Peripheral arterial disease hyperlipidemia

Buchwald H, Bourdages HR, Campos CT, et al. Impact of cholesterol reduction on peripheral arterial disease in the Program on the Surgical Control of the Hyperlipidemias (POSCH). Surgery 1996 120 672-679. 

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... 

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 ... 

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 vascular defense mechanisms associated with most genetic disorders are nonspecific. These mechanisms can aggravate the development of atherosclerotic plaques at predisposition sites. Other nonspecific mechanisms lead to peripheral forms of atherosclerosis by causing a thickening of the vascular wall throughout the arterial system. This peripheral form of vascular disease is characteristic for angiopathies associated with Type 111 hyperlipidemia, diabetes, and many other inherited metabolic diseases. 

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