabetes, and a family history of vascular accidents.
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PMID:[Oral contraception and the vascular risk]. 251 20

The incidence of deep-vein thrombosis was studied in 146 consecutive Korean patients who had a cementless total hip replacement with a porous-coated anatomic prosthesis. All of the patients had discontinued taking aspirin, aspirin-containing compounds, or other antiplatelet medications fourteen days before admission to the hospital for the operation. Deep-vein thrombosis was diagnosed by roentgenographic venography, and pulmonary embolism, by perfusion lung-scanning. There was an unusually low incidence (10 per cent) of deep-vein thrombosis in this series. In contrast to other reports, we did not identify a relationship between deep-vein thrombosis and so-called risk factors such as advanced age, number of venous valves (more than five) in the lower extremity, abnormal coagulation-assay data, certain diseases, or preoperative limitation of mobility. In addition, hypertension, blood group, surgical approach, and choice of cemented or cementless total hip replacement did not seem to affect the incidence of deep-vein thrombosis. There was a low incidence of deep-vein thrombosis in patients in whom obesity, prolonged immobilization postoperatively, varicose veins, and hyperlipemia were not factors.
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PMID:Low incidence of deep-vein thrombosis after cementless total hip replacement. 339 86

Studies of blood clotting factors and prospective and retrospective studies on risk of thromboembolism are reviewed until 1969. Clotting factors 7, 8, 9, and 10, coagulation time, and platelet adhesiveness are increased during oral contraception. The significance, however, is unknown for developing thromboembolism. There are numerous publications on thromboemoblism in pill users, but most are statistically useless case reports. Risks of morbidity from this disorder in normal women are 1.2-2.9/1000 for nonpregnant, 3.1-10.4/1000 for postpartum, and .5/1000 for pregnant. A prospective study by the U.S. Food and Drug Administration found no increased risk, but 3 British retrospective studies found a 3-fold risk of phlebits, a 9-fold risk of hospitalization for thrombophlebitis, and an increased risk of death from pulmonary embolism or cerebral accident. Women at greater risk because of age, weight, or predisposing factors (diabetes, hyperlipidemia, surgery) should be meticulously eliminated by the clinician.
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PMID:[Statement on the thromboembolic risk while taking oral contraceptives]. 542 2

This study was conducted to identify patients at high risk of the development of Pulmonary Embolism (PE) after open heart surgery, to evaluate pertinent diagnostic methods, and to assess the mortality associated with this complication. We evaluated the records of 2,551 consecutive patients who underwent open heart surgery over a 10-year period to identify those patients in whom PE developed. All surgical reports, ventilation/perfusion scans, pulmonary angiograms, and autopsies from the same period were also reviewed. Preoperative and postoperative risk factors for pulmonary embolism were also analyzed, as well as the outcome of this complication in each type of surgical procedure. Pulmonary embolism was identified in 69 (2.7%) patients after open heart surgery, in 43 (62.3%) of whom the diagnosis was established within the first week of surgery. Factors associated with high incidence for PE were hyperlipidemia, congestive heart failure and heparin-induced thrombocytopenia (P < 0.001); obesity and prolonged mechanical ventilation (P < 0.005); and prior right heart catheterization by the femoral approach and prior PE and/or deep vein thrombosis (P < 0.05). The diagnosis of PE was established by a high-probability ventilation/perfusion scan in 25 patients, by pulmonary angiography in 42 (29 of whom had prior V/Q scan read as intermediate or low probability for PE) and by autopsy in two patients. The mortality rate in patients who had PE was 7.2%, while in those without this complication it was 3.2%. These findings suggest that aggressive approach for the diagnosis of PE by pulmonary angiography whenever the V/Q scan is not read as high probability is crucial in patients with recent open heart surgery; such approach may identify patients with PE at an early stage and may have an impact in reducing mortality incurred by this complication. This diagnostic assessment should be emphasized in the perioperative period, especially in patients with multiple significant and identifiable risk factors for PE.
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PMID:Critical role of pulmonary angiography in the diagnosis of pulmonary emboli following cardiac surgery. 882 30

A 29-year old man was admitted to an emergency psychiatric ward because of exacerbation of a chronic paranoid schizophrenia. He was restrained after arrival, and seven days later a deep venous thrombosis and a pulmonary embolism were diagnosed. No haematological predisposing factors (coagulation inhibitor deficiency, activated protein C resistance, or antiphospholipid antibodies) were identified, except for a questionable borderline increase of the fibrinolysis inhibitor PAI-1, and combined type II hyperlipidaemia. During the last 15-20 years, there has been a considerable reduction in the use of restraint and seclusion in Norway. The use of seclusion and restraint may be effective in preventing injury and reducing agitation, but these procedures may also have harmful physical, and in particular psychological side-effects. To our knowledge, this is the first report to demonstrate an association between venous thromboembolism and physical restraint. Immobilisation is a well-known risk factor for thrombophlebitis, and special attention should be paid to this problem on psychiatric wards. However, until more is known about thrombosis in relation to restraint, it is not advisable to recommend prophylactic treatment of thrombosis.
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PMID:[Venous thromboembolism in connection with physical restraint]. 965 10


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