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

Patients with diabetes mellitus have a 2- to 4-fold increased risk of atherosclerotic cardiovascular, peripheral vascular, and cerebrovascular disease, which are the leading causes of morbidity and mortality in this population. Several epidemiological studies have shown an association between diabetic dyslipidemia, which is characterized by hypertriglyceridemia, low levels of high density lipoprotein-cholesterol, postprandial lipemia and small, dense low density lipoprotein-cholesterol (LDL-C) particles, and the occurrence of cardiovascular disease. Other studies have established the beneficial effects of lipid lowering on the reduction of major coronary events in diabetic patients. The recent National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines emphasize diabetes as a coronary heart disease risk equivalent. The NCEP ATP III states that elevated LDL-C is a major risk factor for coronary heart disease, and the primary goal of risk-reduction therapy is the reduction of LDL-C levels to 100 mg/dL. This article defines and describes diabetic dyslipidemia and its etiology and pathogenesis, as well as reviewing guidelines and recommendations for treatment of this disorder. Treatment of diabetic dyslipidemia includes 1) lifestyle modifications: physical activity and a diet low in saturated fats and cholesterol and high in complex carbohydrates and fiber; and 2) pharmacological treatment with (i) oral antihyperglycemic agents: metformin and thiazolidinediones; (ii) weight reduction drugs: orlistat and sibutramine and; (iii) lipid-lowering drugs: HMG-CoA reductase inhibitors, fibric acid derivatives, nicotinic acid, and bile acid sequestrants.
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PMID:Pathogenesis and management of diabetic dyslipidemia. 1596 59

Several potent drugs are currently available for the treatment of hyperlipidemia. These pharmacotherapies include bile acid sequestrants, HMG-CoA reductase inhibitors (commonly referred to as 'statins'), fibrates and nicotinic acid. Combination therapy to reduce plasma cholesterol levels in hyperlipidemic patients is becoming more popular, as concerns about toxicity resulting from the long-term used of systemically acting drugs are raised. One of the more widespread combinations used to reduce plasma cholesterol levels is that of a bile acid sequestrant and a statin. Combinations of bile acid sequestrants with either niacin or fibrates have been found to be very effective in patients with mixed hyperlipidemia, since the triglyceride-lowering effect of niacin or a fibrate complements the cholesterol-lowering effect of the sequestrant. One major advantage of combination therapy is the ability to reduce the dose of each component to more tolerable levels for the patient. An additional advantage is the reduced cost to achieve the cholesterol reduction goal, as the dose response is relatively good at greatly reduced doses for each component.
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PMID:Bile acid sequestrants: their use in combination with other lipid-lowering agents. 1616 Sep 34

Hyperlipidemia is a well-established risk factor for atherogenesis and cardiovascular disease. Statins have been the cornerstone of treatment for hyperlipidemia in recent years and have significantly contributed to the improvement of cardiovascular disease therapy. However, novel antihyperlipidemic agents that have been developed over the last decade possess the capacity to significantly reduce plasma lipoproteins. This review analyzes the pharmacological profile, effectiveness and safety of some promising drugs that are either already in clinical use (eg, ezetimibe and nicotinic acid) or under study (eg, acyl-CoA cholesterol acyltransferase inhibitors, cholesteryl ester transfer protein inhibitors and apolipoprotein A-IMilano).
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PMID:Prospects for the development of novel anti-hyperlipidemic drugs. 1872

