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Query: UMLS:C0242339 (dyslipidemia)
 13,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Essential hypertension is, at least in many subjects, associated with a decrease in insulin sensitivity, whereas glycemic control is (still) normal. Metaanalyses of hypertension intervention studies revealed different efficacy of treatment on cerebral (cerebrovascular accidents [CVA]) and cardiac (coronary heart disease [CHD]) morbidity and mortality. Although CVA were reduced to an extent similar to that anticipated, the decrease in CHD was less than expected. These differences are likely to be caused by the different impact of concomitant cardiovascular risk factors, such as dyslipidemia, impaired glucose tolerance, and non-insulin-dependent diabetes mellitus on CHD and CVA. Frequently these cardiovascular risk factors are ineffectively controlled in hypertensive patients, and moreover, some of the widely used antihypertensive agents have unfavorable side effects and further deteriorate these particular metabolic risk factors. Therefore, the metabolic side effects of antihypertensive treatment have received more attention. During the past few years, studies demonstrated that most antihypertensive agents modify insulin sensitivity in parallel with alterations in the atherogenic lipid profile. Alpha1-blockers and angiotensin converting enzyme inhibitors were shown to either have no impact on or even improve insulin resistance and the profile of atherogenic lipids, whereas most of the calcium channel blockers were found to be metabolically inert. The diuretics and beta-adrenoreceptor antagonists further decrease insulin sensitivity and worsen dyslipidemia. The mechanisms by which beta-adrenoreceptor antagonist treatment exert its disadvantageous effects are not fully understood, but several possibilities exist: significant body weight gain, reduction in enzyme activities (muscle lipoprotein lipase and lecithin cholesterol acyltransferase), alterations in insulin clearance and insulin secretion, and, probably most important, reduced peripheral blood flow due to increase in total peripheral vascular resistance. Recent metabolic studies found beneficial effects of the newer vasodilating beta-blockers, such as dilevalol, carvedilol and celiprolol, on insulin sensitivity and the atherogenic risk factors. In many hypertensive patients, elevated sympathetic nerve activity and insulin resistance are a deleterious combination. Although conventional beta-blocker treatment was able to take care of the former, the latter got worse; the newer vasodilating beta-blocker generation seems to be capable of successfully treating both of them.
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PMID:Antihypertensive therapy and insulin sensitivity: do we have to redefine the role of beta-blocking agents? 979 45

In the past several years, a substantial amount of new information on the epidemiology and pathophysiology of diabetes and vascular disease has become available. Autopsy studies suggest that diabetic patients are susceptible to cerebral small-artery disease and lacunar infarction and may be at risk for large-artery atherosclerotic occlusive disease. Epidemiological studies show that diabetes is a risk factor for ischemic stroke. The pathogenesis of diabetes-associated stroke appears to be linked to excessive glycation and oxidation, endothelial dysfunction, increased platelet aggregation, impaired fibrinolysis and insulin resistance. Macrovascular complications may be prevented by simple primary prevention measures including exercise, weight loss and treatment of dyslipidemia. The role of tight glycemic control in reducing the risk of stroke is still uncertain. Many new insights and treatment strategies are expected in the future.
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PMID:Diabetes mellitus and cerebrovascular disease. 983 10

Most probably the decennia of the 1990s will be called the 'statin decennia' in the history of coronary heart disease prevention. Statins are effective, both in primary and secondary prevention of coronary heart disease, in middle-aged and older (< 76 years) men and women, in both diabetics and non-diabetics with coronary heart disease. Statins used in secondary prevention of coronary heart disease significantly reduce the risk of stroke. They also reduce daily attacks of myocardial ischemia. Pathogenetic pathways leading to 'biological plausibilities' of the statins favourable effects are multiple, which explains their rapid (less than 1 year) influence on coronary events. Until the results from new event trials become available, fibrates have very few indications as first line drug therapy in dyslipidemia. They should be considered in combined therapy with statins. The scientific evidence with statins is overwhelming and the question is no longer 'who should we treat?' but 'who can society afford to treat?'. Health economics are indeed pivotal in the use of statins and public health authorities have to find answers according to their resources or innovative strategies, including new aspects in dietary advice (the 'Mediterranean diet'?).
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PMID:Primary and secondary prevention of coronary artery disease: a follow-up on clinical controlled trials. 986 91

