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Objective:To explore the influence of acupoint catgut embedding combined with Xuezhikang capsule on lipid metabolism and antioxidation effect in patients with statin intolerance and hyperlipidemia of spleen-kidney yang deficiency syndrome.Methods:Randomized controlled trial. A total of 82 patients with statin intolerance and hyperlipidemia who were treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine , Shanghai Puto Area Central Hospital, and Lingyun community health Service center, Xuhui District from July 2020 to June 2022 were selected and randomly divided into two groups with 41 patients in each group by odd-even ball method. The two groups were given diet and exercise guidance, and the control group was given Xuezhikang capsule orally on this basis, and the observation group was given poly(l-lactide-co-glycolide) (PLGA) thread acupoint catgut embedding on the basis of the control group. Both groups were treated continuously for 3 months. The TCM syndromes were scored before and after treatment, and body weight (BW), waist circumference (WC) and body mass index (BMI) were recorded. The levels of TC, TG, HDL-C and LDL-C were detected by fully automatic biochemical analyzer. The levels of serum SOD, GSH-Px and total antioxidant capacity (TAOP) were measured by ELISA. The level of serum endothelin-1 (ET-1) was assessed by radioimmunoassay. Color Doppler ultrasound diagnostic instrument was used to detect the brachial artery flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD).Results:The scores of chilly sensation and cold limbs [(1.27±0.12) vs. (1.46±0.16), t=6.08], loose stool [(1.41±0.16) vs. (1.63±0.18), t=5.85], fatigue [(1.45±0.15) vs. (1.57±0.17), t=3.39], dizziness [(1.15±0.11) vs. (1.26±0.13), t=4.14] and loss of appetite [(1.21±0.13) vs. (1.39±0.15), t=5.81] in observation group after treatment were significantly lower than those in the control group ( P<0.01). BW [(68.03±6.57)kg vs. (71.55±6.76)kg, t=2.39], WC [(85.13±4.63)cm vs. (87.35±4.85)cm, t=2.12] and BMI [(27.35±2.84)kg/m 2vs. (29.18±3.05)kg/m 2, t=2.81]were lower than those in the control group ( P<0.05). The levels of serum TC [(3.15±0.13)mmol/L vs. (3.38±0.17)mmol/L, t=6.88], TG [(1.98±0.11)mmol/L vs. (2.21±0.15)mmol/L, t=7.92]and LDL-C [(2.46±0.26)mmol/L vs. (3.04±0.33)mmol/L, t=8.84]were significantly lower compared with those in control group ( P<0.01) while the level of HDL-C [(1.88±0.24)mmol/L vs. (1.74±0.21)mmol/L, t=2.81]was higher than that of the control group ( P<0.01). The levels of serum SOD [(57.82±5.84)μg/L vs. (55.06±5.61)μg/L, t=2.18], GSH-Px [(96.51±9.52)U/L vs. (92.26±9.25)U/L, t=2.30]and TAOP [(6.21±0.57)U/L vs. (5.94±0.54)U/L, t=2.20]were significantly higher compared to control group ( P<0.05). Serum ET-1 [(60.43±4.36) pg/L vs. (63.71±4.68) pg/L, t=3.28] level was significantly lower than that in control group ( P<0.01), while FMD [(12.48±1.02)% vs. (11.34±0.95)%, t=5.24] and NMD [(15.12±1.24)% vs. (14.44±1.18)%, t=2.54] were significantly higher than those in control group ( P<0.01). Conclusion:The combination of acupoint catgut embedding and Xuezhikang capsule can reduce the scores of TCM syndromes, lower the obesity and blood lipids, enhance the antioxidant function and improve the vascular endothelial function in patients with statin intolerance and hyperlipidemia.
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Objective To investigate the effect of different doses of statins on the clinical efficacy and safety outcome of intravenous thrombolytic therapy of urokinase in patients with acute ischemic stroke(AIS).Methods Based on a large prospective,multicenter study,the Chinese Intravenous Thrombolysis Registry for AIS within 4.5 h of onset(INTRECIS)database,clinical data of 898 patients with urokinase intravenous thrombolysis for AIS were retrospectively analyzed.According to the amount of statin used during hospitalization,the patients were divided into 132 patients in no-statin group,591 patients in conventional statin group and 175 patients in intensive statin group.Clinical outcome measures included 14-day improvement in the National Institutes of Health Stroke Scale(NIHSS)and 90-day excellent prognosis(improved Rankin score≤1 point).Safety measures included recurrent stroke,bleeding events,and 90-day all-cause mortality.Results After adjusting for differences in baseline characteristics(age,coronary heart disease,diabetes,atrial fibrillation,systolic blood pressure,OTT,DNT,previous anti-plate use,blood glucose,and treatment in Class A hospitals),NIHSS scores improved at 14 days after admission and excellent prognosis at 90 days after admission in convention-dose and intensive statin groups were superior to those in no-statin group(P<0.05);Univariate and multivariate analysis of safety outcome indicators showed no statistically significant differences in stroke recurrence and bleeding events among the three groups(P>0.05);The 90-day all-cause mortality was significantly higher in no-statin group(10.6%)than in convention-dose statin group(2.0%)and intensive dose statin group(2.9%)(P<0.01).Conclusions In patients with AIS who were treated with intravenous urokinase thrombolytic therapy,intensive statin use was associated with improved 14-day NIHSS score and near-term prognosis without increasing the risk of stroke recurrence and bleeding events.Statin use is beneficial to reduce mortality.
