Lipid disorders

A 45-year-old woman is admitted for evaluation of intermittentmidsternal chest pain that began 48 hours earlier.The pain is intense and radiates down both arms to theelbows; it has been accompanied by several episodes ofnausea and diaphoresis. She denies classic angina pectorisbut reports that she has experienced episodes of chestdiscomfort that is similar to her current pain-but muchless severe and without radiation-for about 3 months.She has no history of dyspnea on exertion, orthopnea, orparoxysmal nocturnal dyspnea.

In her response to a reader’s question about clot prevention in a patient with systemiclupus erythematosus (SLE) and anticardiolipin antibody syndrome,Dr Bonnie Bermas recommends warfarin (CONSULTANT, September 15, 2003,page 1329).

For 2 days, a 43-year-old woman has had a slightly tender rash on her trunk andextremities. Five days earlier, the patient was given levofloxacin for an upperrespiratory tract infection; because she is prone to yeast infections while takingantibiotics, fluconazole also was prescribed. Her only other medication is an oralcontraceptive, which she has been taking for several years.

A major controversyin cardiologytoday iswhether loweringthe level oflow-density lipoprotein cholesterol(LDL-C) to substantiallybelow 100mg/dL-the current NationalCholesterol EducationProgram goal for patientswith existing coronaryheart disease1-willfurther reduce the incidenceof cardiovascularmorbidity and mortality.

ATLANTA -- The long-running debate about treatment choices for early localized prostate cancer remained the focus of much research into the disease during 2006, a year in which malignancy of the gland was the second leading cause of cancer deaths in American men.

BOSTON -- Despite improved treatment of stroke risk factors, and a decline in age-adjusted annual incidence, the lifetime risk of a stroke has not fallen significantly over the past half century, according to the Framingham Study.

OXFORD, England -- More women than men inherit a propensity for ischemic stroke, irrespective of traditional vascular risk factors, researchers here found.

NEW YORK -- The ban on trans fats in this city was the highest profile event during the year in diet and nutrition, as Americans continued to struggle against ever-expanding waistlines and foods deemed unhealthy.

BOSTON -- Multiple biomarkers such as C-reactive protein, homocysteine, and B-type natriuretic peptide add nuance but little substance to time-honored prognostic cardiovascular risk factors, researchers here reported.

CHAPEL HILL, N.C. -- Low levels of LDL cholesterol appear to confer a greater risk of Parkinson's disease, suggesting that it's possible to have too little of a bad thing, researchers here reported.

Despite Pfizer's high-profile drug failure, boosting HDL still a key heart-disease strategy. Several drugs in development use various mechanisms to raise levels of "good cholesterol." Meanwhile, physicians can do plenty right now to raise patients' HDL levels.

SOUTHAMPTON, England -- Smarter kids are more likely to adopt limited vegetarianism when they mature, according to a large British cohort study.

SOUTHAMPTON, England -- Smarter kids are more likely to adopt limited vegetarianism when they mature, according to a large British cohort study.

UTRECHT, The Netherlands -- Statins are being underdosed by physicians and underused by patients, leading to thousands of unnecessary heart attacks every year, according to a large Danish study.

NEW YORK -- The action by this city's Board of Health to ban the use of artificial trans fats in restaurants, ranging from pizzerias and delis to bakeries and upscale restaurants, could have fallout for mouths and lipid levels across the nation.

ABSTRACT: Prostate-specific antigen (PSA) recurrence is the most common form of advanced prostate cancer. Salvage therapies may be effective even among some high-risk men, although long-term cancer control data are limited. The natural history of PSA recurrence is long but variable. The postrecurrence PSA doubling time can identify men at high risk for progression and death. Early hormonal therapy, possibly via combined androgen blockade, may reduce the risk of progression and improve cancer-specific survival among men with high-risk recurrence. Men with low-risk recurrences likely receive minimal benefit from aggressive early hormonal therapy and may actually be harmed.

BOSTON -- Statins are effective in primary prevention for patients free of cardiovascular disease, according to a meta-analysis.

LEXINGTON, Ky. -- Yo-yo weight loss may increase the risk of gallstone disease in men, researchers reported.

CHICAGO -- Some relatively simple steps by the pharmacy may sharply escalate compliance by older patients, researchers reported here.

CHICAGO -- Women receive significantly less recommended secondary prevention for coronary artery disease than do men, researchers said here.

BOSTON -- Even if diabetes is left out of the equation, higher-than-optimum blood glucose is a major worldwide killer, according to researchers here.

ST. LOUIS -- What a week for fat mice! Only days after Harvard researchers squeaked with joy about the wonders of a compound in red wine, investigators here said a drug used to treat malaria can reverse the so-called metabolic syndrome in chubby rodents.

OAKLAND, Calif. -- Statins appear to be beneficial in reducing death and hospitalizations in heart failure patients, according to researchers here.

BOSTON -- The quality of care in Medicare managed-care plans is far from optimal for all enrollees, varies from plan to plan, and is unequal for black patients, researchers reported.

A 65-year-old man consults his primary care physician because of concern about nonpruritic yellowish lesions on his eyelids. He says they have been present for the past few years but have recently become more numerous.

SAN FRANCISCO -- In highly treatment-experienced HIV patients, an investigational integrase inhibitor sharply reduced viral loads compared with placebo, researchers reported here.

WASHINGTON -- Accentuate the statins soon after hospitalization for acute coronary syndrome to reduce the two-year risk of death and cardiovascular events, according to a meta-analysis.

NEW ORLEANS -- Coronary artery disease patients younger than 55 reap a greater benefit from formal cardiac rehab and exercise training than those who are older, found a study here.

BIRMINGHAM, Ala. -- The American Gastroenterology Association has issued recommendations aimed at balancing the gastrointestinal and cardiovascular pluses and minuses when using nonsteroidal anti-inflammatory drugs (NSAIDs).

BOSTON -- A form of niacin may be a novel treatment for chronic progressive multiple sclerosis, according to researchers here. In a mouse model of MS, nicotinamide- the amide form of niacin, or vitamin B3 - significantly prevented disability.