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

Despite the importance of hyperlipidemia as an independent coronary risk factor and the positive results of recent lipid intervention trials to prevent coronary disease, there remain many unanswered questions regarding the benefits and risks of treating hyperlipidemia. Critical review of epidemiologic studies and clinical trials suggest that the benefits of cholesterol reduction may vary depending on the patient's age, sex, and the presence of other coronary risk factors. Furthermore, one must recognize that there is a small but consistent increase in noncoronary deaths among patients receiving cholesterol-lowering medications that remains unexplained but requires further evaluation. These data underscore the importance of weighing both the risks and benefits of modifying serum lipids. Accordingly, careful evaluation of the underlying risk of developing coronary disease and the potential long-term benefits of intervention are necessary to identify appropriate high-risk patients for treatment among whom the predicted benefits will outweigh the risks.
Cardiovasc Drugs Ther 1993 Nov
PMID:Modifying serum lipids to prevent coronary heart disease: do we have a consensus? 811 Jun 17

Amaurosis fugax has frequently been related to carotid artery disease. In order to determine the relationship between amaurosis fugax and significant carotid artery stenosis, we prospectively studied 81 consecutive patients presenting to an ophthalmologist with this symptom. Neurologic and vascular evaluation with PPG and Duplex-scan were performed. A stenosis of greater than 70% was regarded as significant. DSA was performed in patients with significant stenosis (55 of 81). The presence of risk factors such as hypertension, diabetes, coronary artery disease, tobacco and hyperlipidemia was considered. Mean age was 64.96 years. There was a high prevalence of hypertension, smoking and previous CVA/TIAs. Patients with significant carotid stenosis were endarterectomized. Carotid atheromata plaques were classified in three groups: hemorrhagic plaque (5), dystrophic calcification (8) and ulcerated plaque (42). There was a high correlation (0.87) between ulcerated plaque and amaurosis fugax. We conclude that amaurosis fugax is an important symptom to allocate patients with high risk of carotid disease, specially carotid stenosis complicated with ulcerated plaque. Carotid duplex scan must be done if this symptom is present.
J Cardiovasc Surg (Torino) 1994 Feb
PMID:Amaurosis fugax as a symptom of carotid artery stenosis. Its relationship with ulcerated plaque. 812 72

As the survival rates for cardiac transplant patients improve, the long-term complications of the procedure are becoming apparent. One such complication is a rapidly progressing form of coronary artery disease known as cardiac allograft vasculopathy (CAV). CAV is a major limiting factor in long-term graft survival. It is thought to develop immediately after transplantation, although initially it may be unrecognized because of a lack of sensitive screening techniques. It is estimated that 12% of cardiac transplant recipients will develop CAV each year after transplantation. Most researchers agree that CAV is primarily an immune-related response to transplantation. However, other factors such as hyperlipidemia and obesity have also been implicated as predictors of CAV. This article explores the pathophysiology, risk factors, detection, and treatment of CAV in the cardiac transplant population.
J Cardiovasc Nurs 1994 Apr
PMID:Cardiac allograft vasculopathy. 820 61

Use of the internal thoracic artery for myocardial revascularization has regained general acceptance because it offers better long-term results than do venous conduits. The aim of this study was to ascertain the prevalence of atherosclerosis in the internal thoracic artery and to correlate the prevalence with other known risk factors. A total of 117 patients (male/female ratio 84:33; mean age 56.8 years) were investigated. Sixty-eight patients had coronary artery disease, 25 had combined coronary artery and valvular heart disease, 14 had acquired valvular heart disease, and 10 had other types of heart disease. All but one patient underwent bilateral semiselective internal thoracic arteriography. Evidence of atherosclerotic change was present in 6.6% of the opacified vessels in 11.1% of the investigated individuals. Although all patients with atherosclerotic lesions in the internal thoracic artery had coronary artery disease, no correlation could be found between coronary artery disease and internal thoracic atherosclerosis. Peripheral vascular disease and hyperlipidemia could be identified as predictors of atherosclerotic changes in the internal thoracic artery. Atherosclerosis is somewhat more prevalent in the internal thoracic artery in this study than in the literature. Although the internal thoracic artery is a protected vessel, there is a certain extent of atherosclerosis, that correlates with known risk factors. Our observations should not preclude use of the internal thoracic artery, but they should be considered for patients who are at risk for atherosclerotic changes of the internal thoracic artery.
J Thorac Cardiovasc Surg 1993 Dec
PMID:Internal thoracic artery: prevalence of atherosclerotic changes. 824 59

