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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The risks of cardiovascular disease associated with dyslipidemia differ in women and men, being more strongly associated with triglyceride/high-density lipoprotein in middle-aged women than in men. Although the incidence of heart disease is lower in women because they live longer, over a lifetime, cardiovascular disease in women is equal to that in men, with the greatest incidence after age 65 years. Major coronary events are rare among reproductive-age women who use oral contraceptives and are related to the concomitant effects of age, smoking, diabetes, hypertension, and obesity. Low estrogen-progestin dose oral contraceptives appear not to promote cardiovascular disease and can be used in women with controlled cholesterol elevations. Alternative contraceptive measures should be considered for patients with severe uncontrolled hypercholesterolemia or a lipid disorder that carries a high risk of coronary heart disease. In these conditions, thrombotic propensity associated with supraphysiologic doses of estrogen in oral contraceptives might accelerate coronary thrombosis should an arteriosclerotic plaque rupture. Treatment of hypercholesterolemia should follow the guidelines of the National Cholesterol Education Program and emphasize hygienic measures. Contraceptive selection in hyperlipidemic patients should reflect a balance between the risks--and their management--of developing cardiovascular disease versus the risks of pregnancy.
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PMID:Contraception and dyslipidemia. 851 44

Proportion of severe cases and mortality in stroke patients has decreased steadily in the Minami-Uwa District. The reason for this, has been assumes to be that severe hypertensive patients were being detected and treated in early stage by the increase in response rate of medical check-up and from improvements in health education in cooperation with the Mishou Public Health Center in the towns and Villages in the District. However, as there are multiple risk factors for hypertensive circulatory disease other then it is necessary to determine what factors exist in hypertensive patients. Risk factors for circulatory disease were studied in patients using antihypertensive medication at the time of the health examination. Of 5,284 residents studied from 1993 to 1994 the prevalence of risk factors of atherosclerosis such as obesity, disorders of lipid metabolism and glucose intolerance were higher in hypertensive who were normotensive due to antihypertensive drugs than in the non-hypertensive residents. Patients with resistant hypertension accounted for a third of all the patients using antihypersive drugs. Results also showed a relationship between excessive reduction in diastolic blood pressure and increased risk of coronary heart disease (the J-curve phenomenon) in patients on antihypertensive drug treatment. For preventing circulatory disease, it is important to improve the life style of hypertensive patients, in areas such as physical activity or dietary habits, and develop close cooperation among doctors, public health nurses and nutritionists in the regional community, in addition to increasing compliance in maintaining antihypertensive treatment. Construction of a network among public health, medical care and welfare services is important for prevention and for an improved prognosis in circulatory disease.
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PMID:[Risk factors for circulatory disease in patients on antihypertensive drug treatment]. 961 91

Several studies have reported the penetration and impact of national and international recommendations on the management of dyslipidaemia, a major cardiovascular risk factor. Most of them were carried out on patients participating in clinical trials or on in-hospital cases. The PRAGMA study was developed in order to evaluate management of this condition in general practice, at the heart of the health care system. From September to December 1998, 1,717 general practitioners were chosen randomly and included 6,623 patients considered to have a lipid disorder. In this sample, the prevalence of the main risk factors was as follows: hypertension: 39.6%, diabetes: 11.6%, obesity: 19.6%, past or present smokers: 33.8%. The main lines of management consisted in prescribing lipid lowering drugs (96.6%) with dietary recommendations (95.8%) and a fall lipid profile (59.9%). The main factors spontaneously cited by the general practitioners as being decisional were: the total cholesterol level (47.8%), diet (40.8%), body weight (29.4%) and drug therapy (19.2%). The cardiovascular risk factors were rarely taken into account in their totality. These results suggest that the management of dyslipidaemia patients by general practitioners is far from being optimal. Efforts should be made to change attitudes to take into consideration the global cardiovascular risk factors of patients with lipid disorders.
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PMID:[Management of dyslipidemias diagnosed in general practice in France--The PRAGMA Study]. 1172 9

Hyperlipidemia is now established as a major risk factor for causation of coronary heart disease (CHD) in adults; however, there is much debate on the level of coronary risk at which lipid-lowering drugs should be used. These issues of possible harm or lack of benefit from long-term use of lipid-lowering therapy, and cost effectiveness, are also pertinent in the pediatric setting. Evidence from several countries indicates that children have an increasing prevalence of obesity, hyperlipidemia and type 2 diabetes mellitus. Children who have high serum lipids 'track' these increased levels into adulthood. In some countries there is a trend to screen children for hypercholesterolemia. Family history itself is a poor discriminator in determining which children need to be screened and treated. Estimation of apolipoprotein B and/or apolipoprotein E genotype can improve prediction. Measuring high density lipoprotein cholesterol also helps, but obesity appears to be the best marker for screening children at high risk. These considerations should not cloud the need for case finding and treatment of children with genetic disorders. Low fat diets have been shown to be well tolerated and effective in children; however, there are no major long-term studies demonstrating harm or benefit in those on lipid-lowering drugs. Nevertheless, concerns regarding the psychological effect and the theoretical metabolic effects of long-term lipid lowering remain. Lipid-lowering drugs should be generally restricted to children with genetic disorders of lipid metabolism. Children with diabetes mellitus, hypertension or nonlipid-related inherited disorders leading to premature CHD in adults should be treated with diet, and with lipid-lowering drugs when they reach adulthood. Children with secondary hyperlipidemia should be assessed individually. A number of drugs and nutriceuticals are available for use in children, but only a few drugs are licensed for use in children.
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PMID:Should pediatric patients with hyperlipidemia receive drug therapy? 1196 May 11

