1/6. Applying evidence-based medicine to current practice: a round table panel discussion.Over the past decade, an expanding body of epidemiological and clinical trial data has been collated, culminating in the development of guidelines designed to help physicians make decisions about intervention and the intensity of treatment, based on objective assessments of the overall level of risk for cardiovascular disease. However, guidelines are not prescriptive and allow physicians leeway in interpretation. Thus, it is of clinical interest to explore some of the issues that may influence the use of these guidelines in clinical practice. This paper summarises a round table panel discussion that highlighted the usefulness of current guidelines, but also demonstrated that these guidelines, and the evaluation of cardiovascular risk, need to be used with care and always interpreted in the light of sound clinical judgement.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Case 2. Hyperlipidemia.A 58-year-old man with typical angina since 1994 presents to his physician. His angina is relatively stable and laboratory results indicate that his lipids are elevated. Recommendations for lipid management are discussed.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/6. Management of dyslipidemias in the age of statins.Evidence for the effectiveness of lipid-lowering therapy in reducing CHD risk continues to emerge. In primary prevention, clinical trials have demonstrated a benefit for middle-aged, high-risk men with high LDL cholesterol and, more recently, for men and women with "average" LDL and low HDL cholesterol. Although low HDL cholesterol, small dense LDL particles, elevated lipoprotein (a), elevated apolipoprotein B, and the dyslipidemia of the metabolic syndrome pose an increased in CHD risk in some patients, the risk reduction with lipid-lowering therapy has not been fully investigated. The CHD risk of isolated hypertriglyceridemia remains uncertain. Very high triglyceride levels, however, should be treated to prevent pancreatitis. A lipid-lowering diet and other appropriate lifestyle changes constitute safe advice for all patients with dyslipidemia. In initiating pharmacologic therapy, physicians should view potential risk reduction in the context of a patient's overall CHD risk. The selection of particular medications can be individualized, considering effectiveness evidence from clinical trials, lipid-lowering potency, adverse effects, drug interactions, costs, and patient preferences.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/6. niacin-induced hepatitis: a potential side effect with low-dose time-release niacin.hepatitis developed in five patients who were taking low dosages (3 g/day or less) of time-release niacin. In four of the five patients, clinical symptoms of hepatitis developed after the medication had been taken for a relatively short time (2 days to 7 weeks). This manifestation of hepatotoxicity seems to differ from that previously reported in association with use of crystalline niacin, which occurred with high dosage and prolonged usage of the medication. In view of the recent increased frequency of prescribing niacin for the treatment of hyperlipidemia, physicians should be aware of the potential for hepatotoxicity with even low-dose and short-term use of time-release niacin.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/6. Spurious hyperphosphatemia due to hyperlipidemia.A patient had hyperlipidemia associated with apparent hyperphosphatemia. Further tests on his serum and on the lipemic sera from 15 additional patients revealed a method-dependent overestimation of inorganic phosphorus values. The degree of overestimation was found to correlate positively with the serum triglyceride concentration. Unexplained elevation of the serum phosphorus level should alert the physician to the possibility of spurious hyperphosphatemia due to hyperlipidemia.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/6. Detecting and correcting hyperlipidemia.The dangers of elevated serum cholesterol levels--and in particular, of increased concentrations of small, dense lipoproteins--have been fully delineated. Although effective therapies are available, too many physicians fail to look for hypercholesterolemia, or fail to treat it effectively. Adhering to therapeutic guidelines and encouraging patient compliance can be lifesaving.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |