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Diabetologists in Vidyaranyapura, Bangalore • Postmenopausal changes The lower incidence of coronary heart disease in women under 60 has been thought to be related to the protective effect of oestrogens. This has led to trials of hormone replacement therapy (HRT) in postmenopausal women.23 The results of these trials were surprising to many of the investigators. HRT provided no protection to postmenopausal women. In some groups there was an increased risk of myocardial infarction, especially in the first year. There was a definite increase in the risk of stroke and venous thromboembolism, and there was a probable increased risk of breast cancer. At the moment HRT has no role in the prevention of cardiovascular disease.
Diabetologists in Vidyaranyapura, Bangalore • Postmenopausal changes The lower incidence of coronary heart disease in women under 60 has been thought to be related to the protective effect of oestrogens. This has led to trials of hormone replacement therapy (HRT) in postmenopausal women.23 The results of these trials were surprising to many of the investigators. HRT provided no protection to postmenopausal women. In some groups there was an increased risk of myocardial infarction, especially in the first year. There was a definite increase in the risk of stroke and venous thromboembolism, and there was a probable increased risk of breast cancer. At the moment HRT has no role in the prevention of cardiovascular disease.
Cardiologist in Rajanukunte, Bangalore • Factors that increase triglyceride levels 1 Obesity 2 Alcohol 3 Diabetes 4 Oestrogen (including HRT in 20% of users) 5 Diuretics 6 Beta-blockers Secondary causes: • Cushing’s syndrome • acromegaly • uraemia • acute hepatitis
HEART SPECIALISTS IN YELAHANKA NEW TOWN BANGALORE Triglycerides The independent effect of triglyceride levels is weak, and high triglyceride levels are often associated with other risk factors (e.g. low HDLs). Secondary causes of high triglycerides are common and confuse the picture, as does the fact that serum levels can vary greatly with fasting and recent alcohol intake. The combination of high triglycerides and elevated LDL (combined dyslipidaemia) is associated with a marked increase in coronary disease risk. Isolated extremely high triglycerides (greater than 15 mmol/L) are a risk factor for pancreatitis rather than vascular disease. Modest elevations of triglycerides can usually be managed by weight control, a reduction in alcohol consumption and changes in medication. Table 1.5 Factors that affect HDL levels Factors that increase HDL levels Factors that reduce HDL levels 1 Oestrogen 2 Exercise 3 Small amounts of alcohol (10–20 g per day in men) 1 Smoking 2 Obesity 3 Inactivity 4 Hypothyroidism 5 Postmenopausal state 6 Beta-blockers Table 1.6 Factors that increase triglyceride levels 1 Obesity 2 Alcohol 3 Diabetes 4 Oestrogen (including HRT in 20% of users) 5 Diuretics 6 Beta-blockers 7 Secondary causes: • Cushing’s syndrome • acromegaly • uraemia • acute hepatitis 8 High triglycerides and low HDLs are associated with insulin resistance
HEART SPECIALISTS IN YELAHANKA NEW TOWN BANGALORE Triglycerides The independent effect of triglyceride levels is weak, and high triglyceride levels are often associated with other risk factors (e.g. low HDLs). Secondary causes of high triglycerides are common and confuse the picture, as does the fact that serum levels can vary greatly with fasting and recent alcohol intake. The combination of high triglycerides and elevated LDL (combined dyslipidaemia) is associated with a marked increase in coronary disease risk. Isolated extremely high triglycerides (greater than 15 mmol/L) are a risk factor for pancreatitis rather than vascular disease. Modest elevations of triglycerides can usually be managed by weight control, a reduction in alcohol consumption and changes in medication. Table 1.5 Factors that affect HDL levels Factors that increase HDL levels Factors that reduce HDL levels 1 Oestrogen 2 Exercise 3 Small amounts of alcohol (10–20 g per day in men) 1 Smoking 2 Obesity 3 Inactivity 4 Hypothyroidism 5 Postmenopausal state 6 Beta-blockers Table 1.6 Factors that increase triglyceride levels 1 Obesity 2 Alcohol 3 Diabetes 4 Oestrogen (including HRT in 20% of users) 5 Diuretics 6 Beta-blockers 7 Secondary causes: • Cushing’s syndrome • acromegaly • uraemia • acute hepatitis 8 High triglycerides and low HDLs are associated with insulin resistance
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