Hypolipidemic, hipoglycemiant and antioxidant effects of Myrcia splendens (Sw) DC in an animal type 2 diabetes model induced by streptozotocin / Efectos hipolipemiante, hipoglucemiante y antioxidante de Myrcia splendens (Sw) DC en un modelo animal de diabetes tipo 2 inducido por estreptozotocina

We investigated the effects of dichloromethane extract (DME) from Myrcia splendenson alterations caused by type 2 diabetes in the blood and kidney of rats, in order to reduce side effects caused by synthetic drugs. Rats received streptozotocin (60 mg/kg),15 minutes after nicotinamide (120 mg/kg) or water. After 72 hours, the glycemic levels were evaluated to confirm diabetes and the animals received (15 days) DME (25, 50, 100 or 150 mg/Kg) or water. DME partially reversed hyperglycemia and (100 and 150 mg/kg) reversed hypertriglyceridemia. Histopathological findings elucidated that DME reduced damage to pancreatic islets. DME 150 mg/kgreversed the increases in TBA-RS, the reduction in the sulfhydryl content, 100 and 150 mg/kg increased CAT, reversed the decrease in GSH-Px and increased it activity in the blood. DME 150 mg/kg reversed CAT and GSH-Px reductions in the kidney. We believe that DME effects might be dependent on the presence of phenolic compounds.

Investigamos los efectos del extracto de diclorometano (DME)de Myrcia splendens sobre las alteraciones causadas por la diabetes tipo 2 en la sangre y los riñones de las ratas, para reducir los efectos secundarios causados por las drogas sintéticas. Las ratas recibieron estreptozotocina (60 mg/kg), 15 minutos después de la nicotinamida (120 mg/kg) o agua. Después de 72 horas, se confirmo la diabetes y los animales recibieron (15 días) DME (25, 50, 100 o 150 mg/Kg) o agua. DME revierte parcialmente la hiperglucemia y revierte la hipertrigliceridemia. DME redujo el daño a los islotes pancreáticos. DME revirtió los aumentos en TBA-RS, la reducción en el contenido de sulfhidrilo, aumentó la CAT, revirtió la disminución en GSH-Px y aumentó su actividad en la sangre. Además, DME revirtió las reducciones de CAT y GSH-Px en el riñón. Creemos que los efectos provocados por DME pueden depender de la presencia de compuestos fenólicos.

Ameliorating effect of Malva Neglecta on hyperglycemia and hyperlipidemia in diabetic rats

The plant, Malva neglecta wallr., is widely consumed for medicinal and nutritional purposes. The current study was carried out to assess the hypoglycemic and antihyperlipidemic potential of aqueous methanolic extract of M. neglecta. Chemical evaluation of the extract was performed by high pressure liquid chromatography. Oral glucose tolerance test (OGTT) was done in diabetic rats pre-exposed to 250, 500 and 750 mg/kg plant extract via the oral route. For hypoglycemic and biochemical study, the same therapy was administered to alloxan induced diabetic rats for 14 days. The standard control group received Glibenclamide (5 mg/kg). Ferulic acid, p-coumaric acid and other phenolic acids were detected and estimated in the extract. Administration of the plant extract significantly reduced blood glucose level in diabetic rats subjected to OGTT. The plant extract lowered the fasting blood glucose and alpha amylase, and prevented the damage to pancreas. It also corrected dyslipidemia in diabetic animals following 14 days therapy. Hence, this experimental study establishes the fact that M. neglecta exhibited significant antidiabetic and antihyperlipidemic activities in alloxan induced diabetic rats.

Differential therapeutic effects of Crataegus aronia and simvastatin on the hepatocyte ultrastructure in hepatic steatosis / Efectos terapéuticos diferenciales de Crataegus aronia y simvastatina sobre la estructura del hepatocito en la esteatosis hepática

Complications of fat accumulation in liver, hepatic steatosis such as liver cirrhosis and liver failure are among the common public health problems. We sought to investigate the damage to the hepatocyte ultrastructure induced by high fat diets (HFD) and compared the therapeutic effects at the cellular level of two antioxidant and lipid lowering agents; Crataegus aronia extracts and simvastatin on hepatic steatosis. Rats were either fed with HFD (model group) or low fat diets (LFD) (control group) for 15 weeks before being sacrificed and therapeutic groups started the treatment with these agents after week 11 until the sacrifice day. Harvested liver tissues were examined using transmission electron microscopy (TEM) and liver homogenates were assayed for markers of anti-oxidative stress that are known to be modulated in liver injury. TEM examinations of the model group showed a profound damage to the hepatocytes compared to the control group as demonstrated by steatosis, damaged mitochondria and vaculated cytoplasm, disrupted rough and smooth endoplasmic reticulum and nuclear membrane, dilated intercellular space between hepatocytes, and alterations in lysosomes. In addition, HFD ameliorated the anti-oxidant glutathione (GSH) and augmented the oxidative stress TBARS biomarkers. Both Crataegus aronia and simvastatin significantly reduced lipids and TBARS, and treated damage to hepatic cells, but hepatocyte structures were differentially responded to these agents. However, only Crataegus aronia induced GSH (p=0.001). We conclude that HFD-induced hepatic steatosis caused a substantial damage to the hepatocyte's ultrastructures, and Crataegus aronia and simvastatin treatments differentially reversed hepatic injuries.

