Hyperlipidemia coronary artery disease

LRP6 Missense mutation (familial, autosomal dominant) Autosomal dominant early coronary artery disease (hyperlipidemia, hypertension, diabetes)... 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Some patients will be seen for multiple reasons therefore, the pharmacist may need to record more than one ICD-9-CM code to fully describe the patient visit. For example, if a client with coronary artery disease (CAD) is referred to a pharmacist, it may not be uncommon that the physician requests education on lowering cholesterol through both diet and medications and education on weight loss and smoking cessation. All three conditions (CAD, obesity, and tobacco use) can be coded to represent the health conditions discussed. Example ICD-9 codes for these conditions include 414.01 (native-vessel disease), 272.2 (mixed hyperlipidemia), and 305.1 (tobacco-use disorder) (Buck and Lockyear, 2007). The specific ICD-9 code used on the claim form should be the same code used by the physician to decrease the risk of claim rejection owing to mismatched codes. Therefore, the ICD-9 code should be requested on the referral form from the physician (Snella et ah, 2004). 

Patient B. A 61-year-old man from Mississippi with human immunodeficiency virus infection, coronary artery disease, and hyperlipidemia was examined on August 29 and determined to have hypothermia and multiple second- and third-degree abrasions on his trunk. V. parahaemolyticus was isolated from his blood. Despite receiving antimicrobial therapy with lev-ofloxacin, he died the next day. 

One case of an acute lateral wall myocardial infarction (MI) was reported in a woman after daily ingestion of Edita s Skinny Pill (containing 300 mg bitter orange plus caffeine and guarana) for 1 year (44). The 55-year-old Caucasian woman developed chest discomfort after eating Chinese food. After workup at the hospital, the woman was diagnosed with acute lateral-wall MI and smoking addiction. Her ejection fraction was 0.45. Prior to this incident, she had no known coronary artery disease, hypertension, or hyperlipidemia. 

Cardiovascular Does the patient have atrial fibrillation, a coronary artery disease history, or hyperlipidemia increasing stroke risk Could orthostatic hypotension be due to medications for Parkinson s disease treatment Is a medication such as amantadine causing peripheral edema ... 

Pharmacogenomic studies have been performed on a range of different cultured cells that participate in the formation of atherosclerotic lesion including ECs, SMCs, monocytes, and macrophages [144], as well as animal models [145], atherosclerotic lesion samples and blood-derived cells from patients with hyperlipidemia or coronary artery disease [144], Representative examples of such studies and their contribution towards improving atheroprotective treatments are presented in the following sections. 

Epidemiologic studies have indicated a very strong inverse association between HDL-cholesterol levels and the incidence of arteriosclerotic cardiovascular disease [32]. HDL is thought to promote efflux of cholesterol from peripheral cells in the vascular wall and return of that cholesterol to the liver for excretion in bile, a process known as reverse cholesterol transport [21]. HDL has also been shown to have anti-inflammatory and anti-thrombotic activities [21]. Therefore, HDL levels may influence both the hyperlipidemia and inflammatory processes proposed as factors in the development of atherosclerosis. Although clinical data in support of HDL-raising are limited, in the VA-HIT trial gemfibrozil therapy in men with coronary artery disease and low HDL-cholesterol modestly increased HDL levels and reduced coronary events by 22% [33]. Presently, other methods of effectively and safely increasing HDL-cholesterol levels have not been discovered. 

The PPARs constitute a family of three nuclear receptors that have important roles in physiological lipid and glucose metabolism. Converse, dysregulation of the PPARs has been associated with pathophysiological conditions such as hyperlipidemia, insulin resistance and coronary artery disease. There are three PPAR isoforms -PPARa, PPARy and PPARS (also termed PPARP). All PPARs are expressed in cardiovascular tissues and in addition to their known metabolic actions they exhibit distinct functions. While the expression of PPARa and PPARP/8 is surprisingly high in the heart, PPARy expression is very low and does not appear to play an important role in the heart. Since Chapter 11 in this book is dedicated to the well-established role of the PPARs in metabolic diseases, we will focus in this chapter on the role of P PA Ra in cardiac diseases. 

Modern oral contraceptives can contribute to the incidence and severity of certain diseases if other risk factors are present. The following conditions are considered absolute contraindications for combination oral contraceptives the presence or history of thromboembolic disease, cerebrovascular disease, myocardial infarction, coronary artery disease, or congenital hyperlipidemia known or suspected carcinoma of the breast, carcinoma of the female reproductive tract, or other hormone-dependent/responsive neoplasias abnormal undiagnosed vaginal bleeding known or suspected pregnancy and past or present liver tumors or impaired liver function. The risk of serious cardiovascular side effects is particularly marked in women over 35 years of age who smoke heavily (e.g., >15 cigarettes/day) even low-dose oral contraceptives are contraindicated in such patients. 

In addition to diabetes mellitus, Mr. Applebod has a hyperlipidemia (high blood lipid level—elevated cholesterol and triacylglycerols), another risk factor for cardiovascular disease. A genetic basis for Mr. Applebod s disorder is inferred from a positive family history of hypercholesterolemia and premature coronary artery disease in a brother. 

The fact that a number of different abnormal lipoprotein profiles were found in Cora Nari and her siblings, and that each had evidence of coronary artery disease, suggests that Cora has familial combined hyperlipidemia (FCH). This diagnostic impression is further supported by the finding that Cora s profile of lipid abnormalities appeared to change somewhat from one determination to the next, a characteristic of FCH. This hereditary disorder of lipid metabolism is believed to be quite common, with an estimated prevalence of about 1 per 100 population. 

