Statins: Protection Against Heart Attacks and Strokes—Hallelujah!

2014 ◽  
Author(s):  
Eugene H. Cordes
Keyword(s):  
Primary Care Physicians ◽  
Focal Point ◽  
Saturated Fat ◽  
Good Health ◽  
The United States ◽  
Blood Cholesterol ◽  
Heart Attacks ◽  
Cholesterol Levels ◽  
Life Itself ◽  
Lowering Drug

Cholesterol! This may be the single most famous (or infamous) small molecule of life. Most people view it as a threat to good health and even to life itself. We search for foods that are cholesterol free or at least low in cholesterol. We use them in efforts to achieve a low-cholesterol diet. Our primary care physicians measure our blood cholesterol levels routinely and report the news, good and bad. If the level is high, they recommend a better diet (that is, one lower in cholesterol and saturated fat), more exercise, and perhaps weight reduction. If those measures fail to get the cholesterol level where it should be, it is highly likely that therapy with a cholesterol-lowering drug will be recommended. The drug will usually fall into a class known as statins. Statins are among the most frequently prescribed drugs in the world. The first statin approved for marketing by the FDA in the United States was lovastatin (Mevacor), which happened in 1987. Lovastatin was followed into clinical practice by pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor), cerivastatin (Baychol), pitivastatin (Livalo), and rosuvastatin (Crestor). There are a lot of options from which to choose among the statins. The story of how statins were discovered and developed is pretty amazing. The tale focuses on cholesterol in its several dimensions—what it is, how it is made, how its levels are regulated, the health consequences that may ensue when proper regulation fails, and how statins act to restore that regulation. The task of this chapter is to tell the tale. The focal point is cholesterol. So that is where we begin. There are two sides to most stories, which is certainly the case for cholesterol. Although what we hear about cholesterol is mostly negative (isn’t there some way to get rid of this stuff?), the fact is, we cannot live without it and there are three reasons why. First, cholesterol is an essential component of all our membranes.

Genesis of Statins

2009 ◽  
Author(s):  
Jie Jack Li
Keyword(s):  
Heart Disease ◽  
Thyroid Hormone ◽  
Large Scale ◽  
Hormone Treatment ◽  
Blood Cholesterol ◽  
Heart Attacks ◽  
Cholesterol Levels ◽  
The 1950S ◽  
Loss Of Libido ◽  
Artery Disease

As evidence grew that high blood cholesterol levels were linked to heart disease, scientists in both academia and industry began to look for drugs to lower cholesterol as early as the 1950s. Before Akira Endo discovered the first statin, mevastatin, in the 1970s, many things, including hormones, vitamins, and resins, were tried to lower cholesterol. Some worked, and some did not. Thyroid hormone was one of the fi st drugs used for that purpose. The cholesterol-lowering properties of dextro-thyroxine were discovered by serendipity. At one point, surgical removal of part of the thyroid gland had been used to relieve angina, the pain brought on by exercise in coronary artery disease. Doctors observed that thyroid removal also raised the blood cholesterol level, which in turn sped up arterial degeneration. By deduction, the doctors reasoned that taking thyroid hormone should then decrease blood cholesterol levels. Initial clinical trials proved this theory, and dextro-thyroxine was used to lower cholesterol beginning in the 1950s, when thyroid extract became a standard treatment for hypercholesterolemic (high cholesterol) patients. Unfortunately, too much thyroid hormone made patients tremble all the time. Later, a large-scale, long-term clinical trial named the “Coronary Drug Project” established the association of dextro-thyroxine with ischemic heart disease as a severe side eff ect in men. As a consequence, thyroid hormone treatment was discontinued. Women, in contrast to men, enjoy natural cardiac protection through the action of the female sex hormones, the estrogens. In 1930, a minute quantity of estrogen was isolated from the ovaries of 80,000 sows. In the 1950s, reports appeared that estrogen could lower blood cholesterol levels even more effectively than nicotinic acid, another anticholesterol drug used at the time. Unfortunately, men on estrogen for too long began to develop feminine traits, including breast enlargement and loss of libido, and other side effects, although they did acquire relative immunity from heart attacks until late in life. Due to the lack of safe and effiicacious drugs, some doctors seemed willing to take their chances with estrogens.