Las complicaciones de la acumulación de grasa en el hígado, la esteatosis hepática como la cirrosis hepática y la insuficiencia hepática se encuentran entre los problemas comunes de salud pública. Se intentó investigar el daño a la ultraestructura de los hepatocitos inducido por la dieta alta en grasas (DAG) y se compararon los efectos terapéuticos a nivel celular de dos antioxidantes y agentes hipolipemiantes; Extracto de Crataegus aronia y simvastatina sobre esteatosis hepática. Las ratas fueron alimentadas con DAG (grupo modelo) o dieta baja en grasa (DBG) (grupo control) durante 15 semanas antes de sacrificarse y los grupos terapéuticos comenzaron el tratamiento con estos agentes después de la semana 11 hasta el día del sacrificio. Se examinaron los tejidos hepáticos usando microscopía electrónica de transmisión (MET) y se analizaron homogeneizados de hígado para marcadores de estrés anti-oxidativo, que se sabe están modulados en la lesión hepática. Los exámenes MET del grupo DAG mostraron un grave daño de los hepatocitos en comparación con el grupo control, demostrado por esteatosis, daño mitocondrial y citoplasma vacío, retículo endoplásmico rugoso y liso y membrana nuclear, el espacio intercelular dilatado entre hepatocitos y alteraciones en los lisosomas. Además, DAG mejoró el anti-oxidante glutatión (GSH) y aumentó el estrés oxidativo TBARS biomarcadores. Tanto Crataegus aronia como simvastatina redujeron significativamente los lípidos y TBARS, trataron el daño a las células hepáticas, pero las estructuras de hepatocitos respondieron diferencialmente a estos agentes. Sin embargo, sólo Crataegus aronia indujo GSH (p = 0,001). Concluimos que la esteatosis hepática inducida por HFD causó un daño sustancial a la ultraestructura del hepatocito y los tratamientos de Crataegus aronia y simvastatina diferenciaron las lesiones hepáticas.

An Open label, Prospective, Multi-Center, Observational Study to Evaluate the Lipid Lowering Efficacy and Safety of Rosuvastatin in Indian Dyslipidemics in Routine Clinical Practice.

Altered cholesterol levels in the blood or dyslipidemia is a major modifiable risk factor for CVD and is closely associated with the pathophysiology of CVD. Asians, particularly Indians, have a unique pattern of dyslipidemia; with lower HDL cholesterol, increased triglyceride levels and higher proportion of small dense LDL cholesterol, with characteristic centripetal obesity. ‘Statins’ belong to the group of 3-hydroxy-3-methylglutaryl Coenzyme A reductase inhibitors that have been shown to reduce levels of total and LDL cholesterol. Study Objective: To evaluate the lipid lowering efficacy and safety of Rosuvastatin in Indian dyslipidemics in routine clinical practice by measuring the percent change in Total Cholesterol, LDL, TG and HDL over a period of 16 weeks. Methodology : This was a multicentric, open-labeled, post-marketing surveillance study. A committee of key opinion leaders was formed. A total of 1200 doctors were approached of whom 800 provided us with subject data. Each participating doctor was given case report forms and requested to recruit patients according to the inclusion and exclusion criteria. Lipid profile of each recruited patient was done before initiating therapy and at the end of 4 months. Rosuvastatin was given at a dose of either 5mg/ 10mg OD for 4 months. Results : A total of 11, 656 subjects were recruited into this study out of which 10, 410 complete case report forms were considered (n=10410). The study included 65% males and 35% females. Majority of the subjects were in the age group of 46-55years (35.2%) and 56-65 years (29.4%). In this study, the total cholesterol (TC), LDL-C, Triglycerides (TG) has significantly decreased by 46.13%, 53.74% and 41.93% respectively. Also the HDLC levels increased by 26.84%, thereby, indicating a significant change in the levels of all the dyslipidemic indicators. With the reported number of adverse events (n=4) related to Rosuvastatin, it is evident that the drug is safe and tolerable. There were no significant changes observed in the liver and renal function tests with Rosuvastatin reiterating their safety. Conclusion : Rosuvastatin has shown greater efficacy in lowering LDL cholesterol and non-HDL-cholesterol concentrations. It has been shown to enable more patients to reach their LDL cholesterol goals and to do so with an acceptable safety profile.

