Cardio-oncology case studies
Susan F. Dent in Practical Cardio-Oncology, 2019
The patient was seen in a cardio-oncology clinic for further evaluation of his chest pain. His history and physical examination were unremarkable, and his only cardiac risk factors included his exposure to anterior chest radiation. Lab results indicated a total cholesterol of 252 mg/dL, high-density lipoprotein of 57 mg/dL, low-density lipoprotein of 121 mg/dL, and triglycerides of 79 mg/dL. The patient's atherosclerotic cardiovascular disease (ASCVD) risk was 13%, and a moderate to high intensity statin was recommended. The patient refused a statin. Owing to the poor negative and positive predictive value of most community stress test nuclear scans, other than positron emission tomography—computed tomography (PET-CT), a CCTA was performed, and the images were processed with the Vital Images Vitrea Sure Plaque software for coronary plaque analysis. The Vitrea Sure Plaque software characterizes visualized plaque on coronary CTA and helps define the density of the composition in Hounsfield units. It quantifies plaque burden and coronary remodeling noninvasively. It characterizes a lesion in the vessel wall as either calcified or noncalcified and helps delineate a lipid core vs. a fibrous core (Figure 10.5).
Standards of Care in Diabetes
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
The goals for lipid levels have traditionally divided patients into those with no known cardiovascular disease by history, and those who have a significant history in this area. In defining the goal for low-density lipoprotein (LDL) cholesterol, NCEP guidelines state that the goal should be less than 130 mg/dL in those without a history of cardiovascular disease and less than 100 mg/dL in those with such a history. Many leaders in this field, however, have argued that the patient with diabetes should be considered in the same category as a person without diabetes with a positive history of cardiovascular disease. Studies looking at the risk of cardiovascular events have found that the risk in a patient without diabetes and a positive history of prior cardiovascular disease is the same as a person with diabetes, but no known history. In the 1999 Clinical Practice Recommendations, 100 mg/dL became the LDL goal in all patients with diabetes. The goal for triglycerides (TG) is a level of less than 200 mg/dL. High-density lipoprotein (HDL) cholesterol should be higher than 35 mg/dL in men and 45 in women. A lipid profile should be performed on children older than 2 years of age after diagnosis and once glucose control is established. The goal in those with risk factors in addition to diabetes is an LDL lower than 110 mg/dL. Lipid profiles should be repeated every 5 years if goals are met, or yearly if not.
The Problems of Food Abundance
R. J. Jarrett in Nutrition and Disease, 1979
Before leaving the subject of nutrition and coronary heart disease it must be emphasised that there are many factors concerned in the genesis of atherosclerosis and also in the production of cardiac abnormalities (see Table 2.7). Furthermore, as there is little evidence to suggest that in developed countries the amount of atheroma has increased much in the past 50 years, a period during which there has been a large increase in coronary heart disease deaths, there may well be factors which are not concerned in the genesis of atherosclerosis but which do affect the response of the cardiac muscle to an impaired blood supply. Some of these factors may well be nutritional — like the water factor(s) — while others, like cigarette smoking, are environmental, but not nutritional. Prospective studies in the United States, Sweden and the United Kingdom have shown that the factors which are the most powerful predictors of future coronary heart disease are age, the levels of serum cholesterol and blood pressure, and the number of cigarettes smoked. Cholesterol is present in several distinct lipoproteins in plasma and the level of cholesterol in the high density lipoprotein fraction is inversely related to subsequent coronary heart disease and there is biochemical evidence that this lipoprotein may have a protective, anti-atherogenic role. Apart from age and cigarette smoking, all the factors mentioned can be modified by the nature of the diet.
Sample management for clinical biochemistry assays: Are serum and plasma interchangeable specimens?
Published in Critical Reviews in Clinical Laboratory Sciences, 2018
Gabriel Lima-Oliveira, Denis Monneret, Fabrice Guerber, Gian Cesare Guidi
Variability between serum and plasma from different brands of evacuated tubes. (a) TP – total protein; (b) TRANS – transferrin; (c) HPT – haptoglobin; (d) AAT – α1-antitrypsin; (e) C3 – complement C3; (f) IgG – immunoglobulin G; (g) IgM – immunoglobulin M; (h) IgA – immunoglobulin A; (i) HDL – high density lipoprotein-cholesterol; (j) PHOS – phosphate; (k) Ca – calcium; (l) K – potassium; (m) ALP – alkaline phosphatase; (n) AMYL – amylase; (o) ALT – alanine aminotransferase; (p) GGT – gamma-glutamyltransferase; (q) LD – lactate dehydrogenase; (r) CK – creatine kinase; (s) CRE – creatinine. Serum vs. plasma from different brands of evacuated tubes (x-axis) are plotted against bias values (y-axis). Solid line – bias. Dashed lines – acceptable criteria based on desirable specification for imprecision (DSI) derived from biologic variation for each analyte.
HDL therapy today: from atherosclerosis, to stent compatibility to heart failure
Published in Annals of Medicine, 2019
C.R. Sirtori, M. Ruscica, L. Calabresi, G. Chiesa, R. Giovannoni, J.J. Badimon
High density lipoproteins (HDL) are a major fraction of circulating lipoproteins. Epidemiological and clinical evidence has suggested the existence of an inverse association between HDL-C levels and CHD risk, although recently a U-shaped association between HDL cholesterol concentrations and all-cause mortality was found, i.e. both extreme high and low concentrations of HDL being associated with all-cause mortality risk [1]. A large clinical experience and basic studies have supported the concept that the antiatherogenic role of high HDL-C is mediated by the removal of excess cholesterol from the extrahepatic tissues, carrying it back to the liver for metabolisation, the so-called reverse cholesterol transport [2,3]. In this review article the present status of HDL and its pro-effluxing and anti-cell proliferating properties will be discussed, potentially resulting in an effective HDL therapy for, particularly, coronary conditions.
Obesity and anthropometry in spina bifida: What is the best measure
Published in The Journal of Spinal Cord Medicine, 2018
Joceline S. Liu, Caroline Dong, Amanda X. Vo, Laura Jo Dickmeyer, Claudia L. Leung, Richard A. Huang, Stephanie J. Kielb, Shubhra Mukherjee
The electronic medical record was used to review available laboratory results, vital signs and medication history, including lipid panel, fasting blood sugar, hemoglobin A1c (HbA1c), blood pressure measurements and medications pertaining to diabetes, hypertension or hyperlipidemia. Any medications to treat hyperlipidemia, diabetes, or hypertension were also recorded. Laboratory and blood pressure values were defined as abnormal based on the following criterion: 1) triglyceride ≥ 150 mg/dL; 2) total cholesterol ≥ 200 mg/dL; 3) high-density lipoprotein (HDL) ≤ 40 mg/dL; 4) low-density lipoprotein (LDL) > 190 mg/dL; 5) fasting blood sugar ≥ 126 mg/dL; 6) HbA1c ≥ 6.5%; 7) systolic or diastolic blood pressure ≥ 130/85.33 In cases in which multiple lab values or vital signs were available, all results were reviewed rather than averaging of measurements.
Related Knowledge Centers
- Phospholipid
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- Lipid
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- Lipoprotein
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- Cholesterol
- Vulnerable Plaque