The American journal of medicine
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There is evidence of activation of both blood coagulation and platelets in sickle cell disease. For example, plasma samples obtained in the steady state and during painful crisis demonstrate high levels of thrombin generation, depletion of anticoagulant proteins, and abnormal activation of the fibrinolytic system. ⋯ Therefore, treatments that could decrease thrombin generation or platelet activation may be beneficial in both the treatment of sickle cell disease and the prevention of complications that characterize this genetic disorder. This review discusses hypercoagulability in the various forms of sickle cell disease, including homozygous sickle cell anemia, hemoglobin SC disease, hemoglobin SD disease, and sickle cell-beta-thalassemia.
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Patients with type 2 diabetes mellitus or the metabolic syndrome have a unique dyslipidemia characterized by hypertriglyceridemia; elevated blood levels of apolipoprotein B; small, dense low-density lipoprotein (LDL) cholesterol; and low levels of high-density lipoprotein (HDL) cholesterol, in particular HDL(2)-C. Treatment of the dyslipidemia associated with these disorders should focus on correcting the abnormal lipoprotein levels as well as LDL and HDL heterogeneity. ⋯ In addition, thiazolidinediones or niacin in combination with a statin show promise for correcting defects in LDL and HDL heterogeneity. The ultimate goal of treatment in this patient population is to prevent the development and progression of coronary artery disease.
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Type 2 diabetes mellitus is characterized by progressive beta-cell secretory dysfunction against a background of insulin resistance, which is present many years before the onset of hyperglycemia in most patients. Intensive treatment of diabetes reduces the risk of the onset and progression of microvascular complications and may impact the risk of development of macrovascular complications, notably coronary artery disease. Therefore, aggressive treatment with the goal of achieving serum glucose concentrations as close to normal as possible is warranted. ⋯ In addition, some medications have potential benefits that extend beyond glucose lowering. These include beneficial effects on the adverse metabolic consequences of insulin resistance and possibly beta-cell preservation. Thiazolidinediones should be considered as early as possible in the natural history of type 2 diabetes because of their persistent glucose-lowering effect and their ability to reduce insulin resistance as well as because these agents may preserve beta-cell function and reverse some of the adverse metabolic consequences of insulin resistance.
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The social and economic impact of asthma is substantial worldwide. Although current therapies targeting both airway inflammation and airway hyperreactivity effectively relieve and prevent symptoms in the majority of patients, some patients experience persistent symptoms and a progressive decline in lung function, described as irreversible or refractory asthma. Indeed, there are many unanswered questions about the role of airway remodeling in asthma. This review addresses several topics of controversy, including whether all patients with asthma demonstrate airway remodeling; the contribution of distinct airway resident cells to the development of remodeling; the role of biomarkers or noninvasive measurements in predicting airway remodeling; and the effectiveness of current therapies on airway remodeling and disease progression.