Cholesterol Disorders

The first step in the workup of a patient with a persistent asymptomatic alkaline phosphatase (ALP) elevation is to measure gamma-glutamyltranspeptidase to determine whether the elevation is liver-related or bone-related.

To help answer the question of Mary Ellen Lewis, PA-C, about her patient with a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL and a high-density lipoprotein (HDL) cholesterol level of 100 mg/dL(CONSULTANT, June 2007), I would like to describe my approach to the treatment of dyslipidemia.

A 62-year-old man presents with painful cramps in his left lower leg that began about 6 months earlier and have recently become more frequent. The cramps occur with vigorous walking and cease when he stops for several minutes.

Regular exercise increases cardiorespiratory endurance, tolerance to physical exertion, high-density lipoprotein cholesterol levels, and insulin sensitivity while decreasing adiposity, blood pressure levels, triglyceride levels, and inflammatory markers.1 All of this is probably common knowledge, but it also seems that consistent exercise may reduce the risk of Alzheimer disease (AD) and other types of dementia. This conclusion rests on evidence accumulating from 3 perspectives: observational studies, randomized clinical trials, and animal studies.

In the November issue of Drug Benefit Trends, a Viewpoint titled "How Can We Improve Drug Safety?" and an Editorial titled, "Is the Time Right for a BTC Drug Class?" seemed to send mixed signals about whether there should be a third category of medications stocked behind the counter (BTC) for which pharmacists would provide counseling.

A 48-year-old Hispanic man had a tender, bleeding growth within a darkly pigmented plaque on the right flank. The pigmented lesion had been present since birth; it was previously asymptomatic. The tumor arose out of the mainly flat patch 6 months earlier and had slowly enlarged. The patient worked indoors, wore sunscreen daily, and generally avoided outdoor activities. He had no family history of skin cancer.

Some of my patients who are being treated for hypertension, hyperlipidemia, or both claim that an elevated blood pressure reading or lipid level measurement resulted from a sodium- or fat-laden meal that they had eaten 1 or 2 days before their office visit.

A 50-year-old woman had a 6-month history of severe generalized itchiness and fatigability. There was no associated fever, abdominal pain, or joint pain. A cholecystectomy had been performed 20 years earlier. She had no family history of hypercholesterolemia or liver disease.

GLASGOW, Scotland -- The coronary prevention benefits of five years of statin therapy in a pioneering trial proved to have enduring power as long as a decade after the original study ended, researchers here found.

LONDON -- Stormy relationships may increase long term wear and tear on the heart physically as well as emotionally, leading to a modestly increased risk of coronary events.

SAN DIEGO -- Older patients with HIV infection have robust responses to highly active antiretroviral therapy (HAART), with no increased risk of metabolic disorders or other adverse effects, according to two studies.

SAN DIEGO -- Once stereotyped as wasting away, HIV patients have joined the rest of America in fighting the battle of the bulge, according to results of a study reported here.

Respondents to a MedPage Today poll overwhelmingly supported the concept of annual preventive visits.

HAMILTON, Ontario -- Creatine and conjugated linoleic acid supplements may safely boost the effects of weight training exercise for older adults, researchers found.

LUEBECK, Germany -- Left main coronary artery disease appears to be highly heritable and a better predictor of a sibling's risk than a general family history of heart disease.

DALLAS -- Preoperative evaluation of patients with heart disease should focus on determining current medical status, not providing clearance for surgery, according to an update of guidelines from the American Heart Association and the American College of Cardiology.

BETHESDA, Md. -- Low maternal cholesterol early in pregnancy may increase the risk of preterm delivery among otherwise low-risk white women, researchers found.

A comatose 82-year-old woman is brought to the emergency department. Her husband reports that after dinner she began to have difficulty in speaking, lost consciousness, and fell to the floor. He tried to rouse her, but was unsuccessful and called for an ambulance.

For resistant pruritus ani, have patients try using cholestyramine topically.

SAO PAULO, Brazil -- Treatment of obstructive sleep apnea with continuous positive airway pressure reverses early signs of atherosclerosis, according to researchers here.

Take this MedPage Today poll examining the costs -- in dollars and manpower -- of preventive health visits.

SYDNEY -- For patients with coronary artery disease, a maximum risk reduction required not only the lowest level of LDLs, but also the highest level of HDLs, found investigators here.

HONG KONG -- What's bad for the heart may also be bad for the colon, according to investigators here.

PITTSBURGH -- Preventive care services such as mammography and cholesterol screening are much more likely to be delivered outside the realm of the annual well-patient checkup than as part of it, found researchers here.

CHICAGO -- Statins, widely used for their anti-cholesterol properties, also appear to have anti-microbial and anti-fungal properties, researchers said here.

AMSTERDAM -- Men are up to two and a half times more likely to have newly diagnosed type 2 diabetes than women, but once a woman is diagnosed, the disease is just as deadly for them as for men.

CAMBRIDGE, England -- Apolipoprotein E (apoE) genotypes appear to have a linear relationship with cholesterol levels and heart disease risk, researchers found.

DALLAS -- A byproduct of cholesterol metabolism may help explain why women's risk of heart disease increases after menopause, researchers here said.

Congestive heart failure and cirrhosis are the most common causes of transudative pleural effusions, while pneumonia and malignancy are responsible for the majority of exudative effusions. Plain chest films are valuable in confirming the presence of an effusion, providing clues to the cause, and directing the method of pleural fluid sampling. Thoracentesis is safe and simple, and it is diagnostic in about 75% of cases. Pleural biopsy is indicated for unexplained exudative effusions, most of which are found to result from malignancy or tuberculosis. Medical thoracoscopy, if available, is the procedure of choice for patients with these effusions. Thoracoscopy permits visually directed pleural biopsies and allows for therapeutic intervention at the time of diagnosis, obviating the need for subsequent invasive procedures.

I read with interest Dr Gregory Rutecki's response to a reader's comments (CONSULTANT, February 2007), in which he emphasized the need for early screening and treatment of cardiovascular disease in patients with chronic kidney disease (CKD).