Evaluating metabolic syndrome in a medical physiology laboratory

2004 ◽  
Vol 28 (4) ◽  
pp. 195-198 ◽  
Author(s):  
Bruce Martin ◽  
John B. Watkins ◽  
J. W. Ramsey
Keyword(s):  
Metabolic Syndrome ◽  
Saturated Fat ◽  
Density Lipoprotein ◽  
The United States ◽  
Blood Cholesterol ◽  
Nutritional Factors ◽  
Glucose Levels ◽  
The Metabolic Syndrome ◽  
Program Step ◽  
Physiology Laboratory

The metabolic syndrome, a cluster of factors linked to obesity that contribute to risk for atherosclerosis and Type 2 diabetes, may affect 20–25% of the adults in the United States. We designed a medical physiology laboratory to evaluate and discuss the physiological and nutritional principles involved in the metabolic syndrome. The five criteria used to diagnose this syndrome (fasting blood triglycerides, high-density lipoprotein cholesterol, and glucose, blood pressure, central obesity) were measured by students on each other either previously or during this exercise. In addition, to illustrate nutritional factors involved in causation and treatment of the metabolic syndrome, a meal was provided during the laboratory. Class members were randomized to groups allowed ad libitum meal composition, or constrained to the National Cholesterol Education Program Step I or Step II diets. The composition of the diet (including saturated fat, cholesterol, dietary fiber, and carbohydrate content) was discussed in the context of blood cholesterol, triglyceride, and glucose levels. This laboratory allows a comprehensive analysis of the physiological and nutritional factors involved in the development of the metabolic syndrome.

National Cholesterol Education Program (NCEP): Highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 495-501 ◽  
Author(s):  
Keyword(s):  
Risk Factors ◽  
Children And Adolescents ◽  
Expert Panel ◽  
The United States ◽  
Blood Cholesterol ◽  
Childhood And Adolescence ◽  
Cholesterol Levels ◽  
Chd Risk ◽  
Atherosclerotic Process ◽  
Chd Risk Factors

Compelling evidence exists that the atherosclerotic process begins in childhood and progresses slowly into adulthood, at which time it leads frequently to coronary heart disease (CHD), the major cause of death in the United States. Despite substantial success in reducing CHD mortality in the past two decades, the disease is still responsible for more than 500 000 deaths annually. About 20% of hospital discharges for acute CHD are for premature disease, ie, in patients younger than 55 years of age. Many of these adults have children who may have CHD risk factors that need attention. Estimates of the annual cost of CHD range from $41.5 to $56 billion. The Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents (which appears as a supplement to this issue of the journal) reviews the evidence that atherosclerosis or its precursors begin in young people; that elevated cholesterol levels early in life play a role in the development of adult atherosclerosis; that eating patterns and genetics affect blood cholesterol levels and CHD risk; and that lowering levels in children and adolescents will be beneficial. Cholesterol is the focus of the report, but other risk factors for atherosclerosis and CHD may originate early in life and should be addressed as well. Specifically, cigarette smoking should be discouraged; hypertension should be identified and treated; obesity should be avoided or reduced; regular aerobic exercise should be encouraged; and diabetes mellitus should be diagnosed and treated. SIGNIFICANCE OF BLOOD CHOLESTEROL LEVELS IN CHILDHOOD AND ADOLESCENCE

I. Rationale for Attention to Cholesterol Levels in Children and Adolescents

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 528-536
Keyword(s):  
United States ◽  
Expert Panel ◽  
Artery Bypass ◽  
Saturated Fatty Acids ◽  
The United States ◽  
Blood Cholesterol ◽  
Office Visits ◽  
Eating Pattern ◽  
Cholesterol Levels ◽  
Chd Risk Factors

