Statins in patients with chronic kidney disease: new evidence.

Dyslipidemia represents a common metabolic alteration in chronic kidney disease (CKD). Alterations can be different depending on the stage of the disease and the extent of proteinuria. Despite the high cardiovascular risk in patients with renal impairment, only a small percentage of patients receive adequate cholesterol-lowering therapy. The use of statins, inhibitors of the endogenous synthesis of cholesterol in patients with CKD, represents an efficient therapeutic instrument for reducing cardiovascular risk, at least in the early stage of the disease. Such evidence is currently lacking in dialysis, that is a setting where cardiovascular mortality is not consistently due to classical atherosclerosis. In addition to their efficacy, statins are proved as safe drugs with a high tolerability profile in CKD. In the case of intolerant patients, a new therapeutic perspective is represented by ezetimibe, inhibitor of intestinal absorption of cholesterol, whose effectiveness and tolerability allow its use throughout all stages of the renal disease.

Fibrinogen plasma levels in an apparently healthy general population--relation to environmental and genetic determinants.

Elevated fibrinogen levels are an independent risk factor for cardiovascular ischemic disease. We investigated the relationship between cardiovascular ischemic risk factors, the fibrinogen Bbeta-chain G/A(-455) polymorphism and plasma fibrinogen levels in 989 apparently healthy subjects. Fibrinogen values were higher in subjects with C reactive protein (C-RP) >0.33 mg/dl, BMI >23.9 kg/m2, total cholesterol >4.84 mmol/l, triglycerides > 1.02 mmol/l, PAI-1 antigen >12.2 ng/ml, carriers of the A allele, first-degree relative history of coronary artery disease, or consuming >10 cigarettes per day (p<0.01). Men and ethanol drinkers showed lower plasma fibrinogen levels (p<0.01). The multivariate analysis confirmed the independent effect of C-RP, age, BMI, total cholesterol, gender, PAI-1, -455 G/A polymorphism, (p<0.05). BMI, total cholesterol, PAI-1, alcohol and smoking habit raised with the increase of age and differed between sexes. The A(-455) allele increasing effect was significant in women, especially in subjects aged <30 years, and in men aged <43 years. These results indicate that environmental factors contributed to a larger extent to fibrinogen variability, whereas the A(-455) allele was associated with a steeper increase in younger age quartiles.

[Anesthesia using high doses of fentanyl in coronary patients subjected to myocardial revascularization. Comparison of 2 administration methods]. / Anestesia con fentanyl ad alti dosaggi nei pazienti coronaropatici sottoposti ad intervento di rivascolarizzazione miocardica. Confronto tra due metodiche di somministrazione.

Eighteen patients to be submitted to heart surgery for myocardial revascularization have been considered. The patients were subdivided into two groups, A and B, and a high dose morphinic was administered for the induction and maintenance of the anaesthetic without further analgesic and/or narcotic supplement. The haemodynamic data obtained pointed to excellent stability in patient cardiocirculatory condition: preservation of IC within acceptable values was very interesting, owing to the fact that the high dose morphinic employed triggers very limited myocardiodepression. To conclude, the anaesthesiological techniques adopted seemed reliable and sufficiently protective with regard to exaggerated hyperdynamic responses to algogenic stimuli that trigger harmful haemodynamic conditions in coronary patients.