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THE PROBLEM of what constitutes average, normal, and optimal levels of serum cholesterol and how the results of tests to determine these levels should be applied to clinical practice still bedevils us. High levels of serum cholesterol are associated with an increased incidence of atherosclerosis and death, and a constantly low serum cholesterol level appears protective in this regard. The risk of complications associated with elevated cholesterol levels is increased when other risk factors such as hereditary premature atherosclerosis, hypertension, smoking, and diabetes occur concomitantly. Average levels vary substantially with different ethnic and geographic populations, specific hereditary traits, a number of diseases, and a wide range of dietary habits. This statement is directed to the situation as it exists in the United States today. Leading investigators are now widely recommending that the uppermost acceptable level should be 240 mg/100 ml, based on the standard Abell-Kendall method. This is consistent with

During the last ten years, there has been a substantial accumulation of evidence indicating that poor metabolic control plays an important role in the development of the so-called long-term complications of diabetes (retinopathy, neuropathy, nephropathy, and premature atherosclerosis). 1 On the basis of this evidence, the American Diabetes Association has recently recommended that "it is logical and prudent to reduce blood glucose levels to normal if such attempts are not grossly disturbing to the lifestyle of the patient." 2 Self-monitoring of blood glucose levels, 3 mimicking of normal insulin secretory patterns by preprandial administration of insulin—so-called intensive insulin therapy, 4 and use of glycosylated hemoglobin determination for objective evaluation of long-term control 5 have made achievement of near normoglycemia a practical goal for most patients taking insulin. In intensive insulin programs, meal-related and overnight insulin requirements are usually met either by use of pumps (continuous subcutaneous insulin infusion) or by

Hyperlipidemia (HL) with increase in triglycerides (TG) is frequently seen in uremic patients before TX. In order to assess the lipid abnormalities following renal TX, 22 patient (15 females) x age 17 years (range 5-21), with a functioning renal allograft (serum creatinine x 1.13 mg/dl, range 0.7-2.6) were studied at x 26 months (range 2-55) after renal TX. Serum total cholesterol (TC), TG, and lipoproteins VLDL, LDL and HDL were determined and compared to normal age and sex matched controls. Results (x mg/dl ± SD) are shown in table (†p 95 percentile in 68% and 32% of the patients respectively. A significant correlation between HL and daily Prednisolone dose was found (r=0.55; p

THE RELATIONSHIP between serum lipid levels and the occurrence of coronary atherosclerosis has been adequately analyzed to confirm that elevated serum cholesterol levels and, almost certainly, elevated serum triglyceride levels are among the major risk factors associated with the development of coronary artery disease and myocardial infarction. This concept has been aided by a rational classification of lipid abnormalities based on the characterization of serum lipoproteins. The classification has been most beneficial as a guide to development of logical dietary and pharmacologic regimens for lowering serum lipid concentrations as well as better definitions of both the inheritance and metabolic factors associated with the abnormalities. Type IIa, IIb, and IV hyperlipoproteinemia, all reflecting elevated serum cholesterol or triglyceride levels or both, are associated with the risk of premature atherosclerosis and myocardial infarction. Suitable dietary and drug regimens are available for the control of hyperlipoproteinemia. The temptation to treat an abnormality, in

Achilles tendinitis and tenosynovitis may be an early manifestation of familial type II hyperlipoproteinemia in the pediatric and adolescent age groups, as evidenced by the five kindreds in this report. Episodes of arthritic symptoms usually antedated the appearance of palpable extensor-tendon xanthomas, were gradual in onset, lasted for two or three days, involved one or both Achilles tendons, and resolved spontaneously within 48 to 72 hours. The tendons were often warm, erythematous, and extremely painful to palpation. Appropriate recognition of this diagnostic clinical finding offers the opportunity for early therapy with diet or cholestyramine resin, with an aim toward prevention of premature atherosclerosis in adulthood.

Background Highly effective antiretroviral (ARV) therapy has resulted in improved patient (pt) longevity, but many ARV regimens are associated with increases in blood lipid markers, raising concern with the potential for premature atherosclerosis and coronary artery disease. Prior studies with NVP in ARV-naive pts noted an increase in low-density lipoprotein cholesterol (LDL-C) and triglycerides (TGs), although less significant than the high-density lipoprotein cholesterol (HDL-C) increase. The contribution of the NRTI backbone to this effect was unclear.