Hyperlipidemias: Garcia A

Patterson C, Feightner JW, Garcia A, Hsiung GY, MacKnight C, Sadovnick AD. · Division of Geriatric Medicine, McMaster University, Hamilton, Ont. · CMAJ. · Pubmed #18299540 links to  free full text

Abstract: BACKGROUND: In addition to nonmodifiable genetic risk factors, potentially modifiable factors such as hypertension, hyperlipidemia and environmental exposures have been identified as risk factors for Alzheimer disease. In this article, we provide physicians with practical guidance on risk assessment and primary prevention of Alzheimer disease based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006. METHODS: We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that met the following criteria: dementia (all-cause, Alzheimer disease or vascular dementia) as the outcome; longitudinal cohort study; study population broadly reflective of Canadian demographics; and genetic risk factors and general risk factors (e.g., hypertension, education, occupation and chemical exposure) identified. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care. RESULTS: Of 3424 articles on potentially modifiable risk factors for dementia, 1719 met our inclusion criteria; 60 were deemed to be of good or fair quality. Of 1721 articles on genetic risk factors, 62 that met our inclusion criteria were deemed to be of good or fair quality. On the basis of evidence from these articles, we made recommendations for the risk assessment and primary prevention of Alzheimer disease. For the primary prevention of Alzheimer's disease, there is good evidence for controlling vascular risk factors, especially hypertension (grade A), and weak or insufficient evidence for manipulation of lifestyle factors and prescribing of medications (grade C). There is good evidence to avoid estrogens and high-dose (> 400 IU/d) of vitamin E for this purpose (grade E). Genetic counselling and testing may be offered to at-risk individuals with an apparent autosomal dominant inheritance (grade B). Screening for the apolipoprotein E genotype in asymptomatic individuals in the general population is not recommended (grade E). INTERPRETATION: Despite the personal and societal burden of dementia, our understanding of genetic predisposition to dementias and the contribution of other risk factors remains limited. More importantly, there are few data to explain the overall risks and benefits of prevention strategies or their impact of risk modification.

Le D, Garcia A, Lohsoonthorn V, Williams MA. · Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, Washington, USA. · Southeast Asian J Trop Med Public Health. · Pubmed #17333747 No free full text.

Abstract: The purpose of our study was to evaluate risk factors for hypercholesterolemia and correlates of serum lipid concentrations in Thai men and women. A cross-sectional study was conducted in 1392 patients (380 men and 1012 women) who received health examinations during July 1999 - February 2000 at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Serum total cholesterol (TC), triglyceride (TG) and high density lipoprotein- cholesterol (HDL-C) concentrations were determined using standard procedures. Logistic and linear regression procedures were used to assess the association of several covariates with risk for hypercholesterolemia. The results reveal that the prevalences of hypercholesterolemia (TC > or =200 mg/dl) among men and women were 66.8% and 66.0%, respectively. Among men, hypercholesterolemia was associated with older adults (OR = 3.26), and previous alcohol consumption (OR = 2.05). Risk factors for women included advanced age (OR = 3.19), and a family history of dyslipidemia (OR = 1.59). Serum TC and TG were positively associated with age and previous alcohol consumption among men. Among women, TC and TG were strongly associated with age, body mass index (BMI) and family history of dyslipidemia. In men and women, HDL-C was inversely associated with BMI. More emphasis should be placed on understanding the epidemiology of hypercholesterolemia and other dyslipidemias in Thai men and women. More information regarding risk factors will aid in the development of effective health promotion and disease prevention efforts.

Jamshidi M, Obermeyer RJ, Govindaraj S, Garcia A, Ghani A. · St. Anthony Hospital, 608 NW 9th Street, Suite 4100, Oklahoma City, OK 73102, USA. · J Okla State Med Assoc. · Pubmed #11845676 No free full text.

Abstract: Isotretinoin is a vitamin-A derivative most commonly utilized in the treatment of severe recalcitrant nodulocystic acne. Derangement of lipid metabolism leading to increased triglyceride and cholesterol level has been reported after taking this drug. We report the case of a 43-year-old female with no identifiable risk factor for pancreatitis who developed acute pancreatitis associated with hyperlipidemia while being treated with isotretinoin for hidradenitis suppurativa. To our knowledge, this is the third reported case of isotretinoin-induced hyperlipidemia leading to acute pancreatitis.