Hyperlipidemias: Ades PA

Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JA, Franklin B, Sanderson B, Southard D, Anonymous00052, Anonymous00053, Anonymous00054, Anonymous00055. · No affiliation provided · J Cardiopulm Rehabil Prev. · Pubmed #17558191 No free full text.

Abstract: The American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation recognize that all cardiac rehabilitation/secondary prevention programs should contain specific core components that aim to optimize cardiovascular risk reduction, foster healthy behaviors and compliance to these behaviors, reduce disability, and promote an active lifestyle for patients with cardiovascular disease. This update to the previous statement presents current information on the evaluation, interventions, and expected outcomes in each of the core components of cardiac rehabilitation/secondary prevention programs, in agreement with the 2006 update of the American Heart Association/American College of Cardiology Secondary Prevention Guidelines, including baseline patient assessment, nutritional counseling, risk factor management (lipids, blood pressure, weight, diabetes mellitus, and smoking), psychosocial interventions, and physical activity counseling and exercise training.

Williams MA, Fleg JL, Ades PA, Chaitman BR, Miller NH, Mohiuddin SM, Ockene IS, Taylor CB, Wenger NK, Anonymous00242. · No affiliation provided · Circulation. · Pubmed #11940556 links to  free full text

This publication has no abstract.

Ades PA. · Cardiac Rehabilitation and Prevention, South Burlington, VT 05403, USA. · J Cardiopulm Rehabil Prev. · Pubmed #17558192 No free full text.

Abstract: The benefits of individualizing risk factor therapies and exercise protocols in patients participating in early outpatient cardiac rehabilitation are reviewed. Risk factor intervention modules for modifications of lipid abnormalities and obesity are outlined. Specific individualized exercise regimens are described for patients characterized by the presence of obesity, older age, intermittent claudication, and chronic heart failure, which provide favorable outcomes related to risk factor measures and physical functioning. With adoption and application of an individualized approach for cardiac rehabilitation patients, programs are evolving to become secondary prevention centers for patients with established coronary heart disease.

Polk DM, Keilson LM, Malenka DJ, McGowan MP, Ades PA, Anonymous00086. · Maine Medical Center, Division of Cardiology, Portland, Maine, USA. · J Interv Cardiol. · Pubmed #12053318 No free full text.

This publication has no abstract.

Ades PA, Balady GJ, Berra K. · Division of Cardiology, Fletcher-Allen Health Care, University of Vermont College of Medicine, Burlington, VT, USA. · J Cardiopulm Rehabil. · Pubmed #11591040 No free full text.

This publication has no abstract.

Ades PA. · Department of Medicine, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, USA. · N Engl J Med. · Pubmed #11565523 No free full text.

This publication has no abstract.

Savage PD, Banzer JA, Balady GJ, Ades PA. · Division of Cardiology, University of Vermont College of Medicine, Burlington, Vt, USA. · Am Heart J. · Pubmed #15990744 No free full text.

Abstract: BACKGROUND: Metabolic syndrome (MS) consists of a cluster of obesity-related risk factors that have been linked to the development and progression of coronary heart disease (CHD). The purpose of this study was to examine the prevalence of MS, as defined by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol, in patients with CHD attending cardiac rehabilitation (CR) after a coronary event. METHODS: We analyzed baseline data of 1912 individuals with established coronary artery disease entering CR in Burlington, Vt, and Boston, Mass. RESULTS: Overall, 50% of patients entering CR have MS. A significantly greater percentage of women than men have MS (54% vs 48, respectively, P < .001). This is due to higher prevalence of abdominal obesity, high triglycerides, and hypertension (all, P < .05) in women. In women, the prevalence of MS peaked in the eighth decade vs the fifth decade in men. CONCLUSIONS: The prevalence of MS in patients with CHD participating in CR is greater than twice that of the general population. The prevalence of MS is higher and occurs at an older age in women than men. This study highlights the need for CR programs to develop specific interventions to assist patients with risk factor modification primarily by targeting physical inactivity and weight control.

Kennedy AG, MacLean CD, Littenberg B, Ades PA, Pinckney RG. · Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl Street, Burlington, VT 05401, USA. · Diabetes Care. · Pubmed #15855562 links to  free full text

Abstract: OBJECTIVE: This study analyzed lipid results from a large community-based population of patients with diabetes to assess the feasibility of attaining the standard and new optional LDL-based lipid goals using currently available lipid-lowering medications. RESEARCH DESIGN AND METHODS: Ambulatory patients with diabetes who were interviewed as part of the Vermont Diabetes Information System trial with a reported LDL were analyzed. Patients were categorized into high-risk and very-high-risk cardiovascular status. For patients not at the LDL goal, the required changes in therapy to achieve the goal were assessed. RESULTS: Of the entire cohort, 49.4% (321 of 650) had LDL <100 mg/dl. According to the National Cholesterol Education Program, 29.4% (191 of 650) of patients were very high risk and have an optional LDL goal of <70 mg/dl. Only 15.7% (30 of 191) of very-high-risk patients had an LDL <70 mg/dl. Based on our analysis of high-risk patients, 17 of 459 (3.7%) would require more than two lipid-lowering drugs to achieve an LDL <100 mg/dl. In the very-high-risk group, we estimate that 26.2% (50 of 191) of patients will not reach LDL <70 mg/dl with two lipid-lowering medications. CONCLUSIONS: In many patients with diabetes and cardiovascular disease, it will be difficult to attain an LDL goal of <70 mg/dl. Approximately 25% of patients will require more than two lipid-lowering drugs at maximal doses to attain this goal, assuming 100% tolerance of lipid-lowering medications.

Savage PD, Brochu M, Scott P, Ades PA. · Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA. · Am Heart J. · Pubmed #10966557 No free full text.

Abstract: BACKGROUND: Total physical activity energy expenditure is a determinant of weight loss and risk factor modification in adults. There has been very little study of physical activity energy expenditure in cardiac rehabilitation populations. METHODS: Exercise-related energy expenditure was calculated in 112 patients with coronary artery disease in an outpatient cardiac rehabilitation program. Gross energy expenditure was estimated with the heart rate/oxygen consumption relation as measured during metabolic exercise testing with expired gas analysis. RESULTS: The average exercise training energy expenditure (ETEE) per cardiac rehabilitation exercise session was quite low at 270 +/- 112 kcal. Baseline fitness level (peak oxygen consumption), body weight, total exercise duration per session, age, and body mass index were all significant determinants of ETEE (r = 0.56 to -0.37, all P <.01). Additionally, patients who had undergone coronary bypass surgery and patients with medical comorbidities expended significantly fewer calories during exercise. In women, there was a relation between ETEE and change in total and LDL cholesterol (r = -0.43 and -0.45, respectively), although no such relation was observed in men. CONCLUSION: Cardiac rehabilitation exercise training, as currently structured, burns surprisingly few calories and has little impact in the short term (3 months) on measures of obesity and lipid risk factors. Alternative training programs should be considered to maximize caloric expenditure and modify specific risk factors such as obesity and dyslipidemia.