Hypolipidemic and antioxidant activity of ethanolic extract of Symplocos racemosa Roxb. in hyperlipidemic rats: An evidence of participation of oxidative stress in hyperlipidemia.

Hypolipidemic and antioxidant activity profiles of ethanolic extracts of Symplocos racemosa (EESR) were studied by triton-WR1339 (acute) and high fat diet induced (chronic) hyperlipidemic rat models. In both the models, a significant increase in total cholesterol (TC), triglycerides (TG), very low density lipoproteins (VLDL), low density lipoproteins (LDL) and decrease in high density lipoproteins (HDL) in serum were observed. EESR (200 and 400 mg/kg) and simvastatin (10 mg/kg) administered orally reduced the elevated serum lipids (TC, TG, VLDL, LDL), restored the decreased HDL and improved the atherogenic index. In high fat diet induced hyperlipidemic model, EESR treatment prevented the increased formation of malondialdehyde (MDA) in liver, restored the depleted liver antioxidants, glutathione, superoxide dismutase, catalase significantly. The increased liver cholesterol, HMG-CoA reductase activity and body weight of hyperlipidemic rats were significantly reduced by EESR treatment. The EESR inhibited HMG-CoA reductase, a rate limiting enzyme in cholesterol biosynthesis, thereby causing hypolipidemic effects. EESR treatment also improved histoarchitecture of hepatocytes in hyperlipidemic rats. Experimental findings demonstrated anti-hyperlipidemic and antioxidant activity of EESR, which may be directly or indirectly related to its antioxidant activity. The hypolipidemic activity of EESR may be due to the presence of flavonoids phenolic compounds, phenolic glycosides and steroids.

Tratamento otimizado antiplaquetário, antilipêmico, controle de pressão arterial e frequência cardíaca na doença coronariana crônica assintomática ou angina classe I / Optimized antiplatelet and hypolipidemic treatment, control of blood pressure and heart rate in chronic asymptomatic coronary artery disease or angina class 1

Neste artigo revisaremos o tratamento antiplaquetário e antilipêmico, controle da pressão arterial e controle da frequência cardíaca e sua influência na mortalidade e novos eventos, aplicável a todo paciente portador de doença coronariana crônica.

We review the antiplatelet and hypolipidemic treatment, blood pressure and heart rate control and its influence on mortality and new events, applicable to all patients with chronic coronary disease.

Dislipidemia em crianças e adolescentes / Dyslipidemia in childrem and adolescents

A aterosclerose é um processo que se inicia na infância e se intensifica na vida adulta, dependendo da carga de fatores genéticos e da interação com fatores ambientais. A estria gordurosa é a alteração inicial, presente no endotélio após o nascimento. Por aparecer tão precoce e sem correlação com fatores de risco determinantes da placa de ateroma, a estria gordurosa é considerada uma lesão benigna, universal. A transformação da estria gordurosa em placa fibrosa (lesão aterosclerótica) ocorrerá dependendo do tempo de exposição aos fatores de risco modificáveis e não modificáveis e levará anos para formar a placa aterosclerótica. A importância da avaliação desses fatores, na primeira infância, é fundamental para que seja estabelecido o diagnóstico de alterações como as dislipidemias, na tentativa de instituir um tratamento precoce que evite a progressão da estria gordura em placa fibrosa. Essas ações de prevenção na infância, resultarão em redução do risco de doenças cardiovasculares na vida adulta.

Atherosclerosis is a process that begins in childhood and is intensified in adulthood depending on the genetic and environmental interactions factors. The initial fatty streak is presente in the endothelium after birth without correlation with risk factors involved in atherogenesis, and is considered a benign and universal lesion. The transformation of the fatty streak to fibrous plaque (atherosclerotic lesions) occur depending on the time of exposure to risk factors modifiable and non-modifiable, and it will take years to form fibrous plaque. The importance of recognizing the risk factors early in childhood, is importante to institute early treatment to prevent the progression of fatty streak to fibrous plaque. These preventive measures in childhood result in reduced risk of cardiovascular disease in adulthood.

