Hyperlipidemias: Talbert RL

Talbert RL, Pieper JA, Ito MK, Anonymous00238. · College of Pharmacy, University of Texas at Austin, USA. · Am J Health Syst Pharm. · Pubmed #12901027 No free full text.

This publication has no abstract.

Talbert RL, Anonymous00237. · College of Pharmacy, University of Texas at Austin, USA. · Am J Health Syst Pharm. · Pubmed #12901024 No free full text.

Abstract: Using recently updated guidelines to evaluate and manage lipid disorders is discussed. Coronary heart disease (CHD) is a costly chronic condition associated with significant morbidity and mortality. Epidemiologic data further indicate that dyslipidemia and associated conditions, which may lead to CHD, are grossly undertreated. In 2001, the third National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) released updated guidelines for the evaluation and treatment of lipid disorders. Significant changes to the updated guidelines include designation of a CHD risk equivalent category identifying patients who require aggressive management, recommendation of Framingham-based CHD risk assessment in patients with multiple risk factors, revised target levels for several of the lipids and lipoproteins, and criteria for the identification of patients with the metabolic syndrome. Low-density lipoprotein cholesterol (LDL-C) continues to be the primary target of therapy. In addition, non-high-density lipoprotein cholesterol (HDL-C) is now defined as a secondary treatment target in patients with hypertriglyceridemia. Increased emphasis is placed on the metabolic syndrome, low HDL-C levels, and the presence of multiple and emerging risk factors in guiding the intensity of therapy. The NCEP ATP III guidelines acknowledge challenges in implementing and maintaining patient adherence to both lifestyle changes and pharmacotherapy regimens and provide strategies for increasing treatment success. Implementation of these new guidelines will likely enhance identification, management, and treatment success rates among patients at risk for CHD in the United States.

Talbert RL, Anonymous00236. · College of Pharmacy, University of Texas at Austin, USA. · Am J Health Syst Pharm. · Pubmed #12901023 No free full text.

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Ito MK, Talbert RL, Tsimikas S. · University of California, San Diego School of Medicine, La Jolla, California, USA. · Pharmacotherapy. · Pubmed #16803418 No free full text.

Abstract: Because elevated serum cholesterol levels are strongly associated with coronary heart disease, cholesterol reduction by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (or statins) has been assumed to be the predominant, if not the only, mechanism underlying the beneficial effects of these drugs in cardiovascular diseases. Subgroup analyses of large clinical trials, however, have suggested that the beneficial effects of statins may extend to mechanisms beyond cholesterol reduction. Indeed, recent experimental and clinical evidence indicates that some of the cholesterol-independent or "pleiotropic" effects of statins may be mediated through improving or restoring endothelial function, enhancing the stability of atherosclerotic plaques, and decreasing oxidative stress and vascular inflammation.

Koeller J, Talbert RL. · College of Pharmacy, University of Texas at Austin, USA. · Pharmacotherapy. · Pubmed #12389877 No free full text.

Abstract: Although several clinical trials clearly demonstrate a decrease in mortality and morbidity rates for various patient populations with cardiovascular disease, this disease continues to be the leading cause of death in the United States. Based on various practice surveys and descriptive reports, clinicians apparently are not identifying patients at risk or not treating them to established goals set by national guidelines. Most evidence, including the updated National Cholesterol Education Program Adult Treatment Panel III guidelines, support low-density lipoprotein cholesterol (LDL) as the principal target for intervention. The guidelines also emphasize that a low level of high-density lipoprotein cholesterol (HDL) alone or in association with hypertriglyceridemia increases the risk of cardiovascular disease; also, epidemiologic data taken as a whole signify that a 1% decrease in HDL levels is associated with a 2-3% increase in risk of coronary heart disease. Low HDL levels occur more frequently than once thought, especially in selected populations such as patients with type 2 diabetes and men. Therapeutic lifestyle changes should be implemented first for any lipid disorder. In patients for whom this approach is not adequate, LDL levels need to be lowered to goals based on risk assessment. In addition, low HDL levels and/or hypertriglyceridemia should be managed with a niacin or fibrate product. However, increases in HDL levels and reductions in triglyceride levels are modest with fibrates compared with the dose-related changes seen with niacin products. Reformulation of niacin into an extended-release form minimizes common adverse effects seen with crystalline or sustained-release niacin, and the beneficial effects on the lipid profile are maintained.

