Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0242339 (dyslipidemia)
 13,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results of AFCAPS/TexCAPS provide strong evidence for the benefits of primary prevention through lipid-regulating treatment across the spectrum of clinical coronary events that are often the first manifestations of atherosclerotic disease. These results reinforce current NCEP guidelines and demonstrate the need for the inclusion of HDL-C in clinical evaluations. The clear benefit observed in AFCAPS/TexCAPS reinforces the need to implement treatment in all individuals with average LDL-C and low HDL-C who may be at risk for CHD. According to estimates based on phase-2 NHANES III data (1991-1994), only 1.4 million (6.6%) of 21.1 million American adults eligible for cholesterol-lowering drug therapy by NCEP guidelines were receiving such therapy, including 14% of those eligible in secondary prevention and 4% of those eligible in primary prevention. Of diet- or drug-eligible adults, 65% received no therapy of any kind. Undertreatment of dyslipidemia continues to be a problem today. These statistics suggest that physicians must improve their efforts to reverse the toll of atherosclerotic disease through risk factor management.
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PMID:Lipid management in patients at moderate risk for coronary heart disease: insights from the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). 1048 39

Persons with chronic SCI have several metabolic disturbances. As a consequence of inactivity and the body compositional changes of decreased skeletal muscle with a relative increase in adiposity, a state of insulin resistance and hyperinsulinemia has been demonstrated to exist, associated with abnormalities in oral carbohydrate handling. Elevated plasma insulin levels in persons with SCI probably contribute to the cause of frequent dyslipidemia and hypertension. This constellation of metabolic changes represents an atherogenic pattern of CHD risk factors with many of the distinctive features of a cardiovascular dysmetabolic syndrome that is called syndrome X. Reduction in modifiable risk factors for CHD should decrease the occurrence of catastrophic cardiovascular events. There is evidence to suggest that endogenous anabolic hormone levels are depressed in a proportion of individuals with SCI. Depression of serum testosterone and growth hormone/IGF-I levels may exacerbate the adverse lipid and body compositional changes, reduce exercise tolerance, and have deleterious effects on quality of life. Because of immobilization, individuals with paraplegia have osteoporosis of the pelvis and lower extremities, and those with tetraplegia also have osteoporosis of the upper extremities. In addition, there is evidence to suggest that bone loss progresses with time in persons with chronic SCI. This may be caused by chronic immobilization per se or may be a consequence of adverse hormonal changes, including deficiency of anabolic hormones or deficiency of vitamin D and calcium with secondary hyperparathyroidism. Serum thyroid function abnormalities resembling the euthyroid sick "low T3 syndrome" have been reported in those with acute and chronic spinal cord injury. Depressed serum T3 and elevated rT3 in chronic SCI may be caused by associated illness. Current practice has been hesitant to treat abnormal serum thyroid chemistries associated with nonthyroidal illness. Recognition of metabolic abnormalities in individuals with SCI is vital as a first step in improving clinical care. The application of appropriate interventions to correct or ameliorate these abnormalities promises to improve longevity and quality of life in persons with SCI.
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PMID:Metabolic changes in persons after spinal cord injury. 1068 Jan 61

Dyslipidaemia is an important component of the metabolic syndrome observed in patients with type 2 diabetes, and is characterized by moderate hypertriglyceridaemia and low levels of high-density lipoprotein (HDL) cholesterol concentrations. Dyslipidaemia contributes to increased vascular risk and is therefore a good target for therapeutic intervention in the form of glycaemic control, lifestyle measures and hypolipidaemic drugs. It is proposed that lipid abnormalities in type 2 diabetes are secondary consequences of insulin resistance. Any approach that lowers insulin resistance would be anticipated to have a beneficial effect on dyslipidaemia, but in many cases patients with type 2 diabetes fail to achieve normal lipidaemia through diet, exercise and glycaemic control. Subgroup analyses of major clinical trials suggests that lipid-lowering therapy reduces CHD risk in patients with diabetes, but trials performed specifically in populations of patients with diabetes are ongoing. Until then, patients with type 2 diabetes who have established CHD or high individual risk already warrant aggressive lipid-lowering pharmacotherapy. In the author's view, when ongoing studies are complete it is likely that most patients with type 2 diabetes will be prescribed lipid-lowering drugs.
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PMID:Diabetic dyslipidaemia. 1122 57