A surgical experience between October 1983 and December 1990, with 1467 consecutive patients 65 years of age and over, was used to compare patients receiving single internal mammary artery grafts (n = 736) with those receiving bilateral internal mammary artery grafts (n = 731). The mean age in the single-graft group was 73.2 years and 70.9 years in the bilateral-graft group (p < 0.001). Various clinical parameters were analyzed that revealed that the single-graft group had more women and more patients with unstable angina, a history of previous myocardial infarction, and emergency surgery (p < 0.05). There was no significant difference in cigarette smoking, hypertension, diabetes mellitus, hyperlipidemia, triple vessel coronary artery disease, left main coronary artery stenosis, or left ventricular function between the two groups. Hospital mortality for the single-graft group was 6.4% (47 patients) and 3.1% (23 patients) for the bilateral-graft group (p < 0.004). No significant difference was observed between the groups in the rate of reoperation for bleeding, sternal infection, respiratory failure, stroke, or perioperative infarction. Follow-up was obtained in 663 hospital survivors (96.4%) in the single-graft group and in 691 (97.7%) in the bilateral-graft group. Mean follow-up in the single-graft group was 42.5 months (range, 1 to 92.4 months) and 43.0 months (range, 1 to 90.3 months) in the bilateral-graft group. In the single-graft group, survival was 60.7% +/- 4.8% (+/- standard error of the mean) at 8 years (60 patients at risk); it was 67.9% +/- 8.1% (18 patients at risk) for the bilateral-graft group (p < 0.028). This comparative study demonstrates that bilateral internal mammary artery grafting can be accomplished in elderly patients with low operative risk and hospital morbidity. Moreover, patients in both groups had a reduction in cardiac events and significant functional improvement.
J Thorac Cardiovasc Surg 1993 Jul
PMID:Coronary bypass grafting in the elderly. Single versus bilateral internal mammary artery grafts. 832 Sep 91

Thiazide diuretics have been the mainstay of antihypertensive therapy for over 30 years. Their precise mechanism of antihypertensive action is still incompletely understood. They reduce arterial pressure initially through a fall in plasma volume and cardiac output. However, with chronic administration cardiac output tends to return toward pretreatment levels, suggesting that the long-term pressure reduction is mediated through a reduction in vascular resistance. Although multiple lines of evidence suggest that salt and water loss is an essential part of the mechanism, at least in some cases an indirect vasodilator effect may play a role as well. The antihypertensive efficacy of diuretics is proven; they are at least as effective as other classes of antihypertensive drugs. They have been shown to protect against stroke, but not against mortality from myocardial infarction. There is some concern about the metabolic side effects, such as hypokalemia, hyperglycemia, and hyperlipidemia. In order to minimize these side effects the lowest effective dose should be used. Diuretics are likely to remain first-line antihypertensive agents, but they should be considered as one of several possible choices for the initial therapy among other classes, such as beta-blockers, ACE inhibitors, or calcium entry blockers.
Cardiovasc Drugs Ther 1993 Jan
PMID:The place of diuretics in the treatment of hypertension: a historical review of classical experience over 30 years. 843 77

Postprandial hyperlipidaemia is a risk factor for atherosclerosis in multiple vascular beds, independently of high-density lipoprotein (HDL) cholesterol. An increased level of HDL cholesterol is a strong indicator of a low risk of atherosclerosis. Exercise decreases postprandial lipaemia and, in turn, increases levels of HDL cholesterol. The favourable effects of exercise on lipoprotein metabolism, particularly evident in the postprandial state, may thus help to decrease susceptibility to atherosclerosis in exercise-trained people.
J Cardiovasc Risk 1995 Aug
PMID:Exercise and postprandial lipaemia. 853 49

