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

Allograft coronary artery disease is a major threat to long-term survival after cardiac transplantation. It has been suggested that hyperlipidemia plays a major role in allograft coronary disease. The objective of the present study was to evaluate the effect of a lipid-lowering intervention with diet and drug therapy after cardiac transplantation. Forty-six patients who underwent transplantation between 1988 and 1991 and who were treated with the American Heart Association phase 1 diet and an HMG coenzyme A reductase inhibitor (lovastatin or simvastatin) when low-density lipoprotein cholesterol levels were higher than 3.4 mmol/L were compared with 35 untreated patients having transplantation between 1983 and 1988. Annual coronary angiograms were obtained in both groups. Cholesterol, triglyceride, and low-density lipoprotein levels were significantly lower in the treated group. Actuarial survival and event-free survival (survival free from allograft coronary artery disease) were similar in both groups. Low-density lipoprotein levels lower than 3 mmol/L at the last follow-up had a positive effect on event-free survival. The cholesterol-lowering intervention was not effective in decreasing the prevalence of allograft coronary artery disease. This study suggests that more aggressive measures to lower low-density lipoprotein levels may be necessary to significantly affect allograft disease. Clinical trials should be developed to address this hypothesis.
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PMID:Cholesterol-lowering intervention and coronary artery disease after cardiac transplantation. 831 95

In Japanese, serum cholesterol levels have been increasing. This seems to be due to changes in life style, mainly the increase in dietary fat. Epidemiologic studies in the United States and Europe have shown that patients with hypercholesterolemia have a high risk of ischemic heart disease. Some guidelines for the management of hyperlipidemia have been developed in the United States, Europe, and Japan. The National Cholesterol Education Program (NECP) in the United States divides serum cholesterol level into three grades (desirable: below 200 mg/dl, borderline: between 200 mg/dl and 240 mg/dl, hypercholesterolemia: over 240 mg/dl). Borderline serum cholesterol is also a risk, especially in people complicated by other risk factor(s). As most borderline serum cholesterol seems to be due to polygenic hypercholesterolemia, an attempt to change the diet should be the first recommendation for treatment.
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PMID:[Borderline values of laboratory data in patients with hyperlipidemia]. 836 Oct 27

A hyperlipidemia clinic in which a pharmacist provides primary care is described. The clinic was established at a Veterans Affairs medical center in January 1990. A pharmacist performs limited physical assessments, refers patients to other clinics as necessary, orders laboratory and diagnostic tests, and selects and monitors the use of lipid-lowering medications. Interventions are performed according to the pharmacist's clinical judgment; there is no set protocol. Recommendations for patient management are approved by an attending physician, who prescribes the antilipemic drugs. The pharmacist teaches patients about hyperlipidemia, the impact of diet and life-style, and the mechanism of action, administration, and adverse effects of the antilipemics prescribed. The pharmacist also monitors compliance, laboratory test values, and the response to treatment. Treatment is modeled after the recommendations of the National Cholesterol Education Program. If a patient has not achieved the targeted cholesterol concentration after receiving dietary therapy for three months, further education about diet and lifestyle is provided. If, after three more months, the cholesterol level remains high, drug therapy is begun. Four antilipemic drugs--colestipol, gemfibrozil, lovastatin, and niacin--are used in the clinic. Since it began operating, the clinic has enrolled 284 patients. Compliance with the lipid-lowering agents has ranged from 43% to 100%. Adverse effects have accounted for the majority of cases of noncompliance. A pharmacist provides primary care for patients with hyperlipidemia in an ambulatory-care clinic.
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PMID:Pharmacist management of a hyperlipidemia clinic. 842 86

Prevention of coronary heart disease involves intervention at both the population and the individual level. These procedures are complementary. Opportunistic screening and management of hypercholesterolaemia in general practice is an efficient procedure. Calculations show that the cost of each quality adjusted year of life saved by such an opportunistic approach compares favourably with that of other approaches to coronary heart disease treatment as well as other coronary prevention programmes. Cost-effectiveness is greater in those with existing coronary heart disease but lower for the treatment of younger patients. This presentation considers the relative costs of drug treatment in relation to cholesterol reduction, but emphasizes that high density lipoprotein cholesterol and triglyceride levels must also be considered. Cholesterol management should form part of a multiple risk factor assessment with priority for those at high overall risk. Active dietary intervention should be offered to all patients, with drug treatment reserved for a small minority. The choice of drug treatment should depend on the required cholesterol reduction, the pattern of hyperlipidaemia and the cost of treatment.
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PMID:Cost-effectiveness of hypolipidaemic drugs. 849 54

