Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020473 (hyperlipidemia)
 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although patients with medically treated vasospastic angina have a good outcome, few data exist regarding the role of underlying lesion severity associated with or without hyperlipidemia in the prognosis. Therefore, the aim of the present study was to assess the relationship between the long-term outcome of vasospastic angina and the factors influencing its prognosis. A total of 256 patients (219 men, 37 women; mean age, 54.1+/-9.2) who had coronary spasm with or without underlying lesions and were being treated with calcium channel antagonists were enrolled and followed for 13.6+/-3.7 years. Cardiac events consisted of cardiac death and ischemic events, which included acute myocardial infarction and unstable angina. Cox analysis selected coronary artery stenosis (CAS, >/=50%) and risk factors such as age, hypertension, diabetes mellitus, low-density lipoprotein-cholesterol (LDL-C), sex and smoking. There were 19 cases of cardiac death (7.4%) and 58 of ischemic events (22.7%) during the follow-up period. The presence of significant CAS was an independent predictor of event-free survival (hazard ratio (HR) =2.84, 95% confidence interval (CI) =1.79-4.52, p<0.0001). In 193 patients without significant CAS, there were 10 cases of cardiac death (5.2%, p<0.05) and 34 of ischemic events (17.6%, p<0.01). In that group, high LDL-C was the independent predictor of event-free survival (HR = 3.89, 95% CI = 1.20-12.6, p=0.02). Kaplan-Meier survival analysis revealed significantly lower event-free survival in patients with than in those without lesions (p<0.0001 by log-rank test). These results demonstrate that the most important factor for long-term prognosis of vasospastic angina treated with calcium channel antagonists is significant CAS. High LDL-C, which might alter the underlying coronary endothelial function and/or accelerate atherosclerotic lesions, could also contribute to the occurrence of cardiac events, particularly in patients without significant CAS.
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PMID:Lesion severity and hypercholesterolemia determine long-term prognosis of vasospastic angina treated with calcium channel antagonists. 1463 19

We explored the association between diagnosed rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) and the risk of developing a first-time acute myocardial infarction (AMI) by conducting a population-based, case-control analysis using data from the United Kingdom-based General Practice Research Database (GPRD). Among 8,688 patients with AMI and 33,329 matched controls, the adjusted odds ratio (ORs) of AMI for subjects with RA was 1.47 (95% confidence interval [CI] 1.23 to 1.76), and in subjects with both RA and diagnosed hyperlipidemia, the OR was 7.12 (95% CI 4.16 to 12.18). The risk associated with SLE was 2.67 (95% CI 1.34 to 5.34). These results underline that RA and SLE increase the risk of AMI.
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PMID:Effect of rheumatoid arthritis or systemic lupus erythematosus on the risk of first-time acute myocardial infarction. 1546 98

Around one third of patients with myocardial infarction are diabetic. More vigorous control of hyperglycemia, hyperlipidemia, and hypertension is likely to be of crucial importance for risk reduction. Although the effect of intensive glycemic control appears to be only minor in terms of prevention of cardiac events in diabetic patients, it has a major beneficial impact during acute myocardial infarction and after percutaneous transluminal coronary angioplasty. Lipid-lowering treatment is as effective in diabetic patients with coronary artery disease as in nondiabetic patients. In patients with coronary artery disease, there is strong evidence in favor of the use of b-blockers soon after myocardial infarction as well as in the long term. The metabolic treatment may also be considered as a rational approach for patients with stable angina. The long-term angiotensin converting enzyme inhibitor trials in patients with left ventricle dysfunction soon after myocardial infarction demonstrated a substantial benefit in the subgroup of diabetic patients. Current evidence leads us to recommend revascularization surgery as the first choice in diabetic patients. The management of risk factors should be more intensive in diabetic patients. In diabetic patients with coronary artery disease, most of the medical strategies are as effective as in nondiabetic patients.
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PMID:[Treatment of patients with ischemic heart disease and diabetes]. 1500 79