Tratamento farmacológico das dislipidemias para prevenção da doença cardiovascular e promoção da saúde: fatos versus mitos / Pharmacologic treatment of dyslipidemia to cardiovascular disease prevention and health promotion: facts versus myths

O controle de fatores de risco foi uma das estratégias que se acompanhou de redução na taxa de eventos cardiovasculares em 50% nos Estados Unidos da América. Meta-análise de estudos com estatinas mostrou redução de 20% de desfechos em prevenção primária e secundária de doenças cardiovasculares para diminuição de 39 mg/dL do LDL-c. Já para reduções de LDL-c de 80 a 120 mg/dL, as diminuições das taxas de desfechos são da ordem de 40%-50%. O tratamento hipolipemiante deve ser feito de maneira contínua, é seguro , podendo ocorrer eventos diversos, de modo geral reversíveis e de ocorrência infrequente. O conhecimento das interações farmacocinéticas, do perfil de segurança dos farmácos e de fatores de risco para eventos adversos permite um correto manuseio do tratamento hipiolipemiante e minimiza potenciais riscos.

Risk factors control is one of the most important strategies in the United States of America. Meta-analyses of studies in primary and secondary prevention with statins have shown that a 20% reduction in outcomes was observed for a 1 mmol/L reduction in LDL-c (of 2-3 mmol/L) a 40%-50% decrease in cardiovascular event was observed. Lipid-lowering therapy has to be given continuosly, it is safe, with infrequent and reversible adverse events that can be prevented by appropiate information on pharmacokinetic interactions, risk for drug profile and risk factors for adverse events to promote a correct management of lipid-lowering therapy and minimize potential risks.

Taurine ameliorates hyperglycemia and dyslipidemia by reducing insulin resistance and leptin level in Otsuka Long-Evans Tokushima fatty (OLETF) rats with long-term diabetes

This study aimed to determine whether taurine supplementation improves metabolic disturbances and diabetic complications in an animal model for type 2 diabetes. We investigated whether taurine has therapeutic effects on glucose metabolism, lipid metabolism, and diabetic complications in Otsuka Long-Evans Tokushima fatty (OLETF) rats with long-term duration of diabetes. Fourteen 50-week-old OLETF rats with chronic diabetes were fed a diet supplemented with taurine (2%) or a non-supplemented control diet for 12 weeks. Taurine reduced blood glucose levels over 12 weeks, and improved OGTT outcomes at 6 weeks after taurine supplementation, in OLETF rats. Taurine significantly reduced insulin resistance but did not improve beta-cell function or islet mass. After 12 weeks, taurine significantly decreased serum levels of lipids such as triglyceride, cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol. Taurine significantly reduced serum leptin, but not adiponectin levels. However, taurine had no therapeutic effect on damaged tissues. Taurine ameliorated hyperglycemia and dyslipidemia, at least in part, by improving insulin sensitivity and leptin modulation in OLETF rats with long-term diabetes. Additional study is needed to investigate whether taurine has the same beneficial effects in human diabetic patients.

Rosuvastatina, resistência à insulina, adiposidade, inflamação e esteatose hepática em camundongos alimentados com dieta hiperlipídica / Beneficial effects of rosuvastatin on insulin resistance, adiposity, inflammatory markers and non-alcoholic fatty liver disease in mice fed a high-fat diet

O estudo teve como objetivo avaliar os efeitos da rosuvastatina (ST) e darosiglitazona sobre a resistência à insulina (RI), morfologia do fígado e do tecido adiposo em camundongos alimentados com dieta hiperlipídica (HF). O tratamento com rosuvastatina resultou em uma acentuada melhoria na sensibilidade à insulina caracterizada pela melhor depuração da glicose durante o teste de tolerância à insulina e uma redução do índice HOMA-IR em 70% (P = 0,0008). O grupo tratado com rosuvastatina apresentou redução no ganho massa corporal (-8%, P <0,01) e menor depósito de gordura visceral (-60%, P <0,01) em comparação com o grupo HF não tratado. Em comparação com camundongos HF, animais do grupo HF+ST reduziram significativamente a massa hepática e a esteatose hepática (-6%; P <0,05% e -21; P <0,01, respectivamente). O grupo HF+ST, reduziu os níveis de triglicerídeos hepáticos em 58% comparado com o grupo HF (P <0,01). Além disso, a expressão de SREBP-1c (proteína 1c ligadora do elemento regulado por esteróis) foi reduzido em 50% no fígado dos animais HF + ST (P <0,01) em comparação com o grupo HF. Os níveis de resistina foram menores no grupo HF + ST comparado com o grupo HF (44% a menos, P <0,01). Em conclusão, demonstramos que camundongos alimentados com dieta HF tratados com rosuvastatina melhoram a sensibilidade à insulina, com redução da esteatose hepática. Além disso, ST reduziu o ganho de massa corporal, melhorou os níveis circulantes de colesterol e triglicerídeo plasmático, com menor conteúdo de hepático de triglicerídeo, que foi concomitante com menor resistina e aumento da adiponectina...

