Hypercholesterolemia: Planet Earth

López Rodríguez MJ, Román Riechmann E, Sierra Salinas C, Ros Mar L, Anonymous00271. · Servicio de Pediatría, Gastroenterología Pediátrica, Complejo Hospitalario San Pedro de Alcántara, Cáceres. · An Esp Pediatr. · Pubmed #11696312 links to  free full text

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Anonymous00013. · No affiliation provided · JAMA. · Pubmed #11368702 No free full text.

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Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G, Hill M, Howard G, Howard VJ, Jacobs B, Levine SR, Mosca L, Sacco RL, Sherman DG, Wolf PA, del Zoppo GJ. · No affiliation provided · Stroke. · Pubmed #11136952 links to  free full text

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Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G, Hill M, Howard G, Howard VJ, Jacobs B, Levine SR, Mosca L, Sacco RL, Sherman DG, Wolf PA, del Zoppo GJ. · No affiliation provided · Circulation. · Pubmed #11136703 links to  free full text

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Anonymous59459. · No affiliation provided · Rev Esp Salud Publica. · Pubmed #10918811 No free full text.

Abstract: The report "Cholesterolemia Control In Spain, 2000. A tool for Cardiovascular Disease Prevention" reviews current evidence on cardiovascular prevention and therapeutical advances occurred in the last years, in order to help overall risk-based clinical decision-making. Cardiovascular disease ranks as the first cause of death in Spain, accounting for almost 40% of total mortality. During the last years age-adjusted cardiovascular death rates have been declining, but the absolute number of deaths by coronary heart disease is ascending due mainly to the population aging. Coronary heart disease is the first cause of hospital consultation due both to the lesser coronary heart disease mortality and to the increase in coronary heart disease incidence. The demographic, health and social impact of cardiovascular disease is increasing and it is likely to go on in the next decades. Appropriate treatment of high blood cholesterol and of other major modifiable risk factors is crucial for preventing cardiovascular disease. Specific actions to carry out depend on the risk to get ill. Individual risk stratification is essential as it determines the follow up periodicity and treatment intensity. Priorities of control of cholesterolemia and its consequent risk are based on risk stratification. The groups for intervention are ordered in a descendent priority hierarchy as follows: 1. Secondary prevention: Patients with established coronary heart disease or other atherosclerotic disease. 2. Primary prevention: Healthy individuals who are at high risk of developing coronary heart disease or other atherosclerotic disease, because of a combination of risk factors--including lipids (raised total cholesterol, and LDL-cholesterol, low HDL-cholesterol and raised triglycerides), smoking, raised blood pressure, raised blood glucose, family history of premature coronary disease--or who have severe hypercholesterolaemia, or other forms of dyslipidaemia, hypertension or diabetes. 3. Close relatives of patients with early onset coronary heart disease or other atherosclerotic disease. 4. Others individuals met in connection with ordinary clinical practice. In primary prevention, the therapeutic objective in high risk patients (risk (3)20%--upon the risk chart of the European Societies of Cardiology, Atherosclerosis, Hypertension--or individuals with 2 or more risk factors--National Cholesterol Education Program II-) is set up at LDL-cholesterol < 130 mg/dl. In secondary prevention, the drug treatment will be indicated when LDL-cholesterol (3)130 mg/dl and the therapeutic objective will be LDL-cholesterol < 100 mg/dl. Statins are first line drugs for treatment of high blood cholesterol. Where moderate-severe hypertrigliceridemia or low HDL-cholesterol fibrates are preferred. In acute coronary syndrome hypolipemiant treatment, where indicated, should be used as soon as possible. Coronary heart disease patients should be offered secondary prevention programmes which provide, in a continuous manner, a good clinical and risk factor control, with appropriate cost-effectiveness drugs.

Fodor JG, Frohlich JJ, Genest JJ, McPherson PR. · Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ont. · CMAJ. · Pubmed #10834048 links to  free full text

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Anonymous57848. · No affiliation provided · S Afr Med J. · Pubmed #10745973 No free full text.

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Anonymous57847. · No affiliation provided · S Afr Med J. · Pubmed #10745972 No free full text.