This study was conducted to contribute to the improvement of occupational health surveillance. The subjects of the study were 461 young male workers born between April 1959 to March 1969, who worked at two plants in Tokyo, and who do not usually undergo examination of blood lipid levels at a routine health check-up program. The screening procedure was mainly based on the second report of the National Cholesterol Education Program Expert Panel (Adult Treatment Panel, ATP II). The proportion of the subjects with low HDL-cholesterol level (< 35 mg/dl) was 5.2% for workers in their late twenties (W20) and 8.4% for those in their early thirties (W30). For high LDL-cholesterol (130+ mg/dl), the proportion (underestimated due to non-fasting blood collection) was 7.2% for W20 and 13.5% for W30, and the difference was statistically significant (p < 0.05). Among subjects with low HDL, the proportion of subjects with total cholesterol (TC) being < 200 mg/dl was 94% (15/16) for W20 and 54% (7/13) for W30. This implies that it is difficult to detect subjects with low HDL from values for TC only especially among W20. Hence it is useful to examine HDL in combination with TC. Among subjects with TC being 200-239 mg/dl, the proportion (underestimated) of the subjects with high LDL was 40% for W20 and 26% for W30, and ATP II procedure would fail to incorporate most of them into a treatment program. Thus, accurate estimation of LDL is necessary for subjects with TC being 200+ mg/dl. Relationships of high HDL (60+ mg/dl) to exercise as well as low HDL to obesity (p < 0.05) were found among both age groups. The high prevalence of LDL and HDL abnormality found among the study subjects would imply that it is necessary to initiate evaluation of hyperlipidemia at younger ages and also ATP II procedure needs to be modified for proper surveillance.
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PMID:[Surveillance of hyperlipidemia among young adults in an occupational setting]. 852 41

A "before and after" intervention study, over a five year period, was done in order to find the degree of compliance to dietary recommendations and their effects on serum lipids in a hypercholesterolemic school-aged population. 383 children between 6 and 13 years of age, were identified with hypercholesterolemia (total serum levels above 4.8 mmol/l), in a previous randomized mass screening of 1095 individuals. Some dietary guidelines aimed at decreasing fat consumption and increasing fiber and carbohydrate ingestion were given to the families, and 226 of the children participated in the follow-up. Changes of address and/or school-center was the main cause of non-participation. The follow-up examination consisted in the evaluation of serum lipids and actual diet. Cholesterol serum levels decreased from a mean value of 5.4 mmol/l to 4.8 mmol/l. 59.3% of the sample had reached serum cholesterol levels below the risk threshold. Fat ingestion diminished significantly (40.3% of calories to 36.7%, p < 0.001), saturated fatty acids decreased from 15.3% of calories to 13.5% (p < 0.001), monounsaturated fatty acids decreased from 17.1% to 15.4% (p < 0.001) and polyunsaturated fatty acids remained unchanged. Carbohydrate consumption increased from 45% of the calories to 47.38% (p < 0.001). Dietary changes were greater in individuals out of risk than those who still had high cholesterol levels. These data indicate a good family compliance to the recommendations and that changes in food habits seem to be effective in controlling hyperlipidemia. Dietary changes are better accepted by younger children.
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PMID:Dietary intervention in a hypercholesterolemic school-aged population from Northern Spain. 877 86

The beneficial effect of cholesterol-lowering therapy for secondary prevention in patients with coronary artery disease (CAD) is well established. The therapeutic goal in this situation is a low-density lipoprotein (LDL) cholesterol level of 100 mg/dl. Cholesterol-lowering therapy will not only lead to a reduction in the progression of lesions but also and probably more importantly will reduce lesion activation and rupture and improve endothelial vasomotor function. Depending on the underlying hyperlipoproteinemia, the first choice for single drug therapy is a bile acid-binding resin or a hepatic hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitor in isolated LDL hypercholesterolemia, and nicotinic acid, a fibric acid, or a HMG-CoA reductase inhibitor in combined hyperlipidemia. Combination therapy usually consists of a bile acid-binding resin with either an HMG-CoA reductase inhibitor, a fibric acid, or nicotinic acid in LDL hypercholesterolemia and nicotinic acid with a fibric acid in combined hyperlipidemia.
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PMID:Drug therapy of severe hypercholesterolemia in patients with coronary artery disease. 886 Jul 8

A 22-year-old female with diffuse mixed T cell lymphoma in second complete remission underwent allogeneic BMT from her HLA-compatible brother. Transplantation was complicated by acute graft-versus-host disease (GVHD), cytomegalovirus (CMV) infection, and combined hepatotoxic/cholestatic liver disease 45 days post-BMT. Cholesterol levels reached 65 mmol/l, and high density lipoprotein (HDL) cholesterol decreased to 0.23 mmol/l. She developed skin xanthelasmas, lipemia retinalis, and a solitary lung lesion, which was clinically diagnosed as pulmonary cholesteroloma. All these complications resolved following plasmapheresis and hypolipidemic treatment with lovastatin and cholesterol levels normalized.
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PMID:Solitary pulmonary cholesteroloma, multiple xanthelasmas and lipemia retinalis complicating hypercholesterolemia after bone marrow transplantation. 886 64

