Hyperlipidemia patient evaluation

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 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. 

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