Hyperlipidemias: USA

Minhas R, Humphries SE, Qureshi N, Neil HA, Anonymous00039. · RAND Health, RAND Corporation, Santa Monica, Los Angeles, CA 90407, USA. · Heart. · Pubmed #19168470 No free full text.

This publication has no abstract.

Rehring TF, Stolcpart RS, Hollis HW, Anonymous00182. · Division of Vascular and Endovascular Surgery, Department of Vascular Therapy, Colorado Permanente Medical Group, Denver, CO 80205, USA. · J Vasc Surg. · Pubmed #18372155 No free full text.

Abstract: There is broad and compelling evidence for risk factor reduction to limit cardiovascular morbidity and mortality in patients with peripheral arterial disease. Indeed, vascular surgeons have placed a call to arms to ensure this takes place. Despite this fact, some wariness exists on the part of many vascular surgeons to initiate these strategies, functionally abnegating their responsibilities in this regard. The purpose of this article is to provide a simple reference to guide effective therapies for overall cardiovascular risk reduction in patients with peripheral arterial disease. Specific recommendations are made for tobacco cessation, lipid-lowering therapy, antiplatelet therapy, blood pressure control, and maintenance of normoglycemia.

Fox KM, Gandhi SK, Ohsfeldt RL, Blasetto JW, Bays HE. · University of Maryland School of Medicine, Department of Epidemiology & Preventive Medicine, Baltimore, MD, USA. · Curr Med Res Opin. · Pubmed #17655813 No free full text.

Abstract: OBJECTIVE: To compare effectiveness of rosuvastatin (RSV) with other statins on lowering low-density lipoprotein cholesterol (LDL-C) and LDL-C goal attainment among patients with type 1 or type 2 diabetes mellitus. METHODS: A retrospective study using US General Electric Medical Systems (GEMS) database of patients with diabetes mellitus (ICD9 code = 250, prescription for anti-diabetic medication or fasting blood glucose level > or = 126 mg/dL in the 12 months preceding statin therapy) treated across clinical practices in the US, who were newly prescribed statin therapy during August 2003-March 2006, was conducted. Multivariate linear and logistic regression models were used for analyzing prescription data with baseline LDL-C, age, gender, smoking, very high CHD risk, systolic blood pressure, and statin duration as covariates. RESULTS: Of 4754 diabetes mellitus patients, 5% were prescribed RSV, 59% atorvastatin (ATV), 21% simvastatin (SMV), 5% pravastatin (PRV), 2% fluvastatin (FLV), and 7% lovastatin (LOV). RSV patients had significantly higher (p < 0.05) baseline mean LDL-C levels (138 vs. 117-131 mg/dL), lower average starting dose (11.7 vs. 17.0-63.7 mg) and were younger (p < 0.005) than patients on other statins (mean age 61 vs. 63-69 years). Percent LDL-C reduction was significantly greater (p < 0.0001) with RSV (28.4%) compared to ATV (22.5%), SMV (20.1%), PRV (13.7%), FLV (15.8%), and LOV (17.3%). A greater (p < 0.05) proportion of RSV diabetes patients attained LDL-C goal < 100 mg/dL (72.8%) vs. diabetes mellitus patients on other statins (36.8-67.4%). CONCLUSIONS: Rosuvastatin was more effective in lowering LDL-C and achieving LDL-C treatment goals in the diabetes mellitus population as compared to other statins in real-world clinical practice setting. Validating study results in a different diabetes population with dispensed statin prescriptions will help increase generalizability of study findings.

Woloshin S, Schwartz LM, Kerin K, Welch HG. · VA Outcomes Group, White River Junction, VT, USA. · J Gen Intern Med. · Pubmed #17356986 links to  free full text

