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

The medical effects of modest weight reduction (approximately 10% or less) in patients with obesity-associated medical complications were reviewed. The National Library of Medicine MEDLINE database and the Derwent RINGDOC database were searched to identify English language studies that examined the effects of weight loss in obese patients with serious medical complications commonly associated with obesity (non-insulin dependent diabetes mellitus (NIDDM or type II), hypertension, hyperlipidemia, hypercholesterolemia, and cardiovascular disease). Studies in which patients experienced approximately 10% or less weight reduction were selected for review. Studies indicated that, for obese patients with NIDDM, hypertension or hyperlipidemia, modest weight reduction appeared to improve glycemic control, reduce blood pressure, and reduce cholesterol levels, respectively. Modest weight reduction also appeared to increase longevity in obese individuals. In conclusion, a large proportion of obese individuals with NIDDM, hypertension, and hyperlipidemia experienced positive health benefits with modest weight loss. For patients who are unable to attain and maintain substantial weight reduction, modest weight loss should be recommended; even a small amount of weight loss appears to benefit a substantial subset of obese patients.
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PMID:Beneficial health effects of modest weight loss. 132 66

Abdominal obesity is closely associated with risk factors for cardiocerebrovascular disease and NIDDM and the precipitation of these diseases. Together, they seem to constitute a metabolic syndrome where hyperinsulinaemia, insulin resistance, hyperlipidaemia, hypertension, visceral fat accumulation, cardiocerebrovascular disease and NIDDM are the individual constituents. The background to this syndrome might be a primary aberration expressing itself as an increased sensitivity of the hypothalamo-adrenal axis, and subsequent inhibition of sex steroid hormone secretions. This in turn will probably be followed by metabolic derangements, primarily peripheral insulin resistance, as well as by visceral fat accumulation by mechanisms which are partially visualized by recent work in the field. Visceral fat accumulation may then amplify the metabolic aberrations via hepatic effects of excessive concentrations of portal FFA, producing hyperproteinaemia, hyperglycaemia, hyperinsulinaemia and, perhaps, hypertension. The background to the central endocrine aberration remains more speculative, but factors leading to increased cortisol production, including specific stress reactions, tobacco smoking and alcohol may turn out to be important. The tentative conclusion provides a hypothesis for further work, and has recently obtained considerable support from further observations in humans in other than the endocrine and metabolic areas, as well as from studies in experimental animal models, where such factors can be studied under fully controlled conditions, which is not possible in humans for ethical reasons.
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PMID:Regional fat distribution--implications for type II diabetes. 133 83

Many lipoprotein abnormalities are seen in the untreated, hyperglycemic diabetic patient. The non-insulin-dependent diabetic (NIDDM) patient with mild fasting hyperglycemia commonly has mild hypertriglyceridemia due to overproduction of TG-rich lipoproteins in the liver, associated with decreased high-density lipoprotein (HDL) cholesterol levels. The more hyperglycemic untreated NIDDM and insulin-dependent diabetic (IDDM) patient have mild to moderate hypertriglyceridemia due to decreased adipose tissue and muscle lipoprotein lipase, (LPL) activity. These patients also have decreased HDL cholesterol levels associated with defective LPL catabolism of TG-rich lipoproteins. Treatment of diabetes with oral sulfonylureas or insulin corrects most of the hypertriglyceridemia and some of the decrease in HDL cholesterol. The abnormality in adipose tissue LPL activity corrects slowly over several months of therapy. The treated IDDM patient often has normal lipoprotein levels. The treated NIDDM patient may continue to have mild hypertriglyceridemia, increased intermediate-density lipoprotein levels, small dense low-density lipoproteins (LDL) with increased apoprotein B, and decreased HDL cholesterol levels. The central, abdominal distribution of adipose tissue in IDDM is associated with insulin resistance, hypertension, and the above lipoprotein abnormalities. Improvement in glucose control, in the absence of weight gain, leads to lower triglyceride and higher HDL cholesterol levels. In addition, the diabetic patient is prone to develop other defects that, in themselves, lead to hyperlipidemia, such as proteinuria, hypothyroidism, and hypertension, treated with thiazide diuretics and beta-adrenergic-blocking agents. When a diabetic patient independently inherits a common familial form of hypertriglyceridemia, he might develop the severe hypertriglyceridemia of the chylomicronemia syndrome.
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PMID:Pathophysiology of hyperlipidemia in diabetes mellitus. 171 Jul 39

