Lipid disorders

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.

CHICAGO -- Those habitual college keggers could be chugging toward heart disease later in life, investigators reported here.

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

Remember the "good old days" (boy, do I feel old writing that) when all you had to do was practice clinical medicine and take care of patients? Certainly the fee-for-service/ solo practice era was simpler-but then you couldn't do nearly as much for patients as you can today.

For several months, a 52-year-old woman has had burning discomfort in the region of her lower sternum and frequent acid/sour sensations in her throat; the symptoms are usually associated with burping after meals and recumbency.

NEW ORLEANS -- The potential impact of the COURAGE trial -- the headline-making study that matched medicine to stenting in patients with chronic stable angina -- appears to be in the eye of the clinical beholder.

BALTIMORE -- Statins are associated with a reduced risk of sepsis for kidney patients on dialysis, found researchers here.

KOBE, Japan -- Fish-oil supplements added to statin therapy can further reduce the risk for major coronary events even among patients who already eat a diet heavy in fish, Japanese investigators reported.

NEW ORLEANS -- Torcetrapib, an investigational cholesteryl ester transfer protein (CTEP) that spikes HDLs but boosts blood pressure, may have proatherogenic effects, according to results from a pair of ultrasound studies.

NEW ORLEANS -- Subclinical carotid atherosclerosis appeared to slow down when patients took high-dose rosuvastatin (Crestor), researchers reported here.

NEW ORLEANS -- With an investigational super-potent fibrate called LY518674, HDLs didn't rise as planned for patients with atherogenic dyslipidemia, but serum creatinines went up unexpectedly, researchers here reported.

NEW ORLEANS -- A burst of high-dose statins just before angioplasty and stenting for stable acute coronary syndrome appears to reduce cardiac complications, found an Italian trial.

DALLAS -- When diet and exercise fail to lower cholesterol in children with high-risk lipid abnormalities, statins should be first- line drug therapy, declared the American Heart Association.

BOSTON -- Middle-age volunteers whose parents survived to age 85 or older had significantly better Framingham risk scores than those whose parents died younger, suggesting that cardiovascular longevity may reside in the genes.

SEATTLE -- Angioplasty and stenting of small vessels below the knee are successfully staving off amputation among older patients with severe peripheral arterial disease (PAD), researchers said here.

STOCKHOLM -- Glucose levels at the top end of the normal range ratchet up the risk of congestive heart failure for patients already at high risk, revealed an analysis of two international studies.

ORLANDO, Fla. -- When post menopausal women stop hormone replacement therapy, LDL cholesterol levels are likely to spike, leading many physicians to prescribe statins that may be superfluous, according to researchers here.

ORLANDO, Fla. -- Men who limited alcohol intake to less than a glass of wine a day lived about four years longer than those who consumed similar amounts of beer or spirits, researchers here reported.

CHAPEL HILL, N.C. -- Some newer atypical antipsychotic are better than others at controlling schizophrenia in patients who were previously taking perphenazine, but the newer agents are pretty much the same, found investigators in a new analysis of data from the CATIE study.

NORWICH, England -- The way that toddlers and teens grow may protect them against high cholesterol levels in adulthood, researchers here found.

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The prevention of symptomaticcoronary heart diseaseand other vascular disordersrepresents a significanthealth care priority, especiallyin a population that is growingolder and more obese. However,a recent survey has shownthat many laypersons-and evensome physicians-do not know allthe target lipid levels that are associatedwith optimal reduction ofcardiovascular risk.

In imaging studies in patients older than 55 yearswith suspected coronary artery disease or peripheralvascular disease, more than 80% of renal artery lesionsare associated with generalized atherosclerosis.

LOS ANGELES -- Interrupting antiretroviral therapy for HIV patients increases the risk of cardiovascular disease by more than 50% over four years, a British researcher said here.

STANFORD, Calif. -- For six long months, scores of volunteers with elevated LDL levels wolfed down a daily sandwich spread with a blended raw clove of garlic, eagerly anticipating that when it was all over their lipid would be better. Alas, it did not happen.

KISSIMMEE, Fla. -- The selective estrogen receptor modulator toremifene (Acapodene) improved lipid profiles and increased bone mineral density in androgen deprivation therapy for advanced prostate cancer.