Abstract: BACKGROUND: There is growing interest in using C-reactive protein (CRP) levels to help select patients for lipid lowering therapy--although this practice is not yet supported by evidence of benefit in a randomized trial. OBJECTIVE: To estimate the number of Americans potentially affected if a CRP criteria were adopted as an additional indication for lipid lowering therapy. To provide context, we also determined how well current lipid lowering guidelines are being implemented. METHODS: We analyzed nationally representative data to determine how many Americans age 35 and older meet current National Cholesterol Education Program (NCEP) treatment criteria (a combination of risk factors and their Framingham risk score). We then determined how many of the remaining individuals would meet criteria for treatment using 2 different CRP-based strategies: (1) narrow: treat individuals at intermediate risk (i.e., 2 or more risk factors and an estimated 10-20% risk of coronary artery disease over the next 10 years) with CRP > 3 mg/L and (2) broad: treat all individuals with CRP > 3 mg/L. DATA SOURCE: Analyses are based on the 2,778 individuals participating in the 1999-2002 National Health and Nutrition Examination Survey with complete data on cardiac risk factors, fasting lipid levels, CRP, and use of lipid lowering agents. MAIN MEASURES: The estimated number and proportion of American adults meeting NCEP criteria who take lipid-lowering drugs, and the additional number who would be eligible based on CRP testing. RESULTS: About 53 of the 153 million Americans aged 35 and older meet current NCEP criteria (that do not involve CRP) for lipid-lowering treatment. Sixty-five percent, however, are not currently being treated, even among those at highest risk (i.e., patients with established heart disease or its risk equivalent)-62% are untreated. Adopting the narrow and broad CRP strategies would make an additional 2.1 and 25.3 million Americans eligible for treatment, respectively. The latter strategy would make over half the adults age 35 and older eligible for lipid-lowering therapy, with most of the additionally eligible (57%) coming from the lowest NCEP heart risk category (i.e., 0-1 risk factors). CONCLUSION: There is substantial underuse of lipid lowering therapy for American adults at high risk for coronary disease. Rather than adopting CRP-based strategies, which would make millions more lower risk patients eligible for treatment (and for whom treatment benefit has not yet been demonstrated in a randomized trial), we should ensure the treatment of currently defined high-risk patients for whom the benefit of therapy is established.

Snow V, Aronson MD, Hornbake ER, Mottur-Pilson C, Weiss KB, Anonymous00316. · American College of Physicians, Philadelphia, Pennsylvania 19106, USA. · Ann Intern Med. · Pubmed #15096336 links to  free full text

Abstract: In an effort to provide internists and other primary care physicians with effective management strategies for diabetes care, the Clinical Efficacy Assessment Subcommittee (CEAS) of the American College of Physicians (ACP) decided to develop guidelines on the management of dyslipidemia, particularly hypercholesterolemia, in people with type 2 diabetes mellitus. The CEAS commissioned a systematic review of the currently available evidence on the management of lipids in type 2 diabetes mellitus. The evidence review is presented in a background paper in this issue. On the basis of this systematic review, the CEAS developed recommendations that the ACP Board of Regents then approved as policy. The target audience for this guideline is all clinicians who care for patients with type 2 diabetes. The target patient population is all persons with type 2 diabetes, including those who already have some form of microvascular complication and, of particular importance, premenopausal women. The recommendations are as follows. RECOMMENDATION 1: Lipid-lowering therapy should be used for secondary prevention of cardiovascular mortality and morbidity for all patients (both men and women) with known coronary artery disease and type 2 diabetes. RECOMMENDATION 2: Statins should be used for primary prevention against macrovascular complications in patients (both men and women) with type 2 diabetes and other cardiovascular risk factors. RECOMMENDATION 3: Once lipid-lowering therapy is initiated, patients with type 2 diabetes mellitus should be taking at least moderate doses of a statin. RECOMMENDATION 4: For those patients with type 2 diabetes who are taking statins, routine monitoring of liver function tests or muscle enzymes is not recommended except in specific circumstances.

Dubé MP, Stein JH, Aberg JA, Fichtenbaum CJ, Gerber JG, Tashima KT, Henry WK, Currier JS, Sprecher D, Glesby MJ, Anonymous00228, Anonymous00229. · Indiana University, Indianapolis, USA. · Clin Infect Dis. · Pubmed #12942391 No free full text.

This publication has no abstract.

Morgan JM, Capuzzi DM. · Jefferson Medical College, Thomas Jefferson University, Cardiovascular Disease Prevention Center, Jefferson Heart Institute, Philadelphia, USA. · Geriatrics. · Pubmed #12938250 No free full text.

