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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Our objective was to describe the short-term morbidity of coronary artery bypass operations and the effect of surgery plus aggressive cardiac rehabilitation on the long-term prognosis of severely obese patients with coronary artery disease. We investigated an inception cohort of 28 consecutive severely obese patients with three-vessel coronary disease followed on average for 51 months. The patients' age, preoperative and postoperative weight, risk factors, and cholesterol were measured. We performed coronary artery bypass surgery, then began aggressive cardiac rehabilitation programs. We recorded intraoperative data, perioperative deaths, complications, readmissions, and lengths of stay. Also, New York Heart classifications and use of anti-anginal or cholesterol-lowering medications were noted. All patients were followed up. Despite high morbidity, long-term function and survival of severely obese CABG patients compares favorably with that of average patients. However, aggressive behavior modification fails to alter their postoperative weight or risk profile, placing them at risk for both second CABG procedures and continued obesity-related disease occurrences.
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PMID:Early complications and long-term survival in severely obese coronary bypass patients. 748 23

Asian Indians have the highest rates of coronary artery disease (CAD) of any ethnic group studied, despite the fact that nearly half of this group are life-long vegetarians. CAD occurs early in age and generally follows a malignant course. Although the incidence of classic risk factors is low, high triglyceride and low high-density lipoprotein cholesterol levels, high lipoprotein(a) levels, hyperinsulinemia, and apple-type obesity all show a substantial prevalence in this population. Aggressive modification of life style beginning before adolescence seems justified in view of the malignant nature of CAD in this population. Pharmacologic intervention similar to that of secondary prevention of CAD seems justified as primary prevention in high-risk Asian Indians.
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PMID:Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. 774 82

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

A comprehensive meta-analysis was performed to address the possible association of fluoxetine with violence or aggression. Data from the United States Investigational New Drug Clinical Trial Databases for approved and potential indications (depression, obesity, bulimia nervosa, obsessive-compulsive disorder, smoking cessation, alcoholism; n = 3992) were evaluated. Statistically significantly fewer fluoxetine-treated patients (0.15%) than placebo-treated patients (0.65%) experienced events suggestive of aggression (hostility, personality disorder, antisocial reaction). A relative risk analysis indicated that aggression events were four times more likely to occur in placebo-treated patients than in fluoxetine-treated patients. Although the possibility that some rare phenomenon was not detected cannot be excluded, this meta-analysis did not show fluoxetine to be associated with an increased risk of emergence of violent or aggressive behaviour.
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PMID:Fluoxetine not associated with increased aggression in controlled clinical trials. 827 48

Criteria for the evaluation of new drugs to treat obesity are important as guides for designing clinical trials to test these agents. These criteria must be developed in relation to the realities of obesity, which is a chronic disease associated with morbidity and mortality that is increased by visceral fat deposits. The observation that patients regain weight after stopping drug treatment for obesity argues for the proposition that drugs work only when taken and NOT that the drugs are ineffective. The analogy between the development of treatments for obesity to those for the treatment of hypertension is used to highlight potential areas for new developments. Several features of an ideal drug for the treatment of obesity are suggested. Criteria for evaluating new drugs include both primary and secondary endpoints. The primary endpoint for an anti-obesity drug should be weight loss, possibly by category of success. Losses of total body fat or visceral fat might be alternative primary endpoints. Secondary endpoints include reduction in risk factors for associated diseases and improvement in the quality of life. In trials where vigorous placebo designs including highly aggressive behavior modification or very-low-calorie diets were used, it may be difficult or impossible to detect a response to a drug.
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PMID:Evaluation of drugs for treating obesity. 869 40

The objective of this study was to examine associations in youth between antisocial behavior and cardiovascular profile. Younger brothers of adjudicated delinquents (N = 120) received a standardized psychiatric assessment and an assessment of three factors often studied in behavioral cardiology research: family history of hypertension, resting blood pressure, and obesity. As a group, relative to population norms, these youth exhibited signs of obesity and elevated blood pressure, with 30% of the sample appearing clinically obese and 24% having a blood pressure above the 90th percentile for national norms in their age cohort. Within the sample, score on the Child Behavior Checklist (CBCL) Delinquency scale correlated with blood pressure (r = .29-.34) and an index of obesity, weight/height3 (r = .20). Further, scores on the CBCL Delinquency, Aggression, and Externalizing scales were elevated in boys with a positive family history of hypertension. Among boys at risk for delinquency, disruptive psychopathology relates to factors often studied in behavioral cardiology research. Relationships between risk factors for ischemic cardiovascular disease and hostile behavior may be manifested with measures of disruptive psychopathology.
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PMID:Cardiac profile and disruptive behavior in boys at risk for delinquency. 882 97