The study aimed to evaluate the effects of rosuvastatin (ST) and rosiglitazone on insulin resistance (IR) and liver and adipose tissue morphologies in mice fed a high-fat (HF) diet. Our data show that treatment with rosuvastatin resulted in a marked improvement in insulin sensitivity characterised by enhanced glucose clearance during insulin tolerance and a decrease in the HOMA-IR index level by 70% (P=0.0008). The group of mice treated with rosuvastatin exhibited reduced body mass gain (-8%; P<0.01) and visceral fat pad thickness (-60%; P<0.01)compared with the untreated HF group. In comparison with HF mice, HF+ST mice showed a significant reduction in hepatomegaly and liver steatosis (-6%; P<0.05 and -21%; P<0.01, respectively). In HF+ST mice, the hepatictriglyceride levels were reduced by 58% compared with the HF group (P <0.01). In addition, the expression of SREBP-1c (sterol regulatory element-binding protein) was decreased by 50% in the livers of HF+ST mice (P<0.01) compared with the HF mice. The levels of resistin were lower in the HF+ST group compared with the HF group (44% less, P< 0.01). In conclusion, we demonstrated that rosuvastatin-treated mice fed HF has been improving in insulin sensitivity, with decreased steatosis found in HF mice. Furthermore, ST reduced body mass gain, improved the circulating levels of plasma cholesterol and triglycerides and reduced hepatic triglycerides, which was concomitant with lower resistin and increased total adiponectin...

Unexpected and abnormally low HDL cholesterol levels on combination hypolipidemic therapy.

In general, Indians have low HDL cholesterol levels. Fenofibrate, a drug widely used in the treatment of hypertriglyceridemia, usually also increases HDL cholesterol. There have been a few reports in the literature of a paradoxical decrease in serum HDL-cholesterol in patients treated with fenofibrate, either alone or in combination with a statin. We report three cases of paradoxical decrease in serum HDL- cholesterol in type 2 diabetic patients treated with a statin-fenofibrate combination. ©

Management of acute coronary syndromes in secondary care settings in Kerala: impact of a quality improvement programme.

BACKGROUND: Evidence-based therapies that have been shown to improve outcomes in acute coronary syndromes (ACS) are often underused in clinically eligible patients. We evaluated the impact, efficacy and acceptability of a quality improvement programme to manage ACS. METHODS: A well-defined geographical area was identified and a situational analysis done. All physicians in the area, who were actively involved in the detection and management of ACS, were invited to participate in the quality improvement programme. The programme involved the use of a service delivery package which consisted of standard admission orders and patient-directed discharge instructions. Concurrently, health education in the community to promote self-detection, self-administration of aspirin and self-referral were carried out. All participating physicians were asked to register consecutive cases of ACS (20 each) presenting to their clinics before and after the intervention programme. The pre- and post-intervention data were compared. RESULTS: The use of aspirin at discharge increased from 89.7% to 96.8% (p < 0.05) and that of heparin from 57.6% to 66.3% (p < 0.05). The use of beta-blockers increased from 48.6% to 63.4% (p < 0.05) and that of lipid-lowering therapy from 74.1% to 96.3% (p < 0.05). There was a significant reduction in the use of calcium channel blockers from 21.6% to 8.1% (p < 0.05). The time to thrombolysis decreased significantly (median difference of 54 minutes, p < 0.05) after the intervention programme. CONCLUSION: Structured quality improvement programmes aimed at both patients and providers can be successful in secondary care settings of developing countries.

Efficacy and safety of combination of extended release niacin and atorvastatin in patients with low levels of high density lipoprotein cholesterol.

OBJECTIVE: We investigated the safety and efficacy of combination therapy of extended release (ER) niacin and atorvastatin in patients with low HDL-C and compared the results with atorvastatin monotherapy. METHODS: This open label study recruited consecutive men and women who had coronary artery disease with HDL-C levels <35 mg/dL. These patients were already on atorvastatin therapy targeted to lower low density lipoprotein cholesterol (LDL-C), for a minimum period of 6 months. Group 1, n = 104 (mean age 52.7 years) received ER niacin in addition to atorvastatin and group 2 (n = 106) continued on atorvastatin (mean age 52.3 years). ER niacin dose was built up to a maximum of 1.5 g and atorvastatin dose titrated according to LDL levels in both the groups. The lipoprotein levels at baseline were similar (p = NS). RESULTS: At 9 +/- 1.8 months of follow-up, the mean dose of ER niacin was 1.3 g and atorvastatin 13.2 mg in group 1. In comparison, group 2 patients had mean atorvastatin dose of 15.9 mg. Patients in group 1 had significant elevation in HDL-C cholesterol (39.5 +/- 5.5 vs 35.7 +/- 4.5 mg/dL), reduction in total cholesterol (156.4 +/- 31 vs 164.5 +/- 39.3 mg/dL) and also LDL-C (88.9 +/- 28.3 vs 99.8 +/- 35.4 mg/dL) compared to group 2 (all p < 0.05). The magnitude of reduction in triglyceride levels was not significant between the groups (140.1 +/- 40.4 vs 145.2 +/- 46.5 mg/dL) (p = NS). No major adverse events or clinical myopathy occurred in either groups. Four patients (4%) discontinued ER niacin (2 due to gastro-intestinal symptoms and 2 due to worsening of diabetes). Flushing occurred in 3% patients, but none felt it to be troublesome. CONCLUSION: Adding ER niacin to atorvastatin exhibited beneficial effects on lipid profile with significant elevation of HDL-C cholesterol and further lowering of LDL-C compared to monotherapy. This treatment offered better targeted therapy and was well tolerated with proper monitoring in Indian patients.