Abstract: Coronary heart disease (CHD) is a significant cause of morbidity and mortality in older patients. Therefore, its treatment and prevention is vital to improving the length and quality of life for the geriatric population at large. Clinical trial data have demonstrated that patients age 65 and older derive the same benefit from blood cholesterol reduction as younger adults. As a result, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) recommends appropriate therapeutic lifestyle changes and drug therapy for older individuals with established CHD or for those at high risk for CHD. Drug therapy in this population, while safe, requires careful monitoring and dose adjustment due to potentially altered drug metabolism and concomitant medications. These factors lead to use of lower starting doses of lipid-lowering medications in older patients. Prudent individualized evaluation and customized therapy provide optimal cardiovascular outcomes.

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.

This publication has no abstract.

Anonymous00237. · U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, Maryland, USA. · Ann Intern Med. · Pubmed #12558361 links to  free full text

Abstract: This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations on screening for type 2 diabetes in adults and updates the 1996 recommendations on this topic. The complete USPSTF recommendation and rationale statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site ( http://www.preventiveservices.ahrq.gov ) and the National Guideline Clearinghouse ( http://www.guideline.gov ) and in print through the Agency for Healthcare Research and Quality (AHRQ) Publications Clearinghouse (call 800-358-9295 or e-mail mailto:ahrqpubs@ahrq.gov ). The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on this topic on the Web sites already mentioned. The summary of the evidence is also available in print through the AHRQ Publications Clearinghouse.

Lepor NE, Vogel RE, Anonymous00157. · Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Rev Cardiovasc Med. · Pubmed #12439378 No free full text.

This publication has no abstract.

Dubé MP, Sprecher D, Henry WK, Aberg JA, Torriani FJ, Hodis HN, Schouten J, Levin J, Myers G, Zackin R, Nevin T, Currier JS, Anonymous00022. · Indiana University, Indianapolis, IN 46202, USA. · Clin Infect Dis. · Pubmed #11073755 No free full text.

Abstract: Dyslipidemia is a prevalent condition that affects patients infected with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy. These preliminary recommendations summarize the current understanding in this area and propose guidelines for management. Existing guidelines for the management of dyslipidemia in the general population formed the general basis for our recommendations. Data on the prevalence and treatment of dyslipidemia of HIV-infected patients, implications of treatment-related dyslipidemia in other chronically ill populations, and pharmacokinetic profiles for the available hypolipidemic agents in non-HIV populations were considered. Although the implications of dyslipidemia in this population are not fully known, the frequency, type, and magnitude of lipid alterations in HIV-infected people are expected to result in increased cardiovascular morbidity. We propose that these patients undergo evaluation and treatment on the basis of existing guidelines for dyslipidemia, with the caveat that avoidance of interactions with antiretroviral agents is paramount.

Fried L, Hutchison A, Stegmayr B, Prichard S, Bargman JM. · University of Pittsburgh School of Medicine, Pennsylvania, USA. · Perit Dial Int. · Pubmed #10201335 links to  free full text

This publication has no abstract.

Ansell BJ. · Atherosclerosis Research Unit, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. · Curr Opin Lipidol. · Pubmed #18607193 No free full text.

This publication has no abstract.

DeSilvey DL. · Waldo Cardiovascular Medicine, Belfast, ME 04915, USA. · Am J Geriatr Cardiol. · Pubmed #17086036 links to  free full text

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Hecht HS. · Princeton Longevity Center, Princeton, New Jersey 08858, USA. · Am J Cardiol. · Pubmed #12127614 No free full text.

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Handelsman Y. · Metabolic Institute of America, Tarzana, CA 91356, USA. · Postgrad Med. · Pubmed #19494474 No free full text.

Abstract: Colesevelam hydrochloride (HCl) was approved in January 2008 as an adjunct therapy for improving glycemic control in patients with type 2 diabetes mellitus (T2DM). Colesevelam HCl is a bile acid sequestrant that has been shown to significantly improve both glycemic control and the lipid profile in patients with T2DM when added to metformin-, sulfonylurea-, or insulin-based therapy. In addition, colesevelam HCl may be useful for reducing glucose and low-density lipoprotein cholesterol levels in patients with prediabetes (defined as fasting plasma glucose levels of 100-125 mg/dL or 2-hour poststimulation glucose levels of 140-199 mg/dL), who have an increased cardiovascular risk. As colesevelam HCl is a unique agent-with both significant glycemic and lipid benefits-it has the potential to play an important role in the management of T2DM. This article reviews the place of colesevelam HCl in therapy (both for T2DM and prediabetes), the benefits of early, intensive treatment of T2DM, and the importance of safe glycemic control later in the disease process.