Compelling evidence exists that the atherosclerotic process begins in childhood and progresses slowly into adulthood, at which time it leads frequently to coronary heart disease (CHD), the major cause of death in the United States. Despite an impressive decline in mortality during the past 20 years, CHD is still responsible for more than 500 000 deaths annually. Each year, approximately 1.25 million Americans suffer a myocardial infarction, and about 300 000 coronary artery bypass operations are performed. Moreover, an estimated 7 million Americans have symptomatic CHD, accounting for more than 10 million office visits and more than 2 million hospitalizations per year. About 20 percent of hospital discharges for acute CHD are for premature disease, ie, in patients younger than 55 years of age. Many of these adults have children who may have CHD risk factors that need attention. Estimates of the annual cost of CHD range from $41.5 to $56 billion. Elevated blood cholesterol levels are an important cause of atherosclerosis and CHD according to numerous studies. The need to lower blood cholesterol levels in adults was addressed in 1988 when the National Cholesterol Education Program (NCEP) published the Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. That report presented recommendations for lowering high cholesterol levels in individuals 20 years of age or older.1 The NCEP also has addressed blood cholesterol levels in the population as a whole; the Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction recommended an eating pattern low in saturated fatty acids (SFA), total fat, and cholesterol for all healthy Americans over the age of approximately 2 years2 to reduce average blood cholesterol levels in the United States.

Assessing Population-Based Programs to Reduce Blood Cholesterol Level and Saturated Fats

1991 ◽  
Vol 7 (3) ◽  
pp. 315-326 ◽  
Author(s):  
Erkki Vartiainen ◽  
Gregory Heath ◽  
Earl Ford
Keyword(s):  
Cholesterol Level ◽  
Intervention Group ◽  
Saturated Fat ◽  
Blood Cholesterol ◽  
Published Data ◽  
Blood Cholesterol Level ◽  
Reference Area ◽  
Cholesterol Levels ◽  
Saturated Fats ◽  
Intervention Area

AbstractThis article reviews seven community-based programs for prevention of cardiovascular disease and their effects on blood cholesterol levels and saturated fat intake. In two programs, cholesterol levels were reduced more in the intervention area than in the reference area. In two other programs, cholesterol increased less in the intervention area than in the reference area. In one program, cholesterol levels initially fell in the intervention group and increased in the reference group; after the first 4 years, the levels also started to increase in the intervention group. The final two programs reduced cholesterol equally in both groups. Only two programs reported on the intake of saturated fats; in both, intake of saturated fat was reduced more in the intervention area than in the reference populations. In one program area, total intake of fat was reduced more than in the reference area. Published data do not allow us to draw conclusions regarding which components of the programs were most important. These studies show that the average blood cholesterol level can be affected in a general population.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

Health Communication: Implications for Diverse Populations

2011 ◽  
Vol 18 (1) ◽  
pp. 12-19
Author(s):  
Amy Hasselkus
Keyword(s):  
Health Care ◽  
Health Communication ◽  
Negative Impact ◽  
Linguistically Diverse ◽  
Good Health ◽  
The United States ◽  
Poor Health ◽  
Health Care Decisions ◽  
Diverse Backgrounds ◽  
Health Related

The need for improved communication about health-related topics is evident in statistics about the health literacy of adults living in the United States. The negative impact of poor health communication is huge, resulting in poor health outcomes, health disparities, and high health care costs. The importance of good health communication is relevant to all patient populations, including those from culturally and linguistically diverse backgrounds. Efforts are underway at all levels, from individual professionals to the federal government, to improve the information patients receive so that they can make appropriate health care decisions. This article describes these efforts and discusses how speech-language pathologists and audiologists may be impacted.

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