Cardiovascular risk factors: Belgian target achievement.

OBJECTIVE: The objective of this study was to evaluate the level of target achievement for key modifiable cardiovascular disease (CVD) risk factors (dyslipidaemia, arterial hypertension, hyperglycaemia, smoking, and physical inactivity) in Belgium. METHODS AND RESULTS: This non-systematic review of Belgian data from four recent studies assessed the control of CVD risk factors in clinical settings: the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA), the Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment Study (OPTIMISE), the European Action on Secondary and Primary Prevention by Intervention to Reduce Events Survey (EUROASPIRE III), and data from a general practice-based morbidity registration network (INTEGO). For each study, target achievement levels were evaluated using the guidelines that were applicable at the time of the study. The overall results show that the main CVD risk factors are poorly controlled in patients with established CVD and in patients at high CVD risk. Therapeutic targets may be incompletely reached because of the suboptimal implementation of European guidelines for CVD prevention in routine clinical practice (insufficient lifestyle and dietary adaptations; poor applications of drug therapy to control blood pressure, dyslipidaemia and hyperglycaemia) or the insufficient efficacy of the currently available treatments options in some patients. CONCLUSIONS: This review provides clear and updated evidence for non-target achievement for all major risk factors, with four different study designs and inclusion criteria, and highlights the need for more comprehensive and intensive application of European guidelines recommendations for CVD prevention in Belgium.

Metabolism of stevioside by healthy subjects.

Stevioside (250-mg capsules) was given thrice daily for 3 days to 10 healthy subjects. Blood samples were collected and blood pressure measured after nocturnal fasting, before and at different time points during the third day of the administration of stevioside. No significant differences were found between the control and the stevioside condition for blood pressure and blood biochemical parameters. The 24-hr urinary volume and urinary excretion of electrolytes were not significantly different. Likewise, no significant difference was found for mean blood glucose and insulin between control and stevioside conditions. Thus, oral stevioside is not directly effective as a hypotensive or hypoglycemic agent in healthy subjects at the dose administered in this study. Stevioside, free steviol, and steviol metabolites were analyzed in blood, feces, and urine after 3 days of stevioside administration. No uptake was found of stevioside by the gastrointestinal tract or the amounts taken up were very low and below the detection limit of the UV detector. Stomach juice did not degrade stevioside. All the stevioside reaching the colon was degraded by micro-organisms into steviol, the only metabolite found in feces. In blood plasma, no stevioside, no free steviol or other free steviol metabolites were found. However, steviol glucuronide (SV glu) was found in maximum concentrations of 33 micro g/ml (21.3 micro g steviol equivalents/ml). In urine, no stevioside or free steviol were present, but SV glu was found in amounts of up to 318 mg/24-hr urine (205 mg steviol equivalents/24 hrs). No other steviol derivatives were detected. In feces, besides free steviol, no other steviol metabolites or conjugates were detected. Steviol was excreted as SV glu in urine.

Identification of steviol glucuronide in human urine.

Stevioside (250 mg capsules) was given three times daily to 10 healthy subjects. Steviol glucuronide (steviol 19-O-beta-D-glucopyranosiduronic acid; MM, 494.58; melting point, 198-199 degrees C) was characterized in the 24 h urine as the only excretion product of oral stevioside by MS, NMR, IR, and UV spectroscopy. This is the first report on the unambiguous identification of steviol glucuronide in human urine.