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1 Shepherd Coronary artery disease, the most important cause of death in the United Kingdom, kills about 200 000 Britons each year. Many victims are struck down out of the blue and in the prime of an active working life. Others survive the fIrst attack but are so debilitated by it that they are compelled to fall back on the efforts of their family and the Social and Health Services for their future survival. The epidemic proportions of the problem and the burden which it places on the community at large has led many health care professionals to reassess their attitudes to heart disease prevention. In the past, the clinician's attention has been directed primarily at the treatment of established ischaemic heart disease rather than focussing on forestalling its appearance by attempting to tackle those life-style habits within the population which appear to predispose to it. A number of recent developments make this approach hard to sustain. First, there is now convincing evidence that action taken against cigarette smoking, hyper tension and hypercholesterolaemia offers signifIcant protection to the individual. Secondly, effective and apparently safe antihypertensive and lipid-lowering agents have recently become available to the practicing clinician. Thirdly, developments in computer technology and laboratory equipment manufacture have brought the measurement of coronary risk factors right into the primary health care setting. And, last, but not least, political attitudes towards prevention now favour the enthusiastic general practitioner with an interest in anticipating and averting the development of degenerative diseases like atherosclerosis.
'Fast Facts: Hyperlipidemia' provides a crisp and accurate summary of lipid disorders using clear language and illustrations. Directed at a broad range of healthcare professionals, from primary care physicians to specialists, this updated fifth edition addresses the importance of considering lipoprotein particles, not just their lipids. The authors, renowned experts from the UK and USA, interpret clinical trial evidence in the context of pathogenesis and provide practical solutions to the routine problems encountered in the clinical management of hyperlipidemias. Contents: • Lipids and lipoproteins - structure and physiology • Epidemiology and pathophysiology • Familial (monogenic) hypercholesterolemia • Polygenic hypercholesterolemia and combined hyperlipidemia • Hypertriglyceridemia • Familial dysbetalipoproteinemia • Dyslipidemia in insulin resistance, the metabolic syndrome and diabetes mellitus • Secondary hyperlipidemia • Dietary treatment • Drug treatment • When to treat • Biochemical tests • Useful resources
Cardiovascular disease is the number one cause of death for men and women in this country, surpassing deaths due to all cancers combined. Better awareness of heart disease risk factors and improved treatment modalities has produced great progress in reducing deaths due to myocardial infarction and stroke over the past few decades. Still, more progress is needed, as about half of all first coronary events occur in individuals who have no cardiac symptoms and no previously diagnosed heart disease. The primary care physician, therefore, has an important role in identifying at risk individuals and beginning preventive modalities. In Hyperlipidemia in Primary Care: A Practical Guide to Risk Reduction, a group of leading authorities in the field offers a comprehensive overview of the problem along with practical strategies for treating it. This unique title reviews methods for assessing risk in patients, including an important and thorough discussion of the Framingham algorithm and its limitations and advantages in assessing CVD risk. The book also reviews the evolving world of lipidology and how to apply many of the newer lipid tests to patients in daily practice, putting these tests into proper perspective and offering a rational approach to using them in practice. Finally, treatment issues are covered. As treatment has expanded to more risk groups, a number of different guidelines have been published with recommended lipid goals. This is an evolving area of research with rapidly changing guidelines that are expanding the pool of high risk patients. An invaluable reference that offers a reasonable approach to risk assessment and treatment of individuals at increased cardiovascular risk, Hyperlipidemia in Primary Care: A Practical Guide to Risk Reduction provides the background needed to make scientifically based decisions that can ultimately help greatly reduce the number of patients impacted by cardiovascular disease.
Coronary heart disease is the principal cause of death in all Western countries. Abnormalities in the serum lipids are one of the major risk factors widely recognised as leading to this epidemic of heart disease. These abnormalities occur very com monly in the general community and in general practice, and practitioners are pre vailed upon daily to provide specific advice about diet and cholesterol and to interpret chemical estimations. This is a very emotive area of medicine, one where often the patients most active in seeking advice have the least to gain. On the other hand, there may be young people carrying a severe coronary risk, knowingly or not, who prefer to avoid risk factor in tervention. There are strong vested interests in the commercial world who would prefer to overlook any therapeutic value of dietary modification for selected in dividuals, and others who see great merit in a particular diet. The pharmaceutical in dustry has a vested interest in the cholesterol story as well. The individual doctor needs to decide for himself whether the cholesterol issue requires action or not, and for this he needs access to up to date and relevant data. This is one of the purposes of this book. The use of lipid-lowering therapy is usually quite a straightforward exercise for any medical practitioner, once the decision has been taken to initiate it.
Abstract: The diagnosis and management of hyperlipidemic and hyperlipoproteinemic states are explored from various points of view. Epidemiological observations show an inverse relationship between high density lipoprotein levels and coronary heart disease. Biochemical findings indicate how lipoproteins interact and exert their physiological and pathophysiological effects. Lipids and lipoproteins, in general are discussed. The plasma cholesteral health consequences involve lipid distribution. Research, review and evolution of clinical trials of lipid lowering to prevent coronary heart disease are included. Specific topics include various aspects of hyperlipoproteinemia: classification, diagnosis, primary and secondary types, genetic characteristics, dietary and drug treatment, and surgical management.