By Stephen J. Nicholls
Useful method of prognosis & administration of Lipid issues is an invaluable advisor designed to help physicians in making a correct overview and constructing a accomplished therapy plan for sufferers with lipid issues. This concise and informative guide covers key subject matters resembling rules of lipids and their function in atherosclerosis, scientific method of review, healing techniques, administration of particular sufferer populations, and the position of imaging modalities.
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Extra resources for Practical Approach to Diagnosis & Management of Lipid Disorders
A fasting profile that incorporates measurements of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides is preferred to simple measurements of total cholesterol alone. There is increasing interest in the assessment of non-HDL cholesterol, total: HDL cholesterol and triglyceride:HDL cholesterol ratios, which are recommended as secondary measures for risk assessment. Determination of these parameters does not require any additional analytical measurements, and it permits a more comprehensive assessment of the total burden of atherogenic lipids and features of the atherogenic dyslipidemic state associated with obesity and the metabolic syndrome.
The incidence of hepatic injury as result of statin use is rare. Adverse reactions are more common in patients cotreated with an agent that interacts with cytochrome P450 3A4 metabolism (cyclosporine, fibrates) and are not encountered with the use of pravastatin and fluvastatin, which are metabolized by other mechanisms. Myalgia and transaminase elevation are more typically observed at higher doses. Some patients require dose reduction or use of an alternative agent. Supplementation with coenzyme Q has been proposed as a means to reduce myalgic symptoms, although its use has not been extensively evaluated in clinical trials.
Associated reductions in triglyceride by up to 30% are observed with the more potent agents. Agents have variable effects on levels of HDL cholesterol, with elevations of 3% to 15%. indd 53 9/30/09 2:13:04 PM 54 Chapter 8 ■ ■ In addition to effects on lipids, it has been proposed that statins possess pleiotropic properties that may contribute to their benefit. These activities are independent of their ability to lower LDL cholesterol and appear to result primarily from inhibition of protein isoprenylation.
Practical Approach to Diagnosis & Management of Lipid Disorders by Stephen J. Nicholls