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

Cardiovascular disease (CVD) remains as the first cause of death worldwide. Scientific community works everyday trying to ameliorate this burden. Only in the year 2004 around 2,790 publications about the therapeutic use of antihypertensive agents can be found in MEDLINE. Despite this overwhelming effort and information, only a relatively short number of manuscripts have a real impact in clinical practice. For the busy clinician, it becomes almost impossible to screen and be updated with the landmark publications. The purpose of this article is to provide concise information related to prevention of CVD. We reviewed publications in the past 5 years regarding cardiovascular risk factors with special attention to dyslipidemia, hypertension, diabetes, smoking cessation and obesity, discussing some new findings and treatments. We also discuss obstructive sleep apnea (OSA) as a recently identified cardiovascular risk factor, and provide a general overview about its pathophysiology and treatment.
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PMID:Update in prevention of atherosclerotic heart disease: management of major cardiovascular risk factors. 1695

Small, dense low-density-lipoproteins (LDL) are associated with increased risk for cardiovascular diseases and diabetes mellitus and a reduction in LDL size has been reported in patients with coronary and non-coronary forms of atherosclerosis. LDL size has been accepted as an important predictor of cardiovascular events and progression of coronary artery disease as well as an emerging cardiovascular risk factor by the National Cholesterol Education Program Adult Treatment Panel III. Small, dense LDL, with elevated triglyceride levels and low HDL-cholesterol concentrations, constitute the 'atherogenic lipoprotein phenotype (ALP)', a form of atherogenic dyslipidemia that is a feature of type 2 diabetes and the metabolic syndrome. LDL size and subclasses show specific alterations in patients with the metabolic syndrome that probably significantly increase their cardiovascular risk; however, so far it has not been recommended to incorporate LDL size measurements in treatment plans, when hypolipidemic therapies are installed. Patients with type 2 diabetes are at high cardiovascular risk and it is still on debate if the treatment goals may be identical or whether there are distinct groups with different cardiovascular risks and hence with different treatment goals. Measurements beyond traditional lipids, such as measurements on the presence of small, dense LDL in patients with the metabolic syndrome, may help to identify cardiovascular risk subgroups. In addition, it might be possible in the future to individualize hypolipidemic treatments if more than the traditional lipids are taken into account. LDL size measurement may potentially help to assess cardiovascular risk within the metabolic syndrome and adapt the treatment goals thereafter.
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PMID:Small, dense low-density-lipoproteins and the metabolic syndrome. 1708 Apr 69

The benefits of aspirin treatment in reducing the risk of myocardial infarction, cerebrovascular accidents and vascular death is well-documented among individuals having prior cardiovascular disease, including the subgroup with diabetes mellitus. The role of aspirin in primary prevention is less clear and debatable: the results of the clinical trials currently available are not consistent, although the meta-analyses are favorable in some aspects. There seems to be a disparity between the type of benefit (when found to exist) and gender, the findings being particularly contradictory for diabetic subjects, totalling a minor percentage of the population sample included in the studies. Despite this fact, in 1997, the American Diabetes Association and more recently other scientific societies (including several Spanish societies) have been recommending the use of aspirin in low doses in primary prevention in all type 1 or type 2 diabetic patients over 40 years of age and in all those within the 21-40 age range having any other cardiovascular risk factor in addition to diabetes (family history of vascular disease, hypertension, smoking, dyslipidemia or albuminuria). This study reviews the findings of the randomized, controlled clinical trials on primary cardiovascular prevention with aspirin, on which the official American Diabetes Association guidelines might be based, the conclusion being reached that there is not currently sufficient scientific evidence to uphold these guidelines.
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PMID:[Aspirin for the primary prevention of cardiovascular diseases in diabetic patients. A review of currently available tests]. 1714

Overweight and obesity are increasing problems in many countries and are related to multiple cardiovascular risk factors. Although imaging techniques can determine total body fat and its distribution reliably, anthropometric measurements remain important in clinical practice. The purpose of this study was to determine the association between some anthropometric measurements and dyslipidemia as an important cardiovascular risk factor in Iranian population. A total of 750 subjects (580 females and 170 males) were selected by multistage random sampling from residents of Arak (Iran) and related villages in 2005. None of them had any significant past medical history. Body mass index(BMI), waist circumference(WC), and waist to height ratio(W/Ht) of subjects were measured to identify their relationship with their lipid profile including total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), and the ratio of total cholesterol to high density lipoprotein cholesterol(TC/HDL-C). Fasting blood sugar (FBS) was also measured. WC and W/Ht showed greater correlation with TC, TG, LDL-C, TC/HDL-C level than did BMI. Among lipid profile, TG showed the closest correlation with W/Ht (r=0.309, p<0.001) and WC (r=0.308, p<0.001). HDL-C level did not show any statistical relationship with W/Ht, but it was weakly correlated with WC (r=-0.088, p<0.05). None of the indices showed any association with FBS level. It can be concluded that W/Ht and WC can best predict dyslipidemia in an Iranian adult population. We suggest using both W/Ht and WC as inexpensive and easy methods in clinical and epidemiological fields.
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PMID:Correlation of dyslipidemia with waist to height ratio, waist circumference, and body mass index in Iranian adults. 1746 79

