Rationale for treatment

Article Abstract:

Many important studies of heart disease have concluded that significant health benefits derive from lowering blood cholesterol levels and levels of low-density lipoprotein (LDL) cholesterol (the ''bad'' cholesterol). In particular, the risk of coronary artery disease (CAD; disease of the vessels that supply blood to the heart) is reduced when cholesterol is controlled. A review of some of these studies is presented. Studies that focussed on patients with unusually high levels of blood cholesterol reported that atherosclerotic plaques that have already begun to clog important arteries can regress when patients' blood cholesterol is reduced. The Coronary Primary Prevention Trial data indicated that a one percent reduction in total cholesterol levels yields a two percent reduction in the risk of events associated with CAD. This has since become known as the "two to one ratio". The National Cholesterol Education Program recommends that the total cholesterol level should be less than 200 milligrams per deciliter. From 200 to 239 milligrams per deciliter is regarded as borderline-high only if a subject does not have CAD or more than one CAD risk factor. Otherwise, even this level of total cholesterol is regarded as high and should be reduced. High total cholesterol is defined as more than 240 milligrams per deciliter. Of course, it is now appreciated that the total amount of cholesterol in the blood may not be as important an indicator of CAD risk as the level of LDL cholesterol. High levels of cholesterol associated with high-density lipoproteins (HDL; the ''good'' cholesterol) reduces the risk of atherosclerosis. The National Cholesterol Education Program regards LDL cholesterol levels less than 130 milligrams per deciliter desirable; between 130 and 159 milligrams per deciliter is regarded as borderline-high, but, as with total cholesterol, this value must be considered high for patients with CAD or more than one CAD risk factor. Levels of LDL cholesterol that are more than 160 milligrams per deciliter are high for anyone. In some cases, proper diet may be sufficient to reduce LDL-cholesterol amounts to a satisfactory level, but drug therapy is often required. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hyperlipidemia, Hypercholesterolemia

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Management of hypertension and cardiovascular risk

Article Abstract:

Individuals with hypertension (high blood pressure) are at high risk of developing other types of cardiovascular disease, particularly atherosclerosis (fatty occlusive plaques within the coronary arteries) and acute myocardial infarction (heart attack). In the past 25 years antihypertensive therapy has been aggressively pursued, and treatments have brought about a dramatic reduction in the incidence of hypertension. However, many complications, such as other cardiovascular diseases, have proven to be resistant to antihypertensive therapy. One likely reason for this disappointing outcome may be the metabolic consequences of drugs used to treat hypertension. Diuretics lower blood pressure by increasing urinary fluid excretion and subsequently reducing blood volume, but this class of drugs also has detrimental effects on electrolyte balance (the concentration of various salts in body fluids), and the particular changes wrought by diuretics (decreased levels of potassium and magnesium) have been linked to the development of a variety of heart diseases. Beta blockers, a class of antihypertensive drugs that acts by interfering with the actions of the hormone epinephrine (adrenaline), have adverse effects on lipid (fat) metabolism and thus promote the formation of atherosclerotic deposits. Finally, left ventricular hypertrophy (enlargement of the ventricular chamber of the heart from which blood is pumped to most of the body), a condition that results from hypertension and obesity, among other conditions, does not respond to some antihypertensive therapy, notably diuretics and beta blockers. The newer classes of antihypertensive agents, such as calcium antagonists and angiotensin-converting enzyme (ACE) inhibitors, appear to be much more promising from the standpoint of these issues. More data need to be acquired concerning the effects of long-term hypertension management with ACE inhibitors and calcium antagonists on other forms of heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Cardiovascular diseases, Complications and side effects, Drug therapy, Antihypertensive drugs, Antihypertensive agents, Water-electrolyte imbalances, Fluid-electrolyte imbalance

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Cigarette smoking, adiposity, non-insulin-dependent diabetes, and coronary heart disease in Japanese-American men

Article Abstract:

The relationships among coronary heart disease, or disease of the major blood vessels supplying the heart; glucose intolerance, the inability to absorb and use glucose; central adiposity, the accumulation of fat on the trunk and abdomen; and cigarette smoking were assessed in 219 middle-aged and elderly Japanese-American men. Glucose tolerance was normal in 77 men and impaired in 74 men. In addition, 68 men had type II diabetes (also known as non-insulin-dependent diabetes) and 54 men had coronary heart disease. Central adiposity was related to both non-insulin-dependent diabetes and coronary heart disease. Smoking was associated with body fat distribution, and was strongly correlated with coronary heart disease. Persons who quit smoking at least a month earlier were the heaviest subjects, whereas current smokers without coronary heart disease were the leanest. However, current smokers with coronary heart disease tended to have increased amounts of abdominal fat. Past smokers with coronary heart disease had the greatest amount of central fat. Statistical analysis showed that smoking was related to fat distribution under the skin on the chest and abdomen. Thus, coronary heart disease is associated with a disproportionate increase in intra-abdominal fat and a smoking history. The cessation of smoking is associated with weight gain, especially in the central region of the body in patients with coronary heart disease. The disease processes underlying the relationship between smoking and coronary heart disease require further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Obesity, Smoking, Type 2 diabetes, Japanese Americans

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