Lipid disorders

Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).

CHICAGO -- Painful neuropathy is more common with type 2 diabetes than with type 1, possibly, researchers suggest, because of a link with the metabolic syndrome.

CHICAGO -- Patients with type 1 diabetes appear to favor a low- carbohydrate, Atkins-style diet but end up consuming more fat, according to an observational study.

CHICAGO -- Metabolic syndrome and its components helped predict mortality for diabetic and non-diabetic patients alike, independently of Framingham cardiovascular risk, researchers found.

CHICAGO -- Fructose in sodas and other beverages -- but not glucose -- can set patients on the fast track to atherosclerosis, investigators here reported.

CHICAGO -- Lipoprotein subfraction changes may be at the root of the dyslipidemia accompanying type 2 diabetes and help explain how thiazolidinediones improve carotid intima-media thickness, researchers said here.

SEATTLE -- A year of treatment with the investigational lipid-lowering agent pitavastatin has been associated with less arterial stiffness and better left ventricular function, a Japanese team reported here.

LOS ANGELES -- Strokes in middle age -- though less common than in older age -- strike women more than twice as often as they do men, researchers found.

CAULFIELD, Australia -- The risk of cardiovascular mortality increases at the earliest sign of impaired glucose metabolism, researchers reported here.

ANN ARBOR, Mich. -- Cutting statin pills in half proved safe and effective and could reduce patients' prescription costs, researchers here found.

AMSTERDAM -- High pulse pressure and carotid artery stiffness appear to be risk markers for high-tension, open-angle glaucoma, according to researchers here.

PORTO, Portugal -- As metabolic syndrome becomes more severe, symptomatic heart failure and several cardiac structural and functional abnormalities may increase progressively, researchers here reported.

OXFORD, England -- Statin drugs are highly effective and are generally safe when used as indicated, a literature review confirmed.

BOSTON -- In a discovery that may explain the successes of the Atkins diet, investigators have found that a single hormone may switch on the use of stored fat for fuel when all else fails.

ATLANTA -- Credit for the near halving of the rate of coronary disease deaths in the U.S, from 1980 to 2000, belongs equally to reductions in risk factors and to the rise of evidence-based therapies, found CDC and British researchers.

ABSTRACT: Atypical clinical presentations in the quality, intensity, and radiation of pain are common in patients with acute coronary syndromes. Women with an acute myocardial infarction (AMI) are more likely to have atypical symptoms, such as dyspnea, than men. A history of acute anxiety or a psychiatric diagnosis does not preclude the possibility of an acute coronary event in a patient with chest pain. The clinical response to a GI cocktail, sublingual nitroglycerin, or chest wall palpation does not reliably identify the source of pain. Over-reliance on tests with poor sensitivity, such as the ECG, or on the initial set of cardiac biomarkers will miss many patients with MI. Serial troponin levels obtained at 3- to 6-hour intervals are recommended to evaluate the extent of myocardial damage. Coronary angiography that detects mild non-obstructive disease does not exclude the possibility of sudden plaque rupture and acute coronary occlusion.

Is it necessary to prescribe lipid-lowering therapy for a patient with a mildly elevated total cholesterol level (240 mg/dL), a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL, and a high high-density lipoprotein (HDL) cholesterol level of 100 mg/dL?

TOKYO -- Regular aerobic exercise of at least two hours a week produced a small increase in HDL, according to a meta-analysis.

BOSTON -- Substituting soy into an otherwise healthy diet may be cardioprotective for postmenopausal women, researchers found.

ROCHESTER, Minn. -- A dose of blunt reality, without sugarcoating, helped patients with diabetes appreciate their cardiovascular risks and gave them incentives to be compliant with statins.

SAN DIEGO -- Despite potential health consequences, the metabolic status of patients appears to have little bearing on clinicians' choices of an atypical antipsychotic agent, said investigators here.

SAN DIEGO -- Bifeprunox, an investigational atypical antipsychotic agent, was significantly better than placebo at preventing deterioration of schizophrenia over six months and had a good metabolic profile.

ANAHEIM, Calif. -- Statins may guard the prostate as well as the heart, according to a large screening study in Finland.

SAN DIEGO -- Psychiatrists need to do more objective measurement of the physical and mental health of their schizophrenic patients, researchers said here.

FRAMINGHAM, Mass. -- As serum phosphorus levels increase, so does the risk of cardiovascular disease, even among those with normal kidney function and no evidence of heart troubles, researchers reported here.

BOSTON -- A simple test of insulin secretion may predict which obese patients would be better off with a low-glycemic load diet than a low-fat one, researchers here found.

SANTA MONICA, Calif. -- Women are less likely to achieve good control of both heart disease and diabetes than men because they get lower quality care, researchers here reported.

ORLANDO -- Be they bare-metal or drug-eluting, stents led to a better outcome for diabetic coronary-disease patients when augmented by clopidogrel (Plavix) for more than six months, researchers here reported.

IOWA CITY -- Most users of herbal supplements are doing it for anything that ails them, ignoring specific claims of efficacy, however tenuous, found investigators here.

WASHINGTON -- An employee health program incorporating a fitness center, health education, and incentives improved workers' cardiovascular health and workplace safety, investigators reported here.