Abdominal obesity is associated with cardiovascular disease. This study aims to compare two measures of abdominal obesity [waist and wais-to-hip ratio (WHR)] in patients with DM2 to identify cardiovascular risk factors: ischemic cardiopathy, hypertension, dislipidemia, obesity and diabetic nephropathy. A multicentric study was performed in 820 patients with type 2 DM. Waist circumference strongly correlated with body mass index (BMI), for men (r= 0.814; P< 0.05) and women (r= 0.770; P< 0.05). On the other hand, WRH was weakly correlated (r= 0.263, P< 0.05 for men; r= 0.092, P< 0.05 for women). Only waist circumference correlated with systolic pressure (r= 0.211, P< 0.05 for men; r= 0,224, P< 0.05 for women). ROC curve analysis demonstrated the superiority of waist circumference measurement compared to WHR regarding obesity and hypertension for men and women, and dyslipidemia for men. In conclusion, waist circumference is better correlated with cardiovascular risk factor than WRH.
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PMID:[Waist measure and waist-to-hip ratio and identification of clinical conditions of cardiovascular risk: multicentric study in type 2 diabetes mellitus patients]. 1754 44

To determine the effect of age and sex on cardiovascular risk factor expression in overweight children, data from clinical records of 497 overweight children (2-18 years of age) were examined. Data included average blood pressure (BP), fasting lipids, glucose, and insulin. The sample was stratified by age (younger than 11 and 11 years and older) and analyzed by sex. Subjects with an average BP > or = 90th percentile were classified as having high BP. Insulin and glucose were used in equations to estimate insulin sensitivity. Among subjects 11 years and older (n = 268), 52.6% of males had high BP compared with 32.6% of females (P < .001). Mean high-density lipoprotein cholesterol was lowest in the males 11 years and older compared with the females and younger males (P < .01). Triglyceride levels trended higher in males independent of age. In multivariate analyses, high BP was most strongly associated with age and severity of overweight while triglyceride level was most associated with sex and insulin resistance. The prevalence of high BP and dyslipidemia in overweight children is high. Overweight males 11 years and older have a higher prevalence of high BP and low high-density lipoprotein cholesterol than females and younger males. Greater cardiovascular risk factor expression in overweight males 11 years and older may explain the earlier appearance of cardiovascular disease end points in overweight men.
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PMID:Association of age and sex with cardiovascular risk factors and insulin sensitivity in overweight children and adolescents. 1767 13

Cardiovascular disease (CVD) remains the most common cause of premature death in the chronic kidney disease (CKD) population. Individuals with CKD are at 10-20 times greater risk of cardiac death than controls without CKD, despite stratification for age, race, sex and diabetes. Heightened CVD mortality begins with mild kidney disease and rises further with more advanced kidney disease. Traditional risk factors account for up to 50% of cardiovascular disease in CKD, whilst renal specific markers, including anemia, disordered bone mineral metabolism and oxidative stress, also likely contribute to the total cardiovascular burden in CKD. Despite the increased mortality, there has been a dearth of interventional cardiovascular randomized controlled trials (RCTs) in the CKD population. Furthermore, many patients with kidney disease have been excluded from the majority of mainstream cardiovascular interventional trials. While recently published RCTs on traditional and non-traditional risk factors including dyslipidemia (PPP, 4D and ALERT, VA-HIT), cardiomyopathy (FOSIDIAL, telmisartan, carvedilol), anemia (US Normal Hematocrit, CHOIR and CREATE trials), hyperhomocystenemia (ASFAST, US folic acid trial, HOST), disordered bone mineral metabolism (Cunningham meta-analysis, DCOR), oxidative stress therapy (SPACE, HOPE and ATIC, N-acetylcysteine) and multidisciplinary multiple cardiovascular risk factor intervention clinics (LANDMARK) have added to the available pool of clinical data, level 1 clinical evidence remains significantly lacking. The negative findings in many of these trials highlight the potential dangers of extrapolating findings from non kidney disease patients to those with CKD. Further large, well-designed trials are urgently required to address this issue.
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PMID:Cardiovascular disease in patients with chronic kidney disease. A clinical review. 1791 25