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BACKGROUND:Observational studies have suggested that statin drugs may have a protective effect on bone density,making them a potential treatment option for osteoporosis. OBJECTIVE:To evaluate the causal relationship between drug target-mediated lipid phenotypes and bone mineral density(BMD)using Mendelian randomization methods. METHODS:We obtained single nucleotide polymorphismsrelated to statin drugs and BMD data from the IEU Open GWAS database.The primary analysis method was the inverse variance weighted method,and we also used weighted median,simple median,weighted mode,and MR-Egger regression.We usedβ values and 95%confidence intervals(CI)to assess the causal relationship between statin drugs and BMD.Additionally,we conducted sensitivity analyses to validate the results,assessed heterogeneity using Cochran's Q test,examined for horizontal pleiotropy using the MR-Egger intercept test,and performed leave-one-out analyses to determine if individual or multiplesingle nucleotide polymorphism influenced the results. RESULTS AND CONCLUSION:There was a significant association between the statin target of action,3-hydroxy-3-methyl glutaryl coenzyme A reductase-mediated low-density lipoprotein cholesterol,and heel bone BMD(β=-0.086,95%CI:-0.117 to-0.055,P=5.42×10-8)and whole-body BMD(β=-0.193,95%CI:-0.288 to-0.098,P=7.35×10-5).The findings of this study support the protective effect of statin drugs on BMD.These findings not only deepen our understanding of the relationship between cholesterol-related genes and bone health but also reveal potential therapeutic targets for improving BMD.
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Background & objectives: Statin use has been shown to be associated with a decreased risk of several types of cancer, however, the data on diffuse large B-cell lymphoma (DLBCL) are still inconclusive. This study aimed to systematically summarize all available data on this association and conduct a meta-analysis on the same. Methods: A systematic review was performed using EMBASE and MEDLINE databases from inception upto October 2019 with a search strategy that included terms such as ‘statin’ and ‘DLBCL’. Eligible studies included either case–control or cohort studies that reported the association between statin use and the risk of DLBCL. Relative risk, odds ratio (OR), hazard: risk ratio or standardized incidence ratio of this association and standard error were extracted and combined for calculating the pooled effect estimate using random-effects, generic inverse variance method. Results: A total of 1139 articles were screened. Of these six studies satisfied the inclusion criteria and were included for the meta-analysis. Statin use was associated with a significantly reduced risk of DLBCL with the pooled OR of 0.70 (95% confidence interval, 0.56-0.88; I2=70%). The funnel plot (fairly symmetric) was not suggestive of the presence of a publication bias. Interpretation & conclusions: The present systematic review and meta-analysis found that statin use is associated with a 30 per cent reduced odds of DLBCL. However, the pooled analysis utilized data from observational studies so causation cannot be concluded upon. Hence, it suggested that randomized-controlled studies are still needed to confirm this potential benefit.
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Background: The benefit of prior statin use to reduce the incidence of arrhythmia in acute coronary syndrome (ACS) is still a matter of debate. Statins have multiple pleiotropic effects, which may reduce the incidence of in-hospital arrhythmia. A systematic review and meta-analysis were performed to evaluate prior statin use and the incidence of in-hospital arrhythmia in ACS. Methods: This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We performed a literature search through Pubmed, Proquest, EBSCOhost, and Clinicaltrial.gov. A random-effect model was used due to moderate heterogeneity. Quality assessment was performed using Newcastle Ottawa Scale. Sensitivity analysis was performed by using leave one or two out method. PROSPERO registration number: CRD42022336402. Results: Nine eligible studies consisting of 86,795 patients were included. A total of 22,130 (25.5%) patients were in statin use before the index ACS event. The prevalence of old myocardial infarction, heart failure, hypertension, diabetes mellitus, and chronic renal failure and concomitant treatment with aspirin, clopidogrel, and beta blocker was higher in the prior statin group compared to no previous statin. Overall, prior statin use was associated with a significantly lower incidence of in-hospital arrhythmia during ACS compared to no previous statin (OR 0.60; 95% CI 0.49e0.72; P < 0.00001; I2 ¼ 54%, Pheterogeneity ¼ 0.03). In subgroup analysis, previous statin use reduced the incidence of atrial fibrillation or atrial flutter (OR 0.64; 95% CI 0.43e0.95; P ¼ 0.03; I2 ¼ 73%, P-heterogeneity ¼ 0.01) and ventricular tachycardia or ventricular fibrillation (OR 0.57; 95% CI 0.49e0.65; P < 0.00001; I2 ¼ 8%, Pheterogeneity ¼ 0.35). Conclusions: Based on aggregate patient data, prior statin use may reduce the incidence of in-hospital arrhythmia during ACS, particularly atrial fibrillation or atrial flutter and ventricular tachycardia or ventricular fibrillation.