Goldfine AB, Fonseca VA. · Joslin Diabetes Center, Boston, MA 02115, USA. · Postgrad Med. · Pubmed #19494473 No free full text.

Abstract: Therapy is often required to manage the hyperglycemia, hypertension, and dyslipidemia that occur in patients with type 2 diabetes mellitus (T2DM) in order to control the risk of cardiovascular (CV) events. The importance of managing these risk factors is underscored by the recommendation from the American Diabetes Association and the American Association of Clinical Endocrinologists for treatment of these CV risk factors to target levels. However, relatively few patients achieve simultaneous control of these risk factors. As such, therapy that has positive effects on more than 1 risk factor is of potential benefit. Initially approved as a lipid-lowering agent, the bile acid sequestrant colesevelam hydrochloride (HCl) is now also approved as an adjunct therapy to improve glycemic control in patients with T2DM. This review summarizes the major findings of clinical studies that investigated the glucose-and lipid-lowering effects of colesevelam HCl when added to stable metformin-, sulfonylurea-, or insulin-based antidiabetes therapies in patients with T2DM.

Goldenberg N, Glueck C. · Cholesterol and Metabolism Center of Jewish Hospital, Cincinnati, Ohio, USA. · Vasc Health Risk Manag. · Pubmed #19475774 links to  free full text

Abstract: Statins became available for the treatment of hypercholesterolemia in 1987. Multiple, well-designed, placebo-controlled, double-blind studies revealed that each 1% reduction in serum cholesterol level was associated with about 1% reduction in risk of cardiovascular events. Low-density lipoprotein (LDL) cholesterol reduction to less than 78 mg/dL may be associated with reduction of atheroma burden. Patients with high levels of high specificity C-reactive protein and having LDL cholesterol less than 3.4 mmol/L (130 mg/dL) in primary prevention settings benefited from aggressive LDL cholesterol reduction with rosuvastatin over a 2-year period. However, in real life practice, about half of patients who are prescribed statins discontinue the medication by the end of the year. Medication adherence is lower in younger patients, women, and absence of known coronary heart disease. Personal features of the prescribing physician and dispensing pharmacies also affect patients' compliance. More studies are needed to evaluate if "compliance packets" would benefit patients in a real life situation.

Bigal ME, Kurth T, Hu H, Santanello N, Lipton RB. · Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. · Neurology. · Pubmed #19470970 No free full text.

Abstract: Migraine, especially migraine with aura (MA), is an established risk factor for ischemic lesions of the brain. Recent evidence has also linked migraine to a broader range of ischemic vascular disorders including angina, myocardial infarction, coronary revascularization, claudication, and cardiovascular mortality. The mechanisms which link migraine to ischemic vascular disease remain uncertain and are likely to be complex. Cortical spreading depression, the presumed substrate of aura, may directly predispose to brain lesions and that would explain why MA is consistently demonstrated as a risk factor for cerebral ischemia, while for migraine without aura (MO), the evidence is less consistent. Additionally, individuals with migraine have a higher prevalence of risk factors known to be associated with cardiovascular disease (CVD), including hypertension, diabetes, and hyperlipidemia. The increased prevalence of CVD risk factors is also higher for MA than for MO. Since the evidence linking migraine and CVD is getting robust, neurologists should be aware of this association. Individuals with MO seem to be at little increased risk of CVD. MA is associated with an increased risk of ischemic stroke and likely also for other ischemic CVD events. Accordingly, heightened vigilance is recommended for modifiable cardiovascular risk factors in migraineurs, especially with MA. Ultimately, it will be important to determine whether MA is a modifiable risk factor for CVD and if preventive medications for migraine or antiplatelet therapy might reduce the risk of CVD in patients with MA.