Patrones de prescripción de antilipémicos en un grupo de pacientes colombianos / Prescription patterns for antilipidemic drugs in a group of Colombian patients

OBJETIVOS: Determinar los patrones de prescripción de medicamentos antilipémicos en un grupo de afiliados al Sistema General de Seguridad Social en Salud de Colombia. MÉTODOS: Estudio descriptivo observacional con 41 580 dislipidémicos de ambos sexos, mayores de 20 años, con tratamiento, al menos, de abril a junio de 2006 y residentes en 19 ciudades colombianas. Se diseñó una base de datos de registros sobre consumo de medicamentos, capturados por la empresa que distribuye los fármacos a los pacientes. RESULTADOS: Edad promedio de 58,4 ± 13,5 años; 58,9 por ciento de los participantes son mujeres. Del total de pacientes, 95,6 por ciento recibían monoterapia y 4,4 por ciento dos o más antilipémicos. El orden de prescripción de los medicamentos fue: estatinas (70,9 por ciento), fibratos (27,5 por ciento), resinas fijadoras de colesterol (0,9 por ciento) y otros (0,7 por ciento), todos a dosis bajas. Las combinaciones más empleadas fueron lovastatina + gemfibrozilo (n = 1 568), colestiramina + gemfibrozilo (n = 92), coles tiramina + lovastatina (n = 78). La comedicación más prescrita fue: antihipertensivos (60,9 por ciento), antiinflamatorios (56,5 por ciento), antiulcerosos (22,9 por ciento), antidiabéticos (20,6 por ciento), ASA (3,8 por ciento). Existe subempleo de antianginosos y ASA y sobreempleo de antiinflamatorios y antiulcerosos. CONCLUSIONES: La dislipidemia es un factor de riesgo primario para desarrollar enfermedad coronaria y accidentes cerebrovasculares, causas frecuentes de morbilidad y mortalidad en Colombia y el mundo. Todos los antilipémicos se emplean en dosis menores a las recomendadas. Se plantea la necesidad de diseñar estrategias educativas para corregir algunos hábitos de prescripción y explorar resultados clínicos de formulaciones estudiadas.

OBJECTIVES: To determine patterns in antilipidemic drug prescriptions among a group of patients covered by the General Social Security System (Sistema General de Seguridad Social) in Colombia. METHODS: A descriptive, observational study was conducted of 41 580 hyperlipidemics of both sexes, who were over 20 years of age, undergoing treatment from at least April to June 2006, and were residents of one of 19 cities in Colombia. A database was created to track prescription data collected by the pharmaceutical company that dispenses medications to the patients. RESULTS: The mean age was 58.4 ± 13.5 years; 58.9 percent of the participants were women. Of the total number of patients, 95.6 percent were receiving monotherapy, while 4.4 percent were receiving two or more antilipidemics. Prescriptions were ranked as follows: statins (70.9 percent), fibrates (27.5 percent), bile acid sequestrant resins (0.9 percent), and others (0.7 percent), all at low dosage levels. The most common therapy combinations were lovastatin + gemfibrozil (n = 1 568), cholestyramine + gemfibrozil (n = 92), and cholestyramine + lovastatin (n = 78). Comedications most frequently prescribed were: antihypertensive (60.9 percent), antiinflammatory (56.5 percent), antiulcer (22.9 percent), and antidiabetes drugs (20.6 percent), and acetylsalicylic acid (ASA, 3.8 percent). Antianginals and ASA were being underused, while antiinflamatories and antiulcer drugs were being overused. CONCLUSIONS: Dyslipidemia is a primary risk factor for developing coronary heart disease and stroke, frequent causes of morbidity and mortality in Colombia and the world. All of the antilipidemics are being used at lower-than-recommended dosage levels. Clearly there is a need for creating educational strategies to address these prescribing habits and for exploring clinical results of the pharmaceuticals studied.