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Survivors of intracerebral hemorrhage (ICH) have significantly higher risks of both arterial ischemic events and recurrent ICH after the first event. This uncertainty leaves clinicians with dilemmas about the therapy strategies for the secondary prevention of major vascular events after ICH. Clinicians mainly focus on the prevention of hemorrhage recurrence but overlook the increased risk of ischemic disease after ICH in routine clinical practice. Secondary stroke prevention measures after ICH including antithrombotic and statin treatments remain challenging due to the lack of dedicated studies with strong evidence. Decision-making on stroke prevention requires algorithmic approaches based on the hemorrhagic and ischemic risk stratification. This article systematically reviews the current evidence for the prevention and management of subsequent arterial ischemic events after ICH, aiming to promote further attention and research to address the current controversies and knowledge gap on this topic.
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Dual anti-platelet therapy (DAPT) and statins are recommended by guidelines for the management of cardiovascular diseases (CVDs), even though the duration of treatment is guided by ischemic and bleeding risk. Clopidogrel and aspirin are the most commonly used DAPT in CVDs. Adding a statin to DAPT is helpful in reducing the thrombosis risk. Fixed-dose combination (FDC) therapy in CVD can help to address the factors of convenience, compliance, control, cost, and complication better than free drug combinations. Therefore, the FDC of rosuvastatin (10 mg or 20 mg) + clopidogrel (75 mg) + aspirin (75 mg) is likely to improve compliance in CVD patients, thereby reducing adverse cardiovascular outcomes and cost of treatment. There is lack of awareness on long term benefits of this FDC in Indian patients.
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INTRODUCCIÓN: Debido a sus propiedades antiinflamatorias, se ha planteado que el uso de las estatinas podría influir en la evolución de la infección por el virus de influenza. OBJETIVO: Evaluar el efecto de la terapia con estatinas sobre la mortalidad por influenza. MATERIAL y MÉTODOS: Se realizó un meta-análisis que incluyó estudios que evaluaron el uso de estatinas en pacientes con influenza e informaron los datos sobre mortalidad, después de buscar en las bases de datos PubMed/MEDLINE, Embase y Cochrane Controlled Trials. Se aplicó un modelo de efectos aleatorios. Se analizó el riesgo de sesgos y se desarrolló un análisis de sensibilidad. RESULTADOS: Se identificaron y se consideraron elegibles para el análisis ocho estudios (diez cohortes independientes), que incluyeron un total de 2.390.730 de pacientes. Un total de 1.146.995 de sujetos analizados recibieron estatinas mientras que 1.243.735 de sujetos formaron parte del grupo control. La terapia con estatinas se asoció con una menor mortalidad (OR: 0,66; IC 95%: 0,51-0,85). El análisis de sensibilidad mostró que los resultados fueron robustos. CONCLUSIONES: Nuestros datos sugieren que, en una población con influenza, el uso de estatinas se asoció con una reducción significativa de la mortalidad. Estos resultados deben confirmarse en futuros ensayos clínicos.
BACKGROUND: Due to their anti-inflammatory properties, it has been suggested that the use of statins could influence the evolution of influenza virus infection. AIM: To evaluate the effect of statin therapy on mortality from influenza. METHODS: A meta-analysis that included studies evaluating the use of statins in patients with influenza and reporting data on mortality, after searching the PubMed/MEDLINE, Embase, and Cochrane Controlled Trials databases, was performed. A random effects model was applied. The risk of bias was analyzed and a sensitivity analysis was performed. RESULTS: Eight studies (10 independent cohorts), which included a total of 2,390,730 patients, were identified and eligible for analysis. A total of 1,146,995 subjects analyzed received statins, while 1,243,735 subjects were part of the control group. Statin therapy was associated with lower mortality (OR: 0.66; 95% CI: 0.51-0.85). The sensitivity analysis showed that the results were robust. CONCLUSION: Our data suggest that, in a population with influenza, the use of statins was associated with a significant reduction in mortality. These results must be confirmed in future clinical trials.