Treatment strategies focus first on diet and correction of underl)dng metabolic diseases. Diets that are low in cholesterol and saturated animal fats reduce lipoprotein levels in nearly all patients. In addition, overweight patients should reduce their total caloric intake. Exercise increases serum concentrations of HDL, which is associated with reduced risk of coronary artery disease. Secondary hyperlipidemia frequently subsides spontaneously upon treatment of the underlying metabolic disease or cessation of aggravating factors. 

Table 19-5. Hyperlipidemia Lipoprotein Phenotype Types II and IV are commonly associated with coronary artery disease.

The introduction of fiber into the field of lipid metabolism stems from epidemiological data which compares the incidence of diseases common in the Western world with native African populations.2-4 Specifically, hyperlipidemia and FHC are associated with a striking incidence of coronary artery disease in the U.S.5-8... 

Postprandial hyperlipidemia may play a role in the development of coronary atherosclerosis. Dr. Dcewaki (14) applied the measurement of RLP-C to assess postprandial hyperlipidemia occurring in normolipidemic subjects with coronary artery disease (CAD). He found that RLP-C levels became markedly higher in CAD patients than in controls... 

Hyperlipidemia is known to be one of the most potent factor associated with the premature development of atheromatous arterial disease. Thus an increased serum cholesterol level is frequently found in patients with ischemic heart disease and myocardial infarction, and hypercholesterolemic patients have a high incidence of coronary artery disease. Therefore, because cholesterol is partially eliminated from the body as bile acids (see Section VB), it would be important to know the role of bile acid metabolism in the development of different types of hypercholesterolemia. 

Coronary arteries are the vessels that supply the heart with oxygenated blood. If the artery becomes narrow or get blocked by plaque, the supply of oxygen to cardiac muscles decreases leading to coronary artery disease (CAD) which is the most common type of heart disease and cause of heart attacks [1], This narrowing is known as stenosis. As of 2012, CAD became the most common cause of death in the world [2], which emphasizes how important finding a treatment for such disease is and why it is the subject of interest worldwide. According to the American Heart Association, CAD has a number of risk factors. The most common risk factors include smoking, family history of CAD, hypertension, obesity, diabetes, lack of exercise, stress, and hyperlipidemia. 

Furthermore, dietary intake of fish oil has also shown to enhance the coronary vasomotor activity in patients with coronary artery disease [36] and reduce the number of deaths derived from chronic cardiac failure [29], Altogether, these data suggest that dietary intake of o-3 fatty acid supplements are beneficial to coimteract against cardiovascular-related diseases such as hyperlipidemia, hypertension, atherosclerosis, and myocardial infarction. 

Erectile dysfunction may be the first manifestation of many diseases including diabetes mellitus, coronary artery disease, hyperlipidemia, hypertension, spinal-cord compression, pituitary tumors, and pelvic malignancies. For example, a recent prevalence study found that men with erectile dysfunction were twice as likely to have DM and concluded that erectile dysfunction may be used as an early marker for DM. This relationship was particularly strong in the younger age groups, in vdiich the odds ratio of having DM was 3 (Sun et al. 2006). Two earlier studies found that 11% (Maatman et al. 1987) and 12% (Deutsch and Sherman 1980) of impotent men were found to have previously undiagnosed DM. 

First of all, the typing of hyperlipemias seems to be essential requirement inasmuch as the responses of the Types to diet or drugs are substantially different. Several of the lipoprotein abnormahties appear to lead to vascular disease at an accelerated rate. In Lebanon, for example, there are relatively more cases of hyperlipidemia of Type II. These patients are predominantly children, who have xanthomas in their pre-teen years, angina and typical coronary artery disease in their teens, and an outlook for an average life-expectancy of 25 years [447]. Hyperlipidemia appears to be the primary disease in these children and apparently, leads to the secondary and fatal coronary artery disease. A thorough study of the abnormal lipoproteins of these children is obviously a necessity. 

Brown, B.G., Bardsley, J., Poulin, D., Hillger, L.A., Dowdy, A., Maher, V.M., Zhao, X.Q., Albers, J.J., and Knopp, R.H., 1997. Moderate dose, three-drug therapy with niacin, lovastatin, and colestipol to reduce low-density lipoprotein cholesterol < 100 mg/dl in patients with hyperlipidemia and coronary artery disease. American Journal of Cardiology. 80 111-115. 

Factors associated with increased risk for intermittent claudication include smoking, hypertension, hyperlipidemia, and diabetes mellitus Of these factors, hyperlipidemia has recently become the focus of intense study. A significant association between PAD, hyperlipidemia, and increased mortality secondary to coronary artery disease (CAD) and... 

Cardiovascular diseases are the leading cause of death in the Western world. Basically, atherosclerosis manifests itself in three major organs and thereby leads to severe secondary diseases. Coronary disease results from atherosclerosis of the coronary arteries and culminates in myocardial infarction when vessels are occluded by a thrombus. In the brain, atherosclerosis gives rise to arterial thrombi or ruptures that result in a stroke. Atherosclerosis in the kidney leads to renal failure. Since these diseases significantly lower life expectancy, early recognition and elimination of risk factors (hypertension, diabetes mellitus, hyperlipidemia, and smoking) that promote atherosclerosis are essential. 

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