Lipid Disorders

ABSTRACT: Low-density lipoproteins are the most common atherogenic particles in diabetic dyslipidemia; therefore statins, which dramatically reduce low-density lipoprotein (LDL) cholesterol, are first-line therapy for patients with diabetes. These agents produce equivalent relative risk reductions in those with and without diabetes but confer greater absolute risk reduction because of the increased incidence of ischemic cardiovascular events in those with diabetes. The LDL cholesterol goal for patients with diabetes who do not have coronary heart disease is below 100 mg/dL. For secondary prevention, the goal is below 70 mg/dL. High-dose statin therapy may be required to achieve these goals. Fibric acids are a reasonable initial option for patients with triglyceride levels above 200 mg/dL and high-density lipoprotein (HDL) cholesterol levels below 40 mg/dL; in such patients they reduce risk as effectively as statins. Intermediate-release niacin raises HDL cholesterol levels; the effect is enhanced when niacin is combined with a statin.

SANTIAGO DE COMPOSTELA, Spain -- Ischemic stroke patients already taking statins should be continued on the drugs during the acute phase, clinicians here recommended.

IOANNINA, Greece -- Clinicians may have to reassess the ABCs of the gender differences in disease manifestations specifically linked to X or Y chromosomes.

CLEVELAND -- The efforts to raise HDLs to reduce atherosclerosis is still a worthy objective despite a series of disappointments with new drugs, said clinicians here.

FRAMINGHAM, Mass. -- For assessing coronary risk, measuring apolipoprotein levels adds nothing to prognostic information from conventional lipid measurements, found investigators here.

SIDNEY, Australia -- Age-related macular degeneration is four times more likely to affect current smokers than those who never smoked, researchers here reported.

BELFAST, Ireland -- Sedentary adults who took a brisk half-hour walk on only three days a week lost weight and were rewarded with improved fitness and cardiovascular benefits, researchers reported.

ROCKVILLE, Md. -- The FDA has warned consumers against using three brands of red yeast rice, a product marketed as a natural remedy for high cholesterol, because they may contain lovastatin, the active ingredient in Mevacor.

WATERTOWN, Mass. -- Statins do not seem to reduce production of circulating testosterone and related androgens, researchers here reported.

BALTIMORE --Women who have migraine with visual symptoms have a 50% greater risk of ischemic stroke than women without the headaches, researchers reported.

NEW YORK -- Patients seem to get the message that a prescription for a statin drug does not give them carte blanche to jump off the dietary wagon, investigators here reported.

LOS ANGELES -- Diesel pollution may induce cardiovascular risk, researchers found in a genome-wide study.

BOSTON -- Soft drinks, whether diet or regular, are associated with substantially increased risk of metabolic syndrome among middle-age adults, according to a large community-based study.

SYDNEY, Australia -- Calorie for calorie, weight loss may be easier if diets are high in foods with a low glycemic index, such as lentils, according to a systematic literature review.

HERLEV, Denmark -- Elevated nonfasting triglycerides are associated with increased risk of fatal and nonfatal cardiac events, according to results of two large, long-term, prospective cohort studies.

BALTIMORE -- Older and cheaper oral drugs for type 2 diabetes may be just as effective at controlling glycemia and improving lipid profiles as newer agents, suggested a systematic literature review.

CLEVELAND -- Beta-blocker therapy can provide statistically significant regression of coronary artery plaque, found a review of intravascular ultrasound (IVUS) studies here.

AMSTERDAM -- Measuring the proinflammatory enzyme myeloperoxidase (MPO) might help identify healthy individuals at risk for coronary artery disease, possibly years before onset, investigators found.

COLOGNE, Germany -- Small doses of daily dark chocolate lowered blood pressure by an amount equivalent to established hypertension diet plans.

ATLANTA -- Intensive statin therapy can reduce the risk of major cardiovascular events in patients 65 and older, reported investigators in a large clinical trial.

At a routine blood pressure check, a 63-year-old woman has 2 readings of 165/100 mm Hg. The patient has had essential hypertension since age 41 years. For more than a decade, it was easily controlled with a b-blocker; however, in recent years, her blood pressure has been more variable, with occasional readings of higher than 150/90 mm Hg.

Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).

CHICAGO -- Painful neuropathy is more common with type 2 diabetes than with type 1, possibly, researchers suggest, because of a link with the metabolic syndrome.

CHICAGO -- Patients with type 1 diabetes appear to favor a low- carbohydrate, Atkins-style diet but end up consuming more fat, according to an observational study.

CHICAGO -- Metabolic syndrome and its components helped predict mortality for diabetic and non-diabetic patients alike, independently of Framingham cardiovascular risk, researchers found.