Hyperlipidemia evaluation

EF is a 45-year-old woman who presents to the dermatologist for evaluation of facial acne. She has a history of a 25 lb (11.36 kg) weight gain, irregular menses, and frequent vaginal yeast infections over the past 2 years. She complains of increased facial hair growth and lower extremity muscle weakness. Physical examination reveals facial acne, facial hirsutism, truncal obesity, thin skin, and purple abdominal striae. Her past medical history is significant for hypertension, type 2 diabetes mellitus, hyperlipidemia, and rheumatoid arthritis. 

Short-term evaluation of therapy for hyperlipidemia is based on response to diet and drug treatment as measured in the clinical laboratory by total cholesterol, LDL-C, HDL cholesterol, and triglycerides. 

Fibrate monotherapy of hyperlipidemia may predispose to rhabdomyolysis with acute renal insufficiency. Patients using fibrates should be cautioned regarding strenuous exertion, dehydration, and the need for prompt evaluation of myalgia. 

Two studies evaluated the effects of lipid-lowering therapy on clinical endpoints in the leg. The Program on the Surgical Control of the Hyperlipidemias was a randomized trial of partial ileal-bypass surgery for the treatment of hyperlipidemia in 838 patients (9). After five years, the relative risk (RR) of an abnormal ankle-brachial index value (ABI) was 0.6 (95% Cl, 0.4 to 0.9, absolute risk reduction, 15% points, p < 0.01), and the RR of claudication or limb-threatening ischemia was 0.7 (95% Cl, 0.2 to 0.9, absolute risk reduction, 7% points, p < 0.01), as compared with the control group. 

The use of plant sterols—(3-sitostcrol and sitostanol in consumer products to decrease cholesterol is supported by numerous clinical studies that document their efficacy in lowering mild hyperlipidemia (Jones et al., 1998 Hallikainen and Uusitupa, 1999). Although the normal diet contains plant sterols that range from 160 to 360 mg/day, a 5- to 10-fold increase is required to exert a cholesterol-lowering effect. Consumer products with increased amounts of phytosterols that exceed the content found in the diet have been made available to the consumer. In evaluating the efficacy of including sitostanol ester in margarine as a dietary supplement for children with familial hypercholesterolemia (FH), it was found that serum total cholesterol (TC), intermediate density lipoprotein-cholesterol and LDL-cholesterol levels fell while the HDL-cholesterol/LDL-cholesterol ratio was elevated. 

Lata, S., Saxena, K.K., Bhasin, V., Saxena, R.S., Kumar, A., and Srivastava, V.K. 1991. Beneficial effects of Allium sativu, Allium cepa and Commiphora mukul on experimental hyperlipidemia and atherosclerosis—a comparative evaluation. J. Postgrad. Med. 37(3), 132-135. 

POSCH Program on the Surgical Control of the Hyperlipidemias PROSPER Prospective Study of Pravastatin in the Elderly at Risk PROVE-IT Pravastatin or Atorvastatin Evaluation and Infection Therapy... 

Most clinical determinations of triglycerides are based today on non-chromato-graphic principles total triglycerides are routinely evaluated. Nevertheless, high-temperature GC profiles were shown to be useful in biomedical investigations involving various cases of hyperlipidemia [337,338]. It is possible that the ratios of different triglycerides and cholesteryl esters could provide some metabolic information. 

LBG has previously only been used in trace amounts in food products and has not been evaluated in treating hyperlipidemia. It is a hydrophylic compound that in an unhydrated form could create a bolus-like obstruction of the bowel. Bowel obstruction has been reported with the use of a simiiar hydrophylic compound,15 although Kahn has recently reported feeding subjects 9 gm/day of Guar in capsules which were not hydrated without side effects.l6... 

Otsuka Long-Evans Tokushima Fatty (OLETF) rats have hyperphagia because they lack receptors for cholecystokinin and become obese, developing hyperlipidemia, diabetes, and hypertension (29-31). We previously reported that CLA, especially Q)trans, 2cis (lOr, 12c) CLA, has anti-obese and hypolipidemic effects in OLETF rats. These effects were attributed to the enhancement of fatty acid 3-oxidation and the suppression of fatty acid synthesis (32,33). In the present study we evaluated the effect of CLA isomers (0.5% supplementation with 5% com oil) on the development of hypertension in OLETF rats. 

Primary Hyperlipidemia and Dietetic Treatment. Gas-Liquid Chromatographic Evaluation of the Changes in the Plasma Lipids and Their Fatty Acid Pattern in Hyperlipidemia Following Administration of a Diet Rich in Polyunsarurated Lipids Dan. Med. Bull. 14(1-2) 27-32 (1967) ... 

Gas Chromatographic Evaluation of Plasma Triglyceride Composition in Hyperlipidemia J. Chromatogr. 162(2) 177-184... 

The first study with retinoic acid on humans, however, failed to show any positive effects on the emphysema, but it did show mild negative side effects (including skin changes, transient headache, hyperlipidemia, transaminitis, and musculoskeletal pains) [91]. To evaluate the feasibility of ATRA as a clinical therapy, 20 patients with severe emphysema were enrolled into a randomized, double-blind, placebo-controlled pilot study. In general, treatment was well tolerated and associated with only mild side effects including skin changes, transient headache, hyperlipidemia, transaminitis, and musculoskeletal pains. 

Bunea, R., Khassan el, F., and Deutsch, L. 2004. Evaluation of the effects of Neptune Krill oil on the clinical course of hyperlipidemia. A/fernafive medicine review, 9(4), 420-428. 

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