The effects of BQ-485, a selective endothelin (ET)-A receptor antagonist, on the vasomotion induced by a low dose of ET were investigated. In the isolated rat heart perfused with Krebs-Henseleit solution at a constant flow, intracoronary bolus injection of ET-1 or ET-3 (10 pmol) elicited a rapid transient decrease, followed by a slight sustained increase, in the coronary perfusion pressure (CPP). The decrease in CPP induced by ET-1 was similar in magnitude to (approximately 30%) but shorter in duration than that induced by ET-3. Pretreatment of the heart with saponin (30 micrograms/ml) to denude the coronary endothelium abolished the decrease and markedly enhanced the increase in CPP induced by ETs, indicating that the vasorelaxing action of ETs is endothelium-dependent. The selective ETA receptor antagonist BQ-485 (1 microM) significantly prolonged the duration of the ET-1-induced decrease in CPP, made the vasodilatation by ET-1 indistinguishable from that by ET-3, and eliminated the subsequent increase in CPP. In the saponin-treated heart, BQ-485 also eliminated the ET-1-mediated increase in CPP. These findings suggest that, in rat coronary vascular beds, a low dose of ET-1 elicits vasoconstriction and endothelium-dependent vasodilatation through the ETA receptor on the vascular smooth muscle and presumably the ETB receptor on the endothelium, respectively. Furthermore, it is expected that selective ETA receptor antagonists, including BQ-485, may be able to protect the heart against ET-1-induced coronary spasm in situations, such as hyperlipidemia or artherosclerosis, in which the release and/or function of endothelium-derived vasorelaxing substances is impaired.
J Cardiovasc Pharmacol 1995
PMID:Effects of BQ-485, a selective ETA antagonist, on endothelin-mediated vasomotion in rat coronary vascular beds. 858 27

The mechanism by which women in the reproductive age group are protected from developing coronary heart disease (CHD) as compared with men of similar age is not known. To elucidate whether there is a gender difference in the rate of atherosclerosis formation, we investigated the rate of development of atherosclerosis in both male and female rabbits fed an identical diet consisting of 2% cholesterol for 10 and 15 weeks. The extent of atherosclerosis was correlated with the amount of basal and stimulated release of nitric oxide (NO) from endothelium-intact aortic rings obtained from these animals. Under identical dietary conditions, the female rabbits fed a high cholesterol diet (HCD) for 10 weeks developed very little atherosclerosis (10% surface involvement) as compared with male rabbits (42% surface involvement). However, no significant gender differences in atherosclerosis were observed after 15 weeks of the HCD. The serum cholesterol, high and low density lipoprotein (HDL and LDL) cholesterol were similar in animals fed the HCD for 10 and 15 weeks. The basal release of NO from endothelium-intact aortic rings was significantly greater in control females as compared with males. The magnitude of endothelium-dependent relaxation of aortic rings obtained from both male and female rabbits fed the HCD were impaired to a similar extent, and this impairment correlated with the duration of hyperlipidemia but not with the extent of atherosclerosis. The arginine content of aortic rings were not different between males (257 +/- 52 nmol/g wet weight) and females (345 +/- 62 nmol/g wet weight) or between control and hyperlipidemic groups (males 312 +/- 69; females 301 +/- 65 nmol/g wet weight). Although the precise mechanism for the slower rate of development of atherosclerosis in the female rabbits as compared with males is not clear, the greater basal release of NO in females before they were fed a hyperlipidemic diet, as well as other factors, may be involved. The impairment of endothelium-dependent relaxation in hyperlipidemic animals is not due to a decrease in the availability of arginine, the substrate for NO.
J Cardiovasc Pharmacol 1995 Nov
PMID:Gender differences in atherosclerosis: possible role of nitric oxide. 863 95

Sympathetic nervous system activation has been documented in several cardiovascular disorders. In some, characterized by cardiac failure and portal hypertension accompanying hepatic cirrhosis, the sympathetic nervous stimulation is reflex and, to some extent, compensatory but has adverse consequences. For example, in cardiac failure, the sympathetic nerves of the heart are preferentially stimulated, providing adrenergic support to the failing myocardium but at the probable cost of arrhythmogenesis and progressive myocardial deterioration. The sympathetic activation present in patients with essential hypertension, which involves the sympathetic outflows to skeletal muscle, heart, and kidneys and is seen particularly in younger patients, differs from these examples in that the sympathetic nervous stimulation is apparently not reflex and the primary cause is unknown. There is, however, evidence that activation of forebrain pressor noradrenergic nuclei may be of importance as an underlying central nervous system mechanism. This sympathetic nervous stimulation in patients with essential hypertension, in addition to initiating the blood pressure elevation, may also contribute to the commonly associated metabolic abnormalities of insulin resistance and hyperlipidemia, with neural vasoconstriction having metabolic consequences, impairing glucose delivery and causing insulin resistance in muscle, and retarding postprandial clearing of lipids in liver. Trophic effects of sympathetic activation on cardiovascular growth are claimed but have yet to be demonstrated conclusively in humans.
J Cardiovasc Pharmacol 1995
PMID:Sympathetic nervous system: contribution to human hypertension and related cardiovascular diseases. 864 1


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