Low HDL-cholesterol (<1.02 mmol/L [40 mg/dL] in men or <1.29 mmol/L [50 mg/dL] in women) occurs in about one-third of European patients with dyslipidemia and is an independent cardiovascular risk factor. Simultaneous correction of low HDL-cholesterol and high total-cholesterol and LDL-cholesterol may provide reductions in cardiovascular morbidity and mortality beyond those possible with statins alone. Nicotinic acid (niacin in the US) is the most effective means of increasing HDL-cholesterol available and has been shown to reduce cardiovascular event rates significantly. Niaspan (prolonged-release nicotinic acid) provides a convenient, once-daily means of administering nicotinic acid. Clinical studies with Niaspan have demonstrated marked, long-term increases in HDL-cholesterol with additional useful benefits on triglycerides, LDL-cholesterol, and lipid sub-profiles. The NAUTILUS study demonstrated the beneficial efficacy and tolerability profiles of Niaspan in a usual-care setting. The most common side-effect of Niaspan is flushing, which infrequently causes treatment discontinuation and which usually subsides over continued treatment. The ARBITER 2 and ARBITER 3 studies showed 1-2 years of treatment with Niaspan plus a statin induced regression of atherosclerosis in patients with coronary artery disease. The effect of Niaspan-statin treatment, relative to a statin alone, on clinical cardiovascular outcomes is currently under evaluation. Niaspan represents a practical means of correcting low HDL-cholesterol, an independent risk factor for adverse cardiovascular outcomes.
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PMID:Prolonged-release nicotinic acid for the management of dyslipidemia: an update including results from the NAUTILUS study. 1796 77

The metabolic syndrome increases the risk of atherothrombotic cardiovascular disease (CVD) and diabetes. In turn, diabetes promotes the development of atheroma and is regarded as a coronary heart disease risk equivalent. A multifactorial therapeutic strategy is advocated for patients with the metabolic syndrome to improve cardiovascular risk factor profiles and to reduce the chances of developing type 2 diabetes. Individual components of the syndrome must be addressed using safe, efficacious, and cost-effective measures. There is general agreement that lifestyle modifications, including control of body weight, avoidance of central adiposity, adoption of an antiatherogenic diet, and regular physical activity, are crucial. However, as the magnitude of the individual components of the metabolic syndrome increases with time, lifestyle measures are often insufficient. An individual with metabolic syndrome will often require drug treatment for hyperglycemia, atherogenic dyslipidemia, and high blood pressure, together with antiplatelet therapy. Reducing the need for polypharmacy is an increasingly important consideration for clinicians and the pharmaceutical industry; to date, no single therapy has emerged that targets the root cause(s) of the syndrome. HMG-CoA reductase inhibitors are important agents that reduce CVD morbidity and mortality, in people with impaired fasting glucose or metabolic syndrome. Selective cannabinoid receptor antagonists appear promising because they improve or attenuate several key defects of the syndrome. Thiazolidinediones and metformin are presently licensed for treatment of type 2 diabetes but may prove to have a broader role in future. Novel insulin-sensitizing drugs are under investigation. Drugs that act to prevent or reverse endothelial dysfunction may be of particular utility in preventing cardiovascular disease, especially if initiated before tissue damage has become irreversible. Insulin therapy, which has antiinflammatory and endothelial protective properties, has been shown to reduce morbidity and mortality in high-risk nondiabetic patients during critical illness. Potential synergy between different classes of drugs with metabolic and/or cardiovascular protective properties merits further investigation.
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PMID:Prevention of cardiovascular complications of the metabolic syndrome: focus on pharmacotherapy. 1837 Jul 50

Cardiovascular risk profiling and therapy have traditionally been based on established risk factors, such as age, smoking, sex, hypertension, dyslipidemia, body weight, and diabetes mellitus. Despite optimum therapy, cardiovascular mortality and morbidity remain high. Attention is being devoted, therefore, to identifying new risk factors that can also be used as therapeutic targets. Renal dysfunction manifesting as low glomerular filtration rate, albuminuria, or anemia is a strong risk factor for cardiovascular disease and is prevalent in the general population and among patients with cardiovascular disease. Epidemiological data suggest that 10-11% of the general population have low glomerular filtration rates, 5-7% have increased urinary albumin excretion, and 5-10% have anemia. Each of these features represents an independent but additive cardiovascular risk. Treatments for all these indications can reduce cardiovascular mortality and morbidity as well as renal risk. Such findings suggest that treatment should be directed towards improving renal function in order to achieve optimum cardiovascular benefit. Such a strategy would offer the possibility of multiorgan therapy in diseases characterized by multiorgan impairment, such as type 2 diabetes. I present the evidence that renal dysfunction is a common and powerful cardiovascular risk factor and that treatment strategies intervening in the renin-angiotensin-aldosterone system can be used to target albuminuria and reduce cardiovascular and renal risk.
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PMID:Renal disease: a common and a silent killer. 1858 Aug 63


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