Relatively few studies have examined the clinical effectiveness of cholesterol-lowering drugs in women as compared with men. Most clinical trials do indicate that cholesterol lowering reduces clinical events equally effectively in both genders. However, high-density lipoprotein cholesterol and triglyceride levels may have more prognostic significance in women. The recent finding of a higher risk of death in younger women as compared with younger men who sustain a heart attack, combined with the high proportion of morbidity and mortality due to CHD in older women, emphasizes the need for a better understanding of heart disease in women. This review explores the similarities and differences between women and men regarding the management of dyslipidemia.
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PMID:Optimal management of dyslipidemia in women and men. 1127 70

In this chapter, we have reviewed many of the steps necessary for effective CHD risk reduction. The first step in the office setting is to assess the individual CHD risk. This combines the evaluation of current CHD or a "secondary risk equivalent" with the counting of risk factors and in many cases, the absolute risk calculation. The next steps are to consider each of the major modifiable risk factors (hypertension, dyslipidemia, diabetes mellitus, smoking status) to set goals for each and then work to achieve those goals through lifestyle changes and medication therapy. We reviewed each of these risk factors in detail and then turned to a discussion of emerging risk factors that may help "fine-tune" the risk assessment in some borderline cases. We also discussed additional non-invasive testing that is available to the clinician to help refine the assessment of current burden of disease. Finally, we discuss some of the barriers that exist on both a global and local level to effective treatment of CHD risk factors.
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PMID:Cardiovascular disease prevention. 1252 4

Evidence for the effectiveness of lipid-lowering therapy in reducing CHD risk continues to emerge. In primary prevention, clinical trials have demonstrated a benefit for middle-aged, high-risk men with high LDL cholesterol and, more recently, for men and women with "average" LDL and low HDL cholesterol. Although low HDL cholesterol, small dense LDL particles, elevated lipoprotein (a), elevated apolipoprotein B, and the dyslipidemia of the metabolic syndrome pose an increased in CHD risk in some patients, the risk reduction with lipid-lowering therapy has not been fully investigated. The CHD risk of isolated hypertriglyceridemia remains uncertain. Very high triglyceride levels, however, should be treated to prevent pancreatitis. A lipid-lowering diet and other appropriate lifestyle changes constitute safe advice for all patients with dyslipidemia. In initiating pharmacologic therapy, physicians should view potential risk reduction in the context of a patient's overall CHD risk. The selection of particular medications can be individualized, considering effectiveness evidence from clinical trials, lipid-lowering potency, adverse effects, drug interactions, costs, and patient preferences.
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PMID:Management of dyslipidemias in the age of statins. 1502 90

A few past clinical and recent case-control studies of statin use, for example, in patients with and without prostate cancer have not demonstrated its potential for reducing or preventing the risk for this disease, and the potential for benefit may have been a confounding coincidence. Data from larger continuing and future studies will be needed to resolve this issue, but the recent data on cholesterol or dyslipidemia and risk increase or reduction with treatment are interesting, especially because of other potential improvements with therapy in nonprostate cancers. In addition, the finding that some available cancer treatments improve some parameters of the lipid profile is fascinating, and some cancer drugs are being used in a specific cardiovascular disease treatment setting to improve outcome. Even if CHD, dyslipidemia, and the treatment of these conditions has no role in preventing prostate cancer or its progression, what has been lost? CVD is still the leading cause of death of men, and a heart-healthy program for the patient concerned about prostate disease would reduce this primary cause of death. Patients would take a step forward in improving all-cause mortality. Recent data from surveys, however, continue to demonstrate that men have an inadequate understanding of cholesterol and heart disease. Crisis creates opportunity, and individuals working in urology have ample reasons not only to discuss the overall benefits of reducing lipid markers, but to improve cholesterol and CHD awareness as much as health professionals working in other fields of medicine. The marriage between general preventive medicine and urology seems to be inevitable, and in the authors' opinion, this merger will provide the foundation for novel research that could affect patients' lives dramatically.
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PMID:Prostate cancer and coronary heart disease: correlation or coincidence? 1512