In addition to its use as a nutritional supplement, niacin (nicotinic acid or vitamin B3) is medically prescribed to treat hyperlipidemia and hypercholesterolemia. Use of niacin in low doses usually leads to few adverse drug reactions (ADRs); however, at larger doses, niacin can cause skin flushing, itching, and occasionally more serious effects. The 2005 annual report of the American Association of Poison Control Centers documented 3,109 reports of exposures to niacin. During 2006, the Rocky Mountain Poison and Drug Center (RMPDC) in Denver, Colorado, received multiple calls regarding ADRs after nonmedical use of niacin. A review of call records indicated various uses of niacin, including attempts to alter or mask results of urine drug tests, although no scientific evidence exists that ingestion of niacin can alter a drug test result. To determine the extent of niacin use in attempts to alter drug test results, reports to RMPDC of niacin ADRs were reviewed for the period January--September 2006. The results identified 18 persons who reported nonsuicidal, intentional, nonmedical reasons for using niacin, including eight who specified altering drug test results as their reason for using niacin. Ten other persons, among an additional 18 who offered no reason for niacin use, were categorized as possible users of niacin to try to alter drug test results because of their ages or the amount of niacin ingested. Clinicians, especially those whose patients include teens and young adults, should be aware of the potential use of niacin in attempts to defeat urine drug tests.
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PMID:Use of niacin in attempts to defeat urine drug testing--five states, January-September 2006. 1744 21

Increase in triglyceride (TG) -rich lipoproteins is one of the symptoms clustered in metabolic syndrome and is associated with increased plasma free fatty acid level derived from central obesity and insulin resistance. Increase in triglyceride (TG) -rich lipoproteins is also related to several coronary risk factors such as remnant hyperlipidemia, decreased HDL-cholesterol, elevated small dense LDL, postprandial hyperlipidemia, and hypercoagulability. The first line of treatment for hypertriglyceridemia is the modification of individual life-style, among which, restriction of over-eating and practice of regular exercise are both essential. The consideration of dietary composition, not only the quantity but also the quality of nutrients, such as fat and carbohydrate, and behavior toward diet are also important to manage abnormal lipid profile. Statins, fibrates, nicotinic acid derivatives, and EPA are the drugs recommended for the treatment of dyslipidemias in metabolic syndrome.
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PMID:[Clinical significance of triglyceride-rich lipoproteins in metabolic syndrome]. 1759 89

This review considers the treatment for combined hyperlipidaemia (CH) with a combination formulation of three drugs: a statin, nicotinic acid (NA) and aspirin--a mini-polypill. CH is a highly atherogenic dyslipidaemia manifested either as familial combined hyperlipidaemia or dyslipidaemia related to the metabolic syndrome or Type 2 diabetes mellitus. These types of dyslipidaemia are highly prevalent in the general population. Statin plus extended-release NA is a promising treatment option for the normalisation of these atherogenic lipid alterations, regression of atherosclerosis, as well as for primary or secondary prevention of cardiovascular disease (CVD) events. The addition of aspirin might prove a useful adjunct that might reduce the cutaneous side effects of NA while also acting as an antiplatelet agent in high-CVD-risk patients. However, the effective dose of aspirin may need to be at least 160 mg/day. This triple combination might improve patient compliance when compared with the three drugs administered separately.
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PMID:Do we need a statin-nicotinic acid-aspirin mini-polypill to treat combined hyperlipidaemia? 1792 82

Chylomicronemia is present when triglyceride levels exceed 1000 mg/dL. Chylomicronemia, when accompanied by eruptive xanthoma, lipemia retinalis, or abdominal symptoms, is referred to as the "chylomicronemia syndrome" and can cause acute pancreatitis. Treatment aimed at reducing triglyceride levels includes lifestyle modifications to promote weight loss with diet and physical activity coupled with medications, including fibrates, n-3 polyunsaturated fatty acids, and nicotinic acid. Chylomicronemic patients with acute pancreatitis require insulinization in an inpatient setting to abolish chylomicronemia.
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PMID:Chylomicronemia and the chylomicronemia syndrome: a practical approach to management. 1818 65

