Lipid disorders

Test your clinical skills in this week’s 5-question quiz.

Colesevelam helps reduce serum glucose levels and also lowers LDL-C in patients with type 2 diabetes. Bromocriptine reduces the relative risk of cardiovascular events in patients with type 2 diabetes.

Every-other-day dosing, especially of statins with longer half-lives is shown to preserve lipid-lowering benefits.

Barriers to the use of statins-the most potent medicine currently available in the fight against atherosclerotic heart disease-are both real and perceived.

Lp(a) is an LDL-like particle that exists in plasma in the VLDL range; its density lies between that of LDL and HDL. Lp(a) increases CV risk.

A new link between heart disease and red meat offers an understanding of the cardiovascular health benefits of a vegetarian diet.

Persons who eat a high-fiber diet experience a lower risk of first-time stroke, according to a new meta-analysis that supports current guidelines to increase fiber consumption.

High-potency statin therapy may increase risk of new onset diabetes but also reduces cardiovascular events.

Elevated levels of the biomarker C-reactive protein in patients with HIV infection increased the risk of MI approximately 2-fold.

Much like HIV/AIDS, RA is associated with a higher risk of cardiovascular disease and consequent death. How might inflammation add to the risk?

It would be a mistake to attribute all beneficial outcomes obtained from statins solely to cholesterol lowering. Statins have pleiotropic effects-that is, they are simultaneously capable of producing more than one benefit, and in cardiovascular risk reduction, they accomplish more than simply lowering cholesterol.

Typical interventions in persons without CKD are essential. SHARP and TNT have added to our knowledge. Aggressive cholesterol lowering (probably also affecting LDL particle number as well as traditional measures of LDL) seems to afford better outcomes by lessening residual risk in those with chronic kidney disease.

Diabetes progress; folic acid and autism; acupuncture and allergic rhinitis; depression and shingles vaccine; HMP virus alert.

Goals for HbA1C, blood pressure, and LDL-C among diabetes patients are being met by more, according to the NIH.

It has been predicted that costs for cardiovascular disease will increase to more than $1 trillion dollars annually in the US by 2030. If statins are effective in preventing heart disease, why are costs still rising?

The explosion of data regarding residual risk and contributions from LDL-P predicts an exciting future. Right now, treatment regimens are in flux awaiting further details on LDL-P interventions and a host of new drugs.

Two studies have demonstrated novel research directions for LDL-C and LDL-P. The first revealed that when LDL-C and LDL-P are concordant (that is either both high, normal, or low), either can serve as a good measure of CV risk. However, when they are discordant, cardiovascular events increase.

Reducing hyperglycemia in older patients with chronic kidney disease may be best accomplished using incretin-based agents.

In patients deemed statin-intolerant, lifestyle changes and alternative classes of drugs should be pursued to lower LDL-C.

Despite best efforts with lifestyle modification and adherence to metformin and glimepiride therapy, this man’s A1C continues to rise. What next?

Also known as “broken-heart syndrome,” Takotsubo syndrome is a stress-induced cardiomyopathy.

The elderly patient has had type 2 diabetes for 15 years is now home bound after a stroke. Her HbA1c is 9.6 and she takes only metformin. Review the rest of her laboratory results and propose a management plan.

Would you treat the elevated A1C aggressively-and what would your target level be? Would you consider statins? Dr Shahady invites your insights.

Diabetic peripheral neuropathy may develop in patients who have normal or impaired fasting blood glucose or impaired glucose tolerance, precursors to frank diabetes.

Do you consider an LDL of 100 and a non-HDL of 150 significant? What is your diagnosis? Would you consider medication in addition to recommending lifestyle changes? Answers to these quiz questions here.

A 47-year-old man sees you for a check-up. He complains only of low energy and attributes it to recent weight gain. But, there is much more.

A 62-year-old woman was seen prior to cholecystectomy. She had no cardiac or pulmonary disorders. Examination was unremarkable other than a purplish-reddish, lace-like pattern on the thighs and forearms.

A 17-year-old sexually active young woman presented with sudden loss of vision in the left eye 2 weeks before presentation.

A review of 140 trials and 26 observational studies supports metformin as the best first-line treatment for type 2 diabetes in adults, both stand-alone and in combination with other medications. But second-line treatments are still a judgment call.