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Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Gripe Humana/tratamiento farmacológicoRESUMEN
Background: Oldest?old population is rapidly increasing in all countries, with many prescribed statin therapy. Statins are associated with multiple cardiovascular benefits at various ages. The benefits of statins above the age of 75 are being questioned. The objective of this study was to measure statins use among the oldest?old population, aged 80 years and above, and to study the effect of statins on cognitive function, depression, and quality of sleep. Materials and Methods: This cross-sectional study randomly enrolled 200 community-dwelling individuals aged >80 years. Data were collected upon home visits on sociodemographic, cognitive functions, depression, sleep, chronic diseases, functional limitations, and disabilities. Cognitive function (Mini Mental State Examination), depression (Geriatric Depression Scale), and quality of sleep (Pittsburgh Sleep Quality Index) among individuals using statins versus not using statins were compared. Chi?square test and t-test were done; odds ratios (ORs) with 95% confidence interval (95% CI) were reported. Logistic regression was done to calculate adjusted ORwith age, antidepressants, sedatives, antihistaminics, and sleep medicines. P < 0.05 was considered statistically significant. Results: Overall prevalence of statin use in our study population was 12%; 11.3% in women and 13.2% in men. Cognitive functions, depression, and quality of sleep improved among those using statins (P < 0.05): cognitive impairment – OR: 0.38; 95% CI: 0.16–0.91; depression – OR: 0.41; 95% CI: 0.17–1.02, and poor sleep quality – OR: 0.39; 95% CI: 0.16–0.96. On stratification by gender, men showed a significant association of improved cognitive function and quality of sleep with the use of statins, whereas women did not show any significant associations with cognitive function and quality of sleep but showed almost significant association with improvement in depression. Conclusions: The prevalence of the use of statins was low in our population. Statins had positive effects on cognitive functions, quality of sleep, and depression over 80 years of age in our population, although gender difference exists
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High-intensity statins are the cornerstone of medical management in Acute Coronary Syndromes (ACS). However, their effect on neurocognition are less clear. In this prospective observational study, we gave guideline-directed high-intensity atorvastatin 40 mg to middle-aged statin-naïve ACS patients. Memory assessments were performed before and 6 months after statin therapy using 2 validated scales-the PostGraduate Institute Memory Scale (PGI-MS), and the Logical Memory Passage Test (LMPT). There was no significant difference in the mean PGI-MS test scores (baseline 75.4 ± 7.9, 6months 76.5 ± 8.2;p ¼ 0.26) or the overall composite scores (baseline 32.02 ± 3.2, 6months 32.8 ± 3.1; p ¼ 0.20), after 6 months of statin use. There was a small improvement in immediate recall (baseline score 8.5 ± 2.5, 6 months 9.04 ± 1.8; p ¼ 0.05), and delayed recall (baseline 6.1 ± 2.6, 6 months 6.9 ± 1.9, p ¼ 0.002). High-intensity atorvastatin use did not affect memory at 6 months among statin-naïve middle-aged patients with ACS.
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O infarto agudo do miocárdio (IAM) é a maior causa de mortalidade no mundo. A oclusão coronária determina a necrose completa de cardiomiócitos (células musculares cardíacas) durante as primeiras horas do IAM. Porém, mesmo após a perda de massa de miocárdio viável cessar, a região infartada pode se expandir ou contrair no decorrer das primeiras semanas, afetando o prognóstico dos pacientes. Alguns tratamentos podem auxiliar na recuperação e melhoria do prognóstico desses pacientes, como o uso de estatinas e antiplaquetários, que quando utilizados em conjunto, proporcionam efeitos sinérgicos. O presente estudo investigou e comparou, através da óptica da metabolômica global multiplataforma, tratamentos concomitantes de estatinas (sinvastatina ou rosuvastatina) e antiplaquetários bloqueadores do receptor de ADP (clopidogrel ou ticagrelor), em pacientes que sofreram IAM. Foram coletadas amostras de plasma e urina de cerca 40 pacientes tratados com clopidrogrel e sinvastatina ou ticagrelor e rosuvastatina no Hospital São Paulo em diferentes períodos (basal, 1 mês e 6 meses após IAM). Amostras de plasma (basal e 1 mês) foram analisadas por RPLC-MS nos modos de ionização positivo e negativo, GC-MS e CEMS. Amostras de urina (basal, 1 mês e 6 meses) foram analisadas por RPLC-MS no modo de ionização positivo e HILIC-MS nos modos de ionização positivo e negativo. A abordagem metabolomica global multiplataforma evidenciou alterações no metabolismo de diferentes vias pelos dois tratamentos. Os dois tratamentos proporcionaram um efeito pronunciado no metabolismo de diferentes lipídios, como glicerolipídios, esfingolipídios, glicerofosfolipídios e ácidos graxos, sendo que a combinação rosuvastatina e ticagrelor resultou num efeito mais acentuado. Já o tratamento com clopidogrel e sinvastatina alterou de maneira mais pronunciada o metabolismo de aminoácidos ramificados e de acilcarnitinas de cadeia curta. Observou-se ainda a alteração de possíveis biomarcadores relatados na literatura como associados a problemas cardiovasculares, como hipoxantina, ácido 2-hidroxibutírico, algumas espécies de ceramidas, fosfatidilcolinas e acilcarnitinas de cadeia curta
cute myocardium infarction (AMI) is the main mortality cause in the world. The coronary occlusion determines the complete necrosis of cardiomyocytes (cardiac muscle cells) during the first hours of AMI. However, even after the loss of viable myocardial mass ceases, the infarcted area may still expand or contract during the first weeks after AMI, affecting the patient prognosis. Some treatments may assist patient recovery and improve prognostic, such as statins and antiplatelets which, when combined, provide synergic effects. This study investigated and compared, by untargeted multiplatform metabolomics, simultaneous treatments of statins (simvastatin or rosuvastatin) and ADP receptor antagonist antiplatelets (clopidogrel or ticagrelor) in patients that suffered AMI. Plasma and urine samples from around 40 patients treated with clopidogrel and simvastatin or ticagrelor and rosuvastatin were collected in Hospital Sao Paulo at different time points (basal, 1 month, 6 months after AMI). Plasma samples (basal and 1 month) were analyzed by RPLC-MS in positive and negative ionization modes, GC-MS and CE-MS. Urine samples (basal, 1 month, 6 months) were analyzed by RPLC-MS in positive ionization mode and by HILIC-MS in positive and negative ionization modes. The untargeted multiplatform metabolomics approach has shown that different metabolic pathways have been altered by the two treatments. Both treatments had a profound impact on the metabolism of different lipids, such as glycerolipids, sphingolipids, glycerophospholipids, and fatty acids. However, the combined treatment using rosuvastatin and ticagrelor impacted the most the lipid pathways. On the other hand, clopidogrel and simvastatin treatment affected more intensily the branched chain amino acids and short chain acylcarnitines metabolisms. Reported biomarkers in the literature related to cardiovascular diseases were also observed in this study, such as hypoxanthine, 2-hydroxybutyric acid, some species of ceramides, phosphatidylcholines and short chain acylcarnitines