Pillai AS. · Methodist Family Medicine Residency Program, Houston, Texas, USA. · Am Fam Physician. · Pubmed #19405415 No free full text.

This publication has no abstract.

Borrás IC, Cruz-Jiménez M, Nadal E, Middelhoff A, Rivera A. · Department of Physical Medicine and Rehabilitation, Veterans Hospital Caribbean Healthcare System, San Juan, Puerto Rico, USA. · Bol Asoc Med P R. · Pubmed #19400532 No free full text.

Abstract: In the last few decades cardiac rehabilitation has evolved dramatically. It consists of a multidisciplinary approach for secondary prevention and rehabilitation treatment after an individual has sustained a cardiac event. A key principle for successful cardiac rehabilitation management is the modification of risk factors which have been demonstrated to have a significant impact on overall mortality and morbidity outcomes. This article summarizes some of the evidence that supports modification of risk factors through the use of cardiac rehabilitation.

Giannattasio C, Failla M, Corsi D, Capra A, Meles E, Gentile G, Fantini E, Boffi L, Maestroni S, Scotti V, Mancia G. · Clinica Medica, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Monza, MI. · Ital Heart J Suppl. · Pubmed #19400052 No free full text.

Abstract: The reduction of large arterial distensibility has several adverse consequences for the cardiovascular system. This paper reviews the evidence we have obtained by measuring distensibility through quantification of changes in arterial diameter vs blood pressure changes at large elastic and middle size muscle artery sites. Evidence shows that arterial distensibility is reduced in conditions such as hypercholesterolemia, hypertension, diabetes, and congestive heart failure. In some conditions (e.g. hypertension) the alterations are not uniformly distributed in the arteries of different structure and size whereas in others (e.g. diabetes and heart failure) they are widespread. In diabetes evidence is available that distensibility changes occur early in the course of the disease. Evidence is also available that in all above conditions treatment can improve arterial distensibility thereby reversing the initial abnormality. This is due to a variable combination of structural and functional factors. However, technical ability to determine their precise role in distensibility changes in humans is limited.

Phung OJ, Makanji SS, White CM, Coleman CI. · University of Connecticut, Hartford Hospital Evidence-Based Practice Center, Hartford, CT 06102-5037, USA. · J Am Diet Assoc. · Pubmed #19394473 No free full text.

Abstract: Almond consumption may be associated with improvements in serum lipid profiles. The aim was to evaluate the influence of almonds on lipid parameters to help define the role of almonds as a lipid modulator. MEDLINE, EMBASE, Cochrane CENTRAL, and the Natural Medicines Comprehensive Database were searched through July 2008, with no language restrictions, for randomized controlled trials of almonds in human patients that reported efficacy data on at least one of the following endpoints: total, low-density lipoprotein (LDL), or high-density lipoprotein (HDL) cholesterol, triglycerides, or the LDL:HDL ratio. A manual search of references from primary or review articles was performed to identify additional relevant trials. Five randomized, controlled trials (totaling 142 participants) met all inclusion criteria. Upon meta-analysis, almond consumption ranging from 25 to 168 g/day significantly lowered total cholesterol [weighted mean difference -6.95 mg/dL (95% confidence interval [CI] -13.12 to -0.772) (-0.18 mmol/L [95% CI -0.34 to -0.02])] and showed a strong trend toward reducing LDL cholesterol [weighted mean difference -5.79 mg/dL (95% CI -11.2 to 0.00) (-0.15 mmol/L [95% CI -0.29 to 0.00])]. No significant effect on HDL cholesterol, triglycerides, or LDL:HDL ratio was found. No statistical heterogeneity was observed for any analysis (I2=0% for all). Review of funnel plots and the Egger's weighted regression statistic P values suggested a low likelihood of publication bias in all analyses (P>0.25 for all). Almond consumption may decrease total cholesterol and does not significantly affect LDL or HDL cholesterol, triglycerides, or the LDL:HDL ratio. The current body of randomized trials does not support the ingestion of almonds solely for their lipid modifying effects. Both the lipid modulating effects and the safety/tolerability of almonds should be further investigated through the conduction of larger randomized, double-blinded trials of longer duration. Such studies might focus specifically on whether the efficacy of almonds as a lipid modulator varies by dose or comorbidity.