Abstract: The optimum management of dyslipidaemia requires a comprehensive, diagnostic work-up. This, minimally, includes: Characterisation of any hyperlipidaemic disorder present. Identification of additional risk factors so as to assess overall (global) risk of future coronary heart disease (CHD). The global risk is best assessed by a calculation combining the risk factors in the individual. In severe monogenic dyslipidaemias and in patients with confirmed pre-existing CHD the risk is usually high; in most such cases the use of lipid-modifying drugs (LMDs) is indicated. Assessment of psychosocial, economic and educational factors relevant to management. Prevention and cost-effective management of even moderately dyslipidaemic patients require appropriate modification of lifestyle: avoidance of tobacco smoking, participation in regular exercise, and a health-promoting diet. Depending on individual circumstance, vigorous, personalised intervention and expert assistance from dieticians, biokineticists and other health care personnel may determine success. The correct choice of patient for drug treatment is a key therapeutic decision and is best done after full lifestyle modification. Recent evidence confirms that appropriately prescribed LMD therapy can lower morbidity and mortality from CHD as well as all-cause mortality. Patients with the following features are candidates for LMD therapy: have clinical CHD and a low-density lipoprotein cholesterol (LDLC) level > 3.0 mmol/l despite optimum non-pharmacological intervention, or suffer from familial hypercholesterolaemia (FH) or equivalent severe, monogenic disorder, or have a 10-year risk of an acute clinical coronary event of > 20% (or > 30% risk if extrapolated to the age of 60 years) owing to the presence of the hyperlipidaemia alone or in combination with contributory risk factors. The ideal target LDLC concentration is < or = 3 mmol/l, but a reduction of at least 45% should be regarded as a minimum target in severe cases who do not reach this goal. Successful therapy requires on-going attention to compliance, therapeutic response and side-effects, and may necessitate adjustment or reinforcement. Concurrent or contributory conditions, such as smoking, hypertension and diabetes mellitus, must also be treated along with the clinically manifest CHD. Severely hyperlipidaemic, complicated or unresponsive high-risk cases should be referred to an appropriate specialist or lipid clinic. Prevention of CHD in the community should be encouraged through public and professional education, the provision of community facilities for exercise and recreation, and legislation directed at reducing the use of tobacco products and ensuring the appropriate labelling of food products.

Heathcote EJ. · Division of Gastroenterology, University of Toronto, The Toronto Hospital, Toronto, Ontario, Canada. · Hepatology. · Pubmed #10733559 No free full text.

Abstract: Primary biliary cirrhosis (PBC) is a presumed autoimmune disease of the liver, which predominantly affects women once over the age of 20 years. Most cases are diagnosed when asymptomatic (60%). The antimitochondrial antibody is present in serum in most, but not in all, patients with PBC. The disease generally progresses slowly but survival is less than an age- and gender-matched general population. The symptomatic patient may have fatigue, generalized pruritus, portal hypertension, osteoporosis, skin xanthomata, fat soluble vitamin deficiencies, and/or recurrent asymptomatic urinary tract infections. Many nonhepatic autoimmune diseases are found in association with PBC and may prompt initial presentation. To date, immunosuppressive therapy has not been shown to prolong survival in PBC. The hydrophilic bile acid, ursodeoxycholic acid (UDCA), has been shown when given in a dose of 13 to 15 mg/kg daily for up to 4 years to delay the time to liver transplantation or death. This therapy also causes a significant improvement of all the biochemical markers of cholestasis but has no beneficial effects on any of the symptoms or associated disorders. Treatment with UDCA does not obviate the need for liver transplantation. Therapies to prevent complications arising from malabsorption, portal hypertension, and/or osteoporosis are required as well. Good control of pruritus can be achieved in most patients. PBC is diagnosed with increasing frequency, but the agent(s) responsible for this slowly progressive destruction of the interlobular bile ducts remains elusive and hence a specific therapy remains unavailable.

van der Laan JR, Thomas S. · Nederlands Huisartsen Genootschap, afd. Standaardenontwikkeling, GE Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #10719546 No free full text.

Abstract: The revised guidelines on cholesterol of the Dutch College of General Practitioners (DCGP), which closely follow the consensus of the Dutch Institute for Health Care Improvement, provide thresholds for treatment with statins in patients with elevated risks for coronary heart disease (CHD): patients with a history of cardiovascular disease, with an annual CHD risk larger than 2.5-3%, or with a (suspected) hereditary lipid disorder. Unlike the consensus the DCGP guideline advises only to determine a total cholesterol/HDL cholesterol ratio if the accompanying risk table indicates that the patient might fall in the range where drug treatment is indicated. For this purpose an extra column has been added to the table. In patients with a possible hereditary lipid disorder a higher threshold for referral to a specialist is used because moderately raised levels are common in the population and indicate a familial lipid disorder in only part of the cases.

van Ballegooie E, van Everdingen JJ. · Nederlandse Diabetes Federatie, Leusden. · Ned Tijdschr Geneeskd. · Pubmed #10719544 No free full text.