The Increase in Hepatic Uncoupling by Fenofibrate Contributes to a Decrease in Adipose Tissue in Obese Rats

Fenofibrate is a drug that has been suggested to inhibit weight gain by increasing the catabolism of fatty acid in the hepatic mitochondria. We hypothesized that fenofibrate induces an increase in energy expenditure in the hepatic mitochondria, which results in the reduction of adipose tissue. In this study we measured hepatic uncoupling protein (UCP)-2, -3, core temperatures and abdominal fat composition with MRI in Otsuka Long-Evans Tokushima Fatty rats. The fenofibrate group (n=7) was fed fenofibrate (320 mg/kg) mixed chow. The control group (n=7) was fed chow only. The body weight (531.6+/-7.6 g) of the fenofibrate group was significantly lower than that (744.3+/-14.9 g) of the control group (p<0.005). The areas of visceral and subcutaneous fat in the fenofibrate group (11.0+/-0.9 cm2, 4.2+/-0.3 cm2) were significantly less than those in the control group (21.0+/-0.7 cm2, 7.4+/-0.4 cm2) (p=0.046, respectively). The esophageal and rectal temperatures of the fenofibrate group (37.7+/-0.1 degrees C, 33.1+/-0.2 degrees C) were significantly higher than those of the control group (37.3+/-0.1 degrees C, 32.2+/-0.1 degrees C) (p=0.025, p=0.005). There was de novo expression of UCP-3 in the liver of the fenofibrate group. These data suggest that increased energy dissipation, via hepatic UCP-3 by fenofibrate, contribute to decreased weight gain in obese rats.

The influence of ovariectomy, simvastatin and sodium alendronate on alveolar bone in rats

Bisphosphonates are currently used in the treatment of many diseases involving increased bone resorption such as osteoporosis. Statins have been widely used for the treatment of hypercholesterolemia and recent studies have shown that these drugs are also capable of stimulating bone formation. The purpose of this study was to evaluate the influence of an estrogen deficient state and the effects of simvastatin and sodium alendronate therapies on alveolar bone in female rats. Fifty-four rats were either ovariectomized (OVX) or sham operated. A month later, the animals began to receive a daily dose of simvastatin (SIN - 25 mg/kg), sodium alendronate (ALN - 2 mg/kg) or water (control) orally. Thirty-five days after the beginning of the treatment, the rats were sacrificed and their left hemimandibles were removed and radiographed using digital X-ray equipment. The alveolar radiographic density under the first molar was determined with gray-level scaling and the values were submitted to analysis of variance (a = 5 percent). Ovariectomized rats gained more weight (mean ± standard deviation: 20.06 ± 6.68 percent) than did the sham operated animals (12.13 ± 5.63 percent). Alveolar radiographic density values, expressed as gray levels, were lowest in the OVX-water group (183.49 ± 6.47), and differed significantly from those observed for the groups receiving alendronate (sham-ALN: 193.85 ± 3.81; OVX-ALN: 196.06 ± 5.11) and from those of the sham-water group (193.66 ± 4.36). Other comparisons between groups did not show significant differences. It was concluded that the ovariectomy reduced alveolar bone density and that alendronate was efficient for the treatment of this condition.

Os bisfosfonatos são empregados atualmente para o tratamento de várias doenças caracterizadas pelo aumento da reabsorção óssea, como a osteoporose. As estatinas são amplamente utilizadas para redução de níveis elevados de colesterol e estudos recentes têm revelado sua ação anabólica no osso. O objetivo deste trabalho foi avaliar a influência da deficiência estrogênica e dos tratamentos com sinvastatina ou alendronato sódico no osso alveolar em ratas. Cinqüenta e quatro ratas sofreram ovariectomia (OVX) ou cirurgia simulada ("sham"). Um mês após, os animais passaram a receber diariamente, via oral, 25 mg/kg de sinvastatina (SIN), 2 mg/kg de alendronato (ALN) ou água (controle). Trinta e cinco dias depois do início do tratamento os animais foram sacrificados, as hemimandíbulas esquerdas removidas e radiografadas em aparelho de raios X digital. Foi calculada a densidade radiográfica em tons de cinza da área de osso alveolar sob o primeiro molar mandibular e os valores foram submetidos a ANOVA, ao nível de 5 por cento. Ratas ovariectomizadas ganharam mais peso (média ± desvio-padrão: 20,06 ± 6,68 por cento) que as demais (12,13 ± 5,63 por cento). Os valores de densidade radiográfica, em tons de cinza, foram menores nos animais do grupo OVX-água (183,49 ± 6,47), significantemente diferentes daqueles observados nos grupos que receberam alendronato ("sham"-ALN: 193,85 ± 3,81; OVX-ALN: 196,06 ± 5,11) e no grupo "sham"-água (193,66 ± 4,36). Outras comparações entre grupos não revelaram diferenças estatísticas. Concluiu-se que a ovariectomia reduziu a densidade óssea alveolar e que o tratamento com alendronato sódico foi eficiente para o tratamento desta situação.

