Heart disease hyperlipidemia

Lowering cholesterol levels can arrest or reverse atherosclerosis in all vascular beds and can significantly decrease the morbidity and mortality associated with atherosclerosis. Each 10% reduction in cholesterol levels is associated with an approximately 20% to 30% reduction in the incidence of coronary heart disease. Hyperlipidemia, particularly elevated serum cholesterol and low density lipoprotein (LDL) levels, is a risk factor in the development of atherosclerotic cardiovascular disease. 

In general, the higher the LDL level and the more risk factors involved, the greater the risk for heart disease. The main goal of treatment in patients with hyperlipidemia is to lower the LDL to a level that will reduce the risk of heart disease ... 

While the fibric acid derivatives have antihyperlipidemic effects, their use varies depending on the drug. For example, Clofibrate (Atromid-S) and gemfibrozil (Lopid) are used to treat individuals with very high serum triglyceride levels who present a risk of abdominal pain and pancreatitis and who do not experience a response to diet modifications. Clofibrate is not used for the treatment of other types of hyperlipidemia and is not thought to be effective for prevention of coronary heart disease. Fenofibrate (Tricor) is used as adjunctive treatment for the reduction of LDL, total cholesterol, and triglycerides in patients with hyperlipidemia. 

Phytochemicals have little nutritional value and do not get absorbed in the body, but they seem to turn on certain switches in the biochemical mechanisms, which signal the beneficial pathways to maintain health, and to turn off the switches which proceed to adverse biochemical pathways. Rice bran products have demonstrated significant benefits as nutritional therapies in diabetes, hyperlipidemia, cancer, fatty liver, hypercalcuria and heart disease. There is experimental and clinical evidence for the beneficial health effects of the following bioactives of rice bran ... 

Hyperlipidemia has not clearly been established as a risk factor for stroke, although it is a modifiable risk factor for coronary heart disease. Recent studies show that statin use may reduce the incidence of a first stroke in high-risk patients (e.g., hypertension, coronary heart disease, or diabetes) including patients with normal lipid levels. A recent meta-analysis showed a 25% risk reduction for fatal and non-fatal strokes with statin use.4 Patients with a history of MI, elevated lipid levels, diabetes, and... 

Grover SA, Abrahamowicz M, Joseph L, Brewer C, Coupal L, Suissa S. The benefits of treating hyperlipidemia to prevent coronary heart disease expected changes in life expectancy and morbidity. JAMA 1992 267 816-22. 

The low incidence of ischemic heart disease in the black population of Africa may mitigate the seriousness of the consequence of the metabolic effects of thiazide diuretics, for example hyperlipidemia and hypo-kalemia. 

Lipoprotein disorders are detected by measuring lipids in serum after a 10-hour fast. Risk of heart disease increases with concentrations of the atherogenic lipoproteins, is inversely related to levels of HDL, and is modified by other risk factors (Table 35-1). Evidence from clinical trials suggests that LDL cholesterol levels of 60 mg/dL may be optimal for patients with coronary disease. Ideally, triglycerides should be below 120 mg/dL. Differentiation of the disorders requires identification of the lipoproteins involved (Table 35-2). Diagnosis of a primary disorder usually requires further clinical and genetic data as well as ruling out secondary hyperlipidemias (Table 35-3). 

Diet is a strong factor in the control of atherosclerosis relating to general vascular disease, coronary heart disease, and stroke. The interrelated disorders in atherosclerosis of hyperinsulinemia, hyperlipidemia, and hypertension are strongly subject to dietary influence. The type of dietary protein, animal vs. plant, appears to be as important as the type of lipid, animal vs. plant, in atherosclerosis. Dietary protein type, with its differing amino acid ratios, appears to be a major secretagogue of insulin. 

Hyperlipidemia is a condition characterized by the presence of elevated lipoprotein levels in the blood. The term hyperlipidemia encompasses a number of different conditions, but it most often refers to high levels of cholesterol in the form of low-density lipoprotein (LDL). LDL cholesterol is often called bad cholesterol. High-density lipoprotein (HDL) is the good form of cholesterol. High LDL and/or low HDL levels are widely believed to be linked to increased heart disease risk. Because of the prevalence of hyperlipidemia in developed nations, antihyperlipidemic drugs are in high demand. 

Renaud, S.C., Beswick, A.D., Fehili, A.N., Sharp, D.S., andElwood, P.C. 1992. Alcohol and platelate aggregation the Caerphilly prospective heart diseases study. Am. J. Clin. Nutr. 55, 1012-1017. Rivlin, R.S. 1998. Patient with hyperlipidemia who received garlic supplements. Lipid management. 

Adverse effects Thiazide diuretics induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias (particularly individuals with left ventricular hypertrophy, ischemic heart disease, or chronic congestive heart failure) and who are concurrently being treated with both thiazide diuretics and digitalis glycosides (see p. 160). Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 

PUFAs are potent inhibitors of the HMG-CoA reductase enzyme and similar to statins are useful in the treatment of hyperlipidemias (99-102). Statins enhance plasma AA levels and decrease the ratio of EPA to AA significantly (100). This finding suggests that PUFAs mediate many actions of statins (103) and that this could be one mechanism by which they lower cholesterol levels. Statins and PUFAs have many overlap actions such as the inhibition of IL-6 and TNF-a production and NF-kB activation plus the ability to enhance eNO production thus, both possess anti-inflammatory actions and both are useful in atherosclerosis, coronary heart disease, osteoporosis, stroke, Alzheimer s disease, and inflammatory conditions such as lupus and cancer (3, 4, 94, 104-121). These similar and overlap actions strongly indicate that the molecular mechanisms of actions of statins and PUFAs are similar, if not identical. Furthermore, when a combination of statins and PUFAs are given together, a synergistic beneficial effect was seen in patients with combined hyperlipemia (122). 

Even though the mortality from coronary heart disease has declined recently, atherosclerosis and related vascular disorders still are the leading cause of death in the Western world. The etiology of this disease is multifactorial, with hyperlipidemia, smoking, diabetes mellitus, hypertension, and obesity being well-established risk factors for the development of atherosclerosis. Dietary fat affects plasma lipids, lipoproteins, and vascular inflammation and, thus, is linked to atherosclerosis. 

Coronary heart disease (CHD) is one of the leading causes of morbidity and mortality in the United States. Hyperlipidemia is a major risk factor for atherosclerosis and CHD. Hyperlipidemia is defined as an elevation in blood cholesterol or triglycerides (TG). Lipids are primarily transported in the body by three major lipoproteins low-density (LDL), very-low-density (VLDL), and high-density lipoproteins (HDL). Cholesteryl esters and TG are carried by the lipoproteins, which vary in size and composition of cholesterol and... 

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