UMLS:C0020538 - FACTA Search

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Interest in research on atherosclerosis involving children has been the consequence of confluent evidence that atherogenic process begins in early life and grows silently until the occurrence of clinical events in middle-age or later. We carried out a cross-study in the Mediterranean area on a random sample of a secondary school of Casteldaccia (a farming and fishing village located on the Northern coast of Sicily, East of Palermo), consisting of 186 teen-agers (103 males and 83 females) aged between 10 and 13 years (average age: 11.3 +/- 0.2 years). We determined: total cholesterol, triglycerides, HDL-cholesterol, LDL-Cholesterol, apolipoproteins A1 and B, glycaemia, body mass index (BMI), systolic and diastolic blood pressure. Dietary habits were recorded on two occasions by a weekly diary (of the 7 days food record type) with the collaboration of dieticians. The prevalence of plasma cholesterol levels between 170-200 mg% and exceeding 200 mg% was 24.2% and 12.4% respectively, of overweight (BMI > 25) was 9.7% and of hypertension (SBP > 125 and/or DBP > 85 mmHg) was 8.6%. In comparison with Mediterranean diet according to Euratom study (1969), the following are the most impressive findings: an increase of cholesterol (+54%) and fat intake (+2% of total calories), a reduction of fibre intake (-32%) and an increase of 2S-P difference (+27%) and of total fats/fibre ratio (+53%).
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PMID:Cardiovascular risk factors and dietary habits in secondary school children in southern Italy. 796 74

Widespread information about preventive measures has decreased incidence of coronary artery disease (CAD) in developing countries. However this trend is not seen in India. Cholesterol and other lipoproteins play important role in CAD. In order to assess whether this information has reached General Practitioners (GP's) and their action regarding the recommendations of the US National Cholesterol Education Programme (NCEP), G.P.'s were assessed with the help of a questionnaire. The response rate to the questionnaire was 78.4% of the total G.P.'s of the city. The findings of the study were compared to the NCEP guidelines. Results indicate that, "Ideal", "High" and cholesterol levels dietary needing precautionary measures intervention (ie. 198.2 +/- 13 mg/dl, 256.1 +/- 32 mg/dl and 247.9 +/- 26 mg/dl respectively) were similar to the NCEP guidelines. Levels where therapy is recommended (ie 293.9 +/- 34 mg/dl) is significantly more than NCEP guidelines. Though 77.1% of doctors were aware of protective effect of HDL cholesterol (ie 51.1 +/- 6 mg/dl), routine measurement of lipid profile was undertaken by only 57.1% doctors with mean age of recommendation being 34.1 +/- 11.6. Routine dietary advice and cholesterol estimation was done in 71.4% patients with CAD and 67.3% of patients with hypertension and diabetes. Analysis of action taken falls short of the NCEP recommendations and indicates a need for intensive training of the G.P.s.
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PMID:Awareness of cholesterol as coronary risk factor among general practitioners at Jaipur. 800 26

For optimal case mix adjustment, it is necessary to build risk or severity models to fit the disease and its outcome. For cardiac disease, for example, several risk models predict the outcome of mortality. These risk models include variables that, by themselves in multivariable models, predict death. If a variable is associated with death independent of treatment or quality of care, it has to be adjusted for and, therefore, included in the model. Similar models have to be developed and tested for end-stage renal disease. A complete risk model would consist of age, sex, the severity of the primary disease of interest (here, end-stage renal disease), not just the presence but also the severity of all co-morbid disease, and, finally, a measurement of functional status or quality of life. This last measurements is associated with outcome beyond and independent of the above noted severity components. These factors (or "severity" or "patient mix" dimensions) then have to be developed in relation to a specific outcome or response variable. Cholesterol and hypertension are risk factors for long-term events and mortality, but not for 2-year symptoms and quality of life. Thus, the model has to be defined by the type of outcome and by the time interval over which the variable acts. For end-stage renal disease, at least one of the major types of outcome will be quality of life. Our case mix measures for hospital co-morbidity and for office practice chronic disease are defined by and intended to predict functional status in the short run, because that is the outcome of interest for dollars spent and for most of the care rendered to patients with chronic disease before the very end stages. Creating a valid case mix or severity measurement aimed at or defined by quality of life thus involves the creation of new models, the testing of those models, the revision based on the empirical testing, and, finally, generalizing to other sites beyond which the data were collected. Useful case mix measurements will be parsimonious, feasible, reliable, validated against the outcome of interest, shown to work in diverse settings, and acceptable to users, especially clinicians.
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PMID:Principles and practice of case mix adjustment: applications to end-stage renal disease. 804 37

Hyperlipidemia is an important risk factor of arteriosclerotic diseases. In Japan, as heart disease and cerebrovascular disorders rank second and third as the causes of death, demand has intensified for measures to prevent these diseases. In the U.S., the National Cholesterol Education Program (NCEP) was initiated as a means to prevent CHD by reducing th prevalence of hypercholesterolemia. Since 1988, this program has demonstrated effectiveness in this regard. In Japan, there are no consistent guidelines for the management of hyperlipidemia such as are espoused by the NCEP. In this study, in an endeavor to resolve this problem, a worksite population (1343 adult males) was classified according to the NCEP guidelines and the role and effectiveness of NCEP in this population were studied. A questionnaire concerning life-style and some biochemical findings were also used to classify the subjects according to the NCEP guidelines. Of the subjects, 22.8% were classified as hypercholesterolemic (> or = 240 mg/dl) and another 34.9% as being borderline high risk (> or = 200 < 240 mg/dl). Twenty-five percent of subjects required diet or drug therapy. The percentage of subjects requiring therapeutic intervention increased with age. The therapy group subjects tended to have a larger number of risk factors compared to the normal group. They also featured a significantly high age-adjusted odds ratios for hypertension, diabetes mellitus, obesity, and elevated serum triglyceride. This study suggests that in the health management of those in the therapy group, educational instruction on coronary risk factors is required.
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PMID:[Classification of hyperlipidemia in a worksite population in Japan using criteria of the U.S. National Cholesterol Education Program]. 804 15

The prevalence of hyperlipidemia in adolescents and young adults who are long-term survivors of pediatric renal transplantation with stable graft function has not previously been examined. We studied 33 renal transplant recipients aged 5 to 23 years, who were an average of 7.4 years (range 3 to 11 years) post-transplant. We found hypercholesterolemia in 17 (total cholesterol (TC) > 5.18 mmol/l). Both low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were increased, such that the mean TC/HDL-C and apolipoprotein B/apolipoprotein A1 (Apo B/Apo A1) ratios were below levels associated with increased coronary artery disease risk. Subjects with hypercholesterolemia did not differ from those with normal cholesterol values in current age or age at transplant, serum creatinine, serum albumin, serum triglycerides, HDL-C, TC/HDL-C ratio, Apo B/Apo A1 ratio, prednisone dose, body mass index, gender, use of thiazides or beta blockers, or family history of premature atherosclerosis. Coronary risk factors appear to cluster in these patients, with hypertension in 53% of those with hypercholesterolemia. Lipid profiles were not different in patients treated with prednisone-azathioprine vs. prednisone-azathioprine-cyclosporine A immunosuppression. A significant correlation was found between prednisone dose (mg/m2) and TC, LDL-C and TC/HDL-C. According to National Cholesterol Education Program guidelines, 32% of these long-term survivors of pediatric renal transplantation warrant at least dietary intervention and 10% are candidates for treatment with lipid-lowering drugs. This proportion is likely to increase as the safety of lipid-lowering agents is established in younger children.
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PMID:Hyperlipidemia in long-term survivors of pediatric renal transplantation. 806 64

The purpose of this study was to evaluate the presence of insulin-resistance in non-obese, non-diabetic patients with mild to moderate essential arterial hypertension of recent diagnosis and without prior pharmacological treatment and its relationship with the lipid alteration found in those patients. Twenty-one controls (9 M/12F) and twenty-nine patients (19 M/10 F) were studied. The control group presented mean age: 29 +/- 1.5 years, BMI: 23.9 +/- 0.46 Kg/m2, SBP: 112.6 +/- 2.9 mm Hg, DBP: 68.0 +/- 2.9 mm Hg. The patient group presented mean age: 35 +/- 1.4 years, BMI: 27.3 +/- 0.45 Kg/m2, SBP: 140 +/- 26 mm Hg, DBP: 95.1 +/- 1.4 mm Hg. The fasting levels of glucose, insulin and lipids were measured in each individual. Both controls and patients were subjected to an oral glucose tolerance test (OGTT) with determination of glucose and insulin at 30, 60, and 120 minutes. The patients had significantly (p < 0.05) increased plasma glucose at 0, 30, 60 and 120 min. and increased (p < 0.05) plasma insulin levels at O and 120 min compared to controls. The G/I ratio was significantly lower (p < 0.005) in the hypertensive group, at 0 h and 120 min. Abnormalities in fasting lipid profile were also observed in the patients including a significant increase in TG, Cholesterol, VLDL-C and LDL-C. These increases were especially evident in men and those with higher BMI. There was a positive and significant association between basal-insulin and TG, VLDL-C and DBP in hypertensive patients. We conclude that hyperinsulinemia is present in the majority of hypertensive patients and that hyperinsulinemia is associated with lipid abnormalities specially in men and the most individuals with higher BMI.
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PMID:[Hyperinsulinism and lipid changes in the early stages of essential arterial hypertension]. 812 9

