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Lipid Management (lipid + management)
Selected AbstractsLipid management in populations at risk: Targeting multiple metabolic pathwaysCLINICAL CARDIOLOGY, Issue S3 2004FACC Chief, Luther T. Clark M.D. No abstract is available for this article. [source] Improving lipid management , to titrate, combine or switchINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2004H. Schuster Summary Despite the benefits of statin therapy, cholesterol management remains suboptimal and many patients do not achieve their recommended low-density lipoprotein cholesterol (LDL-C) goals. The use of insufficient doses, limited drug effectiveness and poor patient compliance may contribute to the treatment gap. Options for improving lipid management include dose titration, combination therapy or prescribing a more efficacious statin. LDL-C reductions are generally modest when patients' current statin dose is titrated, and there may be an increased potential for adverse effects. Combining statin therapy with another lipid-modifying agent can provide additional LDL-C reductions, but cost, tolerability and compliance should be considered. In general, switching to a more efficacious statin is a cost-effective way of enabling more patients to achieve recommended targets without increasing dosages. When considering the options available, physicians should balance efficacy, cost and safety to enable more patients to attain LDL-C goals and achieve greater therapeutic gain from statin treatment. [source] Diabetic dyslipidaemia: past, present and futurePRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 2 2004Consultant Physician, FAHA Professor of Endocrinology, Metabolism, Prof DJ Betteridge BSc Abstract Prevention of cardiovascular disease (CVD) in diabetes remains a major challenge for both physicians and patients. Diabetic dyslipidaemia is a major risk factor for CVD and is open to therapeutic intervention. Information now available from randomised, controlled, clinical trials (principally with statins) confirms highly significant benefits in terms of CVD reduction for diabetic patients with and without symptomatic CVD. This evidence base has moved treatment of dyslipidaemia to centre stage in CVD prevention. Important European and American guidelines point to the high CVD risk in type 2 diabetes and type 1 diabetes with albuminuria and advocate aggressive lipid management for primary as well as secondary CVD prevention. Currently there is evidence of sub-optimal uptake of appropriate lipid-lowering therapy and guidelines need to be fully implemented in clinical practice for the benefit of individual patients. In the future it is likely that more combination therapy will be used to treat diabetic dyslipidaemia in order to achieve better overall lipid control. Copyright © 2004 John Wiley & Sons, Ltd. [source] Coronary Risk Factor Management in the Framework of a Community Hospital-Based Ambulatory Exercise Training ProgramPREVENTIVE CARDIOLOGY, Issue 2 2004Morton Leibowitz MD Ischemic heart disease is a chronic illness that causes major mortality and morbidity. Angiographic studies have shown the effectiveness of exercise programs, in combination with aggressive lipid management, in reversing or slowing the progression of atherosclerotic coronary disease. Despite these studies, participation in supervised programs that combine exercise and risk-factor management is limited. The authors measured the ability of a community hospital-based ambulatory cardiac rehabilitation program to recruit patients and to facilitate reduction of risk factors that have been demonstrated to influence progression of disease. Patients were recruited from a single community hospital for an ambulatory exercise training and cardiac risk-factor management program, and clinical and laboratory data was collected periodically. Recruited patients participated in a minimum 3-month period of training and counseling by a multidisciplinary team with follow-up measurements of weight, lipid profile, blood pressure, and exercise capacity. Thirty-two percent of the eligible hospitalized patients were successfully recruited into the program. Dropout rates over the initial 3 months were low (25%). Improvement in low-density lipoprotein cholesterol level (,4.5%), high-density lipoprotein cholesterol level (+7%), body mass index (,2%), systolic blood pressure (,3%), and maximum metabolic equivalents (+25%) were comparable to levels achieved in studies showing angiographic stabilization and/or regression of disease. Implementation of a community hospital-based risk management exercise program is an effective method for improving the long-term management of patients with chronic ischemic heart disease. [source] Prevalence and treatment of hypercholesterolaemia in patients with peripheral vascular diseaseBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000S. M. Evans Background: Hypercholesterolaemia is a recognized risk factor for the development of arteriosclerosis. There is compelling evidence to support the use of lipid-lowering strategies in all hypercholesterolaemic patients with arteriosclerotic disease. In peripheral arterial disease (PAD), national guidelines recommend treatment if total cholesterol exceeds 5·0 mmol l,1. The prevalence of hypercholesterolaemia in patients with PAD was determined and the adequacy of lipid management before vascular referral was examined. Methods: This was a prospective study of 233 consecutive patients admitted electively to this vascular surgery unit between December 1997 and December 1998. Some 68 patients were admitted with carotid disease, 81 with an aneurysm and 84 with intermittent claudication. A fasting venous blood sample was obtained from each patient. Results: There were 175 men and 58 women, of median age 67 (range 37,85) and 68 (range 47,85) years respectively. Only 35 patients (15 per cent) were previously known to be hypercholesterolaemic; all but one were receiving treatment (one dietary, 33 statin). Of the remaining 198 patients, 124 (63 per cent) had a serum cholesterol level above 5·0 mmol l,1. A further 17 patients (9 per cent) had total cholesterol/high-density lipoprotein: cholesterol ratio greater than 5·0; these patients may also benefit from lipid-lowering therapy. In total, 141 (80 per cent) of 176 hypercholesterolaemic patients were undiagnosed at the time of hospital admission. Conclusion: Hypercholesterolaemia is an important and correctable risk factor found in the majority of patients with PAD, but despite national guidelines and clear evidence from randomized controlled trials it is simply not being diagnosed in primary care. All elective patients with PAD should be screened for hypercholesterolaemia during their admission. © 2000 British Journal of Surgery Society Ltd [source] Assessing coronary heart disease risk with traditional and novel risk factorsCLINICAL CARDIOLOGY, Issue S3 2004Peter W. F. Wilson M.D. Cardiovascular disease is the leading cause of death in the industrialized world, and a number of well-characterized factors, including advanced age, hypertension, dyslipidemia, diabetes, and smoking, contribute to cardiovascular risk. Integration of these factors using the Framingham calculation estimates the absolute 10-year risk for coronary heart disease (CHD), which can be used to guide therapy. Recent studies have demonstrated that additional markers, including elevated lipoprotein(a), homocysteine, sitosterol, and particularly C-reactive protein (CRP), are also associated with increased risk for CHD. In particular, high-sensitivity CRP has been shown to identify patients with high CHD risk who may not have elevated low-density lipoprotein cholesterol (LDL-C) and may add to the predictive value of the Framing-ham functions for CHD risk assessment. Assessment of global risk is particularly important in lipid management, as the LDL-C target goals are determined by risk category. [source] | ||||||||||