About 50% of the individuals with a coronary risk show lipid levels within the normal range. Therefore, apolipoprotein profiles could be better risk indicators than TC or TG. Apolipoproteins generally discussed in this context are apo A1, apo B, and apo E. Their diagnostic validity, however, is ambigously evaluated. The individual iso-protein pattern of apo E is important for the differential diagnosis of the type III hyperlipidemia with its strong predisposition for premature atherosclerosis. Moreover, the extent of the apo E sialylation seems to be important because the modification of apo E by sialic acid alters its metabolism. Our date provide evidence that in IDDM and NIDDM the degree of apo E sialylation is increased. Concerning apo A1 and B we tried to find out parameters suitable for the prediction of the coronary risk both in the hyperlipidemic and the normolipidemic state. 64 male survivors of a myocardial infarc"ion and 60 matched controls were included in the study (group I). From group I a supopulation showing non-pathological values for TC and TG was selected (group II with 31 survivors and 44 controls). The diagnostic validity of the parameters apo A1, apo B, TC, HDL-C, apo A1/apo B, TC/apo B, HDL-C/apo B, TG, TG/apo A1, TG/HDL-C, TC-HDL-C/apo B determined by calculation of their sensitivities, specificities, efficiencies, and predictive values. Only the parameters TC/apo B, HDL-C/apo B, and apo B were suitable in the order given for detection of the coronary risk. Using the TC/apo B ratio 71-76% of the controls and 79% of the survivors could be exactly reclassified independent of the group they belonged to.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Apolipoproteins as risk indicators of ischemic heart disease. 258 87

The aim of the present work was to determine and analyse the nutritional status and plasma lipid levels in diabetic and control subjects dependent on the type of lipidemia. The investigations involved four groups: controls with normal lipidemia, diabetic (NIDDM) subjects with normal lipidemia, persons with hyperlipidemia type IV, and without diabetes mellitus, and diabetic subjects with hyperlipidemia type IV. The values for the concentrations of plasma triacylglycerol, cholesterol, phospholipids and HDL-phospholipids were significantly higher in both diabetic groups than in controls. The values for the relative amount and concentration of HDL-cholesterol were significantly lower in diabetics than in the control groups.
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PMID:Nutritional status and plasma lipids in diabetic subjects. 274 21

In 106 type II diabetics with persisting hyperlipidemia (i.e. persistently increased triglycerides greater than 200 mg/dl during intensive diabetes therapy) the Apo E polymorphism was examined in relation to IDDM (n = 68) and NIDDM (n = 38). It was shown that Apo E2 phenotypes are more (22.6% vs. 14.5%, p less than 0.05) and Apo E3 phenotypes less frequent in type II diabetics than in non-diabetic controls (86.8% vs. 94.7%, p less than 0.001). Looking at the increase in Apo E2 phenotypes it could be proved that the phenotype composition was distinctly different between diabetics with and in those without insulin therapy. While in NIDDM the increase was consequent to a higher concentration of Apo E2 homozygotes (p less than 0.005) it was caused by Apo E2 heterozygotes in IDDM (p less than 0.025) accompanied by a simultaneous decrease in Apo E3 homozygotes (p less than 0.025). Regarding blood lipids there was an increase in total cholesterol due only to VLDL cholesterol in IDDM as well as in NIDDM. It is concluded that in spite of similar hyperlipidemias in type II diabetics the increase in Apo E2 phenotypes is different; it is induced by heterozygotes in IDDM and by homozygotes in NIDDM.
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PMID:Apo E 2 phenotypes in type II diabetics with and without insulin therapy. 305 Feb 66

The awareness of hypertension as one of the major risk factors for mortality and morbidity in NIDDM has increased greatly in the past few years. It is now accepted practice to measure BP at least yearly in all such patients. Unfortunately, one cannot yet be sure to what extent diabetics benefit from anti-hypertensive therapy, and the simple assumption that treatment of the increased risk reduces that risk must be constantly questioned. No specific data are yet available for NIDDM, though it would be remarkable if the benefits of decreased cerebrovascular mortality and probable reduced total mortality (Sleight, 1987) did not apply to the higher-risk diabetic subject, at least at the higher levels of diastolic pressure (greater than 105 mm Hg). There is, though, no evidence that mortality or morbidity of coronary artery disease, the major killer in NIDDM, is reduced even in non-diabetics and the present author does not consider there to be any evidence suggesting that thresholds for treatment of hypertension in uncomplicated patients with NIDDM should be lower than those for non-diabetics, unless progressive nephropathy is present. Current advice in the non-diabetic is that levels of blood pressure in adults consistently above 95 mm Hg warrant therapy, aiming to reduce it below 90 mm Hg (World Health Organization, 1986). While the importance of hypertension should not be underestimated, it should not deflect attention from the other risk factors. Cessation of smoking, and by implication its reduction, will, for all smoking patients but the most hypertensive, produce a greater reduction in cardiovascular and total mortality risk than will anti-hypertensive therapy. There are also early signs that effective dietary and/or drug treatment of significant hyperlipidaemia lowers cardiovascular mortality. Choice of anti-hypertensive therapy is especially important, not only for efficacy but also for quality of life, in patients who already suffer major restrictions on diet, freedom and life expectancy. While controlled trials in the subject are of immense importance in determining optimum therapy, there is currently no evidence to favour any particular group of drugs, and an individual patient's therapy should be decided on the basis of their own circumstances.
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PMID:Hypertension. 307 98