John Guillebaud, medical director of the Margaret Pyke Family Planning Center in London, and Andrew Kaunitz, MD, professor and assistant chair of obstetrics and gynecology at the University of Florida Health Sciences Center in Jacksonville, make recommendations on how clinicians should prescribe desogestrel-containing oral contraceptives (OC) amid new data which indicate that the risk for venous thromboembolism (VTE) for such OCs may be lower than first reported. John Guillebaud notes that in the UK, young women with no risk factors are typically started on second-generation OCs because some of these clients may be predisposed for VTE. Patients with a VTE risk factor, such as obesity or severe varicose veins, should be taking second-generation OCs. Patients with an arterial risk factor, such as being a heavy smoker, diabetic, having lipid disorder, or high blood pressure should be encouraged to consider switching to third-generation pills as they near age 30 years. Dr. Kaunitz recommends that current users of desogestrel OCs who are doing well remain with their current OC. For clinicians who prefer to start first-time OC users on new progestin OCs and who believe that vascular disease risks may be higher with desogestrel pills, clients should be started on norgestimate-containing OCs. Other clinicians can choose to use desogestrel-containing OCs in first-time clients.
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PMID:2 methods for prescribing third-generation OCs. 1234 20

To investigate the disorder of lipid metabolism and explore the possible mechanism of increasing risk of atherosclerosis(AS) in simple childhood obesity, serum lipids and apolipoprotein were examined. 49 obese children were selected and another 49 non-obese children were selected as control. Their serum lipids (TG, TC, VLDL-ch, HDL-ch and LDL-ch) and apolipoprotein(apoA1 and apoB100) were measured. The results showed TG, VLDL-ch, apoB100, artherosclerosis index (AI) and LDL-ch/HDL-ch ratio in childhood obesity were significantly higher than that in normal children (P < 0.05), while HDL-ch, apoA1, HDL-ch/TC, apoA1/apoB100 ratio in obese children were obviously lower than that in normal ones(P < 0.05). The results suggested that metabolic disorder of lipid and apolipoprotein took place in obese children. The disorder which may increase the risk of AS should be paid great attention.
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PMID:[Study on plasma lipids, apolipoprotein A1, apolipoprotein B100 in simple obese children]. 1272 89

This study was done to establish the relationship between disorders of lipid metabolism and risk factors of ischemic cerebrovascular stroke, search for correlations between disorders of lipid metabolism and severity of ischemic stroke, and assess the association between fibrinogen levels in serum and risk factors in patients suffering from different types of ischemic stroke. Altogether, 117 patients were enrolled, including 76 males and 41 females aged 20 to 55 years (mean--45.3 years). The patients were divided into three groups depending on the dynamics of neurological symptoms: (1) transient ischemic attacks (TIA); (2) reversible ischemic neurologic deficit (RIND); (3) completed stroke (CS). The diagnosis was based on history-taking, physical examination, laboratory tests and neuro-imaging studies. The tests included a complete blood count, glucose, glucose tolerance, 24-hour glucose profile, coagulation profile, fibrinogen, total cholesterol, triglycerides, HDL and LDL cholesterol fractions, and beta-lipoproteins. Blood was collected on the first day of hospitalization prior to any medication. An ECG, CT, and Doppler USG of carotid vessels were done. Cardiac etiology of stroke was ruled out with Holter ECG and echocardiography. The results were subjected to statistical analysis with Yule's coefficient for two qualitative variables. Lipid disorders usually co-existed with obesity, fat-rich diets and sedentary lifestyle in all ischemic stroke types studied. They were accompanied by elevated blood pressures in every type of stroke and by diabetes in TIA. Lipid disorders were found to co-exist with other risk factors for ischemic stroke predominantly in female patients, while in male patients these disorders were an independent risk factor for ischemic stroke. The extent of lipid disorders correlated with the severity of ischemic stroke. Elevated levels of fibrinogen in serum were detected in female patients in every type of stroke. In male patients, elevated fibrinogen was found only in TIA and co-existed with high blood pressure, diabetes and obesity.
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PMID:[Metabolic disturbances and prognosis in ischemic cerebrovascular stroke in patients up to 55 years of age]. 1460 83

