Biomedical subjects

Craig W Spellman

Publications and source records attributed to Craig W Spellman.

4 recordsLinked to original sources

PubMed2006

Should all diabetic patients receive statins?

Diabetes is known to play a causal role in promoting both microvascular and macrovascular complications. Reducing rates of end-organ damage has been a key objective of multiple clinical trials. In addition to the roles of glycemic and blood pressure control, it is evident that lipid reduction via statin therapy independently helps to reduce the risk of primary and secondary vascular events. This effect seems to remain intact across a broad range of lipid levels, suggesting additional mechanisms for efficacy of statin medications beyond cholesterol reduction. The demonstrated safety and data from recent trials lend support to the argument that all people with diabetes should be started on statin therapy regardless of their cholesterol level. It is also plausible that treating the underlying mechanisms of vascular dysfunction, inflammation, and injury so prevalent in diabetic patients would have similar implications for the patient identified as having insulin resistance or metabolic syndrome.

Atherosclerosis↗

PubMed2003

Combination therapy for dyslipidemia.

In the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines, the emphasis of lipid-lowering therapy is placed on reaching target plasma low-density lipoprotein cholesterol (LDL-C) levels in order to reduce the risk for coronary heart disease (CHD). Although therapeutic lifestyle changes can have a positive effect on LDL-C levels, the ATP III recognizes that a majority of patients with dyslipidemia will also require drug therapy to achieve lipid targets. Currently, only a small percentage of patients, including those with CHD, are reaching goal. Early aggressive use of the effective lipid-lowering agents currently available is critical to achieve target lipid levels in a greater number of patients. Use of drug combinations further enhances the likelihood of achieving target lipid levels. Ideally, the combination of therapeutic modalities used both the endogenous and exogenous pathways of cholesterol synthesis to reduce the amount produced in the body, as well as the amount absorbed from the diet. This article reviews the pharmacotherapeutic effects of combination therapy, summarizes the strengths and weaknesses of current lipid-lowering drug combinations, and identifies the potential impact of the novel cholesterol absorption inhibitor ezetimibe on the LDL-C treatment algorithm.

Adult↗

PubMed2003

Strategies for optimizing lipid treatment outcomes.

The relationship between increased levels of cholesterol and elevated risk for coronary heart disease (CHD) has been described in many epidemiologic and well-designed prospective trials. Since first being elucidated by the Coronary Primary Prevention Trial, reducing levels of blood cholesterol results in a corresponding reduction in CHD risk has been demonstrated by numerous trials. The evidence now indicates that cholesterol reduction by any number of means confers up to a 35% reduction in total mortality, coronary mortality, coronary artery procedures, stroke, and other CHD-related events. This article reviews data that demonstrate cholesterol reduction decreases CHD risk, discusses current and emerging treatment modalities, and describes the methods healthcare practitioners can use to enhance lipid treatment outcomes. It also identifies educational tools that can be used to empower patients to improve their compliance and become actively involved in reducing their CHD risk.

Adult↗

PubMed2003

Management of diabetes in the real world: tight control of glucose metabolism.

This clinical review looks at tight control of blood glucose with oral agents and insulin in adults and children with type 2 diabetes mellitus. It includes recommendations based on the treatment algorithms from the Texas Diabetes Council. The focus is on specific indications for selecting initial monotherapy, early dual therapy, or combination oral therapy. Discussion includes glycemic targets and times to goal along with recommendations for insulin management that depend on patient stratification as "treatment naive" or "combination oral agent failures" (defined as A1c value < or = 9.5% or > 9.5%). This presentation also includes protocols for once-daily injections, multidose insulin injections, and intensive insulin therapy (physiologic insulin delivery) as well as discussion of starting doses, titration schedules, optimum basal bolus insulin regimen, and calculation of insulin augmentation.

Adult↗