Type 2 diabetes mellitus and the closely related metabolic syndrome markedly increase the risk of cardiovascular disease a major contributor is the dyslipidemia. Recent studies and new national guidelines suggest these very high risk patients with cardiovascular disease achieve optional low density lipoprotein cholesterol (LDL-C) level of less than 70 mg/dl. In addition there may be no threshold to begin therapeutic lifestyle change and pharmacologic therapy to reduce LDL-C by 30-40%. Although randomized controlled trials with statins indicate that LDL reduction clearly reduces cardiovascular risk in these patients, the typical dyslipidemia of type 2 diabetes mellitus is also characterized by low high density lipoprotein cholesterol (HDL-C) levels, increased triglyceride-rich lipoproteins and small dense LDL, as well as increased postprandial lipemia. The later lipoproteins increase non-HDL-C levels. In order to address these abnormalities it may be necessary to utilize combined approaches with a fibrate or nicotinic acid, or other agents with statins to help reduce risk beyond statins. In addition, supervised, therapeutic life-style change is often underutilized therapy in patients with established coronary artery disease. This review will focus on maximizing the treatment of dyslipidemia in type 2 diabetes and the metabolic syndrome and discuss the evidence based studies and new developments in the management in these very high risk patients.
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PMID:Cardiovascular disease risk of type 2 diabetes mellitus and metabolic syndrome: focus on aggressive management of dyslipidemia. 1822 May 88

Xantinole nicotinic acid (NA) dose dependently lowers plasma levels of atherogenic lipoproteins and increases blood flow through vasodilation. The aim of this study was to evaluate the effect of NA on cutaneous microcirculation in patients with coronary artery disease and hyperlipidemia. In this open pilot study, five men and three women (74.2+/-9.1 yrs; 81.4+/-7.9 kg; 171.6+/-7.0 cm) with angiographically proven coronary artery disease and hyperlipidemia were included. Nailfold capillary microscopy was used for measurements of erythrocyte velocities at rest and after three minutes of ischemia, before and one hour after intake of 1000 mg of NA. The blood pressure (120+/-12/73+/-8 mmHg vs. 113+/-10/72+/-5 mmHg; p=0.19/0.83) and the heart rate (72+/-8/min vs. 70+/-7/min; p=0.38) remained unchanged. The mean capillary red blood cell velocity at rest (v(RBC); 0.27+/-0.23 mm/s vs. 0.32+/-0.18 mm/s; p=0.089) and the time to maximal post ischemia erythrocyte velocity (t(peak); 21.0+/-7.9 s vs. 24.3+/-15.5 s; p=0.49) did not change. The maximal post ischemic erythrocyte velocity (v(maxRBC); 0.93+/-0.33 mm/s vs. 1.19+/-0.19 mm/s; p=0.0096) raised slightly but significantly, the duration of post-ischemia hyperemia (DpH; 101+/-16 s vs. 127+/-15 s; p=0.0005) increased markedly. One patient reported about flush in the whole body. The administration of 1000 mg of NA resulted in a significant improvement of the cutaneous microcirculation in patients with coronary artery disease and hyperlipidemia.
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PMID:Influence of xantinole nicotinic acid on cutaneous microcirculation in patients with coronary artery disease and hyperlipoproteinemia. 1850 37

A study of prescription patterns by office-based physicians was conducted to analyse the use of lipid lowering drugs (LLD) in a Germany area of 1,768,874 inhabitants during a 1-year period. The prescription database consisted of health insurance files from a random sampling of persons (n=7490) belonging to a large statutory health insurance organization during 1993-1994. During the study period LLD were prescribed to about 2.8% of the study population. Fibrates (43.7%) were the most frequently prescribed drugs followed by HMG-CoA reductase inhibitors (29.5%) and nicotinic acid with derivatives (21.7%). The prevalence of treatment rose with increasing age peaking among 60- to 69-year-olds (7.5%). More than two-thirds of the patients were not treated continuously, receiving LLD for less than 6 months. Thus, in patients being treated with LLD, the therapy seems to be ineffective due to the short episodes of drug administration. The presence of hyperlipidaemia plus additional risk factors such as hypertension led to a higher rate of LLD prescriptions than that for hyperlipidaemia alone. Only half of the patients with a history of previous myocardial infarction and hyperlipidaemia received LLD. Furthermore, patients with hyperlipidaemia and additional risk factors such as arterial hypertension, diabetes mellitus and coronary heart disease (CHD), in whom administration of LLD has often been shown to be effective, were by far too infrequently treated with these drugs. Copyright (c) 2000 John Wiley & Sons, Ltd.
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PMID:The prescribing of lipid lowering drugs during a 1-year period: analysis of 7490 health insurance files. 1902 11


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