Hypertension is a very important cardiovascular risk factor and directly leads to major atherosclerotic cardiovascular diseases, including coronary artery disease, stroke cardiac failure and peripheral artery disease. Hypertension tends to cluster with other atherogenic risk factors like dyslipidemia, insulin resistance, obesity and others. The association between hypertension and dyslipidemia is very frequent and the risk is more than additive and its possible pathogenesis may be of a common mechanism. Insulin resistance is the main cause of both risk factors. Endothelium dysfunction is present in arterial hypertension and dyslipidemia and the pathogenesis of atherosclerosis. The treatment of hypertensive patients must be individualized to accommodate both the concomitant dyslipidemia and other atherogenic factors.
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PMID:[Hypertension and dyslipidemia]. 988 66

Obesity is an essential risk factor for hypertension, coronary heart disease and stroke as well as for metabolic disturbances, especially for type 2 diabetes, hyper- and dyslipidemia, and it is responsible for the metabolic syndrome with insulin resistance and hyperinsulinemia. Disturbances in the lung function are also induced by obesity, as a higher risk for arthrosis on the lower extremities. Some oncological diseases like breast-, endometrial-, and prostatic cancer are associated with obesity. It is evident, that the fat distribution plays an important role in the development of obesity associated diseases: the accumulation of visceral fat has a higher risk as the peripheral fat, probably due to the different metabolism.
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PMID:[Obesity: entrance port to multimorbidity]. 988 99

The metabolic syndrome X, characterized by insulin resistance, dyslipidemia, hypertension, and a male, visceral distribution of adipose tissue, is associated with increased morbidity and mortality from several prevalent diseases, such as diabetes, cancers, myocardial infarction, and stroke. Because the liver has a central role in carbohydrate, lipid, and steroid metabolism, we investigated the relationships between liver pathology and the metabolic syndrome. Blood chemistry, anthropometry (waist/hip circumference ratio), and intraoperative routine knife biopsies of the liver were obtained in 551 (112 men) severely obese patients (body mass index, 47 +/- 9; mean +/- SD) undergoing antiobesity surgery. Steatosis was found in 86%, fibrosis in 74%, mild inflammation or steatohepatitis in 24%, and unexpected cirrhosis in 2% (n = 11) of the patients. The risk of steatosis was 2.6 times greater in men than in women (P < 0.0001). With each addition of 1 of the 4 components of the metabolic syndrome, elevated waist/hip ratio, impaired glucose tolerance, hypertension, and dyslipidemia, the risk of steatosis increased exponentially from 1- to 99-fold (P < 0.001). Fibrosis correlated with steatosis (r = 0.56; P < 0.0001), whereas patients with diabetes or impaired glucose tolerance had a 7-fold increased risk of fibrosis (P < 0.0001). Diabetes, steatosis, and age were all significant indicators of cirrhosis, whereas inflammation was only associated with age. We conclude that the metabolic syndrome via impaired glucose tolerance is strongly correlated with steatosis, fibrosis, and cirrhosis of the liver.
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PMID:Liver pathology and the metabolic syndrome X in severe obesity. 1056 91

In Western countries, cardiovascular disease accounts for substantial morbidity and mortality. In the US, where medical costs and intervention rates are the highest in the world, the direct and indirect costs of cardiovascular disease and stroke have been estimated at $US274 billion (1998 dollars), with the costs of hospitalisation ($US119.9 billion) and lost productivity because of early mortality ($US77.9 billion) representing the largest proportions of this amount. Dyslipidaemia is an important risk factor for coronary heart disease (CHD), a condition which accounts for $US39.3 billion and $US37.9 billion (1998 dollars) in hospitalisation/nursing home costs and lost productivity, respectively, annually in the US. Similarly, the UK National Health Service spends more than 500 million pounds sterling annually on the treatment of CHD. Numerous studies have shown the benefit of lowering cholesterol levels in terms of decreasing CHD-associated morbidity and mortality; however, drug therapy costs for dyslipidaemia can be high. US and European treatment guidelines for dyslipidaemia recommend aggressive treatment for those at highest CHD event risk. Because of the high prevalence of dyslipidaemia in Western countries, these recommendations impact on a substantial proportion of the population and have increased the use of cholesterol-lowering medications. In a limited number of economic studies using clinical data from large prevention trials, the cost of drug therapy was nearly offset by the reduction in costs associated with hospitalisation and revascularisation procedures. Therefore, it appears that the strategy of identifying and treating individuals at highest risk for CHD, although expensive in terms of drug costs, would be expected to reduce the substantial direct and indirect costs associated with this condition.
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PMID:Resource utilisation in the management of dyslipidaemia. 1034 24