Combined hyperlipidemia is increasing in frequency and is the most common lipid disorder associated with obesity, insulin resistance and diabetes mellitus. It is associated with other features of the metabolic syndrome including hypertension, hyperuricemia, hyperinsulinemia and highly atherogenic subfractions of lipoprotein remnant particles including small dense low density lipoprotein-cholesterol. This review examines the mechanisms by which combined hyperlipidemia arises and the various drugs including fibric acid derivatives, hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, and nicotinic acid which can be used either as monotherapy or in combination to manage it and to improve prognosis from atherosclerotic disease in diabetes mellitus, insulin resistant states and primary combined hyperlipidemia. The therapeutic approach to combined hyperlipidemia involves determination of whether the cause is hepatocyte damage or metabolic derangements. Combined hyperlipidemia due to hepatocyte damage should be treated by attention to the primary cause. In the case of metabolic dysfunction because of imbalance in glucose and fat metabolism, therapy of diabetes mellitus and obesity should be optimised prior to commencement of lipid lowering drugs. Both fibric acid derivatives and HMG-CoA reductase inhibitors can be used in the treatment of combined hyperlipidemia with fibric acid derivatives having greater effects on triglycerides and HMG-CoA reductase inhibitors on LDL-C though both have effects on the other cardiovascular risk factors. There is some evidence of benefit with both interventions in mild combined hyperlipidemias and large scale trials are underway. Fibric acid derivatives and HMG-CoA reductase inhibitor therapy can be combined with care, provided that gemfibrozil is avoided, fibric acid derivatives are given in the mornings and shorter half -life HMG-CoA reductase inhibitors are used at night. Combined hyperlipidemia emergencies occur with predominant hypertriglyceridemia in pregnancy or as a cause of pancreatitis. Therapy in the former should aim to reduce chylomicron production by a low fat diet and intervention to suppress VLDL-C secretion using omega-3 fatty acids. In the latter case, fluid therapy alone and medium chain plasma triglyceride infusions usually reduce levels satisfactorily though apheresis may be required. Blood glucose levels also need aggressive management in these conditions. Combined hyperlipidemia is likely to become an increasing problem with the increase in the prevalence of obesity and diabetes mellitus and needs aggressive management to reduce cardiovascular risk.
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PMID:Drug treatment of combined hyperlipidemia. 1472 15

Obesity is one of the most important problems of the modern medicine. The immobile life-style and consumption of high-calorie food are the most remarkable risk-factors of the obesity, which in presence of genetic predisposition contribute to the increasing of the body weight. In the modern literature there are numerous data about the important role of free radical oxidation in the pathogenesis of the obesity. In this relation application of natural antioxidants for the purpose of the correction of excess weight has gained an active research interest. Numerous researches showed natural antioxidants to be effective in correction of elevated blood cholesterol, triglycerides and LDL levels. In this relation the purpose of our research was to investigate effectiveness of green tea catechizes on lipid metabolism disorder, antioxidant status and excess body weight during experimental alimentary obesity. Experiment was conducted on rats kept on high-calorie diet for 7 weeks. Simultaneously one group of animals had been administered catechines in addition to the high-calorie diet during last 4 weeks. The experiment established corrective effect of catechines on the parameters of lipid metabolism (blood cholesterol, triglyceride and LDL levels), epididymal fat mass and antioxidant enzymes activity. Obtained results may be important for the development of weight losing diets.
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PMID:[Effectiveness of green tea catechines for the correction of the alimentary obesity in the experiment]. 1623 98

Dyslipidemia, the most consistent lipid disorder in subjects with obesity and type 2 diabetes mellitus, is associated with increased risk of coronary artery disease. Lipoprotein metabolism is complex and abnormal plasma concentrations can result from alterations in the rates of production and/or catabolism of the various lipoprotein particles. Our in vivo understanding of kinetic defects in lipoprotein metabolism in these subjects has relied on ongoing developments in the use of stable isotope tracers and mathematical modelling. This review deals with the methodological and clinical aspects of stable isotope kinetic studies. The design of in vivo turnover studies requires considerations related to stable isotope tracer administration, duration of sampling protocol, laboratory isolation and measurement of tracer, and interpretation of tracer data, all of which are critically dependent on the kinetic properties of the lipoproteins under investigation. Such stable isotope tracer techniques have provided a mechanistic insight into the understanding of lipoprotein disorders and effects of treatments in the metabolic syndrome. Further development in tracer methodologies, with practicable in-vivo protocols, are required for investigating cholesterol transport in plasma, tissue lipid metabolism, such as cholesterol and lipid transport in macrophages, liver and skeletal muscle, and the turnover of subpopulations of HDL particles involved in reverse cholelsterol transport.
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PMID:Recent advances in the investigation of lipoprotein metabolism using tracer methodology. 1695 33


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