The standard treatment of NIDDM consists of diet, oral hypoglycaemic agents and, mostly as a last resort, insulin. Indications for insulin therapy cannot be generalized for the whole population of NIDDM patients. The defined objectives of therapy for the individual patient will determine the choice and intensity of therapy. These will usually be either a relief of hyperglycaemic symptoms in the elderly patient or normoglycaemia, as in the insulin-dependent diabetic patients, in order to prevent acute and chronic complications. Primary insulin treatment is advisable in patients with hyperglycaemic symptoms and fasting blood glucose levels above 15 mmol/l, as in these patients the major defect will be insulin deficiency rather than insulin resistance. The correction of long lasting hyperglycaemia partly restores insulin sensitivity and B cell function, thereby allowing sequential reduction of insulin dosage. When metabolic control can be sustained with low insulin dosages some of these patients may later respond well to oral hypoglycaemic agents or to diet alone. In the management of non-insulin-dependent diabetic patients it is of great importance to recognize in time when treatment with oral hypoglycaemic agents fails. Insulin therapy should not be withheld on the presumption that it will cause weight gain and will promote development of macrovascular disease. Weight gain can be reduced by adequate dietary counselling and the level of macrovascular risk factors reduces with improved metabolic control. In this context also it should be realized that the correction of hypertension, hyperlipidaemia and the cessation of cigarette smoking is probably of equal importance. Insulin therapy regimens which have been used in non-insulin-dependent diabetic patients have been the same as prescribed for insulin dependent patients. When considering the fact that hepatic overproduction of glucose is the major determinant of fasting blood glucose level and that postprandial glycaemic excursions are superimposed on this level it seems reasonable to aim for normalization of the basal hepatic glucose production. A bedtime injection of an intermediate or long acting insulin can be used for this aim. Other therapeutical approaches which have been studied recently are the use of combinations of insulin and oral hypoglycaemic agents and the use of proinsulin as an alternative for intermediate acting insulin. Before these forms of therapy can be advocated long-term clinical studies are necessary to define their therapeutic role.
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PMID:Insulin treatment of non-insulin-dependent diabetes mellitus. 307 3

Platelet aggregate ratios (PAR) were determined, and threshold concentrations (ED50) of epinephrine, adenosine diphosphate (ADP), and collagen were estimated by platelet aggregometry in 88 IDDM and 52 NIDDM patients without hyperlipidaemia or azotaemia, and in 106 healthy volunteers to revise the question of hyperaggregability in diabetes. ED50-s showed a tendency for negative correlation with age, significant in female but not in male controls. Similar trends were obtained in IDDM and NIDDM females, but were not in IDDM and NIDDM males. The ED50-s of different aggregating agents positively correlated with each other. ED50-s were higher in men than in women in both controls and IDDM patients. Similar but minor differences were observed between women and men in NIDDM. IDDM patients had significantly lower PAR and collagen ED50, and a tendency for epinephrine and ADP to be lower as compared to the sex- and age-matched controls. The differences of PAR were the same, while those of ED50-s were diminished in older NIDDM patients compared to the matched controls. It is concluded, that the previously observed general hyperaggregability in diabetic patients may have partly resulted from sex- and age differences. Threshold concentrations should be compared to sex- and age-matched controls.
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PMID:Sex- and age-dependence of platelet aggregation in diabetes mellitus. 341 60

Mild to moderate hypertriglyceridemia is not associated with specific signs or symptoms in either IDDM or NIDDM. However, symptoms of the "chylomicronemia syndrome," including abdominal pain and acute pancreatitis, can occur when poorly controlled diabetes is present in a patient with a familial form of hyperlipidemia. The low-carbohydrate, high-fat diet that was commonly recommended for diabetics during past years may have contributed to the elevated plasma LDL levels in some individuals. Such "diabetic diets" may also have played a role in the predisposition of diabetics toward atherosclerotic complications.
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PMID:Hyperlipidemia: forestalling complications in older diabetics. 388 43


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