Lipid disorders

OXFORD, England -- Statin drugs are highly effective and are generally safe when used as indicated, a literature review confirmed.

BOSTON -- In a discovery that may explain the successes of the Atkins diet, investigators have found that a single hormone may switch on the use of stored fat for fuel when all else fails.

ATLANTA -- Credit for the near halving of the rate of coronary disease deaths in the U.S, from 1980 to 2000, belongs equally to reductions in risk factors and to the rise of evidence-based therapies, found CDC and British researchers.

ABSTRACT: Atypical clinical presentations in the quality, intensity, and radiation of pain are common in patients with acute coronary syndromes. Women with an acute myocardial infarction (AMI) are more likely to have atypical symptoms, such as dyspnea, than men. A history of acute anxiety or a psychiatric diagnosis does not preclude the possibility of an acute coronary event in a patient with chest pain. The clinical response to a GI cocktail, sublingual nitroglycerin, or chest wall palpation does not reliably identify the source of pain. Over-reliance on tests with poor sensitivity, such as the ECG, or on the initial set of cardiac biomarkers will miss many patients with MI. Serial troponin levels obtained at 3- to 6-hour intervals are recommended to evaluate the extent of myocardial damage. Coronary angiography that detects mild non-obstructive disease does not exclude the possibility of sudden plaque rupture and acute coronary occlusion.

Is it necessary to prescribe lipid-lowering therapy for a patient with a mildly elevated total cholesterol level (240 mg/dL), a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL, and a high high-density lipoprotein (HDL) cholesterol level of 100 mg/dL?

TOKYO -- Regular aerobic exercise of at least two hours a week produced a small increase in HDL, according to a meta-analysis.

BOSTON -- Substituting soy into an otherwise healthy diet may be cardioprotective for postmenopausal women, researchers found.

ROCHESTER, Minn. -- A dose of blunt reality, without sugarcoating, helped patients with diabetes appreciate their cardiovascular risks and gave them incentives to be compliant with statins.

SAN DIEGO -- Despite potential health consequences, the metabolic status of patients appears to have little bearing on clinicians' choices of an atypical antipsychotic agent, said investigators here.

SAN DIEGO -- Bifeprunox, an investigational atypical antipsychotic agent, was significantly better than placebo at preventing deterioration of schizophrenia over six months and had a good metabolic profile.

ANAHEIM, Calif. -- Statins may guard the prostate as well as the heart, according to a large screening study in Finland.

SAN DIEGO -- Psychiatrists need to do more objective measurement of the physical and mental health of their schizophrenic patients, researchers said here.

FRAMINGHAM, Mass. -- As serum phosphorus levels increase, so does the risk of cardiovascular disease, even among those with normal kidney function and no evidence of heart troubles, researchers reported here.

BOSTON -- A simple test of insulin secretion may predict which obese patients would be better off with a low-glycemic load diet than a low-fat one, researchers here found.

SANTA MONICA, Calif. -- Women are less likely to achieve good control of both heart disease and diabetes than men because they get lower quality care, researchers here reported.

ORLANDO -- Be they bare-metal or drug-eluting, stents led to a better outcome for diabetic coronary-disease patients when augmented by clopidogrel (Plavix) for more than six months, researchers here reported.

IOWA CITY -- Most users of herbal supplements are doing it for anything that ails them, ignoring specific claims of efficacy, however tenuous, found investigators here.

WASHINGTON -- An employee health program incorporating a fitness center, health education, and incentives improved workers' cardiovascular health and workplace safety, investigators reported here.

WASHINGTON -- When the stroke is hemorrhagic, secondary prevention measures are significantly less likely to be initiated than when the event is ischemic, researchers said here.

SEATTLE -- Lowering blood pressure with centrally active angiotensen enzyme inhibitors may have the added benefit of reducing the risk of cognitive decline, researchers here reported.

BOSTON -- The risk of a second stroke declined significantly among patients who had a large reduction in LDLs within a month of starting on a statin, investigators reported here.

ABSTRACT: In addition to appropriate pharmacotherapy and assistance with smoking cessation, a secondary prevention plan should include counseling about a heart-healthy diet, a structured exercise program and/or increased physical activity, and assessment of psychosocial risk factors, such as depression. Advise patients to reduce their intake of salt, sugars, refined carbohydrates, and saturated and trans fats; incorporate more fruits, vegetables, and fish into their diet; and balance caloric intake and physical activity to achieve and maintain a body mass index between 18.5 and 24.9 kg/m2. Cardiorespiratory fitness is the key to cardioprotection; the threshold for improving it in persons with coronary heart disease is about 70% of the mea-sured maximal heart rate. Encourage patients to engage in multiple short bouts of physical activity daily, such as taking the stairs instead of the elevator or walking the dog. Among previously sedentary persons, this approach has effects on cardiorespiratory fitness, body composition, and coronary risk factors similar to those of a structured exercise program.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

BETHESDA, Md. -- Heart disease risk factors in early adulthood presage atherosclerosis in middle age, suggesting that early intervention may be beneficial, researchers found.

MIDDLESBROUGH, England -- Whole-grain oats can carry the lipid-lowering banner higher than other whole grains -- but not too high.