A positive family history (FH) of coronary artery disease (CAD) is considered an independent risk factor for developing CAD. However, the natural history, coronary angiographic findings and prognosis of patients with a positive FH developing first acute myocardial infarction (AMI) are not well defined. A cohort of 2,690 consecutive patients with first AMI from two prospective nationwide surveys conducted during 1996 and 1998 in all coronary care units operating in Israel was studied. Baseline characteristics, hospital course, management and outcome of 405 patients with first AMI and a positive FH were compared with 2,285 controls without a positive FH. Coronary angiograms of patients with and without a positive FH were reviewed and compared. Patients with a positive FH were younger (53 vs. 64 years), more often male, current smokers and patients with hyperlipidemia, but less often patients with diabetes or hypertension than patients without a positive FH. Patients with a positive FH developed heart failure during hospital stay less frequently. Thrombolytic therapy was similarly administered to both groups. During the hospital stay, coronary angiography, percutaneous coronary intervention or coronary artery bypass grafting were more frequently performed in patients with a positive FH. The coronary anatomy and the extent of the CAD were similar in patients with and without a positive FH. Crude and covariate-adjusted mortality rates were significantly lower in patients with a positive FH than in patients without a positive FH on day 30 (2.2 vs. 9.6%, p < 0.001; odds ratio 0.50, 95% confidence interval 0.22-0.99) and at 1 year (3.5 vs. 14%, p < 0.001; hazard ratio 0.58, 95% confidence interval 0.42-0.80). Patients with a positive FH developed their first AMI more than 1 decade earlier in comparison to those without such a history. The extent of their coronary disease is similar to the older patients without a positive FH. The better prognosis of patients with a positive FH is mostly explained by their younger age.
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PMID:Family history of coronary artery disease and prognosis after first acute myocardial infarction in a national survey. 1533 23

Atherothrombotic diseases and especially coronary and cerebrovascular diseases are the most important causes of death in western countries. Besides the prevention and treatment of cardiovascular risk factors like hyperlipidemia, smoking and arterial hypertension along with improvements in the catheter-based interventional therapy, the treatment of cardiovascular diseases with platelet aggregation inhibitors improved the the patients' long-term outcome and mortality. The effect of acetylsalicylic acid (ASA) as an inhibitor of the cylooxygenase is well studied and proven in numerous major studies. In these trials, ASA improved prognosis of the patients both in acute and chronic coronary heart disease as well as in the primary prevention of high-risk patients. A similar positive and, in comparison to ASA, even stronger effect was demonstrated with thienopyridines as inhibitors of the ADP receptor on thrombocytes. In additional studies a combination of both substances showed a synergistic effect on platelet inhibition in the treatment of acute coronary syndromes and after stent implantation as interventional therapy of coronary heart disease. According to randomized prospective double-blind studies, a combination therapy with ASA and clopidogrel is indicated for patients with acute coronary syndromes and following coronary stent implantation for up to 12 months. A longer-lasting dual therapy is tested in several ongoing studies, along with the safety of this treatment regimen in combination with lytic therapy in acute myocardial infarction.
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PMID:[Antiplatelet strategies in the acute and chronic therapy of cardiovascular disease]. 1548 52

We describe the case of a 39-year-old human immunodeficiency virus (HIV)-infected man with angiographically documented rapid progression of coronary artery disease. Over a time course of only 2 months, he developed high-grade stenosis of the left anterior descending coronary artery. The risk of myocardial infarction is increased in patients with HIV infection receiving antiretroviral therapy. However, the absolute risk is small and the marked overall benefits of antiretroviral therapy are evident. Patients receiving HIV protease inhibitors should be screened for hyperlipidemia, hyperglycemia, and hypertension. They may be candidates for lipid-lowering therapies depending on their long-term prognosis and individual risk of cardiovascular disease. Care is need because of possible drug interactions between lipid-lowering drugs and antiretroviral therapy. Invasive treatment of acute myocardial infarction does not differ from that in patients not infected with HIV. The rate of progression of coronary artery disease and the restenosis rate, however, are often unexpectedly high in these patients.
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PMID:Rapid progression of atherosclerotic coronary artery disease in patients with human immunodeficiency virus infection. 1602 68

The use of highly antiretroviral therapy (HAART) significantly reduced morbidity and mortality by inhibition of virus replication. Even though long-term side effects are not fully known, this antiviral strategy has revolutionized the care of HIV-infected patients and is widely used in industrial countries. Until now, a variety of metabolic side effects, such as hyperlipidemia and insulin resistance, have been described. These metabolic alterations of antiretroviral therapy increase the cardiovascular risk profile of HIV-infected patients. It could be expected, that the increased cardiovascular risk profile in combination with long-term survival of this patient population, will increase the diagnostics and therapy of coronary diseases of HIVinfected patients in the next years. The present article (1) contains the case report of a 39-year-old HIV-infected male with an acute myocardial infarction, and (2) gives an overview about arteriosclerosis and coronary events in HIV-infected patients and the impact of antiretroviral therapy.
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PMID:[Coronary heart disease associated with the use of highly active antiretroviral therapy (HAART). A case report and review]. 1617 Jun 81