Dyslipidemia, fundamental to the atherosclerotic process, is now a readily correctable risk factor with established efficacy of treatment for reducing risk of CHD and strokes. The current focus on LDL-cholesterol for risk assessment needs to be broadened to accommodate the two-way traffic of cholesterol entering and leaving the arterial intima reflected by the LDL/HDL ratio or the Total/HDL ratio. The choice of lipid therapy should be individualized to take into account the presence of the metabolic syndrome and the lipid profile of the patient. The intensity of therapy and goals should be linked to multivariable risk, particularly in those with modest lipid values. Cardiovascular risk factor clustering is pronounced for each lipid, is promoted by adiposity and greatly influences its CHD hazard. Global risk assessment taking clustering into account is essential for efficient preventive management of lipids. More attention needs to be afforded the absolute risk reduction attainable and must recognize that the number needed to treat to prevent one event increases the lower the lipid value, the lower global risk and the healthier the subject.
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PMID:Risk stratification of dyslipidemia: insights from the Framingham Study. 1597 83

Clinicians sometimes consider family history of CHD when evaluating CHD risk and deciding whether to prescribe a lipid medication. Most clinicians who take family history of CHD into account do so by categorically adjusting the aggressiveness of patient education and preventive medication recommendations (eg, from a low-key informational mode to a more direct influential or persuasive mode). Quantitative methods exist for taking into account any family history of CHD in parents and siblings, when estimating an individual's 10-year risk for a CHD event; at present, these methods are not readily available. For those individuals who have a positive family history of CHD, using family history-adjusted risk estimates could help clinicians more accurately target high-risk individuals who are the most appropriate candidates for therapeutic lifestyle changes and dyslipidemia drug therapy. Electronic health records (EHR) that now include CHD risk estimation as a decision support feature exclude family history from the calculation. Unless family CHD history is included in EHR decision support modules, family history of CHD will be increasingly discounted or ignored, as clinicians come to rely more and more on computerized decision support aids.
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PMID:Family history of coronary heart disease: evidence-based applications. 1632 24

Dyslipidemia is an important, modifiable CHD risk factor. Previous studies have reported the prevalence of dyslipidemia particularly in urban populations. However, its prevalence in rural Northeast Thailand has not been well documented since extensive dietary and lifestyle transitions induced by the rapid socio-economic development of the late 1990s and early 2000s. The authors, therefore, conducted a cross-sectional assessment for the prevalence of dyslipidemia among rural Thais (in Khon Kaen province) using the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) Guidelines. The 325 subjects recruited (136 men; 189 women) averaged 53.8 +/- 17.6 years of age (range, 20-88). After having the subjects fast 12 hours, serum samples were collected. Total cholesterol, triglycerides, low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) cholesterols were measured. The prevalence of hypercholesterolemia (> 200 mg/dL), hypertriglyceridemia (> 150 mg/dL), high LDL-C (> 130 mg/dL) and low HDL-C (< 40 mg/dL) was 31, 40, 20 and 14 per cent, respectively. Women had a 2- to 3.5-fold higher prevalence of hypercholesterolemia and high LDL-C than men, while the prevalence of hypertriglyceridemia was comparable. The prevalence of dyslipidemia increased with advancing age and increasing BMI; notwithstanding, a high prevalence of dyslipidemia was observed in the youngest tertile as well. In conclusion, the present study demonstrated a high prevalence of dyslipidemia in rural Thai adults; consequently, primary lipid screening should be considered for all ages.
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PMID:Prevalence of dyslipidemia in rural Thai adults: an epidemiologic study in Khon Kaen province. 1640 37


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