More than $100 billion is spent in the United States each year on cardiovascular disease, primarily for hospitalizations and revascularization procedures. This is more than for any other disease state. As the clinical practice of medicine shifts from the paradigm of private practice to the managed care environment, cost-effectiveness is becoming increasingly important. A primary measure in analyzing cost-effectiveness is the cost-effectiveness ratio, or the dollar cost per unit of improvement for a given expenditure. This measure allows healthcare planners to compare completely different interventions. With approximately 52 million adult U.S. citizens having elevated low-density lipoprotein (LDL) cholesterol levels, lipid-lowering therapy---with diet or 3-hydroxy-3methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors---is an important consideration for primary care physicians and managed care providers. The National Health and Nutrition Examination Survey (NHANES) III indicates that 75-88% of adults who have coronary artery disease (CAD) risk factors or CAD require only a moderate (20--30%) reduction in LDL cholesterol levels to reach National Cholesterol Education Program goals. The clinical literature shows that all 4 of the currently available HMG-CoA reductase inhibitors can provide appropriate, moderate LDL cholesterol reductions within their recommended dosage ranges. For the majority of patients who need a 20--30% reduction in LDL cholesterol, fluvastatin 20 or 40 mg once daily provides the most cost-effective HMG-CoA therapy, expressed as cost of therapy per 1% LDL cholesterol reduction. For patients who need a >30% LDL cholesterol reduction, a high-dose HMG-CoA reductase inhibitor (e.g., simvastatin 20 or 40 mg/day) or a combination of a lower-dose HMG-CoA reductase inhibitor and a bile acid resin is the preferred initial therapy. Although a true cost-effectiveness analysis would incorporate morbidity and mortality data from clinical trials, analysis using intermediate endpoints, such as LDL cholesterol reduction, suggests that fluvastatin is the preferred initial HMG-CoA reductase inhibitor for the treatment of moderate hyperlipidemia.
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PMID:Cost-effectiveness of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor therapy in the managed care era. 887 73

This study was designed to determine the frequency of hyperlipidemia after orthotopic liver transplantation and whether treatment with a hydroxy-methylglutaryl coenzyme A reductase inhibitor was safe and efficacious. Cholesterol levels were assessed in 45 consecutive adult liver transplants (mean +/- SE). Four of 22 patients on cyclosporine (CsA) (18%) and three of 23 patients on FK506 (13%) had levels >225 mg/dl at 12 months (cholesterol levels for patients on CsA [total n=22]: pre-Tx = 140+/-11, 1 month = 183+/-36,3 months = 221+/-12, 6 months = 211+/-11, 12 months = 202+/-14 [P<0.01 vs. pre-Tx]; FK506 [total n=23]: Pre-Tx = 151+/-13, 1 month = 187+/-22, 3 months = 188+/-10, 6 months = 184+/-13, 12 months = 164+/-9 [P=0.02 vs. CsA]). A separate cohort of patients with stable graft function, cholesterol >225 mg/dl, and two additional risk factors for coronary artery disease were started on pravastatin. Ninety-eight patients were enrolled. Sixteen patients (16%) discontinued the drug because of subjective complaints. No episodes of rhabdomyolysis or hepatotoxicity occurred (cholesterol levels for patients on CsA [total n=65]: pretreatment = 251+/-7, 6 months = 220+/-7 [P=0.01 vs. pretreatment], 12 months = 224+/-8 [P=0.01 vs. pretreatment]; FK506 [total n=17]: pretreatment = 251+/-17, 6 months = 219+/-17, 12 months = 208+/-17 [P=0.08 vs. pretreatment]). Natural killer cells isolated from normal volunteers (n=14) exhibited 27+/-9% specific lysis. Patients on FK506 or cyclosporine-based immunosuppression alone (n=11) exhibited 20+/-4% specific lysis. Standard immunosuppression plus pravastatin (n=10) decreased lysis to 0.2+/-10% (P<0.02 vs. controls and standard immunosuppression). We conclude: (1) posttransplant hyperlipidemia occurs less frequently in liver transplant patients than in renal or cardiac transplants; (2) pravastatin is safe and efficacious for cholesterol reduction in liver transplant patients; and (3) pravastatin coadministered with standard immunosuppression reduces natural killer cell-specific lysis in these recipients.
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PMID:Hyperlipidemia after liver transplantation: natural history and treatment with the hydroxy-methylglutaryl-coenzyme A reductase inhibitor pravastatin. 887 87


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