The present study was undertaken to determine accumulation of risk factors in acute myocardial infarction during two periods of 2002 and 1990-1991. We collected 173 and 153 patients with acute myocardial infarction in 2002 and 1990-1991, respectively, and analyzed the history of multiple risk factors, including diabetes mellitus, impaired glucose tolerance, hyperlipidemia, hypertension and obesity, and laboratory findings. The numbers and their percentages of all the risk factors increased in 2002 compared with 1990-1991. According to plasma glucose level, the patients who had type 2 diabetes mellitus, and impaired fasting glucose or impaired glucose tolerance had increased markedly from 41 to 65%. Multiple accumulation of risk factors had increased during the last one decade, and only one or no risk factor per se was not the case in the patients with acute myocardial infarction. Hyperlipidemia and hypertension became fairly controlled in the patients, but not hyperglycemia in type 2 diabetes mellitus in the period of 2002. These findings may indicate that increased multiple accumulation of risk factors accelerates the occurrence of acute myocardial infarction in 2002 as compared to 1990-1991.
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PMID:Alteration in risk factor accumulations of acute myocardial infarction during the last one decade: analysis of patients admitted in Coronary Care Unit. 1618 3

Utilization rates of aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and statins singly and as part of a multidrug regimen before hospitalization were measured in 109,540 patients with a history of coronary artery disease presenting with acute myocardial infarction to 1,283 hospitals participating in the National Registry of Myocardial Infarction-4. The profile of patients receiving none or only 1 of these therapies was compared with that of patients receiving any 3 or all 4 agents. Most patients (58%) with a history of coronary artery disease presenting with acute myocardial infarction were on none or only 1 of these effective medications at hospital admission. Only 21% of patients were on >or=3 of these therapies. Older age, female gender, and Medicare or no insurance coverage was significantly associated with previous receipt of <or=1 agent. Patients from New England or with a history of diabetes mellitus, hypertension, or hyperlipidemia were more likely to have received >or=3 of these therapies. In conclusion, data from this large national registry have indicated that most patients with a history of CAD were not receiving the recommended combination of cardiac medications before their AMI.
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PMID:Use of combination evidence-based medical therapy prior to acute myocardial infarction (from the National Registry of Myocardial Infarction-4). 1618 17

Many studies have demonstrated that, compared with men, women have increased long- and short-term mortality after acute myocardial infarction (AMI). The reasons for this mortality difference remain in dispute. We analyzed baseline characteristics, in-hospital management, and short-term outcomes of 1,246 men and 537 women with AMI to identify clinical variables that can predict the in-hospital mortality difference between genders. A higher in-hospital mortality was found in women with AMI than in men (11.9% vs 6.9%, p <0.001). Women were generally older, had a higher incidence of hypertension, diabetes mellitus, and hyperlipidemia, and had a higher Killip class of cardiac function compared with men. Reperfusion therapy and beta-receptor blockers were underused in women. Using a multivariate logistic regression model, we identified age, history of hypertension and diabetes mellitus, Killip class of cardiac function, and administration of reperfusion therapy and beta-receptor blockers as significant predictors of in-hospital mortality in patients with AMI, with odds ratios of 1.05 (95% confidence interval [CI] approximately 1.03 to 1.07), 1.65 (95% CI 1.12 to 2.41), 1.92 (95% CI 1.27 to 2.90), 3.62 (95% CI 2.88 to 4.56), 0.39 (95% CI 0.24 to 0.66), and 0.63 (95% CI 0.43 to 0.93), respectively. In conclusion, women with AMI had a higher in-hospital mortality rate than did men, probably due to older age, higher incidence of hypertension, diabetes mellitus, and hyperlipidemia, a higher Killip class of cardiac function, and less utilization of reperfusion therapy and beta-receptor blockers.
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PMID:Predictors of in-hospital mortality difference between male and female patients with acute myocardial infarction. 1702 59


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