Obese patients have not been commonly considered as candidates for body contouring surgery. Using circumferential liposuction techniques, in association with the tumescent technique, and circumferential excisional procedures, this patient population can achieve significant body transformation with acceptably low morbidity. The concept of addressing obese patients in a circumferential fashion, whether using liposuction, excisional therapy, or commonly the combination of both, can more accurately address the significant deformities and achieve more consistent improvement for these patients. Aggressive body contouring procedures can be performed safely with a low morbidity rate and a very high degree of patient satisfaction.
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PMID:Body contouring in the obese patient. 890 95

The authors make an analysis of their experiences with combined operations for extreme forms of obesity in 93 patients. Indications to such operations were considered to be only the diseases which could cause complications of the early and late postoperative period. In spite of more pronounced signs of aggression the combined operations do not enhance frequency and severity of postoperative complications. Recommendations are given for the selection of anesthesia, the access and sequence of operation steps. Measures are proposed which allow the frequency of postoperative complications to be decreased from 59.8 to 29.8%.
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PMID:[Combined operations in extreme forms of obesity]. 916 94

Serotonin is a neurotransmitter involved in a large number of psychophysiological processes including the regulation of mood, arousal, aggression, sleep, learning, nociceptions, nerve growth and importantly, appetitive functions. Alterations of 5-HT receptor activity have been shown to occur in many psychiatric diseases including depression, anxiety, eating disorders, schizophrenia etc. Hence, genetic variation in genes coding for serotonin receptor proteins might well be involved in the genetic predisposition to these diseases and therefore are of great pharmacogenetic relevance. Knockout mice deficient of a functional 5-HT2C receptor have implicated a potential role of this receptor subtype in the serotonergic control of appetite. A Cys23Ser mutation in the human 5-HT2C receptor gene discovered recently prompted us to investigate this mutation with regard to the development of human obesity. We have evaluated this mutation in 241 obese children and adolescents (mean BMI > or = 97th percentile), 80 normal weight children (BMI 5th-85th percentile) and 92 underweight probands (BMI < or = 15th percentile) for a possible association with obesity. The frequencies of the mutant allele in all three weight groups (obese subjects: 0.1597; normal weight: 0.168; underweight: 0.1575) were very similar. Association as well as linkage studies were negative. Therefore it is unlikely that this receptor mutation plays a direct role in the development of human obesity.
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PMID:Evaluation of a Cys23Ser mutation within the human 5-HT2C receptor gene: no evidence for an association of the mutant allele with obesity or underweight in children, adolescents and young adults. 920 Jun 73

People with type II diabetes have a twofold to fourfold increased risk of dying from the complications of cardiovascular disease. Atherosclerosis and vascular thrombosis are major contributors. The increased risk is present before fasting hyperglycemia is seen. These individuals often have a sedentary life-style, poor physical conditioning, insulin resistance, centripetal obesity, hypertension, dyslipidemia, and a prothrombotic state. Chronic hyperglycemia is then added to these risk markers. Microalbuminuria may precede hyperglycemia in type II diabetes, occurs in 30% to 40% of these individuals after diabetes is established, and is a predictor of cardiovascular events. Early intervention in high-risk individuals may delay or prevent fasting hyperglycemia. An all-inclusive approach that focuses on early risk factor (or marker) identification and management to prevent or delay accelerated atherosclerosis and thrombosis in type II diabetes is an attractive strategy. However, the database to support this strategy is limited. In particular, large-scale prospective trial data are not available to support the concept of intensive glycemic regulation to prevent progression of macrovascular disease in type II diabetes. This is in contrast to the situation regarding microvascular disease of the eyes and kidneys. Recently, indirect data of a correlative nature have emerged, and short- and long-term prospective trials at early and late stages of type II diabetes are now being reported. These studies are analyzed and interpreted in this report. In contrast, the database to support an intensive antiplatelet regimen to prevent vascular thrombotic events in people with type II diabetes is large, and these studies are reviewed. They are of a type and magnitude to allow definite recommendations for aspirin therapy in type II diabetes. Aggressive therapy directed at hypertension, hyperlipidemia, and elevated urinary albumin in people with type II diabetes appears to be indicated. Increased attention to the multifactorial aspects of treatment of the type II diabetic patient is needed. Our present challenge is to translate these findings for patients and primary health care providers so that effective actions may be implemented.
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PMID:Multifactorial aspects of the treatment of the type II diabetic patient. 943 50


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