Practical Lipid Management Concepts and Controversies

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ISBN: 9780470056905 | 0470056908
Cover: Hardcover
Copyright: 11/17/2008

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Practical Lipid Management: Concepts and Controversies presents a user-friendly overview of lipid management and a concise summary of best practice according to various international guidelines. Featuring a summary of the various international guidelines and highlights areas of consensus, the book provides balanced guidance on issues about which expert opinion is divided or rapidly evolving. It helps the busy clinician to focus on the key aspects of lipid management for the evaluation and treatment of lipid disorders.Practical Lipid Management: Concepts and Controversies forms an invaluable and useful tool for all primary care physicians and others involved in the management of dyslpidaemias and diseases such as diabetes and atherothrombosis.

Foreword	p. xiii
Preface	p. xv
Acknowledgements	p. xix
Epidemiology of Lipids, Lipid Management and Risk for Coronary Heart Disease: An Overview	p. 1
Early History of Cardiovascular Epidemiology	p. 2
Lipid Risk Factors are Central to Efforts at CHD Prevention	p. 3
LDL-C and CHD Risk	p. 4
LDL-C Lowering and CHD Risk Reduction	p. 6
Other Atherogenic Lipoproteins: Atherogenic Remnants	p. 7
HDL-C and CHD Risk	p. 9
Trends in Lipids and Lipid Management in the USA	p. 10
The National Cholesterol Education Program Evaluation Project Using Novel E-Technology (NEPTUNE) II Survey	p. 10
Controversy: Should a Measure of Atherogenic Lipoprotein Particle Number be used in Risk Assessment And/Or to Evaluate the Response to Lipid Therapy?	p. 12
Vascular Biology and Atherogenesis	p. 19
Introduction	p. 20
Arterial Structure	p. 20
Endothelial Cell Function and Dysfunction	p. 21
The Role of Monocytes and Lymphocytes	p. 24
Atheromatous Plaques	p. 25
Detection, Evaluation, and Treatment Goals for Lipid Disorders in Adults	p. 31
Matching Aggressiveness of Treatment to Absolute Risk	p. 32
Screening for Dyslipidemias	p. 32
Risk Stratification	p. 34
Steps in the Risk Stratification Process - Major Risk Categories	p. 35
Tips for Calculating the Framingham Risk Score	p. 36
Subcategories for Consideration of More Aggressive Optional Treatment Goals	p. 39
Very High Risk Patients, Optional LDL-C Goal <70 mg dl[superscript -1]	p. 40
Moderately High Risk Patients, OPTIONAL LDL-C Goal <100 mg dl[superscript -1]	p. 40
Treatment Goals for Patients with Elevated Triglycerides	p. 40
Triglycerides and HDL-C as Targets for Therapy	p. 41
Controversy: Should Treatment Guidelines Include Targets for the Total/HDL Cholesterol Ratio?	p. 41
Therapeutic Lifestyle Changes in the Management of Lipid Disorders and the Metabolic Syndrome	p. 51
Nature and Nurture in the Development of CHD Risk Factors	p. 52
Lifestyle Factors as Determinants of CHD Risk in Populations	p. 53
Within Country Variations in Lifestyle and CHD Risk	p. 53
The Metabolic Syndrome	p. 54
Therapeutic Lifestyle Changes	p. 55
The TLC Diet	p. 56
Dietary Adjuncts: Viscous Fibers and Plant Sterol/Stanol Products	p. 58
Physical Activity and Weight Reduction	p. 59
Smoking Cessation	p. 59
Importance of Allied Health Professionals	p. 59
Management of Elevated Low-Density Lipoprotein Cholesterol	p. 63
Relationship between LDL-C and Risk for Cardiovascular Events	p. 64
Clinical Trial Support for Very Aggressive LDL-C Reduction for Those at Highest Risk	p. 66
Genetic Disorders Associated with Elevated LDL-C	p. 73
Atherogenic Impact of LDL-C	p. 73
Management of Elevated LDL-C	p. 74
Summary	p. 82
Controversy: How Low Should We Go?	p. 82