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Humanos , Masculino , Femenino , Inhibidores de Agregación Plaquetaria/análisis , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/análisis , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Simvastatina/análisis , Metabolómica/clasificación , Infarto del Miocardio/patología , Enfermedades Cardiovasculares , Antagonistas del Receptor Purinérgico P2Y , Rosuvastatina Cálcica/análisis , Aminoácidos/efectos adversosRESUMEN
Objective:To investigate the characteristics of multimodal ultrasound imaging in elderly hyperlipidemia patients with statin-related myopathy and to provide a reference of new method for non-invasive quantitative evaluation on statin myopathy.Methods:We collected 20 elderly hyperlipidemia patients with statin-related myopathy(the statin-related myopathy group), 20 elderly hyperlipidemia patients without statin-related myopathy after taking statins during the same period(the non-statin-related myopathy group), and 20 healthy volunteers who matched the age and sex of the above two groups during the same period(the healthy control group)in our hospital.Two-dimensional ultrasound, shear wave elastography and superb microvascular imaging were used to obtain thickness, echo, pinnation angle and shear wave velocity(SWV)values as well as vascular index(VI)values of the medial gastrocnemius during relaxation, dorsiflexion, and plantar flexion for each group, which were then analyzed.Results:There were no significant differences among the three groups in general conditions such as age, height, weight, and body mass index(all P>0.05). The mean thickness of the medial gastrocnemius in the statin-related myopathy group was about(1.04 ± 0.20)cm, which was less than(1.34 ± 0.16)cm in the non-statin-related myopathy group and(1.35 ± 0.15)cm in the healthy control group( F=22.03, P<0.001). The pinnation angle in the statin-related myopathy group was about(12.50 ± 1.10), which was less than(18.55 ± 1.28)in the non-statin-related myopathy group and(18.60 ± 1.35)in the healthy control group( F=158.03, P<0.001). Compared with the non-statin-related myopathy group and the healthy control group, SWV during resting, dorsiflexion and plantar flexion in the statin-related myopathy group decreased( F=61.71, 111.96 and 8.69, respectively, P<0.01). The average value of VI in the statin-related myopathy group was about(0.43 ± 0.12)%, which was less than that in the non-statin-related myopathy group(0.75 ± 0.20)% and in the healthy control group(0.93 ± 0.17)%( F=48.93, P<0.001). However, there was no significant difference in values from the parameters between the non-statin-related myopathy group and the healthy control group(all P>0.05). Conclusions:Multimodal ultrasound imaging of statin-related myopathy in elderly hyperlipidemia patients shows distinct characteristics and can be used to evaluate muscle damage of statin-related myopathy.
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OBJECTIVE@#To evaluate the effectiveness of statin treatment strategies based on risk assessment for the primary prevention of cardiovascular diseases by the Western guidelines in a community-based Chinese population from economically developed areas using data from the Chinese electronic health records research in Yinzhou (CHERRY) study.@*METHODS@#A Markov model was used to evaluate the effectiveness of the following statin treatment strategies, including: (1) usual care without cardiovascular risk assessment(Strategy 0); (2) using the World Health Organization (WHO) non-laboratory-based risk charts with statin treatment for high-risk group (risk ≥ 20%) (Strategy 1); (3) using the WHO laboratory-based risk charts with statin treatment for high-risk group (risk ≥ 20%) (Strategy 2); and (4) using the Prediction for Atherosclerotic cardiovascular disease Risk in China (China-PAR) model with statin treatment for high-risk group (risk ≥ 10%, Strategy 3). According to the guidelines, adults in the medium-risk group received lifestyle intervention, and adults in the high-risk group received life-style intervention and statin treatment under these strategies. The Markov model simulated different strategies for ten years (cycles) using parameters from the CHERRY study, published data, meta-analyses and systematic reviews for Chinese. The number of cardiovascular events or deaths, as well as the number need to treat (NNT) with statin per cardiovascular event or death prevented, were calculated to compare the effectiveness of different strategies. One-way sensitivity analysis on the uncertainty of incidence rate of cardiovascular diseases, and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted.@*RESULTS@#Totally 225 811 Chinese adults aged 40-79 years without cardiovascular diseases at baseline were enrolled. In contrast to the usual care without risk assessment-based statin treatment strategy, Strategy 1 using the WHO non-laboratory-based risk charts could prevent 3 482 [95% uncertainty interval (UI): 2 110-4 661] cardiovascular events, Strategy 2 using the WHO laboratory-based risk charts could prevent 3 685 (95%UI: 2 255-4 912) events, and Strategy 3 using the China-PAR model could prevent 3 895 (95%UI: 2 396-5 181) events. NNTs with statin per cardiovascular event prevented were 22 (95%UI: 14-54), 21 (95%UI: 14-52), and 27 (95%UI: 17-67), respectively. Strategy 3 could prevent more cardiovascular events, while Strategies 1 and 2 required fewer numbers need to treat with statin per cardiovascular event prevented. The results were consistent in the sensitivity analyses.@*CONCLUSION@#The statin treatment strategies based on risk assessment for the primary prevention of cardiovascular diseases recommended by the Western guidelines could achieve substantive health benefits in adults from developed areas of China. Using the China-PAR model for cardiovascular risk assessment could prevent more cardiovascular diseases while using the WHO risk charts seems more efficient.
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Adulto , Humanos , Enfermedades Cardiovasculares/prevención & control , China/epidemiología , Análisis Costo-Beneficio , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Prevención PrimariaRESUMEN
Introducción: La enfermedad periodontal es un padecimiento inflamatorio, infeccioso y multifactorial crónico, caracterizado por la inflamación de los tejidos blandos periodontales. En estadios avanzados (periodontitis), produce la destrucción progresiva de los tejidos duros periodontales, lo que conduce a la posterior pérdida de dientes, si esta no es tratada. Objetivo: Determinar la efectividad clínica y radiográfica de las estatinas en el tratamiento de la periodontitis. Métodos: Se realizó una búsqueda de la literatura hasta abril del 2019, en las bases de datos biomé dicas: PubMed, Embase, SciELO, Science Direct, Scopus, Sistema de información sobre literatura gris en Europa, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Google Académico y el Registro Central de Ensayos Clínicos Cochrane. Se definieron como criterios de selección de los estudios que fueran ensayos clínicos aleatorizados, con una antigüedad máxima de cinco años y que reportaran los efectos clínicos y radiográficos (profundidad al sondaje, nivel de inserción clínica, índice de placa, índice de sangrado, índice gingival, defecto intraóseo y profundidad del defecto) de las estatinas en el tratamiento de la periodontitis. Se analizó el riesgo de sesgo de los estudios por el Manual Cochrane de revisiones sistemáticas de intervenciones. Resultados: La estrategia de búsqueda arrojó 19 artículos, de los cuales el 100 por ciento reportó que había diferencia en la profundidad al sondaje, nivel de inserción clínica, índice de placa, índice de sangrado, índice gingival, defecto intraóseo y profundidad del defecto de las estatinas en el tratamiento de la periodontitis. Conclusiones: La literatura revisada sugiere que el uso de estatinas es efectivo, clínica y radiográficamente, en el tratamiento de la periodontitis(AU)
Introduction: Periodontal disease is a chronic multifactorial infectious inflammatory condition characterized by inflammation of soft periodontal tissue. In advanced stages (periodontitis) it causes progressive destruction of hard periodontal tissue, leading to eventual tooth loss if not treated. Objective: Determine the clinical and radiographic effectiveness of statins in the treatment of periodontitis. Methods: A search was carried out in the literature published until April 2019 in the biomedical databases PubMed, Embase, SciELO, Science Direct, Scopus, System for Information on Gray Literature in Europe, Latin American and Caribbean Health Sciences Literature, Google Scholar, and Cochrane Central Register of Clinical Trials. The following selection criteria were defined for the studies: randomized clinical trials published in the last five years and reporting on clinical and radiographic effects (probing depth, clinical insertion level, plaque index, bleeding index, gingival index, intraosseous defect and defect depth) of statins in the treatment of periodontitis. Bias risk analysis was based on the Cochrane manual of systematic reviews of interventions. Results: A total 19 papers were retrieved, of which 100 percent reported differences in the probing depth, clinical insertion level, plaque index, bleeding index, gingival index, intraosseous defect and defect depth of statins in the treatment of periodontitis. Conclusions: The literature review conducted suggests that the use of statins is clinically and radiographically effective in the treatment of periodontitis(AU)
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Humanos , Enfermedades Periodontales/etiología , Periodontitis/diagnóstico por imagen , Sistemas de Información , Resultado del Tratamiento , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Literatura de Revisión como Asunto , Bases de Datos BibliográficasRESUMEN
Objectives: To compare the effects of atorvastatin and rosuvastatin in type II diabetes mellitus (T2DM) patients with dyslipidemia. Materials and Methods: Eighty patients with history of T2DM of more than 3 months duration, glycated hemoglobin <7%, dyslipidemia, and normal electrocardiogram were included in the randomized double-blind trial. The patients received either tablet atorvastatin 20 mg or rosuvastatin 10 mg once a day along with metformin and glimepiride twice daily orally. Patients were evaluated by the change in estimated average glucose (eAG), lipid profile, and incidence of adverse drug reactions (ADRs). Results: Rise in fasting blood sugar (FBS), postprandial blood sugar, and eAG were significant in the atorvastatin group as compared to the rosuvastatin group where there was a significant increase only in FBS levels. Changes in lipid parameters and incidence of ADR were similar in both the groups. Conclusion: Rosuvastatin can be preferred to atorvastatin in T2DM with dyslipidemia due to less variation in the blood sugar parameters, effective control over lipid profile, pleiotropic effects, and less microsomal interactions.
