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

The insulin resistance syndrome, a cluster of potent risk factors for atherosclerotic cardiovascular disease and type 2 diabetes in adults, is composed of hyerinsulinemia, obesity, hypertension and hyperlipidemia. In addition, left ventricular hypertrophy and its precursor increased left ventricular mass, is known to be a powerful predictor of adverse cardiovascular events, both as an independent risk factor and by association with the insulin resistance syndrome. Obesity appears to have a major role in the relations between the components of the insulin resistance syndrome, and their association with increased heart mass. Of significant impact in the adult population, atherosclerotic cardiovascular disease and death are rarely seen in the young, but the pathologic processes and risk factors associated with its development have been shown to begin during childhood. Recent studies revealed the presence of components of the insulin resistance syndrome also in children and adolescents, however, their associations are not well understood. A direct link between obesity and insulin resistance has also been reported in the young, as has the link between insulin resistance and abnormal lipid profile. There is an increasing amount of data to show that being overweight during childhood and adolescence is significantly associated with insulin resistance, abnormal lipids and elevated blood pressure in young adulthood. Weight loss in these situations results in a decrease in insulin concentration and an increase in insulin sensitivity toward normalcy. Moreover, it has been determined that increased left ventricular mass is present in childhood, and is related to other risk factors, namely obesity and insulin resistance. Based on current knowledge, it is reasonable to suggest that weight control, and lifestyle modification, could alter the incidence of the syndrome of insulin resistance, and improve the risk profiles for cardiovascular disease as children make the transition toward adolescence and young adulthood.
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PMID:Insulin resistance and cardiovascular risk in the pediatric patient. 1122 44

Aim of the study was to investigate attitudes and practice of coronary prevention in offices of general practitioners and internists. 67 Austrian physicians took part in a mail survey focussing on hyperlipidemia. 96.6% of participating physicians recommend dietary intervention at least at total cholesterol levels of 250 mg/dl, 98.0% prescribe lipid-lowering drugs at least at total cholesterol levels of 300 mg/dl. At corresponding levels of total/HDL cholesterol ratios and especially at corresponding levels of LDL-cholesterol the proportion was lower. On average 37.9% of physicians spend up to 5 minutes for patients with hyperlipidemia, 10.3% spend more than 15 minutes. The time frame is similar in overweight patients, and bigger in patients with hypertension and diabetes. Dietary therapy is estimated similarly successful in patients with hyperlipidemia and overweight, but estimated more successful in patients with hypertension and diabetes. Drug therapy of hyperlipidemia is estimated more successful than in overweight and diabetes, and worse compared with hypertension. Main measures for improving prevention are more time and specific postgraduate education. The majority of physicians feel that within the last five years quality has improved both in the outpatient and the inpatient care.
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PMID:[Treatment of coronary risk factors by general practitioners in Austria]. 1125 24

This article reviews the pharmacological and clinical aspects of glimepiride, the latest second-generation sulfonylurea for treatment of Type 2 diabetes mellitus (DM). Glimepiride therapy ameliorates the relative insulin secretory deficit found in most patients with Type 2 DM. It is a direct insulin secretagogue; indirectly, it also increases insulin secretion in response to fuels such as glucose. Its action to augment insulin secretion requires binding to a high affinity sulfonylurea receptor, which results in closure of ATP-sensitive potassium channels in the beta-cells of the pancreas. The question has been raised whether insulin secretagogues by acting on vascular or myocardial potassium channels may prevent ischaemic preconditioning, a physiological adaptation that could affect the outcome of coronary heart disease, but there is evidence against this concern being applicable to glimepiride. Glimepiride's antihyperglycaemic efficacy is equal to other secretagogues. It has pharmacokinetic properties that make it less prone to cause hypoglycaemia in renal dysfunction than some other insulin secretagogues, particularly glyburide (also known as glibenclamide in Europe). Its convenient once daily dosing may enhance compliance for diabetic patients who often also require medications for other co-morbid conditions, such as hypertension, hyperlipidaemia and cardiac disease. Glimepiride is approved for monotherapy, for combination with metformin and with insulin. Clinically, its reduced risk of hypoglycaemia makes it preferable to some other insulin secretagogues when attempting to achieve recommended glycaemic control (haemoglobin A(1c) (HgbA(1c)) 7%). Using suppertime neutral protamine Hagedorn (NPH) and regular insulin with morning glimepiride in overweight diabetic patients achieves glycaemic goals more quickly than insulin alone and with lower insulin doses.
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PMID:Clinical review of glimepiride. 1133 17

