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Query: UMLS:C0154251 (lipid disorder)
 795 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coronary artery disease is a common and particularly severe complication of cardiac transplantation because it may cause progressive destruction of the graft by acute or chronic ischemia. The ischemia is usually silent because of cardiac denervation. Cardiac failure related to graft dysfunction, asymptomatic infarction on the ECG, or sudden death, are sometimes the only signs of severe coronary disease. The prevalence of coronary lesions has been evaluated by coronary angiography at nearly 25% at 2 years and 50% at 5 years. The distribution and morphology of the lesions are characteristic: diffuse concentric, irregular and occlusive, predominantly distal stenoses, without a distal and usually without a collateral circulation. The histological features are variable: the association of medial necrosis, severe endothelial lesions and intense parietal inflammation are suggestive of acute arteriolitis, often present during acute rejection, may be related to a common pathological process. Diffuse obliterative arteriolar lesions with concentric proliferation of medial smooth muscle are the usual appearances in transplant patients who have died or been retransplanted. There is no non-invasive diagnostic method sufficiently sensitive of specific which justifies the practice of many groups of systematic annual coronary angiography in transplanted patients. The pathogenesis is poorly understood and probably multifactorial: disorders of lipid metabolism, immunological factors, the atherogenic role of Cytomegalovirus infection. The absence of an identifiable risk factor makes preventive measures difficult. The evolutive risk justifies retransplantation in selected patients, the results of which are less satisfactory but which reduces the risk of acute coronary events and sudden death.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1991 Feb
PMID:[Coronary disease in patient following heart transplantation]. 185 May 86

The first objective is to correct any existing coronary risk factors but this must be achieved with discrimination. Smoking should be strictly forbidden, hypertension reduced and a more active life style encouraged. However, a more nuanced approach should be adopted towards dietetic problems, obesity and disorders of lipid metabolism. It is also very important to teach the patient to use glyceryl trinitrate correctly in the double objective of relieving pain as quickly as possible and of preventing pain by using it in certain critical situations. Clinical practice shows that patients often use glyceryl trinitrate too sparingly. When these general measures have been settled, treatment must be adapted to each particular situation. The patient's age, the frequency of attacks, trigger factors, the repercussions of the disease on the patient's life all have to be considered before deciding on the individual's treatment. In younger patients, a controlled exercise ECG is essential for selecting patients for surgery. The drugs of choice for stable angina are the betablockers which have been shown to be effective and well tolerated. When this group of drugs cannot be used or is ineffective, other major anti-anginal drugs may be chosen according to the individual terrain and their known secondary effects.
Arch Mal Coeur Vaiss 1983 Feb
PMID:[Strategy of the medical treatment of angina pectoris]. 613 3

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.
Arch Mal Coeur Vaiss 2001 Oct
PMID:[Management of dyslipidemias diagnosed in general practice in France--The PRAGMA Study]. 1172 9