Perfil lipídico de pacientes com alto risco para eventos cardiovasculares na prática clínica diária / Lipid profile of patients with increased risk for cardiovascular events in daily clinical practice

Embora existam recomendações especificas envolvendo o tratamento das dislipidemias em pacientes com alto risco, estas recomendações dificilmente são seguidas adequadamente. O objetivo deste estudo é investigar fatores de risco em pacientes com alto risco cardiovascular acompanhados ambulatorialmente no Brasil e Venezuela. Os prontuários de 412 pacientes foram selecionados em 4 instituições. Os pacientes foram divididos conforme a utilização de hipolipemiantes. Pacientes sem hipolipemiantes apresentavam níveis mais elevados de colesterol total (p< 0,001), LDL colesterol (p< 0,001) e HDL colesterol (p< 0,001), além de menores níveis de triglicérides (p< 0,001). O uso de hipolipemiantes foi associado à diminuição dos níveis de colesterol total (251,0 ± 40,0 para 196,0 ± 46,0), LDL colesterol (168,0 ± 36,0 para 116,0 ± 39,0), HDL colesterol (51,0 ± 46,0 para 46,0 ± 12,0) e triglicérides (181,0 ± 120,0 para 160,0 ± 79,0). Concluímos que apenas um pequeno percentual de pacientes, mesmo em uso de estatinas, apresenta níveis de colesterol compatível com os atualmente recomendados. Desta forma, embora as recomendações para tratamento das dislipidemias sejam bem conhecidas, um pequeno percentual de pacientes atinge os valores desejados de colesterol. É necessário um melhor controle dos níveis lipídicos dos pacientes, tanto através da utilização de doses maiores de estatinas como da utilização da associação de hipolipemiantes.

Effectiveness of nicotinic acid and bezafibrate alone and in combination for reducing serum triglyceride level.

OBJECTIVE: To study the effectiveness of nicotinic acid and Bezafibrate alone and in combination for reducing triglyceride level. DESIGN: It was a randomised, prospective, longitudinal study. SETTING: Patients attending a private clinic, and medical department of Kathmandu Medical College, Sinamangal. METHODS: This study included 83 consecutive patients, 19 females and 64 males with hypertriglyceridaemia (defined as serum triglyceride >200mg/dl) attending the department of medicine, Kathmandu Medical College, Sinamangal and private clinic. MAIN OUTCOME MEASURES: Statistically significant reduction of serum triglyceride level. RESULT: 51 out of 83 patients completed the study in which Nicotinic acid alone reduced the serum trygleceride level from 320.62 +/- 104.23 to 182.55 +/- 46.21, which is a reduction of 138.07 +/- 85.69 (P. value = 001). Bezafibrate when given alone also reduced triglyceride level significantly from 345.25 +/- 181.03 to 203.30+/-93.59 which is a reduction of 141.95 +/- 121.130 (P value= .001). When a combination of both drugs was given the reduction of 472.73+/-247.53 (P value =.002) was achieved. CONCLUSIONS: Nicotinic acid is a very effective drug in reducing serum triglyceride level and its effectiveness is similar to Bezafibrate. There is no added benefit of giving a combination of nicotinic acid and Bezafibrate in reducing serum triglyceride level.

Probing the anti-hyperlipidemic efficacy of the allspice (Pimenta officinalis Lindl.) in rats fed with high fat diet.

In this study, the anti-hyperlipidemic effect of aqueous extract of Pimenta officinalis (APO) was investigated in experimental rats fed with high fat diet (HFD). Hyperlipidemia in experimental rats was evidenced by a significant enhancement in the level of glycerol, triglycerides and phopholipids in serum, and also in liver and kidney tissues. HFD caused oxidative stress in these animals as shown by marked increment in the levels of thiobarbituric acid reactive substances (TBARS) and diene conjugates (CD), and a distinct diminution in reduced glutathione (GSH) content in liver and kidneys. Antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX) showed reduced activity in hyperlipidemic rats. All these biochemical parameters showed reliable signs of retrieving towards near-normalcy in APO-administered HFD fed rats. This study unveiled the anti-hyperlipidemic as well as antioxidant activity of APO.