Incidence of hypercholesterolemia in the active duty Navy population in 1986.

A National Institutes of Health Consensus Conference recently advocated lowering the serum cholesterol levels required to diagnose moderate and severe hypercholesterolemia. We reviewed 998 active duty United States Navy personnel who underwent routine physical examinations with determinations of serum cholesterol. Analysis of the data revealed a gradual rise in mean serum cholesterol with increasing age. Moderate elevation of serum cholesterol ranged from 11.3% to 34.6% of the study group, depending on age. Severe hypercholesterolemia was also age dependent and occurred in 2.0% to 9.3% the group. Dietary and cholesterol-binding agents have been shown to reduce the occurrence of myocardial infarction in subjects with cholesterol greater than 265 mg/dl. The incidence of Navy personnel with serum cholesterol above this level ranged from 2 to 10%. It is likely that intervention with dietary or medical therapy would prevent the development or delay the occurrence of coronary artery disease in a large number of active duty U.S. Navy personnel.

Treatment of hypercholesterolemia by a clinical nurse using a stepped-care protocol in a nonvolunteer population.

National trials have demonstrated that the incidence of myocardial infarction and coronary death can be decreased, and progression of atherosclerosis delayed or reversed, by administration of bile acid-binding resins. A cholesterol clinic was established to determine whether a simple protocol would be effective in a nonvolunteer population referred by practicing cardiologists. The clinic was operated by a nurse who followed a stepped-care protocol, similar in concept to that used for treatment of hypertension. In the treatment of 86 patients with type II hyperlipidemia (cholesterol level, greater than 6.85 mmol/L [greater than 265 mg/dL]; triglyceride levels, normal or mildly elevated), compliance with the protocol resulted in reductions in cholesterol level of 19% in patients treated with diet, 23% for those treated with diet plus a bile sequestrant (colestipol hydrochloride or cholestyramine resin), and 25% in those treated with diet plus other cholesterol-lowering drugs. This method of treatment was effective and may serve as a model for the management of large numbers of patients with this condition.

Haemophilus influenzae endocarditis.

Haemophilus influenzae endocarditis on a prosthetic valve has previously been reported only once. Routine physical and laboratory evaluation does not distinguish endocarditis from this organism from other causes of endocarditis. Our patient with prosthetic mitral valve endocarditis was successfully treated with antibiotics, but surgery was subsequently required for congestive heart failure from valve dehiscence.

Endocarditis caused by Actinobacillus actinomycetemcomitans.

Actinobacillus actinomycetemcomitans, a small, gram-negative bacillus with fastidious growth requirements, is a rare cause of endocarditis. The clinical course of this disease is characterized by long duration of symptoms before diagnosis (average of three months), prolonged incubation before growth (average of six days), and a high embolic rate. The optimal antimicrobial regimen cannot be determined from available data, but the combination of ampicillin and an aminoglycoside may offer the best chance for cure. Two cases are presented, one successfully treated. Previously reported cases are reviewed.

Histoplasma capsulatum endocarditis.

Endocarditis is a rare manifestation of disseminated Histoplasma capsulatum infection. A 22-year-old man presented with a seven month history of fever, weight loss, and progressive aortic insufficiency. The diagnosis of H. capsulatum was suggested by a diagnostic rise in complement fixation titers and positive echocardiographic findings. The diagnosis was confirmed prior to surgery by positive bone marrow culture. Progressive congestive heart failure necessitated replacement of the aortic valve which subsequently grew H. capsulatum. In this case, a combination of amphotericin B therapy and valve replacement was curative.