Cholesterol Disorders

Looking at contemporary medicine’s complex landscape, especially in regard to soaring costs, can make practitioners dizzy. For example, if primary care physicians were asked whether it is cost-efficient and reasonable to screen with prostate-specific antigen (PSA) measurement for early-stage prostate cancer in men with terminal pancreatic cancer or to perform colonoscopy for early diagnosis of colon cancer in women with stage IV lung cancer, the answer would be a quick and uniform no. Unfortunately, a recent publication suggests that in the real world the answer has been yes, as disturbing and wasteful as that may be.

Type 2 diabetes mellitus is an epidemic with serious and fatal complications. Some predictions estimate that 440 million persons will have this disease by 2030. Current recommendations state that patients with type 2 diabetes who are receiving monotherapy and who have elevated hemoglobin A1c levels between 7.6% and 9.0% should receive a second agent.

How effective is antimalarial therapy in patients with lupus?

Clinicians sometimes give patients a choice of medication or lifestyle changes to control blood pressure (BP) or cholesterol levels.

Common behaviors of patients taking prescription drugs, such as forgetfulness and procrastination, may result in wasteful spending of $163 billion annually, according to the recently released 2009 Drug Trend Report from Express Scripts.

The US Department of Veterans Affairs (VA) invested in health information technology (IT) and produced a net savings of $3.09 billion, according to results of a new study conducted by the Center for Information Technology Leadership (CITL).1

A 68-year-old African American man presents for a checkup. He has had type 2 diabetes mellitus for the past 5 years but has no nephropathy and no history of cardiovascular disease. He is currently taking atorvastatin, 80 mg/d, and his low-density lipoprotein cholesterol level is 80 mg/dL. His blood pressure was 148/98 mm Hg at the last visit and is now 150/98 mm Hg. What is the best treatment for him?

Forty-five percent of adults in the United States have hypertension, high serum total cholesterol levels, or diabetes, according to a recent report from the CDC.1 Of these persons, approximately 13% have 2 conditions and nearly 3% have all 3 (Figure 1). In nearly 15% of those with 1 of these conditions, it remains undiagnosed.

For more than a week, a 74-year-old man has had diminished vision in his left eye. He reports that the problem started acutely with a sensation of flashing lights in the affected eye, followed by the presence of dark floaters for several days.

What underlying disorders should primary care clinicians be alert for in patients with migraine?

Schizophrenia, a devastating mental illness that affects nearly 2.2 million Americans, is associated with high rates of morbidity and mortality.1 Persons with schizophrenia have a 20% shorter life expectancy than the general population.1,2 Furthermore, among persons with schizophrenia, there is an increased prevalence of metabolic syndrome characterized by a constellation of risk factors, including insulin resistance, abdominal obesity, dyslipidemia, hyperglycemia, and hypertension,3

In the United States, it has been estimated that 7.8% of the total population has diabetes. In 2007, the direct medical expenditures for diabetes were about $116 billion and the total direct and indirect costs were $174 billion, according to the CDC.1

Medication adherence increased in patients who received a 90-day supply compared with those who received a 30-day supply, according to a recent presentation at the Academy of Managed Care Pharmacy’s Annual Meeting.

A 68-year-old woman complains of diffuse, severe myalgia. She reports stiffness, heaviness, and cramping, which are most marked in her thighs and calves. The heaviness and discomfort result in a sensation of weakness as well.

Only 7% of patients with diabetes have reached goals for hemoglobin A1c, LDL cholesterol, and blood pressure. What can be done to help more patients achieve their goals? In this 2-part interview, Dr Edward Shahady shows how group visits can help your patients with diabetes better control their disease and reduce their risk of diabetic complications.

Almost 90% of employers consider employee medication compliance to be a prime health management objective, according to a study by the National Pharmaceutical Council (NPC).1 The majority of study respondents reported that they are analyzing or have plans to analyze prescription data to determine medication compliance for select health conditions.

This discussion reviews the currently available antivirals and recommendations for their use in influenza prophylaxis and treatment. Because our understanding of 2009 H1N1 influenza is still evolving, some off-label use of medications is discussed and noted. Information on 2009 H1N1 is updated frequently, andreaders are encouraged to monitor advisories from federal, state, and local health agencies for up-to-date information. (Drug Benefit Trends. 2010;22:10-14)

What is the role of the primary care practitioner in the care of patients with HIV infection?Although the treatment of human immunodeficiency virus type 1 (HIV-1) infection is usually directed by subspecialists, many patients who are taking highly active antiretroviral therapy (HAART) continue to see their primary care physician. What is the most effective regimen-and what complications should we be on the lookout for?

The authors are affiliated with the University of Mississippi School of Pharmacy, in University, Miss. Dr Yang is assistant professor in the department of pharmacy administration.

Primary care physicians are called upon to assess risk in patients undergoing a variety of surgical procedures. In some ways, perioperative medicine is quickly evolving into a “subspecialty” of its own. Recently, Jaffer and associates1 updated the area with new data accumulated over the past 2 years.

Health care reform is the topic of every conversation, it seems, and many of these conversations are quite impassioned.

Only 25% of adults in the United States aged 50 to 64 years receive recommended preventive health services, including influenza vaccination, cholesterol screening, and breast and cervical cancer screening.

In response to the Practical Pointer "Cholesterol Mnemonic Aids Patient Education" (CONSULTANT, August 2008) about patients who have difficulty remembering the difference between HDL and LDL cholesterol, I use "H" is for happy and "L" is for lousy!

The Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009) was held in Cape Town, South Africa, from July 19 to 22, 2009. More than 5500 delegates from more than 100 countries attended this annual event.

Case 1: Mr A. is a 55-year-old man who comes to your office for a routine physical examination. He is a traveling salesman and has recently gained weight. He does not exercise much and is a frequent visitor to fastfood establishments. His father had “a touch of diabetes” and died of a myocardial infarction (MI) at age 59.

Like other complex chronic diseases, diabetes is difficult to manage effectively in one-to-one visits in the office setting, said Edward Shahady, MD.

Frequently, patients are confused about what is included in a lowcholesterol diet. I sum up the diet in a single sentence that is hard to forget: “Nowhere on God’s green earth has anyone found any plant that has any cholesterol in it.” Or, for those who prefer something even more to the point: “Bunny rabbits don’t die of heart attacks.”

The past 3 decades have seen a profound paradigmatic shift in the treatments available for type 2 diabetes mellitus. Because the disease is complicated by a variety of macrovascular and microvascular pathologies, interventions must be broad-based (tight glycemic and blood pressure [BP] control, serum lipid and urinary protein reductions). This "multifactorial" approach has proven successful.

Diabetes is the most demanding chronic illness. It challenges every fiber of a patient’s body and spirit and demands a system of care that ministers to the biological, social, and psychological aspects of the illness. It takes a “village” to accomplish this task.

Evidence-based medicine supports the aggressive management ofdyslipidemia to prevent cardiovascular disease (CVD) in patients withtype 2 diabetes