Managing diabetic dyslipidemia: aggressive approach.

The United States is experiencing a marked increase in rates of diabetes mellitus and metabolic syndrome, almost certainly in part due to the increase in obesity rates. This phenomenon is likely to also result in an increased risk of coronary artery disease as risk factors increase exponentially. This article defines diabetic dyslipidemia, the rationale for aggressive treatment, and options for ongoing management, including nonpharmacologic therapy and medications, alone or in combination, for management of all aspects of the lipid profile.

Reducing the risk of coronary heart disease via lipid reduction.

Elevated low-density lipoprotein cholesterol (LDL-C) is closely associated with an increased risk of cardiovascular morbidity and mortality. Results from numerous well-designed clinical trials indicate that interventions designed to modify lipid levels significantly reduce the risk of coronary heart disease (CHD), particularly in patients at highest risk. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines recommend matching the intensity of lipid-lowering therapy to the patient's risk of CHD. However, despite the existence of evidence-based treatment guidelines and the availability of many safe and effective lipid-modifying modes of therapy, optimal CHD risk reduction rarely is achieved.

Utility of currently available modes of therapy in reaching lipid goals.

The National Cholesterol Education Program Adult Treatment Panel III lipid management guidelines emphasize the importance of matching the intensity of lipid modification therapy to each patient's risk of coronary heart disease. For many patients who are at low risk, nonpharmacologic interventions such as diet, exercise, and smoking cessation can be effective lipid-lowering strategies. However, many patients require the addition of drug therapy to achieve lipid targets. Currently available lipid-modifying drugs include bile acid sequestrants, fibrates, nicotinic acid, cholesterol absorption inhibitors, and statins. In addition, nonprescription agents such as plant stanols and sterols are available to modify plasma lipid levels. These agents can be used individually or coadministered to achieve lipid goals.

A clinician's guide to a woman's heart.

Contrary to the perception of most women that breast cancer is the leading cause of death in women, it is heart disease and stroke that claim the most lives of women older than 35 years in the United States. The prevalence of cardiovascular disease is likely to increase as more women-notably the "baby boomers"- enter the menopausal period, a time of increased cardiac vulnerability. Primary care physicians should be on the forefront in taking an inventory of risk factors in their female patients and in educating them about the reality of heart disease in their gender and about the risk factors that these patients can modify to decrease their risk. To aid in their efforts, this article provides an overview of those risk factors that are modifiable, such as weight reduction, exercise, and smoking cessation. It also offers an evaluation of the benefit and nonbenefit of vitamin and herbal supplements in reduction of cardiac events.