Controversy: Risks and Benefits of High-Dose Statin Therapy Versus Combination Lipid Drug Therapy	p. 87
Controversy: Do the Benefits of Low-Density Lipoprotein Cholesterol Reduction Depend Strictly on "How Low You Go" or also on "How You Get There"?	p. 90
Management of Elevated Triglycerides and Non-High-Density Lipoprotein Cholesterol	p. 105
Clinical Factors Associated with Elevated TG and Non-HDL-C Levels	p. 106
Disorders of TG-Rich Lipoprotein Clearance	p. 107
Insulin Resistance and Hypertriglyceridemia	p. 108
Excessive Production of VLDL: The Primary Lipid Abnormality in the Insulin-Resistant State	p. 108
Reasons for Elevated Free Fatty Acid Levels in Insulin-Resistant States	p. 109
Body Fat Distribution and Insulin Resistance	p. 109
Insulin Resistance in the Nonobese Patient	p. 109
Hypertriglyceridemia and the Development of Atherogenic Dyslipidemia	p. 110
Lifestyle Management for the Metabolic Syndrome and Atherogenic Dyslipidemia	p. 111
Drug Therapies	p. 112
Intensification of Efforts to Lower LDL-C as a Means of Achieving the Non-HDL-C Goal	p. 112
Targeting Triglyceride-Rich Lipoprotein Reduction as a Means of Achieving Non-HDL-C Goal	p. 113
Fibrates	p. 113
Niacin	p. 114
Omega-3 Fatty Acids	p. 115
Management of Diabetic Dyslipidemia	p. 115
Controversy: Do we Need a Triglyceride Treatment Target to Insure a Predominance of Larger, More Buoyant LDL Particles?	p. 116
Management of Depressed High-Density Lipoprotein Cholesterol	p. 127
The Relationship between HDL and Risk For CVD	p. 128
Prevalence of Low HDL-C	p. 130
Goals for HDL Treatment	p. 131
Antiatherogenic Effects of HDL	p. 132
HDL and Insulin Resistance	p. 137
Effects of Lifestyle Modification on Serum HDL	p. 137
Pharmacologic Management of Low HDL	p. 139
Controversy: Do we Need HDL Treatment Goals?	p. 143
Lipid Management in Population Subsets: Women, the Elderly, Ethnic Minorities, Children, and Adolescents	p. 155
Women	p. 156
Lipids in Women	p. 157
Treatment of Dyslipidemia in Women	p. 157
Sex Hormone Therapy, Lipids, and Cardiovascular Risk in Menopausal Women	p. 159
The Elderly	p. 159
Special Considerations for Lipid Management in the Elderly	p. 160
Ethnic Minorities	p. 160
Risk Factor Incidence and Prevalence in Ethnic Minority Groups	p. 162
Children and Adolescents	p. 162
Emerging Risk Factors and Biomarkers of Cardiovascular Disease	p. 167
Role of Inflammation in the Pathogenesis of Atherosclerosis	p. 168
Biomarkers of Cardiovascular Disease	p. 168
A Primer on Clinical Trials and Critical Review of Clinical Trial Reports for the Clinician	p. 191
Design Issues Affecting the Validity and Generalizability of Clinical Trial Results	p. 192
Chance, Bias, and Confounding as Potential Explanations for Trial Results	p. 199
Efficacy versus Effectiveness	p. 202
Useful Questions to ask when Evaluating a Published Clinical Trial Report	p. 203
Controversy: Should Lipid Drugs be Approved without Clinical Event Data?	p. 204
Case Studies	p. 209
CAD with Recent Acute Coronary Syndrome	p. 211
Peripheral Arterial Disease (PAD)	p. 212
Patient with Heterozygous Familial Hypercholesterolemia	p. 214
Severe Hypertriglyceridemia	p. 214
Metabolic Syndrome	p. 216
Intolerance of Intermediate-Dose Statin Therapy	p. 217
Patient with Ischemic Stroke	p. 218
Patient with Chest Pain on Gemfibrozil	p. 219
Low HDL-C in a Patient with Stable CHD and Early Carotid Disease	p. 220
Statin Drug Interaction With Hepatotoxicity	p. 221
Patient with Dyslipidemia and History of Rhabdomyolysis	p. 222
Statin-Induced Myalgia without Myopathy	p. 223
Index	p. 227
Table of Contents provided by Ingram. All Rights Reserved.

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Practical Lipid Management Concepts and Controversies

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