摘要:

The observation that coronary heart disease was greatest in those individuals with the highest cholesterol levels resulted in the development of interventions to lower cholesterol to improve coronary risk status. Some individuals will achieve target lipid levels with diet and lifestyle modification alone. Therefore, diet and lifestyle modification is the preferred initial treatment. For more aggressive management of those who do not respond to diet and lifestyle modification or who have documented coronary heart disease, lipid-lowering drugs, extensively tested in large, multicenter, randomized clinical trials are preferred. Initially, questions arose about adverse effects of lipid-lowering drugs, but continued use has demonstrated that these drugs are both safe and efficacious. The need remains, however, for clinicians to monitor each patient's response to lipid-lowering diets, lifestyle modification efforts, and drugs and evaluate whether beneficial effects outweigh the cost and potential for adverse effects.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

There are currently four classes of drugs available to treat dyslipidemia: niacin, bile acid-binding resins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, and fibric acid derivatives. Each acts at a unique point in a complex set of interrelated lipid metabolic pathways. The mechanism of action and adverse effects of these four classes are reviewed briefly. The efficacy of Wantioxidants and the importance of compliance issues are described.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Risk factors for cardiovascular disease have been defined by various groups and experts for decades. Unfortunately, the lack of consensus among these groups and the periodic changes in risk factor listings have led to confusion among health care professionals. Because so many risk factors inter-relate, it is difficult to isolate the effect of a specific risk factor on the lipid profile. In an effort to eliminate some of the confusion, this article describes the known effects of physical inactivity, obesity, cigarette smoking, age, hypertension, and diabetes mellitus on lipids and lipoproteins. A summary of the known results is displayed in a table. Because of the complexity of the atherosclerotic disease process and the multifactorial influences on lipid metabolism, this remains an exciting and challenging area for research.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Increasing awareness of the relationship between diet and disease has prompted a notable increase in nutrition research. The focus of many of these studies continues to be on amount and type of fat in the diet. At the same time, a great deal of attention is being directed at other dietary components and their mode of action. The results are promising. More definitive answers must await future clinical trial data. However, the total dietary approach, including compliance measures, remains the foundation on which other nutrition recommendations should be based.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Genetic and environmental factors contribute to the development and progression of atherosclerotic coronary heart disease processes. Major independent risk factors for coronary heart disease, including adverse levels of plasma lipids and lipoproteins, are also influenced by genetic and potentially modifiable environmental factors. Recent advances in molecular biology have resulted in the identification of specific genes associated with lipid disorders. The complex gene-environment interplay that contributes to interindividual variation in components of the lipid profile is also partially clarified. This article provides an overview of available data on the genetic and environmental influences on lipids and lipoproteins with emphasis on implications for clinical practice and future research.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

There is compelling scientific evidence that the modification of cardiovascular risk factors, including hypercholesterolemia, can reduce the incidence of myocardial infarction, effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with and without known cardiovascular disease. Unfortunately, neither the publication of results from clinical trials of cholesterol lowering alone nor the 1993 National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPII) updated guidelines for the treatment of hypercholesterolemia have resulted in widespread changes in cholesterol management and control. Systematic nurse case management of dyslipidemias in patients with or at high risk for the development of coronary heart disease has the potential to improve compliance with NCEP-ATPII guidelines. In cooperation with physicians, nurses have the opportunity to address a major public health problem with the potential to eventually affect the more than 11 million people with coronary heart disease.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Gender-based differences in the prevalence, presentation, and treatment of coronary heart disease (CHD) defines an important area of controversy and research. Gender-based differences include age at onset of CHD, typical presentation of CHD symptoms, relative importance of coronary risk factors, and the potential relationship of ovarian function and estrogen status to the development of CHD. The American Heart Association reported in 1998 that the leading cause of death for American women is cardiovascular disease, with CHD responsible for the majority of total deaths. This article discusses the implication of elevated blood lipids in women. Special emphasis is placed on the role of hormone replacement therapy, an issue unique to women.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Elevated total cholesterol and LDL cholesterol have been well established as risk factors for coronary heart disease (CHD). Several large clinical trials have demonstrated that lipid lowering decreases the incidence and mortality that results from CHD. However, a high percentage of subjects in these studies did not receive benefit from LDL lowering. Many experts believe that other lipid disorders may play a significant role in the atherogenic process, including elevated triglyceride levels alone or in association with a low level of HDL. Do elevated triglyceride levels pose an increased risk for CHD? This article describes the research done evaluating this question, as well as the influences of lifestyle changes and pharmacologic interventions on these dyslipidemias.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

In only 50% of cases of coronary heart disease (CHD) is the cause attributable to the established risk factors of hypertension, cigarette smoking, and elevated total and low-density lipoprotein (LDL) cholesterol levels. This finding has led to research examining other markers for CHD that may have a causal link to the atherothrombotic process. Several of these "emerging" risk factors are reviewed in this article: lipoprotein(a); small dense LDL particle size; hyperhomocysteinemia; and inflammatory, infectious, and hemostatic factors. Evaluation of each of these factors includes a review of the epidemiologic evidence, examination of the pathologic mechanism(s) by which the factor might participate in atherothrombosis, and the clinical utility of screening. Finally, and most relevant for the practicing clinician, the following is addressed: Does evidence exist that selective modification of these risk factors is associated with net clinical benefit?

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID