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Cholesterol & Cardiorespiratory Fitness

Cholesterol & Cardiorespiratory Fitness

Published research suggests that cholesterol levels commonly rise as people age and then decrease later in life. “Abnormal lipids are important risk factors that play a critical role in the development of cardiovascular disease (CVD),” says Xuemei Sui, MD, MPH, PhD. “Therefore, identifying modifiable risk factors that can affect lipid profiles might help reduce the burden of CVD.” Some previous analyses have explored the effect of cardiorespiratory fitness (CRF) on changes in blood glucose and blood pressure and have shown beneficial changes with higher CRF levels. However, few studies have looked at the effect of CRF on age-related longitudinal changes of lipids and lipoproteins. “With the high percentage of sedentary people living in the United States, it is particularly important to understand the specific benefits of exercise and fitness and the roles they play in health,” says Dr. Sui. New Data In a study published in the Journal of the American College of Cardiology, Dr. Sui and colleagues used data from health exams performed during the Aerobics Center Longitudinal Study. The long-term study ran from 1970 to 2006 and included more than 11,400 men between the ages of 20 and 90. Patients did not have known high cholesterol, high triglycerides, CVD, and cancer at baseline. Each participant took a treadmill exercise test to determine their baseline CRF level and had their total cholesterol, LDL cholesterol, triglycerides, HDL cholesterol, and non-HDL cholesterol levels recorded. Important Findings Men with lower CRF levels had a greater risk of developing high cholesterol in their early 30s, according to the results. Men with higher levels of CRF did not develop high cholesterol develop until...
Guidelines for Treating Blood Cholesterol

Guidelines for Treating Blood Cholesterol

In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a new clinical practice guideline for the treatment of blood cholesterol in patients at high risk for atherosclerotic cardiovascular disease (ASCVD). The guideline was prepared by a panel of experts based on an analysis of the results of randomized controlled trials. The guidelines use the highest-quality scientific evidence to focus the treatment of blood cholesterol to those who are likely to benefit most. A Focus on Statins According to Neil J. Stone, MD, who served as chair of the expert panel that wrote the guideline, the ACC/AHA guidelines represent a departure from previous recommendations. “The guidelines don’t recommend specific target levels of LDL cholesterol,” he says. “Instead, they focus on defining patient groups for whom LDL lowering with statins has been proven to be most beneficial.” The panel recommended use of statins after a detailed review of other cholesterol-lowering drugs. “Most statins are generics and have been shown to provide the greatest benefit while having low rates of safety issues when taken as prescribed,” Dr. Stone says. The guidelines note, however, that there is a role for other cholesterol-lowering drugs in selected patients who suffer side effects from statins. The guidelines identified four major groups of patients for whom statins have the greatest likelihood of preventing stroke and heart attacks. Moderate- or high-intensity statin therapy is recommended for patients. 1. With clinical ASCVD. 2. With primary elevations of LDL cholesterol of 190 mg/dL or higher. 3. Aged 40 to 75 with diabetes and LDL cholesterol levels between 70 and 189 mg/dL without clinical ASCVD....
Cardiovascular Disease & Diabetes

