Lipid disorders

ABSTRACT: Subclinical hypothyroidism is associated with elevated low-density lipoprotein (LDL) cholesterol levels and several factors related to atherosclerosis, including increased C-reactive protein levels and impaired endothelium-dependent vasodilatation. However, considerable controversy exists about screening for and treating this thyroid disorder. Thyroxine therapy lowers elevated LDL cholesterol levels in patients whose serum thyroid-stimulating hormone (TSH) concentrations are higher than 10 mIU/L ; thus, most experts recommend treatment for such patients. However, there is no consensus regarding the management of patients with TSH levels of less than 10 mIU/L. Although the evidence supporting treatment of these patients is not compelling, it is reasonable to offer a therapeutic trial of thyroxine to those who have symptoms.

ABSTRACT: Our knowledge of chronic diseases has advanced significantly in recent decades, but patient outcomes have not kept pace. This is largely because the traditional acute care model does not adequately address the needs of patients with chronic disease. Patients play an active role in the management of chronic disease, and successful outcomes are highly dependent on adherence to treatment. Thus, clinicians need to have skills in coaching and encouraging as well as an awareness of factors in patients' backgrounds that are likely to affect their ability or willingness to follow treatment plans. Provider- and system-related factors, such as lack of reimbursement for counseling and high copayments, can also act as barriers to compliance. Among the strategies that can improve adherence are the use of community resources, multidisciplinary approaches, and regular follow-up.

The recent editorial by David T. Nash, MD, "OTC Statins: Panacea or Pandora's Box?" (CONSULTANT, July 2006, page 845), prompted a number of readers to write in. A selection of the comments received, along with a response from Dr Nash, appears below. Additional comments appear on www.ConsultantLive.com.

The optimal approach to subclinical hypothyroidism continues to be debated. Experts disagree over screening for thyroid dysfunction, the threshold TSH level for treatment, and the upper limit of normal of the TSH reference range.

Over the past few decades, the management of chronic disease has assumed a greater role in health care. Diseases such as diabetes, chronic obstructive pulmonary disease, and depression have replaced acute disorders as the leading cause of morbidity, mortality, and health care expenditures.

The recent editorial by David T. Nash, MD, "OTC Statins: Panacea or Pandora's Box?", prompted a number of readers to write in.

KINGSTON, Ontario -- There's a more sophisticated way to calculate just what high lipid levels in teens portend for their cardiovascular futures.

TORONTO -- As better antiretroviral regimens are developed, more patients infected with HIV are succumbing to fatal opportunistic infections that are the hallmark of AIDS.

TORONTO -- Human growth hormone appears to reverse some elements of HIV-treatment related lipodystrophy, researchers reported here.

CHICAGO -- A diet high in saturated and trans fats along with a high intake of dietary copper may be associated with an accelerated decline in thinking, learning, and memory, researchers reported.

TORONTO -- HIV-positive patients are at a small but increased risk of cardiovascular disease from antiretroviral therapy, investigators reported here.

TORONTO -- Increased cholesterol and triglycerides in HIV-infected children being treated with highly active antiretroviral therapy (HAART) can be markedly reduced by switching regimens, researchers reported here.

TORONTO -- HIV patients ages 50 and over do a better job controlling the virus but may need more help managing adverse effects and comorbidities.

LOS ANGELES -- Unmarried life may impinge on life expectancy, according to researchers here.

WASHINGTON -- The Physicians Committee for Responsible Medicine, a crusading group that has long ranked vegetarianism high on its agenda, has made a compelling case for a low-fat vegan diet to improve glycemic control.

LONDON -- For some patients with cardiovascular disease risk factors, the root cause may be the loneliness of childhood, according to a study that followed more than 1,000 adults from birth.

PAMPLONA, Spain -- Severe obstructive sleep apnea more than doubled the risk of a first ischemic stroke in persons over age 70, researchers here reported.

A middle-aged woman is experiencing episodes of chest pain and fatigue. Although stress test results are positive for ischemia, coronary angiography reveals open arteries. What next step would you take?

GRONINGEN, The Netherlands -- Two decades after they were treated with Adriamycin (doxorubicin) for osteogenic sarcoma or malignant fibrous histiocytoma, the cardiac status of 22 long-term survivors continues to worsen.

ROCKVILLE, Md. -- Beware the smooth-tongued Internet pitchmen touting so-called "dietary supplements" that allegedly treat erectile dysfunction and enhance sexual prowess, the FDA has warned consumers.

MADRID -- There's a simple way to calculate a middle-age patient's eventual dementia risk, on a scale of one to 15, according to Swedish investigators.

AARHUS, Denmark -- Older women and men who live alone have a two- to three-fold higher risk for unstable angina, myocardial infarction, or sudden cardiac death, researchers here reported.

ROCHESTER, N.Y. -- Patients taking the antipsychotic Clozaril (clozapine) for schizophrenia need to be monitored for signs of metabolic syndrome, according to investigators here.

ATLANTA -- Combination therapy may be needed to reach lipid lowering goals, researchers reported here.

CHICAGO - Patients with peripheral arterial disease who remain active in daily tasks such as shopping and walking have a third the risk of dying compared with those who are more sedentary.