Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia

Article Abstract:

Coronary heart disease, the result of degenerative changes in the walls of the arteries which serve the heart muscle, has long been linked by epidemiologic data to the level of specific lipids (fats) in the blood. The Program on the Surgical Control of the Hyperlipidemia (POSCH) has conducted a clinical trial of a surgical method to lower cholesterol in the blood. The population was composed of 838 patients, who were assigned either to a surgical group (421 individuals) or a group treated by dietary and other standard (nonsurgical) methods. Patients were eligible for the study if they were between 30 and 64 years of age and had survived one medically documented heart attack. The surgical procedure, ileal bypass, is a method of bypassing a segment of the small intestine, which reduces the absorption of fats and other nutrients. The surgical method is generally reversible and allows the reanastomosis (reconnection) of the gut if required. The data collection on patients in this study continued over a period of years, with the mean follow-up period being 9.7 years. The surgical intervention led to a sustained improvement in the profiles of blood lipids, including a marked decrease in cholesterol, and led as well to a reduction in other problems related to coronary heart disease. The results of the study can be viewed as a further indication of the benefits of reducing cholesterol and other blood lipids in reducing mortality and morbidity of coronary heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Hypercholesterolemia, Ileum

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Changes in sequential coronary arteriograms and subsequent coronary events

Article Abstract:

Changes in coronary arteriograms over time may be used to evaluate a patient's risk of death from atherosclerotic coronary heart disease (ACHD). A coronary arteriogram is an X-ray of the arteries of the heart that is taken after injection of a contrast dye. Among 838 patients with ACHD, 421 underwent surgery to treat ACHD and 417 did not undergo surgery. Among 695 patients who had an arteriogram taken at the time of diagnosis with ACHD and three years later, changes between the initial and three-year arteriogram were associated with death from ACHD. Changes in sequential arteriograms were associated with a higher risk of a heart attack or death from ACHD both among patients who underwent surgery and those who did not. Fewer patients who underwent surgery died or had a heart attack, compared with those who did not undergo surgery. An arteriogram provides a radiographic image of atherosclerotic lesions.

Development and progression, Atherosclerosis, Coronary arteries

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Management of primary hyperlipidemia

Article Abstract:

Preventive cardiology mainly emphasizes the reduction of lipoproteins in primary hyperlipidemia, a condition of excessive fatty acids in the blood. Low density lipoproteins (LDLs) and very low density lipoproteins (VLDLs) are risk factors in heart disease, while large amounts of high density lipoproteins (HDLs) protect against coronary illness. Rather than monitoring LDL cholesterol levels alone, an alternative procedure involving non-HDL cholesterol is suggested. Non-HDL cholesterol analysis identifies apoprotein B particles in lipoproteins. Apoprotein B concentrations are thought to be risk indicators of heart disease. This method is fast and accurate, requires no fasting, and also measures VLDL. A healthy lifestyle of diet and exercise as well as drug therapy decreases the risk of heart disease. Drug treatment may be needed in groups that are especially at risk, such as men over 35 years old.

Health aspects, Physiological aspects, Cholesterol, LDL, VLDL cholesterol lipoproteins, Lipoproteins

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