Talbert RL. · College of Pharmacy, Department of Medicine, The University of Texas Health Science Center, San Antonio, USA. · Am J Manag Care. · Pubmed #12240701 links to  free full text

Abstract: Coronary heart disease (CHD) is a common, costly, and undertreated disorder in the United States, and dyslipidemia is one of its most important modifiable risk factors. Recently, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) published updated guidelines for the treatment of lipid disorders, greatly expanding the number of patients eligible for therapy. In the new recommendations, several significant changes have been made in the identification and management of patients at risk for CHD. Although ATP III maintains that low-density lipoprotein (LDL) cholesterol should be the primary target of lipid-lowering therapy, it identifies non-high-density lipoprotein (HDL) cholesterol (total cholesterol minus HDL cholesterol) as a secondary target in patients with elevated triglycerides. Patients with > or = 2 CHD risk factors should now be assessed for 10-year absolute CHD risk based on the Framingham Point Scale to identify those who require more aggressive treatment. The guidelines also designate a new category, CHD risk equivalent, which recognizes that certain patients have the same high risk as those with established CHD. Diabetes is now identified as a CHD risk equivalent, as are other forms of atherosclerotic disease and multiple risk factors comprising a CHD 10-year risk of > 20%. New lipoprotein classifications are given, and increased emphasis is placed on the metabolic syndrome, a constellation of metabolic risk factors, as a marker for CHD risk. Since adherence poses a major challenge in the management of patients with or at risk for CHD, the new guidelines provide physicians with several strategies for increasing patient compliance. The new guidelines should help physicians better identify and manage patients at risk for CHD, help more patients reach their lipid goals, and thereby decrease cardiovascular morbidity and mortality.

McKenney JM, Bradberry JC, Talbert RL, Cahill E, Brown WV. · National Clinical Research, Richmond, VA 23294, USA. · J Am Pharm Assoc (2003). · Pubmed #15496041 No free full text.

Abstract: OBJECTIVE: To determine the beliefs and attitudes of pharmacists about the significance of high blood cholesterol, coronary heart disease (CHD), nonprescription statin therapy for patients at moderate risk for CHD, and their role in support of cholesterol-lowering treatments in patients. DESIGN: Cross-sectional survey. SETTING: Nationwide sample of licensed pharmacists in ambulatory practice in the United States drawn randomly from databases of the American Pharmacists Association. PARTICIPANTS: 104 independent pharmacists and 169 chain pharmacists. INTERVENTION: Web-based survey. MAIN OUTCOME MEASURE: Respondents' indication of strong agreement with questionnaire statements (selecting 8, 9, or 10 on a 10-point scale). RESULTS: The survey found that 75% and 61% of pharmacists believed strongly that CHD and high blood cholesterol levels, respectively, are significant health problems facing Americans, and 60% believed that not enough is currently being done to reduce this risk. Pharmacists indicated that they very regularly advised patients about prescription and nonprescription treatments (75%) and encouraged adherence to them (78%); a smaller but substantial proportion regularly monitored patient response to prescription (33%) and nonprescription therapies (15%) and provided point-of-care cholesterol testing (7%). The survey also revealed that the majority of pharmacists (68%) would support consumers interested in purchasing a nonprescription statin product and 82% believed such a product would be more effective than currently available cholesterol-lowering dietary supplements. Pharmacists were concerned that patients pursuing nonprescription statins might discontinue their prescription cholesterol-lowering medications (79%), experience adverse effects (79%), and not be able to self-manage their use of a nonprescription statin product (78%). CONCLUSION: Community pharmacist members of APhA believe that CHD and cholesterol are important problems facing many people, routinely provide services that support patients who wish to self-administer nonprescription therapies, and would be interested in supporting consumers who wish to carry out therapy with a nonprescription statin.

Talbert RL. · Department of Medicine and Pharmacology, University of Texas Health Science Center at San Antonio, USA. · J Am Pharm Assoc (Wash). · Pubmed #10730017 No free full text.

This publication has no abstract.