The National Cholesterol Education Program and physician/patient awareness of the risks of hypercholesterolemia have resulted in aggressive screening and treatment of elevated cholesterol levels. The "one size fits all" concept has been used as the criterion for intervention. However, this has been promulgated without convincing evidence that levels of cholesterol are as important in older individuals as in those of middle age. Clearly, cholesterol is not the only contributor to cardiovascular risk, and other risk factors such as smoking, hypertension, diabetes, and obesity should not be ignored. To prevent unnecessary intervention, overzealous interpretation of cholesterol values should be avoided.
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PMID:Cholesterol and the older adult. 821 50

To assess racial difference in cardiac responses to elevated blood pressure, we compared echocardiographic measurements of left ventricular (LV) mass and the wall thickness to chamber dimension ratio (relative wall thickness) in 380 white and 47 black patients with uncomplicated essential hypertension consecutively enrolled in echocardiographic research studies at The New York Hospital Hypertension Center. Diastolic blood pressure and weight were slightly greater in black as compared with white subjects (104 +/- 18 v 98 +/- 11 mm Hg; P = .014 and 82 +/- 17 v 77 +/- 15 kg; P = .037, respectively), however the groups were similar with respect to age, duration of hypertension, cholesterol level, cigarette smoking, past use of antihypertensive therapy, family history of heart disease, and height. On average, LV mass indexed for body surface area and relative wall thickness were significantly greater in blacks than whites (119 v 105 g/m2; P = .02 and 0.46 v 0.39; P = .003) and blacks had twice the prevalence of LV hypertrophy (41% v 19%; P < .001) or concentric remodeling (21% v 12%; P < .05). The magnitude of increased LV mass and relative wall thickness in blacks was similar in men (132 v 110 g/m2; P = .01 and 0.44 v 0.39; P = .04) and in women (107 v 94 g/m2; P = .11 and 0.48 v 0.39; P = .02). In multivariate analyses, systolic blood pressure, age, and race were consistently predictors of increased LV mass and abnormal cardiac geometry. Cholesterol level was not independently associated with increased LV mass but was weakly associated with increased relative wall thickness.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of left ventricular mass and geometry in black and white patients with essential hypertension. 826 36

Atherosclerosis is the principal cause of diabetic morbidity and mortality. Diabetic dyslipidemia, obesity, and hypertension are significant contributing factors in the acceleration of the atherosclerotic process. Regardless of the type of diabetes, increased levels of very-low-density lipoprotein triglyceride, modified levels of low-density lipoprotein cholesterol, and decreased levels of high-density lipoprotein (HDL) cholesterol are the main lipoprotein abnormalities in diabetic patients. These abnormalities can be improved in part by glycemic control, but additional intervention may be needed. Diet and exercise are important elements in the management of dyslipidemia, but lipid-lowering drugs (especially fibrates and HMG-CoA reductase inhibitors) also may be necessary for the control of diabetic dyslipidemia. Based on these findings, the American Diabetes Association Consensus Panel and the revised treatment guidelines of the National Cholesterol Education Program recommend treatment of hypertriglyceridemia/low HDL cholesterol as a risk factor of coronary heart disease in diabetic and nondiabetic individuals alike. Aggressive treatment is recommended, therefore, particularly in diabetic patients and in all patients with existing vascular disease.
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PMID:Prevention of atherosclerosis in diabetes: emphasis on treatment for the abnormal lipoprotein metabolism of diabetes. 826 43

Elevated total blood cholesterol levels (at or above 240 mg/dL) due to increased low density lipoprotein (LDL) cholesterol values (at or above 160 mg/dL) have been associated with an increased risk of coronary heart disease (CHD). It has been shown in controlled prospective studies that when LDL cholesterol is lowered with diet or diet and drug treatment, subsequent risk of CHD morbidity and, in some cases, mortality can be reduced. New guidelines have recently been released by the Adult Treatment Panel (ATP II) of the National Cholesterol Education Program (NCEP). Risk factors for CHD in addition to elevated LDL cholesterol now include: 1) male 45 years or older; 2) female 55 or older, or with premature menopause and not on estrogen replacement; 3) high density lipoprotein (HDL) cholesterol less than 35 mg/dL; 4) hypertension; 5) cigarette smoking; 6) diabetes mellitus; and 7) a family history of premature CHD. After screening with total cholesterol and HDL cholesterol measurements, patients with total cholesterol values at or above 200 mg/dL, HDL cholesterol below 35 mg/dL, and/or CHD should have a fasting cholesterol, triglyceride, and HDL cholesterol measurement. Candidates for diet therapy are those with LDL cholesterol values at or above 1) 160 mg/dL; 2) 130 mg/dL in the presence of two or more CHD risk factors; or 3) 100 mg/dL in the presence of CHD. Candidates for drug therapy after diet treatment are those with LDL cholesterol values at or above 1) 190 mg/dL; 2) 160 mg/dL in the presence of two or more CHD risk factors; or 3) 130 mg/dL in the presence of CHD.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:New recommendations for the diagnosis and treatment of plasma lipid abnormalities. 830 97

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