RESUMEN
@#Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disorder of lipoprotein metabolism mainly due to mutation of the low-density lipoprotein (LDL)-receptor gene (LDLR). It is a life-threatening disease that causes accelerated, multi-vessel atherosclerosis presented in early childhood. Pregnancy in HoFH may pose early coronary morbidity and mortality to both the foetus and mother. The combination of HoFH and pregnancy can be a fatal condition. While statins are very effective in lowering low-density lipoprotein cholesterol (LDL-C) levels, they are generally contraindicated during pregnancy, thus their use during pregnancy is uncommon. On the other hand, lipid apheresis (LA) has turned into an effective treatment to control cholesterol level amid pregnancy. However, the procedure is not widely available in our region. To date, there are scarcely documented case reports of HoFH in pregnancy in which the majority of them underwent LA to keep LDL-C at a low level. We report a rare case of successful pregnancy outcome of HoFH patient treated with lipid-lowering drugs including statin without LA therapy. Apart from that, we also discussed the genetic findings of the proband and all screened family members in which to the best of our knowledge, the first study using the whole-exome sequencing technique to identify the causative gene mutations for familial hypercholesterolaemia among the Malaysian population.
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Although previous studies have indicated that statin therapy can effectively prevent the development of CIN, this observation remains controversial, especially in high-risk patients. A meta-analysis was performed to evaluate the efficacy of statin pretreatment for preventing the development of CIN in patients with chronic kidney disease (CKD) and to determine its effectiveness in various subgroups. We searched the online databases PubMed, EMBASE, and the Cochrane Library. RCTs that involved the comparison of the short-term moderate or high-dose statin pretreatment with placebo for CIN prevention in CKD patients undergoing angiography were included. The primary outcome was CIN prevalence. Seven RCTs comprising 4256 participants were investigated in this analysis. The risk of developing CIN in patients pretreated with statins was significantly lower than that in patients pretreated with placebo (RR=0.57, 95%CI=0.43-0.76, p=0.000). The SCr values of the statin group, when analyzed 48h after angiography were lower than those of the placebo group ((SMD=-0.15, 95% CI=-0.27 to -0.04, p=0.011). In the subgroup analysis, statin pretreatment could decrease the risk of CIN in CKD patients with DM (RR=0.54, 95% CI=0.39-0.76, p=0.000), but not in CKD patients without DM (RR=0.84, 95% CI=0.44-1.60, p=0.606). The efficacy of atorvastatin for preventing CIN was consistent with that observed with the use of rosuvastatin. The risk ratios (RR) were 0.51 (95% CI=0.32-0.81, p=0.004) and 0.60 (95% CI=0.41-0.88, p=0.009), respectively. Our study demonstrated that statin pretreatment could prevent the development of CIN in CKD patients. However, subgroup analysis demonstrated that statin pretreatment, despite being effective in preventing CIN in patients with CKD and DM, was not helpful for CKD patients without DM. Rosuvastatin and atorvastatin exhibited similar preventive effects with respect to CIN.
Asunto(s)
Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Insuficiencia Renal Crónica/complicaciones , Angiografía Coronaria , Medios de Contraste/efectos adversos , Rosuvastatina Cálcica/uso terapéuticoRESUMEN
ABSTRACT Objective: Dyslipidemia is prevalent among patients with hypopituitarism, especially in those with growth hormone (GH) deficiency. This study aimed to evaluate the response to statin therapy among adult patients with dyslipidemia and hypopituitarism. Subjects and methods: A total of 113 patients with hypopituitarism following up at a neuroendocrinology unit were evaluated for serum lipid levels. Dyslipidemia was diagnosed in 72 (63.7%) of these patients. A control group included 57 patients with dyslipidemia and normal pituitary function. The distribution of gender, age, weight, and dyslipidemia type was well balanced across both groups, and all participants were treated with simvastatin at doses adjusted to obtain normal lipid levels. Results: Patients with hypopituitarism and dyslipidemia presented deficiency of TSH (69%), gonadotropins (69%), ACTH (64%), and GH (55%) and had a similar number of deficient pituitary axes compared with patients with hypopituitarism but without dyslipidemia. All patients with dyslipidemia (with and without hypopituitarism) had lipid levels well controlled with doses of simvastatin ranging from 20-40 mg/day. The mean daily dose of simvastatin was not significantly different between patients with and without hypopituitarism (26.7 versus 23.5 mg, p = 0.10). Similarly, no significant variation in simvastatin dose was observed between patients with different causes of hypopituitarism, presence or absence of GH deficiency, number of deficient pituitary axes, prior pituitary radiation therapy or not, and presence or absence of obesity. Conclusions: Patients with GH deficiency without GH replacement showed good response to simvastatin at a mean dose equivalent to that used in individuals with dyslipidemia and normal pituitary function.