This study examined the effect a polymorphism (L162V) in the gene for peroxisome proliferator activated receptor (PPAR) alpha in the development of non-insulin-dependent diabetes mellitus (type 2 DM), obesity and hyperlipidaemia. The frequency of the L162V polymorphism in the PPARalpha gene was determined in 370 morbidly obese patients who underwent gastric banding surgery, 154 patients attending a type 2 DM clinic, 188 patients attending a lipid clinic and 199 healthy blood donors. The overall frequency of the V allele of the L162V polymorphism was 0.06. There were no significant differences in the allele frequency between patients with morbid obesity, hyperlipidaemia, type 2 DM and healthy controls, suggesting that it does not play a major role in the development of these conditions. The polymorphism was associated with a lower body mass index (BMI) in two independently recruited groups of patients with type 2 DM. There was no effect of the polymorphism on subjects without type 2 DM. Thus a polymorphism in PPARalpha protects type 2 DM patients from the overweight which is frequently associated with their condition.
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PMID:A polymorphism, L162V, in the peroxisome proliferator-activated receptor alpha (PPARalpha) gene is associated with lower body mass index in patients with non-insulin-dependent diabetes mellitus. 1140 11

The socio-economic impact of obesity, one of the most prevalent medical disorders in Western society, is mainly due to its association with a higher risk of coronary heart disease. It is likely that atherosclerosis develops against a background of obesity as a result of the insulin resistance that is invariably present in overweight and obese subjects. Fasting plasma lipids may be normal in obese subjects, but they are usually affected by postprandial hyperlipidemia, which is probably due to competition between chylomicrons and VLDL for the same metabolic pathways. The basis for the impaired clearance of atherogenic chylomicron remnants is the fact that obesity causes hepatic apo B-VLDL overproduction, and thus leads to competition with chylomicrons and their remnants at the lipolytic pathway (lipoprotein lipase and hepatic lipase) and receptor level (LDL-receptor and remnant-receptor). The overproduction of VLDL is probably caused by an enhanced hepatic flux of free fatty acids in both the postprandial (from the lipolysis of triglyceride rich particles) and postabsorptive states (from adipocytes). Weight reduction by means of life-style changes, supported by medical interventions with inhibitors of intestinal fat absorption (e.g. Orlistat) or appetite suppressants (e.g. Sibutramine), is essential in order to decrease the risk of atherosclerosis. Furthermore, improvement of risk factors can be achieved by means of fibrate treatment to modulate fasting and postprandial triglyceride levels. Treatment with cholesterol synthesis inhibitors ("statins") may reduce hepatic VLDL production and increase the clearance of atherogenic remnants by upregulating LDL-receptors, thus leading to improved fasting lipid levels and enhanced clearance of chylomicron remnants. Finally, the use of thiazolidinedione derivatives to improve insulin sensitivity may be one of the options for reducing the risk of atherosclerosis in obese subjects.
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PMID:Obesity and free fatty acids: double trouble. 1143 90

Selected cardiovascular risk factors were examined in 272 active pilots of supersonic aircraft in Poland. Hypercholesterolemia was present in 72.4% and hypertriglyceridemia in 17.1% of the pilots. Decreased levels of HDL-cholesterol and increased levels of LDL-cholesterol were found in 86.9% and 69.9% of pilots, respectively. Slightly over half (52.2%) were found to be mildly overweight while 6.6% were obese. The prevalence of smoking was 25.4%. Risk factor modification included non-pharmacological treatment of hyperlipidemia supported by lipid-lowering drugs, depending on the serum lipid level. A significant improvement in lipid profiles was obtained with this strategy, at least over 3 to 6 mo of follow up. The challenge is to develop strategies that will result in maintained improvements.
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PMID:Cardiovascular risk factors in supersonic pilots in Poland. 1143 19