Cardiovascular Disease & Diabetes

According to the American Diabetes Association, cardiovascular disease (CVD) is the major cause of morbidity and mortality for people living with diabetes. “The common conditions that coexist with type 2 diabetes, such as hypertension and dyslipidemia, are clearly risk factors for CVD,” explains Robert H. Eckel, MD. “Diabetes itself confers additional risk for CVD, including coronary heart disease, stroke, peripheral vascular disease, and heart failure. Obesity, metabolic syndrome, and inflammation are other key components to the link between diabetes and CVD.” “Large benefits are seen when multiple CVD risk factors are addressed globally.” Published analyses have shown that controlling individual CVD risk factors helps to prevent or slow CVD in people with diabetes. “Large benefits are seen when multiple CVD risk factors are addressed globally,” says Dr. Eckel. “Clinical trials have shown that lowering glucose aggressively can further help reduce CVD risk, but an individualized approach is necessary for most patients with diabetes.” Individualizing Care for Diabetes The American Diabetes Association recommends an A1C of less than 7% for most patients, but Dr. Eckel notes that A1C goals may differ from patient to patient, depending on their individual characteristics (Table 1). “There are several aspects to consider when selecting a target A1C level, including age, duration of diabetes, the extent of diabetes complications, psychosocial support, physical activity limitations, and risks of hypoglycemia. All of these factors—and other cardiometabolic components—will play a role in guiding how aggressively diabetes should be treated.” Blood Pressure & Cholesterol In addition to glycemic control, the management of blood pressure and cholesterol is important to helping prevent or slow CVD in patients with diabetes (Table...
Repeat Lipid Testing in CHD

Repeat Lipid Testing in CHD

For patients with coronary heart disease (CHD), current performance measures recommend annual lipid testing, followed by treatment intensification in cases when abnormal lipid levels are spotted. Little is known, however, about the frequency and correlates of repeat lipid testing in patients with CHD who have already attained guideline–recommended LDL-cholesterol (LDL-C) treatment targets and receive no treatment intensification. “In these patients, repeat lipid testing may represent health resource overuse and possible waste of healthcare resources,” says Salim S. Virani, MD, PhD. Intriguing New Findings on Repeat Lipid Testing In JAMA Internal Medicine, Dr. Virani and colleagues had an analysis published that sought to determine the frequency and correlates of repeat lipid testing in patients with CHD who have already attained the guideline-recommended LDL-C target of less than 100 mg/dL and received no further treatment intensification. Among 27,947 patients with LDL-C less than 100 mg/dL, the data showed that 9,200 patients (32.9%) had another repeat lipid panel performed at 11 months from their first lipid panel in the absence of any treatment intensification. “Overall, about one-third of patients with CHD continued to undergo lipid testing after they achieved their LDL-C goal without treatment intensification,” says Dr. Virani. “More than 9,000 patients had additional lipid panels in the 11 months after they achieved an LDL-C target of less than 100 mg/dL in the absence of any further treatment intensification (which could be performed to attain the optional treatment target of LDL-C less than 70 mg/dL). About two-thirds of patients in our analysis who also met the optional LDL-C treatment target of less than 70 mg/dL had repeat lipid testing within 11 months...
Diabetes Side Effects: Breaking the Silence

Diabetes Side Effects: Breaking the Silence

Sexual and urologic complications among men and women with diabetes have historically received relatively little attention from clinicians. Diabetes impacts the function and structure of the lower urinary tract, including the bladder and prostate. Studies suggest that urologic complications resulting from diabetes may be even more common than that of widely recognized microvascular complications, such as retinopathy, neuropathy, or nephropathy. “Diabetes can lead to different types of sexual and urologic complications in both men and women,” says Jeanette S. Brown, MD (Table 1). “These include urinary incontinence (UI), poor bladder emptying, sexual dysfunction, lower urinary tract symptoms (LUTS), and urinary tract infections (UTIs). Treatment options are available for many of these sexual and urologic complications. Unfortunately, these problems often go unaddressed because patients oftentimes will not discuss these issues with their clinicians.” Caring for Women: Lower Urinary Tract Symptoms Urinary incontinence has been estimated to be more common in women with type 2 diabetes than in women with normal glucose levels (Table 2). There is also evidence that women with pre-diabetes are at higher risk for incontinence. The clinical diagnosis of UI—and more broadly, LUTS—is typically based on a variety of factors, and Dr. Brown says that clinicians can be proactive by paying attention to patient complaints when they arise. “It can often be difficult for women to speak up when they develop issues like UI, LUTS, or UTIs, but we should be asking them about these symptoms regularly during office visits,” Dr. Brown says. “When symptoms are identified, we can then take that opportunity to educate patients about the possible treatment options that are available to manage these...
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