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Humanos , Adulto , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Dislipidemias/tratamiento farmacológico , Hipopituitarismo/complicaciones , Hipopituitarismo/tratamiento farmacológico , Lípidos/uso terapéutico , Simvastatina/uso terapéutico , Dislipidemias/complicacionesRESUMEN
ABSTRACT Background: Statin therapy has become one of the most important advances in stroke secondary prevention. Objective: To provide evidence from real-world data for evaluating detailed associations between secondary prevention of stroke and statin use in Brazil. Methods: We conducted a prospective cohort study including consecutive patients diagnosed with an ischemic stroke. Subjects were classified into non-statin, simvastatin 20 mg, simvastatin 40 mg, and high-potency statin groups. We also registered the onset of statin therapy, previous use of statins, the adherence to medication, and if there was discontinuation of the therapy. After two years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. Results: Among the 513 patients included in our cohort, there were 96 (18.7%) patients without statins, 169 (32.9%) with simvastatin 20 mg, 202 (39.3%) with simvastatin 40 mg, and 46 (9.0%) with high-potency statins. Patients without statins were at increased risk of stroke recurrence and worse functional outcomes. Concerning etiology, evidence of beneficial use of statins was observed in cases of large-artery atherosclerosis, small-vessel occlusion, and stroke of undetermined cause. Those who presented poor adherence to statins or discontinuation of the treatment had worse prognosis after stroke whereas the early onset of statins use was associated with better outcomes. Patients with simvastatin 40 mg and high-potency statins presented the best functional recovery throughout the follow-up. Conclusions: Statins play an important role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance.
RESUMO Introdução: A terapia com estatinas tornou-se um dos avanços mais importantes na prevenção secundária do acidente vascular cerebral (AVC). Objetivo: Fornecer evidências de dados do mundo real para avaliar associações detalhadas entre a prevenção secundária do AVC e o uso de estatinas no Brasil. Métodos: Realizamos um estudo de coorte prospectivo, incluindo pacientes consecutivos com diagnóstico de AVC isquêmico. Os indivíduos foram classificados em grupos sem estatinas, sinvastatina 20 mg, sinvastatina 40 mg e estatina de alta potência. Também registramos o início da terapêutica com estatinas, o uso prévio de estatinas, a adesão à medicação e se houve descontinuação da terapia. Após dois anos, foram avaliados o resultado funcional, a recorrência do AVC, os principais eventos cardiovasculares e a mortalidade. Resultados: Entre os 513 pacientes incluídos em nossa coorte, havia 96 (18,7%) pacientes sem estatinas, 169 (32,9%) com sinvastatina 20 mg, 202 (39,3%) com sinvastatina 40 mg e 46 (9,0%) com estatinas de alta potência. Pacientes sem estatinas apresentaram maior risco de recorrência de AVC e piores resultados funcionais. Em relação à etiologia, foram observadas evidências do benefício das estatinas nos casos de aterosclerose de grandes artérias, oclusão de pequenos vasos e AVC de causa indeterminada. Aqueles com baixa adesão às estatinas ou que interromperam o uso tiveram pior prognóstico após o AVC, enquanto o início precoce do uso de estatinas foi associado a melhores resultados. Pacientes com sinvastatina 40 mg e estatinas de alta potência apresentaram melhor recuperação funcional ao longo do período de acompanhamento. Conclusões: As estatinas desempenham um importante papel no tratamento do AVC isquêmico, prevenindo sua recorrência e eventos cardiovasculares e melhorando o desempenho funcional.
Asunto(s)
Humanos , Isquemia Encefálica/prevención & control , Isquemia Encefálica/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/tratamiento farmacológico , Brasil , Estudios ProspectivosRESUMEN
OBJECTIVE@#To identify mitochondrial gene variants associated with statin-induced myalgia in Chinese patients with coronary artery disease (CHD).@*METHODS@#This study was conducted in a cohort of 403 patients with CHD receiving rosuvastatin therapy, among whom 341 patients had complete follow-up data concerning myalgia and 389 patients had documented measurements of plasma creatine kinase (CK) level. All these patients underwent genetic analysis using GSA chip for detecting mitochondria gene variants associated with myalgia. A logistic regression model was used to assess the association between 69 mitochondrial single-nucleotide polymorphisms (SNPs) and myopathy in 341 patients. The impact of these mutation sites on CK levels in 389 patients was evaluated by linear regression analysis.@*RESULTS@#G12630A variant was identified to correlate with an increased risk of myalgia in CHD patients (OR: 8.689, 95% @*CONCLUSIONS@#Mitochondrial G12630A variation is associated with statin-induced myalgia in patients with CHD, indicating the necessity of different treatment strategies for patients who carry this risk allele.