Patients with chronic uremia have a substantially elevated risk of death from cardiovascular disease than do the general population. Although uremic and nonuremic groups share some of the risk factors for cardiovascular mortality, such as older age, diabetes, and inflammation, other factors appear to affect cardiovascular mortality in the opposite direction. For example, being overweight and having hyperlipidemia are established risk factors in the general population, whereas lower body mass index and lower plasma cholesterol have been shown to be risk factors for cardiovascular mortality in end-stage renal disease (ESRD). This paradoxical phenomenon is explained by two facts: (1) that malnutrition is a strong predictor of cardiovascular mortality in ESRD and (2) that plasma lipid levels are lowered in malnutrition. However, it is not known whether atherosclerosis is promoted by malnutrition or by low cholesterol level. Because the cardiovascular mortality rate is theoretically the product of event rate and fatality rate after an event, risk factors for cardiovascular mortality could fall into two categories: those raising the event rate and those affecting the fatality rate. Some factors could work both ways. Patients with ESRD show a significant increase in both event rate and fatality rate. Dyslipidemia is an independent factor affecting atherosclerotic arterial wall changes and cardiovascular events in ESRD. Other factors affecting the cardiovascular event rate in ESRD include diabetes and an elevated homocysteine level. In contrast, factors associated with poor survival after an event include diabetes and anemia. Malnutrition could be a factor causing the fatality rate to rise, although there is no direct evidence supporting this possibility. Further studies are needed to show the differential effects of a risk factor on event rate and fatality rate. Patients with ESRD would have a better chance of living longer by better management of the two categories of risk factors.
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PMID:Paradox of risk factors for cardiovascular mortality in uremia: is a higher cholesterol level better for atherosclerosis in uremia? 1157 13

Obesity is a rapidly increasing health problem in all developed countries. Overweight rarely occurs in isolation but as part of a complex pattern of metabolic abnormalities ("metabolic syndrome" or "syndrome X") consisting of hyperlipidemia, hypoalphalipoproteinemia, type II diabetes and atherosclerosis. The disorder is considerably influenced by genetic, behavioural and nutritional factors. Recent data indicate that a group of closely related nuclear receptors, the peroxisome proliferator-activated receptors (PPARs), may be involved in the metabolic changes ultimately leading to obesity. This review summarises the latest developments in the PPAR field, with particular emphasis being placed on the physiological function of PPAR alpha during various nutritional states, and the possible role of PPAR alpha in obesity.
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PMID:The role of PPAR alpha in obesity. 1159 Sep 95

As more is learned about the natural history of the development of atherosclerosis, it is clear that the process that results in morbidity and mortality in adults has its origins in childhood and adolescence. It is also clear that the traditional risk factors, such as hypertension and dyslipidemia, are important in the early stages of the process. It appears that the prevalence and severity of obesity are increasing in children and adolescents in the United States. This trend is associated with increasing blood pressure and the occurrence of type 2 diabetes mellitus in young individuals. These trends may result in increased cardiovascular morbidity and mortality as these overweight pediatric patients become obese adults. Intervention and prevention strategies should be directed at the pediatric population as a whole, as well as at higher-risk individuals. For the latter, it will be necessary to identify those at highest risk. Both nonpharmacologic and pharmacologic approaches may be necessary for treatment of pediatric patients with hyperlipidemia and hypertension. Studies are needed that evaluate the longer-term impact of intervention on cardiovascular risk factors in young patients.
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PMID:Cardiovascular disease risk factors and atherosclerosis in children and adolescents. 1160 68

1. As long-term survival improves after liver transplantation, cardiovascular complications are emerging as a major cause of late morbidity and mortality. It seems reasonable to correct the potentially reversible cardiovascular risk factors of diabetes, hyperlipidemia, and obesity, in addition to hypertension. 2. The results of liver transplantation in diabetics are acceptable in terms of morbidity, mortality, and prevalence of posttransplant diabetes, but the poor outcomes described in some series suggest that more extensive testing for macro- and microvascular disease may become necessary. 3. The management of diabetes in liver transplant recipients is not substantially different from its management in non-transplant patients, except that steroid reduction or withdrawal and minimizing doses of calcineurin inhibitors are beneficial. 4. Hyperlipidemia occurs in all solid-organ transplantation, with prevalence rates the lowest for liver transplant recipients. Following liver transplantation, between 15% and 40% of recipients on average have increased plasma cholesterol levels and about 40% have hypertriglyceridemia. Dietary changes, weight reduction, exercise and statins are the mainstays of therapy. 5. Retrospective studies suggest that long-term survival of obese recipients after liver transplantation does not differ from nonobese recipients. Posttransplant weight gain occurs in most recipients, and approximately two thirds become overweight. The management of posttransplant obesity is similar to that in non-transplant settings.
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PMID:Long-term management of the liver transplant patient: diabetes, hyperlipidemia, and obesity. 1168 72


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