Abstract: Early detection and adequate treatment of complications of diabetes mellitus (DM) are important for many patients in maintaining independence and ability to work. Diabetic retinopathy cannot be prevented. Limitation of damage is possible by aiming for normoglycaemia and normotension. While exudative as well as proliferative retinopathy can occur without any visual symptom, regular ophthalmological examination is necessary for timely laser coagulation. Fundus photography for screening is applicable under certain conditions; fluorescence angiography can be useful in patients with understood deterioration of visual acuity or diabetic maculopathy. In many patients foot disease can be prevented by simple measures: examining the foot at least once a year, recognition of the foot with a high level of risk, education of patient and family, adapted shoes and preventive foot care. Treatment of a foot ulcus consists of relief of mechanical pressure, repair of disturbed skin circulation, treatment of infection and oedema, optimal metabolic control, frequent local wound care and education. Patients with a diabetic foot have to be thoroughly followed up for the rest of their lives. For patients with diabetic nephropathy cardiovascular complications are the main causes of morbidity and mortality. Of all patient with DM older than 10 years urine has to be examined for loss of albumin at least once a year. Treatment of nephropathy consists of non-smoking, sufficient physical exercise, reduction of overweight, well-composed nutrition and particularly treatment of hypertension. Diagnosing cardiovascular diseases in patients with DM is in principle the same as for other patients. Treatment of hypercholesterolaemia has to be based on an absolute risk of 20% for cardiovascular disease in the following 10 years. The limit for treatment will be reached earlier in the presence of microalbuminuria, persistent high HbA1c > 8.5%, triglyceride concentration > 2.0 mmol/l, or a positive family history with myocardial infarction < 60 years. In proven cardiovascular disease one needs to strive for optimalization of the glucose metabolism, non-smoking and if necessary drug therapy.

Becker HJ, Schwandt P, Held K, Bönner G. · · Dtsch Med Wochenschr. · Pubmed #10572535 No free full text.

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Wiersma TJ, Heine RJ, Rutten GE. · Afd. Standaardenontwikkeling, Nederlands Huisartsen Genootschap, Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #10494309 No free full text.

Abstract: The main changes of the first revision of the guideline of the Dutch College of General Practitioners on the diagnosis and treatment of diabetes mellitus type 2 compared with the first edition concern the following aspects: more attention is given to organisation and management of diabetes care; new diagnostic criteria for diabetes are introduced; guidelines are given for the early detection of diabetes in high risk groups; the distinction between sulfonylureas of the first and the second generation has been dropped; in the treatment of patients with diabetes and a body mass index > 27 metformin is the drug of first choice; optional guidelines are given for the treatment with insulin; guidelines are given for the treatment of hypertension and hypercholesterolaemia in patients with diabetes.

Alpers DH. · No affiliation provided · Curr Opin Gastroenterol. · Pubmed #19528879 No free full text.

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Paraskevas KI, Bessias N, Perdikides TP, Mikhailidis DP. · No affiliation provided · Curr Med Res Opin. · Pubmed #19505206 No free full text.

Abstract: Statins play a key role in the management of hypercholesterolemia and other dyslipidemias. However, statins exert several other actions, often referred to as 'pleiotropic'. This Editorial looks at the JUPITER trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), examining, in particular, the occurrence of venous thromboembolism in the rosuvastatin and placebo groups, and discussing these findings in the context of the current literature. The authors conclude that statin use could perhaps be associated with reductions in the risk of venous thromboembolism, and call for further appropriately designed studies.

Helske S, Otto CM. · No affiliation provided · Circulation. · Pubmed #19470899 No free full text.

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Gaspari AL, Di Lorenzo N, Gentileschi P, Camperchioli I. · No affiliation provided · G Chir. · Pubmed #19419612 No free full text.

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Ashikaga H, Blumenthal RS, Jones SR. · No affiliation provided · Am J Cardiol. · Pubmed #19406279 No free full text.

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Lundberg JO. · No affiliation provided · Am J Physiol Heart Circ Physiol. · Pubmed #19304948 No free full text.

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Cook S. · No affiliation provided · Circulation. · Pubmed #19255353 No free full text.

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Neil A, Humphries SE. · No affiliation provided · BMJ. · Pubmed #19158168 No free full text.

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Koh KK, Quon MJ. · No affiliation provided · Int J Cardiol. · Pubmed #19136168 links to  free full text

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Ciaccio EJ. · No affiliation provided · Heart Rhythm. · Pubmed #19121804 No free full text.

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Moulin P. · No affiliation provided · Arch Cardiovasc Dis. · Pubmed #19041834 No free full text.

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Jarvik GP, Brunzell JD, Motulsky AG. · No affiliation provided · J Am Coll Cardiol. · Pubmed #19007591 No free full text.

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