Several placebo-controlled prospective multicenter trials showed convincing evidence that cholesterol lowering with statins reduced mortality due to coronary heart disease. Subgroup analyses of diabetic patients demonstrated significant reduction of coronary death rates in diabetics even more pronounced than that observed with the nondiabetic population. In some studies significant reduction of strokes was also achieved by lipid lowering. In one diabetic subgroup stroke reduction nearly reached significance despite low number of patients. New studies are currently in progress investigating the effect of lipid lowering specifically for diabetic patients. Some of these studies are designed to evaluate the effects of drugs acting primarily on triglycerides, such as the fibrates, or showing both, triglyceride and cholesterol reduction, like some newer statins, especially atorvastatin. The dyslipidemia encountered most frequently with diabetics is an increase of triglycerides and low HDL-cholesterol. Because of the high cardiovascular risk of diabetics the target levels of LDL-cholesterol in secondary and primary prevention should not exceed 100 mg/dl as in secondary prophylaxis in patients without diabetes.
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PMID:[Statins in diabetic hyperlipidemia]. 1040 5

Of the major risk factors of coronary heart disease dyslipoproteinemia, obesity, hypertension, and diabetes are nutrition related and can be considered of metabolic origin. Dyslipoproteinemia affects 2/3 of the adult population. The risk of coronary heart disease can be decreased 2-5 fold by lowering hypercholesterinemia; atherosclerosis in the coronaries may regress and total mortality may decrease. Atherogenic dyslipidemia (i.e. hypertriglyceridaemia, low HDL cholesterol levels, elevated concentrations of small dense LDL) increases the risk as part of the metabolic syndrome. Obesity is already highly prevalent, and it is affecting ever growing proportions of the adult population. Abdominal obesity furthermore predisposes patients to complications. No effective therapy is available for obesity. 3/4 of hypertensive patients are obese and more than half of them have insulin resistance. By decreasing blood pressure, the risk of stroke decreases by about 40%, that of coronary heart disease by 14-30%. Slimming cures are the most important non-pharmacological way of treating hypertension. 5% of the population has diabetes mellitus, and a further 5% has impaired glucose tolerance. Type 2 diabetes predisposes patients to macrovascular complications. The risk of coronary heart disease can be decreased by controlling diabetes by e.g. metformin.
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PMID:[Major nutrition-related risk factors of ischemic heart disease: dyslipoproteinemia, obesity, hypertension, glucose intolerance]. 1044 32

The aim of this review was to examine the relative contributions of systolic and diastolic blood pressures to the risk of cardiovascular disease on the basis of epidemiologic evidence from the Framingham Heart Study and the change in attitudes toward systolic blood pressure that occurred during the course of the study. Historic texts were evaluated in comparison with data from the Framingham Heart Study, a prospective longitudinal analysis of the relation between blood pressure and occurrence of subsequent cardiovascular morbidity and mortality rates in a fixed cohort. Historically, systolic hypertension has been considered an innocent accompaniment to arterial stiffening, occurring as a compensatory phenomenon in the elderly. Epidemiologic data show that the development of hypertension is neither inevitable nor beneficial. The data also provide evidence that systolic pressure is more important than diastolic pressure as a determinant of cardiovascular sequelae. Mild or moderate elevations of systolic blood pressure, even when unaccompanied by diastolic pressure elevations, are associated with an increased risk of cardiovascular disease. Risk is increased further by the added presence of related metabolic disturbances such as dyslipidemia, glucose intolerance, insulin resistance, cardiac hypertrophy, and obesity. Over-reliance on diastolic blood pressure in assessing the risk of hypertension can be misleading. Systolic pressure constitutes a powerful predictor of cardiovascular disease and a valuable tool when incorporated within multivariate risk formulas for estimating the conditional probability of coronary and stroke events.
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PMID:Historic perspectives on the relative contributions of diastolic and systolic blood pressure elevation to cardiovascular risk profile. 1046 14


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